Agenda 21 is the programme of action for sustainable development emanating from the United Nations Conference on Environment and Development held in Rio de Janeiro in 1992. It contains a wide ranging and challenging framework for local, national and global action to create a more sustainable future. The type of development described in Agenda 21 must take account of economic, social, cultural, political and environmental and health concerns- both for present generations and for future ones. The approach to sustainable development pursues a course of action that is economically efficient, socially equitable, responsible and environmentally sound.
The document addresses all major areas of development with a particular emphasis on environmental issues but also considers: international cooperation, combating poverty, human health and population. It emphasises several key aspects of social development including equal rights and empowerment and education. The document itself is around 300 pages long and is divided into 4 sections and 40 chapters. Each chapter includes a statement of objectives, an outline of required actions, guidelines for developing a framework for action, necessary institutional conditions, and the means of implementation, including finance.
Agenda 21 sees human health as fundamental to sustainable development. Health is understood as being an outcome of all the factors that affect human beings. Sustainable development necessitates paying attention to the determinants that shape health outcomes. Agenda 21 and the WHO Health for All strategy have many common principals and complementary processes.
Health can be identified within the sustainable development agenda in the following main ways:
Human health as part of the global ecosystem
Human health is sustained by the global ecosystem. Unsustainable development
and consequent damage to the system will have a direct and negative effect
on human health throughout the world.
Health as a focus for development.
“Human beings are the centre of concern for sustainable development.
They are entitled to a healthy and productive life in harmony with nature”.
Improving health goes hand in hand with development.
Health as an outcome of initiatives to promote
environmental sustainability
Initiatives which are principally taken for local or global environmental
reasons should in most instances result in an improvement in human health,
though this may not be always explicit.
Impact of the health sector on the environment
(as well as other sectors).
The health sector is one of the largest employers and users of natural
resources. It therefore has a key role in ensuring environmental and other
benefits from better management of its activities. The health sector also
has a role in other aspects of Agenda 21 including attention to human
rights and the role of women.
The total number of references to health is over 200 which include the following additional issues: occupational health and safety; primary health care; maternal and child health; poverty and health; health impact assessment of industrial products; housing and health, environmental infrastructure; transport and health; toxic waste; radioactive waste, the health impact of atmospheric changes; the health impact of air and water pollution, deforestation and ultraviolet radiation, the relationship of health to water and sanitation, the impact on health of structural adjustment programmes, solid waste; including health as part of cost- benefit assessment, education and information, the need for public consultation and involvement, and the need for intersectoral action involving health.
Much of Agenda 21 has relevance for the urban environment. The document highlights the role of cities and towns in developing sustainable practices. Capacity at the local level is being developed through the Local Agenda 21 Initiative. Both Agenda 21 and Local Agenda 21 recognise that local authorities play a vital role in educating, mobilising and responding to the public to promote sustainable development. Local Agenda 21 is essentially the process of developing partnerships between local governments and other sectors.
A local agenda 21 should:
- be a short, clear and accessible published document;
- identify the main sustainability issues and aims for the areas;
- contain explicit objectives for both the state of the environment and for the quality of life in the area;
- say which organisations or sectors will take which actions ( and by when) to work towards these objectives- and how performance and achievements will be assessed; and
- set out a review process for the whole programme.
The most significant parts of Agenda 21 particularly relating to the health aspects of sustainable development in cities are:
Chapter 6- Protecting and Promoting Human Health focuses on five main issues- meeting the urban health challenge, reducing the risks from environmental pollution and hazards, protecting vulnerable groups, control of communicable diseases and meeting primary health care needs. It advocates four main groups of activities to meet the urban health challenge. These are to:
- develop and implement municipal and local health plans;
- to survey where necessary the existing health, social and environmental conditions in cities, including the documentation of intra urban differences;
- strengthen environmental health services;
- establish and maintain city networks for collaboration and exchange of models of good practice.
Chapter 7- Promoting Sustainable Human Settlements Development focuses on seven major issues including provision of adequate shelter for all; human settlements management; sustainable land- use planning and management; integrated provision of environmental infrastructure, including water, sanitation, drainage and solid waste management; sustainable energy and transport systems, planning and management for disaster- prone areas; sustainable construction industry; human resources development and capacity building.
Paragraph 7.20 recommends that the WHO Healthy Cities Programme and the Sustainable Cities programme should be intensified to support cities to develop and strengthen their activities along a sustainable path.
Chapter 28- Local Authorities Initiatives in Support of Agenda 21 stresses the importance of local action and coalitions. Objective 28.3 proposes that by 1996 most local authorities in each country should have undertaken a consultative process with their populations and achieved a consensus on a local Agenda 21 for their community.
There are many specific recommendations in Agenda 21 about health. Key recommendations relate to the development of municipal health plans and the strengthening for city networks for health.
The abstract is available in Hungarian, Slovakian, Slovenian and Russian.