138. We recognize that health is a precondition for and an outcome and indicator of all three dimensions of sustainable development. We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and non-communicable diseases, and where populations can reach a state of physical, mental and social well-being. We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and for the entire population, is important to create inclusive, equitable, economically productive and healthy societies. We call for the full realization of the right to the enjoyment of the highest attainable standard of physical and mental health.
139. We also recognize the importance of universal health coverage to enhancing health, social cohesion and sustainable human and economic development. We pledge to strengthen health systems towards the provision of equitable universal coverage. We call for the involvement of all relevant actors for coordinated multi sectoral action to address urgently the health needs of the world?s population.
140. We emphasize that HIV and AIDS, malaria, tuberculosis, influenza, polio and other communicable diseases remain serious global concerns, and we commit to redouble efforts to achieve universal access to HIV prevention, treatment, care and support, and to eliminate mother-to-child transmission of HIV, as well as to renewing and strengthening the fight against malaria, tuberculosis and neglected tropical diseases.
141. We acknowledge that the global burden and threat of non-communicable diseases constitutes one of the major challenges for sustainable development in the twenty-first century. We commit to strengthen health systems towards the provision of equitable, universal coverage and promote affordable access to prevention, treatment, care and support related to non-communicable diseases, especially cancer, cardiovascular diseases, chronic respiratory diseases and diabetes. We also commit to establish or strengthen multi-sectoral national policies for the prevention and control of non-communicable diseases. We recognize that reducing, inter alia, air, water and chemical pollution leads to positive effects on health.
142. We reaffirm the right to use, to the full, the provisions contained in the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), the Doha Declaration on the TRIPS Agreement and Public Health, the decision of the WTO General Council of 30 August 2003 on the implementation of paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health, and, when formal acceptance procedures are completed, the amendment to article 31 of the Agreement, which provides flexibilities for the protection of public health, and, in particular, to promote access to medicines for all, and encourage the provision of assistance to developing countries in this regard.
143. We call for further collaboration and cooperation at the national and international levels to strengthen health systems through increased health financing, recruitment, development and training and retention of the health workforce, through improved distribution and access to safe, affordable, effective and quality medicines, vaccines and medical technologies, and through improving health infrastructure. We support the leadership role of the World Health Organization as the directing and coordinating authority on international health work.
144. We commit to systematically consider population trends and projections in our national, rural and urban development strategies and policies. Through forward-looking planning, we can seize the opportunities and address the challenges associated with demographic change, including migration.
145. We call for the full and effective implementation of the Beijing Platform for Action and the Programme of Action of the International Conference on Population and Development, and the outcomes of their review conferences, including the commitments leading to sexual and reproductive health and the promotion and protection of all human rights in this context. We emphasize the need for the provision of universal access to reproductive health, including family planning and sexual health, and the integration of reproductive health in national strategies and programmes.
146. We commit to reduce maternal and child mortality and to improve the health of women, youth and children. We reaffirm our commitment to gender equality and to protect the rights of women, men and youth to have control over and decide freely and responsibly on matters related to their sexuality, including access to sexual and reproductive health, free from coercion, discrimination and violence. We will work actively to ensure that health systems provide the necessary information and health services addressing the sexual and reproductive health of women, including working towards universal access to safe, effective, affordable and acceptable modern methods of family planning, as this is essential for women?s health and advancing gender equality.
1. Protecting and promoting human health
92. The Commission on Sustainable Development takes note of the report of the
Secretary-General (E/CN.17/1994/3) as well as a background paper on health,
environment and sustainable development prepared by the World Health
Organization (WHO) as task manager.
93. The Commission takes note, with appreciation, of the outcome of the
Inter-sessional Workshop on Health, the Environment and Sustainable Development,
held in Copenhagen from 23 to 25 February 1994 and organized by the Government
of Denmark. In that context, the Commission particularly underlines the
importance of the recommendations of the Copenhagen meeting focusing on the need
to integrate health, environment and sustainable development goals and
activities through innovative and holistic approaches.
94. The Commission reaffirms that the promotion and protection of human health
is of central concern in sustainable development, as reflected in the very first
principle of the Rio Declaration on Environment and Development, 8/ which
states that human beings are at the centre of concern for sustainable
development and are entitled to a healthy and productive life in harmony with
nature. In that context, the Commission stresses the fact that the protection
and promotion of human health depend on activities stemming from all sectors.
95. The Commission welcomes the Global Strategy for Health and Environment
developed by WHO and endorsed by the World Health Assembly.
96. The Commission recognizes the critical importance of funding for health and
highlights the need to focus funding on preventive measures. While emphasizing
the importance of adopting a preventive approach to building health-related
services, the Commission also stresses the necessity of responding to the needs
of curative medicine. To meet those requirements, the Commission calls for the
strengthening of the health infrastructure, particularly in developing
countries, with the cooperation of the international community where necessary.
97. The Commission has identified the rural sector and urban slums as
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
98. 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 one billion people in the world, is
a fundamental prerequisite to providing health for all. The Commission
therefore reaffirms the commitments to poverty eradication in the context of
sustainable development contained in the Rio Declaration, and the fundamental
relationship of the eradication of poverty to the overall goals of health
promotion and protection.
99. 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, the Commission
recognizes 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
100. 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), the Commission takes note of the
similarly special health needs of the aged, the disabled, and the displaced.
The Commission further notes the contribution of food aid as an important aspect
of efforts directed at the improvement of the nutritional and overall health of
101. The Commission notes that traditional health-related knowledge, borne
especially by women and indigenous people, makes a contribution to overall
health and stresses the need for increased research in that field with a view to
supporting its use where adequately validated.
8/ Report of the United Nations Conference on Environment and
Development, Rio de Janeiro, 3-14 June 1992, vol. I, Resolutions Adopted by the
Conference (United Nations publication, Sales No. E.93.I.8 and corrigendum),
resolution 1, annex I.
102. The Commission also notes that 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
103. The Commission underlines that 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, the Commission
stresses the 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. Furthermore, the Commission
stresses the need for assisting countries to implement the set of guidelines for
consumer protection adopted by the General Assembly in 1985.
104. The Commission expresses deep concern about chemical substances with
potential health hazards that are widely used in industry, consumer products and
food production and processing. The impact on human health, especially of longterm
exposure to low doses of synthetic chemicals with potential neurotoxic,
reproductive or immunotoxic effects, and their synergistic effects on nature, is
not yet sufficiently understood. The Commission therefore emphasizes the need
to control their use and to minimize the emission of hazardous chemicals to
prevent increasing concentrations in the environment.
105. The Commission recognizes the ongoing health reform efforts and emphasizes
the need for further concrete actions in the follow-up to the first review of
progress in implementing the activities of chapter 6, particularly for the 1997
review of Agenda 21. In that context, the Commission recognizes four lines of
health reform identified by WHO as constituting a suitable programme of action
for Governments to pursue within the framework of their national sustainable
(a) Community health development: undertaking health promotion and
protection as part of more holistically conceived community-based development
(b) Health sector reform: increasing the allocation of resources to the
most cost-effective health protection and promotion programmes 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.
106. The Commission concludes that the following priorities should receive
particular attention from Governments and the relevant international
(a) Strengthening health-sector representation in national decisionmaking,
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
(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
(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
(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
(j) Enhancing multidisciplinary research into the linkages between health
(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
107. The Commission takes note of the relevant provisions of the Programme of
Action for the Sustainable Development of Small Island Developing States and
urges that adequate support be given to the overall goals of health promotion
and protection identified in the Programme of Action.
108. The Commission invites the Inter-Agency Committee on Sustainable
Development (IACSD) to consider in its follow-up work on chapter 6 of Agenda 21
and in the preparation of the 1997 review, the following priority areas:
(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 crosssectoral
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.
109. The Commission requests that information on the status of community
participation in the health sector be included in the report of the Secretary-
General to be submitted for the 1997 review of Agenda 21.
110. The Commission invites WHO, as task manager, to continue to monitor
progress made by the United Nations and other international agencies in
implementing chapter 6 of Agenda 21. The Commission requests WHO to report
periodically to IACSD on that matter and to make such reports available to the
111. The Commission requests countries to include in their national reports for
the 1997 review session of the Commission a specific section on steps taken to
promote and protect human health, highlighting the positive examples and models,
indicating progress achieved and experience gained, particularly experience from
which others might benefit, and the specific problems and constraints
112. The Commission calls upon Governments to strengthen their commitments to
the health reform process, inter alia, through national, regional and
international inter-sessional meetings that focus on special linkages between
the health sector and other sectors.
113. The Commission stresses the need for full implementation of the agreements
on technology transfer contained in chapter 34 of Agenda 21 and the relevant
decisions of the Commission. In that context, the Commission urges the
international community to find concrete ways and means to transfer appropriate
health-related technologies, including medical and pharmaceutical technologies,
to developing countries and economies in transition.
114. The Commission urges Governments to mobilize financial resources to respond
to the above priorities, as agreed in chapter 33 of Agenda 21 and the relevant
decisions of the Commission.
115. The Commission invites WHO and other relevant intergovernmental bodies to
take those recommendations into full account in their future work.