For the first time, this UN Resolution formally recognises for the right to water and sanitation and acknowledges that clean drinking water and

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1 For the first time, this UN Resolution formally recognises for the right to water and sanitation and acknowledges that clean drinking water and sanitation are essential to the realisation of all human rights.

2 Nel passato, le società non sono riuscite a valutare l'importanza degli ecosistemi, che sono stati spesso ritenuti un bene di tutti e il cui valore è stato di conseguenza sottostimato Supporto: cicli dei nutrienti, impollinazione colture Fornitura o approvvigiona -mento: produzione di alimenti e acqua Regolazione: controllo del clima e delle malattie Gli ecosistemi sostengono la vita e l'attività umana nel loro complesso. I beni e i servizi che offrono sono vitali per il benessere e lo sviluppo economico e sociale futuro. Culturali: benefici ricreatiivi * UN Millennium Ecosystem Assessment

3 -1956 series of expert consultations culminating in a meeting in 1956 in Geneva 1958: International Standards for Drinking-Water published 1958, 1963, 1971: revisions of International Standards for Drinking-Water 1984: 1 ed. WHO Guidelinesfor Drinking-Water Quality (GDWQ) superseededthe International Standards basis for the development of national standards Demand for the document is among the highest and most sustained of all WHO publications

4 G7 Milan Health Ministers Communiqué 5-6 November, 2017 United towards Global Health: common strategies for common challenges There is a need to raise public and professional awareness through information and sharing on the impact of climate and environmental related factors on health, and on the co-benefits PREAMBLE to health of actions aimed at increasing resilience and addressing environmental degradation. We also need to promote the exchange of data, best practices, 1. We, technology the G7 Health and Ministers, tools at all met levels, in Milan particularly on November those 5-6 which 2017, guided are relevant by the G7 at the Taormina Leaders Communiqué and in a spirit of cooperation, to address the global urban, rural and community and workplace levels. Positive results can be challenges we face today. We commit to better prepare our health systems to respond collectively to present and future threats, to protect our citizens wellbeing, in sectors, and promote suchglobal ashealth environment, for broader social, education, economic and security gains. We recognize that alongside recent advancements in health care and global health interdisciplinary coordination, there research, continue to be challenges transport, to global energy, health, including finance, conflict and sustainable crisis, social urban inequalities, planning, rapid globalization sanitation, and urbanization, water environmental-related and waste factors, and increased movement or displacement of people. We acknowledge our achieved by working with our colleagues and stakeholders management, wildlife, agriculture and land use, and food systems.

5 The 2030 Agenda

6 The SDG 6 web

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8 Indicators of the Anthropocene in recent lake sediments differ markedly from Holocene signatures. Comparison of the current Geologic Time Scale (GTS2012), with two alternatives. Colin N. Waters et al. Science 2016;351:aad2622 SL Lewis & MA Maslin Nature 519, (2015) doi: /nature14258

9 Industria alimentare Trattamenti domestici Chioschi dell acqua Caraffe filtranti

10 Water-related outbreaks 948 reported outbreaks of infectious disease potentially related to water ( ) 20% confirmed as related to water Significant underreporting Source: WHO Regional Office for Europe 2016

11 MEAN ANNUAL TEMPERATURE DAYS OF WARM SPELL ( HEAT WAVES ) DAYS WITH EXTREME RAINFALL (FLOOD) Year CONSECUTIVE DRY DAYS (DROUGHT) Year RADIATION BALANCE some main CC drivers some main CC effects Year Year High emissions scenario, representative concentration pathway 8.5 [RCP8.5] (orange), low emissions scenario, [RCP2.6] (green), annual sobserved record (blue), a) Climatic Res. Unit & Tyndall Centre for Clim. Change Res., University of East Anglia, 2015.; b) CMCC exterme climatic events seriously impacting systems and humans retreat of glaciers, coastal erosion, reduction in agricultural production, forest fires, desertification changing distribution of flora and fauna degrading biodiversity depletion of air quality, particularly in urban setting lacks in water access, deficit of safely managed water supplies, sanitation and hygiene re-emergence of previous/past endemic agents exotic communicable diseases, e.g., dengue, chikungunya, zika, crimea congo fever, west nile fever or blue tongue

12 Industria alimentare Trattamenti domestici Chioschi dell acqua Caraffe filtranti

13 Europa ( ) Italia ( ) * Pesticidi Parametri Indicatori Parametri Chimici Parametri Microbiologici Possibly underestimated Small water suppliers (< inhabitants) Risks due to domestic networks Parameters other than those of routine monitoring 98,00 99,00 100,00 % di dati di monitoraggio conformi * Partial data (ca. 65% for )

14 Cyanobacteria - toxins Organoclhorides Cromium VI Aromatic compounds Vanadium Dinitrotoluene Legionella Suspected deliberate contamination Uranium Thallium Perfluoroalkyl compounds Aromatic amines Hydrocarbons P. aeruginosa Norovirus Manganese Aluminium Other indicator parameters Arsenic it is everything under control? * Episodes of alert related to concern of water contamination

15 Hazards Pollution sources Duration of pollution phenomena Water contamination and uses Heavy metals, > 20 organochlorides (8 carcinogenic) Huge ancient landfills (inside and around an industrial site) progressively grown in number and side > 50 yrs Exposed population > Emerging of phenomena Main prevention control gaps (before emergency) Risk Management Polluter payment Follow-up Costs groundwater, surface water, drinking water 2005 Groundwater monitoring by Environmental authorities, in compliance with dir 2000/60/EC Lack of monitoring (before dir 2000/60/EC related actions) Drinking water treatment & changes of drinking water catchment Yes: Tribunal condamned responsible of contamination for human poisoning since the pollution of an environmental matrix (because underground water constitutes a source of water supply) Legal actions. Possible retrospective health impact assessment: Epidemiological study (currently under feasibility assessment)

16 Hazards Pollution sources Polyfluoroalkylated substances (PFAS): highly resistant persistent compounds, wide diffusion; impact on human health: pregnancy complications, thyroid diseases, increasing cholesterol, possible cancer Industry (1968-on course) producing pesticides, pharmaceuticals, and PFAS Duration of pollution phenomena Water contamination and uses Exposed population ca Unknown (possibly 20 yrs) Groundwater, surface water, drinking water Emerging of phenomena Mainprevention controlgaps (before emergency) Risk Management Polluter payment 2013 Environmental Research project Lack of specific limits for PFAS in wastewater; Lack of environmental monitoring; Lack of lesson learnt (similar phenomena in 1977); Lack of sharing of information environmental/health authorities Drinking water advanced treatments; changes of drinking water catchment (in progress) Investigation in progress Follow-up Cost > Restrospective health impact assessment (biomonitoring, epidemiological study and monitoring follow-up), Intersectoral cooperation and risk communication strategy. Health Surveillance Plan. Water safety plans (emphasis on hazardous events related to waste disposal in water recharging areas)

17 Objectives and impact of EU Water legislation Health Drinking Water Dir Bathing Water Dir Floods Directive Groundwater Directive Environmental Quality Standards (EQS) Water Framework Directive Urban Waste Water Dir Nitrates Dir Marine Strategy Framework Dir Envir. Econom.

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19 Pericolosità intrinseca, presenza nell ambiente, concentrazione, attività biologica, destino ambientale Miscelazione & diluizione Volatilizzazione Adsorbimento Ambiente chimico Degradazione biologica Vulnerabilità suolo Captazione Trattamenti di potabilizzazione e distribuzione Distribuzione Esposizione umana: Consumo Igiene personale e domestica Uso potabile Usi agricoli, zootecnia, produzione alimentare Usi ricreazionali, esposizione professionale, ecc.

20 Current Framework for Safe Drinking Water: Health-based targets (National regulatory body) Considers overall public health context and contribution of drinking-water to disease burden Eventually expressed as Water Quality, Performance, or Technology Targets Water supply criteria/procedures/technolog ies Independent surveillance (Wter supplier, Surveillance agency) External audit Monitoring

21 Punti di conformità criteri e procedure consolidate nelle fasi di captazionepotabilizzazionedistribuzione protezione della qualità delle acque captate efficacia e sicurezza dei sistemi di trattamento (mitigazione da rischi potenzialmente associati alla risorsa idrica d origine o alla distribuzione) garanzia igienica degli impianti di distribuzione che forniscono acqua ai consumatori finali

22 Current Framework for Safe Drinking Water: Health-based targets (National regulatory body) Water supply Water Safety Plan criteria/procedures/technolog (Water iessuppy) Independent surveillance (Wter supplier, Surveillance agency) Considers overall public health context and contribution of drinking-water to disease burden Eventually expressed as Water Quality, Performance, or Technology Targets Systematic risk assessment and risk management along the entire DW chain Implementation of step-wise improvements Continuous monitoring Documentation and supporting programmes External audit Monitoring

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24 Iniziativa gestore Seguito emergenza idro-potabile Studio pre-fattibilità / avvio

25 Percorso normativo nazionale di applicazione e approvazione di Piani di Sicurezza dell Acqua & Piano Nazionale di Formazione sui Piani di Sicurezza dell Acqua Introduzione dei PSA nei sistemi di gestione idro-potabile: superare criticità dell attuale sistema di controllo sulle acque prevenire efficacemente emergenze idro-potabili dovute a parametri non oggetto di ordinario monitoraggio, considerando anche gli scenari di cambiamento climatico (ri)definire le zone di approvvigionamento idrico attraverso una identificazione aggiornata delle filiere idro-potabili potenziare la condivisione di informazioni e dati, come espressione della dovuta diligenza, tra gli organi che per diversi ambiti di competenza operano monitoraggi consentire una partecipazione più consapevole e attiva delle comunità locali ai sistemi di prevenzione e controllo delle acque nei diversi territori realizzare banche dati costantemente aggiornate dai soggetti del territorio

26 KEY IMPLICATIONS FOR HEALTH Crisis on water access and safely managed water supply in several Italian regions (6/20 Italian regions calling for a state of emergency in summer 2017) Aquatic ecosystems and groundwater resources seriously impacted Saline intrusion, turbidity, algal blooms, water scarcity causing lower potential of dilution of pollutants in aquifers and bioaccumulation of contaminants No sufficient water level in rivers and lakes failing to achieve a good status Diseases due to lack of water for human consumption, sanitation and hygiene in emergency circumstances Depletion of water quality and possible health impact (non communicable and communicable diseases) current and future scenario MEAN ANNUAL MAXIMUM TEMPERATURE ANNUAL TOTAL PRECIPITATION precipitation temperatures sea water level over-exploitation of water resources gaps in management &

27 WATER RESOURCE STRATEGY to promotenaturalwater conservation, reclaimedwater reuse, leakage control and investments in water sector harmonization and updatingof legislative water quality and parameters strategy to aggregate the fragmentized surveillance authorities and water management companies, the latter also by using economic instruments to promote water-use efficiency across all sectors to strengthencapacitybuilding regardingclimateadaptationin water management (flood and drought control) to increase resilience of water supply chain and sanitation systems to support the adoption and implementationof risk based approachin water and sanitationsector(i.e., water safetyplans, sanitation safety plans), including waterborne diseases risk assessment and management, early warning systems to support the development and up-scaling of technologiesand methods to ensure safe drinking water in sufficient quality and quantity (e.g., desalination technologies for contingency water

28 Protocol on Water and Health Multilateral agreement addressing protection of human health and well-being through linking sustainable water management with prevention, control and reduction of water-related disease Joint WHO and UNECE secretariat

29 General provisions Adequate supplies of wholesome drinking-water Provision of adequate sanitation that protects health and the environment Protection of water resources, including the reduction of harmful discharges Safe use of water for recreational purposes Safe use of wastewater and sewage sludge in agriculture Effective surveillance systems for monitoring and outbreak response

30 National target setting ESTABLISH TARGETS SET DATES REVIEW PROGRESS

31 PROGETTO FINANZIATO MINISTERO DELLA SALUTE DIREZIONE GENERALE PREVENZIONE SANITARIA Supportare le decisioni in tema di salute della Presidenza Italiana del G7 (2017) per definire la Strategia di adattamento agli effetti dei cambiamenti climatici sulla salute dell uomo e del pianeta, secondo la vision Planetary Health CLIMATE AND HEALTH COUNTRY PROFILE ITALY Approfondire le conoscenze per l analisi di impatto e vulnerabilità delle aree fragili Italiane: strategia di prevenzione e adattamento effetti negativi dei CC sulla salute valutazione dell efficacia delle strategie proposta dell Italia come paese pilota a livello internazionale per la valutazione d impatto dei cambiamenti climatici vision: 5-30 anni

32 Credits: Ministero della Salute Direzione Generale Prevenzione Sanitaria Oliver Schmoll OMS Team di PSA Viveracqua