Environmental health

Fact sheet

Key facts

• Over the past 50 years, environmental pollution has intensified in Viet Nam due to rapid industrialization, urbanization and motorization, resulting in urban air pollution, the generation of solid and hazardous wastes, and numerous man-made disasters and emergencies.
• Pollution in urban areas is mainly due to suspended dust particles, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) gasoline, lead and noise.
• Major concerns for human health from dust particles include:
• effects on breathing and respiratory systems,
• damage to lung tissue,
• cancer,
• premature death.
• The elderly, children, and people with chronic lung disease, influenza, or asthma, are especially sensitive to the effects of particulate matter.
• Rapid industrialization is also polluting the air. Dust from cement factories coats much of Hai Phong, the third-largest city, exceeding government air standards by three to eight times.
• In Hanoi, ambient air pollutants have reached disturbing levels. Carbon monoxide concentrations are 1.5 to 1.7 times higher than permissible levels, nitrogen dioxide 2.5 to 2.9 times higher, settleable particulates 43 to 60 times higher, and suspended particulates 5 to 10 times higher.
• Total hazardous healthcare solid waste generated in Vietnam is around 47 tonnes a day. Wastewater generated from healthcare facilities is around 125,000 cubic metres a day (Source: Plan for implementation of Masterolan of Healthcare Waste Treatment in the period 2011-2015 and Orientation to 2020)
• Exposure to air pollutants is largely beyond the control of individuals and requires action by public authorities at the national, regional and even international levels.
• The lower the levels of air pollution, the better respiratory (both long- and short-term), and cardiovascular health of the population will be.

Health impact assessment

• Health Impact Assessment (HIA) is a means of assessing the health impacts of policies, plans and projects in diverse economic sectors, using quantitative, qualitative and participatory techniques.
• HIA helps decision makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health.
• WHO supports the tools and initiatives in HIA to dynamically improve health and well-being across sectors.
• HIA is used for:
• Assessing plans, project, programme or policies before they are implemented.
• Predicting the health impacts of these proposals.
• Recommending mitigation measures:
• to maximize positive health impacts and minimize negative health impacts; and
• to engage decision makers so that they consider health impacts and the determinants of health in their deliberations;

Challenges

• After several years of development by both the Ministry of Natural Resources and Environment and the Ministry of Health, the National Environmental Health Action Plan (NEHAP) was submitted to the Government, but was rejected in early 2012.
• The result is that Viet Nam is having to tackle environmental health problems without a comprehensive and systematic plan.
• At present, 53.6% of healthcare facilities have wastewater treatment systems. 95.6% of healthcare solid waste is classified and collected. 69.2% of hospitals have their hazardous solid waste treated by two-chamber incinerators or by non-incineration technologies or by a contract with outside services.
• Most incinerators cause air pollution (dioxin and furan) due to the lack of a cleaning gas system or its improper operation (at low temperature). Untreated healthcare wastewater in many cases is discharged directly to paddy fields, rivers, ponds and lakes, causing pollution and affecting the food chain.
• Viet Nam lacks figures on mercury sources in healthcare facilities, and awareness among workers is limited.
• No health facility has a standard procedure for separating waste containing mercury.
• Mercury waste is generally collected and incinerated together with other healthcare waste in hospital incinerators or central incinerators, or disposed of in municipal landfills.

WHO's response

• WHO supported the Ministry of Natural Resources and Environment and the Ministry of Health in developing a National Environmental Health Action Plan (NEHAP) to submit to the government for approval.
• However, the action plan was rejected, partly because environmental health and NEHAP are still new concepts to decision makers and partly because the plan somewhat overlaps with other national target programmes such as water and sanitation.
• The approach will be to tackle environmental health comprehensively, with the plan revised and re-submitted in the near future.
• WHO has been supporting efforts to set up standards for indoor air quality, to conduct research into the health impact of air pollution at traffic intersections in big cities as well as to raise public awareness about the health impacts of air pollution.
• WHO has supported the development of regulations on healthcare waste management, including a national action plan, as well as conducting training for healthcare staff. Guidelines on the treatment of healthcare wastewater and solid waste were developed and put into practice.
• With support from WHO, research was conducted into replacing incineration by alternative technologies such as treatment by microwave.
• WHO has been supporting the authorities in developing regulations on pesticides and disinfectants used in the health sector and in households.
• WHO also supported efforts to raise public awareness on mercury use in healthcare settings. Guidelines on mercury use will be developed in 2012-2013, and a pilot mercury-free hospital will be set up in 2012-2013.