Welcome © 2005 The International Bank for Reconstruction to and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved Environment Matters is a magazine of the matters. World Bank Group. You may also find the magazine on the Bank's website -- http:// . . www.worldbank.org/environmentmatters EnvironmentallyandSociallySustainable In line with one of the major themes in the World Bank's Environment Strategy, this year's edition Development Network Managers is devoted to the theme of environmental health. We also provide a broader, annual review of the Chair/Vice President past fiscal year from an environmental perspective, captured most directly in the Director's Over- Ian Johnson view and supported by regional contributions in the latter part of this edition. Environment James Warren Evans Viewpoint articles in this edition reflect several external perspectives. WHO lays out the panorama Agriculture and Rural Development of environmental risk factors; a successful example of combating urban air pollution is provided by Kevin M. Cleaver the former mayor of Bogotá; successful strategies to enhance sanitation among poor people are Social Development Steen Lau Jorgensen suggested by an NGO (WaterAid) with an impressive implementation record; and a leading re- searcher gives his perspective on indoor air pollution. As usual, Environment Matters provides a Bank-wide review of our safeguard policies and conveys the latest data on our environmental Environment Matters is produced by the lending and analytical work. World Bank's Environment staff. This year's feature articles all cluster around the main theme of environmental health: Ruta and Editorial & Production Team for the Annual Review Sarraf explain the basics of economic valuation of health impacts of environmental risks; Kaufmann summarizes a recent study that provides an overview of what we know about the effectiveness of Technical Editor interventions in water & sanitation; Ahmed and Awe return to the theme of indoor air pollution Jan Bojö with a study from Guatemala; Constant and Procee explain how the Bank's Clean Air Initiative Story Editor works in several regions; and Tynan concludes the section with an article on the risks that chemicals Robert T. Livernash pose to human health. Designer, Photo and Managing Editor Jim Cantrell Associate Editor Amajor part of this edition--as in the past--consists of reviews of each of the Bank's Regions. With Alexandra Sears attention to the environmental health theme, each Region has chosen a number of issues and Editorial Assistant projects to feature in their annual review. This section provides ample illustration of the diversity of Diane Flex issues that the Bank is confronting in collaboration with client countries. The regional reviews are complemented by the institutional perspectives of the International Finance Corporation, which Special Contributors deals with private sector development, and the World Bank Institute, which is responsible for Laura Tlaiye Sharon Felzer capacity building in client countries. Sergio Jellinek The Bank's Development Marketplace focused on environment this year, and two winning projects are presented in this edition. New environmental publications from the World Bank are also pre- sented on the back cover. Finally I urge you to please fill out the survey on page 64, as it is essential for us to update our Notes: subscriber database. It also provides an important opportunity for you to provide feedback to us, All $ = U.S. dollars except where noted. so that next year's Environment Matters can be even better. All tons = metric tons. Thanks to Kirk Hamilton and the World Bank Photo Library for the images found in the photo bar on pages 22 through 31. Jan Bojö Lead Environmental Economist, Environment Department, IBRD maps numbered 31562 through 31567 contained in the Regional section of and Technical Editor for Environment Matters 2005 the magazine were produced by the Map Design Unit of the World Bank. The boundaries, colors, denominations, and T H E W O R L D B A N K G R O U P any other information shown on these The World Bank maps do not imply, on the part of the IBRD IDA IFC MIGA ICSID World Bank Group, any judgment on the International Bank International International Multilateral International legal status of any territory, or any for Reconstruction Development Finance Investment Centre for endorsement or acceptance of such and Development Association Corporation Guarantee Agency Settlement of boundaries. The countries identified by Investment Disputes name on these maps are countries to which the Bank provides development Established in 1945 Established in 1960 Established in 1956 Established in 1988 Established in 1966 assistance in the form of loans or advisory 184 countries own, 165 members 178 members 165 members 140 members services, and for which the Bank has a subscribe to its capital designated official responsible for the Lends to creditworthy Provides interest-free Assists economic Assists economic Provides facilities for country. borrowing countries credits to poorer development by development through the conciliation and countries that have a per promoting growth in loan guarantees to arbitration of disputes capita income in 2002 the private sector foreign investors between member of less than $875 and countries and lack the financial ability foreign investors to borrow from IBRD World Bank Publications Info: 202-473-1155 General Inquiries: 202-473-3641 Department Fax: 202-477-0565 Web address: http://www.worldbank.org Cover: A typical kitchen Photographer: Prabir Mallik in rural households of Printed with soy ink on recycled, chlorine- South Asia. The free paper. Please recycle. photograph was taken in August 2004 in The World Bank Group Bangladesh. 1818 H Street, N.W. Washington, D.C. 20433 Environment Matters 2005 -- The World Bank Group LETTER FROM OUR VICE PRESIDENT ENVIRONMENT, H e a l t h, and GROWTH Building on Renewed Commitments C lose to one-fifth of the burden of disease in developing countries can be attributed to environmental risks. Much of this falls on our children, as about two-fifths of infant mortality is associated with environmental factors. Looking closer at the major environ- mental risks, about 1.7 million premature deaths are attributable to unsafe water, poor sanitation, and poor hygiene. As many as one-third of these occur in Africa. Urban air pollution is estimated to result in about 800,000 premature deaths annually, and many developing countries are rapidly urbanizing. But most poor people still live in rural areas, where traditional fuels from biomass and coal are the main sources of energy. Indoor air pollution from solid fuels is estimated to inflict an even greater burden of disease than outdoor air pollution does. Against this backdrop, Environment Matters focuses this year on the strong links between environment and health.There is also a direct connection to economic growth: without a healthy, productive labor force, we will not have the economic growth that is necessary to ensure a pathway out of poverty. There is emerging evidence that climate change is also contributing to the burden of disease in poor countries: more frequent and intense droughts and floods; extension of habitats for disease vectors (spreading malaria and dengue fever, for example); expanding areas where plants and livestock are impacted by pests and pathogens; lower yields of some agricultural crops (in turn impacting nutrition); salinization of coastal areas, including freshwater supplies resulting from sea level rise; and so on. In 2000, more than 150,000 premature deaths were attributed to various climate change impacts, according to the World Health Organization. Behind the statistics are scores of human tragedies.Young lives are cut short, and productive lives are hampered by frequent and often painful disease.These are daunting challenges, but Environment Matters provides many inspiring examples of ways we can successfully meet them. Achieving substantive progress in delivering clean water, improved sanitation, cleaner air, and a safer environment to millions of poor people will be the result of concerted efforts involving governments, communities, civil society organizations, the private sector, and donors. It is time for action.The World's political leaders have reaffirmed their collective commitment to achiev- ing the Millennium Development Goals. Further, the July 2005 Summit of the G-8 countries heightened the industrialized countries'support to environmentally sustainable development for the benefit of the World's poor.These events, together with the warning signals raised by the Millennium Ecosystem Assessment, have contributed to raise international awareness and to strengthen the global commit- ment to foster a healthy environment for this and future generations. Ian Johnson Vice President Environmentally and Socially Sustainable Development Annual Review · 2005 To renew, or begin, a subscription to Environment A Letter from Our Vice President, Ian Johnson 1 Matters, please complete the on-line SUBSCRIPTION RENEWAL FORM. See page 64 for details! Director's Overview 3 Environment Department Director J. Warren Evans reviews Environmental Health and Traditional Fuel 26 the past year's achievements and this year's focus on Use in Guatemala environmental health. Kulsum Ahmed andYewande Awe discuss the results of a study that estimated the health impacts of traditional fuel Viewpoints use in Guatemala. Health and Environment -- 8 The Clean Air Initiative 28 A View from the Persepective of WHO Samantha Constant and Paul Procee review the Bank's Dr. Kerstin Leitner of the World Health Organization in Clean Air Initiative, which is now active in Africa, South and Geneva describes how WHO is working with developing East Asia, and Latin America. countries to reduce the health risks posed by environmental Toxic Chemicals -- A Growing Global Threat 30 pollution. The Bank and its partners are working to help countries A Healthier and Happier City 10 understand and assess the impact of chemicals on human health, according to Ellen Tynan. Enrique Peñalosa, former mayor of Bogotá, Colombia, discusses the challenges of integrating environmental health Regional Articles concerns into urban planning. Reviews of work in the Bank's six Regions focus on efforts to address the linkages among poverty, environmental Sanitation -- No Silver Bullets, but Reasons for Hope 12 pollution, and human health. Simon Trace discusses the Work of WaterAid, an interna- Africa -- Sub-Saharan 32 tional NGO dedicated exclusively to the provision of safe East Asia and the Pacific 36 domestic water, sanitation, and hygiene education to the Europe and Central Asia 40 world's poorest people. Latin America and the Caribbean 44 Indoor Air Pollution -- Update on the Impacts 14 Middle East and North Africa 48 South Asia 52 of Household Solid Fuels Professor Kirk R. Smith of the University of California, Institutional Articles Berkeley discusses the latest research findings on the impact Private Responses to Public Problems -- 56 of indoor air pollution on health. IFC and Environmental Health The International Finance Corporation's efforts to promote Bank-Wide Reviews private sector growth in developing countries address issues Safeguards 17 such as poor worker health and environmentally harmful business practices. The Quality Assurance and Compliance Unit describes the Bank's efforts to adapt safeguards to changing lending IFC -- Updating and Improving Our Environmental 58 priorities. and Social Standards IFC is taking a new approach to social and environmental The Environment and Natural Resources 20 standards for private sector performance in emerging Management Portfolio markets. Anjali Acharya and Eri Tsutsui review the Bank's fiscal 2005 WBI -- Capacity Development and Institutional 60 environmental portfolio. Strengthening Feature Articles The World Bank Institute's Environment and Natural Resources Management learning program helps client Economic Valuation of Environmental 22 countries build their capacity to manage scarce natural Health Impacts of Pollution resources and improve environmental quality. The Bank's Giovanni Ruta and Maria Sarraf look at recent News attempts to measure the economic value of health impacts The Development Marketplace -- 62 caused by environmental pollution. Winners in the Environmental Health Category This year's Development Marketplace theme was Water, Sanitation and Hygiene Interventions 24 Innovations for Livelihoods in a Sustainable Environment for Health -- What Works? Rachel Kaufmann describes a"meta-analysis" that at- SURVEY and Subscription Renewal 64 tempted to determine which interventions in water, for Environment Matters sanitation, and hygiene worked best to bring about sustainable improvements in health. Environmental Publications (inside back cover) Environment Matters 2005 -- The World Bank Group Overview CarnemarkC. Burkina Faso by James Warren Evans Director, Environment Department T hrough its Environment Strategy and many creased environmental lending and a continued strengthen- other initiatives, the World Bank has worked ing of analytical work. It also provides an overview of key glo- diligently for many years to address the link- bal issues and how we address them through partnerships, ages among poverty, environmental quality, information on major trust funds that provide essential sup- and human health. This year's Environment port for our work, as well as comments on some important Matters provides a progress report on the environmental health future challenges. agenda. Environmental health risks--such as polluted water and in- Environmental Lending sufficient sanitation, indoor and outdoor air pollution, lead poi- soning, and the impacts of climate change--significantly Environmental content in Bank lending reversed the decline influence the well-being of hundreds of millions of poor peo- from past years and reached $2.5 billion in new commitments ple.The links are clear: poor people are the first to suffer from for fiscal 2005. This represents more than 11 percent of new a polluted environment. lending. The significant increase in environmental content in the Bank's lending is mainly due to two large development This overview provides a summary of the past fiscal year's (end- policy loans: the First Programmatic Reform Loan for Envi- ing in June 2005) achievements, in which we have seen in- ronmental Sustainability in Brazil ($503 million) and the ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 3 Programmatic Development Policy Loan for Sustainable Development in Colom- Tanzania Small Group and Tree Planting (TIST) bia ($150 million).These programs mark The TIST program empowers and pays groups of subsistence farmers in Tanzania to an important step forward in our efforts restore local deforested areas and to adopt sustainable agricultural practices. It sup- to engage in dialogue on environmental ports small groups to establish small, dispersed reforestation groves using hand tools linkages with key sectors and finance au- and locally available materials. As of today, thousands of smallholders located in four impoverished regions of Tanzania are adopting simple agroforestry techniques, planting thorities. If sustained over time, they trees on their agricultural plots and around human settlements and switching to con- enable the Bank to serve clients in in- servation tillage. This innovative project supported by the BioCarbon Fund links grass- forming and facilitating debate among roots communities to the international carbon market through cost-effective contract- national stakeholders (see examples in ing mechanisms and modern information flows. Millions of trees have been planted Latin America, page 46). and millions more seedlings are in nurseries. The increase in commitments in fiscal 2005 is also attributable to an increased Another important area of opportunity and Natural Resource Management: A Re- coverage of environmental objectives in is subnational programs. For example, view of Fiscal 2002-04 Activities, reviews infrastructure lending.For example,more through a $24 million loan in Brazil-- reports with environmental themes, water and sanitation loans are address- the Integrated Municipality Project/Betim identifies good practice, and presents Municipality--the Bank will support in- ing water quality management issues; ir- trends. The review shows that Country vestment in urban infrastructure and rigation and other water management Environmental Analyses (CEAs), strate- social services and improve municipal operations include support for policies gic environmental assessments (SEAs), governance and regulatory policy. A that address sustainable resource man- public environmental expenditure re- major part of the investment will pro- agement; and urban projects include views,energy-environment reviews,and vide sewerage and water treatment fa- components for wastewater and solid other environmental studies increased cilities resulting in better water quality waste management. Equally important steadily from 2001 through fiscal 2004. in the Betim River and thereby improved are smaller loans that enhance country This increase was sustained in fiscal 2005 public health conditions in the urban capacity to improve environmental and (see the portfolio review article, pages community. Families will also be assist- social conditions when investment in in- ed to move to safer ground from areas 20­21 for further details). frastructure is rapidly growing.For exam- subject to flooding.New urban parks will ple, the Bank recently approved the Lao be created, and vegetation around the The use of Country EnvironmentalAnal- PDR Nam Theun 2 Hydropower Project main river will be restored. ysis has grown in importance,with com- andthelinkedLaosEnvironmentandSo- pleted reports from the Dominican cial Development (LENS) Project (see Strengthened Republic and Egypt,and work under way page 37 in the East Asia and Pacific Re- in countries such as Bangladesh, Ethio- gion article for details). Environmental Analysis pia, Ghana, and Nigeria.While a CEA is a flexible tool with varying coverage, it New approaches are being tested to Analytical and advisory activities (AAA) typically contains (a) a state of the envi- meet local natural resources manage- provide a foundation for defining stra- ronment section that reviews environ- ment objectives while addressing global tegic priorities and for informing policy mental challenges and poverty- issues and to directly support local gov- dialogue and decisions on projects and environment links, (b) a policy analysis ernments in enhancing environmental programs inWorld Bank client countries. section that identifies key policies and management. For example, we believe Since the endorsement of the World their environmental implications, (c) an there is great potential in utilizing car- Bank's Environment Strategy, the Bank institutional capacity assessment, and (d) bon finance to stimulate improved com- has made considerable progress in a business plan that reviews past expe- munity forest management and reduce strengthening its environmental AAA rience and suggests future Bank assis- degradation of sensitive ecosystems (see work. A recent report entitled Analytical tance in the form of lending or analytical Box, above right). and Advisory Activities in Environmental work. 4 ENVIRONMENT MATTERS · 2005 Overview One measure of mainstreaming environ- to climate change. The tool contains a ozone layer depletion,land degradation, ment in the Bank is the extent to which summary of the climate trends and pro- and persistent organic pollutants. GEF our Country Assistance Strategies jections at the project site; identifies com- provides financing for the costs of (CASs) integrate such issues, discuss ponents of the project that might be achieving global environmental goals poverty-environment links,and advance subject to climate risk; explains the na- above what is required to achieve nation- appropriate policy and investment re- ture of the risk; and provides documents al development objectives.In fiscal 2005, sponses. A recent update based on 40 and contacts to help follow up on any 47 new GEF projects were approved for CASs--An Environmental Review of 2002- identified risks. ADAPT is intended for $264 million in GEF financing, and $571 2004 Country Assistance Strategies-- project team members, both within the million in additional Bank financing also shows a modest average improvement Bank and within client countries, who do was mobilized. in this regard. The Eastern Europe and not have specialized knowledge of cli- Central Asia Region deserves special mate change issues.A prototype tool has Climate change. The Bank is engaged in mention for significant improvements in been developed and tested with poten- assisting clients with cost-effective mit- incorporating environmental aspects in tial users through a series of focus igation of greenhouse gas emissions and its CASs.High-scoring CASs were found groups.Applications are foreseen first in in improving understanding of adapta- across the Regions, with Brazil, Georgia, South Asia, with a later modification for tion to climate-change-induced impacts. and Paraguay among the top examples African conditions. The integrated urban transport projects of mainstreaming. These results should supported by GEF in Latin America and not make us complacent, as attention to Global Issues EastAsia are an illustration of novel pro- important environmental issues is still grams that address GHG emission mit- deficient in many countries. Country-level work is the bread and but- igation while improving local air quality. ter of the Bank,but the Environment De- In the area of adaptation, we have This is underlined by the result of a re- partment has a key role also in making worked with India in assessing the im- view of mainstreaming of environment progress toward addressing issues that pact of drought and changes in its length in our client countries'own Poverty Re- transcend national boundaries. A major and intensity on farmers; gains are pos- duction Strategy Papers (PRSPs).Atten- instrument in this regard is the Global sible by shifting irrigation from rice at tion to environment is uneven across Environment Facility (GEF).This facility critical periods to other crops. Finally, countries, but it is increasing as coun- is active in the fields of biodiversity, cli- carbon finance (over $800 million now tries move from interim to full PRSPs. mate change, international waters, available in eight funds) helps finance Good practice is emerging, which can also be a good basis for the Bank's Pov- erty Reduction Support Credits (PRSCs) HamiltonK. or other lending. Climate variability and climate change threaten poverty alleviation and the sus- tainable economic development of de- veloping countries. While the Bank has maintained a strong portfolio of mitiga- tion-related projects, it has been much less active in issues of adaptation to cli- mate change. However, a recent study by the Bank--Assessment and Design for Adaptation to Climate Change: A Prototype Tool (ADAPT)--presents a simple ap- proach that provides a quick way of as- Drylands in Namibia. sessing projects for potential sensitivities ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 5 y emission mitigation projects and capac- Librar ity building in developing countries. Photo Bank Biodiversity conservation. We have sus- orldW tained our leadership in terrestrial and aquatic biodiversity protection through the GEF and have also engaged in part- nerships to raise awareness and mobi- lize support to specific threats. Under partnerships, the following achieve- ments are noteworthy: The Critical Ecosystem Partnership Fund (CEPF). A partnership with Conservation International, GEF, A community health center in the Philippines. the Government of Japan, and the MacArthur Foundation,CEPF has to Trust Funds work for new projects and programs of date committed in excess of $60 mil- a global and regional nature. The pro- lion to support more than 250 com- Support from other donors to environ- gram finances activities in five priority munity-based groups, NGOs, and mental work managed by the World windows that are executed by the World other partners to conserve Earth's Bank has been, and continues to be, Bank. One of them is the Environment biodiversity hotspots. quite essential. A multitude of external Window, through which financing for The Global Program for Sustainable agencies are providing funding forWorld biodiversity, forests, and environmental Fisheries (PROFISH) is a partnership Bank or joint analysis. Here, only two analysis projects are obtained. As of the of developing countries, donors, major trust funds are highlighted. end of 2004, the environment portfolio technical agencies, and the private within BNPP included 21 ongoing pro- sector, intended to introduce inno- TheTrust Fund for Environmentally and grams and 26 completed programs, rep- vative ways to control fishing capac- Socially Sustainable Development resenting a cost of $26 million. An ity and create incentives for more (TFESSD) is jointly funded by the Gov- additional 23 projects are scheduled to sustainable production and to im- ernments of Norway and Finland. The begin implementation during 2005. prove the capture and distribution Fund supplements the World Bank's of benefits from fisheries to fight budget for environmental analytical Challenges Ahead poverty. Equally important, work and nonlending services and sup- PROFISH will provide a platform for ports activities in the priority areas out- Briefly, we must take on several major dialogue among stakeholders on lined in the Bank's Environment challenges in the coming years. controversial issues like reducing Strategy. TFESSD currently funds more subsidies in the sector and making than 140 activities in 80 countries, with Integrating environmental management in foreign access agreements more 50 percent of the funding going to Afri- poverty reduction. By the time you read transparent and equitable. ca. Donor contributions as of December this,the Millennium Review Summit will WWF/World Bank Alliance. Entering 2004 reached $47 million. have taken place at the UN in Septem- a second phase, the program is ex- ber 2005. Progress with respect to panding areas of forest under effec- The Bank-Netherlands Partnership Pro- achieving the MDGs will have been re- tive protection, increasing the cov- gram (BNPP) is an agreement between viewed, and among them the cross-cut- erage of third-party certification,and the Netherlands Ministry of Foreign Af- ting MDG7 on environmental aiming at a 10 percent reduction in fairs and the World Bank to provide sustainability. Environmental manage- global deforestation by 2010. financing and a priority-setting frame- ment in developing countries needs to 6 ENVIRONMENT MATTERS · 2005 Overview be seen in that context--as an integral duce barriers and mitigate risk.The re- "Human health is highly dependent on part of poverty reduction. A major route plenishment of the Global Environment the health of other species and on the to achieve this is through mainstreaming Facility is absolutely crucial in this re- natural functioning of ecosystems. We of environment in Poverty Reduction spect. derive important medicines from various Strategies.If that foundation is laid down, plants, animals, and microbes. Medical subsequent Bank CASs and operations Building on the Millennium Ecosystem As- research depends on a host of other spe- will have something to build on. sessment (MA).This year, a major scien- cies, some of which are endangered.The tific diagnosis has been presented to the emergence and spread of some human Bridging the global-national-local divides. world community showing how hu- infectious diseases is affected by the loss The G8 meeting this summer, attended mankind is putting the very basis for our of certain species, such as predators of by the leaders of the eight largest econo- civilization under stress by exploiting animals that are hosts for some infec- mies, provided new and encouraging and polluting ecosystems. We are now tious organisms or that pass on these or- impetus to the climate change agenda. faced with the responsibility of digest- ganisms to us.Were it not for pollinators Other major global challenges include ing the lessons from this global, monu- and an enormous number of other spe- biodiversity conservation, management mental effort by thousands of scientists cies that make soils fertile and fisheries of international waters, desertification, and turning these findings into opera- productive,our food supply would be se- and chemicals management. But linking tional work.This is very relevant to the verely compromised. And, at the most these global environmental challenges environmental health agenda,the focus fundamental level, ecosystems provide requires us to place the dialogue with cli- of this year's Environment Matters. In- life support services, such as the break- ents in the context of their pressing local creased attention is now being given to ing down of wastes or the purifying of and national development needs--such the linkages between healthy ecosys- air and water, that make all life, includ- as increased access to energy services, tems and healthy people.Dr.Eric Chivi- ing human life, possible. Most people increased food production, improved in- an,Director of the Center for Health and recognize the beauty and the spiritual frastructure to access markets, and im- the Global Environment at Harvard and economic values of Nature,but they proved financial and social services. It Medical School, very effectively de- may not fully understand that their means, for example, finding market so- scribed this linkage when he spoke at health and lives, and the health and lives lutions that are win-win, and mobilizing the World Bank Environment Days in of their children, depend on its preser- additional financing and support to re- 2005: vation." y Librar Photo Bank orldW Children collecting water in Lesotho. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 7 Environment Matters 2005 -- The World Bank Group HEALTH AND ENVIRONMENT A View from the Dr. Kerstin Leitner Assistant Director-General Perspective of WHO Sustainable Development and Healthy Environments World Health Organization Geneva T he relationship between the physical environment An ongoing challenge is to convince policymakers in charge of and human health has been on WHO's agenda public health that environmental determinants need to be ad- since its inception. In its original constitution dressed in order to protect the health of people. Fortunately, of 1946, WHO's core functions included the pro- there is growing awareness that successfully controlling wa- motion of improved housing, sanitation, recre- ter-related diseases, such as malaria and dengue, must include ation, economic and working conditions, and other aspects of nonmedical solutions in addition to treating those who suffer environmental hygiene. The constitution also stipulates that from such illnesses. Environmental conditions also play an WHO should work in cooperation with other specialized agen- important role in cancer incidence. For almost all forms of can- cies. These initial mandates provided a foundation for WHO's cer, the risk of contracting this disease can be reduced if phys- efforts to work in tandem with other stakeholders and to rec- ical environments are safe for human habitation and food items ognize the multidimensional nature of promoting and protect- are safe for consumption. ing human health from adverse environmental factors and risks. The Figure on page 9 shows mortality and DALYs (Disability- Over the decades, the environment and health nexus has re- Adjusted Life Years, a measure of the burden of disease) for a mained much the same. But many man-made factors have ris- selection of the most important environmental risk factors. en in prominence and impact, including air, water, and soil Clearly, unsafe water, sanitation and hygiene are a leading risk pollution; the influence of industrially pro- factor, accounting for about 1.7 million pre- duced chemicals in consumer items (such mature deaths in 2000. This risk factor is as plastics); and drugs and chemical resi- . . . there may be an opportunity closely followed by indoor air pollution-- dues in food. Most recently, the Millenni- for governments, public and pri- a much less publicized source of ill health um Ecosystem Assessment (MA) has vate health care service provid- but still responsible for over 1.6 million comprehensively studied the consequenc- deaths. Men suffer more from outdoor air es of the profound changes that human in- ers, and individuals to look for pollution, while women are more exposed tervention has brought to the planet's solutions that will address risks to indoor air pollution, but for both risk ecosystems and climate. For the first time, rather than treating the conse- factors, the majority of deaths and disease a chapter has been included showing the quences. impact of these changes on human health. fall on children under 5. Lead exposure Not surprisingly, the MA argues for miti- leads to fewer deaths than urban outdoor gation strategies and a more balanced management of Earth's air pollution, but as the figure shows, the impact on people's natural resources to ensure a healthy environment for future health is still significant. Finally, climate change has begun to generations. affect people's health through changes in environmental fac- 8 ENVIRONMENT MATTERS · 2005 Attributable mortality and DALYs for selected environmental risk factors -- 2000 Second, WHO is strengthening-- through cooperation with national in- Climate change stitutions and through its network of collaborating centers--the capacity of Lead exposure local governments and institutions to Urban take a more active and comprehensive outdoor monitoring and reporting role.Air pol- air pollution lution monitoring and surveys show- Indoor smoke from ing the retention of persistent organic solid fuels pollutants in the human body are only Unsafe water, sanitation, two of many such concrete actions. and hygiene 2 1.5 1 0.5 0 0 10 20 30 40 50 60 Third, WHO is assisting its member Million deaths Males Females Million DALYs states to form strategic alliances across Policymakers need to know the approximate magnitude of health impacts, which are sectors and stakeholders. In particular, expected to be the greatest, in which regions, and what actions are required to minimize the strengthening of partnerships with such impacts. a great variety of civil society organi- Source: Adapted from WHO 2002 World Health Report. zations (such as those devoted to con- sumer protection) and the private tors: weather-related disasters, temperature extremes, chang- sector will be an ever stronger focus of technical cooperation. ing habitats for disease vectors, and so on. More attention will be given in this context to the need to artic- ulate and agree on internationally accepted ethical standards Children are particularly vulnerable to environmental health and norms to protect public health authorities from undue in- risks. In 2004, WHO published Inheriting the World: The Atlas of fluence of special interests and to keep a pro poor focus in health Children's Health and the Environment showing the global risks policies and programs. facing children. For instance, we know the devastating influ- ence that high exposure to lead or mercury can have on the Since medical costs are reaching unaffordable levels in many physical and mental development of children, as well as the OECD countries and are out of reach for the majority of people adverse effects of indoor air pollution on children's health. in developing countries, there may be an opportunity for gov- ernments, public and private health care service providers, and We usually know what remedial actions can be taken, but very individuals to look for solutions that will address risks rather often they need to be taken by actors outside the health sector than treating the consequences. This will mean a major para- or in alliance with the health sector. WHO is therefore support- digm shift in terms of our understanding of what constitutes ing its member states through ministries of health in the fol- health and how we can best protect it. It will mean that we do lowing ways. not collectively and individually close our eyes to known risks and that we change behavior, and that public authorities will First, WHO sets norms and standards and issues guidelines issue regulations and provide policy incentives that promote regarding environmental determinants (such as water quality) behavioral changes. that protect human health. Such normative work is based on the scientific advice of independent, internationally renowned Health interventions have increased life expectancy around the experts. In the case of food safety, WHO together with FAO world to unprecedented levels, although the AIDS pandemic funds the international food safety standard-setting CODEX has set many countries back in this regard. Nevertheless, the Alimentarius Commission. In the case of sound chemicals man- challenge now is to promote the knowledge that people can, agement, a similar interagency body might emerge as a result with due precaution, live not only a long but also a long and of the SAICM (strategic approach to international chemicals healthy life. management) process, which is expected to conclude in Febru- ary 2006. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 9 Environment Matters 2005 -- The World Bank Group A HEALTHIER AND HAPPIER CITY eñalosaPE. Enrique Peñalosa former Mayor of Bogotá, Colombia Founder of the Country We Wish and Want Foundation fundación por el país que queremos I San Victorino Plaza. n Bogotá, Colombia, we have been trying to create a shared narrowing road space and crossing street intersections at grade, vision for our 7 million inhabitants. The vision has a num- so that cars have to slow and drive onto the sidewalk instead ber of characteristics. We want a dense city, yet with build- of pedestrians stepping down to the street level. One of ings no higher than six or seven stories, where low-cost, downtown's most important avenues was turned into an ex- high-frequency public transport is viable; abundant cul- clusively pedestrian street, with a water course that flows down tural offerings; people in public spaces; severe limits on pri- from the mountain through the middle of it. vate car use during rush hours, so that pedestrians and bicyclists encounter low pollution levels and low risk of being hit by a Another project to bring downtown back from near collapse motor vehicle; sports facilities, libraries, parks, and plazas near included recovering as public space a large plaza that had been all homes; an ample exclusively pedestrian road network; and completely taken over by vendors, with crime as a consequence. wide, tree-lined, well-lit sidewalks. We want dynamic orga- And 22 hectares of what was probably the most deteriorated nized communities, with a sense of belonging. We want a city urban space in the world--teeming with drug distribution, that will not increase road space in response to traffic jams, but criminal organizations and drug addicts--was demolished in rather will further restrict private car use. We want a city that order to make room for a massive park.Although this was only clearly devotes more space and resources to children than to two blocks away from the Presidential Palace and the histori- motor vehicles. cal and institutional center of the country, it had the highest murder rates in the country, which plummeted after the demo- Every Sunday in Bogotá, 120 kilometers of main arteries are lition. The aim is to attract families and children once again to closed to motor vehicles for a period of seven hours. The length downtown. of the streets being closed more than doubled between 1996 and 2000. More than 1.5 million people, from upper- to low- More than 1,200 parks (from very large to extremely small) were income classes come out to bicycle, jog, walk, and socialize. built all over the city. Three large new libraries (and 14 smaller ones) linked to surrounding areas by large sidewalks and bi- For decades, the main Bogotá avenues had been built without cycle paths act as places that lend the city character and show sidewalks. In the streets where there were sidewalks, parking respect for all citizens. Those libraries received more than 9 bays had been carved out, or cars would simply park on the million visitors in 2002. Two formidable pedestrian structures sidewalks. A campaign to get cars off sidewalk space became marked a radical change in priorities. TheAlameda Porvenir, a an intense crusade that almost led to my impeachment. Hun- 14-kilometer tree-lined pedestrian street with a bicycle path dreds of kilometers of quality sidewalks were built, sometimes across some of the poorest areas of the city, where there are 10 ENVIRONMENT MATTERS · 2005 . . . it is time to give more importance to children's happiness than to motor vehicles. almost no paved motor-vehicle roads, became a powerful sym- The single project that most contributed to improved quality of bol of respect for the community and of the new city model. A life was a bus-based transit system called TransMilenio. Inspired sculpture by an important Colombian artist was placed on the by the Curitiba system in Brazil, we were able to design, build pedestrian street, something not usually found in developing- the infrastructure, create the private partners that would oper- world poor neighborhoods. And along creeks and drainage ate it, get out the thousands of buses that previously operated canals, as part of a project to separate sewage waters that pre- there, and put the system in operation in three years. Today, viously flowed in the open into a box culvert, a 45-kilometer with only 66 kilometers the system moves more than 1 million greenway with more than 400 hectares of park--including pro- people every day, with a public investment of $270 million. tected lakes and wetlands--was built. This is a large feat for a TransMilenio users are saving on average 223 hours annually; dense city. The greenway links poor and wealthy neighbor- 21 percent of them used to go to work by car. It is an expanding hoods, even though some of the wealthy neighborhoods made system financed by a gasoline tax, and it should be moving more large efforts to block it. than 85 percent of the city's population by 2018. Urban transport is a difficult challenge because instead of im- proving with economic development it tends to get worse un- GadepalliS. less a completely different model is adopted. Every day, 40 percent of cars in Bogotá must stay off the streets during two hours in the morning and two hours in the after- noon peak hours. The measure significantly reduces traffic jams and pollution. And in a city where only 28 percent of homes TransMilenio bus system. own cars and only 13 percent of people use private cars for their daily transport, it is quite evident that the public good Although the system is bus-based, its operation is closer to that would be served by banning car use during peak transport of a rail-based system. Articulated buses operate on exclusive hours. Less traffic would mean faster rides on public transport busways, using one or two lanes in each direction. Passengers for the majority, while those who walk or ride bicycles would board the buses only at stations. In this way, when the bus ar- do it more safely and breathe cleaner air. Demand for road in- rives and opens its two doors simultaneously with the station frastructure investment and maintenance would lessen, free- doors, a hundred passengers can exit and a hundred enter in ing resources for other, more important social needs. And seconds. The bus floor is at the same level as that of the station, sprawl would be avoided. making entering and exiting the bus a rapid and safe operation, as well as making the buses fully accessible to the handicapped. While cars tend to be means for social differentiation, bicycles integrate. In Dutch and Danish cities, more than 35 percent of Passengers can change from a local to an express bus with the the population uses the bicycle for transport, while the per- same ticket. They can also change from a bus on one route to centages are insignificant in cities in the developing world, another on a different one without any extra cost. Feeder buses, where the weather is more favorable and bicycles are the only not on exclusive lanes but sharing streets with the rest of the individual means of transport that most of the population can traffic, give people in marginal neighborhoods access to the afford. The main reason is that developing-world cities are system. TransMilenio buses run in the middle of avenues and designed and built for the wealthier minorities. Costly elevated not on the sides, so that vehicles entering and exiting drive- highways are built for the benefit of a few, while bikeways and ways, or delivery vehicles, do not become obstacles. even sidewalks are frequently absent. In Bogotá, we built more than 300 kilometers of physically isolated bicycle paths in less In short, it is time to give more importance to children's happi- than three years. From nearly none, more than 4.5 percent of ness than to motor vehicles.Adifferent, more appropriate model the population now use a bicycle for daily transport needs. And is necessary, as much for equality and environment as for cul- many more use it sporadically. tural identity and self-esteem. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 11 Environment Matters 2005 -- The World Bank Group SANITATION No Silver Bullets, but Simon Trace Director Reasons for Hope Strategic Development WaterAid W aterAid is an international NGO dedicated be a public good, sanitation is sometimes seen as a private exclusively to the provision of safe domestic good, because the solution (particularly in the case of rural water, sanitation, and hygiene education to sanitation) is a household latrine. This can lead to an over- the world's poorest people. WaterAid reliance on self-financing and reluctance on the part of projects are set up by local organizations and governments or donors to invest beyond "demonstration managed by the community. WaterAid also seeks to influence latrines." The health benefits from sanitation are clearly governments' water and sanitation policies. This article will public, however. focus on sanitation as the forgotten environmental health prob- The lack of an institutional home in government for lem and will use the experience of WaterAid and its partners sanitation in many countries, which leads to a lack of to look at some of the factors influencing the success of attempts ownership for the problem or accountability within to address the world sanitation crisis. government. The Problem The search for a "silver bullet"--"It's a health problem, so why can't there be a technical fix like a vaccine or a technology that we can just roll out?" This approach to Globally, some 1.1 billion people lack access to safe water and sanitation by some donors and governments misses the 2.6 billion lack access to safe sanitation. One of the well-known point that the technology (usually a latrine or a sewered environmental health consequences of this situation is that there connection) needs to be accompanied by a behavioral are about 4 billion cases of diarrhea per year, which cause 1.8 million deaths, mostly among children under five.1 change if it is to reap the intended health benefits. Sanitation is very much a forgotten problem globally. Although there are many barriers to overcome, some of Spending in 2000 was estimated at only $1 billion, less than 10 WaterAid's work with its partners in Sub-Saharan Africa and percent of the $13 billion spent on water, even though twice as South Asia suggest that solutions can be found. Some of the many people lack basic sanitation.2And in many countries, the key drivers influencing the success of sanitation programs that scale of the problem is increasing. WaterAid has identified to date can be summarized under two This article concentrates on overcoming some of the more headings: "creating demand" and "meeting demand." practical barriers to achieving coverage, but there are also sig- nificant institutional barriers to scaling up sanitation solutions. Creating Demand Some of these include: Confusion over whether sanitation is a private or a public Whether one looks at demand for sanitation as something that good. Whereas water supply is generally acknowledged to has to be created from scratch or whether it is a question of 12 ENVIRONMENT MATTERS · 2005 unlocking a pre-existing, latent demand, there is no question developing efficient and responsive "supply-side" delivery that much work has to be done to ensure demand for sanita- systems. tion is expressed. In WaterAid's experience, successful sanita- Technology choice. Too many sanitation programs focus on tion programs invoke two ways--hygiene promotion and a single technical solution (often, in rural areas, the ventilated marketing--of stimulating demand improved pit latrine), which may be for sanitation services. unaffordable--both for certain indi- Hygiene promotion. An under- Globally, some 1.1 billion people lack vidual households or for governments standing of the health consequences to subsidizes--and may not meet oth- access to safe water and 2.6 billion lack of unsafe or no sanitation is generally er user requirements. Successful pro- access to safe sanitation. recognized as an essential component grams tend to adopt a "sanitation ladder approach," which promotes a of developing demand for sanitation minimum basic safe disposal and an services. Although a wide range of personal hygiene issues upgrade path for people to follow as they can afford it. This could be looked at, the principal barriers that need to be erect- requires thought in developing and offering a range of techni- ed to break the fecal oral cycle are generally hand washing at cal solutions at different costs. critical times (e.g. after defecation and before eating) and safe Creative financing. There is probably no such thing as a suc- cessful "no subsidy" approach for sanitation for the poor. Within Holmes WaterAid, some successful programs spend money on both capital subsidies and hygiene promotion/marketing activities. aterAid/JimW Others concentrate just on the hygiene and marketing activi- ties and eliminate capital subsidies (probably spending more on promotion and marketing in the process, however). To reach the poorest, in many places it seems that some sort of partial capital subsidy or access to subsidized credit facilities will be required. The key issue to scaling up coverage seems to be mak- ing these subsidies "smart"-- targeted where they are needed and not universal. Helping families build latrines is not enough on its own to solve sanitation problems--WaterAid also runs hygiene promotion sessions, such the one above Efficient and responsive delivery systems. Functional deliv- in Nepal, to raise awareness of the importance of safely using latrines and washing ery systems are needed to ensure "supply" to meet demand. hands afterwards. WaterAid's experience to date suggests that support to devel- op small-scale private sector suppliers is essential to ensuring disposal of all human feces. Keys to success at hygiene promo- the sustainability of the "supply" side of the equation. tion seem to include an understanding of people's unsafe hy- Closing the global sanitation gap is one of the world's giene behavior and a process for monitoring hygiene behavioral greatest environmental health challenges. To meet it success- change. fully will require a lot more commitment and imagination than Marketing.An understanding of the health benefits of san- has been displayed in the past by governments, donor agen- itation is a necessary, but often not sufficient, condition for pri- cies, and other actors in the sector. Affordable solutions are oritizing sanitation in households. Successful programs have possible, however, if some of the above drivers are borne in tended to actively market sanitation as having other wider ben- mind during program design. efits, focusing on ideas such as convenience and dignity or con- cepts of what people aspire to in modern life. Notes Meeting Demand 1. Unicef Website: . The quickest way to kill a sanitation program is to create de- 2. "Framework for Action," Global Water Partnership, 2000. mand for products that are unavailable or unaffordable. Criti- cal factors affecting capacity to meet expressed demand include For more information please visit www.wateraid.org ensuring technology choice, getting the financing right, and ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 13 Environment Matters 2005 -- The World Bank Group INDOOR AIR POLLUTION Update on the Kirk R. Smith Professor Impacts of Household University of California, Berkeley Solid Fuels T he impact of air pollution on health depends on cator of the health hazard of combustion smoke is thought to howmuch pollution people actually experience be small particles, which contain many chemicals. Household during their daily lives, which is called their "ex- coal use, largely found in China today, can present additional posure." Exposures can be great even when emis- hazards because of the intrinsic toxic contaminants in some sions do not affect the outdoor environment sig- coals, including sulfur, arsenic, fluorine, mercury, and selenium. nificantly, if the source of emissions is close to the population. This combination of being used in an activity in close daily It has been estimated that nearly half the world's population proximity to a large population with significant emissions of still uses solid fuels (biomass and coal) for household cooking health-damaging pollutants per unit activity means that house- and spaceheating, mostly in developing countries. In the proper hold solid fuel use produces substantial total population expo- conditions, biomass (wood and agricultural residues) can be sures to important pollutants. The exposures are highest in poor burned quite cleanly, producing mostly carbon dioxide and women and young children of developing countries, both ru- water. Such conditions are difficult to achieve in small-scale ral and urban, who are the groups most often present during inexpensive stoves, however, and the actual emissions of health- cooking with solid fuels. damaging pollutants are quite large per unit fuel, although the total emissions are not large in the context of overall fuel use. Since the mid-1980s and more frequently since the mid-1990s, there have been many dozens of published epidemiological Studies in India and China, for example, show that the per- studies examining a range of health effects from indoor air pol- centage of fuel carbon fully burned to carbon dioxide is typi- lution due to solid fuel use. Because of the difficulty and ex- cally only 90 percent, with some fuel/stove combinations doing pense of exposure assessment in households, however, most as poorly as 80 percent. This means that 10 to 20 percent of the have used a surrogate for true exposure, often simply whether fuel carbon is diverted into products of incomplete combus- the households are using solid fuels or not. Even with such an tion--primarily carbon monoxide, but including benzene, buta- imprecise measure, however, health effects of several sorts have diene, formaldehyde, polyaromatic hydrocarbons, and many repeatedly been found. The best evidence is for (a) acute lower other compounds posing health hazards. The best single indi- respiratory infections (pneumonia) in young children, the chief 14 ENVIRONMENT MATTERS · 2005 killer of children worldwide and the disease responsible for tory infections, the former not bringing a death risk but being the most lost life years in the world; (b) chronic obstructive quite difficult to distinguish in field research from dangerous pulmonary disease, such as chronic bronchitis and emphysema, lower respiratory infections. On the other hand, there is now in adult women who have cooked over unvented solid fuel growing evidence of health effects of other kinds, including stoves for many years; and (c) lung cancer, though the best evi- tuberculosis, cataracts, several other cancers, low birthweight, dence is only for coal smoke. and heart disease. Effects in men are also being seen. Thus, while the estimated impact on childhood pneumonia may decrease The World Health Organization, in a risk assessment that com- in future risk assessments, the impact of other diseases will bined the results of many studies, compared the burden of ill- probably be added. ness and premature death from solid fuel use along with other major risk factors, including outdoor air pollution, tobacco It is one thing to determine that ill health is associated with a smoking, and hypertension among others. The results indicate particular risk factor, but quite another sometimes to show that that solid fuel use may be responsible for 0.8­2.4 million pre- reduction in the risk factor will actually produce an improve- mature deaths each year. As shown in the Figure below, using ment in health. This has only been done in two cases to date, the central ("best") estimates for the risk factors examined puts one in south China with coal and another in Guatemala with solid fuel use approximately tenth among major health risks in wood. The China study, done in retrospect, showed reduction the world in terms of potentially preventable lost life-years. in lung cancer and chronic obstructive pulmonary disease due to introduction of improved stoves in the late 1970s. The other, More recent studies indicate that the past studies of solid fuel a randomized trial of improved stoves in highland Guatemala, use and pneumonia in young children probably overestimated is just now being completed. It focused on childhood pneumo- the risks due partly to confusion of upper and lower respira- nia but also examined heart and lung effects in women. Estimated burden of disease in 2000 measured as lost healthy life years (DALYs) from major preventable risk factors. Those marked with an asterisk are based on outcomes in the Global Burden of Disease database of the World Health Organiza- Although the risk estimates will continue to be refined tion (WHO). The remaining estimates are from the Comparative Risk Assessment and new health effects probably will be added, the chal- managed by WHO (Ezzati and others 2004). lenge in a development context is to find a viable inter- Global Burden of Disease from Top 10 Risk Factors vention that can be relied on to reduce exposures and plus selected other risk factors Underweight improve health cost-effectively. Improved fuels, such as Unsafe sex LPG, undoubtedly produce fewer emissions and exposure Blood pressure Tobacco themselves, but they are expensive and, at least at first, Alcohol people generally do not completely switch away from Unsafe water/sanitation Child cluster vaccination* solid fuels but continue to use them for some tasks. Well- Cholesterol designed, built, and used improved stoves with chimneys Lack of malaria control* Indoor smoke from solid fuels do reduce kitchen pollution substantially, but they pro- duce much lower reductions in human exposures because Overweight Occupational hazards (5 kinds) the smoke is still released in the vicinity of the household. Road traffic accidents* Environmental factors In addition, successful dissemination of well-operating Physical inactivity Lead (Pb) pollution and durable stoves in large populations has not been easy. Urban outdoor air pollution That such stoves may also have social and economic ben- Climate change efits, however, encourages further work to find ways to 0 2 4 6 8 10 Percent of all DALYs in 2000 disseminate them widely. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 15 It is perhaps surprising that biomass stoves also contribute to The only large-scale successful improved stove effort to date global warming even when the fuel is harvested renewably and was in China, which facilitated the introduction of perhaps 180 is thus "carbon neutral," that is, the fuel carbon released into million improved stoves in the 1980s and 1990s without any the atmosphere is captured by re- foreign involvement. It focused on growth of the biomass. This is because fuel savings but did apparently the products of incomplete combus- To blunt global warming, it is the world's achieve some reduction in pollution tion are more powerful greenhouse use of fossil fuels that needs to be ad- exposures as well by use of chimneys, pollutants than CO2, the primary dressed. although little if any improvement in greenhouse gas. In addition to meth- combustion efficiencies. Nepal is cur- ane and other gases, a particularly rently engaged in a national program, powerful greenhouse pollutant from small-scale biomass com- but no air pollution or health assessments of the results have bustion is now thought to be black carbon particles. Thus, the been done to date. Since better standard methods and new 10­20 percent of carbon diverted to non-CO2 pollutants means equipment for assessing the pollution and health implications that there is a net contribution to global warming even if the of improved stove programs are now being developed and field- CO2 is completely recycled in a renewable fuel cycle. To be truly tested, however, there should be reliable information soon about greenhouse-neutral, a biomass fuel cycle must not only be re- the actual changes produced by this and other improved stove newable but also combusted efficiently, which is not the case and fuel programs around the world. in simple biomass stoves. With the high diversion of carbon to Recent References greenhouse pollutants in many household biomass stoves, it is even possible to argue that an efficient clean-burning fossil fuel such as LPG could be introduced as a greenhouse measure. Ezzati, M., and others, eds. 2004. Comparative Quantification of The attractiveness of this approach, however, depends on as- Health Risks: Global and Regional Burden of Disease due to sumptions related to discount rates and atmospheric warming Selected Major Risk Factors. Geneva: World Health potentials of the different pollutants involved. Organization, 2 vols. Sinton, J.E., and others. 2004. "An Assessment of Programs to This is not to say that the growing risk of global climate change Promote Improved Household Stoves in China." Energy is due to the stoves of the poor. Far from it! However, since the for Sustainable Development 8(3):33-52. high greenhouse emissions from small stoves per unit fuel have Smith, K.R., and others. 2004. "Indoor Smoke from Household the same cause as the health-damaging pollutants (incomplete Solid Fuels," in Ezzati, M., and others (eds.), op cit., pp. combustion), it raises intriguing possibilities for introducing 1435-93. Smith, K.R., J. Rogers, and S.C. Cowlin. 2005. Household Fuels improved stoves and fuels that reduce both risks at once, i.e., and Ill-Health in Developing Countries: What Improvements produce substantial "co-benefits." The costs of reducing car- Can Be Brought by LP Gas (LPG)? Paris: World LP Gas bon emissions from stoves with higher combustion efficiency Association and Intermediate Technology Development look to be well within those now being considered in various Group (in press). carbon trading or Clean Development Mechanism schemes. Smith-Siversten, T., and others. 2004. Reducing Indoor Air Thus, it may be possible to purchase carbon savings at a rea- Pollution with a Randomized Intervention Design -- A sonable price and achieve substantial health benefits as a side Presentation of the Stove Intervention Study in the product, or vice versa. What has not been shown, however, is Guatemalan Highlands. Norsk Epidemiologi 14(2): 137-143. whether it is possible to introduce high-efficiency stoves to large Venkataraman, C., and others. 2005. Residential Biofuels in populations such that they are built, operated, and maintained South Asia: CarbonaceousAerosol Emissions and Climate for long-term reliable performance. Impacts. Science 307: 1454-1456. 16 ENVIRONMENT MATTERS · 2005 Environment Matters 2005 -- The World Bank Group Bank-Wide Review T heWorldBank's"safe- See Table 1 for a breakdown of guard" policies (see the applicable safeguards and Table 1) require that Table 2 for the EAcategories of potentially adverse environ- investment projects supported S mental impacts and selected in fiscal 2005. social impacts of Bank invest- ment projects should be iden- Two major events dominated afeguards tified, avoided, or minimized the environmental and social where feasible, and mitigated, safeguard agenda over the last compensated, and monitored. year: (1) development and ap- The broad objective is to inte- proval of a policy for the pilot- CarnemarkC. grate issues into the decision- ing of country systems and (2) making and implementation the revision of the Indigenous processes to support environ- Peoples policy. In addition, mentally and socially sustain- there were major efforts to sup- able development. port safeguards training for Bank staff, borrowers, and oth- During fiscal 2005, the Bank er interested parties. This arti- approved 289 new projects, in- cle also gives an update on the cluding 24 grants from the GEF Inspection Panel. and 10 Pilot Carbon Fund projects. Funding for invest- Use of country ment lending, to which safe- systems guard policies apply, has reached $15.7 billion vs. $6.6 After extensive consultation billion of policy-based lending. with stakeholders, the Bank Table 1. The safeguard policies of the World Bank (IBRD and IDA) during fiscal 2005 (application of safeguards to investments supported in fiscal 2005, in percentages) OP/BP 4.01 Environmental Assessment (73 percent)a Mali. OP/BP 4.04 Natural Habitats (12 percent) OP 4.09 Pest Management (9 percent) OP/BP 4.10 Indigenous Peoplesb(19 percent) OP/BP 4.12 Involuntary Resettlement (35 percent) OP/BP 4. 36 Forests (7 percent) OP/BP 4.37 Safety of Dams (7 percent) OPN 11.03 Cultural Property (14 percent) OP/BP 7.50 Projects on International Waterways (6 percent) OP/BP 7.60 Projects in Disputed Areas (2 percent) Notes: a. This is the sum of EA categories A, B, and FI in Table 2. Category A is used for projects that are likely to have significant adverse environmental impacts, while category B is used for projects with less adverse impacts. FI is used in projects with financial intermediaries. Category C does not require an EA. b. Replaced OD 4.20 Indigenous Peoples on July 1, 2005. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 17 Table 2. EA categories of dures would be applied lated to screening by the Bank involving parks and protected investment projects in fiscal to the pilot program. The to determine whether Indige- areas. 2005 (percentages) Inspection Panel mecha- nous Peoples are present in a Category nism would also apply to project area; (b) the need for Safeguards training A B C FI the pilots. The current set social assessment; (c) equitable 9.8 57.0 26.6 6.6 of 10 safeguard policies sharing by Indigenous Peoples The Quality Assurance and would remain in place in the commercial develop- Compliance Unit (QACU) and has initiated a pilot program and be applied to all other ment of natural and cultural the Regional Safeguard Units (OP/BP 4.00) on the use of Bank-supported investment resources on lands they have have continued to provide country systems for environ- lending. Please refer to the traditionally owned, used, or training on safeguard policies mental and social safeguards. World Bank "Country Sys- occupied; (d) Indigenous Peo- for staff from the Bank, bor- This pilot program recognizes tems" website for additional ples' rights of access to legally rowers, consulting firms, and that there are important oppor- details. designated parks and protect- NGOs. During fiscal 2005, for tunities to increase country ed areas; and (e) non-coverage example, 32 training sessions ownership and development Revised Indigenous of the revised policy with re- were held and over 650 Bank Peoples policy impact of environmental and spect to economic migrants to staff and consultants were social safeguards by working urban areas. Second, it simpli- trained by QACU on individ- directly with the laws, policies, The revised policy on Indige- fies the project processing re- ual safeguard policies and the and procedures and the insti- nous Peoples (OP/BP 4.10) quirement by establishing five application of these policies to tutions of the borrower. A was approved by the Board on clear steps: (1) screening; (2) country systems approach has various sectors and themes. A May 10, 2005 and went into ef- social assessment; (3) "free, pri- already been in place on a se- new course was developed or and informed consultation" fect on July 1, 2005. The revised lective basis for financial man- and run twice on the integra- with affected communities; (4) policy could potentially bene- agement and in national preparation of Indigenous Peo- tion of disabilities issues in the fit (directly or indirectly) 250 competitive bidding for pro- ples Plans or Frameworks; and application of safeguard poli- million Indigenous Peoples curement. The country sys- (5) public disclosure. Incorpo- cies. Brazil and other field of- around the world. The policy tems approach supports ration of the principle of "free, fices held training via was the outcome of a multi- broader efforts to harmonize prior informed consultation" videoconferences--an ap- year consultation process that developmentassistanceamong represents the first application proach that will be expanded involved government repre- donors by aligning priorities into Bank policy of this impor- significantly during the new and programs of recipient sentatives, Indigenous Peo- tant outcome of the Extractive fiscal year. The Bank Regions countries, thus increasing cost- ples' leaders and organiza- Industries Review.3 Third, it also developed their own safe- effectiveness.1 tions, civil society organiza- adds flexibility into the project guards training courses for tions, and nongovernmental processing requirements by headquarters staff, field staff, Eight of the ten environmental organizations (NGOs). specifying that the level of de- and borrowers. After AFR in and social safeguard policies2 tail is proportional to the com- 2004, Joint QACU/regional pi- will be eligible for potential use The revised Indigenous Peo- plexity of the proposed project lots were conducted with ECA, in the pilot program. It is an- ples Policy has retained the and commensurate with the LCR, MNA, and SAR to train ticipated that 14 pilots will be policy requirements of the pre- nature and scale of the pro- task managers in the new re- undertaken during the two- viously used OD 4.20 that posed project's potential ef- gional safeguards manage- year program encompassing a Bank-financed projects are de- fects and by proposing a range of regions, income lev- signed not only to avoid ad- ment process. A noteworthy planning framework (instead els, and project structures, in- verse impacts but, equally of an up-front plan) for projects trend has also been combined cluding individual invest- important, to provide cultural- that involve preparation and client training on safeguards ments as well as sector-wide ly appropriate benefits. The implementation of annual in- and Strategic Environmental approaches. The Bank's nor- revised policy improves on OD vestment programs and mul- Assessment, notably in Latin mal due diligence, supervi- 4.20 in three critical ways. First, tiple subprojects, as well as a America and the Caribbean sion, and disclosure proce- it clarifies (a) Bank policy re- process framework for projects Region. 18 ENVIRONMENT MATTERS · 2005 Bank-Wide Review A new joint committee for Requests for Inspection for Based on the Board's request 3. Striking a Better Balance -- Knowledge Sharing and which the Bank prepared Eli- concerning the 2001 India Coal The World Bank Group and Learning has fostered greater gibility Phase Management Sector Environmental and So- Extractive Industries: The synergies and impacts from a Responses. These requests con- cial Mitigation Project, man- Final Report of the Extractive combined approach to training cerned the Pakistan National agement provided a technical Industries Review, World to be shared by the Environ- Drainage Program and the briefing to Board members in Bank Group Management ment, Social Development, Cambodia Forest Concession September 2004 and a formal Response, September 17, and Rural Development De- Management and Control Pi- report to the full Board in 2004, page 7. partments. It has, in particu- lot Project. As required by the March 2005 on the status of the lar, been instrumental in procedures governing Inspec- ManagementAction Plan. Sub- helping mobilize seed resourc- tion Panel cases, the Panel sub- sequent to the Board's May es for the creation of a commu- For more information, please sequently prepared its reports, 2004 approval of the Manage- contact: nity of practitioners in Impact which recommended proceed- ment Action Plan regarding Assessment in Manila (Philip- ing to the Investigation Phase the 2002 Inspection Panel case Use of Country Systems -- pines). L. Panneer Selvam in each case. In early fiscal year for the Yacyreta Hydroelectric (202) 458-2728, 2005, the Panel recommended Project in Paraguay andArgen- Lpanneerselvam@worldbank.org The World Bank Group took an investigation of the Mumbai tina, management reported on Indigenous Peoples Policy -- active role in the 2005 meeting Navin Rai (202) 458-1298, Urban Transport Project, progress in implementing the nrai@worldbank.org of the International Associa- plantotheBoard(atitsrequest) which had been the subject of Safeguards Training -- tion for Impact Assessment in in August 2004 and will do so requests during the previous Jean-Roger Mercier Boston, where it presented re- again in the next fiscal year. (202) 473-5565, fiscal year. The Board of Exec- cent policy and procedural de- The reports to the Board for jmercier@worldbank.org utive Directors agreed to the Inspection Panel -- velopments within the Bank, both projects can be found at Panel's recommendations in Alexandra Bezeredi IFC, and MIGA as well as cli- . (202) 458-5055, all three cases, and these pro- ent safeguards capacity build- abezeredi@worldbank.org jects are currently being inves- ing with WBIEN. More Notes tigated by the Panel. The Website: . . es and the Panel's Reports and 1. Paris Declaration on Aid Inspection Panel Recommendations are avail- Effectiveness: Ownership, able to the public at . ment, Results and Mutual Panel, created in 1993 by the Accountability, March 2, Board of Executive Directors, As reported in Environment 2005 . Bank operations with respect the Board had approved an in- to its policies and procedures. vestigation of the Colombia 2. OP/BP 4.01, Environmen- Groups of two or more private Cartagena Water Supply, Sew- tal Assessment; OP/BP citizens who believe that they erage, and Environmental 4.04 Natural Habitats; or their interests have been or Management Project. The Pan- OP/BP 4.09 Pest Manage- could be harmed by Bank-fi- el pursued this investigation ment; OP/BP 4.12 Invol- nanced activities can present during fiscal year 2005. In June untary Resettlement; OP their concerns through a Re- 2005, after receiving the Pan- 4.10 Indigenous Peoples; This article was written by the Qual- quest for Inspection. el's report, Bank Management OP/BP 4.36 Forests; OP/ ity Assurance and Compliance initiated its Management Re- BP 4.37 Safety of Dams; Unit--Charlotte Bingham, Harvey Himberg, Stephen Lintner, Jean- In fiscal year 2005, the Inspec- sponse to the Panel's findings and OPN 11.03 Cultural Roger Mercier, Navin Rai, Panneer tion Panel registered two new on the Cartagena project. Property. Selvam, and Banu Setlur. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 19 T Environment Matters 2005 -- The World Bank Group he Environment and and environmental health. Natural Resources W e have continued to make signifcant Theseinvestmentprojectsaredi- progress in imple- versified among key sectors, Management Portfolio menting our Environment such as water, urban develop- Strategy by addressing the ment, transport, energy and Figure 1. Lending trend, end FY05 links among the environment, mining, and agriculture. These 3,000 12 poverty, and development, projectscovervariousareassuch as providing safe water supply 2,500 10 with a particular emphasis on health, livelihoods, and the (for example in Armenia, Iran); 2,000 8 vulnerability of poor people. expanding sanitation access Millions 1,500 6 $ egatnecr Protecting people's health (suchasinBrazil,China,Colom- US Pe 1,000 4 from environmental risks and bia); improving air quality (for 500 2 pollution to reduce the disease example in Romania); and con- trolling industrial wastewater 0 0 burden was highlighted as an FY01 FY02 FY03 FY04 FY05 important focus in the Strate- pollution(forexampleinChina). Figure 2. World Bank project portfolio The ENRM portfolio gy. Both lending projects and by thematic distribution, end FY05 analytical work are now sys- Economic Public sector tematically exploring environ- management government At the end of 2005, the total Environment & natural 1% 8% mental health issues relating to Rule of law resources active portfolio of projects with 2% 12% air and water pollution, toxic ENRM content amounted to Rural Finance & private chemicals, and so on. A new development sector development $10.7 billion--representing Environmental Health Anchor 14% 17% Program has been established 11.5 percent of the Bank's total Urban Trade & development integration in the Environment Depart- active portfolio. Of the $10.7 12% 4% ment to facilitate a better un- billion, the core ENRM portfo- Social protection Human Social and risk lio (projects with more than 65 development Percentages based on derstanding of, and develop dev/gender 8% commitment amounts. 14% 9% tools to address, environmen- percent ENRM content) con- Figure 3. Active ENRM portfolio -- tal health linkages. sists of 53 projects representing thematic distribution, end FY05 $ 2.7 billion in ENRM commit- Biodiversity, New ENRM lending ments. Other environ 2% ($222) Climate mgmt, 3% change, 10% In terms of thematic distri- ($308) ($1,054) In fiscal 2005, the World Bank bution, pollution management Water Environ policy approved 73 projects with En- resource & institutions, and environmental health ac- mgmt, 27% 10% ($ 1,043) vironment and Natural Re- ($2,853) tivities account for the largest sources Management (ENRM) share of the active ENRM port- Land admin & content in 47 countries, mgmt, 14% amounting to $2.5 billion in folio (34 percent). Another 27 Pollution mgmt ($1,546) percent focuses on water re- & env. health, Percentages based on commitments. This represents 34% ($3,653) commitment amounts. about 11.3 percent of total Bank source management activities Figures in $ millions. Figure 4. Active ENRM portfolio -- new lending in the year, an in- within projects. Regional distribution, end FY05 crease from 6.5 percent in fis- In terms of regional distri- South Asia Sub-Saharan cal 2004. This near-doubling of bution, projects in the EastAsia (SAR) Africa (AFR) 15% new lending is mainly attrib- Middle East 9% and Pacific Region account for and North uted to the approval of two the largest portion of the active Africa (MNA) large environmental develop- 7% environmental portfolio (39 Latin America ment policy lending projects and Caribbean East Asia and (in Brazil and Colombia) in fis- percent). This is followed by (LCR) the Pacific 13% (EAP) cal 2005. ENRM portfolios in the South 39% East Europe Of these new projects, as Asia, and the Europe and Cen- and Central many as 25 have objectives re- tral Asia Regions (15 percent Asia (ECA) Percentages based on 16% commitment amounts. latingtopollutionmanagement and 16 percent respectively). 20 ENVIRONMENT MATTERS · 2005 Bank-Wide Review Figure 5. Pollution management and Figure 6. ESW and nonlending TA Figure 7. Active GEF environmental health -- with primary ENRM themes, FY02­ portfolio -- Thematic Active portfolio by Region, end FY05 05 distribution, end FY05 1,800 70 ESW (Reports and Policy Notes) 66 1,578 Ozone 1,600 60 TA total Total amount: $3.7 billion 60 POPs depletion 1,400 51 1% ts Land 10% 50 43 1,200 ecj 42 degradation 39 39 pro 40 2% 1,000 of International llionsi 30 25 Biodiversity M 800 waters $ 634 48% 576 Number20 11% 600 10 400 280 308 277 Climate 0 200 change FY02 FY03 FY04 FY05 28% Percentages based on 0 Notes: Figures exclude supplementals. ESW=Economic and number of projects. AFR EAP ECA LCR MNA SAR Sector work; TA= technical assistance. Within the active ENRM Of these ESWs, about 18 Carbon Finance portfolio, there are as many as percent of products contain The World Bank's carbon finance initiatives are part of the global effort to combat climate change.The Bank's carbon finance business manages about 155 projects with pollution pollution management and en- $858m through 8 different carbon funds, including the Prototype Carbon management and environmen- vironmental health activities. Fund,the Community Development Carbon Fund,and the BioCarbon Fund tal themes, associated with Examples include assessing (see Table below).The Bank has also established a number of technical as- sistance facilities for capacity building and project preparation. The new commitments amounting to the cost of environmental deg- State of the Carbon Market 2005 report shows that the carbon finance mar- $3.7 billion. Of this, more than radation (in China and Iran); ket is expanding steadily; 107 million metric tons of carbon dioxide equiv- 40 percent are concentrated in and identifying health hazards alents (tCO2e) were exchanged through projects in 2004, a 38 percent increase compared with 2003. The report estimates that the volume ex- the East Asia and Pacific Re- from inadequate solid waste changed in 2005 (as of May) was 43 million tCO2e. gion. management (in the Philip- Carbon Finance at the World Bank (as of June 2005) Analytical work pines). In addition, some stud- No. of Emission ies looked at detrimental Reductions Purchase Contract ERPA Emission Agreements (ERPA) in dollars Reductions health effects of environmen- Fund Name contracts signed millions (million tCO2e) Arecent qualitative analysis of tal exposure to arsenic (in Prototype Carbon Fund 21 117.25 29.63 Community Development Fund environmental analytical work 4 3.62 0.78 SouthAsia), and improper san- Other Funds * 5 N/A 3.99 between FY02­04 identifies itation (in Middle East and good practice and highlights North Africa). Note: * These include BioCarbon Funds, the Netherlands Clean Development Facility, the Italian Carbon Fund, the Netherlands European Carbon Facility, the Spanish Car- studies and reports that are bon Fund, and the Danish Carbon Fund. aligned with the objectives of Protecting the the Environment Strategy. This are substances released into projects and has facilitated the review also shows a sustained Global Environment the environment through a va- phase-out of over 172,520 increase in the number of ana- riety of human activities hav- ozone depleting potential tons Since the inception of the Glo- lytical products with ENRM ing a significant impact on at a cost of roughly $750 mil- bal Environment Facility themes since the endorsement lion. Over 454 projects have (GEF), the World Bank Group human health. Ongoing work of the Environment Strategy in has mobilized $14 billion in includes baseline studies of reached completion as of the 2001. public and private funds for POPs (in Uruguay and Cambo- end of calendar year 2004. In fiscal 2005, the Bank biodiversity conservation, cli- dia), and the Africa Stockpiles prepared 60 economic and sec- mate change, ozone depleting Program (in seven African tor work (ESW) products (pol- substances, and international countries in the first phase). This article was prepared by Anjali Acharya, (202) 458-5298, aacharya icy notes and reports) with waters. In fiscal 2005, 47 new Other studies look at finding @worldbank.org, and Eri Tsutsui, primary ENRM objectives. Ex- GEF projects were approved alternatives to POPs in malar- (202) 458-5766, etsutsui@worldbank for $264 million in GEF financ- amples are Country Environ- ia control activities (in Ecua- .org, of the Environment Depart- ing and additional Bank fi- mental Analyses (in Domini- ment. On the global environment, nancing of $571 million. dor), and termite control (in GEF data from Ayesha Aparakka; can Republic and Egypt); En- As an implementation China). Montreal Protocol data from Elaine ergy-Environment Reviews (in agency of the GEF, the Bank is The Bank's Montreal Pro- Feister; and Carbon Finance data ECA); and other environmen- from Laura Bruce, all of the Environ- preparing projects and studies tocol program, now active for ment Department. Environment tal studies (in Bangladesh and in the new area of persistent or- 14 years, has partnered with 21 Strategy website: . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 21 Environment Matters 2005 -- The World Bank Group H ow much is good Finally, imagine you are a pol- health or human life icy maker and you have the worth? Once the choice of spending part of the E question is on the table you national budget on providing cannot easily walk away. Many water and sanitation in rural conomic argue it is not possible or even areas or investing in foreign ethical to put a dollar value on assets that provide a return of Valuation of health. Economists, on the oth- 15 percent. With the returns, in er hand, argue that this is pos- one year you may be able to Environmental sible and, more important, provide water and sanitation- desirable. cover to a larger share of the Health population. However, waiting For the sake of brevity, econo- a year has other costs: newborn Impacts of mists refer to the "value of a children may die due to unsan- statistical life" simply as "the itary conditions. As a govern- Pollution value of a life." The difference ment official, you will have to the word "statistical" makes is implicitly put budget funds crucial and should be ex- and lives in the balance, and as plained. As in any other pub- a good government official lic policy consideration, when you want to have the best scientists try to value health available information. outcomes, they are not consid- ering a particular human be- Making it work ing, such as a relative or best friend. They are rather looking The valuation of health im- pacts looks at two major ele- at a statistical occurrence. The ments: the disability caused by fact that scientists are able to death or illness, and the cost of calculate the average height of illness. Starting from the easi- a population does not tell est item, the cost of illness mea- whether individuals in that sures actual payments to population feel they are too remediate health problems as- short or oversized. sociated with pollution. Under this category, items such as A second key aspect is that ev- doctor visit costs, medical ex- ery day we take bets about our penditures, and loss of caregiv- health; the premium we pay is Benefits and costs of the U.S. Clean Air Act er's time will appear. the information used to value 2010 Clean Air Act Monetized Benefits statistical lives. Valuation cap- But illness also causes tempo- Costs tures individuals' preferences Mortality rary or permanent loss in the for reducing small risks of Chronic Bronchitis productive functions of indi- Other Morbidity death. An individual knows viduals. When death is in- Productivity that driving a car may be lethal volved, two major valuation Visibility and hence is willing to pay methods are available. A low- Agriculture more for safer cars. Every day er-bound value can be ob- 0 20 40 60 80 100 120 Billions of 1990 dollars decisions provide information tained by calculating the Source: USEPA, 1999. "The Benefits and Costs of the Clean Air Act: that embrace much more than earnings lost.An upper-bound 1990 to 2010." Report to Congress: EPA-410-R-99-001. the simple value of the per- value goes beyond labor pro- son's future earnings. ductivity and takes into ac- 22 ENVIRONMENT MATTERS · 2005 Feature Articles count individuals' preferences. Clean Air Act. Implementing The Value of a Statistical Life the act is estimated to cost over COST OF ENVIRONMENTAL DEGRADATION IN IRAN method captures individuals' $25 billion between 1990 and In the Islamic Republic of Iran, a recent study has revealed that willingness to pay through the 2010. Under a cost-benefit the annual health impacts related to inadequate water supply analysis of markets in which analysis framework, the bene- and sanitation services and hygiene practices cause a loss of people trade off money and fits to agriculture, visibility, around 2.2 percent of GDP (World Bank, 2005). Health impacts related to air pollution in large urban cities such as Tehran, health. For example, many and productivity do not justi- Mashad, and Isfahan were estimated at an additional 1.3 per- studies analyze wage differen- fy the new act. After health cent of GDP annually.These numbers are not just a strong sig- tials in job markets involving impacts (in particular, mortal- nal about the need for serious actions,they are also a powerful different health risks. tool to raise awareness about environmental issues and facili- ity) are considered, the net tate progress toward sustainable development. gains from the new law are Often, what we are really in- evident. (mean annual estimate, percentage of GDP, 2002) terested in is comparing alter- 3.0 native policies and select the Economic valuation of health one that minimizes negative 2.5 impacts can prove particular- health impacts. The issue is ly useful in developing coun- 2.0 complex when we have to tries, where attention to compare, for instance, a reduc- environmental problems is 1.5 tion in the cases of asthma with overshadowed by other issues entagecreP a reduction in heart disease 1.0 or lack of information. In Co- prevalence. The World Health lombia, a recent Country En- 0.5 Organization established a rig- vironmental Analysis shows orous methodology to measure waterborne disease represents 0.0 the health gap under different Water Land, Air Waste Coastal the highest environmental bur- Forest types of illness. Disability Ad- den to the economy. The costs justed Life Years (DALY) mea- fall most heavily on vulnera- sure equivalent years of ble segments of the popula- of the new CountryAssistance World Bank. 2003. "Royaume "healthy" life lost by virtue of tion, especially poor children Strategy. du Maroc: Evaluation du being in poor health, disabled under the age of five. Similar Coût de la Dégradation de or, in the extreme case, dead. studies are being undertaken If you want to read more . . . l'Environnement." Sector The common unit of measure- in China, Iran, and Nigeria (for Note No. 25992-MOR. ment allows cost-effective de- Homedes, N. 1996. "The Dis- example, see the Box on Iran, Washington, D.C. cisions. ability Adjusted Life Year at right). World Bank. (forthcoming). (DALY) Definition, Mea- From the tools to "Islamic Republic of Iran: surement and Potential Some countries have success- Cost Assessment of Envi- the results Use." Human Capital De- fully engaged in policy dia- ronmental Degradation." velopment Working Papers. logue following health valu- Sector Note No. 32043-IR. Washington, D.C.: World How can valuing life save Washington, D.C. ation studies. The results for lives? Imagine you are a mem- Algeria were applied at the Bank. ber of parliament asked to pass highest political levels and led Mrozek, J. R., and L. O. Taylor. a new law to regulate activities to an increase in the budget for 2002. "What Determines that cause air pollution. The environmental protection by the Value of Life? A Meta- law will impose high costs on $450 million. In Morocco, the analysis." Journal of Policy This article was prepared by Giovanni Ruta, (202) 473-9388, society through more expen- valuation of health impacts re- Analysis and Management gruta@worldbank.org from the Envi- sive transport, among other lated to waterborne diseases 21(2): 253-70. ronment Department and Maria things. The Figure on page 22 has encouraged the govern- Viscusi, W. K. 1993. "The Val- Sarraf (202) 473-0726, msarraf@ measures the monetary costs worldbank.org, of the Environment ment to focus future interven- ue of Risks to Life and Unit of the Middle East and North and benefits of the introduc- tions in the water sector. This Health." Journal of Econom- Africa Region, with assistance from tion in 1990 of the United States became one of the four pillars ic Literature 31: 1912­46. Bjorn Larsen. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 23 Environment Matters 2005 -- The World Bank Group E very year, some 2 mil- analysis of interventions in lion people die from non-outbreak conditions. diarrheal diseases, ac- A meta-analysis differs W cording to UNICEF and WHO from a standard literature re- estimates. Much of this disease view in that, in addition to ex- ater, burden is caused by contami- amining the impacts of various nated drinking water and in- projects individually, it then Sanitation adequate sanitation. Although statistically combines the re- the vital role of safe water and sults of similar interventions to produce summary measures of and Hygiene sanitation in maintaining health has been recognized for effect. It enables comparisons centuries, many families-- of intervention types and can Interventions especially those in the devel- help to clarify which approach oping world--still lack ade- is optimal for a given situation. for Health -- quate services (see Table, at This effort included a re- left). Increasing coverage is a view of all published papers What Works? key development priority. The listed in computer-searchable Millennium Development databases through June of 2003 Goals targets include halving (when the search was conduct- ed). After screening 2,120 arti- the number of people without cles that included essential key sustainable access to safe wa- words, 50 papers describing 46 ter and basic sanitation by the different interventions in 24 year 2015. countries were identified. Of Having safe drinking water these, 38 had quantified the is usually defined as having an impact of the interventions on "improved" water supply-- health and could be used in the that is, a water supply that is meta-analysis. protected from contamination The interventions were by pathogens and other illness- classed into five categories: (1) causing contaminants. These hygiene (health education and might include, for example, encouragement of specific be- rainwater; a protected spring, haviors such as handwashing); Regional coverage (percent) of improved borehole, or dug well; or sur- (2) sanitation (means of excre- water supply and sanitation facilities in face water that is filtered and ta disposal, often a latrine); (3) 2000* treated to kill pathogens. water supply (provision of a Sanitation is also important Urban new source or improved distri- to prevent excreta from con- bution system, such as a hand- Water supply Sanitation Region (percentage) (percentage) taminating water sources.And pump or household instal- Africa 85 85 good hygiene is important so lation); (4) water quality (treat- Asia 93 78 that contaminants cannot trav- Latin America 93 87 ment to remove pathogens, ei- and the Caribbean el via hands, insects, and im- ther at the source or in the Oceania 98 99 plements into a family's food Europe 100 98 household); and (5) multiple NorthAmerica 100 100 and water. interventions (hygiene, sanita- Given the known impor- tion, and water elements). Rural tance of water, sanitation, and The meta-analysis con- Water supply Sanitation Region (percentage) (percentage) hygiene, a key question is firmed that all of these inter- Africa 47 45 which interventions in these ventions can be effective in Asia 74 31 areas work best to bring about improving health. The inter- Latin America 62 49 and the Caribbean sustainable improvements in ventions reduced diarrheal Oceania 63 81 health. To answer this ques- disease by 25 to 37 percent. Europe 87 74 NorthAmerica 100 100 tion, the World Bank commis- This reduction was measured Note: *Adapted from WHO/UNICEF 2000. sioned a review and meta- using a statistic called "relative 24 ENVIRONMENT MATTERS · 2005 Feature Articles risk," which compares the like- the pipes have breaks or lack Summary of meta-analysis results lihood of illness in people who constant water pressure from Hygiene received the intervention to the less than 24-hour service. Sec- Excluding poor quality studies Handwashing likelihood in people who ond, families who lack in- Education didn't. A relative risk of 1 home connections or 24-hour means that both groups have service must transport water Sanitation equal rates of illness, while a from the collection point and/ Water supply Diarrhoea only relative risk of 0.75 means that or store it in their home. Water Household connection the intervention reduced the can easily become contaminat- Standpipe or community connection illness rate by 25 percent. ed during transport and stor- Water quality Although all the interven- age, especially if hygiene is Source treatment only Household treatment only tions were broadly effective, suboptimal. Source treatment Household treatment the results indicate some pos- cannot address these risks, but · Excluding poor quality studies sible differences and some sur- point-of-use treatment can en- · Urban/periurban locations prises. In general, the strongest sure that water is made safe Multiple interventions were those that just before it is consumed. addressed water quality and For sanitation, only two 0·4 0·6 0·8 1·0 Pooled effect hygiene (see Figure at right). studies were eligible to be in- Note: The colored blocks are the effect estimates for each intervention, and each Note, however, that the differ- cluded in the analysis. Al- horizontal colored line indicates a 95 percent confidence interval (CI) of the esti- mate. The CI conveys how precise the measurement is. If estimates of the interven- ences in effects were not statis- though these showed a good tions were repeated 100 times, we would expect that 95 of them would result in tically significant. effect (32 percent disease re- values captured by the range. The vertical line indicates a relative risk of 1.0. Re- For hygiene, both health duction), more information is sults to the left of the vertical line indicate relative risks < 1.0 (disease rates de- creased) and results to the right of the line indicate relative risks > 1.0 (disease education and handwashing needed to fully assess the im- rates increased). promotion--an area that is cur- pacts of various types of sani- rently receiving much atten- tation. grams to determine if, and tion--were effective, reducing The water supply studies References how, they could have a great- disease risk by 37 percent. Ex- showed a positive impact over- er impact. Fewtrell, L., and J.M Colford, Jr. cluding the poorer-quality all (25 percent disease reduc- 2004. "Water, Sanitation and studies from the meta-analysis tion), but a more stringent In sum, the meta-analysis Hygiene: Interventions and made the impact even stron- re-analysis that removed less results confirm that while ac- Diarrhoea -- A Systematic ger. relevant studies decreased the cess to basic water and sanita- Review and Meta-analysis." For water quality, the im- impact. This was true for both tion are necessary, important Washington, D.C.: World pact depended strongly upon standpipe and household con- additional health gains may be Bank. Available at . household).Treatingwaterinthe was that multiple interven- iors are maintained. Fewtrell, L., and others. 2005. The household--whether through tions, with a 33 percent disease As these interventions are Lancet Infectious Diseases 5: boiling, chemical disinfection, reduction impact, were not implemented, it will be impor- 42­52. or solar disinfection--was very necessarily more effective than tant for future studies to take WHO/UNICEF. 2000. Global Wa- effective, reducing diarrhea interventions aimed at a single note of not just immediate ef- ter Supply and Sanitation As- risk by 35 percent. The effect issue. The reasons for this are fectiveness, but also sustain- sessment 2000 Report. Water was slightly stronger if the not immediately clear, but it is Supply and Sanitation Col- ability and costs. Noting base- analysis was limited to better- tempting to speculate that pro- laborative Council. Geneva: line conditions is also useful, quality studies--according to grams involving multiple in- World Health Organiza- because the optimal interven- tion/United Nations Chil- criteria defined in Fewtrell and terventions tend to focus on tion may vary according to the dren's Fund. Colford (2004)--or rural area one component and give rela- studies. But disinfection at the local situation. Ultimately, we tively less attention to others. This article was written by Rachel source only reduced risk by 11 Because many of the programs should have the tools to enable Kaufmann from Centers for Disease percent. This could be due to a currently sponsored by the each population to choose the Control and Prevention, (678) 938- couple of factors. First, piped World Bank and others are of most feasible, cost-effective, 9737, rkaufmann@cdc.gov. For more information, please visit . nated after source treatment if closely examine these pro- them. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 25 Environment Matters 2005 -- The World Bank Group I n rural areas, burning tra- Study design ditional fuels, such as fire- wood in open fires for The Ministry of Energy and cooking and heating, exposes Mines (MEM) requested the poor women and children to World Bank, with support indoor air pollution (IAP) pri- from the Energy Sector Man- E marily from harmful concen- agement Assistance Program, trations of particulate matter to conduct a study to estimate nvironmental (PM) and other pollutants. the health impacts of tradition- Health impacts include acute al fuel use in Guatemala and Health and respiratory infection (ARI)1-- to outline strategies and poli- notably pneumonia--in chil- cies for mitigating environ- Traditional dren and chronic bronchitis in mental health damage due to women. household energy. The study Fuel Use in was initiated with a workshop in November 2001 attended by In Guatemala, government sta- Guatemala a wide spectrum of Guatema- tistics indicate thatARI was the lan stakeholders, including country's single most impor- representatives from the ener- tant cause of morbidity and gy, health and environment mortality between 1997 and sector ministries; women's and 2000. On average, ARI caused indigenous groups; the private two to three times as many sector; NGOs; and local and deaths as acute diarrhea, the international researchers. second cause of mortality. Fur- thermore, in 1997­2000 pneu- After the study was complet- monia represented the most ed, stakeholders came togeth- important single cause of in- er again in April 2003 to fant death in Guatemala, ac- discuss findings and consider counting for 36 percent of all the reality of the Guatemalan registered infant deaths. context. There was consensus that IAP needed to be ad- Fuelwood is the dominant dressed in the short term, giv- Energy options, ranked by increasing effectiveness cooking fuel in 97 percent of en the close links with poverty in mitigating the health impacts of IAP rural Guatemalan households. reduction and with the fourth Electricity The rural population accounts and fifth Millennium Develop- Less polluting options. May alter food taste. for over 60 percent of the total Unsuitable for certain foods. Acceptability ment Goals related to reducing ion Only LPG stove and hence effectiveness in mitigating population. As documented in atr health impacts of IAP may be affected by child mortality and improving cultural and cooking preferences and costs of the Poverty Assessment Re- LPG/electricity. maternal health. Barriers to concent MP LPG/Fuelwood mix port (2003), over half of all successfully reducing IAP in Guatemalans were living in rural homes included the ab- Must be properly maintained to poverty in 2000.Three-quarters Increasing Improved wood-burning stove achieve effectiveness in mitigating sence of a constituency pre- health impacts of IAP. of rural residents fall below the pared to act (in part due to lack full poverty line, and one-quar- of information and education Use is affected by cultural and cooking Open fire practices. ter live in extreme poverty. on this subject) and a corre- PM = particulate matter Rural electrification rates are sponding lack of policies, re- LPG = liquefied petroleum gas low, with electricity connec- sources, and institutional Indonesia tions in fewer than 40 percent mechanisms to facilitate of the poorest households. change. 26 ENVIRONMENT MATTERS · 2005 Feature Articles Estimates of health impacts of IAP can be achieved women did not see the In summary, IAP has close impacts of IAP in as households move up the link between health and links to child mortality and energy ladder (see Figure, at smoke. Women's groups maternal health and affects Guatemala left). Equally important is an and NGOs--as well as re- particularly vulnerable groups understanding of health im- vised government training of the population such as poor The study was not able to con- pacts of IAP and behavioral and health outreach pro- children and women. There is clusively determine how many change that reflects this under- grams--can play an im- a strong case that Guatemalans people were affected by pollu- standing. portant role in getting the need to act to address this is- tion from burning traditional message to the final users. sue. fuels.2 Estimates, applying The study recommended four Implementing technical op- findings from other IAP health types of broad interventions to tions. The study found that References studies worldwide, indicated improve the effectiveness and most of the existing stoves that the number of annual cas- efficiency of current arrange- Ahmed, K., Y. Awe, D. Barnes, programs focused on fuel es of ALRI among children ments to combat IAP. In addi- M. Cropper, and M. Koji- efficiency, are highly sub- under age five in the Guatema- tion to better targeting existing ma. 2005. Environmental sidized, offer limited lan highlands (where the im- budgetary resources, the in- Health and Traditional Fuel choice to the user, and are pact is most severe) could creased costs of such a pro- Use in Guatemala. Direc- implemented in a modu- potentially be reduced by as gram are expected to be offset tions in Development. lar manner, without inter- many as 24,000, and annual in the longer term by health Washington, D.C.: World improvements. action between the gov- deaths by about 1,000, through Bank. ernment and its policies the reduction of PM10 levels to Monitor the problem and im- and the different suppli- less than 200 µg/m3. (This is Notes prove understanding of the ers. It is essential that the the reference exposure catego- links between health and pov- government take a more 1. Acute respiratory infec- ry, which in theory is achiev- erty reduction in order to proactive role in establish- tion, ARI, may include able by a well-maintained guide the development of acute lower respiratory improved stove or by reliance ing policies that empha- the national poverty re- tract infection (ALRI) or on a gas stove. Based on the size both fuel efficiency duction agenda and for- acute upper respiratory literature, studies generally and health impact as the mulate national policies tract infection (AURI). assume that children in house- key criteria for improved associated with reducing 2. Based on statistics ob- holds that use open fires fall in stove design, and promote health impacts of IAP. tained from the Ministry the exposure range of 1,000­ a market-based system Greater interinstitutional co- of Health in Guatemala, 2,000 µg/m3). This would be that targets stove subsi- ordination is a crucial inter- ALRI incidence rates and about a 60 percent reduction in dies to the poorest and of- vention, since tackling the mortality rates for chil- the annual cases of ALRI mor- fers choice and training for issue of IAP is spread dren under five years old bidity and mortality, among the user. Creation of a across the mandates of dif- in each department in the the 400,000 children under the multistakeholder coordi- ferent government institu- study area ranged be- age of five in the Guatemalan nation group on rural tions. Equally important is tween 533 and 1,450 per highlands who live in house- household energy could coordination among gov- 10,000 and between 1.91 holds in which open fires are ernment, the private sec- facilitate this approach.As and 5.77 per 1,000 respec- used for cooking. tor, NGOs, academia, and a complement to such a tively. Recommendations households--particularly group, MEM could estab- the women who use the lish and lead a technical for addressing IAP stoves and the men who stoves unit that acts on behalf of the consumer, to in Guatemala buy them and often collect This article was prepared by Kulsum firewood for them. certify stoves on both Ahmed, (202) 473-1130, kahmed4@ Making people aware of the efficiency and health worldbank.org, of the Environment The literature and experience Department and Yewande Awe, (202) problem to promote behavior- grounds and facilitate a 458-5795, yawe@worldbank.org., of from various countries indicate al change. A striking find- wider offering of certified the Environment Unit of the Latin that mitigation of the health ing of the study was that stoves. America and Caribbean Region. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 27 Environment Matters 2005 -- The World Bank Group I n three regions--Africa, ies of daily changes in air South and East Asia, and pollution and health and LatinAmerica--the Clean reported the results in the T Air Initiative (CAI) is support- context of broader air pol- ing innovative ways to address lution and health science. he Clean the growing impact of air pol- A major finding was the lution on human health and noticeable increase in dai- Air Initiative improve people's quality of ly mortality for PM10, life, especially the poor in de- which was similar to west- veloping countries. The CAI ern studies using compa- combines training, research, rable methods. and actions on the ground. In Sub-SaharanAfrica, the Recent examples include a dis- Clean Air Initiative spear- tance learning course in Latin headed a successful pro- America, a project focusing on gram focusing on the com- air pollution in Asia, and the plete phaseout of leaded phaseout of leaded gasoline in gasoline in the entire re- Sub-Saharan Africa. BOX 1 gion by December 2005, as REDUCTION OF PARTICULATE stated in the Dakar Decla- On May 24, 2005, some 500 POLLUTION ration of June 2001 (see FROM 2-STROKE ENGINES specialists, practitioners, Box 1). Studies show that In Dhaka,a successful program was imple- and policy makers across the introduction of un- mented to build awareness by disseminat- different parts of Brazil ing information on the health impact of leaded gasoline has direct participated in a distance 2-stroke emissions; the types of engines, health benefits. learning module on health fuel, and lubricant that reduce emissions; the importance of regular maintenance; impact assessment orga- There are major World Bank and the advantages and disadvantages of nized by the CleanAir Ini- various measures for mitigating air pollu- tiative in Latin American projects that are the direct re- tion. Lessons learned have been shared Cities. Based at their local sult of (or are benefiting from) with CAI partners in Africa,and several cit- CAI. Concrete examples are ies are now implementing projects with training centers, they support from CAI. watched a live presenta- urban transport and air pollu- tion via videoconference tion projects in Latin America and web where presenters (Bogotá, Lima, Mexico, São in Brasilia and São Paulo Paulo, Santiago),Asia (Dhaka, BOX 2 discussed major health Colombo, Bangkok, Hanoi, DIESEL PROJECT and economic costs of air Manila, and many cities in pollution and benefits of China), andAfrica (Dakar, Cot- Diesel emissions are complex mixtures mitigation measures. onou, Ouagadougou, Lagos). containing both fine particulate matter Many of these cities are receiv- (such as PM10) and precursors for the for- Last year, the Public mation of secondary particulates.The par- Health and Air Pollution ing Global Environment Facil- ticles emitted by diesel engines are often in Asia (PAPA) project, ity (GEF) support. very small (90 percent are less than 1µm Air pollution health in size),making them readily respirable by under the umbrella of the human beings. The World Bank, in part- Clean Air Initiative for impacts nership with the Pollution Control Depart- Asian Cities, reviewed ment in Thailand, launched the DIESEL over 160 existing health program to better understand factors af- fecting in-use diesel vehicle emissions, effect studies from over 30 Urban air pollution, which has quantify emissions, and assess alternative organizations acrossAsia. worsened in most large cities emission reduction options to assist deci- It carried out a detailed in the developing world over sionmaking. meta-analysis of 28 stud- the last few decades, imposes 28 ENVIRONMENT MATTERS · 2005 Feature Articles a heavy burden on the health development agencies and tered dialogue among the ground, especially to re- of urban populations through- foundations, nongovernmen- decisionmakers at local duce GHG emissions and im- out the developing world. In tal organizations, and academ- and national levels. This prove air quality by promoting some cases, the health effects ic institutions--is widely has raised awareness of sustainable transport policies of air pollution exceed the im- recognized as the regional the relationships among and sound land-use manage- pacts of poor water quality and framework for addressing air air quality, transport, and ment. Technical assistance sanitation problems in urban pollution problems in Latin energy policies and result- (studies, workshops, experts, areas.1 American, Asian, and Sub-Sa- ed in specific urban trans- surveys) and pilot invest- haranAfrican cities. The World port projects in cities and ments--in areas such as non- Indoor air pollution is respon- Bank co-founded the CleanAir improved fuel quality. motorized transport facilities, sible for over 1.6 million annu- Initiative for Latin American Dissemination and Out- improvement of urban land- al deaths and 2.7 percent of the Cities at a launching workshop reach. The CAI website scape/facilities in transport global burden of disease (in in December 1998. As a result () corridors,andmobilitymanage- Disability-Adjusted Life Years of its success, it was also ment systems--are planned has been instrumental in or DALYs).2 The impact of in- launched in Asia in 2001 and for delivery in the next phase. the exchange of informa- door air pollution on human subsequently in Sub-Saharan tion and as a forum for dis- health varies considerably ac- Africa later that year. cussion. Communication Notes cording to the level of devel- activities, using television opment. Children under five Today, the World Bank is a 1. As shown by the Country networks and printed years of age account for more leading player in all three CAI Environmental Analyses media, have raised public than 50 percent of deaths due networks. TheAir Quality The- in LAC for countries such awareness. Documenta- to indoor solid fuel use. matic Group, chaired by the as Brazil, Colombia, Mex- ries based on existing Environment Department and ico, and Peru, where large projects are being success- There are also important link- with representatives of all in- urban centers experience fully disseminated through ages between local pollutant volved units, coordinates and larger numbers of morbid- the network and are re- emissions and greenhouse gas advises on the direction of the ity and mortality cases as- sulting in replication emissions. A recent study3 in regional initiatives. Activities sociated with air pollu- projects. four cities--New York, Mexi- are guided by regional priori- tion. Project level. CAI has fos- co, São Paulo, and Santiago-- ties and formulated through a 2. Global Burden of Disease, tered the formulation and estimated that the adoption of participatory process. Major from . energy efficiency and alterna- implementation of specif- activities include: 3. Cifuentes, Luis A., and tive energy policies for reduc- ic action plans and major Knowledge Management and others. 2001. "Climate ing greenhouse gas (GHG) projects across the three Training. The CAI has pre- Change: Hidden Health emissions will also reduce par- regions (see Box 2). Special Benefits of Greenhouse pared and delivered a ticulate matter and ozone. emphasis has been given Gas Mitigation." Science number of very successful From 2000 to 2020, it would to health and poverty re- 293:1257­1259. and cost-effective courses avoid approximately 64,000 duction, lead phaseout, using the wealth of tech- premature deaths (including and sustainable transport. nical and institutional infant deaths), 65,000 chronic knowledge available at bronchitis cases, and 37 million Future partner institutions. The person-days of work loss or distance learning course other restricted activity. As the Clean Air Initiative's prepared by WBI has been three regional programs CAI approach one of the most successful evolve and grow, there is a and widely recognized ac- need to continue strengthening This article was prepared by Samantha Constant and Paul Procee The CAI--an integrated, mul- tivities in Latin America cross-fertilization and sharing from the World Bank's Environmen- tidisciplinary, and multi-orga- and Asia. knowledge within the Bank tally and Socially Sustainable Devel- nization network involving Policy Dialogue. Through and at the global level. The Ini- opment Division (WBIEN). For more information about CAI, please con- city governments, private sec- field visits and targeted tiative will focus more on the tact Paul Procee at (202) 458-2472, tor companies, international meetings, the CAI has fos- implementation of projects on . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 29 Environment Matters 2005 -- The World Bank Group C hemicals of many physical function and capaci- kinds have become a ty (for example, heavy metals T global issue affecting poisoning). human and environmental oxic health across the boundaries of In terms of human health, per- countries, regions, and econo- sistent organic pollutants Chemicals -- mies. With an estimated $1.5 (POPs) are of particular con- trillion in sales in 1998, the glo- cern because they can move A Growing bal chemical industry employs great distances from their more than 10 million people source, degrade very slowly in Global Threat and accounts for 7 percent of the environment, and accumu- global income. In the develop- late in wildlife and humans. ing world, the impact of chem- Other substances prevalent in icals on the lives of poor the environment are heavy people is growing, as produc- metals such as mercury (from tion of chemicals--as well as coal-fired power plants, indus- processing and formulation-- trial plants, medical equip- steadily increases. Once re- ment, and mining), lead (from leased into the environment, leaded gasoline, consumer chemicals may undergo short- products), and cadmium (from or long-range transport as a re- batteries, sewage waste, fertil- sult of natural environmental izers). Some chemicals work processes. They may be trans- indirectly; for example, chlo- formed into other chemicals rofluorocarbons and other and may cause local, regional, ozone-depleting substances and/or global contamination, created a hole in Earth's pro- expose humans and wildlife tective ozone layer, which has and, in some cases, have toxic increased the incidence of skin effects. cancer and cataracts. Exposure and effects Some statistics have quantified the number of these exposures. Exposure to toxic chemicals A survey of child labor in sev- can be "direct," when the eral developing countries con- chemical moves straight from sidered biological, chemical, the source to the person, or and environmental hazards. "indirect," when the chemical Nine out of ten working chil- goes through intermediate dren are in agriculture, and the pathways. Impacts can be study found that over 60 per- acute, caused by single expo- cent of economically active sures to toxic levels of chemi- children were exposed to haz- cals (for example, pesticide ardous conditions, and over 25 poisonings) or chronic, involv- percent of these hazards were ing exposure to lower concen- due to exposure to chemicals trations over long terms. (Ashagrie 1998). In Mexico, Chronic exposure is gradual studies of children exposed to and often not obvious to de- lead have shown 40 to 90 per- tect, but it can have significant cent of children in certain com- health impacts, such as de- munities with levels up to 10 grading neurological and micrograms/dL per day, and 30 ENVIRONMENT MATTERS · 2005 Feature Articles close to 10 percent in some be more toxic to children who ment, such as theAfrica Stock- of countries to coordinate ob- communities had levels of up are malnourished. In the strug- piles Programme (ASP). (See ligations under a range of to 50 micrograms/dL per gle for a better quality of life page 49 for a description of the chemicals conventions; to inte- day--a level that requires hos- and development, the neuro- ASP.) The Montreal Protocol grate national, regional, and pitalization in the United logical and health effects on shows how the global commu- global objectives for sound States (Romieu, and others children in these countries can nity can work together to de- chemicals management into 1994, 1995). Finally, there are have serious long-term effects. velop a solution to a chemical national plans for sustainable an estimated 3 million cases of threat. The Montreal Protocol growth; and to build capacity acute, severe pesticide poison- POPs exposure also dispropor- Multilateral Fund provided to reduce the risks of chemicals ings worldwide, including tionately affects the poor. POPs funding to developing coun- exposure to their populations about 250,000 deaths. Almost and other pesticides contribute tries to convert to cleaner, non- and environment. all of these cases are in devel- to both acute and long-term ozone-depleting technologies. oping countries (Jeyaratnam impacts on human health. Pes- The Stockholm Convention References 1996). ticide poisonings can occur hopes to follow a similar mod- Ashagrie, K. 1998. Statistics on Impact on poor through direct exposure, due el. The Bank is working with Working Children and Hazard- to lack of training or inade- the Global Environment Facil- ous Child Labor in Brief. Inter- people quate safety equipment. Pesti- ity and clients to provide stra- national Labour Organisa- cide drums and containers are tegic guidance on how to stop tion: Geneva. often reused for water and using POPs and develop alter- Buccini, John. 2004. The Global Of the chemicals discussed food in poor communities natives. Pursuit of the Sound Manage- above, lead, pesticides, and across the globe, exposing chil- ment of Chemicals. Washing- mercury affect people living in ton, D.C.: World Bank. dren and others to the effects At the local level, the Bank and poverty the most. Exposure to Goldman, Lyn, and Nga Tran. of the chemicals. When poorly its partners are working to help lead may occur through a va- 2002. Toxics and Poverty: The stored or disposed of, obsolete countries understand and as- riety of informal sector activi- Impact of Toxic Substances on pesticides (many of which are sess the impact of chemicals on ties such as making ceramics, the Poor in Developing Coun- POPs) can create long-term human health. Studies include tries. Washington, D.C.: recycling batteries, and scav- toxic effects on the environ- an investigation of the health World Bank. enging or through exposure to ment, creating a long-lasting impacts of pesticides in An- Jeyaratnam, J., and D. Koh. 1996. vehicular fumes in countries "Pesticides Hazards in De- and global threat to human dean farming communities in that still use leaded gasoline. veloping Countries." Science health. People who scavenge at Peru, blood monitoring stud- Exposure to mercury can be of the Total Environment 188 landfills and municipal waste ies in China, and breast milk through poorly disposed mer- Suppl 1: S78­85. dumps are often exposed to monitoring studies in Mexico. Romieu I., E. Palazuelos, M. Her- cury waste or as part of the dioxins and furans, two high- Results from these studies will nandez-Avila, C. Rios, I. Mu- processing in artisanal gold ly toxic POPs that are emitted allow countries like China and noz, C. Jimenez, and G. Ca- mining. from incomplete combustion Mexico to be better equipped hero. 1994. "Sources of Lead Exposure in Mexico City." of waste from fires that typical- for the design of successful in- The World Health Organiza- Environmental Health Perspec- ly occur at disposal sites. terventions and solutions. At tion expects the burden from tives 102(4): 384­389. the project level, through its Romieu, I., T. Carreon, L. Lopez, chronic disease in developing Taking action safeguards policies, the Bank E. Palazuelos, C. Rios, Y. economies to outweigh the works to reduce the impact of Manuel, and M. Hernandez- burden from infectious disease At the international level, ap- pesticides (including DDT) Avila. 1995. "Environmental by 2020. Only a subset of proaches to these problems and other chemicals in its Urban Lead Exposure and chronic disease is associated range from global treaties on country work programs. Blood Lead Levels in Chil- with chemicals, but the health dren in Mexico City." Envi- the control of chemicals--such ronmental Health Perspectives effects of these substances are as the Montreal Protocol on Finally, the global community 103 (11): 1036­1040. worse among those who are Chemicals that Deplete the is working together to devel- most vulnerable--those with Ozone Layer and the Stock- op a Strategic Approach to In- This article was prepared by Ellen poor nutrition, with concur- holm Convention on POPs--to ternational Chemicals Man- Tynan, (202) 473-8201, etynan@ rent disease, and children. specific projects to remove tox- agement. The World Bank sees worldbank.org, of the Environment Lead, for example, is known to ic chemicals from the environ- this as a key step in the ability Department. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 31 Sub-Saharan Africa Region Cape Verde Mauritania Mali Niger Eritrea Guinea-Bissau Senegal Chad The Gambia Burkina Sudan Guinea Faso Nigeria Sierra Leone Benin Togo C.A.R. Ethiopia Liberia Cameroon Côte Somalia d'Ivoire Congo Uganda Rwanda Burundi Ghana Kenya Equatorial Guinea D.R. of Tanzania São Tomé and Príncipe Congo Seychelles Gabon Angola Comoros Zambia Malawi Namibia Zimbabwe Mauritius Botswana Madagascar South Mozambique Africa Swaziland IBRD 31567R SEPTEMBER 2005 Lesotho South Africa Hamilton K. Environment and health in Africa BOX 1 ub-SaharanAfrica faces many challenges to ROLLING BACK MALARIA -- sustainable development, including some of ENVIRONMENTAL ISSUES AND OPPORTUNITIES the highest population growth rates in the According to the World Bank's Global Strategy & Booster Program world, growing formal and informal urban- (2005), if at least 60 percent of children under five slept under ization, widespread poverty, a pandemic insecticide-treated bednets there could be as much as a 20 per- AIDS crisis, and a high degree of political cent reduction in mortality and morbidity in children. But, as of fragmentation. The region has 10 percent of the global popu- today, countries are far from reaching this level of coverage, due lation, but had 24 percent of the global burden of disease in in part to production and distribution-related bottlenecks,as well 2000. as significant financing gaps. In the long term, it is important to raise awareness about how According to a draft World Bank study (Doumani 2005), 360­ vector-borne disease spreads, and what behavioral change is 400 million people are living in malaria-prone areas. More than required to stop it, and to set plans for how vectors will be man- 200 million episodes of clinical disease resulted in 1 million aged in urban and rural settings. Resistance to insecticides also deaths from malaria in 2000. The Bank has engaged in a booster must be addressed.Continued monitoring of resistance and iden- program for malaria control in Africa and will apply a multi- tification of alternative products for vector management is one of the areas in which the international community can play a role pronged approach including provision of insecticide-treated in assisting countries. bednets and integrated vector management (see Box 1). Environment Matters 2005 -- The World Bank Group 32 ENVIRONMENT MATTERS · 2005 SUB-SAHARAN AFRICA REGION Diarrheal death has fallen dramatically in significant environmental health issue BOX 3 the last decade, largely as a result of bet- (see Box 3). ter curative services. Nevertheless, water CLEAN AIR INITIATIVE IN supply and sanitation services covered In 2000, over 24 million people were af- SUB-SAHARAN AFRICAN CITIES just over half the population in Sub-Sa- fected by natural disasters such as haran Africa in 2000. More investments drought, high winds, and floods (see Box Urbanization and increasing motorization in Sub-Saharan Africa have resulted in sig- in infrastructure are required, but simple 4). Global climate change is likely to in- nificant degradation of air quality. The and more cost-effective interventions for crease the frequency and intensity of such Clean Air Initiative in Sub-Saharan African disease control deserve attention as well. events. In addition to causing major eco- Cities (CAI-SSA), sponsored by the World For instance, in Ghana the Bank is sup- nomic losses, these disasters exacerbate Bank in collaboration with a number of porting a public-private partnership for communicable diseases such as malaria, partners, is part of a global effort to pro- handwashing with soap; early results in- diarrhea, and meningitis, increasing the tect the urban environment. CAI-SSA has dicate that diseases have already been burden on the poor. A major locust inva- helped a number of governments to reduced (see Box 2). sion in the Sahel in 2004 proved again that phase out the use of leaded gasoline and has raised public awareness on the effects the region is very vulnerable to such of pollution from motorized transport. About 80 percent of the population in shocks. The Bank's response included the Sub-Saharan Africa relies on biomass, Africa Emergency Locust Project, which At a regional conference financed by CAI- coal, and charcoal for cooking (mostly in promotes coordination among donors SSA in June 2001 in Dakar, governments, traditional unimproved stoves), heating, and supports coordinated efforts to pre- the oil industry, and civil society agreed lighting, and as mosquito repellent. The vent the recurrence of a major locust in- to eliminate lead in gasoline throughout resulting indoor air pollution plays a sig- vasion and to obtain pesticides. Sub-Saharan Africa by the end of 2005.The nificant role in child mortality; in 2000, it Bank has concentrated on providing tech- nical assistance. A May 2005 review of is estimated that 730,000 children under The international community is also as- progress in the lead phase-out effort in- five years of age died from respiratory sisting in the management of hazards dicated that the main objective of the disease. Outdoor air pollution also is a such as obsolete and hazardous pesti- Dakar agreement has been accomplished. By January 2006,virtually the entire region is expected to have phased out leaded BOX 2 gasoline. Several factors contributed to this achievement, including effective col- THE GLOBAL PUBLIC-PRIVATE PARTNERSHIP laboration among CAI partners; the strat- FOR HANDWASHING WITH OAP S egy's emphasis on a swift changeover; The Public-Private Partnership for Handwashing is a global initiative to promote handwash- price changes in countries that import ing with soap to reduce diarrhea, a major cause of child mortality in many countries today. their transport fuels, such that unleaded Ghana is one of four participating pilot countries, along with Senegal, Peru, and Nepal. An gasoline was typically less expensive than initial study of the soap market showed that while Ghanaians are major consumers of soap leaded gasoline; and improved under- per capita, with handwashing widely practiced, soap use is not yet a habit. standing of the negative health impacts of even small amounts of lead. The program's objectives in Ghana for the years 2003­05 are to increase the practice of handwashing with soap among mothers and caregivers from 16 percent to 50 percent and to increase the number of schoolchildren aged 6­15 who wash their hands with soap from Fiadjoe.Y an estimated 20 percent to 50 percent. In 2004, the National Handwashing Campaign launched an intensive media campaign through three television networks and 17 radio stations throughout the 10 regions of the country. These public service announcements were complemented by a number of radio and television discussions programs with interviews held throughout the country on na- tional media and district-specific FM radio stations.The communication program was sup- plemented by district-level handwashing action plans for implementation.After six months, reported rates of handwashing with soap among mothers and schoolchildren showed marked improvement over baseline rates.Exposure to all campaign materials was also very high,with over 80 percent of children and adults reporting positive behavior change since the campaign launch. Children on their way to sell fish at a nearby market in Ghana. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 33 BOX 4 THE AFR REGIONAL CASE OF NVIRONMENT AND E HEALTH BENIN ENVIRONMENT PORTFOLIO IN Other environmental Biodiversity Completed in 2004, the Benin First Decentralized City Management Project helped deliver management 5% Climate change better quality and cost-effective basic services to urban residents, especially the poor, in 9% 12% Benin's three main cities.The project was a response to rapid and unplanned urban growth, Water resource management often on environmentally vulnerable land with poor infrastructure. In areas lacking access 19% Environmental to primary drainage, the project also contributed to significantly and sustainably reducing policy and institutions the effects of periodic flooding on public health. Some 17,000 households--about 85,000 16% people--gained access to roads.The project also supported installation of new drains,pro- Pollution management and Land tecting about 400,000 people from periodic flooding. The project's second phase (a pro- environmental health management posed $35 million IDA Credit) will further strengthen urban management in Benin. 28% 11% cides. For example, the Bank-supported achieving the Millennium Development Percentages based on commitment amounts. At the end of June 2005 the active portfolio of Africa Stockpiles Program is a partner- Goals requires a multisector effort that World Bank environmental lending in the AFR ship of NGOs, donors, and industry as- encompasses several ministries, the pri- Region was $1.0 billion. sisting countries with the cleanup of vate sector, and civil society. Internation- fuel burning is a major challenge for the obsolete pesticides. al organizations and donors can play an important role in ensuring seamless co- region. Similarly, a combination of edu- cation and awareness, as well as signifi- Lessons from World Bank projects have ordination and multidonor support to cant investments in water infrastructure, demonstrated that very simple mea- governments in Africa. As shown by the is direly needed to minimize the huge sures--like judicious handwashing with Bank's Locust Project in 2004, it is impor- burden of waterborne diseases. These soap, awareness of how vector-borne dis- tant at an early stage to bring countries, and other environmental health problems ease are transmitted, ventilation, or en- donors, and technical agencies together have to be tackled jointly, because many vironmental cleanup--can greatly reduce to agree on institutional responsibilities of their underlying causes are poor socio- the burden of disease in Sub-Saharan Af- and priorities for action. This should be economic conditions. There are also many rica, especially within the framework of replicated in other sectors. synergies to be captured by integrated community-driven development. Africa is a very poor region and will have approaches. This calls for good sectoral Challenges and to be strategic in addressing its enormous coordination and targeted investments in environment-health challenges. Indoor the most cost-effective interventions. opportunities air pollution is a priority environmental health issue. Finding alternative energy Portfolio Ministries of health have traditionally sources or educating families to minimize been responsible for health outcomes, but the health effects from exposure to solid The Bank-financed portfolio related to environment and health is primarily im- plemented through the financing of (a) projects focusing on environmental is- ZableckisS. sues, (b) health projects with environmen- tal components, or (c) projects focusing on water and urban issues. In addition, the Bank is undertaking studies and sup- porting capacity building activities. At the end of fiscal 2005, the Africa Region Environment portfolio represented a to- tal commitment of about $ 1 billion. The $240 million portfolio of the Global Environment Facility includes invest- ments in biodiversity, climate change, Arusha,Tanzania. international waters, integrated ecosys- 34 ENVIRONMENT MATTERS · 2005 SUB-SAHARAN AFRICA REGION CarnemarkC. BOX 5 tem management, persistent organic pol- Lambert, John D. H., Per A. Ryden, and lutants, and land degradation (see Box 5). Enos E. Esikuri. 2005. Bio-economic MOTHER NATURE --THE SOURCE The Bank also is managing several car- Value of Multipurpose Medicinal Plants for the Rehabilitation of Drylands in OF MEDICINE FOR OOR EOPLE P P bon funds as part of the global effort to mitigate climate change. In 2004, the Af- Sub-Saharan Africa. Washington, Multipurpose medicinal plants can play an D.C.: World Bank. important role in land rehabilitation pro- rica Region developed 19 carbon project Reddy, Rama Chandra, and Sushenjit grams, according to a World Bank review opportunities--including Nigeria Energy Bandyopadhyay. 2004. Household En- paper (Lambert and others, 2005). What Efficiency, Sierra Leone Hydro, and looks like a problem actually provides a ergy Use and Respiratory Health of Chil- Madagascar Biodiversity Corridor--as niche opportunity for countries with dry- dren in Ethiopia and Zambia: Evidence well as a range of projects in collabora- lands to reverse land degradation and from DHS and LSMS Data. Washing- tion with the IFC and the Development advance rural development.These plants, ton, D.C.: World Bank. although not necessarily adding to biodi- Bank of Southern Africa. The Clean De- versity, benefit health, food, and income velopment Mechanism also provides a needs. The review builds on the recogni- market-based opportunity for African tion that by combining indigenous countries to reduce the risk of global cli- knowledge and modern appropriate tech- mate change while mobilizing invest- nology,communities and researchers can This article was prepared by Peter Kristensen, ments in better infrastructure. identify cultivation practices that offer (202) 473-4789, pkristensen@worldbank.org, of new sustainable land management prac- the Environment and Social Development Unit tices to halt desertification. At the same References for Western Africa, with contributions from Fadi Doumani, Karan Capoor, Franck Bousquet, time, if communities can derive a greater John Lambert, Sergio Margulis, Suprotik Basu, share of the increasing annual global val- Doumani, Fadi M. 2005. Environmental and Tracy Hart--all of the Africa Region; and ue of medicinal plants ($65 billion), then Health in Sub-Saharan Africa: Effective Rama Chandra Reddy and Sushenjit Bandyo- actions to rehabilitate degraded lands will pahyay--both of the Environment Department Interventions. (draft) Washington, improve their quality of life. of the World Bank. D.C.: World Bank. AFR website: . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 35 East Asia and Pacific Region Mongolia China Rep. of Korea Lao P.D.R. Myanmar Vietnam Cambodia Thailand Philippines Marshall Islands Malaysia Palau Fed. States of Micronesia Kiribati Indonesia Papua New Solomon Guinea Is. Timor-Leste Samoa Vanuatu Fiji IBRD 31562R SEPTEMBER 2005 Tonga y Librar Photo Bank orldW/ Hoa.T Vietnam he EastAsia and Pacific (EAP) region is achiev- indicates that improvements in water quality could reduce ing impressive rates of poverty reduction, typhoid infection in China by 50 percent and would signifi- around 35 million people annually. But cantly reduce the spread of HepatitisA, 70­90 percent of which growth--a complex process that includes fac- is transmitted by dirty water. Air quality is also a serious con- tors such as urbanization, industrialization, cern in most major cities in the region; for example, particu- institutional and governance issues--has been accompanied late (PM10) concentrations in Jakarta and Beijing ranged and reinforced by a wide range of fundamental changes in the between 110 and 140 µg/m3 in 2002­03 (WHO and U.S. EPA region's environmental conditions.Agrowing body of evidence guidance is for maximum levels of 50­70 µg/m3in any 24 hour is showing that the region's environment is under consider- period). The situation is critical in areas such as northeast Chi- able strain and the services it provides are increasingly threat- na and Mongolia, where coal burning in small and medium ened. For example, natural forest cover has declined boilers, dispersed through low stacks, directly contributes to significantly in many countries; in the Philippines, Indonesia, people's exposure. Indoor air pollution is also a leading cause and Malaysia, declines ranged from 1 to 2 percent annually of respiratory infection, pulmonary diseases, and lung cancer, during the 1990s. and Bank research suggests that death rates from chronic res- piratory disease and respiratory infections in children are 4 Regional environmental priorities and 44 times higher in China than in the western world. Avariety of environmental health implications are linked with In Cambodia, Lao PDR, and Vietnam, Bank studies have iden- exposure to polluted air and water. Ongoing Bank research tified strong linkages among poverty, dirty water, and illness. Environment Matters 2005 -- The World Bank Group 36 ENVIRONMENT MATTERS · 2005 EAST ASIA AND PACIFIC REGION These findings underline the importance cover below, left). The Strategy and in- NAMTHEUN 2 AND LENS -- of establishing environmental manage- formation on related activities is available ment systems at an early stage in the de- at the new EAP environment website AWINDOW TO THE UTURE F velopment process. Increasing pressure (www. worldbank.org/eapenvironment). The Nam Theun 2 Hydropower Project, on the environment is exposing the lim- which provides for the construction of a ited capacity of many of the region's in- Recent large dam on the Nam Theun River in Lao stitutions, especially in the context of PDR,was approved for implementation in decentralization, which is ongoing in accomplishments early 2005.The facility will produce 6,000 many areas. GWh of electricity annually and generate Financing Environmental $2 billion in revenue over a concession pe- While at present East Asia is relatively Improvements riod of 25 years. Thereafter, the dam will under-urbanized, the situation is rapidly be entirely owned by the Government of changing. Between 2000 and 2025, accord- The region's Environment and Natural Lao PDR. ing to the UN Population Division, the Resource Management (ENRM) portfolio urban population is forecast to increase stands at $5.15 billion, with $498 million Potential environmental and social im- pacts have been subjected to careful by 65 percent, or by 500 million, largely of new lending. A thematic breakdown study for many years, and meticulous at- in poorly managed peri-urban areas. The highlights the importance of the pollution tention has been paid to ensure that the environmental challenges created by this and water resource management compo- project meets,and often exceeds,interna- transition place a massive strain on pub- nents. The Bank recently approved the tional environmental and social criteria. lic resources and environmental servic- Lao PDR Nam Theun 2 Hydropower Analytical preparation included impact es; for example, in Vietnam the generation Project and the linked Lao Environment studies on dam safety,indigenous and af- of urban solid waste is expected to in- and Social Project (LENS) (see Box). Oth- fected people,resettlement,cultural prop- crease from 6 million tons to 12.6 million er new ENRM projects include the Phil- erty, and socioeconomic and environ- tons between 2004 and 2010 (World Bank ippines Land Administration and mental impacts. These studies were aug- 2004). Furthermore, transboundary, re- Management Project (II) and the Pearl mented by a comprehensive consultation gional, and global challenges will inten- River Watershed Rehabilitation Project in process to ensure that affected people sify as EAP countries become increa- China. The former is designed to improve were fully informed.The Bank has also pre- singly integrated into the regional and land tenure security, land administration pared complementary projects to support global economy. services, and property valuation systems, NT2 implementation,aimed at enhancing in order to develop more efficient land livelihood opportunities for local people The Bank's regional Environment Strate- markets. The objective of the latter is to and improving the conservation of biodi- versity in the area. The Lao Environment gy, published in March 2005, reviews key establish an integrated rural development and Social Project (LENS) is a development trends, priorities, and Bank activities (see model in highly degraded watersheds of grant designed to strengthen the man- agement of environmental and social is- World Bank Environment THE EAP REGIONAL sues and the use of natural assets around Strategy for the EAP Region ENVIRONMENT PORTFOLIO the NT2 project area.Activities include in- stitutional strengthening and investment Other environmental Biodiversity management in community environmental manage- 2% 2%Climate change ment. Water resource 13% management Environmental 23% policy and institutions southern China, with activities designed 8% to increase productive land area, affores- Land Pollution management tation, sedimentation retention, and ba- management and 14% sic infrastructure development. environmental health 38% Percentages based on commitment amounts. The Global Environment Facility (GEF) At the end of June 2005 the active portfolio of recently approved a $40 million grant for World Bank environmental lending in the EAP a Renewable Energy Scale-Up Program Region was $4.2 billion. in China, a joint initiative supporting ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 37 China's plan to produce 10 percent of its Analytical and sessing progress), Thailand (biodi- electricity from renewable sources by versity), and Vietnam (solid waste man- 2020. The project will include wind and technical assistance agement). biomass power investments and support The Bank provides an extensive range of for capacity building. In Kiribati, EAP is Developing Environmental analytical and technical assistance to sup- helping prepare a climate change adap- port enhanced environmental manage- Partnerships tation project, one of the first efforts to ment and policy development. Examples help a client country adjust its compre- The cross-sectoral nature and number of include analyses of poverty-environment hensive development strategy to the po- stakeholders involved in many environ- linkages in Cambodia, Lao PDR, and Viet- tential impacts of climate change. Other mental issues underlines the need for ef- nam, which have uncovered a number of fective partnerships. One example of the recently approved EAP-GEF projects in- mutually reinforcing linkages among Bank's efforts to engage with civil soci- clude the China Building Heat Reform poverty, environmental damage, and en- ety groups is the Initiative on Faith and and Energy Efficiency Project and the vironmental health factors; for example, Environment, which engages faith-based Vietnam Sustainable Forestry Develop- poor indoor air and water quality lead to groups in conservation throughout the ment Project. The former will reform res- increased rates of respiratory and diarrhe- region. The June 2005 Northern Buddhist idential apartment heat supply policy and al illness. Work in China, in close collab- Conference on Ecology and Development demonstrate energy efficient heating sys- oration with a number of government (in Ulaanbaatar, Mongolia) brought to- tems. EAP also facilitated approval of an ministries, is addressing issues such as gether 250 representatives of monastic $11 million GEF grant for a global Coral environmental administration, water pol- communities, NGOs, government, and Reef Management Research Project to lution control, green accounting, and development institutions to develop costs and health risks from pollution. This coordinate applied coral reef manage- environment and development ideas work contributed to significant strength- ment research work and develop capaci- (). ening of China's State Environmental ty in coral-rich countries. ProtectionAuthority following the Bank's The EAP Region hosted several important recommendations, as well as detailed events, including IUCN's World Con- In China, two large GEF-supported dem- guidance for the next five-year plan. gress in Bangkok, Thailand (November onstration projects are under preparation 2004); the 5th Ministerial Conference on to phase out persistent organic pollutants Other areas of engagement include par- Environment and Development in Seoul, (POPs). Activities to address POPs have ticipation in the decentralization of envi- Korea (March 2005); and the Eco-Asia been scaled up to include a study on PCB ronmental management. In Indonesia, the Congress in Gifu, Japan (June 2005). The and DDT toxicity, assessment of PCB Bank has been involved in extensive pol- Bank actively participated in these events. management, and integrated pest man- icy dialogue with the government and The Bank has also continued its involve- agement approaches as alternatives to the private sector stakeholders on decentral- ment in the successful Clean Air Initia- use of chemicals in termite control. ization and improvement of environmen- tive forAsian Cities (CAI-Asia), the Forest tal management systems, culminating in Law Enforcement and Governance The region's successful ozone depleting the development of a technical assistance (FLEG) Initiative, and others. package to strengthen the institutional substance (ODS) phaseout program, and policy framework and support the which is the largest in the world, received The Bank has been actively developing development of new regulations. new partnerships to address emerging new commitments for programs worth environmental issues. During the post- $39.8 million during fiscal 2005. This in- The Environment Monitor series, which tsunami recovery process, a Multi-Donor cludedtheCFC/HalonAcceleratedPhase- disseminates information on environ- Trust Fund for the Aceh and Northern out Plan in China, and National Methyl mental trends to a wide range of stake- Sumatra region was established address- BromidePhaseoutPlansinthePhilippines holders, remained a key component of the ing both environmental and natural re- and Thailand. In the context of Bank-sup- Bank's analytical work. New monitors source issues. Partnerships with the ported programs, 16,750 (ozone depletion were launched in Lao PDR (environmen- Governments of Italy and the Republic potential) tons of ODS emissions were tal overview), Mongolia (challenges of of Korea have been established to support eliminated during fiscal 2005. urban development), the Philippines (as- analytical work in China, Vietnam, and 38 ENVIRONMENT MATTERS · 2005 EAST ASIA AND PACIFIC REGION Lovei M. Engaging faith communities at Northern Buddhist Conference on Ecology and Development. the Philippines on (a) national climate Reducing carbon emissions remains a application of strategic environmental change strategy; (b) green accounting; (c) high priority. There is increasing evidence assessments (SEA) is now required by leg- the circular economy; and (d) the trans- that climate change is already occurring, islation in several countries, and practi- fer of lessons learned on managing indus- including rising sea temperatures, an ex- cal examples are emerging in different trial pollution, as well as financing tended range of malaria occurrence, and contexts. The international SEA work- environmental improvements. In Mongo- increasingly frequent natural disasters shop, organized by OECD's Develop- lia, a new environmental partnership was such as flash floods. The Bank has also ment Assistance Committee and the established with the Government of the been instrumental in developing the re- Government of Vietnam in Halong Bay, Netherlands to support technical assis- gion's carbon market, which currently Vietnam (January 2005), provided a fo- stands at around $41 million. The market rum for sharing regional and internation- tance and project development for im- is expected to grow rapidly, with a range al experiences. However, much remains proved environmental and natural of new projects being developed, such as to be done, since both regulations and the resource management. HFC-23 and bio-carbon initiatives. capacity to undertake these assessments The challenges ahead are weak in many countries. Other new environment challenges in- clude the growing threat to biodiversity Alongside many long-standing issues, References from the illegal wildlife trade. East and new environmental challenges are contin- Southeast Asia are key suppliers to inter- World Bank. 2004. Vietnam Environment uously emerging. The tragic tsunami national wildlife markets. Demand for Monitor. Washington, D.C.: World event served as a stark reminder of the wildlife, plant, and mineral derivatives is Bank. region's vulnerability to natural disasters leading to unsustainable levels of exploi- Van Song, N. 2003. Wildlife Trading in Viet- and underlined the importance of the tation for many of the region's most char- nam: Why it Flourishes. Singapore: Bank's activities to support effective ismatic and endangered species. This Singapore Economy and Environ- coastal resource management. In the trade was estimated to be worth $66.5 ment Program for Southeast Asia. wake of the disaster, the Bank made rap- million in Vietnam alone in 2002 (Van id assessments of environmental damag- Song 2003). This article was prepared by Magda Lovei, es and made adjustments to ongoing and (202) 473-3986, mlovei@worldbank.org; Andrew Murray, (202) 473-4580, amurray planned projects. New Environment Countries in the region are increasingly @worldbank.org; and Jian Xie, (202) 473-2766, Monitors in the Philippines and Thailand interested in the environmental implica- jxie@worldbankorg--all of the Environment and Social Development Sector Unit of the East are also focusing on coastal resource man- tions of sectoral and macroeconomic pol- Asia and the Pacific Region. EAP website: agement. icy reforms and development plans. The . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 39 Europe and Central Asia Region Slovak Rep. Czech Rep. Estonia Russian Federation Latvia Lithuania Poland Belarus Ukraine Kazakhstan Hungary Moldova Romania Uzbekistan Bulgaria Georgia Kyrgyz Armenia Azerbaijan Rep. Turkey Turkmenistan Tajikistan Cyprus FYR Macedonia Albania Serbia and Montenegro Bosnia and Herzegovina Croatia Slovenia IBRD 31563R2 SEPTEMBER 2005 Johnson.T Turkey nvironmental health issues in the countries of life for their citizens and to become competitive in the in- of the Europe and CentralAsia (ECA) region ternational marketplace. Key elements include restoring util- reflect the attributes of the Soviet era, as well ities and services with due regard to quality, efficiency, as the rapid political transition and associ- affordability, and sustainability; cleaning up "legacy" pollu- ated economic disruptions that followed. tion; and incorporating modern environmental and health Prior to the 1990s, people enjoyed generally good (often highly standards in industrial and agricultural sectors to meet new subsidized) access to water, heat, housing, and health servic- es, and related mortality and morbidity rates were compara- internal and external market demands for safety and hygiene. ble to those in the industrialized countries belonging to the Many aim for compliance with the European Union's (EU) Organisation for Economic Co-operation and Development. acquis communautaire, although often a phased approach is nec- At the same time, however, the region experienced rapid in- essary because of the high cost of upgrading to meet such dustrialization based on highly polluting technologies. The strict requirements. Environmental management must also be collapse of state systems and subsidies for utilities and ser- addressed within the context of important ongoing changes vices left most ECA countries with a deteriorating stock of in institutional structures and responsibilities, including priva- energy, housing, and water supply infrastructure, with obso- tization of state-owned enterprises and a growing emphasis lete and inefficient industrial plants and utilities, and with a on cost recovery for basic services. The World Bank is assist- widespread legacy of polluted soil and water. ing ECA client countries in all these areas through direct in- With economic recovery ongoing over much of the region, vestment and through financial and technical assistance for the challenge for ECA countries now is to restore the quality policy and institutional reform. 40 Environment Matters 2005 -- The World Bank Group ENVIRONMENT MATTERS · 2005 EUROPE AND CENTRAL ASIA REGION Utilities and social Figure 1. Access to infrastructure and energy services in ECA in the early 2000s by location (percentage of households reporting access) services Capital Other urban Rural 100 One of the unfortunate outcomes of the 80 transition was a dramatic deterioration in 60 the "built environment," including hous- ing stock and environmental/social ser- 40 Percentage vices such as energy, water supply, and 20 sanitation. Slums were virtually un- 0 known in the former Soviet Union, but Water District heating Natural gas Electricity Telephone they have become a concern in the newly connection connection connection connection connection independent states due to lack of main- Note: Average among 20 ECA countries for water connection, 19 ECA countries for district heating and telephone connection, 15 ECA countries for natural gas, 10 ECA countries for electricity. tenance, as well as the growth of infor- Source: Dimensions of Urban Poverty in ECA (World Bank 2004). mal settlements resulting from strong rural-urban migration and other popula- BOX 1 tion displacements. There is also a dispar- INVESTING S S WATER ity in access to utilities and services, as IN USTAINABLE AFE infrastructure in secondary towns and ru- Building upon earlier projects that focused narrowly on water supply and sanitation, the ral areas has broken down and not been Bosnia and Herzegovina Urban Infrastructure and Service Delivery Project is supporting a repaired (see Figure 1). The Millennium broad, integrated approach to improving the quality and efficiency of basic infrastructure and service delivery in urban areas.Activities include developing strategic urban planning Development Goals (MDGs) for water processes and preparing urban management plans, strengthening local institutions, im- supply and sanitation are based on for- proving revenue collection and management, and making strategic investments in select- mal connections to "improved" water ed service sectors. supply sources and sanitation facilities. They do not address the situation in many In Croatia, the Bank is using an ECA countries, in which connections to Adaptable Program Loan to HoltJ. such systems that were put in place dur- support the implementation of ing the Soviet era still exist but have de- a comprehensive government program to clean up pollution teriorated and are no longer functional. in coastal cities in order to meet The World Bank is carrying out a region- EU ambient quality standards. al study on "Tailoring MDG7 Goals to The Croatia Coastal Cities Pol- Local Conditions in ECA" to identify in- lution Control Pro- dicators and monitoring methods that ject focuses on institutional will better capture the reality on the strengthening and on-site in- ground. vestment to develop financial- ly and operationally sustainable systems for wastewater collec- Governments are making the restoration Nura River cleanup. tion, treatment, and disposal. of environmental and other basic servic- The Albania Coastal Zone Project also supports wastewater management as part of a broader es a high priority, both in response to program of coastal cleanup and integrated coastal zone management, including wetland domestic demand and to facilitate tour- restoration. ism development, which is seen as an important area for future economic Discharge of untreated animal wastes and manure is a major source of pollution of Moldo- growth in many ECA countries. This is va's ground and surface water, threatening both local health, the Danube River, and the reflected in World Bank assistance in Black Sea.Some 70 percent of the nation's shallow wells--from which much of the popula- the ECA Region, which includes many tion draws its drinking water--contain excessive nitrate concentrations.The Moldova Agri- projects for water supply, wastewater, cultural Pollution Control Project aims to promote the use of environmentally friendly agricultural practices by farmers and agro-industry to reduce nutrient discharges and to and solid waste management. Bank- strengthen policies and regulatory capacity for agricultural nutrient pollution control. It financed investments for safe water sup- will also support planting of shrubs and trees to protect water bodies. ply include "end of pipeline" cleanup ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 41 BOX 2 operations--including toxic waste dumps, contaminated land and water, ENVIRONMENTALLY HEALTHY HEATING and orphaned hazardous waste sites-- The Poland Geothermal and Environment Project, now near- usually remains with the governments in ing completion, aimed to reduce air pollution from local the region. Where enterprises cannot be fossil fuel-fired space-heating boilers by developing a geo- Sargsyan G.privatized, but closure is unacceptable thermal district heating system to serve seven municipalities. because of potential economic and em- Monitoring indicates that SO and PM10 levels now meet both 2 ployment impacts, the challenge is to bal- Polish and EU emissions standards, while NO emissions are x ance economic realities with the need to approaching the EU standard. reduce adverse environmental and health impacts. In Armenia, urban district heating systems have now largely collapsed and most urban apartment dwellers now depend solely on individual heating by wood or coal,putting them at Many governments in the region have risk of chronic respiratory diseases and fires. The Urban Heat- made it a priority to address both legacy ing Project will support a community and private sector led and current pollution in response to pres- approach by removing barriers and creating market condi- Gyumri school boiler (Armenia sure from increasingly informed and tions for commercial provision of heating services,including Urban Heating Project). empowered citizens and in order to meet investment in efficient and safe boilers and monitoring equipment. strict EU emissions and health standards. The World Bank is assisting with direct The Serbia Energy Efficiency Project will support replacement of inefficient lignite and heavy oil-fired boilers with a gas-fired co-generation plant at a clinical center and energy efficien- investment and with financial and tech- cy improvements at schools and hospitals. nical assistance for cleanup operations, replacement of obsolete technologies, and In Belarus, about 1.6 million people living near the Chernobyl nuclear disaster face special improved regulation, monitoring, and hazards, such as the burning of radiation-contaminated wood for home heating and the compliance. Box 3 provides examples of disposal of the ash in their gardens. The proposed Post Chernobyl Recovery Project would Bank-financed operations addressing leg- help alleviate this problem by connecting an estimated 12,000 homes to a gas pipeline. acy pollution issues in the mining, indus- trial, and oil sectors. Projects aimed at operations, reducing point and nonpoint cessibility and efficiency of heating ser- reducing pollution in ongoing industrial sources of pollution, and integrated wa- vices and reduce negative environmen- activities include the Russian Federation tershed and coastal zone management. tal and health impacts (see Box 2). Home Environmental Management Project and Particular targets include coastal areas heating was also the focus of one of the the proposed Ukraine Aligning Industri- and secondary towns, with an emphasis winning proposals in the 2005 Develop- al Development with European Environ- on strengthening local capacity to devel- ment Marketplace competition: the Bos- mental Standards Project. op sustainable service delivery systems, nia and Herzogovina "Green Wool" including community involvement, pub- Project, which converts the unspinnable Agriculture lic/private partnerships, and at least par- wool of a locally adapted breed of sheep tial cost recovery. Box 1 provides details into material for home insulation. While Important environmental health issues in on several projects approved in 2004 or not always thought of in this context, the the agriculture sector include excess 2005. Similar municipal services projects quality and safety of transport and hous- nitrates and other nutrients and agro- are under way or at an advanced stage of ing infrastructure are also important ele- chemicals discharged to surface and preparation in Tajikistan, Turkey, Roma- ments for physical and mental health. groundwater (including threats to inter- nia, and Montenegro. Bank projects targeting these aspects in- national water bodies such as the Danube clude the Albania Road Maintenance River, Black Sea, Adriatic Sea, and Caspi- Indoor heating is essential for health and Project and the Turkey Seismic Risk Mit- an Sea), and the need to meet internation- quality of life in most ECA countries, but igation Project. al standards for food safety in order to the widespread collapse of subsidized, access new markets. Growing local de- state-provided systems has left many Industry and mining mand for safe food and water is comple- people with inadequate or unhealthy mented by the incentive of achieving heating options. The Bank is supporting Responsibility for the pollution legacy compliance with the EU agricultural and a variety of projects to improve the ac- from past state-run industry and mining environmental acquis and access to inter- 42 ENVIRONMENT MATTERS · 2005 EUROPE AND CENTRAL ASIA REGION BOX 3 prepare a rapid Country Environmental Analysis for three upcoming program- CLEANING UP"LEGACY"POLLUTION matic development policy credits. The The environmental legacy of abandoned mines represents a major health hazard in many analysis will prioritize policies and sec- countries; the risks include contamination of soil and of surface and groundwater and the tors in relation to environmental impli- risk of toxic spills from the failure of mine tailings dams. The Poland Hard Coal Mine Clo- cations and risks, assess national and local sure Project is supporting implementation of a sector reform program in southern Poland capacity to mitigate negative impacts, involving both government and mining companies. Environmental Action Plans have been and identify key indicators to track prepared for each mine to be closed.The project is also supporting environmental improve- progress in environmental mitigation. ments at operating mines and building government capacity to enforce regulations and The main focus will be on components monitor performance in anticipation of the plan to privatize all mines by 2007. The Roma- supporting enterprise sector restructur- nia Mine Closure, Environment, and Social Regeneration Project will improve environmen- tal performance of the mining sector to meet EU accession requirements,build capacity for ing and privatization, with particular closing uneconomic mines in an environmentally sustainable manner, and support socio- emphasis on addressing past and present economic regeneration of mining regions. The Romania Hazard Risk Mitigation and Emer- impacts of industrial pollution, as well as gency Preparedness Project is improving management and safety of toxic tailings dams wastewater management, waste dispos- and waste dump facilities and strengthening capacity for disaster management and emer- al, and industrial pollution, where im- gency response. provements are needed to meet the requirements of the EU's environmental In many ECA countries, large quantities of hazardous wastes generated by metallurgical, acquis communitaire. machine-building, and energy industries are stored in unsafe conditions, with leakage of toxic materials into surrounding water, soil, and air. The Kazakhstan Nura River Cleanup Project and Ust-Kamenogorsk Environmental Remediation Projects support isolation, ex- THE ECA REGIONAL cavation,safe storage,and cleanup of existing contamination and implementation of mea- ENVIRONMENT PORTFOLIO sures to prevent future contamination. Other environmental Biodiversity management Remediation of oil-contaminated land and water is an urgent is- oerdenW 2% 1%Climate change sue in a number of ECA countries. In Azerbaijan,more than 10,000 anV.F Water resource 9% management hectares in the Absheron Peninsula are contaminated with oil Environmental 24% policy and from over 100 years of oil extraction activities, threatening the institutions Caspian Sea and constraining development in the capital city of 7% Baku. The Urgent Environmental Investment Project (UEIP) as- Land Pollution sisted the state-owned oil company (SOCAR) to carry out pilot management management and 20% cleanup activities to test the feasibility and efficiency of several environmental health Cleanup of oil contaminated technologies (for example soil washing, bioremediation) and to 37% site on Apsheron Peninsula, develop a long-term cleanup strategy. Azerbaijan. Percentages based on commitment amounts. At the end of June 2005 the active portfolio of national markets. Bank-financed projects petitiveness and Food Safety, and Roma- World Bank environmental lending in the ECA Region was $1.8 billion. in this sector include improving agricul- nia and Croatia AgriculturalAcquis Sup- tural practices to reduce agrochemical port Projects. runoff from fields and to reduce residues This article is dedicated in meat and produce, and improving Development policy to the memory of waste management at animal rearing fa- Jane Holt cilities, slaughterhouses, and other agro- lending processing enterprises. Examples include the Romania Agricultural Pollution Con- Development Policy Lending (DPL) is This article was prepared by Agi Kiss, (202) trol and Romania Environmental Man- becoming a major element of World Bank 458-7180, akiss@worldbank.org, of the agement Projects, Serbia Danube River financing and presents a new set of chal- Environment and Social Development Unit of Enterprise Pollution Reduction Project, lenges for addressing environmental is- the Europe and Central Asia Region, and Jane O. Ebinger, (202) 473-0204, jebinger@ world Moldova Agricultural Pollution Control sues within the context of the revised bank.org of the Infrastructure and Energy Project, Bosnia and Herzegovina Small Operational Policy 8.60. In one pilot ini- Services Department of the Europe and Central Scale Commercial Agricultural Develop- tiative, the Bank is assisting the Govern- Asia Region. ECA website: . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 43 Latin America and Caribbean Region The Bahamas Haiti Jamaica Dominican Rep. Mexico St. Kitts and Nevis Antigua and Barbuda Belize Dominica St. Lucia Guatemala Honduras Barbados El Salvador R.B. de St. Vincent and the Grenadines Nicaragua Venezuela Grenada Trinidad and Tobago Costa Rica Panama Guyana Colombia Suriname Ecuador Peru Brazil Bolivia Paraguay Chile Uruguay Argentina Falkland Islands (Islas Malvinas) A dispute concerning sovereignty over the islands exists between Argentina which claims this IBRD 31564R SEPTEMBER 2005 sovereignty and the U.K. which administers the islands. Johnson.T Brazil n spite of notable progress lowering the mor- Attributable mortality in Latin America and the tality rate of children under five, the impact Caribbean for selected environmental factors, 2000 of environmental factors on health remains Disability Adjusted Life an important problem in the Latin America Deaths Years (DALYs) Sector (thousands) (thousands) and the Caribbean region (LCR). Environ- Water, sanitation, 54 2,045 mental problems are a substantial part of the burden of dis- and hygiene ease in developing countries, and Latin America and the Urban air pollution 58 507 Caribbean are no exception. Polluted water, lack of sanitation Indoor air pollution 26 773 and hygiene, urban air pollution, and indoor smoke from sol- Note: The DALY is a summary indicator that combines the impact of illness, disability, id fuels cause tens of thousands of premature deaths, and they and mortality on population health. Source: WHO 2002. are major contributors to the region's illnesses and disabili- ties (see Table at right). tional aspects of environment-related health problems also deserve attention. The poor, and especially poor children, bear Studies indicate that the monetary costs of environment- a disproportionate share of the burden of environment-relat- related health problems can reach several percentage points ed diseases. Some 117 million children live in poverty in Lat- of GDP. In 2004, the cost of the damage caused by particulate in America and the Caribbean. Most live in crowded, emissions in Latin America and the Caribbean was 0.5 per- substandard housing in areas that lack basic infrastructure. cent of the regional GNI (World Bank 2004). The distribu- This exposes them to respiratory tract infections and diarrhea- Environment Matters 2005 -- The World Bank Group 44 ENVIRONMENT MATTERS · 2005 LATIN AMERICA AND CARIBBEAN REGION related illnesses, which are among the top ly environmental health problem, fol- into account in policy making and lack causes of death among children under lowed by problems related to water, san- an effective voice as a constituency. five in the region (PAHO 2003). The poor itation, and hygiene. In rural areas, are disproportionately affected for several problems related to water, sanitation and The Clean Air Initiative in Latin America reasons: (a) they are typically more ex- hygiene are the most costly, followed by (CAI-LAC). The Bank is scaling up the posed; (b) they are frequently exposed to indoor air pollution. The CEA also in- scope and number of operations to reduce multiple risks; (c) they are more vulnera- cludes the results of a 2004 survey of air pollution in urban areas. Urban air ble; (d) their lack of resources limits treat- public perceptions about Colombia's en- pollution has worsened in most large cit- ment possibilities and increases length vironmental problems. Of the 2,600 re- ies in the developing world over the last and severity of impacts; and (e) human spondents, 79 percent identified air few decades and imposes a heavy bur- capital is their most important asset (fre- pollution as the top environmental prob- den on the health of urban populations. quently the only one), and pollution-in- lem. There were significant differences in duced diseases lower productivity and priorities among income groups; for ex- The Bank has scaled up its work in Latin impair learning ability. ample, low-income groups identified air America through three main avenues. pollution, noise, and natural disasters as First, the Bank is mainstreaming the pro- Because environmental degradation has major problems, while upper-income such important impacts on human health, groups tended to perceive global environ- motion of sound air quality management the Latin America and Caribbean Re- mental impacts (such as global warming practice into operations, particularly gion's Environment Strategy--consistent and loss of biodiversity) and inappropri- those dealing with transport. Besides the with the Bank's Environment Strategy-- ate land use in urban areas as high prior- ongoing operations in Santiago, Lima, identified the improvement of people's ities. Finally, the CEA found that current and Mexico, the Bank is preparing new health by reducing exposure to harmful expenditures are not well aligned with GEF projects for São Paulo, Bogotá and environmental factors as one of its four the priorities of the lower-income groups other Colombian cities, and other cities key development objectives. or with the most costly environmental im- in the region. The latter category will have pacts. The analysis supports the view that $40 million to be allocated on a competi- What is LAC doing to the most vulnerable groups, who bear the tive basis for urban transport proposals greatest costs of environmental degrada- address these issues? that promote the reduction of greenhouse tion, traditionally have not been taken gas emissions and air pollutants. Second, a Washington-based institution is being The Colombia Country Environmental Anal- created to better respond to the main chal- ysis (CEA). The Colombia Country Envi- lenges and tasks ahead, such as (a) attend- ronmental Analysis (CEA) estimates the agiolaPS. ing to a much wider and more diverse cost of environmental degradation in that country using standard economic valua- audience, including all interested cities in tion techniques (see article by Ruta and the region and key sectors such as envi- Sarraf on pages 22­23). The analysis ronment, transport, and energy; (b) shows that the environment-related strengthening participation of partners health problems with the highest costs are and members; (c) ensuring financial sus- waterborne diseases (1 percent of GDP), tainability; (d) better disseminating expe- urban air pollution (0.8 percent of GDP), rience and knowledge about air quality and indoor air pollution (0.2 percent of management; and (e) allowing for more GDP). The burden of these costs falls most extensive and easier exchange of servic- heavily on vulnerable segments of the es and cooperation among the initiative's population, especially poor children un- members and partners. Third, the Bank der the age of five. The analysis provides is coordinating its efforts to better dissem- separate estimates of environmental inate and exchange the experience of the health costs in urban and rural areas. In CleanAir Initiative chapters in LAC,Asia, urban areas, air pollution is the most cost- Ahuachapan,El Salvador. and Africa. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 45 Analytical Work on Indoor Air Pollution. strategy involves technical assistance and THE LCR REGIONAL Exposure to indoor air pollution (IAP)-- investment lending combined with car- ENVIRONMENT PORTFOLIO largely from burning solid fuels in poor- bon finance operations. Other environmental Biodiversity 3% ly designed stoves--increases the risk of management Climate change 2% a range of common and serious diseases The strategy's main objectives are con- 5% Environmental in children and adults, notably acute res- struction of safe final disposal facilities, Water resource policy and management institutions piratory infection (ARI), chronic obstruc- closing of open dumps, and cost-recov- 29% 15% tive pulmonary disease, and lung cancer. ery improvement to make the SWM sys- Land Children under the age of five and the tem economically sustainable. The management Pollution women who look after them and spend strategy is based on (a) development of 23% management and long hours cooking are the most vulner- national and provincial SWM plans; (b) environmental health 23% able to IAP's adverse health effects.ARIs, regionalization of final disposal facilities; Percentages based on commitment amounts. mostly pneumonia, are the second lead- (c) incremental increases in recycling and At the end of June 2005 the active portfolio of ing cause of death in children under five minimization; (d) inclusion of waste World Bank environmental lending in the LCR Region was $1.4 billion. years (after neonatal causes). Worldwide, haulers in the design of the projects; and ARIs account for 2 million deaths (19 per- (e) carbon revenues to assist in the financ- cent) among children under five (WHO ing of O&M costs. The strategy is being ular tourism destinations, with the results 2002). In Latin America and the Caribbe- implemented in five priority countries: an alone, ARIs are responsible for 53,000 Argentina, Brazil, Colombia, Mexico, and disclosed to the public. In another initia- deaths (14 percent) of children under the Uruguay. tive, the energy and environment sectors age of five annually. have strengthened the national clean fu- The LCR Regional els policy by promoting renewable fuels Astudy on environmental health and tra- and improving fuel quality; for example, ditional fuel use in Guatemala pioneered Environment Portfolio the sulfur content of gasoline consumed the region's efforts to estimate the health in the Mexico City Metropolitan Area, impacts of IAP from traditional fuel use Development Policy Loans. LAC has devel- Monterrey, and Guadalajara went from and to outline strategies and policies for oped the first generation of development 1,000 to 300 parts per million. mitigating environmental health damage policy loans (DPLs, formerly known as due to household energy. The lessons structural adjustment loans or SALs) to The Colombia Sustainable DPL (Sus- learned through that study have the po- focus on the environment sector and the DevDPL) will support the Government tential for replication elsewhere in the mainstreaming of environmental con- of Colombia's efforts to improve environ- region.1 cerns in key economic sectors. Brazil, mental management, particularly in ur- Colombia, and Mexico currently have ban areas, by developing a results-based Solid Waste Management Strategy. In spite DPLs. In Mexico, EnvSAL I supported framework for planning and monitoring of progress in collecting solid waste, fi- the Government of Mexico in main- progress toward goals directly linked to nal disposal remains largely unresolved. streaming environmental issues in key sustainable development and achieve- At the regional level, 65 percent of waste sectors through the establishment of ment of the MDGs. The preparation of is unsafely disposed of in open dumps. high-level coordination mechanisms be- critical policies and laws related to air Increased generation of solid waste and tween the environment sector and the major deficiencies in final disposal prac- energy, forestry, water and tourism sec- quality, water quality, solid waste man- tices cause significant human health im- tors. EnvDPL II (currently in operation) agement, and environmental licensing pacts and environmental problems. built on these coordination mechanisms will improve air and water quality in ur- Furthermore, sanitation and environmen- to support activities related to the link- ban centers, leading to decreased morbid- tal health, particularly solid waste man- ages between health and environment. ity and mortality from diarrheal diseases, agement (SWM), are top priorities for In one initiative, the environment sector acute respiratory illnesses, and other environmental agencies in client coun- worked together with the health and health effects. It will also help reduce pro- tries. To respond to these challenges, LCR tourism sectors to monitor water quality tective expenditures for avoiding health launched a regional strategy in 2004. The on the beaches of the country's most pop- risks. 46 ENVIRONMENT MATTERS · 2005 LATIN AMERICA AND CARIBBEAN REGION The Brazil Programmatic Reform Loan for Environmental Sustainability's (En- agiolaPS. vPRL I, $505 million) is intended to sup- images: port the country's goal of balancing Both economic growth with social develop- ment and the maintenance and improve- ment of environmental quality. This is the first operation in a series of up to three loans over a four-year period, possibly to- taling $1.2 billion. EnvPRL I supports ac- tivities that link health and environment, such as a new National Program for Chemical Safety; an agreement to man- age emergencies caused by high-risk haz- ardous chemicals; and creation of an interministerial working group on inte- Country-side farmers' market with abundant herbs Butterfly found in the Quindio Province of Colombia and seeds. Bolivia. near the area of a silvopastoral project that aims to gration of environmental sanitation ac- improve the natural habitat of species. tions. mental management; and (d) facilitation cided) requires commitment, accountabil- Country Environmental Analyses. The of equitable solutions to regional and glo- ity, and learning ability. The Bank has Country Environmental Analysis (CEA) bal challenges so that future generations developed and is continuously upgrad- is the Bank's main analytical tool to as- are guaranteed at least the same oppor- ing lending and nonlending tools to help sess a country's environmental challeng- tunities as the present generation. Meet- client countries meet these difficult chal- es, its capacity to address these challenges ing these objectives, and solving environ- lenges. (in the context of poverty reduction and mental health problems in particular, re- sustainable growth), and the environ- quires institutional coordination. References mental implications of broader develop- ment policies and programs. CEAs assess Ahmed, K., Y. Awe, D. F. Barnes, M. L. Crop- The first institutional challenge is the lack per, and M. Kojima. 2005. Environmental three components: the state of the envi- of effective mechanisms to pick up Health and Traditional Fuel Use in Guate- ronment and priorities for development, signals about the importance of environ- mala. Washington, D.C.: World Bank. environmental policies, and institutional Pan American Health Organization. 2003. mental health. Estimating the cost of Perspectives in Health. Vol. 8, No. 1. capacity. Environmental health consider- environment-related health problems re- WHO. (World Health Organization). 2002. The ations figure prominently in all compo- quires information (on emissions, expo- World Health Report 2002: Reducing Risks, nents. The next CEAs will be conducted Promoting Healthy Life. Geneva: World sure, dose-response functions, and valu- Health Organization. in Peru, El Salvador, and Guatemala. ation parameters) that is not available in World Bank. 2004. The Little Green Data Book. Washington, D.C. most countries in the region. Second, frag- Institutional mentation of responsibilities among Note challenges ahead agencies can transform environmental health into an institutional "orphan" that 1. K. Ahmed, and others (2005). See also separate article by Ahmed and Awe on The LAC Environment Strategy has tar- no agency adopts as a priority or focal indoor air pollution in Guatemala on geted the following objectives: (a) im- point. Multisectoral problems require page 26. provement of people's health by reducing multisectoral solutions. Coordinating a exposure to harmful environmental fac- wide range of agencies and balancing This article was prepared by Juan C. Belauste- guigoitia, (202) 473-8809, jbelausteguigoit tors; (b) enhancement of livelihoods stakeholders' interests to reach agree- @worldbank.org, of the Environment and Social through sustainable management of nat- ments requires robust and competent in- Development Sector Unit of the Latin America ural resources; (c) development of en- stitutions. Third, executing agreements and Caribbean Region. LCR website: . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 47 Middle East and North Africa Region Syrian Lebanon A.R. Malta Morocco Tunisia West Bank and Gaza Iraq I.R. of Iran Jordan Algeria Kuwait Libya Arab Rep. of Bahrain Egypt Qatar U.A.E. Saudi Arabia Oman Rep. of Yemen Djibouti IBRD 31565R SEPTEMBER 2005 Carnemark Tunisia C. G overnments in the Middle East and North that will invest in wastewater collection and treatment: the Africa (MNA) region are coming to the real- Northern Cities Water Supply and Sanitation Project in the ization that ignoring the region's environ- Islamic Republic of Iran, which will improve living conditions mental challenges might become a sig- in Rasht, Anzali, Sari and Babol, and the North Gaza Emer- nificant barrier to development. gency Sewage Treatment Project in West Bank and Gaza. As a result, preparation and implemen- The region also faces serious challenges in areas such as tation of a growing infrastructure portfolio in the MNA Re- solid waste management and handling stockpiles of obsolete gion has included careful attention to both safeguards and pesticides. The Bank is providing assistance through a range environmental mainstreaming issues. The portfolio includes of investment projects, technical assistance projects, research, the transport sector, energy sector (power plants), and water and analytical and advisory activities. Moreover, the MNA sector (water supply and sanitation). Safeguards team ensures that a fair level of environmental Several ongoing and new activities will significantly im- and social safeguards occurs during project preparation. prove living conditions in some of the region's biggest cities. For example, the Bank and the Government of Morocco re- The solid and hazardous waste cently completed a successful series of investments in sanita- tion and wastewater pretreatment in the city of Fez, including agenda the ancient Medina. Another project would expand and re- habilitate sewerage and wastewater treatment in greater Tunis, During fiscal 2005, the MNA Region started many initiatives Tunisia. In 2005, the Bank's board approved two operations in the area of solid waste management in countries such as Environment Matters 2005 -- The World Bank Group 48 ENVIRONMENT MATTERS · 2005 MIDDLE EAST AND NORTH AFRICA REGION Tunisia, Iran, Algeria, Egypt, Morocco, BOX 1 and Jordan. This focus was motivated by increasing regional awareness of the im- THE REGIONAL SOLIDWASTE MANAGEMENT PROJECT portance of proper solid waste manage- The Regional Solid Waste Management Project is intended to provide the necessary tools ment, as well progress resulting from the to the MNA countries to design, develop, and implement the main elements of integrated Regional Solid Waste Management solid waste management;promote the exchange of information and experience within the Project under the METAP program (see region in the solid waste field; and establish a Regional Solid Waste Management Centre of Box 1). These initiatives were based on a Expertise in Tunisia to coordinate the project's activities and programs. The project also new approach integrating the emerging includes a national activity in each of the beneficiary countries that will address priority carbon finance market, which has grown issues and emphasize the"learning by doing"approach.To ensure dissemination of project tremendously in recent years, especially results and lessons learned,regional and national workshops are organized during the course since the Kyoto Protocol entered into of the project with the participation of all stakeholders. force in February 2005. At the request of the Tunisian gov- public health risks associated with poor ernment, the MNA Region is currently Other Regional waste HCW management and treatment. preparing a solid waste management management programs project aiming at rehabilitating nine dump sites, as well as expanding and ret- The Africa Stockpiles Under the Trust Fund for Environmen- rofitting (with gas collection and flaring tally and Socially Sustainable Develop- Programme systems and a leachate treatment system) ment (TFESSD), the World Bank obtained the large Djebel Chekir landfill serving a grant to prepare a regional activity that At least 50,000 tons of obsolete pesticides, the greater Tunis area. In the process of included (a) the development of new ge- many including persistent organic pollut- retrofitting the old dumps and the land- neric legal and procurement documents ants (POPs), have accumulated in stock- fill, it will be possible to claim benefits for implementation of waste disposal fa- piles throughout the African continent. from emission reductions achieved in ac- cilities through a Design-Build-Operate Most of these stockpiles are poorly main- cordance with the Clean Development concept; (b) preparation of a Manual of tained, with some leaking chemical tox- Mechanism rules set forth by the Kyoto Good Practice for Management of Health ins into the ground, water, and air. POPs Protocol. A portion of these emission re- Care Wastes (HCW) suitable for imple- are particularly harmful to global as well ductions will be purchased by the World mentation at the health care establish- as local health and the environment, and Bank, and the corresponding revenues ment level; (c) preparation of model/ thus the resulting pollution is an urgent will serve to offset the cost of the loan generic regulations or bylaws on health environmental hazard and growing from the World Bank. care waste management suitable for sub- threat to public health. national and/or municipal levels; and (d) In Morocco, it is estimated that there The Mediterranean development of a regional awareness pro- are 700 tons of POPs and other obsolete Environmental Tech- gram on HCW management. The region- pesticides (initially used for locust con- al awareness program's main objective is trol) that have accumulated over the years nical Assistance Pro- to assist national and health care institu- on 225 different sites. In Tunisia, it is es- tions to raise the awareness of decision timated that 1,200 tons have been accu- gram makers, community activists, and the mulated and are now stored in 17 sites. staffs of medical and health care facilities The Africa Stockpiles Programme regarding the environmental impacts and (ASP) is a partnership among the World MNA countries are suffering serious en- Bank, FAO, NGOs (headed by the World vironmental and health risks associated Wildlife Fund and Pesticide Action Net- with poor solid waste management prac- OAFof work-UK), the crop protection industry, tices. In response, the Mediterranean Courtesy and concerned governments. These part- Environmental Technical Assistance Pro- ners have agreed to pool resources and gram (METAP) initiated a four-year Re- expertise in a collaborative, comprehen- gional Solid Waste Management Project sive effort to ridAfrica of polluting stock- serving eight MNA countries, which is piles and, of equal importance, to put in financed in partnership with the Europe- place the institutional and training infra- an Commission (see Box 1). Abandoned drums in Tunisia. structure needed to prevent their recur- ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 49 rence. The ASP is currently managed by sia and followed by the other ASP-P1 BOX 2 the Bank's MNA Region, but ASP activi- countries as soon as they are ready to ties in the region will be gradually trans- implement. EGYPT'S PROGRESS IN ferred to a project coordination unit, ACHIEVING ITS MDGTARGETS which will be hosted by the New Part- Egypt Country Envi- nership for Africa's Development. In terms of eradicating extreme poverty The total cost of cleanup, disposal, ronmental Analysis and hunger (MDG #1), significant reduc- and prevention in Africa is estimated at tions from 1.7 percent to 0.4 percent were $250 million over a period of 15 years. During this fiscal year, the MNA Region achieved in the last decade for population living below $1/day. However, 17 percent Seven countries (Ethiopia, Mali, Moroc- completed a Country Environmental of the population still lives below $2/day. co, Nigeria, South Africa, Tanzania, and Analysis (CEA) for Egypt that included a Egypt made improvements in youth liter- Tunisia) are participating in theASP's first comprehensive in-country consultation. acy and net primary enrollment (MDG #2), project (ASP-P1, see map below), a four- The CEA, which spanned the period though 43 percent of the population year activity to implement prevention 1992­2002, proved to be a valuable exer- above age 15 is still illiterate. Gender measures and then inventory and fully cise that put into perspective Egypt's ef- equality (MDG #3) is being promoted with dispose of existing stocks. Another eight forts to address its environmental significant improvements in the educa- countries (from among Benin, Botswana, challenges and underscored the need for tion of females and in job opportunities. Cameroon, Côte d'Ivoire, Ghana, Leso- a new paradigm for stepping up these ef- Significant reductions in the children-un- tho, Namibia, Niger, Rwanda, Senegal, forts. der-five mortality rate (MDG #4) were Sudan, and Swaziland) are scheduled to The CEA focused particularly on four achieved (85.0/1000 to 52.2), as well as in begin preparation and prevention activi- major environmental issues--air quality, the infant mortality rate (67.8/1000 to 41.8). There are also indications of improv- ties during this first phase of operations. water quality, solid waste, and coastal ing maternal health (MDG #5); however, Financial support to the ASP from the zone management--during the period there are still incomplete data on combat- Global Environment Facility, the African 1992­2002. It assessed progress, trends, ing HIV/AIDS and other diseases. Development Bank, the European Union, expenditures, and challenges. Since 2002, the World Bank's Development Grant several notable achievements addressing estimated (in a study published by the Facility, Belgium, Canada, Denmark, Fin- these issues were made by the Govern- World Bank in 2002) at LE 14.5 billion, or land, France, Japan, Sweden, Switzerland, ment of Egypt. and the participating African countries 4.8 percent of GDP (1999 data). Air, soil, Despite large public and donor invest- has already reached $60 million, more and water pollution have inflicted the ments during the last decade (totaling LE than adequate to cover the $50 million es- largest damage. At 48.8, Egypt's Envi- 231.8 billion), including subsidies for timated for ASP-P1. The ASP will be ronment Sustainability Indicator ranks water, energy, and transport amounting launched in late 2005, starting with Tuni- 74th among 145 nations. The Adjusted to approximately LE 200 billion, Egypt Net Savings (ANS) measure, which ad- Africa Stockpiles Programme continues to face serious environmen- justs national savings with respect to nat- tal issues. Irrespective of whether these ural resources depletion, pollution, and investments were fully justified, there investment in human capital, showed is strong evidence that such expendi- that Egypt maintained a modest level of ture levels cannot be sustained. The ANS of 3.4 percent of Gross National In- environment cannot therefore remain come in 2001. Environment degradation a liability but should become an asset was found to affect mostly the poor in to improve socioeconomic develop- Egypt. Furthermore, it is Egypt's poor ment. that suffer most from indoor air pollution At present, the social cost of environ- and from lack of clean water and sanita- mental degradation is already quite tion and municipal waste collection and significant, and it will continue to in- disposal. Environmental issues in Egypt crease if policies and institutional mea- are more prevalent in regions with high sures are not provided, which are then poverty relevance. These issues are pre- followed by targeted priority invest- dominantly rural and account for more ments. The direct health and resource than 55 percent of damage costs, with degradation has been conservatively urban air pollution accounting for more 50 ENVIRONMENT MATTERS · 2005 MIDDLE EAST AND NORTH AFRICA REGION than 40 percent. These social costs are of communicable diseases such as diar- THE MNA REGIONAL likely to offset some of the nation's eco- rheal and respiratory diseases is relative- ENVIRONMENT PORTFOLIO nomic growth gains over time and could ly close to global figures (see Figure, undermine the effectiveness of the gov- below). Diarrheal diseases are exacerbat- Environmental policy ernment's economic reform program. ed by inadequate water supply, sanitation and institutions 11% Other environmental The analysis suggests the need for a and hygiene practices, and respiratory management Land new approach so that Egypt moves (a) diseases by indoor air pollution due to 1% management 7% from a focus on inputs (projects, laws) to both unclean cooking and heating fuels, Water resource output-oriented outcomes (impacts of and poor ventilation. Collectively, these management Pollution projects and legal changes); (b) from a diseases occur mainly at the household 45% management and top-down approach and centralized de- and environs levels in rural areas, where environmental health 36% cisionmaking to a system of information they are steadily eroding the well-being sharing and improved governance; (c) of the poor, especially women and chil- Percentages based on commitment amounts. from a dependence on external assistance dren. At the end of June 2005 the active portfolio of to national resource mobilization; and (d) Environmental health is being pilot- World Bank environmental lending in the MNA to a process of measuring performance to ed in Djibouti, Egypt, and Yemen to im- Region was $779 million. track actions and accommodate learning. prove the well-being of the rural poor. The two main objectives of the CEA This approach is meant to empower com- creasingly scarce natural resources such are to facilitate mainstreaming of select- munities to identify effective and sustain- as water, overgrazed pastures, and over- ed environmental issues into relevant sec- able interventions to reduce critical EH exploited fuelwood, creating conflicts tor activities for improving development risks. The activity in Egypt is focusing on with nomads over resource sharing; (c) a and poverty alleviation, and sustaining four issues (identified on the basis of the gradual collapse of the semi-nomadic sin- the capacity strengthening process of en- cost of environmental degradation at the gle source of wealth, the livestock exclu- vironmental mainstreaming. governorate level) that will address the sively earmarked for domestic use, which environment-poverty-health nexus.Avil- is being substituted by transfers from ur- Environmental health lage focus is being pursued in Djibouti ban migrant workers; and (d) water quan- (two semi-nomadic villages) and Yemen tity and quality contributing to the high in Djibouti, Egypt, and (nine villages). incidence of diarrheal diseases (24.8 per- Preliminary results emerging from cent), fuelwood contributing to the high Yemen Djibouti show (a) an excessive gender incidence of respiratory diseases (29.1 bias in terms of domestic and pastoral percent), and vector-borne diseases such The environmental health (EH) burden of overwork; (b) infrastructure in both vil- as dengue remaining high (21.5 percent). disease reached 20 percent in the MNA lages that is in disarray, dwindling Environmental health proved to be region in 2002. Surprisingly, the burden livestock, poorly managed land use, in- an effective entry point to redefine the re- lationship between the semi-nomads and Four leading causes of communicable diseases per 100,000 population, 2002 their living space in terms of basic infra- structure, land use management, hygiene Mortality by Top Four Global Causes Mortality & Morbidity by Top Four Global Causes practices, and production/consumption (Deaths per 100,000 Population) (DALYs lost per 100,000 Population) patterns. HIV/AIDS HIV/AIDS 70 1,400 60 1,200 50 1,000 40 800 30 600 This article was prepared by Hocine Chalal, 20 400 (202) 458-2153, hchalal@worldbank.org, with 10 200 TB 0 ARLI Malaria 0 ARLI input from Sherif Arif, Allan Rotman, Stefanie Brackman, Steve Maber, Julia Bucknall, and Ahmed Mostafa of the Water, Environment, MNA MNA Rural, and Social Development Sector; and Pier Global Global Francesco Mantovani of the Infrastructure and Private Sector Development Department--all of the Bank's Middle East and North Africa Diarrhea Diarrhea Region; and Fadi Doumani and Murray Note: TB and malaria rank fourth in terms of the communicable global leading cause of death and burden of disease Newton, consultants. respectively. Source: Doumani, Bjerde, and Kirchner 2005. Rural Water Supply, Sanitation, and Hygiene Adviosry Note, World Bank. MNA website: . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 51 South Asia Region Afghanistan Nepal Bhutan Pakistan Bangladesh India Sri Lanka Maldives IBRD 31566R SEPTEMBER 2005 Carnemark Nepal C. ith about 40 percent of the world's poor, Addressing environmental health South Asia is faced with high environmen- risks through multisectoral tal health risks that account for one-fifth of its total burden of disease--comparable to approaches malnutrition and larger than all other preventable factors and Environmental health is a top priority of the South Asia Envi- groups of disease causes. Poverty and the lack of basic infra- ronment Strategy and a major element in achieving several structure, such as lack of safe water and sanitation, clean Millennium Development Goals (MDGs), such as those relat- household energy, and waste disposal options play by far the ed to child and maternal mortality, child nutritional status, infectious diseases, and environmental sustainability. The largest role in environmental health risks. Other concerns in- Bank promotes a holistic approach to health in Country As- clude the growing contribution of the infrastructure and in- sistance Strategies, analytical work, and lending through a dustry sectors to the disease burden. The disease and mortality variety of development projects that have the potential to in- associated with poor environmental health impose both a crease health outcomes. The multidisciplinary nature of envi- ronmental health has led to a Regional focus on four primary heavy human as well as an economic burden, with lost pro- areas: (a) poor water supply and sanitation, (b) indoor air ductivity and livelihoods, increased health care costs, and de- pollution, (c) urban air quality and industrial toxics, and (d) teriorating quality of life. inadequate waste disposal. Environment Matters 2005 -- The World Bank Group 52 ENVIRONMENT MATTERS · 2005 SOUTH ASIA REGION The range of activities supported in- outcomes, but also shaping future project uated options for operational responses clude analytical work to understand and design and policy to maximize health to arsenic mitigation in Asian countries, influence policies and actions that ad- benefits and increase overall cost effec- ranging from Bangladesh and India, the dress health risks and damages, lending tiveness. most well-known cases, to China, Cam- support for targeted interventions, and The Bangladesh Country Environ- bodia, and Vietnam (see Box, below). building of good governance structures mentalAssessment (CEA) found that 10­ To more effectively scale up the pro- that are capable of safeguarding the en- 11 percent of the total burden of disease vision of safe water, the Bank has initiat- vironment and responding to the needs is attributable to unsafe water and poor ed the Bangladesh Water Supply Program of the poor. Environmental health sanitation and excessive arsenic in Project, which is piloting innovative mea- achievements over the past year and fu- groundwater. The study concluded that sures for the provision of safe water sup- ture plans are described below. improved water supply requires greater ply free from arsenic and pathogens in involvement of local governments, high- rural areas and small towns. The project Strengthening Health Con- er levels of investment, improved O&M includes the following components: (a) siderations in Water and services through the private sector, and promoting rural piped water supply with an independent regulatory framework to private sector participation; (b) promot- Sanitation Programs supervise and monitor performance. Fur- ing private sector participation in water ther, improved sanitation technologies supply in municipalities; (c) implement- More than one out of three people in the and low-cost community effluent treat- ing arsenic mitigation measures in ar- region do not have access to adequate ment facilities are essential steps needed senic-affected villages; (d) supporting sanitation and more than one out of six to realize the health gains from sanitation development of adequate regulations, people do not have access to safe drink- coverage. monitoring, capacity building, and train- ing water. In rural areas, access levels are The Bank has also completed a more ing; (e) supporting development of a lo- far less, with sanitation virtually nonex- comprehensive regional assessment of cal credit market for village piped water istent in most countries. Over the past the current knowledge regarding arsenic supply; and (f) implementing a monitor- few decades, the region has made signif- contamination of groundwater and eval- ing and evaluation system for the project. icant strides in scaling up rural water sup- ply and sanitation (WSS); however, despite these improvements, water-relat- RESPONDING TO ARSENIC CONTAMINATION OF GROUNDWATER ASIA IN ed diseases continue to be a common oc- currence and account for a large number A recently released policy report by the Bank,"TowardsaMoreEffectiveOperationalResponse: of child deaths every year. Arsenic Contamination of Groundwater in South and East Asian Countries,"evaluated how ar- senic mitigation can be integrated into broader water supply policies and approaches for The Bank is supporting a rigorous operational effectiveness. evaluation of the health outcomes of ru- ral water supply, sanitation, and hygiene Significant strides have been made since arsenic was first detected in drinking water tube- interventions in two Indian states--Ma- wells in Eastern India in the early 1980s and Bangladesh in the1990s. However, a range of harashtra and Orissa--to evaluate and factors--including projected population growth in the region, continuing private invest- quantitatively demonstrate, using local ment in shallow tubewells, and the drive toward achievement of the MDG related to safe data, the effects of improved water sup- water supply--add to the urgency of adopting a more strategic approach for effective ac- ply and sanitation on childhood diarrhea tion at the project, national, and international levels. and growth. The studies are expected to Although the characteristics of arsenic contamination are unique to each affected country, develop monitoring indicators and make the study results suggest that three simple steps would help governments more effectively them workable and user friendly in the address the problem. At national and local levels, there is a clear need to go beyond data WSS sector and also to examine the con- collection and to actively integrate available knowledge into the water supply sector,such as tribution of factors, such as household ed- available mitigation technologies,areas of arsenic occurrence,and so forth.This also goes for ucation and good village governance, in the health sector (e.g.,teaching health professionals about arsenic),education (ensuring that maximizing child health and other non- when schools are built in arsenic-prone areas, wells are tested for arsenic), and for irrigation health benefits, so that optimal service wells used for drinking (people need to be informed about their safety). packages can be promoted to communi- ties. The design of this evaluation is Globally, there is a need for more cohesion in scientific and medical research, and for the development and funding of a strategic research agenda, to provide a more concrete un- aimed at not only establishing whether derstanding of the epidemiology of arsenic in the Asian context. key interventions achieve their stated ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 53 On the urban side, the Bank is exam- lack of safe sanitation and drinking wa- els of indoor air pollution in rural house- ining the reasons for the relatively small ter. holds with different kitchen and fuel percentage of urban India served by san- In India, a three-year strategic ana- types, (b) the people who are harmed the itation and the low level of investment lytical study undertaken by the Bank was most, and (c) the circumstances under made in this sector. It is estimated that instrumental in putting indoor air pollu- which they are harmed. As a result, in- only 30 to 40 percent of India's urban tion on the government agenda and help- door air pollution emerged as one of the population are currently served by a wa- ing to mainstream these issues in health key areas in the Bangladesh CEA, pav- ter sanitation system. The Urban Sanita- research and rural energy programs. The ing the way for follow-up dialogue and tion and Waste Management Report focus of Bank work in India is now on assistance, particularly exploring oppor- found that there is good technical engi- supporting initiatives put forward by the tunities for replicating the Nepal experi- neering capability in India to design and Government of India and the states, such ence. implement sanitation facilities; however, as a new program to help rural commu- there is a lack of coherent urban sanita- nities meet their total energy require- Management of Urban Air tion policies and project planning. In con- ments (for productive use, lighting, and junction with the report, the Bank is Quality clean cooking) through indigenous, local- producing a new manual and policy notes ly available renewable resources and South Asian cities record some of the on "Policy and Planning Principles and technologies. The program places empha- highest levels of ambient particulate mat- Issues Related to Urban Sanitation." sis on community involvement and ter. Small particles less than 2.5 micron These documents will complement the creating opportunities for rural employ- in diameter (PM2.5) are particularly existing and widely used government ment. In addition, the Bank--through its known to have linkages with respiratory "Manual on Sewerage and Sewage Treat- Energy Sector Management Assistance and cardiovascular ailments, including ment" and will also support the Bank's Program--initiated the evaluation of the premature mortality and morbidity. Ac- preparation of an operational strategy for impact of terminating the central fund- cording to a recent WHO estimate, urban urban sanitation. ing of improved stove programs. particulate air pollution is responsible for In Nepal, indoor air pollution levels Reducing Indoor Air Pollution nearly 150,000 deaths every year in South are particularly high as traditional biom- Asia. Presently, the Bank is active in ur- ass energy is used not only for cooking The Bank has been active in indoor air ban air pollution in India, Bangladesh, but also for heating. The Bank is support- pollution programs in the region due to and Pakistan, where transport and indus- ing the Government of Nepal's Biogas the alarming public health consequences try sectors are likely among the dominant of the use of traditional biomass fuels for Program through Carbon Finance. The sources of urban pollution. cooking and heating. According to the Community Development Carbon Fund Most significant efforts and achieve- World Health Organization (WHO), in- will purchase Carbon Emissions Reduc- ments in strengthening policies and in- door air pollution from solid fuels ranks tion credits and allow for full implemen- stitutions in tackling vehicular pollution fourth among risks to human health in tation of Phase IV of the program, which have been made in Bangladesh through developing countries and ranks third in has a goal of supporting the installation the Bank-supportedAir Quality Manage- South Asia, just below malnutrition and of an additional 162,000­200,000 units by ment Project, which is evaluating policies 2009. During the earlier phases of the pro- and action for mitigating the risks from gram, the country achieved installation transport-related pollution including air y of over 100,000 biogas reactors through a quality monitoring, setting of standards, Librar public-private partnership to promote vehicle emissions, enforcement, training Photo use of biogas for cooking and lighting in and capacity building, public awareness Bank rural areas. In addition to global benefits, and stakeholder participation, and insti- orldW the program will produce local benefits tutional sustainability. ranging from reduced indoor air pollu- In India, following completion of a tion levels in homes to enhanced agricul- study on urban air quality management tural productivity and improved forestry entitled For a Breath of Fresh Air: Ten Years practices. of Progress and Challenges in Urban Air Expanding its involvement in other Quality Management in India 1993­2002, South Asia countries, the Bank has sup- the Bank is finding effective ways to as- ported exposure assessment studies in sist Central and State Pollution Control Indoor cooking in India. Bangladesh to identify (a) the actual lev- Boards (CPCB and SPCBs) through tech- 54 ENVIRONMENT MATTERS · 2005 SOUTH ASIA REGION nical assistance for institutional capacity Pradesh, the Bank has helped municipal- THE SAR REGIONAL building and direct interventions across ities to develop municipal action plans as ENVIRONMENT PORTFOLIO relevant sectors. A workshop on Urban a basis for identifying future sector in- Biodiversity 1% Air Quality Management in India--orga- vestments and attracting private sector Other environmental Climate change 13% nized jointly by the World Bank and finance. This work supports the munici- management Environmental CPCB in October 2004--brought togeth- 1% pal reform efforts in these states, particu- policy and er state governments that are developing institutions larly in areas such as efficiency, the role Water resource management 7% "action plans" for addressing urban air of the private sector, performance assess- 33% pollution in critically polluted cities. Land ment, and increasing emphasis on com- management In Pakistan, the Bank is supporting a munity-led solutions. 8% strategic CEA that will help determine Pollution management and environmental health areas for future engagement based on an 37% ongoing compilation and analysis of the Future plans to build Percentages based on commitment amounts. status of urban air pollution and assess- on present accom- At the end of June 2005 the active portfolio of ment of policies and required actions. The World Bank environmental lending in the SAR Region was $1.6 billion. Bank also supported the first national plishments workshop on UrbanAir Quality Manage- ment in partnership with Clean Air Ini- The Bank is aspiring to increasingly ap- benefits and financing instruments. tiative-Asia in Lahore in December 2004. ply existing knowledge in the field Though such programs have not been through its ability to design and imple- Improving Solid Waste Man- tried in the region and are faced with a ment multidisciplinary projects with the number of institutional, economic, social, agement and Disposal breadth required to have an impact on and technological challenges, they can health. Building on the environmental help to achieve significant health gains if As the rate of urbanization increases, is- health accomplishments of the past year, successfully implemented. sues of solid waste need particular atten- the Bank has launched several new initi- New and important opportunities for tion in the region. Management of solid waste is a broad topic, covering not only atives to provide future support for the engagement are emerging from the recent municipal waste but also industrial, haz- region's efforts in reducing environmen- analytical work in Bangladesh and Paki- ardous, and biomedical waste. In India, tal health risks. stan. The Dhaka Environment Project for example, larger cities have solid waste In India, the Capacity Building for In- under preparation holds significant collection systems in place that achieve dustrial Pollution Management Project promise in the demonstration of good reasonable levels of performance; how- will enhance the national- and state- practices for institutions to manage urban ever, treatment and disposal of the col- level systems for the effective control and watersheds, including water quality lected wastes typically lags behind, management of urban and industrial pol- monitoring, water treatment processes, and--despite some innovative schemes-- lution. The project will support the de- and public awareness. Now that solid most of the waste ends up in offensive velopment and implementation of a analytical findings are at hand and client and polluting dumps. Recent legislative National Rehabilitation Plan for contam- governments are requesting follow-up, and judicial pressure have put pressure inated sites, strengthen institutional ca- the South Asia Region is actively explor- on public sector providers (municipali- pacity building for improved enforce- ing opportunities for environmental ties) to introduce upgraded and accept- ment of environmental regulations, and mainstreaming in the areas of urban air able alternatives to these dumps, but support the implementation of pollution there are institutional capacity, technical, quality management, indoor air pollu- reduction and waste minimization inter- and financial challenges that must be ad- tion, and institutional capacity enhance- ventions through investments particular- dressed. ment measures. To address the problem in India, the ly in hazardous and solid waste manage- Bank is supporting municipal authorities ment. in improving the environmental quality The Bank continues to have a high This article was prepared by Jane T. Nishida, of urban areas, with consequent health, level of commitment to address issues of (202) 458-9562, jnishida@worldbank.org, and Priti Kumar, pkumar2@worldbank.org--both of environment, and economic benefits. indoor air pollution through demand-ori- the Environment and Social Development Based on specific requests from the state ented renewable energy projects, build- Sector Unit of the South Asia Region. governments of Karnataka and Andhra ing on synergies with global environment SAR website: . ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 55 Environment Matters 2005 -- The World Bank Group The role of the formance standards and envi- private sector ronmental and social guide- lines are industry benchmarks T he private sector is the for practitioners worldwide. engine of growth in the AdoptedbytheEquatorBanks, majority of the world's which represent approximate- economies. Ahealthy, sustain- ly 85 percent of the global able private sector has the abil- project finance market, the per- ity to lift millions out of formance standards provide a poverty and in doing so, im- comprehensive environmental prove their lives. This is the and social risk man- agement mission of the International framework, including the Finance Corporation (IFC), health and safety of workers which in fiscal 2004 committed and surrounding communi- ties. By focusing our clients on PRIVATE RESPONSES over $5.6 billion of financing to companies operating in emerg- community and environmen- ing markets. tal health issues, IFC continues to play a leadership role, en- TO PUBLIC PROBLEMS Yet capital alone and good fi- couraging clients to move be- nancial performance will not yond traditional concepts of compliance and instead adopt IFC solve the problems facing AND many of our clients. Poor a broader strategy of corporate social responsibility. Such an ENVIRONMENTAL HEALTH worker health and environ- mentally harmful business approach reflects our mission practices can have a significant as a development institution, impact on the sustainability of as well as simply making good communities and private busi- business sense. nesses, as can lack of access to basic infrastructure, education, New business local financing, or pragmatic models for public advice on environmental and social dimensions of business health operations. IFC's strategy is According to the World Health based on addressing these con- Organization, diseases result- cerns. ing from polluted drinking Adding value water still account for 1.7 mil- lion deaths per year. In many through leadership countries, the private sector is stepping into the breach to pro- IFC's environmental and social vide basic services to commu- leadership has a broad impact nities. IFC is working with a on the private sector. IFC's per- number of clients to finance 56 ENVIRONMENT MATTERS · 2005 Institutional Articles water services through main- presenting its commercial government, without taking utilizing clean energy solu- stream investments, in addi- model for decentralized water sovereign guarantees. The ob- tions. In Brazil, for instance, tion to work through our purification systems in the de- jective is to strengthen munic- Brascan Energetica S.A(BESA) sustainable business facilities, veloping world. With low cap- ipalities' ability to deliver key has more than 100 MW of op- small and medium enterpris- ital expenditures and opera- infrastructure services, such as erating run-of-river hydro- es, and grassroots programs. ting costs, the company can water and sanitation, by im- power generation assets in six provide drinking water to proving their access to private locations. Similarly, Balrampur In the Philippines, an IFC cli- communities at an annual cost capital markets. Chini Mills Limited (BCML), ent, the Manila Water Compa- of $2 per person. In line with one of the largest sugar pro- ny (MWC), is one of two our goal of overcoming barri- Investing in clean ducers in India, has developed private companies providing ers to investments and moving energy solutions two cogeneration projects with water and sanitation services projects toward commercial a total capacity of nearly 40 to Metropolitan Manila since viability, the IFC is providing The list of cities with the most MW, which it supplies to the utility privatization in 1997. a $1.2 million equity invest- severe air pollution is dominat- Uttar Pradesh power grid. MWC serves over 4.7 million ment to WaterHealth to help ed by the capitals of develop- Both are helping reduce their residents in the city. Under the expand its operations in Gha- ing nations. Air pollution has countries' dependence on fos- company's watch, many poor na, India, Mexico, and the Phil- a profound impact on health, sil fuels. and underserved consumers ippines. It is estimated that especially among children. The now enjoy lower prices and through this expansion, plus local effects of this pollution There are many other invest- improved access to water ser- its emergency response to Sri are further compounded by cli- ments in IFC's portfolio that vices. The company now pro- Lanka following the tsunami, mate change. improve public health, wheth- vides 24-hour water service to WHI is reaching 150,000 peo- er they be directly related, such 87 percent of the consumers ple with IFC's financing and As the Kyoto Protocol enters as new hospitals and emission- within its central distribution support. into force, IFC's goal is to en- free vehicles, or indirectly re- network, compared with just courage and support emerging lated, such as awareness 26 percent when it took over In addition, IFC and the World market private sector partici- campaigns for employees re- the concession. Bank have established the pation in the carbon market. garding HIV/AIDS and other Municipal Fund, a joint initia- IFC is well positioned to assist diseases. Directed by our mis- IFC is also supporting an tive to make investments in project sponsors with partici- sion, our strategy, and the Mil- American company, Water- municipalities, municipal enti- pation in the rapidly growing lennium Development Goals, Health International (WHI), in ties, and other tiers of local market for carbon credits. One IFC will continue to look for way of doing this is to link opportunities to foster private Library clean energy producers in sector innovation to address Photo emerging markets with buyers social and environmental con- Bank orldW of carbon credits under the cerns. flexible trading mechanisms of This article was written on behalf of the Kyoto Protocol. IFC by Louise Gardiner, who is also the editor of IFC's Sustainability Re- port. IFC Sustainability website: The IFC has already begun . purchasing emission reduc- tions on behalf of the Dutch For further information, please con- tact: Vikram Widge, (202) 473-1368 government from companies (Carbon Finance), and Jeffrey Liebert, Brazil. in emerging markets that are (202) 458-7885 (Water Purification). ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 57 Environment Matters 2005 -- The World Bank Group Following an intensive review mate change, and biodiversity. and analysis of the Safeguard Central to this approach is the Policies, IFC has recast the client's responsibility to man- Safeguards as Policy and Per- age social and environmental formance Standards on Social impacts and improve project and Environmental Sustain- outcomes. In addition, the Per- ability. The Policy and Perfor- formance Standards address a mance Standards improve and number of additional subjects expand upon the existing Safe- of direct concern to the private UPDATING guards and represent a new sector, such as labor and work- AND approach to social and envi- ing conditions and communi- ronmental standards for pri- ty health and safety. To help IMPROVING vate sector performance in IFC's clients implement and OUR emerging markets. Through meet these new standards, the the Policy and Performance Performance Standards will Standards, IFC is creating con- also be supported by a set of ENVIRONMENTAL cise and comprehensive poli- Guidance Notes and good cies that articulate required practice publications. environmental and social out- AND SOCIAL comes, clarify the roles and re- Consultation on the New sponsibilities of IFC and its Policy client companies, and provide STANDARDS a framework for managing en- Beginning with the public re- vironmental and social perfor- lease of the draft Policy and mance throughout the life of Performance Standards inAu- an investment. gust 2004, IFC conducted an extensive public consultation T he social and environ- process to consult a wide range leadership and approach to The Performance Standards (a) mental standards of of stakeholders on the new environmental and social sus- place new emphasis on imple- IFC are the building mentation through manage- draft standards--including tainability. Based largely on blocks for our approach to sus- ment systems; (b) include IFC's clients, other private sec- the World Bank's operational tainability and are embodied specific requirements for ap- tor companies and industry policies, IFC adopted its cur- in IFC's Safeguard Policies, its propriate community engage- groups, international financial rent Safeguard Policies in 1998 Environmental, Health and ment; (c) deal with social and institutions, labor organiza- in order to manage environ- Safety Guidelines, and its Dis- environmental issues in a more tions, governments, academia, closure Policy. Together, these mental and social issues in the integrated manner; and (d) and civil society organizations. provide a framework to help private sector in emerging strengthen policy coverage of IFC staff met with almost 1,000 our clients manage project markets. IFC's Compliance issues such as pollution, cli- stakeholders through four re- risks and improve their perfor- Advisor/ Ombudsman (CAO) mance, and they help IFC max- completed a review of the Safe- imize the development impact guard Policies in April 2003 IFC'S PERFORMANCE STANDARDS of our investments. and recommended that IFC Social & Environmental Assessment and Management System From Safeguards to take a number of steps to im- Labor and Working Conditions Pollution Prevention and Abatement prove them. Consistent with Performance Community Health and Safety the recommendations of the Land Acquisition and Involuntary Resettlement Standards CAO, IFC embarked on a two- Conservation of Biodiversity and Sustainable Natural Resource Management year process in fiscal year 2004 Indigenous Peoples To date, the Safeguard Policies to update all of its Safeguard Cultural Heritage have been the basis for IFC's Policies. 58 ENVIRONMENT MATTERS · 2005 Institutional Articles gional consultation workshops ments regarding client disclo- Safety (EHS) guidelines, pub- Guidelines and improve their and numerous informal, the- sures will be included in the lished on IFC's website since applicability to projects, incor- matic, and open stakeholder Performance Standards. While 1998. porating the use of perfor- meetings around the world, continuing to respect client mance indicators and and they obtained additional confidentiality, the new Disclo- The Guidelines have become a benchmarks to improve their feedback through a web-based sure Policy will expand the globally applied technical ref- utility to the diverse commu- consultation tool and other amount of project information erence for private sector devel- nity of external users. written submissions. that IFC makes public before opment. Their use extends going to the Board, including well beyond IFC clients to a The total body of environmen- Public consultation on the statements on anticipated de- diverse external community of tal guidelines published as of draft policy documents ended velopment impact and IFC's users such as other internation- August 1, 2004 (as listed on April 29, 2005 and a revised expected development contri- al financial institutions, regu- IFC's website at will be reviewed ther public comment inAugust policy will clarify the other and commercial banks, includ- over a two-year period, with 2005. Once approved by the types of institutional informa- ing those banks that have publication of the updated Board, the Policy and Perfor- tion that will be made available adopted the Equator Princi- Guidelines scheduled for Au- mance Standards are expected and establish a basis for im- ples. gust 2006. Extensive public to become effective January 1, proved access. The Disclosure consultation on the revised 2006. Policy is expected to be ap- The Update Guidelines will coincide with proved by the Board and be- a structured peer review pro- Challenges Ahead Though the Guidelines were come operational at the same cess to ensure that the Guide- intended to be "living docu- lines continue to provide Successful implementation of time as the Policy and Perfor- ments" at their inception, they globally applicable good prac- the Policy and Performance mance Standards. have not been updated since tice. Standards by January 2006 will 1998. The objective of the require extensive internal and The Environmental Guidelines update is to ensure Additional information on the external communication and their continued applicability as updating of IFC's policies and training. IFC is developing a Health and Safety a valued technical reference guidelines is available at: comprehensive communica- Guidelines source and to support the im- . tions initiative and is begin- plementation of IFC's new ning to train staff in both IFC's policy review also in- Policy and Performance Stan- headquarters and field offices cludes a two-year program to dards, notably those related to to implement the new stan- revise the Environmental, the prevention and control of dards. Recognizing our re- Health and Safety Guidelines, industrial pollution and occu- sponsibility to maintain a a set of technical reference doc- pational health and safety. global benchmark for the fi- uments that establish IFC's nancial sector in emerging expectations for managing in- IFC is actively consulting with markets, IFC will also contin- dustrial impacts. The Guide- technical experts to maintain ue to work closely with other lines cover a wide range of the high standard and applica- institutions that intend to ap- sectors, including oil, mining, bility of the Guidelines across This article was prepared by Jon ply the Performance Standards chemicals, forestry, and infra- the diverse market sectors we Richart and Chris Frankel of IFC's Environment and Social Develop- to their operations. structure, among others, and finance. The update of the ment Department with input from Guidelines will incorporate IFC Disclosure Policy are articulated in the following the policy and guidelines review two sources: (a) the industry concepts of sustainable devel- team. Policy review website: . sector environmental guide- opment, cleaner production, IFC's current Disclosure Poli- lines published in Part III of the and environmental and occu- For further information, please con- cy, also prepared in 1998, is World Bank Group's 1998 Pol- pational health and safety as- tact: Motoko Aizawa (202) 473-0803 under review. The new policy lution Prevention and Abate- pects, with an emphasis on (Safeguards Update), Bill Bulmer will address institutional dis- (202) 473-8750 (Disclosure Review), ment Handbook; and (b) IFC's good management practices. and Alex Indorf (202) 473-1492 closure issues. IFC require- Environmental, Health and The process will streamline the (EHS Guidelines update). ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 59 Environment Matters 2005 -- The World Bank Group D uring the past year, broader context of sustainable the World Bank Insti- development and poverty re- tute (WBI) has col- duction. The ENRM program laborated closely with the builds the skills of individuals World Bank's country teams and the capacity of institutions and with partners in develop- that influence the design of ing demand-driven learning new policies or have responsi- programs and activities that bility for the management of CAPACITY are aligned with World Bank environment and natural re- operations and that focus on sources. long-term institution building. DEVELOPMENT Learning program content is The ENRM program (a) helps customized to meet specific improve clients' understand- country needs and priorities in ing of the linkages among eco- client countries. This country- nomic growth and poverty AND focused work is complement- reduction, natural resources, ed by regional and global ecosystem services, and insti- activities. tutions; (b) fosters the acquisi- INSTITUTIONAL tion of skills and practical tools WBI helps countries share and necessary to reconcile econom- apply global and local knowl- ic growth with the challenges STRENGTHENING edge to meet their poverty of promoting clean air, improv- reduction and sustainable de- ing the urban environment, velopment challenges. We do conserving biodiversity and this through courses and sem- natural resources, and mitigat- inars, policy advice, and other ing and adapting to climate learning products and servic- change; and (c) strengthens the es on a range of topics, includ- capacity of institutions to bet- ing environment, health, and ter manage environmental and sustainable development. Our natural resources in more sus- activities reach targeted audi- tainable ways that take local, ences that include policymak- national, and regional factors ers, academics, journalists, into account. nongovernmental organiza- tions, and leaders of civil soci-Assessing ety. environmental health Environment and & economic costs natural resources WBI's ENRM program helps to management develop skills in environmen- tal and natural resource eco- WBI's Environment and Nat- nomics, including training in ural Resources Management tools for assessing changes in (ENRM) learning program environmental health; exam- helps client countries build ples include the global course their capacity to manage scarce on Environmental Economics natural resources and improve for Development Policy and environmental quality in the more intensive courses imple- 60 ENVIRONMENT MATTERS · 2005 Institutional Articles mented by regional and coun- ment and natural resource eco- mon problems faced by many ganizations, and foundations try-level institutions. Pollution nomics courses or were target- municipalities, including pri- in client countries. Partner- impacts on health, such as pre- ed sessions, such as the two vatization, contracting, cost re- ships are often multiyear pro- mature death and disability that were conducted under the covery, and finance issues. grams developed in collabo- from illness, are examined Clean Air Asia Initiative. They Training activities (face-to-face, ration with local capacity- through a multidisciplinary were implemented at various multimedia, and web-based), building or service delivery in- framework that combines air levels: one global event; seven including certification courses, stitutions that will eventually pollution dispersion modeling, regional events forAfrica, East will be complemented and re- deliver learning and knowl- epidemiologic results, technol- Asia, LatinAmerica, and South inforced by local and regional edge sharing programs on ogy choices, and economic val- Asia; and two country-level networks of institutions and their own. uation methods. These are workshops for China and Rus- expertise. used to examine a range of en- sia. In addition, environmen- For example, a partnership vironmental health issues, in- tal health issues were Training materials on indoor that includes the State Environ- cluding the monetary costs discussed in venues such as the air pollution, including a mul- mental ProtectionAdministra- that result from deterioration Better Air Quality Conference tisectoral case study of China, tion of China, WBI, the Inter- of health and the cost effective- for Asia and at regular univer- are being developed for a new nationalAssociation of Impact ness of alternative approaches sity courses on environmental course--on "Accelerating Assessment, and the United to reduce impacts from pollu- economics in China. Course Progress toward the Health States Environmental Protec- tion. participants were either con- Millennium Development tion Agency is helping to ex- ducting environmental health Goals (MDGs) and other pand training activities in Illustrative cases of applying studies themselves or were Health Outcomes"--to be of- China on strategic environ- economic analysis to environ- engaged in policy discussions fered by WBI's Health & AIDS mental assessment and envi- mental health are used as on the management of pollu- learning program in 2005. The ronmental economics. learning tools in WBI capaci- tion in their respective institu- China case study is part of the ty-building activities. These tions. Plans are under way to course's focus on cross-sectoral WBI expands its reach by us- include benefit-cost analysis of assess the results of enhanced determinants and approaches ing communications technolo- amendments to the 1990 U.S. capacity on environmental to achieving the MDGs. The gy as appropriate for each Clean Air Act; World Bank health issues and improve the case study describes the health activity and audience, includ- studies that have examined effectiveness and impact of fu- impacts of indoor air pollution ingvideoconferencingthrough cleanup of the Ganges River in ture events. and explores how China is ap- theGlobalDevelopmentLearn- India; cost-effectiveness anal- proaching the reduction of in- ing Network, the Internet, ysis of air quality improve- Emerging door air pollution, including web-based e-learning and ments in Mexico; and assess- possible interventions. The facilitated online courses, e- ments of improving stoves for environmental course highlights the need to discussions, and digital radio. cooking and heating in the health-related involve many sectors in devel- Our learning products include highlands of Guatemala. oping policies and actions and web sites, CD-Rom libraries, case studies, and other training Capacity program activities the fact that the country con- text remains critical. materials. development WBI is starting a new solid waste management training and knowledge sharing pro- Partnerships & In fiscal 2005, 10 courses in- gram in Africa and India that expanding reach cluded modules on environ- will help develop the capacity mental health issues. Some 230 of governments at the country, Through these and our other This article was prepared by Marian individuals on average spent provincial, and local levels to learning programs, WBI works Delos Angeles and Bonnie Bradford of the World Bank Institute's Envi- one-and-a-half days learning provide adequate and sustain- in partnership to increase our ronmentally and Socially Sustainable specific economic tools direct- able solid waste management. reach, impact, and effective- Development Division. Fax: (202) ly related to environmental Case studies and other training ness. Partners include aca- 676-0978. E-mail: . Website: health concerns. The modules materials are being prepared to demia, the public and private < w w w. w o r l d b a n k . o r g / w b i / were either part of environ- address some of the most com- sectors, nongovernmental or- sustainabledevelopment>. ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 2003­JUNE 2004 (FY04) 61 Environment Matters 2005 -- The World Bank Group T he World Bank's De- environmentally sound eco- velopment Market- nomic development. place (DM) is a com- petitive grant program that Out of the 2,600 applications identifies and directly supports received, 78 finalists came to innovative development ideas. Washington, D.C., for the two- Since 1998, the Development day competition to showcase Marketplace has awarded al- their unique ideas in areas such most $35 million to over 570 as bringing renewable energy groundbreaking projects to small communities, reduc- in more than 70 countries ing air and water pollution, through global competitions promoting sustainable agricul- and country-level and region- ture, and raising environmen- al development marketplaces. tal awareness. The jury selec- ted 31 projects and awarded Open to all, DM draws togeth- close to $4 million in grants. THE DEVELOPMENT er a variety of individuals and Their winning ideas ranged institutions (NGOs, govern- from a radio soap opera in ment agencies, donor agencies, Vietnam that educates farmers MARKETPLACE ­ academic institutions, and pri- on environmentally sound vate sector companies) to find farming practices to re-using unique solutions for common cleansing water from mosques WINNERS problems in the developing for irrigation in water-scarce IN THE world, which can then be ex- Yemen. panded or replicated else- ENVIRONMENTAL where. Winning Environmental This year's DM theme was In- HEALTH CATEGORY novations for Livelihoods in a Sustainable Environment, which Health Projects reflects the Bank's commit- ment to support ideas and in- Two winners of $150,000 novations that demonstrate awards--a project to provide local leadership in promoting low-cost, jetted wells in Mada- McCourtieS. Former Bank President Wolfensohn at the awards ceremony with the 31 winners of this year's Development Marketplace. 62 ENVIRONMENT MATTERS · 2005 Institutional Articles gascar and another designed to which was personally demon- collect used engine oil in strated by Mol at the market- McCourtieS. Nairobi--are highlighted here place--will be manufactured because of their important po- locally so that it would be tential environmental health widely available and afford- benefits. able. The project expects to provide more than 15,000 vil- Jetted wells. Interviewed at the lagers with access to safe World Bank, Adriaan Mol of drinking water. The technique BushProof explained that the has the potential to reach 1 project in Madagascar was de- million people in Madagas- signed to provide clean water car's coastal areas. to rural, coastal areas by rap- idly constructing low-cost, jet- Used engine oil. The objective of ted wells with hand pumps. this project in Nairobi, Kenya, Such projects are badly need- is to clean the Mukuru-Ngong ed in Madagascar, where ac- River by encouraging vehicle cess to safe water in rural areas mechanics to collect used en- is only 14 percent and drops to gine oil instead of dumping it into the river, said Collins zero in many isolated villages. Apuoyo, who enthusiastically The people living in many of represented the project on the these rural areas now use floor of the Development Mar- heavily contaminated surface ketplace. The Development Marketplace winner for cleaning water from rivers, ponds, or engine oil from the Mukuru-Ngong River, Mr. Collins rice fields for drinking. Ashal- Apuoyo, of Kenya. He explained that about 13 low, sandy aquifer with safe million liters of lubricating oil drinking water lies a few are used annually in Kenya, a pollutant into an income sup- water for drinking and cook- meters below their feet, but most of which eventually ends plement and encouraging me- ing," said Apuoyo. local communities lack the up in the water system. In chanics to collect used oil means to tap into this source. Nairobi, many motor vehicle instead of discarding it. The The project also could have mechanics change vehicle oil project would then sell the col- other important benefits. Ac- The project combines two low- along the banks of the Muku- lected oil to recycling and re- cording to Apuoyo, "If we are cost technologies: well jetting, ru-Ngong River and dispose of processing centers. Prelimi- able to stop the oil from getting which directs a powerful the used oil directly into the nary market surveys indicate into the river, we may improve stream of water to cut a well, river; used engine oil accounts potential for selling up to aquatic life, and that may end and the plastic Canzee hand for about 90 percent of oil pol- 60,000 liters of reprocessed oil. up encouraging the communi- pump to draw water out of the lutants in the river. The low- Recycling just one automobile ty to use the fish for nutrition- well. Mol said that the project income neighborhoods along oil change protects 1 to 4 mil- al purposes." team expects to construct 150 the Mukuru-Ngong River then lion liters of water. The project wells in a matter of weeks, use this polluted water for expects 100 vehicle mechanics This article was prepared by Bob proving that a large number of drinking and cooking, result- to participate directly in the Livernash on the basis of interviews wells can be constructed very ing in a high incidence of program, thereby improving by Debra Beattie and background documentation researched by Alex- rapidly--sometimes at a rate of waterborne disease. Moreover, water quality and health for andra Sears. For further information 50 wells per week. The team the oily water has severely re- the 5,000 households who live about the projects, contact Adriaan would also use the wells' nat- duced the river's wildlife. along the river. "If we can re- Mol (adriaanmol@bush proof.com) or Collins Apuoyo (ers11us@yahoo ural sand filtration to clean the duce the amount of disposed .com). water, thus avoiding the use of The project converts used oil oil in the river, it will be good The Development Marketplace costly disinfectant chemicals. into cash and/or loans through for the health of people who website: . Moreover, the Canzee pump-- a credit points system, turning swim in the river and use its ANNUAL REVIEW · JULY 2004­JUNE 2005 (FY05) 63 SURVEY URVEY S U B S C R I P T I O N R E N E W A L Please complete this form in order to continue to receive Environment Matters Dear Readers: We are updating our subscriber database and conducting a survey in anticipation of our tenth anniversary edition in 2006. We will be redesigning the magazine, and our readers'input on the survey will help us reshape the focus and content of the 10th Anniversary edition and beyond. 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Yes No How long have you subscribed to Environment Matters? 1­ 3 years 4­6 years 7­9 years Please take the Survey online at: Environment Department Publications www-esd.worldbank.org/emsurvey THE WORLD BANK 1818 H Street, N.W., Room MC-5-126 Washington, D.C. 20433 U.S.A. toward environmentally and socially sustainable development · 2005 Phone: 202-473-3641 Environment Matters 2005 -- The World Bank Group A Selection of World Bank Group Environmental Publications The following publications may be obtained by sending an email to ematters@worldbank.org, or by phoning the Environment PUBLICA Department Publications Unit at (202) 473-3641. Integrating Environmental Considerations in Policy Formula- Integrating Environmental Issues into PRSPs tion -- Lessons from Policy-Based SEA Experience in ECA Countries TIONS Report No. 32783 ESN No. 12 Forthcoming Nicholas James Dale May 2005 Lessons for Managing Lake Basins for Sustainable Use Report No. 32877 Rethinking the World Bank's Environmental Portfolio Forthcoming Distribution -- Adjusting for Threats and Country Risk ESN No. 11 Local Approaches to Environmental Compliance -- Craig Meisner, Susmita Dasgupta, and David Wheeler Japanese Case Studies and Lessons for Developing Countries November 2004 (WBI Learning Resource Series) Adriana Bianchi, Wilfrido Cruz, and Masahisa Environment Strategy Papers Nakamura Analytical and Advisory Activities in Environmental February 2005 and Natural Resource Management -- ISBN 0-8213-6101-5 $20.00 A Review of Fiscal 2002­04 Activities ESP No. 10 Tools for Civil Society Action to Reduce Forest Corruption -- Anjali Acharya, Milen Dyoulgerov, and Eri Tsutsui Drawing Lessons from Transparency International Forthcoming Kenneth L. Rosenbaum January 2005 Environment Department Papers The Little Green Data Book 2005 Devolution of Resource Rights, Poverty, and April 2005 Natural Resource Management -- A Review (ISBN 0-8213-6076-0) Environment Department Paper No. 104 $15.00 Priya Shyamsundar, Eduardo Araral, and Suranjan Weeraratne Responsible Growth to 2050 May 2005 Kirk Hamilton and Ian Johnson October 2004 Scaling Up Biomass Gasifier Use -- Applications, Barriers, and Interventions Dissemination Notes Environment Department Paper No. 103 Debyani Ghosh,Ambuj Sagar, and V.V.N. Kishore Guidance on Waste Management November 2004 January 2005, No. 66 Environment in Poverty Reduction Strategies Environment Monitors 2004 and Poverty Reduction Support Credits Vietnam: Solid Waste Environment Department Paper No. 102 Thailand: Biodiversity Jan Bojo, Kenneth Green, Sunanda Kishore, Sumith Philippines: Assessing Projects Pilapitiya, and Rama Chandra Reddy November 2004 Environment Strategy Notes Strategic Environmental Assessment -- Assessing the Economic Value of Ecosystem Conservation Concept and Practice Environment Department Paper No. 101 ESN No. 14 Stefano Pagiola, Konrad von Ritter, and Joshua Bishop KulsumAhmed, Jean-Roger Mercier, and Rob Verheem In collaboration with The Nature Conservancy and IUCN June 2005 October 2004 Mitigating Drought ­ Long Term Planning to Reduce Climate Change Vulnerability Disaster Risk Management in a Challenging Climate ESN No. 13 Frank Sperling and Francisco Szekely Enos E. Esikuri May 2005 June 2005