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1. Health and development are intimately interconnected. Both insufficient development leading to poverty and inappropriate development resulting in overconsumption, coupled with an expanding world population, can result in severe environmental health problems in both developing and developed nations. Action items under Agenda 21 must address the primary health needs of the world's population, since they are integral to the achievement of the goals of sustainable development and primary environmental care. The linkage of health, environmental and socio-economic improvements requires intersectoral efforts. Such efforts, involving education, housing, public works and community groups, including businesses, schools and universities and religious, civic and cultural organizations, are aimed at enabling people in their communities to ensure sustainable development. Particularly relevant is the inclusion of prevention programmes rather than relying solely on remediation and treatment. Countries ought to develop plans for priority actions, drawing on the programme areas in this chapter, which are based on cooperative planning by the various levels of government, non-governmental organizations and local communities. An appropriate international organization, such as WHO, should coordinate these activities. [Chapter 6, Para 1]

3. Health ultimately depends on the ability to manage successfully the interaction between the physical, spiritual, biological and economic/social environment. Sound development is not possible without a healthy population; yet most developmental activities affect the environment to some degree, which in turn causes or exacerbates many health problems. Conversely, it is the very lack of development that adversely affects the health condition of many people, which can be alleviated only through development. 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. It is also dependent on a healthy environment, including the provision of a safe water supply and sanitation and the promotion of a safe food supply and proper nutrition. Particular attention should be directed towards food safety, with priority placed on the elimination of food contamination; comprehensive and sustainable water policies to ensure safe drinking water and sanitation to preclude both microbial and chemical contamination; and promotion of health education, immunization and provision of essential drugs. Education and appropriate services regarding responsible planning of family size, with respect for cultural, religious and social aspects, in keeping with freedom, dignity and personally held values and taking into account ethical and cultural considerations, also contribute to these intersectoral activities. [Chapter 6, Para 3]

4. Within the overall strategy to achieve health for all by the year 2000, the objectives are to meet the basic health needs of rural peri-urban and urban populations; to provide the necessary specialized environmental health services; and 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 a matter of priority, health service coverage should be achieved for population groups in greatest need, particularly those living in rural areas. [Chapter 6, Para 4]

5. (a) (vii) Promote health education in schools, information exchange, technical support and training; [Chapter 6, Para 5 (a) (vii)]

7. New approaches to planning and managing health care systems and facilities should be tested, and research on ways of integrating appropriate technologies into health infrastructures supported. The development of scientifically sound health technology should enhance adaptability to local needs and maintainability by community resources, including the maintenance and repair of equipment used in health care. Programmes to facilitate the transfer and sharing of information and expertise should be developed, including communication methods and educational materials. [Chapter 6, Para 7]

8. Intersectoral approaches to the reform of health personnel development should be strengthened to ensure its relevance to the "Health for All" strategies. Efforts to enhance managerial skills at the district level should be supported, with the aim of ensuring the systematic development and efficient operation of the basic health system. Intensive, short, practical training programmes with emphasis on skills in effective communication, community organization and facilitation of behaviour change should be developed in order to prepare the local personnel of all sectors involved in social development for carrying out their respective roles. In cooperation with the education sector, special health education programmes should be developed focusing on the role of women in the health-care system. [Chapter 6, Para 8]

9. Governments should consider adopting enabling and facilitating strategies to promote the participation of communities in meeting their own needs, in addition to providing direct support to the provision of health-care services. A major focus should be the preparation of community-based health and health-related workers to assume an active role in community health education, with emphasis on team work, social mobilization and the support of other development workers. National programmes should cover district health systems in urban, peri-urban and rural areas, the delivery of health programmes at the district level, and the development and support of referral services. [Chapter 6, Para 9]

10. Advances in the development of vaccines and chemotherapeutic agents have brought many communicable diseases under control. However, there remain many important communicable diseases for which environmental control measures are indispensable, especially in the field of water supply and sanitation. Such diseases include cholera, diarrhoeal diseases, leishmaniasis, malaria and schistosomiasis. In all such instances, the environmental measures, either as an integral part of primary health care or undertaken outside the health sector, form an indispensable component of overall disease control strategies, together with health and hygiene education, and in some cases, are the only component. [Chapter 6, Para 10]

12. (e) By continued efforts, to provide health and hygiene education and to ensure universal access to safe drinking water and universal access to sanitary measures of excreta disposal, thereby markedly reducing waterborne diseases such as cholera and schistosomiasis and reducing: [Chapter 6, Para 12 (e)]

13. (b) Public information and health education: [Chapter 6, Para 13 (b)]

13. (b) (i) Provide education and disseminate information on the risks of endemic communicable diseases and build awareness on environmental methods for control of communicable diseases to enable communities to play a role in the control of communicable diseases; [Chapter 6, Para 13 (b) (i)]

16. National and regional training institutions should promote broad intersectoral approaches to prevention and control of communicable diseases, including training in epidemiology and community prevention and control, immunology, molecular biology and the application of new vaccines. Health education materials should be developed for use by community workers and for the education of mothers for the prevention and treatment of diarrhoeal diseases in the home. [Chapter 6, Para 16]

18. In addition to meeting basic health needs, specific emphasis has to be given to protecting and educating vulnerable groups, particularly infants, youth, women, indigenous people and the very poor as a prerequisite for sustainable development. Special attention should also be paid to the health needs of the elderly and disabled population. [Chapter 6, Para 18]

21. Women. In developing countries, the health status of women remains relatively low, and during the 1980s poverty, malnutrition and general ill-health in women were even rising. Most women in developing countries still do not have adequate basic educational opportunities and they lack the means of promoting their health, responsibly controlling their reproductive life and improving their socio-economic status. Particular attention should be given to the provision of pre-natal care to ensure healthy babies. [Chapter 6, Para 21]

23. The general objectives of protecting vulnerable groups are to ensure that all such individuals should be allowed to develop to their full potential (including healthy physical, mental and spiritual development); to ensure that young people can develop, establish and maintain healthy lives; to allow women to perform their key role in society; and to support indigenous people through educational, economic and technical opportunities. [Chapter 6, Para 23]

24. Specific major goals for child survival, development and protection were agreed upon at the World Summit for Children and remain valid also for Agenda 21. Supporting and sectoral goals cover women's health and education, nutrition, child health, water and sanitation, basic education and children in difficult circumstances. [Chapter 6, Para 24]

25. Governments should take active steps to implement, as a matter of urgency, in accordance with country specific conditions and legal systems, measures to ensure that women and men have the same right to decide freely and responsibly on the number and spacing of their children, to have access to the information, education and means, as appropriate, to enable them to exercise this right in keeping with their freedom, dignity and personally held values, taking into account ethical and cultural considerations. [Chapter 6, Para 25]

26. Governments should take active steps to implement programmes to establish and strengthen preventive and curative health facilities which include women-centred, women-managed, safe and effective reproductive health care and affordable, accessible services, as appropriate, for the responsible planning of family size, in keeping with freedom, dignity and personally held values and taking into account ethical and cultural considerations. Programmes should focus on providing comprehensive health care, including pre-natal care, education and information on health and responsible parenthood and should provide the opportunity for all women to breast-feed fully, at least during the first four months post-partum. Programmes should fully support women's productive and reproductive roles and well being, with special attention to the need for providing equal and improved health care for all children and the need to reduce the risk of maternal and child mortality and sickness. [Chapter 6, Para 26]

27. (a) (ii) Undertake widespread adult education on the use of oral rehydration therapy for diarrhoea, treatment of respiratory infections and prevention of communicable diseases; [Chapter 6, Para 27 (a) (ii)]

27. (b) (i) Strengthen services for youth in health, education and social sectors in order to provide better information, education, counselling and treatment for specific health problems, including drug abuse; [Chapter 6, Para 27 (b) (i)]

27. (c) (ii) Provide concrete incentives to encourage and maintain attendance of women of all ages at school and adult education courses, including health education and training in primary, home and maternal health care; [Chapter 6, Para 27 (c) (ii)]

29. Educational, health and research institutions should be strengthened to provide support to improve the health of vulnerable groups. Social research on the specific problems of these groups should be expanded and methods for implementing flexible pragmatic solutions explored, with emphasis on preventive measures. Technical support should be provided to Governments, institutions and non-governmental organizations for youth, women and indigenous people in the health sector. [Chapter 6, Para 29]

30. The development of human resources for the health of children, youth and women should include reinforcement of educational institutions, promotion of interactive methods of education for health and increased use of mass media in disseminating information to the target groups. This requires the training of more community health workers, nurses, midwives, physicians, social scientists and educators, the education of mothers, families and communities and the strengthening of ministries of education, health, population etc. [Chapter 6, Para 30]

32. For hundreds of millions of people, the poor living conditions in urban and peri-urban areas are destroying lives, health, and social and moral values. Urban growth has outstripped society's capacity to meet human needs, leaving hundreds of millions of people with inadequate incomes, diets, housing and services. Urban growth exposes populations to serious environmental hazards and has outstripped the capacity of municipal and local governments to provide the environmental health services that the people need. All too often, urban development is associated with destructive effects on the physical environment and the resource base needed for sustainable development. Environmental pollution in urban areas is associated with excess morbidity and mortality. Overcrowding and inadequate housing contribute to respiratory diseases, tuberculosis, meningitis and other diseases. In urban environments, many factors that affect human health are outside the health sector. Improvements in urban health therefore will depend on coordinated action by all levels of government, health care providers, businesses, religious groups, social and educational institutions and citizens. [Chapter 6, Para 32]

34. (a) (iii) Ensure that public health education in schools, workplace, mass media etc. is provided or strengthened; [Chapter 6, Para 34 (a) (iii)]

34. (a) (iv) Encourage communities to develop personal skills and awareness of primary health care; [Chapter 6, Para 34 (a) (iv)]

41. (b) (ii) Develop and implement health education campaigns, particularly in developing countries, to reduce the health impact of domestic use of biomass and coal; [Chapter 6, Para 41 (b) (ii)]

45. Comprehensive national strategies should be designed to overcome the lack of qualified human resources, which is a major impediment to progress in dealing with environmental health hazards. Training should include environmental and health officials at all levels from managers to inspectors. More emphasis needs to be placed on including the subject of environmental health in the curricula of secondary schools and universities and on educating the public. [Chapter 6, Para 45]

46. Each country should develop the knowledge and practical skills to foresee and identify environmental health hazards, and the capacity to reduce the risks. Basic capacity requirements must include knowledge about environmental health problems and awareness on the part of leaders, citizens and specialists; operational mechanisms for intersectoral and intergovernmental cooperation in development planning and management and in combating pollution; arrangements for involving private and community interests in dealing with social issues; delegation of authority and distribution of resources to intermediate and local levels of government to provide front-line capabilities to meet environmental health needs. [Chapter 6, Para 46]