Toward a Mercury Treaty that protects public health: A health sector platform

This proposed Treaty is promoted by four organisations of Which the Internatioanl Society of Doctors for the Environment (ISDE) is one.
 ISDE is DEA's parent body.
I remind you that by being a member of DEA you are part of in international organisation which works on a whole range of health issues. Furthermore this particular initiative is highly relevant to two DEA initiatives. In greening hospitals and clinics we must note proposals which we can all pursue in our own work places. In our "Coal is a Health Hazard" initiative we can recognise and educate on the role of coal combustion in mercury pollution. In educating about this issue we will soon have the backing of international agreement for action

The Problem
Mercury is a naturally occurring heavy metal that is a potent neurotoxin.
When inorganic mercury is released into the environment, microbial biotransformation produces methylmercury, easpecially in aquatic environments. This organic compound accumulates in the food chain and concentrates in food stuff eaten by humans.

The most likely routes of human exposure on a population basis are ingestion of methylmercury from contaminated fish—a significant source of nutrition for large segments of the world’s population.

Methylmercury adversely affects the nervous systems of humans and some wildlife; the developing brain is more susceptible to methylmercury exposure than are adult brains; the developing brain appears to be most sensitive while in utero.

Mercury is released into the global environment from a broad array of activities, including chlor alkali production, artisenal gold mining, the burning of coal in power plants, and the waste from a diversity of products including measuring devices, including health care devices such as thermometers and sphygmomanometers.

While more than a dozen developed and developing countries are phasing out mercury in health care, many still employ mercury‐based medical devices. A typical large general hospital may have more than a hundred pounds of mercury onsite incorporated into various devices in separate locations. With their routine spillage, these not only contribute to the environmental load of methyl mercury but also expose significant numbers of health care workers to the pulmonary and renal effects of exposure to elemental mercury vapours.

Although the rationale for instituting mercury replacement initiatives is compelling from both occupational and environmental perspectives, financial considerations may also motivate hospitals and health systems to undertake a mercury replacement program. Replacement of fragile mercury‐based medical devices with more durable, accurate safer alternatives has been shown to save health institutions considerable money.

The Health Sector Leading the Way

A diversity of national and international health professional organizations, such as the World Medical Association, the World Federation of Public Health Associations and the International Council of Nurses have recognized the need to reduce the use of mercury in the health care sector.

The World Health Organization has issued a policy paper for the phase‐out of mercury in the health sector.

Health Care Without Harm an international coalition of health professionals, health care institutions and networks has worked to substitute mercury‐based medical devices in the health sector in Asia, Africa, Latin America, Europe and North America for the past decade.

WHO and Health Care Without Harm have set a target of 70% substitution of mercury‐based medical devices globally by 2017. This target is is part of a WHO‐HCWH Global Initiative for mercury‐free health care, a component of the UNEP Products Partnership.

Several national, provincial and municipal health authorities, as well as private sector health care facilities in dozens of countries have mandated such a phase‐out. Several developed and developing countries have demonstrated the technical and financial viability of the substitution of mercury‐based medical devices with safe and accurate alternatives. In the past two years alone, more than 5,000 hospitals in Asia, Africa, Latin America have become committed to substituting merucry‐based medical devices.

The health sector is thus modeling change for society as a whole Such public education is essential for the success of a global mercury treaty.

The Treaty
Governments and Civil Society come together in Stockholm on the 7th of June 2010 to begin a process of negotiations that will produce a global legally binding instrument on control and or phase‐out of mercury use.

As Health professionals representing our professions and the institutions in which we practice urge the delegates to at INC1 to assure that the instrument being negotiated:
1. Protects Human Health and the Global Environment:
Specifically, the Treaty Should:

  • Have, as its objective, to protect human health, wildlife and the environment from mercury by eliminating where feasible anthropogenic sources and releases of mercury;
  • Recognize the particularly vulnerability of children and women of child bearing age, as well as the particularly exposed indigenous peoples, subsistence fishing communities small‐scale gold miners, workers handling mercury, and others;
  • Address the entire mercury life‐cycle;
  • Establish an adequately funded and predictable financial mechanism with new and additional resources sufficient to enable developing countries and countries with economies in transition to fulfill their treaty obligations without compromising their poverty reduction goals.

2. Supports a Transformation to Mercury‐Free Health Care
Specifically the Treaty should:

  • Enable the phase‐out of mercury thermometers and blood pressure devices in the health care sector.
  • Direct its attention to the global phase‐out of production of mercury‐based thermometers and blood pressure devices.
  • Promote oral health through prevention strategies as well as the substitution, where economically and medically feasible, of mercury‐containing dental amalgam with safer composite alternatives.
  • Provide new and additional financial resources for technical support for the transition to mercury‐free health care in developing countries.
  • Provide new and additional financial resources to facilitate the transition to the production of non‐mercury medical devices in developing countries.
  • Encourage health professionals, as advocates for public health, to be involved in community‐based mercury reduction efforts in their local communities, including efforts to cease man‐made mercury emissions from all sources.

3. Promotes Health by Phasing‐out a Broad Spectrum of Mercury‐Related Activities and Products
Restrict the Global Flow of Mercury

  • Reduce and minimize global commercial demand for mercury;
  • Reduce global mercury supply by phasing out mercury mining; mandating permanent, secure, monitored storage for existing mercury stockpiles and all mercury that is recovered from chlor‐alkali plants; and restricting the trade of mercury generated from remaining sources;
  • Establish effective controls on international trade in mercury and mercury‐containing products;
  • Phase‐Out Mercury Use and Emissions
  • In the medium‐term, phase‐out all products and processes that contain or use mercury, and in the interim, establish standards and controls for those products and processes that remain;
  • Minimize the use of mercury in laboratories, schools and other institutions; prohibit inappropriate uses; and incorporate information on mercury toxicity and proper techniques for handling mercury in school curricula;
  • Institute effective measures to reduce and eliminate where feasible the use of mercury in gold mining;
  • Establish Best Available Techniques (BAT) for coal‐fired power plants, cement kilns, and other combustion processes that release mercury to the environment with an agreed schedule for its phased‐in application; aim to phase‐out any of these sources when good alternatives are feasible, available and affordable;
  • Promote the use of renewable, alternative energy sources as a substitute for coal‐fired power plants that release mercury to the environment;
  • Mandate environmentally sound solutions for the management of wastes that contain mercury and mercury compounds including measures to prevent mercury from entering municipal, medical and industrial waste streams;
  • Address the remediation and reclamation of existing mercury‐contaminated sites;

Foster Alternatives to Mercury

  • Promote research and development on sustainable, non‐toxic, alternatives to products and processes that contain or use mercury with special emphasis on addressing the needs of developing countries and countries with economies in transition;
  • Ensure that developing countries and countries with economies in transition do not become dumping grounds for mercury wastes and excess mercury supplies.

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Health Care Without Harm
International Council of Nurses
International Society of Doctors for the Environment
World Federation of Public Health Associations
May 25, 2010

About the Health Sector Organizations Endorsing this Platform

Health Care Without Harm (HCWH)
HCWH is an international coalition of more than 440 organizations in 52 countries working with the health sector to promote environmental and public health. Together with the World Health Organization, HCWH co‐leads a Global Initiative to substitute mercury‐based medical devices in health care. www.noharm.org

International Council of Nurses (ICN)

ICN is a federation of more than 130 national nurses associations, representing the more than 13 million nurses worldwide. ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. www.icn.ch

International Society of Doctors for the Environment (ISDE)

ISDE is an environmental NGO of medical doctors with national and regional member organizations in over 35 countries. ISDE works to help defend our environment both locally and globally to prevent numerous illnesses, ensure the necessary conditions for health, and improve the quality of life. www.isde.org

World Federation of Public Health Associations (WFPHA)

WFPHA is an international, nongovernmental, multi‐professional and civil society organization bringing together public health professionals interested and active in safeguarding and promoting the public’s health. The Federation’s members are national and regional public health associations, as well as regional associations of schools of public health presently numbering more than 70. www.wfpha.org