Sdg 3 Ensure Healthy Lives and Promote Well

81 GOAL #3 GOOD HEALTH AND WELL-BEING ALL AGES BEING FORALLAT PROMOTE WELL- HEALTHY LIVESAND SDG Anthony Capon Christopher N.H.Doll Ralph Chapman Elinor Chisholm José Siri Philippa Howden-Chapman 3

ENSURE 82 GOAL #3 GOOD HEALTH AND WELL-BEING 83 GOAL #3 GOOD HEALTH AND WELL-BEING 84 INTRODUCTION

sdg 3 seeks to ensure health and well- (sdg 11). Health and well-being are also being for all, at every stage of life. In critically dependent on a safe and enabling its 1948 constitution, the World Health environment, supported by mitigation Organization defined health as “a state of of climate change (sdg 13) and sustainable complete physical, mental, and social well- protection and use of the oceans (sdg 14) being and not merely the absence of disease and land (sdg 15) (Waage et al., 2015). or infirmity” and this is the definition The broad interdependence between envi- adopted here. sdg 3 is underpinned by nine ronmental and human health is recognised targets that broadly fall into separate, but in systems thinking and the new focus overlapping groups: reducing morbidity on planetary health (Whitmee et al., 2015; and mortality for vulnerable groups Gatzweiler et al., 2017). (mothers, newborns, the elderly and The text that follows provides an children), reducing communicable and overview of interactions at the goal level non-communicable diseases, reducing risk between sdg 3 – the ‘entry level goal’ factors (tobacco, substance abuse, road for this assessment – and the other 16 SDGs. traffic injuries and hazardous chemicals Taking into account all the underlying and pollution), providing universal targets of this entry goal, a set of key health coverage, and strengthening the interactions is identified between the sdg 3 health sector. While sdg 3 targets do not targets and those of other sdgs, principally specifically address the social determi- interactions within the range of the nants of health and well-being (csdh, highest magnitude or strongest impacts 2008; Solar and Irwin, 2010; Berkman et based on available scientific literature al., 2014), the importance of social factors, and expert knowledge. The typology and such as working conditions, income, seven-point scale for characterising the education, and housing, is recognised range of positive and negative interactions within other sdgs. Waage and colleagues described in the opening chapter to this noted that achieving health and well- report is used to assess the selected target- being for all relies not only on meeting the level interactions and the context in which sdg 3 targets, but also on ending poverty they typically occur. Illustrative examples (sdg 1), providing access to education (sdg 4), from different world regions show how achieving gender equity (sdg 5), reducing these linkages manifest in practice. Policy inequality between and within countries options are identified for how to max- (sdg 10), and promoting peace (sdg 16). imise positive interactions and minimise Health and well-being also relies on negative interactions between now and adequate services and resources, including 2030, and beyond. The chapter concludes infrastructure (sdg 9), food security and with a list of key knowledge gaps related agricultural production (sdg 2), decent to the interactions studied. work (sdg 8), sustainable consumption (sdg 12), provision of water and sanitation (sdg 6), access to energy (sdg 7), and resilient and inclusive cities that provide universal access to housing and transport 85 KEY INTERACTIONS AT GOAL LEVEL

3 + 1 3 + 2 Poverty reduction leads to improved health Health and nutrition are inextricably and well-being, while good health is a linked. The relationship between food strong enabling factor for effective poverty consumption and health is highly reduction. In fact, a healthy population context-dependent. Under-nutrition is is a prerequisite for development, consti- generally associated with poverty, whereas tuting an engine for economic growth. overconsumption can accompany either Conversely, it is very difficult to ensure poverty or wealth and may be associated health without addressing poverty. At with poor nutritional intake. The rela- low income levels, rising incomes lead to tionship between food and nutrition is health gains as basic needs are fulfilled bidirectional: in some cases, ill health (such as nutrition, health care, health can diminish the ability of households or awareness, and shelter). Increased income individuals to farm and produce food, or is likely to enable positive interaction to work and acquire food. Fundamentally, effects, yet beyond a certain threshold, meeting caloric and micro/macro nutri- further increases may not lead to further ent needs is a primary requirement positive health effects. Similarly, poverty for health. Interruptions in food intake reduction will have a greater effect and quality, whether short- or long- on health in the presence of diseases asso- term, can have lasting impacts on mental ciated with poverty, including aids, and physical development, impacts tuberculosis and malaria, as well as ne- that begin during pre-natal growth and glected tropical diseases, diarrheal and continue through childhood. Good respiratory diseases, and the consequences health also depends on consumption of of malnutrition. Where poverty reduction sufficient micronutrients over the life is most needed, governance structures course. Reducing hunger will result in are often ineffective, and great health immediate improvements in health, challenges usually exist. Reducing poverty and carries long-term implications for will generally result in immediate and physical, psychological and neurological long-term improvements in health. This development. Increasing agricultural relationship is highly bidirectional – production may improve food security and ill health can constitute an inescapable reduce hunger; however, it also impacts poverty trap, where governmental on the environment, with potential impli- redistribution is absent. Before conven- cations for infectious disease transmission, tional poverty reduction policies can and can negatively affect health through be effective, the poorest of the poor often contamination of local environments with need special assistance to enable them arsenic, cadmium and other pesticide to engage effectively with poverty reduction residues. Technological elements of food measures. Good governance, plus invest- and agricultural systems, including ment in health, skills, infrastructure and genetically modified organisms (gmos), education, is crucial to reducing poverty. monocultural crop production, food processing, forest clearing, and irrigation, have the potential to increase production, 86 GOAL #3 GOOD HEALTH AND WELL-BEING adversely affect futurefoodsecurity. but alsotoharmtheenvironment and geopolitical and economic considerations. geopolitical andeconomicconsiderations. induced extremeweatherevents,aswell also beincreasinglyaffected byclimate- agricultural production.Foodsecuritywill managezoonoticdiseasesrelatedto There ismuchuncertaintyabouthowto achievement. limits schoolattendanceandeducational can bebidirectional,aspoorhealth tionship betweenhealthandeducation knowledge tomorepeople.Therela- ciency ofhealthinterventionsandspread technologies) may increasetheeffi- using informationandcommunication technologies (suchashealthpromotion in developing-worldcontexts.New are universal,greatergainspossible rapid change.Whiletheserelationships important opportunitiesincontextsof early schooling–lifelonglearningoffers fits fromeducationarenotlimitedto reliance andempowerment.Healthbene- increased income,opportunity, self- can alsoaffect long-termhealththrough or theadoptionofnewtechnologies.It immediately throughchangedbehaviour sentiment). Educationcanaffect health contexts (asinthecaseofanti-vaccine both developing-anddeveloped-world can leadtopoorhealthdecisionsin ill health:forexample,misinformation can alsoplay astrongroleingoodor cation andothersourcesofinformation in thedevelopedworld.Informaledu- countries andhasalsobeendemonstrated education iswellknownindeveloping indeed, thefavourable impactofmaternal ence thehealthstatusofchildren– and paternaleducationcaneachinflu- individual andcommunitylevels.Maternal ciated withbetterhealth,atboth Access tohigh-qualityeducationisasso- 3

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decision-making andeconomicactivities. more timeandresourcestoparticipatein of womenorchildrencanoffer women equality, although improvedhealth effect onhealththangender In general,genderequalityhasagreater women facethegreatestinequalities. among thesegoalswillbegreatestwhere The strengthoftheenablinginteraction term (mediatedthroughchildcare). resources oraccessforwomen)long- immediate (whentheydirectlyimprove improved health.Healthgainsmay be economic gainsandhence overall to lead of women in the paidworkforcecan health outcomes.Increasingparticipation empowerment leadstoimprovedchild health decisionsfortheirchildren,so gains. Moreover, mothersmakemost in thesecasesandleadtoeasyhealth funded, andpromotinggenderequality contexts under-prioritisedandunder- Women’s healthissuesareinsome ables theachievementofbetterhealth. Improving genderequalitygenerallyen- management ofwatertreatment systems. themselves areaddingto the poor poor, itmay bethatwater-bornepathogens unidirectional, althoughwherehealthis contexts. Thisrelationshipisessentially also widespreadinmany high-income and environmental pollutionissues are disease isstillprevalent,butwaterquality world wherewater-borneinfectious is strongestinpartsofthedeveloping gains. Theinteractionbetweenthesegoals also leadstolong-termdevelopmental improving waterqualityandsanitation hepatitis) andimprovednutrition; (e.g. acutediarrhealinfections,viral of decreasedwater-borneinfections gains. Thelatterareimmediateinterms sanitation itisdifficulttoachievehealth – withoutcleanwaterandadequate and accessleadstoimprovedhealth In allcontexts,improvingwaterquality 3 3

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5 6 87 GOAL #3 GOOD HEALTH AND WELL-BEING air pollution)althoughoften avoidable. impacts arelikely(e.g.mortality from environment, avarietyofadversehealth health issues.Whereitdamagesthe rapid economicgrowthmay leadtonew gains asworkers’incomeincreases.Yet, (sdg1), economicgrowthleadstohealth example, whereitreducespoverty sdg8 ishighlycontext-dependent.For The relationshipbetweensdg3and sources whereavailable. access cleaner(moreexpensive)energy poverty canreducehouseholdabilityto some cases,poorhealthandconcomitant use arestronglytechnology-dependent.In interactions betweenhealthandenergy temperature andweatherpatterns.The imity tolow-lyingcoastalzonesandlocal locally uncertainbutmodifiedbyprox- offs. Long-termclimate-relatedrisksare and agriculturalactivitiessuchasburn- modes oftransport,andregionalindustries risk ismodifiedbylocaltopography, health –forexample,urbanairpollution interactions ofenergyproductionwith erate release.Geography canmodifythe of wastestorageandaccidentalordelib- Nuclear energyposesuniquerisksinterms caused bygreenhousegasemissions). and indirectimpactsfromclimatechange in themedium-tolong-term(e.g.direct unclean cookstoves)andverylargethreats pollutants orindoorairpollutionfrom from directexposuretoshort-livedclimate substantial short-termhealthissues(e.g. involving non-cleanenergysourcescreates countries. However, energydevelopment hospitalisation andmortalityintemperate health risks,suchasexcess-winter of affordable energycancreateoramplify have consequencesforhealth.Lack transport, andheating/cooling,allofwhich of otherbasicserviceslikehealthcare, economic developmentandtheavailability Affordable energycontributestoboth relationship betweenenergyandhealth. There aresynergiesandtrade-offs inthe 3 3

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medium aswellhigh-incomesettings. health canconstituteamajordraininlow-, growth andhealthisbidirectional.Ill The relationshipbetweeneconomic ful socialandenvironmental regulation. growth needtobemitigatedbycare wealth. Inaddition,theadverseimpactsof periods ofunemploymentorlack nets, whichmitigatetheconsequencesof the presenceandqualityofsocialsafety growth andhealthisstronglymodifiedby The relationshipbetweeneconomic growth andbetterworkingenvironments. see greaterhealthgainsfromeconomic level. Ingeneral,low-incomecountrieswill growth may maskinequalitiesatlocal lifestyles. Aswell,nationaleconomic communicable diseaseswithchanged tend toexperienceanincreaseinnon- traffic accidents,whilewealthiercountries mortality relatedtopollutionandroad economies often experiencesignificant are complex:forexample,transitional health. However, long-termhealthgains lead tolong-termimprovementsin increases innationalwealthgenerally enable immediatehealthgains,while provision ofdecentworkandbasicincome affects healthovervarioustimescales: heat stress,andinjury. Economicgrowth suffer fromexposuretocontaminants, are notinplace,workers’healthmay construction, ifappropriateprotections such asmanufacturing,agricultureor deaths relatedtoviolence.Inindustries health problemsandofillnesses lead toahigherincidenceofmental new issues–forexample,inequalitymay health benefits,butcanalsocreate gains cannotonlyexcludesomefrom Inequities inthedistributionofwealth health challenges–most prominent isthe been associatedwithtypical patternsof Historically, developmentstageshave vations andinfrastructuresarefavoured. choices aboutwhichindustries,inno- and Synergies ortrade-offs betweenhealth 3

+ sdg9 arestronglydependenton

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88 GOAL #3 GOOD HEALTH AND WELL-BEING can leadtofeedbackloops withnegative This relationshipisbidirectional and ments (e.g.higherlevelsof airpollution). as smoking,andpoorphysical environ- rates ofadversehealthbehaviours such heightened psycho-socialstress,higher through multiplepathways, including Inequalities may createhealthimpacts low-, medium-andhigh-incomecontexts. substantial adversehealthoutcomesin that incomeandsocialinequalitieshave goals. Inparticular, thereisevidence achievement ofhealthandwell-being access topowercancontributethe education, healthcareservicesand Reducing inequalitiesinincome,wealth, technological /infrastructuraladvances. nations toinnovateorimplementvarious participation, andthereforetheabilityof although poorhealthcaninfluencelabour and healthisbasicallyunidirectional, The relationshipbetweeninfrastructure advance ofthecompletionconstruction. quences may belocked-indecadesin infrastructure development,healthconse- term. Duetothelongtimescaleof Health effects canbeimmediatetolong- through promotionofactivetransport. impacts andimprovehealth,suchas especially incities,canminimiseadverse sprawl. However, appropriateplanning, and reducedphysical activityfromurban traffic congestion,roadaccidents ing airpollutionfromvehicleemissions, unintended healthconsequences,includ- investment haswell-establishedadverse motor vehicle-basedinfrastructural and residentialdevelopment.Forexample, urbanisation, transport/mobilitysystems, particularly associatedwithlanduseand there may alsobenegativeimpacts, ture tendtofavour betterhealth.However, in industry, innovationandinfrastruc- decisions. Overthelong-term,advances gated byindustrialandinfrastructural disease, whichcanbeexacerbatedormiti- from infectioustonon-communicable characteristic epidemiologicaltransition 3

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10 lated ruralareas. some slums/informalsettlementsandiso- and thusentrenchinequalities,asin can limitavailable resourcesandrevenues nity level,ahighburdenofillhealth capacity toassurehealth.At thecommu- opportunities andfurtherreducingtheir or care,thusreducingtheirlivelihood to selltheirlandpay formedication high interestratesforcehouseholders borrowing-related ‘poverty-traps’, where limiting workcapacityandthrough can limithouseholdincomebydirectly consequences: forexample,illhealth the longterm;dependence ofhealth is stronglyconnectedwith healthover Sustainable consumption andproduction options forurbandevelopment. of activetravel optionsandthuspolicy participation andtheattractiveness disability canlimitresources,labour unidirectional, althoughillhealthor sustainable citiesandhealthisbasically the long-term.Therelationshipbetween emissions, whichsupportshealthin and hencelimitingorreducingcarbon options foravoiding carbonlock-in design offer someofthemostcost-effective health. Sustainableurbanformand work andeducation,whichsupports access tohealthcareand immediately anddirectlybyimproving port infrastructurepromoteshealth space supportshealth.Inaddition,trans- provides adequatetemperaturesand free ofpollutantsandhazardswhich In theshortterm,housingwhichis illness andnon-communicablediseases. ous traffic,andcontributingtomental hazards suchasairpollutionanddanger- physical activity, exposingpeopleto unhealthy environments, discouraging of health andsupporttheachievement recognised. Well-designed citiespromote The impactof‘place’onhealthiswell 3 3 3 while poorly designed cities create sdg3 whilepoorlydesignedcitiescreate

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89 GOAL #3 GOOD HEALTH AND WELL-BEING sources. trajectories andusezero-carbon energy adopt climate-friendlydevelopment needed toencouragepoorercountries gains. Newfinancingmechanismsare (multi-century) healthanddevelopmental well-being butmajorandlong-lasting immediate improvementsinhealthand Climate actionwillresultinmodest climate changeislargeandgrowing. morbidity andmortalityfromminimising scale ofpotentialsavings withrespectto to achievehealthgoals.Conversely, the of theseeffects, itwillbeverydifficult and massiveflowsofpeople.Intheface breakdown ofgovernanceorsocialnorms, precipitate localorregionalconflicts, tion, whichhave thepotentialto rapidly withthescaleofclimatedisrup- trition. Suchimpactsmay increase tributes tofoodinsecurityandundernu- (e.g. fordengueandmalaria)con- that promotesthespreadofdiseasevectors are indirect,includingclimaticchange frequency ofintensestorms.Othereffects floods anddroughts,increased impacts ofsevereweatherevents,especially heat stressonabilitytoworkoutside, are direct,suchastheeffect ofincreasing Many healthimpactsfromclimatechange goals onsustainableactionisstrongly where regulationisweakest. are mostsevereinlow-incomecontexts some fishstocks)orglobal,butoften (e.g. ecosystemdepletion/collapse,asfor of failingtoachievethiscanbelocal and production.Thehealthconsequences losses toenablesustainableconsumption by whichglobalfinancingmightoffset and researchisneededintomechanisms debates overtherighttodevelopment, gains. Thistensionhasbeenrecognisedin require foregoingimmediateeconomic tainable consumptionandproductionmay or may involve trade-offs. Indeed,sus- these goalsarelesspronounced between planetary health. Short-termconnections recognised inthenewparadigmof 3

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short- andlong-termimpactsonhealth. and willtaketime,butshouldhave both and multi-scaleintegratedgovernance, overfishing, requirescross-sectoralaction challenges, includingpollutionand marine bioprospecting.Tackling marine new pharmaceuticalcompoundsfrom stocks orthepotentialfordiscoveryof availability of thus fish and systems as itaffects theviabilityofmarineeco- short orlongtimescales,particularly diversity canaffect humanhealthover tant healthrisks.Lossofmarinebio- freshwater resourcesandposeconcomi- extreme weatherevents,cancontaminate aquifers, potentiallyexacerbatedby intrusion intogroundwaterincoastal reduce morbidityandmortality. Seawater tion ofmarinepollutionwilllikewise and thusonhealthinthesecontexts.Reduc- can have directimpactsonnutrition, and collapseoffishstocksfromoverfishing marine food sources.Marinepollution and wherepopulationsdepend on areas connected tohumanhealthincoastal The healthofmarinesystemsisdirectly Each hasadirectorindirect connection sioning, regulating,andcultural services. in fourserviceareas:supporting, provi- categorises theroleofnaturalecosystems The MillenniumEcosystemAssessment on carefulmanagementofsuchecosystems. achievement ofhealthgoalsdepends of infectiousdiseasetransmission.Assuch, degrade waterways, increasingtherisk can expandpathogenhabitatsand associated withagriculturalproduction, human health.Changesinlanduse,often can affect agriculturalyieldsandthus resulting fromenvironmental disruptions populations ofbeesorotherpollinators of pathways. Forexample,reductionsin sity, canaffect healthalonganumber ination, andassociatedlossesofbiodiver- desertification, pollutionandcontam- human actions,includingdeforestation, Changes totheenvironment causedby 3 3

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90 GOAL #3 GOOD HEALTH AND WELL-BEING often siloed,andfailtoappreciatesuch to managementandgovernance are consequences inotherareas. Approaches system arelikelytoleadunintended problems, interventionsinonesub- recognised thatwithcomplexsystemic achieving health.Itisincreasingly Effective partnerships arecriticalfor inclusive institutions. is likelytosupportstrongerandmore reciprocally, good communityhealth better healthandwell-beingoutcomes; high-quality governance.Thiscansupport institutions andthepreconditionsfor important roleinmaintainingtrust and governanceprocessescanplay an resistance. Inclusionineconomiclife may have contributedtoantimicrobial have disruptedhealthservicesand and destructionofinfrastructure,which devastating civilstrife,massmigration, in Libya,SyriaandIraqhave promoted development discourse.Thecurrentcrises are often notwellrecognisedinthe of inter-statewarsandconflictsonhealth can posechallengestopeace.Theimpact extreme cases,emerginghealththreats and implementstronginstitutions.In capacity ofgovernmentstodeliverjustice ill healthorofviolenceitselfcanlimitthe exacerbate inequalities.Highburdensof impede initiativestoimprovehealthand health. Conversely, theirabsencecan strongenablersofimprovementsin Peace, justiceandstronginstitutionsare (Millennium EcosystemAssessment,2005). income provisionandculturalidentity necessary forhumanwell-beingsuchas health butalsosupportbroaderaspects aspects ofbothphysical andmental together thesenotonlymapdirectlyto and recreationalcomponents.Taken regulation ofwaterquality, tothespiritual provision offoodandshelter, and basic functionssuchasnutrientcycling, to humanhealthandwell-beingfrom 3 3

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poorer countries). easy importationofcaloriedensefoodsto could have adversehealthimpacts(e.g. relation toremovaloftradebarriersthat increasing costsofmedicines,andin qualified healthworkers,patentsand These couldbethroughabraindrainof especially inlow-incomecountries. adverse impactsoftradeagreements, trade liberalisation,andthepotential concern aboutdiminishingreturnsfrom (sdg8). However, there isincreasing primarily througheconomicgrowth Substantively, trade contributestohealth relation toprivate-publicpartnerships. present, exceptdiscussionsmainlyin ‘outside’ theundevelopmentagendaat and somebilateraltradeagreementsare tionally, themajorityofmultilateral international tradeonhealth.Institu- adequately emphasisingtheroleof The sdgshave beencriticisedfornot its impactsoneducationandcapital. partnerships, bothdirectlyandthrough the capacitytoparticipateineffective is bidirectional,asillhealthitselflimits thinking areneeded.Thisrelationship information groundedinsystems regional partnershipsandexchangeof Cross-sectoral, cross-spatialandmulti- lation ofpotentiallywiserinterventions. or positiveconsequencesandformu- the anticipationofunintendednegative tion ofsystemsapproachesallowsfor cross-sectoral feedbacks.Incontrast,adop-

91 KEY INTERACTIONS AT TARGET-LEVEL

A comprehensive assessment of all SDG 2 sdg interactions at target-level was beyond Specifically target 2.3 the scope of this chapter, but several SDG 3 proposed frameworks exist for integrating Illustrated using the example of improving health and well-being across the sdgs, health outcomes by improving air quality encompassing both health and non-health SDG 8 sectors and locating health and well- Illustrated using the example of the being as both pre-conditions and outcomes interaction between work, labour of sustainable development (Dora et productivity and health in the context of al., 2015; Nunes et al., 2016). This section high temperatures analyses some of these interactions SDG 11 in detail at the target-level. sdgs were se- Specifically targets 11.1 and 11.2; the lected based on the strength of the latter illustrated using the example of interlinkages and the magnitude and the Cheonggyecheon Stream Restoration scale of impact in relation to the overall Project, Seoul objective of the 2030 Agenda, while SDG 13 ensuring a balanced consideration of the Specifically target 13.2 economic, social and environmental dimensions. Target-level interactions are Given the comparatively large number of judged to fall within one of seven cate- target-level interactions for sdg 3, the gories and are scored accordingly: focus is largely on interactions with only indivisible (+3), reinforcing (+2), enabling one target from other sdgs. (+1), consistent (0), constraining (-1), counteracting (-2), and cancelling (-3). Following a generic analysis of the selected interactions, specific examples are provided to illustrate how inter- actions unfold in different geographical and policy contexts.

Six targets/goals were selected for detailed analysis, with three accompanied by an illustrative example: 92 GOAL #3 GOOD HEALTH AND WELL-BEING SDG 3.1, 3.2 3.1, TARGETS 3.9 3.3 3.3 2.3 2.3 2.3 2.3 3

+ SDG mothers, newbornsandchildren which supportsthehealthof to foodandeconomicresources, producers willimproveaccess tivity andincomesofsmall-scale Increasing theagriculturalproduc- productivity andincomegrowth the targetsrelatedtoagricultural of thelabourforcetoachieve effect ontheavailabilityandhealth will haveasignificantpositive Ending communicablediseases communicable disease can exposepeopletotheriskof drinking water, allofwhich resistance invectors,andpollute in pathogensandinsecticide promote antimicrobialresistance transmission, damageecosystems, the riskofanimal-humandisease new pathogenhabitats,increase even atthesmallscale,cancreate Increased agriculturalproduction, people tohazardouschemicals Agriculture labourmayexpose KEY INTERACTIONS 2

+ + SCORE - - 1 1 2 2 degradation regulation topreventecosystem Develop resourcemanagement agricultural productivity support smallholderstoincrease educational policiesthat Implement financialand POLICY OPTIONS Invest inhealthcareservices on thesafeuseofchemicals education toagriculturalworkers to hazardouschemicals.Provide Regulate tominimiseexposure 93 GOAL #3 GOOD HEALTH AND WELL-BEING workers. or causedirectharmtoagricultural and surfacewatercontamination, water throughsoilpollution,ground production canpollutedrinking in vectors.Intensiveagricultural pathogens andinsecticideresistance promote antimicrobialresistancein antibiotics foranimalscan Use ofinsecticidesforcropsand disease transmission which may intensifycommunicable activity canleadtoecosystemshifts induced by humanagricultural Environmental andhabitatchanges households welfare amongindividualsand gains throughincreasedeconomic tion canalsoleadtoindirecthealth supports health.Increasedproduc- can improve nutrition,which Increasing agriculturalproductivity KEY POINTS should occurintandemwith provisionof increasing agriculturalproductivity (2.3) targets provideimportant contextforthis: and non-farmemployment.Othersdg2 and opportunitiesforvalueaddition knowledge, financialservices,markets other productiveresourcesandinputs, through secureandequalaccesstoland, pastoralists andfishers,including indigenous peoples,familyfarmers, food producers,especiallywomen, productivity andincomesofsmall-scale a doubling,by2030,oftheagricultural interact withhealth.Target 2.3callsfor crease agriculturalproductivitycan This sectionconsidershowefforts toin- KEY INTERACTIONS positioned tobenefitfrom suchefforts. involved inagriculturalwork,soarewell of theruralandperi-urban poorare households; inparticular, highproportions economic welfareofindividualsand indirect healthgainsthroughtheimproved Increased productioncanalsoleadto micronutrients essentialforhealth. mote consumptionoftherange local agriculturalproductioncanpro- cardiovascular disease(3.4).Variety in with infectiousdisease(3.3) mortality (3.1), infant mortality(3.2), nutrition supportsreductionsin and neurologicaldevelopment.Sufficient lasting effects onhealthandphysical household economicshocks)canhave conflict, extremeclimaticeventsor (e.g. resultingfromdrought, intake even short-terminterruptionsoffood consumption ofsufficientcalories; increases thelikelihoodofuninterrupted agricultural productivity(2.3)often and livelihoodsforthepoor. scarcity andprovidemuch-neededincome tional inefficienciesthatleadtoregional vulnerable, cancounterthedistribu- production, especiallyamongthemost moreover, promotionofsmall-scale feed unprecedentednumbersofpeople; creased agriculturalproductivityto coming century. Thereisaneedforin- at bothglobalandlocalscalesinthe human populationswillfacefoodscarcity creases inproduction,rapidlygrowing which directly supportshealth.Withoutin- the localscalecanimprovenutrition, at (2.3) commodity markets(2.c). (2.b), andtheproperfunctioningoffood cultural infrastructure(2.a),freetrade knowledge (2.5),andsupportforagri- nance ofgeneticdiversityandtraditional supports ecosystems(2.4),themainte- is sustainable,resilient,adaptableand all (2.1),aguaranteethatfoodproduction organic,safeandnutritiousfoodfor At themostbasiclevel,increased Increasing agriculturalproductivity through cost-effective technologies

and mortality associated and mortalityassociated

newborn/child newborn/child and and

94 GOAL #3 GOOD HEALTH AND WELL-BEING vector management. of ricewithdrylandcropsorintegrated context, forexamplethroughalternation full awareness ofecologicalandsocial countered bycarefulmanagementwith (World Bank,2008).Suchriskscanbe particularly trueinlow-incomesettings of malariaandotherdiseases–thisis can createnewhabitatsforvectors irrigation (orotheragriculturalpractices) (McCauley etal., that efficientlytransmitthedisease increases inspeciesofrodentsandfleas agricultural sites,mediatedbysubstantial of plague-seropositiverodentsasnon- to harbourdoubletheabundance example, agriculturalsiteswerefound promote disease.InTanzania, for pathogen speciesassemblagesinways that agricultural usescanshift vectorsor In somecases,theconversion oflandto etal., sylvatic systems(Jones in humansasaresultofspilloverfrom humans appeartohave originated range ofotherimportantdiseases 2008); forexample,hiv,sars, anda Medicine (us)ForumonMicrobialThreats, over ofzoonoticpathogens(Institute tems, andagreateropportunityforcross- livestock interfaceswithnaturalsys- generally leadstoexpandedhumanand agriculturallands.Suchexpansion production often requiresexpansionof a basiclevel,increasingagricultural ability isnotexplicitlyconsidered.At factors arenotaccountedfor, orifsustain- contextual environmental andsocial control communicabledisease(3.3),if tivity livestock orpoultrypopulationsand may beaccompaniedbyincreases in However, increasedagriculturalproduc- ducks, humanpopulation andrice- with abundanceoffree-grazing domestic influenza, whichhasbeen associated disease. AsignalcaseisthatofH5N1avian cally intensifytransmissionofzoonotic humans andanimals,whichcandramati- closerphysical associationsbetween Increasing agriculturalproductivity(2.3) (2.3) may challengeefforts to 2015). Inothersituations, 2013).

/ or

be harmful to human health, whether be harmfultohumanhealth, whether Insecticides, pesticidesand fertiliserscan air, soilandwatercontamination(3.9). mortality andmorbidityassociatedwith (2.3) may alsochallengeefforts toreduce (who, 2013). class ofemerginginfectiousdisease been conceptuallyomittedasanimportant that insecticideresistancehasgenerally significant issuethatwhohasargued (Reid andMcKenzie,2016).Thisissucha ciated withagriculturalinsecticideuse vector mosquitopopulationswasasso- across Africa, higherresistanceinmalaria review foundthatin23of25studies resistance invectors;forexample,arecent of insecticidesinagriculturecanleadto pathogens (who,2013).Similarly, the use of antimicrobialresistanceinhuman has beenlinkedtotheemergence al., infectious diseaseseverity(Spellberget management canalsocontributeto prevent diseaseinanimalstocks,livestock mote growthandfeedefficiencyor antibiotics areroutinelyusedtopro- (tapeworm infection)(who,2013).Where tosomiasis (bilharzia) ments withpathogensthatcauseofschis- and contaminationofnaturalenviron- ment, canleadtoincreasedeffluentflows accompanied bypoorlandmanage- across systemstonegativelyaffect health. rity, withresultsthatpotentiallycascade change. Suchsystemsthreatenfoodsecu- to plantoranimalpathogensclimate of biodiversityandincreasedvulnerability of production,butmay alsoleadtoloss and yieldallowincreasesinthescale inputs, thismay increaseefficiency fertilisers, pesticides,antibioticsorother panied byextensiveapplicationof involving gmos,andfrequentlyaccom- plant andanimalproduction.Often through afocusonmonoculturesincrop, in agriculturearesometimesachieved (Gilbert etal., cropping intensityinSoutheastAsia Large-scale livestockproduction,when 2011). Antibioticuseinagriculture Increasing agriculturalproductivity 2008). Productivity increases 2008). Productivityincreases and taeniasis

95 GOAL #3 GOOD HEALTH AND WELL-BEING disease spread,thusaffecting foodsystems. also increasethelikelihood ofcatastrophic evolution ofresistance.Monocultures may of chemicalsorantibiotics,promotingthe cultural andmay involve heavier inputs developed worldtendtobemoremono- Agricultural productionsystemsinthe diseases aremorelikelyinthesecontexts. poisoning andemergenceofzoonotic exposed toitseffects. Thus, unintentional in agriculture,andarethereforedirectly where largerproportionsofpeoplework more relevantinlow-incomesettings, between target2.3andhealthtargetsare cancers orotherhealthissues. or long-term,asinthedevelopmentof acute,asinunintentionalpoisoning, longer periods,anditseffects canbe other extremeevents,orcanbuildupover from agriculturecanfollowfloodsor of severalyears.Contaminationresulting generally operatesoveratimescale of antibioticandinsecticideresistance by urbanmobilitypatterns.Theevolution tural borderlands,butwasintensified is likelytohave haditsoriginsinagricul- recent West African Ebolaepidemic travel backandforthbetweenthem.The lands andwhereworkersfrequently proximity tonewly-clearedagricultural urban areasareinrelativelyclose canbeextremelyfast,especiallywhere of agriculturallandsorecosystemshifts in epidemicriskthroughexpansion both short-andlong-termscales.Increases and thehealthtargetsoperateon logical disruptions. ease, birthdefects,andsignificanteco- cancers, neurologicalandrespiratorydis- and long-termincreasedriskofsome been associatedwithbothacutetoxicity and lostlabour. Pesticideexposurehas economic burdens,includingdirectcosts 2008) andisassociatedwithserious of amillionpeopleperyear(World Bank, Unintentional exposurekillsoverathird or throughoccupationalexposure. through contaminationoffoodorwater Many ofthetrade-offs observed The interactionsbetweentarget2.3

comes andfoodsupply, allsupportiveof positive effects onfoodsecurity, in- small-scale producers,and have long-term produce quickgainsinnutritionfor Time: Increasedagriculturalproductioncan KEY DIMENSIONS regulation, whichwillvarywithcontext. should bemitigatedthroughappropriate human harm.Increasedhealthrisks without creatingecologicalordirect to scaleuphealthy small-scaleproduction The largestuncertaintiesconcernhow KEY UNCERTAINTIES lead tonegativehealthconsequences. are morelikelytoadopttechnologiesthat efficiency, growingagriculturalsystems To achieve increases inthroughputand but areinpartafunctionofscale. offs betweenagricultureandhealthvary, sector (World Bank,2008). of skillsandcapacityintheagricultural in somecasesledtosignificantlosses al., Antimalarial Drugs,2004;Audibert et (us) CommitteeontheEconomicsof mitigate theseeffects (InstituteofMedicine substitution withinhouseholdsmay limit agriculturalearnings,althoughlabour have beenshowninsomecontextsto example, highlevelsofendemicmalaria tional capacitiesandknowledge.For in thehealthy labourforceorininstitu- pact onagriculturethroughreductions is bidirectional.Healthissuescanim- livestock choices. ments, croppingpractices)andcrop (e.g. irrigationsystems,feedsupple mental effects ofagriculturaltechnologies of thelikelyecologicalandenviron clear understandingoflocalecologyand offs withhealth,butthisrequiresa achieved whileavoiding negativetrade- productivity. Inmany cases,thiscanbe local andsmall-scaleagricultural to regulationandtechnologyinincreasing Careful considerationmustbegiven 2012). Highratesofhivmortalityhave The strengthofthelistedtrade- The relationshipbetweenthesetargets /

plant

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96 GOAL #3 GOOD HEALTH AND WELL-BEING disease. increases theriskofnon-communicable or resultinecosystemsdegradationthat expose workerstohazardouschemicals and increasingagriculturalproductivitycan reductions inthehealthy labourforce, can have animpactonagriculture through Directionality: Bidirectional.Healthissues inform appropriateregulation. pacts ofincreasedproductivityinorderto and inmonitoringtheecologicalim- practices) andcrop/plant/livestockchoices systems, feedsupplements,cropping in improvingproductivity(e.g.irrigation Technology: Technology canassistboth agriculture atallscales. mitigating impactsonecosystemsfrom governance iskeytoanticipatingand their localcommunities.Moreover, effective tion accruetosmall-scalefarmersand benefits ofincreasedagriculturalproduc- planning arekeytoensurethatthe Governance: Goodgovernanceandcareful may have globalimpactsondiseases. changes inagriculturalproductionlocally of communicablediseasesmeansthat increase somerisks.Theborderlessnature cultures, large-scaleproduction)may of developed-worldagriculture(e.g.mono- production, althoughspecificelements opportunities fromchangesinagricultural income countriesfacehigherrisksand Geography: Ingeneral,producersinlow- effects. poisoning) andlong-term(e.g.cancers) ture canalsohave bothacute(e.g. habitats). Contaminationfromagricul diseases) orlong-term(e.g.shifts invector acute (e.g.outbreaksofnewzoonotic tion. Resultingriskstohealthcanthusbe shifts inecosystemstructureandfunc- techniques canproducerapidorlong-term tural landsorchangesinagricultural long-term health.Expansionofagricul-

97 GOAL #3 GOOD HEALTH AND WELL-BEING SDG 3.1 TARGETS 3.7 3.3 3.2 3.b, 3.c 3.b, 3.8 3.8, 3.9,3.a 3.3, 3.4,3.5,3.6,3.7, 3.4, 3.5,3.6,3.7,3.a,3.10 3.1, 3.2, 3.3, 3.2, 3.1, 3.3 3.2, 3.b 3.a, 3.5, 3.4 3.3, 3.3 3.1, 3.2, 3.1, 3

+

SDG communicable disease mortality andhelpcontrol will assistinreducingmaternal sexual healthcareprovision Targets aroundreproductiveand communicable disease ture mortalityassociatedwithnon- will assistinreducingprema- exposure tohazardouschemicals, stance abuse,andreducing Controlling tobacco,reducingsub- maternal mortality disease willassistinreducing communicable and Achieving targetsfornon- newborn/infant mortality contribute totargetsreduce disease willsubstantially Efforts toeradicatecommunicable KEY INTERACTIONS other healthtargets support theachievementofall supportive researchinfrastructure A stronghealthworkforceand targets will assisttoachievemostother Provision ofuniversalhealthcare 3

+ + + + + + SCORE 2 2 3 2 2 2 and controlstobaccouse exposure tohazardouschemicals, Ensure regulationprevents medical environments during ante-natalcareandin to thecontrolofinfectiousdisease pregnancy. Giveparticularfocus obesity. Eliminatesmokingduring diabetes andriskfactorssuchas communicable diseases,suchas Reduce prevalenceofnon- and medicalenvironments of infectiousdiseaseineducational Give particularfocustothecontrol POLICY OPTIONS in researchinfrastructure Invest inthehealthworkforceand healthcare Prioritise theprovisionofuniversal services andeducation reproductive andsexualhealthcare Support fundingtowards 98 GOAL #3 GOOD HEALTH AND WELL-BEING targets will assistinachieving allother Provision ofuniversalhealthcare communicable disease infant mortalityandhelpcontrol will assistinreducingmaternaland sexual healthcareprovision Targets aroundreproductiveand communicable disease mortality associatedwithnon- will assistinreducingpremature exposure tohazardouschemicals, stance abuse,andreducing Controlling tobacco,reducingsub- and maternalmortality reduce newborn/infant mortality disease willassistintargetsto Efforts toeradicatecommunicable KEY POINTS rate reductions inthematernal mortality ally supportive.Forexample, achieving general thehealthtargetsaremutu- to achievingothertargets.However, in limit resourcespotentiallyapplicable achieve particularhealthtargetscould where fundingislimited,efforts to De Maeseneeretal., health outcomes(Atun etal., and thustheirabilitytodeliverother particularly inlow-incomesettings– integrated operationofhealthsystems, programmes cannegativelyaffect the vertical disease-orientatedhealth whether andunderwhatcircumstances For example,thereismuchdebateover interactions amonghealthtargets. There areseveralpotentialnegative KEY INTERACTIONS will be made easier by achieving (3.1) willbemadeeasierbyachieving 2008). Moreover, 2008;

toxic substancesandtobacco (3.9). incidence by efforts to reduceinfectiousdisease mortality infant Similarly, achievingreductionsinnewborn examples: disease. Thisisillustratedinthefollowing infectious disease,andnon-communicable health, universalhealthcoverage, the targetsconcerningsexual/reproductive newborn deaths(Pattinsonetal., 45% andalsotopreventmaternal shown toreducestillbirthsbyup comprehensive antenatalpackagewas diabetes inpregnancyaspartofa detection andmanagementof communicable diseases(3.3):Early Reducing theincidenceofnon- (Say etal., malaria, andaidsduringpregnancy by orassociatedwithdiseasessuchas pregnancy orchildbirtharecaused maternal deathsduringorfollowing epidemics (3.3):Around25%of Ending communicabledisease deaths (who,2016). significantly reducecomplicationsand access toskilledattendancewill doctor ortrainednurse.Improved currently notassistedbyamidwife, 40% inAfrica andSouth-EastAsia)are (3.8): Millionsofbirths(morethan Achieving universalhealthcoverage (Redden, 2016). legislature’s budgetforfamilyplanning response tomajorcutsinthestate of women’shealthclinicsin2011 after adrasticreductioninthenumber 2014 (MacDormanetal., pregnancy doubledbetween2010and died fromcomplicationsrelatedto United States,therateofwomenwho healthcare services(3.7):InTexas, Increasing accesstoreproductive and to reduce exposure to to (3.3) andtoreduceexposure 2014). will be supported supported be (3.2) will 2016), soon 2011). /

99 GOAL #3 GOOD HEALTH AND WELL-BEING tract infections,pretermbirthcompli- five yearsofagewerelowerrespiratory in 2013amongchildrenyoungerthan The leadingcausesofdeathintheworld to hazardouschemicalssuch asparticulate Convention onTobacco Control (3.a). World HealthOrganizationFramework strengthening theimplementationof the achievementofthistarget,aswill harmful useofalcohol(3.5)willsupport treatment ofsubstanceabuse,including strengthening thepreventionand communicable diseases.Assuch, of alcoholincreasetheriskthesenon- unhealthy dietandtheharmfuluse diseases. Tobacco use,physical inactivity, of deathsfromnon-communicable and asthma)diabetesaccountfor82% chronic obstructivepulmonarydisease cancers, chronicrespiratorydiseases(e.g. diseases (e.g.heartattacksandstroke), chemical exposure(3.9).Cardiovascular tobacco control(3.a),andhazardous towards targetsonsubstanceabuse(3.5), disease (3.4)willbemadeeasierbyaction associated withnon-communicable target ofreducingprematuremortality (Lumley etal., low birth-weightandprematuredelivery complications, includingfoetaldeaths, pregnancy increasesriskof smoke andindoorairpollutionduring (3.2). Smoking,exposuretosecond-hand reductions innewborn/infantmortality and controllingtobacco(3.10)eachsupport children andinfants(3.2). role inendingpreventabledeaths diseases and waterborneothercommunicable coverage 2016). Providingforuniversalhealth Burden ofDiseasePediatricsCollaboration, children youngerthanfiveyears(Global million deathsor54%ofallamong diarrheal deaths.Theseaccountedfor3.4 birth traumaandasphyxia, malaria,and cations, neonatalencephalopathy following Some cancersarelinkedto exposure Along similarlines,achieving the Protecting againsttoxichazards(3.11) (3.3) willclearlyplay animportant , malaria, (3.8) andcombatingaids,malaria, 2004; Popeetal., 2010).

improve populationhealth. Otheractions support fromdonors,and arelikelyto be achievedlocally, insomecaseswith workforce developmentandresearch–can tobacco control,hazardsreduction, health careprovision,promotion, targets Many oftheactionsrequiredto meet other healthtargets(Nilssonetal., of thehealthtargetsenablesorreinforces infectious diseaseincidence.Thuseach ly, efforts to achievethelatterwillreduce (3.1) help reachtargetsformaternalmortality eradicating infectiousdisease(3.4)will gets areclearlybidirectional.Forexample, vaccines andmedicines(3.11). by researchanddevelopmentofessential retention ofastrongworkforce(3.12)and recruitment, training,developmentand health coveragecanbesupportedbythe and tobacco(3.10).Achievinguniversal reductions inconsumptionofalcohol(3.5) healthy sexualbehaviour (3.7)and messaging, educationandresourcesfor service iscriticaltotheprovisionof care professionals.Astrongpublichealth effective andsafetreatmentbyhealth- traffic accidents(3.6)allrelyonaffordable, icals (3.9),orofthoseimpactedbyroad disease (3.4)orfromexposuretochem- communicable (3.3)ornon-communicable infants (3.2),ofpeoplesuffering from women duringchildbirth(3.1),ofnewborns and diseaseprevention.Thehealthof can provideeducationonhealthy lifestyles only provideessentialtreatment,but for accesstohealthprofessionals,whonot sdg3 targets.Universalcoverageallows facilitate achievementofvirtuallyallother essential medicinesandvaccines(3.8)will including accessataffordable pricesto mortality. to reductionsinnon-communicabledisease the air, water, andsoil(3.9)willcontribute illnesses fromhazardouschemicalsin such, reducingthenumberofdeathsand matter wood-smoke,leadandasbestos.As Many interactionsbetweensdg3tar- Achieving universalhealthcoverage, and infantmortality(3.2);converse- – investment invaccines,medicines, 2016).

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100 GOAL #3 GOOD HEALTH AND WELL-BEING other healthtargets. health targetssuppOrtachievementof Directionality: Bidirectional.Eachofthe its spread–arecrucialtoachievingtargets. prevent infectiousdiseaseandmonitor Technology: Technologies –forexample,to efficient andinclusive. programmes areequitable,effective, planning arekeytoensurethathealth Governance: Goodgovernanceandcareful much greatereffort incertainareas. to achieveparticulartargetscanimply socio-economic context,suchthatefforts icantly dependingongeographicand co-operation. Diseaseburdensvarysignif- clean airandwaterrequireregional and environmental healthissuessuchas be managedlocally, infectiousdiseases Geography: Whilesomeofthetargetscan to becomesafe. may takesometimeforair, waterandsoil chemicals canbeintroducedquickly, it while policiestoreducehazardous actions aremorelong-term.Forexample, – wouldhave immediateeffects. Other investing inmaternalandnewbornhealth Time: Actiononseveraltargets–suchas KEY DIMENSIONS strengthening. disease programmesandhealthsystem over thepotentialconflictbetweenvertical discussed. Thereisconsiderabledebate interactions betweenthehealthtargets The evidencebaseisstrongforthepositive KEY UNCERTAINTIES cooperation andlong-termplanning. and cleanairpolicies–requireregional – suchascontrolofinfectiousdisease 1.7 millionasthmaattacks (usepa attacks, 13millionlostwork days, and cases ofprematuremortality, 130,000heart amendments preventedmorethan160,000 resulting fromthe1990CleanAirAct in fineparticlematterandozonepollution stone, 2003).In2010alone,reductions absence oftheCleanAirAct(Chay andGreen- in 1972thanwouldhave doneinthe it isestimatedthat1300fewerinfantsdied immediate impactonhealth.Forexample, The reductioninparticulatematterhadan enforce regulationstolimitairpollution. the FederalGovernmentauthorityto and wasstrengthenedin1990,giving The thus arehighlysupportiveofhealth. et al., at particularrisk(Rossetal., heart diseaseandstroke;elderlypeopleare the developmentofhighbloodpressure, In adults,exposuretoairpollutionpromotes respiratory symptomsincludingasthma. children atgreaterriskofdevelopment negatively affects lunggrowthandplaces death syndrome.Exposuretoairpollution infant mortality, includingsuddeninfant is associatedwithincreasedpost-neonatal diminished lungfunction. Airpollution development ofrespiratorydiseasesand placing babiesatgreaterriskforthe pollution inuteroandlowerbirthweight, a relationshipbetweenexposuretoair course. Severalstudieshave demonstrated gases, affects healththroughoutthelife- matter, ozone,heavy metalsandacidic the UnitedStates’CleanAirActof1970. health (3.2),asshownbytheexperienceof communicable diseases(3.4)andinfant towards meetingtargetsaroundnon- water, airandsoil(3.9)alsoassistcountries hazardous chemicalsubstancesinthe Policies aimedatreducingexposureto AIR ACT AIR QUALITY: THEUSCLEAN OUTCOMES BYIMPROVING IMPROVING HEALTH ILLUSTRATIVE EXAMPLE Air pollution,includingparticulate us CleanAirActbecamelaw in1970 2013). Policiestoreduceairpollution 1970 2012; Shah , 2011).

101 GOAL #3 GOOD HEALTH AND WELL-BEING SDG 3.1, 3.2,3.3 3.9 3.3, TARGETS 8.5, 8.6 3.7, 3.8,3.9 3.1, 3.2,3.3,3.4,3.5,3.6, 3.8 3.8 8.8 8.1 8.1 3 8.5 8.1,

+ SDG education andmedicalcare for health,suchasfood,shelter, gaining accesstotheconditions employed supportspeople Increasing thenumberofpeople disease, illnessanddeath increase theriskofcommunicable ecosystem change,whichcan water, airandsoilpollution the environment,including ciated withadverseeffectson Economic growthcanbeasso- coverage towards providinguniversalhealth spending onhealthcare,including enable governmentstoincrease Increasing economicgrowthcan chemicals reduce exposuretohazardous Safer workingenvironments KEY INTERACTIONS economic growthandemployment the workforceandcontributesto supports peopletoenter Increased health/well-being 8 + + + + SCORE - 1 2 1 3 2 services Invest inhealthcareandsocial inclusive workforce while movingtoequalpayandan and strengthenthetaxbase, lift productivity, createemployment Invest ineducationandtrainingto not degradetheenvironment economic growthdoes relevant industriestoensurethat Put inplacemechanisms POLICY OPTIONS safety intheworkplace protect labourrightsandhealth Strengthen unionsandregulateto into employment in socialservicesthatassistpeople Invest inthecreationofdecentjobs 102 GOAL #3 GOOD HEALTH AND WELL-BEING consequent lossofhealth with environmental damageand but may alsobeassociated to low- ormiddle-incomecountries, Growth isparticularlyattractive well-being outcomes consumption criticallyinfluence the sustainabilityofproductionand of growth anditsrelationshipwith the quality, natureandsustainability well-being iscontextdependent: The interactionbetweengrowth and and othersocialservices government investment inhealth higher growth canenablegreater and health/well-being.Forexample, between growth/employment/work There aremany positiveinteractions KEY POINTS risk ofillnessandinjury unsafe workplacescanputpeopleat conditions, poorlabourrightsand However, stressfulworking medical care,andeducation. enable ahealthy life:food,shelter, access totheresourcesthathelp incomes areassociatedwithgreater At theindividuallevel, higher allocation ofitsbenefits for growth andanappropriate must ensureappropriateconditions being; context-dependentpolicies / well- quality oflifeatleastforsome, eitherin can be‘uneconomic’, namelylowering 2009).Inthelatter,tries (Jackson, growth countries thaninhigher-incomecoun- strongly positiveinlow-tomiddle-income The associationismorelikelytobe health/well-being (Layard andLayard, 2005). the relationshipbetweengrowthand ceived relativedeprivation,whichweakens tries cancreatedifficultiessuchasper- countries andacrossgroupswithincoun- ular, inequalityinincomegrowthacross ‘full’ world(DalyandFarley, 2004).Inpartic- be endlesslysustainableinafiniteand in practicenotuniversal,norcangrowth well-being fromeconomicgrowthare better humanhealth. in thedirectionofeconomicgainand In suchacontext,reducingwastecanwork species, maintainingdietarydiversity. food supplies,andavailability ofcertain populations includelowercostsofmarine The longer-termbenefitsforhuman the discardingofnon-targetspecies. methods arenotwastefulandavoiding include ensuringthatfishharvesting ecosystem-damaging waste.Examples nomic growthpotentialandminimises are usedandallocated–increaseseco- which resources(physical andnatural) resource efficiency–thewith positive linksarewidelyunderstood. andviceversa(Nilssonetal., reinforcing ofhealth stronger employmentcanbeenablingor 2002). Thus,economicgrowthand (Bloom andCanning,2001;Wagstaff, being raisingproductivityandincomes tional, withincreasedhealthandwell- well-being. Interactionsarebidirec- mental protection,whichfurthersupports healthcare, educationandenviron- and enablesgreaterpublicinvestment in ment (8.5,8.6),whichsupportshealth and supportfullproductiveemploy- tivity (8.2)encouragejobcreation(8.3) Economic growth(8.1) KEY INTERACTIONS However, thegainsintermsofhealth It iswidelyacceptedthatgreater /well-being goals, and higherproduc- 2016). These

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103 GOAL #3 GOOD HEALTH AND WELL-BEING more likelytoincreasewell-being, growth countries, whereeconomic growthis urgently required(8.4). consumption significantlygreenerare is thatpoliciestomakeproductionand gains inhealth/well-being.Theimplication some casesconstrainorevencounteract short, high-incomecountrygrowthmay in diminishing benefitsatthemargin.In side-effects ofgrowthcanexceedgrowth’s water. Insuchcases,increasingadverse require theavailability ofcleandrinking maternal andchildmortality(3.1,3.2) water-borne diseases(3.3)andaddress health targets.Forexample,efforts toend health andconstrainefforts toachieve cause damagetoecosystemorhuman water usethatdamagesaquifers)which loss ofsoils/farmlandtourbanexpansion, (e.g. carbon-emittingenergyproduction, which often have environmental impacts growth isdrivenbyproductionsystems, automation associatedwithgrowth.Yet work hours,work-lifebalanceandrapid concern indevelopedcountriesaboutlong Aggarwala, 2008).Thereisalsogrowing by lifeexpectancy(Bloombergand health/welfare asindicatedforexample smaller gainsatthemarginintermsof countries generallyyieldsincreasingly because economicgrowthinhigh-income Costanza etal., mental capital(Kubiszewskietal., based onunderminingsocialandenviron- is adverselyaffected wheregrowthis and considersincomedistribution.Thegpi and pollutioncountagainst‘progress’; so thatnegativeoutcomessuchascrime declining. Thegpiadaptsthegdpmeasure Indicator (gpi)may bestaticoreven well-being, suchastheGenuineProgress more effectively measuresociety’s may beincreasing,butindicatorswhich (gdp) andgrossnationalincomegni circumstances, grossdomesticproduct (e.g. climatechangeimpacts).Insuch spillover impactsonothercountries rich countriesthemselvesorowingto Even withinlow-ormiddle-income Diminishing returnstowell-beingarise 2014). 2013; in ordertoenhanceprofits; butinthe economies inhealthandsafety conditions short term,someemployers may pursue (Concha-Barrientos etal., are exposedtoasbestosintheworkplace yet about125millionpeopleworldwide number ofcancers(Nielsenetal., Exposure toasbestosisassociatedwitha environments forallworkers(8.8) . and promotingsafesecureworking aligned withprotectinglabourrights from hazardouschemicals,isclosely the numberofdeathsandillnesses lated arestillbeingencounteredtoday. irrigation systemsthatarepoorlyregu- but theunintendedconsequencesofnew history ofcivilisation(Diamond,2005), as inSumeria,isalessonfromthedeep cular regionsfollowingsalination,such the shortterm.Theneedtoabandonpartic- cultural productionmay increasein and healthimpacts,eventhoughagri- leading tolonger-termfoodshortages (Millennium EcosystemAssessment,2005), or foodgrowninaparticularregion levels graduallyriseinwatersupplies becomes contaminatedandcontamination to cumulativeeffects assoilgradually chemicals fromagriculturemay lead For example,minorinputsofpolluting outcomes may beindirectorincremental. tainable productiontoadversehealth gated bygovernments. resource base,andtheway thesearemiti- such asphysical effects onthenatural being dependsonthenatureofimpacts, ing’) betweengrowthandhealth tive linkage(‘constraining’or‘counteract- 2014; Stern,2015).Thispotentiallynega- Commission ontheEconomy andClimate, to alossofup13%gdp(Global is estimatedtocausedamageequivalent able. Forexample,airpollutioninChina system processesareespeciallyvulner- specific domainsorregionswhereearth loss ofhealth/well-being,especiallyin environmental damageandconsequent may neverthelessbeassociatedwith Target 3.8,whichinvolves reducing The pathfromenvironmentally unsus- 2004). Inthe /well- 2014);

104 GOAL #3 GOOD HEALTH AND WELL-BEING governments have arole inensuringthat agriculture, horticulture and forestry work, in mostcountries–affecting especially temperatures drivenbyclimatechange For example,withtheincreased sectors may beparticularlyaffected. globalisation andotherimpacts,certain impacts ofclimatechange,continuing time, withchangingtechnologiesandthe of theneedforimprovedhealthandsafety. ployers canleadtogreaterawareness king conditionsbylabourunionsandem- In suchcases,jointmonitoringofwor- with morbidity/mortality(eu-osha,2013). employment, themoreitisassociated safety andthatthehigherinstabilityof association withoccupationalhealthand precarious employmentfoundanegative Studies onthehealthandsafetyeffects of and othersinprecariousemployment. for thehealthandsafetyofmigrantworks risks (eu-osha,2013),orevenpoorregard such asinadequateinformationabout labour conditionsmay reflectotherfactors the levelofregulationbygovernment economy). However, insomecountries (diminishing thequantityofjobsin of productionoff theinternationalmarket production conditionsleadtothepricing costs arisingifandwhenmorecostly and productivityofwork)thesocial better conditionsenhancethequality conditions intheworkplace(where ferred balancebetweenhealthandsafety individual employersaretoassessthepre- are typicallyinabetterpositionthan Governments, givensufficientresources, is advancedattheexpenseofothers. cases, onegoal(thatofgrowthandjobs) environmental degradation:inboth are analogoustogrowthsecuredthrough continuing abrogationoflabourrights upon poorlabourconditions,orthe nomic growthandjobsthataredependent the commercialenterpriseitself.Eco- in somecases–thesustainabilityof sometimes livesofemployeesbutalso– jeopardise notonlythehealthand longer term,pursuitofsuchsavings can As workingconditionschangeover

air pollutioninpartsofChina). populations areespecially vulnerable(e.g. weather andtechnologymean some interacting factorsincludingtopography, especially severeinsomeregionswhere Geography: Lossofhealth/well-beingcanbe well-being overtime. itreduceshealth pressures ronmental growth contributestogrowingenvi- effects. Many impactsarelong-term:where con for­ Time: Taking actiononseveraltargets– KEY DIMENSIONS But mostinteractionsarepositiveandclear. might leadtonegativehealthoutcomes. increased incomeandassociatedspending actions, suchasconditionsunderwhich There areuncertaintiesaboutsomeinter- KEY UNCERTAINTIES long-term health/well-being. minimising trade-offs betweengrowthand sdg3 and8conflictisimportantfor specific contextsandpolicieswhere duction (8.4).Betterunderstandingofthe on sustainableconsumptionandpro- in accordancewiththe10-yearframework growth fromenvironmental degradation, endeavouring todecoupleeconomic dynamic isimplicitinsdg8,whichincludes et al., sustainedhealthandwell-being(Biermann towards agreeneconomy isessentialfor Thus, areorientationofbusinessactivity (Rockström etal., conditions forlong-termwell-being space’ forhumanity, itunderminesthe crosses boundariesofthe‘safeoperating atmosphere, bio-geochemicalcycles)or (biodiversity, forests,waterbodies,oceans, growth damagesthenaturalresourcebase being (vandenBergh,2011).Where ritical ifgrowthistobebeneficialforwell- In short,contextandconditionsare 2011; MaloneyandForbes,undp, 2016). stays uptodate(KjellstromandCrowe, regulation ofhealthandsafetyconditions examplebyimprovingoccupational ditions –wouldhave immediate ­ditions 2012). Anunderstandingofthis 2009; Griggsetal.,

2013). /

105 GOAL #3 GOOD HEALTH AND WELL-BEING (Meadows, 1998). aspiration thangrowthandemployment and well-beingisahigher-levelhuman employment. Morefundamentally, health contributes toeconomicgrowthand increased health/well-beingalmostalways always contributetohealth/well-being, while growthandemploymentdonot Directionality: Bidirectional.However, adverse socialandenvironmental impacts. technologies ortheirapplicationcanhave well-being cannotbeassumedwhensome Technology: Netbenefitsforhealthand can bemitigatedbygovernments. employment. Negativeimpactsofgrowth conditions forgrowthandrewarding planning arekeytoensuringthe‘right’ Governance: Goodgovernanceandcareful hours aresohotthatproductivity islost worldwide, upto10–15%of annualdaylight growth. Modellingsuggests thatcurrently, can limitlabourproductivityandeconomic work (undp,2016).Thismeansthatheat capacity toundertakephysical andmental the riskofhaving accidents,andimpairs Working inhightemperatures increases kidney disease(3.4)(Xiangetal., diseases, mentalhealthissuesandchronic heat exposurecanleadtocardiovascular exhaustion, anddeath.Inaddition,chronic people atriskofacuteheatstroke, High temperaturesanddehydration place place representsanoccupationalhazard. For example,excessiveheatinthework unsafe environment (8.8),harmshealth. supports health.However, workinginan Access toworkincreaseincomes,which Health andworkarecloselyrelated. TEMPERATURES IN THECONTEXTOFHIGH PRODUCTIVITY ANDHEALTH BETWEEN WORK,LABOUR THE INTERACTION ILLUSTRATIVE EXAMPLE 2014).

gies toreduceexposureheat(amc,2013). workers, employers,andofficialswithstrate- response strategiestoprotectresidents, out anearlywarningsystemandplanned Ahmedabad HeatActionPlan.Thissets risk ofheatstressbydevelopingthe cials andpartnersfocussedonreducingthe Azharetal., direct impactonproductivity(nrdc,2013; estimated excess1344deaths,witha heatwave inAhmedabad resultedinan impact offutureheatwaves. The2010 and proactivepolicyactiontoreducethe tating consequencesofheatwaves, India, providesanexampleofthedevas- Crowe, 2011).ThecityofAhmedabad, and labourproductivity(Kjellstrom waves, whichdirectlyimpactonhealth increasing frequencyandseverityofheat of year(undp,2016). labour forlongperiodsatthehottesttimes sectors whereworkerscarryoutheavy tropical environments withlargeprimary especially severeintropicalandsub- mediated byheatstresswouldbe mate changeonlabourproductivityas (Dunne etal., ductivity may beoverus$2trillionby2030 global economiccostofreducedpro- during thelatterhalfofcentury. The output inaffected sectorsofover20% warmer climatecouldresultinreduced labour productivityassociatedwitha to globalwarming.Furtherreductionsin is likelytobeofincreasingconcerndue health, productivityandeconomicgrowth work inthehottestperiodsofday. ing providing shadeorventilationandavoid- reduce workers’exposuretoheat,through policies shouldensurethatemployers both healthandeconomicgrowth,labour ( undp, 2016).Therefore,tosupport Climate changeisassociatedwith The crucialconnectionbetweenheat, 2014). Asaresult,cityoffi- 2013). Theimpactsofcli-

106 GOAL #3 GOOD HEALTH AND WELL-BEING SDG 3.9 3.4 3.3 3.2 TARGETS 11.1 11.1 11.1 11.1 3

+ SDG communicable disease and henceexposureto housing reducescrowding Improving accesstoadequate KEY INTERACTIONS and lead housing, suchaspollutedair currently presentinsome to hazardoussubstances housing willreduceexposure Ensuring accesstoadequate cardiovascular symptoms housing isassociatedwith diseases. Forexample,cold from non-communicable reduce prematuremortality adequate housingislikelyto Improving accessto respiratory illnessinchildren housing isassociatedwith children. Forexample,cold deaths ofnewbornsand the reductionofpreventable adequate housingsupports Improving accessto 11

+ + + + SCORE 2 2 2 2 safety measures) heating orcoolingsystems, clean cook-stoves,ventilation, through installinginsulation, existing dwellings(including support theimprovementof regulation andsubsidiesto and adequatehousingsupply; ensure high-qualityhousing building andtaxpoliciesthat homeless people;planning, of permanenthousingto slum upgrading;theprovision to thelocalcontext,including: range ofmeasuresappropriate adequate housingthrougha Ensure peoplehaveaccessto POLICY OPTIONS 107 GOAL #3 GOOD HEALTH AND WELL-BEING community stability well-being, socialcohesionand enables householdhealthand Adequate provision of socialhousing contact infectiousdiseases crowding andexposuretoclose- housing reduceshousehold Providing safeandaffordable improves mentalandphysical health Providing goodqualityhousing deaths inolderpeople effective inreducingcardio-vascular cooling. Thesemeasuresarealso and installingeffective heatingand prevented by retrofittinginsulation communicable diseasescanbe people fromrespiratoryand under fiveyearsofageandolder Deaths ofnewborn babies,children or areinsevere housingdeprivation unaffordable housing,liveinslums population, notcountingthosein Thirty percentoftheurban KEY POINTS many people,whetherinslumsornot,live and cleanwater(who,2011b).Inaddition, of tenure,sanitationand infrastructure, housing, sufficientlivingspace,security settlements (un,2015b),lackingdurable lion peopleliveinslumsandinformal particular riskstohealth.About 880mil- in slumsandinformalhousingposes grow, housingissuesintensify. Housing of abetterlifeandurbanpopulations As morepeoplemigratetocitiesinsearch KEY INTERACTIONS disease (associatedwithlead; Lanphear brain developmentandcardiovascular asbestos; Goswamietal., reduces theriskofcancer(associatedwith Barnard etal., (Howden-Chapman etal., ventilation, helpsprotectagainstdisease tight andinstallinginsulation,heating cluding throughmakinghousingweather- 2004). Improvinghousingtemperatures,in- et al., (Dhainaut people summer deaths,particularlyforolder Extreme indoor heat alsoincreasesexcess in 11Europeancountries(who,2011a). estimated at38,200peryear(12.8/100,000) winter deathsduetocoldhousingwere et al., disease(Thomson respiratory and vascular cardio- and lowindoortemperatureswith et al., health outcomes(Kimetal., with highbloodpressureandotherpoor dence connectshighindoortemperatures also contributestowardstarget3.4.Evi- (Baker etal., risk ofclose-contactcommunicablediseases dwelling habitable,islikelytoreducethe housing, orthroughmakingpartsofa building newhousing,extendingexisting al., water, sanitationandhygiene (Bakeret testinal diseases,aswellriskfactorsfor culosis, anddiarrhoealgastroin- including flu,pneumonia,typhoid,tuber- ciated withseveralinfectiousdiseases, demics (3.3).Householdcrowdingisasso- or combatcommunicablediseaseepi- and affordable housing(11.1)helpstoend Ensuring accessforalltoadequate,safe high-income countries(Hainesetal., poses riskstohealthinlow-,medium-and (Amore etal., without privacyorany securityoftenure) poor quality, unaffordable housing, tion (definedaspeoplelivingincrowded, hold income)orinseverehousingdepriva- more than30%oftotalmonthlyhouse- in unaffordable housing(definedascosting 2013). Reducinghouseholdcrowding,by Removing dangerous building materials Removing dangerousbuildingmaterials Improving accesstoadequatehousing 2013; Maidment et al., 2013; Maidmentet 2016; van Loenhout et al., 2016; vanLoenhoutet 2013). 2011). Inadequatehousing 2011). 2003; Stedman, 2013) and impaired 2013) andimpaired 2007, 2012;Telfar

2014). Excess Excess 2014).

2012a,b; Uejio

2016), 2016),

2013).

108 GOAL #3 GOOD HEALTH AND WELL-BEING et al., children. and soilwhereitmay beingestedby lead paintdegradesandmixeswithdust also pollutewaterandsoil.Forexample, as leadandasbestos.Thesesubstancescan of exposuretohazardoussubstancessuch contamination (3.9).Housingcanbeasite icals andair, water andsoilpollution deaths andillnessesfromhazardouschem- major roleinreducingthenumberof mote mentalhealthandwell-being(3.4). non-communicable diseasesandpro- reducingprematuremortalityfrom towards housing (11.1)arelikelytocontribute et al., improved mentalhealth(Howden-Chapman with reducingstressandcontributingto ing warmdryhomeshasbeenassociated 2014b). Improvinghousing,throughprovid- mainly inlow-incomecountries(who, using solidfuelsforcookingandheating, hold airpollution,closelyassociatedwith prematurely fromillnessescausedbyhouse- 2014a).In2012,4.3millionpeopledied disease, includingasthma(who,2009,2010, reduces theriskofchronicrespiratory pollutants improvesindoorairqualityand and mould,protectingagainstoutdoor lation, takingmeasurestoreducedampness cooking-stoves, installingventi- (Keall etal., injury hazards reducestheriskoffallsand et al., and respiratorysymptoms. outdoor heatandcoldcardiovascular response relationshipsbetweenindoorand research isneededtounderstandexposure- outcomes areclear, althoughfurther and unaffordable housingand poorhealth Associations betweeninadequate,unsafe KEY UNCERTAINTIES housing (Levinetal., lead poisoningcasesareassociatedwith Improving housing(11.1)willplay a 2008). Modifying homes to reduce reduce to 2008). Modifyinghomes 2007). Thusefforts toimprove 2005; Navas-Acien etal.,

In theus,about70%ofchildhood 2015b). Removingpolluting 2008).

2007; Levin

occupants. affordable housingimprovesthehealth of Directionality: Unidirectional.Betterquality, lamps canreduceindoorpollution. use solidfuelandopencooking-stoves chimneys andventilationwhenpeople housing safer. Forexample,installing Technology: Technology canassistinmaking strong cooperativetradition. requires aredistributivetaxsystemor quality control.Providingsocialhousing good healthandsafetyprocedures tural integrity)requireatrainedworkforce, installing insulation,improvingstruc- improve housing(retrofittinginsulation, Governance: Severalinterventionsto graphical context. to improvehousingalsodependongeo- health. Theeffectiveness ofinterventions housing andposeadditionalrisksto some places,naturaldisasterscandamage with indoorairpollutionaregreater. In the risksofrespiratoryillnessassociated use ofsolidfueliscommon,whichmeans respiratory health.Inlow-incomesettings, cold anddamphousingposesariskto while incoldandtemperatecountries, tures posearisktocardiovascularhealth, in hotcountries,highindoortempera- health dependongeography. Forexample, Geography: Theriskshousingposesto the season. to ahealthy temperaturewilldependon enabling housingtobeheatedorcooled other interventions,suchasthoseaimedat ing leadpipes).Timingoftheeffects of smoke alarmsormosquitonetsreplac- health outcomesimmediately(e.g.installing housing canreducetheriskofadverse housing). Someinterventionstoimprove in paintorexposuretodampandcold tively overtime(e.g.exposuretolead to badwiringorbrokensteps)cumula- mediately (e.g.injuriessustaineddue Time: Poorhousingcanaffect healthim- KEY DIMENSIONS

109 GOAL #3 GOOD HEALTH AND WELL-BEING SDG 3.9 3.8 3.6 3.4 TARGETS

11.2

11.2 11.2 11.2 3

+ SDG diseases or preventnon-communicable activity andhelpstomitigate travel modes,promotesphysical particularly supportingactive Improving transportand pollution and reduceexposuretoair to reductionsincarbonemissions reduced caruseandcontribute and walkingnetworksenable designed publictransport,cycling Compact citieswithwell- and friends,education to healthcare,employment,family Transport systemssupportaccess traffic accidents pedestrians, willreduceharmfrom road userssuchascyclistsand particular regardtovulnerable Improving roadsafety, with KEY INTERACTIONS 11 + + + + SCORE 3 2 3 2 and services and well-connectedtohomes,jobs, transport systemsareintegrated Ensure thatpublicandactive legislation comprehensive roadsafety vulnerable roadusers.Ensure prioritises safetyandprotects Design infrastructurethat crossings lanes, shading,andpedestrian slowing measures,footpaths,cycle such asstreetlighting,traffic appropriate tothelocalcontext, and walkingthroughmeasures modes, andencouragecycling connect activeandpublictransport Ensure thattransportsystems POLICY OPTIONS physical activity of urbantransportandencourage dependence andcarbonintensity development inordertoreducecar accessible mixed-landuseurban Promote policiesforcompact, 110 GOAL #3 GOOD HEALTH AND WELL-BEING to relyonprivatemotorvehicleuse developments, whicharemorelikely transport networksthangreenfield can bettersupportimproved Infill orbrownfield development education amenities, suchashealthcareand networks supportaccesstokey Better andmoreaffordable transport accidents users willreduceharmfromtraffic Improved roadsafetyforvulnerable communicable diseases from, andprevention of,non- support reductioninmortality Enhanced activetravel networks disease incidence ofairpollution-related improves airqualityandreducesthe A reductionintransportemissions KEY POINTS associated withimproving housingand support thepositivehealth outcomes of vulnerableroadusers. and employment;improvingthesafety improving accesstohealthcare,education, air quality;encouragingphysical activity; exposure toharmfulsubstancesandpoor 3.9), viaanumberofpathways: reducing related topollutionandroadtraffic(3.6, incidence ofmortalityandmorbidity communicable diseases(3.4)andthe targets ofreducingtheincidencenon- likely tocontributetowardsthehealth Improving transportsystems(11.2)is KEY INTERACTIONS Achieving target11.2islikely to Improving transportsystems willplay a towards areductionintransport emissions. motorised transportcanalso contribute as wellpublictransport,overprivate tive means(who,2015). encouraging morepeopletotravel byac- roads safercanpreventfatalitieswhile the rolloutofkeyinterventionstomake fic crashesarepredictableandpreventable: ans andcyclists(who,2015).Mosttraf- road trafficdeathsoccuramongpedestri- African region,forexample,43%ofall needs ofmotoristsinmind.Yet inthe ture ismainlyconstructedwiththe road trafficaccidents(3.6).Roadinfrastruc- help reducedeathsandinjuriesfrom such aspedestriansandcyclistscanalso particularly forvulnerableroadusers pollution. a 9.6%increaseinpercapitahazardous per-capita carbondioxideemissionsand urban sprawl thereisa5.7%increasein is estimatedthatforevery10%increasein tions betweenresidents(Litman,2006).It walkable cities,withincreasedinterac- There arealsosocialbenefitstocompact options fornon-drivers(Litman,2016). effects oftravel, andincreasingmobility port, avoiding thecostsandadverse cities canalsoreducetheneedfortrans- et al., al., (Andersenetal., diabetes, andmentalhealthproblems(3.4) obesity andobesity-relatedillnesses, the riskofcardiovasculardisease,cancer, which cancontributetowardsreducing work toencouragewalkingandcycling cycle ways thataresafeandattractive,all for cyclists,andinvesting infootpathsand cities, greenspaces,makingroadssafer et al., comes (HineandMitchell,2003;Syed are associatedwithimprovedhealthout- and tofriendsfamily, allofwhich education opportunities,medicalservices, connect housingtoemploymentand settlements. Affordable transportsystems 2007; Boone-Heinonenetal., The promotionofwalkingandcycling, Improving transportsystems(11.2), 2013; Sagrestanoetal., 2012; Kealletal., 2000; Matthewset 2015a). Compact 2015). Compact 2015). Compact 2009; Lim

111 GOAL #3 GOOD HEALTH AND WELL-BEING vision cantakedecades. developing orredevelopingcitiestofitthis carbon emissionsarereduced.However, is improved,airqualityimproves,and the medium-tolong-term,physical activity for thosewhousetransportnetworks.In the short-term,greateraccessisachieved immediate andlong-termbenefits.In Time: Improvingtransportnetworkshas KEY DIMENSIONS networks andhealtharewell-established. linksbetweenimprovedtransport There arefewuncertainties,becausethe KEY UNCERTAINTIES and illnessesfromhazardousairquality(3.9). and tohelpreducethenumberofdeaths non-communicable diseaseby2030(3.4) help reduceprematuremortalityfrom decisions intourbanplanningislikelyto sions. Integratingimprovedtransport of affected populationsandvehicleemis- including therelativephysical activity effects laterfortransportinfrastructure, to atime-lagbetweendecisionsnowand possibilities forthefuture,contributing in thepresentwill‘lockin’infrastructure Sallis etal., and cycling(Howden-Chapmanetal., works, andactivetravel suchaswalking greater relianceonpublictransportnet- opments canfacilitateashift towards commitments, infillandbrownfield devel- 2016). Withtherightinfrastructure cost ofdevelopment(AdamsandChapman, risk forhumanhealthaswellincreased bodies (Mooresetal., zincandcopperintosoilwater- mental burdens,suchasleachingof motor-vehicle transportcarriesenviron- reliance. Increasedrelianceonprivate can encouragecar-orientatedtransport to infillorbrownfielddevelopments chemicals andair, waterandsoils(3.9). deaths andillnessesfromhazardous major roleinreducingthenumberof Greenfield developmentincomparison 2016). Urbandevelopments 2010), whichcarry 2011;

safety, and encouragingphysical activity. reducing airpollution,improvingroad port systemssupporthealthgoalsby Directionality: Unidirectional.Bettertrans- to pollutionandroadtraffic. reducing mortalityandmorbidityrelated emissions andsafetywillcontributeto Technological improvementstovehicle to renewable,fossil-fuelfreeelectricity. will bebeneficialinplacesthathave access ered publictransportinfrastructure Technology: Aconversion toelectric-pow- the city’stransportnetworks. may providethemandateforimproving central governments.Citymunicipalities strong roletoplay, inassociationwith Governance: Localgovernmentshave a may alsorequirespecialattention. to publictransportandactive international interlinks.Culturalattitudes buses, andregional,national, networks topower(forexample)electric what accessexiststorenewableenergy the ageandbuiltenvironment ofacity, networks, forexampledependingon different methodsofimprovingtransport Geography: Different contextswillrequire 112 GOAL #3 GOOD HEALTH AND WELL-BEING into amultipurposepublic spacewith stream. Cheonggyecheon became reborn for theimmediaterestorationof Myung Bak,whosuccessfullyadvocated election andledtothevictoryofMayor Lee issue duringthe2002Seoulmayoral restoration becomingamajorpolitical contributed totheCheonggyecheon due topoorconstruction.Thesefactors two majorpiecesofinfrastructureinSeoul of thestream,followedcollapse including culturalandhistoricalrenewal in favour ofsustainablewell-being, The dramaticchangeinSeoul’spriorities competitiveness intheareaasawhole. that wascontributingtoalossofeconomic river) werecausinganurbanimbalance infrastructure ofGangnam(southHan stream runs,comparedtothenewer Han river)wheretheCheonggyecheon out infrastructureinGangbook(northof the Cheonggyecheonstream.Theworn motorway ortodeculvertandrestore demolish itcompletelyandbuildanew that adecisionwasneededonwhetherto by theearly2000sitwassodilapidated to rapidindustrialdevelopment.However, Seoul duringthemid-tolate1900sleading easier accesstothedowntownareaof motorway, that covered the stream allowed stream restoration.TheCheonggyecheon being ofitscitizens. sustainability withanewfocusonthewell- government tookstepstowards significant exampleofhowametropolitan Project providesaninternationally The CheonggyecheonStreamRestoration foreseeable futureadverserepercussions. path andacheaperquick-fixsolutionwith expensive butsustainabledevelopment of having tochoosebetweenamore Decision-makers often facethedilemma SEOUL, REPUBLICOFKOREA RESTORATION PROJECT, CHEONGGYECHEON STREAM RESTORATION OF ILLUSTRATIVE EXAMPLE Multiple factorscontributedtothe gyecheon areafellby6–9°C. and average temperatureintheCheong- the stream,reducedheatislandeffect the continuousdepressedlengthof the openingofanewwindingpathalong et al., respectively between2002and2005(Jang gen dioxide(no2)inairby15%and10% fine particulatematter(pm10)andnitro- of vehicles.Therestorationalsoreduced while maintainingtheaverage speed in theCheonggyecheonareabyathird, way usageandreduceddailytraffic the stream. connecting thenorthandsouthsideof length ofthestreamand22bridges continuous pedestrianroadsalongthe new subways stationsclosetothestream, were builtwiththeopeningoftwo trips under10km.Activetravel networks duced, withastandardfixedfeefor tute, 2005).Integratedticketingwasintro- than cartrips(SeoulDevelopmentInsti- bus numbers)andmadeasfast,orfaster improved (e.g.colourcodingandreformed and fasteroption.Busserviceswere ing publictransportthecheaper, easier et al., invested heavily inpublictransport(Chung side ofthestreamandinconjunction, traffic totwo-laneone-way streetsoneither Metropolitan Governmentlimitedcar hicles, butafter itsdemolitiontheSeoul daily trafficflowofaround170,000ve- the lengthofstream. continuous walkways andcycleways along These efforts increasedbusandsub- The motorway hadpreviouslya 2010). Thereductionincarsand 2012). Investment focusedonmak-

113 GOAL #3 GOOD HEALTH AND WELL-BEING SDG 3.4 3.9 TARGETS

13.2

13.2 3

+ SDG KEY INTERACTIONS quality will supportimprovementsinair sures intonationalpolicies Integrating climatechangemea- indirectly constrainhealthcare negatively affecttheeconomyand in someindustries,whichcould emissions mayleadtojoblosses has somecosts.Reducing measures intonationalpolicies Integrating climatechange 13 - + SCORE 1 3 industries transitioning outoffossilfuel support forretrainingofworkers Invest inrenewableenergyand mitigation policies prioritise urbantransportcarbon frameworks tohelpstructureand Utilise systemsthinkingand change andreducingairpollution. simultaneously mitigatingclimate Recognise theco-benefitsfrom POLICY OPTIONS 114 GOAL #3 GOOD HEALTH AND WELL-BEING tation andgovernance technologies, meansofimplemen- so areconsiderationsofavailable pollution andclimateisimportant, behind theinteractionofair While understandingthechemistry tion policies ture andprioritiseurbanmitiga- improve framework canhelpstruc- and airpollution;theavoid-shift- fields isakey source of emissions plants andburningofagricultural Urban transport,industries,thermal ever, botharenecessary than high-incomecountries;how- or medium-incomecountries mitigation may begreaterinlow- undertaking simultaneous On average, theco-benefitsfrom matter forhealth short-lived climatepollutantsalso the long-livedgreenhousegases, While themainfocusremainson benefit health air pollution:bothoutcomeswill mitigate climatechangeandreduce combustion willsimultaneously In general,areductioninfossilfuel KEY POINTS Mitigating climatechange, whilereducing gas emissionsandonlocal airquality. have positive impactsongreenhouse non-motorised transportprovisioncan (Dalkmann etal., existing modesofprivatetransport physical activity, toswitchingfuelsfor better publictransportandhealthy from urbanintensificationthatfacilitates for reducingcarbonemissions,ranging There isawidearray ofpotentialsolutions through actioninthetransportsector. as reducingairpollutioncanbeachieved inhaled, andcontributestoclimatechange. carries arisktohumanhealthwhen these pollutantscontributestosmog, brick production(acp generation), cookingwithbiomass,and bustion (forvehiclesandelectricity industrial processessuchasdieselcom- carbon resultsfromvariousdomesticand tropospheric ozone(un,2015a).Black and aerosolssuchasblackcarbon climate pollutantsincludeparticles cooling influence(acp sulphur isremovinga(temporary)climate clear thatthewidespreadabatementof al., dioxide (so trol harmfulemissionssuchassulphur Paris toBeijing.Accordingly, efforts tocon- with ongoingproblemsincitiesfrom international environmental policydriver pollution. to mitigateclimatechangeandreduceair reducing fossilfuelcombustionwillact the combustionoffossilfuels.Therefore, and localairquality, largelyderive from Emissions, whichaffect boththeclimate policies, strategiesandplanning(13.2). of climatechangemeasuresintonational pollution (3.9)andtheintegration the healthimpactsofair, waterand soil section isontheinteractionbetween action isverybroad.Thefocusofthis many ways andthescopeforclimate Climate changeinteractswithhealthin KEY INTERACTIONS 2013) althoughironically, itisnow Mitigating climatechangeaswell Abating airpollutionisarecurring ² ) have alonghistory(Kanadaet 2014). Well planned , 2014).Eachof , 2014).Short-lived

115 GOAL #3 GOOD HEALTH AND WELL-BEING policies (Howden-Chapmanetal., have lookedintotheco-benefitsofaligned and airpollutionobjectives,many studies Puppim deOliveira,2017). policy packagesinagivensector(Dolland analysis canhelpstructureandprioritise and timescalesforimplementation, different policieshave different challenges relates totechnologiesandbehaviour when the broadercontextofasectorandhowit understanding theco-benefitsofpoliciesin improve framework,whichisaway of conceptualised throughtheavoid-shift- processes. Therangeofstrategiescanbe as wellindustrialandmanufacturing tricity andheatgeneration,especiallycoal, regulation tolimitemissionsfromelec- air pollution,canalsobeachievedthrough Bell etal., review (Nemetetal., care mustbetakentoensure thatsome indivisible. However, within certainsectors, reinforcing. Insomecases, itmay be (3.9) isbroadlyenablingandpotentially health-enhancing airpollutionmeasures climate changemitigation(13.2)and local municipalorregionalpolicygoals. ensuring policymeasurescontributeto climate andairpollutionobjectives,while order tominimisetheriskofmisaligning of implementation,andgovernance,in erations ofavailable technologies,means needs tobecomplementedbyconsid- tion withclimatechangemitigation.This health gainsfromairpollutionreduc- first stepindesigningpoliciesforaligning pollution andclimateisanimportant chemistry behindtheinteractionofair where thereisrelativelylowairpollution. reducing airpollutionlevelsinplaces higher levelsofairpollution,thanfrom health benefitsfromreducing(initially) was becausetherearegreatermarginal countries thanhigh-incomecountries.This mitigation weregreaterinlow-income tonne co average theco-benefits(valuedinus$per Given thealignmentbetweenclimate The interactionbetweenpoliciesaimed Understanding theatmospheric ² ) fromundertakingsimultaneous 2008; Bollenetal., 2010) foundthaton 2009). One 2007; other locations. may be transportedandhave animpacton as airpollutionemittedinonelocation Coordination isvital(eveninternationally) to localmunicipalorregionalpolicygoals. while ensuringpolicymeasurescontribute ing climateandairpollutionobjectives, important tominimisetheriskofmisalign- Governance: Attention togovernanceis than high-incomecountries. higher benefitsinlow-incomecountries with airpollutionreductionyielding benefits andcostsofpolicymeasures, local. Context influencestherelative more gains fromairqualityimprovementsare measures have moreglobalbenefits, Geography: Whilegreenhousegasreduction have fulleffect, ascitiesgrowandchange. of publictransport,willtakedecadesto travel andmaximiseactivetravel anduse policies toalterurbanformminimisecar carbon reductionmeasures,particularly to ‘rebound’overtime.Someinfluential proving vehiclefuelefficiency, aresubject pollution reducingeffects, suchasim- sures withbothcarbonmitigatingandair term influenceonglobalhealth.Somemea- per se.Thelatterwillbeacriticallong- on healththancarbonemissionreduction air qualitygainswillhave afastereffect Time: Healthbenefitsfromconsequential KEY DIMENSIONS strength ofsomepolicymeasures. Uncertainties remainastotheeffect/ KEY UNCERTAINTIES cause moresevereairpollutionevents. well-known andadryorcoldclimatemay Seasonal effects onairpollutionare on airpollutionfromachangingclimate. over alargescale.Therearealsoimpacts and theirlong-termeffects ifdeployed the perspectiveofprecursoremissions, cies inparticularmustbeexaminedfrom counteract thetarget.Fuelswitchingpoli- options donotinadvertentlyconstrainor

116 GOAL #3 GOOD HEALTH AND WELL-BEING likely tosubstantiallyoutweighsuchcosts. but inthelongterm,healthgainsare although offset byjobgainselsewhere; areas dependentonfossilfuelextraction, spending. Thesecouldbeseriousin knock-on effects onhealthand in theshort-term,whichmay have dent onfossilfuelsmay costsomejobs The transitiontoaneconomy lessdepen- through improvementsinairquality. mitigating climatechangeimmediately Directionality: adaptation. impact onclimatechangemitigationand account changingtechnologiesthat Technology: Publicpoliciesmusttakeinto Largely unidirectional: 117 E INTEATION SDG 3 WITH OTHER GOALS

+ SDG 2 + SDG 3 + SDG 8 + SDG 11 + SDG 13 AFFORDABLE AND CLEAN ENERGY GOAL #7

SCORE SCORE

+3 +3 +3 +3 +3 +3 +3

+

+2 +2 +2 +2 +2 +2 +2 +2 +2 +2 +2 +2 +2

+1 +1 0 0 -1 -1 -1 -1

-3 -3 SCORE +3 -3 0 + SDG E INTEATION

+ SDG 2 + -1 -1

3 + 2 2 WITHOTHERGOALS +

SDG + 3 + 2 + 2 + 3 2 + 2 + 2 +

SDG -1 +

1 + 2 + 8 2 + 3 118 GOAL #14 LIFE BELOW WATER +

+ SDG 2 + 2 + 2 + 11 3 + + 1 1 + 2 + 3 +

+ SDG 3 -1 13 +3 0 -3 SCORE 119 KNOWLEDGE GAPS

The preceding sections have illustrated 3 + 2 (2.3) some of the many interactions between Careful case-by-case analysis is needed sdg 3 and the other sdgs. These inter- concerning how intensifying agricultural actions can be positive, negative, or neutral, production is expected to affect the uni- or bi-directional, short- or long-term, environment, including the expansion of and often depend on geography, gov- pathogen habitats and the degradation of ernance and technology. For some inter- waterways actions, the state of science is not yet advanced enough to provide accurate 3 + 3 and reliable assessments. As science More research is needed to strengthen advances and the evidence base grows, the evidence base for connections more comprehensive assessments between sdg 3 targets; for example, the should be possible, enabling significant connection between air pollution and improvements to sdg implementation maternal mortality rates is only beginning strategies at regional, national and local to become clear. However, standalone scales. In general terms, integrated programmes may detract resources from research, monitoring and data analyses broader aspects of the health system will be needed in combination with targeted capacity development to fill 3 + 8 existing knowledge gaps. The section pro- Economic growth occurs differently in vides a non-exclusive list of knowl different contexts: some forms of growth edge gaps that have been identified in are environmentally and socially damag- relation to the complex web of trade- ing, while others (e.g. growth in the supply offs involving the sdg 3 target interactions of infrastructure for renewable energy) described in this chapter. are generally not. Expanding understand- ing of the specific contexts and policies mediating the interdependency between growth and long-term health and well- being is important for minimising critical trade-offs. Further research is needed on the relationship between income gains, employment and health at higher levels of development, given observed diminish- ing returns at high levels of wealth and income for the rich and the engendering of a sense of relative social and economic deprivation among the poor

3 + 11 (11.1) More work is needed on the health impacts of quality, compact city environments with high access to amenities and a mix of 120 GOAL #3 GOOD HEALTH AND WELL-BEING localities climate changeactionsindifferent these pollutantscanbemitigatedthrough information isrequiredonhowmany of locally andfromsurroundingareas.Better multiple (diffuse orpoint)sourcesboth pollution isacomplexissuearisingfrom housing, transportandurbanform.Air developments includingmoresustainable measures contributetolow-carbonurban measures, forexample,howcansuch measures andclimatechangemitigation the alignmentbetweenairpollution Better understandingisneededabout sharing transport andnewmodessuchascar choices, includingactivetransport, public can bestfosterhealth-promotingtransport ing developmentsandredevelopments More researchisneededonhownewhous- dwellings indifferent climates rity ofexistinghousingincludingslum contexts, suchasthequalityandsecu- dwellings contributestohealthinvarious the volumeofenergyefficient,quality knowledge isneededonhowincreasing land uses,includingpublicspaces.Better 3 3

+ +

13 11 (13.2) (11.2)

121 CONCLUDING COMMENTS

With so many interactions between tar- Building on these general considera- gets, it is clear that government-led tions, the six summary tables in the target- actions and policies will be important level interactions section provide for ensuring that positive outcomes options for how policy could address the are achieved as frequently as possible and specific target interactions in practice. negative outcomes are minimised or Although addressed to specific target avoided. This requires the development interactions, many of these policy options of policy frameworks that take a are also relevant for other interactions. systemic, integrated, holistic perspective. For example, it is helpful to focus on interlinked policy goals of cities to gain insights for policy to advance health and well-being outcomes. Governments could usefully engage in policy experimentation to address increasingly urgent climate change issues. Some governments have demonstrated the importance of linking diverse policy measures to create mutually reinforcing measures for change. It is important that planning agencies make use of systems thinking to develop a more integrated view of outcomes that increase health and well-being (Chapman et al., 2016). It may also help to understand where existing vested interests may be working against the achievement of particular targets, and where business and civil society partners can collaborate with policies of local and national governments. Pro-active engagement and enhanced coordination across government departments and ministries, as well as across different levels of government (from international to national to local), and between state and non-state actors including business and non-government organisations, will be required for this to happen effec- tively. Given the diverse levels of interactions, the persistent ‘silo approach’ to policymaking, does not serve the achievement of the health targets well. 122 GOAL #3 GOOD HEALTH AND WELL-BEING Berkman, L.F.,I.KawachiandM. Glymour (eds),2014. Bell, M.L.,D.L.Davis,L.A.Cifuentes,A.J.Krupnick, Baker, M.G.,A.McDonald,J.ZhangandP. Howden- Azhar, G.S.,D.Mavalankar, A.Nori-Sarma,Rajiva, Audibert, M.,P. CombesMotel andA.Drabo,2012. Atun, R.A.,S.BennettandA.Duran,2008.Whendo Andersen, L.B.,P. Schnohr, M.SchrollandH.O.Hein,2000. Amore, K.,M.BakerandP. Howden-Chapman,2011. amc, 2013.AhmedabadHeatActionPlan2013:Guide Adams, M.andR.Chapman,2016.Dodenserurban acp, 2014.BringingDevelopmentandClimateTogether REFERENCES The authorswouldliketoacknowledgethevaluable ACKNOWLEDGEMENTS University Press. Social Epidemiology. SecondEdition.Oxford 069X-7-41. Environmental Health,7:41,doi:10.1186/1476- quality resultingfromclimatechangemitigation. Ancillary humanhealthbenefitsofimprovedair R.D. MorgensternandG.D.Thurston,2008. Wellington. Health ResearchProgramme,UniversityofOtago, Review andBurdenofDiseaseEstimate.Housing Household CrowdinginNewZealand:ASystematic Chapman, 2013.InfectiousDiseasesAttributableto Ahmedabad heatwave.ploSOne,9(3):e91831. excess all-causemortalityassociatedwiththe2010 J.J. Hess,2014.Heat-relatedmortalityinIndia: P. Dutta,A.Jaiswal,P. Sheffield,K.Knowltonand alshs-00678713. Global burdenofdiseaseandeconomicgrowth. health systems?World HealthOrganization. vertical (stand-alone)programmeshaveaplacein Archives ofInternalMedicine,160:1621-1628. during leisuretime,work,sports,andcyclingtowork. All-cause mortalityassociatedwithphysicalactivity Homelessness, 5:19-37. classification ofhomelessness.EuropeanJournal A criticalreviewoftheethosdefinitionand Ahmedabad MunicipalCorporation(amc). to extremeheatplanninginAhmedabad,India. 12:63-70. Zealand territorialauthorities.PolicyQuarterly, areas saveoninfrastructure?EvidencefromNew (acp). in Asia.WhitePaper. AsianCo-benefits Partnership University ofOtago,Wellington, New Zealand. contributions ofJennyOmblerandDavidJu,atthe Daly, H.E.andJ.Farley, 2004.EcologicalEconomics: Dalkmann, H.,C.Brannigan,B.LefevreandA.Enriquez, csdh, 2008.Closingthegapinageneration:Health Costanza, R.,I.Kubiszewski,E.Giovannini,H.Lovins,J. Concha-Barrientos, M.,D.I.Nelson,T. Driscoll,N.K. Chung, J.H.,K.Y.HwangandY.K.Bae,2012.Theloss Chay, K.Y.andM.Greenstone,2003.AirQuality, Infant Chapman, R.,P. Howden-ChapmanandA.R.Capon, Boone-Heinonen, J.,K.R.Evenson,D.R.Taber andP. Bollen, J.,B.vanderZwaan,C.BrinkandH.Eerens, Bloomberg, M.R.andR.T. Aggarwala,2008.Think Bloom, D.andCanning,2003.Thehealthpoverty Biermann, F.,K.Abbott,S.Andresen,Bäckstrand, Principles AndApplications.Island Press. makers inDevelopingCities. 5e. SustainableTransport: ASourcebookforPolicy- 2014. Urbantransportandclimatechange:Module Determinants ofHealth.World HealthOrganization. of health.FullreporttheCommissiononSocial equity throughactiononthesocialdeterminants to leavegdpbehind.Nature,505:283-285. McGlade, K.E.Pickettetal.2014.Development:time factors. pp.1651-1801.World HealthOrganization. burden ofdiseaseattributabletoselectedmajorrisk quantification ofhealthrisks:globalandregional Selected occupationalriskfactors.In:Comparative Üstün, J.Leigh,S.Woo Tak andC.Corvalan,2004. Steenland, L.Punnett,M.Fingerhut,A.Prüss- Policy, 21:165-178. the Cheonggyecheonstreamrestoration.Transport of roadcapacityandself-compliance:Lessonsfrom Bureau ofEconomicResearch,Working Paper10053. Mortality, andtheCleanAirActof1970.National Environment International,94:380-387. to improvehealthandclimatechangemitigation. 2016. Understandingthesystemicnatureofcities Reviews, 10:204-217. systematic reviewofobservationalstudies.Obesity of cardiovasculardiseaseinmenandwomen:a Gordon-Larsen, 2009.Walking for prevention Energy Economics,31:161-181. A combinedcost-benefitanalysis.Resourceand 2009. Localairpollutionandglobalclimatechange: Medicine, 35:414-423. locally, actglobally. AmericanJournalofPreventive Human Development,4:47-71. of nations:Fromtheorytopractice.Journal Science, 335:1306-1307. Anthropocene: improvingEarthSystemGovernance. Bernstein, M.M.Betsilletal.2012.Navigatingthe 123 GOAL #3 GOOD HEALTH AND WELL-BEING Goswami, E.,V. Craven,D.L.Dahlstrom,D.Alexander Global CommissionontheEconomyandClimate,2014. Global BurdenofDiseasePediatricsCollaboration,2016. Gilbert, M.,X.Xiao,D.U.Pfeiffer, M.Epprecht,S.Boles, Gatzweiler, F.W., Y.-G.Zhu,A.V. DiezRoux,A.Capon,C. eu-osha, 2013.Prioritiesforoccupationalsafetyand andJ.John,2013.Reductionsin Dunne, J.,R.Stouffer Dora, C.,A.Haines,J.Balbus,E.Fletcher, H.Adair- Doll, C.N.H.andJ.PuppimdeOliveira(eds.), Diamond, J.,2005.Collapse.PenguinBooks. Dhainaut, J.-F.,Y.-E.Claessens,C.GinsburgandB.Riou, De Maeseneer, J.,C.Van Weel, D.Egilman,K. Public Health,10:5629-5670. International JournalofEnvironmental Researchand a reviewofepidemiologicandexposuredata. and F.Mowat,2013.Domesticasbestosexposure: Better Growth-Climate. 2013 study. jamaPediatrics,170:267-287. 2013: Findingsfromtheglobalburdenofdisease among childrenandadolescentsbetween1990 Global andnationalburdenofdiseasesinjuries Academy ofSciences,105:4769-4774. risk inSoutheastAsia.ProceedingsoftheNational Mapping H5N1highlypathogenicavianinfluenza minh, M.J.Otte,V. MartinandJ.Slingenbergh,2008. C. Czarnecki,P. chaitaweesub, W. Kalpravidh,P.Q. approach. Springer. Urban Environment:Implementingasystems Advancing HealthandWell-being intheChanging S. Jayasinghe,ParnellandY.Zhang,2017. K.Hanaki,L.C.Rietveld,P.J.I. Boufford, Ritchie, Donnelly, G.Salem,H.M.Ayad,I.Speizer, I.Nath, Agency forSafetyandHealthatWork (eu-osha). health researchinEurope:2013-2020.European warming. NatureClimateChange,3:563-566. labour capacityfromheatstressunderclimate development agenda.TheLancet,385:380-391. linking healthandsustainabilityinthepost-2015 Rohani, G.Alabasteretal., Routledge. Implementation ofwin-wininterventionsincities. 2017. UrbanizationandClimateCo-Benefits: departments. CriticalCare,8:1,doi:10.1186/cc2404. 2003 heatwaveinParis:consequencesonemergency 2003. Unprecedentedheat-relateddeathsduringthe Journal ofGeneralPractice,58:3-4. between verticalandhorizontalinvestment.British Strengthening primarycare:addressingthedisparity Mfenyana, A.KaufmanandN.Sewankambo,2008. 2015. Indicators Jones, B.A.,D.Grace,R.Kock,S.Alonso,J.Rushton,M.Y. Jang, Y.K.,J.Kim,H.J.KimandW.S. Kim,2010.Analysis Jackson, T., 2009.ProsperityWithoutGrowth:Economics Institute ofMedicine(us)ForumonMicrobialThreats, Institute ofMedicine(us)CommitteeontheEconomics Howden-Chapman, P., H.Viggers, R.Chapman,K. Howden-Chapman, P., S.Hales,R.ChapmanandC.Shaw, Howden-Chapman, P., A.Matheson,J.Crane,H.Viggers, Hine, J.andF.Mitchell,2003.Transport Disadvantage Haines, A.,N.Bruce,S.Cairncross,M.Davies,K. O.Gaffney,Griggs, D.,M.Stafford-Smith, J.Rockström, Sciences usa change. ProceedingsoftheNational Academyof to agriculturalintensificationandenvironmental and D.U.Pfeiffer, 2013.Zoonosis emergencelinked Said, D.Mckeever, F.Mutua,J.Young, J.McDermott Assessment, 19:99-106. restoration Project.JournalofEnvironmentalImpact of airqualitychangecheonggyecheonareaby for aFinitePlanet.Earthscan. Academies Press. Connections, Workshop Summary. National Environmental, HumanHealth,andEcological 2008. Vector-Borne Diseases:Understandingthe pp. 168-196.NationalAcademiesPress. Economics ofMalariaDrugsinanAgeResistance. and H.Gelband(eds.),SavingLives,BuyingTime: Burden ofMalaria.In:Arrow, K.J.,C.Panosian Antimalarial Drugs,2004.TheHumanandEconomic impacts. EnergyPolicy, 49:134-142. Zealand: Areviewofpolicies,research,andhealth Tackling coldhousingandfuelpovertyinNew O’Sullivan, L.Telfar BarnardandB.Lloyd,2012. system. AirQualityandClimateChange,45:19-23. 2011. Improvingairquality:co-benefitsfortheurban Journal, 334:460. randomised studyinthecommunity. BritishMedical insulating existinghousesonhalthinequality:cluster Woodward, of K.Saville-Smithetal. 2007.Effect M. Cunningham,T. Blakely, C.Cunningham,A. and SocialExclusion.Ashgate,Aldershot,uk. Urban Health,90:810-831. improved housinginlow-incomesettings.Journalof health andadvancingdevelopmentthrough Satterthwaite andP. Wilkinson,2013.Promoting Greenland, A.Hiscox,S.Lindsay, T. Lindsay, D. Nature, 495:305-307. Sustainable developmentgoalsforpeopleandplanet. M.C. Ohman,P. Shyamsundaretal.2013.Policy: , 110:8399-8404. 124 GOAL #3 GOOD HEALTH AND WELL-BEING Lim, S.S.,T. Vos, A.D.Flaxman, G.Danaei,K.Shibuya, Levin, R.,M.J.Brown,M.E.Kashtock,D.E.Jacobs,E.A. Layard, R.andP.R.G. Layard,2005.Happiness:Lessons Lanphear, B.P., R.Hornung,J.Koury, K.Yolton, P. Kubiszewski, I.,R.Costanza,C.Franco,P. Lawn,J. Kjellstrom, T. andJ.Crowe,2011.Climatechange, Kim, Y.-M.,S.H.-K.Cheong,K.ChoiandB. Kim, Y.-M.,S.H.-K.Cheong,B.AhnandK.Choi, Keall, M.D.,N.Pierse,P. Howden-Chapman,C. Keall, M.,R.Chapman,P. Howden-Chapman,K.Witten, Kanada, M.,T. Fujita,M.FujiiandS.Ohnishi,2013.The H. Adair-Rohani etal., Perspectives, 116:1285-1293. implications forprevention.EnvironmentalHealth Sinks, 2008.Leadexposuresinuschildren,2008: Whelan, J.Rodman,M.R.Schock,A.PadillaandT. from aNewScience.PenguinPress. 113:894-899. analysis. EnvironmentalHealthPerspectives, intellectual function:aninternationalpooled environmental leadexposureand children’s Baghurst, R.L.Canfield,etal., Ecological Economics,93:57-68. measuring andachievingglobalgenuineprogress. Talberth, T. Jacksonetal.2013.Beyondgdp: 17:270-281. Journal ofOccupationalandEnvironmentalHealth, and productivityinCentralAmerica.International workplace heatexposure,andoccupationalhealth 23(5S). living inpoorhousingconditions.Epidemiology, temperature andbloodpressureinelderlypeople ofhightemperatureonbody Ahn, 2012b.Effects Environmental HealthandToxicology, 27:e2012013. and bloodpressureinthepoorelderly. ofheatwaveonbodytemperature 2012a. Effects 385:231-238. study: acluster-randomised controlledtrial.Lancet, in thehomeinjurypreventionintervention(hipi) Home modificationstoreduceinjuriesfromfalls Cunningham, M.J.Guriaetal.2015b. doi:10.1136/jech-2015-205466 Journal ofEpidemiologyandCommunityHealth,69, of aninterventiontoencouragewalkingandcycling. active travel:resultsofaquasi-experimentalstudy W. AbrahamseandA.Woodward, 2015a.Increasing Journal ofCleanerProduction,58:92-101. industrial energyefficiencyinKawasakiCity, Japan. historical linksbetweenmunicipalactionsand long-term impactsofairpollutioncontrolpolicy: 2012. Acomparative 2005. Low-level Moores, J.,P. PattinsonandC.Hyde,2010.Enhancing Millennium EcosystemAssessment,2005.Ecosystemsand Meadows, D.,1998.Indicatorsandinformationsystems McCauley, D.J.,D.J.Salkeld,H.S.Young, R.Makundi, Matthews, C.E.,A.L.Jurj,X.-O.Shu,H.-L.Li,G.Yang, Maloney, willa S.andC.Forbes,2010.Whateffect Maidment, C.D.,C.R.Jones,T.L. Webb, E.A.Hathway MacDorman, M.F.,E.Declercq,H.CabralandC.Morton, Lumley, J.,S.S.Oliver, C.ChamberlainandL.Oakley, Litman, T., 2016.SellingSmartGrowth:Communicating Litman, T., 2006.CitiesConnect:HowUrbanityHelps roads: results of a road runoff samplingprogramme. roads: resultsofaroadrunoff the controlofcontaminantsfromNew Zealand’s Human Well-Being: Synthesis.IslandPress. Vermont. Group. TheSustainabilityInstitute,Heartland, for sustainabledevelopment:areporttotheBaaton and Hygiene,92:776-783. Tanzania. TheAmericanJournalofTropical Medicine on plague(Yersinia pestis)activityinrodents oflanduse Barry andK.M.Helgen,2015.Effects Dirzo, R.P. Eckerlin,E.F.Lambin, L.Gaffikin,M. American JournalofEpidemiology, 165:1343-1350. physical activityonmortalityinChinesewomen. exercise, walking,cycling,andoverallnon-exercise Q. Li,Y.-T. GaoandW. Zheng,2007.Influenceof International JournalofBiometeorology, 55:147-160. heat balance?Implicationsforhumanactivity. few degreesofclimatechangehaveonhuman analysis. EnergyPolicy, 65:583-593. energy efficiencymeasuresonhealth:Ameta- and J.M.Gilbertson,2014.Theimpactofhousehold Obstetrics andGynecology, 128:447-455. rate: disentanglingtrendsfrommeasurementissues. 2016. RecentincreasesintheU.S.maternalmortality Reviews 2004(4):cd001055. during pregnancy. CochraneDatabaseofSystematic 2004. Interventionsforpromotingsmokingcessation British Columbia. Governments. VictoriaTransport PolicyInstitute, Modal LocationstoHouseholds,Businessesand the DirectBenefitsofMoreAccessible,Multi- Transport PolicyInstitute,BritishColumbia. Achieve SocialInclusionObjectives.Victoria 380:2224-2260. the GlobalBurdenofDiseaseStudy2010.TheLancet, in 21regions,1990–2010:asystematicanalysisfor attributable to67riskfactorsandfactorclusters risk assessmentofburdendiseaseandinjury 125 GOAL #3 GOOD HEALTH AND WELL-BEING Rockström, J.,W. K.Noone,A.Persson, F.S. Steffen, Reid, M.C.andF.E.McKenzie,2016.Thecontributionof Redden, M.,2016.Texas hashighestmaternalmortality Pope, D.P., V. Mishra,L.Thompson,A.R.Siddiqui,E.A. Pattinson, R.,K.Kerber, E.Buchmann,I.K.Friberg,M. Nunes, A.,K.LeeandT. O’Riordan,2016.Theimportance , 2013.RisingTemperatures,nrdc Deadly Threat: Nilsson, M.,D.GriggsandM.Visbeck,2016.Policy:Map Nielsen, L.S.,J.Bælum,Rasmussen,S.Dahl,K.E.Olsen, Nemet, G.F.,T. HollowayandP. Meier, 2010.Implications Navas-Acien, A.,E.Guallar, E.K. SilbergeldandS.J. space forhumanity. Nature, 461:472-475. Chapin, E.F.Lambinetal.2009.Asafeoperating Journal, 15:107,doi:10.1186/s12936-016-1162-4. resistance inAfricanmalariavectors.Malaria agricultural insecticideusetoincreasing 20 August2016. rate indevelopedworld,studyfinds.TheGuardian. Epidemiologic Reviews,32:70-81. pollution fromsolidfueluseindevelopingcountries. birth weightandstillbirthassociatedwithindoorair Rehfuess, M.Weber andN.G.Bruce,2010.Riskoflow babies? TheLancet,377:1610-1623. how canhealthsystemsdeliverformothersand Rudan, N.Walker andJ.E.Lawn,2011.Stillbirths: Belizan, S.Lansky, E.Weissman, M.Mathai,I. 1(e000068). of healthandwell-being.bmjGlobalHealth, Sustainable DevelopmentGoals:theexample of anintegratingframeworkforachievingthe ). (nrdc Ahmedabad. NationalResourcesDefenseCouncil Recommendations toPrepareOutdoorWorkers in Goals. Nature,534:320-322. the interactionsbetweenSustainableDevelopment 206. Environmental andOccupationalHealth,69:191- - asystematicreviewoftheliterature.Archives Occupational asbestosexposureandlungcancer M. Albin,N.C.HansenandD.Sherson,2014. Letters, 5:014007. change policymaking.EnvironmentalResearch of incorporatingair-quality co-benefitsintoclimate Perspectives, 115:472-482. disease -Asystematicreview. EnvironmentalHealth Rothenberg, 2007.Leadexposureandcardiovascular Research, Auckland. National InstituteofWater andAtmospheric Telfar Barnard,L.,N.Preval,P. Howden-Chapman,R. Syed, S.T., B.S.Gerberand L.K.Sharp,2013.Traveling Stern, N.,2015.WhyAreWe Waiting? TheLogic, Stedman, J.R.,2004.Thepredictednumberofair Spellberg, B.,M.Blaser, R.J.Guidos,H.W. Boucher, J.S. Solar, O.andA.Irwin,2010.Aconceptualframeworkfor Shah, A.S.,J.P. Langrish,H. Nair, D.A.McAllister, A.L. Seoul DevelopmentInstitute,2005.Toward BetterPublic Say, L.,D.Chou,A.Gemmill,O.Tuncalp, A.B.Moller, J. Sallis, J.F.,F.Bull,R.Burdett,L.D.Frank,P. Griffiths,B. Sagrestano, L.M.,J.Clay, R.Finerman,J.Goochand Ross, K.,J.F.ChmielandT. Ferkol,2012.Theimpactofthe Health ServicesUtilisationandCosts, Pharmaceutical Impact ofRetrofittedInsulationand NewHeaterson Arnold, C.Young, A.Grimesand T. Denne,2011.The Health, 38:976-993. to healthcareaccess. JournalofCommunity towards disease:transportationbarriers mit Press. Urgency, andPromiseof Tackling ClimateChange. 1090. 2003 heatwave.AtmosphericEnvironment,38:1087- pollution relateddeathsintheukduringAugust Clinical InfectiousDiseases,52:S397-S428. resistance: Policyrecommendationstosavelives. and D.N.Gilbert,2011.Combatingantimicrobial Reller, J.Rex,D.Schwartz,E.Septimus,F.C.Tenover Bradley, B.I.Eisenstein,D.Gerding,R.Lynfield, L.B. Health Organization. action onthesocialdeterminantsofhealth.World Lancet, 382:1039-1048. failure: asystematicreviewandmeta-analysis.The 2013. Globalassociationofairpollutionandheart Hunter, K.Donaldson,D.E.NewbyandN.L.Mills, sites/default/files/2005-pr-16_0.pdf Seoul: SeoulMetropolitanGovernment.www.si.re.kr/ Transport: ExperiencesandAchievementofSeoul. 2:e323-333. who systematicanalysis.TheLancetGlobalHealth, Alkema, 2014.Globalcausesofmaternaldeath:a Daniels, A.M.Gulmezoglu,M.Temmermann andL. Lancet, 388:2936-2947. achieve healthyandsustainablefuturecities.The to guidecityplanningpolicyandpractice:how Giles-Corti andM.Stevenson,2016.Useofscience individuals. aidsCare,26:314-319. as abarriertoserviceutilizationforhiv-positive M. Rapino,2014.Transportation vulnerability 786. Clean AirAct.TheJournalofPediatrics,161:781- 126 GOAL #3 GOOD HEALTH AND WELL-BEING who, 2009.GuidelinesforIndoorAirQuality: Whitmee, S.,A.Haines,C.Beyrer, F.Boltz,A.G.Capon, Wagstaff, A.,2002.Povertyandhealthsectorinequalities. Waage, J.,C.Yap, S.Bell,C.Levy, G.Mace,T. Pegram, van Loenhout,J.,A.leGrand,F.Duijm,Greven,N. us epa undp, 2016.ClimateChangeandLabour:Impactsof un, 2015b.MillenniumDevelopmentGoalsReport2015. un, 2015a.Transforming ourworld:the2030Agendafor Uejio, C.,J.Tamerius, J.Vredenburg, G.Asaeda,D. Thomson, H.,S.Thomas,E.SellstromandM.Petticrew, van denBergh,J.C.J.M.,2011.Environmentversusgrowth (who). Dampness andMould.World Health Organization planetary health.TheLancet,386(10007):1973-2028. Rockefeller Foundation–LancetCommissionon health intheAnthropoceneepoch:reportofThe B.F. deSouzaDiasetal., handle/10665/71116 2002;80:97-105. http://apps.who.int/iris/ Bulletin oftheWorld HealthOrganization Health, 3:e251-e252. infrastructures, andinstitutions.TheLancetGlobal the unSustainableDevelopmentGoals:interactions, Mayhew, C.MarxandN.Poole,2015.Governing E. Unterhalter, N.Dasandi,D.Hudson,R.Kock,S. elderly persons.EnvironmentalResearch,146:27-34. high indoortemperaturesonself-perceivedhealthof Vink, G.HoekandM.Zuurbier, of 2016.Theeffect Ecological Economics,70:881-890. - Acriticismof‘degrowth’andapleafor‘a-growth’. Environmental ProtectionAgency(epa Act 1990-2020,theSecondProspectiveStudy. U.S. Programme (undp). Heat intheWorkplace. UnitedNationsDevelopment United Nations. Assembly. Sustainable Development.UnitedNationsGeneral Indoor Air, 26:594-604. cardiovascular distresscallsinNewYork City, ny,us. Summer indoorheatexposureandrespiratory Isaacs, J.Braun,A.QuinnandJ.P. Freese,2016. 10.1002/14651858.cd008657.pub2 : Database ofSystematicReviews2013,doi associated socio-economicoutcomes.Cochrane 2013. Housingimprovementsforhealthand Economic Development,Wellington. Zealand: HeatSmart.ReporttotheMinistryof Costs andMortality:EvaluationofWarm UpNew , 2011.TheBenefitsandCostsoftheCleanAir 2015. Safeguardinghuman ). Xiang, J.,P. Bi,D.Pisaniello andA.Hansen,2014. World Bank,2008.World DevelopmentReport2008: who, 2016.GlobalHealthObservatory(gho)data:Skilled who, 2015.GlobalStatusReportonRoadSafety who, 2014b.BurdenofdiseasefromHouseholdAir who, 2014a.GuidelinesforIndoorAirQuality: who, 2013.ResearchPrioritiesfortheEnvironment, who, 2011b.Housing:SharedInterestsinHealthand who, 2011a.EnvironmentalBurdenofDiseaseAssociated who, 2010.GuidelinesforIndoorAirQuality: epidemiological review. Industrialhealth,52:91-101. Health impactsofworkplaceheatexposure:an Publications. Agriculture forDevelopment.World Bank skilled_birth_attendance_text/en www.who.int/gho/maternal_health/skilled_care/ attendants atbirth.World HealthOrganization. World HealthOrganization(who). (who). Pollution for2012.World Health Organization Organization (who). Household FuelCombustion.World Health of Poverty. World HealthOrganization(who). On Environment,AgricultureandInfectiousDiseases Technical paperofthetdrThematicReferenceGroup Agriculture andInfectiousDiseasesofPoverty. Development. World HealthOrganization. (who). and D.Ormandy(eds.).World Health Organization with InadequateHousing.Braubach,M.,D.E.Jacobs (who). Selected Pollutants.World Health Organization