The NEW Lodi Declaration on Rural Health

The NEW Lodi Declaration on Rural Health Adopted by the International Congress on Rural Health (ICRH) and the 4 th International Conference Safety Health Welfare in Agriculture Agro-Food and Forestry Systems (Ragusa SHWA)

Whereas more than 50% of the world’s population live in rural areas,  with  limited  or  no  access  to  primary  health  care,  basic occupational health care, clean water and sanitation,

Whereas unsustainable and unhealthy agricultural practices have influence on the rural population, with potential severe influence on the environment, wildlife, and urban population, through contaminated soil, water and food,

Whereas structural system-related determinants accompanied by unsafe  work  behaviours  causes  occupational  and  work-related diseases and injuries, disabilities, premature deaths, loss of income, as well as human suffering and poverty in rural areas,

Whereas children and women working in agriculture are especially vulnerable to occupational and environmental risks, in addition to consequences arising from the unavailability of basic health service and inadequate housing, in particular from household fuel combustion,

Whereas   international, national   and   local   actions,   although significant  and  honourable,  have  not  been  able  to  respond successfully to all the challenges put before them,

Underlining that the achievement of the highest possible level of health for all people is impossible without improving the health of the rural population, and this is impossible without the involvement of the public sector as a whole,

Taking  into  consideration  the  Declaration  of  the  International Conference on Primary Health Care, Alma-Ata, USSR, 1978, the Global Strategy on  Occupational Health for All adopted by the World Health Assembly with Resolution 49.12 from 1996 and the Global Strategy on Occupational Safety and Health adopted by the International Labour Conference in 2003, the Safety and Health in Agriculture Convention, 2001 (No. 184) of the International Labour Organisation.

Recalling the outcomes of previous international deliberations on occupational  health in agriculture and rural health, such as the Declaration of the First International Congress on Rural Health in the Mediterranean and Balkan  Countries (Bari, Italy, 2002), the Agenda on Rural Health (Loni, India, 2002),  the Declaration on Occupational and Environmental Rural Health (Belgrade, Serbia,

2004), the Lodi Declaration on Healthy Villages (Lodi, Italy, 2006), the  Cartagena  Declaration  on  Rural  Health  in  Latin  America (Cartagena de Indias, Colombia, 2009), and the Goa Declaration for Health in the Global Village (Panaji, Goa, India, 2012),

Recalling the continuing appeal of spiritual and secular leaders and of scholars and scientists worldwide to a responsible stewardship of the Planet, to a shared  and sustainable access to its natural and limited resources, to their preservation for future generations,

We, the 250 participants from 52 countries from all continents who took part in  the International Congress on Rural Health and 4th Ragusa SHWA, held  here  in Lodi, Italy, from September 8th  to September  11th,  2015,   discussed   the  challenges  to  providing adequate occupational and environmental health, food safety, public health and medical services in rural areas, and

WE DECLARE THAT:

1.  We will commit ourselves to help solving occupational, environmental  and  public  health  problems  and  inadequacies  in access to health care in rural areas, in the frame of the WHO global strategy on people centred and integrated health service;

2.  We will advocate for the elimination of child labour in rural and remote  areas,  recognition  of  informal  and  migrant  agricultural workers, and abolishment of modern slavery;

3.  We call for national and international organizations, as well as individuals to work on the improvement of the scope and coverage of  primary  health  care  to  address  better  the  needs  of  rural communities inclusive needs related to health and safety at work such as agrochemical  use, heavy physical work, accidents, heat stress,  dehydration  and  kidney  injuries,  cancer due  to  solar radiation, biological risk factors and zoonoses;

4.  We  will  work  towards  providing  higher  access  of  workers  to occupational  health care with the creation of basic occupational health services in rural areas wherever necessary,

5.  We recognize the need for addressing occupational, environmental and public health risks in rural areas by working together with all of the stakeholders, governments, public sector a while,  and industry, as well as the ministries of health, environment, labour, agriculture and   other   state agencies,   private   enterprises and   workers’ organizations;

6.  We  underline  the  significance  of  local,  regional,  national  and international initiatives to protect and promote the health of the rural population;

7.  We encourage the following organizations: The European Rural and Isolated  Practitioners  Association  (EURIPA),  The  International Association on Rural Medicine and Health (IARM), the International  Commission  on  Occupational  Health  (ICOH),  the WONCA  Working Party  on  Rural  Practice,  as  well  as  the organizations of farmers, agricultural workers, agricultural industry, and the relevant non-governmental organizations and networks, to take action to support and promote the development of Rural Health programmes;

8.  We will dedicate a significant part of our scientific and professional efforts to  create useful, accessible, simple and low-cost tools for occupational, indoor and environmental risk assessment, communication and management;

9.  We call upon the governmental agencies and local authorities to ensure equal and proper access of people in villages, to information on public and occupational health and the environment, stimulate social and environmental justice, as well as to provide means for empowerment of rural  populations to protect and promote their health, and to improve their working and living conditions. Access to health care should be treated as a basic human right. Use of e- health and telemedicine should be promoted in rural area;

10. We  congratulate  our  colleagues  which  have  been  working  on opening  reference centres at the local, national and international level for providing expertise and support to the rural population;

11. We call for the creation of interdisciplinary teams of experts from the field of human and veterinary medicine, public, occupational, and environmental health, health promotion, food safety, chemical safety, agricultural, social and  human sciences, and agricultural engineering which will address the needs of the rural population;

12. We  recommend  introducing  Occupational  Health  and  Safety concerns in training and educational programmes in all of the above- mentioned disciplines at  any level, from health care providers to rural workers and population, in order to build the necessary human resources  and  to  provide  services  of  great  quality to  the  rural population and agricultural workers. Specific country  needs and participatory approach should be addressed;

13. We  urge  the  agricultural  sector  to  realize  its  responsibility for healthy  working  and  housing  conditions  by  expanding  suitable measures for workers and farms and by providing financial means for  scientific  and  educational   developments  to  support  such measures;

14. We are committed to share our practice and experience in devising, implementing   and evaluating   educational programs   for   the improvement of the health of the rural population;

15. We are committed, as citizens, to advocate peace and justice, and the pursuit of the common good as the founding of scientific and professional achievement in our own field of expertise;

We hereby authorize the Congress Presidents, the EURIPA, IARM, ICOH and WONCA Working Party on Rural Practice representatives to sign this declaration on our behalf.

Submitted to the Assembly by Stefan Mandic-Rajcevic (Italy and Serbia)
Signed in Lodi, September 11th 2015

Claudio Colosio, ICRH President
Giampaolo Schillaci, Ragusa SHWA President
Tanja Pekez Pavlisko, President, EURIPA; Vice Chair WONCA Working Party on Rural Practice,
Hans Joaquin Hannich, President, IARM and Shuzo Shintani, Secretary General, IARM
Jukka Takala, President, ICOH and Gert van der Laan, Chair, the ICOH Scientific Committee on Rural Health , ICOH