Health Care Without Harm

Health Care Without Harm (HCWH) is an international coalition of more than 400 organizations in 52 countries working to transform the health care sector so it is no longer a source of harm to people and the environment. HCWH has offices in the United States (Washington DC, Boston and San Francisco), the European Union (Prague), South America (Buenos Aires), and South East Asia (Manila). HCWH also has close programmatic partnerships with organizations working on these issues in the African Region (in Durban, South Africa) and in the South Asian Region (Delhi, India).

HCWH has been working since the mid-1990's to promote the reduction and phase-out of sources of mercury pollution from the healthcare sector. This includes especially, promoting the phase-out of mercury-containing medical devices when reliable and affordable alternatives are available. HCWH has ten years experience in collaborative work on these issues with hospitals, health care systems, health care workers, other NGOs, medical device suppliers, government ministries and international agencies.

HCWH work on mercury began in the United States with mercury thermometer exchange campaigns and related efforts to foster local and state legislation. Building on this work, HCWH developed relationships with major medical device manufacturers; and entered into a formal collaboration with the American Hospitals Association, the American Nurses Association and the US Environmental Protection Agency. This diversity of efforts has significantly influenced the US health care sector and helped create an emerging national consensus on the part of doctors and nurses' associations, pharmacies, major hospital chains, and hospital group purchasing organizations to promote reliable and affordable alternatives to mercury-containing medical devices, and to work for their substitution. Already, more than 5,000 health care facilities in the U.S. have pledged to become mercury free and more than 15 states have banned mercury thermometers (For more information on this, see: http://www.noharm.org/mercury/issue).

HCWH is pursuing similar work in the European Union. We have worked in coalition with a diversity of partners to achieve a recently passed mercury thermometer ban. We are also working towards a phase-out of mercury-based blood pressure devices and a ban on the export of mercury and mercury-based products.

HCWH is also building its efforts in developing countries and countries with economies in transition. Among other efforts, HCWH is a principal cooperating agency in a Global Environment Facility project with the United Nations Development Program (UNDP) and the World Health Organization (WHO) entitled "Demonstrating and Promoting Best Techniques and Practices for Reducing Health Care Waste to Avoid Environmental Releases of Dioxins and Mercury".

This has been approved and will be implemented in eight participating countries: Argentina, India, Latvia, Lebanon, the Philippines, Senegal, Tanzania and Vietnam. This project will, inter alia, promote examples of mercury-free health care, and develop related training programs for health care workers, managers and policy makers. UNDP is the GEF Implementing Agency for this Project. HCWH and WHO are both Principle Cooperating Agencies. Full Project implementation is slated to begin in the third quarter of 2008.

In Association with UNEP, as part of the Products Partnership, HCWH has also organized four regional workshops in South East Asia, Latin America, Southern Africa and South Asia to promote alternatives to mercury in the health care sector in developing countries. These workshops have facilitated the formation of national and/or regional working groups to build capacity and develop strategies to substantially reduce and ultimately eliminate mercury use from the health care sector, and encouraged the launch of mercury-free health care pledges for specific hospitals and clinics in each of the regions. All four events, which took place in 2006-2008, were highly successful in achieving their stated objectives and have resulted in significant, tangible movement towards the phase-out of mercury in the health care sector.

HCWH has also engaged in a successful partnership with UNEP and USEPA to support efforts by the Buenos Aires City government to phase out mercury-based medical devices in 33 city-run hospitals. HCWH has also engaged in Products Partnerships with the North American Commission on Environmental Cooperation to pilot mercury free health care in two hospitals in Mexico City and to promote the development of more far-reaching action on mercury in health care in Mexico. As part of the ongoing partnership with UNEP, HCWH has also organized similar efforts in Malaysia, and plans are under way in Vietnam, India, Brazil and elsewhere. HCWH has also participated in the USEPA partnership to pilot mercury free health care in two hospitals in China.

WHO. World Health Organization

The World Health Organization (WHO), the international agency within the United Nations system responsible for health has a number of programmes that address the threats posed by environmental pollutants providing information and guidelines for risk assessment and management, for preventing human exposure and for improving the diagnosis, treatment and surveillance of health effects.

The Department on Public Health and Environment (PHE) and Regional Offices are committed to helping member states to achieve safe, sustainable and health-enhancing human environments, protected from biological, chemical and physical hazards, and secure from the adverse effects of global and local environmental threats. They facilitate the incorporation of effective health dimensions into regional and global policies affecting health and environment, and into national development policies and action plans for environment and health, including legal and regulatory frameworks governing management of the human environment.

In view of the particular characteristics that human exposure to mercury in the environment may have in different parts of the world, some of the WHO regional offices and agencies have developed specific activities that address specifically the regional needs. For example:

In many instances, WHO responds to specific requests from Member States, for example on how to address the issue of mercury derivatives in vaccines, in dental amalgams, in medical devices. In most instances the response requires a thorough review of the literature, the fast provision of existing guidelines, the preparation of basic study protocols or facilitating contacts with specialized centers or scientists with expertise on heavy metals and human environmental exposures. These cases may in many instances represent sentinel events that raise the awareness of WHO about emerging problems and call for international action.

The programmes and activities listed above represent selected examples of the different activities that WHO and some of its specialized units are developing in order to protect human health from mercury exposure. The work undertaken by WHO sectors in the areas of risk assessment, study methodologies, capacity building, prevention of exposure and response to specific country/regional problems related to mercury has resulted in a remarkable wealth of knowledge, experience and contacts.

A number of professional groups established for the preparation and peer-review of guidelines or training materials, for assessing risks to human health or for responding to concrete incidents due to contaminated environments represent a strong scientific support for the organization as well as a network with great potential for international activities.

WHO's cooperative research efforts, where scientists from developing and industrialized countries may share common interests and work using commonly agreed protocols enhance the chances for finding solutions for health problems in their national and global contexts. The results of internationally harmonized research studies can be used to implement prevention and remediation strategies, putting in place evidence-based public health policies at the country level. These and other collaborative activities also result in technology transfer and improved capacities, and in the build-up of a network of trained scientific collaborators throughout the developing world.

The presence of WHO in a large number of countries and its close contacts with specialized centers and scientific bodies (e.g. professional associations, NGOs,…) provides a highly qualified and strong network or system that facilitates both the dissemination and collection of relevant public health and environmental information, the implementation of activities and the response to international agreements and conventions in relation to mercury as a global health issue.