Introduction to environmental health policy

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1 1 Introduction to environmental health policy Overview In this introductory chapter you will first consider several definitions of environmental health. It will help to clarify which definition is relevant to your own interests, though it is possible that this may change as you progress. Whatever your personal interest, however, it is important that you are aware of the different interpretations that others might legitimately place on this term, since you will certainly encounter them. Second, you will examine the array of principles that impact upon environmental health policy as currently practised. Finally, you will receive a brief and preliminary introduction to the key tools recommended by international agencies, governments and other organizations as aids for decision makers in determining their policies. Learning objectives By the end of this chapter, you will be better able to: identify different interpretations of environmental health specify your own environmental health interests while acknowledging those of other people list considerations that typically influence the formulation of environmental health policy name some of the principal tools used in environmental health assessment. Key terms Environmental health Those aspects of human health and disease that are determined by factors in the environment. Policy Broad statement of goals, objectives and means that create the framework for activity. Often taking the form of explicit written documents but may also be implicit or unwritten. What is environmental health? Before studying environmental health policy, you need to consider what is meant by the term environmental health and what it means to you or your organization. One definition can be found in the European Charter, Environment and Health

2 8 Introduction (WHO 1990). According to this, environmental health comprises those aspects of human health and disease that are determined by factors in the environment. The European Charter also says that the term refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health. However, this definition is still open to interpretation. For example, for some agencies, environmental health is primarily associated with the direct pathological effects of chemicals, radiation and some biological agents whereas others additionally include the effects (often indirect) of the broad physical, social and aesthetic environment, which includes housing, urban development, land use and transport (WHO 1990). Many agencies, including the WHO, are also concerned about the impact upon health and safety attributable to injuries. Injuries themselves may arise from contact with either the natural or the man-made environment. Or they may be accidental, self-inflicted or associated with some malicious act. When thinking about environmental health policy it is necessary to decide which, if any, of these additional issues fall within your domain of interest. There is a further definitional issue. In talking about environmental health, many groups are concerned primarily or solely with risks to people. Their goal is the preservation of human life and the improvement of human health. However, there are others who are at least as much concerned or possibly more so with the nonhuman, but living environment, and yet others still who are concerned with the non-living environment, for example, the rocks beneath our feet, irrespective of whether there are any living organisms around to enjoy them. It can, of course, be argued that, because human beings are part of the wider ecosystem, a healthy environment is necessary to maintain human health. It could also be argued that humans have a moral duty, whether it benefits them directly or not, to look after the environment for the sake of other living organisms, or even to look after it simply because it is there. Table 1.1 is a list of risks that might be incorporated under the heading of environmental health. Activity 1.1 Examine Table 1.1 and, thinking about where you live and your own interests, answer the following questions: 1 What aspects of environmental health do you consider should be included in your working definition, and why? 2 Are there any persons or groups in the place in which you live or work who might favour a different definition and, if so, why? Feedback Basically, it is a matter of choice as to which definition of environmental health you select. There is no correct answer. Table 1.1 shows how wide the possibilities can be. Whatever you decide, it is important to be aware of where you draw the boundaries and also why other people might draw them differently.

3 Introduction to environmental health policy 9 Table 1.1 A taxonomy of risk types according to hazardous agents Hazardous agents Physical agents Chemical agents Biological agents Natural forces Socio-communicative hazards Complex hazards (combinations) Risk Source: Adapted from IRGC (2005) Ionizing radiation Non-ionizing radiation Noise Kinetic energy (explosion, collapse, etc.) Temperature (fire, overheating, cold) Physical hazards (unsafe premises, public spaces, etc.) Toxic substances (with thresholds) Genotoxic/carcinogenic substances Environmental pollutants Mixtures Fungi and algae Bacteria Viruses Genetically modified organisms Other pathogens Wind Earthquakes Volcanic activities Mudslides Drought Floods Tsunamis Bush fires Avalanches Human violence (criminal acts) Humiliation, mobbing Terrorism and sabotage Mass hysteria Psychosomatic syndromes Food (chemical and biological hazards) Consumer products (chemical, physical etc. characteristics) Technologies (physical, chemical, etc.) Large constructions (buildings, dams, highways, bridges, etc.) Critical infrastructures (physical, economic, social/organizational and communicative) Environmental health policy A policy is defined as a course or principle of action adopted or proposed by a government, party, business, or individual etc. (Concise Oxford Dictionary 1991). Policies are normally based on a set of underlying principles. These principles must be related to the issue of concern, in this case, environmental health. In other literature you might also come across the terms plan, and programme. The difference between policies, plans and programmes is not clearly defined, but a

4 10 Introduction fairly common explanation might be: A policy may... be considered as the inspiration and guidance for action, a plan as a set of coordinated and timed objectives for the implementation of the policy, and a programme as a set of projects in a particular area (Wood and Djeddour 1992). Activity 1.2 Thinking about your own situation, write down some underlying principles that might help you develop a strategic policy on environmental health. This is quite a difficult question at this stage if you are new to this field, so do not be concerned if you find it hard. Later, it will become much easier. Feedback Many organizations list their guiding principles on the world-wide web. For example, on its website: the London-based Chartered Institute of Environmental Health (CIEH) lists its principles as: concerns for human health and well-being, and the desire to improve this through appropriate environmental change and intervention; equity, and the wish to promote the benefits of the environmental health approach to all members and sections of society including the most disadvantaged; precaution, because it is believed that prevention of harm is better than cure; an holistic approach, because of the linkage between environmental, social and economic factors and their collective impact upon health and well-being; sustainability, in recognition of the need to create and maintain future conditions which will secure health and well-being; civic participation, because of the requirement that environmental health policy recognize the role of public concerns and the need to maintain openness and transparency in decision-making processes; recognition of the forces of globalization, and the fact that environmental health problems do not respect man-made borders. Factors bearing upon environmental health policy The above principles adopted by the CIEH are of special interest because they refer to many considerations which are on the minds of present-day environmental health policy makers. Activity 1.3 Read through the CIEH principles carefully and make a note of those words and phrases which you think might be important to policy makers.

5 Introduction to environmental health policy 11 Feedback You might have noted the following features of the principles. Do not be concerned if you did not identify all or even many of them, as you now are only at the point where the stage is being set. Nonetheless, it will help you, as you progress, to be able to link sections of this book to sets of principles such as these. What might at first seem like disparate topics will more easily be seen to belong to a whole. The first principle refers to both health and welfare, a theme also picked up by the World Health Organization (WHO) in its writings. The implication is that the interest is not only in the absence of disease, illness and injury, but also wider issues of social welfare and fulfilment. More subtly, the first principle also uses the word appropriate when talking about environmental change and intervention. The matter of what is an appropriate change or intervention is of deep significance to policy makers, as you will discover as you progress through this book. The second principle raises the issue of equity. Equity considerations are now higher on the agenda of policy makers than previously. As you read on, you will understand how this situation arose and the arguments around it. Likewise, the third principle raises an entirely different principle of precaution. It is probable that you have heard of the precautionary principle, and this alludes to it. Policy makers need to understand what this principle is, and when and how to apply it. The fourth principle introduces the idea of an holistic approach, one which is said to recognize the link between environmental, social and economic factors in affecting health. This, as you will discover, marks another important shift which has occurred in thinking in environmental health policy making, and has resulted in the development of many new tools to aid policy makers. The fifth principle brings in yet another concept of great influence in modern policy making, that of sustainability. The sixth principle ventures onto more new ground, that of civic participation in environmental health policy and the need to recognize public concerns and be accountable and transparent. This is why environmental health policy makers need to be familiar with the psychology of risk perception, and methods of risk communication and deliberation. The final principle points out that environmental health issues are not confined to the local, but have regional and even global dimensions. By the time you have finished this book, you will have studied every one of these items and have much to say about them. Their commonality, through sets of principles like these, is worth keeping in mind. Policy tools The above principles of the CIEH contain all the essential elements with which present-day policy makers are likely to be concerned. Other agencies will use different words, but the essence will be basically the same. To help policy makers address these elements, many tools have been devised. You may already be aware, or if not, will soon observe, that great emphasis is seen to have been placed upon the use of risk assessment in particular, in documents published by agencies such as the World Health Organization and the United Nations (UN). For example,

6 12 Introduction Agenda 21, which was designed by the UN as a comprehensive plan of global action aimed at integrating environmental and development issues, including health, into decision making (see Chapter 19), makes extensive reference to the use of risk assessment in determining action plans. Risk-based thinking, of which risk assessment is a part, has, in fact, become an almost standard approach to decision making and can be found in all countries of the world, particularly in national and regional agencies, but is gradually spreading downwards to the local level. Because of its importance, this book continues with a detailed description of the techniques associated with this approach, before moving on to examine other techniques including environmental impact assessment, health impact assessment, and social impact assessment, which have been devised, sometimes in response to perceived weaknesses in risk-based approaches, and at other times to complement them. As a further indication of what lies ahead, Table 1.2 sets out a fairly typical view of the necessary components of an environmental management framework. Although based on a manufacturing company s view of its responsibilities, general environmental emphases are present. As you can see, under the human and environmental safety element, the key tools identified are human health risk assessment, which is the main concern here, and ecological risk assessment. However, other entries are pertinent to our interest, including the efficient use of resources, and hence economic analysis, and addressing what are described as societal concerns. This brings in tools related to understanding and responding, Table 1.2 An overall framework for environmental management of a manufacturing facility Goal Elements Key tools Environmentally and economically sustainable environmental management Human and environmental safety Regulatory compliance Efficient use of resources and waste management Addressing societal concerns Source: Adapted from White et al. (1995) Human health risk assessment Ecological risk assessment Site auditing Waste reporting Material consumption reporting New chemicals testing Product classification and labelling Waste and energy monitoring Material use monitoring Environmental auditing of site Supplier auditing Product life cycle analysis Economic analysis Understanding: opinion surveys consumer research dialogue Responding through: public presentations and publications working groups reporting cooperation with society to find solutions to environmental problems

7 Introduction to environmental health policy 13 all of which ties in with the guiding principles of the CIEH and other agencies working in the field of environmental health policy. Summary In this introductory chapter you thought about the scope of your interests regarding environmental health and noted that others might legitimately define their interests in another way. You examined a typical set of principles of an agency whose interest is environmental health policy, and noted how these principles are concerned with a host of issues ranging from health (of course), to welfare, appropriateness of interventions, equity, precaution, holism, sustainability, participation and globalization. The promise has been made that all these will be covered in this book. Finally, you are aware of the existence of an array of tools which have been devised to help environmental health policy makers perform their duties, and which will be described in later chapters. References International Risk Governance Council (2005) Risk Governance: Towards an Integrative Approach. Geneva: IRGC. White PR, De Smet B, Owens JW and Hindel P (1995) Environmental management in an international consumer goods company. Resources, Conservation and Recycling 14(1): Wood C and Djeddour M (1992) Strategic environmental assessment: environmental assessment of policies, plans and programmes. The Impact Assessment Bulletin 10(1): World Health Organization Regional Office for Europe (1990) Environment and Health: The European Charter and Commentary. WHO Regional Publications, European Series No. 35. Copenhagen: WHO Regional Office.

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