Implementation of environmental health action plans, whether from the global, regional or national level, must finally impact at the local level. In this respect, the promotion of environmental health is a process of local enablement from a global perspective, or, the drawing together and facilitation of local environmental health actions towards national, regional and global ends.
Environmental health (EH) encompasses a wide range of issues and subjects. Those which are regarded as being most suitable to be tackled at the local level are: (a) drinking-water treatment and distribution; (b) food quality and safety; (c) home and workplace accidents; (d) local air pollution abatement; (e) traffic congestion and accidents; (f) housing rehabilitation; (g) solid waste management; (h) noise; (i) social implications of urban and industrial development; and (j) information dissemination and education on illness prevention and wellbeing.
Local Environmental Health Action Plans (LEHAPs) should be produced as a result of developing National Environmental Health Action Plans (NEHAPs), and should include; localised situation analysis, environmental and health monitoring information, identification of indicators, risk assessment information, ranking of issues including those related to public perception, priority setting criteria including risk communication criteria, public participation information, and the local needs and requirements for legal instruments and enforcement measures to address local environmental problems.
A Local Environmental Health Action Plan (LEHAP) is a particular case of applying the principle of subsidiarity, encouraging local action, because the priority to be assigned to environmental health problems will vary greatly from area to area and local solutions have the advantage of fostering support through a feeling of local ownership.
One factor to bear in mind when considering local action is that it may have international implications, for example, effects on international rivers, lakes and seas, and transfrontier air pollution.
Some local authorities are already showing an interest in linking environmental health measures to Local Agenda 21 and the WHO Healthy Cities campaign. The process of engagement between government, local authorities and health authorities has started in some countries.
Six key stages are usually followed when developing an LEHAP: (a) analysis of prevailing health risks; (b) risk assessment, to determine if environmental hazards are affecting local health; (c) solicitation of public participation in prioritizing local EH needs; (d) assessment of the finance and other resources required to implement the project; (e) classification of the tasks in an EH project according to their importance (tasks related to protecting the quality of drinking-water and food safety are the highest priority); and (f) keeping local political leaders, community leaders and the general public informed of progress during project design and implementation.
A NEHAP defines the national framework but, in accordance with the principle of subsidiarity, its successful implementation requires the majority of actions to be undertaken at the local level. This may be achieved in a variety of ways. The formal development of LEHAPs is one way of doing this. Another is to use existing systems and plans such as local development plans. Within existing systems, implementation of the NEHAP by local authorities may give additional impetus to their work on local Agenda 21 issues and the Healthy Cities network (although some of the problems addressed in NEHAPs are rural rather than urban). The integration of plans and initiatives at the local level will bring similar benefits to those from integration of plans at the national level, and many components of a NEHAP may be carried through under the auspices of another plan: these are other examples of a win-win situation.
Whatever the approach to developing local plans, the principles, general approach and methodology will be the same as for a NEHAP, but the number of significant issues is likely to be fewer. Local authorities should ensure that the general public and all interested parties are involved in the process of developing and implementing environmental health actions in their areas. Central government and its agencies need to support actions being taken at the local level, particularly through setting up the planning process, preparing environmental health status reports, selecting priorities, and applying to national and international donors for project funds.
LEHAPs can be used as a means to bring an environmental health component to an overall Healthy City or local Agenda 21 project and to strengthen the benefit of that project from an environmental health point of view. If these action plans are to be successful, it is essential that distinct projects are defined and implemented. All planning exercises raise expectations, so a visible move to the tangible local implementation of practical projects in places which need them is a rational culmination of the NEHAP process.
National authorities alone cannot normally solve local environment and health (EH) problems in an efficient manner. The field of EH encompasses a wide range of issues and subjects, and most should be regarded as best tackled at local level.