Last summer, the European Commission adopted the so-called European Environment and Health Strategy, which is better known as the SCALE Initiative. Its objectives are to reduce the disease burden caused by environmental factors in the European Union (EU), identify and prevent new health threats caused by these factors, and strengthen policymaking capacity in this area.

The European Commission adopted the SCALE Initiative to address such issues. The three European commissioners responsible for environment, health and research jointly designed the strategy.

The SCALE Initiative has five key elements:

1. It is based on a scientific assessment of how multiple pollutants react in the environment through multiple exposure routes, including the presence of contaminants in air, water, food and consumer products.

2. The initiative initially will focus on the population thought to be most vulnerable to environmental hazards: children. The European Commission will launch pilot actions on pollutants, including dioxins, metals and endocrine disruptors, which are particularly relevant to children. EU member states and the World Health Organization (WHO) jointly intend to establish indicators and bio-monitoring systems to assist in better explaining the relationship between pollutants and disease.

3. It is intended to raise the awareness of environmental-health problems and how these problems can be solved.

4. EU legislation will complement both national and international initiatives with related goals, and will place a particular emphasis on safeguarding children.

5. All actions taken under the SCALE Initiative will be evaluated continually for their effectiveness in reducing environmental-related health problems.

The initiative will be implemented in cycles. The first cycle, spanning 2004-2010, will focus on several health effects: childhood respiratory diseases, asthma and allergies; neurodevelopment disorders; childhood cancer; and endocrine-disrupting effects. A detailed "Environment and Health Action Plan 2004-2010" will be prepared prior to the WHO's Fourth Inter-Ministerial Conference on Environment and Health in Budapest this June. A Baseline Report has been developed from diverse inputs.

Other likely actions in the first cycle include gathering information about the relationship between environment and health from the WHO and EU member states; developing indicators and bio-monitoring systems to assess environmental impacts; launching specific pilot actions on priority pollutants relevant to children; enhancing research in targeted areas; and identifying other actions to reduce exposure to contaminants. The Commission intends to focus on particulate matter, nitrogen oxide and ozone in ambient air. Concern with indoor air contaminants initially will center on environmental smoke and the effects of passive smoking on non-smoking women during pregnancy.

As with REACH, the jurisdictional breadth of the SCALE Initiative is limited to the EU. However, the results of the many actions already taken and in play, particularly the identification of diseases, the environmental stressors suspected to cause or contribute to them, and the routes of exposure associated with these stressors, can be expected to have immediate impacts on businesses and regulatory developments in the United States.