Poverty, Health and the Environment
Integrating environmental health into poverty reduction strategies
11th PEP Meeting, 18-20 June 2007Copenhagen, Denmark
EH is important in poverty reduction.
Burden of disease falls disproportionately on poor The poor live where environmental conditions are
worst Disease contributes to poverty (loss of income). The poor pay more for environmental health
services (e.g. water) Other benefits to better EH: lower cost of living,
gender equality, etc. Improved EH contributes to several MDGs
Polluted environment Ill health Productivity Lost earnings
Water, sanitation & hygiene and air pollution are important EH issues.
Attributable mortality & DALY for selected environmental risk factors
Source: Adapted from WHO 2002 World Health Report, in Leitner 2005
EH affects the poor of Africa and South Asia the most.
Environmental disease burden in DALY per 1000 people (Source: WHO 2006)
Costs associated with poor EH
Economic burden associated with poor EH can account for between 2 and 5% of GDP
Costs borne disproportionately by the poor
0.0
0.51.0
1.52.0
2.53.0
3.54.0
4.5
Colombia Peru El Salvador Bolivia Bangladesh Eqypt Pakistan
% G
DP
Water and Sanitation Outdoor Air Pollution Indoor Air Pollution
Source: World Bank CEAs
EH in poverty reduction goals, targets and strategies (I) Review of MDG Goal 7: Environmental
sustainability (UNDP 2006) and Millennium Project Task Force Reports on MDG Targets Overall weak reporting on MDG7; with only 8
out of 158 countries reporting on all global environmental indicators
Actual reporting of progress is even weaker: 116 countries have access to sanitation indicator but only 70 countries reported on it.
Causal link between environment and poverty not well articulated
Slow progress on MDG7
EH in poverty reduction goals, targets and strategies (II)
Review of health (WHO 2004) and EH (WB 2006) in PRSPS EH is not systematically addressed Water & sanitation feature more often in PRSPs
than any other EH issue; often independent of the health component; with sanitation remains secondary
Opportunities for multi-agency collaboration; however need to clarify EH related mandates of different agencies
Need for better data and monitoring
Incorporating EH in PRSP
Understanding natureOf poverty
Choosing poverty reduction objectives
Implementation of programAnd policies
Defining strategy, including:- Macro-structural policies- Governance- Sectoral policies- Realistic costing & budgets
Monitoring outcomes andEvaluating impact
Key actors:
-Central govt& inter-ministerial
Groups-Parliaments, etc-Private sector-NGOs, CSOs-The public
(national, sub-Regional, household)-External partners
2. Prioritizing EH objectives
3. Institutional assessment
5. Monitoring process and outcome indicators
1. Understanding linkage between EH & poverty
PRSP Process EH Input
Cross-cutting Themes:
6. Participation & Stakeholder involvement
7. Awareness Raising andStrategic Communication
4. Choosing EH interventions
Source: Adapted from Klugman 2002 PRSP Sourcebook
EH-Poverty Linkages in PRSPs
Source: Adapted from Dale 2005
EH Theme Example of EH-poverty linkages
Water resource & sanitation
Lack of water supply and sewage system in rural areas leads to increased risk of water-related diseases
Indoor air pollution Burning biomass in poor households for cooking and heating leads to increased risk of acute respiratory infections
Industrial & municipal waste
Leaching from unsanitary landfill sites located in poor areas contaminates water resources & causes health risks
Urban Air Pollution Emissions from energy plants and transport are the main cause of air pollution related respiratory diseases
Institutional development
Inadequate institutional capacity and legal framework underlie the specific EH-poverty issues described above
Understanding Poverty Linkages and Prioritizing EH objectives What is the burden of disease from EH factors? What are the underlying environmental problems
(poor sanitation and hygiene, indoor air pollution, etc.)?
Who are the vulnerable groups (poor, children under five, etc.)?
What are the subsequent economic costs and who bears these costs?
What are the EH issues that matter most from a poverty reduction standpoint?
Institutional Assessment
Assessing institutional capacity & governance on EH issues Cross-sectoral collaboration Vertical collaboration (national/local) Legal and regulatory framework Enforcement Social accountability, particularly with respect
to the vulnerable groups Resource allocation/PEER
Selecting EH Interventions Cost-benefit analysis Cost effectiveness studies Poverty and health impact Political will Social acceptability
Multiple inputs and outcomes in EH
EnvironmentalHealth-global
-national-local
-household
Finance and social marketingPromotionCreditSubsidy, if suitable
InfrastructureWater suppliesDrainageImproved housing
Service deliveryWater supplyRefuse disposal
GovernanceAir pollution codesEH legislation
Behavior ChangeHealth promotionAdvocacy
Some InterventionsAnd examples
Increased attendance and better performance
at school
Empowering women
Improved quality of life
Saving time
Improved health
More sustainable livelihoods
MDG 4, 5, 6
MDG 3
MDG 2, 3, 4, 5
MDG 3
MDG 2
MDG 7
Outcomes MDG target
Source: DFID 2003
Monitoring progress and outcome indicators
Monitoring of exposure, access to services, health improvements Source of data: household surveys National and sub-national level indicators Depends on: data, cost & ease of
measurement, acceptance of indicators, etc Social accountability
Citizen monitoring of public services, access to information, participation in decision-making, access to justice
Cross cutting themes
Participation and stakeholder involvement Awareness-raising and communication
strategies
Source: Tanzania’s Communication Strategy
Moving towards action: Some Tools
Data sources: Census, household surveys (DHS, LSMS), exposure/epidemiological studies
Economic Assessment tools: cost-of-degradation studies, cost-benefit analysis, cost-effectiveness
Environment & Health Assessment tools: EIA, SEA, HIA, CEA
Institutional Assessment tools: CEA, SEA, TAI, PEERs
Participatory Tools: PPA, beneficiary assessments Other Tools: poverty mapping (GIS)
Moving towards action: stakeholder participation
Paris Declaration: ‘increase the impact of aid in reducing poverty and inequality, increasing growth, building capacity & accelerating achievement of the MDGs’
International Multilateral
institutions Bilateral institutions International NGOs International
Foundations International
Research Institutes
National Finance Ministry Health Ministry Environment
Ministry Education Ministry Infrastructure
Ministries National NGOs Media Civil society
organizations Universities Think tanks
Local Grassroots
organizations Health workers Poor communities Universities and
research institutes
Moving toward action: How can PEP help? Broadening the working concept of environment by
incorporating the implications of the bio-physical and socio-economic environments on people and their health.
Making the case for linking environmental health and poverty reduction by highlighting the economic importance of environmental health to poverty reduction and pro-poor growth.
Incorporating environmental health into existing tools, programs, and investments by PEP members to move towards results on this important agenda and consequently a continuous improvement in the quality of life of the poor.
Questions for PEP Members Content:
Scope of paper: PRSPs or wider focus? Adequacy of approach/storyline What else can we include, e.g. tools?
Finalization Process: Which agencies would like to sign off on it? Tell us by
Sept 2007 Level of sign-off (e.g. VP Sustainable Development, WB) Receipt of comments until September 15, 2007 Final draft for agency review and sign-off, November
2007 Publication costs (ADB and others?) Dissemination plan incl. different agency responsibilities
– websites, existing forums, etc.
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