Implement the WHO Chemicals road map to enhance health sector engagement in the SAICM towards the 2020 goal and beyond, approved by the World Health Assembly in 2017 (5).
· Manage health risks from exposures to chemicals: Develop health protection strategies, regulate chemicals, educate the public about health risks, share information and best practices, develop high-quality health care settings.
· Improve knowledge and evidence about the health effects and impacts of chemicals: improve risk assessment methodologies, increase bio-monitoring and surveillance, estimate disease burden from chemicals, share information and collaborate with partners.
· Strengthen national capacities to address health threats from chemicals, including in response to chemical incidents and emergencies: Strengthen national policies and regulatory frameworks, implement the International Health Regulations (2005) and provide training and education.
· Strengthen leadership and coordination: Promote the inclusion of health considerations in all policies related to chemicals, engage the health sector in chemicals management activities at the national, regional and international levels, and engagement of the health sector with other sectors.
Health
National, healthcare, workplace
Governance, regulation, assessment and surveillance, information, education and communication
UGL.WJ.ZZ
Policy change in relation to chemicals and chemical products
Some of the below recommendations (2–9, 11 and 12) are actions included in the WHO Chemicals road map.
Implement the International Health Regulations (2005) to establish/strengthen core capacities for chemical incident and emergency preparedness, detection and response chemical events, including poison centre and laboratory capacities (20).
Health, environment, labour, other sectors
National
Regulation
UGL.VA.ZZ
Capacity building in relation to chemicals and chemical products
UGL.WI.QD
Restrictions through enactment of laws or standards on chemicals and chemical products
Implement the chemicals and waste-related multilateral environmental agreements, particularly health protective aspects, for example:
· Minamata Convention on Mercury (21)
· Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal (22)
· Rotterdam Convention on Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade (23)
· Stockholm Convention on Persistent Organic Pollutants (POPs) (24)
· Montreal Protocol on Substances That Deplete the Ozone Layer (25).
Health, Environment, agriculture, other sectors
National
Regulation
UGL.WI.QD
Restrictions through enactment of laws or standards on chemicals and chemical product
UGS.WI.QD
Restrictions through enactment of laws or standards on wastes and scraps
Nominate a health ministry contact point for the WHO Global Chemicals and Health Network (5).
Health
National
Governance
UGL.VA.ZZ&UEP
Capacity building in relation to chemicals and chemical products
Health services, systems and policies
Support the inclusion of health priorities in all policies relevant to chemicals (5).
Health, other sectors
National
Governance
UGL.WJ.ZZ&UEP
Policy change in relation to chemicals and chemical products
Health services, systems and policies
Facilitate participation of all relevant sectors and stakeholders in chemicals management and strengthen the engagement of the health sector with other sectors, recognizing the shared leadership of the health and environmental sectors (5).
Health, environment, agriculture, labour, other sectors
National
Governance
UGL.TD.ZZ
Collaboration relating to chemicals and chemical
products
Establish health-based guidelines for chemicals in water, air, soil, food, products, and occupational exposure, drawing on WHO norms, standards and guidelines, as appropriate, and participating in their development (5).
Health, other sectors
National
Regulation
UGL.WI.ZZ
Restrictions through laws or standards on chemicals
and chemical products
Support regulations to prevent discharge of toxic chemicals and advocate appropriate recovery and recycling technology, as well as safe storage and disposal (5).
Health, other sectors
National
Regulation
UGL.WI.ZZ&UGS
Restrictions through laws or standards on chemicals and chemical products
Wastes and scraps
+
UGL.TA.ZZ&UGS
Advocacy about chemicals and chemical products
Wastes and scraps
Support implementation of the Globally Harmonized System of Classification and Labelling of Chemicals, coordinating internationally, where appropriate (5, 6).
Health, other sectors
National
Regulation
UGL.VB.ZZ
Awareness raising about chemicals and chemical products
Prevent the construction of homes, schools and playgrounds near polluted areas and hazardous installations (26, 27).
Health, land use planning, construction, housing
National, community
Regulation
UBT.WI.ZZ&UGL
Restrictions through laws or standards on land pollution
Chemicals and chemical products
UAM.WI.ZZ&UGL
Restrictions through laws or standards on design, construction and building products and technology of buildings
Chemicals and chemical products
Conduct public awareness campaigns for priority health concerns related to chemicals throughout their life cycle (e.g. HHPs, lead, mercury, etc.) (5).
Health
National,
community
Universal health coverage
Information, education and communication
UGL.VB.ZZ
Awareness raising concerning chemicals and chemical products
UGL.VF.ZZ
Health alert concerning chemicals and chemical products
Promote communication of relevant information, including training, on chemicals used in products and processes, to enable informed decision-making by all actors throughout a product’s life cycle, and to promote safer alternatives (5).
Health; labour: other sectors
National, community, workplace
Information, education and communication
UGL.PH.ZZ
Training about chemicals and chemical products
Educate and raise awareness about the health effects of chemicals and about actions to prevent exposure to toxic chemicals (28, 29).
Health
National, community, workplace
Universal health coverage
Information, education and communication
UGL.PM.ZZ
Education about chemicals and chemical products
UGL.VB.ZZ
Awareness raiding about chemicals and chemical products
Promote safe storage of chemicals at home (26, 27).
· Keep all chemicals and medicines out of the reach of children, either locked or stored in places they cannot access. This applies to cleaning products in kitchen and bathroom, paraffin or kerosene, medicines, fuels and caustic products in the garage or pesticides in the shed.
· Chemicals should never be stored in drinking bottles.
Health
National,
community
Universal health coverage
Information, education and communication
UGL.VB.ZZ&VCC
Awareness raising about chemicals and chemical products
Home safety behaviours
UAC.VB.ZZ&VCC
Awareness raising about medicaments
Home safety behaviours
Promote the use of child-resistant packages for pharmaceuticals and for chemical products (26).
Health
National,
community
Universal health coverage
Information, education and communication
UAC.VB.ZZ&VCC&UAC
Awareness raising about medicaments
Home safety behaviours
Products and technology for personal use in daily living
Ensure clear labelling for cleaners, fuels, solvents, pesticides and other chemicals used at home and in schools (27).
Health
National, community
Universal health coverage
Information, education and communication
UGL.VB.ZZ&VCC&VCB
Awareness raising about chemicals and chemical products
Home safety behaviours
Workplace safety behaviours
Inform parents, teachers and child-minders about the potential chemical hazards in the places where children spend their time (26).
Health
National, community
Universal health coverage
Information, education and communication
UGL.VB.ZZ&XBO8.6&VCC
Awareness raising about chemicals and chemical products
Community
Home safety behaviours
Raise awareness among families and communities about poison control centres (26). (See also the World directory of poison centres (30)).
Health
National, community
Universal health coverage
Information, education and communication
UGL.VB.ZZ&UEP&XBO8.6
Awareness raising about chemicals and chemical products
Health services, systems and policies
Community
UAC.VB.ZZ&UEP&XBO8.6
Awareness raising about medicaments
Health services, systems and policies
Community
These include the ten chemicals of major public health concern as listed by INCHEM (8). There are various other chemicals, including persistent organic pollutants, which are not included here but are highly hazardous and negatively affect health and the environment, especially when improperly managed.
(31)
Screen drinking-water and identify where delivered water is above the WHO provisional guideline value of 10 µg-arsenic per litre or national permissible limit. Combine screening activities with awareness-raising campaigns.
Health, environment, water
National, community
Assessment and surveillance
UBN.VC.ZZ#ICD- 11 XM2KQ2
Public health surveillance of water quality
Arsenic
Use alternative groundwater sources, microbiologically safe surface water (e.g. rainwater harvesting) or arsenic removal technologies.
Health, environment, water
National, community
Infrastructure, technology and built environment
UBN.VL.ZZ#ICD- 11 XM2KQ2
Environmental remediation to improve water quality
Arsenic
(32)
Stop the use of all types of asbestos as the most efficient way to eliminate asbestos- related disease.
Health, construction, housing
National, community
Regulation
VC1.WI.ZZ&UGL#ICD- 11 XM53B3
Restrictions through laws or standards to improve safety
Chemicals and chemical products
Asbestos
Replace asbestos with safer substitutes and develop economic and technological mechanisms to stimulate its replacement.
Construction; housing
National, community
Infrastructure, technology and built environment, regulation
VCB.WF.ZZ#ICD- 11 XM53B3
Restrictions on the use of products to improve workplace safety
Asbestos
+
VCC.WF.ZZ#ICD- 11 XM53B3
Restrictions on the use of products to improve home safety
Asbestos
Take measures to prevent exposure to asbestos in place and during asbestos removal (abatement).
Construction, housing
National, community
Infrastructure, technology and built environment, regulation
VCB.WI.QE#ICD- 11 XM53B3
Enforcing workplace safety restrictions through laws or standards
Asbestos
Improve early diagnosis, treatment, social and medical rehabilitation of asbestos-related diseases and establish registries of people with past and/or current exposures to asbestos.
Health
Health care, community Universal health coverage
Assessment and surveillance, other management and control
UEP.VN.ZZ#ICD- 11 XM53B3
Establishing health services, systems and policies
Asbestos
+
UEP.VP.ZZ#ICD- 11 XM53B3
Improving access to health services
Asbestos
(33)
Support the use of alternative solvents in industrial processes.
Industry
Workplace
Regulation
UGL.WF.ZZ#ICD- 11 XM0QY7
Restrictions on the use of chemicals and chemical products
Benzene
Develop or update policies and legislation to remove benzene from consumer products and to discourage domestic use of benzene-containing products.
Industry, health
National
Regulation
UGL.WJ.ZZ&UAD#ICD- 11 XM0QY7
Policy change in relation to chemicals and chemical products
Products and technology for personal use in daily living
Benzene
UGL.WI.ZZ&UAD#ICD- 11 XM0QY7
Restrictions through laws or standards in relation to chemicals and chemical products
Products and technology for personal use in daily living
Benzene
Promote building codes requiring detached garages.
Construction, housing
National
Regulation
VCC.WI.ZZ#ICD- 11 XM0QY7
Restrictions through laws or standards to improve home safety
Benzene
(34)
Reduce cadmium emissions from mining and smelting, waste incineration, application of sewage sludge to the land, and use of phosphate fertilizers and cadmium-containing manure, among others.
Industry, agriculture, other sectors
Workplace, national, community
Infrastructure, technology and built environment
UBT.VL.ZZ#ICD- 11 XM0V73
Environmental remediation to reduce land pollution
Cadmium
+
UBM.VR.ZZ#ICD- 11 XM0V73
Reducing emissions to improve outdoor air quality
Cadmium
Support safe and effective measures to increase recycling of cadmium.
Industry, other sectors
Workplace, national, community
Infrastructure, technology and built environment
UGS.TA.ZZ&UEV#ICD- 11 XM0V73
Advocacy about wastes and scraps
Waste recycling and reuse services, systems and policies
Cadmium
Restrict non-recyclable uses of cadmium.
Industry, other sectors
National
Regulation
UA1.WI.ZZ#ICD- 11 XM0V73
Restrictions through laws or standards on production or importation of products
Cadmium
Support the elimination of use of cadmium in products such as toys, jewellery and plastics.
Industry, health, other sectors
National
Other management and control
UAA.TA.ZZ#ICD- 11 XM0V73
Advocate about products for personal consumption
Cadmium
(35)
Identify and safely dispose of material containing or likely to generate dioxin and dioxin-like substances such as electrical equipment.
Environment, other sectors
Workplace, national, community
Regulation, infrastructu re, technology and built environment
UGS.WI.ZZ#ICD- 11 XM9V80
Restrictions through laws or standards relating to wastes and scraps
Dioxin
Ensure appropriate combustion practices to prevent emissions of dioxins and dioxin-like substances.
Environment, waste, industry, other sectors
Workplace, national, community
Regulation, infrastructure, technology and built environment
UBM.WI.ZZ#ICD- 11 XM9V80
Restrictions through laws or standards to improve outdoor air quality
Dioxin
Implement FAO/WHO strategies to reduce contamination in food and feed, and monitor food items and human milk (36).
Food, agriculture
National
Regulation, assessment and surveillance
UAB.VC.ZZ#ICD- 11 XM9V80
Public health surveillance of food
Dioxin
UGR.VC.ZZ#CPC Class 01 91#ICD-11 XM9V80
Public health surveillance in agriculture
Forage products
Dioxin
(37)
Ensure sufficient fluoride intake where this is lacking, so as to minimize tooth decay.
Health, water
National
Regulation
UET.VI.ZZ#ICD- 11 XM1VSS
Fortification of water supplies
Fluoride
Provide drinking-water with a moderate (i.e. safe) fluoride level in areas where groundwater contains high fluoride levels. Guideline values for fluoride in drinking-water and air are available (37).
Water, health
National, community
Regulation
UET.VL.ZZ#ICD- 11 XM1VSS
Environmental remediation in water collection treatment and supplies services and systems
Fluoride
Provide guidance on the need to control population exposures to fluoride and establish the important balance between caries prevention and protection against adverse effects.
Health
National
Regulation
UBN.VA.ZZ#ICD- 11 XM1VSS
Capacity building interventions targeting water quality
Fluoride
+
UBN.PN.ZZ#ICD- 11 XM1VSS
Advising about water quality
Fluoride
(38, 39)
Develop and enforce health, environmental and safety standards for manufacturing and recycling of lead-acid batteries, e-waste and other substances that contain lead (40).
Health, industry, labour, environment, other sectors
National, community
Regulation
UGS.WI.ZZ#ICD-11 XM0ZH6#CPC Group 464
Restrictions through laws or standards on wastes or scraps
Lead
Batteries
Enforce environmental and air- quality regulations for smelting operations.
Health, industry, labour, environment, other sectors
National, community
Regulation
UBM.WI.QE&UB1#ICD-11 XM0ZH6#ISIC Division24
Restrictions through enforcement of laws or standards in relation to outdoor air quality
Natural environment including human changes
Lead
Manufacture of basic metals
Manage drinking-water safety so that quality standards have strict parameters on lead (11).
Health, industry, labour, environment, other sectors
National, community
Regulation
UBN.WI.QD#ICD- 11 XM0ZH6
Restrictions through enactment of laws or standards concerning water quality
Lead
Ensure that health care practitioners have training on, and resources for, the diagnosis and management of lead poisoning.
Health
National
Information, education and communication
UEP.VA.ZZ#ICF d825#ICD-11 XM0ZH6
Building capacity in health services, systems and policies
Vocational education
Lead
Ensure the availability of laboratory capacity for blood lead testing.
Health
National, community
Regulation
UEP.VB.ZZ#ICD- 11 XM0ZH6
Building capacity in health services, systems and policies
Lead
Phase out the use of lead additives in fuels and lead in paint where this has not yet been done; adopt legally binding limits on lead in paint.
Industry, transport, Environment, health,
National
Regulation
UGE.WE.ZZ#CPC Class 35 11#ICD-11 XM0ZH6
Restrictions on production or importation of refined petroleum products
Paints and varnishes and related products
Lead
+
UA1.WE.ZZ#CPC Class 35 11#ICD-11 XM0ZH6
Restrictions on production or importation of products and technology, unspecified
Paints and varnishes and related products
Lead
Eliminate the use of leaded solder in food and drink cans and water pipes; lead in homes, schools, school materials and children’s toys; lead glazing for pottery intended for cooking, eating or drinking; spices; and lead in traditional medicine and cosmetics.
Industry, other sectors
National, community
Regulation
UA1.WE.ZZ#ICD- 11 XM0ZH6
Restrictions on production or importation products, unspecified
Lead
Identify contaminated sites and exposure
routes and take necessary action to prevent human exposure to lead from these
areas.
Identify sources of lead exposure in children such as lead in contaminated soil, paint, toys, water
distribution pipes, etc. (27).
Environment, health, other sectors
National, community
Assessment and surveillance
UBO.VC.ZZ#ICD- 11 XM0ZH6
Public health surveillance of soil quality
Lead
Monitor blood lead concentrations in populations at risk by sensitive analytical methods (41).
Health
National, community
Universal health coverage
Assessment and surveillance
DTA.AB.ZZ&XBO8.6#ICD- 11 XM0ZH6
Measurement of haematological system functions
Community
Lead
Enhance the collection of data on lead in foodstuffs and make this information publicly available so that appropriate action can be taken.
Food
National, community
Assessment and surveillance
UAB.VC.ZZ#ICD- 11 XM0ZH6
Public health surveillance of food
Lead
Educate the public regarding the dangers of
misusing lead- containing products, which covers risks from lead exposure and
the ways to protect themselves, their families and their communities.
This may include public education campaigns to parents and caregivers, schools
including classroom teachers and students, youth associations, community
leaders and health care workers, workers and owners of lead- related industries
(e.g. lead-acid battery recyclers and smelters, ceramic potters, spice
adulterators).
Existing media and communication resources and mediums may be used to reach audiences that may not be aware of the risks of lead exposure to children and pregnant women.
Health, education
National, community
Universal health coverage
Information, education and communication
UA1.PM.ZZ#ICD- 11 XM0ZH6
Education about products and technology, unspecified
Lead
Promote preventive and educational measures to protect young children from lead in their environment.
Health, education
National, community
Universal health coverage
Information, education and communication
VCC.VB.ZZ&XBO8.2#ICD- 11 XM0ZH6
Awareness raising to influence home safety
Family
Lead
+
VCC.PM.ZZ&XBO8.2#ICD-11 XM0ZH6
Education to influence home safety
Family
Lead
(42, 43)
Implement the Minamata Convention on Mercury.
Environment, health
National
Regulation
UGL.WI.QD#ICD- 11 XM1FG4
Restrictions through enactment of laws or standards in relation to chemicals and chemical products
Mercury
(38)
Establish national regulation of the registration, labelling, marketing, purchase and use of pesticides, including HHPs (44- 46).
Agriculture
National
Regulation
UGL.WE.ZZ#ICD- 11 XM7D46
Restrictions on production or importation of chemicals and chemical products
Pesticides
Implement the FAO guidance on the appropriate handling and use of pesticides (47).
Agriculture
National
Regulation
UGL.WI.ZZ#ICD- 11 XM7D46
Restrictions through laws or standards on chemicals and chemical products
Pesticides
Eliminate the use of persistent HHPs and inappropriate wastes, especially HHPs subject to the Stockholm and Rotterdam Conventions (23, 24).
Agriculture
National
Regulation
UGL.WF.QD#ICD- 11 XM7D46
Restrictions through enactment of laws or standards on chemicals and chemical products
Pesticides
Raise awareness and understanding among pesticide users about the importance and ways of protecting health and the environment from the possible adverse effects of pesticides and the existence of less hazardous alternatives.
Health, agriculture, environment
National, community
Universal health coverage
Information, education and communicat ion
UGL.VB.ZZ&VCB#ICD- 11 XM7D46
Raising awareness about chemicals and chemical products
Workplace safety
Pesticides
+
UGL.PM.ZZ&VCB#ICD- 11 XM7D46
Education about chemicals and chemical products
Workplace safety
Pesticides
Educate and inform health professionals on recognition and treatment of pesticide-related poisoning (38).
Health
Health care
Information, education and communication
UET.PM.ZZ#ICD- 11 XM7D46
Education in health services, systems and policies
Pesticides
· WHO 2017: Chemicals road map and workbook (5) The road map identifies concrete actions where the health sector has a lead or important role to play in the sound management of chemicals. The associated workbook helps to prioritize and plan actions outlined in the chemicals road map."
· WHO 2020: Ten chemicals of major public health concern (8) includes information for decision-makers, including tools for action, norms and guidelines, fact sheets, etc. Further resources on the ten chemicals are below.
Air pollution
· See Chapter 2. Air pollution.
Arsenic
· WHO/UNICEF 2018: Arsenic primer: guidance on the investigation & mitigation of arsenic contamination (48)
Asbestos
· WHO 2014: Chrysotile asbestos (49)
Benzene
· WHO 2019: Exposure to benzene: a major public health concern (33)
Cadmium
· WHO 2019: Exposure to cadmium: a major public health concern (34)
Dioxin and dioxin-like substances
· UNEP/Stockholm Convention 2013: Toolkit for identification and quantification of releases of dioxins, furans and other unintentional POPs (50)"
Fluoride
· WHO 2013: Oral health surveys: basic methods – 5th ed. (51)
Lead
· WHO 2020: Global elimination of lead in paint: why and how countries should take action. Policy brief (52) and technical brief (53)
· WHO 2020: Brief guide to analytical methods for measuring lead in paint, 2nd edition (54)
· WHO 2020: Brief guide to analytical methods for measuring lead in blood, 2nd edition (55)
· WHO 2020: Guidance on organizing an advocacy or awareness-raising campaign on lead paint (56)
· UNEP 2018: Model law and guidance for regulating lead paint (57)
Mercury
· WHO 2021: Minamata Convention on Mercury: annotated bibliography of WHO information (43)
· WHO 2021: Exposure to mercury: a major public health concern, second edition (58)
· WHO 2019: Addressing health when developing national action plans on artisanal and small-scale gold mining under the Minamata Convention on Mercury (59)
· WHO 2019: Strategic planning for implementation of the health-related articles of the Minamata Convention on Mercury (60)
· WHO 2018: Health sector involvement in the Minamata Convention on Mercury (61)
· WHO 2015: Developing national strategies for phasing out mercury-containing thermometers and sphygmomanometers in health care, including in the context of the Minamata Convention on Mercury: key considerations and step-by-step guidance (62)
· WHO 2011: A step-by-step guide for phasing our mercury thermometers and sphygmomanometers (63).
Highly hazardous pesticides (HHPs)
· WHO 2020: The WHO recommended classification of pesticides by hazard and guidelines to classification, 2019 edition (64)
· FAO/WHO 2019: Detoxifying agriculture and health from highly hazardous pesticides – a call for action (60)
· FAO 2019: Pesticide Registration Toolkit (45)
The FAO Pesticide Registration Toolkit provides technical advice on various processes and methods in pesticide registration, such as data requirements, assessment methods for parts of the registration dossier, decision-making steps, etc.
Other tools and resources can be found in the IOMC Toolbox.
· IOMC 2020: IOMC Toolbox for decision making in chemicals management (19)
The IOMC Toolbox is a web-based platform that provides access to information and tools on the sound management of chemicals developed by participating organizations of the Inter-Agency Programme for the Sound Management Chemicals (IOMC), that is, FAO, the International Labour Organization (ILO), the United Nations Development Programme (UNDP), UNEP, the United Nations Industrial Development
Organization (UNIDO), United Nations Institute for Training and Research (UNITAR), WHO, the World Bank and the Organisation for Economic Co-operation and Development (see also https://www.who.int/iomc/en/).
· UNEP 2019: Global chemicals outlook II – from legacies to innovative solutions (3)
· SAICM 2021: Chemicals without concern (65)"
· UNEP 2019: Fact sheet titled Suggested steps for establishing a lead paint law (66)
· UNEP 2015: UNEP guidance: on the development of legal and institutional infrastructures and measures for recovering costs of national administration for sound management of chemicals (67)
· UNEP 2019: UNEP guidance – enforcement of chemicals control legislation (68)
· WHO 2020: INCHEM database (13)
This database contains detailed information on the physico-chemical properties and toxicology of numerous chemicals."
· WHO 2020: Guidelines for establishing a poison centre (69)
· WHO 2015: Health in All Policies: training manual (70)
· This training resource guides the systematic consideration of health implications in all public policies to improve population health and health equity."
· FAO 2000: Assessing soil contamination. A reference manual (71)
· ILO/WHO 2020: International Chemical Safety Cards (72)
ICSCs provide essential health and safety information on chemicals to promote their safe use. They are used at the “shop floor” level by workers, and by those responsible for health and safety in factories, agriculture, construction and other workplaces, and often form part of education and training activities. They can also be used by agencies responding to chemical incidents. ICSCs for more than 1700 chemicals are available in many languages.
· ILO 2020: ILO instruments on the sound management of chemicals at work (73)
· UNICEF/Pure Earth 2020: The toxic truth: children’s exposure to lead pollution is hindering a generation of potential (74)
· UNICEF 2018: Understanding the impact of pesticides on children: a discussion paper (75)