Kim KH Implementation status of environmental health goals among Sustainable Development Goals in the context of sustainable development and poverty e

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1 FOCUSED ISSUE OF THIS MONTH J Korean Med Assoc 2017 August; 60(8): pissn / eissn 지속가능발전목표내환경보건목표이행현황과목표달성을위한모니터링현황 김경희 고려대학교환경의학연구소 Implementation status and monitoring of a environmental health-related index in relation to Sustainable Development Goals Kyung Hee Kim, PhD Institute for Environmental Health, Korea University, Seoul, Korea The environmental health goals that are directly and indirectly related with the health goals of the Sustainable Development Goals are connected with the goals and targets of Goal 6 (clean water and sanitation), Goal 7 (affordable and clean energy), Goal 11 (sustainable cities and communities), Goal 12 (responsible consumption and production), Goal 13 (climate action), Goal 14 (life below water), Goal 15 (life on land) and Goal 16 (peace, justice and strong institutions). For example, air pollution can cause such non-communicable diseases as lung cancer and increase the risk of acute respiratory diseases. The World Health Organization reported in 2016 that, in 2012, around 8,710,000 people had died in the world due to the pollution of drinking water, waters and soil, along with inadequate sanitary facilities and services. The World Health Organization also reported that around 4.3 million people had died of ischemic heart diseases, strokes, chronic lung diseases, lung cancer and pediatric pneumonia due to inefficient energy use when cooking at home. These figures show the importance of environmental factors in relation to health. When policy makers carry forward goals and policy measures focused on diseases in consideration of associations among related areas, there is insufficient access to necessary knowledge, means and technologies. Korea has to determine the level and scope for developing a domestic implementation index, while developing a monitoring index in relation to the global index. Consequently, comprehensive achievement of the health goals of Sustainable Development Goal at home and abroad requires a cross-sectoral approach involving comprehensive participation by all stakeholders including the state, corporations and civil society to overcome the segmentalization of goals, beyond improving the existing policies. Key Words: Sustainable Development Goals; Health; Environmental health; United Nations; Official development assistance Received: July 4, 2017 Accepted: July 18, 2017 Corresponding author: Kyung Hee Kim kyonghee80@korea.ac.kr Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서론 2012년 6월브라질리우데자네이루에서개최된국제연합 (United Nations, UN) 지속가능발전회의 (Commission on Sustainable Development, Rio+ 20) 를통해 지속가능한발전과빈곤퇴치맥락에서의녹색경제 (Green economy 662 대한의사협회지

2 Kim KH Implementation status of environmental health goals among Sustainable Development Goals in the context of sustainable development and poverty eradication), 관리체계강화에대한정치적선언문인 우리가원하는미래 (The Future We Want) 를채택하였다 [1]. 지속가능발전을위한녹색경제의역할에대한 UN 회원국이공동으로합의한최초의문서라는점과경제발전과정에서환경에대한미치는영향을최소화하고사회적비용을고려하는녹색경제로의세계경제패러다임전환이라는방향성을제시했다는점에서의미가있다 [2]. 2014년 12월 UN은 Rio+ 20 회의의후속조치로써 2000년수립한새천년개발목표 (Millennium Development Goals, MDGs) 를대체할새로운 Post-2015 개발의제를확정했다. 2015년 9월에열린 UN 지속가능발전정상회의에서 우리가사는세상의변화 : 지속가능발전을위한 2030 의제 가채택되었고 2015 년부터 2030 년까지 UN이추진할새로운목표는지속가능발전목표 (Sustainable Development Goals, SDGs) 로명명되었으며, 17개개발목표 (Goal) 와 169개세부목표 (Target) 를제시했다 [3]. SDGs의 17개목표는사회발전, 경제성장, 환경보호라는축을기반으로하고있으며, 5개의 P축으로각목표들을구조화할수도있다. 5P는사람 (people), 번영 (prosperity), 지구환경 (planet), 평화 (peace), 파트너십 (partnership) 을의미한다 [4]. MDGs가극심한빈곤을종식시키기위한의제로서개발도상국을중심으로사회발전을중심으로목표를설정했던것과달리 SDGs는개발도상국과선진국의공통의문제로모든형태의빈곤과불평등감소에대한의제를포괄적으로포함하고있다 [5,6]. SDG 17개의목표중에는 MDGs 의 8개의목표중세부목표로설정되었던요소들이 SDG에서단일목표로설정된물과위생 (SDG 6), 고용 (SDG 8), 인간거주지 (SDG 11) 목표가있다. 아울러, 새롭게설정된목표로서농업증진 (SDG 3), 평생학습 (SDG 4), 산업화 (SDG 9), 지속가능한소비와생산 (SDG 12), 에너지 (SDG 7) 등이있다 [7]. Goal 3의세부목표들은 MDG 보건목표 에서포함되지않았던환경보건지표들이다수포함된것을확인할수있다. SDGs의보건목표를달성을위해서는타 SDGs 환경분야목 표와폭넓게관련되어상호간의연관성을분석하여전략을구체화하는것이필요하다. 이에, 본고에서는 UN SDGs 중에서보건목표와관련있는환경보건목표를소개하고, 각기관들의 SDGs 이행현황을점검하기위한모니터링지표들을구체적으로소개하고자한다. 지속가능발전목표환경세부목표 1. SDG 6: 모두를위한물과위생설비에대해가용성과지속가능한유지관리보장 2015 년기준, 전세계인구의 91%(66 억인구 ) 가개선된음용수공급원을사용하는것으로보고되고있다 (2000년기준, 82%). 그럼에도 6억6천3백만이개선되지않은음용수원을사용하고있는상황이다 [8]. 이에, SDG Goal 6는깨끗한물과위생에관련된목표로모든사람들이안전한식수와개선된위생시설을보장받는것을포함하여, 수질오염의개선, 통합적인수자원관리등의세부목표가포함되어있다. Goal 6는 6개의 Target으로구성되어있다. 1) Target 년까지안전한식수에대한보편적이고형평성있는접근성보장, 2) Target 년까지개선된위생시설에대한보편적인접근성보장, 3) 2030년까지오염물질감소, 유해폐기물감소, 화학물질배출최소화, 폐수비율 50% 감소, 재활용및재사용률X% 까지증대함으로서수질향상, 4) Target 년까지물사용의효율성증대, 지속가능한물사용보장, 5) Target 년까지국제공유하천협력을포함한모든수준에서통합수자원관리방안실행, 6) Target 년까지물집수, 담수화, 물효율성, 폐수처리, 재활용및재사용기술등과위생관련활동및사업지원을위한국제협력및역량강화증대이며, 상기와 6개의 Target을달성하기위한수단으로서의 Target 6.a, 6.b를포함하고있다. 본목표는식수위생이보장받지못할경우감염성질환이증가할수있다는관점으로판단컨대, 예방적건강증진의목표와부합된다고할수있다 [4,9-11]. 환경보건지속가능발전목표이행현황 663

3 J Korean Med Assoc 2017 August; 60(8): SDG 7: 모두를위한적정한가격의신뢰성있고지속가능한현대적에너지에대한접근성보장가스와전기와같은깨끗한연료와기술로요리를할수있는전세계인구는 2005년 54% 에서대비 2014년 58% 로증가된바있다 [8]. 사하라지역의아프리카는여전히현대적에너지로의접근성이매우낮으며, 발전속도또한매우늦은상황이다. 고형연료를사용함으로써실내오염물질이배출되어호흡기질환에영향을미칠수있다는연구결과들은동목표가보건지표와밀접하다는것을보여준다. 2011년 9월, UN은 2030년까지 모두를위한지속가능한에너지이니셔티브 (Sustainable Energy for All, SE4ALL Initiative) 를창설하여다양한정책을진행하고있다 [12]. 이니셔티브의주요목표는현대적에너지서비스의보편적접근보장, 에너지효율개선속도 2배증가, 전세계재생에너지의비중을 2배로확대이다. 본 Goal은총 3개의 Target과이행수단 2개의목표를포함하고있다. 1) Target 년까지저렴하고믿을수있는현대식에너지서비스의보편적접근성보장, 2) Target 년까지전세계에너지구성에서재생에너지비중의실질적인증대, 3) Target 년까지전세계에너지효율속도개선속도 2배확대와같은구현목표와더불어효과적인달성을위한수단으로서의 Target 7.a, 7.b를제시하고있다 [11]. 3. SDG 11: 회복력있고지속가능한도시와거주지조성대기오염은건강을위협하는주요한환경적위험요소이다. 2012년전세계적으로농촌지역의대기오염으로인한조기사망자로 370만명이며, 도시인구의절반이세계보건기구 (World Health Organization, WHO) 의안전기준보다 2.5배대기오염에노출되는것으로보고하였다 [8]. 도시가직면하고있는문제들인자원사용을개선하고오염과빈곤을감소시킴으로서보건지표개선에기여할수있다는측면에서보건과관련성이있는목표라고할수있다. SDG 11은 7개의 Target과이행수단으로의 Target 3 개를제시하고있다. 특히, Target 년까지대기의질과지자체또는다른주체의폐기물관리에대한중 점관리를통해인구 1명당도시에미치는환경의부정적인효과를감소한다는보건과밀접한관련이있다고할수있다 [11]. 4. SDG 12: 지속가능한소비와및생산의보장지속가능한소비와생산은서비스와제품의전생애주기에효율성을높이고자연자원, 유해물질의사용, 폐기물과오염물질의배출을감소시키는서비스와제품의지속가능한사용으로정의할수있다. 본 Goal은 9개의 Target 과 3개의이행수단을제시하고있다. 본 Goal을달성하기위한중요한수단으로자원의효율적인관리와독성폐기물과오염물질의처리방법은보건학적목표와밀접한관련이있다고할수있다. 본 Goal은국가의정책 (Target 12.1, Target 12.2, Target 12.7) 과더불어, 민간기업의 SDG 관련지표들에대해서지속가능발전보고서를통해공개할것 (Target 12.6) 을목표로제시하고있다. 아울러, 대중들의인식에대한변화 (Target 12.8) 를제시하고있다 [11]. 5. SDG 13: 기후변화와영향에대응하는긴급조치본 Goal은 3개의 Target과 2개의수단목표를제시하고있다. 기후변화는건강, 환경, 산업등에대한범분야목표로단일목표의성격보다는다른의제와연관성이높은지표라고할수있다. SDG에서군소도서개발국의관점에서기후변화와그영향, 그리고가능한위험재해에대처하기위한긴급한조치를강조하고있다 [11,13]. 6. Goal 14: 지속가능한발전을위한대양, 바다, 해양자원의보호와지속가능한이용 7개의 Target과 3개의수단목표를제시하고있다. 세계의바다는, 자신의온도, 화학, 해류와삶을통해인류가지구에거주할수있도록글로벌시스템을구동할수있도록 Target을제시하고있다. 보존을강화하고국제법을통한해양기반자원의지속가능한이용을강화하는것은우리의바다가직면하고있는도전의일부를완화하는데도움이될것이다 [11,13]. 664 대한의사협회지

4 Kim KH Implementation status of environmental health goals among Sustainable Development Goals Table 1. Health-related SDGs targets Source World Health Organization (2015) [17] World Health Organization (2017) [18] Health-related SDG target 1.3, 1.5, 2.1, 2.2, all SDG 3 targets, 4.5, 4.a, 5.2, 5.3, 5.6, 6.1, 6.2, 7.1, 8.5, 8.7, 8.8, 10.2, 10.7, 11.1, 11.2, 11.5, 11.7, 11.b, 12.4, 13.3, 16.2, 16.9, , all SDG 3, 6.1, 6.2, 7.1, 11.6, 13.1, 16.1 Le Banc (2015) [19] 2.2, all SDG 3, 6.1, 6.2, 6.3, 11.2, 11.5, 12.4 GBD 2015 SDG Collaborators (2016) [20] 1.5, 2.2, all SDG 3, 5.2, 6.1, 6.2, 7.1, 8.8, 11.5, 11.6, 13.1, 16.1, Adapted from Nunes AR, et al. BMJ Glob Health 2016;1:e [21]. SDGs, Sustainable Development Goals. 7. Goal 15: 육상생태계의보전, 복원및지속가능한 이용증진, 지속가능한숲관리, 사막화와 토지파괴방지및복원, 생물다양성감소방지 육지기반오염으로부터해양과연안생태계를지속적으 로관리하고보호할뿐만아니라해양산성화의영향을해결 하기위한기반을만들수있다. 9 개의 Target 과이를달성 하기위한수단목표 3 개를제시하고있다 [11,13]. 이외에도 Goal 16 (Target 16.1 모든곳에서모든형태의 폭력과그로인한사망률을대폭감소시킨다 ; Target 16.2 아동학대, 착취, 인신매매및모든형태의폭력과고문종식 ) Table 2. Examples of health issues, SDGs targets and current indicators for each target, our proposed objectives and potential new indicators Health issue Respiratory diseases Diarrhoeal diseases SDGs targets and current indicators for each target 1.1 (1.1.1); 1.2 (1.2.1, 1.2.2); 1.3 (1.3.1); 1.4 (1.4.1); 2.1 (2.1.1, 2.1.2); 2.2 (2.2.1, 2.2.2); 3.3 (3.3.1); 3.4 (3.4.1); 3.8 (3.8.1, 3.8.2); 3.9 (3.9.1); 3.a (3.a.1); 7.1 (7.1.1, 7.1.2); 7.2 (7.2.1); 7.a (7.a.1); 7.b (7.b.1); 11.1 (11.1.1); 11.2 (11.2.1); 11.6 (11.6.2); 12.c (12.c.1); 13.1 (13.1.1, ); 13.2 (13.2.1); 13.3 (13.3.1, ) 1.1 (1.1.1); 1.2 (1.2.1, 1.2.2); 1.3 (1.3.1); 1.4 (1.4.1); 3.2 (3.2.1, 3.2.2); 3.3; 3.8 (3.8.1, 3.8.2); 3.9 (3.9.2, 3.9.3); 6.1 (6.1.1); 6.2 (6.2.1); 6.3 (6.3.1, 6.3.2); 11.1 (11.1.1); 11.6 (11.6.1); 12.4 (12.4.1, ); 13.1 (13.1.1, ); 13.2 (13.2.1); 13.3 (13.3.1, ) Malnutrition 1.1 (1.1.1); 1.2 (1.2.1; 1.2.2); 1.3 (1.3.1); 1.4 (1.4.1, 1.4.2); 2.1 (2.1.1, 2.1.2); 2.2 (2.2.1; 2.2.2); 2.3 (2.3.1, 2.3.2); 2.4 (2.4.1); 3.2 (3.2.1, 3.2.2); 3.4 (3.4.1); 3.8(3.8.1; 3.8.2); 6.1 (6.1.1); 6.2 (6.2.1); 6.3 (6.3.1, 6.3.2); 11.1 (11.1.1); 13.1 (13.1.1; ); 13.2 (13.2.1); 13.3 (13.3.1, ) Lung cancer 1.1 (1.1.1); 1.2 (1.2.1; 1.2.2); 1.3 (1.3.1); 1.4 (1.4.1); 3.4 (3.4.1); 3.8 (3.8.1, 3.8.2); 3.9 (3.9.1); 3.a (3.a.1); 7.1 (7.1.1, 7.1.2); 7.2 (7.2.1); 7.a (7.a.1); 7.b (7.b.1); 11.1 (11.1.1); 11.2 (11.2.1); 11.6 (11.6.1); 12.4 (12.4.1); 12.c (12.c.1) Overweight and obesity Road traffic accidents 1.1 (1.1.1); 1.2 (1.2.1, 1.2.2); 1.3 (1.3.1); 1.4 (1.4.1); 3.4 (3.4.1); 3.8 (3.8.1, 3.8.2); 11.2 (11.2.1); 11.7 (11.7.1) 1.1; 1.2; 1.3; 1.4; 3.5 (3.5.1, 3.5.2); 3.6 (3.6.1); 3.8 (3.8.1, 3.8.2); 11.2 (11.2.1); 11.6 Reproduced from Nunes AR, et al. BMJ Glob Health 2016;1:e000068, according to the Creative Commons license [21]. SDGs, Sustainable Development Goals. 와 Goal 17 이행수단과글로벌파트너십 19 개의세부목표 역시개발재원, 기술, 역량배양, 무역등과같이세부적으로 구분하여소외계층에대한혜택과접근성을높이기위한것 으로보건목표에영향을주는것을설명할수있다. 으로사망하는질환으로뇌졸중이가장높았으며, 허혈성심 질환, 비의도적손상, 암, 만성호흡기질환등의순으로보고 한바있다 [16]. WHO[7] 는 SDG Goal 3 모든사람의건강한삶을보장 SDG 보건목표별모니터링지표와성과지표현황 하고웰빙증진 은여타 SDG Goal 과연계하고있음을보고 한바있다 [17]. 구체적으로 SDG Goal 3 와관련한 SDGs 는 6.1, 6.2, 7.1, 11.6, 13.1, 16.1 로보고한바있다 [18]. 또한 WHO 질병부담자료를이용하여국가별로 SDG Goal 1. WHO의주요보건이슈별 SDG 환경목표연계현황 WHO는아시아태평양지역의질병부담의 24% 가환경적위험요소들에의해기인한것으로보고한바있다 [14]. 2012년기준으로대기오염, 안전하지않은식수, 위생및부적절한위생또는화학물질과같은환경위험의감소를통해소아사망의 26% 와 5세미만아동의전체질병부담의 25% 를예방할수있음을추산한바있다 [15]. 환경적원인 3 세부목표별로점수를계량화한연구결과를통해보건분야 Goal과 Target으로 SDG Goal 3 와 SDG 1.5, 2.2, 5.2, 6.1, 7.1, 8.8, 11.5, 13.1, 16.1 로보고된바있다 (Table 1) [17-21]. Nunes 등 [21] 은주요보건학적질환들은여타환경보건관련지표들과밀접한관련성이있음을보고한바있다 (Table 1). 즉, 사람들의건강은환경과밀접하게연관되어 환경보건지속가능발전목표이행현황 665

5 J Korean Med Assoc 2017 August; 60(8): Table 3. Summaries of the Sustainable Development Goals health and health-related targets Goal 3 Target 3.1 Maternal mortality Skilled birth attendance Target 3.2 Target 3.3 Target 3.4 Target 3.5 Target 3.6 Target 3.7 Target 3.8 Target 3.9 Target 3.a Target 3.b Target 3.c Target 3.d Sustainable Development Goals Target Under-five mortality rate Neonatal mortality rate HIV incidence Tuberculosis incidence Malaria incidence Hepatitis B incidence Need for neglected tropical disease treatment/care Mortality due to NCD Suicide mortality rate Treatment for substance use disorders Alcohol use Deaths from road traffic injuries Family planning Adolescent birth rate UHC coverage index Financial protection Mortality due to air pollution Mortality due to unsafe WASH services Mortality due to unintentional poisoning Tobacco use Vaccine coverage Development aid for health research Essential medicines Health workforce IHR capacity and emergency preparedness Goal 1 Target 1.a Proportion of government spending on essential services, including health Goal 2 Target 2.2 Stunting among children Wasting and overweight among children Goal 5 Target 5.2 /5.3 Stunting among children Wasting and overweight among children Goal 6 Target 6.1/6/2 Safely managed drinking-water services Safely managed sanitation services Goal 7 Target 7.1 Clean household energy Goal 8 Target 8.8 Occupational injury mortality Goal 11 Target 11.6 Air pollution Goal 13 Target 13.1 Mortality due to disasters Goal 16 Target 16.1 Homicide, Mortality due to conflicts, Population subject to violence Goal 17 Target Birth and death registration Source: from World Health Organization. World health statistics 2017: monitoring health for the SDGs [Internet]. Geneva: World Health Organization; 2017 [24]. NCD, non-communicable disease; UHC, universal health coverage; WASH, water, sanitation and hygiene; IHR, International Health Regulations. 씻는경우호흡기감염성질환을감소시킬수있다는연구결과도보고되고있다 [23]. 2. WHO 환경요인으로인한질환별 SDG 목표 WHO [24] 는 SDG 보건목표이행현황을평가하기위한중요한모니터링지표로기대수명으로정의하고있으며, 기대수명은여타 7개의 Goals와연계되고 13개의 Targets와연관성이있다고보고한바있다 (Table 3). 다음은 WHO [25] 가발표한 Monitoring health for the SDGs 에서환경보건 Target과관련한내용을요약하여정리한내용이다. 1) 대기오염으로인한사망률 WHO는 2012년기준, 전세계적으로가정집에서사용하는부적절한연료와비효율적인기술로인해 430만명이사망하였으며, 대기 ( 또는실외 ) 오염으로인해같은해에 3백만명이사망하였음을보고하였다. 위험성이높은집단은 5세미만의아동과고령자이다. 대기오염의경우성인비감염성질환의심혈관질환, 뇌졸중, 폐암을유발하고급성호흡기질환의위험성을증가시킬수있다. 대기오염으로인한사망률감소의주요장애요소로는다음과같이보고하였다. 빈곤층을위한깨끗한연 료와효율적인기술에대한접근성증 있으며, 질병발생과사망률의주요한결정요인이라고할수있다. Nunes 등 [21] 은보건분야이슈별로관련있는 SDG 지표를보고한바있다 (Table 2). SDG 6의세부목표인식수위생의경우, 부적절한식수위생은감염성질환에취약해지는결과를초래할수있으며 [22], 비누를활용하여손을 가부족, 깨끗한연료나화석연료를대체할경우스마트금융혜택부족 ; 운송, 폐기물관리와같은산업부문의건강관련한사안들에대한관리부족과타분야와의협력부족 ; 보건및건강향상을위한모니터링부족 ( 대기오염수준, 자원과공중보건에대한결과 ) 이라고보고하였다. PM 10과 PM 666 대한의사협회지

6 Kim KH Implementation status of environmental health goals among Sustainable Development Goals 2.5 미만의입자상물질의모니터링은주로고소득국가에서수집되고있으며, 저소득및중소득국가의모니터링은매우제한적인상황이다. 2) 위생부족과안전하지않은식수로인한사망률 WHO는전세계적으로식수와수역, 토양의오염, 부적절한위생시설과서비스로인해 8,710,000명의사망자가발생하였음을보고하였다 (2012년기준 ). 사망자의절반 (45% 이상 ) 이전세계인구의 13% 가거주하는아프리카지역에서발생하고있었다. 국가별부적절한 WASH (water, sanitation and hygiene) 관리로인한사망률추정치는역학자료및손세척에대한인식, 안전하지않은식수와위생시설사용의빈도를기반으로한다. 대부분의저소득및중소득국가가구조사를통해모니터링이가능하므로제한된자료의데이터를확보할수있다. 이에, SDG 지표에대한포괄적인자료를확보하기위해서는물과위생서비스수준에대한개선증거와체계적인평가는현재추정치에대한정확성을증가시킬수있다. 3) 안전한식수서비스로의접근동지표와관련하여직접자료에대한이용가능이제한되어 MDG 목표를향한진행상황을모니터링하기위한지표로 개선된식수사용 을사용한바있다. 전세계적으로 1/4 에해당하는지역이배설물로오염되어있으며약 18억명이이러한오염된물을음용하였다. 또한, 개선된식수원은가정에서떨어져있을수도있다. 대부분의사하라지역아프리카국가에서는주로여성과소녀들은물을확보하기위해원거리를이동해야한다. 이러한이유로 SDG에서는포괄적인지표를포함하고있다. 동지표는 SDG 11 회복력있고지속가능한도시와거주지조성 목표와관련된다. 즉, 도시지역에서부유한가정은빈곤한가정보다물공급을개선할수있는기회가더많다. SDG를달성하기위해서는불평등을향상된시스템의모니터링보다체계적인접근이필요하다. 4) 가정내청정에너지사용 2014 년도에는약 31억명의사람들이요리하는데유해연료 ( 고체연료및등유 ) 를사용하였다. 가정에서요리, 난방및조명에서발생하는연기또는가정내오염은인체에유 해한미세한미립자물질, 일산화탄소, 이산화질소및다방향족탄화질소와같은건강에해로운오염물질과관련되어있다. 2012년기준가정내요리시비효율적에너지사용으로인해허혈성심장질환, 뇌졸중, 만성폐질환, 폐암및소아폐렴으로약 430만명의사망자가발생하였다. 이에, 경제성이낮은사람들에게도합리적으로수용할수있는가격과건강상의영향을최소화하기위한해결방안마련을위해첨단연소조리오븐또는깨끗한연료와같은가정용에너지에대한기술투자및혁신이필요한상황이다. 가정에서의연료및기술오염에대한신뢰는빈곤과사회적불평등과밀접하게관련되어있다. 도시내가정은농촌보다청결한연료를사용할가능성이높다. 오염된연료와기술을사용하는가정에서는일반적으로여성과어린이가비효율적인가정용에너지사용으로인한부담을안고있다. 이러한불평등은여성과어린이에게어린시절부터중독 ( 등유사용 ) 과부상, 연료수집으로인한시간낭비등으로인해교육의접근성감소등을초래할수있다. 따라서 WHO는조사기관, 통계청, 국제기구및관련이니셔티브와협력하여가정용에너지사용을보다종합적으로평가하기위해다목적가정조사도구를향상시키고조화시키려는데에노력을기울이고있다. 5) 주변환경오염 2012년기준, 전세계적으로 300만명이실외오염, 특히주변미립자물질에노출되어사망한것으로추정된다. 지리에따라중요한다양성이있다. 최근수십년동안유럽과북미를포함한많은고소득국가의경우, 스모그및초미세물질을감소시키기위한노력으로대기오염이현저하게감소했다. 반면에동남아시아를포함한저소득및중소득국가는인구증가와적절한통제시스템이없는산업화로인해대기오염이증가되었다. 환경오염은산업, 운송 ( 대중교통, 도보및사이클링 ), 청결하고재생가능한에너지, 효율적인건물, 폐기물감소및재활용 ( 고형폐기물및농업폐기물의연소방지 ) 및지속가능한효율적인에너지산업정책에대한투자로감소시킬수있다. 2015년 5월 194개 WHO 회원국모두의만장일치로건강과환경에관한결의안 (WHA 68.8) 을채택하여대기오염 환경보건지속가능발전목표이행현황 667

7 J Korean Med Assoc 2017 August; 60(8): 문제를해결하기위한국제사회의노력과협력강화를회원국에촉구했다. 구체적으로는모니터링을통해대기오염이건강에미치는영향을감시하고평가하는것, 부문별정책에대한건강관련지침을개발하는것과공중보건에위협이되는대기오염을제어하기위한부문간협력구축이포함되었다. WHO [25] 는보건 ( 또는건강 ) 과관련한연구는대기오염으로인한건강에미치는영향을입증하는데중점을두고있으며효과적인개입에대한평가, 건강을위한최선의정책근거를마련하는데있어다른분야와의연계방법을고려하지않는다고지적한바있다. 결의안 WHA 68.8 에제안된바와같이, 대기오염이건강에미치는악영향에대한세계적대응을강화하기위한보건부문의노력을확대함으로서기피불가피한사망의주요원인을예방할수있을것이다. 3. 국제사회의보건및환경보건지표이행전망분석결과 1) 국가별 SDG 목표별이행전망 UN 자문기관인지속가능개발해법네트워크 (Sustainable Development Solutions Network) 는독일베텔스만재단과공동으로 SDG Index & Dashboards를통해총 146개국을대상으로 17개목표별국별초기현황을녹색 ( 이미목표달성 ), 노랑색 ( 주의, 목표달성을위한노력필요 ), 빨간색 ( 미흡, 목표달성의어려움 ) 으로표시해평가하여보고한바있다 [26]. SDG Index는국가차원에서 SDGs 달성및이행을모니터링하고평가하는지표로구성되어있으며, 지속가능한발전목표지표에관한기관간및전문가그룹 (Inter- Agency and Expert Group on SDG Indicators, IAEG- SDG) 이제안하는공식적인지표 230개중에서국제비교가가능한데이터로구성되어있다. 스웨덴 (84.5점), 덴마크 (83.9점), 노르웨이 (82.3점), 핀란드 (81.0점) 등의순으로높았으며, 우리나라는총점 72.7점으로 146개국중 27위로보고되었다. 경제협력개발기구회원국들을대상으로한 SDGs 환경관련분야목표이행전망을분석한결과, 다수의국가들이하나이상의주의경보를보여주고있어선진국들조차 SDGs 의목표달성을낙관할수없는상황이다. 또한, 아프리카지역의 SDG 환경관련분야목표를중심으로이행전망의경우, 대다수의국가들은미흡이상으로평가받고있다는점에서저소득및중소득국가와개발도상국에대한선진국들의체계적인지원과개발도상국의적극적인노력과참여가절실히필요하다. 한국의경우, 목표달성의어려움으로분류되는적색으로평가받은목표는 SDG Goal 3 보건증진 ( 특히 incidence of tuberculosis), SDG Goal 5 성평등 ( 특히 women in national parliaments), SDG Goal 6 물과위생 ( 특히 freshwater withdrawal), SDG Goal 7 에너지 (Renewable energy in final consumption), SDG Goal 8 경제성장 ( 특히 youth not in employment, education, training), SDG Goal 11 도시 ( 특히 PM2.5 in urban areas), SDG Goal 13 기후변화대응 ( 특히 CO 2 emissions from energy), SDG Goal 14 해양자원 ( 특히 Ocean Health Index: clean waters, ocean Health Index: fisheries, marine sites, completely protected), SDG Goal 15 육상생태계 (Red List Index of species survival, terrestrial sites, completely protected), SDG Goal 17 이행수단 / 글로벌파트너십 ( 특히 official development assistance) 영역이다. 2) IAEG-SDG indicators IAEG-SDG는 SDG 17개목표달성을위한지속가능발전지표 (sustainable development indicators, SDI) 체계를개발하고감시체제를구축하고있다 [27]. 2015년 3월, IAEG-SDG가구성한보고서를 UN통계위원회 (UN Statistical Commission, UNSC) 가승인하는절차에따라 SDI 지표프레임워크가작성되었다. 2016년 3월, IAEG-SDG는 UNSC에제출한보고서를통해총 230개의지표를 3개의티어 (Tier) 체계로확정하여보고한바있다. Tier 1은개념적으로분명한지표, 국제적으로통계적방법론이수립되어있으며데이터취득이용이한지표로정의하고있으며 ; Tier 2는개념적으로분명하며방법론이수립되어있으나국가별로데이터취득이쉽지않은지표를의미한다 ; Tier 3는국제적으로합의된방법론이수립되지않고개발중인지표를의미한다 (Table 4) [27]. 현재, Tier 3에해당하는지표는 대한의사협회지

8 Kim KH Implementation status of environmental health goals among Sustainable Development Goals Table 4. Tier classification criteria/definitions for global SDG indicators Criteria Tier 1 Tier 2 Tier 3 Definition Indicator is conceptually clear, has an internationally established methodology and standards are available, and data are regularly produced by countries for at least 50 per cent of countries and of the population in every region where the indicator is relevant. Indicator is conceptually clear, has an internationally established methodology and standards are available, but data are not regularly produced by countries. No internationally established methodology or standards are yet available for the indicator, but methodology/standards are being (or will be) developed or tested. Reproduced from United Nations. IAEG-SDGs: Inter-agency Expert Group on SDG Indicators [Internet]. New York: United Nations; 2015 [27]. 모니터링 평가지표를확보하고각지표별 baseline assessment와정책목표및발전전략을논의하고있다. 그러나대다수의분야별정책입안자들은관련분야의정책과이행수단을고려하여여타관련부문간의협력을위해필요한지식, 기술에대한접근성이부족한상황이다. 이에, 국내외 SDGs 보건목표와더불어포괄적목표달성을위해서는기존에존재하는정책들을개선하는수준이아닌, 국가와기업, 시민사회등의포괄적인이해관계자들의참여로목표간분절화를극복하기위한범분야적인접근이필요한시점이다. 성별, 연령별, 원인별인구 100,000 명당분쟁관련사망자 수가해당한다 [28]. 찾아보기말 : 지속가능발전목표 ; 보건 ; 환경보건 ; 국제연합 ; 공적개발원조 결론 ORCID Kyung Hee Kim, SDGs 는포용성과보편성이라는기조를강조하며, 에너 지, 혁신, 노동환경, 도시문제, 기후변화, 평화와정의등개발도상국 ( 저개발국포함 ) 의개발문제뿐만아니라선진국들의모든형태의빈곤과불평등감소의제를포괄적으로포함하고있다. 17개의 SDGs는각각의개별적으로작용하기보다는지속가능한경제, 사회, 환경등의여타목표들과연계하며포괄적인발전을지향하고있는특징이있다. 앞서본문에서기술한바와같이, SDGs 개발목표중에서보건이슈와직 간접적으로관련이있는환경목표는깨끗한물과위생 (Goal 6), 모두를위한깨끗한에너지 (Goal 7), 지속가능한도시와공동체 (Goal 11), 지속가능한생산과소비 (Goal 12), 기후변화와대응 (Goal 13), 해양생태계보존 (Goal 14), 육상생태계보호 (Goal 15), 평화, 제도 (Goal 16) 등이며, 이들 Goals의 Targets이상호연관되어정책과이행등을통해 SDGs를달성할수있도록구성되어있다. 2017년현재, 우리나라는국내이행수준을평가할수있는지표개발과더불어국제사회의이행지표와도연계하여모니터링지표를개발해야하는상황이다. 이에, 각 SDG Goal 별관련부처들과통계청은 SDGs 이행을평가할수있는 REFERENCES 1. Korea Environment Institute. UN Sustainable Development Goals (SDGs) implementation. Seoul: Korea Environment Institute; Yoon SC, Na DS, Lee HG, Lee KY, Hong CS. Future earth and recent movement of international science community. Seongnam: Korean Academy of Science and Technology; Lim HS. Preliminary study of implementation and follow-up of the SDGs for resource circulation. Sejong: Korea Environment Institute; KoFID; KCOC; GCAP Korea; INDI LAB; KOICA. Sustainable Development Goals that are easy to understand. Seoul: KoFID; Organization for Economic Cooperation and Development. The Sustainable Development Goals: an overview of relevant OECD analysis, tools and approaches [Internet]. Paris: Organization for Economic Cooperation and Development; 2017 [cited 2017 Apr 30]. Available from: org/dac/the%20sustainable%20development%20goals%20 An%20overview%20of%20relevant%20OECD%20analysis. pdf. 6. Kwon Y, Jung JO, Hur YS, Jeong JS, Lee JY. A study on Korea's 환경보건지속가능발전목표이행현황 669

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10 Kim KH Implementation status of environmental health goals among Sustainable Development Goals 26. Bertelsmann Stiftung and Sustainable Development Solutions Network. SDSG Index & Dashboards: a global report [Internet]. New York: Bertelsmann Stiftung and Sustainable Development Solutions Network; 2016 [cited 2017 Apr 30]. Available from: Publikationen/GrauePublikationen/SDG_Index_Dashboard_ full.pdf. 27. United Nations. IAEG-SDGs: Inter-agency Expert Group on SDG Indicators [Internet]. New York: United Nations; 2015 [cited 2017 Apr 30]. Available from: iaeg-sdgs/. 28. United Nations. IAEG-SDGs: Inter-agency Expert Group on SDG Indicators. Compilation of metadata for the proposed global indicators for the review of the 2030 agenda for sustainable development [Internet]. New York: United Nations; 2016 [cited 2017 Apr 30]. Available from: iaeg-sdgs/metadata-compilation/. Peer Reviewers Commentary 필자는지속가능발전목표 (Sustainable Development Goals, SDGs) 중환경보건목표를달성하기위해서는연계되어있는직 간접목표에대한구체적인분석을통해실행전략을구축해야한다는시사점을도출하고있다. 한국내공적개발원조를추진하는이행과정에서문제점으로자주거론되는원조집행의분절화는국내이행의책임을맡고있는다수의정부중안부처들이각해당목표별로성과지표를확정하는과정에서도찾아볼수있다. 국내외포괄적인 SDGs 환경보건목표를달성하기위해서는관련분야 ( 의료계, 보건복지부와환경부, 환경공학및기업체등 ) 의이해관계자집단이참여하여 SDGs 환경보건목표및지표를설정하는범분야적인접근이필요하다고할수있다. 아울러, 국제사회의통합성과지표에대한이행현황과모니터링분석을통해국내 SDGs 지표와도연계할수있는전략마련이필요할것이다. [ 정리 : 편집위원회 ] 환경보건지속가능발전목표이행현황 671