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E/CN.17/1997/2/Add.5 |
Economic and Social Council
Distr. GENERAL
15 January 1997
ORIGINAL: ENGLISH
COMMISSION ON SUSTAINABLE DEVELOPMENT
Fifth session
7-25 April 1997
Overall progress achieved since the United Nations
Conference on Environment and Development
Report of the Secretary-General
Addendum
Protecting and promoting human health
(Chapter 6 of Agenda 21)
(* The report was prepared by the World Health Organization (WHO) as task
manager for chapter 6 of Agenda 21, in accordance with arrangements agreed
to by the Inter-Agency Committee on Sustainable Development (IACSD). It is
the result of consultation and information exchange between United Nations
agencies, international and national organizations, interested government
agencies and a range of other institutions, individuals and major group
representatives.)
CONTENTS
Paragraphs
Page
INTRODUCTION ............................................... 13
I. SELECTING KEY OBJECTIVES ............................. 2 - 73
II. REPORTING ON AND ANALYSING SUCCESS ................... 8 - 124
A. Incorporating health in sustainable development
plans ............................................ 8 - 94
B. Health implications of climate change and
depletion of the ozone layer ..................... 10 - 115
C. Protecting the food supply from environmental
hazards .......................................... 125
III. PROMISING CHANGES .................................... 13 - 315
A. Incorporating health in sustainable development
plans ............................................ 13 - 175
B. Establishing adequate structures for environmental
health services at the local level ............... 18 - 206
C. Developing an effective and efficient
environmental health information system .......... 21 - 227
D. Incorporating health in environmental impact
assessments ...................................... 23 - 257
E. Extending understanding of cumulative effects of
chemicals ........................................ 26 - 298
F. Environmental determinants of emerging
(and re-emerging) diseases ....................... 30 - 319
IV. UNFULFILLED EXPECTATIONS ............................. 32 - 369
A. Incorporating health in sustainable development
plans ............................................ 32 - 349
B. Incorporating health in environmental impact
assessments ...................................... 35 - 3610
V. EMERGING PRIORITIES .................................. 37 - 4210
A. Improving the understanding of the relationship
between health and social, economic and
environmental driving forces ..................... 39 - 4011
B. Incorporating health in environmental impact
assessments ...................................... 4111
C. Strengthening the role of local government ....... 4211
INTRODUCTION
1. The present report reviews progress made in the implementation of the
objectives set out in chapter 6 of Agenda 21 (Protecting and promoting
human health),1/ taking into account the decisions taken by the Commission
on Sustainable Development on this subject in 1994 at its second session.
I. SELECTING KEY OBJECTIVES
2. Principle 1 of the Rio Declaration on Environment and Development2/
states that:
"Human beings are at the centre of concerns for sustainable
development. They are entitled to a healthy and productive life in
harmony with nature."
3. To achieve this goal, it is essential that health be fully
incorporated in global, national and local sustainable development plans.
The health component of such plans should address the key objectives
spelled out in chapter 6 of Agenda 21, namely (a) meeting primary health
care needs, particularly in rural areas, (b) control of communicable
diseases, (c) protecting vulnerable groups, (d) meeting the urban health
challenge and (e) reducing health risks from environmental pollution and
hazards.
4. The Commission on Sustainable Development, in its decision in 1994
concerning human health, added important new concerns, for example, the
need to change consumption and production patterns to ensure that products
and production processes with adverse health and environmental effects
gradually disappear. It also, inter alia, called for the integration of
health into environmental impact assessment procedures and establishing
adequate structures for environmental health services at the local level.
5. The Commission on Sustainable Development also identified five
priority areas for Inter-Agency Committee on Sustainable Development
(IACSD) consideration: (a) supporting countries in development of national
environmental health plans as part of national sustainable development
programmes; (b) extending scientific and public understanding of the
cumulative effects of chemicals in consumer products, plant- and
animal-based food, water, soil and air on human health; (c) determining
mechanisms that identify and control newly emerging infectious diseases and
their possible environmental linkages; (d) providing a status report on the
health implications of the depletion of the ozone layer; and (e) developing
an effective and efficient environmental health information system.
6. For the purposes of this summary report, the following key objectives
have been selected for presentation:
(a) Incorporating health in sustainable development plans;
(b) Establishing adequate structures for environmental health
services at the local level;
(c) Developing an effective and efficient environmental health
information system;
(d) Incorporating health in environmental impact assessments;
(e) Health implications of climate change and depletion of the ozone
layer;
(f) Protecting the food supply from environmental hazards;
(g) Extending understanding of the cumulative effects of chemicals;
(h) Environmental determinants of emerging (and re-emerging)
diseases.
7. Each of these objectives appears in the following sections only when
there is something to be reported.
II. REPORTING ON AND ANALYSING SUCCESS
A. Incorporating health in sustainable development plans
National
8. Just over one third of the 74 countries that reported on progress to
the Commission on Sustainable Development have incorporated health into
their reports. Different approaches are being used for promoting health
sector involvement with other sectors in addressing health and environment-
related issues. In some countries, health and environment-related plans
have been prepared for inclusion in the national plans for sustainable
development. In others, sectoral plans have been reviewed and modified to
include health and environment-related concerns.
Local
9. A dramatic result of the Rio Conference has been the large number of
local Agenda 21 initiatives, especially in cities but also in villages and
even islands. Many of these feature health and health-related objectives
and activities. The World Health Organization (WHO)/Regional Office for
the Americas (AMRO) is promoting the concept of and methodologies for
primary environmental health care, aiming at a larger and more systematic
community participation in the focus of attention on environmental health
risks. A parallel and closely related initiative has been the Healthy
Cities movement. Examples from all continents, all involving networks of
municipal authorities, professionals and citizen groups, were considered at
the United Nations Conference on Human Settlements (Habitat II) "Dialogue
on creating healthy cities in the twenty-first century. Much has been
learned about how to promote health in cities by building on local
resources and capacities, and linking such actions to local Agenda 21. The
local Agenda 21 planning guide, prepared in 1996, makes explicit many
health and health-related issues that should be taken into account in the
steps of community-based issue analysis, drawing in some instances from the
case studies included.
B. Health implications of climate change and depletion
of the ozone layer
10. Documentation concerning specific health and environment linkages have
been prepared since Rio. One of these concerns the impact of climate
change on human health. This was addressed by a task group for WHO, the
World Meteorological Organization (WMO) and the United Nations Environment
Programme (UNEP) and a monograph on this subject has been published which
examines in considerable detail the potential implications of major
components of climate change, including those associated with the depletion
of the ozone layer.
11. WHO, WMO, UNEP and the International Commission on Non-Ionizing
Radiation Protection (ICNIRP) have issued a joint recommendation concerning
the Global Solar UV Index which provides information in regard to raising
public awareness of the potential harm of exposure to sun and to alerting
people to the need to adopt protective measures. These agencies have also
initiated a multi-centre international research project to measure more
accurately the harmful effects of excessive solar ultraviolet (UV)
radiation on the eyes and skin.
C. Protecting the food supply from environmental hazards
12. Since 1962, the Food and Agriculture Organization of the United
Nations (FAO)/WHO Codex Alimentarius Commission has developed an impressive
body of food standards, guidelines and other recommendations which
includes, inter alia, maximum limits on pesticides, contaminants and other
hazards. While non-compulsory, the work of Codex has been widely accepted
because it is based on sound scientific risk assessment. With the
successful conclusion of the General Agreement on Tariffs and Trade (GATT)
Uruguay Round of multilateral trade negotiations which established the
World Trade Organization on 1 January 1995, Codex recommendations related
to health and safety are recognized by the World Trade Organization as
representing the international consensus in respect of the evaluation of
the appropriateness of national health and safety requirements.
Consequently, the Codex has become the basis for the international
harmonization that will serve to promote protection of the consumer from
environmental hazards while facilitating international trade in food.
III. PROMISING CHANGES
A. Incorporating health in sustainable development plans
13. The call for health for all by the year 2000 has provided a
motivational and unifying concept in international health development.
Recognizing that "health for all" still serves as an inspirational goal for
all countries, WHO has initiated a process for renewing the health for all
strategy. The process itself will lead to an improved understanding of the
obstacles to achieving the objectives agreed upon at Rio and other major
United Nations conferences, and will lead countries to formulate new
strategies that are based upon equity and human rights.
14. Regional conferences have brought together ministers of health and the
environment and have led to further commitments to attaining long-term
environment and health policy objectives. The second European Conference
on Environment and Health, which was held in Helsinki in 1994, developed a
framework for the environmental health actions in Europe including a guide
for the development of national plans of action. The target date for
establishing these action plans is 1997.
15. The Pan American Conference on Health and Environment in Sustainable
Human Development was organized by WHO's American region in October 1995.
This Conference adopted the Pan American Charter on Health and Environment
in Sustainable Human Development and a Regional Work Plan. Another outcome
has been the proposed development of a Regional Plan for Investment in the
Environment and Health (PIAS) which identifies the investment in the region
over the next 12 years needed to overcome deficiencies in the health
services infrastructure, the drinking-water supply and basic sanitation.
16. The second Conference on Health, Environment and Development of the
Eastern Mediterranean Region held in November 1995 adopted the Beirut
Declaration on Action for a Healthy Environment, in which countries
pledged, inter alia, to prepare their action plans for health and
environment as part of their sustainable development plan no later than
1999.
17. The ministers for the environment of the seven major industrialized
nations (G-7), who met in May 1996, decided, for the first time, to give
priority to the relation of health and environment so as to highlight the
fact that the protection of public health has been and remains a
fundamental objective of environmental policies (see document A/51/208-
S/1996/543, annex I).
B. Establishing adequate structures for environmental health
services at the local level
18. Africa has the most pressing water supply and sanitation needs in the
world. Despite large investments in the sector during the International
Drinking Water Supply and Sanitation Decade (1981-1990), these needs are
still important. A major obstacle is the difficulty of ensuring the
sustainability of services once they are in place. The Africa 2000
initiative was launched in 1994 to help overcome this obstacle and to
accelerate sector development through increased investment and better use
of funds. A key feature of this initiative is its emphasis on a
participatory approach to improved water supply and sanitation in rural
areas. Another key aspect of Africa 2000 is its focus on operation,
maintenance and management of urban and rural water supply and sanitation
facilities. Different tools have been developed and their testing has been
initiated.
19. At Habitat II, a new global agenda 3/ for sustainable human settlements
development, which recognizes the need for an increased role for local
authorities in sustainable development, was agreed to. A much greater
readiness of national Governments to consult with them in development
planning was apparent. This has led to the planning of a series of
consultations with local government organizations (notably, the Group of 4
+, the International Union of Local Authorities (IULA), UTA, and the
Regional Network of Local Authorities for the Management of Human
Settlements in Asia and the Pacific (CITYNET), among others), which
represent thousands of cities and local authorities worldwide, to promote
health in their planning and management activities using Healthy
City/Healthy Village-type approaches.
20. High refugee concentrations, sometimes occurring rapidly, are
increasingly becoming a feature of local situations. They often lead to
degradation of renewable natural resources which contributes to health
risks of many kinds: food shortage, contaminated drinking water, dust and
smoke, and increased disease-carrying vector-breeding. The Office of the
United Nations High Commissioner for Refugees (UNHCR), jointly with the
International Federation of Red Cross and Red Crescent Societies and WHO is
preparing a practical guide to environmental health management in disasters
and emergencies. UNHCR has recently published a document on environmental
guidelines that specifically addresses the issue of impacts on the health
of refugees due to environmental problems.
C. Developing an effective and efficient environmental
health information system
21. Capacity-building, methodology development and improved information
access, which are essential for the success of any local initiative, are
the focus of the WHO initiative Information for Decision-making in
Environment and Health (IDEAH). Indicators are developed for the major
links between key economic and environmental driving forces and health
effects. These linkages can then be analysed to help local authorities
plan more effective action.
22. In the American region, a project is in process that aims at
integrating the different existing databases relevant to environmental
health. The Latin American and Caribbean Health Services Information
Center (BIREME), the Pan American Center for Sanitary Engineering and
Environmental Services (CEPIS) and the Pan American Center for Human
Ecology and Health (ECO) are participating in this effort. ECO is a source
of much technical information; CEPIS manages the Pan American Information
Network on Environmental Health. The last-mentioned can be accessed
through the Internet.
D. Incorporating health in environmental impact assessments
23. The WHO, FAO, UNEP and United Nations Centre for Human Settlements
(Habitat) Panel of Experts on Environmental Management of Vector Control
(PEEM) promotes incorporation of health concerns within the context of
developmental projects. Various guidelines have been prepared outlining
how development project planners should incorporate health in their impact
assessments.
24. In line with relevant decisions taken by the European Environment and
Health Committee, concrete steps are being taken under the Convention on
Environmental Impact Assessment in a Transboundary Context to integrate the
health component into the environmental impact assessment (EIA) procedure.
25. There are a growing number of development projects in which health
needs of the population in the project areas are being given greater
prominence. One recent development is the inclusion of a human health
component in the wetlands conservation programme of the World Conservation
Union (WCU). Another is FAO's promoting the findings of the PEEM programme
in the construction and management of irrigation systems to reduce the
likelihood of creating suitable habitats for disease vectors. Overall,
however, progress has been of an ad hoc nature.
E. Extending understanding of cumulative effects of chemicals
26. In response to the United Nations Conference on Environment and
Development, an Intergovernmental Forum on Chemical Safety (IFCS) was
established in 1994 to facilitate cooperation between Governments, and
intergovernmental and non-governmental organizations. At its first meeting
in Stockholm in 1994, IFCS recommended that 200 additional chemicals should
be targeted for evaluation of potential effects on health and the
environment by 1997 and, if this target was met, that another 300 chemicals
be evaluated by the year 2000.
27. In response to the need expressed in chapter 19 of Agenda 21 to
produce guidelines for acceptable exposure to a greater number of
chemicals, the Joint FAO/WHO Expert Committee on Food Additives and the
FAO/WHO Joint Meeting on Pesticide Residues have continued to develop
guidelines for tolerable intake levels for contaminants and acceptable
intake levels for pesticides, respectively. The WHO Guidelines for
Drinking-water Quality have been updated and will be subjected to rolling
revision procedures. WHO air quality guidelines for Europe are due in
1997, updated. Guidance values for exposure are being provided in the
Environmental Health Criteria published since 1993.
28. In the field of methodology for risk assessment and for the derivation
of guidelines for exposure to chemicals, work has been undertaken by the
International Programme on Chemical Safety (IPCS) and the Organisation for
Economic Cooperation and Development (OECD) in a coordinated manner to
promote the development, improvement and harmonization of methodologies for
risk assessment as well as for toxicity testing.
29. A promising innovation for accelerating production of comprehensive
assessments of chemicals is the development of a new concise series of risk
assessment documents based on high-quality national reviews. A pilot phase
for Concise International Chemical Assessment Documents (CICADs) is being
undertaken on 21 chemicals.
F. Environmental determinants of emerging (and re-emerging)
diseases
30. The Commission on Sustainable Development's decision to focus on
emerging diseases reflects a consensus that the battle against infectious
disease is far from won, as attested by both the occurrence of "new"
diseases, never before seen in human beings, and the resurgence of diseases
thought to be on the decline. 4/ In 1995, WHO established the Division of
Emerging and other Communicable Diseases Surveillance and Control (EMC).
Its mission is to strengthen national and international capacity in the
surveillance and control of communicable diseases, including those that
represent new, emerging or re-emerging public health problems.
31. Recognizing that environmental factors, for example, land use and
water management, often play an important role in disease epidemiology and
risk, the United Nations Development Programme (UNDP)/World Bank/WHO
Special Programme for Research and Training in Tropical Diseases (TDR) has,
since 1994, been funding research that seeks means for reducing the impact
of development projects on the risk for tropical diseases, in particular
malaria, schistosomiasis, leishmaniasis and onchocerciasis. FAO is
participating in this activity and promoting the inclusion of human health
aspects of land use in research and education (for example, as it pertains
to the quantification, possibly economic, of the malaria risk component).
IV. UNFULFILLED EXPECTATIONS
A. Incorporating health in sustainable development plans
The first principle of the Rio Declaration has yet to be
translated into action
32. The "health gap" has widened since Rio, owing to the growing number of
extremely poor people in the world, and the growing gap between rich and
poor, between educated and uneducated, and between men and women, in
developed and less developed countries, as documented in WHO's The World
Health Report 1995: Bridging the Gaps.5/
33. The pursuit of health is a never-ending one, and is to be engaged in
on many fronts, as reflected in Agenda 21, but results to date reveal that
unacceptably slow progress is being made. Health is still too often
understood only in terms of medical care services, and in many countries,
health is seen as the responsibility solely of the ministry of health.
Even major issue papers prepared within the United Nations system, for
example on the environment and rural development, neglect the human health
dimension. Furthermore, highly relevant inter-agency programmes are being
undermined by the growing pressure on individual agencies to withdraw their
support and participation in light of current budget constraints and
competing priorities.
34. As a consequence of various economic reforms, including structural
adjustment, government-provided social services have been cut back in many
countries. The health sector has not been spared. Growing financial
constraints have led to health sector reforms, but these have largely been
restricted to ensuring the financial viability of curative services and the
development of private care services. In the process, public health has
been neglected along with the contribution of other sectors to health.
B. Incorporating health in environmental impact assessments
35. The integration of health impact assessment into environmental impact
assessment (EIA) is not taking place as recommended by the Commission on
Sustainable Development, in spite of the few promising developments
mentioned above. It is being held up by various bottlenecks. The donor
agencies that have made loans and grants conditional on EIA have done
relatively little to broaden the health dimension of their assessment
methodologies. Desk officers are geared to conservation and global
environmental issues, and their health counterparts have not moved beyond
the delivery of health-care services.
36. There are conservative factors that are connected with the workings of
the national Governments themselves, including their ministries of health.
Development projects with known negative social and health impact have been
approved by planning ministries. The lack of analytic capacity within most
ministries handicaps their participation as full partners in the
intersectoral negotiations that must take place in any serious EIA
exercise.
V. EMERGING PRIORITIES
37. The overriding goal for the future must remain the incorporation of
health in national sustainable development plans. To recognize that human
health is interwoven with development plans in a multifaceted manner, as
exemplified by the diversity of objectives to be covered in achieving this
goal, is to recognize equally that there is no single strategy to be
pursued. As clearly specified in chapter 6 of Agenda 21, "countries ought
to develop plans for priority actions, drawing on the programme areas in
this chapter, which are based on cooperative planning by the various levels
of government, non-governmental organizations and local communities" (para.
6.1).
38. At this stage in the implementation of Agenda 21, the Commission on
Sustainable Development should reaffirm its commitment to the incorporation
of health in national sustainable development plans, as called for by the
first principle of the Rio Declaration, while giving priority to areas
where it has the greatest influence. Three priorities are proposed: (a)
improving the understanding of the relationship between health and social,
economic and environmental driving forces, (b) incorporating health in
environmental impact assessments and (c) strengthening the role of local
government.
A. Improving the understanding of the relationship between
health and social, economic and environmental driving
forces
39. Human health has always been strongly influenced by social, economic
and environmental factors. However, whereas in the past these factors were
largely determined by driving forces operating locally, today these forces
are both local and global in nature. Our understanding of them is not very
advanced, despite continuing study. Ignorance of the various ways that
health is influenced by these driving forces may be one reason for the
health sector's isolation and lack of influence in national and global
policy-making. However, growing public and policy maker awareness of the
strong relationship among human health, the environment and development is
occurring, as exemplified in several of the points covered above.
40. In order to build on this growing understanding, the Commission on
Sustainable Development should focus on the relationship between human
health and selected issues of its agenda, for example, consumption and
production patterns, including trade, employment and sustainable
livelihoods, and energy and transport. It may wish as well to incorporate
within this priority certain areas whose importance it has already
highlighted, in particular expansion of the understanding of the cumulative
effects of chemicals, and environmental determinants of emerging and
re-emerging diseases.
B. Incorporating health in environmental impact assessments
41. This objective, which was highlighted in the decision of the
Commission on Sustainable Development in 1994, remains one of the key
pillars with respect to placing human beings "at the centre of concerns for
sustainable development". As long as Governments and supporting bilateral
and multilateral donor agencies continue to ignore the health impact of
development projects, they are in effect saying no to human development.
This is an issue whose ramifications go well beyond the question of what
the health sector can hope to achieve on its own without the support of all
of its partners, and is thus most suitable for continuing emphasis by the
Commission on Sustainable Development.
C. Strengthening the role of local government
42. In many countries, city problems were often assumed to be the
responsibility of national or provincial/state agencies. One of the
critical changes that occurred between the first United Nations Conference
on Human Settlements in 1976 and the second, (Habitat II) in 1996, has been
the shift in emphasis away from what national Governments should do to how
national and provincial Governments should support the efforts and
initiatives of those living and working in cities. The United Nations
conferences after Rio (the International Conference on Population and
Development (Cairo, 1994); the World Summit for Social Development
(Copenhagen, 1995); and the Fourth World Conference on Women (Beijing,
1995)) all contributed to this stronger local emphasis. This includes
supporting the efforts of city and municipal authorities and of individual
households, community organizations, non-governmental organizations and
private sector institutions. Agenda 21 fully supported this development,
particularly when it called on local authorities to undertake a
consultative process to achieve "a consensus on 'a local Agenda 21' for the
community". The growing number of local agenda 21 programmes is proof of
the operational viability of Agenda 21; less clear perhaps is how the
international community can harness this energy to bring about comparable
changes at all levels of society. The Commission on Sustainable
Development should actively continue to promote these initiatives and
develop mechanisms that keep in sharp focus all of the important
dimensions of sustainable development, including that of human health.
Notes
1/ Report of the United Nations Conference on Environment and
Development, vol. I, Resolutions Adopted by the Conference (United Nations
publication, Sales No. E.93.I.8 and corrigendum), resolution 1, annex II.
2/ Ibid., annex I.
3/ See Report of the United Nations Conference on Human Settlements
(Habitat II), Istanbul, 3-14 June 1996 (A/CONF.165/14), chap. I, resolution
1, annex II, "The Habitat Agenda".
4/ The World Health Report of 1996: Fighting Disease/Fostering
Development (Geneva, Who, 1996) reports on the current infectious disease
threats and the actions needed for their control.
5/ Geneva, Who, 1995.
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Date last posted: 10 December 1999 17:25:35
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