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Air Quality Guidelines for Europe
WHO Regional Publications, European Series, No. 91
2000, x + 273 pages [E]
ISBN 92 890 1358 3
Sw.fr. 92./US $82.80
In developing countries: Sw.fr. 64.40
Order no. 1310091
Provides air quality guidelines for 35 substances known to contribute to the problem of air pollution in Europe. First issued in 1987, the book has been considerably updated and expanded in line with new research findings and advances in the methodology of risk assessment. Guideline values, which were revised in a series of expert consultations, are intended to serve as a basis for the establishment of national standards and other control measures needed to safeguard public health.
The book has three parts. The first outlines the methodological problems involved in assessing the health risks posed by air constituents and contaminants, whether in indoor or outdoor air. Readers are also given a summary of the criteria used in establishing guideline values for both carcinogenic and noncarcinogenic substances and for estimating ecological effects. Part one concludes with advice on use of the guidelines to protect public health.The second and most extensive part presents guideline values for sixteen organic pollutants, twelve inorganic pollutants, four classical pollutants, and three indoor air pollutants, namely tobacco smoke, man-made vitreous fibres, and radon. Each guideline value is supported by a summary of available data on typical concentrations and levels of exposure, and the effects on human health. The final part considers the ecotoxic effects of selected inorganic substances, and includes an explanation of the complex type of air pollution that can damage crops, tree species, and other vegetation.
Acute Effects on Health of Smog Episodes
WHO Regional Publications, European Series, No. 43
1992, 74 pages [E, with summaries in F, G, R]
ISBN 92 890 1306 0
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1310043
Reports the findings of a group of experts commissioned to evaluate the acute short-term effects on health caused by exposure to air pollutants during episodes of smog. Winter- and summer-type smog exposures are considered separately. The report responds to both the public demand to be protected and the corresponding need of health authorities to know when concentrations of specific indicator pollutants reach dangerous levels, what will be the effects on health, and which preventive measures should be taken. Of central concern was the question of whether protective measures currently used by European countries are effective.
In its most important achievement, the report grades health effects observed at different concentrations of sulfur dioxide, particulate matter, and ozone according to degree of severity, and then outlines appropriate protective measures in line with the significance of health effects. For ozone concentrations, the report also defines the percent of the population likely to be affected at different concentrations.
Concerning measures to protect the general public, the report concludes that short-term measures, such as traffic bans and temporary reductions in industrial emissions, are ineffective. Because traffic bans lead to extreme overloading of the public transport system, outdoor exposure to pollutants is likely to increase as people wait for buses or trains, walk to stations and bus stops, or walk or bicycle to work. The report further concludes that long-term measures to reduce baseline levels of pollution represent the most sensible and effective preventive measure.
Assessing the Health Consequences of Major Chemical Incidents: Epidemiological Approaches
WHO Regional Publications, European Series, No. 79
1997, xiv + 90 pages [E]
ISBN 92 890 1343 5
Sw.fr. 22.-/US $19.80; in developing countries: Sw.fr. 15.40
Order no. 1310079
Explains how epidemiological tools can be used to guide the emergency management of chemical accidents and support actions to minimize adverse effects on health. Addressed to public health officials as well as epidemiologists, the book offers extensive practical advice on the choice of epidemiological methods, the design of studies, and the use of findings to support decisions during the acute phase, long-term follow-up, and the preparation of services to manage future incidents. Throughout, recommended uses of epidemiology draw on experiences gained during the investigation of several major chemical accidents in Europe.
The book opens with an introduction to the nature of chemical accidents, routes of exposure, types of effects on health, and factors that can modify these effects. Against this background, guidelines are presented in three parts. The first explains the contributions of epidemiology to the immediate and longer-term management of a major chemical incident. Information includes the types of data needed according to the nature and phase of the emergency, sources of relevant data, and the ethical issues raised by studies. The second and most extensive part gives epidemiologists a comprehensive guide to the range of tools and approaches that may be needed when investigating an accident. Details range from advice on when rapid appraisals are appropriate, through a description of the advantages and disadvantages of using biomarkers of exposure, to a table listing diagnostic tests appropriate for measuring effects on specific organs and systems. The final part discusses the contribution of epidemiology as part of a multidisciplinary response to chemical emergencies.
Further practical information is provided in an annex, which summarizes methods used and lessons learned during the investigation of the chemical fire in Schweizerhalle, Switzerland, the escape of toxic chemicals in Seveso, Italy, the Shetland oil spill in the United Kingdom, and the toxic oil syndrome in Spain.
Assessment of Exposure to Indoor Air Pollutants
edited by M. Jantunen, J.J.K. Jaakkola, and M.
WHO Regional Publications, European Series, No. 78
1997, xi + 139 pages [E]
ISBN 92 890 1342 7
Sw.fr. 32.-/US $28.80; in developing countries: Sw.fr. 22.40
Order no. 1310078
A practical guide to both general principles and specific methods used to assess exposure to indoor air pollutants. Addressed to public health professionals who lack specialized training in this field, the book aims to facilitate well-designed assessments in order to identify health hazards and support strategies for risk management. Information is specific to the assessment of air pollution exposure in such indoor environments as homes, offices, and various public service buildings.
The book has two part. The first, which serves as a general introduction, opens with an explanation of concepts used in exposure assessment and important to the design and interpretation of findings. Against this background, subsequent chapters describe specific direct and indirect methods of exposure assessment, and use the example of volatile organic compounds to show how exposure to mixtures can be measured. Other chapters discuss the influence of temperature and humidity on the indoor environment, provide guidelines for the design of exposure assessment surveys, and discuss the components of quality control.
The second and most extensive part describes currently available methods for assessing six gaseous air pollutants, four categories of particulate air pollutants, and three biological contaminants commonly found in indoor environments and representing distinct methodological problems. Each pollutant is covered according to a common format which includes information on health effects, sources, variation of exposure, and the advantages and disadvantages of methods for assessing exposure. Further practical guidance is provided in an annex, which includes short summaries of exposure assessment studies completed or under way in the USA and several European countries.
Biodiversity, Biotechnology, and Sustainable Development in Health and Agriculture: Emerging Connections
PAHO Scientific Publication, No. 560
1996, xvii + 229 pages + 1 diskette [E, S from PAHO]
ISBN 92 75 11560 5
Sw.fr. 90.-/US $81.00; in developing countries: Sw.fr. 63.-
Order no. 1610560
A multi-authored exploration of the extent to which the rich biodiversity of flora and fauna in Latin America and the Caribbean might be exploited to the economic benefit of these countries and the ultimate improvement of health. Featuring the views of economists, sociologists, lawyers, and scientists, the book aims to paint a realistic picture of what the economic returns might be while also considering the many complex issues pertaining to intellectual property rights, source country compensation, technology transfer, and resource conservation. Two main health-related uses of biodiversity are considered: the development of novel pharmaceutical products and the improvement of nutrition through agricultural advances. Noting that most developing countries lack the technical expertise to exploit their natural biological resources, the authors give particular attention to examples of collaboration between host countries and science and industry in the industrialized world.
The book has fifteen papers presented in six parts. The first, on bioprospecting models, evaluates several benefit-sharing agreements for the commercial exploitation of biodiversity. Particular attention is given to novel contractual mechanisms that can help ensure an equitable financial return to the host country. Papers in part two assess the potential contribution of biodiversity and biotechnology to the discovery of new drugs, particularly in view of the high financial risks and time-frame involved, and the development of new plant varieties and animal breeds. Political issues and policy options are explored in part three, which includes a framework for understanding the biotechnological connection between tropical genetic resources as raw materials and the pharmaceutical industries as profit makers.
Papers in part four outline economic models that can be used to compare the advantages and disadvantages, for both the prospecting industry and the host country, of alternative contractual arrangements governing the use of biological resources in pharmaceutical development and agriculture. Part five discusses intellectual property rights and contracts and considers how existing legal measures for the protection of flora and fauna may constrain the exploration, screening, and exportation of biological resources. The final part sets out the main conclusions reached, emphasizing the policy options and economic prospects.
Children in the New Millennium
Environmental Impact on Health
2002, vi + 142 pages [English]
ISBN 92 4 159016 5
Swiss francs 15.—/US $13.50
In developing countries:
In the context of examining progress made since the 1990 World Summit for Children and the 1992 United Nations Conference on Environment and Development, this book provides an overview of key environmental risks to children’s health and the underlying causes.
Highlighted are children’s special vulnerability and susceptibility to environmental threats at each developmental stage, during pregnancy, infancy and early childhood, through to school age and adolescence. Specific environmental threats of major importance to children are described, including lack of safe water and sanitation, chemical pollution and radiation, indoor and outdoor air pollution and natural resource degradation.
The book also addresses the impacts of global environmental problems on children and future generations, including climate change, desertification, deforestation and the loss of biodiversity.
A series of recommendations are
proposed for action at the local, national, regional and international levels to
improve children’s environmental health.
Climate Change and
An Assessment Prepared by a Task Group on Behalf of the World Health Organization, the World Meteorological Organization and the United Nations Environment Programme
edited by A.J. McMichael, A. Haines, R. Slooff and S. Kovats
1996, xvi + 305 pages [E]
Sw.fr. 30.-/US $27.00; in developing countries: Sw.fr. 21.-
Order no. 1930091
An expert scientific assessment of the impact that climate change might have on the health of the world's population. Addressed to policy-makers as well as researchers, the report adopts a cautious approach, using the best scientific studies to provide reasonable predictions and realistic recommendations for action. Throughout the report, the complexities of climate change, the limitations of current research methodologies, and the consequent uncertainty of future predictions are repeatedly emphasized.
Three years in the making, the book reflects the consensus reached by an international group of eleven experts in areas ranging from computerized simulations of climate to the behaviour of disease vectors in different ecological systems. A further 45 experts contributed to the report or reviewed relevant sections. Close to 700 references to the literature are included in this thoroughly researched and carefully argued report.
The report, which has ten chapters, first summarizes the state of knowledge and the prevailing expert views about anthropogenically-induced climate change and then takes these as the basis for assessing potential health consequences. The health consequences of three major components of climate change are examined in detail: changes in temperature and precipitation, changes in the frequency of heatwaves and other extreme weather events, and a rise in sea level. The potential human health consequences of increased ultraviolet radiation resulting from stratospheric ozone depletion - although not a component of climate change - are also discussed.
To assist researchers in this controversial field, additional chapters discuss the challenge that investigations of climate change pose to orthodox science, and trace progress, over the past five years, in the science of climate modelling and predictions of the consequences for human health. The report concludes with a discussion of the many immediate and long-term strategies that policy-makers can select, supported by a clear call for action: if adverse health consequences are likely to result from climate change, we cannot wait until definitive empirical evidence becomes available; such a "wait-and-see" approach would be imprudent at best and nonsensical at worst.
"... one of the most thorough examinations of
the issue to date..."
The New York Times
"... a major report ... Climate change may
already be spreading disease and pestilence..."
"...an excellent analysis ... clearly laid out,
easy to read and well presented..."
Climate Change and Stratospheric Ozone Depletion
Early Effects on Our Health in Europe
edited by S. Kovats, B. Menne, A. McMichael,
R. Bertollini and C. Soskolne
WHO Regional Publications, European Series, No. 88
2000, xii + 116 pages [E]
ISBN 92 890 1355 9
Sw.fr. 35./US $31.50
In developing countries: Sw.fr. 24.50
Order no. 1310088
A balanced assessment, based on currently available scientific knowledge, of the effects that climate change may have on the environment in Europe and the health of its populations. Written in non-technical language, the book responds to growing public and political concern about the consequences of such widely publicized phenomena as global warming and stratospheric ozone depletion. The book also responds to evidence that recent warming trends in Europe have already affected health.
The book opens with a brief explanation of the causes of climate change and stratospheric ozone depletion, followed by an overview of recent European and global initiatives aimed at monitoring trends and assessing their impact on health. The first main chapter, on climate change in Europe, summarizes currently documented trends and provides a scenario of possible changes throughout the rest of this century. The second and most extensive chapter reviews scientific evidence on specific health consequences. These include effects related to increased episodes of thermal stress and air pollution; changes in foodborne, water-related, vector-borne, and rodent-borne diseases; mortality from floods and other weather extremes; and changes in the production of aeroallergens associated with respiratory disorders, including asthma.
Chapter three considers health effects linked to stratospheric ozone depletion, giving particular attention to adverse effects on the eye and immune system, and skin cancer. The remaining chapters discuss health effects expected in the next decade, and outline actions urgently needed in the areas of policy, monitoring and surveillance, and research.
Services in Europe 6
The Development of Professional Associations
By Martin Fitzpatrick
WHO Regional Office for Europe, Copenhagen
WHO Regional Publications, European Series, No. 94
2002, ix + 88 pages
ISBN 92 890 1361 3
Swiss francs 30.–/US $27.–
In developing countries:
In the European Region, there is a diverse range of professionals engaged in promoting environmental health issues for the benefit of the public’s health. They work in state authorities, local government, nongovernmental organizations and the private sector. All have a common purpose and very often have common or complementary knowledge and skills.
In some European countries, environmental health professionals have organized themselves into associations, but in the majority such associations are not well established and have not realized their full potential in civil society. Given the increasing awareness of the general population and the emergence of specialized groups, there is a need for new means of communication that will ensure a constructive dialogue among professionals, decision-makers at political level, the economic sector and the general public. In this rapidly changing world, environmental health professionals must constantly adapt their practices, knowledge and skills. In this respect all partners at national and international level acknowledge the importance of professional associations.
This publication strives to bring together the collective experience of a range of existing associations of environmental health, while also providing the basic information that will be of particular value to an emerging association or to groups of professionals aspiring to develop such associations. The book attempts to provide a means by which groups of environmental health professionals can formulate their own template for developing associations that clearly represent their particular interests and ethos, within a framework whereby they can find common purpose with other professionals at national and international level.
The European Charter and Commentary
WHO Regional Publications, European Series, No. 35
1990, x + 154 pages [E, F, G, R*]
ISBN 92 890 1126 2
Sw.fr. 26.-/US $23.40; in developing countries: Sw.fr. 18.20
Order no. 1310035
Presents and explains a charter on environment and health formally adopted by the governments of 29 European countries and by the Commission of the European Communities. Adoption of the charter signals a united position, taken by the governments of Europe, on the basic principles, mechanisms, and priorities for further national and international action to protect the environment. Focused on the specific problems faced in Europe, the charter regards environmental health as including not only pollution control and environmental hygiene but all aspects of the physical environment and of socioeconomic development.
The charter is subdivided into sections dealing with entitlements and responsibilities, principles for public policy, strategic elements, priorities, and actions for the immediate future. Each of these sections is then thoroughly elaborated through an accompanying commentary. The commentary on strategies acknowledges the international nature of many environmental problems, including the pollution of air or water across national borders, and the international movement of food, consumer products, wastes, and potentially hazardous chemicals. Problems identified as requiring urgent attention range from depletion of the ozone layer to the noise pollution created by motorcycles with low engine capacity, from the agricultural practice of using untreated sewage sludge on leaf vegetables to the low aesthetic quality and rapid decay of many recently constructed buildings in European cities.
The charter is regarded as representing a major step forward in the development of both public health and environmental policies at a time when political change is greatly enhancing cooperation among European countries.
Environment and Health 1
Overview and Main European Issues
R. Bertollini, C. Dora, M. Krzyzanowski, and D.
WHO Regional Publications, European Series, No. 68
1996, 56 pages [E]
ISBN 92 890 1332 X
Sw.fr. 19.-/US $17.10; in developing countries: Sw.fr. 13.30
Order no. 1310068
Summarizes the impact that specific environmental problems have on the health of Europe's population. Addressed to the general public, the report aims to enhance awareness of the magnitude of ill health linked to the environment, establish priorities, and map out lines for immediate action. Assessments and recommendations draw on the vast body of data collected by the European Environment Agency and the WHO European Centre for Environment and Health.
The report has two parts. The first discusses ten major health problems and explains how these are linked to the environment. Problems identified range from cancer, through respiratory and communicable diseases, to injury, poisoning, birth defects, and impaired mental development in children. Against this background, the second part identifies three priority areas where coordinated action can have a major impact on both the environment and human health: pollution of air with suspended particulate matter, microbiological contamination of drinking water, and road traffic accidents. These were selected because of their relatively well established cause-effect relationship and their susceptibility to known remedial actions. Each is discussed in detail, covering the nature of the problem, its causes, the consequences for health, precise goals for action, and strategies for reaching these goals. Supporting data cited include the link between specific air concentrations of suspended particulate matter and effects on health, the magnitude of illness caused by water-borne transmission of cholera, typhoid, and hepatitis A, and the estimates that road traffic accidents result each day in the injury of over 6000 Europeans and the deaths of close to 350.
Environmental Health: An Islamic Perspective
The Right Path to Health: Health Education through Religion, No. 7
Nonserial publication of the WHO Regional Office for the Eastern Mediterranean
1997, 32 pages [E]
ISBN 92 9021 228 4
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1467014
Discusses the ways in which Islamic teachings and the views of Muslim physicians and scholars can be used to identify specific actions to protect the environment and thus promote human health. Teachings underscoring the links between health and the environment are also reviewed and interpreted.
The opening section stresses the need to maintain a balance between the environment's capacity to support life and human behaviours that create demands on the environment. Particular attention is given to the concept of environmental harmony and the need to preserve the environment's dynamic equilibrium. Section two looks at teachings that underscore the relationship between the physical environment and the maintenance of good health.
Against this background, the next section concentrates on specific abuses of the environment and their significance within the context of Islamic teachings. Problems cited include the excessive use of natural resources, industrial pollution of air and water, overcrowding, misuse of agricultural chemicals, and the production of hazardous wastes. The health effects of increasingly polluted air are described in detail. The final section cites religious teachings that offer guidance in ways to protect the environment and conserve natural resources.
Environmental Health in Urban Development
Report of a WHO Expert Committee
Technical Report Series, No. 807
1991, 65 pages [E, F, S]
ISBN 92 4 120807 4
Sw.fr. 11.-/US $9.90; in developing countries: Sw.fr. 7.70
Order no. 1100807
Assesses what can be done to alleviate the many severe health problems associated with urban environments, where the living conditions of hundred of millions of people adversely affect their health, cause misery, and have potentially catastrophic social consequences. Recommendations and advice respond to the urgent need for an integrated approach to urban development that takes into account all the environmental factors that affect human health and well-being. Particular emphasis is placed on informal settlements, slums, and shanty-towns, where the most serious health problems are found.
The opening sections review problems and needs in urban environments, including information on the origins of the current urban crisis, projected future trends, and factors in the process of urbanization that have a negative impact on health. Conditions that hamper the proper management of urban development are also discussed. Problems identified include the conflict between the promotion of industrial development and the protection of the environment, the failure of environmental management technologies to keep pace with the growth of environmental problems, and the fact that urban systems for water-supply and the disposal of solid wastes are customarily under the control of agencies outside the health sector. The remaining sections outline strategies for improving urban environmental health through the strengthening of managerial policies and technologies and the encouragement of greater community action in self-improvement projects.
Environmental Health Services in Europe 1: An Overview of Practice in the 1990s
I. MacArthur and X. Bonnefoy
WHO Regional Publications, European Series, No. 76
1997, xii + 177 pages [E]
ISBN 92 890 1340 0
Sw.fr. 30.-/US $27.00; in developing countries: Sw.fr. 21.-
Order no. 1310076
Provides an overview of the functions, organization, and management of environmental health services in European countries. Intended to assist in the improvement or reform of existing services, the report draws on information collected from 27 countries to illustrate both the diversity of strategies being used to promote environmental health and the strengths and weaknesses of specific approaches. Throughout, particular attention is given to the major environmental problems faced by countries in central and eastern Europe.
The volume is the first in a new series of technical publications dealing with strategies for improving environmental health services in Europe. The book has seven chapters. The first, which considers why countries need environmental health services, looks at current concepts of environmental health and traces the history of concern, from the early 19th century to the present, about the links between environmental factors and public health. The chapter also outlines the objectives of environmental health services, describes the political factors that shape these objectives, and uses the example of poor housing to show how environmental conditions contribute to social problems. Chapter two considers the different ways that European countries set out strategies for dealing with environmental health concerns. Country examples are used to illustrate the procedures followed when formulating policies and setting priorities.
Other chapters discuss different options for implementing strategies and describe the various functions of environmental health services, including measures used to enforce controls. A chapter on capacity building looks at what countries do to secure sufficient financing, an adequate legal framework, suitably skilled personnel, and reliable information. The volume concludes with chapters on the evaluation of services and possible models for comparing services.
Provides an overview of policies and instruments that can be used by European governments to strengthen or reform environmental health services. Addressed to national planners, the book issues abundant guidance and advice based on an expert review of environmental problems and policy options in 27 European countries. Particular attention is given to the serious environmental health problems inherited by new governments in central and eastern Europe and in countries of the former Soviet Union.
By exploring a wide range of policy options, the book aims to assist efforts to develop realistic and enforceable policies that take into account the importance of government structure, market forces, public-sector financing, legislation, and lobbying. Information ranges from a tabular comparison of the advantages and disadvantages of different environmental policies, through a discussion of legal measures for ensuring that environmental health inspectors have adequate power, to examples of how taxes, fines, and penalties can be used for funding.
The book has six chapters. The first addresses a number of essential principles of environmental management and outlines the objectives of environmental health services. Strategies are discussed in chapter two, which offers advice on policy formulation, situation assessment, priority setting, planning, public participation, and management. Chapter three, on institutional development, provides guidance on the location of environmental health services at the most appropriate level of government. Functions of environmental health services are considered in chapter four, which examines the services that should be provided and discusses their objectives. Particularly detailed information is provided on options for legal remedies, for licenses and pre-development controls, and for economic sanctions and penalties. Chapter five explains how environmental health services function as part of the economy, giving examples of the taxation and penalty systems used in Europe, and the different mixtures of national and local sources of funding. The final chapter considers how best to evaluate the effectiveness of environmental health services.
M. Fitzpatrick and X. Bonnefoy
Environmental Health Services in Europe 3: Professional Profiles
Provides a framework for understanding the staffing implications of current efforts to reform environmental health services in Europe. Addressed to national planners, the report gives particular attention to several changes in the discipline and practice of environmental health, and corresponding changes in staffing needs, that have followed recent international conferences, protocols, and agreements.
The book has four chapters. The first, which focuses on the mission of environmental health services, considers the numerous core areas of responsibility now covered by the concept of environmental health. These range from accident and injury prevention, through air quality, food safety, and pollution control, to occupational health, land-use planning, noise control, and tourism and recreational activities. Within each of these broad areas, specific functions and activities are identified and discussed in detail. Against this background, chapter two introduces the concept of competence and describes the competencies necessary for environmental health professionals. Chapter three deals with those elements of institutional development needed to support professional practice, and discusses the evolving role of the private sector in environmental health services. The final chapter undertakes the complex task of identifying the specific groups of professionals involved in environmental health. Some 73 professions are identified. In view of the interdisciplinary nature of environmental health, the chapter gives particular attention to ways of developing collaboration and teamwork among members of this large body of professionals.
Environmental Health Services in Europe 4: Guidance on the Development of Educational and Training Curricula
M. Fitzpatrick and X. Bonnefoy
WHO Regional Publications, European Series, No. 84
1999, viii + 198 pages [E]
ISBN 92 890 1350 8
Sw.fr. 45./US $40.50; in developing countries: Sw.fr. 31.50
Order no. 1310084
A practical guide to the development of curricula for the education and training of environmental health professionals. Prepared in consultation with educational institutes in a number of countries, the guide responds to both growing concern about environmental hazards and the need to ensure that professionals are adequately equipped with knowledge and skills. By recommending detailed model curricula for a range of professional categories, the book also aims to encourage the harmonization of international efforts to increase competence in the protection of public health from environmental threats.
The book opens with an overview of the development of environmental health services within European countries, followed by a discussion of the main challenges faced in current efforts to prevent and control environmental hazards. Against this background, the first main chapter introduces a framework for discussing training needs and defining learning objectives. Sixteen core areas of environmental health are identified, ranging from the monitoring of air, food, and water quality, through control of the safety of agrochemicals, to auditing the safety of nuclear power plants and other energy sources.
These activities are then discussed according to six core functions of environmental health services, moving from risk assessment, management, and communication to education, training, and research. Common activities that support each function are discussed together with the corresponding requirements for knowledge and skills. On the basis of this analysis, the chapter defines relevant learning objectives for training to perform each of the core functions.
Subsequent chapters consider the advantages and disadvantages of different methodologies for teaching environmental health, and suggest a range of guidelines that can be used to evaluate an educational programme. The first half of the book concludes with a series of concrete proposals for curricula judged suitable for training different categories of professionals.
The second half of the book sets out highly detailed model curricula, including learning objectives, recommended hours of instruction, and suggested content for modules, for four categories of environmental health specialists and two categories of managers.
Environmental Health Services in Europe 5
Guidelines for Evaluation of Environmental Health Services
C.H. Drew, J. van Duivenboden and X. Bonnefoy
WHO Regional Publications, European Series, No. 90
2000, viii + 185 pages [E]
ISBN 92 890 1357 5
Sw.fr. 45./US $40.50
In developing countries: Sw.fr. 31.50
Order no. 1310090
A practical guide to concepts, methods, and instruments for conducting an evaluation of environmental health services. Noting that managers frequently overlook the importance of evaluation, the book also performs a persuasive function, serving to illustrate the advantages of evaluation for purposes ranging from the justification of continuing expenditure to assurance that public health is being adequately protected from hazards in food, air, or water. Throughout the book, examples of evaluations conducted in European countries are used to show how different approaches work to resolve specific practical problems.
The book has six chapters. The first provides a general introduction to the purpose, principles and components of evaluation, as well as procedures that are frequently used. Chapter two applies these general principles to the specific setting of environmental health services, where process, impact, relevance, and adequacy of services may need to be assessed. Factors that make such services difficult to evaluate through traditional mechanisms are also briefly discussed.
Against this background, a chapter on data and indicators provides detailed advice on the choice of indicators, concentrating on the use of process, environmental, health, and urban indicators. Chapter four, on instruments for evaluation, outlines the strengths and weaknesses of several methods of data collection, giving particular attention to tools for economic analysis and qualitative evaluation. The remaining chapters cover the use of results in management decisions, and set out five case studies of evaluations recently conducted in Europe.
Health and Environment in Sustainable Development
Five Years after the Earth Summit
1997, xvi + 242 pages [E]
Sw.fr. 25.-/US $22.50; in developing countries: Sw.fr. 17.50
Order no. 1930108
An expert assessment of what is known about the current state of environmental degradation, its root causes, and the specific consequences for human health. Prepared as WHO's contribution to the five-year follow-up to the Earth Summit, held in Rio de Janeiro in 1992, the report makes a special effort to identify the full range of environmental hazards and then quantify their significance as causes of human morbidity and mortality. The report also documents the progress made in counteracting these hazards, at both national and international levels, since the Earth Summit, and examines opportunities for action to protect health and the environment and avert further damage. Over 500 references to the recent literature are included.
The report has seven chapters. The first introduces a basic conceptual framework for understanding the complex ways in which different environmental hazards and types of exposure cause adverse effects on health. Chapter two considers a number of driving forces, closely linked to socioeconomic development, that exert pressure on the environment, contribute to its degradation, and create severe public health problems. These include population growth, urbanization, inequitable resource distribution, consumption patterns, and advances in technology. Major human activities affecting environment quality are covered in chapter three, which considers trends in the production and disposal of household wastes, the consumption of fresh water, patterns of land use and agricultural development, industrialization, and the production and use of energy.
The fourth and most extensive chapter provides a detailed assessment of the links between poor quality of indoor and outdoor air, water, food and soil, human exposures, and specific risks to health, whether occurring in individual homes and workplaces or in the global environment. Against this background, chapter five looks at ten major disease groups linked to the environment and evaluates their significance when viewed against the total global burden of disease. Using the Disability Adjusted Life Years (DALY) approach, the report concludes that environmental factors are associated with almost a quarter of the total global burden of disease. Opportunities to reduce this burden through environmental interventions are also critically assessed. The remaining chapters evaluate progress made in environmental health protection since the Earth Summit and offer guidelines for further actions at international, national, and local levels.
Health Consequences of the Chernobyl Accident
Results of the IPHECA Pilot Projects and Related National Programmes
1995, vi + 38 pages [E, F]
ISBN 92 4 156181 5
Sw.fr. 11.-/US $9.90; in developing countries: Sw.fr. 7.70
Order no. 1150440
Summarizes the results of international investigations aimed at determining the health consequences of the Chernobyl nuclear accident. The accident, which occurred in late April 1986, resulted in the exposure of over five million people to ionizing radiation caused by fallout of radioactive nuclides. Though the immediate emergency actions taken are described, the report concentrates on findings from the large International Programme on the Health Effects of the Chernobyl Accident (IPHECA).
For thyroid diseases, the report concludes that a sharp increase in the incidence of childhood thyroid cancer has been one of the major health consequences of the accident. In addition, more than 95% of the thyroid cancers reported in children in the affected areas were highly invasive. For leukaemia and related blood diseases, the results obtained so far show no changes in morbidity which could be linked to the effects of radiation; long-term studies are needed. The investigation of brain damage in utero found some evidence to suggest retarded mental development and deviations in behavioural and emotional reactions in a small group of exposed children.
Vehicle pollution, mortality, comparison with deaths from car accidents
This WHO report, Health Costs Due to Road Traffic-related Air Pollution, was prepared for the Third Minsterial Conference on Environment and Health, London, starting 16 June 1999.
|Click here to view a summary of the main conclusions presented in this report.|
|Click here to view the online edition of this report|
Health, Solar UV Radiation and Environmental Change
A. Kricker, B.K. Armstrong, M.E. Jones, and R.C.
IARC Technical Report, No. 13
1993, 212 pages [E]
ISBN 92 832 1427 7
Sw.fr. 30.-/US $27.00; in developing countries: Sw.fr. 21.-
Order no. 1770013
Explores the many methodological and conceptual issues that need to be resolved before researchers can establish reliable predictions of the health consequences of stratospheric ozone depletion. The book responds to major deficiencies in the data needed to estimate the size of health effects likely to arise from an almost certain increase in ultraviolet (UV) irradiance at the earth's surface, caused by environmental change. Specific research proposals are intended to guide the design of a large geographical correlation study to be conducted as part of The International Research Programme on Health, Solar UV Radiation and Environmental Change (INTERSUN).
The book has thirteen chapters, each focused on methodological issues and their relevance to the design of the proposed international study. The first chapter evaluates methods for predicting changes in the incidence of skin cancer. Four subsequent chapters evaluate recent trends in the incidence of melanoma and non-melanocytic skin cancer, review evidence on the causes of these trends, and discuss the strengths and weaknesses of current approaches to the measurement of incidence. Chapter six considers the possible use, for monitoring purposes, of biological markers. Subsequent chapters review methods for measuring the effects of solar UV radiation on the immune system and on the eye. Other chapters assess trends in UV irradiance at the surface of the earth, and describe the range of currently available instruments for measuring UV radiation, concluding that spectral monitoring is the preferred method of measurement.
Indoor Air Quality: Biological Contaminants
Report on a WHO Meeting
WHO Regional Publications, European Series, No. 31
1990, 67 pages [E, with summaries in F, G, R]
ISBN 92 890 1122 X
Sw.fr. 9.-/US $8.10; in developing countries: Sw.fr. 6.30
Order no. 1310031
A state-of-the-art report on health hazards posed by the presence in indoor air of biological contaminants, including suspended viable particles, suspended allergens, animal dander, fragments of dust mites, and other biologically derived suspended material. Emphasis is placed on construction materials and building elements, such as cooling towers, humidifiers, ventilation systems, and design features leading to high indoor humidity, that can introduce or spread airborne biological contaminants.
The book has six main chapters. The first catalogues some 16 infectious diseases, allergic reactions, and other health risks linked to the presence of biological contaminants in indoor air. The second chapter, devoted to hazard assessment, offers advice on strategies available for the investigation of individuals or populations suffering from suspected indoor air-related infectious diseases, including Legionnaires' disease, allergic reactions, or toxic reactions following the inhalation of mycotoxins. Other chapters review methods for environmental sampling and analysis, discuss the main sources of microbiological contaminants in buildings, and identify factors in the indoor environment that can enhance the risk of contamination. The final and most extensive chapter discusses strategies for control, concluding that most biological aerosols in buildings are caused by persistent moisture and inadequate ventilation, and that proper building design and maintenance are needed to reduce acute infections and allergic episodes caused by contaminated indoor air.
Linkage Methods for Environment and Health Analysis
A Report of the Health and Environment Analysis for Decision-making (HEADLAMP) Project
edited by D. Briggs, C. Corvalán and M. Nurminen
1996, viii + 136 pages [E]
Sw.fr. 18.-/US $16.20; in developing countries: Sw.fr. 12.60
Order no. 1930089
A practical guide to the many existing tools and methods that can be used to monitor exposure to environmental pollutants and quantify their effects on human health. Noting that decisions concerning environmental protection have far-reaching and costly consequences, the book responds to the urgent need to base decisions on reliable data about real health hazards and the most appropriate measures for their correction or prevention. The book also aims to encourage closer collaboration between environmental epidemiologists and decision-makers, so that existing scientific knowledge and routine health data can be put to the best practical use. With these goals in mind, the book offers abundant advice on how to obtain information that is reliable, consistent, focused on issues of real concern, quickly available, and issued in an understandable and useful form.
The book has six chapters. Background information is provided in the first, which discusses the magnitude of health problems linked to environmental pollution and introduces the many methodological problems that can complicate the quantification of health impacts, compromise the validity of data, and undermine their utility in the decision-making process. The chapter also describes the HEADLAMP project and its three distinctive features: reliance on established relationships between environmental exposure and health effects, the use of routinely-collected data, and an overriding aim to support preventive action. The second and most extensive chapter explains how carefully selected environmental health indicators can provide vital support to the decision-making process. Specific methods of assessment are then discussed in separate chapters concerned with exposure assessment and the assessment of health effects. Advice on the use of routine exposure data covers sources of data and factors that can influence their quality.
The need to link exposure and health data forms the focus of chapter five, which offers particularly useful advice on the strengths and weaknesses of different approaches to linkage analysis, including the ecological method, time series analysis, quantitative risk assessment and geographical information systems. Though readers are alerted to the many methodological problems and pitfalls surrounding these methods, the authors also demonstrate the solid guidance possible when these tools, and the routine established data they rely on, are put to appropriate use. The concluding chapter elaborates a basic framework for decision-making based on valid, scientific data.
Linkage Methods for Environment and Health Analysis
edited by C. Corvalán, M. Nurminen and H.
1997, v + 153 pages [E]
Sw.fr. 18.-/US $16.20; in developing countries: Sw.fr. 12.60
Order no. 1931089
An expert guide to the many technical and statistical problems that arise when data on environmental exposures and health outcomes are used to make inferences about causality and the projected impact of public health interventions. Addressed to environmental epidemiologists and biostatisticians, the book is specifically concerned with the design of studies using routinely collected data and conducted to support decisions about environmental policy. Since data intended for such purposes must meet the highest standards of accuracy and credibility, the book makes a special effort to explain both the power of available epidemiological and statistical tools and their pitfalls when applied to assess the links between environment and health.
The book has five chapters. The first introduces the special characteristics of aggregate data and explains why these characteristics call for great care when selecting an appropriate analytical method. Chapter two focuses on the ecological method as a research tool for detecting patterns of disease occurrence across space and time and relating the rates of disease frequency to environmental, behavioural, and constitutional factors. While noting that this method is suitable for very large populations and involves relatively rapid and easy techniques, the chapter draws attention to several unique sources of bias in ecological data that must be considered when designing studies and interpreting their findings. Strategies for the minimization of bias are also described in detail.
The use of time series analysis in environmental epidemiology is covered in chapter three, which uses studies of air pollution to illustrate the application of regression modelling to the analysis of temporal data. Chapter four, on quantitative risk assessment, describes the many assumptions, subjective choices, and other uncertainties that need to be considered when using this approach to provide guidance for policy or action. In view of these uncertainties, readers are reminded that the provision of estimates of environmental risks must be accompanied by corresponding estimates of the associated uncertainty.
The final chapter focuses on geographical information systems (GIS) and explains how these research methods, developed by computer scientists, have revolutionized opportunities for the capture, manipulation, graphic presentation, and interpretation of georeferenced data. Noting that many questions facing the environmental epidemiologist are inherently geographical in nature, the chapter describes the specific uses of GIS as powerful research tools for the collection and integration of spatial data and equally powerful policy tools for directing attention to areas and problems of greatest need. A discussion of the expanding application of GIS is balanced by an alert to their particular analytical dangers and advice on ways to avoid errors and inconsistencies.
A guide to the principles and methods of air quality assessment aimed at measuring population exposure to ambient air pollutants and estimating the effects on health. Addressed to policy-makers as well as scientists engaged in air quality monitoring, the book responds to the failure of most monitoring systems to provide data that are useful in estimating and managing threats to health. The need for exposure data on populations at special risk is also addressed. Throughout, emphasis is placed on methods of monitoring and modelling that are cost-effective, targeted, and appropriate to local and national conditions.
The report has six chapters. The first introduces WHO activities related to air quality management and explains the need for monitoring systems capable of assessing health impact. The types of information required for health impact assessment are described in chapter two, which outlines several methods of monitoring and modelling that can be used to measure the level and distribution of exposure to air pollutants in populations, identify population groups with high exposure, and estimate adverse effects on health. Chapter three formulates a general concept of air quality assessment, offering advice on principles for designing a monitoring network, interpreting and reporting data, and solving problems with quality assurance. Also included is a comparison of the advantages, disadvantages, and costs of different methods for air quality monitoring.
Against this background, the fourth and most extensive chapter describes specific methods for the monitoring of carbon monoxide, ozone, sulfur dioxide, nitrogen dioxide, particulate matter, benzene, polycyclic aromatic hydrocarbons, lead, and atmospheric cadmium. Monitoring strategies for each pollutant are presented according to a standard format, which covers health effects, sources and exposure patterns, monitoring methods, recommended strategies for monitoring and assessment, and a practical example. The remaining chapters offer advice on the collation, analysis, interpretation, and dissemination of data, and summarize the main conclusions and recommendations of the report. Detailed technical guidelines for the use of various methods and models are provided in a series of annexes.
The report also reproduces the newly revised WHO air quality guidelines for Europe.
Nuclear Power and Health
The Implications for Health of Nuclear Power Production
WHO Regional Publications, European Series, No. 51
1994, xviii + 145 pages [E]
ISBN 92 890 1315 X
Sw.fr. 26.-/US $23.40; in developing countries: Sw.fr. 18.20
Order no. 1310051
Meets the need for an objective assessment of the risks to human health posed by the use of nuclear power to generate electrical energy. Health risks during normal operation of nuclear power stations and following accidents are considered. Addressed to decision-makers, the book issues recommendations based on recent advances in radiobiology, radiological protection, the health effects of radiation, and experiences following the Chernobyl accident.
The book has seven chapters. Background information is provided in the first, which describes the nuclear fuel cycle from uranium mines to decommissioning. Chapter two summarizes knowledge about the somatic and genetic effects of radiation in normal and accident situations, discusses dose-response relationships, and sets out general principles of radiation protection. The third chapter, on the health hazards of normal operation, explains the risks posed by the release of airborne and liquid radioactive waste, the reprocessing of uranium and plutonium, the transportation of radioactive material, and the treatment and disposal of radioactive waste. Nuclear accidents and their effects on health are discussed in the most extensive chapter, which draws on what has been learned following the catastrophic accidents at Chernobyl and Goiania, Brazil and from accidents linked to the military and medical uses of radiation. Chapter five tabulates and compares data on the risks to workers, the general public, and the environment posed by coal, oil, thermal, and nuclear sources of electrical energy. The concluding chapters assess the risk of theft of radioactive materials, and discuss public information.
Our Planet, Our Health
Report of the WHO Commission on Health and Environment
Chaired by S. Veil
1992, xxxii + 282 pages [C, E, F, S from PAHO]
ISBN 92 4 156148 3
Sw.fr. 45.-/US $40.50; in developing countries: Sw.fr. 20.-
Order no. 1150375
Records the findings of an independent group of experts commissioned by WHO to assess the complex interactions between health status and environmental change within the context of socioeconomic development. The experts were also asked to examine global trends in such areas as resource use, waste generation, and population growth and to determine how these trends will influence both human and environmental health. Conclusions reached range from the need for an immediate halt to population growth to the importance of economic stability as a prerequisite for sound environmental management.
The main part consists of separate chapters analysing the ways in which human needs and activities affect the environment, and thus alter environment-related risks to health, in the areas of food and agriculture, water, energy, industry, and human settlements and urbanization. Each chapter provides a detailed analysis of the current situation in both developed and developing countries, projects future trends, and outlines actions to be taken by citizens, businesses and governments. Examples of resource improvement schemes that have inadvertently caused explosive outbreaks of disease underscore the need to be certain that measures intended to protect the planet do not endanger the health of its human inhabitants. The final chapter discusses transboundary problems involving the transport of air pollutants, the movement of hazardous wastes, ozone depletion, climatic change, and ocean pollution.
"... Coming generations, as well as this one,
should surely thank the WHO for Our Planet, Our Health ... It deserves to become the
vademecum for all those, general public and experts alike, who are concerned with the
future of the planet ..."
Public Health Impact of Pesticides Used in Agriculture
1990, 128 pages [E, F, R, S]
ISBN 92 4 156139 4
Sw.fr. 21.-/US $18.90; in developing countries: Sw.fr. 14.70
Order no. 1150348
Assesses the scope and severity of risks to human health caused by exposure to agricultural pesticides. Drawing upon data collected by WHO and the United Nations Environmental Programme, the book aims to provide a framework for understanding the magnitude of pesticide-associated health problems, identifying groups at special risk, knowing which compounds pose special problems, and finding safer alternatives. Throughout, emphasis is placed on the need to balance alarm about the hazards of pesticides with a sound understanding of precise risks and the best ways to prevent them. Although the book takes a global approach, particular attention is given to the special problems of pesticide safety in developing countries.
Effects on human health are evaluated in separate chapters devoted to experimental and clinical evidence of toxicity and epidemiological evidence of short- and long-term effects. The book concludes that cases of acute poisoning, including suicide attempts, mass poisoning from contaminated food, chemical accidents in industry, and occupational exposure in agriculture, constitute the most serious health hazard associated with pesticides used for agricultural purposes. Some fifteen pesticides, known to pose severe threats to human health or the environment, are singled out for priority attention in future studies. Other chapters identify sources and indicators of human exposure and define populations at special risk.
"... a most impressive WHO publication ... As a
comprehensive repository of the toxicological data on pesticides it is almost
Human and Experimental Toxicology
edited by A. Prüss, E. Giroult and P. Rushbrook
1999, xiv + 230 pages + 4 colour plates (available in English; French and Spanish in preparation)
ISBN 92 4 154525 9
Sw.fr. 72./US $64.80; in developing countries: Sw.fr. 50.40
Order no. 1150453
| Full text online |The companion volume: Teacher's Guide | online photographs to support training |
This handbook provides the first comprehensive guide to the safe and efficient handling, treatment, and disposal of all categories of hazardous waste generated by health-care activities. Although the major emphasis is on waste generated by hospitals, guidelines and advice are also relevant to wastes produced in health centres, research facilities, and laboratories, or associated with home care or treatment in doctors' and dentists' practices.
In publishing this handbook, WHO aims not only to promote a sound managerial approach and the use of appropriate technologies, but also to inform countries about the health risks that result from inadequate management of health-care waste. With these goals in mind, the book provides both an alert to documented public health and environmental hazards and a catalogue of the technical, managerial, and legislative options available for reducing these risks. All components of a waste management policy whether at national or institutional level are considered in detail.
Although recommended policies and procedures have universal relevance, the handbook gives particular attention to conditions in developing countries, where methods for the safe treatment and disposal of hazardous waste may be limited. With these conditions in mind, the handbook includes approaches for gradual improvements together with a catalogue of options for waste management that include both simple and highly sophisticated technologies. Throughout, photographs, lines drawings, checklists, tables, and step-by-step procedures are used to enhance the practical value of the wealth of guidance provided.
The book opens with a definition and characterization of hazardous health-care wastes categorized as infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste, waste with high content of heavy metals, pressurized containers, and radioactive waste. The health consequences of exposure to each category of waste are described in the next chapter, which considers the nature and severity of associated health hazards, factors influencing the likelihood of exposure, persons at risk, and significance for public health. Concentrated cultures of pathogens and contaminated sharps are identified as the waste items that represent the most acute potential hazards to health. Other chapters consider legislative, regulatory, and policy issues, and offer a step-by-step guide to the planning of waste management, including use of a detailed model survey questionnaire for gathering data on waste generation and management practices in hospitals.
Against this background, five chapters offer guidance in a range of specific practices and procedures for safe waste management. Chapters cover strategies for waste minimization, recycling, and reuse; good practices in the handling, segregation, packaging, storage, and transportation of wastes; a wide range of treatment and disposal technologies; treatment and disposal technologies appropriate for specific categories of waste; and the collection and safe disposal of hazardous wastewater. The remaining chapters discuss costs, health and safety practices for health-care personnel and waste workers, the management of spillage and other emergencies, basic principles of hospital hygiene and infection control, and training needs. The final chapter sets out a minimum programme of essential waste management practices considered suitable for smaller rural health care establishments and field hospitals in refugee camps and other temporary situations.
Teacher's Guide: Management of Wastes from Health-Care Activities
A. Prüss and W.K. Townend
1998, v + 227 pages (English)
Sw.fr. 35./US $31.50; in developing countries: Sw.fr. 24.50
Order no. 1930134
| online edition | online photographs to support training |
A spiral-bound collection of resource materials for use in a three-day training course focused on the safe management of health-care wastes. Course materials are aimed at an audience of managers of hospitals and other health-care establishments, policy-makers, and professionals involved in waste management. Noting that health-care waste has a higher potential of infection and injury than any other type of waste, training materials aim to both heighten awareness of specific hazards and illustrate the strategies whether involving national legislation or safe practices at the institutional level that can minimize these risks. The teacher's guide is a companion to the WHO handbook, Safe Management of Wastes from Health-Care Activities.
Training materials include ready-to-copy texts for overhead transparencies or slides, lecture notes, handouts, exercises, worksheets, and evaluation forms. Apart from drawing attention to the public health and environmental hazards of health-care wastes, material for the course includes abundant technical information on various safe options for waste segregation, storage, collection, labelling, transport, treatment, and disposal.
Specific training materials range from overheads listing the components of national programmes for waste management and outlining an action plan, through a handout illustrating technical options for waste treatment, to a worksheet for calculating the costs for construction and operation of an incineration plant. Advice on how to organize and conduct the course is provided together with suggestions for using problem-based approaches and supplementing the materials with locally-relevant examples and exercises.
Site Selection for New Hazardous Waste Management Facilities
WHO Regional Publications, European Series, No. 46
1993, xiv + 118 pages [E] ; in developing countries: Sw.fr. 14.70
Order no. 1310046
A comprehensive guide to the selection of new sites where hazardous wastes can be collected, treated, stored and disposed of in a safe manner acceptable to the general public. Apart from outlining relevant engineering and scientific factors, the book gives particular attention to the measures needed to protect health, preserve environmental quality, and respect the social values and economic wellbeing of the host community. Though intended for use in European countries, the policy and technical options described are applicable to situations in most countries throughout the world.
"... highly recommended for industrial managers,
health and environmental policy planners and interested public groups..."
Indian Journal of Medical Research
"... the first guide to touch on all elements of
facility siting, and to give social factors equal weight with engineering and scientific
UNEP Industry and Environment
The continuing expansion of motorized transport in Europe today raises
crucial questions about the efficiency and the environmental, health and social
implications of land-use and transport policies. The challenge is to promote
healthy and sustainable transport alternatives to prevent the negative effects
of transport systems on human health. This book summarizes the key facts on
which countries based their decision. Developed from a document prepared for the
London Conference, it summarizes the latest scientific evidence on the impact of
transport-generated air pollution, noise and accidents on behaviour and physical
and mental health. The book also highlights the considerable potential health
benefits from non-motorized forms of transport, such as cycling and walking.
Transport, Health and Environment
Edited by C. Dora and M. Phillips
WHO Regional Publications, European Series, No. 89
2000, iv + 82 pages [E]
ISBN 92 890 1356 7
Sw.fr. 35.--/US $31.50
In developing countries: Sw.fr. 24.50
Order no. 1310089
The continuing expansion of motorized transport in Europe today raises crucial questions about the efficiency and the environmental, health and social implications of land-use and transport policies. The challenge is to promote healthy and sustainable transport alternatives to prevent the negative effects of transport systems on human health. This book summarizes the key facts on which countries based their decision. Developed from a document prepared for the London Conference, it summarizes the latest scientific evidence on the impact of transport-generated air pollution, noise and accidents on behaviour and physical and mental health. The book also highlights the considerable potential health benefits from non-motorized forms of transport, such as cycling and walking.