These “actionables” are practical steps for implementing the prescriptions of the WHO Manifesto for a healthy recovery from COVID-19. They aim at creating a healthier, fairer and greener world while investing to maintain and resuscitating the economy hit by the effects of COVID-19.
Policy makers, national and local decision-makers and a wide array of other actors wishing to contribute to a healthy recovery can now take decisive steps by shaping the way we live, work and consume. Effects on environmental degradation and pollution and climate change will be wide ranging. WHO and partner organizations have since long been developing substantive guidance and provide support for building healthier environments for healthier populations.
A comprehensive set of key actionables for achieving a healthier environments is provided accordingly. Their prioritization will depend upon the local context and situation. New investments and reconsideration of priorities in the context of recovery from COVID-19 present unique opportunities for shaping healthier environments and scaling up actions accordingly.
Actionables for a healthy, green recovery
1) Protect and preserve the source of human health: Nature.
Biological Diversity
- Implement and update National Biodiversity Strategies and Action Plans (NBSAPs) in line with the 2011-2020 Strategic Plan for Biodiversity and the 20 Aichi Biodiversity Targets.
- Incorporate biodiversity values, ecosystem protection and the ‘value of nature’ into national and regional policies, strategies and programmes, including in public health policies and in national accounting and reporting systems.
- Eliminate or reform incentives, including subsidies that are harmful to biodiversity, including those that promote monoculture production systems.
- Avoid ecosystem loss and degradation and promote ecosystem integrity and resilience and protection of species.Limit or control human-wildlife contact to reduce the risk of infectious diseases, including zoonotic and vector-borne diseases.
- Promote agrobiodiversity and the use of integrated pest management to reduce the need for chemical pesticides and herbicides.
Climate Change
- Mitigate climate change by reducing greenhouse gas emissions and other climate changing pollutants like black carbon for example through better energy-use choices, agricultural practices, transport, food, city compactness and industrial technology use and practices.
- Implement sustainable infrastructure development and spatial planning to avoid locking societies into greenhouse gas-intensive emission pathways that may be difficult or very costly to change.
- Establish and enforce air quality standards, in line with WHO’s Air Quality Guidelines.
- Adopt very low energy building codes for new buildings and retrofit established buildings.
- Improve the efficiency of material use, recycling and re-use of materials and products and increase overall reduction in product demand.
- Provide climate resilient health and sustainable infrastructure, technologies and services. These may include water and sanitation services, energy supply and waste management technologies.
- Reduce deforestation and implement afforestation and sustainable forest management.
- Ensure and promote enabling environments for behaviour change related to choices of energy use, transport, living, and food, waste generation and general consumption.
Sanitation
- Develop and implement multi-sectoral sanitation policies which include sanitation safety planning, treatment of faecal sludge and wastewater, and reuse in agriculture.
Air Pollution
- Develop coherent multi-sectoral policies and actions across transport, industry, power generation, waste and wastewater management, agriculture, housing and land use sectors for preventing air pollution.
Also develop and implement policies to ensure clean fuels and technologies for cooking, heating and lighting in households.
Chemicals
- Implement the WHO Chemicals Road Map to enhance health sector engagement in the sound management of chemicals.
- Implement the chemicals and waste-related multilateral environmental agreements, particularly their health protective aspects, e.g.:
- Minamata Convention on Mercury.
- Basel Convention on trans-boundary movements of hazardous wastes and their disposal.
- on the prior informed consent procedure for certain hazardous chemicals and pesticides in international trade.
- Stockholm Convention on persistent organic pollutants (POPs).
- Implement the International Health Regulations (2005), a legally binding agreement providing a framework to better prevent, prepare for and respond to public health events and emergencies of potential international concern, including chemical events.
2) Invest in essential services, from water and sanitation to clean energy in healthcare facilities.
Water
- Provide and promote the use of safe drinking water in communities, schools, health care facilities, workplaces and public places.
- Ensure implementation of drinking-water quality regulations and standards.
- Protect drinking-water supplies using Water Safety Plans (WSPs).
- Include safe and sustainable drinking water, sanitation and hygiene in relevant health policies, strategies and programmes.
Sanitation
- Implement sanitation safety planning.
- Support households to incrementally improve their sanitation facilities to meet minimum safety requirements.
- Promote access to safe toilets in schools, health care facilities, workplaces and public places.
- Avoid open defecation and adopt safe sanitation facilities.
Hygiene
- Promote and support the installation of handwashing facilities in homes and institutions such as schools, workplaces and health care facilities.
- Enforce handwashing facilities in public places, food establishments and markets, and include them in routine inspection and monitoring schemes.
- Make soap and water available to households, institutions and public places. Handwashing facilities with soap and water should be available close to (usually within 5 m) sanitation facilities.
- Promote washing hands with soap at critical times, such as after defecation, after child cleaning and before preparing food.
Clean energy
- Provide and use clean and safe cooking, heating and lighting solutions.
- Replace traditional household solid fuel stoves with lower-emission cookstoves that are as clean as possible [10, 11, 31].
- Improve energy efficiency of household appliances, buildings, lighting, heating and cooling.
- Encourage electrification using renewable sources such as solar-, hydro- and wind-based electricity.
Healthy, safe and resilient workplaces for all
- Implement national policies and action plans on occupational safety and health.
- Scale up coverage with essential interventions and basic occupational health services of all workers for primary prevention of occupational and work-related diseases and injuries and promote healthier and safer workplaces, including for migrant and contractual workers and those in the informal economy.
- Build workplace resilience to public health emergencies and outbreaks of infectious diseases in all economic sectors.
Additional actions specific to health care facilities
- Implement or strengthen Infection Prevention and Control (IPC) in health care facilities through a range of occupational health and patient safety measures.
- Ensure availability of sufficient and safe water at all times for drinking, food preparation, personal hygiene, medical activities, cleaning and laundry.
- Ensure safety of water for drinking, cooking, personal hygiene, medical activities, cleaning and laundry for the purpose intended.
- Provide sufficient water-collection points and water-use facilities in the health care setting to allow convenient access to, and use of, water for medical activities, drinking, personal hygiene, food preparation, laundry and cleaning.
- Provide adequate, accessible and appropriate toilets for patients, staff and carers.
- Ensure rapid and safe wastewater disposal.
- Ensure safe segregation, collection, transportation, storage, treatment and disposal of health care waste.
- Promote correct use of water, sanitation and waste facilities.
- Develop national programmes and healthcare facility policies on occupational health for health workers.
- Build capacities to ensure occupational safety and health and work improvements of health workers and other workers, including in public health emergencies.
- Build and renovate healthcare facilities in an environmentally responsible, climate resilient and sustainable way.
- Consider as much as possible options for waste minimization, environmentally preferable purchasing and green procurement, and safe reuse, recycling and recovery.
3) Ensure a quick healthy energy transition.
- Rapidly transition away from fossil fuel combustion (oil, coal, fossil gas) for large-scale energy production, and diesel generators for small-scale production.
- Increase the use of, and financial support for, low-emission fuels and energy sources, and renewable combustion-free power sources (like solar or wind); use incentives.
- Increase reliance on the co-generation of heat and power, and distributed energy generation (e.g. mini-grids and rooftop solar power generation).
- Provide support to employees, communities and industries in transitioning from a carbon-intense to a zero-carbon economy in the form of inclusive participatory decision-making, training programmes, social security schemes, long-term transition plans and financial support.
4) Promote healthy, sustainable food systems.
- Develop or update national food-based dietary guidelines through the full integration of environmental sustainability elements in each of the guideline’s recommendations, according to national contexts.
- Strengthen local food production and processing, especially by smallholder and family farmers, where appropriate.
- Promote diets which are based on a variety of unprocessed or minimally processed foods, include wholegrains, legumes, nuts and an abundance and variety of fruits and vegetables and which can include moderate amounts of eggs, dairy, poultry and fish, and small amounts of red meat.
- Promote the diversification of crops including underutilized traditional crops, applying sustainable food production and natural resource management practices.
- Consider use of trade policy, including instruments such as tariffs and quotas, to improve sustainable food supply.
- Implement policies and actions to create healthy, safe and sustainable food environments (such as strengthening of food control systems, restricting marketing of foods contributing to unhealthy unsustainable diets, nutrition labelling policies, fiscal policies, public food procurement policies, reformulation to gradually reduce saturated fat, sugars and salt/sodium and trans-fat from foods and beverages).
- Improve storage, preservation, transport, and distribution technologies and infrastructure to reduce seasonal food insecurity, food and nutrient loss and waste.
- Preserve fish habitats and promote sustainable fisheries.
5) Build healthy, liveable cities.
City design
- Integrate health into urban planning policies to deliver highly connected, mixed-use and compact neighbourhoods that are economically and socially viable and that promote active living, sustainable mobility, energy efficiency, healthy diets and access to essential services.
- Prioritize active and sustainable mobility as preferred mode of travel in relevant transport, spatial and urban planning policies.
- Improve walking and cycling infrastructure for people of all ages and abilities and create citywide access to safer walking, biking, nature, public spaces and public transport to support mobility, physical activity, recreation, access to services and social interactions, and to reduce the use of energy and resources.
- Improve access to good-quality public and green open spaces for people of all ages and abilities including accessible and safe play areas and recreational spaces for children and young people.
- Plan places that are more resilient to climate change and natural disasters.
Social inclusiveness and cohesion
- Create more socially inclusive places and spaces through a variety in spatial planning, such as in land parcel size, forms of land tenure, and size of housing.
- Develop a common vision for social cohesion and health equity by adopting a people-centred “right to health” framework that includes the right to access, use and transform urban environments.
Clean air
- Ensure cleaner air through implementing interventions in polluting sectors, such as in transport and industry, and through access to cleaner fuels and technologies for cooking, heating and lighting, adequate housing equipment and infrastructure development.
Access to adequate water, sanitation, hygiene, waste management and food
- Provide well-managed water, sanitation and hygiene facilities, adequate waste management and access to safe and healthy food.
Housing
- Ensure access to affordable housing that is not crowded, where indoor temperatures and thermal insulation are adequate, that is equipped with safety devices, and where disease vectors are controlled.
6) Stop using taxpayers money to fund pollution.
- Stop subsidies on fossil fuels, such as for power generation and transport.
- Subsidize or exempt tax of clean energy and fuels such as solar-, hydro- and wind-based electricity.
- Embed environmental and health benchmarks in the financial recovery packages to COVID-19, e.g. by including ‘do no harm’ principles in the financial taxonomy of recovery packages and by actively investing in low-carbon and job-intensive sectors, including the health sector.
Cross-cutting actions
- Strengthen and support implementation of the Health in All Policies approach at the national and subnational level.
- Mainstream health and wellbeing, throughout all public service planning with, specific consideration to people in vulnerable situations such as migrants, refugees, internally displaced people, people in informal settlements etc.
- Support the effective engagement and direct participation of communities in planning and policy development.
- Conduct health, economic and environmental impact assessments of future and existing policies and interventions.
- Collaborate across sectors for managing environmental determinants of health.
- Allocate resources across sectors to account for the expected health impacts of sector-based policies. Use fiscal and financial mechanisms to influence environmental determinants of health through investments in adequate housing, energy efficiency, cycling and pedestrian networks, and mass transit, as well as taxation of unhealthy products and practices.
- Monitor and track risks to health and wellbeing of different population groups; monitor the adoption and health impacts of policies and investments using timely data and targeted indicators; disaggregate by income, gender, age, race, ethnicity, migratory status, geographic location and other characteristics relevant in national contexts.
