Industrial accidents, such as Bhopal, or air pollution crises, such as the London smogs of the 1950s, cause major concern. The short-term effects of exposure to high levels of many toxic substances are understood, but less is known about the consequences of long-term exposure of humans to low concentrations. Hence, environments once considered "safe" for humans years ago are now being reconsidered or proven not to be the case. There is widespread agreement that 85% of all cancers are caused by such broad environmental factors such as smoking, alcohol and drugs, ionizing radiation, and carcinogens in air, food, or water. While the effects of some individual pollutants have been established, we still do not know enough about the combined risks to which people are exposed in air, food and water. Though humanity has made tremendous strides in human health, as witnessed by longer life-expectancies, it is suggested that society as in the past is once again underestimating environmental pollutant's impact upon human health, both physical and mental.
The rural sector and urban slums are particular social sectors that would benefit from the strengthening of health systems because special attention in those areas will strengthen the implementation of the priorities identified in the Commission decisions on human settlements. Poverty is an underlying significant element to be addressed in the integrated implementation of health aspects of Agenda 21. Eradicating malnutrition and hunger, which affects some 1,000 million people in the world, is a fundamental prerequisite to providing health for all.
While recognizing the impact of population growth on health, environment and development, and vice versa, and looking forward to the outcome of the [International Conference on Population and Development], there is a need to recognize that the provision of basic and assured health care, particularly to women and children, is a vital prerequisite to the reduction of high rates of population growth.
The specific needs of vulnerable groups are recognized as priority areas. In addition to the three vulnerable groups identified in chapter 6 of Agenda 21 (women, children and indigenous people), there are similarly special health needs of the aged, the disabled, and the displaced. The contribution of food aid is an important aspect of efforts directed at the improvement of the nutritional and overall health of vulnerable groups.
The work-place is a source of health-related problems and at the same time provides a useful community basis for implementing and monitoring preventive health programmes through the participation of workers.
It is of crucial importance to change consumption patterns, in particular in developed countries, as well as production patterns, in order to ensure that products and production processes with adverse health and environmental effects gradually disappear. Detailed and specific product information, such as adequate labelling, can therefore create changes in the market towards cleaner products. In that context, there is a need for continually updating the [Consolidated List of Products Whose Consumption and/or Sale Have Been Banned, Withdrawn, Severely Restricted or Not Approved by Governments], and for undertaking further measures to broadly disseminate information contained in that list. There is a need to assist countries to implement the set of guidelines for consumer protection adopted by the General Assembly in 1985.
Chemical substances with potential hea1th hazards that are widely used in industry, consumer products and food production and processing are of serious concern. The impact on human health, especially of longterm exposure to low doses of synthetic chemicals with potential neurotoxic, reproductive or immunotoxic effects, and their synergistic effects on nature, is not yet sufficiently understood. There is a need to control their use and to minimize the emission of hazardous chemicals to prevent increasing concentrations in the environment.
WHO envisages four lines of health reform with the context of sustainable development:
The following priorities require particular attention from governments and the relevant international organizations:
Priority areas recommended to the [Inter-Agency Committee on Sustainable Development] (IACSD) with respect to chapter 6 of Agenda 21 and in the preparation of the 1997 review, include:
To contribute to the solution of environmental health problems associated with the rapid urbanization of cities in the third world, the Programme is actively promoting the ['Healthy City'] approach, initiated in the European region. The WHO Commission on Health and Environment, established by the Director-General in 1990, analysed, in-depth, the linkage between environmental changes and health consequences.
The World Health Organization's [Programme on the Promotion of Environmental Health] tackles the increasing threats to health and well-being from a changing environment. In addition to direct technical cooperation with member states in a multitude of projects at field level, the Programme gives prominence to the assessment of health risks from chemical, physical and biological agents. A [Global Strategy for Health and Environment] has been developed by WHO and endorsed by the World Health Assembly.
Through the International Programme on Chemical Safety (IPCS), the United Nations Environment Programme (UNEP), the WHO (WHO), and the International Labour Organization (ILO), cooperate on assessments of the risks posed by toxic chemicals to health and the environment.
UNEP, the UN Food and Agricultural Organization (FAO) and WHO promote environmental means of controlling the vectors of malaria, schistosomiasis and sleeping sickness, through the Joint Panel of Experts on Environmental Management for Vector Control (PEEM), and monitor and control fungal mycotoxins in foods. Several activities of the [Global Environmental Monitoring System] (GEMS) are related to health. The [Human Exposure Assessment Locations Programme] (HEALs), set up by WHO and UNEP, monitors total human exposure to pollutants, and facilitates countries to assess the combined risk from air, food and water pollutants and to take appropriate action.
DANIDA has prepared a series of strategies that examine environmental issues in human health.
Traditional health-related knowledge, borne especially by women and indigenous people, makes a contribution to overall health and needs increased research with a view to supporting its use where adequately validated.