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Action on environmental health to reduce poverty Carlos Dora, WHO


... are used to include environmental health issues in the context of poverty ... Re-examine current priorities, in light of the lessons from the paper /network, ... – PowerPoint PPT presentation

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Title: Action on environmental health to reduce poverty Carlos Dora, WHO

Action on environmental health to reduce
poverty Carlos Dora, WHO
  • The poor suffer from a disproportionately large
    burden of disease from environmental risks
  • Effective interventions exist
  • We need to address the barriers to policy action
  • Emerging opportunities to catalyse change

Environmental threats cause up to one third of
the Global Disease Burden
  • Over 40 of this burden falls upon children
    under the age of five

Environmental Contribution to the Burden of
Disease Examples
  • Diarrhoeal diseases EBD 90 94 of DALYs are in
    children lt14
  • Malaria EBD 90 85 of DALYs are in children lt14
  • Acute respiratory infections EBD 60 90 of
    DALYs are in children lt14
  • Chronic respiratory diseases EBD 50 25 of
    DALYs are in children lt14

Priority Risks
  • Household water security
  • Hygiene and sanitation
  • Air pollution
  • Disease vectors
  • Chemical hazards
  • Unintentional Injuries

Environmental risks causing largest number of
  • Unsafe water sanitation and hygiene 1.7 million
  • Indoor smoke from solid fuels
  • 1.6 million deaths
  • Road traffic injuries
  • 1.2 million deaths

Children are the most vulnerable to environmental
  • metabolic rate
  • Consume more in proportion to weight
  • Immune and nervous system still developing, more
    vulnerable than adults
  • behaviour natural curiosity and lack of

More than 5 million children die every year from
environmentally-related diseases
There are effective interventions
  • 26 reduction in diarrhoea incidence
  • 65 reduction in diarrhoea mortality
  • 77 reduction in schistosomiasis
  • Esrey et al. (1991)
  • Water, sanitation,
  • hygiene interventions

Time-saving (girls)
Improved sanitation in schools (girls)
Improved school attendance
Improved education Improved career opportunities
Improved health
Poverty reduction
Cost Effectiveness Analysis (CEA) of
Interventions on water, sanitation /hygiene
  • Cost-effectiveness ratios (US per DALY

Impact of intervention ? incidence of diarrhoea
for all ages, not just children
Impact of Interventions to Reduce Indoor Air
  • Improved child health
  • ALRI
  • (Low birth weight)
  • (Injuries (fuel collection))
  • (Burns)
  • Types of intervention
  • Source of pollution e.g. improved stoves, clean
  • Living environment e.g. improved ventilation,
    kitchen design
  • User behaviour e.g. use of pot lids, avoiding
  • Improved adult health
  • COPD
  • Lung cancer (coal)
  • (Tuberculosis)
  • (Cataract)
  • (Asthma)
  • Non-health benefits
  • Opportunities for study and income generation
  • Improved quality of life

Cost Effectiveness Analysis (CEA) of
Interventions to address indoor air pollution
  • Cost-effectiveness ratios (International per
    DALY averted) for South and South East Asia

Impact of intervention ? incidence of lower
respiratory infection in children lt 5
Traffic injuries are largely preventable
  • engineering, traffic and land use policies to
    protect vulnerable road users
  • enforcement of speed control, safety belts, drink
    and drive, and helmet use

Exposures to environment risks are associated to
Exposures depend on setting context
  • ecosystem where people live and work
  • Homes, neighborhoods, and schools
  • Workplace, Roads
  • Where children live, grow, learn and play

What are the barriers to policy action?
  • An intersectoral issue - whose business is it?
  • Health sector is equipped and has resources to
    treat diseases, and do some preventive actions,
    but cannot enforce traffic safety or market
    stoves to reduce indoor air pollution,
  • Environment may see their role as nature
    conservation primarily
  • Other sectors may not see that there are
    environment or health impacts of their actions or
    consider them outside their responsibility
  • Need for capacity, knowledge and tools to
    consider context, range of risks to health and
    environment, poverty links and range of solutions
    possible in that setting,

Barriers to action on EH in PRS
  • Little awareness of the potential for reducing
    poverty by improving environmental health.
  • Little knowledge of practical, cost effective,
    interventions, and experience with their
  • Short term political and financing priorities A
    disincentive to focus on environmental
    interventions that have longer term returns
  • little experience transparency on decision making
    and engagement of stakeholders in decision making

PRS Processes an incentive for integrating
Health, Environment and Poverty responses
  • Increase awareness improving environmental
    health can reduce poverty.
  • Create opportunities for cross sectoral /
    participatory work on PRS, health and environment
  • Develop capacity and provide tools for assessing
    environment, health and poverty issues and
    solutions in specific contexts
  • Provide access to knowledge and experience in the
    process of mainstreaming health and environment,
    identify and share good practice

Paper on environment health and poverty, Were
  • Add
  • Insights from the field - what are the
    constraints at country level, why are EH issues
    not considered? how could those constraints be
  • Evidence that improving environmental health
    reduces poverty.
  • Extend health in existing PRSP analyses to cover
    EH issues
  • Results from pilot work in countries on including
    EH issues in PRS/PRSPs.

Section 1 Why EH matters to poverty reduction?
  • Drivers of change, Population growth in slums,
    migration, urbanization, slums, production
  • Determinants of EBD and paths to poverty
    alleviation. Examples of policy contexts e.g.
    agricultural policies and pesticides, vector
    borne diseases, diets rural livelihoods
    urbanization, slums and related EH risks etc.
  • Costs of EH, links to poverty and economic growth
    (loss of productivity, morbidity, mortality,
    access to school …). Examples a) Costs of
    degradation studies, b) Historical studies,
    costs and impacts of good environmental
    management (housing, water and sanitation)
  • Conclusion Need for upstream consideration of EH
    issues in policies and planning.

Section 2 Main EH challenges
  • Traditional risks (Water Sanitation and Hygiene,
    Indoor Air Pollution, Vector Borne Diseases -
    twist on WSH, water access without sanitation
    leads to standing water and new emerging risks?)
  • Modern risks (challenges from urbanization such
    as outdoor air pollution, traffic injuries,
    slums pesticides, toxic waste)
  • Emerging challenges (climate change, biodiversity
  • Highlight within each issue that there are
    specific vulnerable groups (women, indigenous,
    elderly etc.).
  • Specific section on children, using biological
    and social arguments from HECA

Section 3 EH an Inter-sectoral and
Multi-stakeholder Issue. Add
  • EH is not the responsibility of the health or
    environment sectors alone, positive statement on
    the need for inter-sectoral engagement to get
  • Examples of inter-sectoral action, including
    sector responsibilities

Section 4 Taking action to include EH in PRS.
Review to include
  • What are the opportunities / entry points in PRS
    processes for agencies to interact with
    governments / other actors.
  • What are the issues and constraints on the ground
    for EH to be considered, in development
    cooperation for poverty reduction processes, .
  • What tools and approaches are used to include
    environmental health issues in the context of
    poverty reduction development cooperation

Section 4, 1 What are the opportunities for
interactions with national actors in PRS
  • Include a flowchart on PRS pointing out
  • Donor coordination with Government at start of
    PRS process.
  • Analytical work which inputs into PR strategy.
  • Donor interaction with other stakeholders, so
    that their views can be represented in the PRSP
    process, including civil society, NGOs, private
    sector, etc.
  • Dialogue with Government at sectoral level, and
    including at the local level.

Section 4, 2 Little EH in PRSPs
  • No insights from the field.
  • WHO Desk review of 21 PRSPs
  • Standard analytical framework
  • what health issues does the PRSP identify?
  • what strategies are proposed to meet these
  • What monitoring is recommended
  • do other sectors (eg wat/san, env, rural dev)
    include health goals?
  • Reports and PRSPs Database

Section 4, 2 What are the constraints on the
  • All 21 PRSPs contain wat/san strategies, and 17
    contain some kind of pro-poor targeting (eg a
    focus on rural areas)
  • 16 contain Nutrition strategies, of which 9
    target the poor
  • 11 PRSPs will monitor the impact of their wat/san
    strategies in a disaggregated way (eg poor-
    non-poor, rural/urban) but only 3 will do so for
  • Few PRSPs address indoor air pollution even
    fewer link food security and nutrition/health
  • Overall conclusion PRSPs are not realising their
    full potential for cross-sectoral collaboration
  • No insight into constraints on the ground

Section 4, 3 What tools and approaches can be
  • Understanding EH impacts. Analysis of links
    between environment and health issues.
  • Awareness -raising and communication strategies
    Building environmental constituencies
  • Prioritization of issues
  • Showing size of impacts and EH linkages (e.g.
  • Cost of degradation studies.
  • Econometric analysis of survey data, DHS or
  • Participation and Stakeholder Involvement
  • Building capacity for intersectoral action
  • Governance and Institutions Creating and
    Managing Sectoral processes
  • Monitoring process and specific indicators

Challenges for the network to focus on
  • Experience exists but is scattered, and of
    different types science, risks, driving forces,
    EH links, integrated responses, cross sectoral
  • There is a need for
  • Learning network targeted to building capacity on
    how to include EH in poverty reduction.
  • Platform for knowledge Management, with summary
    description of existing knowledge, experience,
    solutions, guidance on where to obtain
  • Focus attention on major EH issues, and how to
    tackle them in the context where they emerge
    (e.g. Slums, agriculture policies).
  • Establish a set of EH indicators linked to all
    the relevant MDGs

Challenges that the network can help address (2)
  • Make connections with inter-governmental high
    level processes in environment and health (ASEAN
    and South Pacific countries, linked to NEPAD).
  • Re-examine current priorities, in light of the
    lessons from the paper /network, using the paper
    as operational tool rather than just a static
  • Examine the coherence of EH issues not just
    across the PRSPs and MDGs, but also within the
    environmental conventions, providing operational
    advice at the strategic level.
  • Collect examples that help inform the EH
    programmes within the network agencies
    themselves, including applying environment and
    health in analytical work, and the role of
    national champions.
  • Continue as a network on EH linked to the PEP

WHO Initiatives - Tools to catalyse better
decision making
  • CHOICE - Comparing cost effectiveness of
  • HECA - Alliance building catalizing action on
    Children Environment and health
  • HELI Promoting combined access to knowledge and
    tools at the country level
  • Burden of disease - Highlighting the human toll
    of environmental diseases in countries /sub
  • Health Impact Assessment - Engaging stakeholders
    on the debate about EH implications of policy
  • Indicators
  • Interagency paper on poverty health and

WHO Initiatives Action to address specific
environmental risks
  • Climate change,
  • Indoor air pollution,
  • Outdoor air pollution,
  • Water quality,
  • Sanitation,
  • Waste disposal,
  • Chemical Hazards, including pesticides,
  • Occupational Hazards
  • Radiation,

WHO CHOICE Cost effectiveness analysis of
interventions to address environmental health
risks factors address Environmental Risk Factors
  • To move from attributable to avoidable burden of
    disease analysis
  • Burden of disease

Risk factors
  • Preventative
  • Curative