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Environment and Health are Closely Related

5 Cross-disciplinary initiatives

This section deals with central issues that are relevant if we are to gain an understanding of the work the authorities are carrying out to protect the population from harmful environmental factors. The following provides an overview of the tools and methods used by the authorities to achieve a high level of protection against negative effects from environmental factors; of how the authorities make use of registration and monitoring; of the research and research fields considered important; and of how the authorities use information and risk communication in the dissemination of knowledge and available intervention opportunities to the public. Moreover, future objectives and initiatives in the areas are pointed out.

The issues are varied and they are dealt with across different authority spheres. Thus descriptions of the different areas are different from previous sections.

5.1 Level of protection

The limitation of public exposure to harmful environmental factors is managed by different authorities, depending on whether limitation is targeted at environmental factors present in the environment, in the working environment, in the indoor climate, or in food and consumer products. The objective is to achieve more cooperation and a mutual understanding of the need to protect public health, and to achieve greater mutual benefit from each other‘s work.

Objectives and initiatives in the near future

More cooperation and coordination across the different ministries within the areas risk assessment, risk management, and risk communication must be ensured, e.g. with regard to the protection of especially sensitive and vulnerable groups of people. Areas where more cooperation and coordination can help promote more uniform protection of the public include:

• Risk assessment and establishment of principles of risk assessment of micro-organisms.
• Risk assessment and establishment of limit values for substances in relation to the working environment, the external environment, and intake via food. This includes taking contributory sources into account in the establishment of limit values.
• The establishment of a common exposure model for food, the environment, the indoor climate, and the working environment, including development and use of models. Use of models for chemical structure-activity relationships in connection with risk assessments.
• Assessment of general problems, e.g. the protection of especially vulnerable and sensitive groups of people, exposure of children and pregnant women, combination effects in relation to exposure to several substances at the same time etc.
• Coordination of work on regulation of chemical substances and materials across different sectors, e.g. regulation of packaging in contact with food, water, medicines, and regulation of packaging waste.
• Coordination of risk assessment and management in areas where protection of the environment and public health is an inter-ministerial task, e.g. in connection with problems regarding use and landfilling of sludge, contaminated soil and, dredged material from harbours.
• Risk communication as an integrate part of communication to the public and among authorities.
• Selection and use of indicators for assessment/measuring of regulatory effects on environmental factors and their impact on the environment and health.
• Coordination and initiatives by the authorities in relation to the indoor climate. These are described in section 4.3.

5.2 Registration and monitoring

In Denmark, there is already extensive monitoring and registration of a number of environmental factors and the incidence of various diseases and causes of death. The objective is to enhance initiatives on environmental factors and health by examining and applying possible parallel processing of databases.

Objectives and initiatives in the near future

As apparent from this document, the Ministry of the Environment is carrying out extensive monitoring and registration of emissions from, and the occurrence of, environmental factors in the environment. The Ministry of Food, Agriculture and Fisheries manages control programmes for selected environmental factors in food. The National Board of Health manages a register of several categories of disease, some including information on causes.

In future there will be three main areas of initiative: Firstly, initiatives to adjust and improve monitoring and registration within the different areas. Secondly, initiatives to achieve better indications of the relationship between environmental factors and health. And thirdly, initiatives to elucidate and improve possible ways of parallel processing of databases.

Existing monitoring programmes and registration are adjusted and updated when required. This is to ensure that programmes and registration continuously illustrate objectives and resultsoptimally within the environment, health, food, the working environment, traffic, and urban and housing issues.

Especially worth mentioning in this context is the fact that the Ministry of the Environment will revise Danish monitoring efforts, and from 2004 include nature monitoring in the Danish Aquatic Monitoring and Assessment Programme, NOVA 2003. The revised programme (NOVANA) will cover the period 2004-2009. The programme will comply with international commitments to monitor and report on the state of the environment and nature.

Work will be carried out to follow up on the indicators for the relationship between environment and health, in the government‘s National Strategy for Sustainable Development. The coordinating working group (see section 6) will establish a subgroup that is to examine possible ways to develop a broader range of indicators for the relationship between environmental factors and health. This includes examining the needs and opportunities to establish monitoring of environment-related health effects in selected areas.

Relevant ministries will examine possible ways of attaining more and better information about the relationship between environmental factors and health via parallel processing of databases within the different areas.

The National Board of Health is in the process of following up a pilot project carried out by Medical Health Officers by reviewing registers and examining possible ways for linking to geographical information systems. On this basis, work on establishing a national geographical information system regarding sickness and mortality rates has been initiated. Two pilot projects are in the start phase.

Funding for analyses based on register data of the relationship between health and environmental impacts from especially chemical substances has been allocated in the Danish Finance Act 2002-2004 (see also sections 3.3, 3.4, and 3.7). Thus, a preliminary investigation has been initiated in 2002 to examine available options and obstacles. This investigation will serve as a start point for joint initiatives by the Ministry of the Environment, the Ministry of the Interior and Health, and the Ministry of Food, Agriculture and Fisheries to prepare an analysis report about available options and proposals and recommendations. The report will be available in 2003.

5.3 Research – needs and initiatives

Research and development projects on the relationship between environmental factors and health are an important part of preventive efforts. A large number of research and development communities in Denmark and abroad take part in the general build-up of knowledge. In a number of selected areas, however, there is a need to enhance Danish knowledge building.

Objectives and initiatives in the near future

It is important to ensure that research into the relationship between environmental factors and health, currently taking place in many different institutes and institutions, is carried further. It is equally important that research is organised and coordinated in the best possible way, bringing the issue of the relationship between environmental factors and health into focus. This will also ensure efficient use of results achieved.

These fundamentally broad research initiatives will elucidate aspects such as:

• occurrence, fate, and distribution of environmental factors in the environment, the working environment, the indoor climate and in food,
• the extent of human exposure to environmental factors, including exposure of especially sensitive groups of people,
• the relationship between environmental factors and negative health effects, e.g. effect mechanisms,
• the development of tools to help prioritise and target initiatives and strengthen prevention,
• socio-economic assessments e.g. of the negative health effects stemming from environmental factors and of the benefits gained from prevention or limitation of negative health effects.

Section 2.1 and sections 3.1 to 4.9 include descriptions of a number of areas in which research can form the basis for targeted and preventive initiatives.

Funds have been allocated in the Danish Finance Act for implementation of a number of development initiatives within the environment and health areas in the period 2002 to 2004. These initiatives are to provide a better knowledge base and contribute to enhancing initiatives within the areas. The initiatives are described in the relevant sections.

Denmark will work to ensure that research into the relationship between environmental factors and health is accorded priority in EU research programmes. The 6th EU Framework Programme for Research and Technological Development was adopted in June 2002 and contains issues related to the environment and health. Thus, within the EU there is focus on the relationship between the environment and health, and Danish research communities can cooperate with other research communities and contribute to international research on the subject.

An overall assessment points at four areas central to future preventive initiatives. These areas may indicate to the Danish Research Councils, research communities and enterprises where the Danish authorities find cooperation on research and development beneficial to society as a whole, and where there might be a commercial interest in gaining further knowledge.

Initiatives will e.g. enhance opportunities for enterprises themselves to assess health risks associated with their products and production processes by.

• Research on cross-disciplinary issues about the relationship between the environment and health

There is a need for better knowledge about the overall significance of negative effects fromchemicals to people throughout their lives. It is vital to gain knowledge about human exposure to environmental factors through thorough knowledge of the occurrence, fate, and distribution of environmental factors. Combination effects represent another central issue in the relationship between environmental factors and effects on health. Combination effects can occur from the simultaneous impact of several different chemical factors, or the simultaneous impact of different types of environmental factors, e.g. simultaneous exposure to organic solvents and noise. Other important issues include delayed effects of exposure to chemical substances; effects of long-term, low-dose exposure to e.g. odours and smells not normally deemed problematic; better knowledge about especially sensitive groups of people; and the significance of micro-organisms to our health and well-being.

There is also a need to develop new methods for testing and assessing chemical substances. These new methods must be more efficient, easier to use for both the authorities and producers, yield better results, and minimise use of animals for testing.

Furthermore, there is a need for knowledge on viruses in the environment and a need to develop methods for detection of viruses.

Finally, there is a need for more knowledge on the interplay between lifestyle factors and environmental factors, including a need for further knowledge on the significance of access to forests, nature, water, parks, and recreational areas for our health and well-being.

• Endocrine disrupting effects

There is a need to extend basic research into possible endocrine-disrupting effects in order to ensure greater knowledge about the mechanisms behind carcinogenic effects, effects on reproduction, and injury to the nervous system.

There is also a need to develop more efficient test tools to identify endocrine disrupters. It is important to establish a stable research community where systematic and continuous development work can take place in coordination with OECD activities.

Finally, there is a need to map the quantities of endocrine disrupters in the environment, how people are exposed, and the level of exposure of different groups of people.

As part of the realisation of the Danish research pool, DKK 40 million have been allocated to cross-disciplinary research into hormone-mimicing substances for the period 2003-2005.

• Allergies

There is a need for better knowledge about how chemical substances in ambient air, the indoor climate, and as food additives may aggravate and increase the incidence of allergies. There is a need to find out whether the indoor climate plays a special role in the development of allergies. Finally, there is a need for better knowledge on how chemical substances contribute to causing skin allergies, and how skin allergies can be prevented.

There is also need for much more precise knowledge about the number of people developing asthma and allergies due to exposure to environmental factors, or where environmental factorsplay a significant role in the pathological picture. There is a need to establish broad knowledge-based national data comprising both exposure and effects-related data, and dealing with both validated questions and investigations.

• Fine and ultra-fine particles

There is a need for better knowledge about the mechanisms behind the negative health effects caused by fine and ultra-fine particles, including respiratory disorders, heart and circulatory disorders, and lung cancer.

In addition, there is a need for better knowledge about the extent and situations in which people are exposed to fine and ultra-fine particles from traffic. In particular, there is a lack of knowledge about the significance of exposure to fine and ultra-fine particles in busy roads.

5.4 Information, openness and risk communication

Active communication and a large degree of openness about knowledge, and, in particular, lack of knowledge, are important if the public is to be provided the opportunity of assessing risks. The many players disseminating knowledge and assumptions about the link between health and the environment have a great responsibility for ensuring that information is balanced and detailed.

Objectives and initiatives in the near future

The overall objective is to ensure adequate, good, and detailed information for all on possible risks and possible effects. Only this way will it be possible for individuals to protect themselves from unwanted negative health effects from environmental factors.

The Ministry of the Environment prioritises continuously providing scientifically sound environmental knowledge. Moreover, the Ministry is working to ensure best possible risk communication and risk management regarding the environment and health for the population and enterprises. The Danish Environmental Protection Agency is cooperating with the Danish Veterinary and Food Administration and the Danish Medicines Agency on the development of different models of risk management and on the possible establishment of a dialogue with retailers, the media, manufacturers, experts, consumer organisations etc. so as to get to know more about how best to communicate uncertain knowledge. In order to reduce thecontents of chemical substances in food products, the cooperating ministries will e.g. consider whether risk communication will be an effective means of motivating consumers to choose not to buy products containing substances that via the environment end up in food.

The Ministry of the Environment will continue enhancing the communication of issues on health and the environment in the form of campaigns and regular dissemination via newspapers, magazines, the Internet and so on. In order to provide the public with easy access to information and knowledge on the environment and health, the Ministry of the Environment has created a new web portal. The portal contains links to authorities, information centres, organisations and societies etc, other web portals and web sites, journals and encyclopaedias, as well as links relevant for children and young people.

The Ministry of the Environment is extending its communication of environmental data each year. Some of these data will be of relevance to the environment and health, such as information about the quality of drinking water or about wastewater. Such data are tools providing consumers and the public quick insight into environmental conditions in their home environment.

The Ministry of Food, Agriculture and Fisheries will continue to publicise the results from its regulation of retailers and restaurants - the so-called smiley-scheme. The aim is also to publicise the results on the Internet, where well-established search facilities exist. As of yet the results are only displayed in the stores/restaurants.

The Ministry of the Environment will ensure that consumers have access to independent, consumer-relevant information about environmental factors and health. In January 2003, the Minister of the Environment decided to establish the ”Information Centre for Environment & Health”. The Centre is to provide the public with accessible, practical, and relevant information on the relationship between the environment and health, while at the same time ensuring dialogue between industry and consumers.

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