Environmental_Degradation-Oct2010

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THE WORLD MEDICAL ASSOCIATION, INC.
WMA STATEMENT
ON
ENVIRONMENTAL DEGRADATION AND SOUND
MANAGEMENT OF CHEMICALS
Adopted by the WMA General Assembly, Vancouver, Canada, October 2010
PREAMBLE
This Statement focuses on one important aspect of environmental degradation, which is
environmental contamination by harmful domestic and industrial substances. It emphasizes the
harmful chemical contribution to environmental degradation and physicians’ role in promoting
sound management of chemicals as part of sustainable development, especially in the healthcare
environment.
Most chemicals to which humans are exposed come from industrial sources and include, food
additives, household consumer and cosmetic products, agrochemicals, and other substances (drugs;
dietary supplements) used for therapeutic purposes. Recently, attention has been concentrated on the
effects of human engineered (or synthetic) chemicals on the environment, including specific
industrial or agrochemicals and on new patterns of distribution of natural substances due to human
activity. As the number of such compounds has multiplied, governments and international
organizations have begun to develop a more comprehensive approach to their safe regulation.
While governments have the primary responsibility for establishing a framework to protect the
public’s health from chemical hazards, the World Medical Association, on behalf of its members,
emphasizes the need to highlight the human health risks and make recommendations for further
action.
BACKGROUND
Chemicals of Concern
During the last half-century, the use of chemical pesticides and fertilizers dominated agricultural
practice and manufacturing industries rapidly expanded their use of synthetic chemicals in the
production of consumer and industrial goods. 1
The greatest concern relates to chemicals, which persist in the environment, have low rates of
degradation, bio-accumulate in human and animal tissue (concentrating as they move up the food
chain), and which have significant harmful impacts on human health and the environment
(particularly at low concentrations). 2
Some naturally occurring metals including lead, mercury, and
cadmium have industrial sources and are also of concern. Advances in environmental health
research including environmental and human sampling and measuring techniques, and better
1
Wiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005
2
http://www.unep.org/hazardoussubstances/Introduction/tabid/258/language/en-US/Default.aspx
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information about the potential of low dose human health effects have helped to underscore
emerging concerns.
Health effects from chemical emissions can be direct (occurring as an immediate effect of the
emission) or indirect. Indirect health effects are caused by the emissions’ effects on water, air and
food quality as well as the alterations in regional and global systems, such as red tide in many
oceans, and the ozone layer and the climate, to which the emissions may contribute.
National and International Actions
The model of regulation of chemicals varies widely both within and between countries, from
voluntary controls to statutory legislation. It is important that all countries move to a coherent,
standardized national legislated approach to regulatory control. Furthermore, international
regulations must be coherent such that developing countries will not be forced by economic
circumstances to circumvent potentially weak national regulations. An example of a legislative
framework can be found at http://ec.europa.eu/environment/chemicals/index.htm.
Synthetic chemicals include all substances that are produced by, or result from, human activities
including industrial and household chemicals, fertilizers, pesticides, chemicals contained in
products and in wastes, prescription and over-the-counter drug products and dietary supplements,
and unintentionally produced byproducts of industrial processes or incineration, like dioxins.
Furthermore, nanomaterials, in some circumstances, can be regulated by synthetic chemicals
regulations but in other cases, may need explicit regulation.
Notable International Agreements on Chemicals
Several notable agreements on chemicals exist. These were prompted by the first United Nations
Conference on the Human Environment declaration in 1972 (Stockholm) on the discharge of toxic
substances into the environment.3
These agreements include the 1989 Basel Convention to
control/prevent trans-boundary movements of hazardous wastes, the 1992 Rio Declaration on
Environment and Development, the 1998 Rotterdam Convention on informed consent and shipment
of hazardous substances, and the 2001 Stockholm Convention on Persistent Organic Pollutants.4 5 6
It should be noted that little information is available on the efficacy of the controls.
Strategic Approach to International Chemicals Management
Worldwide hazardous environmental contamination persists despite these agreements, making a
more comprehensive approach to chemicals essential. Reasons for ongoing contamination include
persistence of companies, absolute lack of controls in some countries, lack of awareness of the
potential hazards, inability to apply the precautionary principle, non-adherence to the various
conventions and treaties and lack of political will. The Strategic Approach to International
Chemicals Management (SAICM) was adopted in Dubai, on February 6, 2006 by delegates from
over 100 governments and representatives of civil society. This is a voluntary global plan of action
designed to assure the sound management of chemicals throughout their life cycle so that, by 2020,
chemicals are used and produced in ways that minimize significant adverse effects on human health
and the environment. The SAICM addresses both agricultural and industrial chemicals, covers all
3
http://www.unep.org/Documents.Multilingual/Default.asp?DocumentID=97&ArticleID=1503&l=en
4
http://www.unep.org/Documents.Multilingual/Default.asp?DocumentID=78&ArticleID=1163
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Wiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005
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http://chm.pops.int/Convention/tabid/54/language/en-US/Default.aspx
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stages of the chemical life cycle of manufacture, use and disposal, and includes chemicals in
products and in wastes.7
WORLD MEDICAL ASSOCIATION (WMA) RECOMMENDATIONS
Despite these national and international initiatives, chemical contamination of the environment due
to inadequately controlled chemical production and usage continues to exert harmful effects on
global public health. Evidence linking some chemicals to some health issues is strong, but there is
not evidence for all chemicals, especially newer or nano materials, particularly at low doses over
long periods of time. Physicians and the healthcare sector are frequently required to make decisions
concerning individual patient and the public as a whole based on existing data. Physicians therefore
caution that they, too, have a significant role to play in closing the gap between policy formation
and chemicals management and in reducing risks to human health.
The World Medical Association recommends that:
ADVOCACY
• National Medical Associations (NMAs) advocate for legislation that reduces chemical
pollution, reduces human exposure to chemicals, detects and monitors harmful chemicals in
both humans and the environment, and mitigates the health effects of toxic exposures with
special attention to vulnerability during pregnancy and early childhood.
• NMAs urge their governments to support international efforts to restrict chemical pollution
through safe management, or phase out and safer substitution when unmanageable (e.g.
asbestos), with particular attention to developed countries aiding developing countries to
achieve a safe environment and good health for all.
• NMAs facilitate better communication between government ministries/departments responsible
for the environment and public health.
• Physicians and their medical associations advocate for environmental protection, disclosure of
product constituents, sustainable development, and green chemistry within their communities,
countries and regions.
• Physicians and their medical associations should support the phase out of mercury and
persistent bioaccumulative and toxic chemicals in health care devices and products.
• Physicians and their medical associations should support legislation to require an
environmental and health impact assessment prior to the introduction of a new chemical or a
new industrial facility.
• Physicians should encourage the publication of evidence of the effects of different chemicals
and dosages on human health and the environment. These publications should be accessible
internationally and readily available to media, non-governmental organizations (NGOs) and
concerned citizens locally.
• Physicians and their medical associations advocate for the development of effective and safe
systems to collect and dispose of pharmaceuticals that are not consumed.
• Physicians and their medical associations should support efforts to rehabilitate or clean areas of
environmental degradation based on a “polluter pays” and precautionary principles and ensure
that moving forward, such principles are built into legislation.
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http://www.chem.unep.ch/saicm/SAICM%20texts/SAICM%20documents.htm
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• The WMA, NMAs and physicians should urge governments to collaborate within and between
departments to ensure coherent regulations are developed.
LEADERSHIP
The WMA:
• Supports the goals of the Strategic Approach to International Chemicals Management
(SAICM), which promotes best practices in the handling of chemicals by utilizing safer
substitution, waste reduction, sustainable non-toxic building, recycling, as well as safe and
sustainable waste handling in the health care sector.
• Cautions that these chemical practices must be coordinated with efforts to reduce green house
gas emissions from health care to mitigate its contribution to global warming.
• Urges physicians, medical associations and countries to work collaboratively to develop
systems for event alerts to ensure that health care systems and physicians are aware of high-risk
industrial accidents as they occur, and receive timely accurate information regarding the
management of these emergencies.
• Urges local, national and international organizations to focus on sustainable production, safer
substitution, green safe jobs, and consultation with the health care community to ensure that
damaging health impacts of development are anticipated and minimized.
• Emphasizes the importance of the safe disposal of pharmaceuticals as one aspect of health
care’s responsibility and the need for collaborative work in developing best practice models to
reduce this part of the chemical waste problem.
• Encourages environmental classification of pharmaceuticals in order to stimulate prescription
of environmentally less harmful pharmaceuticals.
• Encourages ongoing outcomes research on the impact of regulations and monitoring of
chemicals on human health and the environment.
The WMA recommends that Physicians;
• Work to reduce toxic medical waste and exposures within their professional settings as part of
the World Health Professional Alliance’s campaign for Positive Practice Environments.
• Work to provide information on the health impacts associated with exposure to toxic chemicals,
how to reduce patient exposure to specific agents and encourage behaviors that improve overall
health.
• Inform patients about the importance of safe disposal of pharmaceuticals that are not
consumed.
• Work with others to help address the gaps in research regarding the environment and health
(i.e., patterns and burden of disease attributed to environmental degradation; community and
household impacts of industrial chemicals; the most vulnerable populations and protections for
such populations).
PROFESSIONAL EDUCATION & CAPACITY BUILDING
The WMA recommends that:
• Physicians and their professional associations assist in building professional and public
awareness of the importance of the environment and global chemical pollutants on personal
health.
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• National Medical Associations (NMAs) and physician professional associations develop tools
for physicians to help assess their patients’ risk from chemical exposures.
• Physicians and their professional associations develop locally appropriate continuing medical
education on the clinical signs, diagnosis and treatment of diseases that are introduced into
communities as a result of chemical pollution and exacerbated by climate change.
• Environmental health and occupational medicine should become a core theme in medical
education. Medical schools should encourage in the training of sufficient specialists in
environmental health and occupational medicine.
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