The United Nations Conference on Sustainable Development (UNCSD) on 20-22 June 2012 marked the 20th anniversary of the 1992 United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro, and the 10th anniversary of the 2002 World Summit on Sustainable Development (WSSD) in Johannesburg. The Conference focused on two themes: (a) the green economy in the context of sustainable development and poverty eradication; and (b) the institutional framework for sustainable development.
The health community has reasons to both commend and criticise the outcomes of the Rio + 20 conference. On one hand, and for the first time, health was identified as a precondition for sustainable development as the global chronic disease epidemic was recognised as a major hurdle for development. Furthermore, the United Nations Secretary-General launched the “Zero Hunger Initiative” to scale up efforts to end hunger, including a special focus on malnutrition in pregnancy and early childhood.
The United Nations Conference on Sustainable Development (UNCSD) is "too important to fail", warned Ban ki-Moon, the UN Secretary General,. He also pointed that the international community is in danger of squandering a once-in-a-generation opportunity to use the Rio+20 meeting to map out a new course for economic and social development. Nevertheless World leaders were unable to reaffirm commitments on women’s issues - particularly in reproductive rights.
While the original 1992 Rio Declaration resulted in global treaties in the form of convention frameworks on Climate Change, Biodiversity and Desertification, the Rio+20 outcome document only sets points for negotiating voluntary global targets for sustainable development. In comparison the September 2011 UN Political Declaration on non-communicable diseases made considerably more actual commitments than the Rio+20 outcomes document.
The UNCSD recognised Non-Communicable Diseases (NCDs) as “the major development challenge of the 21st century” calling for the global health policy agenda (including universal health coverage and health promotion) to be embraced by the wider global political agenda. The health and NGO community sees such a development as a move in the right direction - in particular compared with the outcome document of twenty years ago, which barely mentioned health and contained no reference whatsoever to the global chronic diseases epidemic.
For mental health and health inequalities, the document states: “We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and the entire population, is important to create inclusive, equitable, economically productive and healthy societies. We call for the full realization of the right to the enjoyment of the highest attainable standard of physical and mental health.”
Communicable and poverty-related diseases (such as HIV and AIDS, malaria, tuberculosis, influenza, or polio) received appropriate attention at the conference, with member states committing “to redoubling efforts to achieve universal access to HIV prevention, treatment, care and support, and to eliminate mother to child transmission of HIV as well as to renewing and strengthening the fight against malaria, tuberculosis, and neglected tropical diseases.” This embodies an important first step to increase political will to address the problem.
There was also a call for action to strengthen health systems through “increased health financing, recruitment, development, training and retention of the health work force, improved distribution and access to safe, affordable, effective and quality medicines, vaccines and medical technologies, and through improving health infrastructure.” In this context, the leadership role of the World Health Organization in coordinating health at an international level was recognised.
The health in all policies approach is another winner with health being mainstreamed in:
access to better energy services including sustainable cooking and heating solutions, which can significantly reduce childhood pneumonia and adult cardiopulmonary disease deaths from indoor air pollution;
greater focus on urban planning measures including more sustainable, energy-efficient housing and transport – which can significantly reduce many NCD risks, e.g. cardiopulmonary diseases from air pollution, health risks from physical inactivity and traffic injury;
better sanitation in cities and villages to protect against the spread of communicable diseases;
sustainable food systems that combat hunger and contribute to better health and nutrition;
more sustainable water usage, meeting basic needs for safe drinking-water, and stewardship of water supplies to grow food;
assurance that all jobs and workplaces meet minimum safety and health standards to reduce cancer, chronic lung diseases, injuries and early deaths.
Although the Rio+20 conference is now over, it is possible to build on the political momentum to include both chronic and communicable diseases in the future global development goals that will replace the Millennium Development Goals. This will bring attention and assistance to promoting health in a global setting. These negotiations are now only beginning - the international health community will continue the campaign to raise the profile of health on the global political agenda.
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