Progress Report Meeting (13th December 2018)
Thu 13.12.2018 • Project team

Progress Report Meeting

“Strengthening Serbian national capacities and inter-sectorial synergies for safe management of
contaminated sites and related hazardous substances to prevent negative impact on human health
and the environment”

December 13th 2018; 10:00 a.m.


Meeting was held in the Institute of Public Health of Serbia “Dr Milan Jovanović Batut”

Progress Report Meeting Programme

  1. Opening and welcomming addresses
  2. The international context
  3. Science and evidence on ICSs
  4. Project progress review (road map and the way forward),
  5. Key stakeholders’ statements
  6. Expert commentary
  7. Discussion
  8. Closing remarks

Introductory words were given by:

  • Dr Branislava Matić Savićević, IPHS, Project Team coordinator;
  • Dr Snežana Pantić Aksentijević, MoH;
  • Ass.Prof. Верица Јовановић, IPHS, acting director;
  • Dr Zsofia Pusztai, WHO Regional Office, Serbia, Belgrade
  • Ivan Đuričković, on behalf of the Minister, MEP

Oral presentations and interventions from the floor were given by:

  • Marco Martuzzi, ECEH, WHO, Bonn, Germany
  • Ivano Iavarone, ISS, Italy; WHO Collaborative Center for Contaminated Sites, Director
  • Branislava Matić Savićević, IPHS, Project Team coordinator
  • Snežana Živković Perišić, IPHS, National Cancer Registry;
  • Dragana Vidojević, SEPA
  • Milenko Jovanović, SEPA
  • Prof. Dr Zorica Bulat, Pharmaceutical Faculty, Belgrade University;
  • Prof. Dr Snežana Šerbula, Faculty of Technical Sciences, Bor, branch of the BU
  • Professor Dimosthenis Sarigiannis, Aristotle University of Thessaloniki, Greece.

Besides the mentioned presenters, part in the discussion was taken by Dr Viša Tasić (MMI Bor) and Prof.dr Aleksandar Ćorac (Medical Faculty of the Priština University, temporarily displaced to Kosovska Mitrovica).

1. Opening and welcome addresses

Dr. Branislava Matić Savićević opened the meeting and welcomed the partners from the Ministry of Health, partners from Italy and Greece and all other partners in the project who helped in producing a short but concise project as well as colleagues from the network of Institutes of Public Health (IPHs). She also expressed her gratitude to UNEP for great support in having confidence in the IPHS as the project implementation agency.

Dr Snežana Pantić Aksentijević (Ministry of Health, MoH) has greeted the guests on behalf the Minister Dr Zlatibor Lončar and Ass. to Minister dr Vesna Knjeginjić, and in her personal name. She expressed satisfaction with the opportunity to hear the first results of the project and the opportunity to get new directions for the future, making living and occupational environment better and safer, while catching up with the developed countries of the EU. She emphasized that the MoH thanks partners and experts, IPHS „Dr Milan Jovanović Batut“ and the IPHs network. Also, she stressed that these institutions represent the true wealth of our health system, an inexhaustible data warehouse and institutions that the Ministry of Health always relies on. She wished in the coming period a lot of success in this, but also other projects that will be implemented in cooperation with the IPHs and the World Health Organization.

Ass. Professor Verica Jovanović welcomed the participants in front of the IPHS and announced the presentation of the six-month joint work and project goals, the possibilities of using the collected data, the identification of key environmental needs and other multisectoral areas in order to define strategies for improving health of the exposed population and for the preservation of the environment. She emphasized that the Institute, as a leading public health institution, with the support of the Ministry of Health and the network of IPHs has a large mission, improving synergy and cooperation with other sectors. She underlined the importance of adopting common conclusions that will link everything that comes with the joint work of: environmental institutions in the area of work of the SEPA; scientific institutions researching on EHIA; industrial companies introducing corporate responsibility, enabling and supporting EHIA, due to possible harm done during the industrial operation of these entities. All above mentioned will enable joint adoption of strategies acting as guidelines for harmonizing the work of more sectors. She emphasized that the communion marked this cooperation, also stressing that today's meeting will present the key steps and measures that will enable the joint forces to work on improving both legal regulations and defining key activities to examine the impact of environmental factors on human health.

Dr Zsofia Pustai addressed the meeting via a previously recorded video clip. She recalled that during the Sixth Ministerial Conference on Environment and Health, last year, the Ostrava Declaration was adopted, in which member states for the first time commit themselves to implementing a multisectoral agreement for the safe management of contaminated sites. She emphasized that the document "Road Map for the Management of Contaminated Sites", as the outcome of this project, is a great opportunity for agreement and cooperation between the Ministry of Health and the Ministry of Environmental Protection, for defining activities in this area, within the National portfolio of actions for environment and health, planned to be finalized in 2019, and by which Serbia will have a national framework for better multisectoral activities. Once again, she underlined the importance of multisectoral cooperation. She wished a successful and fruitful discussion and a good outcome of the meeting, expressing full support from the World Health Organization.

Dr Branislava Matić Savićević pointed out that there really was multisectoral cooperation and praised all the members of the team who participated in the previous 6 months without any interruption in the project activities, what so ever. She stated that due to the speed of the organization only two ministries with full work in the team were involved and expressed the desire to include several sectors in the future due to the scope of the topic. She said that being involved in safe management of CSs takes into account topics such as: social determinants of health, inequities in health status and health care, and other types of vulnerability in the sense of malnutrition, poverty, also focusing on the workers' population, underlining that such sites are a major public health challenge in the broader sense (social inequalities, education). Dr Matić Savićević stressed that, through the networko of IPHs these issues should be covered not only by project activities, but in accordance with the policy of the program of general interest, and that the distribution of resources could include this topic in existing programs of general interest. She also pointed out that today's conference represents only an introduction to future activities, and that therefore the name of the same has been changed so that it is not considered final.

Ivan Đuričković thanked the project team for the successful implementation of demanding project activities in the short term, as well as representatives of the World Health Organization and UNEP on valuable assistance during the project implementation. He emphasized the significance of the results of this pioneering project in terms of assessing the risk of contaminated sites and pollution for human health, as these preliminary assessment results will be an assessment of much deeper analysis and EHIA for the exposed population, originating from the pollution not only in Bor, but at other critical ecological points, as well. He underlined the importance of such a common approach and synergy of the health and environmental sectors to identify ecological black spots that pose the greatest risk to human health, with the aim of prioritizing the solution of these ecological problems. He pointed out that the results of this project could be a solid base for further research in assessing risk for human health through future new projects. He noted that the successful implementation of this project resulted in a fruitful synergy between the two sectors, which will be continued with the creation of a National portfolio of actions, in line with the Ostrava Declaration, as well as cooperation in other similar projects in the future, for which the Ministry of the Environment has always been open.

2. International context - Marco Martuzzi

At the beginning of his presentation, Dr. Marko Martucci thanked the Institute for hospitality, as well as introductory words from both sectors. He emphasized that the process of establishing a concrete dialogue is long lasting. He thanked all participants in the project. He emphasized that, although the project ends, it is important to establish a basis for work on contaminated sites. He thanked UNEP for its support.

He recalled that he comes from the WHO ECEH Bonn Office, and that the topic of contaminated sites is, actually one of the important subjects of his work. He stressed that in the European region some hundreds of thousands of CSs still exist, with most of them connected to industrial and waste disposal origin.

He reminded that European environment and health process (EHP) presents kind of a partnership with 53 countries involved in it. Also, he recollected that within the EEHP, six Ministerial Conferences on Environment and Health have been held, and that in the last, Sixth Conference in Ostrava, the fact that 1.4 million deaths occur anually, due to polluted environment, was presented. The Ministerial Declaration identifies priorities and includes an Annex defining the activities that Member States should take into account in the implementation of the declaration. Among the priorities are: air quality, water and sanitation, chemicals, climate change, cities and regions, the sustainability of health systems, prevention and elimination of waste and contaminated sites. Actually, topic of sound management of waste and contaminated sites (SDG12) was introduced for the first time in this particular Ministerial Declarationa, together with other already pre-existing priorities. Signing a declaration implies that states are obliged to develop the National portfolio of actions for environment and health.

He emphasized that there is much evidence of the impact of contaminated sites and waste, but that they are not clear, for example, the impact of air quality, which can be quantified, and explained that despite the existence of many case studies, there was no answer to the question of what is a comprehensive problem. He listed some of the actions proposed to member states, such as: eliminating uncontrolled and illegal waste disposal, forming of a national inventory on contaminated sites, an action plan for response, prioritizing contaminated sites.

He noted that the results of the project activities were satisfactory and that there was good technical progress and exchange of methodologies and reminded that the educational workshop was held in October. He also pointed out that one of the main outcomes is developing a National Road Map for responsible management of contaminated sites. He added that Serbia is engaged in the drafting of the National Portfolio of Actions on Environmental and Health, and that taking into account contaminated sites in the same way as the quality of air and water & sanitation is of utmost importance. He concluded that the previous performance was the basis for further work and expressed optimism for the practical application of the Roadmap.

3. Scientific evidence in the research of industrial contaminated sites - dr Ivano Iavarone

Dr Ivano Iavarone pointed out that Serbia's involvement in the issue of contaminated sites is an example of activities within the European network (COST IS 1408 Network countries). He reminded that industrial sites are the legacy of previous production models, but that they are still present, and that they are a major problem, although industrial emissions have been reduced over the last decades in Europe. He emphasized that these emissions are significant for pollution of the environment through air, water, land and through the food chain. He also noted that the aspect of injustice in the field of environment and social inequality at these CSs is a very important aspect. Another important problem was the accumulation of chronic diseases and diseases related to the occupational environment in these localities. He explained that there are different sources of pollution in different countries, and that their contribution is different and that pollution of soil and water is mostly investigated, while air pollution is in the process of development from a legal and normative point of view on the European level. He emphasized the need for a common approach to assessing adverse impacts. He recalled that some populations are particularly vulnerable, such as children spending more time outdoors, drinking more water and breathing more air per unit mass compared to adults, and paying special attention to them.

He agreed with Dr Martuzzi that, despite the existence of some evidence from various studies, the overall impact assessment is still missing. He stated that this was the main reason for working on the international level by launching a COST IS 1408 Action. Through this network of institutions and countries, the primary goal was to create a common framework and methodology for assessment and response. This Action has included 33 countries, and Serbia has been an active member for four years. He reminded that contaminated sites are for the first time on the agenda and can be viewed as a priority, starting with the Ostrava Declaration. He stressed that support for the implementation of National Portfolio of Actions on Environmental and Health has been developed.

He recalled that the SENTIERI approach is a national epidemiological surveillance instrument and that it was used to evaluate the changes in the health status of the population that inhabits contaminated sites. He explained that such tools enable identification of preventive activities, the need for remediation of contaminated sites, and the assessment of the effectiveness of remedial measures.

He expressed satisfaction with the inclusion of this method in the final report on the project, the road map, partly relating to future actions and strengthening of institutional capacities. He noted that this approach is based on inter-sectoral activities, both for health and those related to the environment. He emphasized that the final conference of COST Action is to be held in Rome and sent a call to the Serbian members of this Action.

4. Project progress review and the Roadmap - Dr Branislava Matić Savićević

Dr Branislava Matić Savićević pointed out that the whole team has worked on a document "Roadmap for sound management on contaminated sites", in true intersectoral spirit. In creating this guidlines it was important to be in line with the existing capacities giving room for improvement that would be achieved through new potential project activities in the upcoming period. She provided a brief overview of what was done in this project, recalling that the team meeting with foreign experts was held in May this year, although the contract was signed in July, while the First Stakeholders Consultation Meeting was held on June 29th. Also, a training workshop, with an aim of building capacities related to methodological principles.

She indicated that one of the main documents was the Gap Analysis Report, with the aim of making a cross-section of the situation on the existing data in the field of health and the environment, with the following focus on the sites exposed to industrial contamination. She explained that Bor was selected during the analysis of the database because it is the only site in Serbia that has data sets that can be used in a series of more than ten years, both from the environment and from health. She also stressed that additional efforts will be made to address the shortcomings in the databases in further steps.

As the second document of importance for the project, she listed the Road Map for the sound management of contaminated sites in the Republic of Serbia, which, within the framework of a concise action plan, defines a series of activities that should be undertaken in the forthcoming period. She noted that, due to the inability to simply copy the methodology from an environment that does not possess such a reference population as in our country, the offered SENTIERI methodology has been adapted, thanks to colleagues from the Department for Noncommunicable Diseases of the Institute. She also pointed out that a project website and a leaflet were created.

She pointed out that the aim of the project was to focus on the methodologies necessary in the future in order to validly compile data from both health and the environment and to produce relevant data on cause-and-effect relationships with the inevitable difficulties of allocating one particular contaminant. She added that more specific goals were: integration of existing social capacities, creation of a unique operating system that would enable monitoring of environment and health in places with industrial pollution, of certified quality. She noted that working on this project could be a zero-sum study for newly established owners as an epidemiological study that can always be consulted.

She explained that the Roadmap document originated from the Gap Analysis Report and the observations of deficiencies by both sectors, which enabled the delivery of key recommendations and the construction of this strategic plan. She thanked Dr Ivano Iavarone for proposing key components of the document structure: Expanding the knowledge base, Monitoring and reporting, Leadership and coordination and Institutional capacity strengthening.

During her presentation, Dr. Branislava Matić Savićević presented the project team, emphasizing its multisectorality, even within the health sector. She stated that each of the four areas mentioned above was determined on the basis of activities, desired results, indicators, and also gave a timeframe for each of these activities and indicated entities that will participate in the realization of these activities.

It underlined the necessity of expanding and maintaining capacities on the importance of contaminated sites, raising the capacity of evidence, knowledge in terms of effectiveness in strategic moves and interventions, and identifying gaps in knowledge. She added that this could be achieved through the implementation of awareness raising workshops and education of key population groups. She noted that in Bor, in cooperation with colleagues from the Environmental Protection Agency, farmers were educated regarding results related to soil contamination and the possibility of overcoming this problem.

She emphasized the importance of having Health Councils at the local level and encouraging their activities, as well as the importance of the so-called. PPP - public private partnership, or the involvement of large companies based on the principle of corporate responsibility. She pointed out that there are already examples of large companies investing in campaigns and activities related to the health protection through the preservation of the environment.

When it comes to monitoring and reporting, the goal was to set up a working group that would participate in the formation of new by-laws aimed at the work of the cadastre of contaminated sites and monitoring, first of all, the quality of the land, as well as the harmonization of monitoring in contaminated sites. Adding to the list of objectives, she stated improving the supply of Contaminated Sites Cadastre with data, which could be achieved through: creating the application for this purpose, involving staff trained to manage it, clearly defined indicators for environmental monitoring, as well as creation of an information subsystem and model for assessing the impact of environmental pollution on the health of the exposed population.

When it comes to the third component ie. leadership and coordination, she emphasized that the health sector should lead, as suggested by the World Health Organization. One of future actions of this sector is to establish a working group as an intersectoral expert body for the EHIA, as defined in the Public Health Strategy for the period 2018-2026. She noted that it is necessary to adopt a plan of vertical and horizontal communication and coordination of these activities within the mentioned working body.

Dr Branislava Matić Savićević underlined that the fourth part of the Roadmap (Institutional capacity strengthening) is also the weakest point which leaves a great deal of space for future steps: capacity building for analyzing impacts at policy and decision-makers, and at the same time creating scientific-operational multisectoral support for decision-makers, raising technical capacities in terms of staff and laboratories of local IPHs, which will form the basis for the formation of human biomonitoring activities. If conditions are met, by the Ministry of Health and within the National Portfolio of Action on Environment and Health, one of the possible options is to establish a functional expert group in the IPHS "Dr Milan Jovanović Batut", that would be readily available to work on EHIA, according to the experteese of its participants.

Further on, she stated the importance of developing a custom methodology and the adoption of standard operational procedures for further action. She emphasized that it is necessary to form a system of sustainable financing. She, also, clarified that it is of essential need to introduce these activities into regular public health programme curricula, avoiding its exclusive project occurrence. She stressed that capacity building is needed for those local Institutes of Public Health, having jurisdiction for providing public health procedures on the territory hosting key contaminated sites in the country. In the framework of capacity building, she stressed that it would be desirable for colleagues to gain experience and knowledge in the countries of the European Union, concluding that capacity building from this aspect would be feasible.

She said that one of the drawbacks of this project was the participation of only two sectors, and added that any further activity would imply the involvement of at least two sectors (Ministry of Energy and Mining, Ministry of Labor, Employment, Veterans' Affairs and Social Affairs, Ministry of Economy or Serbian Chamber of Commerce). She pointed out that, in addition to vulnerable groups of the general population children, pregnant women, elderly), occupationally exposed population fractions should be taken into account, as well. Dr Matić Savićević, also, mentioned that issue of risk communication is very important for people living in the vicinity of the CSs, and that a lot has to be done in that area, at the national level. Another drawback was the surplus of health data compared to quality and quantity of environmental data, which can be taken as a serious scientific barrier in establishing causality.

In conclusion, she stressed that it is important to define four components: to whom we raise the capacities, what are the capacities, where they are geographically located, how much this process costs. She underlined the strengthening of local level participation and decentralization of the proces, emphasizing the importance of continuing international cooperation, as well as the development of cross-border cooperation. She mentioned as a significant increase in the participation of corporate accountability through PPP communication.

1. Key stakeholders’ statements

Prof. Dr. Zorica Bulat, in front of the Department of Toxicology of the Faculty of Pharmacy of the University of Belgrade, expressed satisfaction with the beginning of such activities in our region. She recalled that the Bor basin was known since the 1990s, when the critical values of sulfur dioxide, which are considered to be solved by the new technological process, have been noted and pointed out that there are still many problems in the toxicological sense. She expressed interest in defining toxic substances that would be monitored and underlined the importance of human biomonitoring. She pointed out that precise depiction of toxic substances allows focusing on risk assessment.

She pointed out that there is less information on food, especially for foods that are locally grown and used by the population that feeds itself. She reminded that at the Faculty of Pharmacy there is a Center for toxicological risk assessment that cooperates with the World Health Organization. However, she stressed that for a complete risk assessment it is necessary to know the internal dose within human biomonitoring. Dr Bulat underlined the importance of linking toxic effects with chronic non-communicable diseases and added that data were needed for that. She underlined the importance of linking toxic effects with chronic non-communicable diseases and added that data were needed for that. She pointed out that there are excellent laboratories and staff available, and that some small obstacles lay before us in order to analyze the human material in those. In the light of that, she added that for now it would be easier to use laboratories that already work with human material, for example, at the Institute of Occupational Medicine and the Institute of Forensic Medicine. She agreed with Dr. Iavarone on the importance of exposure to mixtures of toxic substances and added that this should be included in the analysis. She stressed that a complete risk assessment is necessary if it seeks to involve risk management. She underlined the importance of involvement in the analysis of results from occupational medicine because this group of exposed population represents the healthiest fraction of population, that may be most often controlled in relation to other residents for whom exposure data exists and, as a rule, live in the same area that provides significant information.

Dragana Vidojević presented some SEPA activities that were conducted in previous years. She pointed out that the results of the research are published in the annual reports on the state of the environment and in special national reports (for example, the state of land for 2016 and 2017). She noted that together with UNEP, SEPA published a publications on land pollution where the
results of the project realized in cooperation with UNEP were presented, which was aimed at examining potentially contaminated sites. She noted that SEPA was in charge of international reporting and that she participated in the work of the working group that changed the methodology for reporting on contaminated sites within the EU and associated members. She recalled that the data is available on the Agency's website and portals (air quality data, data and 10 indicators referring to the national list of environmental indicators). Dr. Vidojević pointed out that there were intensive activities aimed at accelerating and improving the cadastre of contaminated sites and providing data for this cadastre. She added that eight workshops were held throughout Serbia, whose participants were representatives of local government units. She presented the results in terms of participation of 95 representatives of cities and municipalities, which is 57 percent of the total invited. She explained that along with trainings, special meetings with local government units were organized precisely on the topic of contaminated sites where land, air and wider environmental pollution were discussed, and that good activities and good
activities came from these activities.

She stated that 32 locations were examined within the UNEP project and program office in Vienna, related to the improvement of land management. In addition to this project, she also referred to a project funded through another UN organization, UNIDO, which deals with the disposal of PCB waste and PCBs location. She noted that in the coming days a training will be held for the management of contaminated sites. She also referred to the support of the Republic of Italy in raising the capacities of SEPA and other institutions and obtaining two characteristic plans for the research of two locations, Zorka Sabac and Viskoza Loznica.

She emphasized that through work with international institutions, the wider multisectoral working groups raised capacity for monitoring and reporting on contaminated sites. She presented the institutions and sectors with which cooperation is being realized. She presented the results of the project with UNEP and explained that a preliminary site and risk assessment was carried out, which includes: the impact on health, ecosystem and migration, probability and level of impact, and the risk assessment itself includes information and data obtained by the field visit itself, expert judgment, research at the site. She pointed out that out of 32 locations, 14 priority locations were identified and that future actions will be directed to detailed research of these locations in order to define rehabilitation and remediation projects. In conclusion, she emphasized that it is necessary that all by-laws be adopted, especially those related to systematic monitoring of air quality and by-laws that will define land protection plans at all executive levels. It was equally important to highlight the development of a national strategy for the management of contaminated sites, the strengthening of institutional capacity for managing contaminated sites, a detailed survey of 14 priority sites, and making a list of priorities from 14 locations, precisely through the methodology developed under this project. She emphasized that besides cross-sectoral cooperation, intersectoral cooperation is also important.

Milenko Jovanovic, SEPA, pointed out that Bor has been one of the black spots for air quality for years or decades, and that research confirms that both land and groundwater are endangered. He explained that the quality of ambient air is seriously monitored when it comes to concentrations of sulfur dioxide from the Bor smelter, but that the problem is not resolved. He explained that the annual concentration was below the limit of 50 micrograms per cubic meter, but that the number of days with overdrafts was not yet taken into consideration and that it was increased during the last year at the City Park in Bor. As an additional problem he pointed out that the smelter is at a lower altitude than the city itself, which additionally burdens the air with the emission of different pollutants. He noted the neglect of monitoring of the concentration of other pollutants, such as, suspended particles. He pointed out that the entire region of Bor is threatened with concentrations of arsenic (water, air, soil) and that the sampling of air at the measuring station of the City Park has just been started, recently. He underlined that less than a month was needed for realization due to efficient cooperation with local self-government, experts from the Mining and Metallurgy Institute and the SEPA. Also, as an aggravating factor, the work of the heating plant on coal as energy source, was mentioned.

Dr Snežana Živković Perišić pointed out that as a key health indicator, cancer is monitored and that the data source is the Central Serbia Cancer Register, part of the European Network of Cancer Registries. She explained that the data refer to all ages and all types of cancer, and that the level of the municipality is the ultimate level for which data exist. In order to give weight to the analysis, epidemiological indicators, such as crude and standardized incidence rate and confidence interval, were used. The SENTIERI method was used to select 35 malignancies that can be linked to environmental media and for which there is evidence that they are related. In the initial level of analysis, the data for the last 10 years have been used. After consultation with Dr Iavarone, it was concluded that the maximum data available in 15 years should be used, which in further analysis led to even stronger evidence of association with the reference population. In addition to these indicators, mortality data were used to analyze chronic non-communicable diseases that are absolutely related to environmental media (acute myocardial infarction, hypertension, diabetes), and in this context, respiratory diseases, digestive, genitourinary diseases, congenital malformations, rare diseases in sensitive populations. Expected cases are compared with those shown (diseased and deceased) in relation to standard groups, in relation to gender, to a certain geographical area and to 35 localization of malignant tumors.

She noted that the SENTIERI approach allows maximum freedom of observation at the population level in the form of aggregated data. She explained that this is a specially designed epidemiological study that has the intention to be ecological. She also pointed out that this is a good opportunity to prove that the multisectoral approach exists and that this approach has enabled a clearly defined methodology, applied in Italy in terms of a nationally conducted emidemiological study and a national interest for remediation in the environment, actually represents a good an example that could be applied from one location to any contaminated sites in Serbia. Dr Živković Perišić stated that 6 important determinants were observed: location, environmental data, population at risk, reference population as a pandane population at risk, outputs ie. health status, as well as socio-economic determinants of health as one of the associated factors. She pointed out that the basic report defines the situation regarding the different environmental media in Bor representing environmental data, then it is defined which is the selected population, how to compare and how to assess the risk. She pointed out that the population at the highest risk from the polluted environment (primarily airborne) is exclusively related to the copper mine, and that the most frequent occurrence of illness is exactly where the measuring station "City Park" is located. She underlined the fact that Bor makes up 0.7 percent of the entire population of the Republic of Serbia.

She explained that the process of usable indicators had to be a method of indirect standardization. She explained that due to the small numbers and people migrating, she gave up risk assessment at the settlement level and that the focus was transferred to the municipality of Bor as such. She noted that more than 10,000 inhabitants of the Bor municipality were employed or related to RTB Bor's activity. She noted that the movement of the population in certain territories is completely negative, the negative increment is present, and the largest population density in the central part of Bor. She pointed out that the preliminary results related to cancer in the Bor region from 2006 to 2015, initially proved to be extremely important and that Bor distinguished itself as one of the spots with highest death rates and partially incidence rates, through previous reports. She explained that the takeover of the reference population, ie, southeastern Serbia respected the access to SENTIERS but in an altered form.

Dr. Živković Perišić She underlined that the increased risk observed in the Municipality of Bor over a prolonged period of time was highly statistically significant and that the most significant were lung cancer, one part of the group of digestive tumors and hematopoietic system diseases. As a very significant direct correlation of environmental risks she identified and explained that if there is a high risk for both men and women, this is a sure sign that the environmental status could be corralted with the given health data, and if the risk is greater in men, there is a potential exposure in the work environment.

From the above mentioned, she concluded that the city of Bor obviously represents an industrial contaminated site that has enough data from the environment due to its history. She emphasized that the project provides the basis for the implementation of a multisectoral cooperation and enables the improvement of both the environment and health through efforts in changing the environmental factors, primarily. She emphasized that the development of an improved epidemiological methodology not only facilitates the improvement of the National portfolio of action on environment and health, but gives Serbia a pioneering role in the closest neghbouring region and the implementation of international studies that are the basis for comparison with all other countries. She expressed the possibility of conducting ecological studies that will show a direct correlation between health and exposure in contaminated sites. She pointed out that the study within this project was retrospective and that it is certainly possible to conduct a prospective study in which the exposure could be monitored in an identical manner. She emphasized that biomonitoring is an essential tool for determining the connection between the
environment and health in contaminated sites and recommended that more attention be directed to sensitive populations (children).

Prof. Snežana Šerbula explained that sulfur dioxide is a product of metal-processing in Bor and that even with new technology it is still present in increased concentrations in ambient air. She noted that the copper ore in Bor is sulphide, being an important source of sulfur dioxide present in the air. She underlined that the biggest problem is hundreds of times higher concentrations of arsenic, and besides it in elevated concentrations there is also cadmium, lead, and accompanying elements that are found in the smallest suspended particles that can be inhaled. She explained to the attendants that these substances are getting into the air under the influence of the wind, and under the influence of watercourses into the watercourses of this region. In addition to mining refineries, it emphasized the existence of flotation, which is part of the process of enriching copper ore. She emphasized that the heating plant does not have a major impact on air pollution and that the amount of toxic substances emitted from it is lower than those originating from RTB Bor. In conclusion, she also underlined the importance of human biomonitoring.

6. Expert commentary - Professor Dimosthenis Sarigiannis

Professor Dimosthenis Sarigiannis pointed out that after considering the most important problems of the particular CS of Bor, he also believes that arsenic is the main pollutant. He emphasized the importance of working at the local level. He pointed out that in addition to pollution of air, pollution of land and plants is not to be ignored, and that a holistic assessment is needed that would encompass all environmental media. He also emphasized the importance of human biomonitoring. He stressed the importance of using this example on other CSs in Serbia and across the borders, as well.

Dr Branislava Matić Savićević added that the Republic of Serbia is a signatory to the Agenda on Sustainable Development and that a Strategy for Sustainable Development has been adopted by the Parliament and pointed out that the SDG 12 (Sustainable Development Goals 12; sustainable production) addresses the problem of contaminated sites and waste management. She pointed out that hazardous waste, not just industrial production affects health. In conclusion, she noted that the Agenda for Sustainable Development will be respected when planning future activities.

7. Discussion

Dr. Viša Tasić pointed out that it would be optimal for human biomonitoring to be applied in Bor in terms of determining the concentration of arsenic in the urine, blood, nails, hair. He praised all participants for the work on this project and pointed out that employees in institutions that present polluters were cooperative in their efforts to serve the project as a guideline for further activities. He reminded that the problem with arsenic in Bor begins to come to light when smelting technology has changed in 2016. He explained that the reason why arsenic and sulfur dioxide are still being recorded over the allowed limits is that the new technology was directed to eliminate sulfur dioxide in the air, while other metals were not included and were not a priority. He noted that there are existing and used technologies in the world, and that some of the existing technology should be added, as it applies, to other gases that are emitted in the air, with no pretreatment procedure.

Prof. Dr. Aleksandar Ćorac expressed gratitude and personal satisfaction for participating in the project. He noted that the area of Kosovo and Metohija is dealing with a significant presence of industrial pollution and that due to the pollution from the lead and zinc industry there are large quantities of waste present and graphicall explained as 8000 trucks in a row. The problem was stated by the presence of toxic substances 100-120 km from the zone of direct contamination in water and sediment due to spread of contaminants through environmental media. He pointed out that the basic value of this project was the launch of this topic, but also noted that the basic mistake of this project could be precisely that, if it stops here, on today’s achievements. He urged his colleagues to make this the first step and to submit proposals for directions in which to go further.

Dr. Ivano Iavarone underlined the possibility of a different examination of the problem and summarized that the conference was started with environmental monitoring, then observing the contribution of epidemiology, toxicology, and that now it was about hygiene and medicine, and concluded how important an intersectoral approach is and should be put in practice. He noted that there should be an approach that is complementary to different disciplines.

Professor Dimosthenis Sarigiannis has shared information on organizing a major South East European Conference on Toxicology in South-East Europe between June and September and stressed that similar problems exist in the countries of this region and called for a joint resolution of the issues during the Symposium on the subject.

8. Closing remarks

Ass.Prof. Verica Jovanovic once again thanked for the patience and participation in the event. She especially thanked UNEP and the World Health Organization for initiating this project and stressed that the environmental impact of health is of high priority. She stressed that there is a common task, in defining how to perform the EHIA, respond to pollutants, and that industrial pollution is also an integral part of our lives, but with corporate responsibility. She noted that there are no negative and positive sides, but that we all need to achieve adequate and acceptable environmental conditions and to preserve and improve our health.

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