**4. Global initiatives**

Due to the continuous interaction between the environment and poor health outcomes, the following global development goals have been identified as contributors/targets to address environmental health. Clearly, environmental stability must be the ultimate goal to alleviate the aforementioned environmentally mediated diseases; in order to accomplish this, however, both poverty and poor baseline health must be addressed [16]. Each goal includes a number of target objectives and timeframes to accomplish in order to alleviate detrimental aspects of each goal.

#### **4.1. Millennium Development Goals**

All of the eight main Millennium Development Goals (MDGs) are applicable to driving EH practices in countries that are part of the UN. Additionally, considering the weight they carry globally, this further justifies the need to include EH within UHC. The main Goal (7) is to ensure environmental sustainability. To ensure sustainability within one's environment is to provide a healthy built environment, free of excess disease and risk factors. Secondly, Goal (4) is to reduce child mortality. This goal is one of utmost importance due to the fat that over a third of the global disease burden falls on children [15]. Goal (1), which aims to eradicate extreme poverty and hunger, is also directly related to environmental health. Similarly to children's high risk, disproportionate burdens of disease cultivate among groups with low SES exacerbating the disease burden; this is a primary focus considering communicable diseases and their high rates of transmission, especially in areas of low SES. Furthermore, Goals (3) and (5) align with gender equality and empowering women/improving maternal health. This vulnerable group, alongside children and low income, also is especially susceptible to disproportionate levels of environmental risk factors, that is, indoor smoke from cooking and childbirth complications. The need for EH within UHC to lessen this disparity and risk is vital, especially in developing countries where access to care and cultural norms prove to be additional obstacles to ensure good health. Of course, Goal (6), to combat HIV/AIDS, malaria and other diseases, has a direct correlation to EH prevention strategies. Additionally, more educated mothers have been shown to have fewer and healthier children [17]. This is directly correlating MDG Goal (2), which is aimed at achieving universal primary education. Lastly, global partnerships for development, Goal (8), are an important concept, especially within lower income countries. As shown previously, disease burden is disproportionately high in these countries, causing stress on both the communities and the economies. The need for better infrastructure and aid from higher income countries is an important factor to consider, despite the fact that this goal is not directly correlated to in country UHC and EH. In country, multisectoral approaches can help lessen this stress partially also.

#### **4.2. Sustainable Development Goals**

The Sustainable Development Goals (SDGs) were created in 2015 by the United Nations and are significant in addressing environmental exposures and therefore decreasing morbidity and mortality. By creating clean, sustainable environments and teaching individuals healthy practices, environmentally mediated diseases associated with the previously mentioned diseases and poor health outcomes, that is, cholera, diarrhea, COPD, cancer, adverse birth outcomes, etc., can be addressed in a global, systematic manner. The burden of many of these diseases, both communicable and noncommunicable, can be alleviated in part by the MDG and SDG. These goals are the driving force for sustainable environmental health practices in countries that are part of the UN.

**4. Global initiatives**

134 Advances in Health Management

**4.1. Millennium Development Goals**

Due to the continuous interaction between the environment and poor health outcomes, the following global development goals have been identified as contributors/targets to address environmental health. Clearly, environmental stability must be the ultimate goal to alleviate the aforementioned environmentally mediated diseases; in order to accomplish this, however, both poverty and poor baseline health must be addressed [16]. Each goal includes a number of target objectives and timeframes to accomplish in order to alleviate detrimental aspects of each goal.

All of the eight main Millennium Development Goals (MDGs) are applicable to driving EH practices in countries that are part of the UN. Additionally, considering the weight they carry globally, this further justifies the need to include EH within UHC. The main Goal (7) is to ensure environmental sustainability. To ensure sustainability within one's environment is to provide a healthy built environment, free of excess disease and risk factors. Secondly, Goal (4) is to reduce child mortality. This goal is one of utmost importance due to the fat that over a third of the global disease burden falls on children [15]. Goal (1), which aims to eradicate extreme poverty and hunger, is also directly related to environmental health. Similarly to children's high risk, disproportionate burdens of disease cultivate among groups with low SES exacerbating the disease burden; this is a primary focus considering communicable diseases and their high rates of transmission, especially in areas of low SES. Furthermore, Goals (3) and (5) align with gender equality and empowering women/improving maternal health. This vulnerable group, alongside children and low income, also is especially susceptible to disproportionate levels of environmental risk factors, that is, indoor smoke from cooking and childbirth complications. The need for EH within UHC to lessen this disparity and risk is vital, especially in developing countries where access to care and cultural norms prove to be additional obstacles to ensure good health. Of course, Goal (6), to combat HIV/AIDS, malaria and other diseases, has a direct correlation to EH prevention strategies. Additionally, more educated mothers have been shown to have fewer and healthier children [17]. This is directly correlating MDG Goal (2), which is aimed at achieving universal primary education. Lastly, global partnerships for development, Goal (8), are an important concept, especially within lower income countries. As shown previously, disease burden is disproportionately high in these countries, causing stress on both the communities and the economies. The need for better infrastructure and aid from higher income countries is an important factor to consider, despite the fact that this goal is not directly correlated to in country UHC and EH. In country,

multisectoral approaches can help lessen this stress partially also.

The Sustainable Development Goals (SDGs) were created in 2015 by the United Nations and are significant in addressing environmental exposures and therefore decreasing morbidity and mortality. By creating clean, sustainable environments and teaching individuals healthy practices, environmentally mediated diseases associated with the previously mentioned diseases

**4.2. Sustainable Development Goals**

All of the SDGs can also be utilized to show the need for EH integration within UHC, as they have a direct correlation to EH and sustainability. They include: Goal (3) good health and well-being, Goal (6) clean water sanitation, Goal (13) combat climate change and impact, Goal (7) affordable and clean energy, Goal (9) industry, innovation and infrastructure, Goal (11) sustainable communities, Goal (12) responsible consumerism and production and lastly, Goals (14) and (15) life below water and on land. Specific examples of their exposures can be found previously in the EH section, that is, climate change and flooding, toxicological exposures within food, and morbidity and mortality of pollution sources.

**Figure 2** shows the contrasting distribution of all major communicable and noncommunicable diseases (and injuries) across countries. The figure illustrates the disproportionate burden these majorly environmental mediated communicable diseases have on LMIC, namely Africa. Most importantly, however, it shows the prevalence of noncommunicable (chronic) disease across these countries in relationship to the disability adjusted life years (DALYs), which illustrate overall disease burden. Although communicable diseases disproportionately burden LMIC, overburdening of NCDs is found among all countries, despite economic status.

**Figure 2.** Burden of disease by cause, country, and gender (2013 estimates)—produced by IHME Viz Hub (adapted from https://ourworldindata.org/burden-of-disease/).
