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carrying capacity. This should be reflected in the evolution of new systems of national accounts and other indicators of sustainable development.

4.12. While international review processes exist for examining economic, development and demographic factors, more attention needs to be paid to issues related to consumption and production patterns and sustainable lifestyles and environment.

4.13. In the follow-up of the implementation of Agenda 21, reviewing the role and impact of unsustainable production and consumption patterns and lifestyles and their relation to sustainable development should be given high priority.

Financing and cost evaluation

4.14. The Conference secretariat has estimated that implementation of this programme is not likely to require significant new financial resources.

B. Developing national policies and strategies to encourage changes in unsustainable consumption patterns

Basis for action
4.15. Achieving the goals of environmental quality and sustainable development will require efficiency in production and changes in consumption patterns in order to emphasize optimization of resource use and minimization of waste. In many instances, this will require reorientation of existing production and consumption patterns that have developed in industrial societies and are in turn emulated in much of the world. 4.16. Progress can be made by strengthening positive trends and directions that are emerging, as part of a process aimed at achieving significant changes in the consumption patterns of industries, Governments, households and individuals.

Objectives

4.17. In the years ahead, Governments, working with appropriate organizations, should strive to meet the following broad objectives:
a. To promote efficiency in production processes and reduce wasteful consumption in the process of economic growth, taking into account the development needs of developing countries;
b. To develop a domestic policy framework that will encourage a shift to more sustainable patterns of production and consumption;
c. To reinforce both values that encourage sustainable production and consumption patterns and policies that encourage the transfer of environmentally sound technologies to developing countries.
Activities

(a) Encouraging greater efficiency in the use of energy and resources

4.18. Reducing the amount of energy and materials used per unit in the production of goods and services can contribute both to the alleviation of environmental stress and to greater economic and industrial productivity and competitiveness. Governments, in cooperation with industry, should therefore intensify efforts to use energy and resources in an economically efficient and environmentally sound manner by:

a. Encouraging the dissemination of existing environmentally sound technologies;
b. Promoting research and development in environmentally sound technologies;
c. Assisting developing countries to use these technologies efficiently and to develop technologies suited to their particular circumstances;
d. Encouraging the environmentally sound use of new and renewable sources of energy;
e. Encouraging the environmentally sound and sustainable use of renewable natural resources.
(b) Minimizing the generation of wastes

4.19. At the same time, society needs to develop effective ways of dealing with the problem of disposing of mounting levels of waste products and materials. Governments, together with industry, households and the public, should make a concerted effort to reduce the generation of wastes and waste products by: a. Encouraging recycling in industrial processes and at the consumed level;
b. Reducing wasteful packaging of products;
c. Encouraging the introduction of more environmentally sound products.
(c) Assisting individuals and households to make environmentally sound purchasing decisions

4.20. The recent emergence in many countries of a more environmentally conscious consumer public, combined with increased interest on the part of some industries in providing environmentally sound consumer products, is a significant development that should be encouraged. Governments and international organizations, together with the private sector, should develop criteria and methodologies for the assessment of environmental impacts and resource requirements throughout the full life cycle of products and processes. Results of those assessments should be transformed into clear indicators in order to inform consumers and decision makers.

4.21. Governments, in cooperation with industry and other relevant groups, should encourage expansion of environmental labelling and other environmentally related product information programmes designed to assist consumers to make informed choices.

4.22. They should also encourage the emergence of an informed consumer public and assist individuals and households to make environmentally informed choices by:
a. Providing information on the consequences of consumption choices and behaviour so as to encourage demand for environmentally sound products and use of products;
b. Making consumers aware of the health and environmental impact of products, through such means as consumer legislation and environmental labelling;
c. Encouraging specific consumer-oriented programmes, such as recycling and deposit/refund systems.
(d) Exercising leadership through government purchasing

4.23. Governments themselves also play a role in consumption, particularly in countries where the public sector plays a large role in the economy and can have a considerable influence on both corporate decisions and public perceptions. They should therefore review the purchasing policies of their agencies and departments so that they may improve, where possible, the environmental content of government procurement policies, without prejudice to international trade principles.

(e) Moving towards environmentally sound pricing

4.24. Without the stimulus of prices and market signals that make cl ear to producers and consumers the environmental costs of the consumption of energy, materials and natural resources and the generation of wastes, significant changes in consumption and production patterns seem unlikely to occur in the near future.

4.25. Some progress has begun in the use of appropriate economic instruments to influence consumer behaviour. These instruments include environmental charges and taxes, deposit/refund systems, etc. This process should be encouraged in the light of country -specific co nditions.

(f) Reinforcing values that support sustainable consumption

4.26. Governments and private -sector organizations should promote more positive attitudes towards sustainable consumption through education, public awareness programmes and other means, su ch as positive advertising of products and services that utilize environmentally sound technologies or encourage sustainable production and consumption patterns. In the review of the implementation of Agenda 21, an assessment of the progress achieved in de veloping these national policies and strategies should be given due consideration.

Means of implementation

4.27. This programme is concerned primarily with changes in unsustainable patterns of consumption and production and values that encourage sustainable consumption patterns and lifestyles. It requires the combined efforts of Governments, consumers and producers. Particular attention should be paid to the significant role played by women and households as consumers and the potential impacts of their combined purchasing power on the economy.

Agenda 21 - Chapter 5 DEMOGRAPHIC DYNAMICS AND SUSTAINABILITY 5.1. This chapter contains the following programme areas:
a. Developing and disseminating knowledge concerning the links between demographi c trends and factors and sustainable development;
b. Formulating integrated national policies for environment and development, taking into account demographic trends and factors;
c. Implementing integrated, environment and development programmes at the local l evel, taking into account demographic trends and factors.
PROGRAMME AREAS

A. Developing and disseminating knowledge concerning the links between demographic trends and factors and sustainable development
Basis for action

5.2. Demographic trends and factor s and sustainable development have a synergistic relationship.

5.3. The growth of world population and production combined with unsustainable consumption patterns places increasingly severe stress on the life -supporting capacities of our planet. These interac tive processes affect the use of land, water, air, energy and other resources. Rapidly growing cities, unless well-managed, face major environmental problems. The increase in both the number and size of cities calls for greater attention to issues of local government and municipal management. The human dimensions are key elements to consider in this intricate set of relationships and they should be adequately taken into consideration in comprehensive policies for sustainable development. Such policies should address the linkages of demographic trends and factors, resource use, appropriate technology dissemination, and development. Population policy should also recognize the role played by human beings in environmental and development concerns. There is a nee d to increase awareness of this issue among decision makers at all levels and to provide both better information on which to base national and international policies and a framework against which to interpret this information.

5.4. There is a need to develop strategies to mitigate both the adverse impact on the environment of human activities and the adverse impact of environmental change on human populations. The world's population is expected to exceed 8 billion by the year 2020. Sixty per cent of the world' s population already live in coastal areas, while 65 per cent of cities with populations above 2.5 million are located along the world coasts; several of them are already at or below the present sea level.

Objectives

5.5. The following objectives should be achieved as soon as practicable:
a. To incorporate demographic trends and factors in the global analysis of environment and development issues;
b. To develop a better understanding of the relationships among demographic dynamics, technology, cultural behaviour , natural resources and life support systems;
c. To assess human vulnerability in ecologically sensitive areas and centres of population to determine the priorities for action at all levels, taking full account of community defined needs.
Activities
Research on the interaction between demographic trends and factors and sustainable development
5.6. Relevant international, regional and national institutions should consider undertaking the following activities:
a. Identifying the interactions between demographic pro cesses, natural resources and life support systems, bearing in mind regional and subregional variations deriving from, inter alia, different levels of development;
b. Integrating demographic trends and factors into the ongoing study of environmental change, using the expertise of international, regional and national research networks and of local communities, first, to study the human dimensions of environmental change and, second, to identify vulnerable areas;
c. Identifying priority areas for action and devel oping strategies and programmes to mitigate the adverse impact of environmental change on human populations, and vice versa.
Means of implementation

(a) Financing and cost evaluation

5.7. The Conference secretariat has estimated the average total annual co st (1993-2000) of implementing the activities of this programme to be about $10 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. A ctual 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) Strengthening research programmes that integrate population, en vironment and development

5.8. In order to integrate demographic analysis into a broader social science perspective on environment and development, interdisciplinary research should be increased. International institutions and networks of experts should enhan ce their scientific capacity, taking full account of community experience and knowledge, and should disseminate the experience gained in multidisciplinary approaches and in linking theory to action.

5.9. Better modelling capabilities should be developed, iden tifying the range of possible outcomes of current human activities, especially the interrelated impact of demographic trends and factors, per capita resource use and wealth distribution, as well as the major migration flows that may be expected with increasing climatic events and cumulative environmental change that may destroy people's local livelihoods.

5.10. Socio-demographic information should be developed in a suitable format for interfacing with physical, biological and socio -economic data. Compatible spatial and temporal scales, cross -country and time-series information, as well as global behavioural indicators should be developed, learning from local communities' perceptions and attitudes.

5.11. Awareness sho uld be increased at all levels concerning the need to optimize the sustainable use of resources through efficient resource management, taking into account the development needs of the populations of developing countries.

5.12. Awareness should be increased of the fundamental linkages between improving the status of women and demographic dynamics, particularly through women's access to education, primary and reproductive health care programmes, economic independence and their effective, equitable participation in all levels of decision -making.

5.13. Results of research concerned with sustainable development issues should be disseminated through technical reports, scientific journals, the media, workshops, forums or other means so that the information can be used by d ecision makers at all levels and increase public awareness.

(d) Developing and/or enhancing institutional capacity and collaboration

5.14. Collaboration and exchange of information should be increased between research institutions and international, regional and national agencies and all other sectors (including the private sector, local communities, non -governmental organizations and scientific institutions) from both the industrialized and developing countries, as appropriate.

5.15. Efforts should be intensifie d to enhance the capacities of national and local governments, the private sector and non -governmental organizations in developing countries to meet the growing needs for improved management of rapidly growing urban areas.

B. Formulating integrated natio nal policies for environment and development, taking into account demographic trends and factors
Basis for action

5.16. Existing plans for sustainable development have generally recognized demographic trends and factors as elements that have a critical influe nce on consumption patterns, production, lifestyles and long-term sustainability. But in future, more attention will have to be given to these issues in general policy formulation and the design of development plans. To do this, all countries will have to improve their own capacities to assess the environment and development implications of their demographic trends and factors. They will also need to formulate and implement policies and action programmes where appropriate. Policies should be designed to add ress the consequences of population growth built into population momentum, while at the same time incorporating measures to bring about demographic transition. They should combine environmental concerns and population issues within a holistic view of devel opment whose primary goals include the alleviation of poverty; secure livelihoods; good health; quality of life; improvement of the status and income of women and their access to schooling and professional training, as well as fulfilment of their personal aspirations; and empowerment of individuals and communities. Recognizing that large increases in the size and number of cities will occur in developing countries under any likely population scenario, greater attention should be given to preparing for the n eeds, in particular of women and children, for improved municipal management and local government.

Objective

5.17. Full integration of population concerns into national planning, policy and decision -making processes should continue. Population policies and pr ogrammes should be considered, with full recognition of women's rights.

Activities
5.18. Governments and other relevant actors could, inter alia, undertake the following activities, with appropriate assistance from aid agencies, and report on their status of implementation to the International Conference on Population and Development to be held in 1994, especially to its committee on population and environment.

(a) Assessing the implications of national demographic trends and factors

5.19. The relationships betw een demographic trends and factors and environmental change and between environmental degradation and the components of demographic change should be analysed.
5.20. Research should be conducted on how environmental factors interact with socio -economic factors as a cause of migration.
5.21. Vulnerable population groups (such as rural landless workers, ethnic minorities, refugees, migrants, displaced people, women heads of household) whose changes in demographic structure may have specific impacts on sustainable develo pment should be identified.

5.22. An assessment should be made of the implications of the age structure of the population on resource demand and dependency burdens, ranging from educational expenses for the young to health care and support for the elderly, and on household income generation.

5.23. An assessment should also be made of national population carrying capacity in the context of satisfaction of human needs and sustainable development, and special attention should be given to critical resources, such as wa ter and land, and environmental factors, such as ecosystem health and biodiversity.

5.24. The impact of national demographic trends and factors on the traditional livelihoods of indigenous groups and local communities, including changes in traditional land use because of internal population pressures, should be studied.

(b) Building and strengthening a national information base

5.25. National databases on demographic trends and factors and environment should be built and/or strengthened, disaggregating data by ec ological region (ecosystem approach), and population/environment profiles should be established by region.

5.26. Methodologies and instruments should be developed to identify areas where sustainability is, or may be, threatened by the environmental effects of demographic trends and factors, incorporating both current and projected demographic data linked to natural environmental processes.

5.27. Case-studies of local level responses by different groups to demographic dynamics should be developed, particularly in ar eas subject to environmental stress and in deteriorating urban centres.

5.28. Population data should be disaggregated by, inter alia, sex and age in order to take into account the implications of the gender division of labour for the use and management of natu ral resources.

5.29. In formulating human settlements policies, account should be taken of resource needs, waste production and ecosystem health.

5.30. 5.30. The direct and induced effects of demogra phic changes on environment and development programmes should, where appropriate, be integrated, and the impact on demographic features assessed.

5.31. 5.31. National population policy goals and programmes that are consistent with national environment and deve lopment plans for sustainability and in keeping with the freedom, dignity and personally held values of individuals should be established and implemented.

5.32. 5.32. Appropriate socio -economic policies for the young and the elderly, both in terms of family and state support systems, should be developed.

5.33. 5.33. Policies and programmes should be developed for handling the various types of migrations that result from or induce environmental disruptions, with special attention to women and vulnerable groups.

5.34. 5.34. Demographic concerns, including concerns for environmental migrants and displaced people, should be incorporated in the programmes for sustainable development of relevant international and regional institutions.

5.35. 5.35. National reviews should be condu cted and the integration of population policies in national development and environment strategies should be monitored nationally.

Means of implementation

(a) Financing and cost evaluation

5.36. The Conference secretariat has estimated the average total an nual cost (1993 -2000) of implementing the activities of this programme to be about $90 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 Governm ents. 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) Raising awareness of demographic and sustainable develop ment interactions

5.37. Understanding of the interactions between demographic trends and factors and sustainable development should be increased in all sectors of society. Stress should be placed on local and national action. Demographic and sustainable develo pment education should be coordinated and integrated in both the formal and non -formal education sectors. Particular attention should be given to population literacy programmes, notably for women. Special emphasis should be placed on the linkage between these programmes, primary environmental care and the provision of primary health care and services.

5.38. The capacity of national, regional and local structures to deal with issues relating to demographic trends and factors and sustainable development should be enhanced. This would involve strengthening the relevant bodies responsible for population issues to enable them to elaborate policies consistent with the national prospects for sustainable development. Cooperation among go vernment, national research institutions, non -governmental organizations and local communities in assessing problems and evaluating policies should also be enhanced.

5.39. The capacity of the relevant United Nations organs, organizations and bodies, internatio nal and regional intergovernmental bodies, non -governmental organizations and local communities should, as appropriate, be enhanced to help countries develop sustainable development policies on request and, as appropriate, provide assistance to environment al migrants and displaced people.

5.40. Inter-agency support for national sustainable development policies and programmes should be improved through better coordination of population and environment activities.

(d) Promoting human resource development

5.41. The international and regional scientific institutions should assist Governments, upon request, to include concerns regarding the population/environment interactions at the global, ecosystem and micro-levels in the training of demographers and population and e nvironment specialists. Training should include research on linkages and ways to design integrated strategies.

C. Implementing integrated environment and development programmes at the local level, taking into account demographic trends and factors
Basis for action

5.42. Population programmes are more effective when implemented together with appropriate cross - sectoral policies. To attain sustainability at the local level, a new framework is needed that integrates demographic trends and factors with such facto rs as ecosystem health, technology and human settlements, and with socio -economic structures and access to resources. Population programmes should be consistent with socio -economic and environmental planning. Integrated sustainable development programmes s hould closely correlate action on demographic trends and factors with resource management activities and development goals that meet the needs of the people concerned.

Objective

5.43. Population programmes should be implemented along with natural resource ma nagement and development programmes at the local level that will ensure sustainable use of natural resources, improve the quality of life of the people and enhance environmental quality.

Activities

5.44. Governments and local communities, including community -based women's organizations and national non-governmental organizations, consistent with national plans, objectives, strategies and priorities, could, inter alia, undertake the activities set out below with the assistance and cooperation of international organizations, as appropriate. Governments could share their experience in the implementation of Agenda 21 at the International Conference on Population and Development, to be held in 1994, especially its committee on population and environment.

(a) Developing a framework for action

5.45. An effective consultative process should be established and implemented with concerned groups of society where the formulation and decision -making of all components of the programmes are based on a nationwide consultative pr ocess drawing on community meetings, regional workshops and national seminars, as appropriate. This process should ensure that views of women and men on needs, perspective and constraints are equally well reflected in the design of programmes, and that sol utions are rooted in specific experience. The poor and underprivileged should be priority groups in this process.

5.46. Nationally determined policies for integrated and multifaceted programmes, with special attention to women, to the poorest people living in critical areas and to other vulnerable groups should be implemented, ensuring the involvement of groups with a special potential to act as agents for change and sustainable development. Special emphasis should be placed on those programmes that achieve multiple objectives, encouraging sustainable economic development, and mitigating adverse impacts of demographic trends and factors, and avoiding long -term environmental damage. Food security, access to secure tenure, basic shelter, and essential infrastructu re, education, family welfare, women's reproductive health, family credit schemes, reforestation programmes, primary environmental care, women's employment should, as appropriate, be included among other factors.

5.47. An analytical framework should be develop ed to identify complementary elements of sustainable development policies as well as the national mechanisms to monitor and evaluate their effects on population dynamics.

5.48. Special attention should be given to the critical role of women in population/envir onment programmes and in achieving sustainable development. Projects should take advantage of opportunities to link social, economic and environmental gains for women and their families. Empowerment of women is essential and should be assured through educa tion, training and policies to accord and improve women's right and access to assets, human and civil rights, labour -saving measures, job opportunities and participation in decision -making. Population/environment programmes must enable women to mobilize th emselves to alleviate their burden and improve their capacity to participate in and benefit from socio -economic development. Specific measures should be undertaken to close the gap between female and male illiteracy rates.

(b) Supporting programmes that promote changes in demographic trends and factors towards sustainability

5.49. Reproductive health programmes and services, should, as appropriate, be developed and enhanced to reduce maternal and infant mortality from all causes and enable women and men to fu lfil their personal aspirations in terms of family size, in a way in keeping with their freedom and dignity and personally held values.

5.50. Governments should take active steps to implement, as a matter of urgency, in accordance with country-specific conditi ons 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 exercis e this right in keeping with their freedom, dignity and personally held values taking into account ethical and cultural considerations.

5.51. Governments should take active steps to implement programmes to establish and strengthen preventive and curative healt h facilities that 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 value s 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 a ll 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.

5.52. Consistent with national priorities, culturally based information and education programmes that transmit reproductive health messages to men and women that are eas ily understood should be developed.

5.53. Constituencies and institutional conditions to facilitate the implementation of demographic activities should, as appropriate, be fostered. This requires support and commitment from political, indigenous, religious and traditional authorities, the private sector and the national scientific community. In developing these appropriate institutional conditions, countries should closely involve established national machiner y for women.

5.54. Population assistance should be coordinated with bilateral and multilateral donors to ensure that population needs and requirements of all developing countries are addressed, fully respecting the overall coordinating responsibility and the ch oice and strategies of the recipient countries.

5.55. Coordination should be improved at local and international levels. Working practices should be enhanced in order to make optimum use of resources, draw on collective experience and improve the implementation of programmes. UNFPA and other relevant agencies should strengthen the coordination of international cooperation activities with recipient and donor countries in order to ensure that adequate funding is available to respond to growing needs.

5.56. Proposals should be developed for local, national and international population/environment programmes in line with specific needs for achieving sustainability. Where appropriate, institutional changes must be implemented so that old -age security does not entirely dep end on input from family members.

Means of implementation

(a) Financing and cost evaluation

5.57. The Conference secretariat has estimated the average total annual cost (1993 -2000) of implementing the activities of this programme to be about $7 billion, in cluding about $3.5 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) Research

5.58. Research should be undertaken with a view to developing specific action programmes; it will be necessary to estab lish priorities between proposed areas of research.

5.59. Socio-demographic research should be conducted on how populations respond to a changing environment.

5.60. Understanding of socio -cultural and political factors that can positively influence acceptance of appropriate population policy instruments should be improved.

5.61. Surveys of changes in needs for appropriate services relating to responsible planning of family size, reflecting variations among different socio -economic groups and variations in different geographical regions should be undertaken.

5.62. The areas of human resource development and capacity -building, with particular attention to the education and training of women, are areas of critical importan ce and are a very high priority in the implementation of population programmes.

5.63. Workshops to help programme and projects managers to link population programmes to other development and environmental goals should be conducted.

5.64. Educational materials, inc luding guides/workbooks for planners and decision makers and other actors of population/environment/development programmes, should be developed.

5.65. Cooperation should be developed between Governments, scientific institutions and non - governmental organizatio ns within the region, and similar institutions outside the region. Cooperation with local organizations should be fostered in ordered to raise awareness, engage in demonstration projects and report on the experience gained.

5.66. The recommendations contained in this chapter should in no way prejudice discussions at the International Conference on Population and Development in 1994, which will be the appropriate forum for dealing with population and development issues, taking into account the recommendations of the International Conference on Population, held in Mexico City in 1984, 1/ and the Forward - looking Strategies for the Advancement of Women, 2/ adopted by the World Conference to Review and Appraise the Achievements of the United Decade for Women: Equalit y, Development and Peace, held in Nairobi in 1985.

Notes
1/ Report of the International Conference on Population, Mexico City, 6 -14 August 1984 (United Nations publication, Sales No. E.84.XIII.8), chap. I.

2/ Report of the World Conference to Review a nd Appraise the Achievements of the United Nations Decade for Women: Equality, Development and Peace, Nairobi, 15 -26 July 1985 (United Nations publication, Sales No. E.84.IV.10), chap. I, sect. A.

Agenda 21 – Chapter 6 PROTECTING AND PROMOTING HUMAN HEALTH 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 p roblems 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 car e. 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 c ultural 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 a s 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 i nteraction 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 exacerb ates 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 suppl y 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 m icrobial 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 2 000, 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 secto rs 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 li ving 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 h ealth 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, s ocially 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 l evels 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 s upport;
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 vari ous 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 me thodology 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 k nowledge 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 a bout $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 facil ities 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 communit y 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.

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 foc using 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 direc t 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 co ntrol 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 integr al 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 level s 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 dwarf ed 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;

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