Only within the moment of time represented by the present century has one species — man — acquired significant power to alter the nature of his world.
— Rachel Carson, The Silent Spring, 1962

THE first Earth Summit in 1992 echoed this view, and the spirit of the conference was captured by the expression ‘Harmony with Nature’, brought to fore with the first principle of the Rio Declaration: ‘Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature.’ The Johannesburg Declaration created ‘a collective responsibility to advance and strengthen the interdependent and mutually reinforcing pillars of sustainable development — economic development, social development and environmental protection — at local, national, regional and global levels.’ All these contemporary discussions mostly dealt with attaining the transition from consumerism to sustainability. Even though the ultimate goal of the transition is integral human development that can be sustained, often sustainable development is perceived only as the process of environment-preservation of natural resources. It very frequently did not recognise the multidimensional and complex concept of human development and health as integral to ensuring progress across every corner of sustainable development — economic growth, social equity, and environmental protection.
The World Health Organisation defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. It is now widely acknowledged that social isolation, poor education, fear of crime, disrupted family life and unhappiness are bad for health: new research suggests that people who have a positive attitude live on average seven years longer than unhappy people (Lyubomirsky et al. 2005). Likewise, poverty, joblessness, powerlessness and economic insecurity are injurious for human health. These are the social and economic dimensions of sustainable development. And environmental damage is damaging for health — air pollution, contaminated water, poor food supplies, heavy road traffics, dislocated neighbourhoods, poorly designed buildings. Climate change brings extremes of heat and cold, flooding, storms, drought and threatens the essentials of human life (DH 1998; King’s Fund 2002). This explanation can be understood from the figurative representation below:
Why these explanations necessary today? This is to set the stage for today’s discussion — is health being recognised as an important element for the promotion of sustainable development? Moreover, if human health is not at the sustainable development agenda, is this the future we want? It’s also worth mentioning that ‘the Future We Want’ is in fact the title of the global conversation that is initiated for ‘building the future through a positive vision for tomorrow’; this is the outcome document for this Earth Summit.
Over the past few decades, development theory has begun to shift its primary focus from economics to human conditions. This shift finds expression in the concepts of human development and the right to development, and has created space for the right to health and other human rights to move closer to the centre of the process of development. For instance, the Ottawa Charter for Health Promotion was adopted at the First International Conference on Health Promotion in 1986. It built on the policy of health for all and highlighted the need to promote health, recognising that building healthier societies was not just the responsibility of the health sector. In the 1970s international organisations realised that we could no longer continue to develop as if the Earth had unlimited resources. In light of this observation, in 1980 the International Union for Conservation of Nature published a report entitled the World Strategy for Conservation, in which the expression ‘sustainable development’ appeared for the first time. In 1987 it appeared again, in a report published by the World Commission on Environment. Entitled Our Common Future, more widely known as the Brundtland Report, this work propelled ‘sustainable development’ along with its definition into common usage. The introductory lines of the article have already captured the subsequent discussions that took place in Rio and Johannesburg.
The year we are living in now — 2012 — marks the twentieth year of the 1992 United Nations Conference on Environment and Development and the global leaders are meeting again at the same venue this year to reshape development discourses and probably to establish post-millennium development goal agenda. It is envisaged as ‘a Conference at the highest possible level, including Heads of State and Government or other representatives. The objective of the Conference is to secure renewed political commitment for sustainable development, assess the progress to date and the remaining gaps in the implementation of the outcomes of the major summits on sustainable development, and address new and emerging challenges’ as posted in the Rio+20 website.
I have already mentioned that the important links between health, the environment and poverty are acknowledged in previously agreed global sustainable development resolutions. We found Agenda 21 emphasising the ‘primary health needs of the world’s population’ as ‘integral to the achievement of the goals of sustainable development and primary environmental care’, and identifies ‘preventive and curative health facilities, especially primary health care and maternal health care systems accessible to all” as a critical component of sustainable development. Furthermore, Agenda 21 affirms that efforts to address health, environmental and socio-economic concerns require inter-sectoral actions — with a particular emphasis on preventative health measures — and that there is a need to ‘to coordinate the involvement of citizens, the health sector, the health-related sectors and relevant non-health sectors (business, social, educational and religious institutions) in solutions to health problems.’
As the sustainable development agenda collects renewed attention and increased political momentum, the global dialogue on sustainable development must address health as a major component of preventable illness and death. Sustainable development itself is intended at ensuring quality of life to present and future generations; quality of life is identified as being able to survive in healthy surroundings (the environmental aspect), with a sufficient standard of living (the economic aspect) and a way of life that is physically, intellectually and ethically satisfying (the social aspect). The assertions I just made speaks for itself — healthy human beings are the end objective of sustainable development. Let me make myself even clearer.
Inevitably, our decisions and actions all have an impact on the environment, the economy and society — the three pillars of sustainable development. For example, when we decide to purchase quality products regionally or locally, we encourage economic development at the regional level and in our own community. At the same time, greenhouse gas release from the transportation of food and other commodities are thereby reduced. This shows that it is important to anticipate the consequences of our actions so as to maximize their positive effects and minimize their negative effects. The goal is to be able to satisfy human needs and aspirations for development today, while letting future generations also meet their various development needs, with respect for the Earth’s resources. The WHO explains ‘people who are healthy are better able to learn, to earn and to contribute positively to the societies in which they live.’ On the other hand, a healthy environment is a precondition for good quality health. Reduction of key air, water and chemical pollution risks can prevent up to a quarter of the total burden of diseases, says the WHO, and a large proportion of childhood deaths. Individuals can be protected from illness as well as contribute to the resilience of societies by protecting people from impoverishment when they are sick, if they are provided with strong, well-designed health delivery systems. They can also supplement to the empowerment of women and they represent a means by which people can hold national authorities democratically accountable (WHO submission to Rio+20).
Millennium Development Goals were adopted by global leaders as unprecedented efforts to meet the needs of the world’s poorest. MDGs set time-bound targets, by which progress in all development indicators can be measured. In Bangladesh, for example, maternal mortality declined from 322 in 2001 to 194 in 2010, a 40 per cent decline in 9 years. The rate of decline was at an average of about 5.5 per cent per year, compared to the average annual rate of reduction of 5.4 per cent required for achieving MDG Target 5. Global prediction distinguishes Rio+20 as the road map of developing set of Sustainable Development Goals. Based on the paragraph 108 of the zero draft of the outcome document i.e. the Future We Want, the SDGs are going to ‘complement and strengthen the MDGs in the development agenda for the post 2015 period.’ However, the six potential SDG themes emerged from a member state retreat in late January were nutritious food for all, sustainable energy for all, safe and sustainable cities of all, sustainable consumption and production by all, decent jobs for all, safe drinking water and sanitation for all. If these themes continue, it is very likely that the post-MDG agenda will not have a specific maternal mortality target that can be measured. I fear, this might interrupt, and even cease the progress we have achieved so far. The updated outcome document of Rio+20 states that ‘sustainable development must be inclusive’; nevertheless, inclusion of maternal and child health, health of urban growing population, emerging non-communicable diseases and setting measurable indicators for all these human health issues does not seem much welcomed.
Achieving substantial progress across the three pillars of sustainable development — economic growth, social equity, and environmental protection — needs the essential support of a healthy global population. Securing and promoting good health for all is contingent on the integration of key health issues into sustainable development policies and programs — namely maternal and child health, urban health, NCDs and use of ICT for health. This will allow the governments to improve the indicators of sustainable development practices and can reaffirm that ‘human beings are entitled to a healthy and productive and prosperous life in harmony with nature.’ Otherwise, this does not seem the desired future we want.
Sohana Samrin Chowdhury is associate coordinator (urban health), Eminence.