Climate change impacts health in very many ways. Its direct effect is in the form of death and injury from the various manifestations of heat stress, storm and surges, landslide and erosion, drowning from flood; vector, vehicle (water, air, vermin and insects) and food borne diseases; malnutrition due to falling agricultural yield (especially in the South-East Asian Region of WHO) and higher market price of cereals due to the fall in yield; mental health problems due to extreme and sudden weather events, migration, change in occupation and aggravation of poverty due to these events and higher cost of health care and medical care. 

United Nations Conference on Sustainable Development (Rio+20) 2012

On 24th December 2009 the UN General Assembly adopted a Resolution (A/RES/64/236) agreeing to hold the United Nations Conference on Sustainable Development (UNCSD) in 2012 - also referred to as 'Rio+20' or 'Rio 20'. The proposal for holding the conference was tabled by the Brazilian Government to follow up the 1992 Earth Summit held in the same place, i.e. Rio de Janeiro. It was supported, among others, by the Government of the People’s Republic of China. Mr. Sha Zukang, the United Nations Under-Secretary-General for Economic and Social Affairs was the Conference Secretary General.

The Conference was attended by about 50,000 people. A break-down of the total number of the accredited participants is given here: 10 047 from NGOs and major groups; 12 250 representatives of 191 Member States and 93 inter-governmental and specialized agencies (including 57 heads of states, 8 vice-presidents, 31 prime ministers, 9 deputy Prime Ministers, 487 ministers, 1 300 UN system representatives, 3 989 media representatives and 1 787 dialogue day participants). The total accredited participants were 29 373. The number of side events held in the main venue of Riocentro was 498. Side events were also held in outlying hotels.

There were three objectives of the Conference: to secure renewed political commitment for sustainable development; assess the progress to date since Rio Summit of 1992 and the remaining gaps in the implementation of the outcomes of the major summits on sustainable development; and finally to address the new and the emerging challenges.

The Conference focused on two areas:

• a green economy in the context of sustainable development and poverty eradication; and
• the institutional framework for sustainable development.

This third conference on sustainable development follows the 1992 and the 2002 Conferences held in Rio de Janeiro, Brazil and Johannesburg, South Africa respectively. The Johannesburg Conference also known as Rio+10, was the first Conference to take the title of Sustainable Development. There was another similar conference called the United Nations World Summit that was held in 2005. The Johannesburg  Conference produced a set of Declarations and a Plan of Implementation. The 2005 Summit, albeit included sub-sections on health, water and sanitation in light of sustainable development, mainly dealt on governance, political and social aspects. As may be seen, the 1992 Earth Summit was not exactly titled as sustainable development rather the United Nations Conference on Environment and Development (UNCED).

The first meeting ever on environment, by the United Nations, that is seldom referred to however, was in fact held in 1972 under the title of United Nations Conference on Human Environment (UNCHE). This 1972 Conference gave birth to the United Nations Environmental Programme (UNEP), which in 1988 established the Intergovernmental Panel on Climate Change (IPCC) in collaboration with the World Meteorological Organization (WMO).

Interestingly it was, the United States of America which came out with the concept of environment and development in the beginning. The first establishment of a national policy for environmental sustainability in the USA came in 1969 with the passage of the National Environmental Policy Act (NEPA), the purpose of which was to "foster and promote the general welfare, to create and maintain conditions under which man and nature can exist in productive harmony and fulfill the social, economic and other requirements of present and future generations." It was followed by the establishment of the Environmental Protection Agency of the USA in 1970.

It is suggested that the 1983 World Commission on Environment and Development (WCED), also known as the Brundtland Commission was a follow up of the 1972 Conference and the 1992 Conference was the follow up of the Brundtland Commission. The Commission produced its report in 1987 called Our Common Future.

In the Rio+20 Conference, a 283 paragraph outcome document, spread over 49 pages, called The Future We Want, was agreed upon. One positive aspect of the Conference was the avoidance of print materials pertaining to the conference proceedings. Soft copies were obtainable on the programmes, schedules and venue maps from the desk computers made available to the participants in the corridors of the conference centre. The main message of the Rio+20 Conference was to propose that Social Inclusion, Economic Development and Environmental Protection are the avenues to sustainable development. It also very boldly came out with the statement that the progress in achieving the Earth Summit 1992 has remained insufficient.

The zero draft of the outcome document of Rio+20 initially did not have any noticeable mention of health but the final document has discussed health quite extensively in paragraph 21, in paragraph 25 (relation between health and climate change) and a separate section on health population from paragraph 138 to 146. There were three intersession and three preparatory meetings held prior to the Rio+20 Conference over a period of about two years, which dealt on the zero draft. These meetings were participated by the UN Member States, inter-government agencies, UN organizations and non government organizations. The health section mainly covered universal health coverage, non-communicable diseases and health systems including human resources for health and logistics. HIV/AIDS was covered prominently. Separate sections dealt on climate change; food security, nutrition and agriculture; water and sanitation; and chemicals and wastes. Availability of the sexual and reproductive health services and the promotion and protection of all human rights found prominent space in the document. Support to Beijing Platform for Action and International Conference on Population and Development, reduction of maternal and child mortality, improvement of the health of women, men, youth and children and gender equity were prioritised. The document did not give a clear declaration on availability of sexual and reproductive right.

Health has been recognised as a precondition for, an outcome of, and an indicator of all three dimensions of sustainable development and it was also agreed that the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and non-communicable diseases. It was agreed that the Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health will be abided by all the parties. The good thing is that the leadership of WHO was recognised per the document.

WHO was recognised as the lead agency on matters of health, while decision was taken to abolish the Commission on Sustainable Development and to replace it with a Universal Intergovernmental High Level Political Forum. While UNEP expected to get a higher profile as an Organization from its present status of Programme it did not in fact decided in the Conference. The only decision in favour of UNEP was that it will be further strengthened. Decision was taken for a new theme- Sustainable Global Development (SDG), which will be presented in the 68th United Nations General Assembly, which might be the future form of the Millennium Development Goals, when its tenure expires in 2015. Colombia and Guatemala were proposers for the SDG. The goals and targets of SDG have not been worked out yet. The areas that will be covered are: Combating poverty, Changing Consumption Patterns, Promoting Sustainable Human Settlement Development, Biodiversity and Forests, Oceans, Water Resources, Advancing Food Security, Energy, including from renewable sources.

Some other areas, relevant to health that the Conference deliberated on were: transfer of technology, transparency, empowerment, equity, support to major groups, ICT, public private partnership, sustainability related information to be given in the yearly report of corporations, urban planning, transportation, energy, green economy, forest, biodiversity (decade of Biodiversity from 2011 to 2020).

By 2020 sound management of chemicals for protecting human health and environment, Strategic Approach to International Chemical Management (SAICM), life cycle approach in chemicals management, 3Rs (reduce, reuse and recycle), phasing out of hydro fluorocarbon were suggested under the heading of chemicals and wastes.

Advocacy was done for allocation of 0.7% of GNP of the developed countries to the developing countries and 0.15% to 0.2% to the least developed countries ensuring quality of assistance and its development impact, south-south cooperation, further simplification of GEF process, capacity building, knowledge management and sharing.

Access to safe water and basic sanitation, human right for drinking water, 2005-2015 International Decade for Action-“Water for Life”, flood and drought and efficiency of water management and assurance of water quality and safety were the salient features under the section of water and sanitation.

The Conference received commitment of more than $513 billion for sustainable development, including in the areas of energy, transport, green economy, disaster reduction, desertification, water, forests and agriculture, and 713 voluntary commitments for sustainable development registered by governments, business, civil society groups, universities and others.

Rio+20 Summit however, met scathing criticism in the blog columns of the Guardian and the Times. The Guardian blog heading reads “Rio +20 makes no fresh, green breast of the new world” and says that unlike the original Earth summit in Rio in 1992, which produced agreements on preserving the climate, the biodiversity of the world and its oceans, this retread produced nothing of substance and no commitment to preserve the fresh green breast of this world.

Brazil had it all wrapped up by Tuesday, three full days before the conference ended. The hosts did so with an ingenious use of typography. In international negotiations, squared brackets are the great signifiers – they denote passages of the text of a proposed agreement that are not yet agreed upon. At summits, environmental and otherwise, the focus of negotiations is teasing out these thickets of square brackets into words that can be agreed by all.

Brazil cut this Gordian knot by simply sweeping out of the text nearly every phrase captured within square brackets. It was a master stroke of diplomacy – every item of controversy was simply removed. As a result, there were no discussions of any substance because there was nothing to discuss. The text was so anodyne there was nothing in it which could be disagreed. So the talks fell, in tumult, to a lifeless ocean (http://www.guardian.co.uk/environment/blog/2012/jun/25/rio-20-great-gatsby).

The TIME heading GOING GREEN: What the Failure of Rio+20 Means for the Climate says “expectations were extremely modest for the Rio+20 Earth Summit that ended last week—and the best thing that might be said about the conference is that it managed to clear that very low bar. Despite the presence of more than 50,000 people and about 100 heads of state and government—though not, notably, U.S. President Barack Obama—the summit produced very little of note. The final statement that was negotiated at Rio—titled "The Future We Want"—was 253 paragraphs of affirmations and entreaties that added up to little more than a plea for something better.

The Chinese diplomat Mr. Sha Zukang, who headed Rio+20 for the U.N., called the statement "an outcome that makes nobody happy," UN Secretary General Mr Ban Ki Moon termed the document as timid. Environmental NGOs screamed "A failure of epic proportions" said the executive director of Greenpeace International, adding that the statement itself was "the longest suicide note in history." (http://www.time.com/time/health/article/0,8599,2118058,00.html)