Canada and Agenda
21Canada and Agenda
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CHAPTER 6
Protecting and Promoting Human Health
-- Trevor Hancock --
Trevor Hancock is a public health consultant working in the area of health promotion in Canada, the United States and Europe. The views expressed in this chapter are those of the author with input from other stakeholders and do not necessarily reflect the views of the Projet de Société.
THE NATURE OF THE PROBLEM
"Human beings are at the centre of concern for sustainable development. They are entitled to a healthy and productive life in harmony with nature".
This is the first principle in the preamble to the Declaration on Sustainable Development adopted at the UN Conference on Environment and Development in Rio de Janeiro in 1992. It makes it clear that human health and wellbeing are intimately linked to environmental sustainability. Indeed, in its report, the World Commission on Environment and Development (WCED) echoed many of the themes and concerns that lie behind World Health Organization's "Health For All" strategy, placing them in an environmental, economic and development context. While there is little in the report that is explicitly about health, in her presentation to the World Health Assembly in 1988, Gro Harlem Brundtland commented "Recently, I was asked why health was not one of these issues [in the Report]. My reply is: ultimately, the whole report is about health." Indeed, in a section on improving health, the report notes that "good health is the foundation of human welfare and hence a broad-based policy is essential for sustainable development.
For its part, WHO' input to the Rio conference was through the WHO Commission on Health and Environment (WHO, 1992). The Commission identified a set of global challenges to health and the environment, including demographic challenges resulting from population growth, the
challenge of the poverty that afflicts some 40% of the world's population, the problem of excessive levels of resource consumption in developed countries and the macroeconomic policies that have stressed economic concerns to the neglect of social, health and environmental effects. The Commission reviewed a set of major issues where health, environment and development are closely related, including food and agriculture, water, energy use, industry, human settlements and transboundary pollution. To address these issues, the report proposed two principles "...central to a healthier and more sustainable planet: first, more equitable access to resources within and between countries; second, citizen participation". It also identified the following three main global objectives:
Achieving a sustainable basis for health for all. This demands a slowing down and eventual halt to population growth as soon as possible, and the promotion of lifestyles and patterns of consumption among affluent groups and developed countries that are consistent with ecological sustainability.
Providing an environment that promotes health. This involves reducing the risk of physical, chemical and biological hazards and ensuring that everyone has the means to acquire the resources on which health depends.
Making all individuals and organizations aware of their responsibility for health and its environmental basis. Health professionals should take the lead in moves to improve the environment and to inform governments and the public about the health implications of development and the costs and benefits of different options to reduce health risks.
Health and development thus are intimately interconnected: sound development is not possible without a healthy population. Yet both insufficient development leading to poverty and inappropriate development resulting in overconsumption, coupled with an expanding world population, can result in severe health problems in both developing and developed nations. These issues have received further attention in the 1993 World Development Report (World Bank,1993) and in WHO's Draft Global Strategy for Health and Environment (WHO,1993) which notes that "....the broad links between health and environment are taken in the context of sustainable development, going beyond the health determinants of the physical environment and encompassing the health consequences of interaction between human populations and the whole range of factors in their physical and social environments". The Draft Strategy calls for an enhanced program for the promotion of environmental health with three main components - rural, urban and global - and an expanded program for the promotion of chemical safety.
Chapter 6 addresses the primary health needs of the world's population in the context of these reports; it is recognized that these health needs are integral to the achievement of the goals of sustainable development and primary environmental care and that the health sector cannot meet basic needs and objectives on its own; it is dependent on social, economic and spiritual development, while directly contributing to such development.
The linkage of health, environmental and socio-economic improvements requires intersectoral efforts. Such efforts, including all sectors of society, should aim to enable people to ensure health-promotion and sustainable development within their own communities. Countries ought to develop plans for priority actions which are based on cooperative planning by various levels of government, NGOs and local communities. The WHO would be an appropriate coordinating body for activities aimed at protecting and promoting human health.
PROGRAM AREAS AND OBJECTIVES
There are five main program areas in Chapter 6. These are:
(1)Rural Primary Health Care
This program area includes the following objectives:
to meet the basic health needs of peri-urban and urban populations, in particular a safe water supply, sanitation, a safe food supply and proper nutrition;
to provide necessary specialized environmental health services;
to coordinate the involvement of citizens, the health sector, health-related sectors and relevant non-health sectors (business, social, educational and religious institutions) in solutions to health problems; and,
to secure health service coverage, especially primary health services, for population groups in the greatest need, particularly those living in rural areas.
(2)Communicable Disease Control
Despite the development of vaccines and other medicines which control and eradicate communicable diseases, many people still suffer from such diseases as polio, cholera, tuberculosis, leprosy, diarrhoea, malaria and schistosomiasis. These communicable diseases are the result of lack of proper housing, clean water and sanitation, combined with inadequate health care.
Within the overall strategy to achieve health for all by the year 2000, national Governments should develop a national health plan to include a national public health system, public information and education, intersectoral cooperation and coordination, control of environmental factors that influence the spread of infectious diseases, and a primary health care system.
Some major global goals are:
to eliminate guinea-worm disease (dracunculiasis) and polio, and control oncho-cerciasis (river blindness) and leprosy;
to mobilize and unify national and international efforts to control HIV infection;
to control tuberculosis, especially the new drug-resistant varieties;
to provide 95% of the world's children with treatment for acute respiratory infections;
to cut childhood diarrhoea deaths in developing countries by 50% to 70%;
to have anti-malaria programs in all countries where malaria presents a significant health problem; and,
to reduce death due to measles by 95% by 1995.
(3)Protection of Vulnerable Groups (infants, youth, women, and indigenous peoples)
The general objectives of protecting vulnerable groups are:
to ensure that all such individuals should be allowed to develop to their full potential (including physical, mental and spiritual development);
to ensure that young people can develop, establish and maintain healthy lives, as agreed upon at the World Summit for Children in 1990;
to allow women to choose their family size and to perform their key role in society; and,
to support indigenous people through educational, economic and technical opportunities.
(4)Urban Health
All too often, urban development is associated with destructive effects, environmental pollution, overcrowding and inadequate housing. These can contribute to excess morbidity and mortality. Since in urban environments, many factors that affect human health are outside the health sector, improving the health and well-being of all urban dwellers will require coordinated action by all levels of government and all sectors of society.
The global objective is to achieve a 10% to 40% improvement in health conditions by the year 2000 through:
the development and implementation of municipal and local health plans by intersectoral committees at the political and technical levels;
the assessment, where necessary, of existing health, social and environmental conditions in cities, including intra-urban differences;
strengthening environmental health services; and,
the establishment and maintenance of city networks for collaboration and exchange of models of good practice.
(5)Environmental Health Risks
In many locations around the world, the general environment, workplaces and even individual dwellings are so badly polluted that the health of hundreds of millions of people is adversely affected.
The global objective is to minimize hazards and maintain the environment to a degree that human health and safety is not impaired or endangered and yet encourage development to proceed. Specific program objectives, by the year 2000, include:
incorporating appropriate environmental and health safeguards as part of national development programs in all countries;
establishing adequate national infrastructure and programs for providing environ-mental injury and hazard surveillance as the basis for abatement in all countries;
establishing integrated programs for tackling pollution at the source and at the disposal site, with a focus on abatement actions in all countries; and,
identifying and compiling the necessary statistical information on health effects to support cost/benefit analysis, including environmental health impact assessment for pollution control, prevention and abatement measures.
CANADIAN POSITIONS AT RIO
1.Official Canadian Position
Canada had three main objectives concerning the protection and promotion of human health:
(1)to seek to have health and well-being recognized as the most fundamental objective of economic development activity;
(2)to seek to have recognized the importance of including health as a fundamental criterion in all development initiatives; and,
(3)to seek support for the concept that individual awareness of health is in itself empowering.
2. Non-Governmental Organizations
Canadian NGOs with expertise on human health focused most of their energies on the Global Forum with the NGO Treaties (see below) rather than on the official UNCED process. Canadian NGOs participating in the UNCED process did advocate that:
human health and well-being depends upon there being a clean, healthy environment, and therefore, that the protection and promotion of human health depends upon and is intricately linked with all of the sustainability issues, including those environment and development issues covered by UNCED as well as those issues, such as disarmament, which were not discussed at UNCED; and,
all sectors of society need to be involved in planning, decision-making, policy implementation and management of both health-care systems as well as those issues which have effects on human health.
Canadian NGOs developed positions on a wide range of those Agenda 21 issues connected to human health, such as human settlements, population, wastes, freshwater etc. With regards to the Agenda 21 chapters focusing on human health, women's groups, in particular, brought forward positions favouring women-centred, women-managed comprehensive reproductive health care and family planning; increased investments in comprehensive health services; increased education; and elimination of environmental occupations health hazards.
3. Business and Industry
Canadian business and industry supported the tenets of this chapter and the Canadian Government position. It is recognized that there is a major role to be played by business in providing a suitable work environment as well as a key element of education.
4.Indigenous
Indigenous Peoples identified the need for support of Indigenous Peoples' NGOs involved in development at the international, national and local levels to recognize traditional healing, and to support and protect intellectual property rights related to traditional medicinal knowledge and healing. In Canada and other areas, programs need to be developed to assist Indigenous Peoples in synthesizing Indigenous knowledge and western medicine.
COMMITMENTS MADE BY CANADIANS
1.Legally-Binding Documents
None.
2.Political Pronouncements
None.
3.Alternative NGO Treaties and Kari-Oca
NGO Treaties
At the same time as UNCED, two major international events were also held at Rio: the Global Forum and the Kari-Oca Conference. At the International Non-Governmental Organization Forum (Global Forum), 3,100 NGOs discussed a number of matters related to environment and development and produced a parallel set of documents: an NGO Earth Charter and 38 Alternative NGO Treaties. Of these treaties, six addressed the issues discussed in Chapter 6.
The Poverty Treaty, Treaty on Urbanization, Treaty in Defense and Protection of Children and Adolescents, Treaty on Population, Environment and Development, Fresh Water Treaty, and Food Security Treaty, are all NGO Treaties which address issues concerning the protection of human health. Some of the proposals and resolutions adopted in these treaties are described below.
NGOs proposed to democratize cities, towns and villages by ensuring fulfilment of all existing national and international rights and by creating new rights, changing the priorities for allocations of common resources locally, nationally and internationally in support of the impoverished population. They also proposed to universalize basic sanitation services and infrastructure with equal access by all urban and rural areas.
In particular, the right of children and adolescents to primary care was recognized. Each day 40 000 children die from malnutrition and common childhood illnesses; 150 million live with chronic health problems. NGOs asserted that children and adolescents have the fundamental right to primary care which includes food, shelter, basic medical attention, opportunity for education and recreation.
In terms of reproductive health care, NGOs emphasized the necessity of women-centred, women-managed and women-controlled comprehensive reproductive care. They also insisted that national and international communities act now to support community-based responses to the AIDS epidemic, and other sexually transmitted diseases, respecting the human rights of those affected.
NGOs stated that all inhabitants of the world should be guaranteed equitable access to potable water and sanitation as a fundamental right. NGOs prefer an alternative holistic approach to watershed management that encompasses both surface and groundwater. They plan to encourage the public and private sector, water users organizations, and local communities to use economic incentives, pricing mechanisms, taxes, user fees, fines, and other mechanisms that will both signal the value of water resources and discourage wasteful and polluting practices.
With respect to food security, NGOs pledged to increase sustainable agriculture production in urban, peri-urban and rural areas at the grass roots level, with emphasis on alleviating poverty and improving regional food supply, small-scale production and self-sufficiency. They also agreed to advocate food security as a central objective in the agricultural and food priorities of local and national governments, intergovernmental agencies, and NGO and community groups, and for food security to become a central objective of trade policies.
Kari-Oca
The second alternative forum at Rio was the International Conference on Territory, Environment and Development (the Kari-Oca Conference). The Kari-Oca Conference was held immediately prior to UNCED by and for the world's indigenous peoples. More than 650 indigenous representatives participated in meetings and cultural events during the conference. They developed and adopted a 109-point Indigenous Peoples Earth Charter.
Within the Kari-Oca Declaration and the Indigenous People's Earth Charter, indigenous peoples stated that they wanted to maintain the right to their traditional and spiritual way of life. They emphasized that their health rights must include recognition and respect of traditional knowledge held by indigenous healers and stated that this traditional knowledge had enabled them to survive. Consequently, it must be recognized and protected. Moreover, they want the usurping of traditional medicines and knowledge to be considered a crime against indigenous peoples. They also requested that the United Nations promote research into indigenous knowledge and develop a network of indigenous sciences.
In the context of this chapter, the indigenous peoples explained their perspective on the interrelationship between human health and a healthy planet by stating: "We feel the earth as if we are within our mother. When the earth is sick and polluted, human health is impossible. To heal ourselves, we must heal the planet and to heal the planet we must heal ourselves." (Statement No. 84)
DEFICIENCIES, GAPS AND CONSTRAINTS WITHIN CHAPTER 6
One problem with this chapter, from a Canadian perspective, is that the five program areas, and in particular the objectives within those areas, tend to reflect a rather conventional health protection approach, rather than the health promotion approach that Canada has pursued in recent years. Moreover, the issues and objectives reflect the basic needs of developing countries, rather than the needs of a more industrialised nation such as Canada. At the same time, it is important to recognise that some of the stated objectives are still not adequately achieved in Canada (as will be discussed in the next section) and that Canada has its own "Fourth World" of Native reserves and settlements.
The most apparent deficiency in Chapter 6 of Agenda 21 is the absence of any reference to the responsibility of the health sector as an economic sector in ensuring that its own practices are environmentally sustainable. The health sector is a significant part of any national economy. Low to middle income countries spend between 2 and 7 percent of GNP on health; established market economies spend from 6 to 10 percent (and in the case of the United States, 12 percent) of GNP on health; and the figure for Canada in 1990 was 9.1 percent (World Bank,1993). Clearly this is an economic sector of significance, and from that viewpoint alone, the health sector should be environmentally sustainable. Yet in many ways the health sector is far from being environmentally sustainable; it uses large quantities of energy and material resources, including substantial and indeed excessive amounts of disposable products, and produces large volumes of solid and liquid wastes and air emissions, including significant amounts of hazardous wastes.
A second reason for focusing on the health sector is because of its moral weight. No other sector in society should be more committed to sustainable development than the health sector. It should set an example of environmentally responsible behaviour, and take a lead role on environmental protection. Health professionals can and should play an influential role in their communities and in society at large to ensure that all development is health-promoting and environmentally sustainable.
COMPARISON BETWEEN CURRENT CANADIAN GOVERNMENT POLICY AND COMMITMENTS MADE
The Canadian government made no formal commitments on the issue of protection and promotion of human health at the Rio Conference. Accordingly, the assessment of its performance must be based on a comparison of the gap between the commitments implicit in the three main objectives of the official Canadian position on the protection and promotion of human health and Canada's actual actions in these areas. In addition, the government's actions can be compared with the five main program areas in Chapter 6. The final three -- protection of vulnerable groups, urban health and environmental health risks -- are of particular importance in this respect.
The first objective was "...to seek to have health and well-being recognized as the most fundamental objective of economic development activity". There is little or no evidence that health and well-being is or has been - or will be - accepted as the most fundamental objective of economic development activity by the Government of Canada, or indeed by any provincial government in Canada. While it can be argued, with good reason, that economic development is beneficial to health, governments of all stripes appear to espouse and pursue economic growth as the central goal of public policy, without questioning whether such growth is environmentally and socially sustainable and whether it is beneficial to or harmful to health. Questions as to what type of growth in which areas is needed, and what the balance should be between economic development and other societal goals, are seldom addressed. Perhaps the closest approach to this position so far has been taken by the Premier's Council on Economic Renewal in Ontario. A recent report of a committee of the Council has proposed the development of strategic goals for the Province based on three co-equal principles: wealth creation, social well-being and environmental protection.
The recognition of health and well-being as the most fundamental objective of economic development activity would require a serious commitment to "healthy public policy", one of three mechanisms for health promotion identified by Health and Welfare Canada in a 1986 policy document, Achieving Health For All. But apart from commissioning a literature review (Pederson et al, 1988) and sending a delegation to the Second International Conference on Health Promotion in 1988, the Government has made no effort to further develop and implement the approach that it itself advocated. Several provincial governments, notably Ontario, Manitoba and New Brunswick, have established bodies to begin to develop this area and Ontario has published a report, Our Environment, Our Health, which explicitly addresses issues linking health and sustainable development in areas such as energy use, agriculture, forestry, and urban planning and development.
The second Canadian objective was "...to seek to have recognized the importance of including health as a fundamental criterion in all development initiatives". Again, there is little evidence that health has been included as a fundamental criterion. In fact, until recently health has been subsumed under social impact as one of the factors in environmental assessment (EA) - itself just one factor in the decision-making process. A serious commitment to health as a fundamental criterion would require a full health impact assessment of all policies and major development proposals. This does not happen in Canada today, except as part of environmental assessment (EA).
On the positive side, the Canadian Environmental Assessment Act includes health as a distinct component in EA. (It is noteworthy, however, that the Act, Canada's principal legislation to protect the environment and human health, does not explicitly mention sustainable development!) In addition, a task force of the (Federal-Provincial) Committee on Environmental and Occupational Health has been working on national guidelines for including health in EA. This work should be completed in 1994. However, it appears that the emphasis will likely be on the conventional physical health measures, rather than the (admittedly harder to measure) mental and social dimensions of health that have been accepted by the federal and provincial governments for some years.
The third Canadian objective that, "...the concept that individual awareness of health is in itself empowering", is itself fallacious. It is not the awareness of health that is empowering; it is being able to do something about one's health that is empowering. As the definition of health promotion adopted by Health and Welfare Canada in 1986 states, "health promotion is the process of enabling people to increase control over and improve their health." In particular, this means that those who are most vulnerable and most disempowered in society must be given the opportunity and the skills to exert more control - individually and collectively - over the events and conditions that affect their health. The recession that has dramatically increased unemployment, poverty, hunger, homelessness and dependence on welfare in Canada, or, for example, the recent destruction of the east coast fishery (due, in no small part, to government failure to take effective action early enough), have had just the opposite effect, disempowering whole communities and thus harming their health.
Such economic and social policies in particular, have harmed the health of large numbers of children. The Government of Canada has failed to live up to its commitments with respect to poverty and the health of children made in Canada's capacity as co-chair of the World Summit on Children in 1990. Coupled with the Government's failure to address poverty, which drew criticism recently from the United Nations Committee on Social and Economic Affairs, this makes a mockery of this objective and the commitment in Chapter 6 to protect the health of vulnerable groups.
A similar criticism applies to the health of indigenous peoples, another of the vulnerable groups identified in Chapter 6. Fundamentally, Canada's indigenous peoples have been disempowered -by being dispossessed and having their culture destroyed - for hundreds of years. This has led to some dreadful examples of abuse. The failure of the Government of Canada, and of the provincial governments, to expeditiously address the issues of land settlements and self-government as a means to restore sovereignty, culture and self-respect, has sown the seeds of the appallingly poor health status of the indigenous peoples. Their health status - and the disgraceful housing conditions, poverty, environmental despoliation and inadequate human services that are at the root of their poor health - should be unacceptable in a civilised country.
In the area of urban health, the Government of Canada has also shown a lack of commitment. The World Health Organisation's Healthy Cities Project - a major program in its "Health For All" strategy in Europe and of growing importance globally - had its origins in Canada. The Department of Health and Welfare funded a national Healthy Communities Project from 1988 until 1991, but then dropped the funding, despite the fact that the project had resulted in health being placed on the social and political agenda of hundreds of cities and towns across Canada, often coupled with environmental and sustainable development issues. Thus the most useful vehicle for addressing urban health and environmental issues - and a project in which Canada was acknowledged as a world leader - has been all but abandoned by the Canadian Government, although latterly a small amount of funding has been made available to keep the project barely ticking over at the national level. Fortunately, local action has kept the project alive in most provinces, although it only functions fully and effectively in Qu‚bec and B.C. where the provincial government has provided funding support.
In the area of environmental health risks, the federal Government, through Health and Welfare Canada, produced a comprehensive report on health and the environment - A Vital Link - in 1992 as part of its contribution to the Green Plan. An Action Plan on Health and the Environment guides funding. In addition, the Committee on Environmental and Occupational Health is working on a National Strategy on Health and the Environment, which is loosely based on the European Charter on Health and Environment (WHO Europe, 1989). However, these actions - and the environmental health work of Health Canada in general - tend to reflect a rather conventional approach to environmental health, emphasizing contaminants and the media (air, water, soil, food) in which they are found rather than the broader concepts of health and their broader links with the environment, and sustainable development. Chapter 9 of A Vital Link does address this broader perspective.
On the positive side, some programs take the broader approach, consistent with the principles of health promotion. These combine a conventional scientific approach (which nonetheless seeks to address the issues in a comprehensive and holistic manner), with community involvement and sensitivity to peoples' needs. These programs include the Great Lakes Health Effects Program, the EAGLE Project (an assessment of contaminants and the health of Native people in the Great Lakes basin) and the Great Bear Project, a similar program for the Treaty 8 region. A broader approach is also evident in the Healthy Environments program of the Health and Social Development Branch of Health Canada, although its social marketing approach places too much emphasis on the concept that individual awareness of health - or, in this case, healthy environments - is empowering (a point addressed earlier).
Finally, while Canada's performance is inadequate when judged against the broad health promotion agenda espoused by Health and Welfare Canada and exemplified by Canada's own objectives at the Rio conference, its work in the narrower field of health protection has been internationally recognised.
CANADIAN ACTIVITIES EVOLVING THROUGH THE SUSTAINABILITY PROCESS
Although there has been no concerted effort to address health protection and promotion in the context of sustainable development, a number of individual initiatives have been undertaken.
Assembly of First Nations (AFN)
The AFN's EAGLE Project studies Great Lakes health issues of aboriginal peoples.
Canadian Association of Physicians for the Environment
Plans are currently being developed to establish this Association. For further details, contact Dr. Tee Guidotti, Department of Environmental and Occupational Health, University of Alberta.
Canadian Healthy Communities Network (CHCN)
Despite the almost total withdrawal of federal funding, the CHCN has continued to exist, linking healthy community activities in the provinces (Qu‚bec, BC and recently Ontario have provincially funded initiatives) with national programs, such as the Active Living, Safe Community and Healthy Environment programs, and with national organisations, such as the Canadian Institute of Planners (CIP), the Federation of Canadian Municipalities and the Canadian Public Health Association. CIP is the host organisation for the CHCN and has done much to link the concepts of healthy communities and sustainable communities.
As a result of these activities, a growing number of municipalities and organisations are examining ways to integrate health and environmental sustainability issues into land use planning.
Canadian Medical Association (CMA)
The CMA's Environmental and Occupational Health Committee commissioned a report on the medical profession and health and sustainable development. The report, which was adopted in 1991, made a number of recommendations with respect to the profession's role as exemplars, advocates, educators and researchers.
Canadian Public Health Association (CPHA)
The CPHA established a Task Force on the Implications for Human Health of Global Ecological Change in 1990. Their report, Human and Ecosystem Health, was adopted by the Board of Directors in 1991 and has been widely distributed. Among its recommendations was the establishment of a National Clearing House on Health and the Environment at the CPHA.
Heath Care Environment Network
This Toronto-based network has been active for several years, encouraging health care facilities and professionals to become more environmentally aware and responsible. They organise regular meetings, educational sessions and publish a regular newsletter.
International Institute of Concern for Public Health (IICPA)
The IICPA has undertaken an initiative called Health 2000 which assesses community health, suggests interventions to promote health and evaluates the effectiveness of the intervention. The initiative is based on community participation in decision-making at all levels of the study and is modelled on the doctor-patient relationship. It is not an epidemiological survey but offers an alternative response to hazards and proposes a new level of health care for the community. The initiative is supported through a grant from the Ontario Premier's Council on Health, Well-Being and Social Justice.
National Round Table on the Environment and the Economy (NRTEE)
The NRTEE is currently finalising a report on Canada's needs and capabilities with respect to reporting on sustainable development. The framework being used incorporates human health as one of the key components of the framework.
The Education Task Force of the NRTEE in an effort to stimulate national debate on sustainable development has undertaken a survey of professional health associations. The survey will help catalyze informal educational efforts, and position the NRTEE to catalyze the next step of sustainable development awareness and educational activities of the associations.
Premier's Council on Health, Well-being and Social Justice (Ontario)
The Premier's Council's report, Our Environment, Our Health, addresses three main themes: healthy ecosystems, healthy communities and healthy workplaces. For each theme, a set of objectives and targets have been established. The objectives proposed for the Province of most relevance to the Projet de Soci‚t‚ are:
healthy ecosystems - promote individual and community health and wellbeing by protecting, preserving and restoring healthy ecosystems; and
healthy communities - promote individual health and well-being and reduce adverse effects on the environment by substantially improving the physical planning and design of communities.
Royal Society of Canada - Canadian Global Change Program (RSC)
The RSC established a Health Research Panel in 1992. The panel has developed a draft research framework for health research on aspects of global change, covering threats to human health from industrial and agricultural pollution, from changes in the global environment, and from current and future levels and patterns of consumption, as well as health related human behavioural responses to global change (Royal Society of Canada, 1993).
University of British Columbia (UBC)
The Department of Family Medicine at UBC is host to the Task force on Healthy and Sustainable Communities. The Task Force has produced a number of papers on various aspects of the issue.
University of Victoria
The Centre for Sustainable Regional Development at the University of Victoria has a Sustainable Communities Initiative which includes in its approach the healthy community concept.
OTHER RELEVANT INTERNATIONAL SUSTAINABILITY-RELATED FORA
The most obvious international forum for linking the protection and promotion of human health to sustainable development is the World Health Organisation. Canada has strong links with the European Region, in particular, because of the shared work in health promotion and healthy cities/communities. As well, a number of Canadians have served in senior positions in WHO Europe. However, Canada's links with the Pan-American Health Organisation (PAHO) are much weaker, despite the fact that we are members of PAHO and not the European Region.
Other relevant fora are those in which Canada participates through the International Development Research Centre (IDRC), the Canadian International Development Agency (CIDA), the Canadian University Consortium on Health in International Development (CUCHID), CPHA's International Health Program and other similar bodies. For example, Health Canada has an IDRC funded project on health and environmental assessment in the Amazon basin.
RECOMMENDATIONS
The recommendations fall into two categories, those concerned with putting our own house in order and those concerned with our global/international role.
Domestic
1.The Government of Canada should initiate public policy as called for in Achieving Health For All. This will involve developing policy structures and processes that will ensure that health and well-being are recognized as the most fundamental objectives of economic development activity and a central concern of all public policy.
2.Health impact assessment should be integrated into environmental assessment by the Federal and Provincial governments; it should be considered at the policy, plan, program and project levels.
3.The Government of Canada should support the Canadian Healthy Communities Network as an effective means of putting health on the agenda of municipal governments and communities and linking it to sustainable development.
4.The NRTEE and/or the Canadian Council of Ministers of the Environment (CCME) and/or other suitable national bodies should convene a working group on health and sustainable development. The working group should address the two themes of health and of the health care system as they relate to sustainable development, developing both a national and an international agenda.
5.The Government of Canada should endorse the Royal Society of Canada research framework for health-related global change research and should support research in the areas defined in the framework. Greater emphasis should be placed on health - as opposed to biomedical - research, including research into the health consequences of unsustainable development.
6.The Government of Canada should financially support the establishment of a National Clearing House on Health and the Environment.
7.The Government of Canada should ensure that its approach to environmental health is broadened to incorporate the wider concepts of health and the environment in the context of sustainable development.
International
1.The Government of Canada should play a more active role in addressing issues of health and sustainable development through the WHO, and especially through the Regional Office for the Americas (PAHO).
2.The Government of Canada should support the Canadian Healthy Communities Network in playing an active role in the international healthy cities/communities movement and in international development projects relating to urban management for health and sustainability. One way to do this may be to ensure that the recently established International Centre for Sustainable Communities in Vancouver also includes the healthy communities perspective in its work.
3.The Government of Canada, through IDRC and CIDA, should support health promotion, healthy public policy, healthy city/community, public health and primary care projects and should ensure that all such projects recognize the links between health and sustainable development.
SUGGESTED READINGS AND INFORMATION SOURCES
A Sustainable Healthy Future: Towards an Ecology of Health, (Melbourne, Australia: Lincoln School of Health Sciences, La Trobe University, 1989).
Brundtland, Gro Harlem. Presentation to 41st World Health Assembly entitled Our Common Future, (Geneva, Switzerland: 1988).
Canadian Public Health Association (CPHA). Human and Ecosystem Health, (Ottawa: CPHA, 1992).
Government of Canada. Achieving Health For All: A Framework for Health Promotion, Ottawa: Department of Health and Welfare, 1986).
. A Vital Link: Health and the Environment in Canada, (Ottawa: Department of Health and Welfare, 1992).
. Canada's Green Plan, (Ottawa: Environment Canada, 1990).
. Canada's Green Plan and the Earth Summit, (Ottawa: Environment Canada, 1992).
. Canada's National Report: United Nations Conference on Environment and Development Brazil, June 1992, (Ottawa: Environment Canada, 1991).
Hancock, Trevor. Sustaining Health: Achieving Health For All in a Secure Environment, Mimeo. (North York, Ontario: Faculty of Environmental Studies, York University, 1989).
and Nigel Richardson. Creating Sustainable, Healthy Communities in Ontario, (A paper prepared for the Ontario Ministry of Municipal Affairs, 1991).
. "Health, human development and the community ecosystem: Three ecological models" in Health Promotion International, 8(1) 1993.
International Development Research Centre (IDRC). Agenda 21: Abstracts, Reviews, and Commentaries, (Theodora Carroll-Foster, editor), (Ottawa: IDRC, 1993).
Keating, Michael. Agenda for Change: A Plain Language Version of Agenda 21 and the Other
Rio Agreements, (Geneva: Centre for Our Common Future, 1993).
Last, John. "A vision of health in the twenty-first century: Medical response to the greenhouse effect" in Canadian Medical Association Journal, 140 1989.
. "Our Common Future" in Canadian Journal of Public Health, 78(6) 1987.
Pederson, Anne et al. Coordinating Healthy Public Policy: An Analytic Literature Review and Bibliography, (Ottawa: Department of Health and Welfare, Health Services & Promotion Branch, 1988).
Premier's Council on Economic Renewal. Ontario 2002, (Toronto: Premier's Council, 1993).
Premier's Council on Health, Well-being and Social Justice. Our Environment, Our Health, (Toronto: Premier's Council, 1993).
Royal Society of Canada (RSC). A Framework for Health-related Global Change Research, Draft. (Ottawa: RSC, April 1993).
World Bank. World Development Report 1993: Investing in Health, (New York: Oxford University Press, 1993).
World Commission on Environment and Development. Our Common Future, (Oxford: Oxford University Press, 1987).
World Health Organization (WHO). City Networks For Health, Technical Discussions Working Paper, 41st World Health Assembly, (Geneva: WHO, 1991).
. Draft Global Strategy for Health and Environment, (Geneva: WHO, 1993).
. Environment and Health: The European Charter and Commentary, (Copenhagen: WHO Europe, 1989).
. Environmental Health in Urban Development, (Geneva:WHO, 1991).
. Our Planet, Our Health: Report of the WHO Commission on Health and Environment, (Geneva: WHO, 1992).
. Report of the Panel on Urbanisation, WHO Commission on Health and Environment, (Geneva: WHO, 1992).
Information Sources:
Canadian Council of Minister of the Environment (CCME), 326 Broadway Street, Suite 400, Winnipeg, Manitoba, R3C 0S5, (204) 948-2090, fax: (204) 948-2125.
Canadian Healthy Communities Network (CHCN)
Canadian International Development Agency (CIDA), Place du Centre, 200 Promenade du Portage, Hull, Quebec, K1A 0G4, tel: (819) 997-5456, fax: (819) 953-5469).
Canadian Medical Association (CMA), 1867 Alta Vista Drive, Ottawa, Ontario, K1G 3Y6, tel: (613) 731-9331, fax: (613) 731-7314.
Canadian Public Health Association (CPHA), 1565 Carling Ave, Ottawa, Ontario, K1Z 8R1, tel: (613) 725-3769, fax: (613) 725-9826.
Canadian University Consortium on Health in International Development (CUCHID)
Federal Environmental Assessment Review Office (FEARO), 200 Boulevard Sacr‚ Coeur, 14th floor, Fontaine Building, Hull, Quebec, K1A 0H3, tel: (819) 997-1000,
fax: (819) 994-1469.
Health Care Environment Network
International Development Research Centre (IDRC), 250 Albert Street, Ottawa, Ontario,
K1G 3H9, tel: (613) 236-6163, fax: (613) 238-7230.
National Round Table on the Environment and the Economy (NRTEE), 1 Nicholas Street, Suite 1500, Ottawa, Ontario, K1N 7B7, tel: (613) 992-7189, fax: (613) 992-7385.
Occupational Health Program, University of Alberta, 13-103 Clinical Sciences Building,
Edmonton, Alberta, T6G 2G3, tel: (403) 492-6291, fax: (403) 492-0364.
Royal Society of Canada, 355 River Road, Ottawa, Ontario, K1G 5J4, tel: (613) 991-6990, fax: (613) 991-6996.
Cite as: Projet de société: Canada and Agenda 21.Winnipeg: IISD, 1995. Online. Internet. http://iisd.ca/worldsd/canada/projet/c06.htm.
