Mechanisms must be established for sustained community involvement in environmental health activities, including optimization of the appropriate use of community financial and human resources.
National authorities alone cannot normally solve local environment and health (EH) problems in an efficient manner. Almost all EH problems affect some localities and communities more than others. Consequently, local-level projects, involving a mix of public, community and even private participation, can be viewed as natural catalysts for the implementation of larger EH national and regional projects.
This strategy features in the framework of Agenda 21 as formulated at UNCED (Rio de Janeiro, 1992), now coordinated by the United Nations Commission on Sustainable Development and implemented through national and local authorities.
Participation of the public and NGOs in decision-making by public bodies on environment and health matters is desirable because it tends both to improve the quality of the resulting decisions and to increase the level of public support for the outcome. Less tangibly but of no less importance, a society in which people feel that their voices can be heard and can make a difference might be expected to have a higher morale than one in which people feel powerless to influence the conditions in which they live and work. This morale factor has numerous and far-reaching implications which, even if hard to quantify, should not be ignored.
The Århus Convention on Access to Information, Public Participation in Decision-Making and Access to Justice in Environmental Matters (1998) sets out a broad legal framework for such participation, establishing minimum requirements for public participation in decisions on specific activities (Article 6), on plans, programmes and policies (Article 7) and on general rules and regulations (Article 8) relating to the environment.
The Declaration of the Third Ministerial Conference on Environment and Health (London, June 1999) states: We recommend that local plans to improve health and the environment should be drawn up and implemented in our countries, either as part of other relevant plans, such as Local Agenda 21 or Healthy Cities Action Plans, or separately. These should be developed preferably by existing bodies and designed to achieve distinct local environment and health improvements.
It continues: We will identify mechanisms within each of our countries, involving but not limited to public sector organizations, community groups and NGOs, to promote well managed local environment and health projects, develop data and monitoring systems, and devise a training and information exchange programme on alternative intersectoral approaches for local implementation. These mechanisms should also promote health issues within the context of Health21 and Agenda 21.
Even in remote areas where medical services are not available it is possible to provide sufficient health services if the villagers are involved and engaged in practising appropriate health care. It has been frequently told that doctors who went to rural areas assuming more hospitals and fully-trained medical professionals were needed, have discovered that the most economical proposition and the only viable one in the long run was village-based heath care with the villagers doing 80 percent to 90 percent of the work.