1. Introduction

2. National Action Plan for Environment and Health
2.1 Background for the action plan
2.2 Contents
2.3 Organisation of the work
2.4 Follow-up and evaluation of the work

3. Goals and principles
3.1 Main goals
3.2 Principles

4. Institutional framework
4.1 Administrative structure
4.2 Legislation and regulations
4.3 Supervision
4.4 Monitoring
4.5 Information
4.6 Advisement
4.7 Economic instruments
4.8 Research

5. Environmental Challenges
5.1 Outdoor air quality
5.2 Indoor climate
5.3 Noise
5.4 Water quality
5.5 Food contaminants
5.6 Chemicals threatening to health and environment
5.7 Injuries
5.8 Radiation
5.9 Outdoor recreation
5.10 Qualities of place – cultural environment and architecture

1. Introduction

The World Commission on Environment and Development presented its report "Our Common Future" in 1987. When Gro Harlem Brundtland was asked why there wasn't a separate chapter in the report about health, she replied: "Every page of this book is about health." 1Dr. Wilfred Kreisel, WHO Geneva, lecture about 'Strengthening Environmental Health Services and the new Health for All in the 21st Century, The International Federation of Environmental Health, 5th World Congress, Stockholm, June 7-12, 1998.

A sound and health-promoting environment is a necessary condition for good health. Negative environmental conditions such as environmental toxins, air pollution and noise represent a threat to health in both the short and long term. In addition, positive environmental conditions such as qualities of place, identity and belonging, aesthetics, outdoor activities, recreation and cultural experiences, etc., help give people health to cope with the demands of everyday life. In the long term, maintaining stable ecosystems and sustainable use of nature's resources is a pre-requisite for "Health for All" in coming generations. There is also reason to believe that environmental protection work will be better understood and given higher priority if its relationship to human health and well being is brought into focus.

This approach to health originated in the "Health for All" strategy of the World Health Organisation (WHO). This strategy focuses on wide public participation in the work to promote health, and on the need to create conditions that encourage local communities to make a contribution and participate in creating a health-promoting environment. The Local Authority Health Care Act, which provides the framework for the health authorities' work with environment and health, is founded on the ideology of "Health for All," that is, that the local community is the most important arena for the public health sector.

"Health for All" agrees more or less completely with Agenda 21, and in particular with Local Agenda 21 (LA21). Local Agenda 21 emphasises the importance of thinking in a long-term perspective, over generations, and of focusing on children's situation particularly. The methodology for implementing Local Agenda 21 clearly emphasises citizen participation and the responsibility that rests on local politicians and the public administration system for information and transparency.

"Health for All" and Local Agenda 21 are about social development which activates citizens to participate in forming their own physical and social local environment. Through this action plan, the Ministry of Health and Social Affairs and the Ministry of Environment want to signal the importance of this idea and set goals which will help create as favourable conditions as possible for Local Agenda 21 work in municipalities and counties.

2. National Action Plan for Environment and Health

2.1 Background for the action plan

In June 1994, the ministers of environment and health in the World Health Organisation approved a European action plan for health and environment. They agreed to develop national action plans to follow up the European action plan at the national level (the Helsinki Declaration). The national action plan should be a joint action plan for the health and environmental authorities in the country, whose purpose it is to integrate these sectors' goals and activities in the fields of health, environment and development. According to the declaration, the plan should be an integral part of, or closely linked to, other national governmental action plans for environment and health, and particularly those related to the UNCED 2United Nations Conference on Environment and Development. process. The situation in each country should be taken into consideration when assigning priority to various activities in the plan.

The following fundamental principles were established for the work with national action plans for environment and health:

• To support solidarity, both among nations and within each country
• To adhere to the subsidiarity principle, that is, that decisions should be delegated to the most local level and that actions and decisions should be made at the most appropriate and effective level
• To ensure sustainable development through appropriate actions in the environment and health sectors to meet the needs of today's population without compromising the ability of future generations to meet their needs, and
• To practice co-operation and partnership, not only between the environment and health sectors, but also with other sectors and co-operating partners.

The action plan described here constitutes Norway's follow-up to the Helsinki Declaration.

2.2 Contents

The action plan contains goals and principles as well as operative goals and appropriate actions. It also includes an appendix with a description and assessment of general instruments that can be used, such as administrative system structure, regulations and supervision, monitoring, advisement, economics, etc. The appendix also includes a status report and analysis of efforts to respond to specific environmental challenges.

This action plan encompasses the national government's goals and actions in the area of environment and health. It does not exclude the possibility that actions may be directed toward municipalities, or that the national government sets goals for work at the municipal level.

The plan includes primarily areas of common interest to both the health and environmental authorities, and where better integration or co-operation is needed. Based on a preliminary analysis as well as the European action plan for environment and health, and the Helsinki Declaration, the following themes have been selected: outdoor air quality, indoor air quality, noise, water quality, food contaminants, chemicals, accidents, radiation, outdoor recreation, and qualities of place (including cultural environment and aesthetics).

Viewed in light of the health status of the entire population, this action plan thus includes only some of the factors that influence health. The plan does not directly address a number of very important conditions such as smoking, nutrition and factors in the social environment. These are nonetheless indirectly addressed through strengthening of general instruments such as supervision, advisement, administrative structure, etc.

2.3 Organisation of the work

In 1995 the Ministry of Health and Social Affairs and the Ministry of Environment appointed an interdisciplinary working group to review the situation today with regard to health and environment. The report was presented in April 1996, and included an overview of the most important health problems that can be related to environmental conditions. The review also included a discussion of general instruments that can be used to achieve national goals.

This report provided the basis for further work with the action plan itself.

Work to develop the action plan was led by a steering group at the level of deputy secretary in the Ministry of Health and Social Affairs and the Ministry of Environment. The practical work was done by a working group under the leadership of the Ministry of Environment and with representatives from the Ministry of Health and Social Affairs, the Ministry of Local Government and Regional Development, National Institute of Public Health, Norwegian Board of Health, Norwegian Pollution Control Authority, Norwegian Radiation Protection Authority and the Research Council of Norway.

There were two sub-groups. The first was led by the public health institute and compiled research-based knowledge on the effects of positive and negative environmental factors on health, and assessed monitoring systems and research needs. The other was led by the Norwegian Board of Health and was responsible for working methods for advisement and administration in the area of environment and health, primarily at the municipal level.

The first part of the work with the action plan was done in parallel with formulation of Report to the Norwegian Parliament nr. 29 (1996-7) Regional Planning and Land Use Policy, and Report to the Norwegian Parliament nr. 58 (1996-7) Environmental Policy for a Sustainable Development. Through these papers, the government and Parliament have already taken a position on the main goals developed through work with the environment and health action plan.

2.4 Follow-up and evaluation of the work

Possible revision and extension of the action plan will be discussed in connection with the sectoral environmental plan for the Ministry of Health and Social Affairs (see Report to the Norwegian Parliament 58 1996-97: Environmental policy for a sustainable development).

Prior to this, an evaluation of the action plan will be carried out. During year 2001, the steering committee will initiate an evaluation.

The steering committee holds regular meetings throughout the implementation period to assess how the plan is being followed up (see Chap. 4.1).

2.5 Economic and administrative aspects

The action plan encompasses goals and actions to strengthen and co-ordinate the general administration of environment- and health issues, such as administrative structure, regulations and supervision, monitoring, advisement, research and development work, economics, etc. It also includes goals and actions directed toward specific environmental challenges such as outdoor air quality, indoor air quality, noise, water quality, food contaminants, chemicals, accidents, radiation, outdoor recreation, and qualities of place (including cultural environment and aesthetics). Where issues are covered by other action plans (such as accidents and indoor climate), those action plans are co-ordinated with the action plan for environment and health. The environment and health action plan has also been harmonised with the Ministry of Environment's efforts to implement Local Agenda 21.

The work with the action plan has been a process lasting several years. Central elements such as new goals for health and environment and some of the instruments have been clarified through Report to the Norwegian Parliament nr. 58 (1996-97) Environmental Policy for a Sustainable Development, and Parliamentary Proposition nr. 1 for 1996-97, 1997-98 and 1998-99.

Since the goals and actions described in the action plan essentially constitute a co-ordination of already existing activities and are based on already approved political goals and framework budgets, the actions described will not require additional resources. Where the action plan identifies a need for expansive instruments and actions, this is formulated as a proposal for consideration, and would be dealt with through ordinary procedures such as routine work with budgets, laws and regulations, etc.

3. Goals and principles

3.1 Main goals

By the year 2000, the Norwegian government will develop and begin implementation of a co-ordinated strategy for environment and health which will contribute to an ecologically sustainable development, protect the population from health threats in the environment and secure environmental quality, such that the entire population can live in sound and health-promoting environments.

3.2 Principles

The following principles are the basis for national health- and environment authorities' work with environment and health:

1. Co-ordination of goals, actions and activities

• The regulations, norms, supervision, reporting requirements, economic instruments, information and advisement of municipalities by the national health and environmental authorities will be co-ordinated in areas where it is relevant to do so.

2. Sustainable development

• In this context we mean by sustainable development:

a) a clearer connection between local actions and global consequences

b) renewed and revitalised local democracy

c) a long-term perspective on developmental trends

d) co-ordination and coherence in a world that operates in sectors

e) a debate about values as they relate to ecological and social sustainability

1. Solidarity

• Solidarity in this context means creating conditions that will give as equal as possible distribution of environmental goods among people. This includes distribution both geographically and between generations, including future generations. Special actions should be taken for vulnerable groups (see Agenda 21, Chap. 6) and areas with the poorest environmental qualities. International solidarity should also be demonstrated.

2. The subsidiarity principle

• The subsidiarity principle means that actions should be taken and authority exercised at the most appropriate level.

3. Co-operation with other sectors

• Co-operation with other sectors means that the health and environmental authorities should work informatively and co-operatively with other sectors toward the goal of integrating health and environmental aspects into the goals and actions of those sectors as well as possible.

In addition to the above principles from the Helsinki Declaration, the following principles will also be fundamental:

1. Actions shall be based on documented facts to as great extent as possible (see European Charter on environment and health).

2. When the factual basis is inadequate or uncertain, the precautionary principle will apply (see the Rio Declaration and principle 2c).

3. Favourable conditions shall be created for continual learning and improvement in the work with environment and health at the national, regional and local level (see Health for All, point 31).

4. To as great an extent as possible, health promotion and prevention efforts shall not be presented as competing with the priorities of the curative health services (see Report to the Norwegian Parliament 37, 1992-93).

5. The citizens involved have a right to information about environment and health conditions, as well as a right to participate in decisions affecting their own environment and health (see Rio Declaration, principle 10, Health for All and the Århus convention on citizens' environmental rights).

6. Actions directed particularly toward children and youths (see Agenda 21, Chap. 6, p. 10).

4. Institutional framework

4.1 Administrative structure

Stronger co-ordination between the environment sector and health sector
is needed, both centrally and at the local level.

Instruments for the preventive health aspect of the health sector are largely administered by the municipality. The national government plays a relatively small role by communicating national expectations and co-ordinating with the environment sector. In the environment sector, on the other hand, there is heavy involvement of national government administration at the central and regional levels, but limited instruments and initiatives at the municipal level.

These differences must be reduced so that the central health and environment authorities co-operate on national policies. The county governor and the county medical officer focus on co-ordination and communicating expectations to the municipalities. They also report back on results and the need to change policy instruments and stimulate the Local Agenda 21 processes through transfer of competence.

Local Agenda 21 represents a common challenge and new possibilities for Co-operation between the environment and health sectors at all levels. To as great extent as possible, municipalities should set their own goals and priorities for environment and health, in consultation with their citizens. In practice this means that the expectations of the national government for municipalities should emphasise the municipality's community planning, and whether this gives integrates environment and health concerns adequately, rather than specific conditions such as noise, accidents, air pollution, etc.

The national government's advice, guidance, reporting requirements and supervision should reflect this by increasingly focusing on planning and implementation processes rather than specific issues. Regional planning is an important arena for co-ordination between the national government and municipalities. Co-ordination through regional planning should therefore be strengthened and developed.

Operative goal 1

By the end of year 2000, the national environment and health authorities shall develop a common set of priorities for environmental issues that are important for people's health, through a continuation of the co-operation begun by the action plan process. A common policy specifying instruments and responsibilities of various levels in the administrative system will be communicated to the regional and municipal level as well as to other sectors.

Operative goal 2

By the end of year 2000, the environmental authorities shall transfer authority for enforcing their special legislation to the municipalities, for environmental issues of a clearly local nature.

Operative goal 3

By the end of year 2000, the county medical officer and county governor shall co-ordinate their activities at the regional level as necessary, such that expectations in the area of environment and health which are communicated from the national to the municipal level are consistent and in agreement with national government policy. They shall also provide relevant feedback to the central level about development trends in the municipalities and the need to adjust policy instruments.

Operative goal 4

The health- and environmental authorities shall stimulate municipalities to give priority to Local Agenda 21 processes, embrace a health-for-all approach and give weight to health and environment in their decisions.

4.2 Legislation and regulations

The municipal government act provides guidelines for how strongly the sectoral shall direct the organisation of municipalities, to ensure that tasks required by law are attended to.

The Plan- and Building Act provides a good platform for co-ordinating environment and health at all levels. The health dimension related to land use questions and preservation of environmental qualities are significant issues, but are only to a small degree articulated and integrated in planning processes.

By transferring authority for the special legislation of the environment sector to the municipalities, the situation will become very favourable for co-ordinating the pollution control act and the Local Authority Health Care Act. This transfer of authority should be viewed in light of the work with new regulations for preventive environmental health under the Local Authority Health Care Act.

Operative goal 1

The legislation on health and environment should be formulated such that it creates favourable conditions for municipalities to work systematically and in the long term with environment and health, and within an overall sustainability perspective (social, ecological and economic).

Operative goal 2

Health- and environment issues shall become more prominent in decision-making processes in regional planning related to land use policy.

4.3 Supervision

There is a great need to strengthen the role of municipalities as supervisory authorities. This can be done through training and guidance of the municipal quality auditors. It is also a challenge for municipalities to carry out control of activities in such a way that unreasonable national discrepancies in the enforcement of laws and regulations do not occur.

Better co-ordination of the national government supervisory authorities should be ensured at the national and regional level.

A challenge facing national government supervisory authorities is to ensure better co-ordination of their own activities at the central and county level, and to ensure that the supervisory authority of municipalities is exercised in a systematic and accountable manner.

Operative goal 1

The municipality and county will be encouraged to implement efficient and holistic management systems in the area of environment and health. This means that supervision methods will stimulate municipalities and counties to start up processes that will ensure systematic and continual improvement of the work with environmental factors important for health.

Operative goal 2

The county medical officer and the county governor shall co-ordinate their supervisory activities as appropriate in the area of health and environment. This co-ordination may include common methodology, co-ordination of supervision and possibly combined supervision, where the county medical officer and county governor find this to be appropriate.

Operative goal 3

Through advisement and training, the municipalities will become enabled to carry out appropriate systems supervision of enterprises according to the regulations under the Local Authority Health Care Act.

4.4 Monitoring

There is a need to co-ordinate health- and environmental monitoring.

There is a need for extensive mapping/monitoring for most of the topics included in the national action plan.

Further, there is a need to consider whether current monitoring of health effects related to environment is adequate.

Operative goal

In 1999, a common strategy for monitoring health effects related to the environment and environmental factors related to health shall be developed.

4.5 Information and participation

The government will use information more actively to increase motivation for environmental work, to strengthen democracy through processes of genuine participation and communication, and to increase understanding and acceptance of environmental protection policy. Information and communication will be used as a separate instrument to some extent, but also to increase the effectiveness of other instruments.

The planning, implementation and evaluation of information activities must be based on the goals and principles for government information policy.

The main goals of the policy are:

• to ensure individual citizens and enterprises genuine access to information about activities in public administration;
• to ensure individual citizens information about their rights, duties and opportunities; and
• to ensure equal and universal access to participate actively in the democratic process.

4.6 Advisement

Conditions should be created such that research-based information about the relationship between environment and health is available in as simple and understandable form as possible.

Methods and tools for experience-based learning should be made available in as simple form as possible. Through their management systems, these methods should promote better local management of work with environment and health.

Conditions should be created such that these experience-based tools and methods will be systematically developed and improved.

Personnel in the field of environment and health should receive active guidance about municipal planning- and management processes.

Non-government organisations play an important role in collecting and spreading knowledge about environment and health that is significant for local policy and administration.

Operative goal 1

A standardised manual shall be developed and maintained containing generally accepted norms in the field of health and environment, and in which the most important interactions between environmental factors and health are presented and graded so that they can be compared.

Operative goal 2

Favourable conditions shall be created for effective distribution, communication and use of knowledge about interactions between environment and health, and for feedback from users about the information material.

Operative goal 3

Guidelines and advisory materials in the area of environment and health shall be periodically assessed for importance and consistency with each other. Based on this assessment, they shall be revised in as co-ordinated a manner as possible. As part of this work, favourable conditions will be created for recording experiences from Norwegian municipalities and international experiences, and making these available to other municipalities in the best way possible.

Operative goal 4

Advisement of personnel in the field of environment and health in the area of municipal planning and steering processes, shall be strengthened.

Operative goal 5

The environment- and health authorities shall work together toward the goal of integrating relevant knowledge about environment and health into health education and education of social planners. Further, personnel in kindergartens, schools and extracurricular programmes shall also have the competence needed to utilise environmental qualities in their pedagogical programmes.

4.7 Economic instruments

Economic instruments, because of their characteristics, should play a more central role in environmental policy. This is due to the nature of several of our most serious environmental challenges. The greenhouse effect, spreading of chemicals dangerous to health and the environment, and local pollution problems all come primarily from numerous small emissions from houses, cars, various products, etc., rather than from single, large point sources. In cases where environmental degradation is due to many small sources, especially, the environmental authorities will not have adequate information about the costs of reducing the emissions. By using fees, the authorities don't need to know the costs of reducing emissions at each source. Environmental fees can thus contribute to cost-effective change, that is, change at the lowest possible cost to society. Saleable quotas have similar properties.

Deposit/return systems and subsidies are other economic instruments that may be appropriate in some situations.

We refer to the discussion of goals and instruments in Chapter 5.

4.8 Research

Research activity related to environmental factors in the indoor and outdoor environment needs to be intensified. This includes indoor climate, drinking water, radiation protection as well as effects of external environmental factors on health, including air pollution and chemicals that present a threat to environment and health. Norway needs active research institutions in order to benefit from the knowledge that is rapid being generated in this field internationally. It is important that the existing research programmes relevant to environment and health be prolonged. Further, the research institutions have called for increased support for research on food quality, consumer safety, accidents and environmental conditions that have a positive influence on health. More research is also needed on traffic, environment and health.

Operative goal 1

Knowledge generation through research that functions as a useful tool for consumers and is relevant to issues facing the administration system shall be given high priority.

Operative goal 2

Generation of knowledge about prevention of accidents having broad health consequences for the public, and accidents that are of particular concern to the population and society, shall be increased.

Operative goal 3

Knowledge generation about environmental conditions that have a positive influence on health, and how society can make use of such knowledge, shall be strengthened.

Operative goal 4

The environment- and health authorities shall be fully aware of the need for research and development work.

5. Environmental Challenges

5.1 Outdoor air quality

Many people are exposed to health-threatening air pollution, especially in large cities. The steering instruments available to reduce local air pollution problems are spread over many different authorities and administrative levels, and are not co-ordinated well enough. Closer co-operation among these authorities is needed in the areas of data collection and reporting, research and instruments. A total review and assessment of instruments has already begun.

Existing national goals

The Ministry of Environment has formulated the following strategic goals and target goals for air pollution (Parliamentary Proposition nr. 1, 1997-98):

Strategic goal:

Air pollution and noise problems shall be prevented and reduced such that peoples' health and well being are protected.

Target goals:

By the year 2005, the daily average concentration of dust (PM ₁₀) shall not exceed 50 µg/m ³> more than 25 days per year. By year 2010, this limit shall not be exceeded more than 7 days per year.

By year 2010, the hourly average concentration of nitrogen dioxide (NO ₂ ) shall not exceed 150 µg/m ³ >more than 8 hours per year.

By year 2005, the daily average concentration of sulphur dioxide (SO ₂) shall not exceed 90 µg/m ³>.

By year 2010, the background concentration of benzene in city air shall not exceed 2 µg/m ³>, calculated as an annual average concentration.

5.2 Indoor climate

Goals and instruments for indoor climate have been formulated on the premise that asthma, allergy and illness related to indoor climate constitute a major health problem. As a group they are one of our most important common health problems, and cause significant suffering, chronic illness and resource use.

Relevant instruments for preventive work with asthma, allergy and illness related to indoor climate are found primarily in the health sector, but also within other sectors' areas of responsibility. It is thus critical to co-operate across sectors. On this background, an interdepartmental action plan has been developed to prevent asthma, allergy and illness related to indoor climate.

Like other chronic diseases, asthma and allergy are the result of an interaction between genetic and environmental factors. Because of the central role played by the environmental factors, the potential for prevention is large. This assumes, however, that risk factors can be identified and that enough knowledge exists about how these can be reduced or eliminated.

It is important to note, however, that much is still unknown in this field, including the most important risk factors are and the most susceptible age groups. Internationally there is a great deal of research and discussion. We can therefore expect that more knowledge will become available in the coming years that will give a basis for reorienting prevention efforts. The goals for targets and instruments must be based on today's knowledge. Although we lack new knowledge about asthma, allergy and diseases related to indoor climate, we do have adequate knowledge in a number of areas about what increases the risk of developing susceptibility to these illnesses and to trigger their symptoms.

Existing national goals

National goals were set by Parliament in connection with Report to the Norwegian Parliament 37 (1992-93), Challenges in health promotion and prevention efforts: (unofficial translation)

"By the year 2002, co-ordinated planning and actions to reduce health-threatening indoor climate shall, together with health-promoting behaviour and knowledge and early intervention in the course of the disease, stop the increase in asthma and allergy among children under 7 years of age, and reduce illness and improve functioning in all age groups."

Operative goals

Based on this overall goal, eight main operative goals were further specified in the Action Plan for prevention of asthma, allergy and indoor climate illnesses:

• Increased knowledge in the population about central risk factors.
• Indoor environments as free of allergens as possible in kindergartens and schools.
• Reduced exposure to health-threatening factors in the indoor environment.
• Reduced outdoor air pollution from various sources.
• Better co-ordination of registration and diagnostics procedures.
• Increased research-based knowledge about disease incidence, causes, risk factors and mechanisms.
• Greater opportunities to avoid substances and products which are not tolerated.
• Increased knowledge among those who suffer from asthma and allergy about how illness can be reduced and ability to function improved.

These goals include asthma and allergy related to other conditions than indoor climate, but most of them are also relevant to the issue of indoor climate.

The following is an overview of actions and instruments with corresponding target goals, taken from the Action Plan for prevention of asthma, allergy and indoor climate illnesses. Only actions related to the Ministry of Health and Social Affairs and the Ministry of Environment are included here.

Target goal 1

The population shall be informed about what actions should be taken to improve the indoor climate in private homes, especially as related to humidity, carpets and pets.

Target goal 2

Schools and kindergartens shall be planned and run such that asthma, allergy and illness related to indoor climate are prevented.

Target goal 3

By Dec. 31, 1999, schools and kindergartens shall be able to document that the indoor climate conforms with regulations.

Target goal 4

The competence of kindergarten and school personnel about conditions at each workplace relevant to indoor climate, shall be increased.

Target goal 5

Municipalities and relevant professional institutions shall be familiar with new standards for indoor air quality.

Target goal 6

The proportion of the population exposed to involuntary passive smoking shall be reduced.

Target goal 7

All expectant parents and parents of babies and small children shall be aware that passive smoking can increase the risk that children will develop respiratory diseases and may cause a worsening of existing illness.

Target goal 8

Increased knowledge about:

• The importance of indoor climate for development of asthma and allergy, and better baseline data on incidence of these illnesses.
• The effect of measures taken, in terms of both health and economics.
• Effective intervening actions in prevention work.

5.3 Noise

Many people suffer from exposure to noise. The noise originates from many different sources and comes under the jurisdiction of many different authorities and administrative levels. A detailed review is needed of the instruments available, to clarify how they can be used more effectively and co-ordinated among the various central, regional and local authorities. To obtain the best possible information base for decision-making, more research and monitoring are also needed.

Existing national goals

The Ministry of Environment set up the following strategic goals and target goals for noise in Parliamentary Proposition 1 (1997-98):

Strategic goals

Air pollution and noise problems shall be prevented and reduced such that peoples' health and well-being are protected.

Target goals

Significantly improved air quality in cities and towns by the year 2005 compared to 1994.

A detailed review of goals and actions is planned for 1999. Operative goals for noise have therefore not yet been formulated.

5.4 Water quality

Existing regulations and guidelines describe how illness due to contagions and other health problems shall be prevented, both for drinking water supplies and for natural and swimming pool bathing water. Many facilities don't fulfil the requirements in the regulations. To promote compliance with the regulations, the government has a "Program for water supply" which can give economic support to improve water plants that don't satisfy the requirements. It has been decided that this program will be continued. In addition, a better overview of the status of small, unregistered water supply facilities is needed.

Existing national goals

When establishing the "Program for water supply" in 1995, the government set the following goal: (unofficial translation)

Water plants that deliver water to the general population or to the food industry, shall deliver adequate amounts of water having quality which is hygienically satisfactory and acceptable to users.

In Parliamentary Proposition 1 (1998-89), the Ministry of Environment set the following goal:

In fresh waters and marine regions, a water quality shall be ensured which maintains species diversity and ecosystem function, and which protects the health and well-being of people. This means that the water quality in terms of nutrients, particles, organic material and oil shall satisfy user- and/or environmental protection interests related to fresh water, fjords and marine areas.

Operative goal 1

Water plants that deliver water to the general population or to the food industry, shall deliver adequate amounts of water having quality which is hygienically satisfactory and acceptable to users.

Operative goal 2

All drinking water supplied to households and the food industry from small, unregistered water supplies shall be hygienically satisfactory.

5.5 Food contaminants

Most of the issues related to food contaminants have been regulated for many years, and there are no data suggesting that food contaminants have direct effects on health in Norway. To maintain this preventive approach, it is important to continue monitoring and mapping activities. More knowledge is needed about intake/exposure in susceptible groups such as children, the elderly, patients and groups that consume large amounts of particular foods.

Oversensitivity reactions due to contaminants should be investigated more closely. Studies are needed on body doses/levels of contaminants in blood, urine and milk, especially for environmental toxins (heavy metals, chlororganic compounds and toxins from moulds).

Increased international trade in foodstuffs and increasing amounts of travel present a challenge to today's systems in terms of preventing disease due to contagions. There is a need to develop and improve systems for mapping and monitoring pathogenic organisms in food and drinking water, including more effective use of the data.

Contagions found in foodstuffs and bacteria that are part of the natural microflora of the foodstuff can be naturally resistant or can develop resistance to antibiotics. There is also reason to focus on possibly transferable genes for resistance in bacteria used to produce various fermented products (including cheese, yoghurt and dried sausages).

Existing goals

Foodstuffs offered to the public shall be safe for health.

Operative goal 1

Reduced exposure to food additives in situations where the approved daily limits for intake may be exceeded.

Operative goal 2

The presence of pesticides in foods shall be reduced as much as possible and shall not exceed the approved limits.

Operative goal 3

Reduced unintentional exposure to allergens in foodstuffs.

Operative goal 4

Reduced risk that microbes in food develop resistance to antibiotics, and reduced the risk that resistant microbes are transferred from food to humans.

Operative goal 5

Incidence of environmental toxins (metals, halogenated organic compounds) in foods shall be reduced as much as possible and intake shall not exceed tolerated amounts.

Operative goal 6

Reduced exposure to contaminants produced by industrial processes (heterocyclic amines, PAH).

Operative goal 7

Food packaging shall not present a threat to health.

Operative goal 8

The National Institute of Public Health and the Norwegian Food Control Authority shall have better knowledge about the impact of natural toxins on health.

Operative goal 9

Foods shall not contain disease-causing micro-organisms.

Operative goal 10

Genetically modified food shall not constitute a threat to health.

Operative goal 11

The causes of food-borne infections shall be identified and eliminated.

5.6 Chemicals threatening to health and environment

Chemicals make everyday life easier, but at the same time they carry a threat of serious effects on the environment and people's health, both at the workplace and in private life. The level of protection in Norway is nevertheless high, compared to other countries. Through the Agreement for the European Economic Area, Norway has full rights and obligations in the great majority of issues related to chemicals, and this ensures harmonised legislation. Few instruments other than juridical regulation have been used. Several new approaches are about to be put into practice, such as required substitution, more concrete criteria for undesirable properties, and lists of undesirable chemicals. An overall strategy for utilizing information about chemicals and health should be developed co-operatively by the health-, environmental- and consumer authorities.

Knowledge about the potential health effects of chemical substances is inadequate: for example, the effect of long-term low dose exposure, interaction among chemicals, and types of exposure conditions that are unique for Norway. The number of new professional personnel who can provide the authorities with knowledge about these issues should be significantly improved.

Monitoring of the concentration of chemicals in the environment and developing effective indicators that link exposure and health effects should be a priority area in the future, and co-operation between the relevant authorities must be formalised. Supervision and controls are an example of established co-operation that functions well.

Existing national goals

Discharge and use of chemicals dangerous to health and the environment shall not cause damage to health or to nature's ability to produce and renew itself. Concentrations of the most dangerous chemicals in the environment shall be reduced to near background levels for naturally occurring substances, and to near zero for anthropogenic compounds (Parliamentary Proposition 1, 1997-98, Ministry of Environment).

Existing target goals

Discharge of specific environmental toxins (see the priority list in Report to the Norwegian Parliament nr. 58 (1996-97) and Parliamentary Proposition 1 (1997-98)) shall be stopped or significantly reduced by year 2000, 2005 and 2010.

Discharge and use of chemicals dangerous to health and the environment shall be continually reduced, with the goal of stopping the discharges within one generation (25 years).

The risk that discharge and use of chemicals will cause damage to health and the environment shall be significantly reduced.

Operative goal 1

The degree of protection of health and environment against damage by chemicals shall be continually improved.

Operative goal 2

Knowledge about the effects that exposure to chemicals dangerous to health and the environment have on health shall be significantly improved, with emphasis on exposure from diffuse sources and the ambient environment.

Operative goal 3

Better flow of and access to information about chemicals dangerous to health and the environment, to all kinds of users.

5.7 Injuries

The most important efforts to prevent injuries take place in municipalities and local communities. The efforts are organised as a co-operation among many actors, in which the public sector, volunteer and private organisations and citizens themselves participate. Municipal-based developmental work is therefore emphasised in the follow-up to the interministerial action plan, and is further ensured through the target goals and actions of "Safe communities." Experience has shown that immediacy and a feeling of responsibility for the challenges and tasks is important, and that preventive actions based on local injury statistics and high-risk conditions give measurable results.

Important tasks at the national level are, in addition to influencing framework factors such as laws, regulations and budgets, to contribute to increased knowledge and competence in the field through research and development work. Further, the national authorities use information, communication and network-building as instruments to ensure that the municipalities have access to knowledge and use this knowledge in their practical implementation work.

The National Institute for Public Health has an important function as supporting partner for the ministries' work to follow up the action plan. One important role is to stimulate the municipal sector to work for accident prevention, including responsibility for advisement, statistics on accidents and injuries and secretariat functions for "Safe local communities."

Existing national goals

The national goals for this field were set by Parliament in connection with Report to the Parliament nr. 37 (1992-93) Challenges in health promotion and preventive efforts: (unofficial translation)

By the year 2000, co-ordinated planning and development of a culture of safety at all levels of decision-making and in all sectors shall lead to a reduction in the number of injuries causing death, hospital admissions and medical treatment due to accidents.

Operative goals

The following main goals were set for this area in the interministerial Action Plan 1997-2002: Prevention of injury at homes, school and recreation:

• 25% reduction in death due to injuries from 1980 to year 2000.
• Injuries leading to hospital admission and medical treatment shall be reduced by at least 10% from 1993 to 2002.

Actions and instruments are taken from the Action plan for prevention of injury at homes, school and recreation. The target goals and actions/instruments are divided into various arenas for accidents: prevention of injuries in homes (including residences and residential areas, service homes for the elderly, nursing homes and fires in residences) prevention of injuries at school, kindergarten and playgrounds, prevention of recreational, sea-, lake and water injuries, prevention of sports injuries and prevention of injuries on streets, highways and railroads (not including traffic accidents). We present here the target goals and instruments which involve the Ministry of Environment and/or the Ministry of Health and Social Affairs.

Target goal 1

Improved knowledge about the factors contributing to injuries in residences, service homes and nursing homes.

Target goal 2

The elderly shall become familiar with how the most common home injuries among the elderly can be prevented.

Target goal 3

Municipal employees, others who work with elderly living at home, personnel who work with children and youths, and parents shall increase their competence in prevention of injuries, including risks of injury and actions to prevent specific kinds of injuries.

Target goal 4

In their zoning plans, municipalities shall set aside and secure areas and facilities in the local environment to be used by children and youths and ensure that kindergartens, playgrounds and schools are located and constructed such that they are safe from pollution, noise, traffic dangers and other threats to health.

Target goal 5

Schools and kindergartens shall have an internal control system which ensures health, environment and safety.

Target goal 6

Activity programmes offered to children and youths, including physical education at school, shall contribute to body awareness and control as a deterrent to injuries.

Target goal 7

The number of rescue operations caused by lack of knowledge about safety in unorganised outdoor recreation, shall be reduced.

Target goal 8

Sports leaders and participants should have knowledge about how sports injuries can be prevented.

Target goal 9

A co-ordinated and improved system for national and local sports statistics.

Target goal 10

Increased research-based knowledge about the effect of instruments.

Target goal 11

Co-ordinated information and efforts to strengthen and stimulate local work to prevent injuries.

Target goal 12

Networks and meeting places for learning, communication of information and knowledge, and transfer of experiences to strengthen and promote local injury prevention work.

5.8 Radiation

The greatest health problems in connection with radiation are related to radon in indoor air, radon in water and ultraviolet radiation. Radon is especially dangerous in combination with smoking.

An estimated 150,000 residences have a radon concentration in indoor air which exceeds the recommended level for remedial actions, 200 Bq/m ³>. Similarly, an estimated 20,000 households have a water supply which exceeds the recommended level for remedial actions, 500 Bq/l. It is important to identify the residences and ground water sources that have values exceeding the recommended level through focused surveys and mapping. Reducing the radon concentration in both indoor air and household water often involves simple and inexpensive actions.

According to the municipal health care act and the Plan- and Building Act, among others, municipalities play an important role in monitoring and informing the public about the existing situation locally, both in terms of remedial actions in existing buildings and requirements for constructing new buildings.

Regarding ultraviolet radiation, the municipalities have an important role in informing the public about protection from the sun and the damaging effects of excessive sun exposure. Further, municipalities are responsible for supervision of solaria. The municipality should be able to provide general information about low frequency and high frequency fields.

Operative goal 1

Change peoples' behaviour when sunning, through better knowledge about effects, health risks and prevention.

Operative goal 2

Municipalities shall have the competence needed for effective supervision of solaria.

Operative goal 3

The municipalities will become enabled to do their own assessments/supervision of sources of radio frequency and extreme low frequency fields.

Operative goal 4

Affected households shall be familiar with measures that can be taken to reduce the flow of radon from the ground. Radon level of all kindergartens in the country shall be measured.

Operative goal 5

Where remedial actions are or could be needed, geographic regions and food products shall be surveyed.

Operative goal 6

The concentrations of radioactive contamination in foods shall be monitored to be able to calculate radiation doses reaching the population, document the situation and make prognoses for trends over time.

Operative goal 7

The dose of radiation exposure due to radioactive contamination of foods shall be limited by monitoring and using allowable limits and feeding treatments before slaughter to reduce the radioactivity level.

5.9 Outdoor recreation

The main challenge for outdoor recreation work in the future is to ensure that all citizen have easy access to nature and recreational areas where they live. This pertains especially to the urban population and to children and youths. The health authorities must be ensured adequate capacity and competence to be able to become much more involved than at present in central issues about area use that have great significance for peoples' health and well-being.

Next, it is necessary to make active and sustained efforts to promote physical activity in natural surroundings and thus counteract the tendency toward sedentary indoor activities. Here a co-operation among sectors at all levels is important, and especially co-operation between the authorities and non-government organisations.

Local Agenda 21 processes in municipalities will be important arenas for developing networks and co-operation. It is important that both the health- and environmental authorities locally exploit this common opportunity to create popular participation in preventive health and health promotion work.

Operative goal 1

The health- and environmental authorities shall, together and individually, contribute to integration of outdoor recreation as a health policy instrument in all county plans and one-fourth of municipal plans by the end of the next plan period (year 2003).

Operative goal 2

By the end of year 2000, the health authorities and environmental authorities shall together contribute to documentation of the areal qualities/resources and environmental qualities of residences, schools and kindergartens in the ten largest cities. The documentation will be completed within a 10-year period for other municipalities containing cities and towns.

Operative goal 3

By the year 2001, the health- and environmental authorities shall, together and individually, contribute to at least 10% of Norway's municipalities having started projects related to green structure by the year 2001.

Operative goal 4

The health authorities and the environmental authorities shall, together and individually, make efforts to see that outdoor recreation becomes an integral part of activities at schools and kindergartens, which is widely used in preventive and health-promotion work in municipalities.

Operative goal 5

By the end of 1999, the environmental and health authorities shall compile research-based knowledge about outdoor recreation and health.

5.10 Qualities of place – cultural environment and architecture

There is a need to:

• improve knowledge about the relationships between health/quality of life and cultural environment in our physical environment;
• collect and systematise relevant knowledge based on experience and results of investigations;
• strengthen the contact between professional groups working with health and development of place;
• establish an interdisciplinary research and development effort in this field, for example through a separate research programme under the Norwegian Research Council;
• build professional competence to work with these topics within municipal and county planning departments; and
• establish permanent fora (or routines), both centrally and locally, for contact and co-operation between the authorities responsible for health and qualities of place.

Operative goal 1

Cultural history qualities shall be integrated into regional and municipal plans.

Operative goal 2

Knowledge about the importance of cultural heritage/cultural environments for health, well-being and quality of life, and as an element of preventive health work, shall be improved.

Operative goal 3

Access to, and distribution of, information about qualities of place shall be improved at all user levels.