A-21: HUMAN HEALTH
Distr.
GENERAL
A/CONF.151/26 (Vol. I)
12 August 1992
ORIGINAL: ENGLISH
REPORT OF THE UNITED NATIONS CONFERENCE ON
ENVIRONMENT AND DEVELOPMENT
(Rio de Janeiro, 3-14 June 1992)
Chapter 6
PROTECTING AND PROMOTING HUMAN HEALTH
INTRODUCTION
6.1. Health and development are intimately interconnected. Both
insufficient development leading to poverty and inappropriate development
resulting in overconsumption, coupled with an expanding world population,
can result in severe environmental health problems in both developing and
developed nations. Action items under Agenda 21 must address the primary
health needs of the world's population, since they are integral to the
achievement of the goals of sustainable development and primary
environmental care. The linkage of health, environmental and
socio-economic improvements requires intersectoral efforts. Such efforts,
involving education, housing, public works and community groups, including
businesses, schools and universities and religious, civic and cultural
organizations, are aimed at enabling people in their communities to ensure
sustainable development. Particularly relevant is the inclusion of
prevention programmes rather than relying solely on remediation and
treatment. 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. An appropriate international
organization, such as WHO, should coordinate these activities.
6.2. The following programme areas are contained in this chapter:
(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;
(e) Reducing health risks from environmental pollution and hazards.
PROGRAMME AREAS
A. Meeting primary health care needs, particularly in rural areas
Basis for action
6.3. Health ultimately depends on the ability to manage successfully the
interaction between the physical, spiritual, biological and economic/social
environment. Sound development is not possible without a healthy
population; yet most developmental activities affect the environment to
some degree, which in turn causes or exacerbates many health problems.
Conversely, it is the very lack of development that adversely affects the
health condition of many people, which can be alleviated only through
development. The health sector cannot meet basic needs and objectives on
its own; it is dependent on social, economic and spiritual development,
while directly contributing to such development. It is also dependent on
a healthy environment, including the provision of a safe water supply and
sanitation and the promotion of a safe food supply and proper nutrition.
Particular attention should be directed towards food safety, with priority
placed on the elimination of food contamination; comprehensive and
sustainable water policies to ensure safe drinking water and sanitation to
preclude both microbial and chemical contamination; and promotion of health
education, immunization and provision of essential drugs. Education and
appropriate services regarding responsible planning of family size, with
respect for cultural, religious and social aspects, in keeping with
freedom, dignity and personally held values and taking into account ethical
and cultural considerations, also contribute to these intersectoral
activities.
Objectives
6.4. Within the overall strategy to achieve health for all by the year
2000, the objectives are to meet the basic health needs of rural peri-urban
and urban populations; to provide the necessary specialized environmental
health services; and to coordinate the involvement of citizens, the health
sector, the health-related sectors and relevant non-health sectors
(business, social, educational and religious institutions) in solutions to
health problems. As a matter of priority, health service coverage should
be achieved for population groups in greatest need, particularly those
living in rural areas.
Activities
6.5. National Governments and local authorities, with the support of
relevant non-governmental organizations and international organizations, in
the light of countries' specific conditions and needs, should strengthen
their health sector programmes, with special attention to rural needs, to:
(a) Build basic health infrastructures, monitoring and planning
systems:
(i) Develop and strengthen primary health care systems that are
practical, community-based, scientifically sound, socially
acceptable and appropriate to their needs and that meet basic
health needs for clean water, safe food and sanitation;
(ii) Support the use and strengthening of mechanisms that improve
coordination between health and related sectors at all
appropriate levels of government, and in communities and
relevant organizations;
(iii) Develop and implement rational and affordable approaches to the
establishment and maintenance of health facilities;
(iv) Ensure and, where appropriate, increase provision of social
services support;
(v) Develop strategies, including reliable health indicators, to
monitor the progress and evaluate the effectiveness of health
programmes;
(vi) Explore ways to finance the health system based on the
assessment of the resources needed and identify the various
financing alternatives;
(vii) Promote health education in schools, information exchange,
technical support and training;
(viii) Support initiatives for self-management of services by
vulnerable groups;
(ix) Integrate traditional knowledge and experience into national
health systems, as appropriate;
(x) Promote the provisions for necessary logistics for outreach
activities, particularly in rural areas;
(xi) Promote and strengthen community-based rehabilitation activities
for the rural handicapped.
(b) Support research and methodology development:
(i) Establish mechanisms for sustained community involvement in
environmental health activities, including optimization of the
appropriate use of community financial and human resources;
(ii) Conduct environmental health research, including behaviour
research and research on ways to increase coverage and ensure
greater utilization of services by peripheral, underserved and
vulnerable populations, as appropriate to good prevention
services and health care;
(iii) Conduct research into traditional knowledge of prevention and
curative health practices.
Means of implementation
(a) Financing and cost evaluation
6.6. The Conference secretariat has estimated the average total annual
cost (1993-2000) of implementing the activities of this programme to be
about $40 billion, including about $5 billion from the international
community on grant or concessional terms. These are indicative and
order-of-magnitude estimates only and have not been reviewed by
Governments. Actual costs and financial terms, including any that are
non-concessional, will depend upon, inter alia, the specific strategies and
programmes Governments decide upon for implementation.
(b) Scientific and technological means
6.7. New approaches to planning and managing health care systems and
facilities should be tested, and research on ways of integrating
appropriate technologies into health infrastructures supported. The
development of scientifically sound health technology should enhance
adaptability to local needs and maintainability by community resources,
including the maintenance and repair of equipment used in health care.
Programmes to facilitate the transfer and sharing of information and
expertise should be developed, including communication methods and
educational materials.
(c) Human resource development
6.8. Intersectoral approaches to the reform of health personnel
development should be strengthened to ensure its relevance to the "Health
for All" strategies. Efforts to enhance managerial skills at the district
level should be supported, with the aim of ensuring the systematic
development and efficient operation of the basic health system. Intensive,
short, practical training programmes with emphasis on skills in effective
communication, community organization and facilitation of behaviour change
should be developed in order to prepare the local personnel of all sectors
involved in social development for carrying out their respective roles. In
cooperation with the education sector, special health education programmes
should be developed focusing on the role of women in the health-care
system.
(d) Capacity-building
6.9. Governments should consider adopting enabling and facilitating
strategies to promote the participation of communities in meeting their own
needs, in addition to providing direct support to the provision of
health-care services. A major focus should be the preparation of
community-based health and health-related workers to assume an active role
in community health education, with emphasis on team work, social
mobilization and the support of other development workers. National
programmes should cover district health systems in urban, peri-urban and
rural areas, the delivery of health programmes at the district level, and
the development and support of referral services.
B. Control of communicable diseases
Basis for action
6.10. Advances in the development of vaccines and chemotherapeutic agents
have brought many communicable diseases under control. However, there
remain many important communicable diseases for which environmental control
measures are indispensable, especially in the field of water supply and
sanitation. Such diseases include cholera, diarrhoeal diseases,
leishmaniasis, malaria and schistosomiasis. In all such instances, the
environmental measures, either as an integral part of primary health care
or undertaken outside the health sector, form an indispensable component of
overall disease control strategies, together with health and hygiene
education, and in some cases, are the only component.
6.11. With HIV infection levels estimated to increase to 30-40 million by
the year 2000, the socio-economic impact of the pandemic is expected to be
devastating for all countries, and increasingly for women and children.
While direct health costs will be substantial, they will be dwarfed by the
indirect costs of the pandemic - mainly costs associated with the loss of
income and decreased productivity of the workforce. The pandemic will
inhibit growth of the service and industrial sectors and significantly
increase the costs of human capacity-building and retraining. The
agricultural sector is particularly affected where production is
labour-intensive.
Objectives
6.12. A number of goals have been formulated through extensive
consultations in various international forums attended by virtually all
Governments, relevant United Nations organizations (including WHO, UNICEF,
UNFPA, UNESCO, UNDP and the World Bank) and a number of non-governmental
organizations. Goals (including but not limited to those listed below) are
recommended for implementation by all countries where they are applicable,
with appropriate adaptation to the specific situation of each country in
terms of phasing, standards, priorities and availability of resources, with
respect for cultural, religious and social aspects, in keeping with
freedom, dignity and personally held values and taking into account ethical
considerations. Additional goals that are particularly relevant to a
country's specific situation should be added in the country's national plan
of action (Plan of Action for Implementing the World Declaration on the
Survival, Protection and Development of Children in the 1990s). 1/ Such
national level action plans should be coordinated and monitored from within
the public health sector. Some major goals are:
(a) By the year 2000, to eliminate guinea worm disease
(dracunculiasis);
(b) By the year 2000, eradicate polio;
(c) By the year 2000, to effectively control onchocerciasis (river
blindness) and leprosy;
(d) By 1995, to reduce measles deaths by 95 per cent and reduce
measles cases by 90 per cent compared with pre-immunization levels;
(e) By continued efforts, to provide health and hygiene education
and to ensure universal access to safe drinking water and universal access
to sanitary measures of excreta disposal, thereby markedly reducing
waterborne diseases such as cholera and schistosomiasis and reducing:
(i) By the year 2000, the number of deaths from
childhood diarrhoea in developing countries by 50 to 70 per cent;
(ii) By the year 2000, the incidence of childhood diarrhoea in
developing countries by at least 25 to 50 per cent;
(f) By the year 2000, to initiate comprehensive programmes to reduce
mortality from acute respiratory infections in children under five years by
at least one third, particularly in countries with high infant mortality;
(g) By the year 2000, to provide 95 per cent of the world's child
population with access to appropriate care for acute respiratory infections
within the community and at first referral level;
(h) By the year 2000, to institute anti-malaria programmes in all
countries where malaria presents a significant health problem and maintain
the transmission-free status of areas freed from endemic malaria;
(i) By the year 2000, to implement control programmes in countries
where major human parasitic infections are endemic and achieve an overall
reduction in the prevalence of schistosomiasis and of other trematode
infections by 40 per cent and 25 per cent, respectively, from a 1984
baseline, as well as a marked reduction in incidence, prevalence and
intensity of filarial infections;
(j) To mobilize and unify national and international efforts against
AIDS to prevent infection and to reduce the personal and social impact of
HIV infection;
(k) To contain the resurgence of tuberculosis, with particular
emphasis on multiple antibiotic resistant forms;
(l) To accelerate research on improved vaccines and implement to the
fullest extent possible the use of vaccines in the prevention of disease.
Activities
6.13. Each national Government, in accordance with national plans for
public health, priorities and objectives, should consider developing a
national health action plan with appropriate international assistance and
support, including, at a minimum, the following components:
(a) National public health systems:
(i) Programmes to identify environmental hazards in the causation of
communicable diseases;
(ii) Monitoring systems of epidemiological data to ensure adequate
forecasting of the introduction, spread or aggravation of
communicable diseases;
(iii) Intervention programmes, including measures consistent with the
principles of the global AIDS strategy;
(iv) Vaccines for the prevention of communicable diseases;
(b) Public information and health education:
Provide education and disseminate information on the risks of
endemic communicable diseases and build awareness on environmental
methods for control of communicable diseases to enable communities
to play a role in the control of communicable diseases;
(c) Intersectoral cooperation and coordination:
(i) Second experienced health professionals to relevant sectors, such
as planning, housing and agriculture;
(ii) Develop guidelines for effective coordination in the areas of
professional training, assessment of risks and development of
control technology;
(d) Control of environmental factors that influence the spread of
communicable diseases:
Apply methods for the prevention and control of communicable
diseases, including water supply and sanitation control, water
pollution control, food quality control, integrated vector
control, garbage collection and disposal and environmentally sound
irrigation practices;
(e) Primary health care system:
(i) Strengthen prevention programmes, with particular emphasis on
adequate and balanced nutrition;
(ii) Strengthen early diagnostic programmes and improve capacities for
early preventative/treatment action;
(iii) Reduce the vulnerability to HIV infection of women and their
offspring;
(f) Support for research and methodology development:
(i) Intensify and expand multidisciplinary research, including focused
efforts on the mitigation and environmental control of tropical
diseases;
(ii) Carry out intervention studies to provide a solid epidemiological
basis for control policies and to evaluate the efficiency of
alternative approaches;
(iii) Undertake studies in the population and among health workers to
determine the influence of cultural, behavioural and social
factors on control policies;
(g) Development and dissemination of technology:
(i) Develop new technologies for the effective control of communicable
diseases;
(ii) Promote studies to determine how to optimally disseminate results
from research;
(iii) Ensure technical assistance, including the sharing of knowledge
and know-how.
Means of implementation
(a) Financing and cost evaluation
6.14. The Conference secretariat has estimated the average total annual
cost (1993-2000) of implementing the activities of this programme to be
about $4 billion, including about $900 million from the international
community on grant or concessional terms. These are indicative and
order-of-magnitude estimates only and have not been reviewed by
Governments. Actual costs and financial terms, including any that are
non-concessional, will depend upon, inter alia, the specific strategies and
programmes Governments decide upon for implementation.
(b) Scientific and technological means
6.15. Efforts to prevent and control diseases should include
investigations of the epidemiological, social and economic bases for the
development of more effective national strategies for the integrated
control of communicable diseases. Cost-effective methods of environmental
control should be adapted to local developmental conditions.
(c) Human resource development
6.16. National and regional training institutions should promote broad
intersectoral approaches to prevention and control of communicable
diseases, including training in epidemiology and community prevention and
control, immunology, molecular biology and the application of new vaccines.
Health education materials should be developed for use by community workers
and for the education of mothers for the prevention and treatment of
diarrhoeal diseases in the home.
(d) Capacity-building
6.17. The health sector should develop adequate data on the distribution
of communicable diseases, as well as the institutional capacity to respond
and collaborate with other sectors for prevention, mitigation and
correction of communicable disease hazards through environmental
protection. The advocacy at policy- and decision-making levels should be
gained, professional and societal support mobilized, and communities
organized in developing self-reliance.
C. Protecting vulnerable groups
Basis for action
6.18. In addition to meeting basic health needs, specific emphasis has to
be given to protecting and educating vulnerable groups, particularly
infants, youth, women, indigenous people and the very poor as a
prerequisite for sustainable development. Special attention should also be
paid to the health needs of the elderly and disabled population.
6.19. Infants and children. Approximately one third of the world's
population are children under 15 years old. At least 15 million of these
children die annually from such preventable causes as birth trauma, birth
asphyxia, acute respiratory infections, malnutrition, communicable diseases
and diarrhoea. The health of children is affected more severely than other
population groups by malnutrition and adverse environmental factors, and
many children risk exploitation as cheap labour or in prostitution.
6.20. Youth. As has been the historical experience of all countries,
youth are particularly vulnerable to the problems associated with economic
development, which often weakens traditional forms of social support
essential for the healthy development, of young people. Urbanization and
changes in social mores have increased substance abuse, unwanted pregnancy
and sexually transmitted diseases, including AIDS. Currently more than
half of all people alive are under the age of 25, and four of every five
live in developing countries. Therefore it is important to ensure that
historical experience is not replicated.
6.21. Women. In developing countries, the health status of women remains
relatively low, and during the 1980s poverty, malnutrition and general
ill-health in women were even rising. Most women in developing countries
still do not have adequate basic educational opportunities and they lack
the means of promoting their health, responsibly controlling their
reproductive life and improving their socio-economic status. Particular
attention should be given to the provision of pre-natal care to ensure
healthy babies.
6.22. Indigenous people and their communities. Indigenous people had
their communities make up a significant percentage of global population.
The outcomes of their experience have tended to be very similar in that the
basis of their relationship with traditional lands has been fundamentally
changed. They tend to feature disproportionately in unemployment, lack of
housing, poverty and poor health. In many countries the number of
indigenous people is growing faster than the general population. Therefore
it is important to target health initiatives for indigenous people.
Objectives
6.23. The general objectives of protecting vulnerable groups are to ensure
that all such individuals should be allowed to develop to their full
potential (including healthy physical, mental and spiritual development);
to ensure that young people can develop, establish and maintain healthy
lives; to allow women to perform their key role in society; and to support
indigenous people through educational, economic and technical
opportunities.
6.24. Specific major goals for child survival, development and protection
were agreed upon at the World Summit for Children and remain valid also for
Agenda 21. Supporting and sectoral goals cover women's health and
education, nutrition, child health, water and sanitation, basic education
and children in difficult circumstances.
6.25. Governments should take active steps to implement, as a matter of
urgency, in accordance with country specific conditions and legal systems,
measures to ensure that women and men have the same right to decide freely
and responsibly on the number and spacing of their children, to have access
to the information, education and means, as appropriate, to enable them to
exercise this right in keeping with their freedom, dignity and personally
held values, taking into account ethical and cultural considerations.
6.26. Governments should take active steps to implement programmes to
establish and strengthen preventive and curative health facilities which
include women-centred, women-managed, safe and effective reproductive
health care and affordable, accessible services, as appropriate, for the
responsible planning of family size, in keeping with freedom, dignity and
personally held values and taking into account ethical and cultural
considerations. Programmes should focus on providing comprehensive health
care, including pre-natal care, education and information on health and
responsible parenthood and should provide the opportunity for all women to
breast-feed fully, at least during the first four months post-partum.
Programmes should fully support women's productive and reproductive roles
and well being, with special attention to the need for providing equal and
improved health care for all children and the need to reduce the risk of
maternal and child mortality and sickness.
Activities
6.27. National Governments, in cooperation with local and non-governmental
organizations, should initiate or enhance programmes in the following
areas:
(a) Infants and children:
(i) Strengthen basic health-care services for children in the context
of primary health-care delivery, including prenatal care,
breast-feeding, immunization and nutrition programmes;
(ii) Undertake widespread adult education on the use of oral
rehydration therapy for diarrhoea, treatment of respiratory
infections and prevention of communicable diseases;
(iii) Promote the creation, amendment and enforcement of a legal
framework protecting children from sexual and workplace
exploitation;
(iv) Protect children from the effects of environmental and
occupational toxic compounds;
(b) Youth:
Strengthen services for youth in health, education and social
sectors in order to provide better information, education,
counselling and treatment for specific health problems, including
drug abuse;
(c) Women:
(i) Involve women's groups in decision-making at the national and
community levels to identify health risks and incorporate health
issues in national action programmes on women and development;
(ii) Provide concrete incentives to encourage and maintain attendance
of women of all ages at school and adult education courses,
including health education and training in primary, home and
maternal health care;
(iii) Carry out baseline surveys and knowledge, attitude and practice
studies on the health and nutrition of women throughout their life
cycle, especially as related to the impact of environmental
degradation and adequate resources;
(d) Indigenous people and their communities:
(i) Strengthen, through resources and self-management, preventative
and curative health services;
(ii) Integrate traditional knowledge and experience into health
systems.
Means of implementation
(a) Financing and cost evaluation
6.28. The Conference secretariat has estimated the average total annual
cost (1993-2000) of implementing the activities of this programme to be
about $3.7 billion, including about $400 billion from the international
community on grant or concessional terms. These are indicative and
order-of-magnitude estimates only and have not been reviewed by
Governments. Actual costs and financial terms, including any that are
non-concessional, will depend upon, inter alia, the specific strategies and
programmes Governments decide upon for implementation.
(b) Scientific and technological means
6.29. Educational, health and research institutions should be strengthened
to provide support to improve the health of vulnerable groups. Social
research on the specific problems of these groups should be expanded and
methods for implementing flexible pragmatic solutions explored, with
emphasis on preventive measures. Technical support should be provided to
Governments, institutions and non-governmental organizations for youth,
women and indigenous people in the health sector.
(c) Human resources development
6.30. The development of human resources for the health of children, youth
and women should include reinforcement of educational institutions,
promotion of interactive methods of education for health and increased use
of mass media in disseminating information to the target groups. This
requires the training of more community health workers, nurses, midwives,
physicians, social scientists and educators, the education of mothers,
families and communities and the strengthening of ministries of education,
health, population etc.
(d) Capacity-building
6.31. Governments should promote, where necessary: (i) the organization
of national, intercountry and interregional symposia and other meetings for
the exchange of information among agencies and groups concerned with the
health of children, youth, women and indigenous people, and (ii) women's
organizations, youth groups and indigenous people's organizations to
facilitate health and consult them on the creation, amendment and
enforcement of legal frameworks to ensure a healthy environment for
children, youth, women and indigenous peoples.
D. Meeting the urban health challenge
Basis for action
6.32. For hundreds of millions of people, the poor living conditions in
urban and peri-urban areas are destroying lives, health, and social and
moral values. Urban growth has outstripped society's capacity to meet
human needs, leaving hundreds of millions of people with inadequate
incomes, diets, housing and services. Urban growth exposes populations to
serious environmental hazards and has outstripped the capacity of municipal
and local governments to provide the environmental health services that the
people need. All too often, urban development is associated with
destructive effects on the physical environment and the resource base
needed for sustainable development. Environmental pollution in urban areas
is associated with excess morbidity and mortality. Overcrowding and
inadequate housing contribute to respiratory diseases, tuberculosis,
meningitis and other diseases. In urban environments, many factors that
affect human health are outside the health sector. Improvements in urban
health therefore will depend on coordinated action by all levels of
government, health care providers, businesses, religious groups,
social and educational institutions and citizens.
Objectives
6.33. The health and well-being of all urban dwellers must be improved so
that they can contribute to economic and social development. The global
objective is to achieve a 10 to 40 per cent improvement in health
indicators by the year 2000. The same rate of improvement should be
achieved for environmental, housing and health service indicators. These
include the development of quantitative objectives for infant mortality,
maternal mortality, percentage of low birth weight newborns and specific
indicators (e.g. tuberculosis as an indicator of crowded housing,
diarrhoeal diseases as indicators of inadequate water and sanitation, rates
of industrial and transportation accidents that indicate possible
opportunities for prevention of injury, and social problems such as drug
abuse, violence and crime that indicate underlying social disorders).
Activities
6.34. Local authorities, with the appropriate support of national
Governments and international organizations should be encouraged to take
effective measures to initiate or strengthen the following activities:
(a) Develop and implement municipal and local health plans:
(i) Establish or strengthen intersectoral committees at both the
political and technical level, including active collaboration on
linkages with scientific, cultural, religious, medical, business,
social and other city institutions, using networking arrangements;
(ii) Adopt or strengthen municipal or local "enabling strategies" that
emphasize "doing with" rather than "doing for" and create
supportive environments for health;
(iii) Ensure that public health education in schools, workplace, mass
media etc. is provided or strengthened;
(iv) Encourage communities to develop personal skills and awareness of
primary health care;
(v) Promote and strengthen community-based rehabilitation activities
for the urban and peri-urban disabled and the elderly;
(b) Survey, where necessary, the existing health, social and
environmental conditions in cities, including documentation of
intra-urban differences;
(c) Strengthen environmental health services:
(i) Adopt health impact and environmental impact assessment
procedures;
(ii) Provide basic and in-service training for new and existing
personnel;
(d) Establish and maintain city networks for collaboration and
exchange of models of good practice.
Means of implementation
(a) Financing and cost evaluation
6.35. The Conference secretariat has estimated the average total annual
cost (1993-2000) of implementing the activities of this programme to be
about $222 million, including about $22 million from the international
community on grant or concessional terms. These are indicative and
order-of-magnitude estimates only and have not been reviewed by
Governments. Actual costs and financial terms, including any that are
non-concessional, will depend upon, inter alia, the specific strategies and
programmes Governments decide upon for implementation.
(b) Scientific and technological means
6.36. Decision-making models should be further developed and more widely
used to assess the costs and the health and environment impacts of
alternative technologies and strategies. Improvement in urban development
and management requires better national and municipal statistics based on
practical, standardized indicators. Development of methods is a priority
for the measurement of intra-urban and intra-district variations in health
status and environmental conditions, and for the application of this
information in planning and management.
(c) Human resources development
6.37. Programmes must supply the orientation and basic training of
municipal staff required for the healthy city processes. Basic and
in-service training of environmental health personnel will also be needed.
(d) Capacity-building
6.38. The programme is aimed towards improved planning and management
capabilities in the municipal and local government and its partners in
central Government, the private sector and universities. Capacity
development should be focused on obtaining sufficient information,
improving coordination mechanisms linking all the key actors, and making
better use of available instruments and resources for implementation.
E. Reducing health risks from environmental pollution
and hazards
Basis for action
6.39. In many locations around the world the general environment (air,
water and land), workplaces and even individual dwellings are so badly
polluted that the health of hundreds of millions of people is adversely
affected. This is, inter alia, due to past and present developments in
consumption and production patterns and lifestyles, in energy production
and use, in industry, in transportation etc., with little or no regard for
environmental protection. There have been notable improvements in some
countries, but deterioration of the environment continues. The ability of
countries to tackle pollution and health problems is greatly restrained
because of lack of resources. Pollution control and health protection
measures have often not kept pace with economic development. Considerable
development-related environmental health hazards exist in the newly
industrializing countries. Furthermore, the recent analysis of WHO has
clearly established the interdependence among the factors of health,
environment and development and has revealed that most countries
are lacking such integration as would lead to an effective pollution
control mechanism. 2/ Without prejudice to such criteria as may be agreed
upon by the international community, or to standards which will have to be
determined nationally, it will be essential in all cases to consider the
systems of values prevailing in each country and the extent of the
applicability of standards that are valid for the most advanced countries
but may be inappropriate and of unwarranted social cost for the developing
countries.
Objectives
6.40. The overall objective is to minimize hazards and maintain the
environment to a degree that human health and safety is not impaired or
endangered and yet encourage development to proceed. Specific programme
objectives are:
(a) By the year 2000, to incorporate appropriate environmental and
health safeguards as part of national development programmes in all
countries;
(b) By the year 2000, to establish, as appropriate, adequate national
infrastructure and programmes for providing environmental injury, hazard
surveillance and the basis for abatement in all countries;
(c) By the year 2000, to establish, as appropriate, integrated
programmes for tackling pollution at the source and at the disposal site,
with a focus on abatement actions in all countries;
(d) To identify and compile, as appropriate, the necessary statistical
information on health effects to support cost/benefit analysis, including
environmental health impact assessment for pollution control, prevention
and abatement measures.
Activities
6.41. Nationally determined action programmes, with international
assistance, support and coordination, where necessary, in this area should
include:
(a) Urban air pollution:
(i) Develop appropriate pollution control technology on the basis of
risk assessment and epidemiological research for the introduction
of environmentally sound production processes and suitable safe
mass transport;
(ii) Develop air pollution control capacities in large cities,
emphasizing enforcement programmes and using monitoring networks,
as appropriate;
(b) Indoor air pollution:
(i) Support research and develop programmes for applying prevention
and control methods to reducing indoor air pollution, including
the provision of economic incentives for the installation of
appropriate technology;
(ii) Develop and implement health education campaigns, particularly in
developing countries, to reduce the health impact of domestic use
of biomass and coal;
(c) Water pollution:
(i) Develop appropriate water pollution control technologies on the
basis of health risk assessment;
(ii) Develop water pollution control capacities in large cities;
(d) Pesticides:
Develop mechanisms to control the distribution and use of
pesticides in order to minimize the risks to human health by
transportation, storage, application and residual effects of
pesticides used in agriculture and preservation of wood;
(e) Solid waste:
(i) Develop appropriate solid waste disposal technologies on the basis
of health risk assessment;
(ii) Develop appropriate solid waste disposal capacities in large
cities;
(f) Human settlements:
Develop programmes for improving health conditions in human
settlements, in particular within slums and non-tenured
settlements, on the basis of health risk assessment;
(g) Noise:
Develop criteria for maximum permitted safe noise exposure levels
and promote noise assessment and control as part of environmental
health programmes;
(h) Ionizing and non-ionizing radiation:
Develop and implement appropriate national legislation, standards
and enforcement procedures on the basis of existing international
guidelines;
(i) Effects of ultraviolet radiation:
Undertake, as a matter of urgency, research on the effects on
human health of the increasing ultraviolet radiation reaching the
earth's surface as a consequence of depletion of the stratospheric
ozone layer;
(ii) On the basis of the outcome of this research, consider taking
appropriate remedial measures to mitigate the above-mentioned
effects on human beings;
(j) Industry and energy production:
(i) Establish environmental health impact assessment procedures for
the planning and development of new industries and energy
facilities;
(ii) Incorporate appropriate health risk analysis in all national
programmes for pollution control and management, with particular
emphasis on toxic compounds such as lead;
(iii) Establish industrial hygiene programmes in all major industries
for the surveillance of workers' exposure to health hazards;
(iv) Promote the introduction of environmentally sound technologies
within the industry and energy sectors;
(k) Monitoring and assessment:
Establish, as appropriate, adequate environmental monitoring
capacities for the surveillance of environmental quality and the
health status of populations;
(l) Injury monitoring and reduction:
(i) Support, as appropriate, the development of systems to monitor the
incidence and cause of injury to allow well-targeted
intervention/prevention strategies;
(ii) Develop, in accordance with national plans, strategies in all
sectors (industry, traffic and others) consistent with the WHO
safe cities and safe communities programmes, to reduce the
frequency and severity of injury;
(iii) Emphasize preventive strategies to reduce occupationally derived
diseases and diseases caused by environmental and occupational
toxins to enhance worker safety;
(m) Research promotion and methodology development:
(i) Support the development of new methods for the quantitative
assessment of health benefits and cost associated with different
pollution control strategies;
(ii) Develop and carry out interdisciplinary research on the combined
health effects of exposure to multiple environmental hazards,
including epidemiological investigations of long-term exposures to
low levels of pollutants and the use of biological markers capable
of estimating human exposures, adverse effects and susceptibility
to environmental agents.
Means of implementation
(a) Financing and cost evaluation
6.42. The Conference secretariat has estimated the average total annual
cost (1993-2000) of implementing the activities of this programme to be
about $3 billion, including about $115 million from the international
community on grant or concessional terms. These are indicative and
order-of-magnitude estimates only and have not been reviewed by
Governments. Actual costs and financial terms, including any that are
non-concessional, will depend upon, inter alia, the specific strategies and
programmes Governments decide upon for implementation.
(b) Scientific and technological means
6.43. Although technology to prevent or abate pollution is readily
available for a large number of problems, for programme and policy
development countries should undertake research within an intersectoral
framework. Such efforts should include collaboration with the business
sector. Cost/effect analysis and environmental impact assessment methods
should be developed through cooperative international programmes and
applied to the setting of priorities and strategies in relation to health
and development.
6.44. In the activities listed in paragraph 6.41 (a) to (m) above,
developing country efforts should be facilitated by access to and transfer
of technology, know-how and information, from the repositories of such
knowledge and technologies, in conformity with chapter 34.
(c) Human resource development
6.45. Comprehensive national strategies should be designed to overcome the
lack of qualified human resources, which is a major impediment to progress
in dealing with environmental health hazards. Training should include
environmental and health officials at all levels from managers to
inspectors. More emphasis needs to be placed on including the subject of
environmental health in the curricula of secondary schools and universities
and on educating the public.
(d) Capacity-building
6.46. Each country should develop the knowledge and practical skills to
foresee and identify environmental health hazards, and the capacity to
reduce the risks. Basic capacity requirements must include knowledge about
environmental health problems and awareness on the part of leaders,
citizens and specialists; operational mechanisms for intersectoral and
intergovernmental cooperation in development planning and management and in
combating pollution; arrangements for involving private and community
interests in dealing with social issues; delegation of authority and
distribution of resources to intermediate and local levels of government to
provide front-line capabilities to meet environmental health needs.
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Notes
1/ A/45/625, annex.
2/ Report of the WHO Commission on Health and Environment (Geneva,
forthcoming).
END OF CHAPTER 6
.
========================================RRojas Research Unit/1996
