Preventable environmental risks lead to a yearly death toll of 13 million people, 7 million of which are caused by air pollution, according to a World Health Organization report presented yesterday to its members attending the organisation’s Executive Board. Time is of the essence and the WHO draft global strategy on health, environment, and climate change received broad support, as well as a draft action plan for small island developing states, particularly vulnerable to climate change.

The “draft WHO global strategy [pdf] on health, environment, and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments” was discussed yesterday during the 144^th session of the WHO Executive Board, which is meeting from 24 January to 1 February.

The draft strategy was drafted in a consultative process through WHO’s regional committees, and spans until 2030, according to the document.

As defined by the strategy, environmental risks are defined as “all the physical, chemical, biological and work-related factors external to a person, and all related behaviours, but excluding those natural environments that cannot reasonably be modified.”

According to the report, more than 90 percent of people are breathing polluted air, three billion people still depend on polluting fuels for lighting, cooking and heating, and more than half the world’s population is exposed to unsafely managed water, inadequate sanitation and poor hygiene. The management of electronic waste, nanoparticles, microplastics and endocrine disrupting chemicals only add to the dim picture.

Climate change is also increasingly affecting people’s health and well-being and leads to more frequent heatwaves, droughts, extreme rainfall and cyclones in many areas. It also leads to transmission of food-borne, water-borne and zoonotic infectious diseases. Least-developed country and small island populations are at higher risks, the draft strategy says.

Health promotion and prevention, according to the draft, do not quite get the attention of policymakers when it comes to financial and human resources, and approaches that focus on treatment of individual diseases rather than improving determinants of health “will be insufficient to tackle modern environment health challenges,” according to the draft strategy.

The formal health sector is uniquely positioned to implement environmental health interventions at the community level, the draft strategy explains, further calling for a rebalancing of health sector expenditure toward primary prevention over the long term. For example, additional funds could originate from the removal of harmful subsidies, it says.

Transformational Approach, Core Functions, Goals

The draft strategy includes six core functions grouped in three themes: “(a) leadership and policies; (b) evidence synthesis and advocacy, including the Organization’s normative function, development of tools, monitoring of implementation and shaping the research agenda that will support public goods for health; and (c) provision of direct country support.”

A list of goals to be achieved is provided in the draft strategy translating the transformational approach needed to improve lives and well-being through healthy environment, including: people being aware of harmful environmental exposures: reduction of environmentally-related diseases; primary prevention measures; countries and major cities setting health-based air quality targets to reduce air pollution; ending of polluting fuels use; cleaner energy systems; efficient public transport systems; more sustainable diets and resilient food systems; better sanitation; reduced exposure to chemicals through well-regulated use; better awareness of ultraviolet radiation; elimination of unnecessary exposures from medical imaging techniques; and national and local governments mechanisms that facilitate cross-sectoral cooperation and integrate health in relevant policies.

As a result of the strategy, the main targets by 2023 would be to: reduce the mortality rate from air pollution by 5 percent; provide access to safely managed drinking water services for 1 billion people; access to safely managed sanitation services for 800 million people; reduce by 40 to 50 percent the number of people in low and middle-income countries served by hospitals without reliable electricity and basic water and sanitation services; reduce by 10 percent the mortality from climate-sensitive diseases; and double the amount of climate finance for health protection in low and middle-income countries.

Support by WHO Members, Suggestions

The draft strategy gathered a large support from EB members and non-members.

Indonesia suggested to add food safety to the WHO intervention areas, and Canada, in its statement [pdf], suggested to include the Artic region as a vulnerable region susceptible to climate change.

In her response, Maria Neira, WHO director, Department of Public Health, Environmental and Social Determinants of Health, said food safety is included in the draft strategy but will be made more explicit, and due note was taken on the importance of the Artic region.

Finland underlined the danger of black carbon, and called for enhanced action globally. The main sources of black carbon “are combustion engines (especially diesel), residential burning of wood and coal, power stations using heavy oil or coal, field burning of agricultural wastes, as well as forest and vegetation fires,” according to a WHO Europe region document [pdf].

Neira said black carbon is high on the WHO agenda, and added that the WHO is member of the Climate and Clean Air Coalition.

The Finnish delegate also called on more engagement with other United Nations agencies to have a “one UN approach.” Israel concurred with that, so did Switzerland and Monaco, which added it would avoid duplication of work. Countries should not be asked several times for the same data, the delegate said.

Sri Lanka remarked on the importance of resources mobilisation, of making an investment case, and suggested that WHO consider developing regional implementation plans of the strategy with timelines, as well as strong monitoring.

Algeria for the African region voiced concerns that despite efforts, several countries, in particular in Africa, continue to suffer from the effects of climate change, and called for a sustainable financial mechanism for the global strategy.

Monaco underlined the WHO-led BreatheLife2030 campaign to which the country will continue to offer financial support. Norway said the BreathLife2030 campaign could be used as a model, and should be referenced in the strategic plan.

Morocco suggested that the strategy announces national and regional plans with the WHO, and that the WHO helps environment and health mechanisms to evaluate risks linked to climate change.

Canada also suggested that the draft strategy shed light on the link between environmental determinants and noncommunicable diseases.

Bolivia called for more attention to vulnerability of developing countries with fragile ecosystems, in particular mountain ecosystems.

Argentina remarked on knowledge gaps, in particular concerning climate change, making it difficult to implement strategies.

Bangladesh found that the strategy needs further attention to action-oriented measures.

Some Reservations, US, Brazil

The United States said more work is needed on the draft strategy, underlining that many issues included are not WHO core functions. Areas such as agriculture are dealt with other international fora or bodies, the US delegate said. The draft strategy should focus on topics where WHO has the best added-value, he said, calling for a consultation to finalise the draft strategy.

Brazil said the draft strategy needs to be discussed further as it is “far from mature,” calling for additional inclusive and participatory discussions. The delegate remarked on the fact that Geneva-based WHO member states were not consulted on the draft strategy “or at least briefed on” by WHO “on such an important and far-reaching document.” This lack of consultations in Geneva has deprived members from the opportunity to ask for clarifications and suggest necessary improvement, the Brazilian delegate said.

In particular, the delegate said, more information is necessary on the definition of environmental emergencies and how they relate to health emergencies.

“The links between the decline of natural resources and conflicts are far from being a consensus, in light of UN General Assembly and Security Council resolutions,” he said, adding that Brazil is not in a position to endorse the terminology “global public goods” in relation to the environmental discussion, as there is no multilaterally agreed definition. This terminology is not in accordance “with the principle of international law that recognises the sovereign right of states to exploit their own resources pursuant to their own environmental and developmental policies,” he said.

Neira said Brazil raised a relevant question on global public goods and the WHO is ready to review the language and reword it as needed, and WHO Director General Tedros Adhanom Ghebreyesus (Dr Tedros) agreed to consultations between the Board and the World Health Assembly in May.

Draft Global Plan of Action for Small Island Developing States

The Board also noted a draft global plan of action [pdf] on climate change and health in small island developing states.

Dr Tedros said the WHO is working with other UN agencies on the issue of health, environment, and climate change, and mentioned the launch in November 2017 of the special joint initiative of WHO and the UN Framework Conference on Climate Change to address climate change impact on health in small island developing states. He said the action plan of this initiative belongs to the governments of those states, which he said should be helped to access the Green Climate Fund.

Image Credits: Flickr – joiseyshowaa.