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Rio at the intersection of health and sustainabilityH uman beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature". Principle 1 of the 1992 Rio Declaration on Environment and DevelopmentoverviewTwenty years on, the United Nations Conference on Sustainable Development represents an opportunity to set the world back onto a sustainable development path in which better and more equitable health outcomes play a key role.In these past two decades, the world has made significant economic and technological advances, as well as advancing towards attainment of a number of the Millennium Development Goals that address poverty and ill health. These positive trends, however, have been accompanied by economic disparities and inequalities, social inequity, persistent gender inequality, a growing deterioration of the environment, as well as recurrent economic, financial, energy and food crises. Rio+20 is a forum where sustainable development policies can be revitalized and strategies redefined, in the context of a green economy and poverty reduction. The themes are shaped around strategies in seven sectors and settings, including: jobs, energy, cities, food, water, oceans, disasters. But cross cutting to all of these areas is human health. Rio+20 offers an important opportunity to " Unhealthy living and work environments contribute to as much as one-quarter of deaths and illness globally "Dr Maria Neira, Director, Department of Public Health and Environment, World Health Organization (WHO)re-examine and reinforce the relationship between health and sustainable development in line with the original Rio Declaration, with a special focus on three key issues: Universal health coverage: a healthy population can more effectively work, earn and contribute to sustainable development; Health in a "green economy": sustainable development strategies need to ensure that urban and rural environments are healthy places to live and work, reducing environmental health risks and hazards, particularly in poor communities; Health relevant milestones and measures of progress: health is relatively easy to measure and health-relevant measures of future sustainable development progress. Historical review While health was one of the foundationsĀ of the first Rio Conference, and of its resulting Conventions, integration of health and environment policy in the intervening two decades has been weak. This has represented a missed opportunity to promote human health through more sustainable development choices, and to use health evidence as a compelling argument for a green economy. To take one example; although almost all of the least-developed countries cite health protection among their top concerns from climate change, fewer than one in four have an adequate health vulnerability and adaptation assessment. Less than 1 per cent of multilateral adaptation funding flows to health, meeting less 086 health

" Some 1.3 million annually people die from urban air pollution; nearly 2 million people die from indoor air pollution from biomass and coal stoves - including nearly half of the global pneumonia deaths in children under the age of five years, and over one million deaths from chronic lung diseases, mostly among poor women. "than 0.5 per cent of the additional costs that climate change imposes through additional costs of disease prevention and treatment. Similarly, there is now good evidence that taking into account the health "co-benefits" of greenhouse gas mitigation policies, such as reduced air pollution, could offset much of the cost of the investment, and lead to policies that are more cost-effective in promoting overall social welfare. However, a recent review showed only one of the 13 major economic models that is used to inform decision makers on how much they should spend on climate mitigation takes into account health co-benefits. It is critically important that we do not miss the opportunity of Rio+20 to develop more coherent policy approaches to simultaneously promote human health, economic development, and environmental protection, and to monitor progress.Universal Health Coverage "Although there have been major advances in human health and healthcare coverage over the last two decades, those benefits have been unequally shared. WHO estimates that more than 1 billion people worldwide do not have access to needed health services, either because those services are not available, or people cannot afford to use them. Moreover, 150 million people each year suffer severe financial catastrophe, because they fall ill, use health services, and need to pay for them, either directly out of pocket or without any prospect of future reimbursement. Many people have to sell assets or go into debt to pay for those health services, with 100 million people being pushed under the poverty line as a result. Coverage of health services also remains very partial or lacking in many countries, as reflected by the different rates of progress in attainment of health-related MDG goals. For instance, only 19 countries will reach the MDG target for reduction of maternal mortality by 2015. Improved access to medicines has been constrained by trade and intellectual property policies and practices, among others. Ensuring universal health coverage can help ensure the health security of millions of vulnerable people worldwide, advancing progress on the social goals that are integral to sustainable development. Along with averting unnecessary deaths and injuries, universal health coverage has numerous other social and economic benefits - it can help people remain active, productive members of society and economies, and thus contribute more to sustainable development. Health inĀ the Green Economy A healthy environment is a prerequisite for good health. A healthy environment means air, water and foods that are free from pollution and contaminants. But it is not only that. In the past two decades, we have learned much more about how health and environment interact with each other, and reinforce each other in many powerful ways. For instance, housing that is leaky and cold can exacerbate health risks from a range of respiratory illnesses, allergies and extreme weather. People living in cities that lack adequate transit, walking and cycling systems are more likely to be at risk of traffic injury or from diseases related to physical inactivity. Thus our built environment affects our working and living conditions as well as our lifestyles and through all of these pathways, health. Altogether, unhealthy living and work environments contribute to as much as one-quarter of deaths and illness globally, WHO-supported expert assessment has concluded. Twenty-five per cent of children under the age of five die from just five known environmental health risks related to indoor and outdoor air pollution; unsafe drinking-water sanitation and hygiene, and lead poisoning and climate change. Most of the deaths among children are in developing countries. Unhealthy living and working environments are a factor in the rapid rise in non-communicable diseases such as heart disease, respiratory diseases, cancers, obesity and hypertension, as well as in some communicable diseases of poverty, such as waterborne diseases, certain vector borne diseases and tuberculosis. Recent work by WHO on "Health in the Green Economy" http://www.who.int/hia/green_economy/en/index.html document the many ways that better health can be stimulated by smarter "green" development policies, rather than being a "casualty" of economic growth. For instance: Sustainable, well designed cities: energy-efficient housing and transit-oriented urban transport systems including walking/cycling networks, can help reduce health risks from unhealthy housing, air pollution and traffic injuries and physical inactivity - reducing risks from heart and respiratory diseases and other health conditions. Compact cities with well-built housing and transit also encourage social mixing and reduce travel for low income people and disadvantaged groups, including women, children, the elderly, the poor and disabled. ? health 087