THE BARI DECLARATION The International Conference on Rural Health in Mediterranean and Balkan Countries took place in Bari, Italy, from November 13 to November 16 2002. The event was organized by the International Centre for Pesticides and Health Risk Prevention of the Azienda Ospedaliera Luigi Sacco - Polo Universitario, Milan-Italy, in collaboration with the Community of Mediterranean Universities (CUM), the International Association of Agricultural Medicine and Rural Health (IAAMRH), the European Rural and Isolated Practitioners (EURIPA), the Universities of Bari, Foggia and Milan, the National Italian Association "L'Agricoltura che Vogliamo" and the Italian National Institute for Occupational Safety and Prevention (ISPESL). Participants from the countries of the area, experts of the different topics related to Rural Health, together with representatives of other countries and International Organizations participated into the Event and provided their views on Rural health problems. All the participants agreed that in the Mediterranean and Balkan region most agricultural areas are similar to each other, despite differences between industrialized and not fully developed areas. These areas face many obstacles to build appropriate public health services. Research, policy and other activities aiming at promoting sustainable development of the region have for a long time neglected rural health problems. The Conference agreed that in this context the development of relevant, quality, cost effective and appropriate health care for rural populations is an urgent need to deal with and pointed out the need for: the development /improvement of a rural health policy in the region the need of strengthening partnership between all sectors in the area of rural health To this aim, these main sectors of action have been identified: Health of the Rural population The main problems for the rural population are: poor economic conditions, socio-cultural isolation, limited access to health care facilities, pesticide exposure, chemical environmental contamination, poor quality of food and limited or even no access to safe drinking water, risk of contact with allergens. Finally, environmental monitoring and health monitoring systems are often poor or lack at all. Occupational Rural Health in agriculture Main characteristics of the Mediterranean and Balkan agriculture are family-based enterprises, lack of health surveillance of workers, high rate of accidents, aging of the workforce, child labor, pesticide exposure, accidents, occupational and work-related diseases. Lack of public health data, weak occupational health legislation, weak insurance systems, poor occupational health systems, and paucity of public health experts significantly affect the quality of occupational health care in agriculture. Environmental Health In most of the Eastern Mediterranean Countries, obsolete pesticides and fertilizers have been imported and used during the last years and significant amounts of obsolete pesticides are stored and may significantly endanger the environment. Some regions are particularly affected by human-made or natural disasters. Domestic and industrial waste management is often insufficient or is absent at all, and environmental health monitoring systems are poor. Also environmental risk assessment activities are carried out only in few cases, and environmental impact studies basically are not carried out. It is therefore evident that adequate interventions are an urgent need to reduce the rural health inequity. A first step in this direction is building a network of all different professionals working in rural health related areas, able to facilitate the development, the planning and the implementation of Rural Health Programs. Necessary actions to be carried out include the identification of contact persons/institutions to build up a network, link up with existing networks and building up reference centres able to collect and disseminate information in the frame of a "Mediterranean and Balkan Rural Health Network" and an even wider network in the European region The main general objectives of network are the following: To assist rural communities to identify their needs regarding public health services and develop, plan and implement prevention programs To develop national programs of surveillance, research and education that have a measurable impact on the health of rural population and agricultural workers. To investigate the health impact of agricultural practice in the region (farmers, their families and other rural residents) The fist activity planned in the period 2002-2004 is the assessment of the rural health situation throughout the region and the definition of "country/area profiles". The development of the profiles is a first network building activity. Based on these profiles, it will be made possible to develop action plans/strategies for rural health reform in the region. The Conference has defined specific objectives for each of the three fields of priority: Rural Health Enforcing legislation (both at central and local level), Providing medical surveillance and health care structures (including poison control centres) Training of general practitioners in Occupational Health Characterization of areas at risk and evaluation of the environmental impact of current agricultural practice. Developing specific programs aimed at food and water hygiene Increasing the quality and number of rural health experts in the region and improving collaboration between experts from different disciplines (e.g. public health, occupational medicine, environment, agriculture, etc). Preventing adverse effects of pesticides to the public Building sustainable health care systems Occupational Rural Health The goals include: Improving occupational rural health Reducing accident rates Updating legislation Preventing adverse effects of pesticides Increasing the quality and number of environmental and occupational health services Increasing the quality and number of occupational health experts in the region. Make country and area-based inventories of occupational priorities. Environment The goals in Rural Environmental protection include Improve and harmonize national legislation with international legislation. Establish modern extension services with well-trained and educated specialists. Reducing environmental pollution Establish a plan for disposal of obsolete pesticides and provide financial resources for it. Make country and area-based inventories of environmental priorities. Training and Education programs Training and education is a fundamental activity to be carried out in each of the fields of priority identified, since local rural health experts are scarce. In this field, a key-problem is the dependency of less developed countries to the industrialized ones. Therefore, the best way to support these countries is the creation of training and education programs dealing with the main local environmental and health problems and addressed to local technical staffs. The Conference agrees to organize pilot-experiences of occupational health and environmental health training activities. The actors and partners include Governmental Institutions, Academia, NGOs, Professional Organizations, patient groups. Also Employers' Associations, Workers' Organizations, Industry and medical associations should be involved. The process will be realized within the framework of the WHO "Health For All" policy in the European Region, taking into account that one of the basic values is 'equity in health and solidarity in action between and within all countries and their inhabitants'. The co-ordination of these various actors is an urgent priority. To this aim, the Conference proposes that Reference Centres should be identified in the area, and that funding to support their activities should be made available. After the First International Conference on Rural Health in Mediterranean and Balkan Countries, similar events will be organized every two years in order to periodically check the activities done and identifying next steps.