Concern for Europe’s Tomorrow
Health and the Environment in the WHO European Region

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tiers or boundaries.
The views expressed in this publication are those of the contributors and do not necessarily represent the deci-
sions or the stated policy of the World Health Organization.
The Federal Minister for the Environment, Nature Conversation and Nuclear Safety (Federal Republic of Ger-
many) provided financial support for, and undertook the printing of, this publication.
Die Deutsche Bibliothek – CIP-Einheitsaufnahme
Concern for Europe’s tomorrow : health and the environment
in the WHO European region / WHO European Centre for
Environment and Health. [Publ. on behalf of the World Health
Organization Regional Office for Europe]. – Stuttgart : Wiss.
Verl Ges., 1995
ISBN 3–8047–1406–4
NE: European Centre for Environment and Health
© World Health Organization 1995
Published on behalf of the World Health Organization Regional Office for Europe by Wissenschaftliche Ver-
lagsgesellschaft mbH
All rights reserved.
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any
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Wissenschaftliche Verlagsgesellschaft mbH, Birkenwaldstraße 44, D-70191 Stuttgart, Germany.

ments. The project was entitled Concern for
Europe’s Tomorrow, and the Scientific Ad-
visory Board of the European Centre de-
cided that the final report should be avail-
able as the scientific basis for deliberations
at the Second European Conference on En-
vironment and Health in Helsinki in June
1994.
The time available for preparation was ex-
tremely limited. The fact that a summary of
the final report was available in time for the
Second European Conference reflects great
credit on the many scientists (more than
270) and officially established national focal
points in the Member States who have taken
part in this major undertaking.
The report highlights a number of issues
that demand urgent attention and has con-
firmed the existence of major differences in
environmental conditions and the health
status of populations between the western
countries of the Region and the countries of
central and eastern Europe and the newly in-
dependent states of the former USSR.
None of the countries of our Region, how-
ever, has room for complacency. As one
example, substantial areas of many Euro-
pean cities provide a deteriorating environ-
ment for their citizens, owing to traffic
noise, pollution and congestion, and social

tries of the WHO European Region. It is
hoped that it will be widely used, not only by
government agencies but also by the very
many nongovernmental organizations deal-
ing with different aspects of the issues ad-
dressed by Concern for Europe’s Tomorrow.
J.E. Asvall
WHO Regional Director for Europe
7
Table of Contents
Foreword
Acknowledgements
Contributors
5
17
17
Introduction
Part I
Background
1 Economic Sectors
Th
e
S
ett
i
ng
23
The Genesis of Concern for
Europe’s Tomorrow
24

33
1.2 The WHO European
Region
33
1.2.1 Basic features and
indicators
33
1.2.2 Development of economic
activities
36
1.2.3 The CCEE and NIS
36
1.3 An Outlook for the Future
39
1.3.1 Some trends
39
1.3.2 Some scenarios
40
1.4 Energy
40
1.4.1 Indicators and trends
41
1
.
5I
n
d
ustry
48
1.5.1 Indicators and trends 48

i
on
63
2.2 Environmental Health
Services
64
2.3 Intersectorality
65
2.4 Involvement at the Local
and Regional Levels
66
2
.
5I
ntervent
i
on an
dC
ontro
l 69
2.6 Public Participation 70
2.7 Environmental Health
Professionals
72
2.8 Conclusions
73
References
73
3
.

h
e
CCEE
and NIS 81
3.6 Funding and Management
of Environmental
Improvement
83
3.7 Economic Instruments
84
3.8 Information
85
3.9 Conclusions
87
3.9.1 Economic strategy
87
3.9.2 Information
88
References
88
4
.
1I
ntro
d
uct
i
on
90
4.2 Demographic, Socioeco-

ty
101
4.5.3 Spatial patterns at the
subnational level
102
4.6 Occurrence of Selected
Diseases
103
4.6.1 Structure of total mortality
by cause
103
4.6.2 Selected groups of
diseases
103
4.7 Inequalities in Health
Status
122
4.8 Conclusions
124
References
125
Table of Contents 9
Part II
Environmental Exposure
5 Air Pollution
6 Water Supply and Quality
5.
1
Intro
d

5.4.1 Pollutants and their
sources
160
5.
4
.
2
E
ff
ects on
h
ea
l
t
h 161
5.4.3 Exposure in Europe 164
5.5 Global and Transboundary
Air Pollution
165
5.5.1 Climate change in the
European Region
166
5.5.2 Ozone depletion in the
European Region
167
5.5.3 Acid deposition in the
European Region
167
5.6 Trends
168

6.2 Exposure
184
6.2.1 Exposure to microbial
contamination
184
6.2.2 Exposure to chemical
contamination
187
6.2.3 Water supply coverage and
shortages
191
6.3 Causes of Exposure to
Waterborne Hazards
194
6
.
3
.
1I
na
d
equate raw water qua
li
ty
and quantity
195
6.3.2 Inadequate treatment and
distribution
196
6.4 Trends

7.1.1 Direct contact with surface
water through bathing
204
7.1.2 Direct occupational contact
with wastewater
205
7.1.3 Aerosols
205
7.1.4 Smells
205
7.1.5 Wastewater irrigation
206
7.2 Exposure
207
7.2.1 Populations with inadequate
sewage disposal or
wastewater treatment
facilities
207
7.2.2 Exposure through
recreational use
210
7
.
2
.
3P
ro
d
uct

8
.
1I
ntro
d
uct
i
on
222
8.1.1 Definitions 222
8.2 Waste Production
223
8.2.1 Municipal waste
223
8.2.2 Industrial waste
225
8.2.3 Mining waste
226
8.2.4 Small-quantity hazardous
waste
227
8.2.5 Health care waste
227
8.3 Waste Management
227
8.3.1 Collection
227
8.3.2 Disposal
228
8.3.3 Recovery, recycling and

Waste Substances
235
8.8 Trends
237
8.9 Conclusions
237
References
238
9
.
1I
ntro
d
uct
i
on
241
9.2 Food Safety Regulations,
Services and Information
Systems
242
9.2.1 Current situation
242
9
.
2
.
2F
oo
d

254
9.4.2 Exposure to chemical
contaminants
258
9.4.3 Evaluation of food contami-
nation factors as indicated
by national focal points
263
9.5 Radioactive Contamination
264
9.5.1 Natural radionuclides
264
9.5.2 Weapons fallout
265
9.5.3 Chernobyl
266
9.5.4 Radiation dose
268
9.5.5 Risk
268
9.6 Safety of Food Produced
by Biotechnology
268
9.6.1 Fermented foods
269
9.6.2 Genetic modification
269
9.6.3 Implications of
biotechnology
269

of food
273
9.8.5 Biotechnologically pro-
duced foods and drinks
273
References
273
10
.
1I
ntro
d
uct
i
on
278
10.2 Arsenic 280
10.2.1 Toxic and carcinogenic
effects
280
10.2.2 Exposure
280
10.2.3 Tissue levels
281
10.2.4 Evaluation of observed
exposure levels and possible
health effects
281
10.3 Cadmium
282

f
o
b
serve
d
exposure levels and possible
health effects
287
10.5 Mercury
288
10.5.1 Toxic and carcinogenic
effects
289
10.5.2 Exposure
290
10.5.3 Tissue levels
290
10.5.4 Evaluation of observed
exposure levels and possible
health effects
291
10.6 Pesticides
292
10.6.1 Toxic and carcinogenic
effects
292
10.6.2 Exposure
295
10.6.3 Tissue levels
296

300
10.8.3 Tissue levels
300
10.8.4 Evaluation of observed
exposure levels and possible
health effects
301
10.9 Polynuclear Aromatic
Hydrocarbons
301
10.9.1 Toxic and carcinogenic
effects
301
10.9.2 Exposure
301
10.9.3 Tissue levels
302
10.9.4 Evaluation of observed
exposure levels and possible
health effects
302
10
.
10 P
o
l
yc
hl
or
i

10.11.4 Evaluation of observed
exposure levels and possible
health effects
309
10.12 Conclusions
310
References
311
11
.
1I
ntro
d
uct
i
on
315
11.2 Ultraviolet Radiation 316
11.2.1 Solar radiation
316
11.2.2 Artificial sources of
UV radiation
318
11.2.3 Biological effects
319
11.2.4 Effects on health
320
11.2.5 Effects on the ecosystem
323
11.2.6 Conclusions

334
12.2 Biological Effects 336
12.2.1 Nature and quality of
ionizing radiation
336
12.2.2 Effects on health
336
12.2.3 Assessment of risk
337
12.3 Control of Exposure
337
12.3.1 Converting exposure to
dose
337
12
.
3
.
2Al
p
h
aem
i
tters
337
12.3.3 Recommendations on
radiation protection
339
12.4 Priorities in Environmental
Exposure

12
.
4
.
6O
ccupat
i
ona
l
exposure
349
12.5 Conclusions 351
References
351
13
.
1Wh
at
i
s
R
es
id
ent
i
a
lN
o
i
se

13.7 Conclusions
364
13.7.1 Land-use planning
364
13.7.2 Health studies on exposed
populations
364
13.7.3 Concern for the future
364
References
365
14
.
1I
ntro
d
uct
i
on
367
14.1.1 Interaction of housing,
other conditions and
health status
367
14.1.2 Housing factors affecting
health
368
14.1.3 Current housing and health
issues in the European
Region

status
374
14.2.3 Housing stock
375
14.2.4 Space
376
14.2.5 Hygiene
377
14.2.6 Indoor air quality
379
14.2.7 Indoor climate
381
14.2.8 Groups with special needs
382
14.2.9 Accidents in the home
384
14.3 Trends
387
14.3.1 Urbanization
387
14.3.2 Homelessness
387
14.3.3 Accidents
387
14.4 Conclusions
388
References
388
15
.

kf
actors
393
15.2.2 Workload and ergonomic
conditions
397
15.2.3 Physical factors
398
15.2.4 Chemical hazards
400
14 Table of Contents
16 Accidents and Man-made Disasters
17 Environmental Health in the CCEE and NIS
15
.
2
.
5Bi
o
l
og
i
ca
l
agents an
d
organic dusts 404
15.2.6 Occupational allergens
406
15.2.7 Hazards to reproductive

15.3.4 Work disability and mortal-
ity of working populations
416
15.4 Conclusions
416
References
419
16
.
1I
ntro
d
uct
i
on
424
16.2 Technological Accidents
with Environmental Effects
on Health
425
16.2.1 Chemical accidents
425
16.2.2 Radiation accidents
431
16.2.3 Accidents affecting food
and drinking-water
433
16
.
3A

and Health
445
17.2.1 Air pollution
445
17.2.2 Water supply and quality
452
17
.
2
.
3S
o
lid
waste
459
17.2.4 Radiation 460
17.3 Discussion
462
17.4 Conclusions
462
References
463
Table of Contents 15
Part III
Analysis, Discussion, Conclusions and Recommendations
18 Estimated Health Effects of Environmental Exposure
and Role of Economic Sectors
19 Conclusions and Recommendations
18
.

ons
494
18.2 Role of Economic Sectors 496
18.2.1 Agriculture
497
18.2.2 Energy
500
18.2.3 Industry
504
18.2.4 Transport
508
18.2.5 Tourism
512
18.2.6 Conclusions
512
References
516
19
.
1I
ntro
d
uct
i
on
519
19.2 Economic Sectors 519
19.3 Environmental Health
Management
521

13
.
1Ul
trav
i
o
l
et ra
di
at
i
on
529
19.13.2 Electromagnetic fields 529
19.14 Ionizing Radiation
530
19.15 Residential Noise
530
19.16 Housing and the Indoor and
Urban Environments
531
19.17 Occupational Health
532
19.18 Accidents and Man-made
Disasters
534
19.19 Environmental Exposure in
some of the CCEE and NIS 535
19.19.1 The NIS
535

task.
The Organization is greatly indebted to all
ministries of health and of the environment
in the Region for their active support. The
network of national focal points for Concern
for Europe’s Tomorrow (CET), acting as
links between the national authorities and
the Regional Office, provided invaluable
help in data collection and evaluation. The
Regional Office is especially grateful to the
chairman and members of the Scientific Ad-
visory Board of the European Centre for En-
vironment and Health who, together with nu-
merous individual reviewers, carried out a
detailed scientific critique of the drafts and
provided sound advice on their improve-
ment. The close cooperation of other inter-
national bodies, especially the European En-
vironment Agency Task Force of the Euro-
pean Commission, is appreciated.
The Regional Office wishes to record its
special gratitude to Dr Barbara MacGibbon,
who undertook the very difficult task of
overall compilation and scientific editing of
the whole report. Without her invaluable
contribution, publication of this book would
not have been possible within the very lim-
ited time available.
National focal points for CET
Contributors

E. Andronache (Institute of Hygiene and
Public Health, Bucharest, Romania)
S.L. Avaliani (Sisin Institute of Community
Hygiene, Moscow, Russian Federation)
A. Avni (Ministry of Health, Jerusalem, Is-
rael)
W. Babisch (Institute for Water, Soil and Air
Hygiene, Federal Health Office, Berlin,
Federal Republic of Germany)
B. Bayar (Ministry of Health, Ankara, Tur-
key)
R. Becher (National Institute of Public
Health, Oslo, Norway)
G. Bechu (Ministry of Health, France)
N.E. Billo (Federal Office of Public Health,
Bern, Switzerland)
K. Binysh (Department of Health, London,
United Kingdom)
G. Biro (National Institute of Food Hygiene
and Nutrition, Budapest, Hungary)
C E. Boström (National Environmental Pro-
tection Board, Stockholm, Sweden)
G. Brunborg (National Institute of Public
Health, Oslo, Norway)
J. Cachia (Department of Health, Valletta,
Malta)
R. Cachia Zammit (Department of Environ-
ment, Valletta, Malta)
J. Carmes (Ministry of Health, France)
P. Caruna (Public Health Laboratory, Vallet-

Jerusalem, Israel)
A. Goren (Tel Aviv University, Tel Aviv, Is-
rael)
F. Gösbebek (Turkish Atomic Energy Insti-
tute, Ankara, Turkey)
J. Gubernskiy (Sisin Institute of Community
Hygiene, Moscow, Russian Federation)
S. Güven (State Statistics Institute, Ankara,
Turkey)
P. Huberty-Krau (Luxem-
bourg)
A. Amato-Gauci (Malta)
R. Passeron (Monaco)
E. Lebret (Netherlands)
E. Dybing (Norway)
J.K. Ludwicki (Poland)
L. Delgado (Portugal)
M. Cucu (Romania)
N.F. Izmerov (Russian
Federation)
M. Synek (Slovakia)
M. Macarol-Hiti (Slovenia)
A. Fresno Ruiz (Spain)
K. Victorin (Sweden)
B. Marti (Switzerland)
S. Yüksel (Turkey)
A.M. Serdiuk (Ukraine)
E. Smales (United King-
dom)
Acknowledgements 19

Budapest, Hungary)
S. Khotimchenko (Institute of Nutrition
of the Russian Academy of Medical
Sciences, Moscow, Russian Federation)
B. Kihlström (National Institute of Public
Health, Oslo, Norway)
E. Kivisäkk (National Radiation Protection
Institute, Stockholm, Sweden)
V. Knizhnikov (Ministry of Health, Moscow,
Russian Federation)
M. Köhalmi (Ministry of Welfare, Budapest,
Hungary)
J. Korytkowsky (Ministry of Environmental
Protection, Warsaw, Poland)
Z. Koszarny (National Institute of Hygiene,
Warsaw, Poland)
D.I. Krammer, Federal Environmental Agen-
cy, Vienna, Austria)
N. Lazarus (Department of Health, London,
United Kingdom)
L. Licari, (Department of Health,Valletta,
Malta)
G. Lilleheil (National Institute of Public
Health, Oslo, Norway)
T. Lindner (Federal Ministry of Health,
Sport and Consumer Protection, Vienna,
Austria)
D. Lupulescu (Institute of Hygiene and Pub-
lic Health, Bucharest, Romania)
T. Majle (National Institute of Hygiene, War-

tection, Reykjavik, Iceland)
T. Popov (National Centre of Hygiene and
Medical Ecology, Sofia, Bulgaria)
V. Radmilovic (Federal Secretariat for La-
bour, Health, Veterans’ Affairs and Social
Policy, Belgrade, Federal Republic of Yu-
goslavia (Serbia and Montenegro))
T. Radunsky (Federal Environmental Agen-
cy, Vienna, Austria)
20 Acknowledgements
J. Rakhmanin (Sisin Institute of Community
Hygiene, Moscow, Russian Federation)
F. Ribarova (National Centre of Hygiene
and Medical Ecology, Sofia, Bulgaria)
D. Ricochon (Ministry of Health, France)
D. Riechman (Ministry of Health, Jerusa-
lem, Israel)
E. Rocco (Ministry of Health, Rome, Italy)
M. Rouge (Ministry of Health, France)
P. Rudnai (National Institute of Hygiene, Bu-
dapest, Hungary)
R. Skinner (Department of Health, London,
United Kingdom)
S. Slorach (National Food Administration,
Uppsala, Sweden)
T A. Stenström (National Bacteriological
Laboratory, Stockholm, Sweden)
J.R. Sveinsson (State Housing Board,
Reykjavik, Iceland)
N. Rusakov (Sisin Institute of Community

N. Tarkan (Middle East Technical Univer-
sity, Ankara, Turkey)
M. Tchutchkova (National Centre of Hygiene
and Medical Ecology, Sofia, Bulgaria)
S. Tekeli (Ministry of Trade and Industry,
Ankara, Turkey)
G. Tezcan (Ministry of Energy and Natural
Resources, Ankara, Turkey)
I. Thirouin (Ministry of Health, France)
S. Thorarinsson (Administration of Occupa-
tional Safety and Health, Reykjavik, Ice-
land)
I. Trettwer (Österreichisches Statistisches
Zentralamt, Vienna, Austria)
B. Tichacek (National Institute of Public
Health, Prague, Czech Republic)
E. Tacoronte (Ministry of Health and Con-
sumer Affairs, Madrid, Spain)
M. Tat (Institute of Hygiene and Public
Health, Bucharest, Romania)
H. Toksoy (Ministry of Agriculture and Vil-
lage Affairs, Ankara, Turkey)
U. Torsmark (National Environmental Pro-
tection Board, Solna, Sweden)
D. Tricard (Ministry of Health, France)
R. Tulbure (Institute of Hygiene and Public
Health, Bucharest, Romania)
G. Ungvary (National Institute of Occupa-
tional Heath, Budapest, Hungary)
L. Vella (Industrial Hygiene Unit, Valletta,

C. Corchia (University of Sassari, Italy)
R.B. Cundall (Medical Research Council,
Chilton, United Kingdom)
H. Dovland (Institute for Air Research, Lil-
leström, Sweden)
K. Gerigk (Robert von Ostertag Institute,
Berlin, Germany)
R.J. Gilbert (Central Public Health Labora-
tory, London, United Kingdom)
A. Henne (Medizinisches Institut für Um-
welthygiene, Düsseldorf, Germany)
D. Hill (Environmental Resources Limited,
London, United Kingdom)
G. Jukes (Institution of Environmental
Health Officers, London, United King-
dom)
E.D. Kroese (RIVM, Bilthoven, Nether-
lands)
S. Lagorio (Istituto Superiore di Sanità,
Rome, Italy)
F. Langeweg (RIVM, Bilthoven, Nether-
lands)
I. MacArthur (Institution of Environmental
Health Officers, London, United King-
dom)
K. Martignoni (Institute of Radiation Hy-
giene, Neuherberg, Germany)
R. Mnatsakanian (Moscow, Russian Feder-
ation)
Eva Nielsen (National Food Agency, Sø-

Research, Poland)
J. Rantanen (Institute of Occupational
Health, Finland)
U. Schlottmann (Federal Ministry for the
Environment, Nature Conservation and
Nuclear Safety, Germany)
V. Silano (Ministry of Health, Italy)
J. Weicherding (General Directorate of
Health, France)
T.B. Zeltner (Federal Office of Public
Health, Switzerland)
B.C.J. Zoeteman (Ministry of Housing,
Physical Planning and Environment, Ne-
therlands).
22 Acknowledgements
Individual scientific reviewers
T. Hancock (Public Health Consultant,
Kleinburg, Ontario, Canada)
P. Kulling (National Poison Information
Centre, Stockholm, Sweden)
M.D. Lebowitz (University of Arizona, Tuc-
son, USA)
D. Larré (Director, Industry and Environ-
ment Office, UNEP, Paris, France)
J.L. Larsen (National Food Agency, Søborg,
Denmark)
C.J. Macfarlane (Ontario International Cor-
poration, Government of Ontario, Cana-
da)
E. Morava (National Public Health and

ski, B. Lübkert-Alcamo (WHO)
P. Bourdeau (Head of DG XI, EEA-Task
Force)
D. Stanners (DG XI, EEA-Task Force, Pro-
ject Manager of the Europe’s environment
report).
WHO Regional Office for Europe
(a) European Centre for Environment and
Health
B. MacGibbon (Scientific Editor)
K. Baverstock, R. Bertollini, B. Fenger,
K. van der Heijden, R. Kersauze, M. Krzyza-
nowski, B. Lübkert-Alcamo, P. Marchandise,
R. Merineau, P. Rushbrook, R. Stern,
S. Tarkowski, I. Vlachonikolis, I. Wadding-
ton, P. Weigert, M. Younes, J. Zakonyi (Pro-
ject Officer for the CET report).
(b) X. Bonnefoy, M.S. Burgher, P. Charlton,
O. Espinoza, E. Grandjean, D. Kello, F. La
Ferla, A. Nanda, A. Nossikov, R. Prokhors-
kas, K. Runeberg, L. Saliba, M. Shabanah,
M.J. Suess, F. Theakston.
WHO Headquarters
E. Giroult, T. Kjellström.
23
Introduction
Many of the great advances in public health
during the nineteenth and twentieth cen-
turies resulted from the realization that un-
satisfactory water supplies, sanitation, work-

health statistics
a
show a general improve-
ment in levels of health within the European
member countries of the Organisation for
Economic Co-operation and Development
(OECD) as assessed by infant and total mor-
tality rates, life expectancy and the incidence
of certain diseases. By contrast, no improve-
ment and in some aspects a deterioration in
health status has occurred in the countries
of central and eastern Europe (CCEE)
b
and
the newly independent states (NIS) of the
former USSR over the last two decades. In
addition, considerable variations occur
a
Health for all database of the WHO Regional
Office for Europe.
b
The CCEE comprise Albania, Bulgaria, the Czech
Republic, Estonia, Hungary, Latvia, Lithuania,
Poland, Romania, Slovakia and the countries
emerging from the former Yugoslavia.
The Setting 23
The Genesis of Concern for
Europe’s Tomorrow
24
The Development of Concern for

health and wellbeing of the broad physical, psycho-
logical, social and aesthetic environment, which in-
cludes housing, urban development, land use and
transport.
While public health policies are understand-
ably mainly directed towards relieving so-
ciety of disease and premature death, the en-
vironment should also be considered as a re-
source for enhancing health and wellbeing.
People aspire to live in communities free of
environmental hazards, with decent homes
in which to raise their families, with oppor-
tunities for employment, education and cul-
ture, and with pleasant and harmonious sur-
roundings that facilitate recreation and so-
cial contact and maintain a healthy and di-
verse ecosystem. Effective environmental
protection, in its widest sense, provides a
framework for many of these aspirations, as
part of enlightened and sustainable socioeco-
nomic development.
While these are desirable aims, already
within the reach of many people in the Re-
gion, the far more basic needs of many
others must also be recognized and dealt
with as a matter of high priority. Many mil-
lions of people in the Region still lack at
least one of the essential prerequisites of en-
vironmental health: safe water, clean air,
sanitation and shelter. A substantial number

countries, the concepts, principles and strat-
egies have already become reflected in
national, regional and local policies. They
have also provided a solid basis for health de-
velopment in the CCEE and NIS, which has
been greatly affected by political change in
the last five years. While retaining their basic
structure, the original targets were updated
in 1991 [3]. As in 1984, nine targets are di-
rectly concerned with aspects of environ-
mental health.
Target 11 – Accidents
By the year 2000, injury, disability and death
The Genesis of Concern for
Europe’s Tomorrow
Introduction 25
arising from accidents should be reduced by
at least 25%.
Target 18 – Policy on environment and health
By the year 2000, all Member States should
have developed, and be implementing, pol-
icies on the environment and health that en-
sure ecologically sustainable development,
effective prevention and control of environ-
mental health risks and equitable access to
healthy environments.
Target 19 – Environmental health manage-
ment
By the year 2000, there should be effective
management systems and resources in all

By the year 2000, the health of workers in all
Member States should be improved by mak-
ing work environments more healthy, reduc-
ing work-related disease and injury, and pro-
moting the wellbeing of people at work.
The need to achieve a better understanding
of the relationship between environmental
factors and the health of individuals and
communities, together with the clear need
for the environment and health sectors at all
levels of government to work closely to-
gether, was recognized by the first European
Conference on Environment and Health,
held in Frankfurt-am-Main, Federal Republic
of Germany, in December 1989.
The Conference culminated in the adop-
tion, by ministers of health and of the en-
vironment and other senior representatives
from 29 European countries and by the
Commission of the European Communities,
of the European Charter on Environment
and Health [1]. The Charter sets out a broad
framework for action by all levels of govern-
ment, by all sectors of society and at the in-
ternational level.
Subsequently, the WHO Commission on
Health and Environment was established
and produced a report entitled Our planet,
our health [4] in preparation for the United
Nations Conference on Environment and