| July 2, 2004--For many people in industrialized countries “save the environment” cries often imply the preservation of a remote plant, bird or animal. But for most poor people in developing countries saving the environment, although rarely articulated as such, translates into something more immediate and imminent—cleaning up their surroundings so they can be healthier and live more productive lives. “If your child is seriously ill from pneumonia or diarrhea, saving the environment is not a luxury,” says Kulsum Ahmed, Lead Environmental Specialist at the World Bank. It’s where the environment is really at a very basic level of poverty reduction. It means good health, so that people can be more productive in their jobs, so their kids can grow up and live. This past Earth Day (April 22), the World Bank called to raise concerted global action to fight diseases caused by the unclean environment by improving the quality of air, water and land itself. Environmental health – cleaning up the environment so that millions of poor people can live healthier lives – is one of the key pillars of the World Bank’s environment strategy, which strives to weave in the focus on the environment into all Bank work. “We need to push more because more can be done to improve the health of poor people,” Ahmed says. The World Health Organization’s (WHO) Burden of Disease reports show that rates of respiratory infections, diarrhea and malaria account for almost 20% of deaths in developing countries with high mortality rates. All these diseases are associated with environmental factors - Currently each year around the world:
- 3 million people die prematurely from water-borne diseases
- More than 700,000 children under 5 die from diarrhea in India alone
- 2 million people die from exposure to stove smoke inside their homes. About half of these deaths occur in India and China. Most victims are children and women from poor rural families that lack access to safe water, sanitation and modern household fuels
- 1 million people die from vector-borne malaria; mostly in Sub-Saharan African countries
- 1 million people die from urban air pollution
Simple Interventions, Difficult to Put into Practice While the correlation between unclean environment and poverty has long been understood, the emphasis on environmental health is a relatively new angle in the Bank’s work. It is a broad, cross-sectoral issue, where solutions are often simple interventions that can be difficult to implement. Tackling environmental health issues requires a holistic approach and a joint effort by different groups that aren’t necessarily even aware of the extent of the problem and don’t naturally coordinate with each other, Ahmed says. An example is how to effectively reduce indoor air pollution, which increases the risk of respiratory illnesses in both children and adults. Most of indoor air pollution is caused by burning traditional energy sources, such as firewood, dung or crop residues, for cooking and heating. In India alone, switching from firewood to cleaner fuels, such as liquefied petroleum gas (LPG) for cooking in the last decade has decreased the number of people exposed to stove smoke inside households by over 80 million. Rigorous epidemiological studies have shown in recent years that hand-washing and good hygiene can reduce deaths caused by diarrhea by 30-50 percent. |
- Some interventions that are effective in reducing indoor air pollution include:
- Providing better ventilation by engaging builders to ensure houses are adequately built with proper chimneys and windows
- Conducting public information campaigns as well as more localized campaigns through engaging women's groups to educate people about environmental hazards and health impact (For example, explaining to women not to carry babies on their backs while cooking so they don’t inhale smoke or how to carry out proper stove maintenance and cleaning)
- Improving existing stove designs so that exposure to smoke is reduced by engaging local non-governmental organizations, energy ministries or rural development agencies, which usually run such programs
- Providing greater access to cleaner fuels by engaging energy ministries usually tasked with such policies
Combining Large-Scale Interventions with Local Ones General larger scale interventions, such as improving infrastructure, energy services, heath care systems and education in poor communities can mitigate the most daunting environmental health risks. But they should also complemented by simple local improvements, which can have a tremendous impact on health. Reducing diarrhea, for example. In addition to treating water at a remote regional facility, people need to make sure they wash their hands with soap. Handwashing is one of the most effective interventions for reducing diarrhea. According to a recent study, the incidence of disease decreases significantly when people use soap, even if the water is polluted. Traditional and Modern hazards Rapid urbanization often creates a double burden for poor people living in slums. On top of dealing with pollution from dirty cooking fuels, primitive stoves, and poor access to water and sanitation, they are simultaneously exposed to modern environmental hazards, such as urban air pollution, exhaust fumes and industrial pollution. More Research Needed More work needs to be done to understand what types of interventions and policies have the best health impact, not rely on those that seem to have the best impact, Ahmed says, referring to the example mentioned above where improved hygiene (handwashing) and sanitation (latrines) have more of an impact on health than relying solely on a water treatment facility. Responding to the Needs of the Poor “In addition to prioritizing this issue and improving coordination among all entities, we also need emphasize policies that promote good governance and respond to the needs of the poor,” says Ahmed.
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