Position Paper-Modena 2014

Why Environmental and Public Health Tracking:
The Modena Position Paper for the Italian Presidency
of the EU Council “for a Better Environment and Health”

Italian version


The environment in which we live and work affects both our health and our economic productivity, among other impacts. At a time of growing recognition of these impacts, of financial crises and of globalization that demands greater European competitiveness, we thus believe that better tracking of the environment and its effects can help achieve the two goals of healthier populations and healthier economies.
Yet the challenges are many. Because governments do not have unlimited resources, they must prioritize spending and programmes. Governments, and specifically their finance ministries, compare spending options in terms of return on investment in both financial and political terms.
On average, spending on health accounted for 9% (unweighted) of GDP in the EU in 2010 (WHO-Europe, 2013). And finance ministries often view this spending as a pure cost rather than as an investment that produces improved health and well-being, lowered treatment costs and greater productivity.
With these benefits in mind, EPHT, or environmental public health tracking, aims to merge, integrate, analyse and interpret environmental hazards, exposure and health data.1
Public-health decision makers can use this timely, accurate and systematic data to inform and develop policies that reduce environmental health burdens and prevent disease efficiently and cost-effectively. Indeed tracking can also support the response to increasing community concern about point sources of pollution (e.g. incinerators and landfill sites) and also contributes to the statutory obligations of several member states around environment and health surveillance.
Indeed, improving the environment and reducing its impact on health should be viewed as an opportunity to boost Europe’s competitiveness and, by extension, its economy, since health and sustainability are pillars of wellbeing and productivity, especially in a time of socio-economic and even cultural crisis.
This was also declared at the Fifth WHO European Ministerial Conference on Environment and Health (Parma Declaration, 2010) , “...this crisis brings new opportunities that should be pursued to improve our economy, both in the area of job creation in environmental and health services as well as in legislation to regulate and reduce the negative long-term effects of uncontrolled emissions in hazardous substances and technologies.”
In terms of how to achieve these goals, WHO-Europe has said that an essential approach consists of providing public health services in response to environmental hazards, which requires a broad and fully integrated strategy using tools ranging from regulation to health promotion, including raising public awareness and educational activities.
Dr Marc Danzon, former WHO Regional Director for Europe, has stated: “A history of environmental crises and their effects has taught us that we need to do a better job of using science as an instrument to support policy-making. The health effects of, for example, toxic oil syndrome, BSE [bovine spongiform encephalopathy] and current issues like climate change, are so striking that countries’ leaders need handy results of research to help them identify the most effective measures to reduce risks and address public concerns.”


1. To promote the creation of an international EPHT network to address environmental challenges to public health by establishing a Working Group in the European Union.

The international EPHT network aims to support the development, implementation and evaluation of national EPHT initiatives. It will provide an international clearinghouse for public-health practitioners and researchers on how to monitor environmental hazards, exposure and health data. It also aims to advance and enhance national EPHT capacity through the support of systematic analyses of environmental health data. And it will promote strong and enduring relationships and partnerships among all levels of governments and countries, across agencies, and with both the private sector and the community. Creation of an international EPHT network can help address situations such as those seen in Italy and other European countries, but are in essence similar across the globe.
All too often, environmental-health protection has generally been confined to the response to a crisis, such as dramatic episodes that reach political impact via involvement of media exposure and popular protest2 without ever becoming the subject of in-depth political debate followed by informed decision-making leading to effective prevention of health and social burdens. As an example relevant to the area where we held our meeting, the Po Valley in Italy (one of the most polluted places in Europe), for over 20 years investigation of the impact of pollution on health herein has never addressed the problem in a systematic, multidisciplinary and consistent way. Public health issues linked to the environment are becoming increasingly complex. Globalization and increasing population size is placing significant stress on the environment, while emerging threats in chronic and infectious diseases, injury, and acts of terrorism, all have associated environmental factors. However, environmental health research has made substantial progress. To address a range of environmental challenges to public health, state and territorial health agencies must build strong and enduring relationships and partnerships. Today, issues concerning the environment and health can and must be taken into proper account especially since the European vision of society is based on sustainability, equity and wellbeing, and should be the reference point for the new idea of Europe that the Italian presidency can adopt and promote on behalf of all Member States.

2. To support research and monitoring of environmental hazards and health risks.

The newly adopted Environment Action Programme for the EU, entitled "Living well, within the limits of our planet," will guide environmental policy up to 2020. Its priority objective No. 3, “To safeguard EU citizens from environment-related pressures and risks to health and wellbeing,” is intended to stimulate research at the EU level in the years to come. An international network on public health and environment tracking, as we are setting up, should be supported as an essential tool in this programme, since it will further understanding of this complex field, document decisions, improve comparability of risks between countries, and enable transparency and trust among citizens, institutions and the private sector.

Approved at Modena on May 30th, 2014
by the International Network on Public Health & Environment Tracking (INPHET)

On behalf of INPHET
Lina Balluz, Centers for Disease Control and Prevention, United States
Kees de Hoogh, Swiss Tropical and Public health Institute, Switzerland
Tony Fletcher, Public Health England, United Kingdom
Paolo Lauriola ARPA Emilia-Romagna, Italy
Giovanni Leonardi, Public Health England, United Kingdom
Sylvia Medina, Institut de Veille Sanitaire, France
Lisbeth Knudsen, Department of Public Health, Denmark
Jan Semenza, European Centre for Disease Prevention and Control, Sweden
Brigit Staatsen, National Institute for Public Health and Environment (RIVM), The Netherlands

We acknowledge the contribution to these ideas and proposals of all participants to the Modena workshop on Environmental and Public Health Tracking to Advance Environmental Health and others who contributed to earlier events of the international network on environmental public health tracking; in particular we thank Roberto Bertollini (B) and Patrick Saunders (UK) for their important contributions.

This paper reflects the views of the authors and not necessarily those of their organizations.

1 EPHT can be defined as: “The ongoing collection, integration, analysis, and interpretation of data about environmental hazards, exposure to environmental hazards, human health effects potentially related to exposure to environmental hazards. It includes dissemination of information learned from these data and implementation of strategies and actions to improve and protect public health” (United States Center for Disease Control and Prevention, 2003)

2 For example in Italy the episodes at industrial works in Taranto and Savona; a similar pattern can be recognized in most countries.

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