Dual system of water safety plan auditing in Hungary: benefits and lessons learnt.

A risk-based approach is recognised worldwide as the most reliable means for the provision of safe drinking water. Efficient implementation of the water safety plan (WSP) approach, recommended by the World Health Organization (WHO), is facilitated by an auditing framework. In Hungary, development of WSPs is a legal obligation for water suppliers. WSPs are subject to a two-stage regulatory audit, a consultative central technical audit and a formal local audit. In 2019, a survey was conducted in cooperation with WHO to evaluate audit experiences of over 1,200 WSPs. Recommendations from the central audit significantly improved coherence and compliance of WSPs, confirming the efficiency of the dual approach. The use of a WSP template provided by the national authority further increased consistency and reduced time and work demand of the audit. Both water suppliers and public health authorities indicated a need for further capacity building on WSP development and auditing. The main challenge for water suppliers is the identification and risk assessment of hazards associated with the water source and distribution within premises. The recast European Union drinking water regulation is expected to accelerate the uptake of WSP and strengthen linkages to water catchment management and water safety in buildings.

Water, sanitation, and hygiene services in health care facilities in the Autonomous Province of Vojvodina, Serbia.

Provision of safe water, sanitation, and hygiene (WASH) services in health care facilities is a priority at the global, national, and local levels. To inform improvements planning, conditions of WASH, waste management, and environmental cleaning were assessed in 81 facilities in the Autonomous Province of Vojvodina, Serbia, as part of a nationally representative survey in 2019. The survey included on-site checks, structured interviews, and drinking-water quality analysis. WHO/UNICEF indicators for WASH service levels and an advanced service level defined at the national level were applied. The results showed that all investigated facilities provided basic water services; 94% of facilities provided basic hygiene and waste management services; 58 and 2%, respectively, provided basic cleaning and sanitation services. Only 1% of investigated facilities met the basic level for all five WASH dimensions. Advanced service levels were only met for hygiene, waste management, and/or cleaning in 15-38% of facilities. In 33% of health care facilities, drinking-water quality was not in compliance with the national standards. The results revealed that there is a need for increased awareness and efforts to ensure basic provisions for sanitation, environmental cleaning, and drinking-water safety.

Montenegro makes important strides towards achievement of the SDGs.

In 2018, Montenegro took an important step towards ratification of the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. A multisectoral national consultation provided a forum where national stakeholders could assist in related decision-making. The Protocol is the first and only multilateral legal agreement linking sustainable water management and the prevention, control and reduction of water-related diseases in the pan-European region. It was adopted in 1999 at the Third Ministerial Conference on Environment and Health in London and entered into force in 2005 as legally binding for the ratifying countries. To date, 26 countries have ratified it, covering about 60% of the population of the pan-European region. Montenegro is on the way to becoming the next country to ratify it and has used it as an instrument to strengthen national action towards progressively reaching regional and global WASH-related commitments, specifically in relation to SDG 3 (good health and well-being), SDG 6 (clean water and sanitation) and the Ostrava Declaration on Environment and Health (2017).

Implementation and evaluation of the water safety plan approach for buildings.

The World Health Organization (WHO) promotes water safety plans (WSPs) - a risk-based management approach - for premise plumbing systems in buildings to prevent deterioration of drinking-water quality. Experience with the implementation of WSPs in buildings were gathered within a pilot project in Germany. The project included an evaluation of the feasibility and advantages of WSPs by all stakeholders who share responsibility in drinking-water safety. While the feasibility of the concept was demonstrated for all buildings, benefits reported by building operators varied. The more technical standards were complied with before implementing WSP, the less pronounced were the resulting improvements. In most cases, WSPs yielded an increased system knowledge and awareness for drinking-water quality issues. WSPs also led to improved operation of the premise plumbing system and provided benefits for surveillance authorities. A survey among the European Network of Drinking-Water Regulators on the existing legal framework regarding drinking-water safety in buildings exhibited that countries are aware of the need to manage risks in buildings' installations, but experience with WSP is rare. Based on the successful implementation and the positive effects of WSPs on drinking-water quality, we recommend the establishment of legal frameworks that require WSPs for priority buildings whilst accounting for differing conditions in buildings and countries.

Priorities for protecting health from climate change in the WHO European Region: recent regional activities.

Evidence of the impact of climate change on health is growing. Health systems need to be prepared and gradually adapt to the effects of climate change, including extreme weather events.Fossil fuel combustion as the driver of climate change poses a tremendous burden of disease. In turn, cutting greenhouse gas emissions in all sectors will achieve health co-benefits. If all countries meet the Paris Agreement by 2030, the annual number of avoidable premature deaths could total 138,000 across the entire European Region of the World Health Organization (WHO).Several international frameworks promote a stronger commitment by countries to implementing the necessary adaptations in the health sector and to addressing health considerations in adaptation measures in other sectors. The WHO has a mandate from its member states to identify solutions and help prevent or reduce health impacts, including those from climate change.National governments are continuing to establish public health adaptation measures, which provide a rationale for and trigger action on climate change by the health community. Effective national responses to climate risks require strategic analyses of current and anticipated threats. Health professionals need to play a proactive role in promoting health arguments and evidence in the formulation of national climate change adaptation and mitigation responses. To this end, country capacities need to be further strengthened to identify and address local health risks posed by climate change and to develop, implement and evaluate health-focused interventions through integrated approaches. Building climate-resilient and environmentally sustainable health care facilities is an essential pillar of health sector leadership to address climate change.

Tracking progress on health and climate change in Europe.

Left unabated, climate change will have catastrophic effects on the health of present and future generations. Such effects are already seen in Europe, through more frequent and severe extreme weather events, alterations to water and food systems, and changes in the environmental suitability for infectious diseases. As one of the largest current and historical contributors to greenhouse gases and the largest provider of financing for climate change mitigation and adaptation, Europe's response is crucial, for both human health and the planet. To ensure that health and wellbeing are protected in this response it is essential to build the capacity to understand, monitor, and quantify health impacts of climate change and the health co-benefits of accelerated action. Responding to this need, the Lancet Countdown in Europe is established as a transdisciplinary research collaboration for monitoring progress on health and climate change in Europe. With the wealth of data and academic expertise available in Europe, the collaboration will develop region-specific indicators to address the main challenges and opportunities of Europe's response to climate change for health. The indicators produced by the collaboration will provide information to health and climate policy decision making, and will also contribute to the European Observatory on Climate and Health.