SoED-Oct2010

Handbook of WMA Policies
World Medical Association ½ S-2010-01-2010

WMA STATEMENT
ON
ENVIRONMENTAL DEGRADATION
AND SOUND MANAGEMENT OF CHEMICALS
Adopted by the 61st
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 empha-
sizes the harmful chemical contribution to environmental degradation and physicians’ role
in promoting sound management of chemicals as part of sustainable development, es-
pecially 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 sub-
stances (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 distri-
bution 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 pro-
tect 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 recom-
mendations for further action.
BACKGROUND
Chemicals of Concern
During the last half-century, the use of chemical pesticides and fertilizers dominated agri-
cultural practice and manufacturing industries rapidly expanded their use of synthetic che-
micals in the production of consumer and industrial goods1
. The greatest concern relates to
chemicals, which persist in the environment, have low rates of degradation, bioaccumu-
late 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 cad-mium
have industrial sources and are also of concern. Advances in environmental health research
including environmental and human sampling and measuring techniques, and better
information about the potential of low dose human health effects have helped to
underscore emerging concerns.
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Environmental Degradation

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 re-
gulated 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 environment3
. 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 Pollutants4 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 con-
tamination 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 Stra-
tegic 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
stages of the chemical life cycle of manufacture, use and disposal, and includes chemicals
in products and in wastes7
.
WORLD MEDICAL ASSOCIATION (WMA) RECOMMENDATIONS
Handbook of WMA Policies
World Medical Association ½ S-2010-01-2010

Despite these national and international initiatives, chemical contamination of the environ-
ment 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 ma-
terials, 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 pu-
blic 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 manage-
ment and in reducing risks to human health.
The World Medical Association Recommends That:
ADVOCACY
• National Medical Associations (NMAs) advocate for legislation that reduces che-
mical pollution, reduces human exposure to chemicals, detects and monitors harm-
ful 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 un-
manageable (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/depart-
ments 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 pro-
ducts.
• 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-govern-
mental organizations (NGOs) and concerned citizens locally.
• Physicians and their medical associations advocate for the development of effec-
tive and safe systems to collect and dispose of pharmaceuticals that are not con-
sumed.
• Physicians and their medical associations should support efforts to rehabilitate or
clean areas of environmental degradation based on a “polluter pays” and pre-
cautionary principles and ensure that moving forward, such principles are built into
legislation.
• The WMA, NMAs and physicians should urge governments to collaborate within
and between departments to ensure coherent regulations are developed.
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LEADERSHIP
The WMA:
• Supports the goals of the Strategic Approach to International Chemicals Manage-
ment (SAICM), which promotes best practices in the handling of chemicals by
utilizing safer substitution, waste reduction, sustainable non-toxic building, recy-
cling, 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 accu-
rate information regarding the management of these emergencies.
• Urges local, national and international organizations to focus on sustainable pro-
duction, 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 moni-
toring of chemicals on human health and the environment.
The WMA recommends that Physicians;
• Work to reduce toxic medical waste and exposures within their professional set-
tings 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 degra-
dation; community and household impacts of industrial chemicals; the most vul-
nerable 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 pol-
lutants on personal health.
Handbook of WMA Policies
World Medical Association ½ S-2010-01-2010

• National Medical Associations (NMAs) and physician professional associations
develop tools for physicians to help assess their patients’ risk from chemical ex-
posures.
• Physicians and their professional associations develop locally appropriate conti-
nuing medical education on the clinical signs, diagnosis and treatment of diseases
that are introduced into communities as a result of chemical pollution and exacer-
bated 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.

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
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
5
Wiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005
6
http://chm.pops.int/Convention/tabid/54/language/en-US/Default.aspx
7
http://www.chem.unep.ch/saicm/SAICM%20texts/SAICM%20documents.htm