Sustainable development has broad appeal and little specificity, but some combination of development and environment as well as equity is found in many attempts to describe it. However, proponents of sustainable development differ in their emphases on what is to be sustained, what is to be developed, how to link environment and development, and for how long a time. Despite the persistent definitional ambiguities associated with sustainable development, much work (over 500 efforts) has been devoted to developing quantitative indicators of sustainable development. The emphasis on sustainability indicators has multiple motivations that include decision making and management, advocacy, participation and consensus building, and research and analysis. We select a dozen prominent examples and use this review to highlight their similarities and differences in definition of sustainable development, motivation, process, and technical methods. We conclude that there are no indicator sets that are universally accepted, backed by compelling theory, rigorous data collection and analysis, and influential in policy. This is due to the ambiguity of sustainable development, the plurality of purpose in characterizing and measuring sustainable development, and the confusion of terminology, data, and methods of measurement. A major step in reducing such confusion would be the acceptance of distinctions in terminology, data, and methods. Toward this end, we propose an analytical framework that clearly distinguishes among goals, indicators, targets, trends, driving forces, and policy responses. We also highlight the need for continued research on scale, aggregation, critical limits, and thresholds.

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This review analyzes five efforts to define sustainability values, including the U.S. National Academy of Sciences, the Earth Charter, the UN Millennium Declaration, and the Global Scenario Group. It then summarizes empirical trends in sustainability values, attitudes, and behaviors, as measured by multinational and global-scale surveys, related to human and economic development, the environment, and driving forces (population, affluence, technology, and entitlements). The review also summarizes empirical trends related to the values identified by the Millennium Declaration as essential to international relations (e.g., freedom and democracy, equality and shared responsibility), and broader contextual values (e.g., capitalism, globalization, institutional trust, and social change) that have sustainability implications. It then identifies several important attitude-behavior gaps and barriers. Finally this review draws several conclusions regarding future research needs and the value, attitude, and behavioral change needed to achieve sustainability.

How do long-term global trends affect a transition to sustainability? We emphasize the ''multitrend'' nature of 10 classes of trends, which makes them complex, contradictory, and often poorly understood. Each class includes trends that make a sustainability transition more feasible as well as trends that make it more difficult. Taken in their entirety, they serve as a checklist for the consideration of global trends that impact place-based sustainability studies.

Sustainable development exhibits broad political appeal but has proven difficult to define in precise terms. Recent scholarship has focused on the nature of a sustainability transition, described by the National Research Council as meeting the needs of a stabilizing future world population while reducing hunger and poverty and maintaining the planet's life-support systems. We identify a small set of goals, quantitative targets, and associated indicators that further characterize a sustainability transition by drawing on the consensus embodied in internationally negotiated agreements and plans of action. To illustrate opportunities for accelerating progress, we then examine current scholarship on the processes that influence attainment of four such goals: reducing hunger, promoting literacy, stabilizing greenhouse-gas concentrations, and maintaining fresh-water availability. We find that such analysis can often reveal ''levers of change,'' forces that both control the rate of positive change and are subject to policy intervention.

Background. After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).Methods. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.Results. Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.Conclusions. Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.

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