Implementing environmental health strategy

Local implementation, involving all relevant parties in partnership, is the most endurable mechanism for tackling the environment and health (EH) problems affecting communities. EH and sustainable development are inextricably linked and require a long-term commitment to local implementation.

The practice of protecting the environment and health is changing. Projects based on national priorities or centrally directed through the allocation of resources are not the most appropriate ways of improving local health and quality of life. National authorities alone cannot normally solve local environment and health (EH) problems in an efficient manner.

The field of EH encompasses a wide range of issues and subjects, and most should be regarded as best tackled at local level. Health, environmental and social issues are complex subjects to address and are often interrelated to one another, as well as to other development and economic issues. All EH issues are complex, and many have political implications that are unavoidable and need to be properly addressed.

Sustainability is not a constant, and there is no clear definition of what is a sustainable local EH project. Sustainability is in the eye of the recipient and depends on whether the commitment and resources are maintained in the succeeding years. Successful and sustainable projects require a sensible project design which clearly identifies what will be achieved and how it will be achieved. All projects have a common "project cycle" and should be divided into a sequence of simple implementation stages.

A traditional approach to developing and implementing EH strategies is used where government health organizations have a relatively high degree of autonomy. A broad EH strategy is first prepared, centrally or in partnership, from which more specific policies are derived. From these policies, individual projects are defined and work begins on defining the scope of each. Typically, projects are oriented primarily towards improving public health. Health, social and environmental data are gathered, and EH goals are established. The data are usually obtained from within the public sector, and their completeness depends on the willingness of the various partners to make data available. Once goals have been set, the next stage is to inform the recipient community and, hopefully, address their comments and suggestions. Ideally, once a common view is established, realistic project targets can be set and an implementation team brought together. Once project funding is secured, work can be implemented and monitored.

The roles of both the private sector and practical, field-based nongovernmental organizations (NGOs) in implementing local EH projects remains largely undefined. A key issue to address in EH projects is how to achieve more complementarity between the different strengths and capabilities available in the public, NGO, community and private sectors.

EH projects should encompass the following principles: equity; sustainability; multisectoral action; community involvement; democratic participation; accountability; good practice; impact assessment; integration; and a precautionary approach.

At the Second European Conference on Environment and Health (Helsinki, June 1994), nation states and the World Health Organisation launched a movement to draw up national environment and health action plans (NEHAPs). This was, in part, a recognition by the states that individual sectors operating in isolation on environment and health matters, through agencies sometimes located far from the seat of a specific problem, cannot always adequately address the general public's requirements. In the process of drawing up their NEHAPs, countries have been engaged in intersectoral search for solutions and have identified the EH priorities to be addressed in the short and longer terms.

Six key stages are followed when developing an EH project: (a) analysis of prevailing health risks; (b) risk assessment, to determine if environmental hazards are affecting local health; (c) solicitation of public participation in prioritizing local EH needs; (d) assessment of the finance and other resources required to implement the project; (e) classification of the tasks in an EH project according to their importance (tasks related to protecting the quality of drinking-water and food safety are the highest priority); and (f) keeping local political leaders, community leaders and the general public informed of progress during project design and implementation.

Multidisciplinary approaches to EH implementation must not be confined solely to health care workers and EH professionals. EH projects are usually viewed by administrations as "health sector" activities. Consequently, there is a risk, when implementing a strategy, that only projects defined, and ultimately led, by health- and EH-oriented specialists will be implemented, through activities with which they are most familiar and comfortable. However, the achievement of good EH spans a far wider range of topics, and different projects benefit from different mixtures of disciplines. There should be an obligation on project implementers to be receptive to specialists from outside the health sector and to actively seek their participation prior to starting project implementation.

Stakeholders who should cooperate in this strategy include: (a) government ministries and enforcement agencies (health, labour, environment, economy, finance and others); (b) employers and their organizations, policy-makers and management leaders in industry, agriculture and other economic sectors; (c) employees and trade unions; (d) financial and insurance institutions; (e) occupational health services, cleaner production centres, environmental health services, and environmental and social consultants; (f) nongovernmental organizations, and associations of professionals in health promotion, occupational health and safety, environmental health, environmental protection, and economic and social development; and (g) education and training institutions, including those for quality management training.