Sustainable Management

of Transboundary Waters in Europe

Dr. R. Bertollini
Director
Division for Technical Services
WHO Regional Office for Europe

WHO Regional Office for Europe, Division of Technical Support

 Programme

• Review of policy
• WHO EURO Region
• Future work
• Discussion

WHO Regional Office for Europe, Division of Technical Support

Policy Formulation Timeline
2000 2001 2002

Jan Report by the

Sec Gen to
CSD
Feb
Mar Ministerial
Declatarion of
the Hage 22
March
Apr
May
Jun
Jul
Aug WSSD
Sep UN Millennium UNECE
Summit Regional
Committee for
the WSSD
and WHO RC
51
Oct WHO RC 50
Nov
Dec International
Freshwater
Conference
WHO Regional Office for Europe, Division of Technical Support
Protocol on Water and Health -
Article 1 Objective
The objective of this Protocol is to promote at all
appropriate levels, as well as in transboundary and
international contexts, the protection of human
health and well-being, both individual and collective,
within a framework of sustainable development,
through improving water management, including the
protection of water ecosystems, and through
preventing, controlling and reducing water-related
diseases.

WHO Regional Office for Europe, Division of Technical Support

 Protocol 3 - Scope
• Surface freshwater
• Groundwater
• Estuaries
• Coastal waters (recreation, aqua)
• Enclosing waters (bathing)
• Water during abstraction, transport, treatment,
supply
• Waste water

WHO Regional Office for Europe, Division of Technical Support

 Protocol 4 - Provisions
a) Adequate supplies of wholesome drinking
water
b) Adequate sanitation protecting health and
environment
c) Effective protection of resources
d) Protection of disease from recreational
waters
e) Monitoring systems

WHO Regional Office for Europe, Division of Technical Support

 Protocol 5 - approaches
f) Management action at lowest administrative
level
g) Social, economic and environmental values
h) Economic instruments & awareness
i) Access to information and public participation
in decision making needed

WHO Regional Office for Europe, Division of Technical Support

 Protocol 5 - Approaches

j) Integrated management on catchment basis

k) Special consideration to vulnerable populations
l) Equitable access to water for all, especially
socially disadvantaged and (economically
excluded)

WHO Regional Office for Europe, Division of Technical Support

 UN Millennium Declaration
Art 19: We resolve further to
Poor people are powerless to
prevent degradation of resources
on which their health depends.
halve, by 2015, the
proportion of the world’s
people whose income is
less than US$1/d and the
proportion of people who
suffer from hunger and, by
the same date, to halve the
proportion of people who
are unable to reach or to
afford safe drinking water

WHO Regional Office for Europe, Division of Technical Support

 UN Millennium Declaration
Art 23 We resolve … to stop the unsustainable
exploitation of water resources by developing
management strategies at the regional, national,
and local levels, which promote both equitable
access and adequate supplies

WHO Regional Office for Europe, Division of Technical Support

 WHO Regional Committee 51
EUR/RC51/R7 WSSD
• Recognizing that many health problems
will be exacerbated by inadequate water
and sanitation … urges MS to
a) Actively involve the Health Sector in
national preparations of the WSSD
b) Address the links between health,
environment, and development in
particular health and poverty alleviation

WHO Regional Office for Europe, Division of Technical Support

 Bonn Freshwater Conference
8. Protect Water Quality and Ecosystems

• Drinking water quality should be safeguarded

because it is essential for human health
• Water supplies should be protected from
pollution from the source to the user
• Treatment of wastewater to be intensified and
made more affordable

WHO Regional Office for Europe, Division of Technical Support

 Bonn Freshwater Conference
15. Improve economic efficiency

• Cost recovery objectives should be no barrier

to poor people’s access to water supply and
sanitation. Where the poor can not afford to
pay the full cost of water supply and
sanitation, tariff systems that allow social
targeting should be established.

WHO Regional Office for Europe, Division of Technical Support

Report of UN Secretary General
II Major Trends
33. Contaminated water, inadequate
sanitation, and poor hygiene cause a large
proportion of ill health and disease…
Malaria… cholera, typhoid, viral hepatitis
A, dysentery, intestinal worms, trachoma,
river blindness, schistosomiasis, arsenic
poisoning, and dengue fever, and other
water-related diseases affect millions of
people in developing countries

WHO Regional Office for Europe, Division of Technical Support

Report of UN Secretary General
II Major Trends (cont)
38. Areas of water scarcity are increasing …
One third of the countries in the water-
stressed regions of the world are expected
to face severe water shortages in the
twenty-first century. By 2025, as much as
two-thirds of the world’s population could
live in countries with moderate or severe
water stress

WHO Regional Office for Europe, Division of Technical Support

Report of UN Secretary General
III.B. Urban poverty
59. Number of urban dwellers lacking access to
safe drinking water increased by 62 million.
Providing safe water and adequate sanitation
to urban and peri-urban population will be a
major challenge.
61. Sustainability of urban development
threatened by wastewater treatment capacity.

WHO Regional Office for Europe, Division of Technical Support

Member States of the WHO EURO Region

WHO Regional Office for Europe, Division of Technical Support

 The Six Sub-regions
1. High Human Development and High Income
2. High Human Development and Upper Middle Income
3. High Human Development and Lower Middle Income
4. Medium Human Development and Upper Middle Income
5. Medium Human Development and Lower Middle Income
6. Medium Human Development and Low Income

High Human Development (HHD): Human Development Index (HDI) value 0.800 and up
Medium Human Development (MHD): HDI value 0.500-0.800
High Income (HIC): GNP per capita US$9,266 and up
Upper Middle Income (UMI): GNP per capita US$2,996-9,265
Lower Middle Income (LMD): GNP per capita US$756-2,995
Low Income (LIC): GNP per capita US$755 or less

WHO Regional Office for Europe, Division of Technical Support

WHO Regional Office for Europe, Division of Technical Support
 Distribution of Population by Levels of
Human Development and Income (1998)

12.40%
105.8 million

46.34%
395.5 million

25.02%
213.5 million

7.56%
0.43% 8.25%
64.5 million High Human Development & High Income
3.7 million 70.4 million
High Human Development & Upper Middle Income

High Human Development & Lower Middle Income

Medium Human Development & Upper Middle Income

Medium Human Development & Lower Middle Income

Medium Human Development & Low Income

 Percentage of Urban Population by Levels of Human Development and Income

90 84.50 1998
80.10
78.71 2015
80 74.60 73.60 73.10
71.07

70 64.60
63.49 60.84
57.52
60 53.11

50

40

30

20

10

0
High Human High Human High Human Medium Human Medium Human Medium Human
Development & High Development & Upper Development & Lower Development & Upper Development & Lower Development & Low
Income Middle Income Middle Income Middle Income Middle Income Income
 Life Expectancy at Birth by Levels of Human Development and Income (2000)

90 Male
80.9
Female
77.1 77.2
80 75.0
72.5 72.3
68.4 69.7
66.9 66.8
70 63.5
62.5

60

50

40

30

20

10

0
High Human High Human High Human Medium Human Medium Human Medium Human
Development & High Development & Upper Development & Lower Development & Upper Development & Lower Development & Low
Income Middle Income Middle Income Middle Income Middle Income Income
 Sub-regional Comparison of Average Poverty Levels
(Collected data varying from those of 1992 through 1999)

30
26.0
Sub-regional Average Poverty Level Measured at Population

25 22.7

20 18.0
Below $2 per Day (%)

15

10 7.8

3.1
5

N/A
0
High Human High Human High Human Medium Human Medium Human Medium Human
Development & High Development & Development & Development & Development & Development & Low
Income Upper Middle Income Low er Middle Upper Middle Income Low er Middle Income
Income Income
 Water availability of countries in sub-regions

25 no data
2500-
1700-2500
1000-1700 (w ater stress)
20 5 -1000 (w ater scarce)

15

13
10

7
5 7
4
2
1 1
2
1 1 1 1 1
0
High Human High Human High Human Medium Human Medium Human Medium Human
Development & Development & Development & Development & Development & Development &
High Income Upper Middle Lower Middle Upper Middle Lower Middle Low Income
Income Income Income Income
WHO Regional Office for Europe, Division of Technical Support
 Domestic Use of Water and Its Percentage of Total

290.1
300 Domestic Use as Percentage of Total
Domestic Use per Capita per Day

236.3
250

200
Liters per capita per day

163.2 162.0
150.9

150

100 81.00

50
26.00
22.68
N/A 14.00 11.63

0
High Human High Human High Human Medium Human Medium Human Medium Human
Development & High Development & Development & Development & Development & Development & Low
Income Upper Middle Income Low er Middle Income Upper Middle Income Low er Middle Income Income
 WHO Information Systems
• Health for All
• Computerized Information Systems for
Infectious Diseases - CISID

WHO Regional Office for Europe, Division of Technical Support

 European Health for All
Database
• Provides easy and rapid access to a wide range of basic
health statistics for the 51 member states of the WHO
European region.

• The data are submitted by the European member

states to the Regional Office or collected from other
international organizations or other sources and are
updated twice a year in January and June.

WHO Regional Office for Europe, Division of Technical Support

 Under 5 Mortality Rate from Diarrhoreal Diseases per 100000

160
High Human Development & High Income

High Human Development & Upper Middle Income

140
High Human Development & Lower Middle Income
Medium Human Development & Upper Middle Income
120 Medium Human Development & Lower Middle Income

Medium Human Development & Low Income

100

80

60

40

20

0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 Viral Hepatitis A Incident per 100000

350
High Human Development & High Income
High Human Development & Upper Middle Income
High Human Development & Lower Middle Income
300
Medium Human Development & Upper Middle Income
Medium Human Development & Lower Middle Income
Medium Human Development & Low Income
250

200

150

100

50

0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 Malaria Incidence per 100000

160
High Human Development & High Income

High Human Development & Upper Middle Income

140
High Human Development & Lower Middle Income
Medium Human Development & Upper Middle Income

120 Medium Human Development & Lower Middle Income

Medium Human Development & Low Income

100

80

60

40

20

0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
 CISID Database
• Computerized Information System for Infectious Diseases (CISID) is a
work of the Communicable Disease Surveillance and Response (CSR)
Programme and the Informatics Support unit (ISS) of the WHO Regional
Office for Europe.

• The first objective is to improve the standardization, timeliness and

completeness of data reported by Member States.

• The second objective is to allow sharing of data at the sub-national level to

identify specific geographic areas of risk, as well as the identification of
risk groups by age and gender.

• CISID eventually aims to monitor some infectious diseases by first (and in

some cases, second) administrative level within the region, and provide a
detailed description of clusters of cases by time, place and person.

WHO Regional Office for Europe, Division of Technical Support

 Cholera and Typhoid Fever from
CISID Database
90 35000

80
30000

70

25000
60

T yp hoid Fever Cases

Cholera Cases

50 20000

40
15000

30

10000
20

5000
10

0
0
1998 1999 2000
1998 1999 2000
 WHO 2000 - 2001
• Protocol
– Expert meeting on evidence base
– Expert meeting on surveillance of natural and man-
made outbreaks
– Expert meeting on aquifer recharge
– Expert meeting on terrorism
• Bilateral assistance
– Tajikistan, Azerbaijan
• Global: DWQG

WHO Regional Office for Europe, Division of Technical Support

 WHO 2002 – 2003 - BCA
• MALTA Health systems in tourist areas
• ROMANIA Surveillance of wbd
• RUSSIAN FEDERATION Implementation of
the Protocol
• TAJIKISTAN dwq
• TURKEMISTAN urban dwq
• CAS Surveillance

WHO Regional Office for Europe, Division of Technical Support

 IVth Ministerial Conference on
Environment and Health
• Children and future generations
• Transport, environment and health
• Water and health
• Local activities
• NEHAP
New issue:
 Sustainable resource management
 Harmonizing reporting systems
WHO Regional Office for Europe, Division of Technical Support
THANK YOU

WHO Regional Office for Europe, Division of Technical Support