WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Environmental health indicators

system: a pilot project

Dafina Dalbokova, Michal Krzyzanowski, WHO Working Group

WHO – ECEH, Bonn Office

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Why indicators?

1. To facilitate national and international assessments

2. To provide coherent structure to EH information

system

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

The scope of environmental health indicators

(C. Corválan, D. Briggs, G. Zielhuis, WHO, 2000)

ACB

A: environmental health indicators: indicator + an EH linkage

B: environmental indicators indicating potential human impact, e.g. deforestation

C: health indicators with unknown but possible environmental cause, e.g. cancers

Environmental domain

Health domain

Source WHO, 2000, page 32

Source Activities

Emissions

Environmental Concentration

Air Water Food Soil

Exposure

External Exposure

Dose

Early/ Subclinical

Moderate/ Clinical

Advanced/ Permanent

Health Effects

Traditional hazards Modern hazardsHuman activitiesNatural phenomena

Developmentactivities

Drivingforce

Pressure

State

Exposure

Effect

ActIons

Source: WHO, 2000, page 43

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What indicators?

Cover the EH issues of a clear public health significance

both at sub- and multi- national level

DPSEEA framework:

… => [State of Environment] => EXPOSURE => HEALTH EFFECTS

ACTIONS: Health protection & Intersectorial policies

Clear definition and known EH linkage:

WHO profiles’ key forms (WHO/SDE/OEH/99.10)

Assuring continuity of earlier (inter)-national work

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EH ISSUE Driving Force

Pressure State Exposure Effect Action

Air Quality #

#

#

#

# #

#

#

#

#

Housing and Settlements # # # #

#

Traffic Accidents #

#

Noise #

#

#

Waste and Contaminated Lands

# # # #

#

Radiation # # #

# + ?

Water and Sanitation # #

#

#

#

#

#

#

#

?#

#

Food Safety # #

# ?

Chemical Emergencies # # #

#

#

#

Workplace #

#

#

Core set of EH indicators (WHO Consultation, May 2000)

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Feasibility Study on agreed protocol to test:

• Data availability, quality and reliability

• Data accessibility and exchange mechanisms

• Capacity for multi-agency (net)-working

• Use and usefulness of the indicators

Participating countries: Armenia, Bulgaria*, Czech Republic*, Estonia, Finland, Hungary, Latvia*, Lithuania, The Netherlands, Poland, Romania*, Russia, Slovakia, Spain, Switzerland*

* Study completed

Pilot implementation in selected countries (WHO planning meeting, October 2000)

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1. Data availability and quality

Data-holder (data collection) organisation ..……………...…………...

Use of standardized methodology for data collection ..………………

Quality Control/ Quality Assurance system ………………………….…

Data compapability over time ……………………………………….….

Data coverage re. population ……………………………………….…..

Spatial coverage & resolution re. sources/ pollutants and population

Regular population-based survey or surveillance programme …...…

Sensitivity of the system to detect ‘hotspots’ / ‘events’ ……...……….

Stratification/ aggregation (age, gender, area, time) ……...………….

Statutory requirement for the data collection ………………………….

./.

Evaluating feasibility: WHO questionnaire (1 of 2)

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2. Data accessibility and exchange mechanisms

Inter-institutional framework for data access/ exchange ….….…….

Access through electronic networks and common format …………

Access to the data at central level ……………………………………

Data-flow & possibilities for streamlining ..………………………….

Legal restrictions ……………………………………….………………

Costs for data access …………………………………………………. Timeliness of the data vs. accessibility ……………………………..

3. Relevance/ usefulness of the indicator

Relation to a policy objective or to existing standards ……….……..

Understandable/ interpretable …………………………………………

Action-orientation ……………………………………………………….

Evaluating feasibility: WHO questionnaire (2 of 2)

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

1. Very useful outcomes:

Standardised inventories of data availability and quality, data-flows

and data-holders on a wide range of EH issues, which:

• facilitates multi-agency networking & streamlining the information

• provides a basis for a meta-information system

• promote working relationships with the data-providers

Identifying which data collection needs further harmonisation

or methodological developments

Creating synergies with relevant ongoing indicator projects based

on the knowledge gained throughout the study

./.

Feasibility study: General feedback (1 of 3)WHO review meeting, July 2001

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2. Main problems:

Necessity to communicate with numerous institutions, i.e. :

• Bringing together more than ten different agencies/ bodies

• Coping with reluctance and insufficient interest

Large variety of parallel initiatives on indicators at (inter)-national scale:

• Several indicators already reported to the EEA, OECD, etc.

• Insufficient inter-agency co-ordination

Organisational changes, transitional period in changing legislation,

on-going health sector reforms

Human resources under conditions of lilmited funding

./.

Feasibility study: General feedback (2 of 3)

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

3. Specific difficulties:

Time-consuming translation

Finding out the primary data source

More than one data source (registry, survey)

Data gathering & electronic networks (future)

Feasibility study: General feedback (3 of 3)

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Participating countries rated the core set of EH indicators

over the following criteria:

Data availability: (score 1 – 3) 1  NO

    2  OBTAINABLE WITH EFFORT

3  YES

Data quality: (score 1 – 3)   1  POOR 2 FAIR

3 GOOD

Usefulness/ Interpretability: (score 1 – 3) 1  NOT USEFUL

2  SOME UTILITY

3  VERY USEFUL

First-round evaluation of the indicatorsWHO review meeting, July 2001

Average Ratings of the EH Indicators (1 of 2)

Indicator code

AIR Q UALITY

0

1

2

3

Air_D1 Air_D2 Air_P1 Air_P2 Air_Ex1 Air_E1 Air_E2 Air_E3 Air_A1 Air_A2

aver

age

NO ISE

0

1

2

3

Noise_E1 Noise_E2 Noise_A1

aver

age

Availability

Quality

Usefulness / Interpretability

Indicator Code

Average Ratings of the EH Indicators (2 of 2)HO USING

0

1

2

3

av

era

ge

WATER AND SANITATIO N

0

1

2

3

Indicator Code

ave

rage

Availability: "1" no; "2" no, but obtainable with effort; "3" yes

Quality: "1" poor; "2" fair; "3" fine

Usefulness / Interpretability: "1" not useful; "2" some utility; "3" very useful

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Focus on « A » Focus on « A »

to meet to meet

policy needspolicy needs

ACB

Environmental domain

Health domain

Source WHO, 2000, page 32

Focus efforts on ‘filling the gaps’Link to overlapping initiatives

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Improving system “sensitivity” by focused data collection

through household surveys e.g. on noise, indoor air Development of cost-effective methodology for data collection

Increasing system “specificity” by integrating health -

environment linkage analysis Development of documented guidance and case examples

Focus on health protection measures for action indicators

Increasing utility for decision-making (incl. presentations)

Increasing relevance for highly developed countries

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IMPORTANT ACTIVITIES ALSO INCLUDE:IMPORTANT ACTIVITIES ALSO INCLUDE:

Review of the existing environment and health information

systems; evaluating the existing capacity

Creation of network for exchanging experience and

information

Information sharing with similar initiatives e.g. US EPHI

Close co-operation and better inter-agency co-ordination

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WHO Working GroupALBANIA: M. AfezolliARMENIA: N. BakuntsAUSTRIA: J. BehofsicsBELGIUM: F. van HoofBULGARIA: H. MilevaCZECH REPUBLIC: F. Kožíšek, R. Kubínová DENMARK: B. JensenESTONIA: J. RuutFINLAND: E. Alanen A. Nevalainen, P-J. Penttilä,T. Wiikinkoski, FRANCE: S. MedinaGERMANY: R. Fehr, W. HellmeierHUNGARY: A. Pintér, A. Páldy, M. Kádár, T. MálnásiLATVIA: S. Velina, I. FeldmaneLITHUANIA: I. Zurlyte, A. Ciuladaite

NETHERLANDS: M. van den Berg,A. Dusseldorp, H. Eerens, P. Frintrop, P. Kramers, J. Lembrechts, M. Ruijten, B. StaatsenPOLAND: B. Wojtyniak, J. ZejdaROMANIA: D. Chiriac, A. Cucu,I. Draguescu, I. IacobRUSSIAN FEDERATION: V. Fourman,N. Burtseva, V. Pavlov SLOVAKIA: K. Halzlova, M. KapasnySWEDEN: P. KörsénSWITZERLAND: R. Lawrence, C. Braun, S. KahlmeierUNITED KINGDOM: D. Briggs, E. MacDonald, K. Pond, Ch. Pugh, J. Queenborough, P. Wilkinson, EBRD: N. IchikawaEEA: P. Bosch