agenda-21.pdf - Page 5

j. To mobilize and unify national and international efforts against AIDS to prevent infection and to reduce the personal and social impact of HIV infection;
k. To contain the resurgence of tuberculosis, with particular emphasis on multiple antibiotic resistant forms;
l. To accelerate research on improved vaccines and implement to the fullest extent possible the use of vaccines in the prevention of disease.
Activities

6.13. Each national Government, in accordance with national plans for public health, priorities and objectives, should consider developing a national health action plan with appropriate international assistance and support, including, at a minimum, the following components:
a. National public health systems:
i. Programmes to identify environmental hazards in the causation of communicable diseases;
ii. Monitoring systems of epidemiological data to ensure adequate forecasting of the introduction, spread or aggravation of communicable diseases;
iii. Intervention programmes, including measures consistent with the principles of the global AIDS strategy;
iv. Vaccines for the prevention of communicable diseases;
b. Public information and health education: Provide education and disseminate information on the risks of endemic communicable diseases and build awareness on environmental methods for control of communicable diseases to enable communities to play a role in the control of communicable diseases;
c. Intersectoral cooperation and coordination:
i. Second experienced health professionals to relevant sectors, such as planning, housing and agriculture;
ii. Develop guidelines for effective coordination in the areas of professional training, assessment of risks and development of control technology;
d. Control of environmental factors that influence the spread of communicable diseases: Apply methods for the prevention and control of communicable diseases, including water supply and sanitation control, water pollution control, food quality control, integrated vector control, garbage collection and disposal and environmentally sound irrigation practices;
e. Primary health care system:
i. Strengthen prevention programmes, with particular emphasis on adequate and balanced nutrition;
ii. Strengthen early diagnostic programmes and improve capacities for early preventative/treatment action;
iii. Reduce the vulnerability to HIV infection of women and their offspring;
f. Support for research and methodology development:

i. Intensify and expand multidisciplinary research, including focused efforts on the mitigation and environmental control of tropical diseases;
ii. Carry out intervention studies to provide a solid epidemiological basis for control policies and to evaluate the efficiency of alternative approaches;
iii. Undertake studies in the population and among health workers to determine the influence of cultural, be havioural and social factors on control policies;
g. Development and dissemination of technology:
i. Develop new technologies for the effective control of communicable diseases;
ii. Promote studies to determine how to optimally disseminate results from research;
iii. Ensure technical assistance, including the sharing of knowledge and know -how.
Means of implementation

(a) Financing and cost evaluation

6.14. The Conference secretariat has estimated the average total annual cost (1993 -2000) of implementing the activities of this programme to be about $4 billion, including about $900 million from the international community on grant or concessional terms. These are indicative and order -of- magnitude estimates only and have not been reviewed by Governments. Actual costs and f inancial 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 sho uld 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 communit y 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 disease s 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 correcti on 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 th ese 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 de velopment, 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 hea lth 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 i ndigenous 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 t hat 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 respon sibly 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 af fordable, accessible services, as appropriate, for the responsible planning of family size, in keeping with freedom, dignity and personally held values and taking into account ethical and cultural considerations. Programmes should focus on providing comprehensive health care, including pre-natal care, education and information on health and responsible parenthood and should provide the opportunity for all women to breast-feed fully, at least during the first four months post-partum. Programmes should fully support women's productive and reproductive roles and well being, with special attention to the need for providing equal and improved health care for all children and the need to reduce the risk of maternal and child mortality and sickness.

Activities

6.27. National Governments, in cooperation with local and non-governmental organizations, should initiate or enhance programmes in the following areas:
a. Infants and children:
i. Strengthen basic health-care services for children in the context of primary health- care delivery, including prenatal care, breast-feeding, immunization and nutrition programmes;
ii. Undertake widespread adult education on the use of oral rehydration therapy for diarrhoea, treatment of respiratory infections and prevention of communicable diseases;
iii. Promote the creation, amendment and enforcement of a legal framework protecting children from sexual and workplace exploitation;
iv. Protect children from the effects of environmental and occupational toxic compounds;
b. Youth: Strengthen services for youth in health, education and social sectors in order to provide better information, education, counselling and treatment for specific health problems, including drug abuse;
c. Women:
i. Involve women's groups in decision-making at the national and community levels to identify health risks and incorporate health issues in national action programmes on women and development;
ii. Provide concrete incentives to encourage and maintain attendance of women of all ages at school and adult education courses, including health education and training in primary, home and maternal health care;
iii. Carry out baseline surveys and knowledge, attitude and practice studies on the health and nutrition of women throughout their life cycle, especially as related to the impact of environmental degradation and adequate resources;
d. Indigenous people and their communities:
i. Strengthen, through resources and self-management, preventative and curative health services;
ii. Integrate traditional knowledge and experience into health systems.
Means of implementation

(a) Financing and cost evaluation

6.28. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $3.7 billion, including about $400 billion

from the intern ational 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 group s. 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 n on- governmental organizations for youth, women and indigenous people in the health sector.

6.30. The development of human resources for the health of children, youth and women should include reinforcement of educational instit utions, 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, intercount ry 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 organ izations 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 peopl e 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. Overcro wding 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 contribu te 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 inadeq uate 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 p lans:
i. Establish or strengthen intersectoral committees at both the political and technical level, including active collaboration on linkages with scientific, cultural, religious, medical, business, social and other city institutions, using networking arra ngements;
ii. Adopt or strengthen municipal or local "enabling strategies" that emphasize "doing with" rather than "doing for" and create supportive environments for health;
iii. Ensure that public health education in schools, workplace, mass media etc. is provided or strengthened;
iv. Encourage communities to develop personal skills and awareness of primary health care;
v. Promote and strengthen community -based rehabilitation activities for the urban and peri-urban disabled and the elderly;
b. Survey, where necessary, t he existing health, social and environmental conditions in cities, including documentation of intra -urban differences;
c. Strengthen environmental health services:
i. Adopt health impact and environmental impact assessment procedures;
ii. Provide basic and in -service training for new and existing personnel;
d. Establish and maintain city networks for collaboration and exchange of models of good practice.
Means of implementation

(a) Financing and cost evaluation

6.35. The Conference secretariat has estimated the avera ge 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 o nly 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 be tter 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.

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 environmen tal 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 b een 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 measure s 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 com munity, 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 countr ies 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 ye t 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 approp riate, 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 th e source and at the disposal site, with a focus on abatement actions in all countries;
d. To identify and compile, as appropriate, the necessary statistical information on health effects to support cost/benefit analysis, including environmental health impact assessment for pollution control, prevention and abatement measures.
Activities

6.41. Nationally determined action programmes, with international assistance, support and coordination, where necessary, in this area should include:
a. Urban air pollution:
i. Develop appropriate pollution control technology on the basis of risk assessment and epidemiological research for the introduction of environmentally sound production processes and suitable safe mass transport;
ii. Develop air pollution control capacities in large cities, emphasizing enforcement programmes and using monitoring networks, as appropriate;
b. Indoor air pollution:
i. Support research and develop programmes for applying prevention and control methods to reducing indoor air pollution, including the provision of economic incentives for the installation of appropriate technology;
ii. Develop and implement health education campaigns, particularly in developing countries, to reduce the health impact of domestic use of biomass and coal;
c. Water pollution:
i. Develop appropriate water pollution control technologies on the basis of health risk assessment;
ii. Develop water pollution control capacities in large cities;
d. Pesticides: Develop mechanisms to control the distribution and use of pesticides in order to minimize the risks to human health by transportation, storage, application and residual effects of pesticides used in agriculture and preservation of wood;
e. Solid waste:
i. Develop appropriate solid waste disposal technologies on the basis of health risk assessment;
ii. Develop appropriate solid waste disposal capacities in large cities;
f. Human settlements: Develop programmes for improving health conditions in human settlements, in particular within slums and non-tenured settlements, on the basis of health risk assessment;
g. Noise: Develop criteria for maximum permitted safe noise exposure levels and promote noise assessment and control as part of environmental health programmes;
h. Ionizing and non-ionizing radiation: Develop and implement appropriate national legislation, standards and enforcement procedures on the basis of existing international guidelines;

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