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Environment and Health are Closely Related

3 Harmful health effects

Exposure to environmental factors can cause nuisance, temporary harmful health effects, or permanent irremediable injury. The following is primarily a description of goals and initiatives towards the more serious effects.

3.1 Allergies and other hypersensitivity diseases

The incidence of hypersensitivity diseases has been increasing in recent years and today these diseases are extremely widespread. The increase, which is primarily seen in the Western world, seems most likely to be due to environmental and life-style changes, however, there is a need for more accurate knowledge about the factors causing the increased incidence. Either separately or in interplay, environmental factors in the indoor climate, in the air, in food, in consumer products, and in the working environment can contribute to causing or aggravating allergies. The Ministry of the Environment has established a National Allergy Research Center for Consumer Products that is to provide an overview of the scope and causes of allergies to chemical substances in consumer products. This will create the basis for enhanced prevention initiatives, including more targeted initiatives and information on the subject.

Objectives and initiatives in the near future

The overall objective is to reverse the trend of increasing numbers of new hypersensitivity and allergy cases due to environmental factors.

As a part of its national strategies and objectives for public health 2002-2010, the government will draw up a strategy for hypersensitivity diseases (asthma and allergies).

The Ministry of the Interior and Health will examine possible ways of ensuring that systematic, uniform, and extensive registration and monitoring of allergies can be carried out in the future, including possible ways of incorporating data from the primary health sector.

The initiatives to prevent allergies caused by chemical substances in consumer products will be enhanced via allocated funding in the Danish Finance Act 2002-2004. The National Allergy Research Center for Consumer Products will continue its work on creating a solid and scientific basis for monitoring the area and strengthened initiatives to prevent allergies caused bychemical substances in consumer products. In this connection, a clinical database is being established, in which data from the primary health sector are also included. The database will in time become a national database and experience will be useful e.g. as a model for quality improvement of the registration and database development that the government wants for the rest of the hypersensitivity area, see the paragraph above.

Initiatives regarding allergenic substances should be seen in context with international initiatives towardschemicals in general, see section 2.1. Denmark‘s many years’ work within the EU to have allergenic substances identified and classified must be continued.

Consumers must be able to protect themselves against allergenic substances in products applied directly to the skin. On the basis of e.g. Danish initiatives, in 2004 new rules on the declaration of perfumes in cosmetics will enter into force throughout the EU.

Allergenic substances must be identified. Furthermore, the Ministry of the Environment will continue the use of computer models (QSAR) to identify the substances that are allergenic. The Ministry of Employment will include allergies in initiatives against chemicals to a greater extent.

In the years to come, research and development will make up part of the basis for the preventive initiatives against allergenic substances. Important areas are:

* combination effects of irritating substances and allergenic substances in the working environment, * tools to assess chemical substances‘ possible allergenic properties, and public exposure to the substances.

3.2 Asthma and other chronic respiratory disorders

A large part of the population suffer from chronic respiratory disorders such as asthma and chronic obstructive pulmonary disease. The incidence of these diseases seems to be increasing. To different extents, they lead to limitations in day-to-day living and deteriorate the quality of life. More Danish women die from these diseases than in countries comparable to Denmark. Environmental factors, but also life-style factors, are deemed to be significant causes. Research and improved registration and monitoring must be ensured in order to target and enhance preventive initiatives against these disorders. Strengthened efforts to improve the indoor climate are also important, as several environmental factors in the indoor climate can contribute to causing or aggravating allergenic respiratory disorders. More efforts to reduce air contents of fine and ultra-fine particles are likewise important, as reduced levels of particles will benefit e.g. the many people that suffer from respiratory disorders. The National Allergy Research Center for Consumer Products providing information on allergies to chemical substances in consumer products will help elucidate the possible significance of chemical substances to allergies.

Objectives and initiatives in the near future

The overall objective is to map and reverse the trends in the incidence of environment-related asthma and other chronic respiratory disorders.

As a part of its national strategies and objectives for public health 2002-2010, the government will draw up a strategy for initiatives regarding hypersensitivity diseases (asthma and allergies). Initiatives pertaining to smoking and early preventive treatment of asthma and allergies in children will be continued.

The Ministry of the Interior and Health will examine possible ways of ensuring that systematic, uniform, and extensive registration and monitoring of the above respiratory disorders can be carried out in future, including possible ways of incorporating data from the primary health sector. The work will be done in order to achieve enhanced and better-targeted preventive initiatives. Experience gained from the establishment of a clinical database at the National Allergy Research Center for Consumer Products will serve as a model for this work.

There is a need for more knowledge about the significance of outdoor air pollution. In the Danish Finance Act 2002-2004, the Ministry of the Environment has allocated funds to more targeted initiatives against particulate air pollution, especially pollution caused by fine and ultra-fine particles.

There is a need for more knowledge and better-targeted initiatives pertaining to the indoor climate in order to prevent respiratory allergies and reduce nuisance and symptoms among people suffering from respiratory disorders (see section 4.3).

Research and development will make up part of the basis for the preventive initiatives against substances that can cause asthma and respiratory diseases. In addition to this, it is also important to examine how substances with adjuvant effects influence the incidence of allergic respiratory diseases.

3.3 Cancer

The incidence of cancer cases is increasing. The most important reasons for this trend are life-style changes and increasing average lifetimes. However, environmental factors also contribute to increasing the risk of cancer. In continuation of the existing initiatives, the objective is to identify, examine, and minimise environmental factors that can contribute to increasing the cancer risk.

Objectives and initiatives in the near future

The overall objective is to minimise the incidence of preventable environment-related cancer by continuing existing initiatives to identify, examine and minimise chemical and physical environmental factors that increase the risk of cancer.

Initiatives regarding carcinogenic substances should be seen in context with international initiatives towards chemicals in general, see section 2.1. Carcinogenic substances must be identified. Denmark will continue the work to have carcinogenic substances identified and regulated in the EU, since previous initiatives have proven to be an effective means of reducing use of carcinogenic substances.

Exposure to radon in homes must be reduced. The National Board of Health and the National Agency for Enterprise and Housing will still be concentrating on activities that can help reduce the radon level in existing buildings.

In order to reduce the incidence of cancer, exposure to fine and ultra-fine particles from traffic must be reduced. The Ministry of the Environment has started projects to elucidate how to best reduce fine and ultra-fine particulates in air. See section 4.4. on air.

The relationship between exposure to environmental factors and cancer must be elucidated. The Ministry of the Environment and the National Board of Health in cooperation with the Ministry of Food, Agriculture and Fisheries and the Ministry of Employment will examine whether parallel processing of existing registers containing information on cancer incidences and special occurrences of certain environmental factors can suggest possible relationships in selected areas in Denmark. See section 5.2 on registration and monitoring.

In the years to come, research and development will make up part of the basis for the preventive initiatives against carcinogenic substances. This also includes carcinogenic substances formed during food preparation, e.g. acrylamide. To begin with, it will be important to identify clear relationships between environmental factors and cancer and the significance of genetic susceptibility.

Research funding of DKK 5.8 million have been allocated to a large research project that is to examine the formation and occurrence of acrylamide in food products. The objective is to be able to control and reduce the formation of acrylamide during commercial food production and to provide consumers with information on how best to reduce the content of acrylamide in the food they prepare at home. The project will continue until 2006.

3.4 Effects on Reproduction (reproductive toxicity)

Reproductive toxicity means e.g. reduced reproduction ability, birth defects and developmental effects later in life. Environmental factors contribute to reproductive toxicity. Ionising radiation and some chemicals can be directly toxic to the reproductive organs and the foetus, if proper preventive measures are not maintained. Some chemicals can be endocrine-disrupting and may therefore have toxic effects on the reproductive system. In the long-term perspective, this may present a serious problem to society. The objective is to continue to identify, examine, and minimise environmental factors that reduce the ability to give birth to healthy babies.

Objectives and initiatives in the near future

The overall objective is to prevent exposure to environmental factors from adversely influencing reproduction and/or the baby.

Initiatives regarding substances that can be toxic to reproduction should be seen in context with initiatives towards chemicals in general, see section 2.1. Denmark will continue the work to have substances that are toxic to reproduction identified and regulated in the EU, since previous initiatives have proven to be an effective means of reducing use of these substances. For more, please see section 3.5. on endocrine disrupters.

The relationship between exposure to environmental factors and reproductive toxicity must be elucidated. The Ministry of the Environment and the National Board of Health in cooperation with the Ministry of Food, Agriculture and Fisheries and the Ministry of Employment will examine whether parallel processing of existing registers containing information on incidences of reproductive toxicity and special occurrences of certain environmental factors can suggest possible relationships. Funds have been allocated for this purpose in the Danish Finance Act 2002-2004. See section 5.2 on registration and monitoring.

3.5 Endocrine-disrupting effects

The increases in the incidence of endocrine-related cancer in women and men, and declining sperm quality in men are suspected of being linked to exposure to chemicals with endocrine-disrupting properties. If this suspicion is true, and the trend continues, this may have serious consequences for the future. Denmark is contributing to international work to first of all ensure that endocrine-disrupting substances are identified, so that they can be replaced with less problematic substances in the long term.

Objectives and initiatives in the near future

The overall objective is to limit the exposure to chemical substances that affect the endocrine system in humans and animals.

There must be research into effect mechanisms, cause-and-effect relationships, and test methods for identification of endocrine-disrupting effects. Fulfilment of the task requires coordinated and systematic efforts by the Ministry of the Environment, the Ministry of the Interior and Health, the Ministry of Food, Agriculture and Fisheries and the Ministry of Employment.

Possible consequences of endocrine-disrupting effects are so serious that we must first of all be able to identify the endocrine-disrupting substances and take necessary measures to have them replaced by less problematic substances. Emphasis must be given to those substances that entail a risk of humans being directly exposed to high doses, e.g. via food, consumer products, the indoor climate and the working environment. Emphasis must also be given to those substances entailing a special risk of foetal and post-natal exposure.

Denmark supports the short-term, medium-term and long-term initiatives in the EU Strategy and is contributing new knowledge on endocrine disrupters to the dynamic EU list of potential endocrine disrupters. 

In the Danish strategy initiatives against endocrine disrupters aim at three areas, namely at studies followed up by action-orientated investigations, including initiatives for the aquatic environment; at further knowledge building and development; and at regulation. In the Danish Finance Act 2002-2004, DKK 3 million have been allocated annually to enhancement of the scientific basis for solving the problem of endocrine disrupters.

The Ministry of the Environment is still supporting the OECD test method development programme for endocrine disrupters, which will develop standardised methods of determining the endocrine-disrupting effects of chemical substances on the environment and human health.

Initiatives regarding endocrine disrupters should be seen in context with international initiatives towards chemicals in general, see section 2.1. The government will work to see endocrine disrupters covered by the authorisation procedure (the REACH system) in the coming EU rules banning substances with particularly harmful effects, unless authorisation for specific use is granted. This will be possible as soon as suitable test methods and criteria for endocrine-disrupting effects have been developed.

In relation to the report on endocrine disrupters from September 2002 by the Environmental and Regional Planning Committee of the Danish Parliament, a national ban will be considered for substances listed in the EU list of the 66 substances with documented endocrine-disrupting effects, which already are subject to EU risk assessment, if the risk assessment has not been completed by 2004. The ban will be considered on the basis of a review of patterns of use, degree of harmfulness, and exposure conditions.

The Ministry of the Environment will also initiate a survey to elucidate patterns of use and exposure conditions for two substances, listed in the EU list of the 66 substances with documented endocrine-disrupting effects, but not currently subject to EU risk assessment.

In addition, the Ministry of the Environment will expand its list of undesirable substances to include substances, not already banned, but listed in the EU list of substances with documented endocrine-disrupting effects At the same time, the Ministry of the Environment will examine whether pesticides present in the EU list, and either banned or not authorised for use in Denmark, are being used for other purposes.

As part of the monitoring of possible links between the declining sperm quality in men and exposure to endocrine disrupters, the Ministry of the Environment and the Ministry of the Interior and Health are supporting a monitoring programme for sperm-quality trends. The Ministry of the Interior and Health will enhance efforts to examine the causes of deteriorating sperm quality and other adverse effects.

In the years to come, research and development will make up part of the basis for the preventive initiatives towards endocrine disrupters. For more on important areas, please see section 5.3 on research.

3.6 Injuries to the nervous system

Effects on the nervous system often cause very complex health problems. We know more today about the consequences of developmental effects in the nervous system in children and age-related deterioration of the nervous system in the elderly. A number of environmental factors can influence the development and function of the nervous system. The harmful effects of certain organic solvents are well-known, and due to targeted initiatives against these, the protection level has increased significantly over recent decades. In other areas knowledge is more limited, but it seems e.g. that endocrine-disrupting substances can cause injuries to the nervous system. In continuation of existing initiatives, the objective is to document, identify, examine, and limit environmental factors that can contribute to increasing the risk of injuries to the nervous system, especially during brain development.

Objectives and initiatives in the near future

The objective is to prevent environmental factors from causing injuries to the nervous system.

Initiatives regarding substances harmful to the nervous system should be seen in context with initiatives towards chemicals in general, see section 2.1. Substances harmful to the nervous system must be identified and exposure to these substances must be limited. Denmark will work within the EU to have neurotoxic substances identified and classified.

There is a need for more precise knowledge about the effects on the nervous system and how these are related to environmental factors, especially in regard to endocrine disrupters. Initiatives will therefore primarily be targeted at endocrine-disrupting substances, see section 3.5.

Better opportunities for studying effects causing injury to the nervous system are required. In cooperation with the Ministry of Food, Agriculture and Fisheries, the Ministry of the Environment will therefore seek to enhance the development of new test methods, especially in relation to identification of endocrine-disrupting effects. For more, see section 3.5.

Substances in the working environment that are most prone to causing injuries to the nervous system must be identified and, if possible, replaced.

Limit values for contents in food of a number of neurotoxic substances, e.g. PCBs, must be established. The point of departure is that limit values are to be established in such a way that even the most sensitive and vulnerable groups of people are protected against adverse health effects.

In the years to come, research and development will make up part of the basis for the preventive initiatives against substances harmful to the nervous system. Important areas are primarily:

• to identify the relationship between exposure to environmental factors and injuries to the nervous system.
• to develop new OECD test methods to identify neurotoxic substances
• to elucidate public exposure to neurotoxic substances, especially the exposure of children and pregnant women.

Other areas fall under endocrine disrupters, see also section 5.3 on research needs.

3.7 Infectious diseases

Many people suffer from infectious diseases each year. Infection among humans is linked with e.g. hygiene and proximity to others. This is the case with e.g. incidences of infectious diseases among children in day-care institutions. Only a small part of infectious diseases in Denmark are caused by micro-organisms in water and food. The objective is to ensure a high level of protection and thereby reduce the incidence of infectious diseases. The target for 2020 is to reduce pathogenic organisms in water to a level that does not cause negative health effects.

Objectives and initiatives in the near future

The overall objective is to keep ensuring a high level of protection. Objectives in the individual areas are to reduce pathogenic micro-organisms to a level that does not cause negative health effects.

The Ministry of the Environment will establish quality requirements or limit values and develop methods of analysis for micro-organisms that may comprise a health hazard in drinking water, bathing water, wastewater, and sludge. An amount of DKK 2 million has been allocated in the Danish Finance Act 2002-2004 to combat microbiological pollution. To begin with, emphasis will be on Giardia and Cryptosporidium parasites.

We must prevent the occurrence of the bacteria Legionella in water installations. In cooperation with the Danish Energy Authority, the National Board of Health (NBH), Statens Serum Institut, and the National Agency for Enterprise and Housing, the Ministry of the Environment has issued a brochure to house owners and caretakers about the problem. The National Agency for Enterprise and Housing regularly revises the building regulations as required, and when new knowledge on how to best safeguard against Legionella in water installations is at hand.

The relationship between intake of, or contact with, polluted water and incidences of diseases must be elucidated. In cooperation with the National Board of Health and the Danish Veterinary and Food Administration, the Ministry of the Environment will examine whether parallel processing of registered data may indicate possible relationships. For more, see section 5.2 on registration and monitoring.

The Ministry of Employment and the National Working Environment Authority strongly recommend that groups of personal that have been recommended vaccination against Hepatitis B, follow the recommendation.

In the years to come, research and development will make up part of the basis for the preventive initiatives towards micro-organisms. Important areas include:

• knowledge on pathogenic micro-organisms in nature,
• knowledge on contributory factors to the development of resistance to antibiotics,
• knowledge about the impact of micro-organisms on human health at low concentration levels, e.g. in drinking water, and
• knowledge on occurrences of viruses in the environment and their significance for public health.

3.8 Hearing damage and noise-related health effects

Noise is a nuisance problem for many people. The working environment is the most important source of noise-related hearing damage but some chemicals can also damage hearing. Noise can contribute to increased stress and the risk of heart and circulatory disorders. The objective is to provide protection for everyone against exposure to environmental factors that can cause hearing damage. In addition, exposure to noise nuisance that can be otherwise harmful to health and deteriorate the quality of life must be limited.

Objectives and initiatives in the near future

Objectives and initiatives to limit damage arising from noise are also described in section 4.2 on the working environment and section 4.8 on noise.

3.9 Other effects

Environmental factors can contribute to the occurrence of other negative health effects and nuisances. Lifestyle factors are clearly the main cause of the high incidence of cardiovascular diseases, however, environmental factors can play a contributory part. Stress-related disorders, odour nuisances and less documented effects, can be due to impacts from environmental factors. There is evidence of new disorders caused by e.g. exposure to chemicals in very low doses and to smells and odours, not normally deemed problematic. Negative health effects stemming from several different simultaneous sources (combination effects) have not been uncovered. It is therefore important to gain more knowledge about possible relationships. This knowledge is a prerequisite for targeted initiatives against unspecific symptoms.

Objectives and initiatives in the near future

Initiatives against other effects should be seen in context with initiatives towards chemicals in general, see section 2.1 on asthma and section 3.2.

The problem of combination effects must be elucidated. The Ministry of Food, Agriculture and Fisheries and the Ministry of the Environment are jointly in the process of carrying out initial work on combination effects.

Unspecific chemicals-related health effects must be examined. In cooperation with Ministry of the Interior and Health, the Ministry of the Environment will assess whether initiatives are needed in this area. The assessment will be on the basis of the recently published report on Multiple Chemical Sensitivity syndrome (MCS).

In the years to come, research and development will make up part of the basis for the preventive initiatives against unspecific chemicals-related health effects. Important areas are:

• knowledge on combination effects from the presence of several chemicals simultaneously and the interplay with individual sensitivity, and
• internationally accepted methods for establishing limit values in regulations to protect people from odours and tastes.

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