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AGENDA 21, CHAPTER 6



PROTECTION AND PROMOTION OF
HUMAN HEALTH





NOTE:	This is a final, advanced version of a chapter of Agenda 21, as 
adopted by the Plenary in Rio de Janeiro, on June 14, 1992.  
This document will be further edited, translated into the 
official languages, and published by the United Nations for the 
General Assembly this autumn.





........../2




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.


PROGRAMME AREAS

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 4 of every 5 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 and 
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 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

6.29.	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, 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:

	(i)	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.


Notes

	1/	A/45/625, annex.

	2/	Report of the WHO Commission on Health and Environment (Geneva, 
forthcoming).

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