" 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 in 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

Sustainable food production: Many experts now believe that policies for healthier and more sustainable food production and consumption need to be addressed in a linked way to ensure access to healthy foods in both cities and rural areas, so as to reduce undernutrition, obesity and malnutrition. More sustainable agriculture can also help reduce pressures on forests and water sources, which in turn affect climate change, vector borne diseases, and social equity - all of which ultimately affect health. Green workplaces: green economies also need to ensure that workplaces are safer from risks of occupational illness and injury. These include risks of injuries, chronic air pollution or chemical exposures. As part of a "green economy" we need a renewed commitment to assessing and reducing these risks in both traditional as well as emerging "green" technologies. Sustainable Energy for All: this initiative spearheaded by the UN Secretary General needs to ensure that the poorest 3 billion people in the world, who rely upon leaky coal and biomass stoves, gain access to clean, modern energy technologies. Clean options include liquified petroleum gas (LPG), and advanced biomass stoves, biogas and renewable sources of wind and solar power, which can provide energy for electricity, as well as heating. Compact urban planning of housing and businesses around public transit systems makes cities much more energy efficient - reducing urban climate change emissions and urban "heat island" impacts, which in turn create more health risks. Energy-efficient and resilient health facilities as part of "Sustainable Energy for All:" in poor countries, many health clinics lack access electricity for basic infrastructure, such as night-time lighting, communications and water purification/refrigeration. This dimension of energy poverty needs to be addressed to assure access to vital health services. Many developed country health facilities, meanwhile, are developing their own onsite energy generation and storage facilities, which provide cleaner, more efficient and more reliable energy - at a lower long term cost. Supporting such energy "self-sufficiency" for health facilities in less well resourced settings, including use of cleaner energy sources and renewables, offers exciting new opportunities to make health facilities models of "Sustainable Energy for All" technologies and approaches. Moreover, in areas where power is either unreliable or non-existent, energy self-sufficiency can make health centres far more resilient and response in emergencies, when grids often fail. This supports another key Rio theme - effective disaster response.way forwardTwenty years after the first Rio Summit policies on urban planning, transport and housing development in many countries still create rather than reduce air pollution, noise and traffic injuries. Food production distribution patterns and policies too often make it harder, not easier, to access healthy foods and achieve good nutrition - so that prevalence of undernutrition remains one of the world's most serious health problems and obesity is rising sharply in low and middle income countries. Urban expansion is most rapid in low and middle income countries. But recent urban development often limits rather than promoting daily physical activity, with sprawl dominating the urban periphery and traffic-choked city centre streets impeding movement on foot or by bicycle. About 30 per cent of urban growth is due to expansion of slum areas. Today, some 1.3 million people die anually 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. By 2050, however, OECD estimates that urban air pollution will become the largest cause of environmental deaths, killing over 3.5 million worldwide annually.Health as an "indicator" of sustainable development progress Sustainable development is sometimes a hard concept to grasp. Health is not. Demonstrating the relationship between the two is therefore a powerful way of supporting climate change mitigation and adaptation. The benefits of better health are usually immediate, personal and local. Opinion surveys of the general public, and of climate negotiators, as well as economic valuation of health effects of mitigation and adaptation measures, all support a much stronger role for health in climate and related development processes.Progress on key "indicators" related to health can be measured and will generate both public and political interest. Examples include indicators that reflect: Progress on universal health access and coverage such as the proportion of people nationally or globally health insurance and the proportion of people nationally or globally with immediate access to a defined set of basic healthcare services;088 health