Summary and Conclusion, Miljøstyrelsen

Environmental Factors and Health

Summary and Conclusion

The aim of this report is to give a comprehensive presentation of the connections between health issues and the environmental regulation in Denmark. The first 4 chapters give an overall presentation of the interface environment/health and an introduction to Denmark and the environmental regulation. The rest of the report focuses on environmental factors in the air, soil, drinking water, bathing water, swimming pools, chemicals, waste, wastewater and noise. The chapters describe the impact on human health, how the area is regulated and the distribution of the single actor’s responsibilities. Furthermore, there is a short evaluation of each area. The evaluation gives an assessment of the level of protection related to the political objectives and identifies the future challenges. These chapters have the same structure but varies in content, reflecting among other things the weight of influence on human health.

Chapter 1 gives some basic information about Denmark, which may enable the reader better to compare the information, presented in this report with the situation in other countries.

Chapter 2 gives definitions of concepts and terms used in the report. The generic model presented describes the life cycle of an environmental factor from emission at the source to human exposure and effect.

The environmental factor is defined as a physical, chemical or biological component in the environment, which may affect human health and well-being. Some examples are micro-organisms, noise, airborne particles, pesticides, metals, and radiation. The environmental factor may be the same and stable in all stages of the system or it may be transformed and finally degraded.

The primary sources in various sectors are described. The source is responsible for generating the environmental factor, which is emitted directly to the environmental media or carried in products and/or waste for later release to the environment. Sectors may be industry, agriculture, waste management etc., and primary sources are the actual emitters of the environmental factors e.g. a factory, a farm, a power plant, etc.

Products and waste are carriers of the environmental factors. Factors may be ’hidden’ or lumped together as in ’building materials’ or ’chemical products’. Products and waste are conceptually separated from sectors and media.

The environmental media in which the factors subside are air, soil and water. For regulatory purposes the environmental media may however be subdivided. For example, the aquatic media are subdivided into drinking water, surface water and bathing water for which different regulation applies, and important factors may vary.

Humans may be exposed to the environmental factor from the different sectors by contact with products or waste, or through contaminated environmental media. The exposure will depend on the occurrence and magnitude of the factor and the occurrence and behaviour of humans in time and space. Regulation of environmental factors may take place in all compartments. The effects of instruments will vary depending on which level in the system they apply to, e.g. regulation at source will mostly lead to greater downstream effects.

Chapter 3 forms a basis for an understanding of the description in the following chapters on regulations, instruments and actors, as the main characteristics of the environmental regulatory framework in Denmark is presented. Again the focus is health issues, but this chapter gives a broader introduction to the environmental regulation.

The environmental law covers most of the regulation of the environmental factors relating to health, and the environmental authorities are responsible for the implementation hereof. The regulation of environmental factors in relation to health is thus to a big extent a subset of what is normally understood as the environmental regulation in Denmark. However, there are several interfaces with other regulatory areas and authorities, most notable the food and health authorities.

The chapter describes the institutional set-up focusing on the role of the environmental authorities, but also describing the interfaces with other authorities, with EU and international organisations, as well as with other relevant actors.

The principles of Danish environmental law are outlined and the most important environmental acts with relation to health are described. These are The Environmental Protection Act, The Planning Act, The Act on Chemical Substances and Products, The Soil Contamination Act and The Water Supply Act.

Moreover, the chapter includes a presentation of instruments applied for achieving the goal of health protection through environmental legislation, divided into integrative instruments, regulatory instruments, economic instruments and informative/other instruments.

Chapter 4 gives a historical introduction, which highlights major events and trends in the environmental policy and debate and contributes to an understanding of the Danish approach to environmental issues.

The overview is divided into three different historical eras beginning around 1960. In the time before 1960, pollution was not perceived as a general problem to society. However, health problems in the larger cities forced authorities to take actions, the most important being construction of sewage systems and implementation of waste collection.

The eras described in this report are structured according to major changes in the environmental policy.

Initial recognition of health and environmental problems (1960-1972): A growing industrialisation in the Danish society results in a large increase in pollution in comparison with the prior decades, and the Danes become aware of the potential health-depreciating effects of pollution; environmental problems are thus discovered, discussed and acknowledged. The focus rests with the local pollution problems. This era is dominated by a health-oriented concern in relation to environmental problems.

Implementation of comprehensive environmental regulation (1973-1991): In the second era, a Ministry of Environmental Protection is established and the first comprehensive Environmental Protection Act in Denmark came into force. A comprehensive complex of regulation is elaborated and implemented during this period and there is also an increasing use of overall action plans outlining environmental objectives. The international aspects of environmental problems are being recognised. As the European integration speeds up during the 1980s, the European Union becomes a still more important arena for environmental and health policymaking, Denmark being a member since 1973.

Prevention of environmental problems (1992-1998): This era is a consequence of the new Environmental Protection Act of 1992. The focus is on individual responsibility and the period is moreover characterised by a focus on the prevention of environmental and health problems, and an intense interest in the regulation of international environmental problems.

In the recent years, there is increased focus on strategic plans aiming towards a sustainable development and stressing issues such as sector integration and the holistic approach.

Chapters 5-12 describe the environmental factors in relation to the media air, soil, drinking water, bathing water and swimming pools, and in relation to waste, wastewater and noise. The sources, human exposure and potential health impacts of the environmental factors are presented. Danish legislation and regulation together with international protocols and EU-directives are summarised along with the sectoral and institutional framework and instruments used for meeting the national and international requirements for managing health issues connected to the environmental factors.

Chapter 5 describes the environmental factors related to air pollution. Ambient levels of most of the primary air pollutants have been declining over the past decade in Denmark due to among other things improvements in energy production and the requirement of catalytic converters on new cars since 1990. However, the decline of NO2 in urban areas has been rather weak.

For several pollutants it has not been possible to identify lower thresholds for effects e.g. for particulate matter and ozone as well as for carcinogens such as benzene and Benzo(a)pyrene. Based on international studies, the observed levels of fine particles (PM2.5) in Denmark might imply increased premature mortality and illness among sensitive groups: persons with existing respiratory illnesses and persons with heart disease. These groups make up a substantial fraction of the population. The level of these health impacts is only roughly estimated in Denmark, because there has been limited Danish research on this, and monitoring of fine particles has not been regularly performed in Denmark.

The average daily human exposure to dioxins in Denmark is also in recent Danish studies estimated to exceed the WHO guideline for tolerable daily intake, but it is not clear to which extent such an exposure level contribute to effects in the Danish population.

The overall goal in relation to air quality is to achieve a quality without any adverse health effects to the public. Because of the present levels of some air pollutants, a more realistic objective of today, however, is to further reduce the levels of these air pollutants in order to minimise any harmful impact on public health.

The new and planned EU air quality directives, and related vehicle, fuel and industrial directives, will establish consistent limit values for additional pollutants, and vehicle and large-industry requirements in all EU member states. These directives will provide continued reductions in the tran boundary pollution that has health impacts in Denmark.

Chapter 6 focuses the environmental factors in soil. A major part of soil contamination originates from former or present activities on the contaminated areas, e.g. industrial and agricultural activities or storage of liquid fuels. Other contamination stems from deposition of airborne pollution. Among the most important pollutants are heavy metals, oil products and additives, polyaromatic hydrocarbons, chlorinated solvents and pesticides. In Denmark, the most significant human exposure routes are considered to be: Ingestion of - or skin contact with - contaminated soil (especially small children), ingestion of drinking water and evaporation of contaminants to indoor air.

The health-based regulation of soil contamination in Denmark has the objective to avoid any harmful impact on public health. In order to fulfil this objective, risk assessment procedures and procedures for the derivation of health based soil quality criteria has been made considering a precautionary approach. Hence, the soil quality criteria are directed towards protection of the most vulnerable group: Small children.

Based on present knowledge, the regulation in broad terms seems to be sufficient to obtain the objective of preventing harmful impacts on public health: There are no recognised cases of harmful impact of soil contamination on public health. A great effort is invested in mapping of contaminated sites and in remediation and/or exposure prevention once contamination is recognised. Mapping and remediation is prioritised, starting with sites with the most sensitive land-use such as residential use, childcare institutions or public playgrounds or sites where groundwater is threatened. Further, liability is the basic principle behind the remediation efforts: The polluter is the primary party to take the measures required combating the impact of soil contamination and to restore the original state of the environment.

Drinking water is the subject media in chapter 7. Environmental factors in drinking water often originate from soil contamination that are washed out and infiltrate into the groundwater. Other sources are extraction-induced contamination e.g. influx of salt or release of nickel from geological layers caused by the lowering of groundwater. Finally, contamination may be introduced in the supply network, especially as microbial growth or as accidental inflow of wastewater.

The objective of the drinking water regulation in Denmark is that the drinking water supply shall be based on unpolluted groundwater - tasteful, clear and free of smell. The consumer shall be able to drink it without worries of contamination. Consequently, the protection of the groundwater resource has a very high priority, and the quality criteria set for groundwater are generally the same (or even lower) as for drinking water, which is basically following the EU directive on drinking water.

Health impacts caused by consumption of drinking water in Denmark are rare and generally the objectives of the regulation are obtained. However, health impacts do occur and primarily as disease caused by microbial contamination in the water supply network. Health impacts from chemical components in drinking water are only observed in a very few cases as nickel allergy (nickel from pyrite rich sediments) or met-hemoglobinemia caused by nitrate.

A key element in the Danish Water Supply Act is the designation of drinking water areas in which main infiltration to the groundwater reservoir takes place. Within such areas detailed mapping and investigations shall identify areas vulnerable to specific contaminants. The areas identified shall be subject to an assessment, comprising a detailed mapping of land use, pollution threats and the geological protection of the groundwater resource. The investigations result in an action plan, which describe the need for action concerning possible restrictions in land use and other human activities. It is within the jurisdictions of the regional and municipal authorities to seek agreements with landowners based on the action plan for regulating agricultural practices, industrial or other activities and possibly purchase of property etc.

An important characteristic of the threat to the drinking water is the delay between the origin of pollution and the occurrence of contaminants in the groundwater, not to say in the drinking water. The delay can be tens of years. Many contaminants are most likely on their way towards the groundwater and cannot be stopped by new regulation. A great number of drinking water abstraction borings has been aborted because of groundwater contamination from either point sources or diffuse sources, and this picture must be expected to continue. Regulation today will in most cases only show results in many years.

Furthermore, all contaminants in groundwater and drinking water are not known because the monitoring programmes only find the substances they are designed for. So other substances not yet being recognised as potential health factors, stay unattended. One of the great challenges of the regulation is therefore to foresee future contamination problems, and in the light of the limited knowledge of many chemicals including their health effects and future occurrence in groundwater, the use of the precautionary principle in the regulation is obvious.

Chapter 8 describes the environmental factors related to bathing water. Environmental factors in bathing water in Denmark are primarily originating in wastewater. The primary impact is by overflow of untreated wastewater during heavy rain, but also by run-off from rural areas and from scattered housing in the countryside not being connected to a wastewater treatment plant. Also incompletely treated wastewater or breakdowns at treatment plants may be sources of environmental factors.

Other sources may be the recreational population using the bathing water, birds and other animals, truly indigenous micro-organisms and to a lesser degree also industrial processes and farming activities. The indigenous micro-organisms of concern are blue-green algae. The algae secrete toxins, but only in rare cases are the concentrations high enough to affect humans. In Denmark there are no fatal cases of human intoxication by algae and no reported epidemics.

There are no recognised cases of negative health impact from contaminated bathing waters in many years, and for the last ten years there has been a further reduction in wastewater impact on the water environment. However, some bathing waters are still influenced by wastewater.

The health objective of the bathing water regulation is to prevent bathing guests from getting ill from bathing in waters appointed as bathing waters. Instruments for obtaining the objective are: The counties and municipalities planning activities, design of wastewater systems , discharge requirements , monitoring of bathing water quality, and occasionally bathing restrictions if the water quality is insufficient .

The microbial quality of bathing waters are monitored, but it is questioned whether the traditional bacterial indicators (faecal coliforms) accurately reflect the quality of the water e.g. the occurrence of more resistant micro-organisms such as viruses and protozoa. Therefore, the Danish monitoring programme is presently under revision also with respect to indicator parameters, monitoring frequency and the reaction time between monitoring result and regulatory action when needed.

Chapter 9 describes environmental factors related to swimming pools, spas and similar recreational water environments.

Environmental factors in the recreational waters include faecally and non-faecally derived micro-organisms originating from the swimmers or contaminated source water, chemicals and by-products related to water treatment, and chemicals that are contributed by the swimmers, e.g. soap residues, cosmetics, suntan oil, sweat and urine.

Human exposure occurs through ingestion of water or inhalation of aerosols and gases like chloroform during swimming and/or through breaks in the protective skin barrier. Acute effects like skin and respiratory irritation resulting from exposure to disinfectants and by-products in the water and in the breathing zone have been described, but the resulting impact on human health is not known. This is also the case with possible long-term effects from exposure to these chemicals. Many of the outbreaks of illness related to swimming pools and other recreational water environments have occurred because disinfection was poorly or not applied. A systematic registration of health related effects from exposure to swimming water and other recreational waters is however not available.

The health objective of the regulation covering recreational waters is to ensure that swimming pools, spas and similar recreational water facilities are operated safely in order to avoid adverse health effects and illness in people using the facilities. Vulnerable groups like children, asthmatics, and sports people who are more frequently exposed are also considered. The goal is to ensure that the swimming pool water has a quality, which will not impair the health of the population and to keep a disinfection level, which prohibits the existence of pathogenic micro-organisms.

The administration of the regulatory requirements is the responsibility of the municipal authorities. The Danish level of protection is considered high, however, the present regulation is under revision to account for the newest knowledge and technical progress.

More knowledge is also required for further improvement of safety, e.g. in relation to the impact of by-products from disinfectants used in the pool water and their toxicological properties. Assessment of possible substitutes to chlorine gas and hypochlorite, which are allowed for disinfection today, is another area of interest.

Chapter 10 focuses on chemicals in products. Both chemical substances which have been put in the products intentionally and chemical substances which appear as contaminants from used raw materials. DEPA's responsibility is primarily related to chemicals, which are marketed in the form of chemical substances, preparations and goods.

Exposure to chemicals largely depends on the use situations. Different patterns are typically seen in relation to occupational exposure to industrial chemicals and exposure of consumers to e.g. household products and chemicals released from toys, clothes and building materials during use.

It is estimated that about 30,000 – 50,000 chemical substances are on the market in the EU. Relatively little is known both about the actual health effects and the effects of the combined impact from different sources on public health related to the use of chemicals. In some areas, e.g. acute toxicity, a certain level of knowledge is available. For acute effects like toxic, harmful, irritant and corrosive effects, it is usually easy to establish a relation between the exposure to a given chemical and the actual effect, because the response follows immediately after the exposure. When it comes to long-term effects like cancer, mutagenicity and reproductive toxicity, it is more difficult to establish firm scientific evidence for effects in humans.

The primary objective of chemical regulation related to health protection is to prevent health hazards and to protect humans from the adverse health effects from exposure to chemicals. A second objective is to promote the use of less health hazardous chemicals through application of cleaner technologies. Key elements in chemical regulation include risk assessment procedures, pre-marketing approval schemes, classification and labelling of chemical substances and preparations and restrictions in the use of chemicals.

A number of other instruments are in use and a part of DEPA's action plans in order to regulate the use of chemicals and increase the level of protection. These include for example voluntary agreements, green guidelines for purchasing, information and campaigns, taxes and fees and subsidies. As the regulation of chemicals is based on the existing level of knowledge, a major concern in relation to industrial chemicals is the large number of substances for which there is insufficient information with regard to hazardous properties. Substances, which are not fully investigated and not yet on the market, may appear as no cause for concern at first, but later may turn out to be problematic. In addition, the regulation of classification and labelling only considers the hazardous properties of the chemicals. However, possible critical uses of the chemical are only regulated and limited when specific use restriction has been introduced. Another aspect, which needs to be further addressed in the regulations, is the protection of vulnerable groups. In this respect, especially exposure to pregnant women (and thereby exposure to the unborn child) and children should be considered, as these groups may either be more susceptible towards chemical exposure or in some cases more exposed.

One of the major challenges in chemical regulation, are thus the procurement of information about the many substances not sufficiently investigated, and the identification of the problematic substances. In this respect, the DEPA supports the use of computerised QSAR-modelling for predicting inherent properties for substances, which have not been adequately assessed.

A higher level of protection in general will depend on intensified efforts and also generation of more knowledge in a number of areas including prevention of use situations resulting in high exposure, increase in the protection of vulnerable groups, reduction of unintentional spreading of chemicals in the environment. At the same time it will depend on increased documentation from the industry of the safety of chemical substances in use, a reduction in the number of non-assessed chemical substances using QSAR-evaluation, and a prevention of the use and spreading of endocrine disrupters.

Chapter 11 gives a presentation of the environmental factors in waste. Emissions from the general waste stream are described, e.g. from waste production, collection and transport and from waste treatment facilities.

The Danish waste regulation has been very successful in hindering human contact with waste, but still humans may be indirectly exposed to emissions from waste management. The overall health objective of the waste regulation is to avoid any harmful impact on public health, whether it is directly through contact with waste or indirectly through emissions from waste management. From the start of the waste management history more than hundred years ago, protection of public health has been an integrated part of the waste regulation.

The principal strategy is to prioritise waste management in the following order (the waste hierarchy): Waste prevention, reuse, recycling, incineration with energy recovery and landfill disposal.

The regulation of the waste area in Denmark is generally very detailed, and the degree of recycling is high. However, it is still the aim to increase the degree of recycling and to identify and separate the problematic waste fractions in order to limit the emissions of substances that may have a negative impact on human health and the environment. The instruments used are both a detailed regulation and economic instruments such as taxes and waste fees. Among the regulatory instruments, the regulations on specific waste fractions and on hazardous waste should be noted for the objective to separate out the most problematic waste fractions, in order to improve the possibilities for recycling of the waste stream. Also the general principle of waste separation as close to the source as possible is crucial to the possibilities for recycling and reuse. Further the classification of hazardous waste is also a vital health protective measure in the Danish waste management system.

Chapter 12 deals with wastewater and the health related environmental factors connected hereto. The primary health concern of wastewater is exposure through bathing water. Though there has been a large reduction in wastewater impact on the water environment during the last ten years (improved wastewater treatment technology, sharpened discharge requirements, dimensioning of retention basins to minimise rainwater overflow etc.), some bathing waters are still influenced by wastewater. The primary impact is by overflow of untreated wastewater during heavy rain, but also by run-off from rural areas and from scattered settlements in the countryside not being connected to a wastewater treatment plant. However, there are no record of diseases or other cases of negative health impact from contaminated bathing waters in many years.

The overall health objective of the wastewater regulation is to avoid any harmful impact on public health, whether it be directly (caused by outlet to surface water or soil) or indirectly (leaching to groundwater or inflow to drinking water installations, through application on farmlands or through effects on eco-systems etc.).

The existing wastewater regulation in Denmark has generally succeeded in limiting the public exposure to wastewater. Only a few cases of drinking water contamination with wastewater are recorded in recent years in Denmark, and they were caused by flow of wastewater into the water supply network. These cases, however, have caused a number of affected persons.

Both the general effluent limit values and the requested national "coverage" of treatment are stricter in Denmark compared to the present EU-directives. 99% of all wastewater connected to sewers is being treated in a wastewater treatment plant. The Danish Parliament agreed in May 1997 an action plan for improved wastewater treatment for the scattered settlements in the countryside. The actions will include a connection to public wastewater treatment, local sand infiltration plants or small wastewater treatment plants. This action plan will contribute to the improvement of the general water quality in rivers, lakes and coastal waters and thereby also contribute to improvements of the bathing water quality.

Health concern related to chemical contaminants in wastewater focuses on heavy metals and man-made chemical substances, and especially the risk of accumulation in fish in receiving waters or the risk of transference to agricultural crops when sludge is applied as a fertiliser in agriculture. For many years, it has been attempted to recycle the sludge from wastewater treatment plants on farmland as fertiliser. However, difficulties in reaching the required criteria for the sludge and the farmers reluctance to receive sludge as a fertiliser have made it necessary to dispose part of the sludge as landfill or to incinerate the sludge.

Noise is the issue of chapter 13. Noise is the environmental factor that affects most people in Denmark. Many people are complaining about noise, and noise is given great attention in the public. Environmental noise in Denmark is usually so low that it is not likely to cause serious human damage like hearing impairment. However, environmental noise is annoying and may have adverse effects.

Present guidelines and criteria values express a compromise between high quality of life and socio-economic considerations (technical, economical and community aspects), accepting that a minor part of the public (typical the 10% most noise sensitive people) might still feel highly annoyed. Recent environmental noise mappings show that �-1 million people out of a total population in Denmark of approx. 5 million are suffering from high noise impact. As traffic noise is the main source of annoyance, much effort has been spent on mapping and evaluating possible actions to limit the number of people annoyed by noise from traffic. In 1993, the Danish government decided that the number of housing unit exposed to more than 65 dB(A) from traffic should be decreased from 130,000 to 50,000 before 2010.

Even though it is evident that traffic is the main environmental noise source, present legislation gives no obvious provisions to control or reduce traffic noise from the existing infrastructure. This means that the only way to control and reduce traffic noise will be by good land use and infrastructure planning. The consequence is that the majority of people annoyed by traffic noise are within housing areas in the bigger cities.

For new public infrastructure, noise considerations have to be carried out as part of the Environmental Impact Assessment study. For new enterprises and public infrastructure the noise polluter conducts all costs regarding planning and construction of the necessary noise abatement. Airports have to obtain an environmental approval before getting into operation.

The Danish Planning Act is, among others, dealing with noise considerations as integrated part of new or changed land use and infrastructure planning. The objective of the Act is to ensure that no new noise problems come about.

The European Union will soon present a new "Directive on Assessment and Management of Environmental Noise" dealing with noise mapping, action planning, common indicators and information to the public. It is foreseen that this directive will focus more on noise and the need for measures to control and to reduce the noise impact.

Conclusion

Human health is influenced by a variety of factors of which environmental factors are important contributors together with life style factors, food, factors in the indoor climate and in the working environment.

The actual impact on human health from the individual environmental factors can be difficult to estimate, due to complex exposure situations. Consequently it can be difficult to evaluate the efficiency of the environmental regulation and other instruments in the Danish environmental and health policy in relation to health protection. Different ministries are involved in the protection of human health and there is a need for coordination of the strategies and efforts in this field.

Historically, the primary objective of much of the Danish environmental regulation has been to protect humans from adverse effects in relation to environmental factors as it is the case with waste and waste water regulation. Efforts to protect environment and human health are therefore to a large extent integrated. Furthermore the Danish environmental policy making is generally open and consultative with a range of measures in place to ensure public participation and stakeholder involvement. Environmental information including information about health impact from environmental factors, is available through a wide variety of publications and dissemination mechanisms.

In general, Denmark is considered to have a high level of protection in most areas covered by the resort of the Danish Environmental Protection Agency, in particular in relation to soil, water, waste and waste water. The level of protection in the national regulation of environmental factors is in general based on a precautionary approach. Precaution is taken into account e.g. when making risk assessments, in derivation of health based quality criteria using safety factors and in designing the level of protection to the most sensitive target group, e.g. small children.

The precautionary principle is one of the most important new political instruments, which Denmark stresses should be applied to the widest possible extent in fields, which have been regulated by the EU, e.g. chemicals and pesticides. The precautionary principle shall be used by decision-makers where there is a need for action but also a lack of scientific certainty.

There are however, areas where further action is needed and more information about the possible impact of environmental factors is required in order to increase the level of protection and to prioritise and target the effort. Such areas are chemicals, noise and environmental and health factors in relation to air.

More knowledge about the actual impact on health from environmental factors and the effects of regulatory and other measures is required in a number of areas, e.g. fine particles and endocrine disruptors. This is the case both in relation to the resort of the Danish Environmental Protection Agency and the coordination with other authorities involved in health protection.

Environment and health covers a wide range of areas from environmental factors over food and indoor climate to working environment. The challenges towards protecting the human health from a variety of different factors are in general coordinated action. This implies shared knowledge of health impacts and concerns related to environmental and other factors in order to prioritise and target future efforts in a cost-effective way.

The present report also serves the purpose of identifying the various environmental factors with a possible impact on health.