Leda E. Nemer WHO European Centre for Environment and Health (ECEH) Rome

1. The Children’s Environment and Health Action Plan for Europe (CEHAPE): The Role of Public Health Professionals Leda E. Nemer WHO European Centre for Environment and Health (ECEH) Rome ISEE-CEE CHAPTER MEETING, Sept. 4-6, 2003

2. Environmental health process Europe Outcomes Ministerial conference 1989 1994 1999 2004 Frankfurt Helsinki London Budapest • - European Charter on Environment and Health • ‘Concern for Europe’s Tomorrow’ • WHO European Centre for Environment and Health • Environment and Health Action Plan for Europe (EHAPE) • National Environment and Health Action Plans (NEHAPs) • European Environment and Health Committee (EEHC) • - Protocol on Water and Health to the 1992 Convention on the • Protection and Use of Transboundary Watercourses and • International Lakes • Charter on Transport, Environment and Health • Renewed the mandate of the European Environment and • Health Committee • - Children's environment and health action plan for Europe • Declaration committing the Ministers toincorporating such a plan into their own national processes

3. A Political Call for Action • A Children’s Environment and Health Action Plan for Europe (CEHAPE) is currently being developed • Provides a framework that Member States can use to develop their national plans and policies for CEH • Responds directly to a political call by Member States • CEHAPE sets the stage for urgency of action • Adaptable to local situation; negotiable

4. What is the CEHAPE? • Policy document that addresses the environmental risk factors most harmful to children. • Main piece is a framework of actions that proposes actions for eliminating exposure and detrimental health effects. • CEHAPE identifies child-specific actions not addressed by general environmental health policy and other political commitments. • Sets out actions by objectives that will allow Member States the flexibility to: - assess their particular situation - prioritize and decide on which actions need attention first depending on the extent of the problem in the country.

5. What does it include? • Includes cross-cutting tools for implementation of the action plan in countries. • Indicators • case studies • priority setting • building partnerships • Using advocacy and IEC improving children’s environmental health

6. Framework of Actions • The key section of the CEHAPE • Format is a table with columns on: - environmental risk factors (15) - main objective/s - settings where action could take place - a code for the type of action - menu of actions which countries can select from • Receives Member State input by means of 3 Ad Hoc Working Group meetings • Currently under revision...

7. CEHAPE process • Core WHO drafting group since February 2003 • 3 rounds of consultation with group of experts • Consultations with EEHC • Series of workshops (MS representatives as hosts and co-organizers) • 3 Intergovernmental meetings (Stockholm, Portugal, etc) • 3 Ad Hoc working group meetings with MS representatives • CHE programme work contributes to CEHAPE • Establishment of links with other programmes and organizations (HECA, ILO, EC, IMCI, Tobacco)

8. Involvement of sectors Because of inter-sectoral nature of children’s environmental health… • Action must be taken in a range of societal sectors (health providers, education, environment, communications, etc) • For now, actions within the framework have been categorized into 5 types to indicate which sector/s might be responsible for implementation of the given action Legend: L = pass and enforce legislation E = promote educational programmes and health promotion P = promote active involvement of children, caretakers, professionals involved in child care and education M = increase knowledge by promoting monitoring of environmental exposures, including research S = improve service delivery and infrastructure

10. Framework of Actions • Actions included are related to environmental exposures that may have an impact on health from conception to late adolescence. • The detrimental health outcomes from exposure in this period could arise at any time of life and not only up through adolescence. The CEHAPE pays particular attention to the priorities and needs of the most vulnerable population groups in low and middle income countries within the region.

11. Guiding principles • The need to focus on child-specific actions to have an impact on their health and identify actions that may not be included in generic environmental policies. • Succinet format - no extensive detail; implementation of the actions and the selection will take place at the country level according to their needs. • As there are substantial differences in children’s environmental health priorities across the European region, the list includes actions that may be a recognized priority in some countries and not in others. Countries and sectors will need to identify their own priority actions within the list according to their specific needs.

12. A Pan-European Action Plan • We are in the process of negotiating Pan-European commitments that can be made across all 52 WHO Europe Member States. • Will be based on burden of disease data • Once framework of actions is agreed upon, we will need action indicators to monitor implementation of the action plan in countries (a next step…)

13. Fourth Ministerial Conference on Environment and HealthBudapest, 2004 European countries are expected to make specific commitments in endorsing a children’s environment and health action plan for Europe (CEHAPE). This will put children’s health at the top of the political agenda, for the sake of the adults of tomorrow. It is hoped that Member States • adopt the children’s environment and health action plan for Europe (CEHAPE). • recognise the need to set up an information platform to facilitate policy-making • include commitments to actions for health on newly emerging issues

14. Discussion 1-How do you see the CEHAPE affecting your work as public health professionals? 2- How would you as public health professionals like to become involved? 3- When the CEHAPE is adopted, would country level briefing be helpful to you? 4- What other ways can WHO and Member States get public health professionals involved in such a process?

15. Thank you ! For more questions, please contact Leda Nemer, Technical Officer for Children’s Health and Environment unit at WHO Rome at Len@who.iten@who.it www.euro.who.int/childhealthenv http://www.euro.who.int/budapest2004