Integration of DOHaD concepts in WHO global health efforts

Transcription

1 Integration of DOHaD concepts in WHO global health efforts Marie Noel Brune Drisse WHO Department of Public Health, Environmental and Social Determinants of Health 1

2 INTEGRATION OF DOHaD CONCEPTS: THE RATIONALE 2

3 SCIENCE IS SHOWING: EARLY ENVIRONMENTAL ORIGINS OF DISEASE Fetal conditions have been proven to impact the chances of developing future conditions, including heart disease, hypertension and type 2 diabetes, respiratory conditions, as well as mental illnesses. WE ARE BEGINNING TO UNDERSTAND THE IMPORTANT AND DIFFERING ROLES ENVIRONMENTAL HAZARDS PLAY THROUGHOUT THE LIFE COURSE 3

4 1.52 Billion Disability Adjusted Life Years 2 WHO has made the case that better use of existing preventive measures could reduce the global burden of disease by as much as 70%. 1 Global Burden of Disease today -70% Potential Impact of Better Prevention 1 The World Health Report 2008; 2 WHO Global Burden of Disease 2004 update Appendix A 4

5 In Environmental Health, Our Strategic Focus Is On Primary Prevention Supporting Health And Well-Being Across Our Journey Through Life Population by stages of disease continuum Healthy Population At Risk Established Disease Controlled Chronic Disease Primary Prevention Second. Prevention / Early Detection Disease Management & Tertiary Prevention Promotion of healthy behaviors, environments, and reduced social inequities across the life course Universal and targeted approaches Screening Case finding Periodic health examinations Early interventions Control risk factors lifestyle & medication Universal and targeted approaches Treatment and acute care Complications management Continuing care Maintenance Rehabilitation Self-management Public Health Primary Health Care All Sectors Primary Health Care Public Health Specialist Services Hospital Care Primary Heath Care Primary Health Care Community Care Prevent movement to the At Risk group Prevent progression to established disease and hospitalization Prevent/delay progression to complications and prevent readmissions 5

6 Our Approach To Primary Prevention Of Social And Environmental Health Hazards Is Built On 3 Pillars Catalyzing Healthy Policies & Interventions Monitoring & Knowledge Generation Normative Leadership & Technical Cooperation Shaping the global health agenda and supporting instruments Catalyzing key stakeholders policy focus on global health initiatives, objectives, action plans, and monitoring mechanisms Developing & promoting effective (and cost-effective) interventions & best practices Monitoring & evaluating health trends, & progress towards agreed targets, undertaking and promoting health impact assessments Development of monitoring indicators, procedures & methods Guiding research and ensuring rigorous review of fact bases Lead formulation and dissemination of technical norms & standards, methodologies, guidelines, tools and global strategies Backstop regional /country offices on technical issues and emergencies 6

7 EXAMPLES OF WHO INITIATIVES OF RELEVANCE TO DOHaD 7

8 Investing in Early Child Development WHO Meeting (2013) Nurturing human capital along the life course: Investing in early child development Roadmap for action on scale-up of effective interventions, identification of indicators and assessment tools, and stimulating research Nurture partnership, advocacy Within WHO: coordinated response and provide leadership in agenda setting (globally and at country level). 8

9 UN Interagency Task Force on the Prevention and Control of NCDs WHO s World Health Assembly agreed to endorse the termsof-reference in May 2014 to coordinate and implement the WHO Global NCD Action Plan Advocating and raising awareness on NCDs Disseminating knowledge and information on how to address NCDs Encouraging innovation and identifying barriers Advancing multisectoral action for NCDs Advocating for the mobilization of resources 9

10 Essential nutrition actions Improving maternal, newborn, infant and young child health and nutrition includes: Interventions targeted at women of reproductive age Interventions targeted at pregnant women (iron, folic acid, vitamin A, calcium, iodine) Interventions for young infants, especially low-birth-weight 10

11 Working On Prevention: Addressing Environmental Determinants OPPORTUNITIES International initiatives Information and tools available and under development Future plans 11

12 RESPONDING TO INTERNATIONAL CALLS FOR ACTION Calls for Action from WHO International Meetings Include: Asturias Declaration: A call to action addressing environmental and occupational determinants of cancer (March 2011, Asturias Lavilés and Gijón, Spain) The Busan Pledge for Action on Children s Health and the Environment pledging to translate research & knowledge into preventive policies and protective actions (June 2009, Busan, Korea) Budapest Ministerial Declaration from the 4 th Ministerial Conference on Health promoting the development of children s environment and health action plans for Europe (June 2004, Budapest, Hungary) 12

13 Mercury and Minamata Minamata convention on mercury: binding global convention under ratification and early implementation Health is directly addressed in the Minamata convention 67th World Health Assembly has adopted the Resolution on Public Health Impacts of Exposure to Mercury and Mercury Compounds: the Role of WHO and Ministries of Public Health in the Implementation of the Minamata Convention on Mercury Identification and protection of vulnerable populations, addressed in the convention, implies national programs to protect neurodevelopment, for which extensive biomonitoring and risk communication will be required 13

14 Early-life exposure to mercury Foetuses are most susceptible to developmental effects due to mercury (WHO, Mercury and Health, 2013) UNEP/WHO project Development of a Plan for Global Monitoring of Human Exposure to and Environmental Concentrations of Mercury ( ) Goals: to develop harmonized approach to assessment of human exposure to mercury - to strengthen the capacity for global monitoring of human exposure - to assist countries in making informed decision for the selection of mercury risk management measures Approach: cross sectional human biomonitoring (HBM) surveys in maternities to assess prenatal exposure Maternal hair samples to assess exposure to methylmercury during the last trimester of pregnancy Two other matrices (TBD) to assess recent exposures Pilot studies in at least five countries globally (sites to be selected) covering various exposure sources and pathways 14

15 Global Alliance to Eliminate Lead Paint Partnership of governments, IGOs, civil society and manufacturers Secretariat provided by WHO and UNEP Goal - to prevent children s exposure to lead via paints containing lead and to minimize occupational exposures to lead in paint Aim - elimination of lead paint - with particular attention to decorative paint, but ultimately all lead paint 15

16 Information For Action Available Tools Publications: lead, mercury, chemicals, POPs, CEH units, EDCs, vulnerability windows for chemicals Training modules and environmental histories Burden of disease estimates Network of WHO collaborating centres on children's environmental health Commitments: CEH Global Action Plan 16

17 Information For Action Current knowledge of the effects of endocrine disrupters on child health. Main focus on congenital disorders, cryptorchidism and hypospadias, which have an endocrine connection, on thyroid hormone-related problems, and on puberty. Accumulating data suggest that many adult diseases have fetal origins, but the causes have remained unexplained. Improving fetal and child health will influence the whole life of an individual. 17

18 Information For Action Global status of scientific knowledge on exposure to and effects of endocrine disrupting chemicals (EDCs). - Effects shown in wildlife or experimental animals may also occur in humans if they are exposed to EDCs at a vulnerable time and at concentrations leading to alterations of endocrine regulation. - Of special concern are effects on early development of both humans and wildlife, as these effects are often irreversible and may not become evident until later in life. 18

19 Identification of Risks of Endocrine-Disrupting Chemicals: Overview of Existing Practices and Steps Ahead WHO Meeting, Bonn, July, 2013 The meeting discussed early-life exposures to chemicals with endocrine-disrupting properties and recommendations included advice for assessment of exposures to EDCs in early-life taking into account knowledge gaps. 19

20 WHO Tiered set of early life age groups for assessing exposure to environmental contaminants (Reg Tox Pharmacol 2014) 20 20

21 Framework of modifying factors for exposure associated with geography and culture GEOGRAPHIC General Milieu CULTURAL Climate Toxin profile (i.e. vector control, agri, industry Disease profile (i.e. infectious) Nutritional status/access to food Immediate community Household Primary Caregiver Genetic profile Individual Child Food behaviours / culture Income Body products Household chemicals Manufactured toys & products Childcare arrangements/allowing crawling, mouthing Occupation/labour Primary Industries Access to medical services Housing quality Access to water & sanitation Physical activity (inside/outsid e/play areas/surface s Medicines, treatments & remedies Substance use/abuse Level of urbanisation 21 21

22 Cleaning up the air we breathe Gathering data & raising awareness Global database on outdoor air pollution in cities Global platform for outdoor air quality monitoring combining satellite imagery, chemical transport models & ground-level monitoring Working with other agencies & sectors Normative work & support to countries WHO Air quality guidelines Reviewing & synthesizing the evidence on the effectiveness on improving health from technological & policy interventions for both acute & chronic exposure -Review of evidence of health impacts of air pollution by EURO Connecting outdoor air pollution to sustainable development & climate UN Secretary General s Sustainable Energy for All initiative Health in the Green Economy 22

23 WHO Collaborating Centres CEH network 23

24 WHAT NEXT? 24

25 CONCRETE NEXT STEPS Respond to global challenges by identifying environmental determinants of health, avoidable exposures, and sustainable interventions for the healthy development of individuals Closed scoping meeting at PPTOX with collaborating centres Conduct initial review of existing guidance International consultation to discuss evidence, identify partners, research gaps, successful interventions, communication strategies: a roadmap for public health 25