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The WHO-HCWH Global
Initiative for Mercury FreeHealth Care
Joshua Karliner, International Team CoordinatorHealth Care Without Harm
Asia Regional Conference for Mercury Free Health Care
March 15, 2011
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Assessment Initiated by United NationsEnvironment Programme Governing Councilat its 21st session in February 2001;
Finding: Hg is persistent and cycles globally emissions in any continent can contributeto deposition in others thus an internationalissue.
UNEP Governing Council 2007:
Concludedthat further long-terminternational action is required to reducerisks to human health and the environment.
Governing Council 2009: Mandates thenegotiation of a legally binding instrument tocontrol mercury globally.
United Nations Mandate onMercury
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3
Global Mercury Consumption
Small-scale/artisanal
gold mining
[800-1000]
Vinyl chloride
monomer
production
[600-800]Chlor-alkali
production
[500-700]
Batteries
[300-600]
Dental use
[240-300]
Other [20-60]Lighting
[100-150]
Electrical and
electronic
[150-250]
Measuring and
control
[150-250]
* Laboratory, pharmaceutical, cosmetic,
cultural/traditional uses, etc.
TOTAL3,000 - 3,900
metric tonnes
October 2006
Source: Maxson,
Mercury flows and safe storage of surplus mercury
for the Environment Directorate, European Commission,August 2006 (with data ranges). See: http://ec.europa.eu/environment/chemicals/mercury/pdf/hg_flows_safe_storage.pdf
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Addressing Mercury in Health Care
Protects worker and patientsafety, as well as the globalenvironment.
Raises the public and
policy makers awarenessof the environmental healthimpacts of mercury in
general.
An important early steptoward Greening the Health
Sector.
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Health Care and the GlobalMercury Cycle
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Mercury Substitution in US andEuropean Health Care
USA Thermometer bans or severe
restrictions in 28 states.
It is virtually impossible to buy amercury thermometer in the US today.
One-third of US population covered bymercury sphygmomanometer bans orrestrictions
European Union Mercury thermometers banned in
2007.
Blood pressure devices on their wayout.
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2005 WHO Policy on Mercury in
Health Care
Short Term: Develop and implement plans toreduce the use of mercury equipment andreplace with mercury-free alternatives. Address
clean-up, storage, disposal.
Medium Term: Increase efforts to reduce use ofunnecessary mercury equipment
Long Term: Support a ban of mercury containingdevices and promote alternatives.
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Global Initiative Launched byWHO and HCWH in 2008
Goal:By 2017, to phase out the demand
for mercury-containing feverthermometers andsphygmomanometers by at least
70% and to shift the production ofall mercury-containing feverthermometers andsphygmomanometers toaccurate, affordable, and safernon-mercury alternatives.
Component of the UNEPProducts Partnership
www.mercuryfreehealthcare.org
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We Are Reaching a Tipping Point
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Seven Steps to Mercury-FreeHealth Care
1. Education and training
2. Pilot hospitals
3. Replication in other hospitals
4. Mega-city/provincial policies
5. National policies
6. Models for replication in regions
7. Contributing to global policy
Each country and region has theirown sequence and approach
t t
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ountr es n ucat on,Training, Pilot and Replication
Phases Brazil
Chile China
Ecuador Indonesia Latvia
Lebanon Nepal Nicaragua
Senegal Syria
Tanzania Thailand Vietnam
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Tool for Education, Training,Pilots and Replication
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Mega-City and Provincial Policies
Mega-cities
Buenos Aires
So Paulo Mexico City
Delhi
Provicnes
Kwa Zulu Natal SouthAfrica
Chaco Argentina
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National Policy Development
Philippines (2008)
Argentina (2009)
In Process
India
South Africa
Costa Rica
Uruguay
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F Ch ll
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Four Challenges
1. Accuracy and Quality
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Accuracy of Blood PressureDevices
Major US health systems usingnon-mercury blood pressuredevices without problems.
Sweden has determined that thereis no problem.
Argentina has banned mercurysphygmomanometers
EC Finding: mercury-free bloodpressure measuring devices
(when clinically validated) aregenerally reliable substitutes formercury-containingsphygmomanometers in routineclinical practice.
Directorate General for Health andConsumers
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TOOLS FOR ASSURING ACCURACY:WHO Is Developing a Guidance Document on
Selection of Alternatives
Countries that have phased-out mercuryhave developed their own criteria, oftenbased on British Hypertension Society orother validating body.
WHO is developing a guidance documentwhich will provide technical advice toMinistries of Health. The document willdraw on a series of standards alreadyused by several governments in differentparts of the world.
Next Steps: The document is currentlyunder review by relevant parties at WHO,and once approved, distributed toMinistries of Health and globally throughvarious channels.
Ch ll
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Challenges
2. Affordability
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Case of Argentina and Brazil
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Affordability Varies by Country
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Challenges3. Mercury Waste
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Tools: UNDP-GEF Global Health Care
Waste Project Guidance Document
Managing on Mercury Waste
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Challenges4. Shifting Production
Quality non-mercury devices mustbe made available at an affordableprice, globally.
China is the largest producer ofmercury based medical devices inthe world.
China also produces many of thealternatives for the world already.
To shift supply to accurate,affordable alternatives changes inpolicy and demand from healthsystems in China and globally arenecessary
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Next Steps Toward Mercury-FreeHealth Care
Next steps
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Next steps
1. Global Phase-out of Mercury in
Health Care Implementing the policies
weve achieved
Scaling up and broadlyreplicating success in dozensof countries
Developing regional and globaltools, guidelines and standards
Building markets foralternatives and transformingproduction
Next Steps
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Next Steps
2. Treaty Process and the Health
Sector The treaty will consider
mandating a phase-out ofmercury-based thermometersand sphygmomanometers.
The health sector is animportant voice for an overalltreaty that protects humanhealth and the environment.
Treaty can reinforce greeningof the health sector
N t St
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Next Steps
3. Mercury is only theMessengerGlobal Greening of
Health Care
Dental Amalgam
Chemicals
Health care waste
Green building
Climate Change
Water
Green procurement
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www.mercuryfreehealthcare.org
http://www.mercuryfreehealthcare.org/http://www.mercuryfreehealthcare.org/