128. Sustainable human settlements depend on the creation of a better environment for human health and well-being, which will improve the living conditions of people and decrease disparities in the quality of their lives. The health of the population depends at least as much on the control of environmental causes of poor health as on clinical responses to disease. Children are particularly vulnerable to harmful urban environments and must be protected. Measures to prevent ill health and disease are as important as the availability of appropriate medical treatment and care. It is therefore essential to take a holistic approach to health, whereby both prevention and care are placed within the context of environmental policy, supported by effective management systems and plans of action incorporating targets that reflect local needs and capacities.

129. Health problems related to adverse environmental conditions, including a lack of access to safe water and sanitation, inadequate waste management, poor drainage, air pollution, and exposure to excessive noise levels, as well as ineffective and inadequate health services, exact a heavy toll on the quality of life and the overall contribution to society of millions of people. They may also aggravate social tension and inequity and increase the vulnerability of people to the effects of disasters. An integrated approach to the provision of environmentally sound infrastructure in human settlements, particularly for people living in poverty in rural and urban areas, is an investment in sustainable human settlements development that can enhance the quality of life, reduce negative impacts on the environment, improve the overall health of a population, and reduce the burden of investment in curative health and poverty alleviation.

130. Many pollution-related risks to health are particularly high in urban areas, as well as in low-income areas, because of higher concentrations of pollutants from, inter alia, industry, traffic, fumes from cooking and heating devices, overcrowding and inadequate solid and liquid waste management. Environmental risks in the home and the workplace may have a disproportionate impact on the health of women and children because of their different susceptibilities and rates of exposure to the toxic effects of various chemicals and given the nature of the tasks that women frequently undertake. Environmental risks may also have a disproportionate impact on children.

131. Many environmental contaminants, such as radioactive materials and persistent organic pollutants, work their way into the food chain and eventually into human beings, thus compromising the health of present and future generations.

132. Exposure to heavy metals, including lead and mercury, may have persistent and harmful effects on human health and development and on the environment. Children and people living in poverty are often particularly vulnerable, and it is of special concern that the effects of high lead levels on children's intellectual development are irreversible. Effective and affordable alternatives to many of the uses of these metals are available. Appropriate alternatives should be sought for those products where exposure to lead can be neither controlled nor managed.

133. Unsustainable and wasteful production and consumption patterns also lead to increasing problems in waste management. It is essential to intensify efforts aimed at minimizing the production and discharge of waste, and at recycling and reuse as much as possible and disposing of the remainder in an environmentally sound manner. This will require changes in attitudes and consumption patterns and in the design of buildings and neighbourhoods, as well as innovative, efficient and sustainable modalities for waste management.

134. The design of the built environment is recognized as having an impact on people's well-being and behaviour and, thereby, on people's health. Good design in new housing and in upgrading and rehabilitation is important for the creation of sustainable living conditions. The design of high-rise housing should complement the context of the neighbourhood in which it will be located. In particular, the large-scale development of high-rise housing can bring social and environmental disadvantages; therefore special attention should be paid to the quality of its design, including the scale and height, proper maintenance, regular technical inspection and safety measures.

135. The liveability of the built environment has an important bearing on the quality of life in human settlements. Quality of life implies those attributes catering for the diversified and growing aspirations of citizens that go beyond the satisfaction of basic needs. Liveability refers to those spatial, social and environmental characteristics and qualities that uniquely contribute to people's sense of personal and collective well-being and to their sense of satisfaction in being the residents of that particular settlement. The aspirations for liveability vary from place to place, and evolve and change in time; they also differ among the diverse populations that make up communities. Therefore, conditions for liveable human settlements presuppose a working democracy in which processes of participation, civic engagement and capacity-building mechanisms are institutionalized.

Actions

136. To improve the health and well-being of all people throughout their life-span, particularly people living in poverty, Governments at the appropriate levels, including local authorities, in partnership with other interested parties, should:

(a) Develop and implement national, subnational and local health plans or strategies and strengthen environmental health services to prevent, mitigate and respond to diseases and ill health resulting from poor conditions in living and working environments and the conditions of people living in poverty, and continue work towards the Agenda 21 objective of achieving a 10 to 40 per cent improvement in health indicators by the year 2000;

(b) Adopt measures to prevent and control air, water and soil pollution and to reduce noise levels, where appropriate, and develop and ensure access to appropriate preventive and curative health-care systems in order to tackle related health problems;

(c) Ensure adequate research to assess how and to what extent women and children are particularly susceptible or exposed to environmental degradation and hazards, including, as necessary, research and data collection on specific groups of women and children, particularly women with low incomes, indigenous women and women belonging to minorities;

(d) Improve shelter conditions so as to mitigate those health and safety risks, particularly risks to women, older persons, children and people with disabilities, that are associated with activities in the home;

(e) Build capacity at all levels for effective environmental health management;

(f) Develop and implement programmes to ensure universal access for women throughout their life-span to a full range of affordable health-care services, including those related to reproductive health care, which includes family planning and sexual health, consistent with the report of the International Conference on Population and Development;

(g) Develop, where appropriate, criteria for maximum permitted and safe levels of noise exposure and promote noise assessment control as part of environmental health programmes;

(h) Raise awareness of the interdependencies between the environment and health and develop within communities the knowledge, attitudes and practices needed to improve personal and community health, with special attention to hygiene;

(i) Promote, where appropriate, planning and good design in human settlements, both in new developments and in upgrading and rehabilitation, while emphasizing aesthetic qualities as well as sound and sustainable technical and functional qualities, enriching and enlightening the overall quality of life of people;

(j) Establish processes to increase the exchange of information, experience and technical assistance among national, subnational and local Governments, including among Governments at the same level, and across sectors for environmental health improvements;

(k) Ensure that due priority is given and adequate resources made available from all sources, at the national, regional and international levels, to combat the threat to individuals and public health posed by the rapid spread of HIV/AIDS globally and by the re-emergence of major diseases, such as tuberculosis, malaria, onchocerciasis (river blindness) and diarrhoeal diseases, in particular cholera;

(l) Promote safe and healthy workplace conditions for men and women.

(a) Develop and implement national and local plans, policies and specific cross-sectoral programmes addressing all relevant chapters of Agenda 21;

(b) Develop laws and policies that specify appropriate ambient environmental quality levels and set targets for environmental improvements and identify instruments for their achievement appropriate to national and subnational priorities and conditions;

(c) Establish, equip and build capacity for monitoring and evaluating compliance with environmental regulations and effectiveness of enforcement at all levels;

(d) Set environmental standards so as to facilitate the selection and development of appropriate technologies and their appropriate use;

(e) Identify and address the disproportionately high and adverse effects of policies and programmes on the human health or the environment of people living in poverty and those belonging to vulnerable and disadvantaged groups;

(f) Provide incentives and disincentives to promote the use of clean production and energy- and water-saving processes and technologies that, among other things, can increase economic opportunities in the areas of environmental technology, environmental clean-up and environmentally friendly products and can improve the attractiveness and competitiveness of human settlements for economic investments;

(g) Provide guidelines and training for the application of procedures for the assessment of environmental health impacts;

(h) Undertake environmental assessments and environmental impact assessments for development plans and projects, respectively, that may significantly affect the quality of the environment;

(i) Support mechanisms for consultations and partnerships among interested parties to prepare and implement local environmental plans and local Agenda 21 initiatives and specific cross-sectoral environmental health programmes;

(j) Raise awareness of environmental issues and develop within communities the knowledge, attitudes and practices needed for sustainable human settlements development;

(k) Take appropriate action to manage the use of heavy metals, particularly lead, safely and effectively and, where possible, to eliminate uncontrolled exposure in order to protect human health and the environment;

(l) Eliminate as soon as possible the use of lead in gasoline;

(m) In cooperation with the international community, promote the protection of the living environment and strive to restore contaminated land, air and water to levels acceptable for sustainable human settlements.

(a) Incorporate the principles and strategies contained in Agenda 21 and the Rio Declaration on Environment and Development in an integrated manner: the precautionary principle approach, the polluter pays principle, the pollution prevention principle, the ecosystem approach, including strategies pertaining to carrying capacity, and environmental and social impact assessments;

(b) Promote practices and patterns of production and consumption that will conserve and protect freshwater and saltwater resources and topsoil, as well as air and soil quality;

(c) Ensure that clean water is available and accessible to all human settlements as soon as possible through, inter alia, the adoption and improvement of technology, and ensure that environmental protection and conservation plans are designed and implemented to restore polluted water systems and rebuild damaged watersheds;

(d) Dispose as soon as possible, within both rural and urban areas, of sewage, waste waters and solid wastes, including hazardous wastes, in a manner that conforms with national or international environmental quality guidelines;

(e) Promote environmental protection and public health by proper treatment and the recycling and reuse of environmentally compatible sanitation and treatment/disposal of waste water and solid waste;

(f) Make a concerted effort to reduce the generation of wastes and waste products by, inter alia, setting national and local goals for the reduction of packaging;

(g) Develop criteria and methodologies for the assessment of environmental impacts and resource requirements at the local level throughout the life cycle of products and processes;

(h) Develop and implement legal, fiscal and administrative mechanisms to achieve integrated ecosystem management;

(i) Establish mechanisms to ensure transparent, accountable and cost-effective management and maintenance of infrastructure.

(a) Promote the conservation and sustainable use of urban and peri-urban biodiversity, including forests, local habitats and species biodiversity; the protection of biodiversity should be included within local sustainable development planning activities;

(b) Protect existing forest resources and promote, where possible, afforestation around and within human settlements in order to fulfil basic needs relating to energy, construction, recreation and food security;

(c) Encourage, where appropriate, the establishment of productive and recreational green belts around urban and rural agglomerations in order to protect their environment and contribute to the provision of food products;

(d) Reduce significantly the degradation of the marine environment emanating from land-based activities, including municipal, industrial and agricultural wastes and run-off, which have a pernicious impact on the productive areas of the marine environment and coastal areas;

(e) Ensure that children have access to the natural world on a daily basis through free play outdoors, and establish education programmes to help children investigate their community environments, including natural ecosystems;

(f) Ensure adequate opportunity for public participation by all interested parties at all levels of environmental decision-making.

141. Meeting this challenge requires an integrated approach to water resources management that takes cognizance of the links between water, sanitation and health, between the economy and the environment, and between cities and their hinterland, and harmonizes land-use planning and housing policies with water sector policies and ensures a comprehensive and coherent approach to setting and enforcing realistic standards. A strong political commitment, cooperation across disciplines and sectors, and an active partnership of all interested parties is essential to integrated water resources management. To this end, Governments at the appropriate levels, in partnership with other interested parties, should:

(a) Pursue policies for water resources management that are guided by the broader consideration of economic, social and environmental sustainability of human settlements at large, rather than by sectoral considerations alone;

(b) Establish strategies and criteria (biological, physical and chemical water quality) to preserve and restore aquatic ecosystems in a holistic manner, giving consideration to entire drainage basins and the living resources contained therein;

(c) Manage supply and demand for water in an effective manner that provides for the basic requirements of human settlements development, while paying due regard to the carrying capacity of natural ecosystems;

(d) Promote the forging of partnerships between the public and private sectors and between institutions at the national and local levels so as to improve the allocative efficiency of investments in water and sanitation and to increase operational efficiency;

(e) Support responsible agencies in developing their capacity for assessing the demand of communities and incorporating such demand in the planning of environmental infrastructure services;

(f) Implement the institutional and legal reforms necessary to remove unnecessary overlaps and redundancies in the functions and jurisdictions of multiple sectoral institutions and to ensure effective coordination among those institutions in the delivery and management of services;

(g) Introduce economic instruments and regulatory measures to reduce wastage of water and encourage recycling and reuse of waste water;

(h) Develop strategies to reduce the demand for limited water resources by increasing efficiencies in the agricultural and industrial sectors;

(i) Carry out tenure regularization, as appropriate, in informal settlements to achieve the minimum level of legal recognition required for the provision of basic services;

(j) Promote the development and use of efficient and safe sanitary systems, such as dry toilets, for the recycling of sewage and organic components of municipal solid waste into useful products such as fertilizers and biogas;

(k) Take into consideration the needs of women in making technological choices in respect of the level of and access to basic services;

(l) Ensure the full and equal participation of women in all decision-making relating to water resource conservation, management and technological choice.

(a) The full participation of all interested parties in spatial planning, design and practices that contribute to sustainability, efficiency, convenience, accessibility, safety, security, aesthetics, diversity and social integration in human settlements;

(b) Interaction between and among different social groups through the development and maintenance of cultural facilities and communications infrastructure;

(c) An adequate supply of affordable housing for all;

(d) Legislation to safeguard the rights and interests of workers, to enhance consumer rights and to ensure security of tenure;

(e) An economic environment capable of generating employment opportunities, as well as offering a diversity of goods and services;

(f) Capacity-building, institutional development and civic engagement to contribute to integration and an overall productivity increase in human settlements.

144. In seeking to prevent transboundary pollution and minimize its impact on human settlements when it does occur, Governments should cooperate to develop appropriate mechanisms for assessing the environmental impact of proposed activities that are likely to have a significant adverse impact on the environment, including an evaluation of relevant comments provided by other potentially affected countries. Governments should also cooperate to develop and implement mechanisms for prior and timely notification, exchange of information and consultation in good faith, and mitigation of the potential adverse effects regarding those activities, taking into account existing international agreements and instruments.