"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"

Project No.: QSPTF/13/13/GOV/19

1st Stakeholders Consultation Meeting

June 29th , 2018

Venue: Institute of Public Health of Serbia „Dr Milan Jovanović Batut”

9.30-10.00 Registration

10.00-10.30 Welcome and description of the objective and expected goals of the day
Marco Martuzzi, WHO Bonn Office "Linking Ostrava Declaration and WHO activities to the issue of ICSs"
Ivano Iavarone, National Institute of Health, ISS, Italy; Director of the WHO Collaborating Centre for environmental health in contaminated sites "Introducing COST IS1408 Action together with the Consensus Statement of the COST Action participating experts"

10.30-10:45 Branislava Matić Savićević, M.D.,MSc, Head of Environmental Health and School Hygiene Department, IPHS, Team coordinator The QSP Project on ICSs in Serbia: Objectives and goals

10:45-11:00 Questions and Answers

11.00-11.15 Dragana Vidojević, PhD, Serbian Agency for Environment Protection (SEPA) "Overview of SEPA activities in managing contaminated sites"

11.15-11.30 Sonja Roglić, MEP, Head of Department for Chemicals, SAICM National Focal Point – title to be defined

11.30-12.00 Coffee break

12.00-12.15 NGO "Mladi istraživači" – Presenting their view on the subject of industrial contamination in Bor

12.15-12.30 Ljiljana Lekić, Bor Municipailty, Office for Environment Protection - Scope of environmental monitoring in Bor

12.30-12.45 RTB Bor – Environmetal protection measures undertaken in RTB Bor - representative to be defined

12.45-13.00 Dr Snežana Živković Perišić, IPHS, Department for NCDs, Cancer Register, epidemiologist - "Assesment of Population Health Risk in Bor"

13.00-13.30 Discussion and conclusions

13.30-14.30 Lunch

Minutes 

The meeting was attended by the following stakeholders, as presenters and active participants in the discussion:

1. Marco Martuzzi, WHO ECEH Bonn Office
2. Dr Ivano Iavarone, (National Institute for Health, Instituto Superiore di Sanita, ISS),
Italy; director of the WHO Collaborating Centre for Environmental Health in
Contaminated Sites
3. Dr Zsofia Pusztai, Head of the WHO Country Office in Serbia
4. Dr Verica Jovanović, acting Director of the Institute of Public Health of Serbia „Dr Milan
Jovanović Batut“,
5. Dr Branislava Matić Savićević, Institute of Public Health of Serbia „Dr Milan Jovanović
Batut“, Head of the Environmental Health and School Hygiene Department
6. Dragana Vidojević, Serbian Environment Protection Agency (SEPA), Head of
Department for Indicators and Monitoring
7. Ivan Đuričković, Ministry for Environment Protection (MEP), Department for Chemicals
8. Representative of the Bor branch of the NGO „Young Researchers“
9. Ljiljana Lekić, Bor Municipality, Office for Environment Protection
10. Saša Perišić, RTB Bor, ass.CEO, responsible for environment protection
11. Prof. Snežana Šerbula, Technical Faculty Bor, branch of the Belgrade University
12. Dr Snežana Živković Perišić, Institute of Public Health of Serbia „Dr Milan Jovanović Batut“, Cancer register, epidemiologist

Dr Matić Savićević has chaired the meeting, together with Dr Pusztai, Dr Verica Jovanović and Dr Ljiljana Jovanović.
Dr Matić Savićević has greeted the attendees on behalf of the Institute and other participants in the project, pointing out the need of establishing practical synergy in between health and
environment sectors.
Dr V. Jovanović has thanked the present colleagues and greeted all stakeholders that are to cooperate in defining and implementation of the methodology for correlating environmental factors with the health data of the exposed population, on behalfo of the IPHS. She pointed out that this kind of correlation is to be tested towards the end of the year, utilizing existing relevant health data, together with environmental data from previous reasearch and studies (undergone with the support of UNEP). The upcomming research will be, also, supported by UNEP, together with the WHO experts, implemented by national experts in the field of contaminated sites. She has addressed key stakeholders present at the meeting, who are to point out in their presentation to come at the environment and health consequences that the project will follow up, together with the ability and readiness of the relevant to improve environment protection measures, along with their regular activities, in accordance with the SDGs, that Serbia has adopted, as well. She stressed the aim of today's meeting is to highlight key needs imposed through the process of corporate responsibility in the field of its industrial activities.

Dr Pustai has reminded that this week has already witnessed an important high-level meeting hosted by the Ministry of Health, attended by the Minister of environment protection (Goran Trivan), State secretary of the Ministry of Health (Prof.dr V.Djukić), diplomats from the countries deeply involved in environmental issues in Serbia, such as Norway, Sweeden, South Korea, Japan, together with the national experts for different EH fields. Aim of the mentioned meeting was to discuss possibilities for joint programmes and projects of both ministries, for the sake of improvements in environment and health, in line with the EU Accession Agenda. She stressed that an issue of contaminated sites is a challenge not only for Serbia alone, but in the majority of European countries, causing high concern due to its potential to provoce serious health problems in the exposed population groups. She has expressed her opinion could be of high importance for the defining of the National framework for conatminated sites' management, creating a solid ground for such kind of future inter-sectoral cooperation.

Dr Lj. Jovanović expressed great satisfaction with this week's meetings, which show the existing awareness and support of both ministries to actively engage in setting up a national portfolio of actions in Serbia foreseen by the Ostrava declaration. She stated that population living in the vicinity of the ICSs could be exposed to harmful chemicals even in the prenatal period, with significant impact on immune system and capability of transplacental transfer to future offspring, in the case of women in childbearing age. She expressed hope that the project will show the place of Serbia in the broader, WHO European Region, in which, it is estimated, some 30% of Member States (MS) does not have solid legal framework covering management of contaminated sites. She pointed to the possibility that this pilot project was applied to other areas emphasizing the importance of joint, both horizontal and vertical, action in achieving results.

During his presentation, Marco Martuzzi has pointed out that Europe holds hundreds of thousands of CSs, which have not been observed in a systematical mode, and whose impact on human health has not yet been clearly defined, although a lot of them was in focus of relevant case studies. He stated that WHO European Region has 53 MSs, and that European Center for Environment and Health of the WHO (ECEH Bonn Office) during its work successfully
cooperates with international organizations, NGOs, UN agencies. Once in a 5-6 year period a Ministerial Conference on Environment and Health is held. Namely, the last one was held in Ostrava (Czech Republic) in 2017, with a previous one been held in Parma, Italy (2010). At the Sixth Ministerial Conference on Environment and Health in Ostrava, a Declaration has been adopted, which is a non-binding legal document on the priorities related to: improvements in air quality, water and sanitation, hazardous chemicals, climate change and health, waste generation and contaminated sites, urban health, environmentally sustainable health systems. He added that a majority of listed priorities could be found in previous declarations, but that topics of waste production and contaminated sites were included in the priority list for the first time in Ostrava Declaration (2017). Marco Martuzzi has underlined that the final goal of this project is strengthening national response on the issue of contaminated sites, primarilly implying on the legal framework, methodology, technical capacities (training workshops), together with the intersectoral dialogue, as the one achieved on the day of this meeting. He pointed out that the existing methodology needs adjustments and promotion. Also, he added that this kind of assessment of health impact of contaminated sites in Bor could be a good model for such CSs in the region.

Dr Ivano Iovarone said that similar situations with contaminated sites and health exist all over the world and that, from the international point of view, contaminated areas are an expression of a development model rarely dedicated to environmental sustainability. Nevertheless, as he noted, there is significant progress in reducing industrial emissions in the European region in the last decade. He added that, although there are studies as evidence, there is no quantification of the problem due to fragmentation, and because different studies have different points of observation. In his further statement, he said that the characterization of the impact of contamination is a difficult task that requires the cooperation of various experts, because there are different sources of contamination (in Serbia, primarily mining and metalprocessing), heterogenous hazards, chemical mixtures, vicinity of urban areas, difficulties in quantifying human environmental exposure, multiple aetiology of most diseases, aspect of social and health inequities in specific vulnerable population groups, such as children, women in
childbearing age, pregnant women, working force, people living in poor social conditions. In addressing this issue, a COST Action (IS 1408 Industrially Contaminated Sites and Health Networks) has been initiated in 2015, on contaminated sites and health networks, with a key objective of establishing a European network of experts from both sectors, simultaneously with the development of mutual approach towards heterogenous aspects of contaminated sites and health.

Nearly 150 participants from 33 countries participated in this Action, among which Serbia has one of the leading participants. The main aim of this Action is for each participating country to comprehend the management of contaminated sites and health as a priority, as defined in the Ostrava Declaration, and that each of them develop a national agenda on commitments that must be achieved and implemented in the coming years. At the last meeting of the participants of this Action (February 2018, Bonn, Germany), a Consensus Statement, a short list of contaminated sites and health impacts was reached, in order to develop a national portfolio. The main objective of this action is to promote a common approach, which can be achieved through studies into assessment of the availability of data, assessing gaps in information, identifying priorities in the list of polluted areas in all participating countries, which also includes Bor. Further on, this can be achieved using the SENTIERI approach, which represents the first level approach applied in Italy. It represents a national epidemiological surveillance system in contaminated sites based on standardized methods and reliable health information systems. This method assesses the health profile of people in contaminated areas using certain health indicators that are currently available data. According to him, this approach could be adopted to develop epidemiological surveillance programs in other countries. Serbia is a susceptible country for this approach, as it has a reliable information system, such as Cancer Register and data from the National Statistical Service. He stressed that, in order to assure the development of national portfolios of actions, the network established within this Action has to maintain the role in promoting mutual inter-sectoral cooperation and bridging the communication gap among researchers, experts, policy-makers and society, i.e. people living and working at the contaminated regions.

In her presentation, Dr Matić Savićević pointed out significance of achieving realistic synergy between two sectors, on the issue of contaminated sites in Serbia, especially in practical means, not limitted to pure paperwork. She stated that this project could serve as a pivot for developing a national framework for the sound management of contaminated sites in order to eliminate, prevent or minimize risks to human health and the environment. She pointed out that this can be achieved through a multisectoral approach and the involvement of key stakeholders, with an emphasis on local institutions. She added that the reason for the selection of this site is the large number of already existing relevant data and expert papers. As the key objectives, she pointed to continuation of already established cooperation between the ministries, continuous and timely exchange of data relevant to the topic, the ability to review deficiencies, the possibility of preventing the emergence of new contaminated sites, through organized activities, especially at the local level, as well as defining priorities and methodology at the national level. She noted that this string of actions would encourage thinking about new by-laws on the joint management of contaminated areas from the aspect of protection of health and the environment. She recalled that since 2010, chemical management has been carried out through the Ministry of Environmental Protection and pointed to the need to integrate healthcare into the management of chemicals, globally. She also stressed the necessity of exchanging key lessons learned with other countries and the possibility for Serbia to be an example for countries in the region. This necessiates further joint work on a new legal framework which will facilitate the above mentioned activities, budget line definition for their implementation, together with a more precize definition of the institutional framework.

Dr Vidojević made a review of SEPA's core competencies in the following fields: conducting monitoring of both air and water quality, development of information system for environmental protection, managing National cadaster of pollution sources, managing the National laboratory, regular annual reporting on the state of the environment. She stated that SEPA has the mandate to collect, analyze and process all kinds of environmental data, forwarding them further on towards European Environment Agency, in the form of indicators, entitled „progress in managing contaminated sites on the territory of the Republic of Serbia“. SEPA conducts air quality monitoring on 3 automatic measuring stations in Bor, including measuring of daily concentrations of sulphur-dioxide. Due to the technical innovations in the smelting process, daily exceedings of the SO2 have dropped from 144/365 days in 2012 (measuring station „Gradski Park“) to 21/365 days. Monitoring of surface water (Borska River) in Bor and its surroundings is conducted at 8 sampling sites, at 6 watercourses, in the period 2005-2016. Surface water quality was marked as “very good” at all but one measuring points, which is Rgotina at Borska River, marked as “bad”. Furtherly, it conditions the quality of River Timok at the measuring point Čokonja depleting it to the status of “good”. If the value of the Water Quality Index is decreased for 5 index points, it means that water quality is significantly worsened. Priority substances and priority hazardous substances measured in Borska River were present in concentrations far beyond limit values for cadmium, lead, dissolved nickel. Dissolved copper and manganese in Borska River were significantky beyond limit values. She mentioned below that soil, as a limited and non-renewable natural resource, should be monitored continuously. It is essential that new by-laws are to be adopted on the basis of Law on soil protection (2015), in the following period, including those concerning contaminated sites. SEPA's managing of the Cadaster of contaminated sites is layed on legal grounds. Collection of data commenced in 2005, including data on waste disposal sites, locations of business entities and operators, locations of industrial accidents and contaminated sites. Cadaster includes the following: general data (geological, hydrological, pedological, climate characteristics), data on activities leading to pollution, on the types of polluting substances and the status of contaminated sites. Methodology for the identification and characterization of CSs is given by the sub-law. Criteria for assessing land quality are given in the Regulation adopted in 2010, in which limit values fully achieved sustainable land quality, while remediational values are those values in which the basic functions of the land are endangered and which require remedial and sanitation measures. According to the data from the Cadastre, there are 709 identified localities in Serbia, of which 478 are potentially contaminated, 103 are contaminated, 76 are thoroughly investigated, and 52 have been through the rehabilitation process. The annual national costs for the management of contaminated sites are not at an enviable level. Dr Vidojević has made a short overview of the UNEP/GEF project: "Improvement of cross-sectoral land management through reduction of pressure on land and land use planning", started in 2015, during which research was carried out on 37 industrial sites, and in 2017, also, sampling was performed at 32 potentially contaminated sites, including Bor. The research itself is, in fact, is a list of contaminated sites that are proposed for rehabilitation and remediation or for detailed research. During the sampling of soil in Bor 2012, exceedances of limit and remediation values for copper, nickel and arsenic were found, and in 2017, the exceedance of remediation values for arsenic and copper at 4 sites were notrd. In conclusion, dr Vidojević made the following observations: Republic of Serbia does not have a strategy for managing contaminated sites; out of 709 locations, 478 need to be further explored; there is a need for risk assessment at several contaminated sites, and Bor represents the first, pilot location.

Mr Đuričković presented strategic, legal and institutional framework for managing environment in Republic of Serbia. Key strategic document is the National Strategy on Sustainable Development, followed by: National Programme on Environment Protection, Waste Management Strategy for the period 2010-2019., National implementation plan for implementation of the Stokholm Convention (2009.), The Energy Development Strategy of the Republic of Serbia until 2025 with projections until 2030, National Strategy for Accession of Serbia to EU, National Strategy for Approximation in the Environment, National Program for Adoption of the EU Acquis, Post-screening document for negotiation chapter 27 (action plan for the negotiation process, on the basis of which the European Commission allows the opening of Chapter 27). Also, a National Profile of Chemicals Management has been developed. He defined the legal framework for environmental governance, which primarily includes ratified international treaties (over 20 conventions and protocols relating to the management of chemicals, waste, pollution prevention, reduction of exposure to hazardous chemicals at the workplace), together with the umbrella law in this area, Law on Environmental Protection.

It regulates the management of natural resources, measures and conditions for environmental protection, environmental monitoring, information and public participation, economic instruments, environmental responsibility, as well as supervision and penalty provisions, basic procedures for determining the status of a threatened environment, measures remediation and remediation. In addition to this umbrella law, a set of system laws and a series of dozens of by-laws were adopted. Regarding the institutional framework, Mr. Đuričković emphasized that within the Ministry of Environmental Protection there are 7 sectors, as well as an administrative body (Environmental Protection Agency). Within the Financial Management and Control Department there is the Budget Green Fund Unit; Within the Environmental Management Department there is the Department of Chemicals; The organizational unit in charge of land protection is located within the Sector for Nature Protection and Climate Change; The Unit for Environmental Project Management is located within the Project and Strategic Planning Sector; Waste and Water Management Unit is located within the Waste and Waste Management Division; within the Sector for Environmental Monitoring and Precaution is the Environmental Inspection; The Sector for European Integration and Cooperation is also isolated. When mentioning the UNEP/UNDP project "Strengthening synergy between the Basel, Rotterdam, Stockholm and Minamata Conventions in the Republic of Serbia", Mr Đuričković has underlined the development of synergy between these agreements in the field of chemicals and waste management, awareness raising, capacity building, reporting, data management. Within this project, activities are planned for further development of the political framework for synergy and conventions at the national level, development and update of strategic documents, establishment of the national information system for the management of all data.

Representative of the NGO “The Young Researchers” has expressed readiness for cooperation, relying on NGO’s forty years of experience. He emphasized that environmental problems must be viewed from a broader perspective, and that work is needed not only at the national, but also at the local level. In this light, he suggested that, in addition to strengthening national ones, in the project itself, the strengthening of local capacities will be added. In front of the organization, he offered to educate and inform citizens about the results of the project within the framework of the Ecological Days Bor program, which covers 30 different environmental topics each year, including health. He noted the activities of the organization in the form of developing a system of public debates, advocacy for adapting national and local documents to European standards, activities in the drafting and revision of the ecological plan. He emphasized the importance of mine waste and the establishment of a link between the Environmental Agency and the Ministry of Energy on this issue. He drew attention to the importance of solving historical pollution and better control when opening new mines in the sense of preventing the creation of new historical pollution, with the help of spatial plans of mining areas, projects of new mines, impact studies.

Mrs Lekić (Environmental Protection Office of the Municipality of Bor), has recalled the historical and geographical background of the industrial zone in the territory of Bor and pointed to the inevitable enormous impact on health. According to her, the local self-government, on the basis of legal obligations and its own needs, conducted air quality monitoring within the local network of measuring points, which is complementary to the state. Within this sampling network, SO2 is monitored at 2 measuring points on daily bases, 365 days per year. After a suggestion from the Ministry of Environment Protection, PM10 concentrations are followed at one measuring point, together with the contents of heavy metals (lead, cadmium, nickel and arsenic). The concentration of wet deposition and the content of the above mentioned metals in them are monitored at 3 measuring points. This program is carried out by accredited laboratories of the Institute for Mining and Metallurgy, monthly reports are publicly available on the website of the Municipality of Bor, and they are submitted to the SEPA and the MEP. She also added that water quality control for drinking water supply at 30 measuring points is performed four times a year. Usually, samples not complying with national standards are characterized with the presence of bacteria of faecal origin. She pointed out that the problem of waste water is still not resolved, and that there is a need and obligation to monitor the quality of the land. The Program for monitoring the quality of the land for 2018 was developed by the Environmental Protection Office of the Municipality of Bor and is currently in the process of obtaining consent in the MEP, although there are no subsidiary acts that define the way in which it is reported and monitored. It was convinced that the land quality data would be available until the end of this project, with the list of site locations being directly exposed to the impact of industrial pollution, as well as those assumed to be out of control. She stated that a large number of strategic documents, studies with a lot of data that could be used for the project and expressed readiness for cooperation were available.

Mr Saša Perišić, assistant to managing director of RTB Bor, has stressed in his presentation readiness of RTB Bor for any form of cooperation and capacity-building activities that improve the control of environmental pollution and control of the impact on the health of citizens. He said that the influence of the mining and smelting complex is, undoubtedly, significant and leads to the release of various harmful components in the environment, but at the
same time, expressed a determination to correct the current situation. He cited past activities in this direction, in terms of purchasing 2 stations located within the state air traffic control network, and in the further plan, the procurement of one more. In conclusion, he graphically depicted the reduction in the average content of sulfur dioxide in the air below the limit values in the previous two years as a sign of progress compared to 2012, despite the fact that production in this activity is on the rise.

Prof. dr Snežana Šerbula (Faculty of Technical Sciences, Bor) has instructed the present audience ito the details of pyrometallurgicalcopper production, during which the hazardous substance arsenopyrite is released as a by-product. She also, noted, that fine dust from the tailings, spreads with ease under the influence of even the weakest winds, underlying significance of the terrain phytostabilization in preventing this phenomenon to happen. As key sources of contamination, she listed: mining activities, mining waste, mining wastewater disposal, mineral dumping sites, tailings dumps, smelting of copper ore (most common is sulphide ore, which has been releasing a large amount of sulfur dioxide during the exothermic process, until 2016). PM10 particles contain high concentrations of measured heavy metals (Pb, Cd, As, Ni). Although there are de-dusting technologiesthe finest and definitely most hazardous particles, nevertherless reach deep into the lungs. Further on, she stressed that a sychronicity is established between level of production of anode copper and data on As concentrations measured in PM10. During the period of 2010-2017 As in PM10 has been exceeding limit values at all 5 established sampling sites. The criticality of the problem was painstakingly demonstrated by the case of white smoke that spreads in the direction of dominant winds in bright skies, despite the decrease in the concentration of sulfur dioxide. In addition to arsenic, lead and cadmium are present in the particles. Since the criteria for limit values in 2010 have been tightened according to the WHO, their concentration is above the allowed values, which also applies to PM10, per se. She underlined the influence of the mining industry on plant material, where elevated concentrations of copper, arsenic and cadmium were recorded.

Dr Živković Perišić presented her work developed together with dr Dragan Miljuš, who could not attend the meeting. During her presentation, she made a review of the history of the Cancer Registry and ways of its management. Data on the illness are published annually, using current classification of the disease. Mortality and demographic statistics are available and represent the domain of activities of the Statistical Office of the Republic of Serbia. According to the SENTIERI approach, within the project’s framework, the use of epidemiological indicators of illnesses, dying and population indicators is planned. Center of interest for this research is Bor Municipality. Besides the vicinity of two bordering countries (Romania and Bulgaria), the municipalities surrounding Bor are similar to Bor in its age-related demographic structure. Benefits of the Municipality of Bor as the center of this research are the following: availability of data for the period of 17 years; 37-year period of moniotoring mortality and morbidity of the population, SENTIERI applicable to municipal level, including morbidity data. She drew attention to the existing shortcomings: determining indicators of morbidity for the year 2016 is not yet finalized; researchers doing the epidemiological study are not familiar with the location of the CS, where population is exposed to direct contamination from a point source; population at the level of "settlements" (population unit smaller than municipality) is defined only through census (last two in 2002. and 2011). In the meantime, an agreement was reached on the list of mortality data that will be collected for a longer period. In this way a much stronger cause- effect relationship is established between disease and environmental status. A list of 35 cancer localizations is chosen, that could be directly linked to the environmental. The focus of this study will be, primarily, malignant tumors. Within this study, the population of Central Serbia will not be used as a reference population, but Bor as a municipality. Data currently suggest an increase in tumor risk for all localizations other than skin cancer in men. The increase is also present in women for tumors of other localizations. The risk in the entire Bor region is higher for men for all localities, and for women in particular. When analyzing the Bor municipality itself, using the same methodology, both men and women have an increased risk of becomming ill from tumors at all localizations. An agreement was reached to expand the list of tracking diagnoses, while following 35 cancer localizations (from 2001 to 2015), in order to form a cohort of 16 agespecific groups at interval of 5 years. Mortality will be monitored for a 35- year period, in order to form 7 cohorts that correspond to age-specific rates. She stated that the relationship will be examined not only with the environmental factors, but also with the life-styles. She concluded with the statement that, when there is data for cancer in the form of a registry, which is easy to access, and the analysis is successful if a unique methodology is used, it is undoubtedly possible to obtain appropriate results, with initial analysis already in favor of causality in terms of increased frequency of all malignancy in men and women in the municipality of Bor.

Discussion

Mrs Grujić, geochemical engineer, has pointed out that the public does not have enough information about the type and degree in which the environmental factor can negatively affect the health and the emergence of the most serious diseases. She referred to the presentation given by Dr. Vidojević and welcomed the shift in the availability of data on various pollutants such as soil and water contamination, but stressed that when assessing land contamination, the so-called "geochemical factor", i.e. contamination by certain elements that originate from the mother rock and that in that sense it is necessary to improve the database for the whole of Serbia.
She stated the example of Vojvodina (Panonian Plate = parts of administrative territories of Croatia, Hungary, Serbia), geographical region known for its naturally ocurring arsenic contamination, as a geochemical anomally. She also pointed out that the increased content of copper and arsenic in herbal material in Bor, described by prof. Dr. Šerbula in her presentation, is not the result of anthropogenic influence, but naturally increased concentrations of these elements originating from the mother rock. She underlined the need for a special consideration of this topic from a geochemical aspect. She also questioned the existence of scientific evidence for the association of environmental factors with the occurrence of malignant tumors and the way in which the effect of such a factor can be quantified in the onset of multiple etiology.
Dr Matić explained that for certain heavy metals documented literature exist in abundance, stating that on its contact surfaces with human tissues (mucous), due to its long-term and low.level exposure a proliferation of cancer cells ocurrs.
Dr Perišić Živković responded that IARC publishes data on all carcinogenes, both from the microbiological aspect and from the environment, so for example, H. pylori is considered carcinogenic as well as heavy metals and dioxins. Epidemiological studies are conducted to determine causality in order to discover connectivity. With the help of SENTIERI approach, a precise link is established that tumors of 35 different localizations are directly related to
environmental factors. There is a slight increase in the risk of all malignancies in men at the level of the Bor District, but there is an evident increase in the municipality itself. This gives an incentive to start researching. She said that it would be monitored if there was an increased risk of dying from certain localities, that it was accurately determined what would be monitored and measured in relation to the environment, i.e. which factors are related to the tumor, which is clearly defined by the International Agency for Research on Cancer. She also pointed to the possibility of removing the so-called. confounding factors, which makes it difficult to realistically consider the cause.
In her response to the statement of Mr Grujić, Dr Šerbula she pointed out that WHO is an international authority responsible for the outcomes of researches on the impact of certain elements and hazardous substances on human health and environment, in general, and that all respectful environmental agencies (US SEPA, EEA, SEPA) harmonize limit values according to the WHO guidelines, and accordingly, the limit values for certain substances are lowered. When it comes to Bor, the control zone represents an area where there is no excessive concentration of copper. In Bor, the limits are exceeded, both for land, as well as for plant material and breeding, which means that the natural fundus of heavy metals in the soil has been exceeded. The real problem, according to prof. dr Šerbule, is the absence of a geochemical map for all areas in Serbia. The good thing, though, is existing awareness of the expert society on the presence of naturally ocurring high heavy metal concentrations in particular areas.
Zagorka Stević Gojkov, on behalf of the Office for Research and Improvement of Local and Regional Development - Association "Kapilar", posed a question to the local community of Bor about financial resources invested for environmental protection. The second question was meant for the representatives of academia and RTB Bor, and it related to the time span required to initiate the procedure for preventing pollution, bearing in mind that the data are numerous. Mrs. Gojkov's third question was related to the possibility of other forms of sustainable businesses, other than mines, bearing in mind their detrimental effect on human health.
Dr M. Martuzzi answered that some of the influences were scientifically confirmed, such as long-term effect of PM particles, microbiological contamination of water and others. He added that one-fourth of all causes of the disease came from the environment. There are many factors, some of which are insufficiently known, and this mixture is a problem that can be solved by means of existing evidence and certain epidemiological indicators. He underlined the main goal, which is to determine the overall health of the population of Bor, the environmental factors in this region, both now and in the past, bearing in mind the latent period of 20-30 years. This is
a big challenge and everything can not be fully clarified. One of the essential objectives is to establish and maintain such an open form of communication, in which everyone has a stake in this project.
Gospodin Perišić pointed to the importance of this economic activity and wealth in natural resources. He emphasized that over 200 million € were invested in a new smelter, since the old, built 57 years ago, no longer met today's standards. He also announced a similar investment in the revitalization of the plant. He pointed out that the rehabilitation of all activities carried out during the last 115 years is not possible by independent work, and that time and financial resources are needed in order to achieve an appropriate solution. According to him, 100 million dinars are invested annually for investments in ecology.
Prof. Dr Sherbula also underlined the importance of joint work and financial investment. She stated that there were activities in the field of environmental protection within the Faculty of Technology in Bor. The Ecology Council has been established to deal with environmental issues.
Dr Iavarone has welcomed the willingness of RTB Bor for cooperation and pointed out the Polluter Pays Principle. He emphasized that the project does not question the role of contaminating substances as human carcinogens because they have already been classified in that context. The aim of the project is to compare the population of this municipality with people living in the wider region, i. comparison of similar populations. He added that it is not enough to provide evidence and facts, but it is also necessary to remedy the contaminated areas.
Mr. Djurickovic clarified that the principle of sustainable development does not, in any way, imply to zero pollution, but sustainable development represents a balance between development that is socio-economically justified and maximally minimizing harmful effects of such activities. He replied to Ms. Stevic Goykov's question that it would not be possible to abolish mining in Bor, because no country can give up such a powerful natural resource. He stated that the Ministry would insist that all future investments be in line with the best available techniques. He emphasized that the Ministry appreciates the openness of the RTB and expressed an opinion on the common interest of all those present on the implementation of the project in the best way. He noticed that what is recognized as a key source of human exposure can be a powerful argument to RTB for applying for a project to address this factor.
Prof. Dr. Sherbula recalled the cooperation with Birkinfeld ecological camp, which deals with the training and education of people in the field of environmental protection. She pointed ut that "zero" emissions, which, for example, exists in Cacak, in Bor is simply not possible. According to her, the new mines will be operating by the international companies in 2023, which conditions more mining activities, tailings, flotation materials. In this context, the support of the entire community is needed.
Zdenka Miljković, secretary of the Secretariat for Environmental Protection of the City of Pančevo, pointed out that local governments have no legal basis to influence whether such types of industries that are important for the whole country can be realized in a certain area or not. She supported Mr. Djurickovic in terms of sustainable development, which requires time and financial resources. She stated that the situation in Pancevo is better, although there are also many problems, including still existing pollution from NATO bombing, due to presence of POPs in the environment. She reminded the participants that there is a large chemical and petrochemical complex in Petrozavodsk, oil refinery, nitrogen, artificial fertilizers and other related industries, which Bor does not own. She presented a problem of zero state, on the case of the impossibility of comparing the soil if there is a phenomenon of pesticides that have long been banned, and have a long half-life, and asked what will be the zero analysis in this case. She suggested that the methodology for quantification of environmental health impact should be
pushed down to the local level and that it should be implemented in network of the public health institutes. She pointed to the importance of concrete activity.

Dr Matić Savićević explained that, within the project activities a workshop is planned, serving the purpose of forwarding toand sharing this methodological experience with colleagues from the local IPHs, together with initiation of the implementation phase. She emphasized that education will be organized in those local institutions in which jurisdictions are located sites of public health significance, and this includes Pancevo.
Prof. dr Aleksandar Ćorac, prof. higijene Medicinskog fakulteta u Kosovskoj Mitrovici, made a review of the participants' presentations and stressed that the data should serve as a guideline and a means of preventing health consequences. He underlined the importance of a new data management model of health and environmental information that can be shared within the divergent expert community.

Dr Matić Savićević closed the meeting by sharing a positive impression that, with critical energy, the goals can be achieved. She announced an organized visit to Bor, highlighting