Health took its place at the center of deliberations as the World Summit on Sustainable Development got underway yesterday with delegates raising concerns that while there had been some advances in improving the health of people around the world since the Rio summit, the reality was that they were not on target.

Dr David Nabarro, Executive Director of the WHO opened the discussions saying that since Rio there had been an increased awareness of the fundamental role of health in sustainable development. This, he added, was reflected in international policies and trade agreements although poor people still bore the greatest burden of disease and were most vulnerable to polluted air, unclean water and unsafe working conditions.

But the cycle of disease, poverty and environmental degradation could not be broken without an injection of significant additional resources. He added that it would require at least $30bn to be spent on health each year to break this cycle. This would give rise to a six fold increase in productivity and would save six million lives each year. While this was a considerable sum, it amounted to only 0.1% of the GDP of the world’s richest nations, said Dr Nabarro.

But it was not only money that was needed. Partnerships at both international and national level, the transfer of technologies and new trade agreements were all required if the cycle was to be broken.

Other key areas he named were controlling and eradicating communicable diseases, particularly HIV/Aids, and improving maternal and child health.

Dr Robert Hecht, of the World Bank, said that important lessons had been learnt in the past 10 years, one of which was that specific health threats could be anticipated and targeted before they took hold.

HIV/Aids was one case, but another that had not been tackled, and which would pose a huge threat to health in developing countries in the years to come was tobacco. Extra resources were required, he said, but this had to be combined with sound government policies and an increased capacity to plan and manage.

They had also learnt that environmental health tended to fall between the cracks and that special partnerships were needed across the sectors of water, health and sanitation. Speakers from around the world spoke on these themes, reiterating the point that to create an environment that encouraged the good health of all, far more needed to be done to enable poor people to access clean water, air and sanitation, to improve health facilities and to increase access to medicines.

Norwegian health minister, Borge Brende, said the 13 million people on the brink of famine in southern Africa were a reminder of how natural resources were fundamental to health.

“We should not leave the summit without a clear plan for addressing the famine in southern Africa . and to addressing the barriers that prevent people in developing countries from accessing vaccines and medicines,” was the contribution of South African health minister Dr Manto Tshabalala Msimang.