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;094 health

Reduction in key environmental health risks such as proportion of households using clean and safe cooking fuels and technologies or the proportion of urban populations that live in areas that meet WHO's ambient air quality guidelines;Reductions in diseases that can be directly attributed to environmental risks such as occupational cancers or respiratory and cardiovascular diseases attributable to indoor or outdoor air pollution. Global policies sustainable development can also be improved by enhancing awareness of, and accountability for, the health impacts of policy decisions. This can be promoted by the wider use of health impact assessment, which supports the inclusion of health into decision-making processes.Long term studies of urban cycle commuters in Shanghai and Copenhagen have indicated that such commuters experienced a 20-30 per cent lower annual mortality risks, on average, in comparison to other commuters. Measuring active travel to work, particularly when safe travel networks are available, could be a health-relevant measure of healthy physical activity. Better home insulation, heating/cooking systems and indoor ventilation, can have a significant impact on the reduction of respiratory diseases, including asthmas, pneumonia and tuberculosis, as well as reducing people's vulnerability to extremes of heat and cold. In some countries, such as New Zealand, estimates of the short-term health benefit of such housing investments has helped drive "climate smart" investments in housing energy efficiencies and retrofits. Economic evaluation can also demonstrate how greener investments can yield measurable cost savings for health. For instance, the benefit-cost ratio of replacing polluting, leaky biomass stoves with liquid petroleum gas can be 4:1, including savings in lives and health care costs as well as fuel expense. Measurement of the combined health and energy savings of other new stove technologies (advanced biomass, biogas, etc). In many off-grid health facilities, renewable energy sources may be a cheaper and more reliable source of basic electricity, once the initial capital investment has been made. Higher up the energy ladder, it has been estimated that energy efficiencies in health facilities, including development of more clean, onsite energy generation, could yield immediate, annual facility savings on the order of 10-30 per cent in a sector estimated to account for 5-7 per cent of national greenhouse gas emissions in some developed countries. These statistics illustrate how health improvements and economic development need not be tradeoffs, but are deeply complementary to one another - and indeed to sustainable development in the green economy context. nhealth 095