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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

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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/

s1 josh karliner_hcwh

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