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D. Addressing urban health problems
Basis for activity
6.32. The adverse conditions in which hundreds of millions of people live in urban and suburban areas disrupt normal life and lead to the loss of health and social and moral values. The growth of cities limits the possibilities of society in terms of meeting human needs, and therefore
hundreds of millions of people do not receive sufficient income, are forced to eat poorly, live in adverse conditions and not use the necessary services. The growth of cities leads to environmental degradation, thereby creating a serious danger to the population, and limits the ability of municipal authorities to ensure the improvement of the environmental health conditions that people need. Quite often, urban development has devastating consequences for the physical environment and resource base, which are necessary for sustainable development. Environmental pollution in urban areas causes excessive morbidity and mortality. Overcrowding and poor living conditions cause respiratory diseases, tuberculosis, meningitis and other diseases. In cities, many factors that affect human health are outside the health sector. In this regard, improving the health situation in cities will depend on concerted action at all levels of government, health authorities, enterprises, religious groups, public and educational institutions and citizens. In cities, many factors that affect human health are outside the health sector. In this regard, improving the health situation in cities will depend on concerted action at all levels of government, health authorities, enterprises, religious groups, public and educational institutions and citizens. In cities, many factors that affect human health are outside the health sector. In this regard, improving the health situation in cities will depend on concerted action at all levels of government, health authorities, enterprises, religious groups, public and educational institutions and citizens.
6.33. It is necessary to strengthen the health and well-being of all urban residents so that they can contribute to economic and social development. The global goal is to improve health outcomes by 10–40 percent by the year 2000. By the same amount, it is necessary to improve indicators characterizing the state of the environment, housing conditions and the situation in the health sector. These include the development of quantitative goals in the following areas: infant mortality, maternal mortality, percentage of underweight infants, and specific indicators (for example, the incidence of tuberculosis as an indicator of overcrowding in housing; diarrheal diseases as an indicator of inadequate water and sanitation requirements; the number of accidents in industry and transport, which indicates the potential for preventing injuries; and social issues such as drug abuse, violence and crime, which indicate fundamental violations in society.)
6.34. Local authorities, with appropriate support from national governments and international organizations, should be encouraged to take effective measures to implement or strengthen the following activities:
a) the development and implementation of municipal and local health plans:
i) the creation or strengthening of intersectoral committees at both the policy and technical levels, including active cooperation with scientific, cultural, religious, medical, commercial, social and other urban institutions, using contact agreements;
ii) adoption or strengthening of municipal or local “incentive strategies”, within which the main emphasis would be not on providing direct assistance to the population, but on attracting them to solving existing problems and creating favorable conditions for providing health care;
iii) ensuring the implementation or strengthening of public health education in schools, in the workplace, through the media, etc .;
(iv) assisting communities in training and raising awareness of primary health care;
(v) Promoting and strengthening community-based interventions to restore the ability to work for people with disabilities and older people living in urban and peri-urban areas;
b) study, if necessary, of the sanitary, social and environmental conditions existing in cities, including the preparation of documentation on existing intra-urban differences;
(c) Strengthening environmental health services:
i) adoption of health and environmental impact assessment procedures;
ii) providing basic training for new and existing employees on the job;
(d) The establishment and maintenance of urban networks in order to facilitate collaboration and exchange of good practices.
a) Financing and cost estimation
6.35. The Conference secretariat estimates that the average total annual cost (1993–2000) of activities under this program will be about $ 222 million, including about $ 22 million provided by the international community at no cost or concession conditions. This cost estimate is only indicative and approximate and has not yet been considered by governments. Actual costs and financing conditions, including any non-preferential terms, will depend, inter alia, on specific strategies and programs, the implementation of which will be decided by governments.
b) Scientific and technical means
6.36. Decision-making models should continue to be improved and made more widely used to assess the costs and impact of alternative technologies on human health and the environment. To improve the process of urban development and management, more reliable national and municipal statistics based on proven standardized indicators are needed. One of the priority areas of activity is the development of methods for determining intra-city and intra-district differences in sanitary and environmental conditions, as well as methods for applying this information in the framework of planning and management.
c) Human Resource Development
6.37. Programs should provide for the organization of orientation courses and basic vocational training for employees of municipalities who participate in activities to improve the sanitary condition of cities. It is also necessary to carry out on-the-job basic training for employees of services to improve the environmental health.
d) Capacity building
6.38. This program seeks to build the capacity of municipalities and local governments and their collaborating central government, private sector and universities in planning and management. Capacity-building activities should focus on obtaining more complete information, improving coordination mechanisms linking all key links, and ensuring more efficient use of available tools and resources for program implementation.

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