|CHAPTER 11: HUMAN HEALTH - INTRODUCTION|
Good health and well-being require a clean and harmonious environment in which physical, physiological, social and aesthetic factors are all given their due importance. The environment should be regarded as a resource for improving living conditions and increasing well-being.
This basic statement results from a self-evident but often neglected fact that human health depends on the availability and quality of food, water, air and shelter. It is a basic requirement of health that the global cycles and systems on which all life depends are sustained. The potential of the environment to have adverse effects on health has been realised for centuries. However, in recent years, public awareness of environmental health hazards has increased. This has been due, in part, to the rapid development of industry and new, potentially hazardous, technologies. The progress of scientific research revealing the existence of previously undetected hazards, which may have been present for some time, has also increased public concern.
This chapter summarises the information on the main issues related to the health status of the European population and on known links of health with environmental conditions in Europe. It is derived from material presented in the report Concern for Europe's Tomorrow (CET) (WHO, in press). The main objectives of the CET report are the evaluation of the environmental issues of clear health significance, the assessment of European population exposure to the environmental factors possibly affecting health, and the indication of health impacts of these factors.
In the description of health status of the European population presented in the CET and summarised here, a major limitation is the difficulty in providing a proper measurement of health. Mild deficits of health are very subjective; small physiological changes can be measured but their health significance, for example, as predictors of a disease, is not always clear. More serious health deficiencies, even those requiring treatment, are rarely recorded in a way enabling inference about the population health status. Epidemiological studies are necessary to establish prevalence of certain diseases, but the availability of such studies in Europe is very limited due to the costs and resources needed to conduct this type of research. For this reason most of the information on health status is based upon the registration of death the most severe health deficiency. Mortality data have been collected in all European countries for many years and recorded according to a uniform classification of causes of death. Total and age-specific mortality data, combined with information on age structure of a population, serve to calculate that widely used demographic indicator, 'life expectancy'.
Life expectancy and cause of death constitute the basis for the descriptive analysis of the main aspects of population health status in Europe presented below. The latest data available relate to 1990, and to the countries existing in 1990. For the indices of health status available for all, or most, countries, the results of national data analysis are presented for three groups of countries: countries of Central and Eastern Europe (Poland, East Germany, former Czechoslovakia, Hungary, Romania, Bulgaria, former Yugoslavia), former USSR (including its parts of Asia), and the remaining countries hereafter referred to in this chapter as 'Western Europe' or 'European OECD countries'. This grouping is dictated largely by the available statistics which, for example, do not separate data related to European and non-European parts of the former USSR. However, the relative homogeneity of the mortality patterns within these three groups allows for this kind of classification. Whenever possible, the descriptions based on mortality data are supplemented by information from epidemiological studies evaluating less severe health deficiencies. Further, the known health hazards of specific environmental media and factors are reviewed, and their possible impact on health in Europe is evaluated. These descriptions are preceded by a short summary of issues to be considered before the links between health and environment are assessed.
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