Ensuring a healthy environment

A sick environment undermines the health of its inhabitants. Insanitary infested living conditions kill about 17 million people every year, some 11 million of them under five. Nearly half of all deaths in developing countries are caused by infectious or parasite born diseases. Contamination of drinking water and food are main causes ill-health and disease such as cholera. Malaria and schistosomiasis are other widespread harmful diseases. Humans also become ill from man-made environmental pollutants such as toxic chemicals, and when protective regulations are applied. A million unintentional acute poisonings are caused by pesticides alone every year, killing some 20,000 people each year.

Industrial accidents, such as Bhopal, or air pollution crises, such as the London smog 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 health 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 long-term 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: (a) Community health development: undertaking health promotion and protection as part of more holistically conceived community-based development programmes; (b) Health sector reform: increasing the allocation of resources to the most cost-effective health protection and promotion programmer as seen in the longer run and in the interest of attaining sustainable development; (c) Environmental health: increasing the understanding of the impact of policies and programmes of other sectors upon human health and mobilizing financing and action in those sectors accordingly; (d) National decision-making and accounting: health impact assessments, accounting and other means of promoting the integration of health, the environment and sustainable development into national decision-making with a view to strengthening health-sector representation and incorporating health and its financing in development planning.

The following priorities require particular attention from governments and the relevant international organizations: (a) Strengthening health-sector representation in national decision making, including the full participation of major groups; (b) Establishing a firm partnership between health/health-related services, on the one hand, and the communities being served, on the other, that respects their rights and local traditional practices, where adequately validated; (c) Including population issues in basic health systems, as approved in chapter 6, paragraphs 6.25 and 6.26 of Agenda 21 and without prejudice to the outcome of the International Conference on Population and Development; (d) Including food security, the improvement of the population's nutritional status, food quality and food safety in national development plans and programmes aimed at improved health in the context of sustainable development; (e) Reassessing health expenditures with a view to more cost-effective health protection and promotion measures, including, where appropriate, the increasing use of economic instruments, such as user fees and insurance systems, in order to generate funds for efficient health systems; (f) Assuring that health is integrated into environmental impact assessment procedures; (g) Enhancing efforts to prevent and eradicate communicable diseases, including acquired immunodeficiency syndrome (AIDS) and malaria; (h) Establishing adequate structures for environmental health services at the local and, where appropriate, provincial levels in order to further encourage decentralization of health-related programmes and services and to take full advantage of the potentials within the sphere of the local authorities; (i) Increasing public awareness for health aspects, especially with respect to nutrition, communicable diseases, population issues and health hazards from modern lifestyles through primary, secondary and adult education. Special effort should be made to incorporate environmental health issues in the training of all professionals directly or indirectly faced with environmental and health problems (e.g., medical professionals, architects and sanitary engineers); (j) Enhancing multidisciplinary research into the linkages between health and environment; (k) Assuring access, exchange and dissemination of information on health and environment parameters for everyone, with particular attention to the needs of vulnerable groups and other major groups; (l) Ensuring that knowledge of clean technology is disseminated in such a way that it contributes to the prevention of man-made health problems, especially concerning the use of pesticides and food production and processing; (m) Ensuring close collaboration and coordination of concerned United Nations organizations in the implementation of those priorities; (n) Building, where possible, on the achievements of existing programmes developed individually and jointly by United Nations agencies, governments and relevant groups in civil society; (o) Promoting the participation of non-governmental organizations and other major groups in the health sector as important partners in the development of innovative action, and strengthening a bottom-up community involvement; (p) Encouraging further partnerships between the public and the private sectors in health promotion and protection; (q) Building up greater institutional capacity in the tangible implementation of those priorities from the point of conception and planning to the management and evaluation of appropriate health and environmental policies and operational elements at community, local, national, regional and international levels.

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: (a) Supporting developing countries and economies in transition in the development of national environmental health plans as part of national sustainable development programmes; such plans should (i) address the cross-sectoral aspects of environmental health and identify action by other sectors for health protection and promotion, and (ii) emphasize the provision of environmental health services at the local level, along with the development of primary environmental care; (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. Those chemicals include agricultural and non-agricultural pesticides, as well as other chemicals with, inter alia, neurotoxic, immunotoxic and allergic effects. Special attention should be given to the impacts on vulnerable groups; (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 based on epidemiological studies in the context of the INTERSUN project, involving, inter alia, WHO, the International Agency for Research on Cancer (IARC), the United Nations Environment Programme (UNEP) and the World Meteorological Organization (WMO), taking into account ongoing work under the Montreal Protocol;(e) Developing an effective and efficient environmental health information system to collect and disseminate national, regional and international information on newly emerging environmental health problems by 1997.

To help the poor improve their household environments, governments can provide a regulatory and administrative framework within which efficient and accountable providers (often in the private sector) have an incentive to offer households the services they want and are willing to pay for, including water supply, sanitation, garbage collection, clean-burning stoves and housing. Government has a vital role in disseminating information about hygienic practices. It can also increase security of land tenure for the poor, which would encourage low-income families to invest more in safer, healthier housing.

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.