Canada blocks move to deem asbestos hazardousPublished by MAC on 2011-06-28
Source: CBC News, Canadian Press, statements
Joins "gang of four" promoting the toxic material
Last week, a total ban on global trading of white asbestos moved closer, as all but four signatories to the Rotterdam Convention agreed to include the material on its hazardous chemicals list.
The Convention guarantees the right of governments to exercise "prior informed consent" to importation of materials that they consider could harm the health of their citizens.
Scandalously, Canada once again joined Kazakhstan, Kyrgystan and Vietnam in continuing to block the measure.
Commendably, for the first time, India backed it. However, this doesn't mean the Indian government will halt construction of asbestos plants within the country itself.
On the contrary.
Previous coverage on MAC:- Indian health experts deplore Canadian asbestos move
From Linda Reinstein, President/CEO and Co-Founder Asbestos Disease Awareness Organization (ADAO) The hyperlinks to our letter and statement:- http://www.asbestosdiseaseawareness.org/wp-content/uploads/Shri-Nitish-Kumar.pdf http://www.asbestosdiseaseawareness.org/wp-content/uploads/ADAO-Bihar-Submission.pdf
Canada blocks move to deem asbestos hazardous
By Laura Payton
22 June 2011
Canada has stepped in to block the listing of chrysotile asbestos on an international list of hazardous chemicals.
Putting chrysotile asbestos on the Annex III list of the Rotterdam Convention would let countries where companies import it to turn it away if they don't think they can safely handle it.
Canada kept quiet throughout the sessions so far this week, relying on other countries to register their objections. Officials in Ottawa refused to answer repeated questions about whether they would oppose the listing.
But the delegate from Ukraine dropped the country's objection Wednesday, prompting the Canadian delegation to speak up in opposition.
The convention needs consensus to be able to make changes to the list. The only countries still objecting are Canada, Kazakhstan, Kyrgystan and Vietnam, said Alexandra Caterbow, who represents 500 non-governmental organizations as an observer at the meeting.
There's confusion over whether Ukraine opposes the listing, after the delegate later renewed his objection.
Caterbow said the Canadian delegation's late move is outrageous and a slap in the face to the other delegates who laid out their positions when the presiding chair asked for them.
There's one remaining mine in Canada, located in the riding of Industry Minister Christian Paradis.
Conservative government officials insist chrysotile asbestos is safe if handled properly.
India, one of the countries that import the chemical from Canada, dropped a longstanding objection to adding it to the convention.
Canada's objection "is really quite disappointing for many Canadians and certainly for workers around the world," said Fe De Leon, a researcher at the Canadian Environmental Law Association.
There are two more days of talks before the Rotterdam Convention meetings close. They don't meet again for another two years.
Canada blocks asbestos from hazardous chemicals list at UN summit
By Steve Rennie
The Canadian Press
22 June 201
OTTAWA-Canada has opposed listing chrysotile asbestos as a hazardous chemical, the United Nations confirmed Wednesday, even as the Conservative government maintained its silence back home.
At a summit in Switzerland, Canada's delegation ended days of silence and speculation by opposing the inclusion of asbestos on a UN treaty called the Rotterdam Convention.
"Yes, I can confirm they intervened in the chemicals contact group meeting this afternoon and opposed listing," Michael Stanley-Jones of the UN Environment Program said in an email.
Vietnam, Kazakhstan and Kyrgyzstan also opposed the listing.
Listing asbestos on Annex III of the convention would force exporters such as Canada to warn recipient countries of any health hazards. Those countries could also then refuse asbestos imports if they didn't think they could handle the product safely.
Canada has twice before played a lead role in blocking the inclusion of asbestos under the Rotterdam Convention, which operates by consensus.
Until Wednesday, it appeared Canada's strategy was to abstain while other asbestos-exporting countries blocked the move.
Natural Resources Minister Joe Oliver denied late Tuesday afternoon that Canada had taken any position or was registering an objection. He repeated the government's oft-used talking points about encouraging safe use of the material.
Asked directly, Oliver said "We haven't taken a position opposed to the inscription. We haven't, to my knowledge, there has been no position taken there. The way the - the way it works at Rotterdam is that it - that it's determined by consensus and if there are countries that oppose, then it won't happen. My understanding, and I'm not - I'm not certain on this, but I understand that there are some countries that are in fact opposed. So the question is moot."
"It won't happen. Okay?" he told reporters.
Government departments were keeping tight-lipped about what position Canada took to Geneva. The governing Conservatives continue to claim that Canada's chrysotile asbestos can be used safely "under controlled conditions."
Environment Canada still wouldn't disclose Canada's position in Geneva - even after the UN confirmed it.
"With regards to your question on Rotterdam, our previous response that our position at Rotterdam will be the same as our position in Canada, which is that we promote the safe and controlled use of chrysotile, still stands," the department said in an email.
The department refused to answer a follow-up question.
Canada's position, although not surprising given its public support of the asbestos industry, still left anti-asbestos activists fuming.
"It is absolutely incredible. Canada has just thumbed its nose at the whole world," human-rights activist Kathleen Ruff said in an email.
"It single-handedly has refused to allow the listing of chrysotile asbestos as a hazardous substance. Canada single-handedly has destroyed the convention as far as asbestos is concerned."
World Condemns Canadian Govt's Support for Hazardous Chrysotile Asbestos
BANI Welcomes India's First Step Towards Prohibition of Asbestos at UN Meet
Ban Asbestos Network of India (BANI) statement
24 June 2011
New Delhi/Patna: Ban Asbestos Network of India (BANI) Welcomes India's dramatic change in position at the UN Meet on Hazardous Chemicals in Switzerland unlike Canada, Kazakhstan, Kyrgyzstan and Vietnam who voted against listing chrysotile asbestos or white asbestos in Annexure III of the Rotterdam Convention on hazardous materials.
The list makes it legally compulsory for asbestos producing countries to warn importing countries of the health risks associated with the cancer-causing chemical. Indian Government reversed its past opposition to its listing.
The fifth meeting of the Conference of the Parties (COP5) to the UN's Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade underway in Geneva, Switzerland concludes today. The meeting which commenced on 20th June dealt with the possible inclusion of four new chemicals including Endosulfan and Chrysotile Asbestos in Annex III to the Rotterdam Convention.
Meanwhile, international unions and Indo-Canadian Community has denounced Canadian Government's support for Chrysotile Asbestos based companies at COP5. Environmental groups in India have severely criticized the irresponsible act of Canadian government to adopt a colonial attitude of criminal callousness in the matter of incurable diseases caused by Canadian asbestos mined in Quebec and traded world wide. BANI deprecates the stand of Canadian Government which is akin to supporting slow poisoning of citizens in India and elsewhere.
On 22nd June, 2011 Indian Government supported the listing of Chrysotile asbestos as a hazardous chemical substance while Canada opposed it. India ratified the Convention on 24th May 2005. The act of becoming a Party to the Convention does not in itself obligate other Parties to ensure that there are no exports of the chemicals listed in Annex III to your country. To guarantee this, the Parties needs to provide the Secretariat of the Rotterdam Convention with Importing Country Response for each of the chemicals listed in Annex III of the Rotterdam Convention stating that no consent for each one.
The Convention aims to promote shared responsibility and cooperative efforts among Parties in the international trade of certain hazardous chemicals in order to protect human health and the environment from potential harm. It also contribute to the environmentally sound use of those hazardous chemicals, by facilitating information exchange about their characteristics, by providing for a national decision-making process on their import and export and by disseminating these decisions to Parties.
The 46 page current text of the Rotterdam Convention includes the amendments adopted by the First Meeting of the Conference of the Parties (Geneva, 20 - 24 September 2004) and the Fourth Meeting of the Conference of the Parties (Rome, 27 - 31 October 2008). The Convention promotes the exchange of information on a very broad range of chemicals. The text of the Rotterdam Convention was adopted on 10 September 1998 by a Conference of Plenipotentiaries in Rotterdam, the Netherlands. The Convention entered into force on 24 February 2004.
BANI observes that the inclusion of chrysotile asbestos in Annex III list of chemicals is not an invitation for Indian Government to ban their use. The purpose of the prior informed consent procedure is to allow India to make their own informed decisions on future imports of the chemical depending on their own needs, circumstances and uses of the chemical.
However, if Indian Government decides not to allow any future import of chrysotile asbestos, then it must also ensure that any domestic manufacture and use of the chemical is banned.
In view of such requirements, BANI demands that Government of India should ban the domestic manufacture and use of the chrysotile asbestos along with its import after its support for listing of this lethal mineral fiber in the UN list of Hazardous Industrial Chemicals. This decision alone can take Indian Government's decision to its logical end.
S.C. Gupta, Indian Designated National Authority - Industrial Chemicals, Joint Secretary, Ministry of Chemicals & Fertilizers, Phone: +91 11 23383756, Telefax: +91 11 23070104
Rajiv Gauba, Official Contact Point, Joint Secretary (HSM Division), Ministry of Environment and Forests, Phone:+91 11 2436 0634, Telefax +91 11 2436 3577
Dr. Manoranjan Hota, Official Contact Point,Director (HSM Division), Ministry of Environment and Forests, Phone:+91 11 2436 7663, Telefax: +91 11 2436 7663
Website of the Rotterdam Convention: http://www.pic.int/
UN Meet Proves Asbestos Cement Products Manufacturers' Wrong
BANI Appeals to HIL to Shift to Non-Asbestos Green Building Materials
Work of Indian Govt Officials at UN Chemicals Meet Appreciated
Ban Asbestos Network of India (BANI) statement
25 June 2011
New Delhi: Ban Asbestos Network of India (BANI) wishes to place on record its appreciation of the role of the Government of India representatives in the Indian delegation at the fifth meeting of the Conference of the Parties (COP5) to the UN's Rotterdam Convention on the Prior Informed Consent (PIC) Procedure for Certain Hazardous Chemicals and Pesticides in International Trade held in Geneva, Switzerland concluded on 24th.
The meeting which commenced on 20th June dealt will be remembered for Government of India's support for the listing of Chrysotile Asbestos in Annex III to the Rotterdam Convention, the PIC list of industrial chemicals. Declaration on Chrysotile Asbestos given below.
The Government of India representatives in the delegation in Geneva, Switzerland are the following:
1. Ms. Mira Mehrishi
Ministry of Environment and Forests
Paryavaran Bhawan, CGO Complex
New Delhi 110003
Tel.: +91 (11) 2436 2285
Fax: +91 (11) 2436 3918
2. Mr. Manoranjan Hota
Hazardous Substances Management Division
Ministry of Environment and Forests
CGO Complex, Lodhi Road
New Delhi 110003
Tel.: +91 (11) 2436 7663
Fax: +91 (11) 2436 7663
3. Mr. Sanjay Bansal
Department of Chemicals and Petro-Chemicals
Ministry of Chemicals and Fertilizers
Room No. 230, A-Block
New Delhi 110001
Tel.: +91 (98) 1051 9226
Fax: +91 (11) 2338 8628
4. Ms. Jyoti Singhal
Department of Agriculture and Cooperation
Room n° 478-A
New Delhi 110114
Tel.: +91 (11) 2338 7962
Fax: +91 (11) 2338 7962
BANI salutes the work of these members in safeguarding national interest in Geneva. BANI also applauds the role of Rotterdam Convention Alliance in highlighting the public health concerns.
BANI expresses its sadness and dismay at the presence of chrysotile asbestos industry representatives at the CoP 5 in Geneva, Switzerland who are resisting the ban on chrysotile asbestos trade although its mining is banned in India. These representatives include:
1. ASBESTOS CEMENT PRODUCTS MANUFACTURERS' ASSOCIATION
Mr. Manohar Lal
Asbestos Cement Products Manufacturers'
502, Mansrovar, 90 Nehru Place
New Delhi 110019
Tel.: +91 (11) 4105 5427
Fax: +91 (11) 4652 1496
Email: firstname.lastname@example.org /
2. ASBESTOS INFORMATION CENTRE
Mr. Abhaya Shankar
Asbestos Information Centre
502 Mansarovar, 90 Nehru Place
New Delhi 110019
Tel.: +91 (40) 2370 1872
Fax: +91 (11) 2370 0601
The UN List of participants is attached.
BANI underlines that both ASBESTOS CEMENT PRODUCTS MANUFACTURERS' ASSOCIATION and ASBESTOS INFORMATION CENTRE are one and the same organisation and they operate from the same premises. Their primary task is to propagate misinformation about safe and controlled use of chrysotile asbestos. COP5 has proven that their propaganda will not succeed.
In a display of manifest unethical practice, while they operate as NGOs which are meant to be non-profit groups, these two groups act to protect the profit of chrysotile asbestos based companies at any cost.
BANI has disclosed that Abhaya Shankar who represented ASBESTOS INFORMATION CENTRE at COP5 is the Managing Director of Hyderabad Industries Limited (HIL), a CK Birla group company engaged in the production of asbestos cement products.
Instead of abandoning asbestos based projects despite indisputable evidence against the lung cancer causing chrysotile asbestos, HIL, one of the largest producers of asbestos cement sheets in the world has embarked on a Rs 100-crore expansion plan and it is in the process of adding another asbestos sheets production line at its Satharia plant, located 40 kms from Jaunpur in Uttar Pradesh involving an investment of Rs 50 crore with a capacity of 100,000 tonnes per annum taking its total installed capacity to 1 million tonnes per annum. The company has plans of a chrysotile asbestos based manufacturing facility at a cost of Rs 50 crore in Kumarbagh, West Champaran, Bihar in an agricultural field. BANI has visited its plant site which is facing opposition of the farmers.
HIL is currently a leader in asbestos sheets production in the country with a share of 21 per cent in the Rs 3,000-crore market. In 2009-10, its turnover and net profit stood at Rs 756 crore and Rs 89.7 crore respectively.
Its brand Charminar is in the market for over six decades. The company's target was to cross a turnover of Rs 1,000 crore three years down the line. At present, HIL has 12 manufacturing plants spread across the states of Andhra Pradesh, Haryana, Jharkhand, Kerala, UP, Maharashtra, Gujarat, Orissa and Tamil Nadu. The company has taken over of a fiber cement sheets manufacturing facility situated at Saidpura, Dora Bassi, Punjab, with a capacity of 45,000 MT/Annum.
BANI encourages HIL to go for non-asbestos based green building products now that it has learnt about hazardous effects of chrysotile asbestos at COP5 in Geneva. HIL should pay heed to the resolutions of International Labour Organisation and World Organisation referred to in the Supreme Court order, issued on January 21, 2011 seeking elimination of future use of asbestos based products. The Court too [had] cognisance of the Ban White Asbestos Bill pending in the Parliament.
BANI demands that HIL should abandon its plans to set up new chrysotile asbestos plants in Bihar, UP, Punjab or anywhere in the country taking cognisance of the reiteration of the hazardous nature of chrysotile asbestos fibers. The decision of the Government of India with regard to chrysotile asbestos marks the beginning of the end of the asbestos industry in India.
BANI underlines that Sanjaya Kanoria, Chairman of the Asbestos Cement Products Manufacturers' Association (ACPMA) is the Managing Director, A Infrastructure Ltd which has proposed to set up a asbestos based plant in Madhubani, Bihar. BANI wonders about the name "A INFRASTRUCTURE", does substituting the alphabet "A" in place of "Asbestos" make it less hazardous and a non-carcinogen?
BANI notes that ACPMA Director General who was at COP5 is a retired IAS officer of 1977 batch, Rajasthan cadre. He was Joint Secretary and Director General Labour Welfare in the Ministry of Labour, Government of India. BANI wonders as to what would be the outcome of the labour welfare done for asbestos workers during his tenure. He is also President of an NGO named Assist workers engaged in welfare of unorganized sector workers. Do both these NGOs ACPMA and Assist workers work to protect asbestos workers who suffer from incurable and fatal diseases like lung cancer, asbestosis and mesothelioma?
It is about time Asbestos Cement Products Manufacturers' Association advised its members to shift to manufacturing of non-Asbestos Green Building materials because no amount of advertisements, advertorials and public relations exercise can stop an idea whose time has come.
Study after study has linked the killer fibers of chrysotile asbestos to lung disease but Canadian government which got rid of asbestos fibers from its Parliament Buildings and its Prime Minister's residence, is acting at the behest of the asbestos companies to resist putting warning labels on asbestos products and is suppressing findings of research. Although UN Conference ended without chrysotile asbestos being listed. The recommendation to list chrysotile asbestos will be put forward at the next Conference of the Parties in 2013, Indian government has taken a public interest position and has disassociated itself from Canadian government which blocked its listing.
Declaration on Chrysotile Asbestos
Recognizing the achievement in adding the hazardous chemicals aldicarb, alachlor and endosulfan to the Rotterdam Convention;
Recalling that decision RC-3/3 of the third Conference of the Parties, adopted by consensus, found that the criteria for listing chrysotile asbestos in Annex III were met;
Deeply concerned that the listing of chrysotile asbestos nonetheless has been prevented by a small number of Parties for three consecutive Conferences of the Parties;
Noting that the reasons put forward for preventing listing by consensus were not relevant to the criteria of the convention;
Encouraged by the willingness of some Parties to reconsider their position and support the listing;
Call upon all Parties to hold paramount the protection of human health and the environment;
Resolve to move forward to list chrysotile asbestos in Annex III and improve the effectiveness of the Convention in listing chemicals in the future;
Declare our intent to pursue further action under the Convention to ensure that the export of hazardous chemicals occurs only with the prior informed consent of the importing Party and that the Party is provided with accurate information on the characteristics, potential dangers, safe handling and use of those chemicals.
• The African Group (Benin, Botswana, Burkina Faso, Burundi, Cameroon, Congo, Cote
d´Ivoire, Djibuti, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea, Kenya,
Madagascar, Mali, Mauritania, Mozambique, Niger, Nigeria, Senegal, South Africa,
Sudan, Togo and Zambia)
• The European Union and its member states (Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxemburg, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom)
• New Zealand
Canadian & Israeli Doctors Warn Against Asbestos Plants in Bhojpur
Erin Brockovich of South America Supports War Against Asbestos Plants
Take Lessons from 70 year old Asbestos Mistakes of Israel: Prof Richter
Canadian Association Physicians for the Environment, Toronto
15 June 2011
New Delhi- In a letter to Bihar Chief Minister dated June 10, 2011, Dr Jean Zigby. President, Toronto based Canadian Association Physicians for the Environment and Kathleen Ruff, Senior Human Rights Advisor, Ottawa based Rideau Institute have asked him to halt the plan to open three asbestos plants in Bhojpur.
The letter states, "As a political leader, we hope that you will heed reputable, independent science and that you will make the protection of public health your top priority. We have written this letter in the hope of alerting you to the human tragedy that asbestos has caused in Canada and thus help to prevent a similar tragedy in India."
The letter observes that "Government health experts have pointed out that there has been a complete failure to achieve "safe use" of asbestos in Canada itself and believe that "safe use" of asbestos is, in fact, impossible, anywhere in the world. The use of asbestos in the past has left a tragic legacy of asbestos-related disease and death in Canada and in very country where asbestos has been used. Besides Bhojpur, we have learnt that asbestos plants are proposed in Madhubani, Champaran, Vaishali and Muzaffarpur and your government has allotted land for four asbestos plants.
In our opinion, such industrial units are inadvisable and medically indefensible."
In a related development in a letter to Ban Asbestos Network of India (BANI) dated Jun 16, 2011, Erin Brockovich of Brazil, Fernanda Giannasi, Engineer and Labour Inspector at the Labour and Employment Superintendence in São Paulo, Brazil has expressed support for the tireless campaign against asbestos plants in Bhojpur and the proposal of such factories in Muzaffarpur, Madhubani, Vaishali, West Champaran etc. She is deeply concerned about the death toll due to the malevolent role of asbestos forces.
Giannasi feels that increasing awareness of the hazards of asbestos based products will lead to decline public demand. In effect, she has demanded boycott of asbestos products. She has been a Labour Inspector in Sao Paulo State for more than 25 years. She has received both Brazilian and international honours for her work with asbestos victims; in 2001, she was a successful finalist in the prestigious Claudia Award for Brazil's Woman of the Year. Giannasi was elected a Fellow of the renowned Italy based Collegium Ramazzini, a premier institute on environmental and occupational health.
She has spearheaded the ban asbestos campaign in South America. Given her pro-people and pro- worker reputation, a Brazilian asbestos mining company (SAMA) sought a court order to prevent Giannasi from inspecting its operations because of her "affiliation with a victims' advocacy group" on March 15, 2011. Giannasi has impounded asbestos shipments bound for Asia in the past. Giannasi is credited for having identified a source of widespread occupational disease whilst working in Brazil's asbestos heartland - an Osasco, an industrial town in Greater São Paulo. She visited New Delhi in 2002 and was dismayed to find that the situation of asbestos victims is not even acknowledged by the policy makers. It is indeed sad that there has not been even an iota of improvement since then.
The co-author of the letter from Canada, Ruff is the author of Exporting Harm: how Canada Markets Asbestos to the Developing World.
The copies of the attached letter from Canadian Association Physicians for the Environment and Rideau Institute has been sent to Sonia Gandhi, Dr Manmohan Singh, Lal Krishna Advani, Jairam Ramesh, Ghulam Nabi Azad, Anand Sharma, Pranab Mukherjee, Dr Murali Manohar Joshi, Sushma Swaraj, Arun Jaitli, Dr C P Thakur, and Sushil Kumar Modi on behalf of 11 eminent specialists like Dr Éric Notebaert, MD, MSc, Associate Professor of Medicine, University of Montreal, Quebec; Dr Gilles Paradis, MD, MSc, FRCPC, FACPM, FAHA, Professor, Faculty of Medicine, McGill University, Montreal, Quebec, Canada, Colin L. Soskolne, PhD, Professor (Epidemiology), School of Public Health, University of Alberta, Edmonton, Alberta, Canada, Dr Fernand Turcotte, MD, MPH, FRCPC. Professor Emeritus of Public Health and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Canada, Dr Yv Bonnier Viger, MD, MSc, MM, CMSQ, FRCPC, Medical Specialist in Public Health and Preventative Medicine; Director of the Department of Social and Preventative Medicine, Faculty of Medicine, Laval University, Quebec; President of the Quebec Association of Physicians specializing in Community Health, Quebec, Canada, Dr John R. Keyserlingk, MD, MSc, FRCS , FACS, Surgical Oncologist, St Mary's Hospital & Hôpital du Sacré Coeur; Director, Ville Marie Oncology Center, Montreal, Quebec, Canada Dr Tim K. Takaro, MD, MPH, MS., Associate Professor, Associate Dean for Research, Faculty of Health, Sciences, Simon Fraser University, British Columbia, Canada, Dr Daya R Varma, MD, PhD, Professor Emeritus, McGill University, Canada, Edward W. Keyserlingk, LLM, PhD, Professor of Medical Ethics & Health Law (retired), Faculty of Medicine, McGill University; former member, Law Reform Commission of Canada; formerly the Public Service Integrity Officer, Government of Canada, Abby Lippman, PhD, Professor, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada and Dr Pierre Deshaies, MD, MSc, FRCPC, Professeur de clinique, Department of Social and Preventative Medecine, Faculty of Medicine, Laval University, Quebec, Canada.
In a letter to BANI, Prof Elihu D Richter, MD, Hadassah. School of Public Health and Community Medicine, Hebrew University- Jerusalem, Israel has expressed support for the ban asbestos campaign in Bihar in particular and India general saying, "India should not repeat the mistakes of going back some 70 years which will kill tens of thousands of workers and their families." In the letter dated June 14, 2011, he has supported call for listing of Chrysotile Asbestos in UN list of Hazardous Chemicals. Prof Richter was in New Delhi in March 2011 and has co-signed the New Delhi Declaration Seeking Elimination of all forms of asbestos including chrysotile from India. BANI feels that struggle against asbestos plants in Bhojpur and the global movement against these killer fibers is part of the same effort.
For Details: Dr Jean Zigby. President, Canadian Association Physicians for the Environment, Toronto, Ph: 416-306-2273 Web: www.cape.ca
Kathleen Ruff, Senior Human Rights Advisor, Rideau Institute, Ottawa, Ph: 613-565-9449, Web: www.rideauinstitute.ca
Fernanda Giannasi, Engineer and Labour Inspector, São Paulo, Brazil
Prof Elihu D Richter MD, Hebrew University-Hadassah. School of Public Health and Community Medicine, Jerusalem, Israel