regional seminar on the health impact of air...

WHO-EM/PEH/565/E

Report on the

Regional seminar on the health impact of air pollution

Cairo, Egypt 9–11 December 2007

WHO-EM/PEH565/E

Report on the

Regional seminar on the health impact of air pollution

Cairo, Egypt 9–11 December 2007

© World Health Organization 2008 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 2670 2535, fax: +202 2670 2492; email: [email protected]). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 2276 5400; email [email protected]).

Document WHO-EM/PEH/565/E/04.08/90

CONTENTS

1. INTRODUCTION.............................................................................................................2

2. TECHNICAL PRESENTATIONS ....................................................................................3 2.1 Health impact of air pollution ..................................................................................3 2.2 The WHO air quality guidelines global update 2005...............................................3 2.3 The new WHO air quality guidelines for particulate matter, ozone, nitrogen

dioxide and sulfur dioxide........................................................................................4 2.4 CEHA activities on air pollution and quality control...............................................4 2.5 Indoor smoke from solid fuels: assessing the environmental burden of disease .....4 2.6 Outdoor air pollution: assessing the environmental burden of disease....................5 2.7 Air quality monitoring for health protection............................................................5 2.8 Demonstration of AirQ: air quality and health impact assessment tool...................6

3. COUNTRY PRESENTATIONS........................................................................................6 3.1 Egypt ........................................................................................................................6 3.2 Islamic Republic of Iran...........................................................................................6 3.3 Morocco ...................................................................................................................7 3.4 Qatar.........................................................................................................................7 3.5 Saudi Arabia .............................................................................................................8 3.7 Tunisia......................................................................................................................8 3.8 United Arab Emirates...............................................................................................9

4. SUMMARY OF DISCUSSIONS......................................................................................9

5. GROUP WORK...............................................................................................................10

6. RECOMMENDATIONS.................................................................................................11

Annexes 1. AGENDA .............................................................................................................................13 2. PROGRAMME ....................................................................................................................14 3. LIST OF PARTICIPANTS ...................................................................................................16 4. ELEMENTS FOR ESTABLISHING AN ALLIANCE BETWEEN THE MINISTRY OF

HEALTH AND THE MINISTRY OF ENVIRONMENT FOR THE ADVANCEMENT OF ENVIRONMENTAL HEALTH ...........................................................................................20

WHO-EM/PEH/565/E Page 2

1. INTRODUCTION

A regional seminar on the health impact of air pollution was organized by the World Health Organization (WHO) Regional Office for the Eastern Mediterranean from 9 to 11 December at the Regional Office in Cairo, 2007. The seminar was attended by 19 participants from 18 Member States in the Region (Afghanistan, Bahrain, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen). The objective of the meeting was to assess the health impact of air pollution in the Region in view of the finalization of the 2005 update of the WHO air quality guidelines.

Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, delivered the opening address and noted that a human being took in approximately 10 times as much air as the combined weight of water and food each day, and there was little an individual could do to clean the air before taking it in. In addition, the health risk from air pollution could spread over a long distance. Globally, indoor air pollution from solid fuel use was responsible for 1.6 million deaths due to pneumonia, chronic respiratory disease and lung cancer, with the overall disease burden exceeding the burden from outdoor air pollution fivefold. In high-mortality developing countries, indoor smoke was responsible for an estimated 3.7% of the overall disease burden, making it the most lethal killer after malnutrition, unsafe sex and lack of safe water and sanitation. The immediate conclusion to be drawn was that high priority needed to be given to improving indoor air quality both in rural and urban areas, in developing and in developed countries. This included strong action to prevent passive inhalation of tobacco smoke, and indeed to prevent active smoking.

Dr Gezairy referred to the scarcity of solid data on the situation in the Region and said that improving people’s health through air pollution control was a daunting task. There were some examples of action to deal with air quality issues in some countries; improving air quality in cities by reducing vehicular emissions, including through phasing out of regular leaded fuel was, for instance, under way in a number of countries. In Cairo, the mitigation of lead pollution resulting from lead smelters in Shubra Al Khaima was a case in point.

Dr Gezairy reminded participants of the considerable influence WHO’s normative work had had on environmental health quality inside countries. This is the case, for example, with the guidelines for drinking-water quality, the joint WHO/Food and Agriculture Organization of the United Nations (FOA) Codex Alimentarius standards and for the air quality guidelines. WHO recently issued its new guidelines for air quality that apply worldwide based on expert evaluation of current scientific evidence. These guidelines recommended revised limits for the concentration of selected air pollutants: particulate matter, ozone, nitrogen dioxide and sulfur dioxide, applicable across all WHO Regions.

Dr Ismail Ahmed Al Kamish (Sudan) was appointed Chairman and Dr Salim Said Al Wahaiby (Oman) as Rapporteur. The agenda, programme and list of participants are included as Annexes 1, 2 and 3, respectively. Annex 4 contains a list of elements for establishing an alliance between the ministry of health and the ministry of environment for the advancement of environmental health.


2. TECHNICAL PRESENTATIONS

2.1 Health impact of air pollution Dr Houssain Abouzaid, Coordinator, Healthy Environment Programme

Contaminants released in the air from natural sources include gases and suspended particulate matter from volcanoes, forest fires, dust storms, nitrogen oxides produced by lightning, radon of geological origin, suspended pollen, bacteria and other living organisms, as well as various products resulting from decomposition of organic matter, etc. Anthropogenic sources of air pollution have existed at least since humankind discovered fire. Pollution increased rapidly with industrialization, use of fossil energy sources, manufacturing and the ‘chemicalization’ of daily life.

Air comes into intimate contact with vulnerable tissues of lung that are damaged or allow the transfer of the pollution into the blood and to different locations of the body. In normal situations, air pollution is characterized by low doses, long exposure, discrete effects and repeated or continuous occurrence. Health effects are the result of the complex interaction of the dose and time of exposure on one hand, and the degree of reversibility of the biological effect on the other hand.

Effects of air pollutants show a great variety in what concerns organ specificity, time response and potential of bioaccumulation; they occur: in the respiratory system; on immune system allergies mostly indoors; on the skin and mucous tissues; as sensory effects; in the central nervous system; in the cardiovascular system; and as carcinogenic effects.

Pneumonia, chronic respiratory disease and lung cancer are the main affections associated with air pollution. It was estimated that in 2000, 59 000 people died in the Region from exposure to outdoor air pollution and 118 000 people died from exposure to indoor smoke. Public health can also be indirectly affected by absorption of air pollutants in plants, animals and other environmental media resulting in contamination of food or drinking-water, which constitute additional sources of human exposure and affect the structure and functions of ecosystems including their ability to self-regulate. Occurrence of magnified reactions of the reflex type such as vomiting, diarrhoea or even asthma can equally create problems.

2.2 The WHO air quality guidelines global update 2005 Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Center for Environmental and Health, Bonn Office

The focus on the four selected pollutants (PM10/PM2.5, ozone (O3), nitrogen dioxide and sulphur dioxide (SO2)) was determined by availability of new scientific evidence linking these pollutants with health as well as by the ubiquitous human exposure to these pollutants, resulting in substantial burden of disease. Countries are advised to reduce exposure to these pollutants in order to reduce negative health effects. The most recent scientific data indicate the link of the exposure to fine particulate matter with the


development of cardiovascular disease, supporting earlier evidence linking cardiovascular mortality with exposure.

2.3 The new WHO air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide Dr Houssain Abouzaid, Coordinator, Healthy Environment Programme

By publishing its global air quality guidelines, WHO challenged governments to improve air quality in their cities in order to protect people's health; reducing levels of particulate matter could reduce deaths in polluted cities by as much as 15% every year. A global consultation on the conclusions emerging from the scientific evidence was needed to generalize to the other Regions the results of the systematic review carried out focusing on the WHO European Region.

It may be noted that for the previous edition of the air quality guidelines, the deliberations of the WHO expert group did not lead to guideline values but rather to exposure–response relationships as guidelines because no threshold could be established for the onset of health effects. But for the present edition of the guidelines, the WHO expert group did derive guideline values. It should be noted, however, that as thresholds have not been identified and given the substantial inter-individual variability in exposure and in the response to a given exposure, it is unlikely that any standard or guideline value will lead to complete protection for every individual against all possible adverse health effects of particulate matter.

On the other hand, controlled studies involving exercising asthmatics indicate that a proportion experience changes in pulmonary function and respiratory symptoms after periods of exposure to SO2 as short as 10 minutes.

2.4 CEHA activities on air pollution and quality control Mr Mazen Bader Malkawi, Technical Officer

Activities and services of the Centre for Environmental Health Activities (CEHA) to the 22 Member States of the Region have included: three intercountry meetings, 12 national training workshops, 17 special studies, four assessments and the production of nine documents. This is in addition to fund-raising activities to promote action. A literature review study was drafted by CEHA in mid 2007; 53 peer-reviewed studies dealing with exposure of children to indoor air pollution in the Region were reviewed. The study concluded that indoor air pollution is a major health hazard in some countries of the Region. It also highlighted the gap of information and the need for research.

2.5 Indoor smoke from solid fuels: assessing the environmental burden of disease Dr Mohammed Elmi, Regional Adviser, Food and Chemical Safety

The document Environmental burden of disease, series No. 4 emphasizes the utilization of relative risks for exposure–response relationships, and a binary classification scheme for exposure levels for indoor air pollution. The disease burden of the population was measured using various metrics, such as disability-adjusted life years (DALYs). The


most important and challenging step was to obtain the exposure levels and disease burdens for local assessment.

Given both the energy and economic situation in many Member States indoor air pollution is greatly contributing to the burden of diseases, particularly among women and children who are most vulnerable to this neglected public health risk that require interventions. Solid fuel in many countries is the main source of cooking and heating energy. Given these limitations, local assessments should focus on two ventilation related factors: improved stoves and outdoor cooking. Other important interventions are behavioural change and energy efficiency.

2.6 Outdoor air pollution: assessing the environmental burden of disease Dr Mohammed Elmi, Regional Adviser, Food and Chemical Safety

It is important that air quality monitoring is conducted on the basis of preventing and reducing air pollution risks. Emphasis has been placed on the importance of monitoring four parameters: PM10, PM2.5, SO2, NO2 and O3; which could provide proxy information of other pollutants in the air. Particulate matter measurements were stated as priority that could be linked to burden of diseases in large cities of the Region. The quantitative assessment of the health impact of outdoor air pollution are based on assessment of the ambient exposure of the population to particulate matter, determination of the size of population groups exposed; incidence of the health effects being estimated; and dose response.

2.7 Air quality monitoring for health protection Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Center for Environment and Health, Bonn Office

To address health concerns related to air pollution, air quality monitoring and modelling must be adequate for evaluation of population exposure and include assessment of PM10 and/or PM2.5. These objectives are not always fulfilled by the networks designed to serve other possible aims of air quality monitoring, e.g. those designed to detect threats to natural ecosystems or to assess compliance with existing legislation. The information generated by the networks should be communicated in a readable and timely way to decision-makers and the public, providing support to air quality management and detecting threats to the population’s health. The central role in assessing health impacts of air pollution relies on monitoring of PM10/PM2.5, as this pollution is associated with the highest attributed burden of disease. The methods of PM10/PM2.5 monitoring are relatively new and require special approaches. As human health is the main target of PM10/PM2.5 pollution, the health sector has a specific interest in the development of particulate matter assessment by relevant air quality assessment authorities. The framework plan for development of particulate matter monitoring presented to the seminar should be used both as a background to the review of the existing networks as well as to the development of the national plans in countries or cities where such networks need to be created.


2.8 Demonstration of AirQ: air quality and health impact assessment tool Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Center for Environment and Health, Bonn Office

WHO estimates of burden of disease (per 100 000 people) attributed to urban air pollution in the poorer areas of the Region are the second highest globally. This demonstrates high relevance for local estimates of burden of disease attributed to air pollution. WHO software tool AirQ facilitates calculation of the effects of short-term exposure on mortality and morbidity based on the distribution of population exposure, baseline incidence of a selected health outcomes as well as relative risk linking exposure with health effects generated by epidemiological studies. Also the effects of long-term exposure on survival can be estimated with AirQ, calculated as the years of life lost due to the exposure, reduction of life expectancy or annual number of deaths attributable to exposure.

3. COUNTRY PRESENTATIONS

3.1 Egypt

Air pollution is a very dangerous problem that is due to the industrialization, transport, etc. Network for air pollution monitors PM10, TSP, CO, SO2, NO2, lead, O3 and black smoke. The annual data show that annual concentrations of NO2, SO2, CO and O3 are below the national standard, also most of site where we monitored Pb show concentration within national standard. Only PM10 and TSP concentrations are higher than the national standard. There was a significant relation between the pollutants and cardiopulmonary diseases, cardio-obstructive pulmonary disease, asthma and cardiac disease.

3.2 Islamic Republic of Iran

Urban air pollution has affected the population of eight polluted cities: Tehran, Karaj, Isfahan, Tabriz, Mashhad, Shiraz, Arak and Ahhvaz. These cities have a combined population of more than 20 million people (2006). Tehran with a population of 7 975 679 is the most populous city and has air pollution monitoring systems (14 stations). The air pollution law was ratified by parliament on 23 April 1995, and the objectives of this law were control of air pollution and to maintain and promote public health. The implementation and planning of the first clean air act programme was undertaken for Tehran in 1996, but they did not consider the health effects of air pollution. With strenuous efforts by the Ministry of Health and Medical Education, the Tehran action plan, clean air programme (2005–2010) followed up the health impact assessment of air pollutants.

The clean air act programme has been effective in motivating policy-makers to increase budgets for planning. The health impact assessment of air pollution also assisted in the preparation of national standards for air pollution.


3.3 Morocco

The population of Morocco was approximately 30 million in 2004. Half of these people (48.2%) are settled in two main regions: the north-west and central region. In Morocco, the cost of air pollution is estimated at 1.9% of gross domestic product (GDP) of US$ 450 million. Road traffic is responsible in Morocco for between 50% and 75% of urban air pollution. The number of vehicles in circulation has increased from 306 359 in 1970 to 1647 269 in 2000 with an increase rate of 5.6% per year. The use of diesel oil vehicles has increased from 10% in 1970 to 50% in 2000, 74% of vehicles are older than 10 years and only 7% of vehicles are less than 5 years old.

The emissions inventory (2000) in Morocco include: greenhouse gases, CO2, methane (CH4), SO2, nitrous oxide (N2O), nitrogen (Nox), CO, non-methane volatile organic compounds (NMVOC). With the aim of assessing air quality in Morocco, several studies have been conducted in urban area of big cities (Rabat and Casablanca) by different departments (Health, Environment and Public Works). The air quality data in urban areas with high road traffic density or in industrial areas exceeds by many times the air quality standards. The Ministry of Health and Environment Department carried out an eco-epidemiological study in Casablanca (Casa-Airpol, 2000). The aim of this study was to provide greater information about health risks due to air pollution and to try to establish a correlation between air pollution level and some respiratory pathology. The public authority issued a law relating to air pollution in 2003. The objectives of this law are to prevent, reduce and limit air pollution emissions in order to protect human health and the environment.

To improve air quality, the national strategy for environmental protection and sustainable development, adopted in 2002, has considered the improvement of air quality as a national priority. The action plan has two axes: monitoring air quality and assessing the health impact and regulation of air quality and pollutant emissions.

3.4 Qatar

Qatar has paid particular attention to air quality through regulations and the implementation of norms and standards and through dissemination of knowledge and awareness among the society at large. Qatar is currently witnessing unprecedented population, industrial and economical growth. The amount of gaseous emissions has increased as a result of the large number of construction and building giant projects. Adding to that, emissions from vehicles have also increased greatly as a result of the vast increase in the numbers of cars.

In Qatar, there is a network of air fixed and mobile air quality monitoring stations in Doha and AlWakra cities run by the Supreme Council for Environment and Natural Reserves. The National Health Authority is also planning to conduct air quality monitoring. A plan for monitoring air quality parameters in the capital is being designed. This plan aims to monitor the essential air parameters in order to identify any potential health hazards.


At the same time, the authorities at Mesaeed and Ras Laffan industrial cities are carrying out air quality-monitoring activities through many fixed stations. These stations provide valuable data related to the following pollutants: NOX, CO, SO2, ozone, hydrocarbons (HC), and other elements. On the other hand, industrial companies in Mesaeed and Ras Laffan are also monitoring the emissions from their industrial plants. By publishing the executive regulations of law number 30 of 2002 related to environmental protection in Qatar, the norms and standards related to gas emissions to the atmosphere became legally binding. Qatar is implementing a number of measures aimed at reducing air pollution in closed areas and minimizing its impacts. Since 1997, all transport vehicles have used lead-free gasoline. Qatar is deploying considerable effort to build national institutions and to strengthen its legal framework to preserve good air quality. The State encourages and promotes scientific research in this field through specific research studies in Qatar University and the other international universities in the Educational City in Qatar. Qatar has also signed many agreements and conventions on the subject of air quality.

3.5 Saudi Arabia

There has been rapid growth in Saudi Arabia of oil refineries, petrochemical manufactures, cement factories, desalination plants, power stations and a huge increase in the number of cars, buses and other vehicles. In addition, more than 330 000 cars are imported annually into Saudi Arabia. All these sources of pollutants are causing health problems among to individuals and damaging the environment. These pollutants include: COx, SO2, NOx, O3, H2S, PM, hydrocarbons and Pb. These outdoor pollutants can have serious health impacts, depending on the length of exposure. The Saudi Metrology and Environmental Agency addresses air quality standards. There are many mobile station and real time monotroing station in cities of Saudia Arabia.

3.6 Syrian Arab Republic

A limited number of air quality monitoring campaigns have been conducted in the Syrian Arab Republic. Results indicated a general deterioration of air quality in most cities of the country. Concentrations of TSP and gaseous emissions exceed the allowable limits in terms of air quality standards. These emissions play an important role in the formation of smog, which covers the atmosphere of populated urban centres and impacts on human health. Smog also affects the vegetative cover and the integrity of building materials, particularly those of cultural and archaeological value. The Syrian Arab Republic lacks systematic and continuous monitoring programmes for air emissions whether for populated urban centres or for industrial areas.

Several studies have been conducted by individual local organizations to assess the level of air pollution in several parts of the country, despite the fact that monitoring data are limited and insufficient to quantify the real extent of air pollution.

3.7 Tunisia

In Tunisia, there is a national network for air quality monitoring conducted by 10 operational stations which will become 24 stations to be divided between all governorates in


the country. This network provides characterization of air quality in a continuous way. So the results allow the possibility of conducting epidemiologic studies and to evaluate the sanitary impact of the degradation of air quality especially in the most polluted cities, but in reality, evaluation of sanitary impacts related to air pollution is limited to some epidemiologic studies which are unreliable. There is a significant lack of data related to health and exposure, collecting health data and the quality of health data.

There is a national study programmed in the Eleventh plan and there is a real need to know how to conduct this study in terms of choices of cities, exposed populations, samples, time periods, etc. In Tunisia, national standards for air quality are being updated in order to reduce health risks of air pollution so the preparation of these guidelines must be undertaken on a solid basis such as using results of the epidemiologic studies, WHO guidelines, toxicological studies, sources of emissions, etc.

3.8 United Arab Emirates

In a changing world of urban development and social welfare, the United Arab Emirates continues to achieve outstanding success in economic, social and tourism aspects in such a way that environmental protection is part of an important and strategic infrastructure for supporting current and future safe and sustainable growth. There is a Federal Law, number 24 (1999) for the protection and development of the environment.

The Environment Agency of Abu Dhabi is monitoring the quality to obtain a better understanding of the urban, residential and industrial air quality for finding effective solutions to air quality issues and for sustainable development of the Emirate. The Agency ambient air quality monitoring network consists of 10 fixed stations and two mobile stations measuring some or all of CO, SO2, NOx, O3, H2S, PM10, benzene, toluene, ethylbenzene and xylene (BTEX) and NMHC.

The Environmental Research and Wildlife Development Agency (ERWDA) of Abu Dhabi was designated as the lead agency, in partnership with the United Nations Environment Programme (UNEP), for the development and implementation of the Initiative of Abu Dhabi Global Environmental Data (AGEDI).

Dubai Municipality created a specialized web site for representing measured data of air quality in Dubai which is updated daily with a coloured overall quality index representing the status of air in six stations measuring CO,SO2, NO2, O3, H2S, PM10, benzene (C6H6), Pb and HF with availability of online education material to the public in Arabic and English.

4. SUMMARY OF DISCUSSIONS

The reduced number of parameters (four) covered in the new WHO air quality guidelines and the importance health effect of other air contaminants was discussed. It was explained that if the four parameters of the guidelines are effectively controlled, there is a good probability that other air pollutants will be controlled as well. But of course if in a


particular situation specific pollutants appear to be relevant even in that case, then these need to be addressed properly.

The relatively lower impact of indoor air pollution in the Region compared to the effect of outdoor air pollution; roughly a mortality ratio of 2:1, instead of approximately 5:1 in countries with a similar level of development. It was explained that one element of explanation of this state of affairs may be the number of large cities in the Region with serious outdoor pollution, notably, Baghdad, Cairo, Karachi, Lahore, Tehran, etc.

The importance of considering not only the effect of indoor smoke, but also the effect of air conditioning when dealing with indoor air pollution was stressed. The health effects are due to suspended particulate matter. It was emphasized that for suspended particulate matter, consideration of the size of the particles is important in addition to their mass or number per cubic metre. Particulate matter is not a single compound but rather a set of particle sizes including coarse (particles with an aerodynamic diameter between 2.5 and 10μm), and fine particles (with an aerodynamic diameter below 2.5μm).

Collaboration is necessary between health and environment sectors to advance health protection from risks related to air pollution. The health and environment sectors must establish to develop joint activities and programmes that would be beneficial for both sectors and the excerpt from the technical discussion paper on health effects of environmental conditions presented to the Regional Committee in 2002 was presented Participants agreed that this is indeed a prerequisite for effective action against air pollution.

Difficulties associated with the adoption of national air quality standards include the costly control actions of compliance with air quality standards and lack of funds in some countries to achieve the same air quality standards as other countries. Setting standards should imply a cost–benefit analysis, even if it is hard to harmonize human health costs. It was concluded that in many developing countries, the process of developing national air quality can only be achieved in a long-term process, with equity considerations.

5. GROUP WORK

Participants were divided into three groups to address elements for a regional plan for reducing disease associated with indoor and outdoor air pollution. Each group was asked to address one of the following issues: indoor air quality; outdoor air quality; institutional aspects and alliance.

The groups concluded that there were serious health problems related to indoor combustion of biomass fuel in many countries of the Region and urban air pollution in the larger cities in the Region. Different countries are at different stages in relation to air pollution assessment, monitoring and control, and problems are exacerbated by the fact that ministries of health are not always associated with air quality assessment and management. Even when monitoring has been conducted for some time, evidence regarding health effects and the estimate of the burden of disease remains weak. This most probably weakens the advocacy for action by authorities concerned.


Only very few indoor air quality programmes are currently being implemented. WHO issued recently its new air quality guidelines for health-based guidelines. These guidelines provide a good basis for: derivation of national standards; revising air quality monitoring strategies; and developing remedial action for the reduction of health risk associated with air pollution in the Region. High priority needs to be given to: improving indoor air quality; including from smoking, in rural and urban areas; and improving air quality in polluted larger cities.

6. RECOMMENDATIONS

To Member States

1. Review the availability of air quality monitoring and its relevance for health impact assessment (in main cities): PM10/PM2.5 monitoring; relevance for population exposure assessment; collect PM10 (and NO2, SO2) data necessary for health impact assessment of main city/cities (and submit annual averages to WHO).

2. Use adequate tools for the estimation of the environmental burden of disease related to indoor air pollution.

3. Whenever excessive concentration of a pollutant is detected in the air, conduct exposure assessment to evaluate how many people are exposed to it.

4. Develop/update national standards and regulations based on the four priority parameters covered by the new WHO air quality guidelines (particulate matter, NO2, SO2 and O3).

5. Establish a national committee on air quality and health.

6. Strengthen surveillance of the indoor and outdoor impacts on health.

7. Establish an alliance between the Ministry of Health and the Ministry of Environment to protect human health from the effect of air pollution.

To WHO

8. Provide technical information for advocacy in the area of air quality.

9. Provide a technical capacity-building package to countries to monitor health effects of indoor and outdoor air quality.

10. Issue a letter from the Regional Director conveying the recommendations of the meeting and suggesting the establishment of an alliance between the Ministry of Health and Ministry of Environment to protect human health from the effects of air pollution.


11. Support the development of national air quality standards and regulations based on WHO guidance.

12. Foster networking between countries of the Region in relation to the protection of human health from the effects of air pollution.

WHO-EM/PEH/565/E Page 13 Annex 1

AGENDA

1. Opening

2. Election of officers

3. Health impacts of air pollution

4. The new WHO air quality guidelines

5. Assessment of health impact of air pollution

6. Air quality monitoring for health protection

7. National presentations and other presentations

8. Air quality management in Cairo and field visit

9. Elements for a regional plan for reducing disease burden associated to indoor and outdoor air pollution (group work)

10. Closure


PROGRAMME

Sunday, 09 December 2007

08:30–09:00 Registration 09:00–09:20 Address by Dr Hussein Gezairy, WHO Regional Director for

the Eastern Mediterranean 09:20–09:30 Election of Officers

Adoption of agenda and programme 09:30–09:45 Objectives of the seminar

Dr Houssain Abouzaid, Coordinator, Healthy Environment Programme

09:45–10:15 Group photograph 10:15–10:45 Health impacts of air pollution

Dr Houssain Abouzaid, Coordinator, Healthy Environment Programme

10:45–11:30 The WHO air quality guidelines global update 2005 Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Center for Environmental and Health, Bonn Office

11:30–12:00 The new WHO air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide Dr Houssain Abouzaid, Coordinator, Healthy Environment Programme

12:00–12:30 Discussion 13:30–15:00 Country presentations 15:15–15:45 CEHA activities in air quality control

Dr M.Z. Ali Khan, Director, Regional Centre for Environmental Health Activities

15:45–16:15 National presentations and other presentations (UNEP, UNRWA)

Monday, 10 December 2007

09:00–09:30 Indoor smoke from solid fuels: Assessing the environmental burden of disease

Dr Mohamed Elmi, Regional Adviser Food and Chemical Safety

09:30–10:00 Outdoor air pollution: assessing the environmental burden of disease at national and local levels

Dr Mohamed Elmi, Regional Adviser, Food and Chemical Safety 10:00–10:30 Discussion 11:00–11:30 Air quality monitoring for health protection


Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Center for Environment and Health, Bonn Office

11:30–13:00 Demonstration of the WHO/EURO Air quality health impact assessment software

Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Center for Environment and Health, Bonn Office

14:00–16:00 Elements for a regional plan for reducing disease associated with indoor and outdoor air pollution (three groups)

16:00–16:45 Group work presentation

Tuesday, 11 December 2007

09:00–11:00 Air quality management in Cairo Mr Ahmed Hagag, Agency of Environmental Affairs, Ministry of Environment

11:30–12:30 General discussion 13:30-14:00 Conclusions and recommendations

14:00–14:15 Closing session Dr Houssain Abouzaid, Coordinator, Healthy Environment Programme


LIST OF PARTICIPANTS

AFGHANISTAN Dr Amanullah Hussini Director of Environmental Health Ministry of Public Health Kabul

BAHRAIN Dr Samir Abd Allah El Hadad Chief of Occupational Health Unit Ministry of Health Manama

DJIBOUTI Mr Ahmed Houssein Bouh Responsible of POPs Project Ministry of Environment Djibouti

EGYPT Mr Mohammed Ibrahim Refaey El Amawy Environmental Monitoring Center Cairo

ISLAMIC REPUBLIC OF IRAN Ms Sheida Malekafzali Ministry of Health Tehran

IRAQ Dr Sinan Yousuf Anton Ministry of Health Baghdad


JORDAN Mr Abdullah Hayasat Specialist in Public Health Ministry of Health Amman

LEBANON Dr Khalil Adwan Head of Health Service in Mount Lebanon Ministry of Health Beirut

MOROCCO Mr Khalid Bribri Medical Assistant Environmental Health Unit Directorate of Epidemiology and Disease Control Ministry of Health Rabat

OMAN Dr Salim Al Wahaiby Director Department of Environmental and Occupational Health Ministry of Health Muscat

PALESTINE Mr Nader Barhoush Environmental Health Department – West Bank Ministry of Health Jerusalem


QATAR Mr Mohammad Abdalla Al Ghanim Health Inspector Environmental Health Section Public Health Department Ministry of Health Doha

Mrs Fatma Kamel Al Otoum Health Inspector Environmental Health Section Public Health Department Ministry of Health Doha

SAUDI ARABIA Dr Nezar Khodari Director Environmental Health Unit Ministry of Health Riyadh

SUDAN Dr Ismail Ahmed Al Kamish Environmental Health and Food Control Administration Federal Ministry of Health Khartoum

SYRIAN ARAB REPUBLIC Dr Atef Al Tawil Director of Environmental Health Department Ministry of Health Damascus


TUNISIA Mrs Rajaa Mazouzi Engineer Directorate of Environment Protection Ministry of Public Health Tunis

UNITED ARAB EMIRATES Mrs Jamila Al Sweedy Specialist in Medical Physics Ministry of Health Abu Dhabi

YEMEN Dr Ahmed Salem Melkat Environment Protection Authority Ministry of Water and Environment Sana’a

OTHER UN ORGANIZATIONS

Mr Ghassan Madieh, Field Sanitary Engineer, West Bank Field, UNRWA

WHO SECRETARIAT

Dr Hussein A. Gezairy, Regional Director, WHO/EMRO Dr Haifa Madi, Director, Health Protection and Promotion, WHO/EMRO Dr Houssain Abouzaid, Coordinator Healthy Environment Programme, WHO/EMRO Dr Riyad Musa Ahmad, WHO Representative, Afghanistan , WRO/AFG Dr Mohamed Elmi, Regional Adviser, Food and Chemical Safety, WHO/EMRO Dr Said Arnaout, Regional Adviser, Health of Special Groups, WHO/EMRO Dr Michal Krzyzanowski, Regional Adviser, Air Quality and Health, WHO European Centre for Environment and Health, WHO/EURO Mr Mazen Malkawi, Technical Officer, WHO/CEHA Mr Ahmed Hagag, WHO Temporary Adviser, WHO/EMRO


ELEMENTS FOR ESTABLISHING AN ALLIANCE BETWEEN THE MINISTRY OF HEALTH AND THE MINISTRY OF ENVIRONMENT FOR THE

ADVANCEMENT OF ENVIRONMENTAL HEALTH

Shared agendas and plans of action can be formulated around the core functions of public health and environmental management. For this to occur, the health and environment sectors must establish an alliance to develop joint activities and programmes that would be beneficial for both sectors.

In this context, the health sector would receive support and collaboration from the environmental sector for functions such as:

• advocacy for implementing preventive measures to protect public health environment-

related risks, in other sectors

• conducting epidemiological surveillance of environment-related diseases

• strengthening the community capacity to manage health and environmental

interactions

• advocacy for and implementation of environmental health impact and risk assessment.

The environmental sector would receive support and collaboration from the health sector in matter related to:

• establishing and operating environmental control programmes and services

• incorporating health concerns as an integral part of the environmental impact

assessment process

• capacity-building to assess, prevent and control environmental hazards to health.

Joint work should also concern developing norms, standards and legislation; determining research needs and carrying out collaborative research activities; and developing and implementing interagency emergency response capabilities.

Excerpt from EM/RC49/Tech.Disc.2, July 2002

regional seminar on the health impact of air...

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