Growing inequalities in child injury deaths in Europe.

In this short report, we describe and compare mortality data for injuries in children aged <15 years in the WHO European region as estimated by the WHO Global Health Estimates for 2000 and 2011. Child injury deaths have decreased overall. Mortality rate ratios between low- and middle-income countries (LMIC) and high-income countries in the region show an increase in relative inequalities for childhood deaths from unintentional injuries and a narrowing from intentional injury. This growing inequality in unintentional injury is a public health concern and calls for renewed efforts to reduce childhood injuries in LMIC the region.

Progress in preventing injuries: a content analysis of national policies in Europe.

The aim of this paper is to provide a content analysis of national policies to address violence and injury prevention in the World Health Organization (WHO) European Region so as to inform where future improvements can be made. Multiple search methods were used to identify national policies for violence and injury prevention. Application of a framework based on a WHO guide was used for policy analysis. A multiple correspondence analysis (MCA) was additionally conducted. One hundred and twenty-three national policies were identified; of these, 80 were available in English language and analysed further. Most national policies had been developed after 2003. The majority of policies fulfilled most of the WHO criteria for effective policy-making. Policy areas requiring improvement include quantifying objectives, targeting the socio-economic gap in injury burden and increased focus on primary prevention. Results from the MCA confirmed the ones obtained with the descriptive statistics. Encouraging progress is being made in formulating national policy for violence and injury prevention within the WHO European Region. There are specific areas that warrant increasing attention in future policy development.

European facts and the Global status report on violence prevention 2014

This regional fact sheet is published with the first Global status report on violence prevention 2014 and assesses measures countries are taking to prevent violence. Data were collected in 41 of the 53 countries of the WHO European Region and new global, regional and national estimates of homicide were computed. The findings show that nearly 35 000 people were victims of homicides in 2012. Those most at risk are males aged 30–59 years. The non-fatal effects of violence are enormous and far-reaching and pose a strain on health systems and societies. More data-informed national plans need to be developed in the Region. Countries are investing in solutions to prevent violence, but scaling-up is urgently required. Laws to protect against violence have been widely enacted, but reported enforcement is inadequate and needs to be improved. Health systems need to take the lead on developing quality services to identify, refer, protect and support victims. Policy-makers and practitioners from different sectors need to work together to implement evidence-informed solutions that focus on equity and the life course approach.

European report on preventing child maltreatment

Child maltreatment is a leading cause of health inequality, with the socioeconomically disadvantaged more at risk. It worsens inequity and perpetuates social injustice because of its far-reaching health and development consequences. Inspite of child maltreatment being a priority in most countries in the WHO European Region, few have devoted adequate resources and attention to its prevention. This report outlines the high burden of child maltreatment, its causes and consequences and the cost−effectiveness of prevention programmes. It makes compelling arguments for increased investment in prevention and for mainstreaming prevention objectives into other areas of health and social policy, reflecting the whole-of-society approach promoted by Health 2020 and the need for increased intersectoral working and coordination. The report offers policy-makers a preventive approach based on strong evidence and shared experience to support them in responding to increased demands from the public to tackle child maltreatment. Prevention programmes that stop maltreatment from occurring in the first place and reduce children’s exposure to adversity have wide-ranging public health and societal benefits.

Health impact assessment of waste management facilities in three European countries.

BACKGROUND: Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely unknown. We conducted a health impact assessment of landfilling and incineration in three European countries: Italy, Slovakia and England. METHODS: A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km of an incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined with air pollution dispersion modelling for particulate matter (PM10) and nitrogen dioxide (NO2). For incinerators, we estimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributable cases of congenital anomalies and low birth weight infants. RESULTS: About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England, respectively. The additional contribution to NO2 levels within a 3 km radius was 0.23, 0.15, and 0.14 µg/m3, respectively. Lower values were found for PM10. Assuming that the incinerators continue to operate until 2020, we are moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0, and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, the attributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. The total exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderately confident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3 whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively. CONCLUSIONS: The current health impacts of landfilling and incineration can be characterized as moderate when compared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact on public health. There are several uncertainties and critical assumptions in the assessment model, but it provides insight into the relative health impact attributable to waste management.

Inequalities, inequities, environmental justice in waste management and health.

BACKGROUND: The scientific evidence on the health effects of waste-related exposure is not conclusive. Differential exposure to waste by socio-economic status (SES) is often documented, but the interplay between environmental and social factors, crucial for policy making, is not well known. This review aims at investigating the role of health inequalities and inequities in waste management. METHODS: Grey and peer-reviewed literature, published after 1983, was reviewed from Europe and the USA. RESULTS: Available data provide consistent indications that waste facilities are often disproportionally more located in areas with more deprived residents, or from ethnical minorities. This applies to waste incinerators, landfills, hazardous waste sites, legal and illegal. In studies considering health effects (mainly from Europe), risks are estimated with standardization for SES. Such standardization almost always decreases risk estimates for several cancers and reproductive outcomes. However, effect modification is not investigated in these studies. CONCLUSIONS: The patterns of association between waste-related environmental pressures and SES suggest that some of the observed inequalities in exposure and health represent a case of environmental injustice as they are the result of social processes and may be prevented, at least partly. Disentangling the possible health effects remains difficult, due to limitations in the methodology. It seems important to investigate if disadvantaged people are more vulnerable, i.e. risks differ in different social groups living in the same area. Notwithstanding these open questions, public health officers and decision makers should identify waste management policies to minimize their potential health impacts and their unequal distribution.

Health impact of PM10 and ozone in 13 Italian cities

Over the last few decades, the evidence on the adverse effects on health of air pollution has been mounting. A broad range of adverse health outcomes due to short- and long-term exposure to air pollutants are established. This report estimates the health impact of PM10 and ozone on urban populations of 13 large Italian cities. To do so, concentration–response risk coefficients were derived from epidemiological studies, and 25 adverse health outcomes and different exposure scenarios were considered. The health impact of air pollution in Italian cities is large: 8220 deaths a year, on average, are attributable to PM10 concentrations above 20 μg/m3. This is 9% of the mortality for all causes (excluding accidents) in the population over 30 years of age; the impact on short-term mortality, again for PM10 above 20 μg/m3, is 1372 deaths, which is 1.5% of the total mortality in the whole population. Hospital admissions attributable to PM10 are of a similar magnitude. Also, the impact of ozone at concentrations higher than 70 μg/m3 amounts to 0.6% of all causes of mortality. Higher figures were obtained for the effects on heath that result in morbidity. The magnitude of the health impact estimated for the 13 Italian cities underscores the need for urgent action to reduce the health burden of air pollution. Compliance with European Union legislation can result in substantial savings, in terms of ill health avoided. Also, local authorities, through policies that aim mainly to reduce emissions from urban transport and energy production, can achieve sizeable health gains.