Concern for Europe’s Tomorrow Health and the Environment in the WHO European Region pot

Ger-Die Deutsche Bibliothek – CIP-Einheitsaufnahme Concern for Europe’s tomorrow : health and the environment in the WHO European region / WHO European Centre for Environment and Health.

Concern for Europe’s TomorrowHealth and the Environment in the WHO European Region

The use of general descriptive names, trade names, trademarks, etc in a publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.

The designations employed and the presentation of the material in this publication do not imply the expression

of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron- tiers or boundaries.

The views expressed in this publication are those of the contributors and do not necessarily represent the sions or the stated policy of the World Health Organization.

deci-The Federal Minister for the Environment, Nature Conversation and Nuclear Safety (Federal Republic of many) provided financial support for, and undertook the printing of, this publication.

Ger-Die Deutsche Bibliothek – CIP-Einheitsaufnahme

Concern for Europe’s tomorrow : health and the environment

in the WHO European region / WHO European Centre for

Environment and Health [Publ on behalf of the World Health

Organization Regional Office for Europe] – Stuttgart : Wiss.

Verl.-Ges., 1995

ISBN 3–8047–1406–4

NE: European Centre for Environment and Health

© World Health Organization 1995

Published on behalf of the World Health Organization Regional Office for Europe by Wissenschaftliche lagsgesellschaft mbH

Ver-All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written per- mission from the copyright holder.

Wissenschaftliche Verlagsgesellschaft mbH, Birkenwaldstraße 44, D-70191 Stuttgart, Germany.

Printed in Germany

Foreword

The remarkable political changes that have

taken place within the European Region in

the last five years have greatly enlarged the

potential for international collaboration The

First European Conference on Environment

and Health was held in Frankfurt in

De-cember 1989, when these dramatic changes

were at their height Ministers from 29

coun-tries, and the European Commission,

ap-proved a Charter that set out the principles,

strategy and priorities for achieving an

effec-tive approach to the many areas in which

en-vironmental conditions may significantly

af-fect human health

The Charter reflected the ministers’

con-cern that the nature and extent of

environ-mental health problems throughout the

Re-gion had not been adequately assessed The

WHO European Centre for Environment

and Health, which was established as a

di-rect result of the Conference’s

recommen-dations, was therefore given as its first major

task the development of a comprehensive

re-view of available data in such fields as water

supply and sanitation, air and water

pollu-tion, radiation protecpollu-tion, food safety,

occu-pational health, and housing and

settle-ments The project was entitled Concern for

Europe’s Tomorrow, and the Scientific

Ad-visory Board of the European Centre

de-cided that the final report should be

avail-able as the scientific basis for deliberations

at the Second European Conference on

En-vironment and Health in Helsinki in June

1994

The time available for preparation was

ex-tremely limited The fact that a summary of

the final report was available in time for the

Second European Conference reflects great

credit on the many scientists (more than270) and officially established national focalpoints in the Member States who have takenpart in this major undertaking

The report highlights a number of issuesthat demand urgent attention and has con-firmed the existence of major differences inenvironmental conditions and the healthstatus of populations between the westerncountries of the Region and the countries ofcentral and eastern Europe and the newly in-dependent states of the former USSR

None of the countries of our Region, ever, has room for complacency As oneexample, substantial areas of many Euro-pean cities provide a deteriorating environ-ment for their citizens, owing to trafficnoise, pollution and congestion, and socialdeprivation Clearly, not all issues are ofequal importance and it is hoped that the ob-jective scientific nature of this report willhelp to allay unjustified public fears and toprovide a more realistic perception of risk.Above all, the report is intended to be of as-sistance in rational decision-making, so thatreal priorities may be identified and limitedresources efficiently utilized

how-The process of developing this report hasdemonstrated the shortcomings of the avail-able data, in both coverage and consistency.Nevertheless, the report is a major step for-ward I am confident that the network ofnational focal points, which has now beenfirmly established, and the close collabor-ation between the WHO Regional Office forEurope and other international organiz-ations, in particular the European Environ-ment Agency, provide excellent prospects forconsiderable improvements in the quantity

6 Foreword

and quality of available information between

now and the Third European Conference

planned for 1999

The present volume, which has been

devel-oped in very close cooperation with the

Eu-rope’s Environment Task Force of the

Euro-pean Commission, represents a major step

forward in collaboration among all 50

coun-tries of the WHO European Region It is

hoped that it will be widely used, not only bygovernment agencies but also by the verymany nongovernmental organizations deal-ing with different aspects of the issues ad-dressed by Concern for Europe’s Tomorrow

J.E AsvallWHO Regional Director for Europe

The Scope and Purpose of Concern

Limitations and Constraints 28Beyond Concern for Europe’s

1.3 An Outlook for the Future 39

8 Table of Contents

3 Economics, the Environment and Health

2.2 Environmental Health

2.4 Involvement at the Local

and Regional Levels 66

2.5 Intervention and Control 69

3.2 The Productive Economy

and the Environment 76

Socioeco-nomic and Lifestyle Data 91

4.2.1 Population size and

4.2.2 Population distribution 92

4.2.3 Socioeconomic factors 92

4.2.4 Lifestyle indicators 93

4.3 Availability and

Interpreta-tion of Health Data 93

5.2 Potential Health Effects 140

5.2.1 Sulfur dioxide and

5.4 Indoor Air Pollution 160

5.4.1 Pollutants and their

5.4.3 Exposure in Europe 1645.5 Global and Transboundary

5.6.3 Problems in exposure and

health risk assessment 1705.6.4 Global and transboundary

6.4.5 Management and control 199

7.1.1 Direct contact with surface

water through bathing 204

7.1.2 Direct occupational contact

7.2.3 Production and

consump-tion of raw foods irrigatedwith water of insufficient

9.2 Food Safety Regulations,

Services and Information

Table of Contents 11

10 Multimedia Exposure to Selected Chemicals

9.3.3 Foodborne diseases due to

9.4.3 Evaluation of food

contami-nation factors as indicated

by national focal points 263

tion of food and relatedfoodborne diseases 2729.8.3 Chemical contamination of

12.4.1 Radiation accidents 33912.4.2 Safety of nuclear power

14.1.3 Current housing and health

issues in the European

14.1.4 European health for all

targets related to housing 369

14.1.6 Current problems in

Euro-pean urban development 370

15.2 Important Factors at Work

and in the Work

14 Table of Contents

16 Accidents and Man-made Disasters

17 Environmental Health in the CCEE and NIS

15.2.5 Biological agents and

15.3.4 Work disability and

mortal-ity of working populations 416

Table of Contents 15

Part III

Analysis, Discussion, Conclusions and Recommendations

18 Estimated Health Effects of Environmental Exposure

and Role of Economic Sectors

19 Conclusions and Recommendations

19.4 Economics, the

19.5 State of Human Health 522

19.8 Water Supply and Quality 524

19.9 Wastewater and Surface

19.16 Housing and the Indoor and

Urban Environments 53119.17 Occupational Health 53219.18 Accidents and Man-made

Acknowledgements

The European Centre for Environment and

Health of the WHO Regional Office for

Eu-rope prepared this volume through its

divi-sions in Bilthoven and Rome, together with

the coordination unit in Copenhagen The

assessment of the situation in the fields of

health and the environment covering such a

vast area as the WHO European Region

would not have been possible without the

ac-tive support and collecac-tive efforts of a great

many contributing individuals and

institu-tions The Regional Office is grateful to all

who participated in this effort, either as

authors, as reviewers or in any other

capac-ity The extensive list of contributors is a

measure of the size and complexity of the

task

The Organization is greatly indebted to all

ministries of health and of the environment

in the Region for their active support The

network of national focal points for Concern

for Europe’s Tomorrow (CET), acting as

links between the national authorities andthe Regional Office, provided invaluablehelp in data collection and evaluation TheRegional Office is especially grateful to thechairman and members of the Scientific Ad-visory Board of the European Centre for En-vironment and Health who, together with nu-merous individual reviewers, carried out adetailed scientific critique of the drafts andprovided sound advice on their improve-ment The close cooperation of other inter-national bodies, especially the European En-vironment Agency Task Force of the Euro-pean Commission, is appreciated

The Regional Office wishes to record itsspecial gratitude to Dr Barbara MacGibbon,who undertook the very difficult task ofoverall compilation and scientific editing ofthe whole report Without her invaluablecontribution, publication of this book wouldnot have been possible within the very lim-ited time available

National focal points for CET

18 Acknowledgements

Other national contributors

J Alexander (National Institute of Public

Health, Oslo, Norway)

T Anavi (Tel Aviv University, Tel Aviv,

Is-rael)

E Andronache (Institute of Hygiene and

Public Health, Bucharest, Romania)

S.L Avaliani (Sisin Institute of Community

Hygiene, Moscow, Russian Federation)

A Avni (Ministry of Health, Jerusalem,

Is-rael)

W Babisch (Institute for Water, Soil and Air

Hygiene, Federal Health Office, Berlin,

Federal Republic of Germany)

B Bayar (Ministry of Health, Ankara,

Tur-key)

R Becher (National Institute of Public

Health, Oslo, Norway)

G Bechu (Ministry of Health, France)

N.E Billo (Federal Office of Public Health,

Bern, Switzerland)

K Binysh (Department of Health, London,

United Kingdom)

G Biro (National Institute of Food Hygiene

and Nutrition, Budapest, Hungary)

C.-E Boström (National Environmental

Pro-tection Board, Stockholm, Sweden)

G Brunborg (National Institute of Public

Health, Oslo, Norway)

J Cachia (Department of Health, Valletta,

Malta)

R Cachia Zammit (Department of

Environ-ment, Valletta, Malta)

J Carmes (Ministry of Health, France)

P Caruna (Public Health Laboratory,

Vallet-ta, Malta)

F Cicogna (Ministry of Health, Rome, Italy)

M Csanady (National Institute of PublicHealth, Budapest, Hungary)

M Dodic-Fikfak (University Institute forMedicine and Social Welfare, Ljubljana,Slovenia)

B Drougge (National Environmental tion Board, Stockholm, Sweden)

Protec-B Duigu (Ministry of Reconstruction andSettlement, Ankara, Turkey)

S Dumitrache (Institute of Hygiene andPublic Health, Bucharest, Romania)

M Eriksson (National Board of Health andWelfare, Stockholm, Sweden)

N Essiz (State Planning Organization, kara, Turkey)

An-L Ewetz (Institute of Environmental cine, Stockholm, Sweden)

Medi-W Fonahn (National Institute of PublicHealth, Oslo, Norway)

E Fröhlich (Federal Office of Public Health,Bern, Switzerland)

M Gauci (Industrial Hygiene Unit, Valletta,Malta)

S Gelberg (Ministry of EnvironmentalQuality, Jerusalem, Israel)

M Gerber (Ministry of EnvironmentalQuality, Jerusalem, Israel)

Y Gil (Ministry of Environmental Quality,Jerusalem, Israel)

A Goren (Tel Aviv University, Tel Aviv, rael)

Is-F Gösbebek (Turkish Atomic Energy tute, Ankara, Turkey)

Insti-J Gubernskiy (Sisin Institute of CommunityHygiene, Moscow, Russian Federation)

S Güven (State Statistics Institute, Ankara,Turkey)

E Smales (United dom)

King-Acknowledgements 19

J.-E Haugen (National Institute of Public

Health, Oslo, Norway)

F Hirka (National Institute of Public

Health, Budapest, Hungary)

A de Hollander (RIVM, Bilthoven,

Nether-lands)

J Hongslo (National Institute of Public

Health, Oslo, Norway)

A Horvath (National Institute of Hygiene,

Budapest, Hungary)

M Hristova (Institute of Radiobiology and

Radioprotection, Sofia, Bulgaria)

H Huitfeldt (National Institute of Public

Health, Oslo, Norway)

J Indulski (Institute of Occupational

Medi-cine, Lodz, Poland)

H Isnard (Ministry of Health, France)

L Ivanovska (Ministry of Health, Skopje,

The Former Yugoslav Republic of

Mace-donia)

M Izrael (Institute of Radiobiology and

Radioprotection, Sofia, Bulgaria)

V Kalivoda, Federal Environmental Agency,

Vienna, Austria)

K Karlowski (National Institute of Hygiene,

Warsaw, Poland)

N Kehlkovskiy-Sergeev (Institute of

Indus-trial Hygiene and Occupational Diseases,

Moscow, Russian Federation)

M Kertész (National Institute of Hygiene,

Budapest, Hungary)

S Khotimchenko (Institute of Nutrition

of the Russian Academy of Medical

Sciences, Moscow, Russian Federation)

B Kihlström (National Institute of Public

Health, Oslo, Norway)

E Kivisäkk (National Radiation Protection

Institute, Stockholm, Sweden)

V Knizhnikov (Ministry of Health, Moscow,

Russian Federation)

M Köhalmi (Ministry of Welfare, Budapest,

Hungary)

J Korytkowsky (Ministry of Environmental

Protection, Warsaw, Poland)

Z Koszarny (National Institute of Hygiene,

Warsaw, Poland)

D.I Krammer, Federal Environmental

Agen-cy, Vienna, Austria)

N Lazarus (Department of Health, London,

D Lupulescu (Institute of Hygiene and lic Health, Bucharest, Romania)

Pub-T Majle (National Institute of Hygiene, saw, Poland)

War-R Maynard (Department of Health, don, United Kingdom)

Lon-S Maziarka (National Institute of Hygiene,Warsaw, Poland)

T Meredith (Department of Health, don, United Kingdom)

Lon-V Metodiev, National Centre of Hygieneand Medical Ecology, Sofia, Bulgaria)

M Micallef (Department of Health, Valletta,Malta)

I Miller (Institute of Hygiene and ology, Prague, Czech Republic)

Epidemi-C Milu (Institute of Hygiene and PublicHealth, Bucharest, Romania)

B Montaville (General Directorate forHealth, Paris, France)

C Morawa (International Office of the eral Environmental Agency, Berlin, Ger-many)

Fed-H.-G Mücke (Institute for Water, Soil andAir Hygiene, Federal Health Office, Ber-lin, Germany)

E Ne’eman (Tel Aviv University, Tel Aviv, rael)

Is-B Nikiforov, National Centre for Hygieneand Medical Ecology, Sofia, Bulgaria)

K Ormerod (National Institute of PublicHealth, Oslo, Norway)

O Petursson, Office of Environmental tection, Reykjavik, Iceland)

Pro-T Popov (National Centre of Hygiene andMedical Ecology, Sofia, Bulgaria)

V Radmilovic (Federal Secretariat for bour, Health, Veterans’ Affairs and SocialPolicy, Belgrade, Federal Republic of Yu-goslavia (Serbia and Montenegro))

La-T Radunsky (Federal Environmental

Agen-cy, Vienna, Austria)

20 Acknowledgements

J Rakhmanin (Sisin Institute of Community

Hygiene, Moscow, Russian Federation)

F Ribarova (National Centre of Hygiene

and Medical Ecology, Sofia, Bulgaria)

D Ricochon (Ministry of Health, France)

D Riechman (Ministry of Health,

Jerusa-lem, Israel)

E Rocco (Ministry of Health, Rome, Italy)

M Rouge (Ministry of Health, France)

P Rudnai (National Institute of Hygiene,

T.-A Stenström (National Bacteriological

Laboratory, Stockholm, Sweden)

J.R Sveinsson (State Housing Board,

Reykjavik, Iceland)

N Rusakov (Sisin Institute of Community

Hygiene, Moscow, Russian Federation)

E Rydén (National Board of Housing,

Build-ing and PlannBuild-ing, Karlskrona, Sweden)

E Sabir (Ministry of Labour and Social

Se-curity, Ankara, Turkey)

M Sammut (University of Malta, G’Mangia,

C Serrano Carcia (Institute of Hygiene at

the Workplace, Madrid, Spain)

V Shinev (Institute of Occupational Health,

Moscow, Russian Federation)

A Spassov (National Centre of Hygiene and

Medical Ecology, Sofia, Bulgaria)

D.I Stadler (Bundesministerium für

Land-und Forstwirtschaft, Vienna, Austria)

F Störmer (National Institute of Public

Health, Oslo, Norway)

M Sulcova (National Institute of Hygiene

and Epidemiology, Bratislava, Slovakia)

L.B Sztanyik (National Institute of

Radiobi-ology and Radiohygiene, Budapest,

I Thirouin (Ministry of Health, France)

S Thorarinsson (Administration of tional Safety and Health, Reykjavik, Ice-land)

Occupa-I Trettwer (Österreichisches StatistischesZentralamt, Vienna, Austria)

B Tichacek (National Institute of PublicHealth, Prague, Czech Republic)

E Tacoronte (Ministry of Health and sumer Affairs, Madrid, Spain)

Con-M Tat (Institute of Hygiene and PublicHealth, Bucharest, Romania)

H Toksoy (Ministry of Agriculture and lage Affairs, Ankara, Turkey)

Vil-U Torsmark (National Environmental tection Board, Solna, Sweden)

Pro-D Tricard (Ministry of Health, France)

R Tulbure (Institute of Hygiene and PublicHealth, Bucharest, Romania)

G Ungvary (National Institute of tional Heath, Budapest, Hungary)

Occupa-L Vella (Industrial Hygiene Unit, Valletta,Malta)

T Ulgen (Ministry of Health, Ankara, key)

Tur-L Ursu (Institute of Hygiene and PublicHealth, Bucharest, Romania)

A Vassallo (Department of Health, Valletta,Malta)

A Wadge (Department of Health, London,United Kingdom)

K Wahlberg (National Board of tional Safety and Health, Solna, Sweden)

Occupa-H Walker (Department of Health, London,United Kingdom)

M Waring (Department of Health, London,United Kingdom)

S Whitehead (Department of Health, don, United Kingdom)

Lon-R Zechner (Federal Ministry of Health,Sport and Consumer Protection, Vienna,Austria)

J.H Bernhardt (Institute of Radiation

Hy-giene, Neuherberg, Germany)

C Corchia (University of Sassari, Italy)

R.B Cundall (Medical Research Council,

Chilton, United Kingdom)

H Dovland (Institute for Air Research,

Lil-leström, Sweden)

K Gerigk (Robert von Ostertag Institute,

Berlin, Germany)

R.J Gilbert (Central Public Health

Labora-tory, London, United Kingdom)

A Henne (Medizinisches Institut für

Um-welthygiene, Düsseldorf, Germany)

D Hill (Environmental Resources Limited,

London, United Kingdom)

G Jukes (Institution of Environmental

Health Officers, London, United

K Martignoni (Institute of Radiation giene, Neuherberg, Germany)

Hy-R Mnatsakanian (Moscow, Russian ation)

Feder-Eva Nielsen (National Food Agency, borg, Denmark)

Sø-R Novick (Potomac, USA)

O Juhl Pedersen (Technical University, penhagen, Denmark)

Co-P Peterson (MARC, London, United dom)

King-J Rantanen (Finnish Institute of tional Health, Helsinki, Finland)

Occupa-J Roberts (Adhealth Ltd, United Kingdom)

F Sella (Apples, Switzerland)R.M.C Theelen (RIVM, Bilthoven, Nether-lands)

P Teufel (Robert von Ostertag Institute, lin, Germany)

Ber-B.T Williams (University of Sheffield,United Kingdom)

E Wirth (Institute of Radiation Hygiene,Neuherberg, Germany)

M Wohlen (Gothenburg, Sweden)

Scientific reviewers

Scientific Advisory Board

Sir Donald Acheson (Chairman, London

School of Hygiene, United Kingdom)

A.M Kellerer (Institut für Strahlenbiologie,

Germany)

M Maroni (International Centre for

Pesti-cide Safety, Italy)

G Pershagen (National Institute of

Environ-mental Medicine, Sweden)

J.K Piotrowski (Institute of Environmental

V Silano (Ministry of Health, Italy)

J Weicherding (General Directorate ofHealth, France)

T.B Zeltner (Federal Office of PublicHealth, Switzerland)

B.C.J Zoeteman (Ministry of Housing,Physical Planning and Environment, Ne-therlands)

22 Acknowledgements

Individual scientific reviewers

T Hancock (Public Health Consultant,

Kleinburg, Ontario, Canada)

P Kulling (National Poison Information

Centre, Stockholm, Sweden)

M.D Lebowitz (University of Arizona,

Tuc-son, USA)

D Larré (Director, Industry and

Environ-ment Office, UNEP, Paris, France)

J.L Larsen (National Food Agency, Søborg,

Denmark)

C.J Macfarlane (Ontario International

Cor-poration, Government of Ontario,

Bu-R Visser (OECD, Paris, France)

G Winneke (Medizinisches Institut für welthygiene, Düsseldorf, Germany)

Um-Project Group of the Europe’s environment

report

J.-P Ribaut (Council of Europe)

J Benes, Jaroslav Mejzr (ex-Czechoslovakia)

T Moth Iversen (Denmark)

C Avérous, C Chung, P Schreyer (OECD)

M Leonor Gomes (Portugal)

A.M Goudyma, D Kolganov (Russian

D Stanners (DG XI, EEA-Task Force,

Pro-ject Manager of the Europe’s environment

report)

WHO Regional Office for Europe

(a) European Centre for Environment and

Health

B MacGibbon (Scientific Editor)

K Baverstock, R Bertollini, B Fenger,

K van der Heijden, R Kersauze, M

Krzyza-nowski, B Lübkert-Alcamo, P Marchandise,

R Merineau, P Rushbrook, R Stern,

S Tarkowski, I Vlachonikolis, I ton, P Weigert, M Younes, J Zakonyi (Pro-ject Officer for the CET report)

Wadding-(b) X Bonnefoy, M.S Burgher, P Charlton,

O Espinoza, E Grandjean, D Kello, F LaFerla, A Nanda, A Nossikov, R Prokhors-kas, K Runeberg, L Saliba, M Shabanah,M.J Suess, F Theakston

WHO Headquarters

E Giroult, T Kjellström

Introduction

Many of the great advances in public health

during the nineteenth and twentieth

cen-turies resulted from the realization that

un-satisfactory water supplies, sanitation,

work-ing conditions, houswork-ing, food and air quality

were major contributors to disease and short

lifespans More recently, protection of the

environment for its own sake and the

main-tenance of biodiversity for future generations

have become important political issues

throughout the world The relationship of

human health and wellbeing to

environ-mental influences is an important dimension

of these issues

The relationship between environmental

factors and health is complex Many diseases

have multifactorial causes and the influence

of lifestyles and social and economic factors

may be difficult to separate from

environ-mental exposures

Over recent decades, much of the WHO

European Region has experienced rapid

economic growth, but the benefits of

in-creased overall prosperity have not always

been accompanied by adequate measures to

The Setting safeguard the quality of the environment.This has resulted in a wide range of direct

threats to human health as well as potentialindirect effects, including some that mayoccur in the future as a result of the unsus-tainable nature of much economic develop-ment

The situation is far from uniform Basichealth statisticsa show a general improve-ment in levels of health within the Europeanmember countries of the Organisation forEconomic Co-operation and Development(OECD) as assessed by infant and total mor-tality rates, life expectancy and the incidence

of certain diseases By contrast, no ment and in some aspects a deterioration inhealth status has occurred in the countries

improve-of central and eastern Europe (CCEE)b andthe newly independent states (NIS) of theformer USSR over the last two decades Inaddition, considerable variations occur

a Health for all database of the WHO Regional Office for Europe.

b The CCEE comprise Albania, Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and the countries emerging from the former Yugoslavia.

The Scope and Purpose of Concern

Limitations and Constraints 28Beyond Concern for Europe’s

24 Introduction

among different social groups within

individ-ual countries of the Region, the poor

every-where suffering more ill-health than the

better off If appropriate and cost-effective

action is to be taken to create a greater

de-gree of equity in health throughout the

Re-gion, a better understanding must be reached

of the role of the environment in influencing

health, compared with social and economic

inequalities, lifestyles and the quality of

health care systems

The definition of environmental health

given in the European Charter on

Environ-ment and Health [1] should be borne in

mind:

Environmental health includes both the direct

pathological effects of chemicals, radiation and some

biological agents, and the effects (often indirect) on

health and wellbeing of the broad physical,

psycho-logical, social and aesthetic environment, which

in-cludes housing, urban development, land use and

transport.

While public health policies are

understand-ably mainly directed towards relieving

so-ciety of disease and premature death, the

en-vironment should also be considered as a

re-source for enhancing health and wellbeing

People aspire to live in communities free of

environmental hazards, with decent homes

in which to raise their families, with

oppor-tunities for employment, education and

cul-ture, and with pleasant and harmonious

sur-roundings that facilitate recreation and

so-cial contact and maintain a healthy and

di-verse ecosystem Effective environmental

protection, in its widest sense, provides a

framework for many of these aspirations, as

part of enlightened and sustainable

socioeco-nomic development

While these are desirable aims, already

within the reach of many people in the

Re-gion, the far more basic needs of many

others must also be recognized and dealt

with as a matter of high priority Many

mil-lions of people in the Region still lack at

least one of the essential prerequisites of

en-vironmental health: safe water, clean air,

sanitation and shelter A substantial number

are without the first and most fundamental

prerequisite for health, namely peace

Reha-bilitation of public services essential for ronmental health and resettlement of largenumbers of refugees will be major inter-national tasks when hostilities have ceased

envi-If countries are to improve the health of theirpeople, they must know what environmentalconditions prevail Concern for Europe’s To-morrow was launched to assess the state ofenvironmental health in the Region To ex-plain fully how this project came about, wemust go back a little in time

In 1980, the Member States of the WHOEuropean Region adopted a common Euro-pean strategy for attaining health for all [2].This called for fundamental changes in ap-proaches to health development It focused

on four areas of concern: lifestyles andhealth, the risk factors affecting health andthe environment, the reorientation of thehealth care system, and the mobilization ofpolitical, managerial and technological sup-port to bring about these changes In 1984,the Member States of the Region approved

38 regional targets encompassing theseareas Their adoption proved to be a decisiveevent that gave a strong impetus to the widepolitical acceptance and implementation ofthe European health for all strategy In manycountries, the concepts, principles and strat-egies have already become reflected innational, regional and local policies Theyhave also provided a solid basis for health de-velopment in the CCEE and NIS, which hasbeen greatly affected by political change inthe last five years While retaining their basicstructure, the original targets were updated

in 1991 [3] As in 1984, nine targets are rectly concerned with aspects of environ-mental health

di-Target 11 – Accidents

By the year 2000, injury, disability and death

The Genesis of Concern for Europe’s Tomorrow

Introduction 25

arising from accidents should be reduced by

at least 25 %

Target 18 – Policy on environment and health

By the year 2000, all Member States should

have developed, and be implementing,

pol-icies on the environment and health that

en-sure ecologically sustainable development,

effective prevention and control of

environ-mental health risks and equitable access to

healthy environments

Target 19 – Environmental health

manage-ment

By the year 2000, there should be effective

management systems and resources in all

Member States for putting policies on

en-vironment and health into practice

Target 20 – Water quality

By the year 2000, all people should have

ac-cess to adequate supplies of safe

drinking-water and the pollution of grounddrinking-water

sources, rivers, lakes and seas should no

longer pose a threat to health

Target 21 – Air quality

By the year 2000, air quality in all countries

should be improved to a point at which

rec-ognized air pollutants do not pose a threat to

public health

Target 22 – Food quality and safety

By the year 2000, health risks due to

micro-organisms or their toxins, to chemicals and

to radioactivity in food should have been

sig-nificantly reduced in all Member States

Target 23 – Waste management and soil

pol-lution

By the year 2000, public health risks caused

by solid and hazardous wastes and soil

pollu-tion should be effectively controlled in all

Member States

Target 24 – Human ecology and settlements

By the year 2000, cities, towns and rural

communities throughout the Region should

offer physical and social environments

sup-portive to the health of their inhabitants

Target 25 – Health of people at work

By the year 2000, the health of workers in all

Member States should be improved by

mak-ing work environments more healthy, ing work-related disease and injury, and pro-moting the wellbeing of people at work

reduc-The need to achieve a better understanding

of the relationship between environmentalfactors and the health of individuals andcommunities, together with the clear needfor the environment and health sectors at alllevels of government to work closely to-gether, was recognized by the first EuropeanConference on Environment and Health,held in Frankfurt-am-Main, Federal Republic

of Germany, in December 1989

The Conference culminated in the tion, by ministers of health and of the en-vironment and other senior representativesfrom 29 European countries and by theCommission of the European Communities,

adop-of the European Charter on Environmentand Health [1] The Charter sets out a broadframework for action by all levels of govern-ment, by all sectors of society and at the in-ternational level

Subsequently, the WHO Commission onHealth and Environment was established

and produced a report entitled Our planet,

our health [4] in preparation for the United

Nations Conference on Environment andDevelopment in Rio de Janeiro in 1992 Thisreport analysed, within the global perspec-tive, the various ways in which the environ-ment interacts with health in the context ofsocioeconomic development, and provided aseries of broad recommendations for action

at international, national and local levels.The Rio Conference endorsed the so-calledAgenda 21 [5], an action plan for the twenty-first century that sets a far-seeing course to-wards sustainable development Its healthcomponent largely reflects the findings ofthe WHO Commission and acknowledgesthat, within the overall principle of sustain-ability, major changes in approach arerequired if health impairment due to environ-mental degradation is to be arrested and fu-ture adverse environmental impacts onhealth prevented

In response to Agenda 21, a global egy for health and the environment was en-

strat-26 Introduction

dorsed by the World Health Assembly in

May 1993 [6] An environmental

pro-gramme for Europe, including an Action

Programme for Central and Eastern Europe

[7], was approved by an intergovernmental

conference on the European environment

held in Lucerne, Switzerland, in April 1993

This action programme for the CCEE

ac-cepts that health impacts are an important

part of the immense environmental

prob-lems facing these countries as they move

to-wards parliamentary democracy and market

economies, although in many areas concrete

information on these health aspects is

lack-ing

Ministers at the First European

Confer-ence on Environment and Health had

al-ready acknowledged the inadequacy of the

existing database and recognized that its

strengthening was a prerequisite for national

decision-making and the setting of priorities

As a direct consequence of the adoption of

the European Charter, the WHO European

Centre for Environment and Health was

es-tablished as an integral part of the WHO

Re-gional Office for Europe Its priority

man-date was collaboration with Member States

on the development of an improved

in-formation system, covering all aspects of the

relationships between environmental

condi-tions and human health

At the first European Conference on

En-vironment and Health in 1989 [1] it was

agreed that:

European Ministers of Health and the Environment

should meet again within five years to evaluate

national and international progress and to endorse

specific action plans drawn up by WHO and other

in-ternational organizations for eliminating the most

significant environmental threats to health as rapidly

as possible.

In preparation for this Second European

Conference on Environment and Health,

The Development of Concern for

Europe’s Tomorrow

which was held in Helsinki in June 1994, theWHO European Centre for Environmentand Health was asked to assess all aspects ofenvironmental health in the countries of theRegion, based on available national data andother information: the project known asConcern for Europe’s Tomorrow

Since this project was first planned in

1991, many political changes have takenplace in the Region and the number of WHOMember States has increased from 31 to 50.While it was impractical to collect suffi-ciently detailed data from the NIS, theformer Czechoslovakia and the former Yu-goslavia for inclusion in the main text of thereport, the special conditions that exist inthese countries had to be reflected A separ-ate chapter in this report therefore summar-izes the main environmental health issues inthese countries

From the outset, it was essential to work

in harmony with other international bodiesinvolved in assessing environmental condi-tions in the European Region, in particularthe Commission of the European Commu-nities (CEC) As a result of the UnitedNations Economic Commission for Europe(ECE) Ministerial Conference held at Do-bris Castle in the former Czechoslovakia inJune 1991, the development of a pan-Euro-pean report on the state of the environmentwas begun A close working relationship hasbeen established between the CEC secre-tariat coordinating preparation of this reportand the project office at the WHO RegionalOffice coordinating the development of thisbook Further, joint use has been made ofsome of the data available for these two com-plementary projects

The major sources of information havebeen individual countries, international or-ganizations and internal WHO material.Member States were invited to nominatenational focal points; they came together at aplanning meeting in October 1991 andagreed on the project’s general concept andmain lines of development From the outset

it was accepted that, in view of the shorttime frame, only existing data should be util-ized It was hoped that the limitations that

Introduction 27

became evident during the progress of the

work would indicate priority needs and

stimulate the long-term development of an

effective information system after the

com-pletion of the project

Small task forces were convened to

de-velop questionnaires on the various sectoral

issues Countries completed the

question-naires through the newly established

net-work of national focal points The replies,

along with data and information obtained

from other sources, were thereafter analysed

by the chapter managers within the WHO

European Centre for Environment and

Health The process of development of the

project, and this report, involved two

subse-quent meetings of the national focal points,

which greatly contributed to its successful

completion

The Scientific Advisory Board of the

WHO European Centre for Environment

and Health acted as an independent peer

re-view body for the emerging document and

reviewed progress in November 1992,

Sep-tember 1993 and January 1994 Peer review

of separate chapters was carried out by

ap-propriate specialists

The main aim of the project was to provide a

balanced and objective overview of the

prin-cipal environmental issues of present or

po-tential concern for health in the WHO

Euro-pean Region Of course, not all issues are of

equal significance and priority in terms of

human health While this book does not

pro-vide a detailed comparative risk assessment,

it is meant to help achieve a better

under-standing of the more important

environ-mental factors that affect the health of the

overall population or of potentially

vulner-able groups It is hoped that the gap between

perceived risk and actual risk can thereby be

narrowed by improving public information

The Scope and Purpose of

Con-cern for Europe’s Tomorrow

and facilitating informed debate This willhave the twofold result that, on the onehand, people’s undue worries can be allayedand limited resources devoted to the mostimportant tasks and, on the other, author-ities and individuals can be persuaded totake action to prevent risks that they do notnow take seriously enough

It is axiomatic that prevention is betterthan cure In terms of environmental protec-tion, the anticipation and avoidance of po-tential harm not only benefit human healthand wellbeing, but are almost always morecost-effective than later environmental clean-

up and treatment of disease Such preventiveaction involves many different areas of gov-ernment, including agriculture, energy pro-duction, housing, industry, land use andurban planning, and transport At present,the frequent absence of a multisectoral ap-proach to environmental health manage-ment, and the lack of effective coordination

of action, result in socioeconomic ment having impacts on the environmentthat adversely affect the health and wellbeing

develop-of the population

This book attempts to facilitate the sal of these practices by presenting an overallpicture of the effects on health of environ-mental conditions throughout the EuropeanRegion, thus demonstrating the need for thevarious sectors of government and society tointeract if improvements are to be made Inview of the many transfrontier environ-mental issues that have public health impli-cations, the book also tries to demonstratethe need for countries to share informationsystems, as an objective basis for decision-making

rever-The European Charter emphasized thatcareful environmental stewardship could notonly prevent adverse effects on health butalso contribute towards wellbeing It is easier

to recognize wellbeing than to provide a orous, scientific definition of it, and thereare no satisfactory measures of the benefits

rig-of an aesthetically pleasing environment inhealth terms A mutually supportive commu-nity within a diverse and sustainable eco-system, however, bestows benefits that go

28 Introduction

beyond the prevention of individual diseases

Epidemiology has not yet succeeded in

deal-ing with these concepts, nor are there

satis-factory indicators This book tries to develop

a perspective whereby enhancement is as

im-portant as prevention, although very little

quantitative information is available on this

difficult but important issue

The project has shown the many

shortcom-ings in the existing databases and systems for

collection, collation, analysis and

dissemi-nation On many topics, reliable data for

sessing health impacts could not be

as-sembled Much information is fragmented,

incomplete and of doubtful relevance and/or

validity, and does not undergo proper quality

control procedures Much is collected and

remains within separate administrations at

central, regional and local levels Much

monitoring seems to lack clear objectives

and does not appear to be used in

decision-making or environmental health

manage-ment Many single studies have been carried

out that have not or cannot be replicated An

ever present danger is that only the positive

results of epidemiological studies are quoted,

while the results of well conducted studies

leading to negative results are not taken into

account

All those taking part in the development

of the project, whether at country or

inter-national level, were aware of these

con-straints and difficulties From the beginning,

they realized that it would not be possible to

make a comprehensive assessment of

envi-ronmental health for all parts of the Region

They nevertheless considered that the

objec-tive was so important that they were fully

jus-tified in making the attempt

Limitations and Constraints

The investment that is being, and will be,committed to environmental management inthe interests of human health and wellbeing

is large, particularly in the context of the mited total resources available Policies musttherefore be based on sound data, and deci-sions on priorities for action should take thecost–benefit aspects into account Betterdata will facilitate a proactive stance,whereby the potential effects on health ofdifferent forms of development may be pre-dicted and prevented, rather than waitinguntil remedial action becomes necessary,which may be very costly even if practicable.However good the information system,data are not always available to support aparticular course of action While acknowl-edging these shortcomings, one must some-times resist the temptation to delay actionwhile searching for the underlying causes ofproblems, or for data to define their precisenature Society must sometimes act on intu-ition based on experience Such justificationcan be found in the sanitary movement inEurope during the nineteenth century, whengreat advances were made in controllingcommunicable diseases many years beforethe etiological agents were identified and theproblems precisely identified by epidemi-ological science

li-To obtain better data, harmonized andcomparable data collection and managementare clearly needed throughout the Region,based on the use of core indicators of envi-ronmental health The national focal pointshave stressed that, to achieve this objective,they require technical support from theWHO European Centre for Environmentand Health Such information systems can-not be the prerogative and responsibility ofonly one authority They require carefulplanning and continuing collaborationamong the various sectors at all levels.Further, such systems should be designedwith clear objectives Their relevance and ef-

Beyond Concern for Europe’s Tomorrow

Introduction 29

fectiveness can be evaluated by their

ultiliz-ation in the resolution of practical issues

The national focal points have

recom-mended that (a) lessons learned from the

ex-perience of Concern for Europe’s Tomorrow

be fully applied at national and international

levels, and (b) the information collected be

periodically updated and reviewed so as to

provide a more accurate and comprehensive

picture of the environment and health

situ-ation throughout the Region and, as far as

possible, to predict trends

[1] Environment and health The European Charter

and commentary Copenhagen, WHO Regional

References

Office for Europe, 1990 (WHO Regional cations, European Series, No 35).

Publi-[2] The work of WHO in the European Region 1980.

Copenhagen, WHO Regional Office for rope, 1981.

Eu-[3] Health for all targets The health policy for rope Copenhagen, WHO Regional Office for

Eu-Europe, 1991 (European Health for All Series

No 4).

[4] Our planet, our health Report of the WHO mission on Health and Environment Geneva,

Com-World Health Organization, 1992.

[5] Report of the United Nations Conference on vironment and Development, Rio de Janeiro, 3–14 June 1992 New York, United Nations, 1992

En-(document A/Conf 151/26 (Vol 1)).

[6] WHO Global Strategy for Health and ment Geneva, World Health Organization,

Part I

Background

Chapter 1

Economic Sectors

This book provides a situation analysis of

health and the environment in the Member

States of the WHO European Region Owing

to the political changes of recent years, these

countries have nearly doubled in number

and their heterogeneity has become much

more apparent This chapter describes the

basic economic circumstances that largely

determine the conditions and chances for

de-velopment in environmental health in most

of these countries

Further, this chapter briefly outlines some

of the main patterns of economic activity in

the Region whose growth is essential for

human development As both

socioeco-nomic factors and the state of the

environ-ment influence health, information on

over-all economic development, the structure of

economies and other basic data are essential

to an understanding of the mutual

relation-ships between health, the environment and

economic sectors The question as to

1.1 Introduction whether the economic environment, produc-tion and consumption are able and willing to

support sustainable development is one ofthe most important challenges for the future

At the end of the twentieth century, theEuropean Region faces major political, econ-omic, social and environmental changes.Many Member States are in a transitionalphase in their political systems and socioeco-nomic development, as they move from cen-trally planned to market economies Thiscreates special requirements, particularpossibilities and considerable constraints.This chapter highlights some of these in re-lation to the environmental health situation

1.2.1 Basic features and indicators

As of January 1994, the WHO European gion had 50 Member States Of these, 12 are

Re-1.2 The WHO European Region

1.3 An Outlook for the Future 39

34 Economic Sectors

described as countries of central and eastern

Europe (CCEE) and 15 constitute the newly

independent states (NIS) of the former

USSR Together, these two groups are often

called countries or economies in transition,

in reference to the enormous political,

econ-omic and social changes currently taking

place (Table 1.1) While the developed

mar-ket economies of the Region vary, they are

referred to as western countries when being

compared with the CCEE and NIS

Using gross national product (GNP) per

head, the World Bank classified the

coun-tries of the world into four major groups

ac-cording to the level of their economic output

[1] No country of the European Region was

in the first group, the countries with low

in-comes, but 16 were found in the group with

lower-middle incomes (a GNP per head of

US $ 636–2555) in l991 While 10 countries

had upper-middle incomes (US $ 2556–

7910), 19 belonged to the high income group

with a GNP per head of more than US

$ 7910 (Table 1.2)

The populations of countries in the WHO

European Region range from some tens of

thousands to approximately 150 million, and

their areas from some tens of square

kilo-metres to about 17 million Their economicpower is also extremely diverse: the gross do-mestic product (GDP) per year ranges fromsome hundreds of millions of US dollars tomore than US $ 1500 billion.a Taking theGDP per head in the United States in 1991

as 100 %, the GDP per head, in purchasingpower parity, in the countries of the Regionwas estimated to range from 10 % to nearly

99 % [1–3] The countries differ much less intheir scores on the human developmentindex (Table 1.2), which combines three keycomponents (income, knowledge and lon-gevity) to arrive at an average deprivationindex [4] An index of 0.80 or more indi-cates high, 0–0.79 medium, and below 0.50low human development

In 1991, the countries in transition had apopulation of about 410 million, or nearlyhalf of the Region’s total population of 850million For 1991, the World Bank estimatedthe average GNP per head in the middle in-come countries of the Region as US $ 2670,with an average annual growth rate of 0.9 %

in the period 1980–1991 The GNP per head

a 1 billion = 109.

Table 1.1: The central and eastern Member States of the WHO European Region

The WHO European Region 35

Table 1.2: Economic and development indicators for countries of the WHO European Region

36 Economic Sectors

in the high income countries of the Region

was about US $ 11 000–33 000, and the

aver-age annual growth rate of GNP in all the

high income economies was 2.3 % in the

period 1980–1991 The average annual

growth rate of GNP for all countries of the

world was 1.2 % for this period [1]

1.2.2 Development of economic

activities

Economic growth, the main drive of

socioe-conomic development, represents the

aggre-gation of activities in the various economic

sectors Worldwide it has shown

unprece-dented development this century The global

GDP, estimated at US $ 600 billion in 1900,

grew to US $ 5000 billion in 1960 and about

US $ 21 000 billion in 1991 [1,5]

Table 1.3 shows long-term trends in

econ-omic growth in the different regions of the

world The growth of the gross world

prod-uct slowed in the 1980s The decrease was

slight in the developed market economies,

but very significant in both the CCEE and

the NIS, as well as in the developing

coun-tries A fall of more than 50 % in economic

growth in the 1980s and its overall

conse-quences, along with other factors,

con-tributed to the enormous changes in the

CCEE and NIS at the end of the 1980s and

the beginning of the 1990s

Table 1.4 illustrates economic growth in1989–1993 The annual growth of GDP hasconsiderably decreased worldwide since

1989, with negative growth in 1991 andnegative growth per head in 1991 and 1992[6] While GDP grew in the developingcountries, economic growth in the developedmarket economies slowed considerably, re-sulting in growing unemployment and in-flation In addition, the new and disturbingphenomenon of “jobless growth” has be-come more visible [4] and the economies intransition showed an extremely sharp de-cline in output These factors have had con-siderable consequences throughout theEuropean Region, and they affect the medi-um-term economic outlook The optimisticearly expectations for the possibilities af-forded by the political changes in the CCEEand NIS have been significantly modified.Table 1.5 shows the distribution of GDPbetween the different sectors of the econ-omy The data clearly indicate an overall de-crease in the share of agriculture, an increase

in the role of industry in two groups of tries, and a decrease for industry and an in-crease for services in the third

coun-1.2.3 The CCEE and NIS

The domestic economies of the CCEE andthe former USSR were characterized by a

Table 1.3: Economic growth 1971–1900

The WHO European Region 37

lack of market signals, inefficient production

and distribution, lack of incentives to

in-crease productivity, outdated technologies,

the intensive use of natural and other

re-sources, and a seriously degraded

environ-ment The basic objectives of the historic

changes that began in these countries in the

late 1980s can be organized in three main

groups: building a functioning democratic

system, gaining the support of the

popu-lation for the painful transition to

mar-ket-based economic structures, and

design-ing a proper strategy and tactics for forming the economy [7]

trans-The transformation processes have compassed all aspects of the economies andsocieties concerned, although conditions,the pace of change, and its results and prob-lems may differ considerably between coun-tries The broad objectives and direction ofchange are similar everywhere The “short-age economy” characteristic of the previousdecades will cease to exist: the buyer’s mar-ket is to replace the seller’s market and ex-

en-Table 1.4: Percentage annual change in gross domestic product, 1989–1993

Table 1.5: Distribution of gross domestic product between the agricultural, industrial and service sectors in the countries of the WHO European Region, 1970 and 1991

38 Economic Sectors

cess supply is to replace excess demand The

growing number of and choice between

com-modities are expected to help to create

possi-bilities of a higher quality of life for the

people in these countries

Soon after the political changes, the

CCEE and NIS started to act in many fields

The first measures included liberalizing

prices, eliminating subsidies, strengthening

governments’ budgets, controlling the

money supply, regulating wages, devaluating

domestic currencies to stimulate exports,

and opening economies to foreign

competi-tion Later, more systematic measures could

be observed Great changes in ownership

patterns and a basic restructuring of both

economic sectors and institutions became

necessary to deal with the inherited

macro-economic imbalances, distorted prices and

poor behavioural patterns of managers,

workers and consumers, and to speed up

technological development

The establishment of new legal

frame-works for the structural transformation of

the economy and society has proved to be a

time-consuming, difficult task The

imple-mentation of new laws related to

accountan-cy, banking or bankruptaccountan-cy, and many other

economic and social issues, require changes

not only in the theoretical approach but also

in the behaviour of economic agents

Pro-ducers and consumers must make their

deci-sions, actions and responses suitable for a

market-driven environment

The structural, organizational and

owner-ship changes in the economy constitute the

fundamental elements of the current

transi-tion process Old, large state enterprises

have been transformed into several smaller

companies, and a larger number of new and

in general small and medium-sized

busi-nesses have come into being Private

owner-ship has begun to play a decisive role For

example, the number of companies in

Hun-gary that are legal entities rose from 15 000

at the end of 1989 to about 69 000 by the

end of 1992 [8]

The impact of the instruments and

institu-tions of the market economy, however, has

revealed the inefficiency of the former

condi-tions Economic pressure has led to the fastreduction of low-efficiency production, butnew and efficient replacements have not ap-peared equally quickly The trade betweenthe CCEE and the NIS collapsed, whiletrade with the developed market economieshas only started to grow The lack of com-petitiveness of the economies of the CCEEand NIS, coupled with restrictions on tradewith western countries, made it impossible

to offset the enormous losses that occurred.These problems, along with the contraction

of domestic demand in most of the countries

in transition, led to a very sharp decline ineconomic output; this decline is estimated tohave been more than 30 % from 1969 to

1993 [9]

In addition, employment has declined stantially In December 1992, unemploy-ment ranged from 2.6 % in the Czech Repub-lic to 15.9 % in Bulgaria In absolute figures,Poland had 2.5 million unemployed people,Romania 929 000 and Hungary 663 000 [9].The losses of jobs in large enterprises was fartoo great to be absorbed by the smaller pri-vate businesses High rates of inflation arealso a major problem in the countries intransition, although their intensity varies.Unemployment and inflation are major con-tributors to falling standards of living andgrowing poverty in large segments of thepopulation

sub-Economic and social trends in the CCEEand NIS have been less favourable than en-visaged The accumulated developmentneeds in practically every economic and so-cial area, and the high external debt burden

of most of these countries, have createdenormous and increasing needs for re-sources Domestic sources can supply onlypart of these resources, so external financing

is regarded as very important

It is now widely recognized that, despitethe differences between countries, the transi-tion processes will stretch far into the future

In addition, the countries in transition willseek much more international assistance for

a longer time than originally envisaged[10,11]

The transformation process offers

possi-An Outlook for the Future 39

bilities to build environment and health

needs into the overall adjustment

pro-grammes All the CCEE and NIS have put

the correction of the underlying causes of

en-vironmental degradation somewhere on the

political agenda The proper assignment of

priorities is of enormous importance,

par-ticularly in view of the general lack of

re-sources Reducing the immediate threats to

health and improving environmental health

management, while supporting and

influenc-ing economic transformation, should be vital

issues in these countries

Making quantifiable improvements in

en-vironmental health in the CCEE and NIS is

not an easy task To counterbalance both the

accumulated problems and recent negative

experiences, the Environmental Action

Pro-gramme for Central and Eastern Europe,

adopted at the ministerial conference in

Lu-cerne in April 1993, covers both the

elimin-ation of the most urgent environmental

prob-lems and the integration of environmental

concerns into economic decision-making in

the Region [12] Box 1.1 summarizes the

main messages of the plan

1.3.1 Some trends

While making a reliable long-term forecastabout economic trends in the Region is stillvery difficult, important tendencies suggestthe basic path that economic progress mayfollow [14]

• The transition to a more complex and lesspredictable “world political and economicorder” will continue and the leadershiprole of some countries and groups ofcountries will increase

• Differences within and between countriesand groups of countries will continue to

be important factors in internationalpolitics and economics, requiring the in-troduction of special mechanisms to elim-inate the most serious problems and re-duce inequalities

• The economy as such will play an evenbigger role than at present, as military sol-utions for all kinds of problems becomeless feasible

1.3 An Outlook for the Future

Box 1.1: Environmental Action Programme for Central and Eastern Europe

The Programme describes the necessary policy reforms and the short- as well as the er-term investment priorities It forecasts that in the long term, market reforms – es-pecially industrial restructuring – together with appropriate environmental measures willtake care of a large part of the emissions causing health and economic damage in the Re-gion Alternative sources of employment have to be found, however, for workers in ineffic-ient and polluting industries, which need to be closed

long-In the short term, strict sequencing and prioritization of tasks are necessary and ments should address the most serious health problems Measures to deal with problemsparticular to different countries should be ensured, as should support to reinforce and ac-celerate environmental investments by enterprises in response to environmental policies,expenditures for the operation, maintenance, repair and rehabilitation of existing publicenvironmental services, as well as for “win-win” types (both economically and environ-mentally beneficial) of investment and for institution building

invest-The Programme describes the main regional and global environmental concerns, theinstitutional prerequisites to support policies, and the suggested process, means andmechanisms for implementation

Source: World Bank [13].

40 Economic Sectors

• The need for more sustainable

develop-ment will be greater as resources become

depleted, environments polluted and

envi-ronmental consciousness enhanced Such

development requires substantial changes

in production and consumption patterns,

as well as measures to control and

elimin-ate pollution

• Rapid development in science and

tech-nology will continue to create possibilities

for new solutions, and sometimes new

concerns Technological improvements

will result in major shifts in the economy

and the structure of employment

• Energy consumption will increase further,

and energy conservation and efficiency

will play a much greater role than at

pres-ent Biotechnology will continue to

de-velop and require extensive policy and

legal responses With the further

develop-ment of microelectronics, the role of

com-munication networks will be very

import-ant

• There is little ground for assuming that the

rate of economic growth in the Region

will substantially increase in the short

term; unemployment and growing social

problems are expected to continue to be

associated with development in the long

term

• The free movement of labour, goods,

ser-vices and capital investments will be

grad-ually established inside the European

Union (EU); economic growth,

unemploy-ment and widening of the Union will be

the main issues facing EU countries and

institutions

• Decentralization to the local level – with

serious problems, however, in

reorganiz-ing political and economic power

struc-tures, as well as in creating local capacities

– will continue and have an important

im-pact on social policies

1.3.2 Some scenarios

Various scenarios have been prepared for

economic and environmental development

The most recent, which attempt to describe

the main features of economic and mental development in Europe from 1990 to

environ-2010, come from the National Institute ofPublic Health and Environmental Protection(RIVM) in the Netherlands, and are entitledGlobe I and Globe II [15] They are based

on a number of other forecasts, such as the

“conventional wisdom” (used in Globe I)and the “high prices” scenarios (used inGlobe II) of the Commission of the Euro-pean Communities; the “overall economicprojections” of the United Nations Econ-omic Commission for Europe; and the “busi-ness as usual” (Globe I) and the “acceleratedpolicies” (Globe II) scenarios of the Inter-governmental Panel on Climate Change.Other projections on long-term trends weretaken into account; these included the impli-cations of the different EU directives (GlobeI), and the recent proposals for restructuring

EU agriculture (Globe II), the MontrealProtocol on Substances that Deplete theOzone Layer (Globe I) and its Londonamendments (Globe II), and others

Globe I is based on more conservativeviews of future political and socioeconomicdevelopment, and simply extrapolates pres-ent trends Globe II, while being fully feas-ible, assumes the implementation of the bestpolicy options, the use of the best availabletechnology and full international cooper-ation Globe I predicts a 50 % increase inGDP in all the CCEE and NIS and in Turkeybetween 1990 and 2010, while Globe II pre-dicts a 90 % increase Both predict that GDP

in western Europe will grow by 70 % in thisperiod The GDP per head in the CCEE andNIS is predicted to grow from 3300 ECU to

4400 (Globe I) or 5600 ECU (Globe II).Both forecast growth in GDP per head from

6700 to 10 800 ECU

Energy production, transport, formation and use are important contribu-tors to socioeconomic development and thus

trans-1.4 Energy

Energy 41

to health, although they may also result in

the depletion of natural resources,

environ-mental degradation and health impairment

The environmental and health effects of the

energy sector may be exacerbated in the

fu-ture, as energy demand is rising, but

con-comitant improvements in energy

conser-vation and efficiency may slow this trend

1.4.1 Indicators and trends

Table 1.6 shows that the 40 greatest

pro-ducers of energy in 1989 included 13

coun-tries of the WHO European Region, while

the 40 greatest energy consumers included

20 European countries In addition,

Euro-pean Member States comprise half of the 30

countries with the greatest energy

consump-tion per head of populaconsump-tion [3]

In the period 1980–1991, the annual

aver-age growth rate in global energy

consump-tion was 3.8 % in the countries with middle

incomes, but only 1.5 % in the high income

countries Table 1.7 shows the annual

aver-age growth rates for some European

coun-tries between 1980 and 1991 Many of the dustrialized countries of the world reducedthe energy intensity per unit of economicoutput In the Federal Republic of Germany,for example, GNP increased by 60 % be-tween 1970 and 1990, while primary energyconsumption grew by only 16 % andemissions of most air pollutants declined(Fig 1.1)

in-Energy balances and indicators of energyproduction and consumption in the EU,CCEE and NIS suggest significant differ-ences Fig 1.2 shows the actual and pro-jected changes in final energy consumption(that is, consumption of primary and sec-ondary energy by end-use sectors: industry,households, transport, services and agricul-ture) in these three groups of countries be-tween 1985 and 2005 The trends in theCCEE and NIS, however, depend on thepace of economic recovery and the nature ofdevelopment Fig 1.3 shows the actual andprojected changes in energy production.The major energy sources currently used

in western Europe and the CCEE are oil and

Table 1.6: Ranking of WHO European Member States among the 40 greatest producers and consumers of energy in the world, 1989