1. Public health and environment 1 |1 | Including Health into Rio + 20 debates and decisions _____ Dr Carlos Dora Interventions for Health Environments Department of Public Health and Environment World Health Organization

2. Public health and environment 2 |2 | 1.The development of new sustainable development goals (SDGs) post 2015 has started and should gain momentum following the Rio+20 conference. 2.The Rio + 20 discussions are likely to influence the new SDGs. 3.Health is not included as such in the list of critical issues being discussed at the Rio + 20 conference on sustainable development. 4.Health is closely linked those critical issues (as listed in the UN website): energy, food, water, jobs, cities, oceans and disasters. 5.Health indicators that help assess the impacts/success of policies in those critical areas are being developed through expert consultation (questionnaire survey and meeting). 6.These indicators should help mainstream health into the Rio discussions, and hopefully contribute to the new SDGs. Key Messages

3. Public health and environment 3 |3 | Mandate: Health in Rio + 20 Zero Draft and briefing with Missions in Geneva 1.Health is an important input to sustainable development – healthy people are better able to learn, work and contribute to their economies and societies. Universal access to health services is key input to better health. 2.Sustainable Development can improve health – smart strategies for transport, housing, energy & agriculture reduce NCDs and diseases of poverty, and enhance health (e.g. physical activity). This is not automatic! "Health in green economy" opportunities have not been fully exploited. Health risks and benefits of different economic development strategies need more explicit consideration. 3.Health indicators can measure the success of sustainable development goals and support governance.

4. Public health and environment 4 |4 | The Health Sector can lead with evidence and indicators of Sustainable Development –Evidence on health impacts of sustainable development strategies/innovations (health determinants) –Wider use of Health Impact Assessment (HIA) to ensure health as an outcome of all policies –Define health-relevant goals, indicators, and tools for measuring/monitoring results

5. Public health and environment 5 |5 | Process for developing health indicators for Rio critical areas Consultation with experts on framework, rationale and proposed indicators Questionaire survey with further experts on health indicators for Rio critical areas Disseminate proposed indicators for discussion Review impacts/results following Rio Contribute to new SDGs

6. Public health and environment 6 |6 | Proposed framework for developing health indicators for Rio Framework proposed: determinants of health, health in all policies, DPSEA, health impact assessment. Analysis of how policies and strategies in the sectors discussed in Rio (energy, cities, jobs etc.) affect health – describe the chain of events Sector policies related distal and proximal determinants health outcomes Identification of health indicators that is associated with success of the strategies for that sector discussed in Rio.

7. Public health and environment 7 |7 | Connecting knowledge – making the link to the root causes of disease influenced by sector policies (Watkiss et al, 2003)

8. Public health and environment 8 |8 | Health evidence to promote transparency and accountability # coal fired power plants in use # number of motorized vehicles # of households using solid fuels for cooking and heating Indoor air pollution levels # of people exposed Cardiovascular disease Respiratory disease Pneumonia in children Chronic respiratory disease in mothers and children X Outdoor air pollution levels # of people exposed X

9. Public health and environment 9 |9 | Health as a measure of the sustainability of policies and investments Monitoring investments and policy implementation e.g. in water and sanitation

10. Public health and environment 10 | Inputs, Processes, OutputsOutcomes The global monitoring framework Regional Global National Joint Monitoring Programme (JMP) HH surveys Census Statistics Office Regional assessments (e.g. CSOs) Sector Info & Monitoring Agencies for water, sanitation, health Joint Sector Reviews Agencies + budget/finance UN-Water GLAAS

11. Public health and environment 11 | A global monitoring framework for W&S Financial flows Sector policies Institutional settings Human resource capacity describe the Use of water supply sources Use of sanitation facilities

12. Public health and environment 12 | Sanitation versus Water: Striking disparity, 2012 report highlights - World met target in 2010 - 783 million without imp water - 6% drinks from surface water - 7 countries <50% - World unlikely to meet target - 2.5 billion without - 1.1 billion defecate in open - 44 countries <50%

13. Public health and environment 13 | Dissemination: One page health briefings For each Rio critical issue: The links between sector policies and health Five health indicators Description of how health can inform success in the policies propose

14. Public health and environment 14 | WHO/Hans Everts Energy - % of households using clean fuels/cooking and heating technologies. Green jobs - % of workplaces/jobs meeting basic occupational health and safety standards – including air, water, exposure to chemicals and radiation, lighting & ventilation. Energy in health care – % of health care facilities with access to clean energy and water supplies. Governance – % of large projects integrating health co-benefits considerations into their planning and implementation, e.g. through a health impact assessment (HIA). Health indicators of Sustainable Development