Health and the
Environment: Integrating health concerns in National Sustainable Development
Dr Alex Andjaparidze
World Health Organisation
(WHO) Representative, East Timor
"Human beings are at the centre of concerns
for sustainable development. They are
entitled to a healthy and productive life in harmony with nature."
- Earth Summit 1992 Rio Declaration.
Health prospects anywhere in the world depend on
sustainable development of our natural and social environment. Health cannot be
separated from a myriad of environmental elements as diverse as air and fresh
water, poverty and living conditions, sanitation, chemicals, diseases vectors,
over consumption, under development, technology and trade.
Attaining the goal of healthy people in healthy
environments requires far more than the application of medical technology or
even the total efforts of the health sector working alone.
Integrated efforts by all sectors, organisations,
individuals and communities are required to make socio-economic development
sustainable and humane, ensuring a sound environmental basis for health.
Like all living beings, humans depend on their
environment to meet health and survival needs.
Human health suffers
when the environment no longer meets human needs, for sufficient and safe
supply of food, water, sanitation and shelter, due to inadequate or poor
distribution of resources.
Health suffers when people are exposed to hostile
environmental agents such as microorganisms, toxins, armed enemies, or drunken
drivers.
Human health is essential for sustainable development.
Without health, human beings would be unable to engage in development, combat
poverty and care for their environment. In turn, care of the environment is
essential for human welfare and the development process. A healthy environment leads
to a healthy population, as seen by the fact that an unhealthy environment
leads to many environmentally related diseases and health problems.
In East Timor in 2000, the curative institutions -
international NGOs and the military medical team of INTERFET - provided more
than 690,000 consultations and curative interventions to the population. Poor
environmental quality is directly responsible for around 70% of all preventable
ill health in East Timor, with respiratory infections, diarrhoeal diseases and
malaria heading the list. Acute respiratory infections among adults and
children account for approximately 35% of total consultations and curative
interventions; diarrhoeal diseases 30%; and suspected malaria 18% of total
consultations. Furthermore, the outbreaks of dengue haemorrhagic fever,
Japanese encephalitis and cases of filariases and visceral leishmaniasis which
are vector born diseases are not uncommon in many parts of East Timor. It is
estimated that 80% of children in East Timor have intestinal parasitic
infections, which are also closely associated with the environment,
particularly with poor sanitation.
The three main causes of
death and disability in East Timor are; 1) diarrhoeal diseases due largely to
contaminated food and water and lack of sanitation, 2) respiratory diseases
particularly tuberculosis and pneumonia caused often by crowded unhealthy
living conditions and 3) deadly malaria due to inadequate drainage and mosquito
control.
Mortality in East Timor is
contributed to by other mosquito borne diseases like dengue haemorrhagic fever
and Japanese encephalitis, as well as by non-communicable diseases, chronic
diseases, injuries from road traffic accidents and other conditions.
Let
us look into the current environmental conditions in Dili. A rough estimate of the population of Dili
is 120,000, which constitutes approximately 20% of the total population of East
Timor. In Dili, little attention has
been given to environmental issues in the post-crisis period, as major
attention has been focused only on emergency and rehabilitation needs. Dili does not have any kind of sewerage
system for wastewater treatment. The wastewater management practices in Dili
consist of on site disposal facilities either with pit latrines or with septic
tanks. The effluent from the concentrated pit latrines usually finds its way to
the shallow groundwater, and the effluent overflow from septic tanks
contaminates surface water drains. The existing latrines and septic tanks in
the absence of a sewerage system, pollute the water coming from dug wells and
shallow tub wells as well as polluting drain water. The high underground water table in the lower lying parts of Dili
obstructs the sub-surface infiltration of wastewater and this situation becomes
even worse during the wet season. Existing water supply service pipelines
(catering to approximately 50% of population of the city) are quite often
situated inside the road drains indicating the possibility of drain water getting into the leaking pipes.
The
existing water and sanitation situation in Dili provides opportunities for
contamination of drinking water by different infectious pathogens responsible
for diarrhoeal diseases, viral hepatitis and other water-borne infections. In
addition, absence of proper drainage and water storage systems are increasing
the breeding sites for vectors of malaria, dengue fever, Japanese encephalitis,
filariases and visceral leishmaniasis in the city and surrounding areas. The
disease surveillance data indicate that during the year 2000, Dili district
accounted for the following approximate percentages of total reported cases in
East Timor; 30% of bloody diarrhoea cases, 27% of watery diarrhoea cases, 40%
of dengue infections, and 18 % of malaria cases.
As
has been seen in many developing countries, there is a possibility that the
population of Dili will grow, attracting more migration of rural people to the
city for employment. If plans for the water supply and sanitation
system are not simultaneously developed, the population increase and the
resulting environmental implications will further aggravate the environmental
problems and other health hazards in Dili.
A
water supply and waste management system is a complete process on its own and
can be functionally categorised into;
(a)
source abstraction, treatment, and storage,
(b)
bulk or individual distribution, and
(c)
subsequent disposal of generated wastewater with suitable treatment.
Recently,
the Division of Health Services and WHO made joint comments on a project
proposal for Dili water supply, rehabilitation and improvement. This proposal
only dealt with the work on source abstraction and did not cover the future
implementation of water distribution or wastewater disposal.
The
service ratio under the new system if implemented aims at 70%, which leaves the
remaining 30% of the population dependent on the traditional sources such as
shallow tub wells, dug wells and the small scale communal supplies that are
scattered around the city: the system will have virtually no control over the
quantity and the quality of water in use.
The
daily per capita supply of safe water in the city is designed to be 249 litres,
which is five times higher than the present supply of about 50 litres. The
existing distribution networks would not withstand the sudden increase in the
system supply and in consequence may give rise to more leaks, and burst
mains. It is admitted in the proposal
that if the wastewater in the city is not controlled properly then the anticipated
increase in the supply may yield additional 2 mm of wastewater per day in the
distribution area as surface runoff. Most of the overflows from the septic
tanks at present are flowing freely to the surrounding ground or the open
drains built for stormwater runoff. The artificial wetlands created by the
excessive amount of the wastewater generated in Dili may contaminate the soil
and surface water bodies and raise the groundwater table, imposing more
difficulties for sub-soil infiltration and decomposition of the waste inside
pit latrines.
The existing
conditions in Dili with regard to the drainage and the on-site facilities for
defecation reveal a very critical situation.
This does not mean that an improved water supply
system for Dili is not an urgent need. The proposal is most welcome in this
regard. However, our main concern is that the project proposal is incomplete,
as it has not dealt with the simultaneous planning for the management of the
water and subsequent wastewater problems. In such a situation, generation of
additional wastewater may be responsible for further deterioration of the
quality of water supplied, irrespective of the efforts to improve the quality
of the bulk water supply.
The Division of Health Services and the World Health
Organisation recommended to the ETTA Division of Water Supply and Sanitation
Services, that the proposed water supply rehabilitation work including the
distribution system in Dili should propose simultaneous development of a
sewerage reticulation system and improvements to the existing drainage system.
I hope that our recommendations will be taken into consideration and the
project will be implemented accordingly.
Please remember the
following commonly held wrong
assumptions from the experiences of other countries:
·
Improved water supply alone leads to better health. There is no need
for sanitation;
·
Sanitation improvement has minimal health benefits and no
socioeconomic benefits;
·
All good sanitation options are expensive and difficult to
implement;
·
Water, air, and soil are free goods and we should not have to pay
for improving them;
·
Safe and adequate water supply alone is a pre-condition for good
sanitation;
·
Message-giving will change behaviors;
·
Traditional and cultural attitudes are barriers to good sanitation
practices.
It is quite possible that you may have already heard
such statements from individuals and organisations. However, you should bear in mind that the above statements are
wrong assumptions. It is our responsibility
to rectify by them, giving importance to sustainable, overall equitable
sanitation to all people in East Timor.
WHO strongly recommends that any development project in East Timor should take into consideration the impacts on the health of the population and clear their proposals with health authorities. WHO is willing to provide the required technical support to the Division of Health Services in this important task.