HOW TO USE THIS VOLUME

This volume is intended for use by staff from various agencies involved with economic develop-
ment and are divided into different parts for different audiences. The guidelines are intended to
fill a void in the literature by bridging gaps—in particular, gaps between environmental assess-
ments, which are supported by a vast literature, and health assessments, which is only in a nascent
state and by providing background on the set of environmental health problems associated with
various sectors. The guidelines cover six broad sectoral areas, stressing the environmental health
dimensions of each:
    •   Agriculture and rural development               •    Industry
    •   Energy                                          •    Infrastructure
    •   Environment                                     •    Multisectoral global issues
    •   Health
The guidelines can help prioritize investments by:

    •   Defining realistic expectations of projects to improve health, given the myriad of factors
        at play and the time it takes to improve health
    •   Identifying areas in which piggybacking of resources can lead to broader health impacts
        than would otherwise be possible and multisectoral links can be forged based on institu-
        tional complementarity
    •   Illustrating that health is not merely a sector for investments, but also a goal of the entire
        process of sustainable development.

Part 1: Harmonizing Sectoral Priorities
Intended for policymakers and practitioners alike, part 1 of this volume explains the foundations
of environmental health and proposes a new approach that taps health benefits systematically out-
side the health sector through multisectoral collaboration. Chapter 1 details the differences and
challenges of environmental health in developing countries. The new approach introduced in
chapter 2 addresses these challenges by harmonizing sectoral approaches through targeted col-
laboration and partnerships to maximize health benefits outside the health sector. Chapter 3 as-
serts that environmental health measures can target a greater share of the burden of disease as the
health sector, that is, roughly 20 percent for a fraction of the cost of health sector interventions.
Chapters 4 through 6 compare and contrast six alternatives to making sound decisions, devising
entry points, and establishing mutual benefits from targeted collaboration.

Part 2: Environmental Health Assessment Guidelines
Intended for Bank Task Managers and practitioners in the field, part 2 of this volume provides
basic tools to identify, prioritize, and propose remedial measures for many multisectoral health
problems, many of which could and do otherwise fall between the cracks in single sector projects.
Chapter 7 provides basic environmental health background pertinent to all sectors covered in part
2. Chapters 8–14 provide guidance on environmental health linkages within and among sectors,
which are summarized in a checklist at the end of each chapter. This edition of Environmental
Health: Bridging the Gaps focuses particular attention on cross-sectoral linkages with infrastruc-
ture interventions between the agriculture and rural development sector (chapter 8) and the infra-
structure sector (chapter 13). The other chapters briefly review linkages in the energy (chapter 9),
environment (chapter 10), health (chapter 11), and industry (chapter 12) sectors and with global

issues, that is, those that affect the planet as a whole (chapter 14), because many of the issues
have already been addressed in chapters 7, 8, and 13.

Part 3: Putting Theory into Practice
Chapters 15, 16, and 17 summarize the findings and present background material from a work-
shop in Ghana, “Targeted Collaboration among Line Agencies, Local Communities and the Min-
istry of Health,” putting into practice the ideas of parts 1 and 2. Innovations included a multisec-
toral environmental health needs assessment, as well as suggestions for remedial measures. The
summaries can be useful for policymakers and the details, process, and recommendations can be
useful for practitioners in the field. Annex A provides a rapid checklist on environmental health
for practitioners and task managers. Annex B provides one-page summaries of about twenty ma-
jor diseases (description, transmission, and intervention).

A glossary and bibliography of resources available on environmental health and other forms of
assessments may be found among other back matter for the volume.

Exclusions to this Volume
This volume does not deal with the several important issues described below.

Individual industries. Pertinent environmental health issues are generally dealt with under the
overall general best practice for “occupational health and safety.” These practices are amply cov-
ered in the literature and materials are readily available, for example, Pollution Prevention and
Abatement Handbook 1998: Toward Cleaner Production (World Bank 1998 * ). In general, how-
ever, occupational health and safety guidelines tend to focus on the workspace itself and in-house
employees and do not cover residential areas surrounding individual plants or industrial zones.
This leaves an important gap in coverage by such guidelines.

Nutrition. Nutrition is dealt with only indirectly in three sets of linkages: (a) pesticide and fertil-
izer use in food production, (b) deficiencies of sanitation that contribute to diarrheas and anemia,
and (c) the broad housing environment with respiratory diseases in infants and children. In addi-
tion, the debate over meat (animal fat) is a new and rapidly evolving field that cannot be dealt
with adequately in this volume. The debate revolves around the notion that production of meat for
human consumption is not the least-cost solution to meet increasing global nutritional needs. (It is
far less efficient to produce grains for animal food than grain for direct human consumption, and
diets high in animal fat can be unhealthy.)

Genetic engineering. Research is evolving so rapidly, much of it highly controversial, that it is
difficult for this volume to make practical recommendations.

Mental health. According to the World Health Organization (WHO), mental health problems are
on the rise and constitute an increasing share of the burden of disease. This volume only calls at-
tention to the existence of such problems in the context of rural to urban migrations, but do not
propose remedial measures.

Disasters. Pertinent material can be found through the Bank’s “Disaster Management Facility,”
which concentrates on prevention and mitigation of the effects of disasters. (The extreme degra-
dation created by warfare, especially the plight of refugees, is beyond the scope of this volume,
especially because the Bank is not a relief agency.) This volume could, however, be appropriate

    Web site address: <> (accessed September 2000).

in projects that deal with (a) reconstruction in the aftermath or provision of basic infrastructure
for displaced persons and (b) efforts to derive economic estimates of health damages, which now
tend to report and valuate property damage, but only cite death rates.

Nuclear energy. The Bank does not lend for nuclear energy, except in selected cases that might
involve mitigating measures for cleanup or reduction of hazards.

Formal education. Although training is considered essential in this volume, they do not address
proposals for adapting curricula in formal education. A proper understanding of environmental
health, especially long-term and indirect effects, should eventually be incorporated into primary,
secondary, and university education.

                                 ACRONYM LIST

AGETIP   Agence d’Exécution des Travaux d’Intérêt Public
AIDS     Acquired immunodeficiency syndrome
APOC     African Programme for Onchocerciasis Control
BOD      Biological oxygen demand
BOD      Burden of disease
BP       Bank Procedure
CAS      Country assistance strategy
CBO      Community-based organization
CDF      Comprehensive development framework
CFC      Chlorofluorocarbon
COD      Chemical oxygen demand
DALY     Disability-adjusted life year
DDT      Dichlorodiphenyltrichloroethane
EA       Environmental assessment
EHA      Environmental health assessment
EHP      Environmental health profile
EMP      Environmental management plan
ENSO     El Niño Southern Oscillation
EPA      U.S. Environmental Protection Agency
EU       European Union
GIS      Geographic information system
GP       Good Practice
GWh      Gigawatt hour
HA       Health assessment
HIA      Health impact assessment
HIPC     Heavily indebted poor countries
HIV      Human immunodeficiency virus
IBRD     International Bank for Reconstruction and Development
IDA      International Development Agency
IDWSSD   International Drinking Water Supply and Sanitation Decade
IFC      International Finance Corporation
IMF      International Monetary Fund
IMO      International Maritime Organization
IPCC     International Panel on Climate Change
IPCS     International Programme on Chemical Safety
IPM      Integrated pest management
LEAP     Local environmental action plan
LPG      Liquefied petroleum gas
MARPOL   International Convention for the Prevention of Pollution from Ships
MIGA     Multilateral Investment Guarantees Agency
MLGRD    Ministry of Local Government and Rural Development
MOA      Ministry of Agriculture
MOH      Ministry of Health
NEAP     National environmental action plan
NEHAP    National environmental health action plan
NGO      Nongovernmental organization
OECD     Organisation for Economic Cooperation and Development
O&M      Operations and maintenance
OCP      Onchocerciasis Control Programme
OP       Operational Policies
ORT      Oral rehydration therapy
PA       Poverty assessment

PAH     Polychromatic hydrocarbon
PAHO    Pan-American Health Organization
PER     Public expenditures review
PM      Particulate matter
POP     Persistent organic pollutant
ppb     Parts per billion
ppm     Parts per million
PPS     Public -private sectors and stakeholders
PRSP    Poverty reduction strategy paper
QALY    Quality-adjusted life year
SA      Social assessment
SAEMA   Shama -Ahanta East Metropolitan Area
SAL     Structural Adjustment Lending
SDC     Swiss Development Corporation
SIA     Social impact assessment
SIDA    Swedish International Development Cooperation Agency
SPM     Suspended particulate matter
SSA     Sub-Saharan Africa
STD     Sexually transmitted disease
TB      Tuberculosis
TOR     Terms of reference
TOR     Tema OH Refinery
TPM     Total particulate matter
TSP     Total suspended particulate
UESP    Urban Environ mental Sanitation Project
UNEP    United Nations Environment Programme
VIP     Ventilated improved pit
VOC     Volatile organic compound
VRD     Vector-related disease
WHO     World Health Organization


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