Health and sustainable development

In 1992, the UN Earth Summit in Rio de Janeiro proclaimed, in its Agenda 21, that “people are at the centre of concerns for sustainable development and that they are entitled to a healthy and productive life in harmony with nature.” It looked as if the centrality of human wellbeing, health and survival to the sustainability project – both as criterion of success and as contributory asset – was at last being recognised. The subsequent 20 years, however, have seen little further progress. Human population health and its fundamental significance, as final-common-outcome of all other environmental and ecological disruptions and deficits, remains on the margins of understanding and priority in international policy discourse.

Health: the over-looked heart of sustainable development

Modern urban populations are largely oblivious to the fundamental sources of health and wellbeing. ‘Health’ is rarely discussed as an expression of shared ecological conditions and supports. Rather, the importance of ‘good health’ to each individual; the health-care system focus on treating individuals; the corrosive effect of neoliberalism on community perspectives; and our urban-centred distancing from the rhythms and vicissitudes of nature – all have contributed to a general ignorance about the dependence of population health on the diversity, vitality and biocapacity of the natural environment. Food does not grow in supermarkets; annual variations in influenza strains are not mere random events.

Poor health is only ever recognised when symptoms emerge

Although the linkage between environment, sustainability and human health has been slow to gain recognition, it is now happening – in part, ironically, because of the observable increase in health risks from the increased frequency and severity of extreme weather events and climatic conditions over the past two decades. However, full recognition requires a new mind-set and a refocus on more distant time horizons. Meanwhile, most national health ministries lack the expertise, vision and resources to engage more than cosmetically. The health dimension of the sustainability discourse is chronically under-represented in international conferences and agreements.

Milestones for health and sustainable development

Over the past half-century, various milestones – some positive, some negative in their contribution to this evolution of understanding – are worth noting. These include:

1962: Silent Spring: Rachel Carson’s now-famous book brought together research findings on toxicology, ecology and epidemiology fronts, showing that the increasing use of persistent organochlorine agricultural pesticides was causing ecological damage, bioaccumulation in food chains, and species losses – and posed risks to human health. 

1972: UN Environment Conference, Stockholm: High-level recognition of the intensification of local and regional environmental pollution as a blight on human health – urban air pollution, acid rain, heavy metals, persistent organochlorine pollutants, etc. National legislation was enacted to protect environments and to reduce toxicological risks to human health. There was, however, little explicit reference to exceeding environmental and ecological limits – and breaching ‘sustainability’.

1978: Alma Ata Declaration (WHO) on Health for All: Focus was on primary health care, without explicit reference to (prerequisite) environmental sustainability:

An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts.

1986: Ottawa Charter on Health Promotion (WHO):

Five action areas for health promotion were identified, one of them being: “Create supportive environments – the protection of the natural and built environments, and the conservation of natural resources must be addressed in any health promotion strategy.” Sustainable development was gradually entering the discourse.

1987: Report of UN World Commission on Environment and Development (Brundtland Report):  Showed little comprehension of the central significance of human health as the ultimate, integrating, measure of whether societies are on track to a socio-ecologically sustainable future that would underwrite Earth’s life-and-health-support system. Focus was on achieving balance between economic development and environmental conservation, and protecting the interests of future generations.

1992: UN Conference on Environment and Development (UNCED), informally known as the Earth Summit, Rio de Janeiro, June, 1992. Two health-related outputs from the conference were:

  1. Agenda 21: Protecting and Promoting Human Health: This document set human health as a central element in economic and social development (as quoted in opening paragraph).
  2. UN Framework Convention on Climate Change (UNFCCC): Seeks to stabilize atmospheric greenhouse gas concentrations at a level that would prevent dangerous anthropogenic interference with the climate system.

Article 1 (definitions) states:

1. "Adverse effects of climate change" means changes in the physical environment or biota resulting from climate change which have significant deleterious effects on the composition, resilience or productivity of natural and managed ecosystems or on the operation of socio-economic systems or on human health and welfare. (emphasis added)

1993: 'Planetary Overload: Global Environmental Change and the Health of the Human Species' by McMichael AJ, Cambridge University Press, 1993.  First book to explore comprehensively the risks to future population health from climate change and other human-induced systemic environmental changes (to stratosphere, oceans, soils, water supplies, biodiversity, etc.) Widely read, especially in North American university courses; still in print.

2000: UN Millennium Development Goals: an itemised approach to reducing major social, economic and population health deficits and inequities to agreed target levels, by 2015. In a missed opportunity, the health-related goals were only weakly linked to considerations of environmental and ecological support systems, which were sequestered in item #7 (‘Environmental sustainability’).

2008: Annual World Health Assembly, Geneva: High-level recognition of climate change risks to human health. WHA endorsed the proposed Research, Strategy and Action plan, including assistance to member states.

2012: United Nations Conference on Sustainable Development (Rio+20): This conference glossed over the extent and deeper significance of human-induced changes to the planet’s biophysical and ecological operating system. The omission of human health as a fundamental consideration of sustainable development was a glaring deficiency, indicating the persistence of widespread ignorance and narrow-visioned priorities at national governmental level. Again, the health sector was seriously under-represented at the conference.

The primary output, The Future We Want (UN 2012), listed seven priority areas: job creation, food security, water, energy, sustainable cities, oceans, and natural disasters. The failure to connect human welfare, health and survival to these first-order needs was widely criticised, including by the international medical journal The Lancet.

Immediately before the conference The Lancet published a special issue highlighting the indissoluble nexus between population growth, under-funded family planning programs, environmental pressures (including greenhouse gas emissions), and their linkage to short-falls in achieving the UN Millennium Development Goals that relate most directly to health, poverty and equity.

One redeeming outcome of the Rio+20 Conference was the statement in the draft Research Framework: “Global environmental change now impacts on local access, quality and use of air, water, land, and marine and terrestrial ecosystems, with implications for global health, food security, energy access, equity, and environmental justice. We are entering a new phase of human development on Earth, where science indicates that global sustainability is a prerequisite for human wellbeing at local as well as global scales.” (Emphases added)


There is, now (at last), a sufficient base of growing awareness to build on. However, until we understand fully how human health, lives and survival, over decades and generations, depends on the achievement of sustainable development, our policies and actions will be under-powered.  

Further readings/information

Haines A, Alleyne G, Kickbusch I, Dora C. From the Earth Summit to Rio+20: integration of health and sustainable development. Lancet 2012 379(9812):193.

The Lancet (editorial). Global health in 2012: development to sustainability. Lancet 2012; 379(9812):193.

United Nations. 1992. Agenda 21. Protecting & Promoting Human Health. Available: [accessed 7 August 2012].

UN Department of Economic and Social Affairs (2009). Agenda 21.

United Nations. 2012. The Future We Want—Zero Draft of Rio+20 Outcome Document.




January 2013

About the author

Canberra, Australia

Tony (AJ) McMichael is Professor Emeritus (Population Health) at the Australian National University, Canberra. He has had broad experience... (Read more)

Tony McMichael | Timeline for 'Health and sustainable development'

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