Delhi Sustainable Development Summit

DSDS 2002: Plenary session 4, 10 February 2002

Managing Natural Resources for Society: Welfare and Health Implications
A Cassels and Y von Schirnding, WHO; Geneva
(Address delivered by Dr Yasmin von Schirnding; Focal Point: Agenda 21; WHO; Delhi Sustainable Development Summit , 8-11 February 2002)

"Sustainable Development and the Role of Health"

Mr Chairperson, Distinguished Colleagues, Friends
It is a privilege and an honour for WHO to have been asked to speak at this important meeting. Let me start with a few words about sustainable development and health in general. As is well known, sustainable development means integrating the economic, social and environmental objectives of society in order to maximise human well-being in the present, as well as in the future.

Our focus here is on the health dimension of sustainable development. Not to stress the importance of one sector alone, but because peoples’ health and well-being is genuinely central to all three pillars of the sustainable development agenda.

In this respect I would like to say a few words about the context in which we are working. I see six key themes or challenges to which we must respond.

First: we have been working for many years to put health higher on the international political and development agenda. In many ways we have made spectacular progress – due in part to the collective efforts of civil society, national governments and international organisations. But also, let us not forget, the growing prominence is also due to the overwhelming seriousness of the health problems facing our societies – not least HIV/AIDS.

Increased political attention brings new actors to the scene. Not all are familiar with the problems of development that many of us have worked with for years. We have to articulate complicated agendas like the role of health in sustainable development as clearly and succinctly as possible.

It is indeed a complex agenda. The environment is connected to the economic. The economic to the social. The national to the international to the local. Causes and effects are hard to disentangle, particularly from a health perspective. And yet this is precisely the problem facing governments: how to find mutually supportive strategies; how to seek coherence across different sectors; how to ensure complementarity of policies; how to handle trade-offs; how to maximise the impact that can be achieved by an ever wider group of institutional actors.

Second: From targets to strategies. The conferences of the 1990’s have given us a series of important targets – the Millennium Development Goals endorsed by our Heads of State. The achievement of these goals, where once again health is prominent, is not just going to happen through economic growth alone. These goals can however be achieved if we focus on the things that matter – and move beyond targets to strategies and new ways of working – particularly in the field of development assistance, as discussed yesterday.

Third: we need to think about a new financial realism. What will it actually take to achieve the targets we have set? Various estimates have been made of what it might cost to finance an adequate set of interventions and the infrastructure that is needed for them to reach poor people.

There is no doubt that there is a gap, but – and this is the good news – mobilising the additional resources needed will have a huge pay-off in terms of the goals of sustainable development.

We have a growing body of evidence that we have previously under-estimated the economic losses that result from ill health – and the other side of the coin, the gains in terms of economic development and poverty reduction that can accrue to countries that invest in peoples’ health.

The fourth theme: is that with greater global attention to peoples’ health comes the impetus for global action. We are seeing an increase in the number of global initiatives to address key health problems – this is undoubtedly a positive development, if it succeeds in leveraging new resources for health. But in the long term it will be even more important if it succeeds in leveraging new institutional behaviours. By which I mean making sure that it helps show the way to focusing on critical health problems, whilst at the same time strengthening nationally-led development processes – such as poverty reduction strategies and sector programmes.

Fifth: As we examine the role of health in sustainable development, we need to look at health in the round. Not just the health sector as it is traditionally defined, not just health interventions – but the nexus of policies and practices across government and civil society that impact on peoples’ health.

We cannot ignore the determinants of ill health – those that are rooted in the environment, those that result from changes in life-style and living habits, those determined by the food we eat or the water we drink, and those that are a function of peoples’ access to information, services and political power.

At this point I would like to highlight one particular concern. And that is this: how can governments establish mechanisms that help to drive healthy public policy through all their areas of responsibilities? Can it just be the responsibility of the Ministry of Health to advocate and lobby? However effective they may be, this is a lot to ask. How do we make health everyones’ business? The business of all sectors – be they agriculture, housing, energy, transport…

In sum, the challenge is: how to move on from the idea that health is central to sustainable development to an institutional reality where it starts to influence policy and practice.

The last of the themes concerns – once again – the fact that health is not solely a national issue. Achieving an impact on poverty reduction or sustainable development in any country is influenced by a wide range of international factors and agreements.

These include the management of debt, a growing interest in the application of human rights accords to economic and social development, international trade agreements that affect access to markets world wide and influence the price of key commodities; and systems and incentives that influence the production of global public goods –those things that require co-operation between countries for their production and whose benefits extend beyond the borders of a single nation.

Focusing on the last point: we have much in our current armoury which can help address the health of poor people. But we need more – much more. Better systems of surveillance, better ways of performing (and tools for measuring how well we are performing), more research on "neglected" diseases and ill-health conditions, on new and emerging health problems, on applying what we currently know about disease and ill-health in a more effective manner (both from a preventive as well as a curative perspective) etc.

In framing the health agenda for WSSD, what should our messages be? Our own sense is that we need a two-pronged approach. First, that investment in people’s health has a major payoff in terms of all three pillars: environmental, social and, particularly economic development. Health has been an undervalued strategy in the war against poverty. We have the evidence it is now time to act.

The second prong looks at the role of health in greater depth in relation to the specific issues that will form the agenda for WSSD. These will emerge from the regional prepcoms, from the various multistakeholder dialogues, from the prepcom process underway at the global level. There is some way yet to go. But there is little doubt that whatever the themes are agreed – be they concerned with energy, water resources, agriculture, climate, poverty – that health will have a role to play.

In framing our message, I am certain that it will be useful to pick out key factors from our analysis of context: an international environment that supports national action; additional financial resources from national and international sources, with much work to be done on new mechanisms to ensure they reach where they are needed and that they are well spent; effective systems both within the health sector and across governments – with health as a driver of public policy; people at the centre of the frame with a focus on better outcomes; and a sustained effort to mobilise popular support for all these efforts.