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1 Introduction1 The Roundtable on Environmental Health Sciences, Research, and Medicine 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. 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. Through multidisciplinary collaboration, the Innovation Collaborative seeks to connect and leverage expertise across a variety of fields related to sustain- able development, including economics, energy, environmental sciences, medicine, public health, and health communication. In December 2012, members of the Innovation Collaborative met to develop the statement of task for the 2013 Global Environmental Health and Sustainable Development Spring Webinar Series (see Box 1-1). 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 economics, environmental health, global health, and public policy to present their experiences and thoughts on the webinar topic areas. Participants in these webinars examined frameworks for global development goals and connections to 1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus. PREPUBLICATION COPY: UNCORRECTED PROOFS 1

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2 INCLUDING HEALTH IN GLOBAL FRAMEWORKS BOX 1-1 Statement of Task An ad hoc committee will plan and conduct a public three-part webinar series (workshop) in spring 2013 on three themes identified from the 2012 fall meeting of the Roundtable on Environmental Health Sciences, Research, and Medicine and its collaborative on Global Environmental Health and Sustainable Development. The webinars will feature invited presentations and discussions to look at the role of health in measuring a country’s wealth (going beyond gross domestic product), health scenario communication, and international health goals and indicators. The workshop will focus on fostering discussion across academic, government, business, and civil society sectors to make use of existing data and information 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. health indicators, the role for health in the context of novel sustainable economic frameworks that go beyond gross domestic product, and scenarios to project climate change impacts. OVERVIEW OF SUSTAINABILITY, MILLENIUM DEVELOPMENT GOALS, AND POST-2015 GOALS Defined in the 1987 report by the World Commission on Environment and Development (WCED) (commonly known as the Brundtland Commission), the term “sustainability” comes from the concept of sustainable development defined 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—in which health is both an outcome of and precondition for all three pillars (UN, 2012). In 1992, sustainable development was formally endorsed by the international community at the historic Earth Summit held in Rio de Janeiro, Brazil. 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). PREPUBLICATION COPY: UNCORRECTED PROOFS

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INTRODUCTION 3 At the Millennium Summit held in 2000, world leaders adopted the Millennium Declaration (UN General Assembly, 2000)—a document that sought to uphold human dignity especially for the most vulnerable people—which gave rise to eight global development goals known as the Millennium Development Goals (MDGs) (see Box 1-2). The global community set a 15-year implementation plan to achieve the specific targets established for each MDG in order to realize overarching object- ives such as poverty eradication, improved human health, and protection and management of the natural resources base. 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 PREPUBLICATION COPY: UNCORRECTED PROOFS

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4 INCLUDING HEALTH IN GLOBAL FRAMEWORKS 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 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. As 2015 approaches, efforts are under way at the UN to develop a set of post-2015 goals that will provide a framework for global development efforts during the next 15 years. In July 2012, the UN High-Level Panel of Eminent Persons for the Post-2015 Development Agenda was convened and tasked to make recommendations for this development agenda that will extend beyond 2015.2 Their report was released at the end of May 2013 and titled A New Global Partnership: Eradicate Poverty and Transform 2 The UN High-Level Panel was convened by the UN Secretary General to advise on the global development framework beyond 2015, the target date for the MDGs. The panel comprises 27 eminent leaders from civil society, the private sector, and government (http://www.un.org/sg/management/hlppost2015. shtml [accessed August 26, 2013]). PREPUBLICATION COPY: UNCORRECTED PROOFS

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INTRODUCTION 5 Economies Through Sustainable Development.3 The High-Level Panel highlighted the lack of collaboration between environmental and develop- ment group efforts to further the MDGs and noted that “the MDGs fell short by not integrating the economic, social, and environmental aspects of sustainable development as envisaged in the Millennium Declaration, and by not addressing the need to promote sustainable patterns of con- sumption and production.” In considering new goals and targets for post- 2015 that will promote sustainable development, the High-Level Panel considered tangible topics such as hunger, poverty, sanitation, and water, as well as projections related to cross-cutting topics such as population growth and climate change. Discussions about the post-2015 goals and targets will continue until to September 2015, when the UN General Assembly is expected to adopt a new global development agenda. 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. The presentations and discussions that occurred during the webinars are summarized in the subsequent chapters. Chapter 2 provides a summary of the featured presentations and discussion on existing efforts to develop goals and indicators for the post-2015 development agenda. Chapter 3 presents a summary of the remarks and presentations focused on sustainable economic frameworks and links to health. Chapter 4 summarizes the presentations on climate change scenarios and health outcomes. The webinar agendas can be found in Appendix A and the speaker biosketches are included in Appendix B. 3 The report is available at http://www.post2015hlp.org/wp-content/uploads/20 13/05/UN-Report.pdf (accessed August 26, 2013). PREPUBLICATION COPY: UNCORRECTED PROOFS

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6 INCLUDING HEALTH IN GLOBAL FRAMEWORKS REFERENCES 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. UN. 2012. The future we want. A/CONF.216/L.1. New York: United Nations. UN General Assembly. 2000. United Nations Millennium Declaration. A/RES/55/2. New York: United Nations. WCED (World Commission on Environment and Development). 1987. Our common future. Edited by G. H. Brundtland. Oxford: Oxford University Press. PREPUBLICATION COPY: UNCORRECTED PROOFS