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world community sometimes acts slowly. People at local
level can influence their situation more directly and
often more swiftly. This is what makes the work of the
Sundsvall Conference so important, because it
highlights concrete efforts. Global and local changes
must proceed hand in hand..."
Mrs.
Ingela Thalén
Minister of Health and Social Affairs Sweden
SUNDSVALL
STATEMENT ON SUPPORTIVE ENVIRONMENTS FOR HEALTH
The
Third International Conference on Health Promotion:
Supportive Environments for Health - the Sundsvall
Conference - fits into a sequence of events which
began with the UNICEF/WHO International Conference on
Primary Health Care, in Alma-Ata (1978), and the First
International Conference on Health Promotion in
Industrialized Countries, in Ottawa (1986). Subsequent
meetings on Healthy Public Policy, in Adelaide (1988)
and a Call for Action: Health Promotion in Developing
Countries, in Geneva (1989) have further clarified the
relevance and meaning of health promotion. In parallel
with these developments in the health arena, public
concern over threats to the global environment has
grown dramatically. This was clearly expressed by the
World Commission on Environment and Development in its
report Our Common Future, which provided a new
understanding of the imperative of sustainable
development.
The
Third International Conference on Health Promotion:
Supportive Environments for Health - the first global
conference on health promotion, with participants from
81 countries - calls upon people in all parts of the
world to engage ectively in making environments more
supportive to health. Examining today's health and
environmental issues together, the Conference pointed
out that millions of people are living in extreme
poverty and deprivation in an increasingly environment
that threatens their health, making the goal of Health
For All by the Year 2000 extremely hard to achieve.
The way forward lies in making the environment - the
physical environment, the social and economic
environment, and the political environment- supportive
to health rather than damaging to it.
The
Sundsvall Conference identified many examples and
approaches for creating supportive environments that
can be used by policy-makers, decision-makers and
community activists in the health and environment
sectors. The Conference recognized that everyone has a
role in creating supportive environments for health.
A
CALL FOR ACTION
This
call for action is directed towards policy-makers and
decision-makers in all relevant sectors and at all
levels. Advocates and activists for health,
environment and social justice are urged to form a
broad alliance towards the common goal of Health For
All. The Conference participants have pledged to take
this message back to our communities, countries and
governments to initiate action. We also call upon the
organizations of the United Nations system to
strengthen their cooperation and to challenge each
other to be truly committed to sustainable development
and equity.
A
supportive environment is of paramount importance for
health. The two are interdependent and inseparable. We
urge that the achievement of both be made central
objectives in the setting of priorities for
development, and be given precedence in resolving
competing interests in the everyday management of
government policies.
Inequities
are reflected in a widening gap in health both within
our nations and between rich and poor countries. This
is unacceptable. Action to achieve social justice in
health is urgently needed. Millions of people are
living in extreme poverty and deprivation in an
increasingly degraded environment in both and rural
areas. An unforeseen and alarming number of people
suffer from the tragic consequences of armed conflicts
for health and welfare. Rapid population growth is a
major threat to sustainable development. People must
survive without clean water or adequate food, shelter
and sanitation.
Poverty
frustrates people's ambitions and their dreams of
building a better future, while limited access to
political structures undermines the basis for
self-determination. For many education is unavailable
or insufficient, or, in its present forms, fails to
enable and empower. Millions of children lack access
to basic education and have little hope of a better
future. Women, the majority of the world's population,
are still oppressed. They are sexually exploited and
suffer from discrimination in the labour market and
many other areas which prevents them from playing a
full role in creating supportive environments.
More
than a billion people worldwide have inadequate access
to essential health care. Health care systems
undoubtedly need to be strengthened. The solution to
these massive problems lies in social action for
health and the resources and creativity of individuals
and their communities. Releasing this potential
requires a fundamental change in the way we view our
health and our environment and a clear, strong
political commitment to sustainable health and
environmental policies. The solutions lie beyond the
traditional health system.
Initiatives
have to come from all sectors that can contribute to
the creation of supportive environments for health,
and must be acted on by people in local communities,
nationally by gobernment and nongovernmental
organizations, and globally through international
organizations. Action will involve predominantly such
sectors as education, transport, housing and urban
development, industrial production and agriculture.
DIMENSIONS
OF ACTION ON SUPPORTIVE ENVIRONMENTS FOR HEALTH
In
a health context the term supportive environments
refers to both the physical and the social aspects of
our surroundings. It encompasses where people live,
their local community, their home, where they work and
play. It also embraces the framework which determines
access to resources for living, and opportunities for
empowerment. Thus action to create supportive
environments has many dimensions: physical, social,
spiritual, economic and political. Each of these
dimensions is inextricably linked to the others in a
dynamic interaction. Action must be coordinated at
local, regional, national and global levels to achieve
solutions that are truly sustainable.
The
conference highlighted four aspects of supportive
environments:
1.
The social dimension, which includes the ways in which
norms, customs and social processes affect health. In
many societties traditional social relationships are
changing in ways that threaten health, for example, by
increasing social isolation, by depriving life of a
meaningful coherence and purpose, or by challenging
traditional values and cultural heritage.
2.
The political dimension, which requires governments to
guarantee democratic participation in decision-making
and the decentralization of responsibilities and
resources. It also requires a commitment to human
rights, peace, and a shifting of resources from the
arms race.
3.
The economic dimension, which requires a
re-channelling of resources for the achievement of
Health For All and sustainable development, including
the transfer of safe and reliable technology.
4.
The need to recognize and use women's skills and
knowledge in all sectors, including policy-making, and
the economy, in order to develop a more positive
infrastructure for supportive environments. The burden
of the workload of women should be recognized and
shared between men and women. Women's community-based
organizations must have a stronger voice in the
development of health promotion policies and
structures.
PROPOSALS
FOR ACTION
The
Sundsvall Conference believes that proposals to
implement the Health For All strategies must reflect
two basic principles:
1.
Equity must be a basic priority in creating supportive
environments for health releasing energy and creative
power by including all human beings in this unique
endeavour. All policies that aim at sustainable
development must be subjected to new types of
accountability procedures in order to achieve an
equitable distribution of responsibilities and
resources. All action and resource allocation must be
based on a clear priority and commitment to the very
poorest, alleviating the extra hardship borne by the
marginalized, minory groups, and people with
disabilities. The industrialized world needs to pay
the environmental and human debt that has accumulated
through exploitation of the developing world.
2.
Public action for supportive environments for health
must recognize the interdependence of all living
beings, and must manage all natural resources taking
into account the needs of coming generations.
Indigenous peoples have a unique spiritual and
cultural relationship with the physical environment
that can provide valuable lessons for the rest of the
world. It is essential therefore that indigenous
peoples be involved in sustainable development
activities and negotiations be conducted about their
rigths to land and cultural heritage.
IT
CAN BE DONE: STRENGTHENING SOCIAL ACTION
A
call for the creation of supportive environments is a
practical proposal for public health action at the
local level, with a focus on settings for health that
allow for broad community involvement and control.
Examples from all parts of the world were presented at
the Conference in relation to education, food,
housing, social support and care, work and transport.
They clearly showed that supportive environments
enable people to expand their capabilities and develop
self-reliance. Further details of these practical
proposals are available in the Conference report and
handbook.
Using
the examples presented, the Conference identified four
key public health action strategies to promote the
creation of supportive environments at community
level.
1.
Strengthening advocacy through community action,
particularly through groups organized by women.
2.
Enabling communities and individuals to take control
over their health and environment through education
and empowerment.
3.
Building alliances for health and supportive
environments in order to strengthen the cooperation
between health and environmental campaigns and
strategies.
4.
Mediating between conflicting interests in society in
order to ensure equitable access to supportive
environments for health.
In
summary, empowerment of people and community
participation were seen as essential factors in a
democratic health promotion approach and the driving
force for selfreliance and development. Participants
in the Conference recognized in particular that
education is a basic human right and a key element to
bring about the political, economic and social changes
needed to make health a possibility for all. Education
should be accessible throughout life and be built on
the principle of equity, particularly with respect to
culture, social class and gender.
THE
GLOBAL PERSPECTIVE
Humankind
forms an integral part of the earth's ecossystem.
People's health is fundamentally interlinked with the
total environment. All available information indicates
that it will not be possible to sustain the quality of
life, for human beings and all living species, without
drastic changes in attitudes and behaviour at all
levels with regard to the management and preservation
of the environment.
Concerted
action to achieve a sustainable, supportive
environment for health is the challenge of our times.
At
the international level, large differences in per
capita income lead to inequalities not only in access
to health but also in the capacity of societies to
improve their situation and sustain a decent quality
of life for future generations. Migration from rural
to urban areas drastically increases the number of
people living in slums, with accompanying problems
including a lack of clean water and sanitation.
Political
decision-making and industrial development are too
often based on short-term planning and economic gains,
which do not take into account the true costs to our
health and the environment. International debt is
seriously draining the scarce resources of the poor
countries. Military expenditure is increasing, and
war, in addition to causing deaths and disability, is
now introducing new forms of ecological vandalism.
Exploitation
of the labour force, the exportation and dumping of
hazardous waste and substances, particularly in the
weaker and poorer nations, and the wasteful
consumption of world resources all demonstrate that
the present approach to development is in crisis.
There is an urgent need to advance towards new ethics
and global agreement based on peaceful coexistence to
allow for a more equitable distribution and
utilization of the earth's limited resources.
ACHIEVING
GLOBAL ACCOUNTABILITY
The
Sundsvall Conference calls upon the international
community to establish new mechanisms of health and
ecological accountability that build on the principles
of sustainable health development. In practice this
requires health and environmental impact statements
for major policy and programme initiatives. WHO and
UNEP are urged to strengthen their efforts to develop
codes of conduct on the trade and marketing of
substances and products harmful to health and the
environment.
WHO
and UNEP are urged to develop guidelines based on the
principle of sustainable development for use by Member
States. All multilateral and bilateral donor and
funding agencies such as the World Bank and
International Monetary Fund are urged to use such
guidelines in planning, developing and assessing
development projects. Urgent action needs to be taken
to support developing countries in developing their
own solutions. Close collaboration with
nongovernmental organizations should be ensured
throughout the process.
The
Sundsvall Conference has again demonstrated that the
issues of health environment and human development
cannot be separated. Development must imply
improvement in the quality of quality of life and
health while preserving the sustainability of the
environment.
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The
Conference participants therefore urge the United
Nations Conference on Environment and Development
(UNCED), to be held en Rio Janeiro en 1992, to take
the Sundsvall Statement into account in its
deliberations on the Earth Charter and Agenda 21,
which is to be an action plan leading into the 21st
century. Health goals must figure prominently in both.
Only worldwide action based on global partnership will
ensure the future of our planet.
This
Statement is the first of three outcomes from the
Sundsvall Conference. The Conference report and
handbook will expand the principles of the Statement
in the form of practical guidelines for action for the
future at all levels. Together, the three documents
provide a coherent way forward.
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