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Sustainable Development
What Has Sustainable Development to Do with Our Health?
We cannot reach and maintain human health and a healthy environment without
sustainable development. It's about the future for children and the future
of children's health.
Definition of Sustainable Development
The United Nations Agenda 21 defines sustainable development as development
that meets the needs of the present without compromising the ability of
future generations to meet their own needs. Human health is central to
this definition. According to the 1992 Rio Declaration on Sustainable
Development, "Human beings are at the centre of concern for sustainable
development. They are entitled to a healthy and productive life in harmony
with nature."
"Environmental health" and "sustainable development" are critical concepts
in preventive medicine in this industrial era of unprecedented economic
growth, resource depletion and global pollution. It is clear that a person's
economic situation and the state of the environment in which a person
lives are strong determinants of health. Indeed, Hippocrates counselled
the physician to assess the local environment of the patient when diagnosing.
Sustainable development is a prerequisite to reaching and maintaining
environmental health.
Since the 1992 Rio Earth Summit, national governments have accepted that
economics must make the change to sustainable development and that human
health is a central aspect for the understanding of sustainable development.
Regrettably, after fifteen years of research and deliberations, sustainable
development is rarely given more than lip service.
Principles of Sustainable Development
There are three key principles integrating sustainable development and
environmental and human health:
- Integration of environment and economy: Economic and environmental
measures affect each other. This interaction must be studied as one
complex system, and measures must be adopted to be mutually enhancing
and not in conflict with each other. Both the economy and the environment
have to be made sustainable.
- Intergenerational equity: Meeting the needs of present generations
without jeopardizing the needs of future generations means that we will
not mortgage the livelihood, health and well-being of our children and
grandchildren.
- Social equity: With respect to human health and social equity,
addressing susceptible or vulnerable subpopulations is the key. In general,
the main vulnerable population with respect to environmental health
is children. When it comes to policy on "Children's Environmental Health,"
Canada is far behind the United States, so it is good to see that physicians
in Canada are showing the way.
The Canadian Public Health Association issued a special supplement on
children's health and the environment in 1998. The Ontario College of
Family Physicians (in conjunction with the Canadian Environmental Law
Association) demonstrated in their exhaustive report that the standards
used to test chemicals are not definitive and do not adequately or scientifically
take into account the differences between children and adults. The OMA,
BCMA and OCFP have effectively generated public interest for government
action against air pollution, which also affects vulnerable groups like
children.
It has long been been known that children's health is vulnerable to poor
economic standards. We are now aware that children are especially vulnerable
to the various aspects of environmental pollution and degradation. Unfortunately
-- due in part to current macroeconomic measurements -- increasing economic
growth often perversely decreases the health of the environment, which
can jeopardize the health of children. This is why sustainable development
is so critical to human health and why it is good sustainable development
practice for projects in the medical community to tie in the economic
costs and benefits when we study children's environmental health. What
is really worrying is that the the World Trade Organization and so-called
"free trade" agreements make mere mention of sustainable development while
the rules and terms of these agreements still actually disallow its principles
and processes. Economic globalization must be based on sustainable development
in order to ensure human health.
(For a more in-depth discussion, read Trevor Hancock on Agenda 21, Chapter
6 at The International
Institute for Sustainable Development.)
The Role of Physicians in Sustainable Development
Physicians can play a strong role in promoting sustainable development
for the benefit of community and individual health. Here's how:
- Become involved in and support government and nongovernmental organizations
and their sustainable development programs. (For example, join CAPE
- Canadian Association of Physicians for the Environment.)
- Switch to ethical/screened investments individually and through the
CMA pension fund.
- Promote awareness of environmental health and sustainable development
as part of wellness and disease prevention in your work.
- Suggest and support projects in your provincial medical associations
addressing aspects of environmental health and sustainable development.
- Think and talk sustainable development in your professional, business,
social and community involvements.
- Trade in your sports car for a Honda Civic and your SUV for a Suburu
Legacy. But leave your vehicles in your driveway as often as possible
-- it will be good for your environmental and your economic health.
The Disorder
"The Warning to Humanity issued in 1993 by the Union of Concerned Scientists
spelled out the grave damage suffered by the environment as a consequence
of uncontrolled population growth and unrestrained exploitation of all
aspects of the global environment, and outlined immediate remedial action:
control all environmentally damaging activities, restore and protect the
earth's life support systems, manage resources more effectively, stabilize
the population, and reduce inequalities...." (Royal Society of Canada,
Implications of Global Change for Human Health, 1995)
The Treatment
"Environment and Human Health: Over the last century, economic
growth, advances in medicine, and improved diet have allowed substantial
improvement in some of the traditional measures of the health status of
Canadians, including reduced mortality of children and an increased life
span for both men and women. While economic prosperity has enhanced Canadian
health status in some respects, unsustainable use of resources and unsustainable
production and consumption processes have led to environmental degradation,
creating potential new threats to human health and the environment on
which human life depends.
"Environmental hazards range from toxic materials in the air we breathe,
the food we eat and the water we drink and swim in, to hazards in the
natural and built environments including extreme weather conditions, exposure
to UV radiation, toxic chemicals and hazardous workplace processes and
practices.
"There is increasing scientific evidence of linkages between these threats
and a growing numbers of illnesses, injuries and death. For example, air
pollution accounts for at least 5,000 premature deaths annually; at least
10% of cancers are attributable to environmental and occupational hazards;
asthma is responsible for 25% of all school absences; and 15% of Canadians
may be affected by environmental sensitivities. Immune system depression
and neurological disorders have also been linked to hazards in the environment,
and there is growing evidence of linkages between contaminants in our
air and water and human reproductive disorders. Anticipated changes in
climate are expected to affect the pattern of morbidity and mortality
in Canada through changes in pathogen patterns, health impacts of more
severe weather events, air pollution episodes, and food crop disturbances.
"Environment Canada, along with Health Canada, has an important role
to play in addressing these issues. The Canadian Environmental Protection
Act, 1999, gives the Minister of the Environment a wide range of powers
and duties with respect to the regulation of environmental hazards including:
toxic substances; toxic products of biotechnology; nutrients; regulation
of the federal house; fuels and fuel components; ocean dumping; transportation
of hazardous waste; and international air pollution. [....]
"Air, Water, Climate Change: Impacts on Human Health: One challenge
for us at EC is to consider how the human health aspect could be more
strongly and directly addressed in our work on air and water quality and
climate change. In each of these areas, there are important linkages between
deteriorating environmental quality and the health of Canadians. Through
further focus on the human health aspects we could achieve: -a more complete
understanding of the effects of air quality and water quality on human
health, and the effects of climate change on human health; -a more direct
and comprehensive response to these issues on the part of governments;
-a more informed public that understands the impact of these environmental
problems on their health and that is able to make responsible decisions.
"In order to achieve these outcomes, we would need to: strengthen our
science and knowledge base in one or more of these areas in order to more
fully understand the impacts of the environmental problem on human health,
particularly, for example, on emerging issues such as the effects of endocrine
disrupting substances; build better partnerships with other government
departments (particularly Health Canada) and with provinces and internationally;
and find ways of better communicating with Canadians.
"Vulnerable Populations: Children and Aboriginal People: Certain
populations are particularly vulnerable to environmental hazards and could
provide an appropriate focal point in designing and implementing any environmental
health initiatives.
"Children are more vulnerable to environmental hazards due to the rapid
growth and critical neurological development that occurs during the fetal
stage and early childhood, combined with the immaturity of their immune
and metabolic systems. Aboriginal people in Canada are also particularly
vulnerable to environmental conditions. Inuit people are among the most
exposed in the world to environmental contaminants. One of the greatest
environmental health concerns for Aboriginal people in Canada is the contamination
of their food supply. They also have concerns about being able to secure
clean, healthy and varied sources of medicinal plants that are part of
traditional Aboriginal holistic healing systems.
"By focusing on these most vulnerable populations, EC would be addressing
some of the intra- and inter-generational equity issues that are an important
part of sustainable development. A focus on children's and Aboriginal
people's health could achieve: -a better understanding of the risks that
environmental hazards pose to children and Aboriginal people in Canada,
and a better capacity to track improvements or deterioration in the environmental
health of these vulnerable populations; -a more informed public in Canada
that understands the particular vulnerabilities of children and Aboriginal
people to environmental hazards; -greater capacity within Aboriginal communities
to address their own environmental health issues; -a more comprehensive
approach to childhood development issues in Canada that addresses not
only the social and economic factors, but the environmental factors at
the same time.
"These outcomes could be achieved through a variety of activities, including:
- efforts to improve our science and develop more targeted risk management
measures;
- developing appropriate indicators of environmental health for these
vulnerable populations;
- implementing awareness campaigns both in Aboriginal communities and
in the population at large about the particular vulnerability of certain
groups to environmental contaminants;
- encouraging other federal programs focused on the well-being of these
populations to include an environmental component in their work." (from
the public consultation paper on Environment Canada's Sustainable Development
Strategy 2000)
"Policy making in all sectors must include considerations of the impact
of those policies on environmental and human capital. Currently such integration
is for the most part lacking within OECD governments and the OECD itself.
The result is costly and avoidable policy conflict. [...] For
example, the lack of integration between health and environment policies
generates additional costs for such already overburdened public health
services as air and water pollution, which causes acute and chronic illness
for large numbers of people. Poorly designed agricultural policies encourage
overuse of fertilizers and pesticides, adding the cost of ensuring drinkable
water. This list could go on through the full range of sectorial policies.
[...] Similar policy conflicts result from the integration failures
at the macroeconomic-policy level. The global system of trade rules has
evolved largely in isolation from the environmental rules embodied in
the many international environmental conventions." (The Report of the
High Level Advisory Group on the Environment to the Secretary General
of the OECD, November 25, 1997, entitled Guiding the Transition to Sustainable
Development: A Critical Role for the OECD)
"Sustainable human settlements depend on the creation of a better environment
for human health and well-being, which will improve the living conditions
of people and decrease disparities in the quality of their lives. The
health of the population depends at least as much on the control of environmental
causes as on the clinical responses to disease. Children are particularly
vulnerable to harmful urban environments and must be protected. Measures
to prevent ill health and disease are as important as availability of
appropriate medical treatment and care. It is therefore essential to take
a holistic approach to health, whereby both prevention and care are placed
within the context of environmental policy, supported by effective management
systems and plans of action incorporating targets that reflect local needs
and capacities." (Agenda 21, Habitat Agenda, Item 93, 1992)
The Role of Physicians
"The Canadian Medical Association has long recognized the important links
between health and environment, and our members have expressed growing
concern about the health consequences of the environmental crisis we face.
In producing this report, the CMA adds its support to the growing move
towards environmentally sustainable economic development in the belief
that such a move is of fundamental significance to the health of all Canadians.
[...] The modern definition of health goes beyond the absence
of disease to take into account the effects of a person's lifestyle and
environment in determining his or her total state of well-being." (Canadian
Medical Association, Health, the Environment and Sustainable Development,
1991)
"Human development and the achievement of human potential require a
form of economic activity that is socially and environmentally sustainable
in this and future generations." (Canadian Public Health Association,
Human and Ecosystem Health, 1992)
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