Developing national environmental health action plans

The preparation of a National Evironmental Health Action Plan (NEHAP) helps to develop a common understanding of environmental health issues across a broad spectrum of government ministries, national and local authorities, environmental and health authorities and the public within a country. The process brings together the environment and health sectors in areas of common problems leading to an integrated approach. Developing a NEHAP leads to savings by improving the prioritisation of schemes by demonstrating the additional benefit that many health oriented schemes can bring to environment oriented schemes and vice versa.

A NEHAP is by definition an action plan. Its principal purpose is to set out the actions that a country intends to take to improve environmental health, that is, for any topic area, the actions for closing the gap between the objectives and the situation report. A NEHAP will contain commitments to undertake certain environmental health measures.

The following considerations could affect the form and presentation of a NEHAP: (a) is the plan intended to be a legal or political document? (b) is the plan intended to represent a consensus view? (c) does it fairly reflect the differences (whether views, powers or responsibilities) between central and local authorities and agencies? does it take account of resources? (d) will it promote a sense of national ownership?
Almost all NEHAPs have followed the outline and approach presented in the Environmental Health Action Plan for Europe, which reflects WHO's health for all strategy, the Environmental Programme for Europe of the United Nations Economic Commission for Europe and the EU's Fifth Environmental Action Programme. All NEHAPs have been prepared as an official document of the central government and adopted either by the cabinet or by the parliament.

Many actors have roles to play. Central government authorities have three essential tasks: to improve policy instruments for the environment and health; to develop a strategy for implementing the NEHAP; and to manage, on a continuing basis, the framework for implementing the NEHAP. Regional and local authorities are the main actors in the practical implementation of NEHAPs.

By signing the "Declaration on Action for Environment and Health in Europe", which was adopted by the European ministers of health and the environment at their meeting in Helsinki in 1994, European nations undertook to present by 1997 national action plans designed to reduce environmental health risks.

Most of the countries in principle have followed a seven-step planning process: (a) government commitment to proceed; (b) environmental health assessment; (c) public consultation; (d) implementation strategy; (e) framework for planning; (f) government position on priority actions; and (g) finalizing and adopting an action plan.

The Environmental Health Action Plan for Europe (EHAPE) sets out a range of actions for consideration within a NEHAP though the list is not intended to be comprehensive. Any action that would apply would need to be tailored to the particular circumstance of a country. It divides consideration of environmental health for action in countries into the following principal areas: (1) Institutional framework; (2) Environmental health management tools; (3) Specific environmental hazards; (4) Living and working environments; (5) Economic sectors; and (6) International actions. The EHAPE subdivides each of the principal areas into more manageable, discrete topics. For each sub-division, the EHAPE sets out a basis for consideration, suggests objectives, and suggests actions for consideration. None of these is prescriptive but all of it is useful for those writing NEHAPs.

Some countries will have particular concerns which it would be right to address in a national plan. An example is a high incidence of tick-borne encephalitis which Latvia has included in its NEHAP. Two more general problems, not addressed in the EHAPE but addressed in the plans of some pilot countries are noise and chemical safety. The latter is a particular feature of the NEHAPs of both Hungary and Sweden, whilst Bulgaria has a problem with 'hot-spots' of heavy metal contamination featured in its NEHAP.

The real justification for a NEHAP is the benefit stemming from the decisions made in the plan itself. A NEHAP cannot be justified solely as a response to an international commitment.