Environmental and occupational health

» Climate change and health

During the past decades, environmental resources and ecosystems have been threatened as a result of lack of precipitation, persistent drought, heat stress, air pollution, water pollution, soil erosion and loss of biodiversity. Islamic Republic of Iran is experiencing climate change by rises in temperature and sea level and increasing frequency of dust storms and other disasters. A national policy for climate change was endorsed at Cabinet level in 2017 and relevant ministries and organizations are responsible for the development and implementation of efficient interventions for adaptation and mitigation measures.

Ongoing activities include:

• health vulnerability assessment and climate-based modelling by the Ministry of Health and Medical Education with the technical support of WHO;
• regional and global webinars with the support of the WHO Regional Office to share experiences and lessons learned in line with WHO guidance;
• development of a sustainable and resilient cold chain to facilitate access to COVID-19 tools, in collaboration with the United Nations Industrial Development Organization (UNIDO) and with consideration to environmental health initiatives.

» Air quality (air pollution)

Islamic Republic of Iran is facing severe problems in terms of air quality. About 11% of all deaths and 52% of all the burden of diseases in the country are attributable to environmental risk factors. Ambient particulate matter pollution ranked first among the 10 risk factors for the environmental burden of diseases in Islamic Republic of Iran in 2019. Sand and dust storms also are sources of particulate matters. Burning fossil fuels is the primary source of climate-warming emissions, while also a major contributor to health damaging air pollution.

Ongoing and upcoming activities include:

• developing the sand and dust storms plan of action based on the situation analysis as a continuation of the 2019 activity;
• assessing the health impacts of air pollution using WHO’s AirQ+ software;
• supporting the national team and technical working group in updating the advocacy plan document developed in 2017.

» Sand and dust storms

Multiple regions in the country have faced severe sand and dust storms in recent years. For every 10 micrograms per cubic metre increase in PM10 during dust events, the mortality rate increases by 1%.

The most significant socioeconomic effects of sand and dust storms include closure of schools and offices, cancellation of flights, migration from areas affected by dust storms, decrease in food production (such as dates, which was reduced by 60% in 2010), loss of livestock and decrease in the number of bees and level of honey production.

To tackle and prevent the effects caused by sand and dust storms, the activities listed below are ongoing, in collaboration with national counterparts.

Establishment of criteria to develop the Tehran Ministerial Declaration and follow up on international declarations and national policies and commitments.

Analysis of the health response to sand and dust storms by the Ministry of Health and Medical Education with WHO technical support to enhance governance capacity in: identifying, monitoring, evaluating and managing environmental risk factors such as sand and dust storms; and in strengthening multisectoral partnerships with non-health organizations (Department of Environment, Ministries of Oil and Energy) to implement interventions and mitigation measures to protect health.

» Water, sanitation, and hygiene (WASH) and waste management

WASH is a relatively well addressed subject in Islamic Republic of Iran. Policies exist on drinking-water, sanitation and hygiene at both urban and rural levels, and implementation plans for all 3 are undergoing revisions. Cost estimations for the WASH plan are being conducted successfully at urban and national levels. Ninety-one percent (91%) of people have access to drinking-water at a safely managed level (94% in urban areas and 83% in rural areas), 88% of people have access to sanitation at basic services level (92% in urban areas and 79% in rural areas), and there are no data on hygiene statistics.

Ongoing activities to support improvements to water, sanitation, and hygiene include:

• Development of WHO/UNICEF joint monitoring programme for water supply, sanitation and hygiene country reports.
• Facilitating the Islamic Republic of Iran’s contribution to the joint monitoring programme in-country consultation for household estimates of 2000–2020, based on Sustainable Development Goal indicators 6.1, 6.2 and 6.3.1.
• Conducting situation analysis and assessment of WASH services in health care facilities and establishing baseline data in close collaboration with the WHO Regional Centre for Environmental Health Action (CEHA).
• Implementing the UN-WATER Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2021–2022 in the country. Islamic Republic of Iran is one of the two countries in the Region that are piloting e-GLAAS to assess the feasibility of using the REDCap platform as a data collection tool for future GLAAS cycles.

» Occupational health

The Environmental and Occupational Health Centre in the Ministry of Health and Medical Education is responsible for supervising occupational health programmes and activities at the national level. In each university, under the supervision of the Ministry, the Centre is responsible for monitoring and building the capacity of experts engaged in the field and reporting to the Ministry. The WHO country office, in collaboration with the Ministry and the Environmental and Occupational Health Centre, is currently working on developing an occupational health national profile for the Islamic Republic of Iran by conducting a literature review and assessing the implementation of the “Global plan of action on workers’ health” in the Islamic Republic of Iran using the regional tool.

• Adapt and implement technical packages to develop occupational health standards, establish a surveillance system, and develop human resources and occupational health as vital elements of the national health strategy.
• Share healthy work practices to develop updated training curricula to improve human resource knowledge, including occupational health physicians and occupational hygienists.
• Strengthen national policies for health at work and promote healthy work and work environments, engaging employers, workers and government collaboration.
• Illicit United Nations and WHO collaborating centres’ support to facilitate Member States’ development of employers’ policies on occupational health and safety as a priority.
• Implement joint research projects on health risk assessment and joint knowledge-based research projects.
• Support the country to implement joint projects with United Nations partners, such as the International Labour Organization.

» Environmental and social workstream in COVID-19 Emergency Response Project (ICERP)

The environmental and social team in ICERP has been established to implement the assessment and safeguarding of environmental, occupational health, and patient safety standards. The ICERP assessments were conducted by the WHO country office, on behalf of the Ministry of Health and Medical Education, and in collaboration with one of the top technical assessment companies in the health sector in 3 phases: preparatory, facility assessment and follow-up.

The activities listed below have been implemented toward project execution.

• Development of an environmental and social team assessment tool based on national and international references and standards, in collaboration with the Ministry of Health and Medical Education.
• Piloting of 3 sites to validate the assessment tool.
• Implementation of an on-site assessment in 182 facilities (137 hospitals and 45 laboratories) and grading based on the identified non-conformities conducted.
• Issuing of recommendations for improvement to identified non-conformities in facilities and technical consultation to fulfil gaps.
• Follow-up assessing and grading after implemented corrective actions by the Ministry and facility to announce full compliance of site.
• Documenting of lessons learned with in-depth interview sessions with all involved parties in the environmental and social team component of the project.

» Cross-cutting areas

We support sustainable health-related cooling systems, such as cold chains (cold rooms, etc.) by equipping and upgrading facilities and procedures to be resilient and environmentally sound.

• Equipping cold rooms with sustainable and environmentally friendly equipment in 2 provinces –Golestan and Kohgilouye and Boyer Ahmad.

• Conducting capacity-building on sustainable cooling and operationalizing them in the country (jointly with UNIDO).
• Supporting an integrated approach across the country to enhance and scale up sustainable cooling in more provinces and areas (such as medicine storage).