According to the Rio Declaration in 1992, the 'Protecting and promoting human health conditions' action item under Agenda 21 must address the "primary health needs of the world's population, since they are integral to the achievement of the goals of sustainable development and primary environmental care. The linkage of health, environmental and socio-economic improvements requires inter-sectoral efforts".

The United Nations Development Programme's (UNDP) Global Health and Development Programme addresses the relationship between health and sustainable human development. Health interventions in developing countries are likely to be sustainable in the presence of political, social and economic environments, which support them. In recent years a series of major initiatives have been launched, namely, the International Partnership against AIDS in Africa (IPAA), the International AIDS Vaccine Initiative (IAVI), the Global Alliance for Vaccines and Immunisation (GAVI), Roll Back Malaria, the Malaria Medicines Initiative (MMV) and the Stop TB Initiative.

Over the past few years the EC and the World Health Organisation (WHO) have developed a productive partnership at policy level. The organisation of a high ministerial level round table on communicable diseases in 2000, the development of the EC programme for action on these diseases, the establishment of the Global Fund, and progress on drug affordability are clear results of such international policy agreements.

Actions, such as the abolition of tariffs and tax barriers to reasonably cheap drugs from abroad, are being evaluated by the 'Agreement on related aspects of Trade and Intellectual Property Rights' (TRIPS), and we need more medicines at affordable prices and delivered on a reliable basis to developing countries. The basic issue is to establish a clear balance between the implementation of TRIPS licensing and the voluntary supply to cheap medicines by pharmaceuticals.

The challenge of taking interventions to a global scale is being addressed with the Global Fund to fight HIV/AIDS, tuberculosis and malaria to which the EC is a major contributor. In the recent report of Working Group 5 of the Commission on Macroeconomics and Health2 (Part One, The Challenge), it is stipulated in 'A new commitment', point 32: "Global public health is at a critical point. The time is thus right for a new commitment to international action. This should take the form of a sustained programme aimed specifically at helping health systems in developing countries to control the most serious causes of ill health among the poor. It should make use of interventions that have already proven effective but which are not, at present, being applied as widely as necessary."

Food safety is an increasing global concern related to the liberalisation of trade, in particular since the foundation of the WTO and the introduction of novel foods, including GM foods, into the food chain. The global framework as regards food safety has been under development for a long time through the WHO and the Food and Agriculture Organization (FAO) with the Codex Alimentarius Commission3, the International Office of Epizootics (OIE) and the International Plant Protection Convention (IPPC). However, it has made a considerable shift in the past ten years through the World Trade Organisation (WTO) as a new global player, specifically with the Agreement on the Sanitary and Phytosanitary Measures (SPS). In order to improve international food standards, the WHO and the FAO have recently launched an evaluation of their joint food standards programme. The Community is playing an active role to ensure that the international framework encourages and defends the rights of countries to maintain high public health standards for food safety.

¹ Source: EC Publication Healthy Societies, Research DG (2002)

² Interventions, Constraints and Costs in Improving Health Outcomes of the Poor: The Report of Working Group 5 of the Commission on Macroeconomics and Health (2001)

³ FAO/WHO Codex Alimentarius: http://www.codexalimentarius.net/

In addition to the water-related components of Agenda 21, the Dublin International Conference on water and environment in 1992 has established key principles for water resources management. In December 2001, the Bonn International Freshwater Conference has developed a set of recommendations, in preparation for WSSD. The EU is also working with International networks such as the 'Global Water Partnership', the 'Collaborative Council on Water Supply and Sanitation' and others.