|WIT's World Ecology Report - Vol. 09, No. 1 - Critical Issues in Health and the Environment (WIT, 1997, 16 p.)|
We have developed a mistaken notion that environmental health factors play an important role in setting global policies. This presentation examines the strengths and weaknesses of the voices of the health community. Although environmental health factors are considered pertinent to setting general policies within the health sector itself, and to a lesser extent, for environmental policies, as a whole, current research seems to accentuate pollution abatement, and be going ever inward instead of looking at the multidisciplinary dimensions of most problems. The main conclusions are that the current emphasis on pollution control may be giving a false sense of security of achievement in global environmental health improvement, at the cost of lack of attention to traditional environmental health factors that are so common throughout the developing countries.
How can we redress the imbalance of an excessive focus on pollution? An ongoing World Bank study, "Bridging Environmental Health Gaps", is a first step. It's no secret that most causes of disease, injury and death in developing countries - inadequate sanitation, poor personal hygiene, road accidents, tobacco smoke, pollution - lie outside the control of the health sector. Yet, the policies of sectors that exert these direct health impact are not set by health criteria. The study helps identify opportunities to improve health in World Bank operations outside the health care system, namely, through infrastructure interventions (i.e., water supply, sanitation, drainage, housing, urban development, transport, telecommunications.)
Each of the three volumes has a separate message based on its emphasis.
1) The Main Report (Volume I) is directed toward project management, based on 203 Sub-Saharan Africa (SSA) infrastructure projects (1984-94) and 300 Bank documents. It contains background on environmental health and a checklist on how projects can help relieve the burden of disease. 2) Volume I reveals that consideration of environmental health in Bank projects has been minimal to date.
2) Volume II is a cross-sectoral literature review of about 2,000 works. Where Volume I summarizes infrastructure lessons, Volume II discusses each sector. The literature indicates the "limited role health has actually played in determining policies outside of the health sector".
3) Volume III looks at the role of environmental health in sustainable development and contains recommendations. It identified significant issues that have not yet been resolved within the Bank, and cites the possibility of going against the first dictum of public health-that remedial measures do not harm-even for well intentioned projects;-cut and paste science inevitably leads to cut and past priorities;-unclear sectoral responsibilities lead to incomplete solutions;-sustainable development notions are confused with sustainable pollution abatement.
Leaving the door open for potential negative health repercussions is not sustainable development, even though it might be an admirable attempt at sustainable pollution control. In economic terms, to overlook environmental health is equivalent to setting national energy policies based exclusively on agriculture/industrial uses, coupled with their elasticities and externalities.
An innovative feature of the above study was to base the analysis on potential for solutions, as opposed to the more traditional approach of the incidence and prevalence of the problems. Thus the study showed the untapped power of interventions outside the health sector at improving health. In Sub-Saharan Africa, the top five burdens of disease are malaria, injuries, respiratory illness, diarrheas, tropical cluster (i.e., vector-related diseases), and the childhood cluster (mainly perinatal conditions). Collectively, these account for nearly half of the total burden of disease, as measured in Disability-Adjusted Life Years (DALY), a socioeconomic measure of human suffering combining morbidity and mortality factors. In fact, thumbnail calculations showed that about 44% of the total burden of disease is amenable to infrastructure improvements. In other words, for all but the childhood cluster, infrastructure project interventions potentially could have a substantial impact, perhaps even greater than health sector interventions.
A wide range of potential interventions exists for targeted collaboration among the ministries of health and agencies which provide various public and private services. These areas of collaboration should be explored. In addition, the economic impact equivalent to the thumbnail of 44% for infrastructure interventions should be applied to other sectors, particularly agriculture and energy. Their potential repercussions are also potentially enormous, but the linkages to environmental health have been poorly studied. It is hoped that further study on such linkages will allow us to speak of an "estimate" rather than a "thumbnail calculation".
SOURCE: Jim Listorti, World Bank
Causes of Death
SOURCE: The World Health Report