WHO:Implementing the CEHAP for Europe:the role of intersectoral collaboration

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This text is taken from the WHO report "Health and Environment in Europe: Progress Assessment", 2010, ISBN 978 92 890 4198 0. [2]

As part of the follow-up to the Budapest Conference commitments, many Member States prepared national children’s environment and health action plans. To assess the status of and challenges in the integrated policy action on children’s health and environment, the Regional Office conducted a survey in the Member States in the autumn of 2009. A total of 42 Member States(Respondent countries by EurG grouping: EurG-A: Andorra, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Nether- lands, Norway, Portugal, Spain, Switzerland and the United Kingdom; EurG-B: Bulgaria, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia; EurG-C: Albania, Bosnia and Herzegovina, Croatia, Israel, Serbia, The former Yugoslav Republic of Macedonia and Turkey;EurG-D: Armenia, Azerbaijan, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) responded to the CEHAPE(Children’s Environment and Health Action Plan for Europe: survey (Annex 1); four further countries responded after the deadline (marked on the map in Fig. 66 but not included in the analysis).[1]

National CEHAP programmes across the WHO European Region[1]

National CEHAP programmes

Overall, 38 out of 42 Member States have either developed (n=28) or are currently developing (n=10) national children’s environment and health action plans. However, while EurG-A, B and C countries mostly have their national CEHAPs ready, many countries in EurG-D are still developing them.

Across the Region, national CEHAPs are predominantly (74%) a part of existing national environment and health action plans (NEHAP) or other national policies and action plans, rather than stand-alone action plans. The vast majority of existing and developing CEHAPs are national in scope while also including strong sub-national components.

Only half of the participating countries are involving young people in developing their national CEHAP programmes for action to safeguard children’s health and environment. Young people have been involved in the development of CEHAPs in at least half of the EurG-C and EurG-D countries, but much less frequently in EurG-A and EurG-B countries.[1]

The level of implementation of existing CEHAPs varies across the Region, with about 70% of respondents reporting medium or high levels. EurG-A and EurG-B countries reported mainly medium to high implementation rates, while countries in EurG-C and EurG-D assessed implementation as either medium or low.

Since the adoption of the CEHAPE in 2004, Member States have reported a wealth of national developments in the field of environment and health as a contribution to achieving the four regional priority goals. Most countries (60%) addressed all four goals, while some focused their efforts on a few national priorities. Policy measures range from legislation (including, for example, harmonization with EU legislation), action plans and strategies to research initiatives, awareness-raising campaigns, monitoring of exposure, health surveillance, health promotion programmes, etc.[1]

Impact of CEHAPE

According to an assessment made by the environment and health focal points in Europe, the CEHAPE as a European policy platform has had a broad range of impacts at national and sub-national levels across the Region. It has stimulated coordinated action on children’s health that cuts across departmental and sectoral boundaries and involves different levels of government in countries.

Policy action areas positively influenced by the CEHAPE, by country grouping[1]

CEHAPE has positively influenced interventions to decrease environmental risks to children’s health (90%), development of EH information and monitoring systems (95%), public information and awareness (95%), national policy-making (80%) and intersectoral collaboration (90%). Improvements in intersectoral collaboration have mainly occurred between the health and environment sectors, followed by transport and education. Interestingly, CEHAPE seems to have strongly influenced countries in the EU and western Europe to develop national CEHAPs. CEHAPE has also prompted action on the regional and local scale in 60% of countries.

Across the Region, the policy areas least influenced by CEHAPE were

  1. collaboration with other countries sharing similar problems and
  2. the mobilization of human and/or financial resources: one quarter of the responding countries failed to mobilize such resources for EH issues.[1]

Challenges in implementing CEHAPE

While the challenges in implementing the CEHAPE nationally vary from country to country, they are found in all the groups of countries and include the following.

  • Insufficient human and/or financial resources are the most commonly reported challenge (70%) which, together with insufficient capacity to implement the plans, underlines that the continued commitment of all partners is urgently required for successful CEHAPE implementation in the countries.
  • Low relative importance compared to other policy processes makes it difficult to focus on implementation in half of the countries (although this is not the case in EurG-D countries).
  • Despite the positive influence of CEHAPE in bringing together diverse sectors and stakeholders, inadequate intersectoral collaboration continues to be a challenge to EH action in as many as half of the countries in the Region.
  • Low awareness about the CEHAPE process is reported by a quarter of the countries.
  • Unsustainable action within the time-frame of specific activities prevents long-term improvements in environment and health in 20% of countries.
  • Insufficient political support in 20% of countries is an obstacle for putting in place integrated action.[1]
Main challenges in taking action under the CEHAPE, by country grouping[1]

There is a steep east-west gradient, with the lowest capacity available for implementation in the newly independent states. Furthermore, insufficient intersectoral collaboration also hinders CEHAPE implementation across the Region, although this is much less of a problem in EurG-A than in the other groupings.

WHO support to CEHAPE implementation

As a consequence of the above-mentioned gradient across countries in their capacity to deal with EH issues, requests for WHO support for activities in this field were particularly frequent from EurG-B, EurG-C and EurG-D countries. This was, however, mainly in regard to the planning of action.[1]

Addressing cross-cutting issues

In anticipation of the Fifth Ministerial Conference on Environment and Health in 2010, many countries have already begun addressing cross-cutting issues in their national policy-making processes on environment and health. These include collaboration with other stakeholders, socioeconomic inequalities, public information and advocacy, involvement of sectors other than environment and health, gender issues and involvement of local authorities (for example, through the decentralization of action, allocation of funds and enabling of local decision-making). There is a general trend across the Region towards involving sectors other than environment and health, such as local authorities, and collaboration with new stakeholders such as nongovernmental organizations. Gender issues remain, however, rather low on the policy agenda (only one third of the countries considered them) and not enough attention is paid to socioeconomic inequities, particularly in the newly independent states. Public information and advocacy issues were mostly considered in the western part of the Region and the EU12 countries.

Cross-cutting issues of relevance to children’s environment and health already being addressed in national policy processes, by country grouping [1]

Member States made the following main recommendations for strengthening CEHAPE and its impact in the countries:

  • the regional priority goals should be revised to reflect emerging and cross-cutting issues as well as sub-national priorities;
  • tools should be prepared for evidence-based action as part of CEHAPE;
  • exchange of experience should be fostered on initiatives to improve children’s environment and health;
  • integration of CEHAPE in other international processes should be improved; and the stronger leadership and technical support should be provided by WHO (especially in EurG‐B, C and D).

As already noted, implementing CEHAPE involves a wide range of economic and governmental sectors, so that intersectoral collaboration is of paramount importance. The following section provides insight into existing country structures and mechanisms for intersectoral collaboration, based on the WHO EH policy survey.[1]

Intersectoral collaboration on health

All Member States reported the involvement of different economic and governmental sectors in health-related policy programmes. The majority of integrated country policy programmes connect environmental topics to relevant health issues such as the NEHAP, CEHAP and environmental action plans, thus bringing together the environment and health sectors. Agriculture, education and transport are other sectors commonly involved in health-related integrated policy programmes. EurG-C countries reported a high rate of programmes involving the labour sector, and EurG-D countries reported the highest rate of involvement of the industrial sector.

Sectors involved in health-related intersectoral programmes in the countries[1]

Almost all countries have organizational arrangements in place to facilitate the working relationships between government bodies and stakeholders. Structures for intersectoral collaboration can be involved in institutional infrastructures to a greater or lower extent and be based on more or less formal arrangements. The following options were considered:

  1. advisory groups with a clear (presumably greater) mandate involving dedicated departments from relevant administrations;
  2. structures involving the departments and working on an informal basis;
  3. working groups with a clear, although limited, mandate involving representatives of different sectors; and
  4. structures involving representatives of various sectors working on an informal basis.

For the health sector, the existence of a dedicated unit in the ministry of health dealing with health integration in other sectors and policies was also considered.

While structures were used in various ways across the Region, the most common were multisectoral working groups with a clear mandate (60%). Interdepartmental advisory groups were the least common collaborative structure (25%). More than half of the countries reported the existence of a dedicated unit in the ministry of health.[1]

Structures for intersectoral collaboration on environment and health, by country grouping[1]

The range of collaborative structures in the EurG-A grouping could be explained by the less centralized national political systems under the EU supranational framework. Furthermore, with the adoption of the polluter pays principle in many European countries, the responsibility for control of pollution levels has shifted away from the health sector to the relevant jurisdictions (for example, transport in the case of air pollution).

Both intersectoral collaborative structures with clear mandates (such as multisectoral working groups) and informal structures are rare in EurG-D countries. Interdepartmental collaboration is common, although it is mainly without a clearly formulated mandate. Meetings were the main mechanisms for collaboration on environment and health. Both formal and informal meetings were reported, with formal ones being most common (70%). Only two countries (Denmark and Slovakia) claimed to allocate funds in support of collaborative structures. While all countries show commitment to intersectoral collaboration, sustainable and effective cooperation on environment and health cannot be achieved without adequate financial support.[1]

Mechanisms of intersectoral collaborative structures by country grouping[1]

See also


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 WHO Health and Environment in Europe: Progress Assessment, 2010, ISBN 978 92 890 4198 0[1]