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Agenda 21 has presented a golden opportunity for health authorities to increase their influence on national planning and to reverse the trend of environmentally damaging and health-threatening development. Many countries have instituted new policy and planning tools since the Earth Summit to make environmental concerns a part of the planning process, for instance, via national environmental action plans (NEAPs) (world Bank, 1995b).

However, although much progress has been made in recent years concerning development of more comprehensive environmental health policies and strategies, many countries have been relatively slow to adopt them. This has been due in part to gaps in knowledge, the perception that evidence on which to act is insufficient (Anon, 1996c), and the very real challenges facing the health sector in addressing policy needs with respect to energy, industrialization and advanced technology. Nevertheless, appreciation is growing that the health sector has a key role to play in helping ensure that the policies and strategies of various sectors and organizations contribute positively to health protection and promotion.