What is the DSET?

1. Comparison of Health and Envrionnmental Protection Systems – Joint seminar EHESP – NPHS; Thurthday 12 march 2009 French Health Protection System in the light of new reforms : preventing outbreaks –preventing risks related to economic activities Michèle Legeas DSET, EHESP EHESP

2. What is the DSET? • DSET : departement of Education and Research in Environnmental and Occupationnal Health • An approach focused on health and not on environnment, even if sustainable development issues are taken into account; • Main skills of the team (about 12 people) : health risk analysis and health risk management; applied to: • Spacial development (including industrial risks); • Air quality (indoor and outdoor); • Water ressource protection; water quality related to uses; • Health risks and housing; • Food quality and safety; • Health risks related to physical agents, like EMF; EHESP

3. What is the DSET and who I’m ? • Skills and tools of the team : • Epidemiology • Statistics • Chemistry, microbiology, toxicology, physical sciences • Process engineering • Quantitative health risk assessment (QHRA) • Risk management • My own area of reflexion : • Management of environmental situations related to health risk, particularly those related to microbiological agents EHESP

4. Main approach to environnmental health in France today • Not real global difference between France and others countries inside EU • Prevention is better than cure : best available technologies, substitution, vaccination, health education, epidemiological monitoring,… • Prevention is based on rules, standarts and control • one specificity In France should be noted about the control : even currently, state control remains predominant compared to self private control; • this is translate in laws like those concerning prior authorization procedures for all activities that may have an impact on the environnment (since 1815!) EHESP

5. Mains specificities of the risk of epidemic • pathogenic microbiological agents are very frequently in the environnment (food, water, hosptitals, at home,…); • only a small number are contagious or transmissible in mass; • usally, the disease appears quickly after the exposure (few days or months) • precautionnary measures must be related to the epidemic potential of a microorganism and its mode of transmission; • it is necessary to make a distinction between managing the risk of few cases of sick persons and the risk of a serious outbreak EHESP

6. Main specificities of the risks related to industrial activities • risks related to industrial activities at large, are : accident or pollution (chronic, or sub-chronic), and generally linked to chemicals ; • chemicals or physicals agents can spread around the initial site, but people only in contact with the agents are likely to be sick (except for example with dust lead, wich can be transfered to others people by direct contact); cases observed are compulsory directly exposed people (or, more rarely, the descendants of these people); • usally, an epidemic can not be observed until several years (more than 5 to 10 years); EHESP

7. Current approach for microbiological risks in france • In some cases, scientific expertise based on QHRA or qualitative risk analysis (state agencies on health safety : AFSSA, AFSSET, AFSSAPS) • plans against natural or criminal outbreaks: like prepardness against influenza pandemic, or against bio-terrorism risks • continuous monitoring of health population state, with reporting for specified diseases and, now, with reporting of non specific cases, named syndromic surveillance (InVS) • rapid epidemiological intervention, for the analysis of the situation and design of control process (CIREs) • rules for hygienic practices, wether in industry, agriculture, care, water production or at home, via regulatory obligations but also health education EHESP

8. Current approach for economic activities at risks in France • Scientific expertise: as often as possible (by the same state agencies as above, and other private or semi-public partners (like INERIS, INSERM, CNRS, BRGM, BRPC,…) • Authorization procedure for the biggest industrial or agricultural installations or majors facilities (highways, airport,…), at least; with a compulsory impact on health study for each site • Control: theoritically, monitoring not only of pollution but also of operation related to depolluting process • European rules application: principle of substituion of most dangerous substances, precautioanary principle,… EHESP

9. Major research on these questions: • toxicology: to understand how and to what extend chemicals (pesticides, industrial by-products, drugs in effluents from hospital,…) induce health adverse effets; • microbiology: identification of types, sub-types of microbes with PCR(or now, disease insect vectors), and their ecology • QHRA: to improve modelisation of the distribution of the risks inside a population (statistical tools); • exposure: to improve scenarios on how much and how do people be contamined; • risks management: sociological, political, economical, factors influencing management decisions EHESP

10. Thank’s for your attention!I’m now ready to try to answer your questions, far I’m able to do so. EHESP

11. The concept of «at risk situation» allow to discuss each stage of the chain of risk, that can interfere with the occurrence of sick people: • the presence of the really pathogen strain, • the number, the location and the characteristics of exposed people (lifestyle, gender, age, particular weaknesses in terms of health), • the characteristics of exposure (frequency, duration, intensity), • the doses of these dangerous agents in contact with people so "effective" (the correct route of exposure in relation to the effects ). • When all these data are well described (even just qualitatively), you can desing management measures, targeting each of these items, alone or combined, even if you are unable to calculate an individual probability of the disease. EHESP

12. And now, please, present the approaches to issues of environnmental health in your own countries EHESP