Environment and Health are Closely Related1. STRATEGY AND TEN-POINT PLAN1.1 Principles1.2 Ten-point plan - prioritisation and action One of the objectives of ensuring a good environment is to limit negative environmental impacts and thereby prevent adverse effects on public health. Examples are the efforts to reduce air pollution or to improve wastewater treatment. Better living conditions, better health and safety in the workplace, information and education, and an improved diet, have also benefited health.
This strategy has several objectives. First and foremost, the strategy sets human health in focus in relation to the environmental factors that affect us all in our everyday lives, for example via the air, the water and our diet. The strategy is intended to establish an overview and describe objectives and initiatives. What environmental factors affect our health, and how much do they affect us? Where are we exposed to environmental factors, and where do they come from? How can the environmental factors be limited and what must be done in the future to protect human health? What are the authorities doing now and what are they going to do in the years ahead? What can other parts of society do, for example the commercial sector and the individual citizen? In many areas we have a sound knowledge of how the different environmental factors affect health, but there are also many areas in which we do not know sufficient to take targeted action. Another objective of the strategy is to integrate and enhance the foundation for the efforts of the various authorities to best protect the population against the various environmental factors. A number of authorities are responsible for different aspects of the impact of environmental factors on health. Within their areas of responsibility they each take initiatives to protect the population. Solving the individual problems requires that the authorities communicate and work together. Good coordination and cooperation between the authorities involved are therefore of great importance. The strategy is intended to create the framework for closer cooperation between the authorities on the basis of their common objectives. It is also important to assess regularly the effectiveness of the measures and ensure that there is a good foundation for decision-making. The Environmental Assessment Institute can contribute to this. In today‘s society, human health is affected by both lifestyle factors and environmental factors. Examples of lifestyle factors are tobacco, alcohol, diet, exercise habits, and outdoor recreation. Smoking and alcohol abuse are extremely important factors that can shorten life and affect the general health of the population. The Government has set objectives and initiatives for lifestyle factors in the programme "Life-long health, 2002-2010”. Our health can be affected by environmental factors. Some have positive effects, such as access to outdoor recreational areas, while others can lead to different diseases and hence contribute to premature death. Environmental factors are chemical, physical and/or biological factors in our surroundings, in products, in food, in the working environment or in the indoor climate, see Figure 1. Environmental factors and lifestyle factors can influence each other and intensify the positive or negative effects on health. It is sometimes difficult to distinguish completely between an environmental factor and a lifestyle factor. Smoking is a lifestyle factor, while passive smoking is regarded as an environmental factor. Another example is sunbathing. It is difficult to avoid ultraviolet radiation when moving about outdoors, and the daily exposure must be regarded as an environmental factor. Actual sunbathing, on the other hand, is regarded as a lifestyle factor. In simple terms, an impact that one chooses oneself is a lifestyle factor, while an impact that the individual has difficulty in avoiding is an environmental factor. This strategy covers initiatives against the negative environmental factors.
1.1 PrinciplesThe objective of the initiatives against environmental factors that can have a harmful effect on health is to achieve and maintain a high level of protection so as to best safeguard the population against environmental factors in their surroundings, in food, in other products, in the working environment, in the indoor climate, and against harmful chemicals. This also means that children and the elderly or other population groups particularly sensitive to some environmental factors must be accorded special protection. The population must have access to information on the authorities‘ spheres of responsibility and priorities, and on the initiatives implemented. The strategy is based on four fundamental principles:
These are the principles behind the efforts to protect the population against environmental factors that can negatively affect health. Everyone must be ensured a high level of protection The principle of a high level of protection means that the level of environmental and health protection must be high. Everyone, irrespective of gender and age, must have the possibility of a healthy life without the risk that their health will be unnecessarily affected by environmental factors. For example, people must be able to drink water and live in their homes without putting their health at risk, irrespective of whether they are particularly sensitive to environmental factors due to age, gender, genetic disposition, or during certain periods. This means that special consideration must be paid to some groups – particularly children, pregnant women, and other vulnerable or especially exposed groups. The precautionary principle must be applied The precautionary principle must be incorporated into the overall assessment to achieve a high level of protection. The precautionary principle stems from a desire to protect people and nature, even in the absence of comprehensive scientific proof of harmful effects and their magnitude. The precautionary principle is an important political principle that is acknowledged by the EU and in Danish policy. The principle must be applied when it is suspected that something constitutes an unacceptable risk to the environment or human health, but where the scientific foundation is inadequate and cannot be improved within an acceptable time frame. An example of how the precautionary principle has been incorporated in decision-making is the initiatives concerning phthalates, including the provisions on phthalates in toys. The adverse effects of environmental factors on health must be prevented The environment and health initiative must be preventive and must contribute to sustainable development. People‘s health must not be gradually impaired through polluted food, the emission of harmful substances to the environment, indoor climate, the working environment or via consumer products. Prevention can be achieved by employing the substitution principle to replace hazardous chemicals with less hazardous ones. We must find a balance where both the selection of hazardous chemicals and their use are limited to what is necessary to avoid products that contain chemical substances that are actually unnecessary to the function of the product. The authorities, enterprises, and the general public all have a responsibility. Prevention can also be achieved by identifying and using technologies that have less impact on the environment, and thereby on health. We must avoid pathogenic organisms in drinking water, food, bathing water, wastewater, and sludge. Quality standards or limit values must be set for micro-organisms so as to avoid diseases. The high level of hygiene must be preserved. Information and involvement must be ensured so that everyone can take responsibility for a healthy life The question of the possible negative impacts of environmental factors on health can give cause for concern. Information on the significance of environmental factors for health and the regulations that apply is therefore of great importance. It is vital for people to have easy access to such information, for example information about the substances contained in the products and food that we use, or information about what we ourselves can do in our daily lives to avoid environmental factors that affect our health. Everyone shares responsibility and we must work together if we are to reduce the adverse effects of environmental factors on health, and if we are to make knowledge and information available. Authorities, consumers, manufacturers, the retail trade, and employers and employees in enterprises each have a responsibility. The authorities are responsible for ensuring the possibilities for a healthy life. Among other things, this means requirements to enterprises and manufacturers and information to consumers. Consumers must be able to expect that the goods they purchase are not harmful to health. Consumers must be informed by the authorities and other bodies in such a way that they can respond to the information they receive and thereby share responsibility for their own health. There must be easy access to independent cross-disciplinary information on topics concerning the environment and health. 1.2 Ten-point plan - prioritisation and actionThe series of initiatives that this strategy identifies are collated and prioritised in a ten-point plan. The plan focuses on the creation and dispersion of the harmful environmental factors, e.g. via the air, water or food, and it deals with special impacts in relation to protecting public health in the years to come. Finally, the plan focuses on cross-sectoral and international cooperation, since such cooperation is necessary for an effective effort. The ten-point plan is to help achieve the goals set - including long-term goals. The different elements in the ten-point plan have not been ranked according to priority.
It is necessary to prioritise the initiatives in order to achieve the greatest possible effect on health with the resources available. In prioritising the initiatives, emphasis is placed on reducing a number of environmental impacts that can have serious effects on health (deaths, serious disease), or that affect large numbers of people (e.g. noise). Emphasis is also placed on the long-term perspective through the initiatives aimed at prevention and the maintenance of a high level of protection. The initiatives are focussed through a concerted build-up of knowledge in important areas. The prioritisation also reflects the fact that some issues are global in nature, thus necessitating active Danish participation in international cooperation in this area. The concrete initiatives are to be implemented in the most effective manner. The costs and benefits of the individual initiatives will be evaluated regularly. With the report "Making markets work for environmental policies - achieving cost-effective solutions" the Government has indicated an environmental policy shift towards cost-effective solutions when achieving environmental objectives and increased use of market forces. 1. Negative impacts from chemicals are to be reduced, and the substitution of hazardous substances by less hazardous ones must be accelerated It is known that some chemical substances have harmful effects on health. It is difficult to assess the overall health impact for the population, though, because knowledge of the effects of many chemicals is inadequate. In Denmark we currently use around 20,000 chemical substances that are constituents in an even greater number of products and goods. We use more and more substances because they often improve the products‘ properties or characteristics. The population is therefore increasingly encountering chemicals in everyday life. Chemical substances are found in products and the environment and can occur as pollutants, for example in food, in the indoor climate and in the working environment. Chemicals are spread across national borders. As a consequence, protection against hazardous chemicals is not just a national matter. The objective is to reduce the negative effects of chemicals and to substitute as many hazardous chemicals as possible with less hazardous ones. The Government has set the goal that no products or goods should be on the market in 2020 that contain chemicals having particularly problematic effects on health and the environment. Products and goods will continue to contain harmful chemical substances for many years to come. The treatment of these products when they become waste must not give rise to any problematic effects on health and the environment. A further vision for 2020 is that no employee should be exposed to harmful effects of heavy metals, carcinogens, organic solvents or other hazardous chemicals in the workplace. The first step in reducing the negative impact of chemicals is to phase out the most harmful substances and the hazardous substances that are used in large amounts. Targeted action must be taken globally, regionally in the EU, and nationally. A primary need is therefore for more data on the effects of the substances so as to have a better basis for selecting those for which action needs to be taken. In order to enhance the effectiveness of the efforts and also avoid unnecessary testing on animals, we must make greater use of computer modelling and alternative, simple test methods to predict the effects of the substances. In its Budget for 2002 and the following two years the Government has allocated special funds to enhance efforts to limit the negative impact of chemicals on health and the environment. Authorities, manufacturers, and employers must phase out or reduce the use of hazardous substances. The authorities will use a variety of instruments, including banning particularly hazardous substances or regulation to restrict their use. Special groups of substances such as pesticides and biocides have to be approved before use. The Cleaner Product Programme will support the development of alternatives and cleaner production methods. One tool for phasing out or substituting hazardous substances with less hazardous ones is the official lists of problematic substances. Manufacturers, suppliers, importers, and employers have a particular responsibility for ensuring that the least hazardous appropriate substances are used in production and products, and that products and foods are not polluted by undesirable substances. Industry must be made responsible for investigating the toxicity of chemicals and for ensuring that the chemicals used do not harm the environment and human health. Retailers are responsible for making use of the information provided by the manufacturers and for ensuring that the consumers are informed in the best possible way about the safest way to use the products they sell. Retailers and consumers must be able to make a conscious choice about what they wish to sell and buy. Moreover, consumers should be given ample opportunity to choose products that have as few adverse effects as possible on the environment and health. Enterprises using chemicals must involve their employees in the task of reviewing the use of chemicals and of substituting hazardous chemicals with less hazardous ones. 2. The incidence of allergy and respiratory disorders is to be reduced Both allergy and respiratory disorders affect many people in their day-to-day lives. The incidence of these diseases is increasing. The precise reasons for this are not yet known, however. Some people are genetically disposed to allergies and chronic respiratory diseases. The effects of chemicals, food, fine particles, and micro-organisms can evoke or promote the development of allergies and exacerbate the disorder in allergic people. The reasons why an increasing number of people suffer from allergies need to be better understood. The objective is to phase out substances that cause or exacerbate allergies, especially from consumer products, the working environment, food products, and the indoor climate, so as to reverse the trend and reduce the incidence of allergy and respiratory disorders. One of the means of achieving this will be that products containing allergenic substances will have to be labelled so that consumers can choose whether they want to purchase these products, and so that manufacturers can use alternative substances. At the same time, the basis for reducing the number of cases of allergies caused by chemical substances in consumer products is to be improved. The Ministry of the Environment has therefore established a National Allergy Research Center for Consumer Products. Furthermore, the Ministry of the Environment will intensify the use of computer models to identify more rapidly the substances that are allergenic. In the EU, Denmark will work towards the future introduction of positive lists, for example for hair dye. During the Danish Presidency an agreement was reached that allergenic perfumes must be declared on cosmetic products. Denmark will work for the introduction of similar regulations requiring the labelling of allergenic perfumes in detergents and cleaning agents. Such a proposal has been put forward in the EU. In addition, activities to improve the air quality in relation to outdoor air pollution and the indoor climate will be vital for people suffering from respiratory disorders and hypersensitivity diseases (see point 5). The Government will draw up a strategy for hypersensitivity diseases (asthma and allergies). 3. Measures directed at endocrine-disrupting substances are to be intensified Observations in the environment have shown that chemical substances with endocrine disrupting properties can affect reproduction in animals. In humans the substances are suspected of being partly responsible for damage to reproduction and for the increasing number of cases of cancer. If the suspicion is correct and the development continues, this will have consequences for our future. It is particularly the effect of endocrine disrupters during vulnerable periods such as the foetal period that are of significance for the development of diseases later in life. Research on potential endocrine disrupters and their possible effects needs to be enhanced. The objective is to identify and thereafter substitute the endocrine disrupters in products so as to reduce their occurrence in our surroundings. One of the means of pursuing this objective is active support for the EU Strategy for Endocrine Disrupters, which includes assessing and prioritising the most problematic substances. The Ministry of the Environment, the Ministry of Food, Agriculture and Fisheries, the Ministry of Employment and the Ministry of the Interior and Health will strengthen cooperation to identify and then replace the most problematic substances and the substances to which we are most exposed. Research needs to be strengthened on the relationship between exposure to endocrine disrupting chemicals and effects on health. It is vital to develop better methods for testing substances for endocrine disrupting effects so as to determine more rapidly which substances have such effects. 4. Noise nuisance is to be reduced High noise levels can cause hearing damage and increase the incidence of stress-related diseases. At workplaces high noise levels are still a serious problem, although it is decreasing. Around 1,800 cases of work-related hearing damage are still reported each year. Children‘s institutions are often plagued by high noise levels. Road traffic is the main source of noise nuisance outside and in homes. The objective is to protect the population and employees as far as possible against loud and bothersome noise. In 2003, the Government will publish a strategy aimed at reducing noise from road traffic (Road Noise Strategy). The Road Noise Strategy will help ensure a good basis for the implementation of the EU Environmental Noise Directive. The foundation for drawing up the strategy will include an analysis of the costs and benefits of regulating noise. The National Agency for Enterprise and Housing will reassess the noise-related requirements for new buildings. The assessment is intended to e.g. contribute to a reduction in noise from neighbouring flats in multi-storey housing and to improvement of the acoustic conditions in children’s institutions and schools. Up to the year 2005, the National Working Environment Authority will accord high priority to noise levels that can cause hearing damage, focusing particular attention on noise in day-care centres. Special initiatives must be taken against sectors of industry where noise can occur at levels that damage hearing, e.g. the metalworking and the engineering industry. In addition, the National Working Environment Authority will review very noisy machines and work processes where it is not currently possible to attenuate the noise sufficiently so that future initiatives can be better focussed. 5. The negative impacts on health from air pollution and from the indoor climate are to be reduced We must reduce emissions of harmful substances from vehicles in our towns. The Government is aiming for a 50% reduction in particulate emissions from traffic in towns by the year 2010. Implementation of an EU directive means that Denmark must reduce its emissions of sulphur dioxides (SO2), nitric oxides (NOx), volatile organic hydrocarbons (VOCs) and ammonia before 2010. The Government aims to reduce emissions of NOx and hydrocarbons from the transport sector by 60% by 2010 relative to the level in 1988. The relationship between particulate pollution and harmful health effects is well documented. However, there is a need to know more about how individual sources of pollution contribute to human exposure to fine and ultra-fine particulates and to know more about the health effects related to emissions from these sources - especially in a Danish context. It is important to gain more knowledge about these relationships in order to identify particularly pollutant sources, other than diesel-driven vehicles, and in order to give more precise assessments of the health benefits of specific measures against the individual sources of pollution. Most people spend approximately 90% of their time indoors. The indoor climate is therefore of great importance to our health and well-being. Ventilation conditions, heat, damp in buildings and humid air are the most important factors for the indoor climate and for conditions for house dust mites and mould fungus. A poor indoor climate can also be caused by animal hair, wood-burning stoves, cooking odour, tobacco smoke and chemical substances that evaporate from building materials and furniture, cleaning agents and other chemical products. Someenvironmental factors in the indoor climate can be allergenic, e.g. house dust mites and animal hair, while others are irritants. The objective is to reduce the adverse effects of the indoor climate on health as much as possible. Radon, which is a naturally occurring radioactive gas present everywhere underground, is a contributory cause of approx. 300 new cases of lung cancer each year. Approx. 1/6 of these cases occur in non-smokers. The main means of reducing radon levels in buildings are to ensure that they are insulated from the ground and well ventilated. An important means of achieving this objective in future will be a coordinated, enhanced effort by the authorities. Information activities must be intensified to inform the public on how to improve the indoor climate at home, e.g. through building design, building use, maintenance, ventilation and cleaning. At workplaces, supervision of compliance with the regulations must be enhanced. There is also a need for more research in order to gain greater insight into how and to what extent the different environmental factors in the indoor climate affect us and thereby enhance the possibilities for preventing negative effects on health from indoor-climate problems. 6. Food is to be safe and free from pollution Food can be polluted with harmful chemical substances. Some substances are more problematic than others because they are persistent and accumulate in the food chain. The objective is to ensure consumers access to safe and unpolluted food. It is important to prevent food from being polluted. This will be achieved by taking action directed at the source of the pollution. Many food products are imported and it is therefore important that efforts are continued internationally to promote food safety and to impose strict requirements concerning emissions and the use of the most problematic chemical substances. Besides reducing pollution at source, one of the main means of achieving the objective is the setting of limit values for undesirable chemical substances. Limit values for the residual concentrations in food have been set for a number of heavy metals, pesticides, veterinary medicines, food additives and some of the chemicals that can be released from food packaging. The Ministry of Food, Agriculture and Fisheries will adjust existing limit values and set new ones, as new knowledge is acquired. Denmark is working actively for the introduction of limit values for all types of chemical contaminants in both Danish and imported food. All limit values will be established according to the precautionary principle and they will be set as low as possible. The authorities will monitor compliance with current limit values and ensure good information about the quality and safety of food. The food manufacturers are responsible for complying with the regulations on safety and quality. In 2000 and 2001, the Ministry of Food, Agriculture and Fisheries and the Ministry of the Environment published action plans to reduce dioxin and dioxin-like substances in food. For example, extensive monitoring of the occurrence of dioxins in fish caught in Danish waters is to be initiated so that fishery at particularly polluted "hotspots" can be banned if necessary. From 2005 onwards, waste incineration plants, which are one of the major sources of dioxin emissions, must comply with a more stringent limit value for the amount of dioxin they are permitted to emit. 7. Groundwater and drinking water must be protected In most places in Denmark the groundwater is so pure that it can be used directly as drinking water. However, there are areas where the groundwater is at risk from pesticides leaching down through the soil. Drinking water can also be polluted by metals and chemicals emitted from water pipes and taps in homes. The Government‘s objective is for Danes to be able to continue using untreated groundwater as drinking water and to be in no doubt as to the quality of their drinking water with respect to pesticide residues, other chemical substances, and microbiological pollution. In Denmark, the principle is that there must be no pesticide residues in groundwater at levels exceeding the limit value. The main instruments for protecting the groundwater against pesticides are to ban or restrict the use of pesticides that can threaten the groundwater. In the past few years, many pesticide active ingredients that can threaten the groundwater have been banned. These efforts will continue. The warning system for groundwater monitoring is an important initiative in this context. The warning system provides the possibility for rapid intervention in the form of reassessment, and a ban or use restrictions in the case of approved pesticides that contaminate the groundwater. The consumption of pesticides can be reduced while also ensuring economically viable agricultural production. In 2003 a new target will be set to reduce further the application frequency. In addition, the Ministry of the Environment and the Ministry of Food, Agriculture and Fisheries are in the process of identifying areas that are particularly vulnerable to leaching of pesticides. The quality of our drinking water must not be impaired by substances released from water pipes and taps. The National Agency for Enterprise and Housing and the Ministry of the Environment will therefore reassess the present national approvals with a view to raising the level of protection and ensuring that the concentrations of metals given off by installations do not exceed the drinking water standards. 8. Research into the significance of environmental factors on health is to be enhanced Research into the relationship between environmental factors and health is important. Greater understanding of causal relationships, mechanisms, exposure and effects of different environmental factors will provide a better basis for planning preventive action against problematic chemicals and other environmental factors. The Danish Strategic Environmental Research Programme has been providing more knowledge in this area for a number of years. This programme has now been concluded. The objective is that research into the relationship between environmental factors and health is to be continued. It is necessary that the future research initiatives consider important issues such as the significance of the negative effects of chemicals for the individual, combination effects, and the development of effective methods for testing and assessing chemical substances. In this connection, areas of research that will be accorded high priority are endocrine disrupting effects, allergies, and fine and ultra-fine particles. There is already extensive monitoring and registration of a number of environmental factors and the incidence of various diseases. The objective is to enhance our knowledge of relationships between environmental factors and health so as to obtain the necessary documentation to inform and focus efforts where they will have the greatest effect. In order to better understand the relationship between environmental factors and health, the authorities will analyse and clarify the possibility of obtaining more information by parallel processing databases containing environmental and geographical information with health databases. A cross-disciplinary group will be appointed to develop a comprehensive set of indicators illustrating the relationship between environmental factors and health. Among other things the objective is to establish a permanent system for monitoring environment-related health risks. 9. Cooperation between the authorities must be strengthened Various authorities are responsible for specific tasks concerning environment, food, the working environment, indoor climate, traffic, and public health in general. These are complex areas, where regulation necessitates considerable knowledge about sources of pollution and impact on human health, the magnitude of the impacts, the dangerousness of environmental impacts, and knowledge about public health. It is therefore important to optimise cooperation between the administrative authorities and the research centres so as to maximize the effect of the efforts. It can be difficult for the individual citizen to obtain a clear picture of what can affect one‘s health and to what extent, what initiatives the authorities have implemented and, particularly, what one can do oneself to avoid various substances and products and thus reduce possible harmful effects on health. People’s environmental rights are assured through such legislation as the Act on Access to Public Records, rules on citizen involvement, and the right of appeal in the various environmental laws. The objective is to ensure that action is centred on people and the impacts to which they are exposed and that integrated and prioritised action is taken across the board to regulate and reduce impacts on public health. Research centres must also cooperate and coordinate their activities so that society benefits optimally from their work. Authorities, manufacturers, employers, and the media must all participate in disseminating information about the risks in a useful and well-balanced way so that people can act appropriately to prevent and reduce risk. As a means of achieving these objectives the government will accord importance to strengthening wide-ranging cooperation on the question of environmental factors and health. It is proposed that a coordinating working group should be established between the authorities to ensure coordinated and integrated action against environmental factors that can affect health. The working group is to follow up and ensure the implementation of this Strategy for environmental factors and health, for example in such cross-disciplinary areas as stipulating the level of protection and setting limit values. In this context, there may be a need to involve other players, e.g. from regional and municipal authorities, medical health officers, industry, research and organisations. The work is to be based on environmental, health, and economic considerations so as to maximise the benefits obtained for the investment. The Working Group will also act as an “umbrella” for a wide range of cooperation fora in specific areas. The Working Group will prepare a report on the progress of the work by the end of 2005, including a proposal for future priority areas. On the communications side, the authorities‘ objective is to provide good and relevant information on environmental factors and health and to establish a mutually beneficial dialogue with business and individuals. People are to be provided information on health risks in such a way as to enable them to assess the significance of environmental factors for health and thereby help prioritise the initiatives. At the same time, people are to be assured easy access to the information they seek. 10. Increased attention must be accorded to environmental factors and health in international cooperation For many years now, the effect of environmental factors on human health has become increasingly dependent on international conditions. Many food products, chemicals, and goods are produced elsewhere in the world and imported to Denmark. Moreover, we can be affected by pollution in other countries and continents. Examples are the hole in the ozone layer over the Antarctic caused by emissions of ozone-depleting substances or transboundary atmospheric pollution. The task of protecting health against environmental factors must therefore also be solved in international cooperation. The objective is that Denmark makes active international efforts and provides environmental assistance aimed at helping to solve global, regional, and local problems. The main means of achieving this objective include Denmark’s participation in the international regulation aimed at protecting and improving health. This applies both in the EU, the UN and other international fora. Denmark will strive to ensure that global cooperation in the chemicals area is successful. Moreover, Denmark and the EU accord high priority to cross-disciplinary action for health, the environment, and combating poverty, including initiatives in such areas as water and energy |
