re gional pro file dam ming the sene gal riverpdf.wri.org/wrr98_chapter03_profiles.pdf · the sene...

A re gional ef fort to har ness the wa ters ofthe Sene gal River for hy dro power, ir ri ga -tion, and trans por ta tion has re sulted inpro found en vi ron mental changes in theriver ba sin. These en vi ron mental changeshave, in turn, caused se vere health andgen eral wel fare prob lems for the riverbasin’s resi dents. This case study il lus -trates the com plex re la tion ships that canun fold be tween peo ple and their en vi ron -ment as so cie ties work to meet theirgrow ing needs for en ergy, ag ri cul turalpro duc tion, and in dus trial de vel op ment.Al though many of the harm ful ef fectswere pre dicted be fore the proj ect be gan,the pro ject’s pur ported bene fits—wa terstor age for ir ri ga tion, drought, and do -mes tic sup ply; elec tri cal power for ur banar eas and in dus try; and a trans por ta tionchan nel to the sea for land- lockedMali—were deemed too im por tant toforgo. Now, years later, the river ba sinman age ment author ity, na tional min is -tries in three ri par ian coun tries (Mali,Mau ri ta nia, and Sene gal), and in ter na -tional agen cies fi nanc ing the proj ect aretry ing to miti gate some of the most se vere prob lems as they con tinue work to re al izethe pro ject’s po ten tial bene fits.

Back ground

The Sene gal River is the sec ond long estriver in West Af rica (1). Its prin ci pal tribu -tary, the Baf ing River, rises in the high -lands of Guinea’s Fouta Djal lon and runsnorth into Mali, where it joins the BakoyeRiver at Ba fou labe to form the Sene galRiver. From Ba fou labe, the Sene gal Riverflows north west through Mali and downto Kayes, re ceives wa ters from the FalemeRiver, and then flows onto the flood plainstart ing at Bakel in Sene gal. For its re -main ing length from Bakel to the At lan ticOcean, the Sene gal River forms the bor der be tween Mau ri ta nia to the north andSene gal to the south.

The up land ar eas above Bakel, and par -ticu larly those in Guinea, re ceive 700 to

2,000 mil li me ters of rain fall an nu ally and pro vide vir tu ally all of the flow in theSene gal River. An nual rain fall be lowBakel is typi cally be tween 150 and 300mil li me ters. Tribu tar ies to the Sene galRiver are tem po rary, sea sonal sys temsthat func tion as dis tribu tar ies when flowis high in the main chan nel. In its natu ralstate, the Sene gal Riv er’s an nual flood in -un dated ap proxi mately 150,000 hec taresin an av er age year and up to 350,000 hec -tares in high- flow years. In the dry sea son, fresh wa ter flow stopped in the lowerreaches of the river, and salt wa ter flowtrav el ing up stream cre ated es tu ar ine con -di tions from the At lan tic coast to Da gana,ap proxi mately 250 kilo me ters in land.These con di tions cre ated a natu ral di vi -sion of the river ba sin into three zones: an up per ba sin above Bakel; the mid dle val -ley from Bakel to Da gana; and the delta,or lower val ley, from Da gana to the At lan -tic coast.

Ap proxi mately 2 mil lion peo ple of sev -eral eth nic groups live in the river ba sin.The pre domi nant groups are the Malinkein the up per ba sin, the Son inke aroundBakel, the Pu laar and Mau res in the mid -dle val ley, and the Wolof in the delta. Allof these groups are agro pas tor al ists, re ly -ing for their live li hood on a com bi na tionof ag ri cul ture, small ani mal hus bandry,and fish ing. Herd ers have his tori callytrav eled with their cat tle from the val leyfloor in the dry sea son to the ad ja cent Sa -he lian fringe ar eas in the rainy sea sonand floods.

Be cause of their de pend ence on theriver, resi dents’ for tunes have risen andfallen through the years in re la tion to theavail abil ity of wa ter from rain fall andfloods. From 1968 to 1973, the re gion ex -pe ri enced a pro longed and se vere greatdrought that caused ex ten sive fam ine andfo cused in ter na tional at ten tion on the Sa -hel re gion.

108 World Re sources 1998–99

Re gional Pro file Dam ming The Sene gal River

De vel op ment Pro jects onthe Sene gal River

Be cause of its size and re gional im por -tance, the Sene gal River has long been atar get for de vel op ment proj ects. Therewere two in ter na tional ef forts to de velopag ri cul ture, navi ga tion, and hy droe lec tricproj ects in the four ri par ian states (in -clud ing Guinea) dur ing the co lo nial pe -riod in the 1930s and early 1940s. In the1960s, af ter gain ing in de pend ence, the ri -par ian coun tries cre ated an Inter- Country Com mit tee and a suc ces sor or gani za tionto pur sue an in te grated de vel op ment pro -gram for the river ba sin. How ever, most of the early at tempts at de vel op ing the riv -er’s re sources failed, ei ther for tech ni calrea sons or be cause of ten sion among thepar tici pat ing states.

In the early 1970s, cir cum stances fi -nally com bined to fa vor mount ing sev erallarge- scale proj ects. In 1970, a U.N.-spo n -sored study iden ti fied sev eral po ten tialsites for hy droe lec tric dams in west ernMali and north east ern Guinea. In 1972,par tially in re sponse to the great droughtand the re sult ing at ten tion from in ter na -tional agen cies, the gov ern ments of Mali,Mau ri ta nia, and Sene gal cre ated a re -gional river ba sin author ity, the Or gani sa -tion pour la Mise en Va leur du FleuveSene gal (OMVS). Guinea was not in cluded in the OMVS be cause of its lack of in ter est and ef fec tive par tici pa tion in the ear lierre gional or gani za tions. The three mem ber states of the OMVS thought a re gional or -gani za tion would be the best way to pri -ori tize eco nomic ob jec tives for de vel op ing re sources in the ba sin, to or gan ize a co op -era tive ef fort, and to reach agree ment oncom mon re spon si bili ties for fi nanc ingand man ag ing the ma jor works. Arab oilstates also took an in ter est in fi nanc ingproj ects on the Sene gal River, a re flec tionof their pros per ity dur ing the oil boom ofthe 1970s and of their de sire to as sistother mem bers of the Is lamic com mu nityand in crease Is lamic eco nomic and cul -tural in flu ence in the re gion.

The OMVS mem bers de vel oped an in te -grated plan for de vel op ment of the Sene -gal River, de signed to stimu late eco nomic

growth in the three mem ber coun triesand to mod er ate the ef fects of drought onpeo ple liv ing in the ba sin. The plan hadsix com po nents:

● an up land hy droe lec tric dam on theBaf ing River at Man an tali, Mali, for wa -ter stor age and power pro duc tion;

● a low land dam on the Sene gal Rivernear Diama, Sene gal, to limit salt wa terin tru sion, regu late wa ter lev els in themid dle val ley, and store wa ter for do -mes tic wa ter sup plies;

● fa cili ties and con di tions (i.e., locks,chan nel dredg ing, and water- levelman age ment) to en sure navi ga bil ityfrom the At lan tic coast at Saint- Louis,Sene gal, to Kayes, Mali;

● ir ri ga tion proj ects and ag ri cul tural de -vel op ment in the mid dle and lower val -ley;

● ur ban wa ter sup plies us ing the res er -voir cre ated by Diama Dam; and

● de vel op ment of agro in dus try.

The OMVS was given di rect author ityfor build ing and op er at ing the two damsand re spon si bil ity for de vel op ing thenavi ga tion proj ect. The mem ber states re -tained re spon si bil ity for de vel op ing ir ri -ga tion, wa ter sup ply, and agro in dus trialproj ects within their own ter ri to ries.

Po liti cally, the ma jor sell ing points ofthe plan were that it would lessen the im -pact of fu ture droughts and help close thefood gap that was emerg ing as rapidpopu la tion growth out paced do mes ticfood pro duc tion. The OMVS was di rectedto man age the riv er’s wa ter re sources toachieve two ob jec tives that re lated pri -mar ily to ag ri cul ture: first, to re duce thelarge sea sonal and an nual fluc tua tions inwa ter avail abil ity; and sec ond, to con trolflood ing so that land in the val ley couldbe de vel oped for ir ri gated ag ri cul ture.Sene gal and Mau ri ta nia would re al izemost of the bene fits from meet ing theseob jec tives: of the 375,000 hec tares of landthat were to be de vel oped for ir ri ga tion,all but 9,000 hec tares were in these twocoun tries. The hy dro power and navi ga -tion com po nents were in cluded in theplan pri mar ily to meet Mali’s in ter ests.

The ex pec ta tions of mu tual bene fit andac cel er ated de vel op ment, cou pled withthe cri sis con di tions cre ated by the greatdrought and re al is tic pros pects of in ter -na tional fi nanc ing, en abled the threecoun tries to over come en trenched sus pi -cions and pro ceed with the proj ect. Thethree mem ber states have main tained alevel of co op era tion suf fi cient to com plete con struc tion of both dams. Diama Damwas com pleted and be gan stor ing wa ter in 1986. The res er voir be hind Man an taliDam be gan fill ing in 1987 and reachedspill way level in 1991. Other por tions ofthe plan have de vel oped more slowly thanfirst en vi sioned. Ir ri ga tion proj ects havebeen com pleted in the mid dle val ley, andrice and sugar cane pro duc tion have in -creased, al though not as rap idly as origi -nally pre dicted. Fi nanc ing was re centlyar ranged for the hy dro power com po nent,which in volves in stal la tion of tur binesand gen era tors at Man an tali Dam andbuild ing trans mis sion lines to the threecapi tals (Da kar, Nouak chott, and Ba -mako) and sev eral points in the ba sin.Plans for the navi ga tion com po nent havebeen modi fied to re flect more re al is ticwa ter man age ment con di tions, ship pingsys tems, and as so ci ated de vel op ment ofsea and river ports. Some crit ics main tain that the navi ga tion proj ect is still un re al -is tic and will likely never be built. Plansare be ing de vel oped for wa ter sup ply proj -ects in Sene gal. Most re cently, a smallamount of in dus trial de vel op ment has oc -curred in the val ley, pri mar ily con nectedwith the ag ri cul tural sec tor.

Al though the OMVS has im ple mentedpor tions of its de vel op ment plan, the proj -ects have not yet gen er ated sub stan tialeco nomic bene fits for the mem ber states.Ag ri cul tural de vel op ment has pro ceededmore slowly than ex pected, in part be -cause of in ap pro pri ate plans for ir ri ga tion proj ects, low yields be ing ex pe ri enced inex ist ing proj ects, and (un til re cently) cen -tral ized con trol over ag ri cul tural plan -ning, pro duc tion, dis tri bu tion, and mar -ket ing. The power and navi ga tion proj ects have not yet been im ple mented. There issome ques tion whether the full plan, evenif com pleted, will ever gen er ate the level

World Re sources 1998–99 109

En vi ron men tal Change and Hu man HealthR E G I O N A L P R O F I L E S : S E N E G A L

of eco nomic bene fit origi nally pre dicted.The Sene gal River dams were ini ti ated ina global eco nomic cli mate that fa voredlarge de vel op ment proj ects and a po liti cal cli mate in which the ma jor do nors ex -erted lit tle in flu ence—too lit tle, main tainsome crit ics—over proj ect plan ning andim ple men ta tion (2)(3)(4).

What ever bal ance may even tu ally be re -al ized be tween the eco nomic bene fits andcosts of the proj ects for the re gion and for each coun try, it is also im por tant to con -sider the dis tri bu tion of those costs andbene fits and, par ticu larly, the situa tion ofpeo ple most di rectly af fected by the proj -ects— those liv ing in the river ba sin. Thecom pleted proj ects and the OMVS’ prac -tices to date in man ag ing wa ter lev els inthe ba sin have pro vided few bene fits andse ri ous nega tive con se quences for thebasin’s resi dents—some an tici pated, andsome un an tici pated. The eco logi cal,health, and so cial con se quences will beex plored in the fol low ing sec tions.

Eco sys tem Changes in theSene gal River Ba sinThe Man an tali and Diama dams havechanged the river ba sin eco sys tem in sev -eral ob vi ous and pro found ways. The an -nual flood has been re duced sub stan tially, be cause the flow from the Baf ing Riverhas been im pounded at Man an tali Dam.The amount of wa ter avail able from othertribu tar ies is con sid era bly less than thatfrom the Baf ing River. Wa ter has been re -leased from Man an tali Dam to pro vide aman aged flood every year since 1987. Un -for tu nately, the vol ume of wa ter re leasedeach year has been far less than wouldhave been avail able un der natu ral con di -tions. And dur ing sev eral years, the pe -riod cho sen for a wa ter re lease was poorly timed.

The Sene gal River now flows year- round. The re gion above Diama Dam isnow a sta ble fresh wa ter lake and nolonger shifts to es tu ar ine con di tions dur -ing the dry sea son. The area be low DiamaDam now has a rela tively con stant es tu ar -ine status, as op posed to the pre vi ousshifts be tween fresh wa ter and es tu ar ine

con di tions that oc curred as a re sult ofhigh fresh wa ter flows in the flood sea sonand low- to- nonexistent fresh wa ter flowsin the dry sea son. The shore line is in -creas ing as ir ri ga tion ca nals are de vel -oped. Weeds and grasses char ac ter is tic ofa fresh wa ter lake are grow ing along thebanks of the river and ca nals from DiamaDam to Da gana and could even tu allyreach an other 100 kilo me ters in land toBo gué. The vege ta tion, par tially sub -merged along the riv er’s edge, is fa vor ablehabi tat for the snails that carry schis to -somia sis; in creas ing vege ta tion is the pri -mary cause of the grow ing dis ease prob -lem among the popu la tion of the lowerba sin.

The changes in aquatic habi tat and thephysi cal bar rier of Diama Dam havegreatly af fected fish er ies in the lower val -ley, delta, and coastal wa ters. Be fore thedams were built, the sedi ments car ried bythe an nual flood were an im por tantsource of nu tri ents for coastal fish er ies,and the flood plains in the up per deltawere spawn ing and feed ing grounds forsalt wa ter and fresh wa ter spe cies. A ma jorcoastal fish ing in dus try was cen teredaround Saint- Louis, and fish were an im -por tant source of pro tein for peo ple liv ing in the val ley. Al though the pro longeddrought had al ready re duced an nualcatches in the val ley be fore the dams were built, a study in 1994 con cluded that thedams have gen er ally had a det ri men tal ef -fect on fish pro duc tion both in the val leyand in the up per part of the delta. Peo pleliv ing in the val ley main tain that fish con -sump tion has de creased since 1988. Theysay that the fish now con sumed are al -most ex clu sively salt wa ter spe cies,trucked in from the Sene gal ese and Mau -ri ta nian coastal ar eas.

Above Man an tali Dam, a large, deepfresh wa ter lake now ex ists in what waspre vi ously a for ested val ley. The dam wasde signed to store 11 bil lion cu bic me tersof wa ter, enough to sup ply 2 years’ flowdur ing a drought. The sur face of LakeMan an tali now cov ers 447 square kilo me -ters; its shore line is ap proxi mately 150kilo me ters, and it is 65 me ters deep at thedam. Stud ies con ducted be fore the dams

were built pre dicted that fish popu la tionswould in crease in the lake be hind Man an -tali Dam (sta bi liz ing at around 3,000 met -ric tons an nual pro duc tion) and de creasebe low the dam (5). Al though the fishpopu la tion in Lake Man an tali did in -crease af ter the res er voir was filled, thean nual catch has never reached pre dictedlev els and has fallen sharply in sub se -quent years, to 420 met ric tons in 1991and 285 met ric tons in 1993. The de -creased catch re flects in part the tech -niques and equip ment used by the fish er -man, who were ac cus tomed to fish ing inriv ers rather than in a deep lake, and alsothe move ment of peo ple away from thearea.

En vi ron men tal Changesand Health Prob lemsPeo ple liv ing in the Sene gal River ba sinhave long suf fered from schis to somia sis,ma laria, and other in fec tious and vector- borne dis eases en demic in large ar eas ofsub- Saharan Af rica. Be fore dams werecon structed, mal nu tri tion was wide -spread in the val ley, and in fant and childmor tal ity rates were high, es pe cially dur -ing the ex tended drought. The de vel op -ment plan en dorsed by the mem ber states of the OMVS pre dicted that resi dents’well- being would im prove as ag ri cul tureand trans por ta tion ex panded and peo plehad more in come and greater ac cess tofood, wa ter, and health care.

The re al ity has been dif fer ent. Ag ri cul -ture is de vel op ing, but more slowly thanan tici pated and in a man ner thatstretches the fi nan cial and hu man re -sources of ex ist ing land hold ers. Trans por -ta tion has not im proved. Al though somein di ca tors of health have im proved in there gion, health risks from cer tain dis -eases—most no ta bly schis to somia sis, di -ar rheal dis eases, and ma laria—have in -creased, in some cases dra mati cally. Thenet im pact of the Sene gal River de vel op -ment proj ects on peo ple’s health hasclearly been nega tive to this point.


SCHIS TO SOMIA SIS

Schis to somia sis re sults from in fec tion byspe cies of the tre ma tode Schis to soma. The para site has a com plex life cy cle with astage that in fects fresh wa ter snails, whichthen re lease lar vae into the wa ter. Hu mans come into con tact with the lar vae whenthey wade in shal low wa ters (for ex am ple,when col lect ing wa ter, wash ing clothes, or, for chil dren, play ing); they be come in -fected when lar vae pene trate the skin.Lar vae mi grate through the host’s cir cu la -tory sys tem and lungs while de vel op inginto ma ture male and fe male worms; theyeven tu ally mi grate to blood ves sels in theab do men and form per ma nent re pro duc -tive pairs, af ter which the fe males maypro duce large num bers of eggs for manyyears.

There are two main spe cies of Schis to -soma that in fect hu mans in Af rica; theyrely on dif fer ent snail hosts, set tle in dif -fer ent tis sues of their hu man hosts, andpro duce dif fer ent forms of the dis ease. S.man soni set tle in blood ves sels near theliver or in tes tines and cause in tes ti nalschis to somia sis; S. hae ma to bium set tlenear the blad der and cause uri nary schis -to somia sis. The se ver ity of the dis ease ineach in di vid ual de pends on the po si tionand size of the egg load and the host’s cel -lu lar re sponse to it. In tes ti nal schis to -somia sis causes di ar rhea and bloodystools in mod er ate cases and, in heavy in -fec tions, per ma nent or gan dam age thatcan lead to death. Uri nary schis to somia sis causes blood in the urine; se vere cases in -volve se ri ous dam age to the uri nary tract,some times lead ing to blad der can cer.

Be fore 1986, uri nary schis to somia siswas en demic in the Sene gal River ba sin,with rela tively low rates of in fec tion in the lower val ley and mod er ate to high rates in the mid dle and up per val leys. Since thecon struc tion of Diama Dam, the snailhosts of S. hae ma to bium have ex tendedtheir range and in creased their number in the lower val ley, es pe cially along theLamp sar River (a south ern branch of theSene gal River in Sene gal). In fec tion ratesin hu mans have also in creased. A 1994sur vey found the preva lence of uri naryschis to somia sis was mod er ate (11 to 12

per cent) among school chil dren sur veyedalong the Mau ri ta nian shore of the Sene -gal River at Rosso, Bagh dad, and JidrelMoghuen. That year, the snail host wasfound for the first time in the Taouey ca -nal in Sene gal, near its out fall to LakeGuiers. There was no evi dence at that time of in fec tion among school chil dren inMbane, a town on the east ern shore of thelake, al though the pres ence of the snailhost sug gests that fu ture in creases in dis -ease rates in this area are pos si ble.

The net im pact of the Sene gal

River de vel op ment proj ects

on peo ple’s health has clearly

been nega tive to this point.

In the up per val ley around Lake Man -an tali, the preva lence of uri nary schis to -somia sis was high (69 to 95 per cent) insev eral lake shore vil lages and in a vil lagejust down stream of the dam, ac cord ing tothe 1994 sur vey. Preva lence de creasedwith greater dis tance from the dam (to 49per cent and 7 per cent in two vil lages fur -ther down stream). In at least one place inthe mid dle val ley, in the ir ri ga tion proj -ects around the Foum Gleita Dam in Mau -ri ta nia, the preva lence of uri nary schis to -somia sis has been re duced to less than 5per cent by a com bi na tion of miti ga tionmeas ures and natu ral con di tions. Theformer in cludes switch ing from rice toother crops on some of the land and keep -ing ir ri ga tion ca nals free of weeds. Theseef forts are aided by the natu rally flat ter -rain of the lake bed be hind the dam,which re sults in large fluc tua tions in thelo ca tion of the wa ter line along the shoreas wa ter lev els fluc tu ate in the lake. Thesefluc tua tions dis turb the growth of mar -ginal vege ta tion along the lake shore andre duce the amount of fa vor able habi tat for snails.

The most dra matic health im pact of the Diama and Man an tali dams and the newwa ter man age ment re gime has been thein tro duc tion and rapid spread of in tes ti -

nal schis to somia sis in the lower val ley.Be fore 1986, S. man soni was not pres ent in the lower and mid dle val leys and hadbeen re ported at only a few lo ca tions inthe up per val ley. In 1988, soon af ter thecom ple tion of Diama Dam, a new fo cus ofin tes ti nal schis to somia sis was re ported in a sugar cane proj ect area in Richard- Toll,on the Sene gal side of the river. Preva -lence reached epi demic lev els the fol low -ing year in Richard- Toll and, by 1993, hadclimbed to nearly 100 per cent in thenearby vil lage of Ndombo and 70 per centin Ngnith, a vil lage on Lake Guiers. In1994, dis ease preva lence was 82 per centamong school chil dren at Mbane on LakeGuiers and 47 per cent at Da gana, the east -ern most bound ary of Lake Diama. TheseSene gal ese chil dren had heavy in fec tionswith very high egg counts.

In the Mau ri ta nian por tion of the lower val ley, in tes ti nal schis to somia sis was firstre ported in 1994 with preva lence rates of25 to 32 per cent in chil dren in three towns from Rosso to Jidrel Moghuen; these chil -dren had in fec tions of light to mod er atese ver ity. How ever, the snail host of S. man -soni was found in large num bers withhigh in fec tion rates along the Mau ri ta -nian shore of the Sene gal River andspread ing north ward into the Ga rak ca nal at Tougene and the So kam ca nal nearLake Rkiz. These find ings sug gest that the ex tent and in ten sity of the epi demic willlikely in crease in Mau ri ta nia, pos si bly fol -low ing the same course as in Sene gal.

As of 1994, the prob lem with in tes ti nalschis to somia sis had not ex tended into the mid dle val ley and had not in creasedgreatly in the up per val ley. Un der the cur -rent op er at ing re gime, Lake Diama endsat Da gana; above Da gana, the Sene galRiver is still within its origi nal banks.There is lit tle or no growth of mar ginalweeds in this re gion and, there fore, nohabi tat for the snails.

The in tro duc tion of in tes ti nal schis to -somia sis and the in creases in uri naryschis to somia sis are due to a com bi na tionof hu man fac tors. First, Diama Damelimi nated salt wa ter in tru sion into thelower river and main tained nearly con -stant wa ter lev els, cre at ing con di tions fa -



vor ing the growth of mar ginal vege ta tionalong the river edges and the spread ofthe snail hosts of Schis to soma spe cies.Sec ond, S. man soni was proba bly in tro -duced to the lower val ley by peo ple mi -grat ing into the re gion, pos si bly from theup per val ley. Popu la tion in the re gion hasin creased rap idly, es pe cially around their ri ga tion proj ects at Richard- Toll, as peo -ple move there to take ad van tage of newjobs. Wa ter sup ply and sani ta tion fa cili -ties have not kept up with this rapidgrowth. As a re sult, the in creased con -tami na tion of sur face wa ters, and theirgreater use by resi dents, has con trib utedto higher trans mis sion rates for schis to -somia sis and in creased risks for other wa -ter borne dis eases as well. The in creasedpreva lence of uri nary schis to somia sisaround Lake Man an tali—as well as thein creased number of the type of snails as -so ci ated with in tes ti nal schis to somia -sis—are due to the year- round pres enceof wa ter in the lake and its nearly con -stant wa ter level.

RIFT VAL LEY FE VER

Rift Val ley Fe ver is a mosquito- borne vi -ral dis ease that is most of ten be nign inhu mans but can oc ca sion ally lead toblind ness, en cepha li tis, and fa tal hem or -rhagic fe ver. Epi dem ics are com mon inlive stock and can cause high rates of still -births and abor tions. The vi rus is trans -mit ted to hu mans by bit ing in sects (mos -qui toes, sand flies, and, pos si bly, ticks) orby di rect con tact with blood or or gans ofin fected ani mals af ter slaugh ter.

An out break of Rift Val ley Fe ver oc -curred near Rosso, Mau ri ta nia, in 1987soon af ter the com ple tion of Diama Damand the ini tial fill ing of Lake Diama. It be -gan dur ing the rainy sea son in pas tor al istgroups in Mau ri ta nia and spread toRosso, even tu ally ap pear ing on both sides of the river. The out break was the firstknown epi demic of Rift Val ley Fe ver inhu mans west of Uganda and re port edlykilled more than 200 peo ple (6). The dis -ease had been ob served only once be forein epi demic form in hu mans, in Egypt in1977 near the As wan High Dam on theNile River. Al though the ex act eco logi cal

con di tions con du cive to rapid trans mis -sion of Rift Val ley Fe ver re main un clear,the ini tial fill ing of a nearby res er voirmay be a fac tor, since this was a com moncon di tion in the events at As wan in 1977and Mau ri ta nia in 1987 (7). Fill ing theDiama res er voir cre ated more stand ingwa ter—a lo ca tion pre ferred by the Ae desmos quito, the prob able vec tor of Rift Val -ley Fe ver in Mau ri ta nia (8).

The po ten tial for such an out break inthe Sene gal River ba sin had been iden ti -fied in pre- dam con struc tion health as -sess ments in 1980, 1984, and just be forethe on set of the rainy sea son in 1987 (9).De spite these warn ings, authori ties in theba sin did not take nec es sary pre cau tionsto pre vent an out break.

MA LARIA

Ma laria oc curs in most parts of the Sene -gal River ba sin. Most re ported cases aredue to ma laria tropica (Plas mo dium fal ci -pa rum), which can cause se vere dis easeand death. The risk of in fec tion is greaterin the up per val ley than in the lower ar eas be cause the rainy sea son is longer and the amount of rain fall is higher, cre at ing bet -ter con di tions for the mos quito vec tor(Anophe les spe cies). Fal ci pa rum ma lariahas be come a se ri ous con cern in Af ricabe cause of the para site’s grow ing re sis -tance to an ti ma lar ial drugs.

Evi dence is con flict ing re gard ingwhether the new wa ter man age ment re -gime on the Sene gal River and the ex pan -sion of ir ri gated ar eas in the lower val leyare caus ing an in crease in ma laria in fec -tion rates. Re li able evi dence shows that A.gam biae popu la tion den si ties have in -creased dur ing the rainy sea son (Augustto De cem ber) in the mid dle val ley, andthat ma laria trans mis sion is con tinu inglater into the dry sea son (De cem ber toApril). Rou tine sur veil lance data fromhealth serv ice fa cili ties in Rosso,Richard- Toll, and Po dor re flect an over allin crease in the number of ma laria cases,al though most of the re ported cases werenot con firmed by mi cro scopic analy sis. In con trast, lon gi tu di nal stud ies con ductedin the delta re gion at Kasak- Nord and themid dle val ley at Po dor, and an un pub -

lished study per formed in 1991 by theOMVS through out the ba sin, do not showin creased ma laria.

MAL NU TRI TION

Mal nu tri tion has been wide spread in theSene gal River val ley for a long time; it was par ticu larly se vere dur ing the droughtsbe fore con struc tion of the dams. TheSene gal River de vel op ment proj ects wereex pected to im prove the nu tri tional status of val ley resi dents as ir ri gated ag ri cul ture cata lyzed eco nomic de vel op ment andbrought sig nifi cant im prove ments in peo -ples’ so cio eco nomic status, giv ing themmore in come to spend on nu tri tion andhealth. Al though the situa tion is com plexand no authori ta tive stud ies ex ist withwhich to com pare nu tri tional status be -fore and af ter dam con struc tion, the avail -able in for ma tion sug gests that over all, the qual ity of peo ples’ diet and their nu tri -tional status have not im proved sig nifi -cantly, and may have de clined, since con -struc tion of the dams.

Be fore the dams were built, val ley resi -dents grew and con sumed a wide va ri etyof food crops grown in fam ily plots andsmall fields in the riv er’s flood plain. Con -struc tion of the dams, in ter rup tion of thean nual flood, and ex pan sion of ir ri ga tionproj ects has re duced tra di tional ag ri cul -ture and has in creased rice and sugarcane cul ti va tion. In the lower and mid dleval ley, resi dents’ di ets now ap pear to in -clude more rice, a smaller va ri ety of vege -ta bles in most vil lages, and lower con -sump tion of meat, dairy prod ucts, andfresh wa ter fish. This change may re flectthe fi nan cial strain on fam ily re sourcescaused by low rice yields and farm ers’ at -tempts to grow two crops of rice each year, and also the re duced live stock pro duc tion and fish catch in the val ley. For rice- producing fami lies, rice is the pre domi -nant food in the diet and is usu ally eatenat least once or twice a day. Rice is less nu -tri tious than mil let and sor ghum, whichused to be sta ples in the diet but are nowmore dif fi cult to find in the mar kets.

Sev eral stud ies of nu tri tional status intowns along the Sene gal ese shore of theSene gal River in 1990–91 found the


preva lence of chronic mal nu tri tion inchil dren at lev els be tween 20 per cent and36 per cent. One study con cluded that lev -els of mal nu tri tion ob served in 1992 werecom pa ra ble to those in 1983, be fore con -struc tion of the dams (10). The same study found the preva lence of nu tri tional stunt -ing to be 22 per cent and wast ing to be 11per cent in 1990 among chil dren aged 0 to5 years old, with some what lower lev elsob served in 1992 (16 per cent and 5 per -cent, re spec tively). On the Mau ri ta nianside of the river, a 1986 study in the Trarza dis trict (around Rosso) found chronicmal nu tri tion to ex ist among 25 per cent ofchil dren younger than 5 years of age. In a1994 study, rates of chronic mal nu tri tionamong chil dren in the same re gion werees ti mated at 36 per cent, with 11 per cent of chil dren show ing evi dence of nu tri tionalwast ing.

DI AR RHEAL DIS EASES

Changes in wa ter man age ment prac ticesand vol un tary mi gra tion into the lowerval ley have af fected the rates of di ar rhealdis eases in ba sin resi dents. De vel op mentplans for the re gion called for im prove -ments in wa ter sup ply, sani ta tion, andhealth serv ices, but few im prove mentshave been made to date.

In the lower val ley, mod est im prove -ments have been in suf fi cient to deal withpopu la tion move ments. In Richard- Toll,an in flux of work ers to serve the sugarcane in dus try added an ad di tional 50,000peo ple to the popu la tion, over whelm ingim prove ments in the town’s wa ter sup plyand sani ta tion fa cili ties. There is an in -creased risk of chol era and other wa ter -borne dis eases in the Richard- Toll area,and there was a chol era epi demic nearRosso, Mau ri ta nia, in 1987. Be cause fu -ture im prove ments to the wa ter sup plysys tems of Da kar and Saint- Louis willdraw on wa ter from Lake Diama and Lake Guiers, the qual ity of those wa ter bod iesmay soon af fect these large popu la tioncen ters as well.

In the mid dle val ley, the regu la tion ofwa ter lev els in the river has al lowed thede vel op ment of wind- powered wa terpumps. These pumps draw wa ter from aq -

ui fers bor der ing the river, re sult ing in anim prove ment of wa ter sup plies for thesevil lages. Fur ther away from the river, how -ever, the ab sence of the an nual flood hasin ter rupted the pre vi ous cy cle of aq ui ferre charg ing, re sult ing in a grad ual de clinein the wa ter ta ble and re duced wa teravail abil ity. The re sult has been a rise inthe re ported rates of di ar rheal dis ease.Along the river in the up per val ley, di ar -rheal dis ease has con tin ued to be a se vereprob lem de spite regu la tion of the river,and health authori ties in Kayes, Mali, re -port that con di tions have wors ened.

So cial Changes and Con flictThe en vi ron mental and health changesseen in the Sene gal River ba sin have nothap pened in iso la tion; the change in wa -ter man age ment and the growth of ir ri -gated ag ri cul ture have also broughtbroad- based so cial changes, in clud ingten sions be tween pas tor al ists and farm ers and among eth nic groups as well. Thedam proj ects re sulted in the re lo ca tion ofroughly 10,000 peo ple in more than 40vil lages and ham lets in Mali. The Mal iangov ern ment, the U.S. Agency for In ter na -tional De vel op ment (USAID), and theWorld Health Or gani za tion moved thesepopu la tions from the area in un dated bythe Man an tali Dam and re set tled them innew sites on the pla teau above the lakeand down stream along the Baf ing River.One year af ter be ing re set tled, vil lag ersre ported in a 1989 USAID study that theyhad in suf fi cient land for cul ti va tion andgraz ing and in suf fi cient wa ter for gar den -ing. Hous ing and per sonal wa ter sup plieswere con sid ered ade quate at that time, be -cause the ad di tional ex ter nal fund ing that ac com pa nied the dam proj ects en suredthat these ba sic items were sup plied to the dis placed popu la tions. Health prob lemsare com mon in re set tled popu la tions, andin creases in di ar rheal ill nesses and al ler -gies, a mea sles epi demic, and an out breakof live stock dis ease were re ported amongsome of the re set tled vil lages. Somehealth in di ca tors did im prove for the resi -dents of some re set tled vil lages, where

resi dents had been guar an teed health cen -ters and one wa ter point for every 100 in -habi tants. Two years af ter their dis place -ment, resi dents con tin ued to re ceivead di tional sup port, such as sup ple men talnu tri tion pro grams funded by the do norgov ern ments.

Tra di tional sys tems of live stock pro -duc tion have been al tered in the mid dleval ley. Con struc tion of the dams was ex -pected to fos ter an in crease in live stockpro duc tion, but herd ers have had to copewith a de crease in pas ture land due to theper sis tent drought, the re duc tion in thean nual flood, and the ex pan sion of ir ri -gated land. The in creased dif fi culty ofgain ing ac cess to the river for wa ter ingani mals and the re duc tion in graz ing land has led to ten sions be tween pas tor al istsand farm ers.

The de vel op ment of ir ri ga tion along theSene gal River also dis turbed pat terns ofland use and land ten ure, ex ac er bat ing eth -nic con flict among groups in the re gion.Tens of thou sands of peo ple lost theirprop erty rights, and mas sa cres oc curred in both Mau ri ta nia and Sene gal (11).

Look ing For wardDam build ing will con tinue to be an im -por tant ele ment of eco nomic de vel op -ment plans in many coun tries. The po ten -tial bene fits for ag ri cul ture, wa ter sup ply,power pro duc tion, trans por ta tion, in dus -trial de vel op ment, and flood con trol areob vi ous and de sir able. Given this ex pec ta -tion, what les sons can be drawn from theex pe ri ence of Mali, Mau ri ta nia, and Sene -gal in de vel op ing the Sene gal River?

This case study il lus trates the manysec on dary im pacts that a dam proj ectmay have on the health, live li hood, so cialstruc ture, and gen eral wel fare of peo pleliv ing in the area. Many of these im pactscan be pre dicted—in deed, most of theim pacts of the Sene gal River dams werepre dicted in pre con struc tion stud ies.

If many of the nega tive im pacts of theSene gal River dams were pre dicted, thenwhy were they not avoided? The an swer iscom pli cated. First, the fi nanc ing con sor -tium could have re quired changes in the



pro ject’s de sign but did not. The fi nanc ing agree ments for the dams were reached inthe late 1970s, at a time when most par -tici pants were not es pe cially sen si tive toen vi ron mental im pacts and, in any case,were ea ger to par tici pate in the proj ectand would not have been in clined to forcechanges to which the bor row ing coun tries ob jected.

Sec ond, the peo ple who have been hurtby the proj ect lack po liti cal power andwere not rep re sented ef fec tively ei ther inthe proj ect de sign or in its op era tion.Meas ures that would have re duced thepro ject’s nega tive im pacts on val ley resi -dents were not im ple mented be cause they were per ceived to be ad verse to the pro -ject’s ob jec tives. In the Sene gal River ba -sin, more at ten tion should have been paidto how bene fits and costs would be dis -trib uted among vari ous groups. Gen er ally speak ing, even when the over all bal anceof bene fits to risks is posi tive and a proj -ect is jus ti fi able at the level of na tional in -ter est, the dis tri bu tion of bene fits andcosts may be quite un fair. This situa tionwas cer tainly ap par ent with the Sene galRiver dams proj ect. The bene fits of theproj ect—in come from ir ri gated ag ri cul -ture and elec tri cal power from Man an taliDam—will be en joyed pri mar ily by thepeo ple liv ing in the capi tal cit ies, whilepeo ple liv ing in the val ley pay the pricefor the proj ect in terms of poorer health,changed live li hoods, re lo ca tion, and dis -rupted so cial re la tion ships.

Third, even if the OMVS had the po liti -cal will to re duce the nega tive im pacts re -sult ing from con struc tion of the Sene galRiver dams, the or gani za tion does nothave the tech ni cal ca pa bil ity to do so.Many of the nega tive im pacts could be re -duced even now by mak ing op era tionalchanges in the proj ect. For ex am ple, morewa ter could be re leased to re store an an -nual flood. Planned varia tions in the wa -ter lev els of Lake Man an tali and LakeDiama could be used to con trol snailpopu la tions and re duce the spread ofschis to somia sis. Yet, if the OMVS were tode cide that such meas ures have merit, it

would need greater ca pa bili ties in termsof wa ter re source mod el ing, plan ning, and op era tions; genu ine ex per tise in otherdis ci plines (e.g., health and so cial sci -ences); and im proved mecha nisms forcom mu ni cat ing with na tional agen cies ofits mem ber states.

The ex pe ri ence with the Sene gal Riverdams, there fore, points to at least the fol -low ing five les sons:

● More ef fort is needed to evalu ate the en -vi ron mental, health, and so cial im -pacts of dams sys tem ati cally in or derto pre dict their var ied im pacts more ac -cu rately and with greater cer tainty.

● The de sign re views and evalua tionscon ducted by in ter na tional fund ingagen cies rep re sent a criti cal junc ture atwhich to make modi fi ca tions thatwould re duce nega tive im pacts.

● Dam proj ects should in clude fund ingfor meas ures needed to miti gate theiren vi ron mental, health, and so cial im -pacts as an in te gral part of the proj ect.

● In sti tu tional ar range ments cre ated forman ag ing such proj ects should in clude rep re sen ta tives of af fected popu la tionsin po si tions of real author ity.

● These in sti tu tions need fund ing andtech ni cal as sis tance to de velop ade -quate tech ni cal ca pac ity and a mul ti -dis ci plin ary staff that un der stands and can ad dress the broad range of po ten -tial nega tive im pacts.

There is some hope that con di tions willim prove in the Sene gal River val ley as are sult of in ter na tional at ten tion to theprob lems. An in ter na tional con sor tiumhas re cently con cluded ne go tia tions withthe OMVS for the pur chase and in stal la -tion of tur bines and hy droe lec tric gen era -tors at Man an tali Dam and power dis tri -bu tion lines from Man an tali to thena tional capi tals and sev eral lo ca tions inthe val ley. The proj ect in cludes fund ingfor a study of al ter na tive wa ter man age -ment re gimes at Man an tali Dam and, spe -cifi cally, for evalu at ing op tions for ma -nipu lat ing wa ter lev els to re duce

schis to somia sis trans mis sion and otherim pacts. The World Bank, which is amem ber of the power proj ect con sor tium,is also de vel op ing health sec tor proj ectsin Sene gal and Mau ri ta nia that will im -prove health serv ices and dis ease sur veil -lance. The World Bank is also de vel op ingwa ter sup ply and sani ta tion proj ects inSene gal that will im prove fa cili ties and re -duce the popu la tion’s ex po sure to schis to -somia sis.

Ref er ences and Notes1. Un less noted oth er wise, in for ma tion in this ar ti cle

is taken from Diop et al., Sene gal River Ba sinHealth Mas ter Plan Study (Wa ter and Sani ta tion for Health (WASH) Field Re port No. 453, De cem ber1994, re print ed.).

2. Con struc tion costs for the two dams amounted toUS$637 mil lion. The funds came prin ci pally fromthe gov ern ments of Saudi Ara bia, Ku wait, AbuDhabi, the Fed eral Re pub lic of Ger many, France,Iran, and the Af ri can De vel op ment Bank. TheUnited States (U.S.Agency for In ter na tional De vel -op ment) and the World Bank de clined to pro videcapi tal funds for the proj ects, but sup ported en vi -ron mental as sess ments and other re search re latedto the proj ects and pro vided fi nan cial and tech ni cal as sis tance for re lo cat ing vil lages that were dis -placed by the Man an tali Dam.

3. Anne Guest, “Con flict and Co op era tion in a Con -text of Change: A Case Study of the Sene gal RiverBa sin,” in Bounda ries in Ques tion: New Di rec tions in In ter na tional Re la tions, John Mac mil lan and An -drew Linklater, eds.(Pin ter Pub lish ers, Lon don,1993), pp. 163–173.

4. Ibid. 5. Gan nett Fleming Cord dry and Car pen ter, Inc., “As -

sess ment of En vi ron men tal Ef fects of Pro posedDe vel op ments in the Sene gal River Ba sin,” pre pared for the Or gani sa tion Pour La Mise en Va leur duFleuve Sene gal, 1977.

6. John Walsh, “Rift Val ley Fe ver Rears Its Head,” Sci -ence, Vol. 240 (June 10, 1988), pp. 1397–1399.

7. Wil liam R. Jo bin, “Rift Val ley Fe ver: A Prob lem forDam Build ers in Af rica,” Wa ter Power and DamCon struc tion (August 1989), pp. 32–34.

8. Op. cit. 3.9. J.P. Digoutte and C.J. Pe ters, “Gen eral As pects of

the 1987 Rift Val ley Fe ver Epi demic in Mau ri ta nia,”Re search in Vi rol ogy, Vol. 140, No. 1 (1989), pp.27–30.

10. E. Bene fice and K. Si mon don, “Ag ri cul tural De vel -op ment and Nu tri tion Among Ru ral Popu la tions:A Case Study of the Mid dle Val ley in Sene gal,1993,” Ecol ogy of Food and Nu tri tion, Vol. 31, No.1–2 (1993), pp. 45–66.

11. Tho mas Homer Dixon, En vi ron men tal Scar city andVio lent Con flict: Evi dence from Cases, Peace andCon flict Stud ies Pro gram, Uni ver sity of To ronto.Avail able on line at: http://ut1.li brary.uto ronto.ca/disk1/www/docu ments/pcs/evid1.htm (Janu ary1998).

Eugene P. Brantly and Karen E. Ram sey, En vi ron -men tal Health Pro ject of the U.S. Agency for In ter -na tional De vel op ment, Wash ing ton, D.C.


No country better typifies the confluenceof trends discussed in this report—northe challenges they pose to environmentalquality and public health—than doesmodern China. Since the economic re-forms of 1978, China has experienced dra-matic industrialization and rising energyuse against a backdrop of populationgrowth and unprecedented urbanization.China’s astounding industrial growth overthe past two decades has created a coun-try poised to become a major economicpower in the 21st Century. Per capita,China is still one of the world’s poorestcountries, yet the future looks promis-ing—incomes are rising, poverty rates arefalling, and life expectancy is up. Yet,along with these gains, China is grapplingwith some of the most serious environ-

mental problems on the planet, which inturn could prevent China from sustaininghigh levels of economic growth in thecoming decades.

Recognizing the urgency of these prob-lems, the Chinese Government has en-dorsed a suite of policies to curb air andwater pollution. The extent to which thesepolicies are successful has direct bearingon not only the health of the Chinese peo-ple and the local environment but theglobal environment as well.

Encompassing a geographically vastarea with a number of distinct ecologicalzones, China extends from the massiveand sparsely populated Gobi Desert andthe mountains of the southwestern Hima-layas to the densely inhabited valleys ofthe eastern coast. As the world’s most

populous country, with more than 1.2 bil-lion people, China’s economic growth isthe fastest and most sustained of any ma-jor country in the world, rising an averageof 10 percent annually over more than adecade (1). In fact, some autonomous re-gions in the golden southeastern coastalzones have grown nearly 20 percent annu-ally, doubling in less than 4 years (2).

Industry is China’s largest productivesector, accounting for 48 percent of itsgross domestic product (GDP) and em-ploying 15 percent of the country’s totallabor force (3). In the 1990s, the output ofChina’s 10 million industrial enterpriseshas increased by 18 percent annually (4).Without a doubt, Chinese industry islargely responsible for lifting many mil-lions of people out of poverty. It also un-

World Resources 1998–99 115

Regional Profile China’s Health and Environment

derlies a huge and growing demand forenergy.

China’s demand for high-grade energysuch as oil and natural gas will increaserapidly, although coal will continue todominate the energy structure, account-ing for more than 75 percent of total en-ergy production. From 1990 to 1995, Chi-na’s oil demand grew at 4.3 percentannually, while oil production increasedonly 1.2 percent each year. As a result ofthese trends, China has become a net oilimporter (5).

Along with industrialization has comerapid urbanization, especially in what isknown as the southern coastal crescentthat runs from Guangzhou to Shanghai.The proportion of the population living incities has grown about 50 percent since1980. Some 370 million people now live incities, and this number is expected togrow to 440 million by the turn of the cen-tury (6). A World Bank model predictsthat by the year 2020, 42 percent of Chi-na’s population, more than 600 millionpeople, will live in urban areas over-whelmingly concentrated in the easternand southern coastal provinces (7).

Since the political transformation of1949, dramatic and extensive social im-provements have accompanied China’sgrowth. In 1949, the new People’s Republicof China faced a massive burden of nutri-tional deficiency and infectious and para-sitic diseases. More than half the popula-tion died as a result of infectious andother nondegenerative diseases beforereaching middle age—a pattern still com-mon throughout much of the developingworld. Since 1949, the average life span inChina has risen from 35 years to the cur-rent 70. The infant mortality rate hasdropped from 200 per 1,000 to 31 per1,000. Infectious diseases, while still a se-rious problem in some parts of the coun-try, claim the lives of a mere 0.0004 per-cent of the population each year (8). Thedecrease in morbidity and mortality ratesassociated with infectious diseases inChina is a remarkable achievement for theworld’s most populous country. This de-cline can be attributed to an aggressive

campaign to improve primary health careand tackle infectious diseases (9).

However, over the coming decades, Chi-na’s deteriorating environment threatensto undermine the gains that rising in-comes would otherwise bring. China’srapid industrialization, urbanization, andeconomic growth are contributing to res-piratory diseases and chronic illnessessuch as cancer. Levels of particulate airpollution from energy and industrial pro-duction in several of China’s megacities,such as Shanghai and Shenyang, areamong the highest in the world, leading tocorresponding problems of lung diseasein their populations. Water pollution insome regions, such as in the Huai RiverValley, is also without parallel.

In 1996, the government annual report,State of the Environment, noted that envi-ronmental pollution was expanding intothe countryside, and that ecological de-struction was intensifying (10). Environ-mental problems are seriously affectingoverall social and economic developmentin the country. China Environment News, anational newspaper of the National Envi-ronmental Protection Agency (NEPA), re-ported that in recent years, economiccosts associated with ecological destruc-tion and environmental pollution havereached as high as 14 percent of the coun-try’s gross national product (GNP) (11).More recently, the World Bank estimatedthat air and water pollution cost Chinanearly 8 percent of its GNP, around US$54billion (12). Although solid scientific dataare lacking, the government has identifiedenvironmental factors as one of the fourleading factors influencing the morbidityand mortality of China’s people today (13).The importance of environmental factorsis well understood by some, as shown by a1994 opinion survey about risks. Respon-dents who hold science or engineering de-grees ranked risk from pollution ahead ofnatural disasters (14).

Responding to growing public concernsabout the environment, the Chinese Gov-ernment has officially named the environ-ment as one of its top priorities and hascommitted itself to reversing the trend ofenvironmental deterioration (15). Over the

past decade, China has increased environ-mental spending, adopted market incen-tives, strengthened lawmaking and en-forcement, and promoted nationwideenvironmental education. Decisions madein the next decade or two about energy,transportation, and agricultural technolo-gies will largely determine how successfulChina will be in achieving its goal of sus-tainable development.

This case study describes the initialfindings of an ongoing project betweenthe World Resources Institute (WRI) andthe Chinese Government to evaluate thelinks between environment and health inChina. The goal of this collaborative proj-ect is to develop information and indica-tors that will enable decisionmakers tomake informed choices about the envi-ronment, energy, infrastructure, and re-lated issues.

The first section of this profile focuseson air pollution trends and the impact ofair pollution on human health. Routinemonitoring of air pollution and good hos-pital and health records have enabled re-searchers to gain a fairly clear picture ofair pollution’s impact on human healthand what the future will hold if air pollu-tion continues to worsen. Water pollutionalso presents a major threat to publichealth, although data in this area are lesscomplete. Although data limitations pre-vent a comprehensive review, the secondsection reviews the most recent evidenceconcerning the extent of health problemsassociated with water pollution. The thirdsection reviews China’s laws and policiesto protect the environment and health.

Air Pollution and HealthEffects

POOR AMBIENT AIR QUALITYPREVAILS

“The residents of many of China’s largestcities are living under long-term, harmfulair quality conditions,” Zhao Weijun, dep-uty director of the air pollution depart-ment of NEPA, reported in 1997 in ChinaEnvironment News (16). China has longrecognized air pollution as a critical prob-

116 World Resources 1998–99

lem. Ambient concentrations of total sus-pended particulates (TSP) and sulfur di-oxide (SO2) are among the world’s highest.(See Figure China.1.) In 1995, more thanone half of the 88 cities monitored for SO2

were above the World Health Organization(WHO) guideline. All but two of the 87cities monitored for TSP far exceededWHO’s guideline. Some cities such as Tai-yuan and Lanzhou had SO2 levels almost10 times the WHO guideline (17).

Largely because of controls at powerplants and within households, particulateemissions have not risen as much asmight have been expected with the dou-bling of coal consumption. Overall, par-ticulate emissions in China have re-mained relatively level since the early1980s (18). In fact, in some large cities,ambient particulate concentrations havedecreased markedly since the 1980s (19).In contrast, SO2 emissions have roughlyparalleled the increase in coal consump-tion, reflecting heavy coal burning and in-adequate sulfur control measures.

Coal burning, the primary source ofChina’s high SO2 emissions, accounts formore than three quarters of the country’scommercial energy needs, compared with17 percent in Japan and a world average of27 percent (20). China’s consumption ofraw coal increased annually by 2 percentbetween 1989 and 1993 (21). (See FigureChina.2.) Meanwhile, SO2 emissions in-creased by more than 20 percent and TSPincreased by approximately 10 percent(22). The country is expected to burn 1.5billion metric tons of coal annually by theyear 2000, up from 0.99 billion metrictons in 1990 (23). Without even more dra-matic measures to control emissions thanare currently in place, the deterioration ofair quality seems inevitable.

Particulates and SO2 are the ambient airpollutants of greatest concern; both arebyproducts of coal combustion. While in-dustrial emissions of heavy metals andtoxics are also significant contributors toair pollution in China, they are not rou-tinely monitored and will not be ad-dressed in this section.

The extent and type of air pollution inChina vary dramatically by geographic re-

gion. SO2 and particulate emissions arehighest in the northern half of China,where coal is used to heat homes andother buildings for several months of theyear and where industrial centers also de-pend heavily on coal burning. Yet, air pol-lution in the North would be much worseif not for the higher quality, cleaner coalthat is available there. By contrast, thecoal mined in the South is high in sulfurand extremely polluting, contributing to

serious problems with acid precipitation,especially in the southwest provinces ofSichuan, Guizhou, Guangxi, and Hunan(24) (25).

Industry accounts for two thirds of Chi-na’s coal use—industrial boilers aloneconsume 30 percent of China’s coal. Theseboilers are usually highly inefficient andemit through low smoke stacks, contribut-ing to much of China’s ground-level airpollution, especially small particulates


Environmental Change and Human HealthR E G I O N A L P R O F I L E S : C H I N A

China’s Air Pollution Levels Are Among the World’s HighestFIGURE CHINA.1 Ambient Concentrations of Air Pollutants, 1995

Source: The World Bank, Clear Water, Blue Skies: China’s Environment in the New Century (The World Bank, Washington, D.C., 1997),Figure 1.1, p. 6.

China’s Growing Consumption of CoalFIGURE CHINA.2 Energy Demand in China, 1971–95

Source: International Energy Agency, Energy Statistics and Balances: Non-OECD Countries, 1971–1995, on diskette (Organisation forEconomic Co-Operation and Development, Paris, 1997).

and SO2. Inefficient and dirty boilers areparticularly problematic because many ofthe industries that use them are located indensely populated metropolitan areas,placing populations in these areas at highrisk of exposure. The residential sectoraccounts for approximately 15 percent oftotal coal use, yet is estimated to contrib-ute to more than 30 percent of urbanground-level air pollution (26)(27).

Although the energy and industrialsectors are now the biggest contributorsto urban air pollution in China, the trans-portation sector is becoming increasinglyimportant. The number of motor vehicleson China’s roads has tripled since 1984,climbing from less than 2.4 million in1984 to 9.4 million in 1994 (28). By 2020,the urban vehicle population is expectedto be 13 to 22 times greater than it is to-day (29). This trend will likely have a ma-jor influence on the future of China’s airquality. The shift toward vehicle use ismost apparent in China’s big cities. For ex-ample, from 1986 to 1996, the number ofvehicles in Beijing increased fourfold,from 260,000 to 1.1 million. Although thisis only one tenth of the number of vehi-cles in Tokyo or Los Angeles, the pollutiongenerated by Beijing motor vehiclesequals that in each of the two other cities(30).

The problem stems not just from thegrowing size of the vehicle fleet but alsofrom low emissions standards, poor roadinfrastructure, and outdated technology,which combine to make Chinese vehiclesamong the most polluting in the world

(31). Vehicle emissions standards in Chinaare equivalent to the standards of the de-veloped world during the 1970s, and somedomestic companies are manufacturingvehicles modeled after vehicles from 20years ago. Actual emissions often exceedthese standards: Chinese vehicles emit2.5 to 7.5 times more hydrocarbons, 2 to 7times more nitrous oxides (N2O), and 6 to12 times more carbon monoxide (CO)than foreign vehicles (32). In Beijing,Shanghai, Hangzhou, and Guangzhou, upto 70 percent of CO emissions have beenattributed to motor vehicles. Cars alsocontribute a large share of hydrocarbonsand N2O in the cities where data are avail-able (33). (See Table China.1.) As a result,although China’s vehicle fleet is smallcompared with the developed countries,its large cities are already blanketed withsmog.

A recent study in Beijing revealed thatat all monitoring points within the ThirdRing Road—a rough boundary separat-ing downtown Beijing and its out-skirts—the CO levels exceeded the na-tional standard (4 micrograms per cubicmeter per day). During the summer,ozone concentrations repeatedly exceededthe national standard, which is set on anhourly basis—often several times per day.In addition, concentrations of N2O havealmost doubled over the past decade (34).

Compounding these pollution prob-lems is the fact that the burgeoning Chi-nese motor vehicle fleet is largely fueledby leaded gasoline. Although lead expo-sure is known to be a significant health

hazard in China, no routine monitoring ofenvironmental concentrations or blood-lead levels is performed. A few studieshave been conducted and are describedbelow. These scanty data suggest that am-bient lead levels in the urban area of ma-jor cities such as Beijing are usually 1 to1.5 micrograms per cubic meter—the na-tional standard is 1 microgram per cubicmeter. In some areas, ambient lead levelscan reach as high as 14 to 25 microgramsper cubic meter (35). The health effects,described below, are significant, althoughrecent and dramatic government actionsto phase out leaded gasoline will likelyhave a major impact on this problem. Bei-jing and Shanghai as well as other citieshave already begun to act, and the coun-trywide phaseout is expected to be com-plete by the year 2000.

HEALTH EFFECTS FROM AMBIENTAND INDOOR AIR POLLUTION

Air pollution is thought to be one of theleading risk factors for respiratory dis-eases, such as chronic obstructive pulmo-nary disease (COPD), lung cancer, pulmo-nary heart disease, and bronchitis,diseases that are the leading causes ofdeath in China. The fact that men andwoman have similar rates of these dis-eases, despite women’s much lower smok-ing rates, provides evidence that this highdisease burden is related to pollution (36).

Although only a limited number of epi-demiologic studies have been conducted,air pollution has clearly contributed toboth excess mortality and morbidity inChina. At this stage, however, it is ex-tremely difficult to tease apart whichsources of air pollution have the greatestimpact on human health, indoor or out-door. In urban areas, there is a great dealof exchange between outdoor and indoorair, both of which are polluted from dif-ferent sources—indoor primarily fromthe burning of coal for cooking and heat-ing. Summaries of selected recent esti-mates of health impacts are presented toprovide a more complete understandingof the complex relationship between airpollution and human health.


Outdated Vehicles Degrade Urban Air QualityTABLE CHINA.1 Percentage of Emissions in Selected Chinese Cities Attributable to Motor Vehicles

PERCENTAGE ATTRIBUTABLE TO MOTOR VEHICLES

CARBON MONOXIDE HYDROCARBONS NITROUS OXIDES CATEGORIES

Beijing 48–64 60–74 10–22 DistrictShanghai 69 37 DistrictShenyang 27–38 45–53 DistrictJinan 28 4–6 DistrictHangzhou 24–70 RoadUrumqi 12–50 RoadGuangzhou 70 43

Source: He et al., “Status and Development of Vehicular Pollution in China,” Environmental Science, Vol. 7, No. 4 (August 1996).

Based on dose-response functions fromstudies conducted within China and inother countries, the World Bank has esti-mated the number of deaths and diseasesassociated with air pollution among ur-ban populations. Using the Chinese stan-dards as a benchmark, they estimate thenumber of deaths that could be preventedif air pollution were reduced to those lev-els. According to their calculations, ap-proximately 178,000 deaths, or 7 percentof all deaths in urban areas, could be pre-vented each year. Another measure of airpollution’s impact on health is thenumber of hospital admissions from res-piratory diseases. This study found346,000 hospitalizations associated withthe excess levels of air pollution in urbanareas. Table China.2 summarizes the esti-

mated health impact of both ambient andindoor air pollution in China (37).

In China, the effects of outdoor air pol-lution are compounded by those of indoorair pollution. Households using coal fordomestic cooking and heating are espe-cially at risk because coal emits very highlevels of indoor particulate matter lessthan 2.5 microns in size—the size be-lieved to be most hazardous to health.(These concentrations can be more than100 times the proposed U.S. ambient air24-hour standard.) Exposure to thesesmall-sized particles is especially harmfulbecause they persist in the environmentand reach deep into the lungs (38).

Indoor air pollution affects both urbanand rural populations. Nor is it simply aproblem indoors: numerous studies haveshown that intense indoor coal burningcan affect ambient air quality as well. Forinstance, rural neighborhoods are gener-ally unaffected by urban sources of airpollutants but can be extremely pollutedfrom the burning of coal indoors. TableChina.3 shows the extremely high levels ofparticulates in both rural and urban in-door environments (39). Indoor air pollu-tion causes as many health problems assmoking, with the effects concentratedamong women and children (40).

Although the proportion of China’shouseholds that burn polluting biomassfuels indoors for cooking and heating re-mains significant, it has been decliningwith the proliferation of alternative en-ergy sources. Largely as a result of gov-ernment investments, about one third ofurban Chinese now have access to gas forcooking, and coal-burning households areincreasingly turning to the use of cleaner,more efficient briquettes (41).

Perhaps the most compelling exampleof the health impact from indoor air pol-lution is the extremely high lung cancerrates among nonsmoking women in ruralXuan Wei County. Studies conducted bythe United States Environmental Protec-tion Agency (U.S. EPA) report that in thethree communes with the highest mortal-ity rates, the age-adjusted lung cancermortality rate between 1973 and 1979 was125.6 per 100,000 women, compared with

average rates of 3.2 and 6.3 for Chineseand U.S. women, respectively, for the sametime. Because surveys showed that virtu-ally no women (in the county) smoked to-bacco products, other sources of potentexposure must have contributed to thesetroubling rates. Analyses of indoor airand blood samples from the women indi-cate that fuel burning inside the homewas largely responsible for the lung can-cers. The U.S. EPA studies found a strongassociation between the existence of lungcancer in females and the duration oftime spent cooking food indoors. The lev-els of carcinogenic compounds present insmoky coal (a local type of coal thatsmokes copiously) were found to be muchhigher in the women who used smokycoal for cooking (42)(43).

Since the 1980s, a number of studiesexamining the relationship between am-bient air pollution and health effects inChina have been conducted. It is impor-tant to remember that although the stud-ies measured only ambient air pollutionlevels, in reality people are exposed to acombination of indoor and outdoor air.One of most definitive of these studies ex-amined the relationship between air pol-lution and mortality in two residential ar-eas of Beijing. According to this study, therisk of mortality was estimated to in-



Air Pollution’s TollTABLE CHINA.2 Estimates of Respiratory Damage ThatCould Be Avoided by Meeting Class 2 Air Quality Stan-dards in China

PROBLEMNUMBER OF

CASES AVERTED

Urban air pollutionPremature deaths 178,000Respiratory hospitaladmissions

346,000

Emergency room visits 6,779,000Lower respiratory infec-tions or child asthma

661,000

Asthma attacks 75,107,000Chronic bronchitis 1,762,000Respiratory symptoms 5,270,175,000Restricted activity days(years)

4,537,000

Indoor air pollutionPremature deaths 111,000Respiratory hospitaladmissions

220,000

Emergency room visits 4,310,000Lower respiratory infec-tions or child asthma

420,000

Asthma attacks 47,755Chronic bronchitis 1,121,000Respiratory symptoms 3,322,631,000Restricted activity days(years)

2,885,000

Source: The World Bank, Clear Water, Blue Skies: China’s Envi-ronment in the New Century (The World Bank, Washington,D.C., 1997), Table 2.1, p. 19.

Air Quality May Be Worse IndoorsTABLE CHINA.3 Indoor Particulate Air Pollution fromCoal Burning in China (Sample Studies)

PLACEURBAN/RURAL

PARTICULATES(micrograms per

cubic meter)

Shanghai Urban 500–1,000Beijing Urban 17–1,100a

Shenyang Urban 125–270Taiyuan Urban 300–1,000Harbin Urban 390–610a

Guangzhou Urban 460Chengde Urban 270–700a

Yunnan Rural 270–5,100Beijing Rural 400-1,300Jilin Rural 1,000–1,200a

Hebei Rural 1,900–2,500Inner Mongolia Rural 400–1,600a

Source: World Health Organization (WHO), Health and Envi-ronment in Sustainable Development: Five Years after the EarthSummit (WHO, Geneva, 1997), p. 86.

Note: a. Particles less than 10 micrometers in size.

crease by 11 percent with each doublingof SO2 concentration, and by 4 percentwith each doubling of TSP. When the spe-cific causes of mortality were examined,mortality from COPD increased 38 per-cent with a doubling of particulate levelsand 29 percent with doubling of SO2. Pul-monary heart disease mortality also in-creased significantly with higher pollu-tion levels. Levels of air pollutionmeasured often exceeded WHO guide-lines, particularly in winter when ambientair pollution was exacerbated by indoorfuel burning and climatic conditions. Yet,what was striking is that excess mortalitywas associated with pollutant levels belowWHO guidelines, suggesting that theguidelines cannot be perceived as a safelimit (44).

Respiratory diseases, hospitalization, ordoctor visits are often a more sensitivemeasure of the impact of air pollution onhuman health than mortality. One recentstudy confirmed that as concentrations ofSO2 and TSP rose in Beijing, so did visitsto the emergency room. This increase inunscheduled hospital visits occurred bothwhen air pollution levels were extremelyhigh (primarily in the winter) and whenthe levels were below WHO’s recom-mended guidelines, bolstering studies indeveloped countries that have shown ex-cess respiratory disease and mortality atlower doses (45). Although Beijing hasbeen the focus of many studies, it has nomonopoly on bad air. Chongqing, the larg-est and most recently declared autono-mous zone, has a higher concentration ofSO2 than any of China’s five other largestcities (46). A recent study found that sev-eral symptoms of compromised health,including reduced pulmonary functionand increased mortality, hospital admis-sions, and emergency room visits, werecorrelated with higher levels of air pollu-tion in Chongqing (47). A study conductedin another of China’s largest cities, Shen-yang, estimated total mortality increasedby 2 percent with each 100 microgramsper cubic meter increase in SO2 concentra-tion, and by 1 percent for each 100 micro-grams per cubic meter in TSP (48).

Respiratory diseases are not the onlyhealth impacts of concern associated withair pollution. Lead exposure, for instance,leads to neurological damage, particularlyin children. China has no comprehensivenational data on blood-lead levels, a reli-able biomarker of exposure, but somestudies show that blood-lead levels are farabove the threshold associated with im-paired intelligence, neurobehavioral de-velopment, and physical growth. (The U.S.standard is 10 micrograms per deciliter.)Between 65 and 100 percent of children inShanghai have blood-lead levels greaterthan 10 micrograms per deciliter. Thosein industrialized or congested areas hadlevels averaging between 21 and 67 decili-ters (49). In Shanghai, prenatal exposuresto lead from urban air were associatedwith adverse development in the childrenduring their first year of life (50).

Water Scarcity, WaterPollution, and HealthChina’s rapid economic growth, industri-alization, and urbanization—accompa-nied by inadequate infrastructure invest-ment and management capacity—haveall contributed to widespread problems ofwater scarcity and water pollutionthroughout the country. China has someof the most extreme water shortages inthe world. Of the 640 major cities inChina, more than 300 face water short-ages, with 100 facing severe scarcities (51).As discharges of both domestic and in-dustrial effluents have increased, cleanwater has become increasingly scarce. Theimpact of China’s dual problem of waterscarcity and water pollution exacts acostly toll on productivity. Water short-ages in cities cause a loss of an estimated120 billion yuan (US$11.2 billion) in in-dustrial output each year. The impact ofwater pollution on human health has beenvalued at approximately 41.73 billionyuan per year (US$3.9 billion), which isalmost certainly an underestimate (52).Although Chinese decisionmakers are in-creasingly concerned about the damagesassociated with water pollution, years ofneglect and a lack of funding for research

have resulted in limited data on water pol-lution and even fewer epidemiologic stud-ies on the links between water pollutionand human health effects.

China has a total of 2,800 billion cubicmeters of annually renewed fresh water;the world’s most populous country isfourth in the world in terms of total waterresources (53). Considering per capita wa-ter resources, China has the second lowestper capita water resources in the world,less than one third the world average.Northern China is especially water-poor,with only 750 cubic meters per capita; thisgeographic region has one fifth the percapita water resources of southern Chinaand just 10 percent of the world average(54).

The distribution of groundwater issimilarly skewed: average groundwater re-sources in the South are more than fourtimes greater than in the North. Dramaticshifts in annual and monthly precipita-tion cause floods and droughts, whichfurther threaten economic growth.

As surface water quality has worsened,the Chinese have increased their extrac-tion of groundwater to meet water de-mand. As a result, overextraction ofgroundwater has become a serious prob-lem in a number of cities including Nan-jing, Taiyuan, Shijiazhuang, and Xi’an.Groundwater depletion is most problem-atic in coastal cities, including Dalian,Qingdao, Yantai, and Beihai, where saltwa-ter intrusion is on the rise (55). Althoughthere is no comprehensive monitoring ofChina’s groundwater, studies suggest thatgroundwater quality, not just quantity, isseverely threatened in many regions. Ac-cording to one estimate, one half thegroundwater in Chinese cities has beencontaminated (56).

INDUSTRIAL AND MUNICIPALWASTEWATER THREATENS CHINA’SWATER QUALITY

Each year, large amounts of pollutants aredumped into China’s water bodies frommunicipal, industrial, and agriculturalsources. China is the world’s largest con-sumer of synthetic nitrogen fertilizers(57). As a result of these activities, pollu-


tion is widespread in China’s rivers, lakes,and reservoirs. Except for some inlandrivers and large reservoirs, water pollu-tion trends in China have worsened in re-cent years, with the pollution adjacent toindustrially developed cities and townsbeing particularly severe (58).

Some of the major threats to waterquality stem from inadequate treatmentof both municipal and industrial waste-water. In 1995, China discharged a total of37.29 billion cubic tons of wastewater, notincluding wastewater from township-and-village enterprises (TVEs), into lakes,rivers, and reservoirs. Approximately 60percent was released from industrialsources, the rest from municipal. Withonly 77 percent of industrial wastewaterreceiving any treatment in 1995, nearlyone half of the industrial wastewater dis-charged failed to meet government stan-dards (59). Industrial discharges usuallycontain a range of toxic pollutants includ-ing petroleum, cyanide, arsenic, solvents,and heavy metals (60).

Although the amount of wastewaterdischarged from regulated industries hasleveled off since the early 1990s, dis-charges from TVEs and municipalsources have increased rapidly (61). Theincrease from TVEs can be traced to therising proportion of total industrial out-put from these enterprises and to a lack ofpollution control over these enterprisesbecause of their widely scattered geo-graphical distribution. In addition, localauthorities are reluctant to tighten controlover pollution when pursuit of economicbenefits is their first goal.

Treatment of municipal sewage lags farbehind that of industrial wastewater. In1995, China had only 100 modern waste-water treatment plants (62). Beijing hadonly one secondary sewage treatmentplant, with a capacity of 500,000 metrictons, which cannot keep pace with the in-creasing amounts of sewage in the city(63). Treatment should improve rapidly,however, following the amendment of theWater Pollution Prevention and ControlLaw (64), which set more restrictive regu-lations, as well as a recent government de-

cision requiring all cities with a popula-tion of more than 500,000 to have at leastone sewage treatment plant (65).

Water bodies near urban areas are gen-erally the most severely polluted, and thesituation is deteriorating. Many urbansections of rivers are polluted by toxic andeven carcinogenic compounds, such as ar-senic. Although most Chinese attempt toprotect themselves from bad water byboiling it, boiling does not affect many ofthe toxins.

Biological contamination remains aproblem as well. Indeed, fecal coliform,mostly from sewage, has become the mostchallenging drinking water pollutant inthe country. In 1994, 54 out of 134 riverstested did not meet Grade 4 and 5 surfacewater standards, indicating that the waterwas deemed unsuitable for even indus-trial or agricultural use. About 90 percentof the sections of rivers around urban ar-eas were found to be seriously polluted.Because heavy industry is concentrated innorthern China, the major river systemsin the North are more heavily pollutedthan those in the South (66). (See FigureChina.3.)

HEALTH IMPLICATIONS

Access to Safe Drinking Water is Key toProtecting Public Health

The health of China’s people depends, to agreat extent, on the quantity and qualityof its drinking water supply. Drinking wa-ter quality is largely determined bysources of incoming water, modes of wa-ter supply, and the level of water treat-ment. The majority of Chinese urban andsome suburban residents now have accessto tap water, while the largest portion ofthe rural population still relies on hand-or motor-pumped wells, or they fetch wa-ter directly from rivers, lakes, ponds, orwells, with little or no treatment at all.Large rivers are the most common sourceof urban drinking water, as well as themajor source for rural residents in manyparts of the country.

In only 6 of China’s 27 largest citiesdoes drinking water quality meet statestandards, according to one recent study.

Groundwater did not meet state standardsin 23 of these cities (67). The problem ismore pronounced in rural China. In somerural areas, the fecal coliform in thedrinking water supply exceeds the maxi-mum level by as much as 86 percent; intowns and small cities, the rate is about 28percent. Currently, around 700 million peo-ple in China drink water that fails to meetstate standards for fecal coliform (68).

Over the past decade, the governmenthas launched a major initiative to improveaccess to safe drinking water in rural ar-eas. From 1991 to 1995, the governmentspent 14.45 billion yuan (US$1.35 billion)to improve the drinking water supply inrural regions (69). Although the ruralpopulation with access to tap water morethan doubled between 1987 and 1995,when it reached 47 percent, more than onehalf of those people still drank water thatfailed to meet safety standards (70).

Infectious Diseases Associated with PoorWater Quality

Despite an overall decline in mortalityfrom infectious diseases in China, thepopulation still suffers from a number ofdiseases associated with inadequatedrinking water quality and sanitation. For



Polluted RiversFIGURE CHINA.3 Water Quality Is Low at 135Monitored Urban River Sections, 1995

Source: The World Bank, Clear Water, Blue Skies: China’s Envi-ronment in the New Century (The World Bank, Washington,D.C., 1997), p. 14.Note: Grades 4 and 5 are deemed unsuitable for direct hu-man contact.

the past two decades, diarrheal diseasesand viral hepatitis, both diseases associ-ated with fecal pollution, have been thetwo leading infectious diseases in China.In 1995, the incidence of hepatitis was 63per 100,000, a 46 percent decrease from1991. After a sharp drop from 1991 and1992, the incidence of dysentery has risensince 1994, in part because of the deterio-ration of water quality. A sudden upswingin the incidence of typhoid fever in 1991and a large outbreak in some provinces in1992 were also partly attributed to thepoor drinking water quality in rural ar-eas. In 1991, typhoid fever incidencereached as high as 10.6 per 100,000. Al-though the incidence of waterborne dis-eases is still high compared with manyother countries, effective medical care haskept mortality low, averaging less than 0.1per 100,000 (71).

It is more difficult to establish the im-pacts of industrial and chemical waterpollution on human health than pollutionby human waste. However, recent epide-miological studies suggest that exposureto organic and inorganic chemicals indrinking water may significantly contrib-ute to chronic disease. Liver and stomachcancers are the leading causes of cancermortality in rural China. Many studies inChina and abroad have shown a strong as-sociation between drinking water pollu-tion and cancer incidence and mortality.An example is a study conducted in Luji-ang County, Anhui Province, where mor-tality rates for stomach and liver cancerswere associated with the high levels of in-organic substances in surface water (72).Although diet and alcohol consumptionmay play some role in the increases ofthese cancers, environmental causes can-not be dismissed (73). Since the 1970s,deaths from liver cancer have dou-bled—China now has the highest livercancer death rate in the world (74).

In southern China, where some of thepopulation has long depended on pondsfor drinking water, the rates of digestive-system cancers are very high. An investi-gation of 560,000 people in 23 villagesand towns showed that between 1987 and1989, cancer mortality was 172 per

100,000, which is much greater than theaverage mortality rates in rural China (75).Gastric, esophageal, and liver cancers ac-counted for 85 percent of all cancers.Other studies reported that the high inci-dence of liver cancer in Jiangsu’s Qidongand Guangxi’s Fushun regions is highlycorrelated with drinking water pollution(76)(77). Further research is needed to con-firm this link and identify the specificpollutants at fault.

Impact of Wastewater Irrigation on Health

Irrigation with wastewater has been acommon practice in many parts of Chinathroughout its 2,000-year-old agriculturalhistory. In the past several decades, how-ever, the age-old practice of using nightsoil has been supplemented by the use ofindustrial wastewater as well, leading toproblems with both biological and chemi-cal contaminants. Irrigation with indus-trial wastes is especially common in thenorthern regions, where water is scarce.Pollutants, including some organic pollut-ants, heavy metals, and carcinogens, enterthe food chain in the irrigation processand can affect human health.

Numerous studies since the 1970s haveshown significant increases in cancerrates and deaths, as well as birth defects,in areas that rely on wastewater for irriga-tion. For example, research in Shenyangand Fushun showed that the incidence ofintestinal infections and enlargement ofthe liver was, respectively, 49 percent and36 percent higher in the irrigated areasthan in the control area. There were twiceas many cancer patients in the sewage-irrigated area. In Fushun, in LiaoningProvince, more than 13,000 hectares offarmland are irrigated with water pol-luted with oil. The adjusted rate of malig-nant tumor mortality was almost twicethat of the control area, and the incidenceof congenital malformation was doublethe rate in the control area (78). Althoughthese associations raise alarms, they donot prove that wastewater is to blame.

Township-and-Village Enterprises:Lack of Regulation Poses Major Threat toHealth and Environment

The rapid development of TVEs will havean enormous impact on China’s waterquality in the coming years. Althoughtheir development can be traced back tothe late 1950s, these enterprises boomedin the past 10 years. The economic successof the TVEs has reduced poverty for mil-lions of farmers, but they have also in-flicted severe damage on the environmentin rural China. Even though the ChineseGovernment has enacted a number oflaws and policies to control and regulateindustrial discharges (79), the governmenthas not yet effectively regulated TVEs (80).

By 1995, more than 7 million TVEs ex-isted throughout China, with a total out-put of 5.126 trillion yuan (US$671 bil-lion), accounting for 56 percent of thetotal industrial GDP—considerably morethan the contribution of state-owned en-terprises. The number of TVEs is ex-pected to continue to grow. A conservativeestimate holds that the TVEs dischargemore than half of all industrial wastewa-ter in China—more than 10 billion metrictons. Most TVEs have no wastewater orhazardous waste treatment facilities, andsince TVEs are widely scattered acrossvast rural areas, wastes from TVEs havethe potential to affect the health of manypeople (81).

A 1989–1991 investigation of the 10leading TVE industries in seven provincesand municipalities showed that industrialwastes were discharged without any treat-ment and control. An analysis of thehealth of 860,000 people in the area re-vealed that the incidence rate of chronicdiseases was between 12 and 29 percent,much higher than the national average forrural areas, which is approximately 9 per-cent. The total mortality in polluted areasaveraged 4.7 per 1,000, higher than the av-erage 3.6 in the control area. Life expec-tancy in the polluted areas was 2 yearslower than in the control area. Althoughnot definitive, evidence suggests that in-dustrial pollution from TVEs could be-come a major threat to human health inChina (82).


Laws and Policies toProtect the Environmentand HealthChina’s achievements in health and lifeexpectancy over the past four decadeshave far exceeded what could be expectedfor a country at its stage of economic de-velopment, according to a recent WorldBank evaluation. Behind these dramaticgains in public health was an extraordi-nary campaign for the Chinese peoplecarried out by the central government,which provided family planning, child-hood immunization, accessible primaryhealth care (particularly for mothers andchildren), improved nutrition, infectiousdisease control, better education, and im-provements in housing and sanitation.(See Table China.4.) Morbidity and mor-tality from infectious diseases continue todecline on average in most areas of China,although in remote and poor regions, thelevels of communicable disease remainmuch higher than the national averages.The overall success of these programs canbe attributed to the central government’sapproach of adopting the best of tradi-tional methods and wedding these withmodern methods. For instance, a cam-paign to eradicate major public healthscourges, such as diphtheria and syphilis,succeeded in large part because it in-volved vast numbers of traditional doc-tors in the rural areas (83).

Along with rising income and improvedliteracy rates, the era of reform hasbrought more environmental awarenessto the Chinese people. A few recent stud-ies in China showed that as communitieshave become wealthier and better edu-cated, the public has begun to push forstronger regulations and enforcement (84).The increase in media coverage of pollu-tion accidents has contributed to the pub-lic’s awareness. A popular saying in Chi-na’s developed eastern region is, “Thehouse is new, the money is enough, butthe water is foul and the life is short” (85).

How will China set priorities to preventenvironmental exposures and protectpublic health? Although the governmenthas already begun to address particulate

and SO2 emissions, much remains to bedone. While regulatory standards willlikely reduce emissions from power plantsand state-regulated industries, smallerresidential sources and TVE industrieswill continue to threaten air quality. Resi-dential coal burning for cooking andheating will continue to be a major sourceof exposure until there is more universaladoption of cleaner fuels. Even though thegovernment has focused some attentionon mobile source pollution, it will be adifficult problem to address, given therapid expansion of the fleet of vehicles.

ENVIRONMENTAL LAWS ANDREGULATIONS

Since the promulgation of the Environ-mental Protection Law in 1979, the first ofits kind in China, 5 pollution-control stat-utes and 10 natural resource conservationstatutes have been enacted. The Environ-mental Protection and Natural ResourcesConservation Committee of the NationalPeople’s Congress, the lawmaking arm,submitted a 5-Year Legislative Plan to theNational People’s Congress in 1993. Ac-cording to the plan, approximately 7 keyenvironment and natural resource stat-utes will be created or amended by 1998,and more than 17 such statutes will becreated or amended by the end of thiscentury. The United States, by compari-son, has passed approximately 21 majorenvironmental acts in the last four dec-ades.

The Energy Conservation Law waspassed on November 1, 1997, and came

into force on January 1, 1998. The scope ofthis law extends to energy from coal,crude oil, natural gas, electric power, coke,coal gas, thermal power, biomass power,and other energy sources. This law may bethe harbinger of strengthened efforts bythe Chinese Government to prohibit cer-tain new industrial projects that seriouslywaste energy and employ outmoded tech-nologies.

Despite the complex system of legisla-tive and policy tools in place and the net-work of environmental officials through-out China, compliance with environ-mental regulations remains low, essen-tially because economic development re-mains the country’s priority at all levels ofsociety.

As part of its efforts to strengthen envi-ronmental law enforcement, the govern-ment revised its criminal code to punishviolations against the environment andresources. This step may provide law en-forcement agencies with some power.However, the vagueness of standards inmany laws and regulations, coupled withthe lack of a comprehensive enforcementregime, has led to a situation where manyenvironmental laws still reflect deals cutbetween the local environmental protec-tion agencies, NEPA, other ministries, lo-cal government bodies, and the pollutingenterprises. Thus, the degree of actualcompliance and enforcement depends onthe region concerned and the personali-ties involved. Often, the richer the poten-tial investor, the more strictly environ-mental policy will be applied (86).



Most Chinese Have Safe Water and SanitationTABLE CHINA.4 Access to Safe Drinking Water and Sanitation Among Selected Countries in Asia, 1990

PERCENTAGE OF THE POPULATION WITH ACCESS TO

SAFE DRINKING WATER SANITATION a

COUNTRY URBAN RURAL TOTAL URBAN RURAL TOTAL

China 87 68 72 100 81 85India 86 69 73 44 3 14Indonesia 35 33 34 79 30 45Sri Lanka 80 55 60 68 45 50Japan 100 85 96 100 100 100

Source: The World Bank, Clear Water, Blue Skies: China’s Environment in the New Century (The World Bank, Washington, D.C., 1997),Table 2.2, p. 20.

Notes: a. Assumes that residents have access to water for washing and that sewage is removed from the house through outdoorlatrines, night-soil collection systems, or flush toilets.

For the next decade or so, China’s rapiddevelopment will likely lead to further un-certainty in the regulatory regime. In themeantime, an increasing array of re-sources are being devoted to enforcement,and discussions are currently underwayto elevate NEPA to ministerial status,which may give NEPA more leverage andauthority in law enforcement. Nonethe-less, many Chinese officials adamantlyhold that economic development mustcome before environmental protection.They also disagree about how stringentenvironmental initiatives need to be toprotect the health of billions of citizenswhile maintaining economic growth. Thisinternal struggle enhances the paradoxi-cal quality of Chinese environmental law,which may at once appear both simpleand complex, or lenient and severe (87).

USING ECONOMIC INSTRUMENTS—HARNESSING THE MARKET

In its transition from a command to amarket economy, China is trying to har-ness the market to work for the environ-ment rather than against it. Continuedand accelerated economic reform is a pre-requisite to reorient state enterprises sothat they respond to environmental pen-alties. Liberating international trade willgive Chinese industry access to the latestenvironmental technology. The develop-ment of capital markets is necessary toprovide financing to firms and munici-palities supplying environmental infra-structure. Adjustments of the pricing sys-tem are needed to ensure that it reflectstrue environmental costs.

Despite the fact that China is resource-poor, it prices its energy and water farlower than the actual costs. However, greatstrides are being made to rectify this situa-tion. Over the past 3 years, the governmenthas raised and partly deregulated coalprices; in most areas, coal prices now coverthe costs of production and delivery. In ad-dition, many cities and provinces are cur-rently preparing to increase sewage andwater charges to consumers and industries.In Taiyuan of Shanxi Province, for instance,the price bureau has announced that waterprices will quadruple over the next 5 years

in order to recover supply costs (88).Shanghai recently increased tap waterprices by between 25 and 40 percent tofund water quality improvement pro-grams and to make sewage self-financing.Guangzhou and Chongqing are eager todo the same (89).

The increasing market orientation ofthe industrial sector offers an opportu-nity to use market-based pollution con-trols more effectively. Achieving pollutioncontrol objectives will require increasingpollution charges. NEPA has proposed a10-fold increase in the air pollution levy;this increase would go a long way towardreducing air pollutant emissions. Higherlevies are needed both to lower currentemissions and to finance the large invest-ment required to achieve desired ambientair quality in Chinese cities. Currently, thepollution levies are assessed only on dis-charges that exceed the standard; in otherwords, emissions cost the polluter noth-ing until the standards are breached.Moreover, effluent charges are based onthe pollutant that exceeds the standard bythe greatest amount and do not reflect therisks posed by other pollutants. TheWorld Bank has been working with NEPAto overcome these shortcomings. Thesetwo organizations are developing a systemthat incorporates both maximum dis-charge rates for all pollutants as well asincentives to encourage emissions at lev-els below the maximum allowed (90).

INCREASING ENVIRONMENTALINVESTMENT

Environmental protection demands morespending. The Chinese Government hasattributed the continued deterioration ofthe environment largely to lack of fund-ing. Despite extremely ambitious 5-yearplans to control environmental pollutionin the past, insufficient investment hasprevented realization of these goals. Nowin its Ninth 5-Year Plan period, the gov-ernment has adopted the Trans-CenturyGreen Plan, which sets targets for envi-ronmental protection for the year 2010. Inconjunction with other environmentalprotection plans, NEPA is striving to sta-bilize the emissions of several pollutants

at 1995 levels by the year 2000. The per-centage of SO2, particulates, untreatedsewage, and heavy metals sewage treatedwould be increased from its current 19percent to 25 percent, and treatment of in-dustrial wastewater would be expandedby about 70 million metric tons. This am-bitious plan, which NEPA estimates willcost 450 billion yuan (1.3 percent of Chi-na’s GNP) to achieve, accords top priorityto certain areas, especially along the eastcoast and in some parts of its inner land:the Hai, Huai, and Liao rivers; the Chao,Dianchi, and Tai lakes; and two areas insouthwest China with pronounced prob-lems with SO2 levels and acid rain (91).

Industries and local governments areincreasingly looking for new sources offunding, through the “polluter pays” prin-ciple, urban environmental infrastructurefunds, and even bank loans. The centralgovernment is playing a more supportiverole in seeking loans and foreign invest-ment and implementing economic poli-cies. The government intends to increasethe proportion of GNP spent on control-ling pollution from the current 0.8 per-cent to more than 1 percent at the turn ofthe century, or approximately 188 billionyuan (US$17.5 billion) (92). Some citiesare investing in an even higher propor-tion. For instance, Beijing, Shanghai, andXiamen have decided to allocate up to 3percent of their GDP to pollution control.Tianjin will set aside up to 2 percent (93).In the meantime, China also hopes thatforeign investment will continue to pro-vide funds supporting its ambitious plansto address pollution. A recent World Bankreport noted that investing about 1 per-cent of GDP each year gradually rising to2.5 percent over the next 25 years—di-vided roughly equally between air andwater investment—would greatly reducepollution in China by 2020 (94). The reportalso noted that the operating and the av-erage investment costs each year of such aprogram would gradually rise to about 2.5percent of GDP by the end of the period.According to the World Bank, the benefitsof these measures exceed the costs bylarge margins, and these measures are es-


sential if China is to redirect its develop-ment toward a more sustainable path.

Changhua Wu, Michelle Gottlieb, and Devra Davis,Health, Environment, and Development Program,World Resources Institute, Washington, D.C.

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