Health and population

138. We recognize that health is a precondition for and an outcome and indicator of all three dimensions of sustainable development. We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and non-communicable diseases, and where populations can reach a state of physical, mental and social well-being. We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and for the entire population, is important to create inclusive, equitable, economically productive and healthy societies. We call for the full realization of the right to the enjoyment of the highest attainable standard of physical and mental health.

139. We also recognize the importance of universal health coverage to enhancing health, social cohesion and sustainable human and economic development. We pledge to strengthen health systems toward the provision of equitable universal coverage. We call for the involvement of all relevant actors for coordinated multi-sectoral action to address urgently the health needs of the world's population.

140. We emphasize that HIV and AIDS, malaria, tuberculosis, influenza, polio and other communicable diseases remain serious global concerns, and we commit to redouble efforts to achieve universal access to HIV prevention, treatment, care and support, and to eliminate mother-to-child transmission of HIV, as well as to renewing and strengthening the fight against malaria, tuberculosis and neglected tropical diseases.

141. We acknowledge that the global burden and threat of non-communicable diseases constitutes one of the major challenges for sustainable development in the 21st century. We commit to strengthen health systems toward the provision of equitable, universal coverage and promote affordable access to prevention, treatment, care and support related to non-communicable diseases, especially cancer, cardiovascular diseases, chronic respiratory diseases and diabetes. We also commit to establish or strengthen multi-sectoral national policies for the prevention and control of non-communicable diseases. We recognize that reducing, inter alia, air, water and chemical pollution leads to positive effects on health.

142. We reaffirm the right to use, to the full, the provisions contained in the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), the Doha Declaration on the TRIPS Agreement and Public Health, the decision of the WTO General Council of August 30, 2003 on the implementation of paragraph six of the Doha Declaration on the TRIPS Agreement and Public Health, and, when formal acceptance procedures are completed, the amendment to Article 31 of the agreement, which provides flexibilities for the protection of public health, and, in particular, to promote access to medicines for all, and encourage the provision of assistance to developing countries in this regard.

143. We call for further collaboration and cooperation at the national and international levels to strengthen health systems through increased health financing, recruitment, development and training and retention of the health workforce, through improved distribution and access to safe, affordable, effective and quality medicines, vaccines and medical technologies, and through improving health infrastructure. We support the leadership role of the WHO as the directing and coordinating authority on international health work.

144. We commit to systematically consider population trends and projections in our national, rural and urban development strategies and policies. Through forward-looking planning, we can seize the opportunities and address the challenges associated with demographic change, including migration.

145. We call for the full and effective implementation of the Beijing Platform for Action and the Program of Action of the International Conference on Population and Development, and the outcomes of their review conferences, including the commitments leading to sexual and reproductive health and the promotion and protection of all human rights in this context. We emphasize the need for the provision of universal access to reproductive health, including family planning and sexual health, and the integration of reproductive health in national strategies and programs.

146. We commit to reduce maternal and child mortality and to improve the health of women, men, youth and children. We reaffirm our commitment to gender equality and to protect the rights of women, men and youth to have control over and decide freely and responsibly on matters related to their sexuality, including access to sexual and reproductive health, free from coercion, discrimination and violence. We will work actively to ensure that health systems provide the necessary information and health services addressing the sexual and reproductive health of women, including working toward universal access to safe, effective, affordable and acceptable modern methods of family planning, as this is essential for women's health and advancing gender equality.

Promoting full and productive employment, decent work for all and social protection

147. We recognize that poverty eradication, full and productive employment and decent work for all, and social integration and protection are interrelated and mutually reinforcing, and that enabling environments to promote these need to be created at all levels.

148. We are concerned about labor market conditions and widespread deficits of available decent work opportunities, especially for young women and men. We urge all governments to address the global challenge of youth employment by developing and implementing strategies and policies that provide young people everywhere access to decent and productive work, as over the coming decades decent jobs will need to be created to be able to ensure sustainable and inclusive development and reduce poverty.

149. We recognize the importance of job creation by investing in and developing sound, effective and efficient economic and social infrastructure and productive capacities for sustainable development and sustained, inclusive and equitable economic growth. We call on countries to enhance infrastructure investment for sustainable development and we agree to support UN funds, programs and agencies to help assist and promote the efforts of developing countries, particularly the least developed countries, in this regard.

150. We recognize the importance of job creation by adopting forward-looking macroeconomic policies that promote sustainable development and lead to sustained, inclusive and equitable economic growth, increase productive employment opportunities and promote agricultural and industrial development.

151. We emphasize the need to enhance employment and income opportunities for all, especially for women and men living in poverty and, in this regard, we support national efforts to provide new job opportunities to the poor in both rural and urban areas, including support to small and medium-sized enterprises.

152. We recognize that workers should have access to education, skills, health care, social security, fundamental rights at work, social and legal protections, including occupational safety and health, and decent work opportunities. Governments, trade unions, workers and employers all have a role to play in promoting decent work for all, and all should help young people to gain access to needed skills and employment opportunities, including in new and emerging sectors. Women and men should have equal access to opportunities to acquire job skills as well as to worker protections. We recognize the importance of a just transition, including programs to help workers adjust to changing labor market conditions.

153. We also recognize that informal unpaid work, performed mostly by women, contributes substantially to human well-being and sustainable development. In this regard, we commit to work toward safe and decent working conditions and access to social protection and education.

154. We recognize that opportunities for decent work for all and job creation can be generated through, inter alia, public and private investments in scientific and technological innovation, public works in restoring, regenerating and conserving natural resources and ecosystems, and social and community services. We are encouraged by government initiatives to create jobs for poor people in restoring and managing natural resources and ecosystems, and we encourage the private sector to contribute to decent work for all and job creation for both women and men, and particularly for young people, including through partnerships with small and medium-sized enterprises and cooperatives. In this regard, we acknowledge the importance of efforts to promote the exchange of information and knowledge on decent work for all and job creation, including green jobs initiatives and related skills, and to facilitate the integration of relevant data into national economic and employment policies.

155. We encourage the sharing of experiences and best practices on ways to address the high levels of unemployment and underemployment, in particular among young people.

156. We stress the need to provide social protection to all members of society, fostering growth, resilience, social justice and cohesion, including those who are not employed in the formal economy. In this regard, we strongly encourage national and local initiatives aimed at providing social protection floors for all citizens. We support global dialogue on best practices for social protection programs that takes into account the three dimensions of sustainable development and, in this regard, we note International Labor Organization Recommendation 202 concerning national floors of social protection.

157. We call upon states to promote and protect effectively the human rights and fundamental freedom of all migrants regardless of migration status, especially those of women and children, and to address international migration through international, regional or bilateral cooperation and dialogue and a comprehensive and balanced approach, recognizing the roles and responsibilities of countries of origin, transit and destination in promoting and protecting the human rights of all migrants, and avoiding approaches that might aggravate their vulnerability.

Oceans and seas

158. We recognize that oceans, seas and coastal areas form an integrated and essential component of the Earth's ecosystem and are critical to sustaining it, and that international law, as reflected in the UN Convention on the Law of the Sea, provides the legal framework for the conservation and sustainable use of the oceans and their resources. We stress the importance of the conservation and sustainable use of the oceans and seas and of their resources for sustainable development, including through their contributions to poverty eradication, sustained economic growth, food security and creation of sustainable livelihoods and decent work, while at the same time protecting biodiversity and the marine environment and addressing the impacts of climate change. We therefore commit to protect, and restore, the health, productivity and resilience of oceans and marine ecosystems, and to maintain their biodiversity, enabling their conservation and sustainable use for present and future generations, and to effectively apply an ecosystem approach and the precautionary approach in the management, in accordance with international law, of activities having an impact on the marine environment, to deliver on all three dimensions of sustainable development.

159. We recognize the importance of the UN Convention on the Law of the Sea to advancing sustainable development and its near universal adoption by states, and in this regard we urge all its parties to fully implement their obligations under the convention.

160. We recognize the importance of building the capacity of developing countries to be able to benefit from the conservation and sustainable use of the oceans and seas and their resources and, in this regard, we emphasize the need for cooperation in marine scientific research to implement the provisions of the UN Convention on the Law of the Sea and the outcomes of the major summits on sustainable development, as well as for the transfer of technology, taking into account the Intergovernmental Oceanographic Commission Criteria and Guidelines on the Transfer of Marine Technology.

161. We support the Regular Process for Global Reporting and Assessment of the State of the Marine Environment, including Socioeconomic Aspects, established under the General Assembly, and look forward to the completion of its first global integrated assessment of the state of the marine environment by 2014 and its subsequent consideration by the assembly. We encourage consideration by states of the assessment findings at appropriate levels.

162. We recognize the importance of the conservation and sustainable use of marine biodiversity beyond areas of national jurisdiction. We note the ongoing work under the General Assembly of an ad hoc open-ended informal working group to study issues relating to the conservation and sustainable use of marine biological diversity beyond areas of national jurisdiction. Building on the work of the ad hoc working group and before the end of the 69th session of the General Assembly we commit to address, on an urgent basis, the issue of the conservation and sustainable use of marine biological diversity of areas beyond national jurisdiction, including by taking a decision on the development of an international instrument under the UN Convention on the Law of the Sea.

163. We note with concern that the health of oceans and marine biodiversity are negatively affected by marine pollution, including marine debris, especially plastic, persistent organic pollutants, heavy metals and nitrogen-based compounds, from a number of marine and land-based sources, including shipping and land run-off. We commit to take action to reduce the incidence and impacts of such pollution on marine ecosystems, including through the effective implementation of relevant conventions adopted in the framework of the International Maritime Organization (IMO), and the follow-up of the relevant initiatives such as the Global Program of Action for the Protection of the Marine Environment from Land-based Activities, as well as the adoption of coordinated strategies to this end. We further commit to take action to, by 2025, based on collected scientific data, achieve significant reductions in marine debris to prevent harm to the coastal and marine environment.

164. We note the significant threat that alien invasive species pose to marine ecosystems and resources and commit to implement measures to prevent the introduction, and manage the adverse environmental impacts, of alien invasive species, including, as appropriate, those adopted in the framework of IMO.

165. We note that sea-level rise and coastal erosion are serious threats for many coastal regions and islands, particularly in developing countries, and in this regard we call on the international community to enhance its efforts to address these challenges.

166. We call for support to initiatives that address ocean acidification and the impacts of climate change on marine and coastal ecosystems and resources. In this regard, we reiterate the need to work collectively to prevent further ocean acidification, as well as enhance the resilience of marine ecosystems and of the communities whose livelihoods depend on them, and to support marine scientific research, monitoring and observation of ocean acidification and particularly vulnerable ecosystems, including through enhanced international cooperation in this regard.

167. We stress our concern about the potential environmental impacts of ocean fertilization. In this regard, we recall the decisions related to ocean fertilization adopted by the relevant intergovernmental bodies, and resolve to continue addressing with utmost caution ocean fertilization, consistent with the precautionary approach.