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A check-list for Johannesburg
EDITORIAL
THE LANCET Volume 360, Number 9333
A check-list for Johannesburg A formless, chaotic, and unwieldy talking shop, dogged by rows during the many preparatory meetings, and rigged in favour of corporate interests. Such are the advance notices for the World Summit on Sustainable Development, beginning next week in South Africa. It is easy for armchair critics to be cynical. Many of the goals of the 1992 Rio Earth Summit, set out in its action document, Agenda 21, have not been achieved. GEO-3, the recently published Global Environmental Outlook, describes increasing poverty, greater inequality, and continued political paralysis. Historically this summit comes at the most precarious moment since the end of the Cold War. Famine mixed with ruthless political violence in Southern Africa; geopolitical instability postSeptember 11; a threatened US war with Iraq; escalating conflict between Israelis and Palestinians; nuclear stand-off between Pakistan and India; economic collapse in Latin America; the globalisation of inequity; and successive corporate crises in the world’s dominant hyperpower. The so-called new world order now feels more like the old world order, simply writ larger. Therefore the temptation to be cynical should be put to one side. The Johannesburg summit will only work with vision, optimism, and courage. In 1992, the central theme of sustainable development was the environment, following the work of Gro Harlem Brundtland—the present Director General of WHO —and her World Commission on Environment and Development. In a decade, that emphasis has broadened to include health, water, food, conflict, and energy. In this week’s issue, The Lancet publishes an analysis of health’s contribution to this process by the WHO’s technical lead on sustainable development, Yasmin von Schirnding (p 632). What should doctors expect from Johannesburg? There are five tests that health professionals can apply. ● Water and sanitation: von Schirnding identifies access to clean water as the single most important prerequisite for health and sustainable development. 2·5 billion people—over a third of the world’s population—have no access to improved sanitation, and over 1·5 million children die each year from diarrhoeal disease. THE LANCET • Vol 360 • August 24, 2002 • www.thelancet.com
● Child health: If governments want to provide a healthier future for succeeding generations, two issues must be confronted—tobacco use and HIVAIDS. UNAIDS acts as an excellent focal point for advocacy, political change, and programme development. WHO’s tobacco-free initiative offers similar opportunities. But while HIV-AIDS is an easy issue for politicians to ally themselves with, antitobacco policies are more difficult to embrace given that the product remains legal. Indeed, tobacco is barely mentioned in GEO-3; it needs to be taken seriously by South African summiteers. ● Financing for development: Talk is necessary, but money is essential. Rich nations have failed to steer a course towards 0·7% of GNP for official development assistance. Lack of funding by these countries kills those living in poverty. This deliberate and amoral policy of neglect should be a key political issue in the western world. It is not. ● Population: Presently a low priority for Johannesburg, changes in population growth and structure are having substantial impacts on health and development. As a minimum, politicians must commit to family planning programmes—a particular source of embarrassment for the US government, which recently ended its funding for such international activities—and education, especially for women, about reproductive health. ● Conflict: A recent UN report concluded that countries spend over US $800 billion on weapons and other military resources—2·6% of the world’s GDP. Sustainable development demands security—is spending on arms the most productive way to achieve that security? Alternative solutions need to be debated. The World Summit on Sustainable Development is not a junket. It is a vital moment to hold governments to account for their stewardship of the world’s resources. The health professions have an increasingly important part to play in this debate. Their voices deserve to be heard not only in Johannesburg, but also in those countries whose governments could make a real difference to the lives of the poor.
The Lancet
581
For personal use. Only reproduce with permission from The Lancet Publishing Group.
THE LANCET Volume 360, Number 9333
A check-list for Johannesburg A formless, chaotic, and unwieldy talking shop, dogged by rows during the many preparatory meetings, and rigged in favour of corporate interests. Such are the advance notices for the World Summit on Sustainable Development, beginning next week in South Africa. It is easy for armchair critics to be cynical. Many of the goals of the 1992 Rio Earth Summit, set out in its action document, Agenda 21, have not been achieved. GEO-3, the recently published Global Environmental Outlook, describes increasing poverty, greater inequality, and continued political paralysis. Historically this summit comes at the most precarious moment since the end of the Cold War. Famine mixed with ruthless political violence in Southern Africa; geopolitical instability postSeptember 11; a threatened US war with Iraq; escalating conflict between Israelis and Palestinians; nuclear stand-off between Pakistan and India; economic collapse in Latin America; the globalisation of inequity; and successive corporate crises in the world’s dominant hyperpower. The so-called new world order now feels more like the old world order, simply writ larger. Therefore the temptation to be cynical should be put to one side. The Johannesburg summit will only work with vision, optimism, and courage. In 1992, the central theme of sustainable development was the environment, following the work of Gro Harlem Brundtland—the present Director General of WHO —and her World Commission on Environment and Development. In a decade, that emphasis has broadened to include health, water, food, conflict, and energy. In this week’s issue, The Lancet publishes an analysis of health’s contribution to this process by the WHO’s technical lead on sustainable development, Yasmin von Schirnding (p 632). What should doctors expect from Johannesburg? There are five tests that health professionals can apply. ● Water and sanitation: von Schirnding identifies access to clean water as the single most important prerequisite for health and sustainable development. 2·5 billion people—over a third of the world’s population—have no access to improved sanitation, and over 1·5 million children die each year from diarrhoeal disease. THE LANCET • Vol 360 • August 24, 2002 • www.thelancet.com
● Child health: If governments want to provide a healthier future for succeeding generations, two issues must be confronted—tobacco use and HIVAIDS. UNAIDS acts as an excellent focal point for advocacy, political change, and programme development. WHO’s tobacco-free initiative offers similar opportunities. But while HIV-AIDS is an easy issue for politicians to ally themselves with, antitobacco policies are more difficult to embrace given that the product remains legal. Indeed, tobacco is barely mentioned in GEO-3; it needs to be taken seriously by South African summiteers. ● Financing for development: Talk is necessary, but money is essential. Rich nations have failed to steer a course towards 0·7% of GNP for official development assistance. Lack of funding by these countries kills those living in poverty. This deliberate and amoral policy of neglect should be a key political issue in the western world. It is not. ● Population: Presently a low priority for Johannesburg, changes in population growth and structure are having substantial impacts on health and development. As a minimum, politicians must commit to family planning programmes—a particular source of embarrassment for the US government, which recently ended its funding for such international activities—and education, especially for women, about reproductive health. ● Conflict: A recent UN report concluded that countries spend over US $800 billion on weapons and other military resources—2·6% of the world’s GDP. Sustainable development demands security—is spending on arms the most productive way to achieve that security? Alternative solutions need to be debated. The World Summit on Sustainable Development is not a junket. It is a vital moment to hold governments to account for their stewardship of the world’s resources. The health professions have an increasingly important part to play in this debate. Their voices deserve to be heard not only in Johannesburg, but also in those countries whose governments could make a real difference to the lives of the poor.
The Lancet
581
For personal use. Only reproduce with permission from The Lancet Publishing Group.