Agenda 21¹ and the Rio Declaration on Environment and Development² puts a human face on sustainable development, clearly stating that sustainable development is development that leads to maximizing human potential while protecting the environment, but that if there is a conflict, human welfare must be determinative. This has created tension between activists from the developed world, who were generally opposed to development, and those from the developing world, who realized that development was essential for human welfare, even if it had environmental costs. This view of sustainable development, however, is clearly articulated in the introduction to Chapter 6 of Agenda 21, entitled "Protecting and Promoting Human Health."³ The remainder of Chapter 6 applies this approach to key populations and programs, delineating a detailed set of objectives for personal medical services, public health services, and environmental health issues.

Agenda 21 expands the traditional environmentalist focus on illnesses related to environmental pollution to a broad emphasis on basic medical care, preventive medicine, and the improvement of mental and physical health. This parallels the World Health Organization's (WHO's) broad definition of health: "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."⁴ In the developing world, health is very pragmatically related to development: if a significant part of the population is partially disabled by diseases such as malaria, or if whole professional classes are destroyed by the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS), then this makes economic development much less efficient, which leads to unnecessary delay and environmental impact. Even in the United States there are serious access to medical care problems and failures in the public health system that impact economic development and well being.