Reaching the sustainable development goals through healthy environments: are we on track?

The adoption of the 2030 Agenda for Sustainable Development in 2015 opened new opportunities to work towards healthy environments through 'whole of government' and 'whole of society' approaches. It created a strong policy platform that acknowledges health as a result and an enabler of sustainable policies across all sectors of government. Five years into the process, an initial analysis of emerging trends indicates that, despite some encouraging developments in policy as well as overall progress in economy and technology, there remains a gap between rhetoric, ambition and reality. In particular, the monitoring system for environment and health-related sustainable development goals (SDGs) and targets requires further development; inequalities in environment and health persist and in some areas have increased; equity is not yet a central element of implementation and reporting on the achievement of the SDGs; and, most worrying of all, trends in key environmental indicators that are vital to the survival of the human species, such as those related to climate change and biodiversity, are still on an overall negative path. In summary, governments must significantly and rapidly increase action to secure the habitability and safety of planet Earth. The public health community assumes an unprecedented role in placing and maintaining health and equity at the heart of the political agenda. This demands new governance models conferring on the health sector a clear mandate and legitimacy to operate across sectors. It also requires enhancing capacities among health professionals to embrace this new level of complexity, understand the multiple links between sectoral policies and health, and successfully engage with other government sectors and stakeholders.

[Disparity on the grade of exposure to ecological risks in the European region of WHO].

Disparity in relation of ecological conditions and health concerns to the general differences in environmental conditions and in large extent is stipulated by socio-economic and demographic differences in the impact of its hazards. In addition to differences in the impact the inequality in relation of ecological conditions and health can also be caused by social or demographic differences in exposure to certain risks. This article offers an assessment of the evidence and data on differences in the impact of the environment in the European Region of the World Health Organization (WHO) received during the recent work of the European Regional Office of WHO. The obtained results testify that socio-demographic disparity in the impact of the environment exists in all countries. Such inequality can be seen in respect of a variety offactors, such as age, gender income level, or on the contrary, poverty, education and employment, household type, location of the home.

[The value of housing conditions and urban environment for the health].

Housing and urban environments represent the physical context for everyday life and have a significant impact on population health and well-being. Depending on the quality of housing and urban conditions, they can support or restrict the health of their residents through a variety of aspects such as air pollution, noise, thermal conditions, safety aspects and environmental contamination. Therefore, housing and urban conditions are important dimensions for environmental health and knowledge on the main risk factors and their associated health effects is needed to identify adequate interventions and measures in the home and urban environment. This paper summarizes the results of WHO work on the health relevance of housing and urban environments and describes the health impact of the major risks observed in human settlements.

[Summary of ongoing activities on environmental noise and health at the WHO regional office for Europe].

The environmental noise is an important public health issue, according to recent assessment of the burden of diseases among environmental health risk factors in order of importance the environmental noise occupies the second place after air pollution. The World Health Organization (WHO) for the first time published its public health recommendations for the environmental noise in 1999 in the "WHO Guidelines for Community Noise (1999)". These recommendations found their development in WHO Night Noise Guidelines for Europe" (2009). From then onward there have been published new important data on the impact of the environmental noise on the health, that stipulated the revision of existing guidelines. Furthermore, both in the European Union (EU) Directive 2002/49/ EC and the Parma Declaration from 2010 there was pointed out the importance of renewal environmental noise recommendations. Responding to appearing interrogation, WHO Regional Office for Europe has recently initiated the process of the elaboration of new guiding principles known as "WHO Environmental Noise Guidelines for the European Region". The Guidelines will include a systematic review of most critical or important health consequences and also concentrate on health benefits of measures for the reducing noise levels. The Guidelines will consider noise coming from various noise sources such as aircraft, railroad, personal electronic devices and wind turbines. The Guidelines will also consider the particularity of such accommodations as residences, hospitals, and educational facilities. The work in the mentioned spheres is ongoing and the revised Guidelines are expected to be published in mid-2015. The Guidelines will provide up-to-date information on the health risks related to the environmental noise and evidence-based recommendations in order to support for WHO Member States in their efforts to prevent of the excessive noise and the struggle with their negative impact.

Mortality associated with exposure to carbon monoxide in WHO European Member States.

In closed environments, the concentration of carbon monoxide (CO) can easily rise to health-threatening levels. CO-related incidents are often caused by poor condition or inappropriate use of indoor combustion devices as well as structure fires but are also due to suicides. To evaluate the incidence of CO poisoning in Europe, national data on CO-related mortality and morbidity were compiled from Member States of the WHO European Region using a standardized data collection form. National data on CO poisoning were provided by 28 Member States. Within the maximum reporting period (1980-2008), a total of 140 490 CO-related deaths were reported (annual death rate of 2.2/100 000). The number of hospital admissions available from six countries was 31 473. Unintentional CO deaths accounted for 54.7% of the CO-related deaths (35.9%: unintentional inhalation; 18.8%: related to structure fires). The intentional deaths related to CO exposure account for 38.6% of all CO-related deaths (38.1%: suicides; 0.5%: homicides). CO exposure is preventable but causes a substantial amount of deaths in many European countries. More efficient measures and policies to prevent CO poisoning and better reporting of CO mortality are necessary.

[The potential of the member states of the European Region of WHO in the field of prevention of adverse effects of chemicals on human health and measures for its strengthening].

The issue of providing chemical safety for the population, and especially for the most vulnerable groups remains to be actual in relation to the significant contribution of the impact of hazardous chemicals in the forming of morbidity rate, industrial growth and return of chemical products, rapid development and introduction of new technologies. The international community has adopted a series of mandatory and voluntary initiatives in the field of chemical safety. Strategic document for the WHO European Region, determining priorities in this area, is the Parma Declaration. Implementation of a wide range of arrangements set out in the Declaration requires sufficient capacity of the health sector and other concerned parties, the scope of which is addressed to aspects of healthcare from exposure to hazardous chemicals. Performed by the WHO European Centre for Environment and Health (ECEH) the assessment of existing in this area capacity based on the survey permitted to identify significant gaps in the legislative regulation, policies and planning, human and technical resources, the collection and exchange of information, education and training. With the participation of national experts ECEH developed a set of recommended measures aimed to the creation and strengthening the potential. Development and implementation of effective national strategies/plans/actions with regard to regional priorities and recommended actions will allow to increase the level of chemical safety for the population of the region as a whole.

[The main conclusions about the medical aspects of air pollution: the projects REVIHAAP and HRAPIE WHO/EC].

For the time present the World Health Organization (WHO) is coordinating two major international projects aimed to provide the European Union (EU) with science-based information on health aspects of air pollution for a comprehensive analysis of EU policy in the field of air quality, scheduled for 2013. The information provided is structured in the form of answers to 26 policy-forming key questions, defined by the European Commission (EC). The questions cover the both general aspects that are important for air quality management, and also specific topics related to the health effects of certain air pollutants. Texts of the answers to the questions were provided on requests of large group of invited experts from leading specialized institutions around the world. First stages of the overview of existing data have shown that in recent years there has been published a significant amount of information proving adverse health effects of suspended particulate matter (PM), ozone (O3) and nitrogen dioxide (NO2) in an amount, which typically occurs in the air in Europe. These new data confirm the findings reported in renewed in 2005 WHO Guidelines for Air Quality (GAQ), and show that the negative health effects in some cases may take place at concentrations of aeropollutants in the air below mentioned in the GAQ in 2005. In the review there are presented the scientific arguments in favor of adoption of strong measures to improvement air quality and reduction of the burden of diseases associated with air pollution in Europe. The conclusions formulated within a framework of these projects, are equally referred to all Member States and can become a basis for the development and implementation of effective strategies to reduce air pollution and reduction of its negative impact on the health of the population.

Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis.

BACKGROUND: As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity. OBJECTIVES: To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions. DATA SOURCES: Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS. STUDY APPRAISAL AND SYNTHESIS METHODS: Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research. RESULTS: Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised.

Routine stair climbing in place of residence and body mass index: a pan-European population based study.

OBJECTIVE: Stair climbing is highlighted as a component of a regiment of daily physical activity by various health agencies. This study examined the association between daily stair climbing, as measured by floor of residence in buildings without elevators, and body mass index (BMI). METHODS: We analyzed data from a cross-sectional survey of housing and health, conducted by the WHO in eight European cities in 2002 and 2003. BMI was computed from self-reported height and weight; respondent and housing characteristics were also included in regression models that accounted for the clustering of respondents within the same household. RESULTS: Among 2846 normal weight adults, there was an interaction between floor of residence and sex (P=0.017). Among men, residence on a higher floor was significantly associated with lower BMI (P=0.003); BMI of men residing on the fourth floor or above was 0.88 lower than men residing on the first floor. Among women, there was no significant association between floor of residence and BMI (P=0.161). CONCLUSIONS: These results suggest an association between daily stair climbing and BMI among men but not among women. If replicated, these results support initiatives encouraging stair climbing as a path toward physical fitness among men.

Noise-induced annoyance and morbidity results from the pan-European LARES study.

Traffic noise (road noise, railway noise, aircraft noise, noise of parking cars), is the most dominant source of annoyance in the living environment of many European countries. This is followed by neighbourhood noise (neighbouring apartments, staircase and noise within the apartment). The subjective experience of noise stress can, through central nervous processes, lead to an inadequate neuro-endocrine reaction and finally lead to regulatory diseases. Within the context of the LARES-survey (Large Analysis and Review of European housing and health Status), noise annoyance in the housing environment was collected and evaluated in connection with medically diagnosed illnesses. Adults who indicated chronically severe annoyance by neighbourhood noise were found to have an increased health risk for the cardiovascular system and the movement apparatus, as well as an increased risk of depression and migraine. Furthermore adults with chronically strong annoyance by traffic noise additionally showed an increased risk for respiratory health problems. With regards to older people both neighbourhood and traffic noise indicated in general a lower risk of noise annoyance induced illness than in adults. It can be assumed that the effect of noise-induced annoyance in older people is concealed by physical consequences of age (with a strong increase of illnesses). With children the effects of noise-induced annoyance from traffic, as well as neighbourhood noise, are evident in the respiratory system. The increased risk of illness in the respiratory system in children does not seem to be caused primarily by air pollutants, but rather, as the results for neighbourhood noise demonstrate, by emotional stress.