There is increasing understanding that poverty and ill health are among the main driving forces behind environmental degradation and that a healthy environment is essential for good health and effective poverty alleviation.

Clearly, there can be no sustainable development without ensuring basic health services for all and giving people the means and opportunities to work their way out of deprivation and poverty.

This is why the interlinkages between poverty, environment and health should be at the centre of our attention at the World Summit on Sustainable Development in Johannesburg next year.

Health and the environment
We know that the environment in which people live significantly affects their health and the quality of their lives.

Environmental factors that have a negative influence on human health include:

• Unsafe and scarce drinking water and inadequate sanitation. It is estimated that more than 1 billion people do not have access to adequate supplies of clean water, and that 3 million people die every year of water-borne diseases. Around 90 per cent of malaria cases in the world are attributable to environmental factors.

• Indoor and local air pollution. Many of the world’s households use unprocessed solid fuels for cooking and heating and have insufficient ventilation. It is estimated that 2 million people die every year as a result of exposure to indoor pollution. Local pollution also poses a health hazard in many large cities, and increased urbanization may lead to even greater health problems caused by environmental factors.

• Food security (healthy food and long-term security of supply). A healthy environment for food production is essential for a sustainable food supply and good nutrition. Food contamination is a growing problem. Organic chemicals and heavy metals that persist in the environment and accumulate through the food chain may have adverse effects on human health, leading to cancer, reduced fertility and neurological damage. Security of supply depends on conserving soil productivity and protecting genetic diversity, as well as on how the resources are used.

• Global warming. Climate and weather affect human health in many ways. The incidence of extreme weather is increasing. Storms, hurricanes and floods kill thousands of people every year and increase the risk of contaminated water.

These examples clearly illustrate the interlinkages between health and the environment. Both communicable and non-communicable diseases are highly influenced by environmental conditions. The World Health Organization reports that 25 per cent of all preventable illnesses are directly caused by environmental factors.

Poverty and the environment
The burden of health problems caused by environmental factors to a large degree rests on the shoulders of the poor. In fact, the overwhelming majority of the 3 million people who die every year from water-borne diseases are poor people. The 2 million people who die every year of indoor pollution are mostly poor children and women.

Recent estimates suggest that premature death and illness due to major environmental risks account for a fifth of the total burden of disease in the developing world. The disease burden from environmental risks is far less in rich countries.

While the poor are generally hit the hardest by environmental degradation, poverty itself is also a main factor behind the continuing degradation of the environment that results from extreme population growth, deforestation and overexploitation of marginal land, mushrooming urbanization and production without cleaning technologies.

We cannot expect the poorest to work their way out of this poverty trap alone. Coherent international action is required.

Multi-sectoral approach
Many determinants of environmental health are of a cross-border nature and can therefore only be dealt with on the basis of a common international understanding and commitment. Today it is particularly important to ensure the early ratification of the Cartagena Protocol on Biosafety to the Convention on Biological Diversity, the Kyoto Protocol to the United Nations Framework Convention on Climate Change and the recently concluded Convention on Persistent Organic Pollutants. The phasing out of the use of toxic and bio-accumulative chemicals is a prerequisite for securing safe food. Further global action in this field should focus on reducing health risks stemming from heavy metals. Norway has suggested that UNEP should initiate a global assessment process beginning with mercury and, as appropriate, other heavy metals that give cause for concern.

Global problems have been held hostage by the need for consensus

We must work together to identify an appropriate policy approach and develop comprehensive multi-sectoral strategies in the field of environmental health. The development of environmental health policy tools to ensure the mainstreaming of environment and health concerns in all sectors should be encouraged. Moreover, strategic and health impact assessments, improved risk management, development of a better knowledge base on the interlinkages between poverty, health and the environment, and better education are all measures that should be further expanded and developed.

Norway gives priority to supporting the developing countries’ efforts to improve environmental conditions and human health and supports effective implementation of international conventions and rules. Concrete measures to combat environment-related health problems must be based on local conditions and priorities. Within our development assistance programmes, improved sanitation and water services are given priority along with improved energy services to poor households. Cleaner production initiatives to improve local air quality are also prioritized. Measures in urban areas focus on improving the living conditions of the poorest segments with an emphasis on health and the environment.

Cooperation at every level
Global, national and local efforts for social progress and environmental protection must underpin each other. Since Rio, we have seen progress in many fields, particularly with regard to local and national initiatives. Too often, however, global problems have been held hostage by the need for consensus. Regretfully, most states are reluctant to undertake obligations that go to the core of their economic life, regardless of the long-term benefits.

The way the larger developing countries grow, and the way they use natural resources, will affect the whole world. It is of the utmost importance to everyone that they use environmentally friendly technologies and management principles, and seek broad-based economic and social development. Communicable diseases, many of our most pressing environmental problems, and streams of refugees seeking a better life, represent challenges to every nation. They are truly international problems that can only be solved by joint international action.