A serious review of what is and what is not routinely collected needs to be undertaken, and updated to twenty-first century needs. This requires United Nations supervision to insure data compatibility, since it is often important to be able to make international comparisons of statistics in order to identify causal or potentially causal agents of disease. Once a core of important health indicators has been identified, each Nation should be encouraged to incorporate this core into its routine Vital Statistics, with whatever additional information may be required for local or regional use. This standardized core collection should then be made public through the UN.
Such a data base is essential for planning. Proposed new projects need to build on information gathered on related projects already operating somewhere in the world. Humans tend not to have major differences in types of response to noxious agents, although they may differ in degree of response. Environmental Health Impact Assessment needs to be included in all planning if there is to be pollution control, disease prevention and sensible abatement measures. There has been no action, to my knowledge, on this basic well documented need since it was proposed at the Rio conference. The call for statistics based on practical, standardized indicators was explicit in (6.36). Even in developed countries such meaningful collection of information is rare and isolated, and often expensive epidemiological studies must be mounted to obtain it. With a little thought and planning, monitoring of key indicator illnesses could become routine.
Current failure to collect meaningful data means that polluter's promises of "no harm" are rarely checked against reality. This favors the continuation of the status quo, and throws the burden of proof of harm on the victim, who usually lacks the resources or training to undertake such a task. Documenting harm of the cigarette has for example, required some 60 years of research by many Universities and Cancer Centers. It is unreasonable to place the burden of proof of harm on the isolated smoker.
Another negative outcome of the laissez faire approach to environmental health monitoring is that safer alternatives to risky industrial and technological projects goes unexplored and research into alternatives is unfunded. Only after harm is incontestably documented is there any movement. A shocking example of this can be seen in the dispute over automobile air bags. They were designed to save a large tall and heavy male from the impact of a collision. Since their implementation, fifty one "people" have died, 34 children and almost all of the rest were women shorter than 5'4" (163 cm). After a man died because he was leaning forward, trying to tune his radio, the automobile industry started to look into the problem. The warning which have been released by public health departments typically "blame the victim" who may have put a child in the front seat, or did not move the driver's seat back as far as it would go, etc. There is considerable resistance to reducing the force of the deployed air bag, probably because this would reduce its effectiveness for the large strong male. Fortunately, being decapitated by an air bag is a "first cause of death", reportable in official vital statistics and the public has been alerted to the danger. Killing a child with insecticide spray is not so obvious, but the tragedy is just as great. This latter event may require thousands of deaths and millions of dollars of research to capture the attention of the public.
Reducing or Eliminating Environmental Health Problems:
Once an environmental health problem has been discovered, documented and quantified by a dose-response estimate, one can begin to control exposures to a "safe" level, or eliminate as much as possible exposures to the noxious agent. This means that one must agree on a reasonable definition of "safe", and set standards so that this safe limit is unlikely to be exceeded in normal uses of the environment.
For many years a "safe industry" has been defined as one which kills no more than one member of the public per million exposed to it per year. There are movements today in developed countries to allow a more liberal one fatality per hundred thousand, or one fatality per ten thousand per year. The criteria needs to be standardized, since in the popular use of "safe" there needs to be only one clear meaning. For example, in Ontario, a safe level of toxic chemicals in drinking water is based on the likelihood that it will cause no more than one fatal cancer per million in the public, if each one drinks a liter per day for a year. The safe level of tritium, a radioactive product discharged into water from nuclear reactors, however, is deemed to mean that only fifty fatal cancers will be caused under the same conditions. This deceives the public since "legal" is assumed to have the same level of "safety" for all noxious substances.
In Agenda 21, there is a discussion of international standards in (6.39) which indicates sensitivity for the value judgements which underlie standard setting, universal applicability of standards, and validity of standards set in the developed world for use in the developing world. This recognizes, for example, that standards set for workers who are Caucasian, 20 to 30 years of age, and in good health, may be inappropriate for Asians, who have a different body build and may be exposed to higher levels of infectious diseases. These differences could be accommodated if local or regional groups had the option of setting more (but not less) restrictive standards.
There are other problems related to standards setting. Under ACTIVITIES. M (ii) in section (6) of Agenda 21, there is a call for interdisciplinary research on the combined health effects of exposure to multiple environmental hazards, including epidemiological investigations of long-term exposures to low levels of pollutants and the use of biological markers capable of estimating human exposure, adverse effects and susceptibility to environmental agents. I know of no governmental effort to implement these suggestions, although they are very important to sustainability of any project. Locating a nuclear power plant in an area which is already trying to cope with a toxic waste dump would be foolish, but environmental impact assessments, unlike health impact assessments, do not consider the stresses caused by other industries or technologies in the vicinity of a proposed plant. Each plant is judged in isolation. Biological markers of an already stressed population might be an abnormally high incidence of asthma in children, or a significantly shifted mean for lymphocyte counts.
Means of Implementation of Environmental Health Goals:
Under MEANS OF IMPLEMENTATION, C), Agenda 21 stresses the need to teach environmental health in secondary schools and universities, and to train professionals in this field. Health Canada has active programs in this area. There is some small effort in the United States. The Women of Europe for A Common Future, based in the Netherlands, have probably progressed further than any other group with which I have worked, but they are an NGO. Certainly, education needs to follow identification of hazards, and needs to reinforce standards. All of these initiatives for a better future need to work in tandem, and they need to support of local, national and international bodies.
Need for New Institutions:
In order to achieve the Agenda 21 goals, Section 38 is devoted to International Institutional Arrangements. This ambitious Agenda 21 programme allows for development of existing UN agencies, and strongly recommends involvement of NGO's, "particularly women's groups" (38.14). Institutional development has not been holistically and creatively dealt with since Rio.
I believe that progress on the above important environmental health issues has been very slow due to some structural weaknesses built into Agenda 21:
It calls for a High Level Advisory Body: "consisting of eminent persons knowledgeable about environment and development, including relevant sciences, appointed by the Secretary General in their personal capacity." I believe that such an advisory body is key to the overall success of the Programme, and should be constituted as a permanent group of highly qualified persons in diverse but relevant fields of expertise. I would suggest an International Environment Agency (IEA), of the stature of the World Trade Organization. They should be selected, and rotated, by professional organizations relevant to the required expertise, not appointed informally by the Secretary General. Many of the most important tasks for implementing Agenda 21 are given to UNEP (38.22), which is an excellent agency for implementation of programmes internationally because of its broad contacts and its good reputation globally. However, UNEP is ill equipped to discuss the scientific basis of standards, or to resist global pressures to reduce health and environmental quality in favor of trade considerations. The sciences of environmental assessment, health assessment, and risk analysis for the international community is a full time job, not an extra which could be picked up by an already over worked agency like UNEP. Other parts of Agenda 21 are assigned to UNDP (38.24), which is asked to coordinate with UNEP. I would suggest that these two agencies be coordinated through the International Environment Agency recommended above.
Standard setting for toxic and hazardous materials in the environment has in the past been primarily based on the work place experience of white, middle class, young healthy males. It is therefore inappropriate in most cases for women and children, persons of different body build and genetic inheritance, persons suffering from malnutrition or serious illnesses, or for protecting the ecosystem. In spite of these problems, most current environmental health standards are derived from the occupational health studies of the developed Western world. A serious review of all currently used standards, and clarification of their health base, should be the first work of a new International Environment Agency. This agency will have to resolve many problems such as the biological endpoint which needs to be protected and the level of protection deemed to be sufficient.
Serious disputes over the definitions of "detriment" occur, for example in the nuclear industry "detriment" is defined as a cancer death while in organophosphate regulation subtle developmental deficits caused by exposure of the fetus are considered to be "detriments" to be avoided. Occupational health specialists in Eastern European countries consider keeping workers in a chronic state of stress to be a detriment, while in the West, overt illness or permanent disability must be demonstrated. Moreover, in the competitive economic climate of world trade, protection of health and environment is considered a "cost" of production leaving the conscientious producer at a disadvantage in the marketplace. Sometimes good environmental practice is labeled a barrier to trade.
A competent international professional agency is needed to determine acceptable standard setting to protect human health and the global environment. It must be independent of vested interests with respect to the pollutants regulated and national interests. Members should take an oath to work for the common good, i.e. they should belong to a global public sector.
The only organization which currently recommends international public and worker health standards is the International Commission on Radiological Protection (ICRP). This is a self- appointed and self-perpetuating NGO composed of users of ionizing radiation and national regulators of countries having nuclear programmes. ICRP could well be dissolved in favor of the IEA, which would have appointments to membership from professional organizations, membership terms, occupational, public health and toxicology specialists. The ICRP admits to recommending risk benefit trade-offs, rather than setting standards fully protective of human health. It make no attempt to address harm to ecosystems or to the general environment.
Because of the circulation of air and water on the planet earth, most environmental disputes are international in nature. The IEA needs to be related to an International Court of the Environment, a specialized court of the International Court of Law. A description of this court has been advanced by Judge Amedeo Postiglione, of the Supreme Court of Italy. It needs not have further development here. (Contact for the International Court of the Environment Foundation and Judge Postiglione in Rome is: Tel: +39-6- 686 85 97 or Fax: +39-6-683 007 83).
The IEA would have a broadly defined and difficult task. It would need to encompass the micro problems of toxic chemicals in aerosol releases and the macro problems of fishery depletion. The frustration of unclear international standards for environmental protection are evident in many recent disputes, for example, over-fishing on Canada's Grand Banks off of Newfoundland, or over the disposal of weapons grade plutonium through burning it in civilian nuclear reactors.
There can be no sustainable development if the health and genetic integrity of humans, the ecosystem and the environment which supports all forms of life on this planet are compromised. Until there is a central agency with responsibility for setting guidelines and a court for resolving disputes, problem solving will continue to revolve around questions of economics, competition, trade and political power. In a risk vs. benefit climate, such as is created by aggressive capitalism, the players who will receive the benefits (governments and industry) should not be asked to also describe the risks (to the public, the environment and future generations). They will tend to exaggerate the benefits and minimize the risks, within a restricted "world" defined for handling the problems they perceive. It will require a strong and independent voice for human survival, future generations and the environment to provide a countervailing force to the force of trade and corporate profits.
Policy gaps have already been noted with respect to the weak structure recommended by Agenda 21: no permanent expert voices, no court for resolving disputes, and no stature for this issue in the marketplace comparable to that of the World Trade Organization.
Local governance could strengthen the sustainability criteria by better collection of data, in standardized internationally compatible form, to provide early warning of trouble and feedback on the true impacts of policy decisions. Adoption of the Healthy City Model, promoted by the World Health Organization, educational efforts to both inform the public and train professionals in environmental health, and serious interaction with the proposed International Court of the Environment would be helpful. The Court proposes itself to be open to cases brought by NGO's as well as nation states. NGO's need to be alerted to support this concept.
Establishment of an International Environment Agency and an International Court of the Environment, as has been proposed and is evolving under the leadership of Judge Postiglione of the Supreme Court of Italy represents an important initiative. The acceptability of the product of this initiative is the responsibility of all who care to see Agenda 21 spawn a flowering of global society in new and sustainable directions.
Specific Recommendations:
For more information, contact:
Rosalie Bertell, PhD, GNSH
International Institute of Concern for Public Health
Suite 710, 264 Queens Quay W.
Toronto, ON M5J 1B5
Tel: (416) 260-0575
Fax: (416) 260-3404
Email: 103062.1200@compuserve.com