Chapter 1. Issues: An Overview
ISSUES IN HEALTH, ENVIRONMENT AND SUSTAINABLE DEVELOPMENT: AN OVERVIEW
In this chapter, an introduction is given to issues in health, environment and sustainable development which are of worldwide concern today. Countries face a myriad of problems relating on the one hand to poverty and a lack of basic services, and on the other to large-scale, rapid industrialization, urbanization and technological development. Problems are often simultaneously local and global. Key milestones which have shaped recent thinking and approaches to dealing with health and environmental problems in the context of sustainable development are highlighted, and the challenges faced by the health sector are outlined.
THE CHANGING NATURE AND SCOPE OF CONCERNS
The spectrum of health, environment and development hazards has changed considerably over the millennia of human existence. In the past 50 years in particular, the world has seen considerable health gains. For example, childhood mortality and morbidity have been greatly reduced by better control and prevention of infectious diseases. People are living much longer. Between the 1950s and the 1990s, average life expectancy increased from 46 to 65 years, and the gap in life expectancy between rich and poor countries narrowed considerably, from 25 years in 1955 to 13.3 years in 1995 (1). There have been major advances in science and technology and health and medicine, infrastructure has expanded, literacy has increased, education has improved and incomes and opportunities have increased, especially for women. Yet, despite all this, in many instances the health gaps between and within countries are widening. Not all regions of the world have shared equally in improvements to health. Sub-saharan Africa, the world’s poorest region, still has average life expectancies far below those of the wealthiest countries. Underlying much of this unequal burden of disease is the fact that environmental factors are a major contributor to sickness and death throughout the world, especially in the poorest regions (2).
Old and New Problems Occurring Simultaneously
Age-old public health hazards such as inadequate and unsafe food and water, microbiological contamination of the environment and poor sanitation and environmental hygiene are still prevalent. In addition, new environment and
Health in Sustainable Development Planning: The Role of Indicators development problems have emerged, some of which appear to threaten the entire ecosystem. While factors associated with the development process and the changing use of technology have resulted in considerable gains to people throughout the world, they have also presented additional threats to people’s health. Many of the “newer” hazards associated with chemical contamination of the environment are as significant for developing countries as they are for industrialized countries. Countries nevertheless differ with respect to the spectrum of health, environment and development problems with which they have to deal and to which they give priority. The level of economic development and the policy choices of individual countries are important factors determining the nature of the problems faced and the ways in which they are addressed. In industrialized countries, typical health and environmental problems include outdoor air pollution, radon in homes and schools, the “sick building” syndrome, toxic chemicals in drinking-water, non-ionizing electromagnetic radiation and pesticide residues in food. In developing countries, health and environmental problems are often related to poverty and arise largely as a result of such factors as rapid, uncontrolled urbanization and agricultural and land-use practices. In addition to hazards related to pollution, vector-borne environmental diseases may be prevalent as well as health and environmental problems associated with a lack of proper shelter, water and sanitation or...
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