Warford J J
Centre for Economic and Social Research on the Global Environment, University College, London.
Bull World Health Organ. 1995;73(3):387-95.
Recent years have seen considerable progress in integrating environmental concerns into the mainstream of development policy and planning. Economic instruments designed explicitly for environmental purposes may help to achieve cost-effective solutions, and generate public revenues. Macroeconomic and sectoral policies may impact heavily upon the environment, and there is much scope for policy reforms that are justified in both economic and environmental terms. Progress in this area has been much more rapid than in the case of health objectives, even though the rationale for environmental improvement is often ultimately related to human health and well-being. It is proposed that lessons from recent experience in the use of economic instruments and policies to achieve environmental objectives are highly relevant for the health sector, which should seek and encourage support for measures that requires consumer and producers of environmentally degrading products to pay for the economic and social costs of the damage resulting from their use. Policy reform at the macroeconomic or sectoral level may yield cost-effective solutions to some health problems, and may even bring about improvements in health status that involve no net cost at all. The countrywide impact of such policies indicate that health agencies, including WHO, should develop the capacity to understand how economic policies and the adjustment process impact upon human health, not only direct through the effect on incomes, but also indirectly, via changes in the natural environment. Ability to conduct rigorous health impact assessment of economic policy reform, which requires a multidisciplinary effort, is a necessary condition if health ministries are to maximize their effectiveness in influencing overall government economic policy.
近年来，在将环境问题纳入发展政策与规划主流方面已取得显著进展。专门为环境目的设计的经济手段有助于实现成本效益高的解决方案，并创造公共收入。宏观经济政策和部门政策可能对环境产生重大影响，而且在经济和环境两方面都合理的政策改革空间很大。尽管改善环境的基本原理往往最终与人类健康和福祉相关，但该领域的进展比卫生目标方面的进展要快得多。有人提出，利用经济手段和政策实现环境目标的近期经验教训与卫生部门高度相关，卫生部门应寻求并鼓励支持要求环境退化产品的消费者和生产者为其使用造成的损害所带来的经济和社会成本买单的措施。宏观经济或部门层面的政策改革可能会产生解决某些卫生问题的成本效益高的办法，甚至可能带来根本无需净成本的健康状况改善。此类政策在全国范围内的影响表明，包括世卫组织在内的卫生机构应培养能力，以了解经济政策和调整过程如何不仅通过对收入的影响直接影响人类健康，而且还通过自然环境的变化间接影响人类健康。如果卫生部要在影响政府整体经济政策方面最大限度地提高成效，具备对经济政策改革进行严格卫生影响评估的能力（这需要多学科的努力）是一个必要条件。
