Over the last decades there has been a major increase in mortality from non-communicable diseases (NCDs) world-wide. NCDs account for 70% of the 56.4 million world deaths in 2015 (http://www.who.int/gho/ncd/mortality_morbidity/en). Environmental stressors contribute significantly to the NCD burden, and diseases related to pollution may represent up to 16% of total deaths world-wide. In 2012, 23% of global deaths were attributable to the environment, amounting to 12.6 million deaths. When accounting for both death and disability, the fraction of the global burden of disease due to the environment is 22%. In children under five years, up to 26% of all deaths could be prevented, if environmental risks were removed. Up to 7% of health-care costs may be related to diseases triggered by pollution. On the other hand, it is also recognized that high-quality environments can have a positive effect on health, for example green spaces or safe walking and cycling paths in urban areas (e.g. WHO, 2016). There is also growing acceptance of a psychosocial dimension in the relationship between people and the physical context in which they live which contributes to mental and physical wellbeing (Gee and Payne-Sturges 2004)4. Additionally, other diseases such as infectious diseases are also increased by climate change. Areas of concern related to environmental factors ((biotic and abiotic) are diverse and may interact considerably; they include: air quality, water quality, food quality, chemicals, waste management and contaminated sites, climate change, infectious agents (including those from zoonotic origin), urban areas, Inequalities, health sector and occupational settings. Understanding how individual stressors affect human health and characterizing their putative interactions, is a major challenge that needs to be addressed for the next decade.
Integrating the European environment, climate and health research effort with global health impact and risk assessment strategies.
While a significant amount of research has been devoted to each field, there is little integration of this effort. Developing an interdisciplinary approach would have significant added value in terms of the health impacts of climate change, environmental pollutants, transmission routes to human beings, cumulative risks, impact on particularly sensitive groups and prevention strategies. This general approach will also allow a fair appraisal of the benefits that a healthy environment can have on human health. Targeted studies will actually help in characterizing those positive impacts. This has to be done in partnership with all relevant organizations, agencies and authorities involved in the environment and health nexus at the European and national levels. It will rely on existing programmes with similar aims, notably the human biomonitoring initiative HBM4EU EJP, as well as other programmes relevant to the major objectives of the Ostrava declaration,5 the EU environment action programme and the Global Burden of Disease efforts. The challenge is to bring together decision makers, agencies and practitioners as well as research institutions, to develop common objectives.
Developing concrete preventive and precautionary recommendations at the population and individual levels.
Another major issue is to widen the application and use of environmental and exposure data. These data are primarily used in public health and at a population level. It seems relevant to develop a better understanding of such data at the individual level to support preventive actions, behavioral recommendations and advice, while taking into consideration ethical issues. An important challenge would be to assess the effectiveness of these recommendations. EU citizens expect concrete recommendations in their daily life to help them increase environmental benefits and decrease the risks of negative outcomes. In this regard, one of the challenges is to identify the limits of acceptable resilience.
B : Scientific and Technical challenges
Integrating environmental, climate and human health research efforts
The interdisciplinary interaction between the environmental studies (including ecosystem quality and ecosystem services, human health studies and social studies can be improved considerably. A large amount of data has been gathered in both cases, but integrated approaches combining ecosystem and human health have not been sufficiently conducted. There are cases where such connections are established, such as for zoonoses, and vector-borne diseases for which an OneHealth/EcoHealth integrative thinking has been developed. Such a research perspective can also benefit other types of diseases such as chronic noncommunicable diseases, In most cases, little has been done to understand the effects of (a)biotic stressors on biodiversity, ecosystem stability, resilience and consequently on human health. Obviously this will not underestimate the importance of other factors, such as diet quality and behavior, but rather call for a more integrated multidisciplinary approach. Another development related to the integration of various research lines is the reliance on health impact assessment studies; these allow combining the effects of different environmental stressors on health, using a common metric such as DALYs (Disability-adjusted life-years lost). Guidelines are lacking to help harmonizing these health impact assessment studies.
Collecting, interpreting and using massive long-term data
Although a considerable amount of data has been generated by scientists in ecology and human health, there is still a substantial need to develop observation tools and data management programmes. Long-term monitoring of transmission or exposure systems must be organized and supported by appropriate means and measures. A major challenge will be to integrate and interpret massive data generated by environmental and human studies, as well as citizen science projects, then to translate those data to make them useful to policy makers.
C :Integrating Health, Social and Economic impacts
A better assessment of the social and economic impacts of environmental effects on health and wellbeing.
Cost-benefit data and cost effectiveness of decisions are crucial for decision-making in general, and in environment and health in particular. Methods and applications of economic assessments (taking into account sustainability options) are currently developed on the health side and on the environment side, however there is a lack of integration and harmonization. An important challenge is to elicit a stronger engagement of the EH research community at large, and a better awareness of how evidence on health impacts is used in economic evaluations.
Improving the identification of health, social and economic impacts of environmental stressors in different sectors.
The exposome depends on the type of activities and behaviors, and therefore varies according to the socioeconomic sector. These include transport, agriculture, urban development, etc. Relevant studies will be conducted to assess the impact of those exposures in the different sectors. Exposures are also dependent on the behavior and different daily life settings of an individual such as home, transportation, workplace, educational settings, etc. and on their combination.
Establishing an integrated assessment of workers health in occupational settings including environmental, social and behavioral components.
Occupation and employment are an essential component of adult life and a major determinant of health and healthy ageing. The workplace can lead to unusual exposures both qualitatively and quantitatively. Some activities can also induce physical, psychological and social stress. Despite the profound changes in working life in recent years, there has been very limited prioritization of health research on occupation and employment. HERA will facilitate an integrated research strategy for occupational health in Europe, in connection with existing projects on occupational health, and will provide a foundation for an enhanced evidence base for the identification of health risks related to occupation and employment to foster preventive strategies and policies.
D: Achieving efficient dissemination and Knowledge transfer
Promoting dissemination of state-of-the-art environment and health research from “high-research capacity countries”
to “Low-capacity” ones, within EU and including neighboring countries, part of the WHO European Region. Action will be taken to fill the large gap existing between countries within the EU and beyond, in terms of capacity, resources, data, expertise, infrastructure etc. Mechanisms will be identified to put in place a stable and sustainable platform for the exchange and dissemination of current methods and strategy for EH research – including assessment of impact of measures – in Europe, especially targeting young generations of scientists, practitioners, NGO members and involved citizens. Cultural, financial and language barriers will be considered, in order to make the knowledge and evidence on EH being developed in lead countries, more accessible to other countries. The exposome covers all exposures (chemical, physical, psychological, etc.) that an individual is subject to during all his/her life. ·
Supporting knowledge transfer and information of the public.
Because environmental issues are often very sensitive, it is all the more critical to spread information and education to citizens and public authorities in Europe about the environmental factors, that are detrimental to health as well as those that have a positive impact on health.