The Ministry of Health has already closed the prior public consultation on the draft Royal Decree that seeks to establish a Environmental Health Surveillance System which will address factors with impact on human health, such as extreme heat and pollutants. A key issue and a long-awaited initiative, tells EL PERIÓDICO DE ESPAÑA Dr. José María Ordóñez Iriarte, member of Reports of the Spanish Society of Public Health and Health Administration (SESPAS). “The hallmark of environmental health is health protection, that is, primary prevention” where the focus, he emphasizes, must be placed on the most vulnerable, such as children or the elderly.
The main objective of the surveillance system in which Health works is “harmonize surveillance of environmental risks both at the regional, state and international levels. The initiative is framed in the Strategic Health and Environment Plan (PESMA) approved in 2021, which establishes measures to reduce the impact of the main environmental factors on health and is part of the Public Health Strategy.
The proposals
SESPAS has presented its proposals to improve this Environmental Health bill such as the need to incorporate a consensual method to develop protocols, unify mechanisms and periodicity in all autonomous communities and clearly define the role of the different entities and committees involved. Dr. Ordóñez Iriarte responds to this newspaper about what he considers essential, what should appear in the new regulations.
Q. What do we talk about when we talk about environmental health and what is the approach from public health?
A. Environmental health, according to the canonical definition preferred by the World Health Organization (WHO), is “that discipline that includes aspects of human health that are determined by physical, chemical and biological environmental factors, external to people”. It also refers to the theory and practice “of evaluating, correcting, controlling and preventing environmental factors that may adversely affect the health of present and future generations.”
Furthermore, this expert adds, the General Public Health Law itself, dedicates a space to environmental health: “Its functions are the identification, evaluation, management and communication of health risks that may arise from environmental conditions; the monitoring of environmental factors of a physical, chemical or biological and environmental situations that affect or can affect health; as well as the identification of policies in any sector that reduce risks”.
Water or air quality
Specifically, he explains, Spanish environmental health controls the quality of the supply water, swimming pools and bathing areas; surveillance programs are maintained for facilities likely to generate cases of legionellosis (cooling towers, nebulizers, etc.) or monitoring the application of all safety regulations. chemical substances and mixtures that the European Union has implemented.
Control involves monitoring risk factors such as extreme temperatures, pollen, electromagnetic fields derived from power stations or radon.
This control also involves monitoring risk factors such as extreme hot and cold temperaturespollen, electromagnetic fields derived from power stations and mobile phone base stationsradon or entomological surveillance of vectors with interest in public health such as the tiger mosquito, sandflies, black flies, culicids… or indoor air quality.
Prevent diseases
SESPAS considers it essential that the regulatory text highlights aspects such as disease prevention. Therefore, it requests that the new Surveillance System allow the early detection of risk factors such as air, water and soil pollution, as well as the presence of disease vectors.
Likewise, they demand that you also focus on identify and monitor specific risks affecting vulnerable groups, such as children, the elderly, people with chronic illnesses and disadvantaged communities. “This is crucial to reduce health inequities and guarantee adequate protection for all citizens,” the society asserts.
The pandemic
Q. Why was such a law necessary and why is a surveillance system essential?
A. The covid-19 pandemic revealed the fragility of the epidemiological surveillance systems that we have in Spain, which were created in 1995, through the Royal Decree that created the National Epidemiological Surveillance Network ( RENAVE), very focused on notifiable diseases. For this reason, Royal Decree 568/2024, of June 18, has just been published, creating the State Public Health Surveillance Network. We move from an epidemiological surveillance network to a public health surveillance network; That is, in addition to diseases, they incorporate the determinants of health, morbidity and mortality.
In the expert’s opinion, both systems that have been created “ad hoc”, from environmental health itself, and those that are managed by other administrations, but that have a great interest in public health, must be integrated. Among the first are the National Drinking Water Information System (SINAC), National Bathing Water Information System (Náiade) or the Swimming Pool Information System (Siloé).
Antibiotic resistance
But, also, in the case of pollen, in some autonomous communities there are surveillance networks linked to public health programs; there is surveillance of antibiotic resistance in animals and humans; biomonitoring of chemical substances, linked to the National Health Survey or a vector surveillance system with public health interest that has reached “a certain relevance” in various autonomous communities.
They also consider it important integrate the surveillance of the Veterinary Alert Network in those controls. “It is a broad field that, little by little, is developing in our country,” admits Dr. Ordóñez Iriarte about environmental health.
The pharmacist
The other great value of these information systems is the annual analysis of the information obtained. For example, it can be defined, in time and space, where the levels of nitrogen oxides have been exceeded, what concentrations were reached, which population has been exposed (segregated by age), etc., and all of this will allow the public health system to influence those responsible for policies, in this case environmental ones, so that they propose actions that can progressively reduce these levels of exposure.
A toilet with great value that would greatly enhance the work of social literacy community pharmacist, SESPAS emphasizes. “In our opinion, the National Health System I could count on him much more and it could be established on a big speaker of public health actions, giving individualized advice on vector issues, temperatures, of pollenetc.”, concludes the specialist.