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EUROPEAN COMMISSION
European Research Area
International Public Health
Symposium on Environment and
Health Research.
Science for Policy, Policy for Science:
Bridging the Gap
Madrid, Spain, 20–22 October 2008
Report
ABSTRACT
The WHO Regional Office for Europe and the Carlos III Institute of Health of the Spanish Ministry of Science and
Innovation, with the support of the Spanish Ministry of Health and Consumer Affairs and the European
Commission’s Directorate-General for Research, organized the International Public Health Symposium on
Environment and Health Research. The Symposium provided a platform for mutual collaboration between public
health professionals and researchers in the field of public health in general, as well as environment and health,
contributed evidence for use in the preparations for the 2010 Ministerial Conference on Environment and Health
and helped set priorities for future policy-oriented environment and health research in the European Union under
the Seventh Framework Programme. Concluding that much remained to do to close the science–policy gap, the
Symposium participants recommended a range of tools and institutional structures to bridge it.
This publication was made possible with the support of the Carlos III Institute of Health of the Spanish Ministry of
Science and Innovation and the European Commission Directorate-General for Research.
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© World Health Organization 2009

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CONTENTS
Page
FOREWORD IV
Introduction 1
Discussion 2
Approaches to research for policy-making 2
Achievements and needs 2
Latest research and trends in the science–policy interface 3
Conclusions and recommendations 4
References 5
Annex 1. Programme 6
Annex 2. Participants 11
BOOK OF ABSTRACTS 29
iii
Foreword
Many studies have been undertaken in the last decade to provide scientific evidence for policies
to reduce the threats to health posed by the many environmental hazards to which people are
exposed in their daily lives. A recent WHO survey, conducted in relation to the International
Public Health Symposium on Environment and Health Research, concluded that while studies on
the association between health and outdoor air pollution and extreme weather events linked to
climate change have made important progress, much study is needed in other areas, whether
newly identified or neglected.
The European Commission recognizes the need for and supports further research on the
environment and health; the Directorate-General for Research has allocated a significant
budget for research activities in this area in its fifth, sixth and seventh framework programmes
for research. The current Seventh Framework Programme (2007–2013) has a dedicated
environment and health subactivity from which a number of projects have already been selected
for funding.
One of the projects funded under the Sixth Framework Programme, SPHERE (Strengthening
Public Health Research in Europe), provided a bibliometric analysis of six public health
research fields, including environment and health, in 29 European countries for the period
1995–2005. A remarkable finding was that most environmental health research addressed solely
technical issues, while only 1.2% of publications addressed environmental health policy. This
illustrates the need for a more collaborative approach in environmental health research to build
bridges between scientific results and policy initiatives.
Further, the history of environmental crises and their effects has taught that science needs to be
better used to support policy-making. The health effects of toxic oil syndrome and current issues
such as climate change, for example, strikingly show that countries’ leaders need readily
available research results to help them identify the most effective measures to reduce risks and
address public concerns. The ad hoc collaboration between the Spanish Government and the
WHO Regional Office for Europe through the Scientific Committee for the Toxic Oil Syndrome,
established in the aftermath of the outbreak in the 1980s, is a good example of how decisions for
public health interventions, based on limited but sound evidence, can be made using a
multidisciplinary approach and can serve as a model for managing food safety and future
environmental disasters and outbreaks of previously unrecorded diseases.
The Symposium – which brought a group of international experts from the environment and
health research community together with key European decision-makers in Madrid, Spain –
provided a unique opportunity and a step towards better cooperation between all stakeholders.
While the lively two-and-a-half days of debate in Madrid were not exhaustive, this publication
collates the participants’ main ideas on future needs in environment and health research and
their suggestions for improving the interaction of science and policy in this field. It can be used
as a basis for considering new initiatives in the European Commission framework programmes
and the European environment and health process, and to support research at the national level
aiming to bridge the gap between science and policy-making.
Dr Marc Danzon Mr José Manuel Silva Rodríguez Dr José Jerónimo Navas Palacios
WHO Regional Director Director-General Director, Carlos III Institute of
for Europe Directorate-General for Research, Health, Madrid, Spain
European Commission
iv
Introduction
The WHO Regional Office for Europe has always recognized two needs that must be met to
increase the effectiveness of countries’ responses to environmental health challenges: to close
the gaps between research and policy-making and to strengthen multidisciplinary research
approaches for public health, especially environmental health practice. It also recognizes the
need for communication strategies to address the general public in emerging environmental
health crises. The Regional Office and the Carlos III Institute of Health of the Spanish Ministry
of Science and Innovation in cooperation with the Spanish Ministry of Health and Consumer
Affairs, with the support of the Environment Directorate of the European Commission (EC)
Directorate-General for Research, therefore organized the International Public Health
Symposium on Environment and Health Research in Madrid, Spain on 20–22 October 2008 (1).
The Symposium provided an opportunity for discussion of the most recent developments in
research since the conference held in Aarhus, Denmark in preparation for the Fourth Ministerial
Conference on Environment and Health in Budapest, Hungary in 2004. The Fifth Ministerial
Conference on Environment and Health (2) is to take place in Parma, Italy in 2010; it will review
countries’ progress towards creating healthier environments for children by tackling unsafe and
inadequate water supplies, and exposure to air pollution, and physical, chemical and biological
agents. It will also focus political efforts on emerging or inadequately addressed priorities. As
part of the preparation for the Conference, the Symposium aimed to bring together a wide range
of scientists, research professionals, policy-makers and representatives from nongovernmental
organizations in the WHO European Region to discuss how to translate research into policy-
making while continuing to identify emerging issues and research needs. The Symposium was
intentionally organized back to back with the second high-level meeting organized to prepare for
the 2010 Conference (3) in order to ensure conclusions and recommendations of scientists were
immediately discussed.
Owing to the important role of public opinion in emerging environment and health crises, the
Symposium programme (Annex 1) included a workshop for representatives of the media to train
them to write about the health protection from environmental risks, particularly those discovered
through research, in a way that would be best understood by the general public, thereby raising
awareness, improving understanding and promoting action at ground level.
The Symposium provided a platform for discussion and further collaboration between public
health professionals and researchers, with particular emphasis on environment and health. It also
identified priorities for possible future policy-oriented environment and health research in the
European Union (EU) Seventh Framework Programme for research and technological
development (4). The Symposium’s specific objectives were:
x to present recent environment and health research and related studies and projects;
x to illustrate countries’ experiences in responding to emerging environmental health
challenges by looking at different national research activities;
x to identify missing information and knowledge for adequate policy development in response
to environmental hazards (including risk communication and policy in the presence of
scientific uncertainties and public concern); and
x to evaluate and discuss different approaches to studying interlinked health determinants.
In the opening session of the Symposium, Dr Marc Danzon, WHO Regional Director for Europe,
Mr José Manuel Silva Rodríguez, Director-General of the EC Directorate-General for Research,
Dr Bernat Soria Escoms, Minister of Health and Consumer Affairs, Spain; and Dr Cristina
Garmendia Mendizábal, Minister of Science and Innovation, Spain welcomed the participants
(Annex 2), stressing the need for better cooperation between stakeholders and advocated for
1
improving the links between research and policy-making on the environment and health. They
augured that all participants would have successful discussions in order to meet these needs.
Discussion
The participants met in plenary sessions to discuss the achievements and needs of research in
environment and health, and the latest research and trends in the science–policy interface. Four
parallel sessions on: emerging issues, using findings to identify priorities for policy; tools for
assessing health risks as a means for policy-making and bridging the gap between science and
policy-making, prompted more focused discussion. Poster sessions on a range of scientific topics
helped to identify priorities for research, as described in the later parts of this publication. The
symposium concluded with a round table discussion on policy-makers’ needs and research
findings, in which a panel composed of various stake holders was invited to reflect on of the
discussions of the other days and to share their own experience with efforts to bridge the gap.
Approaches to research for policy-making

Policy-making in public health develops and implements effective and efficient action to benefit
health. Because most problems are multi-causal and action is expensive, research is needed to
provide the basis for policy development by identifying problems and their causes and predicting
the causes and effects of action in quantifiable terms and with acceptable confidence. For
example, cost–benefit studies predicting the life-years gained through applications of different
options helped policy-makers in the United Kingdom to choose the measures to apply in their air
quality strategy.
Coping with current issues such as climate change requires a new scientific paradigm, and a
more complex, whole-system approach. New alliances are needed both within and between
science and policy-making; each needs more of the other’s expertise to work together
effectively. Cost–effectiveness analysis is a useful tool in this approach, as shown by examples
from the United States of America of choosing policy options to reduce dioxins in food, using
quality-adjusted life-years (QALYs) to measure the health effects of policies and changing
industrial methods to benefit health and the environment.
Achievements and needs

The preparations for the Fifth Ministerial Conference on Environment and Health in 2010
include assessing the progress made in closing the knowledge gap. An informal poll taken by the
Regional Office in summer 2008 asked researchers and policy-makers to name the most
significant achievements of the previous 10 years in improving understanding of the links
between health and the environment, as called for by the Third Ministerial Conference on
Environment and Health in London, United Kingdom in 1999 (5). Responses were received from
96 experts. They identified significant progress in improving the understanding of health risks of
ambient air pollution, especially particulate matter, and in developing and applying risk
assessment methodology. These were 2 out of the 10 research areas identified as needing more
study by a programme of the European Science Foundation, the WHO Regional Office for
Europe and the Directorate-General for Research, which was carried out in 1995–1999 in
preparation for the Third Ministerial Conference on Environment and health. In addition,
understanding of the links between noise and cardiovascular diseases has markedly improved,
although this subject was not included on the priority list. While much research information on
which policy-makers can act is already available, targeted funds and further study are still
needed to fill the gaps.
A case study of occupational and environmental cancer in Azerbaijan provided examples of both
achievements in confirming the cancer burden and involving all stakeholders, and needs for
greater scientific capacity and stronger links between science and policy-making (6). The study
2
showed the needs for better-quality data and local research expertise, particularly in
environmental epidemiology, to support decision-making, particularly in countries with
emerging economies and limited resources. An integrated approach, supported by international
partners and the national government, is needed to bridge the science–policy gap.
NGOs can help strengthen this bridge by helping to identify problems, providing independent
data, ensuring communication with stakeholders, demonstrating appropriate interventions and
proposing cost-effective policy solutions. Ensuring sustained funding towards a particular
research objective would help NGOs to participate throughout the life of a project or study.
Latest research and trends in the science–policy interface

Recent research on air pollution, climate change and the emerging issue of cumulative exposure
to chemicals shows the need for more comprehensive approaches by both policy-makers and
scientists. The traditional unicausal paradigms for research approaches and the evaluation of
evidence are insufficient to deal with both the complexity of the links between risk factors and
health, and uncertainty about the mechanisms of effects and the impact of actions or policies. As
policies may have unintended consequences, more comprehensive studies are needed on their
effects.
Research shows that reducing air pollution improves health and that action by all stakeholders –
scientists, policy-makers, health professionals, NGOs and the public – can benefit health and the
economy. Studies of climate change show the needs for comprehensive action for mitigation and
adaptation, including a focus on meeting the energy needs of the poor, ensuring the
decarbonization of energy supplies and increasing political pressure on the transport sector to
reduce greenhouse gases and improve health. Science needs to expand its approach to address
the cumulative effects of chemicals, including the effects of mixtures of endocrine disrupters, to
be able to make a cumulative risk assessment of chemicals that act in similar ways.
Other important topics for research include developing hazard-assessment methods for newer
technologies, such as nanotechnology and the effects of nanoparticles, and prioritizing research
on a range of issues related to global climate change, such as increased risk of exposure to
infectious diseases and allergies. Further attention is also needed to improve understanding of
and apply the tools required for large-scale impact assessment of energy sources and long-term
biomonitoring of human populations in Europe. Other valuable tools that need to be prioritized
include mechanisms to ensure that policy-makers receive the right information for effective early
warning and risk assessment and management, thereby allowing appropriate application of the
precautionary principle. All these topics need more study.
Both scientists and policy-makers need better ways to deal with uncertainty, which cannot be
eliminated and is sometimes promoted to impede action. As pledged in the Rio Declaration on
Environment and Development (7), the precautionary principle should be used to enable action
in conditions of uncertainty.
Further, science and policy have a cyclical relationship. As science feeds information into policy,
policy calls forth additional study to evaluate the action taken and help choose among future
options. Policy developments – such as the adoption of EU thematic strategies and action plans,
the publishing of reports such as the fourth assessment of the Intergovernmental Panel on
Climate Change (8) and the WHO environment and health process (9) – have driven the
progressive increase in the environment and health research conducted under the framework of
the Fifth, Sixth and Seventh EU framework programmes of research (4).
To promote efforts to bridge the gap between science and policy, support for environment and
health research and monitoring needs to be maintained at the national and international levels.
Communication between research disciplines remains poor, despite the need for cooperation.
3
Conclusions and recommendations
Much work is still required to close the science–policy gap. The Symposium participants made a
number of recommendations in contributing to preparations for the Fifth Ministerial Conference
on Environment and Health, including a range of tools and institutional structures for this task.
1. Paradigms should be revised and supportive tools developed to capture the complexity and
interdependence of environmental health issues.
x Assessment of the health effects of policies should be broadened to consider all their
implications, including transboundary and unintended effects.
x Risk-assessment methodology should be extended to deal with multiple exposures and
mixtures of chemicals, and focus on vulnerable groups.
x Scientists should:
while working to reduce uncertainty, learn how to make decisions in its presence; and
reframe the sufficiency of evidence required for action, applying the precautionary
principle in situations involving potentially irreversible effects and uncertainty.
x A dynamic informal system to gather relevant information on risks in general and a new
robust and transparent paradigm for the assessment of emerging risks need to be developed.
Existing Region-wide information platforms, such as the Environment and Health
Information System in Europe (ENHIS), should be used and expanded, to make the
information more transparent and comparable.
x Scientific evidence on cause–effect relationships between environmental factors and health
needs regular systematic review.
x Criteria to identify hotspots in the European Region and a register of hotspots should be
developed.
x Further research initiatives should seek potential future problems, such as emergings risks of
emerging infectious diseases.
2. Efficient structures should be created and maintained to facilitate and stimulate interaction
between scientists, policy-makers and the public.
x Greater integration and collaboration should be promoted between ministries of health and
the environment, and public health should be placed at the core of policy-making for all
sectors that affect it.
x Different disciplines, sectors and countries should collaborate on research, and mechanisms
should be developed to optimize human and financial resources for such collaboration,
within and beyond the WHO European Region.
x The stakeholders in environmental health issues – including civil society and the mass media
– should be involved in appraising the health effects of policies. Information on risks and
research outcomes should be communicated more clearly to policy-makers and the public.
Policy-making processes should be more transparent.
3. WHO should contribute to bridging the science–policy gap by:
x helping countries to take account of the latest scientific developments in addressing policy
questions that interest them; and
x acting as a knowledge broker: facilitating access to the best available research and working
with countries’ policy-makers and scientists to support decision-making where and when
needed.
4
References
1. International Public Health Symposium on environment and health research
Madrid, Spain, 20–22 October 2008 [web site]. Copenhagen, WHO Regional Office for
Europe, 2008 (http://www.euro.who.int/symposium2008, accessed 3 November 2008).
2. Fifth Ministerial Conference on Environment and Health, Italy, 2009 [web site].
Copenhagen, European Environment and Health Committee, 2008
(http://www.euro.who.int/eehc/conferences/20080306_1, accessed 3 November 2008).
3. Second High Level Preparatory Meeting, Madrid, Spain, 22–24 October 2008 [web site].
Copenhagen, European Environment and Health Committee, 2008
(http://www.euro.who.int/eehc/meetings/20080523_1, accessed 3 November 2008).
4. Seventh Framework Programme on Research [web site]. Brussels, European Union, 2008
(http://cordis.europa.eu/fp7/home_en.html, accessed 3 November 2008).
5. Declaration. Third Ministerial Conference on Environment and Health, London, 16–18 June
1999. Copenhagen, WHO Regional Office for Europe, 1999
(http://www.euro.who.int/Document/E69046.pdf, accessed 3 November 2008).
6. Soskolne CL et al. Environmental epidemiology: theory and practice in developing,
conducting and disseminating health research. Copenhagen, WHO Regional Office for
Europe (in press).
7. Rio Declaration on Environment and Development. New York, United Nations, 1992
(A/CONF.151/26 (Vol. I); http://www.un.org/documents/ga/conf151/aconf15126-
1annex1.htm, accessed 3 November 2008).
8. IPCC Fourth Assessment Report: Climate Change 2007 [web site]. Geneva,
Intergovernmental Panel on Climate Change, 2007
(http://www.ipcc.ch/ipccreports/assessments-reports.htm, accessed 3 November 2008).
9. Environment and health process: the ministerial conferences [web site]. Copenhagen,
European Environment and Health Committee, 2008
(http://www.euro.who.int/eehc/conferences/20021010_1, accessed 3 November 2008).
5
Annex 1. Programme
Welcome and opening session

Dr Cristina Garmendia Mendizábal, Minister of Science and Innovation, Spain (Chair)
Dr Bernat Soria Escoms, Minister of Health and Consumer Affairs, Spain
Mr José Manuel Silva Rodríguez, Director-General, Directorate-General for Research, European
Commission
Dr Marc Danzon, Regional Director, WHO Regional Office for Europe
Keynote presentations
Dr Manuel Posada de la Paz, Head, Rare Diseases Research Centre, Carlos III Institute of
Health, Madrid, Spain (Co-Chair)
Dr Isabel Noguer, Deputy Director, International Research Programmes and Institutional
Relations, Carlos III Institute of Health, Madrid, Spain (Co-Chair)
What we need from research and how to effectively translate research findings into policy-
making?
Dr Robert Maynard, Health Protection Agency (England and Wales), Chilton, United Kingdom
Is science serving policy-makers’ needs?
Professor Robert Lawrence, Centre for a Livable Future, John Hopkins Bloomberg School of
Public Health, Baltimore, Maryland, United States
Questions and answers
Session I. Achievements and needs of research in environment and health

Closing the knowledge gap: Progress made in research since the Third Ministerial Conference on
Environment and Health (1999)
Dr Michal Krzyzanowski, European Centre for Environment and Health, WHO Regional Office
for Europe
Models of science and policy: From expert demonstration to participatory dialogue
Dr Silvio Funtowicz, Institute for Protection and Security of the Citizen, European Commission
Joint Research Centre, Ispra, Italy
Bridging the gap between science and policy-making: A case study of occupational and
environmental cancer from Azerbaijan
Professor Colin Soskolne, School of Public Health, University of Alberta, Edmonton, Canada
Have the gaps between the science and policy decreased? The role of NGOs in identifying
knowledge gaps and policy-making
Ms Genon Jensen, Executive Director, Health and Environment Alliance (HEAL), Brussels,
Belgium and Ms Sascha Gabizon, Executive Director, Women in Europe for a Common Future
(WECF) and European Eco-forum, Munich, Germany
6
Session II. Latest research and trends in the science–policy interface
Dr Silvio Funtowicz, Institute for Protection and Security of the Citizen, European Commission
Joint Research Centre, Ispra, Italy (Co-Chair)
Professor James Bridges, Chair of EU Scientific Committee on Emerging and Newly Identified
Health Risks (SCENIHR), Brussels, Belgium (Co-Chair)
Ambient air pollution and health: Should we do more?
Dr Sylvia Medina, French Institute of Public Health Surveillance (InVS), Saint Maurice, France
Climate change, energy and health
Professor Andy Haines, London School of Hygiene and Tropical Medicine, United Kingdom
The emerging issue of cumulative exposure to chemicals – reason for concern?
Professor Andreas Kortenkamp, School of Pharmacy, University of London, United Kingdom
EU Commitment to environment and health research: from the Fifth to the Seventh Framework
Programme
Dr Tuomo Karjalainen, European Commission, Research Directorate General, Brussels, Belgium
Session III. Parallel sessions
A. Emerging issues in environment and health

Mr Peter Pärt, Advisor, Institute of Environment and Sustainability, European Commission,
Directorate-General Joint Research Centre, Ispra, Italy (Co-Chair)
Mr Paul Lincoln, Chief Executive, National Heart Forum, London, United Kingdom (Co-Chair)
Emerging issues and the role of the Scientific Committee for Emerging and Newly Identified
Health Risks (SCENIHR)
Professor James Bridges, Chair of EU Scientific Committee on Emerging and Newly Identified
Health Risks (SCENIHR), Brussels, Belgium
Nanoparticles and health
Professor Vyvyan Howard, Centre for Molecular Bioscience, University of Ulster, United
Kingdom
Emerging issues in environment and health – The case of vector-borne diseases in Europe
Dr Guy Hendrickx, Avia-GIS, Zoersel, Belgium
Chemical hot spots and environmental health: from assessment to action in the Russian
Federation
Professor Boris Revich, Institute of Forecasting, Russian Academy of Sciences, Moscow,
Russian Federation
Strategy for scientific cooperation and networking on emerging risks in food safety
Dr Hubert Deluyker, European Food Safety Authority, Parma, Italy
Energy choices and health
Dr Paul Wilkinson, London School of Hygiene and Tropical Medicine, United Kingdom
Health impact of the waste cycle in the provinces of Naples and Caserta (Italy)
Dr Pietro Comba, Italian National Health Institute, Rome, Italy
Discussion
7
B. Using research findings to identify priorities for policy
Professor Wim Passchier, Department of Health Risk Analysis, University of Maastricht,
Maastricht, Netherlands (Co-Chair)
Mr David Gee, Project Manager, Emerging Issues and Scientific Liaison, European Environment
Agency, Strategic Knowledge and Innovation, Copenhagen, Denmark (Co-Chair)
Knowledge evaluation: the Health and Environment Network (HENVINET)
Dr Alena Bartonova, Norwegian Institute for Air Research (NILU), Kjeller, Norway.
EnVIE – EU policies on indoor air quality and health
Dr Eduardo de Oliveira Fernandes, University of Porto, Portugal.
The dioxin crisis in Belgium: from crisis to scientific knowledge and a new policy
Dr Herman Diricks, Belgian federal agency for the safety of the food chain, Brussels, Belgium
London congestion charging scheme
Professor Ross Anderson, St George’s University of London, United Kingdom
Policy interpretation of human biomonitoring research results in Belgium: priorities and
complexity, politics and science
Mr Hans Keune, Centre for Health and Environment, University of Antwerp, Belgium
Soil contamination resulting from transport related pollution and its implications for public
health
Dr Mirza Kazimov, Medical State University, Baku, Azerbaijan
Toxic oil syndrome: lessons learned from an interdisciplinary collaboration
Health, Madrid, Spain
Discussion
C. Tools for assessing health risks as a means for policy-making

Professor Andreas Kortenkamp, School of Pharmacy, Centre for Toxicology, London, United
Kingdom (Co-Chair)
Dr Jouko Tuomisto, Department of Environmental Health, National Public Health Institute
(KTL), Kuopio, Finland (Co-Chair)
Using a sufficiency of evidence for timely prevention in multi-causal complex and uncertain
biological systems
Mr David Gee, Project Manager, Emerging Issues and Scientific Liaison, European Environment
Agency, Strategic Knowledge and Innovation, Copenhagen, Denmark
Integrated assessment of systemic risks to human health
Professor David Briggs, Imperial College of Science, Technology and Medicine, London, United
Kingdom
Russian experience on risk assessments in environment and health
Professor Simon Avaliani, Centre for Risk Assessment, Russian Academy of Advanced Medical
Studies, Moscow, Russian Federation
Novel methods for human and ecological risk assessment of combinations of stressors
Dr Hans Løkke, National Environmental Research Institute, University of Aarhus, Denmark
Health and environment integrated methodology and toolbox for scenario assessment
(HEIMTSA) – an overview
Dr Fintan Hurley, Institute of Occupational Medicine, Edinburgh, United Kingdom
8
Strengthening technical capabilities for health impact assessment: the case of HIAir
Dr Piedad Martín Olmedo, Andalusian School of Public Health, Granada, Spain
Using health impact assessment to compare risk as an illustration of the interface between
science and policy
Dr Daniel Greenbaum, Health Effects Institute (HEI), Boston, United States
Discussion
D. Bridging the gap between science and policy-making

Professor Professor Philippe Grandjean, University of Southern Denmark, Odense, Denmark
(Co-Chair)
Dr Hilary Walker, Branch Head, Radiation, Chemical and Environmental Hazards Branch,
Department of Health, London, United Kingdom (Co-Chair)
Evaluation of scientific evidence to support policies
Dr Michal Krzyzanowski, European Centre for Environment and Health, WHO Regional Office
for Europe, Bonn, Germany
Multifaceted consequences of the Chernobyl accident: lessons learned and ways forward
Dr Mikhail Balonov, Institute of Radiation Hygiene, St Petersburg, Russian Federation
Role of industry and business community in bridging the gap between science and policy-making
Dr Loredana Ghinea, European Chemical Industries Council (CEFIC), Brussels, Belgium
European Conference on Human Biomonitoring: from biomarkers to human biomonitoring as a
policy support tool in environmental health
Dr Anne-Catherine Viso, French Public Health Institute (InVS), Saint-Maurice, France
Health at work and healthy environment
Dr Jadranka Mustajbegovic, School of Medicine, University of Zagreb, Croatia
An environmental and occupational health research programme to respond to policy-makers’
needs: AFSSET’s experience
Dr Jean Lesne, French Agency for Environmental and Occupational Health Safety (AFSSET),
Maisons-Alfort, France
Environmental public health research in Europe: bibliographic analysis of literature
Professor Stanislaw Tarkowski, School of Public Health, Nofer Institute of Occupational
Medicine, Lodz, Poland
Discussion
Session IV. Bridging the gap between science and policy-making

Dr Argelia Castaño Calvo, National Centre for Environmental Health, Carlos III Institute of
Keynote presentations
The gap between science and policy-making: the seven deadly sins of science
Professor Philippe Grandjean, University of Southern Denmark, Odense, Denmark
Climate change: bridging the gap between science and policy-making
Professor Jean-Pascal van Ypersele, International Panel on Climate Change (IPCC)
9
Plenary: reporting back by chairs of parallel sessions
Mr Peter Pärt, Advisor, Institute of Environment and Sustainability, European Commission,
Directorate-General Joint Research Centre, Ispra, Italy
Mr Paul Lincoln, Chief Executive, National Heart Forum, London, United Kingdom
Professor Wim Passchier, Department of Health Risk Analysis, University of Maastricht,
Maastricht, Netherlands
Professor Andreas Kortenkamp, School of Pharmacy, Centre for Toxicology, London, United
Kingdom
Dr Jouko Tuomisto, Department of Environmental Health, National Public Health Institute
(KTL), Kuopio, Finland
Dr Hilary Walker, Branch Head, Radiation, Chemical and Environmental Hazards Branch,
Department of Health, London, United Kingdom
Round-table: policy-makers’ needs and research findings

Dr Franklin Apfel, Managing Director, World Health Communication Associates, Compton
Bishop, United Kingdom (Moderator)
Professor Frank Ackerman, Global Development and Environment Institute, Tufts University,
Medford, United States of America
Dr Deborah Cohen, Deputy Magazine Editor, BMJ Editorial, British Medical Journal, London,
United Kingdom
Professor Vyvyan Howard, International Society for Environmental Doctors (ISDE),
Biomanaging Research Group, Centre for Molecular Bioscience, University of Ulster, Coleraine,
United Kingdom
Dr Gernot Klotz, World Business Council on Sustainable Development (WBCSD), Executive
Director, Research and Innovation, European Chemical Industries Council (CEFIC), Brussels,
Belgium
Dr Elisabeth Lipiatou, Head, Climate Change and Environmental Risks, European Commission,
Brussels, Belgium
Mr Robert O’Keefe, Vice President, Health Effects Institute, Boston, Massachussetts, United
States of America
Dr Elizabet Paunovic, Assistant Minister of Health, Sector for EU integrations and International
Cooperation, Ministry of Health of the Republic of Serbia, Belgrade, Serbia
Ms Mona Westergaard, Senior Advisor on International Environmental Issues, Danish
Environmental Protection Agency, Ministry of Environment, Copenhagen, Denmark
Closure of the Symposium
10
Annex 2. Participants
Dr Lyudmila Aksyonova
Head, International Cooperation and Programmes Department, State Committee for Nature
Protection of the Republic of Uzbekistan, Tashkent, Uzbekistan
Dr Imran Abdulov
Deputy Head, Division of Environmental and Nature Protection Policy, Ministry of Ecology and
Nature Protection, Baku, Azerbaijan
Dr Marita Afezolli (Selfo)
Head, Hygiene and Epidemiology Sector, Department of Primary Health Care, Ministry of
Health, Tirana, Albania
Ms Dorina Ago
Chemist, Environment and Health, Institute of Public Health, Tirana, Albania
Ms Maryse Arendt
Director, The Pregnancy Childbirth and Parenting Centre, Itzig, Luxembourg
Professor Giorgio Assennato

General Director, Regional Agency for Environmental Protection (ARPA) Puglia, Bari, Italy
Professor Herman Autrup

Institute of Public Health, University of Aarhus, Denmark
Mr Ralph Baden
Biologist, Department of Occupational Health, Ministry of Health, Luxembourg
Ms Carla Baer Manolopoulou

President, Clean up Greece, Athens, Greece
Dr Nune Bakunts
Head, Legal Instruments, State Hygiene and Anti-Epidemic Inspectorate, Ministry of Health,
Yerevan, Armenia
Ms Anne Barre
Director, Women in Europe for a Common Future (WECF) France, Annemasse, France
Dr Fabrizio Bianchi
Director of Research, Epidemiology Unit, National Research Council, Pisa, Italy
Mr Pierre Biot
Environment and Health Expert, Federal Public Service Health, Food Chain Safety and
Environment, Brussels, Belgium
Ms Hildegunn Blindheim Jablonska

Senior Adviser, Department of Chemicals and Local Environment Management, Norwegian
Pollution Control Authority, Oslo, Norway
Mr Leonard Boduri
Adviser to the Minister, Cabinet of the Minister, Ministry of Environment, Forestry and Water
Administration, Tirana, Albania
11
Dr Stephan Boese-O’Reilly
Assistant Professor, Department of Public Health, Medical Decision Making and Health
Technology Assessment, University for Health Sciences, Medical Informatics and Technology,
Hall in Tirol, Austria
Ms Elena Isabel Boldo Pascua

Researcher, Health Impact Assessment, Cancer Epidemiology Unit, Rare Diseases Research
Centre, Carlos III Institute of Health, Madrid, Spain
Dr Catherine Bouland
Member of the National Cell, Environment and Health, Brussels Institute for the Management of
the Environment (IBGE), Brussels, Belgium
Ms Emmanuele Bourgeois
Research Department, Belgian Science Policy, Brussels, Belgium
Mr Koldo Cambra Contin

Health Risk Evaluation Specialist, Department of Health, Basque Government, Vitoria-Gasteiz,
Spain
Ms Patricia Cameron
Unit Director, Chemicals Policy and Nanotechnology, Friends of the Earth, Germany, Berlin,
Germany
Dr Mario Cardaba Arranz

Technical Officer, Environmental and Occupational Health, Ministry of Health and Consumer
Affairs, Madrid, Spain
Dr N. Carmichael
Secretary-General, European Centre for Ecotoxicology and, Toxicology of Chemicals
(ECETOC), Brussels, Belgium
Dr Fernando Carreras-Vaquer
Deputy Director, Environmental and Occupational Health, Ministry of Health and Consumer
Dr Ludwine Casteleyn
Researcher, Department of Human Genetics, University of Leuven, Brussels, Belgium
Ms Nita Chaudhuri
Health Promotion and Environment Specialist, Women in Europe for a Common Future
(WECF), Sustainable Development Environment and Public Health, Croissy sur Seine, France
Ms Diana Mariana Cocarta

Senior Researcher, Environmental Engineer, Department of Energy Production and Use,
Politehnica University of Bucharest, Romania
Dr Shane Colgan
Research officer, STRIVE (Science, Technology, Research and Innovation for the Environment)
Environmental Protection Agency Ireland, Dublin, Ireland
12
Dr Liliana Cori
Researcher, Institute of Clinical Physiology – National Research Council , Rome, Italy
Mr Massimo Cozzone
Senior Officer, Environmental Research and Development, Ministry for the Environment, Land
and Sea, Rome, Italy
Dr Eva Csobod
Director, Environment and Health Topic Leader, Country Office Hungary, Regional
Environmental Centre for Central and Eastern Europe, Szentendre, Hungary
Dr Bruno de Buzonniere
Health Director, Veolia Environnement, Paris, France
Dr Bruna De Marchi
Head, Mass Emergencies Programme, Institute of International Sociology of Gorizia (ISIG),
Italy
Ms Ellen Dhein
Manager, Children’s Health, Environment and Sustainability, Bayer AG, Leverkusen, Germany
Mr Paulo Diegues
Head, Environmental Health Division, Directorate General of Health, Lisbon, Portugal
Mr Herman Diricks
Federal Agency for the Safety of the Food Chain (FAVV), Brussels, Belgium
Professor Elena Dominguez

Seconded National Expert, Environment Directorate, Directorate-General for Research,
European Commission, Brussels, Belgium
Dr Raquel Duarte-Davidson
Head, Chemical Hazards and Poisons Division, Centre for Radiation, Chemicals and
Environmental Hazards, Health Protection Agency, Chilton, United Kingdom
Dr Gyula Dura
Acting Director General, National Institute of Environmental Health, Budapest, Hungary
Dr Mohssine El Kahloun
Collaborator, Belgian Federal Science Policy and Federal Public Service Health, Food Chain
Safety and Environment, Brussels, Belgium
Mrs Ingrid Elbertse

Project Officer, Women in Europe for a Common Future (WEFC), Utrecht, Netherlands
Dr Salma Elreedy
Head, European and International Relations, Methods, Research and External Relations
Department, French Agency for Environmental and Occupational Health Safety, (AFSSET),
Maisons-Alfort, France
Mr Eddy L. Engelsman
Ambassador, Physical Activity and Health, Ministry of Health, Welfare and Sport, The Hague,
Netherlands
13
Ms Zana Fakin
Junior Advisor, International Relation Department, Ministry of Environmental Protection
Physical Planning, Zagreb, Croatia
Mr Christian Farrar-Hockley
Policy and Information Officer, Health and Environment Alliance (HEAL), Brussels, Belgium
Dr Lucia Fazzo
Researcher, Environmental Epidemiology, Environment and Primary Prevention, Department of
Environment Epidemiology, Istituto Superiore di Sanità, Rome, Italy
Mrs Jana Feldmane
Head, Division for Environmental Health, Department of Public Health, Ministry of Health,
Riga, Latvia
Ms Sascha Gabizon
Executive Director, Women in Europe for a Common Future (WECF) and European ECO-
FORUM, Utrecht, Netherlands
Mr Giulio Gallo
Administrator, Directorate-General for Health and Consumers, European Commission,
Luxembourg, Luxembourg
Dr Jose Garcia
European Projects Office, Carlos III Institute of Health, Madrid, Spain
Professor Emilio Gelpi

Director, Spanish Council for Scientific Research (CSIC), Institute of Biomedical Investigations
of Barcelona (IIBB), Spain
Ms Berit Ellefsen Gjerstad

Head of Section, Department of Chemicals and Local Environmental Management, Norwegian
Pollution Control Authority, Oslo, Norway
Professor Dragan Gjorgjev

Director, Republic Institute for Health Protection, Ministry of Health, Skopje, the former
Yugoslav Republic of Macedonia
Mr Valeriu Goncear
Senior Consultant, Department of Preventive Medicine, Ministry of Health, Chisinau, Republic
of Moldova
Ms M Luisa Gonzales
Technical Expert, Directorate-General of Public Health, Ministry of Health and Consumer
Ms Sonja Grossberndt
Network Children’s Health and Environment, University of Applied Sciences Magdeburg,
Germany
Ms Monica Guarinoni
Deputy Director, Health and Environment Alliance (HEAL), Brussels, Belgium
14
Ms Sonja Haider
Director, Chemicals, Women in Europe for a Common Future (WECF), Germany, Munich,
Germany
Ms Katarina Halzlova
Head of Department, Public Health Authority of the Slovak Republic, Bratislava, Slovakia
Professor Thomas Hartmann

Children’s Health and Environment Network, University of Applied Sciences Magdeburg-
Stendal, Germany
Ms Johanna Hausmann
Press officer, Women in Europe for a Common Future (WECF), Munich, Germany
Dr Diana Hein
Deputy Head of Division, Immission Control, Ministry of the Environment and Conservation,
Agriculture and Consumer Protection of the German State of North Rhine-Westphalia,
Düsseldorf, Germany
Dr Henk Hilderink
Senior Policy Adviser, Global Sustainability and Climate, Netherlands Environmental
Assessment Agency (PBL), Bilthoven, Netherlands
Ms Neli Hindziuk
Deputy Head, Physician, Republican Centre of Hygiene, Epidemiology and Public Health,
Minsk, Belarus
Dr Jon Hilmar Iversen

Director, Norwegian Directorate of Health, Oslo, Norway
Professor Matti Jantunen
Research Professor, Department of Environmental Health, National Public Health Institute
(KTL), Kuopio, Finland
Dr Reinhard Joas
Managing Director, BiPRO GmbH, Munich, Germany
Ms Jill Jönsson
Communication Manager, Chemicals as Contaminants in the Food Chain (CASCADE) Network
of Excellence, Karolinska Institute, Novum , Huddinge, Sweden
Ms Nadia Kamel
Scientific Officer, European Respiratory Society Brussels Office org, Brussels, Belgium
Dr Lis Keiding
Staff Specialist, Centre of Health Promotion and Prevention, National Board of Health,
Copenhagen, Denmark
Mr Ravindra Khaiwal
Research Fellow, Centre for Atmospheric and Instrumentation Research (CAIR), University of
Hertfordshire, Hatfield, United Kingdom
15
Dr Edwin M. Kilbourne
Senior Partner, Martin, Blanck and Associates, Dunwoody, United States of America
Dr Gernot Klotz
Executive Director, Research and Innovation, European Chemical Industries Council (CEFIC),
Brussels, Belgium
Ms Hanneke Kruize
Researcher on Environment and Health, Centre of Environmental Health Research, National
Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
Ms Hana Kuncova
Chemicals Health Monitor Project Coordinator, Health and Environment Alliance (HEAL),
Brussels, Belgium
Dr Carlos Lahoz
Department of Immunology, Jiménez Díaz Foundation, Madrid, Spain
Mrs Helen Lampropoulou

Health Visitor, Division of Sanitary Mechanics and, Environmental Hygiene, Hellenic Ministry
of Health and Social Welfare, Athens, Greece
Dr Christian Langebartels
Head of Department, Program Planning and Management, Helmholtz Center Munich, Research
Center for Environmental Health, Germany
Dr Erik Lebret
Chief scientist, Environmental Health Research, National Institute for Public Health and the
Environment (RIVM), Bilthoven, Netherlands
Ms Dorte Lerche
Technical Advisor, Chemicals, Environmental Protection Agency, Ministry of Environment,
Copenhagen, Denmark
Mr David Ludlow
Director European Research Programmes, University of Bristol, United Kingdom
Ms Helen Lynn
Director, Wildcard Research and Communications, London, United Kingdom
Ms Gwynne Lyons
Director, Chem Trust, Norwich, United Kingdom
Dr Regina Maria Madail Vilao
Director, Department for Environmental Policies and Strategies, Portuguese Environment
Agency, Amadora, Portugal
Dr Guy Alois Magnus
Director, European Society for Research and Prevention on Environment and Health, Brussels,
Belgium
Mr Shakeel Mahmood
Member, Bangladesh Environmental Society, Dhaka, Bangladesh
16
Ms Maja Mampaey
Policy advisor, Health and Environment, Environment, Nature and Energy Department, Brussels,
Belgium
Dr Rie Masho
Senior researcher, Research and Development, Centre for Environmental Information Science,
Tokyo, Japan
Professor George Morris

Scientific Policy Adviser, Scottish Executive Health Department, Edinburgh, United Kingdom
Dr Mark McCarthy
Department of Epidemiology and Public Health, University College London, United Kingdom
Ms Siobhan McEvoy
Acting Chief Environmental Health Officer, Environmental Health, Department of Health and
Children, Dublin, Ireland
Ms Marieta Mima
Executive Director, Environmental Centre for Administration and Technology (ECAT) Tirana,
Albania
Ms Bente Moe
Senior Adviser, Primary Health Services, Norwegian Directorate of Health, Oslo, Norway
Dr Komil Mukhamedov
Leading Specialist, Principal Sanitary Epidemiologic Directorate, Ministry of Health, Tashkent,
Uzbekistan
Ms Zhuldyz Murzabekova
Head, Division of Sustainable Development and, Scientific and Analytical Provision, Ministry of
Environmental Protection, Astana, Kazakhstan
Dr Elaine Mutch
Lecturer, Newcastle University, Newcastle Upon Tyne, United Kingdom
Mr Timur H. Nazarov
Director, Tabiat Ecological Scientific Centre, Ministry of Agriculture, Environmental Protection
and Forestry, Dushanbe, Tajikistan
Professor Benoit Nemery

Professor of Toxicology and Occupational Medicine, Catholic University Leuven (K.U.
Leuven), Leuven, Belgium
Dr Marguerite Jane Newbold

Research Fellow, Centre for Atmospheric and Instrumentation Research (CAIR), University of
Hertfordshire, Hatfield, United Kingdom
Dr Louise Newport
Scientific Policy Manager, Radiation, Chemical and Environmental Hazards, Department of
Health, London, United Kingdom
17
Dr Julie Ng-A-Tham
Coordinator Environment and Health, Directorate-General Environment and Chemicals, Waste
Radiation Protection Directorate, Ministry of Housing, Spatial Planning and the Environment,
The Hague, Netherlands
Professor Mark J Nieuwenhuijsen

Research Professor, Centre for Research in Environmental Epidemiology (CREAL), Barcelona,
Spain
Dr Isabel Noguer
Deputy Director, International Research Programmes and Institutional Relations, Carlos III
Institute of Health, Madrid, Spain
Dr Matthias Otto
Head of Department, Children’s Environment and Health, German Academy of Paediatrics,
Osnabrück, Germany
Mr Dirk Pallapies
Epidemiologist, Research Institute of Occupational Medicine German Social Accident Insurance
(BGFA), Bochum, Germany
Dr Mikko Paunio
Senior Medical Officer, Health Department, Ministry of Social Affairs and Health, Helsinki,
Finland
Ms Katrina Perehudoff
Project Assistant, Health and Environment Alliance (HEAL), Brussels, Belgium
Ms Lea Peternel
Senior Adviser, Sector for the Prevention and Development of Public Health, Ministry of Health
of the Republic of Slovenia, Ljubljana, Slovenia
Dr Roseanne Philen
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention,
Atlanta, United States of America
Dr Ingemar Pongratz
Senior Scientist, Department for Biosciences and Nutrition, Karolinska Institute, Huddinge,
Sweden
Professor Nikoloz Pruidze

Deputy Minister, Ministry of Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
Ms Marianne Rappolder
Environmental Hygiene, Federal Environment Agency, Berlin, Germany
Dr Radu Rautiu
Senior Project Manager, European Projects – Health and Environment, Imperial College London
Consultants LTD, United Kingdom
Dr David Ray
Associate Professor of Neurotoxicology, School of Biomedical Sciences, University of
Nottingham, United Kingdom
18
Dr Maria Helena Rebelo
Head of Unit, Environmental Health Department, National Institute of Health, Lisbon, Portugal
Ms Angela Richter
Research Manager (Biology), Brussels office, Helmholtz Association of German Research
Centres, Brussels, Belgium
Ms Isabel Ripa
Women in Europe for a Common Future (WECF), Spain, Logroño, Spain
Ms Elizabeth Salter Green

Director, Chem Trust, London, United Kingdom
Mr Sergey Samoylov
Head, Department of Economics and Management of Rational Nature Use, State Committee for
Nature Protection, Tashkent, Uzbekistan
Ms Ulrike Schmülling
Adviser, Brussels Liaison Office, Federation of German Chemical Industries, Brussels, Belgium
Dr Carlos Segovia
Technical Adviser, International Research Programmes and Institutional Relations, Carlos III
Institute of Health, Madrid, Spain
Ms Diana G. Smith
Communications Director, Health and Environment Alliance (HEAL), Brussels, Belgium
Dr Zornitsa Spassova
Junior Research Associate, Health System Functioning, National Centre of Public Health
Protection, Sofia, Bulgaria
Ms Anna Starzewska-Sikorska
Scientific Director, Institute for Ecology of Industrial Areas, Katowice, Poland
Ms Kristien Stassen
PhD student, Integrated Environmental Studies, Flemish Institute for Technological Research,
Mol, Belgium
Mr David Stone
Principal Specialist, Environment and Health Science and Evidence, Natural England,
Peterborough, United Kingdom
Professor Arne Svejgaard

Department of Clinical Immunology, Section 7631, University Hospital of Copenhagen
(Rigshospitalet), Copenhagen, Denmark
Professor António Tavares

Coordinator, Environmental Health Department, Dr Ricardo Jorge National Health Institute,
Lisbon, Portugal
Professor Benedetto Terracini

Professor of Medical Statistics (retired), Turin, Italy
19
Dr Tomas Turecki
Project Officer, Unit I.5 Climate Change and Environmental Risks, Directorate-General for
Research, European Commission, Brussels, Belgium
Ms Györgyi Ujszaszi
Nesting Coordinator, Large Family Association (NOE), Budapest, Hungary
Ms Maria Ulaszewska
PhD student, Faculty of Agriculture, Ecology, Biochemistry and Chemistry of Pesticides,
University of Milan, Italy
Dr Pierre Vaiss
Project manager, Health and environment, Ministry for Ecology, Energy, Sustainable
Development and Town and Country Planning (Regional Development), Paris, France
Mr Theo van Alphen

Senior Researcher, Centre for Environmental Health Research, National Institute for Public
Health and the Environment (RIVM), Bilthoven, Netherlands
Ms Erna van Balen

Researcher, Centre of Environmental Health Research, National Institute for Public Health and
the Environment (RIVM), Bilthoven, Netherlands
Mrs Chantal Van den Bossche

Communications Officer, Public Relations and Press, Women in Europe for a Common Future
(WECF), Utrecht, Netherlands
Mr Peter van den Hazel

Environmental Health Consultant, Environmental Health unit, Public Health Services Gelderland
Midden, Arnhem, Netherlands
Dr An van Nieuwenhuyse
Programme leader, Environmental Health Unit, Scientific Institute of Public Health, Brussels,
Belgium
Ms Lisette van Vliet

Toxics Policy Advisor, Health and Environment Alliance (HEAL), Brussels, Belgium
Ms Catarina Venancio
Head of Unit, Environment Information and Management, Portuguese Environment Agency,
Amadora, Portugal
Mrs Eugenia Verlan

Deputy Head of Division, Analysis, Monitoring and Policy Evaluation Division, Ministry of
Ecology and Natural Resources, Chisinau, Republic of Moldova
Professor Eurgenio Vilanova Gisbert

Director, Bioengineering Institute, University Miguel Hernández, Alicante, Spain
Dr Fritz Wagner
Deputy Director, Disease Prevention and Health Promotion, Federal Ministry of Health, Family
and Youth, Vienna, Austria
20
Dr Eleonora Wcislo
Environmental Risk Analysis, Institute for Ecology of Industrial Areas, Katowice, Poland
Ms Claudia Weigert
Architect, Environmental Health Division, Directorate General of Health, Lisbon, Portugal
Dr Corinna Weinz
Manager, Environment and Health Concepts, Environment and Sustainability, Bayer AG,
Leverkusen, Germany
Ms Birgit Wirsing
National Contact Point Environment and Health, Project Management Agency in the German
Aerospace Centre, Bonn, Germany
Ms Dorota Wojcik
Chief Specialist, Public Health Department, Ministry of Health, Warsaw, Poland
Dr Birgit Wolz
Head of Division, Federal Ministry for the Environment, Nature and Consumer Protection,
Bonn, Germany
Speakers
Professor Frank Ackerman
Global Development and Environment Institute, Tufts University, Medford, United States of
America
Dr Franklin Apfel
Managing Director, World Health Communication Associates, Compton Bishop, United
Kingdom
Professor Simon Avaliani

Russian Medical Academy of Post-Graduate Education, Moscow, Russian Federation
Professor Mikhail Balonov

Head of Protection Laboratory, Institute of Radiation Hygiene, St Petersburg, Russian Federation
Mr Benjamin Barrett
King’s College London, United Kingdom
Dr Alena Bartonova
Senior Scientist, Centre for Ecological Economics, Norwegian Institute for Air Research
(NILU), Kjeller, Norway
Professor James Bridges

Chair of EU Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR),
Brussels, Belgium
Professor David Briggs

Professor, Environment and Health Sciences, Department of Epidemiology and Public Health,
Imperial College of Science, Technology and Medicine, London, United Kingdom
21
Ms Deborah Cohen
Deputy Magazine Editor, BMJ Editorial, British Medical Journal, London, United Kingdom
Dr Hubert Deluyker
European Food Safety Authority, Parma, Italy
Dr Silvio Funtowicz
Institute for Protection and Security of the Citizen, European Commission Joint Research Centre,
Ispra, Italy
Mr David Gee
Project Manager, Emerging Issues and Scientific Liaison, European Environment Agency,
Strategic Knowledge and Innovation, Copenhagen, Denmark
Ms Loredana Ghinea
Manager, Emerging Science/Policy Issues, Research and Innovation, the European Chemical
Industry Council (CEFIC), Brussels, Belgium
Professor Philippe Grandjean

Institute of Public Health, University of Southern Denmark, Odense, Denmark
Mr Daniel Greenbaum
President, Health Effects Institute, Boston, United States of America
Professor Andrew Haines

Dean, London School of Hygiene and Tropical Medicine, United Kingdom
Mr Guy Hendrickx
Managing Director, Spatial information systems, Agriculture and Veterinary Information and
Analysis (Avia-GIS), Zoersel, Belgium
Professor Vyvyan Howard

Biomanaging Research Group, Centre for Molecular Bioscience, University of Ulster, Coleraine,
United Kingdom
Mr Fintan Hurley
Institute of Occupational Medicine, Edinburgh, United Kingdom
Dr Tuomo Karjalainen
Scientific Officer, Environment Directorate, Directorate-General for Research, European
Commission, Brussels, Belgium
Dr Mirza Kazimov
Head, General Hygiene Department, Medical State University, Ministry of Health, Baku,
Azerbaijan
Mr Hans Keune
Department of Sociology, University of Antwerp, Belgium
Professor Andreas Kortenkamp

School of Pharmacy, Centre for Toxicology, London, United Kingdom
22
Professor Robert Lawrence
Director, Centre for a Livable Future, John Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, United States of America
Dr Jean Lesne
Head, Research and Scientific Watch Unit, Methods, Research and External Relations
Department, French Agency for Environmental and Occupational Security, Paris, France
Mr Paul Lincoln
Chief Executive, National Heart Forum, London, United Kingdom
Ms Elisabeth Lipiatou
Head, Climate Change and Environmental Risks, European Commission, Brussels, Belgium
Dr Hans Løkke
National Environmental Research Institute, University of Aarhus, Denmark
Dr Piedad Martin-Olmedo
Senior Scientist, Public Health, Andalusian School for Public Health, Granada, Spain
Dr Robert L. Maynard
Head of Air Pollution and Noise Groups, Chemical Hazards and Poisons Division, Health
Protection Agency, Chilton, United Kingdom
Dr Sylvia Medina
Coordinator of European programmes, Department of Environmental Health, French Institute for
Public Health Surveillance (InVS), Saint Maurice, France
Professor Jadranka Mustajbegovic

Professor and Chair, Department of Environmental and Occupational Health, University of
Zagreb, School of Medicine, Andrija Stampar School of Public Health, Zagreb, Croatia
Mr Robert O’Keefe
Vice President, Health Effects Institute, Boston, Massachussetts, United States of America
Dr Eduardo Oliveira Fernandes

Professor, Mechanical Engineering, Institute of Mechanical Engineering (IDMEC) - Faculty of
Engineering University of Porto (FEUP) , Porto, Portugal
Mr Peter Pärt
Advisor, Institute of Environment and Sustainability, European Commission, Directorate-
General Joint Research Centre, Ispra, Italy
Professor Wim Passchier

Department of Health Risk Analysis, University of Maastricht, Maastricht, Netherlands
Dr Elizabet Paunovic
Assistant Minister of Health, Sector for EU integrations and International Cooperation, Ministry
of Health of the Republic of Serbia, Belgrade, Serbia
Dr Manuel Posada de la Paz

Head, Rare Diseases Research Centre, Carlos III Institute of Health, Madrid, Spain
23
Professor Ralf Reintjes
Head of Unit, Emerging Risks Unit, European Food Safety Authority, Parma, Italy
Professor Boris Revich

Head, Laboratory of Environmental Health, Institute of Forecasting Russian Academy of
Science, Moscow, Russian Federation
Dr Colin L. Soskolne
Department of Public Health Sciences, School of Public Health, University of Alberta,
Edmonton, Canada
Professor Stanislaw Tarkowski

Scientist, School of Public Health, Nofer Institute of Occupational Medicine, Lodz, Poland
Professor Jouko Tuomisto

Department of Environmental Health, National Public Health Institute (KTL), Kuopio, Finland
Professor Jean-Pascal van Ypersele

Vice-Chair, Intergovernmental Panel on Climate Change (IPCC) Worging Group 2 (WGII), The
Institute of Astronomy and Geophysics Georges Lemaître (ASTR), Catholic University of
Louvain, Belgium
Dr Anne-Catherine Viso
European Affairs Officer, French Institute for Public Health, St Maurice, France
Dr Hilary Walker
Branch Head, Radiation, Chemical and Environmental Hazards Branch, Department of Health,
London, United Kingdom
Ms Mona Westergaard
Senior Advisor on International Environmental Issues, Danish Environmental Protection
Agency, Ministry of Environment, Copenhagen, Denmark
Dr Paul Wilkinson
Head of Unit, Public and Environmental Health Research, London School of Hygiene and
Tropical Medicine, United Kingdom
Observers
Dr Ignacio Abaitua Borda
Researcher, Toxic Oil Syndrome, The Toxic Oil Syndrome and Rare Diseases Research Centre
(CISATER), Subdirectorate-General of Health, Carlos III Institute of Health, Madrid, Spain
Dr Margarita Alonso Capitan

Medical Consultant, Environmental and Occupational Health, Ministry of Health and Consumer
Ms Rosario Alonso Fernandez

Expert in Control of Chemicals Legislation, Directorate-General of Public Health, Ministry of
Health and Consumer Affairs, Madrid, Spain
24
Dr Marina Ayuga Martinez
Dr Carmen Barrueco
Head, Notification Unit, Subdirectorate-General of Environmental and Occupational Health,
Ministry of Health and Consumer Affairs, Madrid, Spain
Mrs Covadonga Caballo-Dieguez

Subdirectorate-General of Environmental and Occupational Health, Ministry of Health and
Consumer Affairs, Madrid, Spain
Ms Carmen Castañon
Assistant Director-General, Human Resources and Economic-Budgeting Services, Ministry of
Dr Argelia Castaño Calvo

National Centre for Environmental Health, Carlos III Institute of Health, Madrid, Spain
Dr Maria José Carroquino Saltó

Researcher, WHO Collaborating Centre for Epidemiology of Environment-related Diseases,
Carlos III Institute of Health, Madrid, Spain
Ms Rosa Cepeda Casares

National Centre for Environmental Health, Carlos III Institute of Health, Madrid, Spain
Dr Raquel Fernandez Sanchez

Expert in Human Health Hazard Assessments, Directorate-General of Public Health, Ministry of
Mr Miguel Angel Ribes Ripoll

Section Chief, Environment and Health observatory, Madrid, Spain
Mr Ildefonso Hernandez
Director-General of Public Health, Ministry of Health and Consumer Affairs, Madrid, Spain
Dr Angustias Herrera
Expert in Human Health Hazard Assessments, Directorate General of Public Health, Ministry of
Ms Esther Martin
Head of Service, Subdirectorate-General of Environmental and Occupational Health, Ministry of
Dr Maria Concepcio Martin Arribas

Carlos III Institute of Health, Madrid, Spain
Ms Maria Elena Morales Martin

Expert in Human Health hazard Assessment, Plant Protection Products, Ministry of Health and
25
Mr José María Ordonez Iriarte
Vice President, Spanish Health Association, Directorate General of Inspection and Control,
Madrid, Spain
Dr Isabel Ortega Crespo

Environmental Health, Ministry of Health and Consumer Affairs, Madrid, Spain
Mr Manuel Pascual-Marcos
Expert in Human Health Hazard Assessments, Plant Protection Products, Ministry of Health and
Mr Concepcion Pena-Perez
Expert in Human Health Hazard Assessments, Plant Protection Products, Ministry of Health and
Mr Alejandro Ramirez-Gonzalez
Rare Diseases Research Centre, Carlos III Institute of Health, Madrid, Spain
Ms Ana Fresno Ruiz

Ministry of the Environment and Rural and Marine Affairs, Madrid, Spain
Mr Gerardo Sanchez Jimenez

Dr Belen Sevil Grimal
Expert in Human Health Hazard Assessments, Directorate General of Public Health, Ministry of
Dr Elina Valcarce de Angulo
Head, Human Health Hazard Assessments, Directorate General of Public Health, Ministry of
Dr Francisco Vargas Marcos

Ministry of Health and Consumer Affairs, Madrid, Spain
Mr Daniel Vega Casado

Expert in Human Health Hazard Assessments, Phytosanitary Products, Ministry of Health and
World Health Organization

Regional Office for Europe
Mr Roger Aertgeerts
Regional Adviser, Rome office, Noncommunicable Diseases and Environment
Ms Larissa Badde
Administrative Assistant, Bonn office, Noncommunicable Diseases and Environment
Ms Sabrina Bijlsma
Technical Officer, Environment, Health Coordination and Partnerships
Ms Mary Stewart Burgher
Editor, Health Intelligence Services (Rapporteur)
26
Ms Cristiana Chiapparelli
Secretary, Partnership and Communications
Mr Oluf Christoffersen
Supervisor, Printing and Conference Services
Dr Marc Danzon
WHO Regional Director for Europe
Dr Rokho Kim
Scientist, Noise and Housing Burden of Disease, Bonn office, Noncommunicable Diseases and
Environment
Ms Giorgia Knechtlin
Secretary
Dr Martin Krayer von Krauss
Technical Officer
Dr Michal Krzyzanowski
Regional Adviser, Bonn office, Noncommunicable Diseases and Environment
Dr Lucianne Licari
Regional Adviser, Environment, Health Coordination and Partnerships, Partnership and
Communications
Dr Marco Martuzzi
Scientific Officer, Health Impact Assessment, Country Policies and Systems
Dr Nata Menabde
Deputy Regional Director
Dr Bettina Menne
Medical Officer, Global Change and Health, Rome office, Noncommunicable Diseases and
Environment
Mr Jens Nielsen
Technical Assistant, Information and Communications Technology
Mr Andrew Odeke
Secretary, Partnership and Communications
Ms Emanuela Polidori
Secretary, Rome office, Noncommunicable Diseases and Environment
Ms Francesca Racioppi
Scientist, Accidents, Transport and Health, Rome office, Noncommunicable Diseases and
Environment
Ms Andrea Rhein-Hubert
Programme Assistant, Bonn office, Noncommunicable Diseases and Environment
Dr Nathalie Röbbel
Consultant, Partnership and Communications
Mr Charles Robson
Head, Translation and Editorial, Health Intelligencer Services
27
Ms Cristiana Salvi
Technical Officer, Partnership and Communications
Mr Vitali Shkaruba
ICT Assistant (Telecommunications), Rome office, Noncommunicable Diseases and
Environment
Ms Natalia Sterlikova-Løhr
Programme Assistant, Partnership and Communications
28
Book of abstracts
SCIENCE FOR POLICY, POLICY FOR SCIENCE:

BRIDGING THE GAP
INTERNATIONAL PUBLIC HEALTH SYMPOSIUM

ON ENVIRONMENT AND HEALTH RESEARCH
MADRID, SPAIN, 20-22 OCTOBER 2008

This book of abstracts contains the abstracts of the presentations to be
given at the International Public Health Symposium on Environment and
Health Research (Madrid, Spain, 20-22 October 2008). The Symposium is
organized by the WHO Regional Office for Europe and the Institute of
Health Carlos III of the Spanish Ministry of Health and Consumer Affairs
in co-operation with the European Commission Research Directorate-
General (EC DG Research). A second version of this book of abstracts,
including the Symposium proceedings and recommendations, will be
published after the Symposium.
Address requests about publications of the WHO Regional Office for Europe to:
Publications
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DK-2100 Copenhagen Ø, Denmark
Alternatively, complete an online request form for documentation, health information, or for permission
to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest).
© World Health Organization 2008
All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests
for permission to reproduce or translate its publications, in part or in full.
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.
All reasonable precautions have been taken by the World Health Organization to verify the information
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stated policy of the World Health Organization.
page ii
SCIENCE FOR POLICY, POLICY FOR SCIENCE: BRIDGING THE GAP
INTERNATIONAL PUBLIC HEALTH SYMPOSIUM ON ENVIRONMENT AND HEALTH RESEARCH
Table of content
INTRODUCTION ..............................................................................................................................................................VI
WHAT WE NEED FROM RESEARCH AND HOW TO EFFECTIVELY TRANSLATE RESEARCH
FINDINGS INTO POLICY-MAKING ............................................................................................................................. 1
ROBERT L. MAYNARD
IS SCIENCE SERVING THE NEEDS OF POLICY-MAKERS?................................................................................ 2
ROBERT S. LAWRENCE
SESSION I: ACHIEVEMENTS AND NEEDS OF RESEARCH IN ENVIRONMENT AND
HEALTH .............................................................................................................................................................................. 3
CLOSING THE KNOWLEDGE GAP: PROGRESS MADE IN RESEARCH SINCE THE THIRD
MINISTERIAL CONFERENCE ON ENVIRONMENT AND HEALTH (1999)....................................................... 4
MICHAL KRZYZANOWSKI
MODELS OF SCIENCE AND POLICY: FROM EXPERT DEMONSTRATION TO PARTICIPATORY
DIALOGUE........................................................................................................................................................................... 5
SILVIO FUNTOWICZ
BRIDGING THE GAP BETWEEN SCIENCE AND POLICY-MAKING: A CASE STUDY OF
OCCUPATIONAL AND ENVIRONMENTAL CANCER FROM AZERBAIJAN........................................................ 6
COLIN L. SOSKOLNE1 AND FRANCESCA RACIOPPI2
HAVE THE GAPS BETWEEN THE SCIENCE AND POLICY DECREASED? THE ROLE OF
NONGOVERNMENTAL ORGANIZATIONS IN IDENTIFYING KNOWLEDGE GAPS AND IN MAKING
POLICY.................................................................................................................................................................................. 9
GENON K. JENSEN1 AND SASCHA GABIZON2
SESSION II: LATEST RESEARCH AND TRENDS IN SCIENCE-POLICY INTERFACE ............ 11
AMBIENT AIR POLLUTION AND HEALTH: SHOULD WE DO MORE?............................................................ 12
SYLVIA MEDINA
CLIMATE CHANGE, ENERGY AND HEALTH ........................................................................................................... 14
ANDY HAINES
THE EMERGING ISSUE OF CUMULATIVE EXPOSURE TO CHEMICALS – REASON FOR CONCERN?16
ANDREAS KORTENKAMP
THE EUROPEAN UNION COMMITMENT TO ENVIRONMENT AND HEALTH RESEARCH: FROM THE
FIFTH TO THE SEVENTH FRAMEWORK PROGRAMME ...................................................................................... 17
TUOMO KARJALAINEN
SESSION III: PARALLEL SESSION A: EMERGING ISSUES IN ENVIRONMENT AND
HEALTH ............................................................................................................................................................................ 18
EMERGING ISSUES AND THE ROLE OF THE SCIENTIFIC COMMITTEE ON EMERGING AND NEWLY
IDENTIFIED HEALTH RISKS OF THE EUROPEAN UNION................................................................................ 19
JIM BRIDGES
NANOPARTICLES AND HEALTH ................................................................................................................................ 21
CHARLES VYVYAN HOWARD
EMERGING ISSUES IN ENVIRONMENT AND HEALTH – THE CASE OF VECTOR-BORNE DISEASES
IN EUROPE........................................................................................................................................................................ 23
GUY HENDRICKX
CHEMICAL HOT-SPOTS AND ENVIRONMENTAL HEALTH – FROM ASSESSMENT TO ACTION IN
THE RUSSIAN FEDERATION....................................................................................................................................... 25
page iii
BORIS REVICH
STRATEGY FOR SCIENTIFIC COOPERATION AND NETWORKING ON EMERGING RISKS FOR FOOD
SAFETY ............................................................................................................................................................................... 27
HUBERT DELUYKER
ENERGY CHOICES AND HEALTH .............................................................................................................................. 28
PAUL WILKINSON
HEALTH IMPACT OF THE WASTE CYCLE IN THE PROVINCES OF NAPLES AND CASERTA, ITALY.. 29
PIETRO COMBA AND LUCIA FAZZO
SESSION III: PARALLEL SESSION B: USING RESEARCH FINDINGS TO IDENTIFY
PRIORITIES FOR POLICIES ................................................................................................................................. 31
KNOWLEDGE EVALUATION: THE HEALTH AND ENVIRONMENT NETWORK HENVINET...................... 32
ALENA BARTONOVA
ENVIE – EUROPEAN UNION POLICIES ON INDOOR AIR QUALITY AND HEALTH.................................. 34
EDUARDO DE OLIVEIRA FERNANDES
THE DIOXIN CRISIS IN BELGIUM: FROM CRISIS TO SCIENTIFIC KNOWLEDGE AND A NEW
POLICY................................................................................................................................................................................ 36
HERMAN DIRICKS
LONDON CONGESTION CHARGING SCHEME: EVALUATION OF IMPACT................................................. 38
H. ROSS ANDERSON (ON BEHALF OF THE HEI INVESTIGATION TEAM: FRANK KELLY (PRINCIPAL INVESTIGATOR),
ROSS ANDERSON, BEN ARMSTRONG, RICHARD ATKINSON, BEN BARRATT, SEAN BEEVERS, DICK DERWENT, DAVE
GREEN, IAN MUDWAY, CATHRYN TONNE & PAUL WILKINSON)
POLICY INTERPRETATION OF HUMAN BIOMONITORING RESEARCH RESULTS IN BELGIUM:
PRIORITIES AND COMPLEXITY, POLITICS AND SCIENCE ............................................................................. 39
HANS KEUNE1, KAREN VAN CAMPENHOUT2, BERT MORRENS1, JOHAN SPRINGAEL3, GUDRUN KOPPEN4, ANN
COLLES4, ILSE LOOTS1, HANA CHOVANOVA5, MAAIKE BILAU6, LIESBETH BRUCKERS7, VERA NELEN8, WILLY
BAEYENS9, NIK VAN LAREBEKE10
SOIL CONTAMINATION FROM MOTOR VEHICLE POLLUTION AND ITS HEALTH EFFECTS ................ 41
MIRZA Ⱥ. KAZIMOV
TOXIC OIL SYNDROME: LESSONS LEARNED FROM INTERDISCIPLINARY COLLABORATION.......... 43
MANUEL POSADA DE LA PAZ1, EMILIO GELPI, BENEDETTO TERRACINI, BÉNOIT NEMERY, ARNE SVEJGAARD,
STANISLAW TARKOWSKI, CARLOS LAHOZ, EDWIN M. KILBOURNE, ROSSANNE M. PHILEN AND LUIS SOLDEVILLA AS
THE WHO/CISAT SCIENTIFIC COMMITTEE FOR THE TOXIC OIL SYNDROME
SESSION III: PARALLEL SESSION C: TOOLS FOR ASSESSING HEALTH RISKS AS A

MEANS FOR POLICY MAKING ............................................................................................................................. 45
USING A SUFFICIENCY OF EVIDENCE FOR TIMELY PREVENTION IN MULTI-CAUSAL, COMPLEX
AND UNCERTAIN BIOLOGICAL SYSTEMS............................................................................................................. 46
DAVID GEE
INTEGRATED ASSESSMENT OF SYSTEMIC RISKS TO HUMAN HEALTH ................................................... 47
DAVID BRIGGS
EXPERIENCE ON RISK ASSESSMENT IN ENVIRONMENT AND HEALTH IN THE RUSSIAN
FEDERATION .................................................................................................................................................................... 48
SIMON L. AVALIANI
NOVEL METHODS FOR HUMAN AND ECOLOGICAL RISK ASSESSMENT OF COMBINATIONS OF
STRESSORS...................................................................................................................................................................... 50
HANS LØKKE1, GERRIT SCHÜÜRMANN, SABY DIMITROV, PHILIPP MAYER, MARK HUIJBREGTS, DAVE SPURGEON,
MARTIN HOLMSTRUP, KEES VAN GESTEL, JAN BAAS, UWE SCHLINK, MIKAEL HILDÉN
HEIMTSA: EXTENDING HEALTH IMPACT ASSESSMENT AND COST–BENEFIT ANALYSIS TO
EUROPEAN POLICY SCENARIOS............................................................................................................................... 52
FINTAN HURLEY
page iv
STRENGTHENING TECHNICAL CAPABILITY FOR HEALTH IMPACT ASSESSMENT: THE CASE OF

HIAIR .................................................................................................................................................................................. 54
PIEDAD MARTÍN-OLMEDO
USING HEALTH IMPACT ASSESSMENT TO COMPARE RISK AS AN ILLUSTRATION OF THE
INTERFACE BETWEEN SCIENCE AND POLICY..................................................................................................... 56
DANIEL S. GREENBAUM
SESSION III: PARALLEL SESSION D: BRIDGING THE GAP BETWEEN SCIENCE AND
POLICY MAKING ......................................................................................................................................................... 57
EVALUATION OF SCIENTIFIC EVIDENCE TO SUPPORT POLICIES .............................................................. 58
MICHAL KRZYZANOWSKI
MULTIFACETED CONSEQUENCES OF THE CHERNOBYL ACCIDENT: LESSONS LEARNED AND
WAYS FORWARD ............................................................................................................................................................ 59
MIKHAIL BALONOV
ROLE OF INDUSTRY AND THE BUSINESS COMMUNITY IN BRIDGING THE GAP BETWEEN
SCIENCE AND POLICY-MAKING ............................................................................................................................... 61
LOREDANA GHINEA
EUROPEAN CONFERENCE ON HUMAN BIOMONITORING: FROM BIOMARKERS TO HUMAN
BIOMONITORING AS A POLICY SUPPORT TOOL IN ENVIRONMENTAL HEALTH ................................... 63
ANNE-CATHERINE VISO (ON BEHALF OF THE CONFERENCE COMMITTEE)
HEALTH AT WORK AND HEALTHY ENVIRONMENT ............................................................................................ 65
JADRANKA MUSTAJBEGOVIC
AN ENVIRONMENTAL AND OCCUPATIONAL HEALTH RESEARCH PROGRAMME TO RESPOND TO
POLICY-MAKERS’ NEEDS: THE EXPERIENCE OF THE FRENCH AGENCY FOR ENVIRONMENTAL
AND OCCUPATIONAL HEALTH SAFETY .................................................................................................................. 67
JEAN LESNE
ENVIRONMENTAL HEALTH RESEARCH IN EUROPE: BIBLIOMETRIC ANALYSIS.................................... 69
STANISLAW TARKOWSKI
SESSION IV: BRIDGING THE GAP BETWEEN SCIENCE AND POLICY MAKING ................... 71
THE GAP BETWEEN SCIENCE AND POLICY-MAKING: THE SEVEN DEADLY SINS OF SCIENCE...... 72
PHILIPPE GRANDJEAN
CLIMATE CHANGE: BRIDGING THE GAP BETWEEN SCIENCE AND POLICY-MAKING ......................... 74
JEAN-PASCAL VAN YPERSELE
page v
Introduction
The relevance of environment and health (EH) research to policy making is well
appreciated by researchers and policymakers alike. The constant progress in EH
research provide a challenge to policy makers to find ways to address newly identified
EH problems. On the other hand the public’s demand for policies to address their
concerns requires tailor made research which may not have the same focus as that of the
research community.
The WHO Regional Office for Europe has always recognized the need to close these
gaps between research and policy making and to strengthen multi-disciplinary research
approaches for public health and especially environmental health practice in order to
effectively tackle the environmental health challenges. In addition there is a need for
adequate communication strategies to address the general public in case of emerging
environmental health crises.
For this reason, the WHO Regional Office for Europe and the Institute of Health Carlos III
of the Spanish Ministry of Science and Innovation with support of the Spanish Ministry of
Health and Consumer Affairs and DG Research, Directorate Environment have agreed to
organize an International Public Health Symposium with a special focus on Environment
and Health in Spain in 2008. This symposium will provide an opportunity for discussion of
the most recent developments in research on environment and health since the ‘An
environment for better health’ conference which took place in Aarhus in preparation for
the Fourth Ministerial Conference on Environment and Health in Budapest in 2004. It
aims to bring together a wide range of scientists, research professionals, policy makers
and representatives from non-governmental organizations from the WHO European
Region that will ensure interesting discussions on how to better translate future research
into policy making whilst continuing to identify emerging issues and research needs.
Objectives of the Symposium
The symposium aims to provide a platform for mutual collaboration between public health
professionals and researchers in the field of public health in general, with a particular
emphasis on environment and health. It is expected that the outcomes of the international
symposium will provide the evidence base of policy discussions during the preparations
for the Fifth Ministerial Conference on Environment and Health in Italy 2009 and it will
also contribute to setting priorities for future policy-oriented EH research activities within
the context of the next EU Research Framework Programme on Environment and Health.
The specific objectives of the international symposium include:
to present recent environment and health research and related studies and
projects
to illustrate country experiences in response to emerging environmental health
challenges by looking at different national research activities
to identify missing information and knowledge for adequate policy development in
response to environmental hazards (including risk communication and policy in
presence of scientific uncertainties)
to evaluate and discuss different approaches to studying interlinked health
determinants
page vi
What we need from research and how to effectively

translate research findings into policy-making
Robert L. Maynard
Health Protection Agency (England & Wales), London, United Kingdom
Modern policy development depends on cost-benefit analysis. This is a recent

development and has replaced easier methods for decision-making used when
environmental problems were obvious. Nowadays, the causes of effects are less easy to
identify and quantify. Research forms the basis for such work, especially in predicting the
benefits delivered by policies. Many diseases are multifactorial in origin: separating out
the causal factors is difficult but very important. Defining exposure–response curves is a
key function of research and may be difficult especially as regards thresholds of effect.
Guidelines and standards are also key to effective policy development – both for
providing policy targets and as a basis for assessing progress. These approaches have
been developed in the United Kingdom, and the Air Quality Strategy of the United
Kingdom is based on health and tested for costs and benefits for each policy measure.
About the author
Robert Maynard leads the Air Pollution and Noise Unit of the Health Protection Agency.
He is a medical physiologist and toxicologist and led the Department of Health’s work on
air pollution from 1990 to 2006. Before that, he led the Medical Division at the Chemical
Defence Establishment at Porton Down. He has edited monographs on Air Pollutants,
Chemical Warfare Agents and the Scientific Foundations of Trauma. He edited WHO’s
Air quality guidelines for Europe in 1998. He was a co-organizer of a Royal Society
meeting on nanoparticles in 2005. He holds an Honorary Chair in Public Health at
Birmingham University and was awarded a CBE for his work on air pollution in 2000.
Opening session page 1

Is science serving the needs of policy-makers?
Robert S. Lawrence
Director, Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, USA
Policies related to protecting the environment and public health in a time of global climate
change, population growth, greater demands for equity, nanotechnology and growing
scarcity of water, cropland and other resources will depend more than ever on good
science. Although many of the advances of science in recent centuries have come from
applying Cartesian reductionism and its distinctions between parts and wholes and
between causes and effects, contemporary policy-makers in environment and health
must address complex ecological challenges not suited to the science of Descartes.
Scientists with expertise in ecology, neurobiology, evolutionary biology and
developmental biology are needed to provide new kinds of data for policy-makers to use:
1) in establishing regulations on the discharge of toxins into the environment; 2) when
conducting risk-risk trade-off analysis; 3) in making decisions about the optimal use of
regulatory budgets to maximize allocative efficiency; 4) in using the precautionary
principle to shape policy in the absence of adequate safety data; and 5) when choosing
among strategies that rely on regulation versus creating incentives.
Three brief case studies will be used to examine the barriers that often prevent scientists
from engaging in policy development and policy-makers from participating in shaping
scientific exploration and the potential for bridging these barriers through a shared
commitment to an ecological perspective. The case studies are: 1) reducing dioxin in the
food supply; 2) developing a common method of measuring health that allows for
comparing the cost-effectiveness of regulations designed to protect the environment
and/or human health; and 3) assessing the impact on human health and the environment
of the industrialization of meat production.
About the author
Robert S. Lawrence is Professor of Environmental Health Sciences, Health Policy and

International Health at the Johns Hopkins Bloomberg School of Public Health and is the
founding Director of the Center for a Livable Future. A graduate of Harvard College and
Harvard Medical School, he trained in internal medicine and then joined the Epidemic
Intelligence Service, Centers for Disease Control and Prevention, United States Public
Health Service. At the University of North Carolina, he directed a community health
services project funded by the Office of Economic Opportunity. From 1974 to 1991, he
directed the Primary Care Division at Harvard Medical School. From 1991 to 1995, he
served as Director of Health Sciences at the Rockefeller Foundation, overseeing grants
to improve health in Asia, Africa and Latin America. He is a founding member of
Physicians for Human Rights, which shared the 1997 Nobel Peace Prize for its work to
ban anti-personnel landmines. He chairs its Board and has investigated human rights
abuses in Chile, Czechoslovakia, Egypt, El Salvador, Guatemala, Kosovo, the Philippines
and South Africa. He chaired the United States Preventive Services Task Force from
1984 to 1989 and is an adviser to the Task Force on Community Preventive Services of
the United States Centers for Disease Control and Prevention. For the Institute of
Medicine, he has chaired committees on Dioxin in the Food Supply and Evaluation of
Measures of Health Benefits for Environmental, Health and Safety Regulation.
page 2 Opening session

SESSION I:
ACHIEVEMENTS AND NEEDS OF RESEARCH

IN ENVIRONMENT AND HEALTH
Session I page 3
Closing the knowledge gap: progress made in research since

the Third Ministerial Conference on Environment and Health
(1999)
Michal Krzyzanowski
Acting Head, Bonn Office, WHO European Centre for Environment and Health, WHO
In 1999, the Declaration of the Third Ministerial Conference on Environmental Health in

London recognized the need for research of the highest reliability and quality as a tool for
decision-making. The ministers signing the Declaration encouraged and supported the
European Commission, the European Science Foundation and WHO and, where
relevant, other international organizations in developing collaboration in the area of
environment and health research. It has also encouraged appropriate national bodies to
implement the research in the direction proposed in Environment and health research for
Europe, prepared by the European Science Foundation in liaison with the European
Commission and WHO. The recommended research was considered necessary to
improve the risk assessment and risk management process and covered 11 broad topics,
all related to the policy agenda of the European environment and health process.
It is difficult to assess to what extent the recommendations contributed to progress in

understanding the links between environmental factors and health and in improving the
tools used to support decision-making. Thousands of studies were completed in Europe
and elsewhere on the topics discussed in the European Science Foundation document.
Some of this research has already been used to support important risk assessment
reports and policy decisions. However, the availability of research funding and the
interests of the research community do not necessary follow the lines of the European
Science Foundation programme, and the progress in various topics is very unequal.
Important progress has been made in studies on the relationships between health and
ambient air pollution and on the relationships between extreme weather events and
climate change, but much more has to be done in some other areas. WHO surveyed the
opinions of environmental health experts on the most significant research achievements
of the last 10 years in summer 2008. The overview of the results of this survey will be
presented at the Symposium.
About the author
Michal Krzyzanowski is Acting Head of the Bonn Office of the WHO European Centre for
Environment and Health, WHO Regional Office for Europe. His technical work focuses on
gathering and evaluating scientific evidence on the health effects of environmental
hazards, in particular of air pollution. He led the recently completed global update of the
WHO Air Quality Guidelines and coordinates the development of WHO guidelines on
indoor air quality. He has also led a series of WHO projects developing a European
Environment and Health Information System. Before joining WHO in 1991, Krzyzanowski
conducted epidemiological research on the health aspects of air pollution and other
environmental factors in Poland, United States and France. He has an MSc in Physics
from Warsaw University and ScD and PhD (Dr.hab) in epidemiology from the National
Institute of Hygiene, Warsaw, Poland.
page 4 Session I
Models of science and policy: from expert demonstration to

participatory dialogue
Silvio Funtowicz
Institute for the Protection and Security of the Citizen, European Commission Joint
Research Centre, Ispra, Italy
Science is the basis of the material culture that has profoundly transformed the world; it is
also a primary source of legitimacy for policy arguments. As science-related policy issues
have come to be recognized as complex and more inherently difficult to resolve, the
concept of the role of science has also developed and matured. Today, when science is
deployed in the policy context, facts may be uncertain, values in dispute, stakes high and
decisions urgent.
Several conceptual models of the relationship between science and decision-making in

policy processes can be defined.
Modern model
Scientific facts, employed in rigorous demonstrations, would determine correct policy.
There are no limits to the progress of human control over the environment and no limits
to the material and moral progress of humanity.
Precautionary model
It is discovered that the scientific facts are neither fully certain in themselves nor
conclusive for policy. Progress cannot be assumed to be automatic, and control over the
environment can fail. Because of this imperfection in the science, an extra element in
policy decisions, precaution, legitimizes decisions.
Framing model
Scientific information becomes one among many inputs to a policy process. Debate is
known to be necessary, as different stakeholders have their own perspective and values
shaping their arguments. Hence the framing of the relevant scientific problem to be
investigated, even the choice of the scientific discipline to which it belongs, becomes a
prior policy decision that is part of the debate among stakeholders.
Demarcation model
People working in institutions with their own agendas create the scientific information and
advice. The information and advice cannot be guaranteed to be objective and neutral. A
clear demarcation between the institutions (and individuals) that provide the science and
those in which it is used is advocated as a means of protecting science from political
interference. This also ensures that political accountability rests with policy-makers and is
not shifted.
Extended participation model

Defending a monopoly of accredited expertise for providing scientific information and
advice becomes ever more difficult. Numerous coordinated legitimate perspectives (with
their own value commitments and frameworks) are accepted. Through this co-production
of knowledge, the extended peer community creates a democracy of expertise.
The three models of imperfection form a sequence of increasing severity, admitting

incompleteness (precaution), misuse (framing) and abuse (demarcation). The final
model, of extended participation, involves a change in the form of governance.
Session I page 5
About the author
Silvio Funtowicz taught mathematics, logic and research methodology in Buenos Aires,
Argentina. During the 1980s he was a Research Fellow at the University of Leeds, United
Kingdom. He is the author of Uncertainty and quality in science for policy (1990, Kluwer,
Dordrecht) in collaboration with Jerry Ravetz and numerous articles on environmental
and technological risks and policy-related research. He has lectured extensively and is a
member of the editorial board of several publications and the scientific committee of
many projects and international conferences.
page 6 Session I
Bridging the gap between science and policy-making: a case

study of occupational and environmental cancer from
Azerbaijan
Colin L. Soskolne1 and Francesca Racioppi2

1
Professor of Epidemiology, Department of Public Health Sciences, School of Public
Health, University of Alberta, Edmonton, Canada, 2 WHO European Centre for
Environment and Health, Rome, Italy, WHO Regional Office for Europe
After the dissolution of the USSR in the 1990s, extensive environmental pollution that
had accumulated over several decades in the City of Sumgayit, Azerbaijan, was
recognized. Sumgayit was brought to global attention primarily through broadcasting a
documentary film, The dead zone, featuring graphic videos of the Sumgayit children’s
cemetery and images of malformed children from a local hospital. These health effects
were alleged to be related to occupational and community environmental contamination
directly associated with working or living in proximity to the City’s chemical complex.
Children, it was claimed, had died from a range of congenital and cancer causes; cancer
was also said to be killing adults.
Public concern prompted the first environmental cancer study in Azerbaijan in 2001–
2003. It addressed concerns that residents of the industrial City of Sumgayit experienced
an increased cancer burden subsequent to intense occupational and environmental
pollution. Analysis of vital statistics data for the years 1980–2000 suggested that
Sumgayit had an increased cancer burden. Poor data quality and suspected
underreporting prevented accurate estimates of incidence or mortality rates. A lack of
data needs to be remediated if policy-makers are to engage in rational evidence-based
(science-based) decision-making.
Because many emerging economies need local expertise for scientific research,
capacity-building has become a priority for many international development
organizations. The policy gap can only be addressed by developing human resources. In
particular, skill sets are needed that include generating scientific knowledge and
expertise in establishing and maintaining disease registries and administrative databases
and in establishing and maintaining health information systems. Such capacity would
benefit not only retrospective assessments but, more importantly, would create a new
generation of professionals able to support the prospective development of industrial
activities and infrastructural change in these emerging economies.
Environmental epidemiology training courses were conducted in Azerbaijan in the year

prior to this research: 2000. The project, an extension of this training, demonstrated that
international collaboration can result in the successful completion of health research in an
emerging economy. While international collaboration is useful for imparting expertise to
local researchers, comprehensive capacity-building programmes, providing ongoing
professional development, support and an enabling environment, rather than scientific
training alone, are required to achieve long-term sustainability and measurable
outcomes. Developing and implementing policies and institutional arrangements that
encourage health impact assessment related to economic development will create a
demand for professionals skilled in health research.
Session I page 7
About the author
Colin Soskolne has been Professor of Epidemiology in the Department of Public Health
Sciences at the University of Alberta since 1985. In 1999, he completed a sabbatical year
as Visiting Scientist with the WHO European Centre for Environment and Health in
Rome, Italy. He has published more than 300 books, peer-reviewed papers, letters and
reports. His interests have spanned the fields of occupational cancer epidemiology, HIV
and AIDS, professional ethics, environmental epidemiology and, most recently,
sustainability. His most recent book Sustaining life on earth: environmental and human
health through global governance brings together his work as an interdisciplinary scholar.
He is concerned about current policies globally that are degrading life-supporting
ecosystems, with dire consequences for human health and well-being.
page 8 Session I
Have the gaps between the science and policy decreased?

The role of nongovernmental organizations in identifying
knowledge gaps and in making policy
Genon K. Jensen1 and Sascha Gabizon2

1
Executive Director, Health and Environment Alliance, Brussels, Belgium,
2
Executive Director, Women in Europe for a Common Future, Utrecht, the Netherlands
The vital role of nongovernmental organizations (NGOs) in highlighting knowledge gaps

and connecting research results with policy opportunities has increasingly become
recognized. NGOs add legitimacy to the political debate by bringing forward society’s
concerns and values and reaching out to local groups. NGOs also help to ensure that
research is communicated to a broad set of stakeholders, including policy-makers, other
scientists and the mass media. NGOs also provide a watchdog function in alerting
society to emerging environmental health risks and raising general awareness. However,
significant gaps still exist in ensuring that environment and health research is used for
evidence-based policy changes in the European Union (EU) and the wider European
Region of WHO despite the substantial money spent for this purpose.
Women in Europe for a Common Future (WECF) and the Health and Environment
Alliance (HEAL), as representative stakeholders for the environmental NGOs and the
health and medical community within the European Health and Environment Committee,
have actively contributed to building up NGO participation in research and will highlight
examples of their work.
Since its inception in 2003, HEAL and its member networks have advocated for the
inclusion of environment and health in research and policy in Europe, which has earned
HEAL a lead position within the NGO sector, particularly on EU research policy. It sits on
the advisory groups of many EU-funded research projects such as INTARESE
(Integrated Assessments of Health Risks from Environmental Stressors in Europe), the
NewGeneris Project and HENVINET, thus actively contributing to ensuring research
results are considered in EU environmental policy-making.
Three examples illustrate HEAL’s efforts: a) ensuring that the REACH implementation
process considers the latest research on endocrine-disrupting chemicals and related
diseases such as breast cancer; b) bringing new scientific understanding of the health
effects of pesticides to EU policy reform; and c) carrying out community research on
mercury levels in women to raise awareness of the health effects of low-level exposure.
Within chemical safety, pesticides and mercury policies, HEAL has worked to reduce the
research into policy lag by commissioning science, providing accessible summaries of
emerging evidence and disseminating information at strategic policy junctures.
Since 1995, WECF has worked to bring policy and science closer together, in particular
on the four issues of safe chemicals, safe food, safe water and safe energy. Working in
coalitions with other NGOs and scientists, WECF contributes to policy development in
particular on how the observed increase in developmental abnormalities in children
(diabetes, attention deficit disorder and childhood cancer) can be linked to exposure to
hazardous chemicals in consumer products and food. The networks of WECF and
EcoForum provide a platform to identify and call public attention to environmental health
issues on which governments should take urgent measures, such as the wide-scale use
of asbestos in eastern Europe, the Caucasus and central Asia or the risks from
nanotechnology in the EU.
Session I page 9
About the author
Génon Jensen is Executive Director of the European NGO network, Health and
Environment Alliance (HEAL), which she created in Brussels, Belgium in 2003. HEAL
now brings together more than 50 groups representing organizations of health
professionals, health advocates, patients, women and consumers. HEAL has established
a strong record in bringing key research findings to European policy-makers on how
contamination of the environment is affecting people’s health. Génon Jensen has been
an official member of the European Environment and Health Committee since 2000. She
is also on the Steering Committee of the International POPs [persistent organic
pollutants] Elimination Network. Before setting up HEAL, she was the Director of the
European Public Health Alliance. She frequently contributes articles on environmental
health policy, including on children’s health, pesticides, mercury and climate change, to
various specialist publications and newsletters. She is a co-author of several publications
and reports, such as Halting the child brain drain: why we need to tackle global mercury
contamination and Cutting back on pesticides for healthier lives.
Sascha Gabizon is Executive Director of Women in Europe for a Common Future, a

network of 90 women’s and environment organisations based in 30 countries in the WHO
European Region. She worked for an international consultancy in Spain and then joined
the Wuppertal Institute for Climate, Energy and Environment in Germany, where she was
the co-founder of the Wuppertal Institute’s FrauenWissen (Women Scientists). In 1994,
she joined Women in Europe for a Common Future to prepare the WECF contribution to
the Fourth World Conference on Women in Beijing in 1995. Since 1996, she has been
the director of WECF and developed the network and its activities. In 1999 she founded
WECF offices in Germany and France, which work in close cooperation with the
Netherlands WECF office, serving as secretariats for the network activities of WECF. As
Executive Director of WECF, she is responsible for the EU policy work of WECF. WECF
works in four thematic areas, one of which is chemical safety. In recent years, WECF’s
focus has very much been on the new EU chemicals legislation REACH. But WECF also
works with partners in eastern Europe on finding solutions for problems of obsolete
pesticide burials and of asbestos in building materials. The other thematic areas are safe
energy, safe water and sanitation and safe food and sustainable rural development.
WECF sustainable development programmes involve some 30 000 beneficiaries in the
WHO European Region, who receive access to safe water supply and sanitation, safe
renewable energy and are trained on agriculture with low chemical inputs. Sascha
Gabizon has published many case studies and articles.
page 10 Session I
SESSION II:
LATEST RESEARCH AND TRENDS IN SCIENCE-POLICY INTERFACE
Session II page 11
Ambient air pollution and health: should we do more?
Sylvia Medina
InVS (French Institute for Public Health Surveillance), Saint Maurice, France
Policy-makers, research scientists and representatives of intergovernmental and

nongovernmental organizations keep asking: “Do we have enough information to justify
tightening standards further on air quality?” and “Do we need more evidence?”.
Air pollution has decreased in some locations through the implementation of clean-air
policies. Yet air pollution continues to be a health hazard, as seen in new studies we will
present on the detrimental effects it has on our lungs, heart and arteries and on children’s
central nervous systems.
Accountability studies conducted to measure the benefits of clean-air policies reveal that
reducing air pollution can indeed improve health, as we will show. And health impact
assessment can quantify the potential health benefits of future strategies to reduce air
pollution; we will use findings of Apheis (Air Pollution and Health: A European Information
System) to illustrate these potential benefits at the European and local levels.
What this means is that the latest scientific evidence, the policy successes achieved in
Europe and elsewhere, and the potential health benefits shown by health impact
assessment demonstrate that the impact of air pollution on health can be reduced further.
There is thus good reason to continue reducing emissions and tightening air-quality
standards in Europe.
For those needing more evidence, European research and public-health projects such as
ESCAPE (European Study of Cohorts for Air Pollution Effects), Aphekom (Improving
Knowledge and Communication for Decision Making on Air Pollution and Health in
Europe), INTARESE (Integrated Assessment of Health Risks from Environmental
Stressors in Europe) and others will provide more-detailed information on active
components in particles; better knowledge on the long-term health effects of air pollution
in Europe; integrate policy-relevant road traffic indicators, evaluate the incorporation of
chronic diseases and susceptibility factors in health impact assessment and calculate
related costs; and stimulate dialogue between stakeholders in Europe.
About the author
Sylvia Medina is an epidemiologist dedicated to improving public health through research

on the effects of ambient air pollution on health, with special emphasis on the practical
application of her work. In particular, the projects she coordinates seek to understand
and cross the last mile that too often separates scientists and their findings in this area
from the minds and actions of policy-makers, health professionals and the general public.
She currently coordinates European activities at the Department of Environmental Health
of the French Institute for Public Health Surveillance (InVS) in Paris, including the new
Aphekom project. She coordinated health impact assessment of environmental risk
factors from 2004 to 2007 under the ENHIS (European Environment and Health
Information System) project co-funded by the European Commission and coordinated by
the WHO Regional Office for Europe; the Apheis project on air pollution and health
involving 26 European cities from 1999 to 2004; and the ERPURS (Evaluation des
Risques de la Pollution Urbaine) surveillance programme health in Paris from 1992 to
1997. She participates regularly in European research projects, such as Airnet, Aphena,
Aphea, Phewe and INTARESE, co-funded by the European Commission. She won the
page 12 Session II
Epidaure Prize for Research in Medicine and Ecology in 1996, and the Generation 2000
Doctors Prize, awarded to her for enabling the general public to better understand
scientific information on environmental health.
Session II page 13
Climate change, energy and health
Andy Haines
Director, London School of Hygiene & Tropical Medicine
Access to plentiful supplies of energy has underpinned the development of industrialized

society and made an essential contribution to the high levels of public health enjoyed by
high-income countries today. However, about 1.6 billion people still lack access to
electricity and 2.4 billion depend on combusting solid fuels (such as dung, wood and
coal) for cooking and other household functions. Lack of access to clean and affordable
energy affects health in several ways. These include causing about 1.6 million annual
deaths from indoor air pollution and an additional 800 000 annual deaths from outdoor air
pollution, particularly in urban centres, to which transport emissions make an important
contribution.
Largely as a result of the work of scientists involved in the Intergovernmental Panel on

Climate Change, it is now widely accepted that climate change is occurring as a result of
anthropogenic (human-induced) factors, in particular the combustion of fossil fuels but
also greenhouse gas emissions from land-use change, agriculture and livestock
production. Climate change is likely to have wide-ranging and mostly adverse effects on
health, particularly in low-income countries. Cold-related deaths will decrease and heat-
related deaths will increase; the balance will vary according to geographical location.
Other health effects include: those due to the likely increase in the frequency and
intensity of climate-related disasters such as floods, droughts and wind storms; changes
in the incidence of water-related diseases; changes in the distribution of vector-borne
diseases; and probable increases in malnutrition.
Key challenges include developing and implementing policies that reduce emissions of
greenhouse gases, achieving co-benefits for health, such as through reductions in air
pollution, and addressing the unmet needs of disadvantaged populations by improving
access to adequate supplies of clean energy. Improving access to energy supplies and
the services they provide for disadvantaged populations can also help to improve their
capacity to adapt to climate change, for example by providing electricity for refrigeration,
pumping of water and improved communication. Research to assess the health effects of
climate change, the potential cost-effectiveness of adaptation strategies and the
magnitude of health co-benefits from greenhouse gas mitigation strategies in sectors
such as transport, power generation, the built environment and agriculture can make
important contributions to policies that lead to reductions in greenhouse gas emissions
while improving public health.
About the author
Andy Haines became Director of the London School of Hygiene & Tropical Medicine in
2001. He was previously Professor of Primary Health Care and Director of the
Department of Primary Care and Population Sciences at Royal Free and University
College Medical School, London. He was formerly Director of Research & Development
at the NHS Executive, North Thames and a member of the Council of the Medical
Research Council. He has also worked internationally in Jamaica, Nepal and the United
States of America. His research interests are in epidemiology and health services
research. He has many publications on these topic areas. He was a member of the
page 14 Session II
Intergovernmental Panel on Climate Change for the Second and Third Assessment
Reports in 1996 and 2001. He sits on many national and international committees,
including the WHO Advisory Committee on Health Research.
Session II page 15
The emerging issue of cumulative exposure to chemicals –

reason for concern?
Andreas Kortenkamp
Professor and Head, Centre for Toxicology, University of London School of Pharmacy,
London, United Kingdom
The last few years have seen considerable improvements in knowledge about
combination effects between chemicals, in particular those with endocrine activity.
Determinants of (additive) cumulative effects are now quite well understood. Experiments
under controlled laboratory conditions have shown that the joint effects of endocrine
disrupters are (dose) additive, both with in vitro and in vivo test systems. Demonstrations
of significant combination effects with mixtures in which all components were present at
ineffective doses have highlighted the possibility of underestimating risks with the
traditional chemical-by-chemical approach. These findings have lent urgency to demands
that combination effects need to be taken into account in chemicals regulation. This
presentation will briefly review recent findings related to endocrine-active chemicals with
the aim of assessing how this new knowledge can be used productively to improve the
risk assessment and regulation of chemicals. One of the key issues to be resolved will be
to establish rational criteria for the grouping of chemicals for cumulative risk assessment.
About the author
Andreas Kortenkamp’s research focuses on predicting and assessing the effects of multi-
component mixtures of endocrine-active chemicals. The goal of this work is to validate
models that allow quantitative predictions of mixture effects on the basis of information
about the potency of individual mixture components. He is involved in a European Union–
funded project on endocrine disruption and has been responsible for coordinating the
European Union CREDO cluster on endocrine disruption as well as the EDEN project
(Fifth Framework Programme). His research interests include environmental factors in
breast cancer and unravelling the mechanistic detail of estrogen and antiandrogen
action. More recently, he has begun to explore options for regulating chemical mixtures.
page 16 Session II
The European Union commitment to environment and health

research: from the Fifth to the Seventh Framework
Programme
Tuomo Karjalainen
Climate Change and Environment and Risks Unit, Directorate-General for Research,
European Commission, Brussels, Belgium
The European Union (EU) has been at the forefront of research in environment and
health since the start of the Fifth Framework Programme of Research (FP5: 1998–2002),
which included an environment and health key action. The recent finalization of more
than 90 multinational multidisciplinary projects funded by FP5 has greatly expanded
understanding of the complex links between environmental risk factors and their effects
on the health of individuals and populations.
This knowledge has been key to developing national and EU policy initiatives designed to
protect the environment and promote human health throughout the EU, such as the
European Environment and Health Action Plan 2004–2010, adopted in 2004. Its main
aim is to improve the understanding of the link between environmental factors and health.
The implementation of the goals of this action plan through research started in the Sixth
Framework programme (FP6: 2002–2006) via the funding of many large- and small-scale
research projects on health topics identified as priorities in the Action Plan. The EU has
spent more than €200 million on FP6 environment and health projects, and the results
should start to become available soon.
The efforts are continuing in the Seventh Framework Programme (FP7: 2006–2013),
which has a dedicated environment and health sub-activity in the environment theme.
Many projects of interest to the general public, scientific community or policy-makers on
environment and health links have already been selected from the first two calls for
proposals.
About the author
Tuomo Karjalainen received a DMD degree from Karolinska Institute in Sweden in 1983
and a PhD degree in Experimental Pathology from Indiana University in 1990. After a 10-
year academic and research career in the Department of Microbiology of the University of
Paris-Sud in France, he joined the European Commission’s Directorate-General for
Research in 2002 as a Scientific Officer. He has since worked on issues related to
environment and health, participating in preparing calls for proposals and managing
multi-partner, multi-country EU-funded projects on environment and health. He is
currently in the Climate Change and Environment and Risks Unit, which is in charge of
the environment and health sub-activity in FP7.
Session II page 17
SESSION III:
PARALLEL SESSION A: EMERGING ISSUES IN ENVIRONMENT AND

HEALTH
page 18 Session III -A

Emerging issues and the role of the Scientific Committee on

Emerging and Newly Identified Health Risks of the European
Union
Jim Bridges
Chair, Scientific Committee on Emerging and Newly Identified Health Risks
A crucial aspect in maintaining a high level of health and environmental protection for
citizens in the European Union is to recognize the implications of relevant emerging
issues and take appropriate actions sufficiently early.
To inform the procedures needed, the causes of past failures must be considered, such
as inadequate monitoring and surveillance, failure to make important relevant information
available to the risk assessors and risk managers, incorrect interpretation and
extrapolation of the scientific information available, inability to communicate the risks to
risk managers, inappropriate action or inaction by risk managers and the failure to
anticipate the consequences of new technical developments or changes in legislation.
The Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) is
charged with highlighting emerging issues that it considers may have significant
implications for human health and/or the environment and with evaluating the risk
associated with emerging and newly identified issues given priority by the European
Commission services. Three aspects of this work will be considered: identification of
issues, priority-setting process for assessment and methods for evaluation.
Identification. Picking up emerging issues at an early stage requires knowledge of:
research and technical advances that open up the prospect of new products
and/or processes and/or raising concerns about end-of-use fate;
monitoring programmes or episodic observations;
changes that may result from alterations in price and supply of materials and
commodities;
substantial modifications in legislation, public welfare measures or other
sociocultural or demographic elements;
mass-media, political and public concerns; and
security developments.
An active network or networks of experts in each of these aspects has to be built and
maintained to ensure early recognition. There is an ongoing effort to put such networks in
place involving several European Union agencies and scientific committees.
Priority-setting for assessment. An effective network is likely to result in the

identification of many issues of potential relevance. It is therefore essential that a
transparent and suitable process be put in place to set priorities for issues for in-depth
assessment. The starting-point for this has been to introduce a system for classifying and
ranking the importance of emerging issues based on: knowledge of the agent or factor
involved, the population or area likely to be affected, the anticipated rate of change in
effects and the nature of the potential consequences of the effects. This system needs to
be developed further, including testing it in actual examples. It will then need to be
reviewed by stakeholders and be regularly updated or reappraised.
Methods. Assessing emerging issues inevitably means that full risk assessment using
conventional methods will be thwarted by lack of data. Instead, a tiered approach is
Session III - A page 19

required, and an issue-specific framework may be necessary. SCENIHR has adopted

this approach for nanotechnology and is developing this for electromagnetic fields.
Next steps. As identified above, progress depends on a high level of continuing

collaboration between many key organizations. However, a dynamic and somewhat
informal structure is essential to meet the needs of this highly challenging and continually
changing field. The more bureaucratic the system, the less likely it is to provide the
prompt responses that are required.
About the author
Jim Bridges has published almost 400 research papers and reviews, particularly on
mechanisms of toxicity and risk assessment. He is Emeritus Professor of Toxicology and
Environmental Health at the University of Surrey, having previously served as the Head
of the European Institute of Health and Medical Sciences. He was previously the Dean of
Science and, before that, founding Director of the Robens Institute of Industrial and
Environmental Health and Safety. He is the Chair (since 2004) of SCENIHR. Previously
he was chair (1997–2004) of the European Union Scientific Advisory Committee on
Toxicology, Ecotoxicology and the Environment. He also advises the European Food
Safety Authority (emerging issues) and Directorate-General for Research (environmental
health). He is also a past member of a number of committees in the United Kingdom. He
has served as Chairman of the British Toxicology Society and the Federation of
European Societies of Toxicology. He also founded the European Drug Metabolism
Workshops. He has held visiting appointments at the University of Rochester, University
of Texas (South West Medical School), the United States National Institute of
Environmental Health Sciences and the National Research Institute (Mexico City). Jim
Bridges currently chairs Research for Sustainability, a research and consultancy
organization based in the United Kingdom.

Nanoparticles and health
Charles Vyvyan Howard

Professor of Bioimaging, University of Ulster, Coleraine, United Kingdom
People have always been exposed to nanoparticles, mainly comprising marine aerosol.
However, relatively few other inorganic nanoparticles of less than 100 nm were in the air
throughout human prehistory. The main biological nanoparticles were viruses. Human
defence mechanisms against nanoparticles evolved principally to cope with the biological
threat posed by viruses.
Nanoparticles can gain entry to the body by a number of routes, including inhalation,
ingestion and across the skin, and can then travel around the body into various organs,
including across the blood–brain barrier (1). It has been shown that insoluble
nanoparticles can be toxic and therefore potentially hazardous (2). Nanoparticles have a
potential for toxicity that appears to be related primarily to their small size rather than to
the type of material from which they are made, although much research still needs to be
done before this question is fully understood. One area of concern that is still
inadequately researched is the ability of nanoparticles to cause protein misfolding (3).
Epidemiological evidence shows that exposure to particulate aerosols leads to long-term

health effects, primarily of the cardiopulmonary system (4). Evidence also indicates that
short-term effects from poor air quality are due to particle overloading.
Several expert working groups have met under the auspices of the European Union, and
it appears that new legislation will be considered in the near future
(http://europa.eu.int/comm/health/ph_risk/events_risk_en.htm). Although it is easy to
appreciate how nanotechnology is being harnessed to positive uses in the
pharmaceutical, electronic, food and water industries, the generation of unnecessary
nanoparticles, especially insoluble ones, urgently needs to be controlled and minimized
in the ambient environment. For example, there are early indications that some types of
carbon nanotube can mimic asbestos and induce mesothelial tumours (5). It seems
important that the long-term environmental fate of such products be determined before
mass production proceeds.
References
1. Gumbleton M. Caveolae as potential macromolecule trafficking compartments within

alveolar epithelium. Advanced Drug Delivery Reviews, 2001, 49:281–300.
2. Oberdörster G. Toxicology of ultrafine particles: in vivo studies. Philosophical

Transactions of the Royal Society of London A, 2000, 358:2719–2740.
3. Billsten P et al. Adsorption to silica nanoparticles of human carbonic anhydrase II

and truncated forms induce a molten-globule-like structure. FEBS Letters, 1997,
402:67–72.
4. Wichmann HE, Peters A. Epidemiological evidence of the effects of ultrafine particle

exposure. Philosophical Transactions of the Royal Society of London A, 2000,
358:2751–2769.
5. Takagi A et al. Induction of mesothelioma in p53+/– mouse by intraperitoneal

application of multi-wall carbon nanotube. Journal of Toxicological Sciences, 2008,
33:105–116.

About the author
Charles Vyvyan Howard is a medically qualified toxico-pathologist and is Professor of

Bioimaging at the University of Ulster. He is a Fellow of the Royal College of Pathologists
and held the Presidency of the Royal Microscopical Society from 1996 to 1998. Since
2003, he has served as a member of the United Kingdom Government’s Advisory
Committee on Pesticides and is a Member of their specialist Medical and Toxicology
Panel. He is currently the President of the International Society of Doctors for the
Environment. His research team is making investigations into the toxicology of
nanoparticles under grants from the European Union Sixth and Seventh Framework
Programmes. He co-edited Particulate matter: properties and effects upon health in
1999. He has sat on two EU expert groups considering the health hazards posed by
nanotechnology.

Emerging issues in environment and health – the case of

vector-borne diseases in Europe
Guy Hendrickx
Managing Director, Avia-GIS, Zoersel, Belgium
The introduction, establishment and/or spread of vector-borne diseases depends on

complex relationships between hosts, vectors and pathogens.
Vertebrate hosts include humans, domestic and wild mammals and birds. The numbers
are influenced by the availability of food, which depends on soil and climate. Seasonal
availability of resources may trigger migration movements (livestock transhumance and
bird migration). The hosts are warm-blooded; low ambient temperatures are not a main
factor restricting spread.
Invertebrate vectors include mainly mosquitoes, midges, sandflies and also ticks. Their
metabolism depends on ambient temperature. Optimal conditions of temperature and
humidity and the availability of sites for egg-laying and the development of intermediary
stages are needed to obtain sufficiently dense adult populations. During adverse
conditions, the vectors go into diapause (hibernation, aestivation) as adults, eggs or
larvae. Medium- or long-range spread or migration of flying arthropods may be favoured
by wind. Invertebrate vectors may be disseminated through local or global transport
networks.
Pathogens (virus, bacteria and protozoa) are essentially parasites, and their survival
depends on the maintenance of the host-vector cycle (contact between both), the
availability of sufficient numbers of hosts and vectors and a sufficiently high ambient
temperature enabling the development in the vector. Hosts develop immunity. Young
become new hosts after loss of maternal immunity. During adverse conditions for the
vectors, pathogens may persist in the host as a chronic infection associated with certain
tissues or they may be carried across the placenta. In the vector, pathogens may persist
in the surviving adults or be transmitted transovarially. Pathogens may also be carried
into or out of an area by migrating hosts or vectors.
Key factors having an impact on host-vector-pathogen cycles in continental Europe

therefore are:
x factors affecting the presence and abundance of hosts and vectors;

x factors affecting contact between hosts and vectors;
x ambient temperature and moisture enabling or affecting the development of
vectors;
x ambient temperature enabling or affecting the development of pathogens in
hosts;
x mechanisms enabling the survival of vectors during the adverse season; and
x mechanisms enabling the persistence of pathogens in hosts or vectors during
the adverse season.
Based on the results obtained in three projects: EDEN (Emerging Vector-borne Diseases
in a Changing European Environment (EU Framework Programme 6), V-borne
(assessment of magnitude and importance of vector-borne diseases in Europe) and
TigerMaps (development of Aedes albopictus risk maps (European Centre for Disease

Prevention and Control)), examples are given that highlight public health research
priorities in emerging vector-borne diseases.
About the author
Guy Hendrickx graduated as doctor in veterinary medicine in 1985 and has more than 20
years of experience in spatial epidemiology, livestock geography and decision support
systems. From 1986 to 2000 he completed a series of long-term assignments in Burkina
Faso, Rwanda, Togo and the United Republic of Tanzania. His main research activity
was the development and implementation of countrywide geographical information
systems (GIS) applied to integrated vector-borne disease control. In 1997 he was a
laureate of the Belgian National Academy of Overseas Sciences. In 1999 he obtained his
PhD. In 2000 he created Avia-GIS, a consulting company specializing in spatial agro-
veterinary and public health information systems. In 2004, collaboration with ERGO,
Environmental Research Group Oxford, United Kingdom, was formalized through the
establishment of Euro-AEGIS. CIRAD contracted Avia-GIS to write and manage the
EDEN project. Recently, two short-term projects were finalized for the European Centre
for Disease Prevention and Control: V-borne and TigerMaps.

Chemical hot-spots and environmental health – from

assessment to action in the Russian Federation
Boris Revich
Laboratory of Environmental Health, Institute for Forecasting, Russian Academy of
Sciences, Moscow, Russian Federation
Hot-spots are a public health and environmental policy priority in many countries of the
world. It is assumed that the number of hot-spots in the Russian Federation is quite
significant. There has been a certain shift in the understanding of the hot-spot situation in
the Russian Federation during the past 15 years. The law on natural environment
protection states that hot-spots are territories where sustained negative changes in the
health of the population have been identified. The state environmental expertise
classified 12 cities as corresponding to this status. This list may be complemented by
about 50–70 localities. Special territory and population health rehabilitation programmes
have been developed in previous years in the cities with official hot-spot status at the
federal or regional level. These programmes are financed through the federal budget as
well as regional budgets. For example, in Krasnouralsk (the Urals), lead emission at
copper melting plants was reduced and the lead concentration in the blood was
measured in day-care centres. Repeated measurement of the concentration of lead in
children’s blood showed considerable reduction. An effort has also been made in another
city with lead industry in the eastern part of the Russian Federation, where the lead
concentration in the blood of 70% of the children examined exceeded the WHO-
recommended norm of 10 μg/dl. Currently the lead industry has suspended operations in
connection with this. The experience of other cities in the Russian Federation in reducing
the lead concentration in the environment and children’s blood is not known, although
more than 20 smelting plants and accumulator production and processing plants function
in the Russian Federation.
In the cities with the greatest environmental dioxin or polychlorinated biphenyl (PCB)
contamination, the concentrations of these substances in breast-milk and in blood were
reduced. The case–control method showed the relationship between infertility and PCB
concentration in women’s blood, breast cancer and local fish and pork consumption,
dioxin concentration in boys’ blood and locally produced fruit and vegetables.
Federal programmes aimed at reducing the environmental contamination of chemicals

are practically nonexistent in the Russian Federation. Engagement of the Russian
Federation in European environmental efforts on human health assessment projects
should contribute to new scientific bodies forming that master modern epidemiological
techniques and to the development of scientifically based action plans for policy-makers.
About the author
Boris Revich’s main research projects since 1996: lead and children’s health, Save the
Children (1996–1997); PCB and infertility: Serpukhov study, United States National
Institute of Environmental Health Sciences and Harvard School of Public Health (1996–
1997); principal investigator, biokinetic lead model, United States Environmental
Protection Agency (1998–1999); dioxins and male sexual development: Chapayevsk
case study, principal investigator from the Russian Federation, grant from Harvard
School of Public Health (1998–); National Environment and Health Action Plan of the
Russian Federation, project with the WHO Regional Office for Europe and the Ministry of
Health, Russian Federation (1998–1999 and 2002–2003); environmental capacity-
building in the newly independent states, Environmental Defense Fund (2004–2007);
dioxin and breast cancer: Chapaevsk case study, MacArthur Foundation (2000-2001);
lead author, chapter on health, the Fourth Assessment Report of the Intergovernmental

Panel on Climate Change (2004–2007); climate change and public health in the Russian
Federation, Russian Foundation for Basic Research (2003–2005); climate change and
mortality in Moscow, Environmental Defense Fund (2005–2007); and climate change and
public health in the Arctic part of the Russian Federation, Russian Foundation for Basic
Research (2008).

Strategy for scientific cooperation and networking on

emerging risks for food safety
Hubert Deluyker
Director of Scientific Cooperation and Assistance, European Food Safety Authority,
Parma, Italy
Several food safety incidents in the last decade have raised concerns about the modern
food production chain. This has resulted in a decline in trust in food safety regulations
and management. The European Union (EU) has responded to this by issuing Regulation
(EC) No 178/2002 of 28 January 2002 laying down the general principles and
requirements of food law, establishing the European Food Safety Authority (EFSA) and
laying down procedures in matters of food safety. This clearly describes the food safety
framework in the EU, including the role and responsibilities of its partners in the
establishment of efficient tools for the early prevention of foodborne outbreaks.
Potential threats to consumers can be reduced if new hazards and (increased) exposure
to known hazards are detected at an early stage and information is rapidly exchanged
between partners engaged in maintaining food safety. The clear need to set up a
structured reliable system for early warning of emerging risks was indicated as a priority
for the EFSA after its establishment. This has ultimately led to the creation of a dedicated
Emerging Risks Unit in 2008.
The mission of the Emerging Risks Unit is to “undertake action to identify and
characterise emerging risks in the field within EFSA’s mission”. Setting up efficient
structures for identifying emerging risks will enable more confident predictions of the
likelihood of an emerging risk at an early stage. Alert signals can thus contribute to
prevention and support management of risks at a population level. The presentation will
give an overview on the strategy and current state of activities related to the identification
of emerging risks in food safety undertaken by the EFSA.
About the author
Hubert Deluyker has been EFSA’s Director of Scientific Cooperation and Assistance
since 2008. His directorate supports EFSA’s risk assessment work and develops the
EFSA’s scientific cooperation with Member States in a range of fields covering the peer
review of pesticides, data collection and emerging risks. He joined the EFSA in 2004 and
was formerly Head of the EFSA’s Assessment Methodology Unit. Before working for the
EFSA he was a clinical research scientist in animal health from 1989 to 2004 for Pfizer in
Puurs, Belgium, where he led a range of multidisciplinary and multinational research and
development projects. He was also Associate Professor in Epidemiology from 1991 to
2000 at the School of Veterinary Medicine of the University of Ghent, Belgium. He
previously worked as District Veterinary Officer for Belgium’s Ministry of Agriculture. He is
a Diplomate of the European College of Veterinary Pharmacology and Toxicology and a
Diplomate of the European College of Veterinary Public Health.

Energy choices and health
Paul Wilkinson
London School of Hygiene & Tropical Medicine, London, United Kingdom
Energy is critical for all aspects of modern living, and access to inexpensive energy
resources, mainly in the form of fossil fuels, has been key to economic development.
Although access to energy resources has delivered many benefits, the combustion of
carbonaceous fuels also causes substantial current health burdens, mainly arising
through pollution of the outdoor air and accident risks. Excessive dependence on energy
resources also contributes to unhealthy lifestyles in relation to the diet, levels of physical
activity and methods of production, while greenhouse gas emissions related to fossil
fuels are a principal cause of anthropogenic climate change, with all the consequences
this may entail for population health. Current fossil-fuel dependence is therefore not only
unsustainable but also contributes to major public health burdens and is a driver for many
forms of inequity in health. Concerns with energy have been accentuated by the recent
price volatility of oil, the spectre of dwindling supplies of the cheapest energy reserves
and related issues of energy security. These concerns provide added impetus to the
pursuit of energy efficiency and the switch towards energy sources that are not based on
fossil fuels. Such changes are likely to have appreciable benefits for public health
through a variety of routes. Feasible gains in the efficiency and technology of energy use
in towns and cities and in homes can potentially improve health by protecting against
temperature-related morbidity and mortality and alleviating fuel poverty. A shift towards
renewable energy production would also put increasing focus on cleaner energy carriers,
with particular benefits to urban air quality. Further, transport systems that reduce
dependence on private motor vehicles and encourage walking and cycling are likely to
benefit health in multiple ways. Although there are formidable social, political, economic
and technological barriers to achieving more equitable and sustainable use of energy, the
potential benefits to health are substantial.
About the author
Paul Wilkinson is Reader in Environmental Epidemiology, Public & Environmental Health

Research Unit, London School of Hygiene & Tropical Medicine. He trained in clinical
medicine and public health in the United Kingdom, principally in Oxford and London. He
began epidemiological research at the National Heart & Lung Institute, from which he
moved to the London School in 1994. He has long-standing research interests in
environment and health links, especially in relation to climate change and energy, and in
the research methods for investigating those links. He is a member of the Centre on
Global Change and Health, a WHO Collaborating Centre on Global Change and Health
based at the London School.

Health impact of the waste cycle in the Provinces of Naples

and Caserta, Italy
Pietro Comba and Lucia Fazzo

Unit of Environmental Epidemiology, Department of Environment and Primary
Prevention, Istituto Superiore di Sanità, Rome, Italy
The awareness of the health risks associated with the uncontrolled export of hazardous
waste from countries where specific regulations are operating towards those where such
regulations are lacking or inadequately enforced has led the Organisation for Economic
Co-operation and Development and the United Nations Environment Programme to
adopt the Basel Convention on the Control of Transboundary Movements of Hazardous
Wastes and their Disposal to face this problem, avoid illegal activities and develop
mitigation strategies (1).
The stringency of enforcement of regulations may also vary within a country, based on
differences among regions and local authorities. This is the case that determined the
widespread illegal practice of dumping toxic waste in the Provinces of Naples and
Caserta in Italy.
At the request of the Department of Civil Defence of the Government of Italy, a

multidisciplinary study group including scientists from the WHO European Centre on
Environment and Health, National Research Council, Istituto Superiore di Sanità, in
cooperation with the Campania Region Epidemiological Observatory and the
Environmental Protection Agency, performed an epidemiological study aimed at
assessing the likely health effects of the waste cycle in Campania (2).
Clustering analysis of cancer mortality and occurrence of malformations in 196

municipalities in the Provinces of Naples and Caserta, standardized by socioeconomic
deprivation index, led to the detection of clusters of mortality by lung, liver, gastric, kidney
and bladder cancer and of the prevalence of total malformations and malformations of
the limbs and the cardiovascular and genitourinary systems, mainly concentrated in the
area where most of the illegal practice of dumping toxic waste took place (3).
A correlation study showed that, at the municipality level, total mortality, all-cancer
mortality, mortality from some specific cancer sites and anomalies of the internal
genitourinary system showed increasing risks from increasing exposure to a waste
exposure index with statistically significant linear trends (4).
Although more research is needed to assess the causality of the observed association,
the study findings are useful for setting priorities for environmental remediation and for
identifying populations suitable for analytical epidemiological studies and biomonitoring
and may contribute both to decision-making and to a transparent information process.
References
1. Harjula H. Hazardous waste: recognition of the problem and response. Annals of

the New York Academy of Sciences, 2006, 1076:462–477.
2. Comba P et al. Cancer mortality in an area of Campania (Italy) characterized by

multiple toxic dumping sites. Annals of the New York Academy of Sciences, 2006,
1076:449–461.
3. Fazzo L et al. Cluster analysis of mortality and malformations in the Provinces of

Naples and Caserta (Campania Region). Annali dell’Istituto Superiore di Sanità,
2008, 44:99–111.

4. Martuzzi M et al. Cancer mortality and congenital anomalies in a region of Italy with
intense environmental pressure due to waste. Submitted for publication.
About the author
Pietro Comba has current research projects including epidemiological studies in

contaminated sites and in areas with high levels of exposure to 50 Hz magnetic fields. He
is interested in the ethical aspects of environmental health and the precautionary
approach to public health policies. He has some experience in cooperation with countries
in Latin America in these domains.

SESSION III:
PARALLEL SESSION B: USING RESEARCH FINDINGS TO IDENTIFY

PRIORITIES FOR POLICIES
Session III - B page 31

Knowledge evaluation: the Health and Environment Network

HENVINET
Alena Bartonova
Senior Scientist, Centre for Ecological Economics, Norwegian Institute for Air Research,
Kjeller, Norway
The main objective of HENVINET is to establish long-term cooperation between

researchers, policy-makers and other stakeholders in the area of environment and
health. To fulfil the objective, work is done pursuing two tracks: (1) organizing and
assessing knowledge on environmental causes related to the HENVINET health topics
and (2) building a communication web portal for linking scientific and user communities.
The HENVINET health topics are broadly defined by the European Environment & Health
Action Plan 2004–2010 and the preceding SCALE process: asthma and allergies,
cancer, neurodevelopmental disorders and endocrine-disrupting effects. The consortium
has reviewed the scientific basis with the aim of constructing causal diagrams based on
the DPSEEA (driving forces–pressures–state–exposure–effects–actions) framework
identifying environmental factors relevant to these topics.
The causal diagrams serve two purposes: as a logical framework for knowledge
evaluation of policy-relevant questions and for describing tools available to practitioners
who make decisions in environment and health. Several tools for professionals have
been described and included in a database to provide inspiration and concrete help to
users.
The causal diagrams (supported by the scientific review) are now being prepared for
knowledge evaluation by the consortium and by other stakeholders. An evaluation
framework has been developed, asking the evaluator to estimate the probability or
precision with which he or she believes a certain element of the diagram can be
assessed or predicted. Simplified diagrams are being constructed for a limited set of
policy questions, asking for the respondents’ opinions on knowledge status and
prediction possibilities for each element or link in the diagram and for the causal chain
diagram as a whole.
The aim is to submit the diagrams to various groups of users and to analyse the
similarities and dissimilarities of their evaluations. Such analysis may provide insight into
the perceptions and views pertinent to the selected policy questions and will serve as gap
analysis of relevant knowledge. A limited evaluation has been performed for climate
change and a respiratory health–related diagram. Diagrams and evaluation results will
soon be available for other policy questions.
In addition to the scientific activities, HENVINET is constructing a web portal for social
networking of the environment and health community with the aim of allowing easy
access to experts, a knowledge base, projects and issue-related information. We hope to
achieve a wide interest in and subscription to the portal. Project information can be found
at http://www.henvinet.eu.
Acknowledgement: HENVINET is a coordination action funded by the Sixth Framework

Programme of the EU, Contract No. 037019, started in November 2006 and planned until
October 2010.
page 32 Session III -B

About the author
Alena Bartonova, Senior Scientist at the Centre for Ecological Economics, Norwegian
Institute for Air Research, has received her scientific training in mathematical statistics at
the Charles University, Prague, Czech Republic. She has worked in environmental health
for 25 years. Her key expertise includes statistical modelling, data analysis, data
management, uncertainty and sensitivity analysis, assessment of human environmental
exposures, environmental PSIR analysis (related to air quality) and assessment of the
socioeconomic aspects of emission abatement measures including evaluation of costs
and benefits. She participated in Norwegian and international studies of the effects of air
pollution on respiratory health, human well-being and material damage, with special
interest in exposure to air pollutants and the externalities of air pollution. Currently, she is
participating in or leading several research projects related to the development of
methods for integrated environmental health impact assessment and for assessing
exposure at the individual and population levels.

EnVIE – European Union policies on indoor air quality and

health
Eduardo de Oliveira Fernandes

Professor, Faculty of Engineering, University of Porto, Porto, Portugal
EnVIE is a coordinated action on indoor air quality and related health effects supported
by the Sixth Framework Programme of the European Commission. EnVIE involves 18
institutions from 11 countries, with a proportion of almost 50:50 between the technical
and the health side, and the purpose is to produce a set of policies for EU on indoor air
quality and health. This will be the basic content of a report to be submitted to the
European Commission by the end of October 2008.
The policies with which EnVIE is dealing are for non-industrial buildings such as homes,
schools and offices, but the same principles apply to enclosed spaces such as vehicles.
Industrial and other regulated environments are excluded.
The EnVIE concept (Fig. 1) is a methodological attempt to respond to the difficulties

usually associated with the numerous and diversified parameters claimed to be involved
when trying to characterize the status of indoor air and, even more, when the relationship
between indoor air quality and health effects is at stake. The sequence of the method
starts from a selected shortlist of highest-priority health effects (i) that can be associated
with the indoor air and is used to try to identify from the literature the key types of indoor
exposure (ii). From the latter, EnVIE will proceed to identify causes and related sources
(iii) and will end with the assessment of the existing, missing and recommend policies to
control these sources and, eventually, health outcomes. New research needs are also
identified.
Fig. 1. The EnVIE concept
CO: carbon monoxide. (S)VOCs: volatile and semivolatile organic compounds

Source: EnVIE Co-ordination action on Indoor Air Quality and Health Effects, SSPE-CT-2004-502671 (2004-2008).
Reproduced with permission of the author

Several possible approaches to improving indoor air quality are considered, including:
assessing the impact of specific indoor air pollutants by appraising hazard, exposure and
risk; source control and ventilation; exposure guidelines; emission standards for products
and appliances; legislation; disseminating information (such as guidance for the public),
education and training; and influencing designers, builders, managers and operators of
buildings.
Despite the attempt to simplify the approach to the issue, the complexity of indoor
pollution and the multitude of parties responsible for generating and potentially acting to
control indoor air pollution make the coherent development of risk reduction strategies
difficult. To be effective, any policies directed at improving indoor air quality need to be
part of a comprehensive overall management strategy involving governments,
institutions, professional bodies and individuals. Plans need to be target both new and
existing buildings.
About the author
Eduardo de Oliveira Fernandes has devoted the past 30 years of his career to teaching,
research, consulting and public activities on various topics related to energy and
environment. He founded a research and technological development group on building
thermal physics with major pioneering activities in Portugal on solar technologies and
thermal behaviour of buildings, indoor air quality, energy and environment in the urban
space and energy planning at the regional and urban levels. Some positions held: Chair,
Department of Mechanical Engineering (1980–1982); Vice-Rector (1986–1991);
Secretary of State for Environment of the Government of Portugal (1984–1985); Chair,
Portuguese Mechanical Engineers (1992–1994); Vice-President, PLEA (Passive and Low
Energy Architecture) (1987–1991); Vice-President (1991–1995) and President of
International Solar Energy Society (1995–1997). Responsible for the concept
energy/environment of EXPO’98 in Lisbon (1993–1998). Secretary of State for Energy of
the Government of Portugal (2001–2002). Chair, Advisory Board, Energy Agency of
Lisbon (2003–2006). President, Energy Agency of Porto (2006–).

The dioxin crisis in Belgium:

from crisis to scientific knowledge and a new policy
Herman Diricks
Director-General, Federal Agency for the Safety of the Food Chain, Brussels, Belgium
At the end of January 1999, a mixture of polychlorinated biphenyls (PCBs) and dioxins
was unintentionally added to a stock of recycled fat used in the manufacture of feedstuffs
for poultry, pig and bovine farms in Belgium. The incident caused a massive international
recall operation, a temporary export ban on Belgian products and enormous economic
damage.
After the incident was discovered, a large monitoring programme for PCBs and dioxins
was launched to trace contaminated products and to restore the Belgian quality label.
Belgium’s authorities still closely monitor PCBs and dioxins.
The Ministry of Agriculture commissioned a scientific study to compile all data available
and to review the main sources of PCDD/PCDF and PCBs to determine the origin and
extent of the contamination and to identify which ones may influence the accumulation
and metabolism of PCBs and dioxins in the different matrices monitored. This study was
based on more than 55 000 analyses.
The study showed that the total amount of PCBs accidentally mixed could be estimated
at 50 kg/100 litres of PCB oil containing about 1 g toxic equivalent of dioxins and two
times more dioxin-like PCBs. The incident could be attributed to a single source of
contamination limited to the first quarter of 1999. Significant secondary contamination,
which might have occurred as a result of animal fat recycling, could be excluded. The
incident affected poultry, especially reproduction animals, and to a much lesser extent pig
farms, whereas the bovine livestock was largely spared. The analysis of the ratio of PCB
to dioxins revealed significant metabolic differences between animal species.
It has been estimated that the daily consumption of highly contaminated meals during 60
days would theoretically double the current PCB and dioxin burden, to a level similar to
that of subjects living in the 1980s or of people regularly eating contaminated seafood.
The knowledge built during the crisis was used to revise not only Belgium’s food safety
policy but also the European policy. It also enabled authorities to quickly master
subsequent incidents with PCBs and dioxins.
Belgium’s inspection services were merged into one agency. Since contamination
dissipates in a very complex way through the whole food chain, one agency responsible
for the whole food chain can carry out rapid and efficient crisis management.
The incident demonstrated the need for a credible, independent structure capable of
giving sound scientific advice. Along with the new agency, a scientific committee was
founded. This was done not only at the national level in various countries but also at the
European level by the creation of the European Food Safety Authority. The constant
need for data led in Belgium to a national control programme based on a scientific
approach. This facilitates the use of data from the official control programme for research
purposes.

About the author
Herman Diricks has been Director-General at the Federal Agency for the Safety of the
Food Chain since 2002 and responsible for control policy. He graduated as an engineer
for chemistry and agricultural industries at Ghent University in 1983. After a short stay at
the Free University of Brussels as a scientific collaborator, in 1986 he started at the
Ministry of Agriculture, first as an adviser, then as the Director of the Information and
Communication Technology department and finally becoming staff member of the
Secretary-General. Subsequently he worked for a year as an adviser to the Minister for
Agriculture and then two years as an independent consultant before starting at the
Federal Agency for the Safety of the Food Chain.

London Congestion Charging Scheme: evaluation of impact
H. Ross Anderson (on behalf of the HEI Investigation team: Frank Kelly (principal
investigator), Ross Anderson, Ben Armstrong, Richard Atkinson, Ben Barratt, Sean
Beevers, Dick Derwent, Dave Green, Ian Mudway, Cathryn Tonne & Paul Wilkinson)
Division of Community Health Sciences, St George’s, University of London, London,
United Kingdom
The London Congestion Charging Scheme (CCS) was implemented on 17 February

2003 to restrict traffic entering central London from 07:00 to 18:00 Monday to Friday. The
Congestion Charging Zone (CCZ) comprises only 1.4% (22 km2) of Greater London and
has a resident population of less than 400 000 (London population 6.8 million). The
impact of the scheme has been evaluated by direct measurement of traffic and pollutant
concentrations and by modelling. There was a sustained reduction of 20% in traffic
entering the zone, but the initial 30% reduction in congestion has not been sustained.
Several other changes in traffic management and public transport were implemented
over the same period. The effect of the scheme on air quality was evaluated by direct
measurement of roadside and background concentrations of the main pollutants using
the existing monitors and by emission-dispersion modelling. The results of modelling
suggested small reductions in particulate matter with an aerodynamic diameter of less
than 10 μm (PM10) and nitrogen dioxide, which were larger in the CCZ than in the rest of
London. These models controlled for weather conditions and the characteristics of the
vehicle fleet. The reductions were greater in more socially deprived areas. Monitoring
data during the days and hours of operation of the CCS were compared between the
CCZ and an outer London control area for two years on each side of the implementation
date. This found that, in the CCZ, background concentrations of PM10, carbon monoxide
and nitric oxide were reduced while nitrogen dioxide was increased. An analysis of
weekends, when the CCS does not operate, obtained similar results, suggesting that any
link between the CCS and changes in air quality is complex. No direct assessment of
health effects has been done, but modelling approaches indicate benefits in proportion to
the small changes in pollutants. Traffic control schemes are likely to increase in cities
across the world and evaluation should be encouraged. The methods will involve both
modelling and empirical investigation. Both present considerable challenges in terms of
data availability and in the interpretation of results.
Acknowledgement: The Health Effects Institute supported this work.
About the author
H. Ross Anderson qualified in medicine in Melbourne. From 1966 to 1972, he worked in

Papua New Guinea, where he investigated chronic lung disease and asthma and their
relationship to indoor air pollution and other factors. This was followed by two years at
the United Kingdom Medical Research Council’s Pneumoconiosis Unit in South Wales
and two years on an MSc at the London School of Hygiene and Tropical Medicine. In
1976 he was appointed to St George’s, University of London and has been Professor of
Epidemiology and Public Health since 1985. His main research is in the epidemiology of
asthma and the health effects of air pollution.

Policy interpretation of human biomonitoring research

results in Belgium: priorities and complexity, politics and
science
Hans Keune1, Karen van Campenhout2, Bert Morrens1, Johan Springael3, Gudrun
Koppen4, Ann Colles4, Ilse Loots1, Hana Chovanova5, Maaike Bilau6, Liesbeth Bruckers7,
Vera Nelen8, Willy Baeyens9, Nik Van Larebeke10
1
Faculty of Political and Social Sciences, University of Antwerp, Antwerp,
2
Environment & Health, Flemish Government, Environment, Nature and Energy
Department, Brussels, 3 Faculty of Applied Economics, University of Antwerp,
4
Environmental Toxicology, Flemish Institute of Technological Research, Mol,
5
Flemish Agency for Care and Health, Division of Public Health Surveillance, Brussels, 6
Department of Public Health, Ghent University, 7 Center for Statistics, Hasselt University,
Diepenbeek, 8 Provincial Institute of Hygiene, Antwerp, 9 Free University of Brussels, 10
Study Centre for Carcinogenesis and Primary Prevention of Cancer, Department of
Radiotherapy, Nuclear Medicine and Experimental Oncology, University of Ghent,
Belgium
Key challenges in environment and health are interpreting research data and translating
them into policy measures. We describe a process in which these two challenges are
integrated in the Flemish Centre for Health and Environment, working directly for and in
close collaboration with the Flemish Government: the interpretation of human
biomonitoring results for policy-making. From 2001 to 2006, the Centre investigated the
relationship between environmental pollution and human health by measuring pollutants
and health effects among more than 4000 Flemish inhabitants. A major challenge
concerns translating these human biomonitoring data into concrete policy priorities and
measures.
Within the context of the Centre, medical, environmental and social scientific experts and
policy-makers cooperatively developed an action plan for interpretation and policy uptake
of the human biomonitoring results with three successive phases, each focusing on
different aspects. The first phase focuses on setting priorities for the results for policy
uptake: how severe are specific results in public health risks? The second phase focuses
on two questions. What are the causes of a specific monitoring result? Can a (local)
source for the pollution be identified? In the third and final phase, the focus is on which
policy measures are feasible to effectively tackle the environmental problems. In the
beginning the discussions in the action plan steering group mainly focused on
environmental and medical scientific interpretation of the monitoring data. Consultation of
scientific experts as well as the literature was considered sufficient to produce the
necessary knowledge and answers. The limitations of an exclusively scientific endeavour
became clear while trying to build bridges towards policy interpretation. Setting policy
priorities when factors other than (medical and environmental) scientific ones had to be
taken into account proved to be very complex and initially hard to realize. Social
scientists introduced other relevant assessment criteria (such as social preferences and
the feasibility of policy measures) and proposed creating a stakeholder jury that would
judge relevant data and knowledge from a broader perspective. Including this step, the
government can make a decision informed by both expert and jury advice. In 2007, the
action plan was successfully put into practice to give advice on priority-setting to the
Ministers of Environment and Health.

About the author
Hans Keune worked as a researcher at the Research Institute on International Industrial

Relations in Amsterdam in 1999–2000. In 2000, he started working at the University of
Antwerp. Until 2002, he worked on a research project on the work-life balance (the
development of an instrument of social audit) at the Faculty of Applied Economics. From
2002, he started working at the Research Department for Technology, Energy,
Environment on the Centre of Expertise for Environment and Health, a project funded by
the Flemish Government for 2001–2006. In 2007, he moved to the Sociology Department
at the Faculty of Political and Social Sciences to work on the extended project on the
Centre of Expertise for Environment and Health (2007–2011). His expertise is mainly
related to environment and health (science, social issues and policy-making), risk
(perception, communication and assessment), knowledge (production, integration,
interpretation and application), complexity, inter- and transdisciplinarity (boundary
between work science, government, society and participation), action research and group
assessment and decision support methods (such as multi-criteria decision analysis,
Delphi method and focus groups). He has published articles in several national and
international peer-reviewed journals and books.

Soil contamination from motor vehicle pollution and its

health effects
Mirza Ⱥ. Kazimov
Head of the Department of General Hygiene and Ecology, Azerbaijan Medical University,
Baku, Azerbaijan
Pollution from motor vehicles has become a major environmental problem in recent
years. Road traffic has been growing in Azerbaijan, especially along the international
highways. Every year the flow of motor vehicles increases by 25% or more.
We have studied chemical soil pollution in areas adjacent to one of Azerbaijan’s

international highways, taking into consideration the effects on soil pollution of such
factors as the distance from the road, soil cultivation, availability of a roadside plantation
zone and the predominant wind direction. Samples of soil were tested for total petroleum
hydrocarbons, aromatic polycyclic hydrocarbons, 3,4-benzo(a)pyrene and heavy metals
(Pb, Zn, Cd, Hg and As). Also studied were the status of chemical pollution of plants,
including those used for food, mutagenicity of soil and population morbidity (particularly
among pregnant women).
Soil and plants (wild plants, potatoes and wheat) were found to be contaminated, with the
degree of contamination hazard categorized as “very high” and “high”. The degree of
motor vehicle pollution of areas adjacent to the roads was found to manifestly depend on
soil cultivation, availability of roadside plantation zones, the distance from the road and
the prevailing wind direction. The presence of chemical mutagens in automotive
emissions leads to increased soil genotoxicity, which results in greater defectiveness of
pollen grains, particularly in perennial plants.
Contamination of soil with chemical pollutants from motor vehicle emissions in areas
adjacent to international highways has a significant public health impact. A high
percentage of pregnant women (the most vulnerable population) are reliably referred to
high-risk groups – those with a disease history. Anaemia and spontaneous abortions
were very common among this population.
The evidence and practical results obtained through research have been used for
decision-making in public health and environmental protection. The President of
Azerbaijan has issued two decrees on improving the environmental situation in the
country. Relevant ministries and agencies have developed measures intended to clean
up areas of anthropogenic contamination, to reduce environmental pollution in populated
areas and to undertake health monitoring with a view to identifying and assessing public
health risks.
About the author
Mirza A. Kazimov graduated from Azerbaijan Medical University in 1974. In 1974–1977

and 1982–1988 he took a postgraduate course and a doctorate course, respectively, at
the Central Institute of Advanced Doctors’ Training in Moscow. He has been a Doctor of
Health Sciences since 1988, and since 1990 he has been Professor of Common Hygiene
and Ecology. Since 1992, he has worked as head of the Department of Common
Hygiene and Ecology at Azerbaijan Medical University. Kazimov has provided scientific
supervision for 12 PhD dissertations in environmental health. He has written more than

200 research papers, including 4 monographs and 6 textbooks on common hygiene and
ecology. Kazimov is the focal point for environment and health at the Ministry of Health of
Azerbaijan.

Toxic oil syndrome: lessons learned from interdisciplinary

collaboration
Manuel Posada de La Paz1, Emilio Gelpi, Benedetto Terracini, Bénoit Nemery, Arne
Svejgaard, Stanislaw Tarkowski, Carlos Lahoz, Edwin M. Kilbourne, Rossanne M. Philen
and Luis Soldevilla as the WHO/CISAT Scientific Committee for the Toxic Oil Syndrome
1
Head, Research Institute for Rare Diseases (IIER), Institute of Health Carlos III and
Director, WHO Collaborating Centre for the Epidemiology of Environment-related
Diseases, Madrid, Spain
Toxic oil syndrome (TOS) is a unique episode in medical history for at least two reasons:
first, its occurrence in Spain in 1981 was unprecedented; second, no similar outbreaks or
even similar patients have been reported, with the possible exception of eosinophilia-
myalgia syndrome.
The hypothesis that a contaminated food oil caused the illness was formulated thanks to
the observations of an astute clinician and the criticizable (but not necessarily wrong)
results of “shoe leather” epidemiology. The decision to effect public heath interventions
based on limited but high-quality epidemiological evidence is a classic example of public
health epidemiology at its finest.
Even though about 20 000 people were affected within the first three months and more
than 300 people had died within the first seven months of the outbreak, the national
public health care system demonstrated both its ability to deliver services to the victims
and the epidemiological capacity to develop the appropriate research on the causes.
Fatty acid anilides and the fatty acid esters of 3-(N-phenylamino)-1,2-propanediol were
epidemiologically implicated as possible causal agents of TOS. Analytical oil chemistry
results show that people with TOS ingested many interrelated compounds. However, the
exact chemical agent or agents responsible for TOS have not been identified and,
despite considerable research efforts using a variety of experimental systems, confidently
reproducing the human disease in animals has not been possible. This failure to identify
the exact causal agent is not only frustrating from a scientific viewpoint of view but also
worrying for public health because it means that a repetition of similar food-related
poisonings cannot be excluded or prevented.
The creation of ad hoc close collaboration with WHO through the TOS Scientific
Committee has been crucial for clarifying the cause and pathogenesis of TOS.
Nevertheless, international scientific support for investigating TOS has ended. The
lessons learned from this episode include the importance of early interventions in public
health emergencies, even in the absence of full scientific evidence, and the
indispensability of close and continuous communication among investigators from all
scientific backgrounds as well as with the victims of the episode. In addition, several
messages should remain on record for future outbreaks. These include the need for: 1) a
nominal roster of victims, 2) well-designed repositories of biological materials, 3) a
multidisciplinary scientific approach and 4) the participation of victims in research.
TOS is slated to be a landmark example of interdisciplinary collaboration that can serve

as a model for food security and other future outbreaks of previously unrecorded
diseases and other environmental disasters.

About the author
Manuel Posada de la Paz is a graduate in Medicine and Surgery from the Universidad
Autónoma de Madrid and a PhD in Medicine. He has received a Special Award,
Specialist in Internal Medicine (Res. Phys. System) and is also a Specialist in Preventive
Medicine and Public Health. He has led more than 15 research projects addressing
several fields such as specific rare diseases (such as toxic oil syndrome and
scleroderma), autistic spectrum disorders, rare diseases epidemiology as well as gene-
environmental issues. He has collaborated with more than 30 projects at the national and
European level and published more than 100 papers in national and international peer-
reviewed journals. He is a member of the International Society for Biological
Environmental Repositories focused on biobanks and a member of the Rare Diseases
Task Force.

SESSION III:
PARALLEL SESSION C: TOOLS FOR ASSESSING HEALTH RISKS AS A

MEANS FOR POLICY MAKING
Session III - C page 45

Using a sufficiency of evidence for timely prevention in

multi-causal, complex and uncertain biological systems
David Gee
Head of Group Science, Policy and Innovation, European Environment Agency
Expanding knowledge is providing us with insights into the complex, multi-causal, and
uncertain world of biological systems wherein much disease and dysfunction arises from
multi-stage, multi-pathway causal webs, often initiated at the foetal stage of development.
Preventing such harm involves timely action on appropriate strengths of evidence, using
the precautionary principle and causal inferences that are relevant to multi-causal,
complex systems.
As such decisions involve ethical choices, as well as the best available science,
stakeholders need to be involved at all stages of risk assessment, management and
communication. Efficient and effective dialogue on hazards and risks requires clear and
consistent approaches to evaluating evidence and associated terminology.
About the author
David was educated in politics and economics and has worked for over 30 years at the
science/policy interface of occupational and environmental risk assessment & reduction,
with UK Trade Unions: with the Environmental Group, Friends of the Earth, where he was
Director; and, since December 1995, with the European Environment Agency (EEA), an
EU information-providing body in Copenhagen, where he is responsible for “Emerging
Issues and Scientific Liaison” and Group leader for science, policy and innovation. He
has published reports and lectured on many issues, including scientific uncertainty; the
precautionary principle; environmental health; environmental taxes and ecological tax
reform; and clean production/ eco-efficiency. He is initiator, co-editor and contributor to
the widely cited and used EEA report, “Late lessons from early warnings: the
precautionary principle 1898-2000” (2001) which is now going into vols 2, 3 and 4.
page 46 Session III -C

Integrated assessment of systemic risks to human health
David Briggs
Imperial College, London, United Kingdom
The environmental health issues facing policy-makers are growing in their complexity and
scale. Faced with these new, systemic issues, policies to protect human health from
environmental threats are necessarily becoming more precautionary and integrated in
approach. To help develop and evaluate these policies, decision-makers (as well as
other stakeholders) need more comprehensive and balanced information both on the
magnitude and origins of the problems they are trying to address and on the implications
of their actions. Traditional methods of risk assessment, which focus on singular hazards
with direct implications for health, are inevitably found wanting in this respect. Instead,
more integrated and flexible methods of assessment are needed that take account of the
broader context within which policy is carried out, the multifactorial nature of the
problems that have to be solved and the far-reaching effects of policies and other
interventions. Drawing on research undertaken in two large European Union–funded
projects – INTARESE (integrated assessment of health risks from environmental
stressors in Europe) and HEIMTSA (health and environment impact methodology and
toolbox for scenario analysis) – this paper outlines the concept of integrated
environmental health impact assessment as a tool for analysing complex, systemic risks.
It presents a rationale for integrated assessment, describes a framework for analysis,
illustrates how this approach can be used better to inform policy and discusses some of
the scientific and conceptual challenges that have to be met.
About the author
David Briggs is Professor of Environment and Health Science in the Department of

Epidemiology and Public Health at Imperial College London. A geographer and
environmental scientist by background, his research focuses on applying geographical
information systems techniques for exposure modelling and risk and health impact
assessment. Currently he is coordinating the 34-partner INTARESE integrated project,
which is aimed at developing methods for integrated assessment of health effects from
environmental stressors and is principal investigator on a range of other projects
including studies of air pollution, mobile phone masts, power lines, multiple deprivation
and pesticides. He was until recently a member of the Scientific Committee of the
European Environment Agency and has been a long-time consultant to the European
Commission and a regular consultant to WHO. He has published more than 100 peer-
reviewed articles and about 20 books and research monographs and reports.

Experience on risk assessment in environment and health in

the Russian Federation
Simon L. Avaliani
Department of Community Hygiene, Centre for Risk Assessment, Russian Academy of
Advanced Medical Studies, Moscow, Russian Federation
Traditionally in the Russian Federation, environmental regulation to ensure health safety

was based on a set of hygienic norms. Unfortunately, quantitative methods of
assessment of health damage were not widely used. This creates a barrier to formulating
environmentally sound health policies. A key problem is defining priorities in
environmental decision-making, which is especially important in the Russian Federation.
Environmental health research and management both require multidisciplinary
approaches. Experience in the United States and the European Union shows that the
implementation of risk assessment and risk management methods in environmental
decision-making process has been very successful. These methods have been
extensively tested in the Russian Federation during the past decade. The results of these
studies demonstrated the advantages of environmental risk regulation for policy-makers.
This presentation is mainly based on the results of regional risk assessment studies that
have taken place in more than 20 regions of the Russian Federation during the past
decade. As a result of these studies, about 50 comprehensive, community-based risk
assessments with cost-effectiveness and cost-benefit analysis and policy
recommendations have been completed. In this study, the main task was to select a
short-list of priority pollutants that are typical for the Russian Federation. These
substances must have clearly documented dose–response relationships that can also be
used to estimate the expected incidence of adverse health effects. Since several
pollutants generate multiple and sometimes not comparable risks, it was decided in this
analysis to focus on two types of health risks affecting the general population of the
Russian Federation: excess risk of cancer; and excess mortality risk from inhalable
particulate matter with an aerodynamic diameter of less than 10 μm (PM10) and 2.5 μm
(PM2.5). The exposed population was defined using ambient air quality monitoring data
and dispersion modeling.
Previous studies showed the following.
Particulate matter (PM10 and PM2.5 fractions) was identified as the major
substance posing health risk in the Russian Federation. Additional mortality
related to these fractions in the ambient air vary from 45 000 to 90 000 annually
for the Russian Federation.
The lifetime individual carcinogenic risk from exposure to air and water pollutants
in most large cities of the Russian Federation is on the order of 0.5 per 1000
population.
Large cities with population exceeding 1 million have risk levels of nearly 1 per
1000 population, and some cities exceed this level.
In some extremely polluted areas (“zones of emergency ecological situation”) the
risk may reach 10 per 1000 population.
Priorities have been set for the risk factors and sources for regulation.
The economic value of reducing human health risk has been assessed.

Current application of risk assessment and risk management methods includes the
following.
Risk assessment and risk management methods are being used to ensure the
safety of the population in the areas of possible impact of industrial facilities – for
substantiating the sanitary-buffer zones and to inform the federal and local
authorities and population about their environmental quality.
Large industrial companies (Gazprom, refineries, etc.) are exploring risk
assessment methods to improve environmental management.
Cities have used risk assessment to mitigate health risk from mobile sources
(Moscow).
About the author
Simon L. Avaliani received a Physician’s Diploma in Internal Medicine, MD and PhD from
the Tbilisi State Medical Institute. He currently specializes in risk assessment for human
health, toxicology and hygiene. His fields of interest include risk assessment for human
health, ecological risk assessment and environmental impact assessment, the
environmental health hazard pathway, environmental monitoring and exposure
assessment, the development of environmental health indicators, health and environment
analysis for decision-making, risk management and risk communication.

Novel methods for human and ecological risk assessment of

combinations of stressors
Hans Løkke1, Gerrit Schüürmann, Saby Dimitrov, Philipp Mayer, Mark Huijbregts, Dave
Spurgeon, Martin Holmstrup, Kees van Gestel, Jan Baas, Uwe Schlink, Mikael Hildén
1
Director of Research, Department of Terrestrial Ecology, National Environmental
Research Institute, University of Aarhus, Silkeborg, Denmark
Living organisms are never subject to single stressors at set doses but rather to a
complex array of physical, chemical and biological environmental stressors. The project
NoMiracle: Novel Methods for Integrated Risk Assessment of Cumulative Stressors in
Europe under the Sixth Framework Programme of the European Union addresses the
problems of combined risks to health or the environment from multiple stressors.
A survey of risk experts across Europe and beyond pinpointed uncertainty and ambiguity
in complex risk management using novel representational and data-collecting methods.
Two master cases will demonstrate to policy-makers and other stakeholders the utility of
the new knowledge and methods developed in NoMiracle.
NoMiracle focuses on polar and bioactive compounds and offers paradigm-shifting

methods within environmental chemistry, toxicology and ecotoxicology for ranking
priorities, estimating exposure, assessing effects and calculating risk. The project has
developed novel models and methods:
to address partitioning in soil organic and biological matter in terms of

fundamental interaction forces and to characterize well-defined availability
aspects of the compound concentrations in various environmental media; and
to predict biodegradability patterns, to simulate metabolic pathways and to

consider spatial variation for multimedia fate predictions.
These new tools can reduce uncertainty in both human and ecological exposure
assessment of contaminants. Other NoMiracle developments include:
a series of effect parameters in test organisms or cell systems (ranging from

bacteria to higher vertebrates) whose measurement enables the identification of
dysfunction at all levels of organization after multiple chemical exposure;
new experimental designs and models to quantify the impact of natural stressors
in combination with chemicals;
new approaches in toxicokinetic modelling, including time series assessment of

uptake and effect in different species using resource allocation concepts;
integrated tools for elucidating the molecular mechanisms of mixture toxicity, thus
offering the potential to detect effects occurring at the biochemical level;
a better model to describe mixture toxicity, integrating toxicological,

toxicodynamic and molecular data; the dynamic energy budget model may
diminish the experimental effort that is needed to describe mixture effects; and
an algorithm for human and wildlife mobility to enable individual-level and

spatially explicit risk assessment of cumulative stressors, with the results to date
suggesting strong implications for the future structure of ecological and human
random walk models.

NoMiracle will provide a more solid scientific basis for setting safety factors and
implementing guidelines and regulations for chemicals.
About the author
Hans Løkke has long experience of research, research management, risk analysis and
education, primarily on the ecotoxicology of pesticides and chemicals. He has been
involved in developing test guidelines and assessing the risk of polluted sites. From 1992
to 1997, he coordinated the Danish Centre for Ecotoxicological Research within the
Danish Environmental Research Programme with participation from 14 institutions. Since
1974, he has served as an expert for the European Commission in various areas, such
as a member of the Scientific Pesticide Committee from 1986 to 1994. Since 1984, he
has been a member of the Danish Pesticide and Biocide Council and Vice Chair since
1992. Since 2004, he has coordinated NoMiracle.

HEIMTSA: extending health impact assessment and cost–

benefit analysis to European policy scenarios
Fintan Hurley
Scientific Director, Institute of Occupational Medicine, Edinburgh, United Kingdom
The idea behind HEIMTSA is to extend available health impact assessment (HIA) and
cost–benefit analysis (CBA) methods and tools to enable evaluation at the European
level of the environmental health effects of real-life policy scenarios in such key sectors
as transport, energy, agriculture, industry, households and waste treatment and disposal.
This will support the work of the European Commission, especially the European
Environment & Health Action Plan.
Drawing on past HIA and CBA studies, HEIMTSA will follow the effects of policies from
emissions to air, soil and water through changes in environments and human exposure,
to effects on health and their monetary value (the full-chain or impact-pathway approach).
The project will also develop an associated set of tools, or a modular integrated
assessment system, for implementing the method Europe-wide.
HEIMTSA will pay particular attention to the health effects of mixtures of pollutants and to
effects in susceptible subpopulations, such as women, children and people with pre-
existing illness. It will also address the assessment and representation of uncertainty;
issues of spatial scale in the development and application of HIA methods; and the use of
mapping as a means of communicating results. HEIMTSA will actively liaise with policy
users and with other researchers and projects, especially 2-FUN and INTARESE.
HEIMTSA is a four-year project that started on 1 February 2007. Following initial set-up
and scoping work, we are now developing and applying methods at the same time. We
are doing this by integrating the methodological work (such as on uncertainty, spatial
scale and developing an exposure scenario approach) with the practical work of four
case studies (outdoor air pollution; air pollution from indoor sources; noise; and pollution
from complex pathways) selected to cover a range of practical and methodological
issues. Multidisciplinary teams are carrying out these case studies and will report by 31
January 2009. A second set of case studies will start in February 2009.
We intend that HEIMTSA will help to develop HIA and CBA capability in Europe by
improving methods and tools, through dissemination and training, and more generally, by
raising the profile of HIA and CBA methods in developing policies that protect public
health from environmental pollution.1
About the author
Fintan Hurley is an epidemiologist with a background in statistics. He has worked for

many years at the Institute of Occupational Medicine and is involved in the Institute’s new
Centre for Health Impact Assessment. Since the early 1990s he has been active in health
impact assessment of outdoor air pollution, including the long-term ExternE (External
Costs of Energy) European Research Network funded by the European Commission and
the cost-benefit analysis of the European Commission’s flagship Clean Air for Europe
(CAFE) Programme. He now leads the EU Sixth Framework Programme Integrated
Project HEIMTSA, including health impact assessment of a wide range of environmental
pollutants and stressors. He chairs the quantification subgroup QUARK of the United
Kingdom Committee on the Medical Effects of Air Pollutants, and is, from time to time, a
member of various working groups on health effects and/or health impact assessment of
1
© Fintan Hurley - published with permission of the author

air pollution for WHO, the United States Environmental Protection Agency, the European
Commission and other international bodies.

Strengthening technical capability for health impact

assessment: the case of HIAir
Piedad Martín-Olmedo
Andalusian School of Public Health, Granada, Spain
The WHO Regional Office for Europe and the European Commission endorse health
impact assessment (HIA) as a relevant instrument for developing evidence-based
recommendations to support decision-makers in protecting and improving community
health and well-being.
The procedure of HIA is usually described as following the steps listed:
screening: determining whether HIA is warranted or required;

scoping – determining which effects will be considered and the plan for the HIA;
appraisal: determining the magnitude, nature, extent and likelihood of potential
health effects;
decision-making and recommendations: making explicit the trade-offs to be made
in decision-making and formulating evidence-informed recommendations; and
evaluation and monitoring: process and impact evaluation of the HIA and the
monitoring and management of health effects.
The Effectiveness of Health Impact Assessment project carried out between 2004 and
2007 funded by the European Union Public Health Work Programme examined the use,
implementation and institutionalization of HIA across Europe and captured HIA at the
national, regional and local levels. This mapping exercise came to demonstrate that HIA
has already contributed considerably to better public decision-making, but certain barriers
and difficulties were also identified. Lack of capacity and people with the research skills
needed to assist in collecting and understanding data and literature related to the
appraisal phase of HIA is considered a major barrier to its use in most places. This is
especially relevant if, in accordance with the health in all policies approach in Europe,
HIA must move from something public health enthusiasts do to something all competent
policy-makers do. One solution to this lack of capacity would be providing public
databases, establishing relevant indicators that can be issued in the policy evaluation
and developing tools that are easy to use in predicting health outcomes.
In this context, HIAir is a tool that enables online calculation of the number of health
events that could potentially be prevented from exposure to urban air pollution in a
specific population using European databases or local data (public and/or private). This
tool intends to provide support in evaluating different policy scenarios for reducing air-
pollution levels and assessing new strategies, being accessible to non–public health
specialists. HIAir was developed in the course of the ENHIS-2 (European Environment
and Health Information System) project, and it will be upgraded during the ongoing EU
project Aphekom – Improving Knowledge and Communication for Decision-making on Air
Pollution and Health in Europe.

About the author
Piedad Martin-Olmedo is a senior scientist who developed her career in collaboration

with multidisciplinary teams at the Spanish National Research Council, Edinburgh
University, the United States Agency for Toxic Substances and Disease Registry and the
European Union Directorate-General for Health and Consumers. Her research interest
has mainly focused on human chemical exposure assessment and identifying potential
sources of exposure as well as air pollution health impact assessment. She participated
in the ENHIS-1 and ENHIS-2 projects on applying public health risk assessment methods
to drinking-water pollutants, developing environmental health indicators and creating a
new tool to estimate the burden of disease related to outdoor air pollution. She is also the
partner coordinator for the Aphekom project.

Using health impact assessment to compare risk as an

illustration of the interface between science and policy
Daniel S. Greenbaum
President, Health Effects Institute, Boston, MA, United States of America
Environmental policy-makers are inevitably faced with the challenge of deciding how to
allocate limited resources to address the issues that are likely to have the most
significant public health benefits. This can occur within one area of environmental quality
(such as air quality and decisions about which pollutants and sources need the most
attention) as well as across multiple environmental areas (such as air versus water
versus land and ecosystems). Although information can never be perfect for comparing
disparate pollution sources and health effects, efforts to conduct systematic and
comparative health impact assessments can help to shape the decisions with better and
more consistent information and to identify key additional science needs going forward.
This presentation briefly describes this challenge and then uses two examples – the
challenge of comparing risk among multiple components and sources of particulate
matter air pollution (and the Health Effects Institute’s response to that) and WHO’s
comparative health risk assessment of several environmental stressors (the global
burden of disease) – to illustrate the strengths and weaknesses of different approaches
and to discuss how such information can be made most useful to decision-makers.
About the author
Daniel S. Greenbaum joined the Health Effects Institute (HEI) as its President and Chief
Executive Officer on March 1, 1994. In that role, Greenbaum leads HEI’s efforts to
provide high-quality, impartial, relevant and credible science about the health effects of
air pollution to inform air quality decisions in high-income countries and in low- and
middle-income countries. Greenbaum has focused HEI’s efforts on providing timely and
critical research and reanalysis on particulate matter, air toxics, diesel exhaust and
alternative technologies and fuels. Greenbaum recently served on the Committee on
Estimating Mortality Risk Reduction Benefits from Decreasing Tropospheric Ozone
Exposure of the United States National Research Council. He has been a member of the
Board of Environmental Studies and Toxicology of the National Research Council and
Vice Chair of its Committee on Air Quality Management in the United States. Greenbaum
also chaired the Blue Ribbon Panel on Oxygenates in Gasoline of the United States
Environmental Protection Agency, which issued the report Achieving clean air and clean
water, and the Clean Diesel Independent Review Panel of the United States
Environmental Protection Agency, which reviewed technology progress in implementing
the 2007 Highway Diesel Rule. He is also a member of the Board of Directors of the
Environmental Law Institute. He regularly presents the results of HEI’s scientific work to
United States and international audiences, the United States Congress, the Asian
Development Bank, leaders in several Latin American countries and the European
Parliament. Greenbaum has three decades of government and nongovernmental
experience in environmental health. Just before coming to HEI, he served as
Commissioner of the Massachusetts Department of Environmental Protection from 1988
to 1994, where he was responsible for the Commonwealth’s response to the Clean Air
Act as well as its award-winning efforts on pollution prevention, water pollution and solid
and hazardous waste

SESSION III:
PARALLEL SESSION D: BRIDGING THE GAP BETWEEN SCIENCE AND

POLICY MAKING
Session III - D page 57

Evaluation of scientific evidence to support policies
Michal Krzyzanowski
Acting Head, Bonn Office, WHO European Centre for Environment and Health, WHO
The quality and effectiveness of policies and public health decision-making, addressing
environmental determinants of health, depends on the reliability of the scientific evidence
describing the links between health and its determinants. Solid scientific evidence is
essential for ensuring the credibility of environmental health risk assessment and its
ability to be used in public debate as a convincing tool, mobilizing policy-makers and the
public. The results of many studies from various countries and research disciplines
contribute to this evidence base. Creating this evidence base requires systematically
retrieving the accumulated literature, evaluating the quality of the research producing
individual results and synthesizing the conclusions from the studies gathered. The
interpretation of the evidence often relies on the scientific judgement of the reviewing
expert groups. Their technical quality and independence is essential for the unbiased
evaluation of the evidence and its reliability as a basis for policy development.
WHO has a long and widely recognized record of organizing reviews, synthesizing
scientific evidence on the health aspects of environmental exposure and making its
conclusions available to policy-makers. Internationally renowned experts contribute to
preparing WHO guidelines and other evidence reviews. The WHO Air Quality Guidelines
and Guidelines for Drinking-water Quality are examples of the reviews used as the basis
for national and international environmental norms and standards. The WHO reviews
make the best globally available scientific evidence accessible to all countries, in
particular to those with insufficient resources for a comprehensive, critical and timely
review of the quickly growing research results. The content and format of the WHO
guidelines or recommendations that would be the most effective in supporting policies in
various countries will be discussed at the Symposium.
About the author
Michal Krzyzanowski is Acting Head of the Bonn Office of the WHO European Centre for
Environment and Health, WHO Regional Office for Europe. His technical work focuses on
gathering and evaluating scientific evidence on the health effects of environmental
hazards, in particular of air pollution. He led the recently completed global update of the
WHO Air Quality Guidelines and coordinates the development of WHO guidelines on
indoor air quality. He has also led a series of WHO projects developing a European
Environment and Health Information System. Before joining WHO in 1991, Krzyzanowski
conducted epidemiological research on the health aspects of air pollution and other
environmental factors in Poland, United States and France. He has an MSc in Physics
from Warsaw University and ScD and PhD (Dr.hab) in epidemiology from the National
Institute of Hygiene, Warsaw, Poland.
page 58 Session III - D

Multifaceted consequences of the Chernobyl accident:

lessons learned and ways forward
Mikhail Balonov
Professor of Radiobiology, Head of Protection Laboratory, Institute of Radiation Hygiene,
St. Petersburg, Russian Federation
The accident at the Chernobyl Nuclear Power Plant in 1986 was the most severe in the
history of the nuclear industry, causing a huge release of radionuclides over large areas
of Europe. The accident was a human tragedy and had significant environmental, public
health and socioeconomic effects.
The immediate victims of the accident were a cohort of several hundred emergency and
recovery operation workers who received high radiation doses; of these, 134 acquired
acute radiation sickness and 28 died in 1986. Another cohort affected by radiation
comprises children and adolescents who received substantial radiation doses in the
thyroid gland in 1986 mainly due to consuming milk containing radioactive iodine. About
5000 thyroid cancer cases were detected in this cohort during 1991–2005. Many of these
cases were caused by radiation and more are expected in the future; more than 99%
were successfully treated.
The majority of the more than 600 000 emergency and recovery operation workers and 5
million residents of the contaminated areas in Belarus, Russian Federation and Ukraine
received relatively minor radiation doses that are comparable to the natural background
levels. Apart from the dramatic increase in thyroid cancer incidence among those
exposed at a young age and some increase in leukaemia in most exposed workers, there
is no clearly demonstrated increase in somatic disease due to radiation.
There was, however, an increase in mental problems among the affected population,
compounded by the social disruption that followed the break-up of the USSR. After a
number of years, along with the reduction in radiation levels, the accumulation of
humanitarian consequences, severe social and economic depression in the affected
regions and associated mental problems of the general public and the workers had
become the most significant problem for the authorities to address.
Radiation caused numerous acute adverse effects on the plants and animals living in the
higher-exposure areas: in localized sites at distances up to 30 kilometres from the
release point. Following the natural reduction of exposure levels, biological populations
have been recovering from acute radiation effects. As a result of the removal of human
activities, populations of many plants and animals have eventually expanded, and
paradoxically, the present environmental conditions have positively affected the biota in
the exclusion zone.
Studying the effects of the Chernobyl accident has made an invaluable scientific
contribution to the development of nuclear safety, radioecology, radiation medicine and
protection as well as the social sciences. Targeted research on some of the long-term
environmental, health and social effects of the Chernobyl accident should be continued
for decades to come.
The Chernobyl accident initiated the global nuclear and radiation safety regime. Since the
Chernobyl accident, the world has become more cautious towards using nuclear energy
and radiation sources. However, the current and future research programmes of high-
income countries should address some knowledge gaps in radiological disciplines. The
paper will outline these research areas.

About the author
Mikhail Balonov, DSc has 40 years of experience in radiation protection of humans and
the environment. He has expertise and practical experience in setting radiation safety
standards, regulations and criteria for controlling public exposure and environmental
restoration, radiation monitoring, modelling and dose assessment. He has assessed the
effects of environmental releases of radiation due to routine operation of and accidents at
nuclear facilities in the Russian Federation, including Chernobyl Nuclear Power Plant,
Mayak Fissile Material Storage Facility, the nuclear test sites in Semipalatinsk and
Novaya Zemlya and the nuclear fleet. He was a staff member of the International Atomic
Energy Agency from 2000 to 2006 and Head of the Unit of Safety of Radioactive
Discharges. He developed safety standards and technical reports on control and
monitoring of environmental radioactivity, radionuclides in food and drinking-water and
organized numerous scientific meetings and training courses. He has substantial
experience of successful scientific cooperation in radiation protection of the public and
the environment with institutions in western and eastern Europe and the United States.
He has long-term involvement in joint projects with the European Commission in
environmental dosimetry, radioecology, remediation, dose reconstruction and risk
assessment.

Role of industry and the business community in bridging the

gap between science and policy-making
Loredana Ghinea
Manager for Emerging Science and Policy Issues, Research and Innovation Team,
European Chemical Industry Council, Brussels, Belgium
The business community recognizes and accepts its responsibilities to society in

ensuring that its activities are conducted in a manner that enable a healthy future.
Bridging the gap between science and policy-making is a major element of a business
development strategy.
Europe’s chemical industry, in this case, considers environment and health activities to
be an important pillar of the work towards ensuring a high level of protection of human
health. It has therefore been actively engaged in this area and contributes to integrating
health aspects into its approaches and products. This practice also allows for a solid
base for sustainable and competitive European industry.
Within this framework, the continual aim of understanding the effects of environmental
factors on human health is at the core of the European Chemical Industry Council (Cefic)
Long-range Research Initiative (LRI), a complex research programme implemented in
cooperation with government bodies, science universities and research institutions. It is
following the latest scientific trends, the political needs and the societal concerns such as
intelligent testing, complex environments and acceptance of technology.
The LRI was developed for three reasons:
industry relevance: identifying the needs and priorities for continually refined
research in view of product improvement or development, such as resource-
efficient production and products;
policy and society relevance: contributing to the present and evolving knowledge
as a basis for the policy debates or developments and public communication,
such as interpretation of data; and
action relevance: providing a robust basis for regulatory and voluntary action to
ensure sustainability of products, such as robust test methods.
An important aspect of Cefic’s interest in the research agenda is its ability to reach out
into reality; it is not only about “risk” research, but also “priority for action” research and,
further, “solution” research.
The aspect of priority for action is important for identifying and assessing action options
as it supports the policy-makers by making the tools feasible and able to be
implemented.
We need cutting-edge scientific work that serves as early warning; however, what we
need even more is the baseline research that enables the interpretation of findings to be
able to effectively improve the health of the European population.
The solution aspect is essential as part of the stakeholders’ responsibility towards a

sustainable future; such examples can be found in Cefic’s present work on technology
development and transfer (within European Union technology platforms) and on
innovative solutions (such as for clean water, clean air and health monitoring).

About the author
Loredana Ghinea’s main area of work is environment and health and how science and
research on the impact of environmental factors on human health can be translated into
European Union policies that ensure a sustainable society in Europe. This general issue
encompasses topics such as the impact of chemicals on susceptible populations, indoor
air quality, health impact assessment, human biomonitoring as well as emerging science
issues such as nanotechnology, climate change and their impact on public health.
Loredana has a background in political science with a particular focus on European
Union regulatory issues.

European Conference on Human Biomonitoring: from

biomarkers to human biomonitoring as a policy support tool
in environmental health
Anne-Catherine Viso (on behalf of the conference committee)

Head, European Affairs, French Institute for Public Health Surveillance, Saint-Maurice,
France
InVS, the French Public Health Surveillance Institute (www.invs.sante.fr), is organizing

the European Conference on Human Biomonitoring with the support of the Ministry of
Health, Youth, Sport and Associations on 4–5 November 2008.
The Conference aims at illustrating the usefulness and added value of human
biomonitoring for policy and for public health actions. The main sessions will focus on:
the value of human biomonitoring compared with environmental and health

surveillance;
the communication of human biomonitoring results to study participants, health
professionals, nongovernmental organizations and the general public;
the contribution of research to implementing human biomonitoring programmes
and to interpreting human biomonitoring information;
the role of human biomonitoring in evaluating policy actions;
the organization of human biomonitoring programmes in various countries,
including the United States and Canada, and at the European level in the context
of setting up a European pilot study to obtain reference values; and
the conditions required to ensure the sustainability of human biomonitoring
programmes in the different countries: research, capacity including laboratories
and biobanks, funding, multidisciplinary expertise, biobanks and coupling
biomonitoring with health examination surveys.
This presentation will allow information to be collected and the views of the participants in
the Conference to be compiled, especially for countries in the WHO European Region
that are not in the European Union and for which collecting more information on their
research programmes and human biomonitoring practices and needs would be useful.
This conference is a follow-up of the actions implemented as part of the European

Environment & Health Action Plan 2004–2010 of the European Commission and in
particular of the ESBIO (expert team to support human biomonitoring in Europe)
coordination action funded by the European Commission (Framework Programme 7,
http://www.eu-humanbiomonitoring.org/sub/esbio.htm). Other projects funded by the
European Commission will contribute to the Conference.
About the author
Anne-Catherine Viso headed the International Affairs and Risk Assessment Methods
Department at the French Agency for Environmental and Occupational Health Safety
(Afsset) from 2003 to 2006. She initiated a European network of organizations in charge
of funding environment and health research in support of policy (10 European Union
countries represented) with the aim of setting up joint research programmes between
more than three countries. At Afsset, she coordinated the working group on improving the
performance and interoperability of the environment and health information systems for

enhanced data linkage initiated by France’s National Environment and Health Action Plan
in 2004–2005. From 1994 to 2003 she worked for the world’s largest environmental
services company (now known as Veolia Environment SA) as European research officer
in support of European regulation and standardization related to water quality for the
Research and Development Division.

Health at work and healthy environment
Jadranka Mustajbegoviü
Andrija Stampar School of Public Health, School of Medicine, University of Zagreb,
Zagreb, Croatia
Working and living environments are widely recognized as sources of health risks. The
purpose and aim of this research is to explore which psychosocial, physical and chemical
factors in the environment in which people live and work are responsible for health
damage and disease outbreak as well as how and to what extent.
The work of various researchers involved in this project is indispensable in reaching this
aim. They will achieve the results and specific goals not only in the laboratories of
Department for Environmental and Occupational Health but also in collaborating,
adequately equipped institutions. The study is multidisciplinary designed and compound
of several research units. Personal and family medical history, data about conditions and
their way of life and work, diet and dietary habits, housing conditions and social and
economic conditions will be collected through questionnaires. The correct assessment of
the influence of work processes on health is a prerequisite for certain disease prevention
activities and the protection of health in the workplace. It is therefore important to
ascertain the presence of danger and the level of health damage in certain economic
activities, occupations and specific work processes.
The specific goals of this research are:
to explore the presence of physical, chemical and biological factors in water, food
and air in the living and working environment;
to identify the main points of the mutual influence between environment and
people in real conditions;
to identify the sources of pollution with special attention to waste as a potential
contaminant and to analyse the points of origin and passages of waste, especially
medical waste;
to determine the risk in certain economic activities, occupations and specific work
processes;
to estimate the effects of long-term exposure of humans to low levels of pollution
and low levels of radiation;
to explore the quality of psychosocial factors, especially of interpersonal
relationship on the workplace, work methods and organization;
to explore how and to what extent genotype and environment are responsible for
outbreak of diseases and how to orient health care; and
to estimate the risk of the exposed population in conditions of professional and
non-professional exposure.
Scientific findings should support existing laws or serve as a basis for modifying them.
Research will provide data on the content and concentration of examined factors. The
work on this project will create a better-connected group of researchers from specific
multidisciplinary fields, thus enabling better environment and health management as well
as better organization and application of health care, execution of public health projects
and more precise legal decrees.

About the author
Jadranka Mustajbegoviü started her education at the University of Zagreb, School of

Medicine (1970–1975) followed by postgraduate study in occupational health at the
University of Zagreb School of Medicine (1980–1982) with a specialist Diploma in
Occupational Health. She followed several international training courses (Medical School,
University of Utrecht, 1992 and School of Public Health, SUNY Albany, 1994). She is
Professor and Chair of Environmental and Occupational Health at the Andrija Stampar
School of Public Health, Medical School, University of Zagreb. She is working on projects
in the areas of: water, food and the living environment – determinants of health; health at
work and healthy environment; health at work: health care workers, reproduction and
environment; students’ nutrition; and effects of organic aerosols on respiratory function.

An environmental and occupational health research

programme to respond to policy-makers’ needs:
the experience of the French Agency for Environmental and
Occupational Health Safety
Jean Lesne
Head, Research and Scientific Surveillance Unit, French Agency for Environmental and
Occupational Health Safety, Paris, France
The French Agency for Environmental and Occupational Health Safety is a public body
reporting to France’s Ministries of Employment and Solidarity; Health, Youth and Sport;
and Ecology, Energy, Sustainable Development and Territorial Development. The
Agency’s main mission is to provide scientific advice based on expert assessment of the
human health risks related to environmental or occupational exposure. By definition, its
activity is based on an interaction between scientists and decision-makers. It has a key
position in reducing the gap between research and policy on environmental and
occupational health risks. To fulfil its mission of providing independent and transparent
scientific advice, the Agency strongly relies on the involvement of researchers who are
expected to provide an intelligent and broad contribution despite a lack of incentives for
the academic community to engage with the policy-making process. In addition, the
Agency hosts a mechanism for funding research, a scientific surveillance unit for
providing access to and synthesizing existing knowledge and a specific unit interested in
public scientific debate. This operational structure brings together, in the same body, a
good understanding of the policy-making process, of targeted science needs and of what
is at stake in many public controversies, in particular the public’s assumptions, values
and concerns.
The Agency started reflecting about mechanisms for defining research programmes that
are oriented towards policy support to ensure more policy-relevant research results. Most
calls for research proposals even on specific themes result in a mixed bag of projects
that do not necessarily amount to anything very useful in policy terms. At the programme
definition stage, several difficulties must be addressed: policy-makers can have difficulty
in formulating questions for science that will be useful to making choices between policy
options, and effective stakeholder involvement is not easy on sensitive issues.
The Agency considers that managing research programmes is part of its role in
facilitating the transfer of research findings into policy-relevant scientific advice.
Consequently, it emphasizes the need for measuring and evaluating the impact of the
research programme in terms of input from science into policy-making. This is an
important yet difficult issue that transcends the narrow focus of quality assurance
systems. This evaluation needs to be extended to the full science-into-policy process to
include formulating research questions, mapping the research community involved and
ensuring the actual policy uptake of research material.

About the author
Jean Lesne is Head of the Research and Scientific Surveillance Unit at the French
Agency for Environmental and Occupational Health Safety. As a microbiologist, he was
Professor at the French National School of Public Health and Deputy Director of the
Laboratory of Research in Environmental Health for 18 years.

Environmental health research in Europe: bibliometric

analysis
Stanislaw Tarkowski
Professor, School of Public Health, Nofer Institute of Occupational Medicine, Lodz,
Poland
Environmental health research in Europe was analysed bibliometrically as part of the

public health literature review element of the SPHERE (Strengthening Public Health
Research in Europe) project funded by the European Union Sixth Framework
Programme. The aim was to provide an overview of the extent of published
environmental health research in Europe and to assess recent output in this field and
main research directions. The results also aimed to contribute to the overall objective of
SPHERE to provide advice on the future development of public health research both to
the European Union and to individual European countries.
The Medline database was accessed using PubMed of the United States National Library
of Medicine. Only original, peer-reviewed research journal articles published between
July 1995 and June 2005 by authors from 28 countries in the European Economic Area
at the time plus Switzerland were retrieved.
The study located 6329 references in the PubMed database and matched them with 11
predefined relevant topics and 31 subtopics. The largest number of articles was in
working environment and health (2339) followed by environmental exposure (1314) and
environmental illnesses (952); these were the primary focus of 73% of the articles. The
number of articles varied considerably between countries. Ten countries accounted for
81% of all articles.
Several disciplines contribute to environmental health impact assessment, including

various branches of the biomedical and environmental sciences. Major advances have
been made in all of these areas during recent years and have contributed to the progress
in understanding the association between health and the environment. The European
Economic Area is an important contributor to this field, accounting for 22% of the global
input.
Various networks and databases disseminate scientific data and knowledge. Clearly,
many research teams have been involved in environmental health research, the results
of which have been published in 711 scientific journals. More collaborative research is
needed to link these fields of data and knowledge more effectively and to use them better
in planning future environmental health research.
This overview suggests that investigations of complex public health–related problems

such as exposure to different pollutants at different levels of pollution, duration and
frequency and their combined influence on health in different populations should be more
strongly emphasized. Public health policy increasingly needs to be based on concepts of
multiple causality and complexity.
About the author
Stanislaw Tarkowski headed the Department of Environmental Health Hazards at the

Nofer Institute until 2004. He was a Director of the Environment and Health Division of
the WHO Regional Office for Europe from 1988 to 1995. His scientific interest is in
environmental health and public health. He has been conducting scientific research on
environmental and occupational exposures and health risk assessment. He is President
of the Polish Association of Public Health and a member of the Executive Council of the

European Public Health Association and of the Committee of Public Health and
Epidemiology of the Polish Academy of Sciences.

SESSION IV:
BRIDGING THE GAP BETWEEN SCIENCE AND POLICY MAKING
Session IV page 71
The gap between science and policy-making: the seven

deadly sins of science
Philippe Grandjean
University of Southern Denmark, Odense, Denmark and Harvard School of Public Health,
Cambridge, MA, USA
A common concern is that science is not sufficiently conducive to furthering public health
priorities, thus widening the gap between science and policy-making. Complaints about
ivory-tower scientists suggest that they are indifferent to the welfare of others and rather
have an inordinate appetite for credentials and publications that replicate ad nauseam
their favourite study designs while ignoring serious societal issues. For example, most
articles in environmental health journals focus on a limited, rather stable list of pollutants.
Another problem is that the science frequently does not appear as impartially as it
should. The Vatican earlier this year deemed pollution a sin, so would it not be fair to ask
whether science can be sinful? I have compiled a list (below) of vices in environmental
health science as suggested by the traditional seven deadly sins. Virtues are essential to
counter these sins. Such virtues have been inspired by the precautionary principle. They
might be helpful in bridging the gap between science and decision-making.
Vice Precautionary virtue
Pride Preoccupation with methods Humility Exploration of uncertainty
Envy Failure to recognize Fairness What could be known,

achievements by others given the evidence?
Wrath Self-righteous intimidation of Empathy Weighing in all relevant

competitors evidence
Lust Desire for academic honours Restraint Balanced choice of

research methods and
topics
Gluttony Excessive craving for Innovation Limiting attempts of

publications replication
Greed Benefit from vested interests Transparency Involvement of all

stakeholders
Sloth Callousness to injustice Compassion Public health responsibility
Source: Grandjean P. Seven deadly sins of environmental epidemiology and the virtues of precaution.
Epidemiology, 2008, 19:158–162.
In bridging the gap, science must address the changing needs for documentation and
insight. The precautionary principle suggests that resources should not be spent chasing
a formal proof but that uncertainty should be explored and its implications characterized.
We must ask ourselves what could be known given the (limited) research insights and
opportunities. We should not forget that the absence of evidence does not represent
evidence of the absence of a hazard. Science planning and reporting is a social activity
and part of a dynamic interface with policy-making and intervention. It therefore must
include open discussion of perspectives and uncertainty with stakeholders.
page 72 Session IV
About the author
Philippe Grandjean is Professor and Chair of Environmental Medicine at the University of

Southern Denmark, Odense, Denmark. He is also Adjunct Professor of Environmental
Health at Harvard School of Public Health and serves as the Consultant in Toxicology for
the National Board of Health, Denmark. He is editor-in-chief of the web-based journal
Environmental Health and is a member of several other editorial boards of scientific
journals. He has served on or chaired committees under the auspices of WHO, the
International Agency for Research on Cancer, the European Commission, the
International Union of Pure and Applied Chemistry, the Collegium Ramazzini and the
United States Environmental Protection Agency, and he is a member of the Panel on
Food Contaminants of the European Food Safety Authority. Among the 400 scientific
publications, of particular relevance is the research on the adverse effects of
environmental contaminants, such as mercury, on child development. He has also
initiated discussions of the implications for science due to the adoption of the
precautionary principle.
Session IV page 73
Climate change: bridging the gap between science and

policy-making
Jean-Pascal van Ypersele

Vice-Chair, Intergovernmental Panel on Climate Change and Professor of Climatology
and Environmental Sciences, Katholieke Universiteit Leuven, Belgium
Climate change is happening now, mostly as a result of greenhouse gases from human
activities. The effects will be important, with most damage in low- and medium-income
countries, but high-income countries will be affected too.
Human health effects are emerging and could be much more severe in a warmer climate.
Adverse health effects will be greatest in low-income countries. Those at greater risk in
all countries include urban poor people, older people and children, traditional societies,
subsistence farmers and coastal populations.
The Intergovernmental Panel on Climate Change attempts to provide the best policy-
relevant information on climate-related issues, including health aspects. Gaps in
information persist on trends in climate, health and environment in low-income countries,
where data are limited and other health priorities take precedence for research and policy
development.
Climate change–related health impact assessment in low- and middle-income countries

will be instrumental in guiding adaptation projects and investments.
Some comments on how to bridge the gap between science and policy in this context will
be made.
About the author
Jean-Pascal van Ypersele is Professor of Climatology and Environmental Sciences and

directs the Master Programme in Science and Management of the Environment at
Katholieke Universiteit Leuven. He has specialized in modelling climate and the climate
effects of human activities and has recently worked on the effects of climate change. He
forecast the death toll of the 2003 heat wave in Belgium. His 2004 report with Philippe
Marbaix on the effects of climate change for Belgium, prepared at the request of
Greenpeace, drew a lot of attention. He has participated in Intergovernmental Panel on
Climate Change (which shared the 2007 Nobel Peace Prize with Al Gore) activities since
1995 and was elected Vice-Chair in September 2008. He participates regularly as a
scientific adviser in United Nations conferences on climate issues. He chairs the Energy
& Climate Working Group of the Belgian Federal Council for Sustainable Development.
He speaks frequently to a variety of audiences and is regularly interviewed by the mass
media on climate issues. In 2006, he received the International Polar Foundation special
prize and has been awarded the Francqui Chair in 2008 by the Université Libre de
Bruxelles.
page 74 Session IV
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© World Health Organization 2009

Conclusions and recommendations 4

Approaches to research for policy-making

Achievements and needs

Latest research and trends in the science–policy interface

Welcome and opening session

Session I. Achievements and needs of research in environment and health

Session III. Parallel sessions

A. Emerging issues in environment and health

C. Tools for assessing health risks as a means for policy-making

D. Bridging the gap between science and policy-making

Session IV. Bridging the gap between science and policy-making

Round-table: policy-makers’ needs and research findings

Closure of the Symposium

Professor Giorgio Assennato

Professor Herman Autrup

Ms Carla Baer Manolopoulou

Ms Hildegunn Blindheim Jablonska

Ms Elena Isabel Boldo Pascua

Mr Koldo Cambra Contin

Dr Mario Cardaba Arranz

Ms Diana Mariana Cocarta

Professor Elena Dominguez

Mrs Ingrid Elbertse

Professor Emilio Gelpi

Ms Berit Ellefsen Gjerstad

Professor Dragan Gjorgjev

Professor Thomas Hartmann

Dr Jon Hilmar Iversen

Mrs Helen Lampropoulou

Professor George Morris

Professor Benoit Nemery

Dr Marguerite Jane Newbold

Professor Mark J Nieuwenhuijsen

Professor Nikoloz Pruidze

Ms Elizabeth Salter Green

Professor Arne Svejgaard

Professor António Tavares

Professor Benedetto Terracini

Mr Theo van Alphen

Ms Erna van Balen

Mrs Chantal Van den Bossche

Mr Peter van den Hazel

Ms Lisette van Vliet

Mrs Eugenia Verlan

Professor Eurgenio Vilanova Gisbert

Professor Simon Avaliani

Professor Mikhail Balonov

Professor James Bridges

Professor David Briggs

Professor Philippe Grandjean

Professor Andrew Haines

Professor Vyvyan Howard

Professor Andreas Kortenkamp

Professor Jadranka Mustajbegovic

Dr Eduardo Oliveira Fernandes

Professor Wim Passchier

Dr Manuel Posada de la Paz

Professor Boris Revich

Professor Stanislaw Tarkowski

Professor Jouko Tuomisto

Professor Jean-Pascal van Ypersele