Key messages

In Europe 12.9 % infants die due to respiratory diseases. Data for Slovenia show that in 2013, 8.7 % of all infants aged 28-364 days died due to respiratory diseases (NIJZ, 2014). In 2014 and 2015 in Slovenia no newborns died due to respiratory diseases (NIJZ, 2016). Studies have shown a very complicated link between level of air pollution and infant mortality due to respiratory diseases, mainly due to various external factors (allergens, cigarette smoke, diet, lifestyle, etc.).

Asthma has become the most common chronic disease among children and is one of the major causes of hospitalization to the fifteenth year of age. In 1999-2004, asthma prevalence in children in EU varied from less than 5% to over 20%. Most hospital admissions of children with asthma is in Ljubljana and Maribor. As more and more people are sensitive to allergens, allergic diseases may increase in the Europe in the coming years. Recent evidences support relationship between exposure to air pollution and exacerbation of asthma, mainly due to exposure to particulate matter (PM10).

Slovenia belongs in the group of EU countries, which are more polluted due to particulate matter (PM10). The average annual concentration of PM10 is exceeding the limit value recommended by the World Health Organization (20 µg PM10/m3). Very young children, including unborn babies and elderlies, are particularly sensitive to air pollutants like PM. Analyses show that in Slovenia every 2 of five children is exposed to negative consequences of PM10 pollution. Most children living in European cities are exposed to PM10 levels that do not exceed 30 micro g/m3 but in Slovenia 15 % of children are exposed to concentrations of PM10 between 30-40 µg /m3. As a consequence, 15 % of hospitalization of children is due to respiratory diseases.

Slovenia reported 1-3 waterborne outbreaks per year during 2006 – 2015. In these outbreaks, associated with drinking water, 5 - 263 cases were reported. Some outbreaks had unidentified etiologies, some were caused by: Cryptosporidium parvum, Escherichia coli, rotavirus, norovirus, Bacillus cereus, Campylobacter jejuni, Salmonella Typhimurium.

In Slovenia, in 2015, 93 % of population was supplied with drinking water from supply systems, which had undergone water quality monitoring in situ, on user's pipes. Drinking water monitoring did not include 6 % of the Slovenian population; systems, which supply less than 50 persons (i.e. own water supply systems, rainwater), or were not included due to some other reasons (i.e. incomplete record). Generally, all residents of Slovenian cities are supplied with drinking water with arranged monitoring. Accessibility of drinking water did not improve significantly in the period 2004-2015.

Due to external air pollution by ozone, leaf injuries of the ozone-sensitive clone of white clover were visible in Ljubljana, Rakičan pri Murski Soboti and Iskrba pri Kočevski Reki in the period 2000-2007.
According to the state of epiphytic lichens, the preservation of forests and air quality is poor in the entire territory of the Republic of Slovenia, except in forests at higher altitude in the Alps and partially in the Dinaric mountain range.
Acidification of forests represents a potential danger only in the non-hydrocarbon part of Slovenia, especially in the east of the country. According to rough estimates, the critical loads occur particularly in the wider area of both major thermals (Zasavje, Celjska kotlina and Šaleška dolina). Excessive eutrophication of forests for deposition from the air does not take looming forest areas in Slovenia.
Content of metals and nitrogen are increased in the vicinity of major cities, industrial and thermal-energy centers. Increased values in western Slovenia are the result of remote transport, in northeastern Slovenia mainly due to transport and agriculture. In 2006, the nitrogen concentration were highest in Slovenia (among all the participating countries in project).

Leukemia is the most common children cancer. It represents 25 to 30% of all new diagnosed cancer cases in children younger than 15 years in the world. Causal mechanisms for the occurrence of leukemia in children are poorly known, but it is often referred connection with environmental risk factors.Data from European cancer registries indicate that the incidence rate of childhood leukemia between 1970 and 1999 grew on average by 0.7% per annum in the last twenty years has been 1% per year, mostly in countries with higher economic status (SES). In Slovenia, due to the small number of cases can not be described significant trend over the period 1998-2013 but  incidencevaries between 5 and 18 new cases per year.

Data for Slovenia show that number of newly diagnosed cases of melanoma in persons under 55 years of age is increasing. Melanoma is more often by women then by men. Most of the melanoma cases are most likely related to acute, occasional and excessive sun exposure, mainly in childhood. Nevertheless there is a 20-40 year time delay between the sun exposure and the occurrence of cancer, the incidence of melanoma in persons under 55 years of age, is a good indicator of the final success of measures taken against excessive exposure to ultraviolet (UV) radiation in childhood.
Children in some primary schools and kindergartens in the Municipality of Ljubljana are exposed to road traffic noise. From 105 kindergartens and 54 elementary schools the limit value of environmental noise for playgrounds 55dB(A) determined by the WHO was exceeded at all facades at only one kindergarten. In 29 elementary schools and 48 kindergartens, this limit was exceeded, at least at the most exposed facade. In the school year 2013/2014 there were 11,925 pupils in those 29 elementary schools and 5,946 children in 48 kindergartens. According to the data we assume that noise from road traffic at most schools and kindergartens does not disturb kids at play and rest.
Nevertheless, we would like to point out that noise at the most exposed facade at 4 elementary schools and 8 kindergartens exceeds the level of indicator Lday 65 dB(A), which could represent the possibility of interference in the activities on the premises of schools and kindergartens. It is recommended that noise measurements are carried out in those premises and provide mitigation measures to reduce the noise at these buildings.
The estimated average dietary intakes of metals (lead, cadmium, mercury) do not exceed the tolerable reference intakes. Metals in selected categories of food very rarely exceeded the limits set by law, but there are some occasional cases and such foods often originate from the more industrial polluted areas. Therefore, it is necessary to adopt regular monitoring programs for metals in foods and the appropriate long-term measures in the case of exceedances.
In Slovenia the concentration of dioxins in human milk is low and comparable to those in the neighboring countries. Long-term surveillance will be possible once regular national human biomonitoring is established and assured.
Due to high levels of lead in the environment has been an area of ​​Upper Mežica Valley in 2007 proclaimed as a brownfield site and receive special rehabilitation with the aim to protect human health, especially children. The data show that the burden of children with lead improved in the first years of the program, while it stays pretty much on the same level in the last years. For further improvement will be the key appropriate measures implemented, improving the living environment and the continued maintenance of progress. In the future it will be required more targeted work with smaller groups and individual children, in which will be found an increased risk of lead and individual-oriented advice in favor of improving the state of lead in the blood of a child.

One of the main reasons of mortality due to respiratory diseases is chronic pulmonary disease (COPD). The highest mortality due to respiratory diseases in Slovenia is in Zasavje region and the lowest in Central-Slovenian region (2009-2015). Mortality due to respiratory diseases is decreasing; it decreased for 14,87%,  in the year 2000 it was 73,9/100 000 of all population as in the year 2015 it was 63,3/ 100 000 of all population.

Foodborne diseases remain an important public health challenge and they are an important cause of morbidity and mortality worldwide.

During 2011 – 2015 Slovenia reported 365 different outbreaks. The largest group represents the outbreaks with contact transmission where the most common etiologic agent was norovirus (170), followed by the foodborne disease outbreaks (33).

In 2015 three (3) food - borne outbreaks were notified with probable food vehicle. In one case the causative agent was S. Coeln, in the second one Shigella Sonnei and in the last one Bacillus Cereus. The outbreak caused by Shigello  Sonnei was linked to travel on Cape Verde.

In these outbreaks the total number of illnesses was 31, with no human deaths and no one was hospitalised.

Daily numbers of deaths increase during heat waves. Excess mortality during heat waves is greatest among the elderly and people with pre-existing illness. Three heat waves occurred in year 2013. The average number of deaths was 52 deaths per day during the period of heat waves and 48 deaths per day during the period of non-heat wave days.

The incidence of acute gastrointestinal infections (AGI) and foodborne diseases remains high. The most frequent is gastroenterocolitis of unknown etiology, followed by viral infections of the gut which are becoming increasingly important. Among bacterial infections Campylobacter infections prevail followed by infections caused by Salmonella,Clostridium difficile, adenoviruses and pathogenic E.coli. The real burden of the CNB and foodborne diseases can be assessed only through research.

Population exposure to allergic pollen of Alder (Alnus), Birch (Betula), grass (Poaceae) and Ambrosia increases not only in Slovenia but also worldwide. Climate change results in increased average air temperature and longer growing season length. This is why allergenic pollen in connection to climate change shows a clear advancement of flowering date of allergic plants. Observed trends show annual differences between continental Slovenia and Primorje. Evidence show significantly increased burden of betula pollen in air in Slovenia.
Children in primary schools and kindergartens in the Municipality of Nova Gorica are only partially exposed to exceeded levels of road traffic noise. Measurements show that limit value for playgrounds (55 dB (A), set as a recommendation by the World Health Organization, is exceeded only at the most exceeded facade by 3 of 12 elementary schools and 5 of 16 kindergartens. As in the school year 2012/2013 1,162 students (in those 3 schools) and 439 children (in those 5 kindergartens) were exposed to some noise it would be reasonable to carry out noise measurements. According to the data we assume that in the classrooms road traffic noise does not interfere children by learning and playing.
In Slovenia 7 % of people live in flood-prone areas. The most extensive flood areas are in northeast and in subpannonian Slovenia, in subalpine valleys and basins and plains along Ledava, Mura and Ščavnica. The largest share of the population in areas of flooding is in Savinjska (13%), Koroška (12%), Zasavska, (10%) and Osrednjeslovenska (9%) statistical region.
Lyme borreliosis (LB) is the most common vector-transmitted infectious disease in Slovenia. From 3,000 to over 6,000 patients with LB were registred from 2005 to 2014 in Slovenia. Since the introduction of statutory registration of LB, incidence rate is increasing and is one of the highest in the EU. The increase reflects better recognition of the disease, awareness of the general population about symptoms and signs consistent with LB. We assume that the lifestyle i.e. living or working in environment where there is a possibility of infection, is equally if not more important than the density of ticks and environmental factors.

Life expectancy at birth in Slovenia is gradually getting longer, for both men and women. Life expectancy at birth for women is slightly longer than it is for men. It is noted that life expectancy at birth in western Slovenia is longer. Life expectancy at birth in the year 2014 for women in Slovenia is 84.1 years for men and 78.1 years.

The limit value for environmental noise for playgrounds (55dB(A)) determined by the WHO was exceeded at the most exposed facade at 12 primary schools. However none of 34 kindergartens and 22 primary schools was exposed to excess noise limit at all four facades. There were 4,097 pupils in 12 schools and 2,909 children in 24 kindergartens where the high noise levels at most exposed facades were determined in the school year 2013/2014. According to the data we assume that noise from road traffic does not represent a serious problem for children and pupils at play outside and at work inside those buildings. However we recommend more detailed noise measurements to be carried out at the most exposed schools and kindergartens.

The highest levels of dioxins and PCBs were found in fish liver in EU between 1995 and 2010. Between 2012 and 2014 in Slovenia the highest levels were found in fish meat, following meat and fat tissues of cattle and sheep. Food producers and competent authorities should proactively make efforts to reduce dioxins and PCBs in feed and food.