Islamic Republic of Iran | Priority areas | Environmental and occupational health

WHO in Islamic Republic of Iran

Environmental and occupational health

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What we do

» Climate change and health

During the past decades, environmental resources and ecosystems have been threatened as a result of lack of precipitation, persistent drought, heat stress, air pollution, water pollution, soil erosion and loss of biodiversity. Islamic Republic of Iran is experiencing climate change by rises in temperature and sea level and increasing frequency of dust storms and other disasters. A national policy for climate change was endorsed at Cabinet level in 2017 and relevant ministries and organizations are responsible for the development and implementation of efficient interventions for adaptation and mitigation measures.

Ongoing activities include:

  • health vulnerability assessment and climate-based modelling by the Ministry of Health and Medical Education with the technical support of WHO;
  • regional and global webinars with the support of the WHO Regional Office to share experiences and lessons learned in line with WHO guidance;
  • development of a sustainable and resilient cold chain to facilitate access to COVID-19 tools, in collaboration with the United Nations Industrial Development Organization (UNIDO) and with consideration to environmental health initiatives.

What we have achieved

  • The stewardship role of the public health sector has been catalyzed through building partnerships and establishing a national committee on climate change and health effects within the Ministry of Health and Medical Education.
  • The Ministry contributed to the first, second and third national United Nations Framework Convention on Climate Change (UNFCCC) reports.
  • One of the first comprehensive profiles for health vulnerability to climate has been developed and Islamic Republic of Iran is the only country in the Region that has piloted and conducted a health care facility resilience assessment.
  • Joint WHO and UNFCCC climate change and health country profiles were developed in 2015 and 2022.
  • A national programme on climate change health vulnerability assessment strategic directions toward adaptation to climate was implemented by relevant sectors.
  • A climate-based assessment of health was implemented in the fields of communicable diseases, NCDs, disasters, air pollution, water pollution, food safety and occupational health to address climate change in 6 climatically different provinces.
  • WHO guidance on climate-resilient and environmentally sustainable health care facilities was piloted in Islamic Republic of Iran through adaptation for validation and reliability of the checklists. To examine the adaptive capacity, climate resilience and environmental sustainability of the health system in the country at the facility level, various types of health care facilities were assessed, piloting the WHO guidance in the same 6 provinces.

What is next

  • Further support is needed to strengthen intersectoral collaboration between health and other sectors in developing and implementing the health adaptation plan through the SCHFS.
  • Service providers and relevant stakeholders need to be mobilized to protect health and the environment, including during emergencies.
  • Regulation and governance need to be enhanced for implementation of action plans.
  • Scaling up Infrastructure of data/information integration and compilation
  • Addressing the required improvements identified from vulnerability and resilience assessments to enhance the climate adaptation, resilience, sustainability, and preparedness of the health system
  • Promotion of the methodology and lessons learned of piloting WHO guidance for climate-resilient and environmentally sustainable health care facilities at the regional and headquarters level.

What we do

» Air quality (air pollution)

Islamic Republic of Iran is facing severe problems in terms of air quality. About 11% of all deaths and 52% of all the burden of diseases in the country are attributable to environmental risk factors. Ambient particulate matter pollution ranked first among the 10 risk factors for the environmental burden of diseases in Islamic Republic of Iran in 2019. Sand and dust storms also are sources of particulate matters. Burning fossil fuels is the primary source of climate-warming emissions, while also a major contributor to health damaging air pollution.

Ongoing and upcoming activities include:

  • developing the sand and dust storms plan of action based on the situation analysis as a continuation of the 2019 activity;
  • assessing the health impacts of air pollution using WHO’s AirQ+ software;
  • supporting the national team and technical working group in updating the advocacy plan document developed in 2017.

What we have achieved

  • A situation analysis of the health response to sand and dust storms in Islamic Republic of Iran was conducted and plan of action developed to promote science and build evidence on the impact of air quality.
  • Evidence was built on indoor air pollution health risk assessment in public places of Tehran (indoor-to-outdoor air ratio of identified pollutants) and cost-effective interventions were implemented.
  • Islamic Republic of Iran’s participation at the regional workshop to operationalize the regional framework of action on health and the environment was supported and training on the health impact assessment of air pollution conducted (AirQ+)
  • A symposium on environmental and occupational health in the country and regionally was held, including discussions on sand and dust storms, air pollution and climate change.

What is next

  • Promoting cost-effective interventions on the impact of air quality and building background evidence.
  • Upscaling the source appointment and impact assessment studies in all polluted cities in Islamic Republic of Iran.
  • Investing and providing support to engaging the population to effectively update the advocacy plan.

What we do

» Sand and dust storms

Multiple regions in the country have faced severe sand and dust storms in recent years. For every 10 micrograms per cubic metre increase in PM10 during dust events, the mortality rate increases by 1%.

The most significant socioeconomic effects of sand and dust storms include closure of schools and offices, cancellation of flights, migration from areas affected by dust storms, decrease in food production (such as dates, which was reduced by 60% in 2010), loss of livestock and decrease in the number of bees and level of honey production.

To tackle and prevent the effects caused by sand and dust storms, the activities listed below are ongoing, in collaboration with national counterparts.

Establishment of criteria to develop the Tehran Ministerial Declaration and follow up on international declarations and national policies and commitments.

Analysis of the health response to sand and dust storms by the Ministry of Health and Medical Education with WHO technical support to enhance governance capacity in: identifying, monitoring, evaluating and managing environmental risk factors such as sand and dust storms; and in strengthening multisectoral partnerships with non-health organizations (Department of Environment, Ministries of Oil and Energy) to implement interventions and mitigation measures to protect health.

What we have achieved

  • The Islamic Republic of Iran hosted an international meeting to develop the Tehran Ministerial Declaration that was presented to the United Nations General Assembly in September 2021. Member States are keen to honour commitments made in international declarations and develop national policies to overcome the cross-border challenges presented by sand and dust storms.
  • Best practices in dealing with sand and dust storms in the region were presented.
  • A situation analysis on the health response to sand and dust storms was undertaken in 2019 by the Ministry of Health and Medical Education with WHO technical support.
  • Multisectoral partnerships with non-health organizations were developed, including with the Iranian Department of Environment, Ministries of Oil and Energy that are implementing interventions and contingency measures in parallel with the health sector.

What is next

  • Technical and operational strengthening of early warning systems to reduce preventable casualties.
  • Strengthening cooperation between all responsible sectors (through the Supreme Council of Health and Food Security) for health adaptation and response.
  • Integration of practices and technical expertise though establishment of a national and regional network.

What we do

» Water, sanitation, and hygiene (WASH) and waste management

WASH is a relatively well addressed subject in Islamic Republic of Iran. Policies exist on drinking-water, sanitation and hygiene at both urban and rural levels, and implementation plans for all 3 are undergoing revisions. Cost estimations for the WASH plan are being conducted successfully at urban and national levels. Ninety-one percent (91%) of people have access to drinking-water at a safely managed level (94% in urban areas and 83% in rural areas), 88% of people have access to sanitation at basic services level (92% in urban areas and 79% in rural areas), and there are no data on hygiene statistics.

Ongoing activities to support improvements to water, sanitation, and hygiene include:

  • Development of WHO/UNICEF joint monitoring programme for water supply, sanitation and hygiene country reports.
  • Facilitating the Islamic Republic of Iran’s contribution to the joint monitoring programme in-country consultation for household estimates of 2000–2020, based on Sustainable Development Goal indicators 6.1, 6.2 and 6.3.1.
  • Conducting situation analysis and assessment of WASH services in health care facilities and establishing baseline data in close collaboration with the WHO Regional Centre for Environmental Health Action (CEHA).
  • Implementing the UN-WATER Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2021–2022 in the country. Islamic Republic of Iran is one of the two countries in the Region that are piloting e-GLAAS to assess the feasibility of using the REDCap platform as a data collection tool for future GLAAS cycles.

What we have achieved

  • A situational analysis and assessment of WASH services in health care facilities was conducted through adaptation and localization of the WHO/UNICEF Joint Monitoring Programme (JMP) checklist on WASH in health care facilities. A national online platform was developed to gather data and results were analyzed by the JMP team and presented to regional and global bodies.

What is next

  • Addressing WASH challenges through the development of policies, strategies and regulation, including in emergencies.
  • Implementing sustainable sanitation and water management through an evidence-based mechanism proposed by the Institute for Environment Research, Tehran University of Medical Sciences.
  • Implementing water and sanitation safety plans, such as the WHO water safety plan and sanitation safety plan.
  • Strengthening programmes on WASH in health care facilities and documenting successes in regional and international reports.
  • Promoting and supporting sustainable health care solid waste and wastewater management.
  • Promoting agreement between municipalities and the Ministry of Health and Medical Education, in close contact with the Department of the Environment on an integrated safe approach for the management of health care waste.
  • Showcasing the methodology and sharing the experience on adaptation and localization of the WHO/UNICEF JMP checklist for the situational analysis and assessment of WASH elements in health care facilities.

What we do

» Occupational health

The Environmental and Occupational Health Centre in the Ministry of Health and Medical Education is responsible for supervising occupational health programmes and activities at the national level. In each university, under the supervision of the Ministry, the Centre is responsible for monitoring and building the capacity of experts engaged in the field and reporting to the Ministry. The WHO country office, in collaboration with the Ministry and the Environmental and Occupational Health Centre, is currently working on developing an occupational health national profile for the Islamic Republic of Iran by conducting a literature review and assessing the implementation of the “Global plan of action on workers’ health” in the Islamic Republic of Iran using the regional tool.

What we have achieved

  • In June 2020, the Islamic Republic of Iran presented “Occupational safety and health of health workers in COVID-19 in the Eastern Mediterranean Region: risks faced and experiences”, which looked at best practices regarding the protection and training of health care workers during the pandemic.
  • The best practice document “COVID-19 response in the workplace: a risk-based decision-making matrix for physical distancing” was developed to share Islamic Republic of Iran’s experience and model for performing risk assessment and decision-making for closure and re-opening of businesses/industries and implementing protective measures in the workplace.
  • The document “Executive occupational health intervention model for prevention and emergency response against coronavirus (COVID-19) and other acute respiratory infections in Iranian workplaces”, was developed. It is a qualitative study conducted by the Occupational Health Research Centre through analysis of documents and executive reports, focus group discussions and interviews with policy-makers, experts and the local community on occupational safety and health policies implemented during the pandemic.
  • “Occupational health for workers in the Eastern Mediterranean Region: literature review and tool for situation analysis” was developed by the Occupational Health Research Centre and a checklist/dashboard of questions to assess implementation of the “Global action plan on worker’s health” in Member States of the Region.

What is next

  • Adapt and implement technical packages to develop occupational health standards, establish a surveillance system, and develop human resources and occupational health as vital elements of the national health strategy.
  • Share healthy work practices to develop updated training curricula to improve human resource knowledge, including occupational health physicians and occupational hygienists.
  • Strengthen national policies for health at work and promote healthy work and work environments, engaging employers, workers and government collaboration.
  • Illicit United Nations and WHO collaborating centres’ support to facilitate Member States’ development of employers’ policies on occupational health and safety as a priority.
  • Implement joint research projects on health risk assessment and joint knowledge-based research projects.
  • Support the country to implement joint projects with United Nations partners, such as the International Labour Organization.

What we do

» Environmental and social workstream in COVID-19 Emergency Response Project (ICERP)

The environmental and social team in ICERP has been established to implement the assessment and safeguarding of environmental, occupational health, and patient safety standards. The ICERP assessments were conducted by the WHO country office, on behalf of the Ministry of Health and Medical Education, and in collaboration with one of the top technical assessment companies in the health sector in 3 phases: preparatory, facility assessment and follow-up.

The activities listed below have been implemented toward project execution.

  • Development of an environmental and social team assessment tool based on national and international references and standards, in collaboration with the Ministry of Health and Medical Education.
  • Piloting of 3 sites to validate the assessment tool.
  • Implementation of an on-site assessment in 182 facilities (137 hospitals and 45 laboratories) and grading based on the identified non-conformities conducted.
  • Issuing of recommendations for improvement to identified non-conformities in facilities and technical consultation to fulfil gaps.
  • Follow-up assessing and grading after implemented corrective actions by the Ministry and facility to announce full compliance of site.
  • Documenting of lessons learned with in-depth interview sessions with all involved parties in the environmental and social team component of the project.

What we have achieved

  • Development of a comprehensive assessment tool based on national and international standards and references to assess safeguarding of environmental, occupational health and patient safety.
  • Assessment implementation in 137 hospitals and 45 laboratories (initial, on-site and follow-up) in a short period of time in 31 provinces of Islamic Republic of Iran with consideration of COVID-19 risks and restrictions.
  • Safeguarding all sites in the project and achieving full compliance according to the environmental and social workstream assessment criteria.

What is next

  • Upgrading the environmental and social team assessment tool and utilizing it as a standard readiness assessment tool for similar projects

What we do

» Cross-cutting areas

We support sustainable health-related cooling systems, such as cold chains (cold rooms, etc.) by equipping and upgrading facilities and procedures to be resilient and environmentally sound.

What we have achieved

  • Equipping cold rooms with sustainable and environmentally friendly equipment in 2 provinces –Golestan and Kohgilouye and Boyer Ahmad.

What is next

  • Conducting capacity-building on sustainable cooling and operationalizing them in the country (jointly with UNIDO).
  • Supporting an integrated approach across the country to enhance and scale up sustainable cooling in more provinces and areas (such as medicine storage).