Pada tahun 1992, sehubungan dengan
“sustainable development” pemerintah-pemerintah dunia menyepakati
dokumen “Agenda 21” berupa pedoman tindakan-tindakan yang perlu
diambil menuju Pembangunan Berkelanjutan. Berikut, disajikan potongan
dari ikhtisar dokumen besar itu, yaitu Bab 6 tentang Perawatan dan
Pengembangan Kesehatan, meliputi: Kesehatan masyarakat pedesaan,
Pengendalian Penyakit menular, Perlindungan kelompok yang rentan,
Kesehatan masyarakat perkotaan dan Mengurangi risiko
pencemaran.
Masing-masing disusun dalam skema yang menliputi:
Dasar Tindakan, Sasaran, Kegiatan2, dan Sarana Implementasi.
Protecting
& 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:
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;
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;
Develop and implement rational and
affordable approaches to the establishment and maintenance of health
facilities;
Ensure and, where appropriate,
increase provision of social services support;
Develop strategies, including
reliable health indicators, to monitor the progress and evaluate the
effectiveness of health programmes;
Explore ways to finance the health
system based on the assessment of the resources needed and identify
the various financing alternatives;
Promote health education in
schools, information exchange, technical support and training;
Support initiatives for
self-management of services by vulnerable groups;
Integrate traditional knowledge and
experience into national health systems, as appropriate;
Promote the provisions for
necessary logistics for outreach activities, particularly in rural
areas;
Promote and strengthen
community-based rehabilitation activities for the rural handicapped.
B) Support research and methodology
development:
Establish mechanisms for sustained
community involvement in environmental health activities, including
optimization of the appropriate use of community financial and human
resources;
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;
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:
By the year 2000, the number of
deaths from childhood diarrhoea in developing countries by 50 to 70
per cent;
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:
Programmes to identify
environmental hazards in the causation of communicable diseases;
Monitoring systems of
epidemiological data to ensure adequate forecasting of the
introduction, spread or aggravation of communicable diseases;
Intervention programmes,
including measures consistent with the principles of the global AIDS
strategy;
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:
Second experienced health
professionals to relevant sectors, such as planning, housing and
agriculture;
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:
Strengthen prevention
programmes, with particular emphasis on adequate and balanced
nutrition;
Strengthen early diagnostic
programmes and improve capacities for early preventative/treatment
action;
Reduce the vulnerability to HIV
infection of women and their offspring;
(f) Support for research and
methodology development:
Intensify and expand
multidisciplinary research, including focused efforts on the
mitigation and environmental control of tropical diseases;
Carry out intervention studies
to provide a solid epidemiological basis for control policies and to
evaluate the efficiency of alternative approaches;
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:
Develop new technologies for
the effective control of communicable diseases;
Promote studies to determine
how to optimally disseminate results from research;
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:
Strengthen basic health-care
services for children in the context of primary health-care delivery,
including prenatal care, breast-feeding, immunization and nutrition
programmes;
Undertake widespread adult
education on the use of oral rehydration therapy for diarrhoea,
treatment of respiratory infections and prevention of communicable
diseases;
Promote the creation, amendment
and enforcement of a legal framework protecting children from sexual
and workplace exploitation;
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:
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;
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;
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:
Strengthen, through resources
and self-management, preventative and curative health services;
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:
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;
Adopt or strengthen municipal
or local "enabling strategies" that emphasize "doing
with" rather than "doing for" and create supportive
environments for health;
Ensure that public health
education in schools, workplace, mass media etc. is provided or
strengthened;
Encourage communities to
develop personal skills and awareness of primary health care;
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:
Adopt health impact and
environmental impact assessment procedures;
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:
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;
Develop air pollution control
capacities in large cities, emphasizing enforcement programmes and
using monitoring networks, as appropriate;
(b) Indoor air pollution:
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;
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:
Develop appropriate water
pollution control technologies on the basis of health risk
assessment;
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:
Develop appropriate solid waste
disposal technologies on the basis of health risk assessment;
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:
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;
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:
Establish environmental health
impact assessment procedures for the planning and development of new
industries and energy facilities;
Incorporate appropriate health
risk analysis in all national programmes for pollution control and
management, with particular emphasis on toxic compounds such as lead;
Establish industrial hygiene
programmes in all major industries for the surveillance of workers'
exposure to health hazards;
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:
Support, as appropriate, the
development of systems to monitor the incidence and cause of injury
to allow well-targeted intervention/prevention strategies;
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;
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:
Support the development of new
methods for the quantitative assessment of health benefits and cost
associated with different pollution control strategies;
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).
