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 wellbeing, 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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