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.