Information Services and Use

Data on which to base the setting of priorities for implementing strategies to reduce public health risks must be of sufficient quality to justify semiquantitative risk assessment. Clusters of negative health outcomes have traditionally alerted authorities at local or national levels to the potential need for regulating suspected environmental hazards, although most initial observations neither reach statistical significance nor uniquely identify putative insults. Four classes of risk factors (environmental and occupational exposures, lifestyle, individual susceptibility, and access to and quality of primary health care) may each account for approximately one quarter of the observed variations in death from the most common causes (e.g. heart and cerebrovascular disease, cancer, and accidents). Preliminary evidence within Europe shows that local mortality from these and other causes can vary by a factor of 2 to 6 regardless of the scale of the region examined, strongly implying a fractile-like structure to the non-uniformity of possibly random health data. This suggests that efforts to identify causes of variations in health outcome cannot be successful without a region-wide, reasonably unified data set of health outcomes and potential risk factors. Several alternative strategies for establishing a Unified European Environmental Health Database are considered, together with possible mechanisms for providing basic information for the management of suspected environmental health hazards and quantified health risks.

Administrative data collected in large registers such as the Danish National Inpatient Register can be used to generate and even test hypotheses on associations between environmental health hazards and hospitalization. This paper describes the necessary record linkages and transformations before an outcome file can be made available in a database. Special attention is drawn to the question of confidentiality.

In order to meet the demand for better tools to support interpretation of statistical data on health outcome, hospital registry data, and data on occupational health in terms of establishing correlation between health and occupational and environmental factors, it has been suggested to establish a new European database on environmental health. Since, however, there already exist numerous collections of relevant data in many European countries, it might be preferable to aim at a solution which as far as possible could utilize already existing data and information, and improve existing data through a systematic effort to supplement the collections with additional data, where necessary. A number of exploratory contacts between WHO and relevant European institutions have already taken place in the first part of 1988 in order to set up a framework for further action. As a follow-up of these contacts the Berlin workshop on environmental health data has been arranged with the aim of discussing:

– the need for a database (or an integrated system of databases) on environment health;

– the possibilities and requirements for expert systems to support interpretation of environmental health data and analyze correlations between health risks and environmental and/or occupational factors;

– identification of data collections suitable as a basis for a joint environmental health system;

– identification of barriers for merging of data from different collections;

– specification of optimal data collection and registration for a joint system;

– specification of requirements for WHO and/or national strategies for collection of health data as basis for identification of health risk factors;

– recommendations to WHO for further action in view of the comments from the participants in the workshop.

As a basis for the discussions at the workshop a brief state-of-the-art-report is presented on two areas, where recent developments might contribute to meet demands for appropriate use of existing data collections and for creation of systems, which could support analysis, planning and decision making in environmental and occupational health.

Since the 70's the Commission of the European Communities has been developing an original databank on the impact of chemical substances on man and his environment. The original project was conceived as a research topic and was executed both by the Indirect Action programme of the Commission and by the Commission's own research establishment in Ispra (Italy). The data bank has been operational for more than 5 years through Datacentralen in Copenhagen and can be used worldwide. The unit who has been building ECDIN has acquired a considerable experience in databank building and chemical information handling.

The IRPTC was established by the United Nations Environment Programme (UNEP) in 1976, upon the recommendation of the United Nations Conference on the Human Environment held in Stockholm in 1972. It consists of a central unit and a network for information exchange. The main objective of IRPTC is to provide information adequate for the assessment of the hazards to health and the environment posed by chemicals. It is designed primarily to assist authorities responsible for protection of human health and the environment, however, its services are available to everyone.

Can cancer registry data routinely collected serve a purpose beyond the simply descriptive, and in particular, can they have a role in the investigation of environmental hazards? In this working paper, we review the means by which routine cancer registry data can be used in hazard identification, and describe the extent of coverage and availability of cancer incidence data in the European region.