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To: EU Health Commissioner, John Dalli; and
President of the European Commission, José Manuel Barroso;
European Commissioner for the Environment, Janez Potocnik;
Members of the European Parliament;
WHO focal points for environment and health
Re: United Nations High-level Summit on Non-Communicable Diseases (NCDs), 19-20 September 2011

Brussels, 13 September 2011


Dear Commissioner Dalli,

Show EU leadership by putting environmental prevention on the agenda

The Health and Environment Alliance (HEAL) is writing to you today to urge you to put "Environment and Health" onto your policy agenda for the United Nations Summit on non-communicable diseases (NCDs) later this month.

HEAL is the leading European not-for-profit organisation addressing how the environment affects health in the European Union. We demonstrate how policy changes can help protect health and enhance people’s quality of life. HEAL’s more than 65 member organisations, representing health professionals, patients, citizens, women, youth and environmental experts, help to bring independent expertise and evidence from the health community to different decision-making processes. Members include international and Europe-wide organisations, as well as national and local groups.

HEAL is both astounded and very disappointed to note that the draft documents for the UN High-Level Summit ignore the role of environmental factors in causing chronic illness, such as lung conditions, cancer, heart disease, obesity, diabetes and other non-communicable conditions.

Given the body of scientific evidence linking air pollution, hazardous chemicals, and radiation to chronic disease, how can the policy measures to tackle these threats be left off this important agenda?

Why add the "environment" as a fifth factor?

HEAL agrees with fellow leading non-governmental organisations represented in the European Chronic Diseases Alliance (ECDA) that prevention must be the number one priority and that four key lifestyle factors must be addressed, namely tobacco, poor diets, alcohol and lack of physical activity.

But environmental causes must be added as a fifth factor. A huge opportunity for primary prevention of chronic disease will be missed if equal focus is not given to reducing peoples’ everyday exposure to threats from environmental degradation, including from exposure to harmful chemicals. Exposure to air pollutants alone is responsible for an estimated 450,000 premature deaths each year in Europe.

The EU’s has long played a visionary role in bringing environmental factors to disease prevention. This commitment was already evident in 2003 when the environment and health strategy was launched, followed by an action plan in 2004.

In 2010, the European Parliament underlined this focus on environmental health prevention by calling for the European Partnership for Action against Cancer to "include a component on environmental factors, these being defined as not only environmental tobacco smoke, radiation, and excessive UV exposure, but also hazardous chemicals in the indoor and outdoor environment to which people are exposed, including endocrine disruptors".

A wealth of EU research now links environmental factors to disease. Research also demonstrates how reducing environmental exposures through effective policy and legislation prevents ill-health.

The effect of air pollution on chronic disease has been scientifically recognised and widely known for 20 years and the EU has adopted a wide range of policy measures. Today, attention is turning to the potential of environmental policy change in cancer prevention. Immediately prior to a World Health Organization meeting in Asturias, Spain on Environmental and Occupational Determinants of Cancer: Interventions for Primary Prevention earlier this year, the New England Journal of Medicine, March 2011, wrote:

"The most valuable approaches to reducing cancer morbidity and mortality lie in avoiding the introduction of carcinogenic agents into the environment and eliminating exposure to carcinogenic agents that are already there."

A second reason why environmental factors must be brought to the agenda is the risk of further chronic disease as a result of climate change. Like many other regions of the world, Europe is seeing a growing number of extreme weather events. Climate change in Europe will affect air quality producing increased incidence of heart and respiratory conditions, especially during heat waves. The European Respiratory Society has shown that deaths and hospital admissions rise substantially as temperatures in cities rise above certain levels.

A third and equally important reason why the environmental factor must become a focus at the UN Summit is the threat of chronic non-communicable disease to children. At the WHO Fifth Ministerial Conference on Environment and Health in Parma in March 2010, you showed your commitment to tackling children’s environment and health by supporting time-lined targets in action plan agreed there. At that meeting, you mentioned the growing incidence of asthma and allergy, with one in every five children in Europe suffering from a chronic respiratory condition or allergy.

Other childhood conditions of growing concern, including cancer, obesity and diabetes, are also linked to environmental exposure. Childhood cancers are increasing at a rate of more than 1% per year in Europe, and rates of obesity and diabetes are reaching epidemic proportions.

The growing burden from environment-related ill-health in children is reflected in health care costs. A recent review in the US estimated health costs of children’s environmental illness at 3.5% of the nation’s total budget, up from 2.8% in a similar study in 1997.

Such a toll is a problem not only for health finances but more importantly, it represents a threat to Europe’s future.

Yet, despite the likely contribution to increasing rates of chronic disease, the important role that environmental policy change can play in primary environmental prevention may hardly be mentioned at the talks.

Environmental prevention pays for itself

As EU Health Commissioner, you are ideally suited to present the case for a greater emphasis to be given to environment and health at the UN Summit.

The European Union has a strong track record and recognised leadership role in environmental health and can present examples of environmental policy changes that, by reducing chronic disease, more than pay for themselves.

The number one example is the EU’s strong backing for tobacco control. Smoke-free public places legislation is already saving lives and improving health across the European region, according to WHO. Studies from countries that enforce bans on smoking in public places are finding reductions in heart attacks, with scientific literature indicating that hospitalisation rates for myocardial infarctions are decreasing by 20–40%.

Further improvements in air quality could reduce many of the estimated 450,000 deaths that occur each year due to exposure to air pollutants. Recent EU-funded (DG SANCO) research project Aphekom showed that improving air quality in European cities would be especially beneficial for children. Both EU and US studies show that the costs of changes to improve air quality more than pay for themselves. Most recently, the US Environment Protection Agency (EPA) concluded that the health benefits achieved from policies aimed at cleaner air "far exceed" the costs of implementing clean air protection.

Another example of cost-effective legislation is the EU’s pioneering chemical policy. Although it is too early to assess the impact of this legislation, a European Commission assessment of REACH prior to its introduction stated that if this legislation succeeds in reducing chemical-related diseases by only 10%, the health benefits are estimated at 50 billion Euros over 30 years. This corresponds with 2,200 to 4,300 fewer cancer cases in the workplace annually.

Finally, the extremely good news: a proportion of chronic disease can be prevented as a "by product" or "co-benefit" of certain climate change policy. For example, HEAL has shown that if the EU were to move promptly from the current 20% target on greenhouse gas emissions reduction to a 30% target for climate change, the public health benefits in terms of reduced respiratory and heart disease could reach 30.5 billion Euro per year in 2020.

The leading medical journal, the Lancet, has also looked at the co-benefits for health of climate change policy. One example shows that transport policy aimed at reducing carbon emissions (encourage more walking and cycling, restriction of car travel, lower-carbon-emission motor vehicles) could prevent a substantial proportion of the following chronic diseases: cardio-vascular, diabetes, breast and colon cancer, dementia and depression.

The synergies of climate and health policy in relation to air quality, clean energy and "active transport" are highlighted in the EU’s "Low-Carbon Roadmap 2050”.

Meeting the democratic challenge

The European Chronic Disease Alliance represents the views of several million health experts and citizens. HEAL and its large membership joins them in the call for putting prevention first and setting targets and well-resourced commitments. We also support their recommendation to address the four key factors.

In addition, HEAL would like to ensure that conflicts of interests are avoided in expert consultations in order to protect environmental health. However, we are writing primarily to urge you to add the environmental factor as an important agenda area in the prevention of chronic disease.

European citizens are clearly worried about exposure to chemicals and other environmental pollutants. A recent Eurobarometer shows that pesticide residues in food are a number one worry for 72% of EU consumers, a higher percentage than in 2005.

European governments also want renewed investment and action in "Environment and Health". In December 2010, EU environment ministers gave clear backing for a second Environment and Health Action Plan (EHAP). In particular, they asked that one of the priorities would be to address children’s environment and health as "identified in the Parma Declaration on Environment and Health".

HEAL hopes very much that you will decide to bring the huge potential of environmental prevention of chronic disease to the agenda in the UN High-level Meeting on chronic, non-communicable diseases in New York later this month. We believe that this addition will create inspiration and visionary impact to the global discussions.

We would welcome a meeting with you to discuss this further.

Yours sincerely,

Genon Jensen
Executive Director
Health and Environment Alliance (HEAL)

Attachment: HEAL fact sheet - Chronic disease: How do environmental factors play a role?

Last updated on 19 October 2011

About HEAL

The Health and Environment Alliance (HEAL) is a leading European not-for-profit organisation addressing how the environment affects health in the European Union (EU). We demonstrate how policy changes can help protect health and enhance people’s quality of life. Read more »


HEAL has over 70 member organisations, representing health professionals, not-for-profit health insurers, doctors, nurses, cancer and asthma groups, citizens, women’s groups, youth groups, environmental NGOs, scientists and public health institutes. Members include international and Europe-wide organisations, as well as national and local groups. Read more »

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