How bad is the environment for our health?
The Bulletin interview with Kerstin Leitner.
Kerstin Leitner earned her Ph.D with a thesis on socioeconomic development in Kenya at Berlin’s Free University in her native Germany in 1975. A year later, she embarked on what was to become a 27-year career with the UN Development Programme (UNDP). She held several posts in Africa, Asia, Europe and the Middle East. Most recently, from 1998 to 2003, she was UN Resident Coordinator and UNDP Resident Representative in China, and before that, from 1997 to 1998, she was Senior Special Adviser to the UNDP Assistant Administrator and Director in Asia and the Pacific.
Since Kerstin Leitner became Assistant Director-General of WHO’s Sustainable Development and Healthy Environment cluster of departments, in September 2003, her team have sharpened their focus to provide information and knowledge to numerous Member States on the public health impact of environmental factors. She talks about this and other aspects of her cluster’s work.
Q: What is the disease burden due to environmental factors?
A: Some experts say a third of the disease burden of children is due to environmental factors. It’s extremely difficult to prove that. We often lack the epidemiological basis. Often we only have ‘guestimates’. We know that allergies and asthma are caused by environmental factors, but it’s difficult to say to what extent and whether people become susceptible to allergies because of air pollution or chemical residues in food. There is clearly a link between certain types of cancer and environmental factors. One of the best known cases is asbestos and lung cancer. But lung cancer can also be caused by other factors, such as smoking. This is where our work is particularly demanding. You have to make judgements. You don’t want to be alarmist but also not too laid back. You need to strike a balance.
Q: Have you changed your team’s focus in any way?
A: We have become sharper in our focus as we look at environmental, social and economic determinants of health and globalization. We always put the emphasis on the public health dimension. It’s easy to get carried away by various aspects of chemical safety, but our task is to look at the impact of this on individual and public health and what public health authorities — in particular ministries of health — should be doing to protect people’s health. It sounds easy but often it is not. We work in a context where we do not have full scientific or epidemiological information, so there has to be a consultation process between us and the scientists, and then with our clients, the ministries of health, and with other stakeholders. We need to decide whether WHO should recommend precautionary measures, for example, when we are dealing with health threats that can cause irreversible damage.
Q: Does your work bring WHO into conflict with industry?
A: Over the last few years more and more big companies see that it is in their long-term interest to have a safety, health and environmental policy which they can apply to themselves as well as to their suppliers and distributors. Occasionally you hit on an issue where you cannot identify a real viable alternative for industry. That is when things can get rough. We have seen this in the past with the tobacco industry, now the sugar industry and, in our field of interest, it’s the asbestos mining industry.
Q: Why is a sector-wide approach to health needed and how does this work?
A: If a developing country is donor attractive, the last thing you want is to have national government funding for these sectors running in parallel to that of donors. A sector-wide approach allows the government to state where it would like to invest itself and where it would welcome donor support. In its current incarnation the sector-wide approach is fairly new, but there have been precursors. WHO has also developed a guidance note on how the UN system could and should participate in sector-wide approaches.
Q: What progress has your cluster made in terms of supporting Member States through the Country Focus Office?
A: As a pilot project, we started by assessing what it would take to re-profile the country offices of Kenya, Malawi and the United Republic of Tanzania to be responsive to the needs of each country’s health sector. Africa is the region that has most actively embraced this approach. These countries have formed at least one country cooperation strategy and are in the process of replicating the experience in Kenya to re-profile all their country offices.