Using this method, we find hundreds of environmental treaties with health-related provisions. Not surprisingly, most treaties designed primarily to protect natural resources do not include provisions on human health. Environmental law and health law remain two distinct bodies of international law. However, no fewer than 338 environmental treaties include at least one health-related provision and some of them include up to seven of these provisions. Health-related provisions appears a total of 540 times in HEIDI.
General trends
HEIDI reveals that health concerns entered the environmental regime much earlier than a focus on UN-sponsored activities might suggest. Although the 2013 Minamata Convention on Mercury and the 2015 Paris Agreement on climate change might be the most visible environmental treaties with health-related provisions, they build on a long heritage. For example, a 1903 treaty concluded among riparian states of the Rhine regulated the packaging, labeling and handling of substances that are dangerous for human health.
As illustrated by Fig. 1, the number of environmental treaties, including those with health-related provisions, rose rapidly in the 1970s. This period was characterized by growing ecological concerns, particularly in high-income countries. The ratio of new environmental treaties with health-related provisions over the total number of new environmental treaties peaked in the early 2000s. This was around the time of the 2002 Johannesburg Summit on Sustainable Development, where health was one of the central themes. Since then, the ratio is declining, but the cumulative number of environmental treaties with health-related provisions continues to increase.
We observe that the number of health provisions is strongly and positively correlated with the number of parties to an environmental treaty. In addition, multilateral treaties include more health provisions on average than bilateral treaties.
However, as Fig. 2 shows, the geographical distribution of health provisions is irregular. On average, high-income countries have concluded more environmental treaties with health provisions than developing countries. Germany, France and the United States are part to more than 80 environmental treaties with health provisions. In contrast, almost all African and Asian countries have signed fewer than 40 environmental treaties with health provisions.
In Fig. 3, we present the number of environmental treaties for the different issue areas and the number of treaties that include at least one health provision. We note that health provisions are more frequent in absolute terms in environmental treaties related to agriculture and pollution. Health provisions are unlikely to be found in environmental treaties devoted to fisheries or fresh water, even though these two issue-areas clearly have environmental health implications.
The fourteen categories of health provisions in HEIDI can be divided into three groups. First, we considered the provisions relating to the treaty’s general principles or objectives. The second group includes provisions about institutional matters, which particularly focus on how the treaty in question relates to global health institutions. The third group concerns the operational provisions, which are usually related to the implementation of the treaty. In this section, we describe the nature, frequency and distribution of these provisions.
Principled provisions
We identified six categories of health-related provisions dealing with the general objectives. The most frequent type, with 150 occurrences, is a reference to human health in the environmental treaty’s preamble. For example, in the 1989 Basel Convention on the Control of Transboundary Movements of Hazardous Waste, there is a reference to the awareness of “…the risk of damage to human health and the environment caused by hazardous wastes and other wastes and the transboundary movement thereof.”
In 97 treaties, we found causal statements about how a substance (e.g. radioactive material, inflammable substances or polluted water) or an activity (e.g. waste disposal) is considered dangerous to human health. For example, the Convention on The Protection of The Marine Environment of The Baltic Sea Area states “Pollution means introduction by man, directly or indirectly, of substances or energy into the marine environment, including estuaries resulting in such deleterious effects as hazard to human health…”.
In 96 treaties, we found provisions stating that protection or promotion of human health is one of the treaty’s objectives. The first time that human well-being or health was cited as an objective in an environmental treaty was in the 1972 Convention for the Prevention of Marine Pollution by dumping from ships and aircraft, an agreement between several European countries: “The Contracting Parties pledge themselves to take all possible steps to prevent the pollution of the sea by substances that are liable to create hazards to human health, […].”
A less frequent type of causal claims, found in 20 treaties, concerns statements about the importance of natural, biological and genetic resources for human health. The preamble to the 2010 Nagoya Protocol on Genetic Resources acknowledges “the importance of genetic resources to […] public health….”.
An important branch of international law concerns human rights and health services or living conditions that promote health. However, only 12 environmental treaties mention the right to health or the obligations of parties regarding the right to health. Most of the treaties that do so involve Russia or Eastern European countries, such as the 1997 environmental agreement between Belarus and Slovakia, which is also one of the first treaties to refer to “the human right to a healthy environment”. More recently, we also found references to the right to health in the preamble of the 2015 Paris Agreement on climate change. This provision was the result of concerted advocacy efforts from public health actors [28].
Another principled provision that refers to human health in environmental treaties is related to the precautionary principle. This is the duty to take action to prevent harm to the environment or human health, even when scientific evidence remains uncertain. There are more than one hundred references to the precautionary principles in the treaties in HEIDI, but only 13 of these provisions explicitly refer to human health. These provisions are usually found in treaties involving the European Union that were concluded in the 1990s and 2000s.
Institutional provisions
Institutional provisions are less frequent than principled provisions. They are usually of a general order, as they do not specify exactly what they require from the parties involved or from the secretariat responsible for the treaties. Six environmental treaties require their parties to cooperate with the WHO and three include a requirement to cooperate with another health organization. For instance, the 1985 Vienna Convention for the Protection of the Ozone Layer provides that “The Conference of the Parties shall [...] seek [...] the services of competent international bodies [...] in particular […] the World Health Organization.”
In other cases, the treaty may refer to the WHO (ten occurrences) or another health organization (three occurrences) without actually prescribing cooperation with them. This is illustrated by the 1999 Protocol on water and health to the Convention on protection of transboundary watercourses, which includes a provision that mentions: “The quality of the drinking water supplied, taking into account the Guidelines for drinking-water quality of the World Health Organization”. We note that the probability of finding a provision on cooperation with WHO is higher in treaties involving jointly high-income and developing countries.
Operational provisions
The third group of health-related clauses in environmental treaties relates to operational rules. Four types of clauses belong to this group. The most frequent type (61 treaties) are exceptions, which allow parties to the treaties to derogate from their treaty obligations for the purpose of protecting public or human health. For example, exceptions may include the right to kill an animal that endangers human lives or in times of famine, the right to access ports in the case of medical emergency (in fisheries agreements) and the right to impose more stringent measures to enhance human health protection. Such exceptions are particularly common in treaties that Canada is party to.
The second type of operational provisions, found in 54 environmental treaties, state that parties have the right to impose a quarantine for the cross-border trade of products. The majority of these provisions concern bilateral treaties between developing countries that were negotiated in the 1950s and 1960s.
The third type concerns clauses that commit parties to working toward harmonizing health policies. Ten environmental treaties call their parties to adopt similar guidelines, methods, policies, standards or procedures. The 1995 Convention to Ban the Importation into The Forum Island Countries of Hazardous and Radioactive Wastes and To Control the Transboundary Movement and Management of Hazardous Wastes Within the South Pacific Region specifies that: “The Conference of the Parties […] shall promote the harmoniation, at high levels of protection, of appropriate legislation, policies, strategies and measures for minimising harm to human health and the environment.”
Finally, we found four treaties in which parties commit to investing in health services and capacity building: the 1978 Treaty for Amazonian Cooperation; the 2001 Stockholm Convention on persistent organic pollutants; the Framework cooperation agreement between Austria and Venezuela; and the 2013 Minamata Convention on mercury. This last treaty include the following commitments:
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(c) Promote appropriate health-care services for prevention, treatment and care for populations affected by the exposure to mercury or mercury compounds; and.
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(d) Establish and strengthen, as appropriate, the institutional and health professional capacities for the prevention, diagnosis, treatment and monitoring of health risks related to the exposure to mercury and mercury compounds.