In a new policy document, the United Nations (UN) recommends shifting the burden of proof for pollution-related harms to health from individuals to polluters.

It also urges governments to make polluters pay for permanent air quality enforcement and oversight programs and to establish fines and penalties to disincentivize violations.

Other recommendations include improving data tracking on pollution metrics, increasing public information, and limiting fossil fuel production and use by increasing pollution control and developing zero-emission public transport.

The policy document follows the Cannavacciuolo and Others v. Italy case, in which the European Court of Human Rights found that Italy violated human rights by failing to protect residents in the Campania region from toxic pollution like illegal dumping, burying, and burning of waste.

In response to the court’s orders, Italy adopted a comprehensive strategy to tackle the issue. It includes identifying polluted areas, implementing targeted decontamination, managing pollution-related health risks, and intensifying efforts to fight illegal waste disposal.

“Europe has not formally shifted the burden of proof, but it is moving towards a model where states and polluters carry greater responsibility for preventing and accounting for environmental harm to health,” Rafael Benitez, director of social rights, health, and environment at the Council of Europe, told Medscape News Europe.

Coordinated National Policies

The UN’s new policy document sets objectives based on several existing instruments, some of which are binding, said Benitez. The Council of Europe Strategy on the Environment (2025-2030), for example, which frames environmental harm as a human rights issue, sets out how the 46 Council of Europe member states should act on environmental protection. 

Additionally, the Council of Europe Convention on the Protection of the Environment through Criminal Law, which concerns criminalization, sanctions, and cooperation, will become binding and enforced once it is ratified by at least 10 states. As of 17 March 2026, it had received five signatures but no ratifications.

“Once it enters into effect, it would require parties to implement coordinated national policies to prevent environmental crime,” said Benitez, adding that it would provide for specialized training for professionals and for raising public awareness. The convention stresses the need to collect reliable data and promote research on the causes and effects of environmental crime (eg, illegal dumping of toxic waste, unregulated fishing, and clandestine mining).

Questions About Implementation

Medscape News Europe spoke with Philippe Grandjean, MD, professor of geographical and register-based epidemiology at the University of Southern Denmark, Odense, Denmark. While he supports the UN recommendation, he noted that financial interests can delay decisions, as is the case with pesticides, plastics, and per- and polyfluoroalkyl substances. 

Cecilia Arsene, PhD, professor of chemistry at Alexandru Ioan Cuza University of Iaşi, Romania, also had concerns about how the recommendation would realistically be enforced. A general societal lack of interest in the impacts of pollutants on human health could make it difficult, she noted.

“I don’t see any real interest from other Romanian scientists, nor from the government or companies, in developing these kinds of strategies,” she said, noting that the “first real investment” in this regard should be in public education.

She added that cases of “long-range transboundary pollution” where air masses move between jurisdictions could make implementation more complicated. “Questions will remain. Who should be burdened?” she said.

Linking pollution to individual health outcomes is another obstacle for implementation, said Benitez, as the process remains difficult. He added that monitoring gaps are also a hurdle and that fossil fuels and polluting industries are “deeply embedded” in society.

Clinical and Environmental Effects

Nevertheless, Benitez was optimistic about how the recommendations, if implemented, could affect public health.

“The criminal law approach could deter major polluters, reducing population exposure,” he said, adding that the recommendations would likely lead to stronger prevention, with states required to act earlier on pollution risks.

He noted that the recommendations may mean that clinicians increasingly treat environmental exposure as a core health determinant and that health systems may need to improve surveillance and reporting of pollution-related illness.

The author of the policy document, UN Special Rapporteur Astrid Puentes Riaño, plans to take the report to the World Health Assembly and international climate negotiations later this year.

Benitez, Grandjean, and Arsene reported having no relevant financial relationships.

Annie Lennon is a medical journalist. Her writing appears on Medscape, WebMD, and Medical News Today, among other outlets.