1. INTRODUCTION
At the 4th Ministerial Conference on the Environment and Health organized by the World Health Organization in Budapest in 2004, ministers in charge of health and ministers in charge of the environment signed the Ministerial Declaration 'For the Future of Our Children'. One of the obligations deriving from this declaration is the adoption of national action plans for the environment and children's health. Taking into consideration this international obligation, as well as Article 33 Sections 2 and 3 of the Law on the Government (The Official Gazette, no. 55/05, 71/05-correction, 101/07 and 65/08), on May 9th 2008, the Government passed the Decision on establishing National Committee for the Environment and Children's Health, with the scope of duty to suggest activities in the field of the environment and children's health, as well as initiate the cooperation with other organizations in relation to this issue. According to the Decision, the National Committee for the Environment and Children's Health was to submit its reports to the Government every 3 months, as well as to draft the Proposal of the National Action Plan for the Environment and Children's Health in the Republic of Serbia for the Years 2009 -2019 (from now on referred as: the Action Plan) by the time the Fifth Ministerial Conference.
The Action Plan is a specific plan stipulating the aims and measures related to the environment and children's health that already exist in various strategies adopted by the Government (Sustainable Development Strategy, Public Health Strategy), as well as other national documents (the National Integration Program), for the competent state bodies, as well as local self-government and associations (NGO-s).
The aims set by the Action Plan are:
- coordination of all relevant activities related to the decrease and prevention of children's health impacts from environment;
- The inclusion of children's health issues in environmental policies;
- The inclusion of all social stakeholders, especially the nongovernment sector, in activities aimed at increasing the public awareness of the environment impact on children's health;
- The improvement in children's health by improving the environment quality.
The right to health and the right to healthy environment that would contribute to wellbeing are human rights set by the Constitution. This complex and all-encompassing approach includes the participation of all relevant stakeholders. The Children's Environment and Health Action Plan is a set of important measures and activities, which identifies those who are to carry out those activities and includes indicators that would be used to measure and evaluate the realization of those activities. One of the basic principles is multidisciplinary and inter-sectoral coordination, since health determinants related to the environment are numerous and derive from different areas. Scientific findings related to these determinants were translated into tangible activities that are to be carried out by relevant decision makers, while the Action Plan represents a document that enumerates activities based on facts and widely accepted scientific findings related to the impact of the environment on children's health.
All of the decision-making at the local level that would be more competent due to the existence of the Action Plan deserves a special mention.
In order to conduct the Action Plan, it is necessary to strengthen the institutional, legislative, and financial frameworks of the Plan.
2. ACTION PLAN METHODOLOGY
The Action Plan is for the 2009 - 2019 period. This plan sets out priorities grouped in 4 priority aim clusters, which were defined at the Fourth Ministerial Conference on the Environment and Health, as common for the European region, and those were the frameworks when defining specific activities in the Republic of Serbia. The activities took into consideration the lack of development of those 4 key areas; a lack of a strategic and legislative framework, and common scientific knowledge about the impact of the environment on children's health; the failure to systematically investigate the impact of the environment on health in the Republic of Serbia; and, a lack of research results related to the environment impact on health. Good Practice Guidelines published by the World Health Organization were used. The World Health Organization provided technical support during the Action Plan drafting, while the National Committee for the Environment and Children's Health worked together with the World Health Organization and UNICEF experts. Besides the experts, the representatives of ministries and institutions, the representatives of the World Health Organization and UNICEF, the representatives of associations were also included in the National Committee. The expert public, as well as the general public, were included in the process by attending several workshops and public presentations. Booklets aimed at raising awareness was published and handed out at these events. A web page of the Action Plan was created containing all the relevant activities and communication tools. All these activities were financed with the support of the Ministry of Foreign Affairs of the Kingdom of Norway that was awarded to the Ministry of Health. The funds of 108.000,00 euros were allocated to the 'Capacity Building for the Application of the Action Plan for the Environment and Children's Health in the Republic of Serbia and Awareness Raising' project. The project started in December 2008 and will be finalized in December 2009.
In consultations during the drafting of the Action Plan, it was decided to draft the Plan for a period of 10 years, since that was the shortest period of time during which the results for all 4 aim clusters could be obtained.
A Government body, the Group for the Evaluation of the Implementation of Activities is to be formed to follow up the implementation of the Action Plan.
3. ACTION PLAN AIMS
At the Fourth Ministerial Conference on the Environment and Health, four basic priorities for the European region were defined. The countries were left to decide what their national activities would be within those four priorities. The four priorities are:
- Regional Priority I – Water and sanitation;
- Regional Priority II – Accidents, injuries, and psychical activity;
- Regional Priority III – Air quality;
- Regional Priority IV – Chemical, physical and biological substances and occupational health.
Within each of the four aforementioned priorities, long-term and medium-term goals were set as well, while within the medium-term goals certain clearly defined activities were set with an aim to create conditions for the implementation of other measures, to improve the system of the environmental quality control, and to track certain negative factors in the environment that might impact children's health. The medium-term goals revolve around conducting studies, creating new registries, and programming new computer applications and systems for environmental indicator evaluation, as outlined in the ENHIS (Environmental National Health Information System) database used in the EU member states and, also, recommended by the World Health Organization to be used in all of the countries of the European region as this database is suitable for the evaluation of the impact of the environment on children's health.
These activities, besides other activities related to the need for adaptation to new climate change impacts on health, are common activities for all four European priorities and are outlined at the end of the Action Plan. Namely, climate change is an unavoidable factor in this part of Europe when planning activities related to health, especially in the summer months when heath waves occur, and they require coordination of all social stakeholders, particularly the health system which has to meet a higher demand for health services due to population's exposure to extremely high temperatures, in particular the children who are very sensitive.
The most sensitive segment of the population of children to environmental factors, especially when it comes to air pollution, are children up to four years. Due to this fact, many of the activities in the Plan are focused on this age group. When the Action Plan was drafted, special attention was paid to the fact that children are not little people and that their reactions to environmental factors are different to those of an adult. Moreover, the fact that children of different ages are very sensitive to certain conditions, especially if chemicals are involved, was also taken into consideration, particularly the fact that the physiological development of children has certain 'sensitivity windows' which represent a grave danger for children's health. In this light, a special pediatrician 'green card' is to be used by pediatricians who will record all special environmental influences on a child's health which can lead to certain pathological occurrences.
Up until now, very little attention was paid to environmental factors when children visited the pediatrician. Moreover, a difficulty in creating this Action Plan was the fact that there are no research studies and analyses of the environment impact on children's health in Serbia, so the results of research studies from other countries with similar environmental conditions were used.
It should be noted that the Republic of Serbia is one of the last European countries, but not in the world, that did not join the United Nation's Environmental Program (UNEP) action for the abolishment of leaded fuel by the end of 2008. Lead from fuel is one of the biggest threats to children's health and can, with significant probability, cause mental retardation in children who have been exposed to high concentrations of lead in the environment (in children who live or go to school in busy neighborhoods when it comes to traffic). Unfortunately, there are no research studies on the Republic of Serbia and lead; however, since our children are the same as children in any other country, the creators of this Action Plan could have expressed their agreement with this initiative for the abolishment of leaded fuels. Since the Strategy has already been put into practice, we can just reiterate the 2015 deadline for the abolishment of leaded fuel. The abolishment would not cost anything since all the vehicles, regardless of age and type, can use unleaded gas.
FINANCIAL MEANS FOR THE ACTION PLAN IMPLEMENTATION
Financial means necessary for the realization of the activities for 2009 outlined in the Action Plan have already been set aside in the Budget Law for 2009 and have been divided by ministries and activities.
When discussing Budget Law for each consecutive year, the requests for funding of activities outlined in the Action Plan will also be taken into consideration. The Action Plan will be realized according to the financial capabilities of the Republic of Serbia.
