1. DEFINITION

1. Methodological guidelines for setting up an environmental health surveillance system (EHSS) around a toxic waste incinerator(Component 2)ENHAnce Health partners

2. 1. DEFINITION • Surveillance is the ongoing and systematic collection, analysis and interpretation of data in the process of describing and monitoring public health situations, closely related to timely dissemination of information for prevention and control. (CDC) • This information will be used for planning, implementing and evaluating public health interventions and programs. Surveillance data are used both • to determine the need for public health action • to assess the effectiveness of these actions.

3. DEFINITION (continued) Surveillence is not meant for assessment of cause-effect relationships (it is not totally excluded, either) but to make it possible for the decision-makers to take preventive actions (interventions) if necessary

4. ENVIRONMENTAL HEALTH SURVEILLANCE MONITORED HEALTH DATA ENVIRONMENTAL MONITORING DATA Peak value Increase in incidence or prevalence Increase in incidence or prevalence

5. 2. REASONS for setting up an EHSS near to waste incinerators • Waste incinerators may cause harm to human health, because they emit toxic gases and particles. • Permitting of incinerators is handled by government regulatory agencies based on risk assessment analysis using toxicological data on substances assumed to be emitted by the incinerator under operating conditions. • Although modelling and other risk assessment methodologies provide useful predictive data, this should be supplemented with actual data from the facility in question with data on its environment and health status of the potentially affected population.

6. REASONS for setting up an EHSS near to waste incinerators (continued) • A review from a public health perspective of design, operating, maintenance and monitoring data of a proposed incinerator is critical to ensure that it is not likely to be harmful to the public. • Health monitoring is as important as facility monitoring: i.e. the conduct of well designed health monitoring studies before, during and after operation of the facility should be an integral component of the overall project. • There are very few data on the actual human health impacts of incinerator emissions on the health of communities near incinerators.

7. REQUIREMENTS FOR HEALTH OUTCOMES TO BE MONITORED • Relevance to the expected biological effects of the emitted pollutant • Availability • Reliability and validity • Low cost • Capacity to detect short-term or long-term effects or both

8. POPULATION GROUPS TO BE MONITORED Sensitive subgroups • infants and children(developing organism, hand-to-mouth exposure, ineffective detoxication capacity, higher amount of exposure relative to their weight, increased absorption rate etc.) • pregnant women and their foetuses(rapid cell growth, barrier function of the placenta may fail, many toxic agents can cross the placenta, especially vulnerable periods (windows) of the foetal development) • elderly people and people with chronic illnesses (decreased adaptation capacity)

9. 3. ELEMENTS OF THE EHSS • Monitoring air pollution • Monitoring the health status of the population - mortality data - morbidity data = routinely collected = routinely not collected

10. Analysis of the health state of the population • Demographical characterization • Mortality/morbidity analysis - age-specific and cause-specific comparison of areas (exposed vs. national) point-source analysis time-series analysis GIS (exposure and disease mapping) risk assessment

11. INDICATORS Environmental indicators • Measured pollutants emitted by the incinerator • Indicators of air pollution Health indicators • Demographic data • Health status • Morbidity of some chronic and acute diseases • Mortality (several cause and age-specific M)

12. Thank you for your attention