Jan 4, 2010
Prayer attributed to Maimonides (Rabbi Moshe ben Maimon, 1135–1204 <C.<E.), a physician born in Moorish Cordoba, Spain. The text is also available via the Internet: http://www.fordham.edu/halsall/source/rambam-oath.html.
The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time, and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.
I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
SOURCE: Hippocrates, Works, vol. 1:299–301, trans., Francis Adams. New York: Loeb. Available on the Internet: http://www.humanities.ccny.cuny.edu/history/reader/hippoath... .
The document below is available via the Internet: http://www.who.int/hpr/docs/almaata.html.
The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration:
The Conference strongly reaffirms that health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.
The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries, is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.
Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.
The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.
Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations, and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
Primary health care:
All governments should formulate national policies, strategies, and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources, and to use available external resources rationally.
All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.
An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente, and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.
The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world, and particularly in developing countries, in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, non-governmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing, and maintaining primary health care in accordance with the spirit and content of this Declaration.
Proclaimed at the Fifth ASEAN Health Ministers Meeting in Yogyakarta, Indonesia, April 28–29, 2000. Below, some portions of the Declaration have been excerpted and others summarized. The full text of the Declaration is available via the Internet: http://www.asean.or.id/function/ahmm_dec.htm.
"WE, the Ministers of Health of ASEAN Member Countries, representing Brunei Darussalam, the Kingdom of Cambodia, the Republic of Indonesia, the Lao People's Democratic Republic, Malaysia, the Union of Myanmar, the Republic of the Philippines, the Republic of Singapore, the Kingdom of Thailand, and the Socialist Republic of Viet Nam;
"RECALLING that the ASEAN Vision 2020, adopted by the 2nd Informal Summit held in Kuala Lumpur in December 1997, envisioned ASEAN as a concert of Southeast Asian nations, outward looking, living in peace, stability, and prosperity, bonded together in partnership in dynamic development and in a community of caring societies;
"SUPPORTIVE of the need to promote social development and address the social impact of the financial and economic crisis as outlined in the Hanoi Plan of Action (HPA) implementing ASEAN Vision 2020 and adopted during the 6th ASEAN Summit held in Hanoi in December 1998;
"RESPONDING to the call of the Hanoi Declaration adopted by the Sixth ASEAN Summit held in Hanoi in December 1998 that we shall, together, make sure that our people are assured of adequate medical care and access to essential medicines and that cooperation shall be stepped up in the control and prevention of communicable diseases, including HIV/AIDS;
"FULLY AWARE that, despite significant progress made in uplifting the quality of life of individuals in our region, health problems continue to be associated with poverty and are increasingly associated with urbanisation, industrialisation, environmental pollution, lifestyle diseases, and stress-related conditions;
"RECOGNIZING the need to prepare the health sector for the challenges and opportunities arising from globalisation and trade liberalisation;
"ENCOURAGED by the notable progress made by the ASEAN Sub-Committee on Health and Nutrition and the ASEAN Task Force on AIDS in formulating action plans and programmes and in implementing regional activities on health, despite funding constraints;
"DO HEREBY AGREE, IN THE SPIRIT OF ASEAN SOLIDARITY AND MUTUAL ASSISTANCE, TO STRENGTHEN ASEAN COOPERATION ON HEALTH TO MEET THE CHALLENGES OF THE NEW MILLENNIUM, BY ADOPTING THE FOLLOWING FRAMEWORK:"
The Declaration states the mission of the signatory nations to include strengthening regional cooperation to ensure health, advocating to promote increased awareness of health issues, and ensuring the availability of health care and health-related products and services.
The Declaration specifies various strategies to support these goals, including "greater emphasis on health promotion and disease prevention" and the intensification of "human resources development."
A series of steps are outlined in order to carry out the goals and principles of the Declaration, including the implementation of existing ASEAN plans and programs, an effort to "address the impact of globalisation/trade liberalisation on the health sector," and strengthening the mechanisms for collaboration among the ASEAN nations.
On December 10, 1948 the General Assembly of the United Nations adopted and proclaimed the Universal Declaration of Human Rights [Resolution 217 A ]. Following this historic act the Assembly called upon all member countries to publicize the text of the Declaration and "to cause it to be disseminated, displayed, read and expounded principally in schools and other educational institutions, without distinction based on the political status of countries or territories." Below, some portions of the Declaration have been excerpted and others summarized. The full text of the Declaration is available via the Internet: http://www.un.org/Overview/rights.html.
"Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,
"Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,
"Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law,
"Whereas it is essential to promote the development of friendly relations between nations,
"Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person, and in the equal rights of men and women and have determined to promote social progress and better standards of life in larger freedom,
"Whereas Member States have pledged themselves to achieve, in co-operation with the United Nations, the promotion of universal respect for and observance of human rights and fundamental freedoms,
"Whereas a common understanding of these rights and freedoms is of the greatest importance for the full realization of this pledge,
"Now, therefore, THE GENERAL ASSEMBLY proclaims THIS UNIVERSAL DECLARATION OF HUMAN RIGHTS as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.
"All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.
"Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional, or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing, or under any other limitation of sovereignty.
"Everyone has the right to life, liberty and security of person.
"No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.
"No one shall be subjected to torture or to cruel, inhuman, or degrading treatment or punishment."
All persons are equal before the law and are entitled to equal legal protection including a lack of discrimination, access to legal tribunals, freedom from arbitrary arrest and/or detention, and the right to the presumption of innocence.
All persons have a right to privacy, to nationality and asylum, and to political participation; as well as freedom of movement and association and freedom of thought, conscience, and religion.
"Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social, and cultural rights indispensable for his dignity and the free development of his personality.
"(1) Everyone has the right to work, to free choice of employment, to just and favorable conditions of work, and to protection against unemployment. (2) Everyone, without any discrimination, has the right to equal pay for equal work. (3) Everyone who works has the right to just and favorable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection. (4) Everyone has the right to form and to join trade unions for the protection of his interests.
"Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
"(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care, and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection."
All persons have a right to education and full participation in the cultural life of the community.
"(1) Everyone has duties to the community in which alone the free and full development of his personality is possible. (2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order, and the general welfare in a democratic society. (3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.
"Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein."
The Warning was written on November 18, 1992 and was subsequently signed by over 1,500 scientists from all countries. The full text of the Warning appears below. It is also available via the Internet: http://www.ucsusa.org/about/warning.html.
Human beings and the natural world are on a collision course. Human activities inflict harsh and often irreversible damage on the environment and on critical resources. If not checked, many of our current practices put at serious risk the future that we wish for human society and the plant and animal kingdoms, and may so alter the living world that it will be unable to sustain life in the manner that we know. Fundamental changes are urgent if we are to avoid the collision our present course will bring about.
The environment is suffering critical stress:
Stratospheric ozone depletion threatens us with enhanced ultra-violet radiation at the Earth's surface, which can be damaging or lethal to many life forms. Air pollution near ground level and acid precipitation are already causing widespread injury to humans, forests and crops.
Heedless exploitation of depletable ground water supplies endangers food production and other essential human systems. Heavy demands on the world's surface waters have resulted in serious shortages in some 80 countries, containing 40% of the world's population. Pollution of rivers, lakes, and ground water further limits the supply.
Destructive pressure on the oceans is severe, particularly in the coastal regions which produce most of the world's food fish. The total marine catch is now at or above the estimated maximum sustainable yield. Some fisheries have already shown signs of collapse. Rivers carrying heavy burdens of eroded soil into the seas also carry industrial, municipal, agricultural, and livestock waste—some of it toxic.
Loss of soil productivity, which is causing extensive land abandonment, is a widespread byproduct of current practices in agriculture and animal husbandry. Since 1945, 11% of the Earth's vegetated surface has been degraded—an area larger than India and China combined—and per capita food production in many parts of the world is decreasing.
Tropical rain forests, as well as tropical and temperate dry forests, are being destroyed rapidly. At present rates, some critical forest types will be gone in a few years and most of the tropical rain forest will be gone before the end of the next century. With them will go large numbers of plant and animal species.
The irreversible loss of species, which by 2100 may reach one third of all species now living, is especially serious. We are losing the potential they hold for providing medicinal and other benefits, and the contribution that genetic diversity of life forms gives to the robustness of the world's biological systems and to the astonishing beauty of the Earth itself.
Much of this damage is irreversible on a scale of centuries or permanent. Other processes appear to pose additional threats. Increasing levels of gases in the atmosphere from human activities, including carbon dioxide released from fossil fuel burning and from deforestation, may alter climate on a global scale. Predictions of global warming are still uncertain—with projected effects ranging from tolerable to very severe—but the potential risks are very great.
Our massive tampering with the world's interdependent web of life—coupled with the environmental damage inflicted by deforestation, species loss, and climate change—could trigger widespread adverse effects, including unpredictable collapses of critical biological systems whose interactions and dynamics we only imperfectly understand.
Uncertainty over the extent of these effects cannot excuse complacency or delay in facing the threat.
The Earth is finite. Its ability to absorb wastes and destructive effluent is finite. Its ability to provide food and energy is finite. Its ability to provide for growing numbers of people is finite. And we are fast approaching many of the Earth's limits. Current economic practices which damage the environment, in both developed and underdeveloped nations cannot be continued without the risk that vital global systems will be damaged beyond repair.
Pressures resulting from unrestrained population growth put demands on the natural world that can overwhelm any efforts to achieve a sustainable future. If we are to halt the destruction of our environment, we must accept limits to that growth. A World Bank estimate indicates that world population will not stabilize at less than 12.4 billion, while the United Nations concludes that the eventual total could reach 14 billion, a near tripling of today's 5.4 billion. But, even at this moment, one person in five lives in absolute poverty without enough to eat, and one in ten suffers serious malnutrition.
No more than one or a few decades remain before the chance to avert the threats we now confront will be lost and the prospects for humanity immeasurably diminished.
We the undersigned, senior members of the world's scientific community, hereby warn all humanity of what lies ahead. A great change in our stewardship of the Earth, and the life on it, is required if vast human misery is to be avoided and our global home on this planet is not to be irretrievably mutilated.
Five inextricably linked areas must be addressed simultaneously:
The developed nations are the largest polluters in the world today. They must greatly reduce their overconsumption, if we are to reduce pressures on resources and the global environment. The developed nations have the obligation to provide aid and support to developing nations, because only the developed nations have the financial resources and the technical skills for these tasks.
Acting on this recognition is not altruism, but enlightened self-interest: whether industrialized or not, we all have but one lifeboat. No nation can escape from injury when global biological systems are damaged. No nation can escape from conflicts over increasingly scarce resources. In addition, environmental and economic instabilities will cause mass migrations with incalculable consequences for developed and undeveloped nations alike.
Developing nations must realize that environmental damage is one of the gravest threats they face, and that attempts to blunt it will be overwhelmed if their populations go unchecked. The greatest peril is to become trapped in spirals of environmental decline, poverty, and unrest, leading to social, economic, and environmental collapse.
Success in this global endeavor will require a great reduction in violence and war. Resources now devoted to the preparation and conduct of war—amounting to over $1 trillion annually—will be badly needed in the new tasks and should be diverted to the new challenges.
A new ethic is required—a new attitude towards discharging our responsibility for caring for ourselves and for the Earth. We must recognize the Earth's limited capacity to provide for us. We must recognize its fragility. We must no longer allow it to be ravaged. This ethic must motivate a great movement, convince reluctant leaders and reluctant governments and reluctant peoples themselves to effect the needed changes.
The scientists issuing this warning hope that our message will reach and affect people everywhere. We need the help of many.
We call on all to join us in this task.
The Convention was adopted and opened for signature, ratification, and accession by General Assembly resolution 44/25 of November 20, 1989. It entered into force September 2, 1990. Below, some portions of the Convention have been excerpted and others summarized. The full text of the Convention is available via the Internet: http://www.unicef.org/crc/fulltext.htm.
"The States Parties to the present Convention,
"Considering that, in accordance with the principles proclaimed in the Charter of the United Nations, recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,
"Bearing in mind that the peoples of the United Nations have, in the Charter, reaffirmed their faith in fundamental human rights and in the dignity and worth of the human person and have determined to promote social progress and better standards of life in larger freedom,
"Recognizing that the United Nations has, in the Universal Declaration of Human Rights and in the International Covenants on Human Rights, proclaimed and agreed that everyone is entitled to all the rights and freedoms set forth therein, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status,
"Recalling that, in the Universal Declaration of Human Rights, the United Nations has proclaimed that childhood is entitled to special care and assistance,
"Convinced that the family, as the fundamental group of society and the natural environment for the growth and well-being of all its members and particularly children, should be afforded the necessary protection and assistance so that it can fully assume its responsibilities within the community,
"Recognizing that the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love, and understanding,
"Considering that the child should be fully prepared to live an individual life in society and brought up in the spirit of the ideals proclaimed in the Charter of the United Nations and in particular in the spirit of peace, dignity, tolerance, freedom, equality, and solidarity,
"Bearing in mind that the need to extend particular care to the child has been stated in the Geneva Declaration of the Rights of the Child of 1924 and in the Declaration of the Rights of the Child adopted by the General Assembly on 20 November 1959 and recognized in the Universal Declaration of Human Rights, in the International Covenant on Civil and Political Rights (in particular in articles 23 and 24), in the International Covenant on Economic, Social and Cultural Rights (in particular in article 10), and in the statutes and relevant instruments of specialized agencies and international organizations concerned with the welfare of children,
"Bearing in mind that, as indicated in the Declaration of the Rights of the Child, 'the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth,'
"Recalling the provisions of the Declaration on Social and Legal Principles relating to the Protection and Welfare of Children, with Special Reference to Foster Placement and Adoption Nationally and Internationally; the United Nations Standard Minimum Rules for the Administration of Juvenile Justice (The Beijing Rules); and the Declaration on the Protection of Women and Children in Emergency and Armed Conflict,
"Recognizing that, in all countries in the world, there are children living in exceptionally difficult conditions and that such children need special consideration,
"Taking due account of the importance of the traditions and cultural values of each people for the protection and harmonious development of the child,
"Recognizing the importance of international cooperation for improving the living conditions of children in every country, in particular in the developing countries,
"Have agreed as follows:"
The Convention states the terms and scope of the agreement, including that in all matters addressed "the best interests of the child shall be a primary consideration."
The Convention stipulates certain basic rights of all children, foremost amongst which is the right to life and subsidiary rights to a name, identity, family, and nationality. In keeping with these rights, the Convention requires that all parties to the agreement take measures to "combat the illicit transfer and non-return of children abroad."
Continuing the enumeration of rights held by children, the Convention names the freedoms of thought, speech, conscience, and religion, as well as the freedoms of privacy and assembly.
In order to support the exercise of the rights recognized by the Convention, the parties agree to encourage and, as needed, regulate activities pertaining to the parenting and care of the child, including the physical safety of the child, foster care and adoption, mental and physical disability, health care, and social and economic security.
The Convention recognizes each child's right to education, participation in his or her culture, and play, and encourages measures to support that right.
The Convention names and recognizes the child's right to be free from various forms of exploitation and abuse, including physical and sexual abuse, economic and sexual exploitation, exposure to addictive drugs, and warfare.
The Convention names and establishes measures to support the various rights of the child before national penal courts.
The Convention stipulates various measures by which the parties to the agreement will promulgate and support the above articles of the Convention.
The Convention stipulates the procedure by which the Convention will be presented to and ratified by the parties to the agreement, and be thereafter administered by the Secretary General of the United Nations.
Proclaimed at the First European Conference on Environment and Health, Frankfurt-am-Main, Federal Republic of Germany, December 7–8, 1989. Below, some portions of the Charter have been excerpted and others summarized. The full text of the Charter is available via the Internet: http://www.who.dk/policy/ehchart.htm.
"In the light of WHO's [World Health Organization] strategy for health for all in Europe, the report of the World Commission on Environment and Development and the related Environmental Perspective to the Year 2000 and Beyond (resolutions 42/187 and 42/186 of the United Nations General Assembly) and World Health Assembly resolution WHA42.26,
"The Ministers of the Environment and of Health of the Member States of the European Region of WHO, meeting together for the first time at Frankfurt-am-Main on 7 and 8 December 1989, have adopted the attached European Charter on Environment and Health and have accordingly agreed upon the principles and strategies laid down therein as a firm commitment to action. In view of its environmental mandate, the Commission of the European Communities was specially invited to participate and, acting on behalf of the Community, also adopted the Charter as a guideline for future action by the Community in areas which lie within Community competence."
The Charter states that "the environment should be managed as a positive resource for human health and well-being," and stipulates that "comprehensive strategies" be undertaken to achieve that end. Among those strategies the Charter specifies: the responsibility of public and private bodies to promulgate and implement appropriate regulations, the establishment of control measures and safety standards to reduce health risks, the use of appropriate technologies, and the creation of information systems and contingency plans to monitor and respond to health risks. The Charter also recommends a multi-disciplinary approach to epidemiological surveillance and "greater attention to all aspects of environmental health."
The Charter specifies that governments and other public authorities should "pay particular attention" to a number of issues of the environment and health. Those issues include: "global disturbances of the environment," urban development, drinking water, microbiological and chemical safety of food, and the environmental impact of various fuels, chemicals, and wastes.
The Charter states that member states of the European Region and the WHO Regional Office for Europe should undertake various actions, including: reversing negative trends in environmental health, increasing regional cooperation, strengthening international mechanisms for assessing potential hazards to health, and establishing a European Advisory Committee on the Environment and Health.
Described as "a comprehensive, nationwide health promotion and disease prevention agenda," Healthy People 2010: Understanding and Improving Health "is designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century." Below is the complete text of the introduction. Available via the Internet: http://www.health.gov/healthypeople/document/.
Healthy People 2010 presents a comprehensive, nationwide health promotion and disease prevention agenda. It is designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century.
Like the preceding Healthy People 2000 initiative—which was driven by an ambitious, yet achievable, 10-year strategy for improving the nation's health by the end of the 20th century—Healthy People 2010 is committed to a single, overarching purpose: promoting health and preventing illness, disability, and premature death.
Healthy People 2010 builds on initiatives pursued over the past two decades. In 1979, Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention provided national goals for reducing premature deaths and preserving independence for older adults. In 1980, another report, Promoting Health/Preventing Disease: Objectives for the Nation, set forth 226 targeted health objectives for the Nation to achieve over the next 10 years.
Healthy People 2000: National Health Promotion and Disease Prevention Objectives, released in 1990, identified health improvement goals and objectives to be reached by the year 2000. The Healthy People 2010 initiative continues in this tradition as an instrument to improve health for the first decade of the 21st century.
Healthy People 2010 represents the ideas and expertise of a diverse range of individuals and organizations concerned about the nation's health. The Healthy People Consortium—an alliance of more than 350 national organizations and 250 State public health, mental health, substance abuse, and environmental agencies—conducted three national meetings on the development of Healthy People 2010. In addition, many individuals and organizations gave testimony about health priorities at five Healthy People 2010 regional meetings held in late 1998.
On two occasions—in 1997 and in 1998—the American public was given the opportunity to share its thoughts and ideas. More than 11,000 comments on draft materials were received by mail or via the Internet from individuals in every State, the District of Columbia, and Puerto Rico. All the comments received during the development of Healthy People 2010 can be viewed on the Healthy People Web site: http://www.health.gov/healthypeople/.
The final Healthy People 2010 objectives were developed by teams of experts from a variety of Federal agencies under the direction of Health and Human Services Secretary Donna Shalala, Assistant Secretary for Health and Surgeon General David Satcher, and former Assistant Secretaries for Health. The process was coordinated by the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services.
Healthy People 2010 is designed to achieve two overarching goals:
These two goals are supported by specific objectives in 28 focus areas. Each objective was developed with a target to be achieved by the year 2010.
Over the years, it has become clear that individual health is closely linked to community health—the health of the community and environment in which individuals live, work, and play. Likewise, community health is profoundly affected by the collective beliefs, attitudes, and behaviors of everyone who lives in the community.
Indeed, the underlying premise of Healthy People 2010 is that the health of the individual is almost inseparable from the health of the larger community and that the health of every community in every State and territory determines the overall health status of the Nation. That is why the vision for Healthy People 2010 is "Healthy People in Healthy Communities."
One of the most compelling and encouraging lessons learned from the Healthy People 2000 initiative is that we, as a nation, can make dramatic progress in improving the nation's health in a relatively short period of time. For example, during the past decade, we achieved significant reductions in infant mortality. Childhood vaccinations are at the highest levels ever recorded in the United States. Fewer teenagers are becoming parents. Overall, alcohol, tobacco, and illicit drug use is leveling off. Death rates for coronary heart disease and stroke have declined. Significant advances have been made in the diagnosis and treatment of cancer and in reducing unintentional injuries.
But we still have a long way to go. Diabetes and other chronic conditions continue to present a serious obstacle to public health. Violence and abusive behavior continue to ravage homes and communities across the country. Mental disorders continue to go undiagnosed and untreated. Obesity in adults has increased 50 percent over the past two decades. Nearly 40 percent of adults engage in no leisure time physical activity. Smoking among adolescents has increased in the past decade. And HIV/AIDS remains a serious health problem, now disproportionately affecting women and communities of color.
Healthy People 2010 will be the guiding instrument for addressing these and emerging health issues, reversing unfavorable trends, and expanding past achievements in health.
Community partnerships, particularly when they reach out to nontraditional partners, can be among the most effective tools for improving health in communities.
For the past two decades, Healthy People has been used as a strategic management tool for the federal government, states, communities, and many other public- and private-sector partners. Virtually all states, the District of Columbia, and Guam have developed their own Healthy People plans modeled after the national plan. Most states have tailored the national objectives to their specific needs.
Businesses; local governments; and civic, professional, and religious organizations also have been inspired by Healthy People to print immunization reminders, set up hotlines, change cafeteria menus, begin community recycling, establish worksite fitness programs, assess school health education curriculums, sponsor health fairs, and engage in myriad other activities.
Addressing the challenge of health improvement is a shared responsibility that requires the active participation and leadership of the federal government, states, local governments, policymakers, health care providers, professionals, business executives, educators, community leaders, and the American public itself. Although administrative responsibility for the Healthy People 2010 initiative rests in the U.S. Department of Health and Human Services, representatives of all these diverse groups shared their experience, expertise, and ideas in developing the Healthy People 2010 goals and objectives.
Healthy People 2010, however, is just the beginning. The biggest challenges still stand before us, and we all have a role in building a healthier nation.
Regardless of your age, gender, education level, income, race, ethnicity, cultural customs, language, religious beliefs, disability, sexual orientation, geographic location, or occupation, Healthy People 2010 is designed to be a valuable resource in determining how you can participate most effectively in improving the nation's health. Perhaps you will recognize the need to be a more active participant in decisions affecting your own health or the health of your children or loved ones. Perhaps you will assume a leadership role in promoting healthier behaviors in your neighborhood or community. Or perhaps you will use your influence and social stature to advocate for and implement policies and programs that can improve dramatically the health of dozens, hundreds, thousands, or even millions of people.
SOURCE: U.S. Department of Health and Human Services (November 2000). Healthy People 2010: Understanding and Improving Health, 2nd edition. Washington, DC: U.S. Government Printing Office.
Proclaimed at the First International Conference on Health Promotion Ottawa, Canada, November 17–21, 1986. Below, some portions of the Charter have been excerpted and others summarized. The full text of the Charter is available via the Internet: http://www.who.dk/policy/ottawa.htm.
"Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being.
"The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. Improvement in health requires a secure foundation in these basic prerequisites.
"Good health is a major resource for social, economic, and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioral, and biological factors can all favor health or be harmful to it. Health promotion action aims at making these conditions favorable through advocacy for health.
"Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills, and opportunities for making healthy choices. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men.
"The prerequisites and prospects for health cannot be ensured by the health sector alone. More importantly, health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organizations, by local authorities, by industry, and by the media. People in all walks of life are involved as individuals, families, and communities. Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.
"Health promotion strategies and programs should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural, and economic systems."
The Charter defines health promotion in terms of the following activities: building healthy public policy in the full range of administrative and legislative action; creating supportive environments via a socioecological approach to health; strengthening community action and democratic planning processes; developing personal skills via education; and reorienting health services toward health promotion in addition to curative services.
Citing caring, holism, and ecology as central issues, the signatories to the Charter pledged to promote health in various ways, including: advocating a clear political commitment to health and equity in all sectors; counteracting trends and products that harm health; reorienting health services toward health promotion; recognizing health and its maintenance as a major social investment.
The Charter concludes with a statement calling on the World Health Organization and other international bodies to advocate the promotion of health.
Below is an excerpt from the Nuremberg Code. The complete text is available via the Internet: http://www.ushmm.org/research/doctors/Nuremberg_Code.htm.
The great weight of the evidence before us is to the effect that certain types of medical experiments on human beings, when kept within reasonably well-defined bounds, conform to the ethics of the medical profession generally. The protagonists of the practice of human experimentation justify their views on the basis that such experiments yield results for the good of society that are unprocurable by other methods or means of study. All agree, however, that certain basic principles must be observed in order to satisfy moral, ethical, and legal concepts:
SOURCE: Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10, vol. 2 (1949). Washington, DC: U.S. General Printing Office.
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