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and mortality from infectious diseases. However, these interventions can, due to over- or misuse, become unbalanced and the direction reversed, resulting in, for example, multi-resistant pathogens and auto-immune diseases. Anti-microbial resistance is a natural phenomenon, but the occurrence increases with inappropriate use of anti- microbial drugs; for example, in animal husbandry and by poor infection prevention and over-prescription, as well as waste from the pharmaceutical industry. The consequences are detrimental, as without efficient treatment options, common infections can become lethal and the success of organ transplantation, cancer chemotherapy and major surgery are compromised. Coordinated policies and regulations are required across the region, such as investing more in health promotion and disease prevention and including the avoidance of the overuse of antibiotics, rather than interventional health care. Such coordinated actions should include an environmental perspective, both in terms of preventing hazards and by creating healthy living environments for all.


The rise of life-style related and NCDs, including mental disorders, puts further stress on health systems and economic, social and natural resources (Horton 2013) (More...5). Four out of five Europeans die from NCDs and the region is, so far, the most affected globally (WHO 2015a). Many of these deaths could be avoided by integrated, multi-stakeholder public health actions, preventing exposure to harmful agents and promoting healthy environments and lifestyles (WHO 2015a; Hanson et al. 2011). This was acknowledged by health ministers participating at the European Environment and Health Process, and included in the Parma Declaration (WHO 2010a) and in Health 2020 (WHO 2015a).


Greater efforts are needed to reduce the high burden of environmentally-related disease and to address the unequal distribution between countries, as well as the disproportionate effects on poor and vulnerable groups. New approaches,


such as One Health5


, may be useful for encompassing the


interdependencies between human, animal, and plant health and well-being (More...6).


1.2.3 Climate change - a threat that should be addressed to protect health


The threat to human health from climate change is so great that it could undermine the last 50 years of gains in development and global health, according to the 2015 Lancet Commission on Health and Climate Change (Watts et al. 2015). The consequences for the pan-European region’s environment, health and economy are significant and only remotely foreseeable (McMichael 2013), with the highest load on poor and vulnerable populations, and with accumulating negative impacts on coming generations (IPCC 2014).


Health impacts caused and exacerbated by climate change


Pan-European health is already affected by climate change (D’Ippoliti et al. 2010; Garcia-Herrera et al. 2010; Dear et al. 2005). Impacts of climate change affect health through floods, heat waves, droughts, reduced agricultural productivity, exacerbated air pollution and allergies and vector, food and water-borne diseases. In addition, less direct processes will affect health in currently unpredictable ways (Figure 1.2.2). These impacts include climatic influences on mosquito populations, bacterial proliferation rates and changes in freshwater flows and quality (Bourque and Cunsolo Willox 2014; McMichael 2013; McMichael et al. 2006; Smith et al. 2014).


5 ‘One Health’ is a concept with the aim to “improve health and well-being through the prevention of risks and the mitigation of effects of crises that originate at the interface between humans, animals and their various environments” and for that purpose to “promote a multi (cross) sectoral and collaborative approach and a ‘whole of society’ approach to health hazards, as a systemic change of perspective in the management of risk” (One Health Global Network 2012). This approach has been formally endorsed by the European Commission, the US De- partment of State, US Department of Agriculture, US Centers for Disease Control and Prevention (CDC), World Bank, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE), United Nations System Influenza Coordination (UNSIC), various Universities, NGOs and many others (One Health Global Network 2012; CDC 2010).


31


Chapter 1: Regional Context and Priorities


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