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EXECUTIVE BOARD130th sessionGeneva, 16-23 January 2012
TECHNICAL BRIEFINGImplementing the Political Declaration on NCDs:
Commitments of Member States and WHO
What does Minamata mean for the oral health community in a resource-constrained setting?
WHO’s views and perspectives from the African region
Dr Benoit Varenne, DDS, MPH, PhDRegional Adviser, Oral Health
Non Communicable Diseases ClusterWHO Regional Office for Africa
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1. Context of the Minamata Convention development and coming into force
2. Current and future interventions
3. The Minamata Convention - an opportunity for oral health
Presentation outline
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=> Mercury can only be eliminated by reducing its use through introduction of alternatives
Global context - Mercury
Mercury is a highly toxic heavy metal Mercury is one of the ten chemicals
of major public health concern Mercury is a natural element that
cannot be created or destroyed Most mercury comes from human
activities & heavy industry Excess mercury supply should be
stored
(Source: UNEP & WHO)
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Global context - Mercury in Healthcare Facilities
Thermometer blood pressure devices Fluorescent Lamps Dental amalgam Batteries pharmaceuticals and
vaccines
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Þ A significant amount of mercury is released from the use of dental amalgam into the environment
Þ Low awareness of both oral health community, policy makers and population at large
African Context - Dental Amalgam
A majority of restorations are made in Amalgam
The use of capsulated amalgam is increasing but mercury liquid & alloy mixing devices are still used
Designated containers for waste dental amalgam & amalgam separators are rare
Unsound waste management practices mixing its hazardous wastes with general wastes
Lack of data, legislations and policy Suppliers of amalgam to Africa: China, US,
Australia, Turkey, Iran, Europe & India
(Source: East Africa Dental Amalgam Phase down project)
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Global Context - Global Mercury Consumption by Sector
__________________________________________________________
Global mercury demand (metric tonnes) 2015 ___________________
Small-scale/artisanal gold mining 650-1,000 Vinyl chloride monomer (VCM) production 1,250 Chlor-alkali production 315-385 Batteries 130-178 Dental use 270-360 Measuring and control devices 165-193 Lighting 108-135 Electrical and electronic devices 102-126 Other (paints, laboratory, pharmaceutical, etc.) 170-357 ___Total 2,160-3,984
(Source: UNEP. Mercury-containing products partnership area business plan, 2013)
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Highlights of the Minamata Convention
The MC provides controls and reductions across a range of products, processes and industries
The treaty also addresses the direct mining of mercury, export and import of the metal and safe storage of waste
A range of mercury products will be banned by 2020 Certain types of non-electronic medical devices are
also included for phase-out by 2020 Exceptions for some large measuring devices where
currently there are no mercury-free- alternatives Vaccines have been excluded from the treaty The MC calls for a phase down of dental fillings using
mercury amalgam
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128 signatures - 30 ratificationsChina is the 30th country to have ratified. Twelve African countries.
The Convention comes into force 90 days after ratification by 50 countries
Who have signed & ratified the Convention?
http://www.mercuryconvention.org/Home/tabid/3360/Default.aspx
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…to phase down the use of dental amalgam shall include two or more of the measures from the following list:
Highlights of the Convention Measures to be taken by a Party…
i. Setting national objectives aiming at dental caries prevention & health promotion
ii. Setting national objectives aiming at minimizing its useiii. Promoting the use of cost-effective and clinically effective mercury free ‑
alternativesiv. Promoting research & development of quality mercury-free materials v. Encouraging professional organizations and dental schools to educate &
train dental professionals and students on the use of mercury-free dental restoration alternatives & on promoting best management practices
vi. Discouraging insurance policies, & programmes that favor dental amalgam use
vii. Encouraging insurance policies & programmes that favor the use of quality alternatives to dental amalgam
viii. Restricting the use of dental amalgam to its encapsulated formix. Promoting the use of best environmental practices in dental facilities
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Interventions - The UNEP Global Mercury Partnership
The UNEP Global Mercury Partnership works closely with stakeholders to assist in ratification and effective implementation of the Minamata Convention on Mercury
Goal: to protect human health and the environment from the release of mercury and its compounds to the environment
It is a voluntary multi-stakeholder partnership
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Interventions - The UNEP Global Mercury Partnership
• The 8 work areas of the Partnership have business plans setting out objectives, targets and priorities for action
• Initial funding has been pledged by Japan, Norway and Switzerland
• Support for countries is also provided by the Global Environment Facility (GEF)
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Interventions - EADP, East Africa Dental Amalgam Phase-Down Project, Phase I (2012-15)
WHO and UNEP initiated demonstration projects to phase down dental amalgam in partnership with FDI and IDM
Focused on 3 countries: Kenya, Tanzania and Uganda Aims: to demonstrate the phase-down approach of dental
amalgam use in low-income countries Priority areas and outcomes :
Strengthen oral health promotion and disease prevention Environmentally sound management of waste in dental clinics Promotion of measures to reduce releases during trade and supply as
well as from dental clinics Strengthen the awareness of the general public to dental amalgam
alternatives Training dental professionals
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Interventions - EADP Phase II
The project has shown that dental amalgam phase down is applicable in LMICs
The successes and gains of Phase I resulted in an extension to a 2nd phase
“Phase down of Dental Amalgam through an Environmentally Sound Lifecycle Approach and multi-sectoral action in Ethiopia, Kenya, Tanzania, Uganda and Zambia”
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1. Context of the Minamata Convention development and coming into force
2. Current and future interventions
3. The Minamata Convention - an opportunity for oral health
Presentation outline
Supporting the inclusion of oral
health-care interventions in
third-party payment schemes as a means of achieving UHC &
contributing to SDGs
Encouraging oral health community working through
multisectoral approach &
partnership beyond the health sector
Building capacities of oral health
professionals on oral health promotion
and disease prevention
Promoting research of quality,
affordable, safe, and environmentally
friendly alternatives to dental amalgam
Why the Minamata Convention should be considered as an opportunity for the oral health community ?
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Creatingawareness of the
environmental risks in health care
facilities & promoting responsible
environmental stewardship
Promoting preventive
interventions at PHC level, in school
settings and toward communities to
increase control over their health
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