Overview of environment-related health risks in the Netherlands

The table below contains an overview of the state of knowledge relating to the health risks associated with environmental factors. The long list of possible harmful environmental factors from 'Zorgen voor morgen' (RIVM, 1988) has been considerably reduced. This can be accounted for, on the one hand, by improvements in our understanding of the harmfulness of environmental factors and, on the other, by the fact that the levels of exposure have been reduced considerably by successful environment policy (RIVM, 2001). However, air pollution and noise continue to be stubborn environmental problems.

Environmental theme	Effects on health, current state of knowledge
Indoor environment	Damp, fungi and smells in the home are some of the causes of a range of human health problems. The effects vary according to the cause and can include nuisance, allergic and rheumatic complaints, or respiratory disorders and carcinogenic effects Effects have been established at the population level for a number of substances and agents (NO2, CO, VOS, benzene, formaldehyde, particulate matter and asbestos). It is unclear precisely what connection there is between humidity and the quality of indoor air on the one hand, and asthma and Chronic Obstructive Pulmonary Disease (COPD) on the other. Little is known about the impact on health in cases of combined exposure. Exceptions are exposure to radon and smoking, and the combination of asbestos and smoking There are no recent data about exposure indoors to biological agents, noise and electromagnetic fields. Relevant sections and indicators in the Environmental Data Compendium Health problems in the Netherlands caused by the indoor environment, 1997
Soil	Living on polluted land probably does not cause direct harm to health in the Netherlands because exposure is limited except in specific situations. Exposure to pollutants in the soil is too slight to cause any effects. The ingestion of particles of soil by young children and the consumption of contaminated food are the main ways people are exposed to soil pollution. Any effects are dependent on the nature of the pollution. Exposure is estimated using models. There are uncertainties associated with this modelling approach, particularly due to the assumptions made about concentrations in the soil and intake. The total volume of soil pollution in the Netherlands will probably be identified in 2005. Intervention values have been drawn up for soil pollutants on the basis of human and eco-toxicological research. Relevant sections and indicators in the Environmental Data Compendium Guide to 'Soil quality' section
Drinking water	The risks to health associated with drinking tap water are very slight. The quality of drinking water in the Netherlands is generally good. The majority of the population is connected to the mains supply. Infants who drink water from lead pipes constitute a risk group. The high nitrate levels in ground water in some areas are only a problem for people who get their drinking water from private wells. The possible health effects of organic anions (acetates, phthalates, oxalates) are not known. A great deal of research is still being conducted into the effect and occurrence of pathogens in drinking water. Research is being conducted into the risks of the increased use of surface water to prepare drinking water and the effectiveness of treatment methods. Risk management takes place at source. The measures include replacing lead pipes and monitoring possible pollutants at drinking-water pumping stations. Relevant sections and indicators in the Environmental Data Compendium Pesticides in drinking water in the Netherlands, 1993-2001 Intake shutdowns by water supply companies in the Netherlands, 1983-2002
External safety External safety deals with the risks affecting local residents caused by air traffic and by the production, the use, the storage and the transport of dangerous substances. This is not just a question of the locations of the companies themselves but also of transportation to and from those locations.	At present, there are at least 37,000 people in the Netherlands who live in areas where the standard for local risk is exceeded. These are therefore all the people exposed to a risk in excess of 1 in 1 million of a fatal accident as a result of an incident at a company in their vicinity. For 20,000 people, this risk is accounted for by aviation; for 14,000, the risk is attributable to LPG stations. At various locations in the Netherlands, the probability of an accident with fatal casualties is greater than the accepted group risk standard. In addition to these statistical risks, the perception of risk-bearing activities plays a role. There is scarcely any research in the Netherlands into the impact of the perception of risk-bearing activities on well-being. The health of the victims was investigated after the Bijlmer aircraft disaster and the firework disaster in Enschede. Work also began on the establishment of a centre of expertise for research into disasters. Risk-bearing situations and companies in the Netherlands are surveyed and risks are quantified from a preventive perspective. The data are assessed against standards for the risk to individuals and to groups. Relevant sections and indicators in the Environmental Data Compendium External safety risks: the risk of an accident (introduction) Group risk: The probability of a disaster in the Netherlands by branch, 2001 Local risk in the Netherlands, 2001
Noise	Exposure to noise can result in nuisance, sleep disturbance, raised blood pressure, cardiovascular disease and reduced cognitive performance. Effects such as nuisance and sleep disturbance can occur at noise exposures as low as 40 dB(A). Of the effects listed, nuisance is the most common. The link between noise and specific effects can be explained in various ways: The relationship between noise and nuisance has been adequately explained. Questions remain about the precise role of non-acoustic factors. There is still no reliable dose-response relationship for noise in relation to interference with sleep and the consequences for health in the long term. There is clear evidence of a causal link between noise and stress-related complaints such as raised blood pressure and cardiovascular disease. There is limited evidence of a correlation between noise and impaired functioning in children. There is at present insufficient evidence that noise affects the hormonal and immune systems. There are various models for measuring and validating exposure to noise at national and local levels. Relevant sections and indicators in the Environmental Data Compendium Guide to 'Noise and odour nuisance' section Complaints about aircraft noise from Schiphol, 1986-2001 Environmental complaints about companies in the Netherlands, 2001
Odour	Exposure to odour can result in nuisance, and sometimes severe nuisance. The degree of odour nuisance is usually estimated on the basis of complaints or model calculations. Odour nuisance is also studied by means of telephone or written surveys, and sometimes by asking people to keep diaries. Relevant sections and information elsewhere in the Environmental Data Compendium Odour nuisance: introduction Odour nuisance in the Netherlands by source, 1990-2002
Genetically modified organisms (GMOs) There is still little known about the potential impact on health of the use of genetically modified organisms.	There is still little known about the potential impact on health of the use of genetically modified organisms.
Quality of living environment Physical environment, spatial planning, social environment.	There has not been sufficient research into the relationship between the quality of the living environment and a sense of well-being/health. There are regular studies of the quality of the living environment in general. These include POLS, a periodical study conducted by Statistics Netherlands, and figures about housing collected by the Social and Cultural Planning Office (SCP). However, there is still too much diversity in the indicators used so that the results of various studies are often impossible to compare. The definitions and measuring instruments are not uniform enough. Instruments are needed for estimating the combined impact on well-being on different scales. Relevant sections and information elsewhere in the Environmental Data Compendium Guide to 'Human living environment' section
Light	Too little is known at the moment about the possible effects of disturbance due to the increase of artificial light during the evening and at night on people's sense of well-being (Gezondheidsraad, 2001).
National air pollution	Air pollution by particulate matter or ozone was responsible in 2000 for 1 to 4% of total premature mortality and of emergency admissions for pulmonary and cardiovascular disorders in the Netherlands. It is not known whether ozone and particulate matter are the substances that cause the effect or whether they are only the indicators of a harmful mixture. Little is still known about the chronic effects of traffic-related local air pollution (such as asthma, allergies and chronic respiratory problems) in both adults and children. Concentrations of substances in outdoor air are measured by the National Air Quality Monitoring Network. Local environmental quality is measured using environmental traffic maps and dispersion models. There are also a number of local monitoring networks. Emission data are also collected which can be used in models to estimate the exposure of the population. Relevant sections and information elsewhere in the Environmental Data Compendium Guide to 'National air quality' section Health effects in the Netherlands of particulate matter and ozone, 2000
Substances	A list was recently drawn up of 50 substances, the control of which requires priority. Our knowledge about the health effects of these substances is limited. Little is still known about the health effects of endocrine-disruptive substances. The same is true of the effect of cumulative exposure to various substances. Relevant sections and information elsewhere in the Environmental Data Compendium Emissions of priority substances to air, water and soil in the Netherlands, 1990-2010 Emissions of pesticides in the Netherlands, 1984-2000 Guide to 'Environmental quality' section Dioxins, furans and PCBs in breast milk of mothers in the Netherlands, 1988-1998 PCB and mercury in eels in the Netherlands, 1980-2000
Radiation (ionising) Ionising radiation is particle radiation (including alpha and beta radiation) or electromagnetic radiation with enough energy to bring about ionisation in matter.	Possible impacts of ionising radiation include increased sensitivity to cancer and hereditary disorders. Ionising radiation can also cause congenital abnormalities (teratogenic effects). It is impossible to give a quantitative estimate of teratogenic effects in the Dutch population. Acute harm is possible at high doses. The effects of ionising radiation were described in detail in a report by the Health Council (1992). The radiation dose is measured in the Netherlands. Almost 70% of it is from natural sources and around 30% is from medical applications, while a small percentage is from other human activities. Information about radon: see indoor environment. Relevant sections and information elsewhere in the Environmental Data Compendium Guide to 'Radiation' section
Radiation (non-ionising) Non-ionising radiation is electromagnetic radiation with less energy, UV, visible light and infrared radiation	UV radiation can cause skin cancer. No link has been found between radio-frequency electromagnetic radiation (such as from radio and television waves, mobile telephones and mobile telephone base stations) and genotoxic or carcinogenic effects, or other clinical syndromes. Of the 3 million Dutch children, approximately 20,000 live in the proximity of high-voltage power lines. It is thought that exposure to the magnetic fields generated by these lines explains one of the 110 new cases annually of childhood leukaemia. However, this phenomenon has not yet been explained. It is unclear whether there is a causal link. Relevant sections and information elsewhere in the Environmental Data Compendium Guide to 'Radiation' section Additional risk in the Netherlands of skin cancer due to increase in UV radiation, 1980-2000 UV radiation in Europe, 1980-2000 UV radiation in the Netherlands, 1980-2001 Exposure of children to the magnetic fields of overhead power lines, 2001
Food safety	Various programmes have been launched for the routine monitoring, checking and testing of food and drink products. These include monitoring for the presence of pesticides and dioxin-like substances. A lot of attention has been devoted in recent years to endocrine-disruptive substances. There has still not been enough research into the health impact of these substances. Relevant sections and information elsewhere in the Environmental Data Compendium Dioxins, furans and PCBs in breast milk of mothers in the Netherlands, 1988-1998 PCB and mercury in eels in the Netherlands, 1980-2000
Bathing water	Health problems may be caused by the recreational use of surface water. The main problems are gastro-intestinal infections, skin infections, Weil's syndrome and eye infections. A lot is known about the presence of parasites and various micro-organisms but the implications for public health are unclear. There is no complete picture of the contamination of regional waters (including the sediment layers). The registration of health complaints associated with bathing water is incomplete and very complex. Relevant sections and information elsewhere in the Environmental Data Compendium Quality of bathing water, 1992-2003 Health problems in the Netherlands related to recreation in surface water, 1990-1999
Sources consulted VROM/VWS (2002). Environmental Health Action Plan. Implementing more powerful policy. Ministry of Health, Welfare and Sport Ministry of Housing, Spatial Planning and the Environment/Ministry of Health, Welfare and Sport (report number: VROM 020396/05-02 21767/206), The Hague. TNO preventie en Gezondheid (2001). Milieu en gezondheid 2001-overzicht van risico's, doelen en beleid; TNO rapport 2001.95. The ESF Scientific Programme on Environment and Health, 1999. GG & GD Amsterdam (1996). Handboek binnenmilieu. Amsterdam City Health Service. Landelijke Vereniging voor GGD'en (1996). Handboek buitenmilieu.
Source: RIVM	RIVM/EDC/Oct02