1 Health andSustainable DevelopmentMeeting of Senior Officials and Ministers of HealthSummary ReportJohannesburg, South Africa19-22 January 2002 WHO/SDE/ : EnglishDistr.: LimitedWorld Health OrganizationSouthern AfricanDevelopment CommunityDepartment of HealthRepublic of South AfricaCopyright World Health Organization 2002 This document is not issued to the general public, and all rights are reserved by the World HealthOrganization (WHO). The document may not be reviewed, abstracted, quoted, reproduced or translated, inpart or in whole, without the prior written permission of WHO. No part of this document may be stored in aretrieval system or transmitted in any form or by any means - electronic, mechanical or other - without theprior written permission of WHO. The views expressed in this document by named authors are solely the responsibility of those andSustainable DevelopmentMeeting of Senior Officials and Ministers of HealthSummary ReportJohannesburg, South Africa19-22 January 2002 World Health OrganizationSouthern AfricanDevelopment CommunityDepartment of HealthRepublic of South AfricaHealth and Sustainable Development Meeting of Senior Officials and Ministers of Health |3 Table of Contents1| Meeting synopsispage: 52| Senior officials meeting page: 7 Poverty, Disease Burden and Sustainable Development Globalization, Trade and Health Environment and Health Implications of Urbanization, with Special Reference to Johannesburg Strengthening the Role of Health in Sustainable Development : From Rio to Johannesburg3| Ministerial segment page: 13 Annex 1 - Programmepage: 19 Annex 2- List of Participantspage.
2 23 Annex 3- Background Paper: Health and Sustainable Development page: 29|51| Meeting synopsis The Ministry of Health of South Africa, supported by the World Health Organization(Department of Health and Development ), organized and hosted a ministerial meeting on Health and Sustainable Development in Johannesburg, South Africa, from 19-22 January2002. The meeting was one of a series to plan the Health agenda for the upcoming WorldSummit on Sustainable Development (WSSD). It was preceded by a WHO meeting, hostedby the Government of Norway, from 29 November to 1 December 2001 in Oslo, Norway onthe theme Making Health Central to Sustainable Development Planning the HealthAgenda for the World Summit on Sustainable Development . The present meeting brought together ministers of Health , senior officials and other repre-sentatives from countries of the Southern African Development Community (SADC), fromChina, India, Indonesia, Norway and the United States*, as well as representatives fromother ministries, international organizations, and non-governmental organizations.
3 Theobjective of the meeting was to help further define issues and strategies of relevance to thehealth agenda for the World Summit on Sustainable Development (WSSD). The meetingwas organized in two parts: a senior officials meeting which took place on 19 January, followed by a ministerial segment which took place from 20 to 22 January 2002. During the meeting of senior officials, a background paper, and a paper outlining ideas forinclusion in a declaration on Health and Sustainable Development , were considered. Thedeliberations were informed by presentations on Poverty, Disease Burden andDevelopment given by Professor Eric Buch of the University of Pretoria, Globalization,Trade and Health presented by Mr Nhlanhla Masuku of USK International (Pvt.) Ltd., Environment and Health Implications of Urbanization, with Special Reference toJohannesburg given by Ms Angela Mathee of the Medical Research Council of South Africa,and Strengthening the Role of Health in Sustainable Development : from Rio toJohannesburg presented by Dr Yasmin von Schirnding of the World Health the ministerial segment of the meeting, addresses were given by Dr Andrew Cassels,Director, Department of Health and Development , World Health Organization, theHonourable Mr Ronnie Kasrils, Minister of Water Affairs and Forestry, Republic of SouthAfrica, and the Honourable Ms Mathabiso Lepono, Minister of Environment, Gender andYouth Affairs, Kingdom of Lesotho.
4 The keynote address was given by the Honourable DrManto Tshabalala-Msimang, Minister of Health , Republic of South the sessions which followed, further deliberations took place on the background paper,and the draft declaration. Inputs and modifications were discussed and agreed, subsequentto which the Johannesburg Declaration on Health and Sustainable Development , and thebackground paper were adopted.* The United States was not present on the second day when the Declaration was finalized. Health and Sustainable Development Meeting of Senior Officials and Ministers of Health2| Senior officials meetingThe senior officials meeting was officially opened by the Director-General of Health ofSouth Africa, Dr Ayanda Ntsaluba welcomed all to the meeting. He highlighted the importance of this meeting indeveloping a Health sector position for the World Summit on Sustainable Development , andbriefly outlined the key issues of relevance in this regard.
5 He explained the organization ofthe meeting and emphasised the importance of working constructively together to present asuitable set of proposals to the ministerial segment of the meeting taking place from 21 to22 January order to inform the discussions during the course of the meeting, presentations weregiven in three theme areas: Poverty, Disease Burden and Sustainable Development Professor E. Buch. Globalization, Trade and Health - Mr N. Masuku. Environment and Health Implications of Urbanization, with Special Reference toJohannesburg- Ms A. Mathee. The background to work on Health and Sustainable Development , and the context to themeeting, was given by Dr Yasmin von Schirnding, Focal Point: Agenda 21, World HealthOrganization, in a presentation on Strengthening the Role of Health in SustainableDevelopment: From Rio to Johannesburg.
6 These presentations are summarized , Disease Burden and Sustainable DevelopmentProfessor Buch began his talk with an overview of the global disease burden. He emphasized thefact that, while there had been improvements in some indicators, the disease burden, for bothcommunicable and non-communicable diseases, still remained high and the poor carried a disproportionate burden of disease. Global Development goals and targets were unlikelyto be met unless efforts to achieve them were dramatically and rapidly scaled up, he looking at the linkages between poverty and ill- Health , it could be seen that poverty was atthe root of much ill- Health , and this poverty was multi-dimensional. At the same time, poorhealth could lead to poverty, both at the national, and household levels. Conversely, goodhealth could add billions of dollars to gross domestic product, and Professor Buch outlinedsome of the pathways through which this would asserted that Sustainable Development was the key to improved Health , since the povertydriving ill- Health was interconnected with factors such as poor economic growth, inequity,globalization, environmental degradation and weak Health services.
7 Health services had anHealth and Sustainable Development Meeting of Senior Officials and Ministers of Health |7important role to play in Sustainable Development by reducing the disease burden. However,this role was being undermined by the insecurity of Health services in many developingcountries, as well as under-funding and stunted technological Development . In considering ideas for a declaration on Health and Sustainable Development , Professor Buchsaid that this should be aimed at reinvigorating Sustainable Development , and focusing onways to bequeath a healthy life for present and future generations. Efforts should focus on thepoor and marginalized in all countries as they bear the greatest Health burden. He outlinedthe following as being fundamental in achieving healthy Sustainable Development : Reaffirmation of the global Development goals and targets for reduction of disease burden; Rapidly moving disease programmes to scale; Implementation of Sustainable poverty reduction strategies and ensuring that healthconcerns were addressed in these strategies; Renewed commitment to achieving the target of of GNP for Development aid, andearmarking funds within this for spending on poverty related ill- Health ; Bringing Health into global environment concerns; Wider use of Health impact examining ways to meet the critical need to strengthen and secure Health systems,Professor Buch outlined the following as being important for consideration in the declaration: A call for global commitment to strengthening Health systems.
8 Commitment by countries to invest a greater proportion of their own resources to healthservices alongside vastly increased external funding; Fair financing mechanisms to cover the costs of Health care; An agreement on ethical strategies to enable the retention of human resources in thedeveloping world; More research on the diseases of the poor; A worldwide campaign for global Health , Trade and HealthMr Masuku looked at the complexity of the relationship between globalization, trade andhealth, and referred to empirical evidence to date that suggests that trade liberalization-ledglobalization has largely disadvantaged developing economies in trade and Health reviewed the structural adjustment programmes of the international financial institu-tions which had left many developing countries with unsustainable balance of trade deficits,depleted foreign exchange reserves and subsequent shortages of essential medicines anddrugs.
9 These same failed policies have been discarded, or are being pushed through discussions in OECD countries and the World Trade Organization. 8| Health and Sustainable Development Meeting of Senior Officials and Ministers of HealthMr Masuku said that what was required was a resource-based Sustainable developmentagenda, with strong anti-poverty policies. Mr Masuku concluded that, in order for globaliza-tion to benefit trade and Health : Sustainable Development policies must take precedence over trade liberalization andother market-oriented policies; National governments must allocate at least 5 % of GDP to the Health sector; Equity in Health policies must be and Health Implications of Urbanization, with Special Reference to JohannesburgMs Mathee looked at urbanization as a driving force which ultimately led to pressures on theenvironment through the emission of pollutants into the air, water and soil.
10 This in turn led to: a deterioration in the state of the environment, and; the exposure of people to pollutants and toxics, often synergistically or cumulatively; a range of effects on Health , ultimately requiring; various actions, especially preventative actions, to address all of the above (policies, programmes, projects).She illustrated these with pictures and graphic examples of settings of environmental degradation and Health risk from the Johannesburg area. The example of inner city shackfarms in Johannesburg was drawn on to show how rapid unplanned urbanisation couldlead to people living in settings in which shelter was insecure, air quality was poor, access towater and sanitation was limited, income was minimal. In addition, residents of the shackfarms constantly had to deal with high levels of noise, a lack of adequate ventilation, limitedprivacy and the threat of violence.