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Poverty,Health,andtheEnvironmentWilfridoCruzWorkshoponEconomicDevelopment,PovertyReductionandEnvironment,andClimateChangeBangkok,17-19September2008EnvironmentandHealth:ComplexInteractions•Earlyperspectivetookstaticviewthatpoorcountriesinevitablywillhavepoorhealthconditions•RecentpublicationfromUNandotherinternationalandbilateraldevelopmentagencieshavepresentedcleareststatementto-datethatpoverty,health,andenvironmentareintegralcomponentsofdevelopmentstrategies:Poverty-EnvironmentPartnership,Environment,Health,&Poverty:PlacingEnvironmentalHealthonDevelopingCountries’DevelopmentAgendas,June2008Theoldview:A1991PollutionMemofromWBChiefEconomistDATE:December12,1991FR:LawrenceH.Summers'…shouldn'ttheWorldBankbeencouragingMOREmigrationofthedirtyindustriestotheLDCs?Icanthinkofthreereasons:1)thecostsof…pollutiondependsontheforegoneearningsfromincreasedmorbidityandmortality.[thus]pollutionshouldbedonein…thecountrywiththelowestwages…2)…under-populatedcountriesinAfricaarevastlyUNDER-polluted,theirairqualityisprobablyvastlyinefficientlylowcomparedtoLosAngelesorMexicoCity.3)Thedemandforacleanenvironment…islikelytohaveveryhighincomeelasticity.Theconcernoveranagentthatcauses…cancerisobviouslygoingtobemuchhigherinacountrywherepeoplesurvivetoget…cancerthaninacountrywhereunder5mortalityis200perthousand…Memomayhavebeenwrittenonlytoprovokediscussionbutillustrateswhy,fromshort-sightedeconomicreasoning,healthimprovementmaynotbeviewedasavalidgoalinitself.•Whyarelifespansshorter,morbidityhigherinpoorcountries?•Dohealtheffectsappearonlyaftermanyyears?•[Docompaniesincreasepollutionwhentheymovetopoorercountries?]Widespreadnegativereactionstomemopointedtoerrors:EthicalanddistributionalButbeyondtheobviouserrorsarekeytechnicalormedicalissues:Memocontroversyshowsthatbeforewecandopropereconomicanalysis,needforcomplementaryinformation:DiseaseTransmission:pollutionandhealthimpactsmoreimmediateandpervasivethangenerallyknownPublicHealthandDevelopment:Healthimpactsonthepoorworseindevelopingcountriesthaninrichcountries,•lessEnvironmental,sanitationcontrols•Publichealthsystemslessdeveloped•LesseconomicoptionsavailableathouseholdandmacrolevelHowprevalentisthePoverty-Healthproblemandhowlargeistheeffect?•Agricultureareasaffectedbyexcessiveorinappropriatepesticide,fertilizeruse•FactoryworkerssubjecttooccupationalhazardsByoccupation:•riskyjobsnotefficientlycompensatedbywagepremiuminlabormarketBygeographicgrouping:•Urbanareashavelargeslumsaffectedbysevereairandwaterpollution•EvenRuralareassubjecttoairpollution(indoor)Bybroadindustryclassifications:ExamplesofEnvironmentalHealth–PovertyLinkagesWatersupplyandsanitation•Lackofwatersupplyandsewageinfrastructureinruralareasleadstowater-relateddisease;childhooddiarrhealeadstolowereducationandcumulativeearnings•Poorpeoplepayahighpercentageoftheirincomeforwater,whichcutsthehouseholdfoodbudgetIndoorairpollution•BurningbiomassinpoorhouseholdsforcookingandheatingleadstoincreasedriskofacuterespiratoryinfectionsIndustrial&municipalwaste•Uncollectedwasteincreasesrodentinfestationandprovidesbreedinggroundforflies•Contaminationofsurfacewater,groundwater,andsoilbyindustrialtoxicwastesresultsinhealthrisks•LeachingfromlandfillsiteslocatedinpoorareascontaminateswaterresourcesandcauseshealthrisksExamplesofEnvironmentalHealth–PovertyLinkagesMalaria•Vector-bornediseasessuchasmalariaarelinkedtoawiderangeofenvironmentalconditionsrelatedtomosquitobreeding,includingirrigation,poordrainage,andstagnantwaterUrbanairpollution•EmissionsfromenergyandtransportsourcesarecontributorstorespiratorydiseaseburdenandprematuredeathsInstitutionaldevelopment•InadequateinstitutionalcapacityandlegalframeworksunderliethespecificenvironmentalhealthandpovertyissuesdescribedaboveSource:Poverty-EnvironmentPartnership,Environment,Health,&Poverty:PlacingEnvironmentalHealthonDevelopingCountries’DevelopmentAgendas,June2008PotentialInterventions:Micro:Needformoretargetedhealthprogramsbysourceandbyimpactgroup.Forexample:•Forindustrialpollutionaffectingnearbypoorcommunities,needtoinvolvebothfactoryownersandcommunityleaders•Forindoorairpollutionsourceandimpactareidentical,butruralhouseholdsneededucationandfinancialassistancefromhealthagenciesCommunity-wideorsectoral:•Needtomitigateunwantedeffectsofsomegrowthpolicies:dieselfuelsubsidiesmayworsenairpollutionincongestedurbanareas;fertilizerandpesticidesubsidiesmayincreaseillnessinfarmingcommunities.•Introducepro-healthpolicies:realisticwaterpricingmayallowimprovedprovisionofsafedrinkingwater•Communityaction:policiesforpublichearingsandpollutioninformationdisclosuremayprovidesupportforcommunityleadersandfactoryownerstonegotiatepollutionpreventioninitiativesKeyfactorsthatneedtobeaddressedinpovertyreductionstrategiesEnhancedlivelihoodsecurityabilitytouseassetsandcapabilitiestomakelivingconditionsmoresecureandsustainableReducedhealthrisksmitigationoffactorsthatputthepoorandmostvulnerable(women,children)atriskfromdisease,disabilities,poornutrition,earlydeathReducedvulnerabilityreductionofthreatsfromenvironmental,economic