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Introduction

The Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1998 and provides a structured opportunity for regular and open communication among experts interested in environmental health topics from a variety of government, academic, industry, and consumer groups. Through meetings and workshops, the Roundtable has focused on the state of environmental health sciences and decision making, identification of populations vulnerable to environmental hazards, and translation of environmental health research into public health practice. The Roundtable defines the environment broadly—a definition that incorporates the natural, built, and social environments—and considers how changes in the environment can impact human health through direct and indirect pathways (IOM, 2006).

In September 2012, the Roundtable established the Global Environmental Health and Sustainable Development Innovation Collaborative as an ad hoc activity to provide an adaptable pathway for discussing issues related to sustainable development and for sharing scientific information across United Nations (UN) system entities, international and governmental organizations, academia, the private sector, and civil society. The Innovation Collaborative is composed of Roundtable members and other stakeholders with a shared interest in developing cooperative activities and strategies to advance global goals on sustainable development and human health. Through multidisciplinary collaboration, the Innovation Collaborative seeks to connect and leverage expertise across a variety of fields related to sustainable development, including economics, energy, environmental sciences, medicine, public health, and health communication.

The Innovation Collaborative held a series of webinars in October, November, and December 2012 to help inform the post-2015 development agenda process that was under way and being led by the UN. Provided below is a brief background of key events and reports that informed the planning of the webinar series, as well as details on the purpose of the webinar series and the overall structure of this summary.



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1 Introduction The Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1998 and provides a structured opportunity for regular and open communication among experts interested in environmental health topics from a variety of government, academic, industry, and consumer groups. Through meetings and workshops, the Roundtable has focused on the state of environmental health sciences and decision making, identification of populations vulnerable to environmental hazards, and translation of environmental health research into public health practice. The Roundtable defines the environment broadly—a definition that incorporates the natural, built, and social environments— and considers how changes in the environment can impact human health through direct and indirect pathways (IOM, 2006). In September 2012, the Roundtable established the Global Environmental Health and Sustainable Development Innovation Collaborative as an ad hoc activity to provide an adaptable pathway for discussing issues related to sustainable development and for sharing scientific information across United Nations (UN) system entities, international and governmental organizations, academia, the private sector, and civil society. The Innovation Collaborative is composed of Roundtable members and other stakeholders with a shared interest in developing cooperative activities and strategies to advance global goals on sustainable development and human health. Through multidisciplinary collaboration, the Innovation Collaborative seeks to connect and leverage expertise across a variety of fields related to sustainable development, including economics, energy, environmental sciences, medicine, public health, and health communication. The Innovation Collaborative held a series of webinars in October, November, and December 2012 to help inform the post-2015 develop- ment agenda process that was under way and being led by the UN. Provided below is a brief background of key events and reports that informed the planning of the webinar series, as well as details on the purpose of the webinar series and the overall structure of this summary. 1

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2 GLOBAL DEVELOPMENT GOALS OVERVIEW OF SUSTAINABILITY The term sustainability comes from the concept of sustainable development defined in the 1987 report Our Common Future by the Brundtland Commission of the United Nations as “development which meets the needs of current generations without compromising the ability of future generations to meet their own needs” (WCED, 1987). Sustainable development is supported by three pillars—the economic, social, and environmental dimensions—where health is both an outcome of and a precondition for all three pillars (UN, 2012). Being built on multiple disciplines, sustainable development follows an integrated systems-based approach to encompass the aims of development, including human well- being, quality of life, freedom, and opportunity (NRC, 2011). Because of this approach, sustainability frameworks are increasingly utilized to address intractable problems throughout the world, particularly growing challenges around global environmental degradation and poverty (NRC, 2011). In 1992, sustainable development was formally endorsed by the international community at the historic UN Earth Summit held in Rio de Janeiro, Brazil. Box 1-1 includes a list of the international sustainable development conferences and documents discussed in this chapter. The Earth Summit resulted in the creation of Agenda 21, an ambitious action plan for global sustainable development (UN, 1993), and the Rio Declaration, which outlined 27 principles for global sustainability (UN, 1992). For example, Principle 1 of the Rio Declaration states that “human beings are at the center of concerns for sustainable development . . . they are entitled to a healthy and productive life in harmony with nature” (UN, 1992), clearly articulating that protecting human health is the cornerstone of sustainable development. Principle 4 goes on to state that “in order to achieve sustainable development, environmental protection shall constitute an integral part of the development process and cannot be considered in isolation from it” (UN, 1992). This principle places environmental protection on an equal plane with development, a requirement to ensure that resources are available for present and future generations. The Rio Declaration also highlights the need to eradicate poverty and decrease disparities in standards of living to achieve the objectives of sustainable development. Following these efforts, world leaders gathered in New York City in 2000 for the Millennium Summit and adopted the Millennium Declaration (UN General Assembly, 2000), which gave rise to the Millennium Development Goals (MDGs). The MDGs are a set of eight health-related development goals intended to reduce extreme poverty throughout the world, protect the environment, and improve conditions for vulnerable populations (see Box 1-2). Each goal includes a

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INTRODUCTION 3 BOX 1-1 International Sustainable Development Conferences and Documents Conferences  1992: Earth Summit (Rio de Janeiro, Brazil)  2000: Millennium Summit (New York, United States)  2002: World Summit on Sustainable Development (Johannesburg, South Africa)  2005: World Summit (New York, United States)  2012: United Nations (UN) Conference on Sustainable Development (Rio+20 Conference) (Rio de Janeiro, Brazil) Documents  Our Common Future (WCED, 1987)  Rio Declaration (UN, 1992)  Agenda 21 (UN, 1993)  Millennium Declaration (UN General Assembly, 2000)  Report of the World Summit on Sustainable Development (UN, 2002)  2005 World Summit Outcome (UN General Assembly, 2005)  The Future We Want (UN, 2012) series of time-bound targets for achieving and tracking progress across countries through 2015. In 2002, the MDGs were reaffirmed at the World Summit on Sustainable Development in Johannesburg, South Africa (UN, 2002), and a plan of implementation was developed that reinforced the interdependent components of sustainable development (economic development, social development, and environmental protect- ion) and overarching objectives, including poverty eradication, improved human health, and protection and management of the natural resources base. Following the 2005 UN World Summit, the MDG targets were updated to incorporate intergovernmental agreements from the event; Targets 5B, 6B, and 7B were added, and Target 1B was added as a revision of a previous target listed under MDG 8. Despite these efforts, many of the MDGs have not been achieved, and adverse trends have been reported for several of the environmental targets (UN, 2013). For example, global carbon dioxide emissions have increased by more than 46 percent since 1990, nearly one-third of marine fish stocks are overexploited, and an estimated 863 million people continue to reside in slums in the developing world (UN, 2013). One possible explanation for this slow progress is lack of integration across the social, economic, and environmental priorities found in the MDGs (Haines et al., 2012). In addition, the drafting process primarily involved

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4 GLOBAL DEVELOPMENT GOALS BOX 1-2 Millennium Development Goals (MDGs) and Targets 1. Eradicate extreme poverty and hunger 1A. Halve, between 1990 and 2015, the proportion of people whose income is less than $1 per day 1B. Achieve full and productive employment and decent work for all, including women and young people 1C. Halve, between 1990 and 2015, the proportion of people who suffer from hunger 2. Achieve universal primary education 2A. Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling 3. Promote gender equality and empower women 3A. Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 4. Reduce child mortality 4A. Reduce by two-thirds, between 1990 and 2015, the under-5 mortality rate 5. Improve maternal health 5A. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio 5B. Achieve, by 2015, universal access to reproductive health 6. Combat HIV/AIDS, malaria, and other diseases 6A. Have halted by 2015 and begun to reverse the spread of HIV/ AIDS 6B. Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it 6C. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases 7. Ensure environmental sustainability 7A. Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources 7B. Reduce biodiversity loss, achieving, by 2020, a significant reduction in the rate of loss 7C. Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation 7D. By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers

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INTRODUCTION 5 8. Global partnership for development 8A. Develop further an open, rule-based, predictable, nondiscriminatory trading and financial system 8B. Address the special needs of the least developed countries 8C. Address the special needs of landlocked developing countries and small-island developing states 8D. Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term 8E. In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries 8F. In cooperation with the private sector, make available the benefits of new technologies, especially information and communications NOTE: Please see The Millennium Development Goals Report 2013 for a detailed assessment of global and regional progress made toward the MDGs and targets: http://mdgs.un.org/unsd/mdg/Resources/Static/Products/ Progress2013/English2013.pdf (accessed August 14, 2013). SOURCE: UN, 2008. experts from the UN system (who took the targets from the text of the Millennium Declaration) and lacked direct participation from civil society and nongovernmental organizations (NGOs); as a result, imple- mentation was slow in some countries and regions (UN System Task Team on the Post-2015 UN Development Agenda, 2012; Vandemoortele, 2011). PURPOSE OF THE WEBINAR SERIES In June 2012, world leaders and participants from government, NGOs, the private sector, and civil society gathered in Rio de Janeiro for the UN Conference on Sustainable Development to honor the 20th anniversary of the 1992 Earth Summit (commonly referred to as Rio+20). The official discussions of the Rio+20 Conference highlighted seven areas for priority attention (decent jobs, energy, sustainable cities, food security and sustainable agriculture, water, oceans, and disaster readiness), and focused on issues related to the green economy in the context of sustainable development and poverty eradication. A formal outcome document was prepared at the conclusion of the conference that reaffirms the need to achieve sustainable development by promoting sustained, inclusive and equitable economic growth, creating greater opportunities

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6 GLOBAL DEVELOPMENT GOALS for all, reducing inequalities, raising basic standards of living, fostering equitable social development and inclusion, and pro- moting the integrated and sustainable management of natural resources and ecosystems that supports, inter alia, economic, social, and human development while facilitating ecosystem conservation, regeneration and restoration, and resilience in the face of new and emerging challenges. (UN, 2012). The document also highlights the need for a set of Sustainable Development Goals (SDGs) that address and incorporate all three dimensions of sustainable development and that can be integrated into the UN post-2015 development agenda (a global framework that is being developed to maintain the progress of the MDGs beyond 2015). The follow-up to the Rio+20 Conference provides an opportunity for guidance on the post-2015 development agenda framework and the SDGs, which will likely converge and be adopted at the September 2015 UN General Assembly. The challenge is to achieve collective support for effective, meaningful, concise, and easy-to-communicate global develop- ment goals that will focus on the three areas of sustainable development and benefit the health of populations at the global, regional, and national levels. In an effort to provide varied perspectives that may benefit higher-level policy discussions, the Global Environmental Health and Sustainable Development Innovation Collaborative hosted a webinar series during October, November, and December 2012. The statement of task for the webinar series can be found in Box 1-3. The webinars covered lessons learned from the MDG process and insights on topics and goals that may be considered for inclusion in the development frameworks being debated and negotiated at the global level. An independent planning committee (whose role was limited to planning the webinar series in accordance with the procedures of the National Research Council [NRC]) invited experts within the fields of environmental and global health to present their experiences and thoughts on the topic areas and encouraged representatives from government, academia, and civil society to participate in the discussion sessions that followed the presentations. STRUCTURE OF THE SUMMARY This summary was prepared by the workshop rapporteur as a factual summary of what occurred during the webinars. All views presented in the summary are those of the webinar participants. The summary does not contain any findings or recommendations by the planning committee or the Roundtable.

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INTRODUCTION 7 BOX 1-3 Statement of Task An ad hoc committee will plan and conduct a public three-part webinar series (workshop) on Sustainable Development Goals (SDGs) and human health. The webinars will feature invited presentations and discussions to look at possible health-related measures and metrics that can be utilized for creating new SDGs as the Millennium Development Goals sunset in 2015. The workshop will focus on fostering discussion across academic, government, business, and civil society sectors to make use of existing measurements that can be adapted to track progress of global sustainable development and human health. The committee will develop the webinar agendas, select invited speakers and discussants, and moderate the discussions. A workshop summary based on all three webinars will be prepared by a designated rapporteur in accordance with National Research Council policies and procedures. The presentations and discussions that occurred during the webinars are summarized in the subsequent chapters. Chapter 2 considers lessons learned from the MDGs and opportunities for aligning environmental health objectives with the post-2015 development agenda. Chapter 3 includes provide perspectives on possible health goals and indicators for sustainable development while making connections to climate change. Chapter 4 provides insights on making linkages between sustainable development, health equity, and social justice. The webinar agendas can be found in Appendix A, and the speaker biosketches are included in Appendix B. REFERENCES Haines, A., G. Alleyne, I. Kickbusch, and C. Dora. 2012. From the Earth Summit to Rio+20: Integration of health and sustainable development. The Lancet 379(9832):2189–2197. IOM (Institute of Medicine). 2006. Rebuilding the unity of health and the environment in rural America. Washington, DC: The National Academies Press. NRC (National Research Council). 2011. Sustainability and the U.S. EPA. Washington, DC: The National Academies Press. UN (United Nations). 1992. Report of the United Nations conference on environment and development, Rio de Janeiro, Brazil, 3–14 June 1992. A/CONF.151/26. New York: United Nations. UN. 1993. Earth Summit: Agenda 21. The United Nations programme of action from Rio. New York: United Nations.

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8 GLOBAL DEVELOPMENT GOALS UN. 2002. Report of the World Summit on Sustainable Development. Johannesburg, South Africa, 26 August–4 September 2002. A/CONF.199.20. New York: United Nations. UN. 2008. Official list of MDG indicators. http://mdgs.un.org/unsd/mdg/ host.aspx?Content=indicators/officiallist.htm (accessed August 14, 2013). UN. 2012. The future we want. A/CONF.216/L.1. New York: United Nations. UN. 2013. The Millennium Development Goals report 2013. New York: United Nations. UN General Assembly. 2000. United Nations Millennium Declaration. A/RES/55/2. New York: United Nations. UN General Assembly. 2005. 2005 World Summit Outcome. A/60/L.1. New York: United Nations. UN System Task Team on the Post-2015 UN Development Agenda. 2012. Review of the contributions of the MDG agenda to foster development: Lessons for the post-2015 UN development agenda. Discussion note. http://www.un.org/millenniumgoals/pdf/mdg_assessment_Aug.pdf (accessed August 20, 2013). Vandemoortele, J. 2011. The MDG story: Intention denied. Development and Change 42(1):1–21. WCED (World Commission on Environment and Development). 1987. Our common future. Edited by G. H. Brundtland. Oxford: Oxford University Press.