Public Disclosure Authorized - €¦ · The Bank’s Development Marketplace focused on environment this year, and two winning projects are presented in this edition. New environmental

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T H E W O R L D B A N K G R O U PThe World Bank

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All $ = U.S. dollars except where noted.All tons = metric tons.

Thanks to Kirk Hamilton and the WorldBank Photo Library for the images found inthe photo bar on pages 22 through 31.

IBRD maps numbered 31562 through31567 contained in the Regional section ofthe magazine were produced by the MapDesign Unit of the World Bank. Theboundaries, colors, denominations, andany other information shown on thesemaps do not imply, on the part of theWorld Bank Group, any judgment on thelegal status of any territory, or anyendorsement or acceptance of suchboundaries. The countries identified byname on these maps are countries towhich the Bank provides developmentassistance in the form of loans or advisoryservices, and for which the Bank has adesignated official responsible for thecountry.

Environment Matters is a magazine of theWorld Bank Group. You may also find themagazine on the Bank’s website — http://

www.worldbank.org/environmentmatters

Environmentally and Socially SustainableDevelopment Network Managers

Chair/Vice President

Ian Johnson

Environment

James Warren Evans

Agriculture and Rural Development

Kevin M. Cleaver

Social Development

Steen Lau Jorgensen

Environment Matters is produced by theWorld Bank’s Environment staff.

Editorial & Production Teamfor the Annual Review

Technical Editor

Jan BojöStory Editor

Robert T. LivernashDesigner, Photo and Managing Editor

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Diane Flex

Special Contributors

Laura TlaiyeSharon FelzerSergio Jellinek

The World Bank Group1818 H Street, N.W.Washington, D.C. 20433

World Bank Publications Info: 202-473-1155General Inquiries: 202-473-3641Department Fax: 202-477-0565Web address: http://www.worldbank.org

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Cover: A typical kitchenin rural households ofSouth Asia. Thephotograph was takenin August 2004 inBangladesh.

In line with one of the major themes in the World Bank’s Environment Strategy, this year’s editionis devoted to the theme of environmental health. We also provide a broader, annual review of thepast fiscal year from an environmental perspective, captured most directly in the Director’s Over-view and supported by regional contributions in the latter part of this edition.

Viewpoint articles in this edition reflect several external perspectives. WHO lays out the panoramaof environmental risk factors; a successful example of combating urban air pollution is provided bythe former mayor of Bogotá; successful strategies to enhance sanitation among poor people aresuggested 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 aBank-wide review of our safeguard policies and conveys the latest data on our environmentallending and analytical work.

This year’s feature articles all cluster around the main theme of environmental health: Ruta andSarraf explain the basics of economic valuation of health impacts of environmental risks; Kaufmannsummarizes a recent study that provides an overview of what we know about the effectiveness ofinterventions in water & sanitation; Ahmed and Awe return to the theme of indoor air pollutionwith a study from Guatemala; Constant and Procee explain how the Bank’s Clean Air Initiativeworks in several regions; and Tynan concludes the section with an article on the risks that chemicalspose to human health.

A major part of this edition—as in the past—consists of reviews of each of the Bank’s Regions. Withattention to the environmental health theme, each Region has chosen a number of issues andprojects to feature in their annual review. This section provides ample illustration of the diversity ofissues that the Bank is confronting in collaboration with client countries. The regional reviews arecomplemented by the institutional perspectives of the International Finance Corporation, whichdeals with private sector development, and the World Bank Institute, which is responsible forcapacity building in client countries.

The Bank’s Development Marketplace focused on environment this year, and two winning projectsare 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 oursubscriber database. It also provides an important opportunity for you to provide feedback to us,so that next year’s Environment Matters can be even better.

Jan BojöLead Environmental Economist, Environment Department,

and Technical Editor for Environment Matters 2005

© 2005 The International Bank for Reconstructionand Development / The World Bank1818 H Street, NWWashington, DC 20433All rights reserved Welcome to

matters. . .

Photographer: Prabir Mallik

Integrating Environmental Considerations in Policy Formula-tion — Lessons from Policy-Based SEA ExperienceReport No. 32783Forthcoming

Lessons for Managing Lake Basins for Sustainable UseReport No. 32877Forthcoming

Local Approaches to Environmental Compliance —Japanese Case Studies and Lessons for Developing Countries(WBI Learning Resource Series)Adriana Bianchi, Wilfrido Cruz, and MasahisaNakamuraFebruary 2005ISBN 0-8213-6101-5 $20.00

Tools for Civil Society Action to Reduce Forest Corruption —Drawing Lessons from Transparency InternationalKenneth L. RosenbaumJanuary 2005

The Little Green Data Book 2005April 2005(ISBN 0-8213-6076-0)$15.00

Responsible Growth to 2050Kirk Hamilton and Ian JohnsonOctober 2004

Disseminat ion NotesDisseminat ion NotesDisseminat ion NotesDisseminat ion NotesDisseminat ion Notes

Guidance on Waste ManagementJanuary 2005, No. 66

Environment Monitors 2004Environment Monitors 2004Environment Monitors 2004Environment Monitors 2004Environment Monitors 2004

Vietnam: Solid WasteThailand: BiodiversityPhilippines: Assessing Projects

Environment Strategy NotesEnvironment Strategy NotesEnvironment Strategy NotesEnvironment Strategy NotesEnvironment Strategy Notes

Strategic Environmental Assessment —Concept and PracticeESN No. 14Kulsum Ahmed, Jean-Roger Mercier, and Rob VerheemJune 2005

Mitigating Drought – Long Term Planning to ReduceVulnerabilityESN No. 13Enos E. EsikuriJune 2005

Integrating Environmental Issues into PRSPsin ECA CountriesESN No. 12Nicholas James DaleMay 2005

Rethinking the World Bank’s Environmental PortfolioDistribution — Adjusting for Threats and Country RiskESN No. 11Craig Meisner, Susmita Dasgupta, and David WheelerNovember 2004

Environment Strategy PapersEnvironment Strategy PapersEnvironment Strategy PapersEnvironment Strategy PapersEnvironment Strategy Papers

Analytical and Advisory Activities in Environmentaland Natural Resource Management —A Review of Fiscal 2002–04 ActivitiesESP No. 10Anjali Acharya, Milen Dyoulgerov, and Eri TsutsuiForthcoming

Environment Department PapersEnvironment Department PapersEnvironment Department PapersEnvironment Department PapersEnvironment Department Papers

Devolution of Resource Rights, Poverty, andNatural Resource Management — A ReviewEnvironment Department Paper No. 104Priya Shyamsundar, Eduardo Araral, andSuranjan WeeraratneMay 2005

Scaling Up Biomass Gasifier Use —Applications, Barriers, and InterventionsEnvironment Department Paper No. 103Debyani Ghosh, Ambuj Sagar, and V.V.N. KishoreNovember 2004

Environment in Poverty Reduction Strategiesand Poverty Reduction Support CreditsEnvironment Department Paper No. 102Jan Bojo, Kenneth Green, Sunanda Kishore, SumithPilapitiya, and Rama Chandra ReddyNovember 2004

Assessing the Economic Value of Ecosystem ConservationEnvironment Department Paper No. 101Stefano Pagiola, Konrad von Ritter, and Joshua BishopIn collaboration with The Nature Conservancy and IUCNOctober 2004

Cl imate ChangeCl imate ChangeCl imate ChangeCl imate ChangeCl imate Change

Disaster Risk Management in a Challenging ClimateFrank Sperling and Francisco SzekelyMay 2005

PUBLIC

ATIONS

A Selection of World Bank Group Environmental PublicationsThe following publications may be obtained by sending an email to [email protected], or by phoning the EnvironmentDepartment Publications Unit at (202) 473-3641.

Environment Matters 2005 — The World Bank Group

http://www.worldbank.org/environmentmatters

http://www.worldbank.org/environmentmatters

http://www.worldbank.org

LETTER FROM OUR VICE PRESIDENT

Close to one-fifth of the burden of disease in developing countries can be attributed toenvironmental risks. Much of this falls on our children, as about two-fifths of infantmortality is associated with environmental factors. Looking closer at the major environ-mental risks, about 1.7 million premature deaths are attributable to unsafe water, poorsanitation, 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 developingcountries are rapidly urbanizing. But most poor people still live in rural areas, where traditional fuelsfrom biomass and coal are the main sources of energy. Indoor air pollution from solid fuels is estimatedto 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 alsoa direct connection to economic growth: without a healthy, productive labor force, we will not have theeconomic 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 poorcountries: 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 areimpacted 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. In2000, more than 150,000 premature deaths were attributed to various climate change impacts, accordingto the World Health Organization.

Behind the statistics are scores of human tragedies. Young lives are cut short, and productive lives arehampered by frequent and often painful disease. These are daunting challenges, but Environment Mattersprovides many inspiring examples of ways we can successfully meet them. Achieving substantiveprogress in delivering clean water, improved sanitation, cleaner air, and a safer environment to millionsof poor people will be the result of concerted efforts involving governments, communities, civil societyorganizations, 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 heightenedthe industrialized countries’ support to environmentally sustainable development for the benefit of theWorld’s poor. These events, together with the warning signals raised by the Millennium EcosystemAssessment, have contributed to raise international awareness and to strengthen the global commit-ment to foster a healthy environment for this and future generations.

Ian JohnsonVice President

Environmentally and Socially Sustainable Development

ENVIRONMENT,H e a l t h,

and GROWTHBuilding on Renewed Commitments


Annual Review • 2005

A Letter from Our Vice President, Ian Johnson 1

Director’s Overview 3Environment Department Director J. Warren Evans reviewsthe past year’s achievements and this year’s focus onenvironmental health.

Viewpoints

Health and Environment — 8A View from the Persepective of WHODr. Kerstin Leitner of the World Health Organization inGeneva describes how WHO is working with developingcountries to reduce the health risks posed by environmentalpollution.

A Healthier and Happier City 10Enrique Peñalosa, former mayor of Bogotá, Colombia,discusses the challenges of integrating environmental healthconcerns into urban planning.

Sanitation — No Silver Bullets, but Reasons for Hope 12Simon Trace discusses the Work of WaterAid, an interna-tional NGO dedicated exclusively to the provision of safedomestic water, sanitation, and hygiene education to theworld’s poorest people.

Indoor Air Pollution — Update on the Impacts 14of Household Solid FuelsProfessor Kirk R. Smith of the University of California,Berkeley discusses the latest research findings on the impactof indoor air pollution on health.

Bank-Wide Reviews

Safeguards 17The Quality Assurance and Compliance Unit describes theBank’s efforts to adapt safeguards to changing lendingpriorities.

The Environment and Natural Resources 20Management PortfolioAnjali Acharya and Eri Tsutsui review the Bank’s fiscal 2005environmental portfolio.

Feature Articles

Economic Valuation of Environmental 22Health Impacts of PollutionThe Bank’s Giovanni Ruta and Maria Sarraf look at recentattempts to measure the economic value of health impactscaused by environmental pollution.

Water, Sanitation and Hygiene Interventions 24for Health — What Works?Rachel Kaufmann describes a “meta-analysis” that at-tempted to determine which interventions in water,sanitation, and hygiene worked best to bring aboutsustainable improvements in health.

Environmental Health and Traditional Fuel 26Use in GuatemalaKulsum Ahmed and Yewande Awe discuss the results of astudy that estimated the health impacts of traditional fueluse in Guatemala.

The Clean Air Initiative 28Samantha Constant and Paul Procee review the Bank’sClean Air Initiative, which is now active in Africa, South andEast Asia, and Latin America.

Toxic Chemicals — A Growing Global Threat 30The Bank and its partners are working to help countriesunderstand and assess the impact of chemicals on humanhealth, according to Ellen Tynan.

Regional ArticlesReviews of work in the Bank’s six Regions focus on efforts toaddress the linkages among poverty, environmentalpollution, and human health.

Africa — Sub-Saharan 32East Asia and the Pacific 36Europe and Central Asia 40Latin America and the Caribbean 44Middle East and North Africa 48South Asia 52

Institutional ArticlesPrivate Responses to Public Problems — 56IFC and Environmental HealthThe International Finance Corporation’s efforts to promoteprivate sector growth in developing countries address issuessuch as poor worker health and environmentally harmfulbusiness practices.

IFC — Updating and Improving Our Environmental 58and Social StandardsIFC is taking a new approach to social and environmentalstandards for private sector performance in emergingmarkets.

WBI — Capacity Development and Institutional 60StrengtheningThe World Bank Institute’s Environment and NaturalResources Management learning program helps clientcountries build their capacity to manage scarce naturalresources and improve environmental quality.

NewsThe Development Marketplace — 62Winners in the Environmental Health CategoryThis year’s Development Marketplace theme wasInnovations for Livelihoods in a Sustainable Environment

SURVEY and Subscription Renewal 64for Environment Matters

Environmental Publications (inside back cover)

To renew, or begin, asubscription to EnvironmentMatters, please complete the on-lineSUBSCRIPTION RENEWAL FORM. See page 64 for details!

3

Overview

ANNUAL REVIEW • JULY 2004–JUNE 2005 (FY05)

hrough its Environment Strategy and manyother initiatives, the World Bank has workeddiligently for many years to address the link-ages among poverty, environmental quality,and human health. This year’s Environment

Matters provides a progress report on the environmental healthagenda.

Environmental health risks—such as polluted water and in-sufficient sanitation, indoor and outdoor air pollution, lead poi-soning, and the impacts of climate change—significantlyinfluence the well-being of hundreds of millions of poor peo-ple. The links are clear: poor people are the first to suffer froma polluted environment.

This overview provides a summary of the past fiscal year’s (end-ing in June 2005) achievements, in which we have seen in-

by James Warren EvansDirector, Environment Department

creased environmental lending and a continued strengthen-ing of analytical work. It also provides an overview of key glo-bal issues and how we address them through partnerships,information on major trust funds that provide essential sup-port for our work, as well as comments on some importantfuture challenges.

Environmental LendingEnvironmental content in Bank lending reversed the declinefrom past years and reached $2.5 billion in new commitmentsfor fiscal 2005. This represents more than 11 percent of newlending. The significant increase in environmental content inthe Bank’s lending is mainly due to two large developmentpolicy loans: the First Programmatic Reform Loan for Envi-ronmental Sustainability in Brazil ($503 million) and the

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4 ENVIRONMENT MATTERS • 2005

Programmatic Development Policy Loanfor Sustainable Development in Colom-bia ($150 million). These programs markan important step forward in our effortsto engage in dialogue on environmentallinkages with key sectors and finance au-thorities. If sustained over time, theyenable the Bank to serve clients in in-forming and facilitating debate amongnational stakeholders (see examples inLatin America, page 46).

The increase in commitments in fiscal2005 is also attributable to an increasedcoverage of environmental objectives ininfrastructure lending. For example, morewater and sanitation loans are address-ing water quality management issues; ir-rigation and other water managementoperations include support for policiesthat address sustainable resource man-agement; and urban projects includecomponents for wastewater and solidwaste management. Equally importantare smaller loans that enhance countrycapacity to improve environmental andsocial conditions when investment in in-frastructure is rapidly growing. For exam-ple, the Bank recently approved the LaoPDR Nam Theun 2 Hydropower Projectand the linked Laos Environment and So-cial Development (LENS) Project (seepage 37 in the East Asia and Pacific Re-gion article for details).

New approaches are being tested tomeet local natural resources manage-ment objectives while addressing globalissues and to directly support local gov-ernments in enhancing environmentalmanagement. For example, we believethere is great potential in utilizing car-bon finance to stimulate improved com-munity forest management and reducedegradation of sensitive ecosystems (seeBox, above right).

Another important area of opportunityis subnational programs. For example,through a $24 million loan in Brazil—the Integrated Municipality Project/BetimMunicipality—the Bank will support in-vestment in urban infrastructure andsocial services and improve municipalgovernance and regulatory policy. Amajor part of the investment will pro-vide sewerage and water treatment fa-cilities resulting in better water qualityin the Betim River and thereby improvedpublic health conditions in the urbancommunity. Families will also be assist-ed to move to safer ground from areassubject to flooding. New urban parks willbe created, and vegetation around themain river will be restored.

StrengthenedEnvironmental AnalysisAnalytical and advisory activities (AAA)provide a foundation for defining stra-tegic priorities and for informing policydialogue and decisions on projects andprograms in World Bank client countries.Since the endorsement of the WorldBank’s Environment Strategy, the Bankhas made considerable progress instrengthening its environmental AAAwork. A recent report entitled Analyticaland Advisory Activities in Environmental

and Natural Resource Management: A Re-view of Fiscal 2002-04 Activities, reviewsreports with environmental themes,identifies good practice, and presentstrends. The review shows that CountryEnvironmental Analyses (CEAs), strate-gic environmental assessments (SEAs),public environmental expenditure re-views, energy-environment reviews, andother environmental studies increasedsteadily from 2001 through fiscal 2004.This increase was sustained in fiscal 2005(see the portfolio review article, pages20–21 for further details).

The use of Country Environmental Anal-ysis has grown in importance, with com-pleted reports from the DominicanRepublic and Egypt, and work under wayin countries such as Bangladesh, Ethio-pia, Ghana, and Nigeria. While a CEA isa flexible tool with varying coverage, ittypically contains (a) a state of the envi-ronment section that reviews environ-mental challenges and poverty-environment links, (b) a policy analysissection that identifies key policies andtheir environmental implications, (c) aninstitutional capacity assessment, and (d)a business plan that reviews past expe-rience and suggests future Bank assis-tance in the form of lending or analyticalwork.

Tanzania Small Group and Tree Planting (TIST)

The TIST program empowers and pays groups of subsistence farmers in TThe TIST program empowers and pays groups of subsistence farmers in TThe TIST program empowers and pays groups of subsistence farmers in TThe TIST program empowers and pays groups of subsistence farmers in TThe TIST program empowers and pays groups of subsistence farmers in Tanzania toanzania toanzania toanzania toanzania torestore local deforested areas and to adopt sustainable agricultural practices. It suprestore local deforested areas and to adopt sustainable agricultural practices. It suprestore local deforested areas and to adopt sustainable agricultural practices. It suprestore local deforested areas and to adopt sustainable agricultural practices. It suprestore local deforested areas and to adopt sustainable agricultural practices. It sup-----ports small groups to establish small, dispersed reforestation groves using hand toolsports small groups to establish small, dispersed reforestation groves using hand toolsports small groups to establish small, dispersed reforestation groves using hand toolsports small groups to establish small, dispersed reforestation groves using hand toolsports small groups to establish small, dispersed reforestation groves using hand toolsand locally available materials. As of todayand locally available materials. As of todayand locally available materials. As of todayand locally available materials. As of todayand locally available materials. As of today, thousands of smallholders located in four, thousands of smallholders located in four, thousands of smallholders located in four, thousands of smallholders located in four, thousands of smallholders located in fourimpoverished regions of Timpoverished regions of Timpoverished regions of Timpoverished regions of Timpoverished regions of Tanzania are adopting simple agroforestry techniques, plantinganzania are adopting simple agroforestry techniques, plantinganzania are adopting simple agroforestry techniques, plantinganzania are adopting simple agroforestry techniques, plantinganzania are adopting simple agroforestry techniques, plantingtrees on their agricultural plots and around human settlements and switching to con-trees on their agricultural plots and around human settlements and switching to con-trees on their agricultural plots and around human settlements and switching to con-trees on their agricultural plots and around human settlements and switching to con-trees on their agricultural plots and around human settlements and switching to con-servation tillage. This innovative project supported by the BioCarbon Fservation tillage. This innovative project supported by the BioCarbon Fservation tillage. This innovative project supported by the BioCarbon Fservation tillage. This innovative project supported by the BioCarbon Fservation tillage. This innovative project supported by the BioCarbon Fund links grassund links grassund links grassund links grassund links grass-----roots communities to the international carbon market through costroots communities to the international carbon market through costroots communities to the international carbon market through costroots communities to the international carbon market through costroots communities to the international carbon market through cost-----effective contracteffective contracteffective contracteffective contracteffective contract-----ing mechanisms and modern information flows. Millions of trees have been planteding mechanisms and modern information flows. Millions of trees have been planteding mechanisms and modern information flows. Millions of trees have been planteding mechanisms and modern information flows. Millions of trees have been planteding mechanisms and modern information flows. Millions of trees have been plantedand millions more seedlings are in nurseries.and millions more seedlings are in nurseries.and millions more seedlings are in nurseries.and millions more seedlings are in nurseries.and millions more seedlings are in nurseries.

5

Overview


One measure of mainstreaming environ-ment in the Bank is the extent to whichour Country Assistance Strategies(CASs) integrate such issues, discusspoverty-environment links, and advanceappropriate policy and investment re-sponses. A recent update based on 40CASs—An Environmental Review of 2002-2004 Country Assistance Strategies—shows a modest average improvementin this regard. The Eastern Europe andCentral Asia Region deserves specialmention for significant improvements inincorporating environmental aspects inits CASs. High-scoring CASs were foundacross the Regions, with Brazil, Georgia,and Paraguay among the top examplesof mainstreaming. These results shouldnot make us complacent, as attention toimportant environmental issues is stilldeficient in many countries.

This is underlined by the result of a re-view of mainstreaming of environmentin our client countries’ own Poverty Re-duction Strategy Papers (PRSPs). Atten-tion to environment is uneven acrosscountries, but it is increasing as coun-tries move from interim to full PRSPs.Good practice is emerging, which canalso be a good basis for the Bank’s Pov-erty Reduction Support Credits (PRSCs)or other lending.

Climate variability and climate changethreaten poverty alleviation and the sus-tainable economic development of de-veloping countries. While the Bank hasmaintained a strong portfolio of mitiga-tion-related projects, it has been muchless active in issues of adaptation to cli-mate change. However, a recent studyby the Bank—Assessment and Design forAdaptation to Climate Change: A PrototypeTool (ADAPT)—presents a simple ap-proach that provides a quick way of as-sessing projects for potential sensitivities

to climate change. The tool contains asummary of the climate trends and pro-jections at the project site; identifies com-ponents of the project that might besubject to climate risk; explains the na-ture of the risk; and provides documentsand contacts to help follow up on anyidentified risks. ADAPT is intended forproject team members, both within theBank and within client countries, who donot have specialized knowledge of cli-mate change issues. A prototype tool hasbeen developed and tested with poten-tial users through a series of focusgroups. Applications are foreseen first inSouth Asia, with a later modification forAfrican conditions.

Global IssuesCountry-level work is the bread and but-ter of the Bank, but the Environment De-partment has a key role also in makingprogress toward addressing issues thattranscend national boundaries. A majorinstrument in this regard is the GlobalEnvironment Facility (GEF). This facilityis active in the fields of biodiversity, cli-mate change, international waters,

ozone layer depletion, land degradation,and persistent organic pollutants. GEFprovides financing for the costs ofachieving global environmental goalsabove what is required to achieve nation-al development objectives. In fiscal 2005,47 new GEF projects were approved for$264 million in GEF financing, and $571million in additional Bank financing alsowas mobilized.

Climate change. The Bank is engaged inassisting clients with cost-effective mit-igation of greenhouse gas emissions andin improving understanding of adapta-tion to climate-change-induced impacts.The integrated urban transport projectssupported by GEF in Latin America andEast Asia are an illustration of novel pro-grams that address GHG emission mit-igation while improving local air quality.In the area of adaptation, we haveworked with India in assessing the im-pact of drought and changes in its lengthand intensity on farmers; gains are pos-sible by shifting irrigation from rice atcritical periods to other crops. Finally,carbon finance (over $800 million nowavailable in eight funds) helps finance

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Drylands in Namibia.


emission mitigation projects and capac-ity building in developing countries.

Biodiversity conservation. We have sus-tained our leadership in terrestrial andaquatic biodiversity protection throughthe GEF and have also engaged in part-nerships to raise awareness and mobi-lize support to specific threats. Underpartnerships, the following achieve-ments are noteworthy:

The Critical Ecosystem PartnershipFund (CEPF). A partnership withConservation International, GEF,the Government of Japan, and theMacArthur Foundation, CEPF has todate committed in excess of $60 mil-lion to support more than 250 com-munity-based groups, NGOs, andother partners to conserve Earth’sbiodiversity hotspots.The Global Program for SustainableFisheries (PROFISH) is a partnershipof developing countries, donors,technical agencies, and the privatesector, intended to introduce inno-vative ways to control fishing capac-ity and create incentives for moresustainable production and to im-prove the capture and distributionof benefits from fisheries to fightpoverty. Equally important,PROFISH will provide a platform fordialogue among stakeholders oncontroversial issues like reducingsubsidies in the sector and makingforeign access agreements moretransparent and equitable.WWF/World Bank Alliance. Enteringa second phase, the program is ex-panding areas of forest under effec-tive protection, increasing the cov-erage of third-party certification, andaiming at a 10 percent reduction inglobal deforestation by 2010.

Trust FundsSupport from other donors to environ-mental work managed by the WorldBank has been, and continues to be,quite essential. A multitude of externalagencies are providing funding for WorldBank or joint analysis. Here, only twomajor trust funds are highlighted.

The Trust Fund for Environmentally andSocially Sustainable Development(TFESSD) is jointly funded by the Gov-ernments of Norway and Finland. TheFund supplements the World Bank’sbudget for environmental analyticalwork and nonlending services and sup-ports activities in the priority areas out-lined in the Bank’s EnvironmentStrategy. TFESSD currently funds morethan 140 activities in 80 countries, with50 percent of the funding going to Afri-ca. Donor contributions as of December2004 reached $47 million.

The Bank-Netherlands Partnership Pro-gram (BNPP) is an agreement betweenthe Netherlands Ministry of Foreign Af-fairs and the World Bank to providefinancing and a priority-setting frame-

work for new projects and programs ofa global and regional nature. The pro-gram finances activities in five prioritywindows that are executed by the WorldBank. One of them is the EnvironmentWindow, through which financing forbiodiversity, forests, and environmentalanalysis projects are obtained. As of theend of 2004, the environment portfoliowithin BNPP included 21 ongoing pro-grams and 26 completed programs, rep-resenting a cost of $26 million. Anadditional 23 projects are scheduled tobegin implementation during 2005.

Challenges AheadBriefly, we must take on several majorchallenges in the coming years.

Integrating environmental management inpoverty reduction. By the time you readthis, the Millennium Review Summit willhave taken place at the UN in Septem-ber 2005. Progress with respect toachieving the MDGs will have been re-viewed, and among them the cross-cut-ting MDG7 on environmentalsustainability. Environmental manage-ment in developing countries needs to

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A community health center in the Philippines.

7

Overview

ANNUAL REVIEW • JULY 2004–JUNE 2005 (FY05) 7

be seen in that context—as an integralpart of poverty reduction. A major routeto achieve this is through mainstreamingof environment in Poverty ReductionStrategies. If that foundation is laid down,subsequent Bank CASs and operationswill have something to build on.

Bridging the global-national-local divides.The G8 meeting this summer, attendedby the leaders of the eight largest econo-mies, provided new and encouragingimpetus to the climate change agenda.Other major global challenges includebiodiversity conservation, managementof international waters, desertification,and chemicals management. But linkingthese global environmental challengesrequires us to place the dialogue with cli-ents in the context of their pressing localand national development needs—suchas increased access to energy services,increased food production, improved in-frastructure to access markets, and im-proved financial and social services. Itmeans, for example, finding market so-lutions that are win-win, and mobilizingadditional financing and support to re-

duce barriers and mitigate risk. The re-plenishment of the Global EnvironmentFacility is absolutely crucial in this re-spect.

Building on the Millennium Ecosystem As-sessment (MA). This year, a major scien-tific diagnosis has been presented to theworld community showing how hu-mankind is putting the very basis for ourcivilization under stress by exploitingand polluting ecosystems. We are nowfaced with the responsibility of digest-ing the lessons from this global, monu-mental effort by thousands of scientistsand turning these findings into opera-tional work. This is very relevant to theenvironmental health agenda, the focusof this year’s Environment Matters. In-creased attention is now being given tothe linkages between healthy ecosys-tems and healthy people. Dr. Eric Chivi-an, Director of the Center for Health andthe Global Environment at HarvardMedical School, very effectively de-scribed this linkage when he spoke atthe World Bank Environment Days in2005:

“Human health is highly dependent onthe health of other species and on thenatural functioning of ecosystems. Wederive important medicines from variousplants, animals, and microbes. Medicalresearch depends on a host of other spe-cies, some of which are endangered. Theemergence and spread of some humaninfectious diseases is affected by the lossof certain species, such as predators ofanimals that are hosts for some infec-tious organisms or that pass on these or-ganisms to us. Were it not for pollinatorsand an enormous number of other spe-cies that make soils fertile and fisheriesproductive, our food supply would be se-verely compromised. And, at the mostfundamental level, ecosystems providelife support services, such as the break-ing down of wastes or the purifying ofair and water, that make all life, includ-ing human life, possible. Most peoplerecognize the beauty and the spiritualand economic values of Nature, but theymay not fully understand that theirhealth and lives, and the health and livesof their children, depend on its preser-vation.”

Children collecting water in Lesotho.

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to Lib

rary


. . . there may be an opportunity

for governments, public and pri-

vate health care service provid-

ers, and individuals to look for

solutions that will address risks

rather than treating the conse-

quences.

T he relationship between the physical environmentand human health has been on WHO’s agendasince its inception. In its original constitutionof 1946, WHO’s core functions included the pro-motion of improved housing, sanitation, recre-

ation, economic and working conditions, and other aspects ofenvironmental hygiene. The constitution also stipulates thatWHO should work in cooperation with other specialized agen-cies. These initial mandates provided a foundation for WHO’sefforts to work in tandem with other stakeholders and to rec-ognize the multidimensional nature of promoting and protect-ing human health from adverse environmental factors and risks.

Over the decades, the environment and health nexus has re-mained much the same. But many man-made factors have ris-en in prominence and impact, including air, water, and soilpollution; the influence of industrially pro-duced chemicals in consumer items (suchas plastics); and drugs and chemical resi-dues in food. Most recently, the Millenni-um Ecosystem Assessment (MA) hascomprehensively studied the consequenc-es of the profound changes that human in-tervention has brought to the planet’secosystems and climate. For the first time,a chapter has been included showing theimpact of these changes on human health.Not surprisingly, the MA argues for miti-gation strategies and a more balanced management of Earth’snatural resources to ensure a healthy environment for futuregenerations.

An ongoing challenge is to convince policymakers in charge ofpublic health that environmental determinants need to be ad-dressed in order to protect the health of people. Fortunately,there is growing awareness that successfully controlling wa-ter-related diseases, such as malaria and dengue, must includenonmedical solutions in addition to treating those who sufferfrom such illnesses. Environmental conditions also play animportant role in cancer incidence. For almost all forms of can-cer, the risk of contracting this disease can be reduced if phys-ical environments are safe for human habitation and food itemsare safe for consumption.

The Figure on page 9 shows mortality and DALYs (Disability-Adjusted Life Years, a measure of the burden of disease) for aselection of the most important environmental risk factors.Clearly, unsafe water, sanitation and hygiene are a leading risk

factor, accounting for about 1.7 million pre-mature deaths in 2000. This risk factor isclosely followed by indoor air pollution—a much less publicized source of ill healthbut still responsible for over 1.6 milliondeaths. Men suffer more from outdoor airpollution, while women are more exposedto indoor air pollution, but for both riskfactors, the majority of deaths and diseasefall on children under 5. Lead exposureleads to fewer deaths than urban outdoor

air pollution, but as the figure shows, the impact on people’shealth is still significant. Finally, climate change has begun toaffect people’s health through changes in environmental fac-

A View from thePerspective of WHO

Dr. Kerstin LeitnerAssistant Director-GeneralSustainable Development and Healthy EnvironmentsWorld Health OrganizationGeneva

HEALTHAND

ENVIRONMENT


9ANNUAL REVIEW • JULY 2004–JUNE 2005 (FY05)

tors: weather-related disasters, temperature extremes, chang-ing habitats for disease vectors, and so on.

Children are particularly vulnerable to environmental healthrisks. In 2004, WHO published Inheriting the World: The Atlas ofChildren’s Health and the Environment showing the global risksfacing children. For instance, we know the devastating influ-ence that high exposure to lead or mercury can have on thephysical and mental development of children, as well as theadverse effects of indoor air pollution on children’s health.

We usually know what remedial actions can be taken, but veryoften they need to be taken by actors outside the health sectoror in alliance with the health sector. WHO is therefore support-ing its member states through ministries of health in the fol-lowing ways.

First, WHO sets norms and standards and issues guidelinesregarding environmental determinants (such as water quality)that protect human health. Such normative work is based onthe scientific advice of independent, internationally renownedexperts. In the case of food safety, WHO together with FAOfunds the international food safety standard-setting CODEXAlimentarius Commission. In the case of sound chemicals man-agement, a similar interagency body might emerge as a resultof the SAICM (strategic approach to international chemicalsmanagement) process, which is expected to conclude in Febru-ary 2006.

Second, WHO is strengthening—through cooperation with national in-stitutions and through its network ofcollaborating centers—the capacity oflocal governments and institutions totake a more active and comprehensivemonitoring and reporting role. Air pol-lution monitoring and surveys show-ing the retention of persistent organicpollutants in the human body are onlytwo of many such concrete actions.

Third, WHO is assisting its memberstates to form strategic alliances acrosssectors and stakeholders. In particular,the strengthening of partnerships witha great variety of civil society organi-zations (such as those devoted to con-sumer protection) and the private

sector will be an ever stronger focus of technical cooperation.More attention will be given in this context to the need to artic-ulate and agree on internationally accepted ethical standardsand norms to protect public health authorities from undue in-fluence of special interests and to keep a pro poor focus in healthpolicies and programs.

Since medical costs are reaching unaffordable levels in manyOECD countries and are out of reach for the majority of peoplein developing countries, there may be an opportunity for gov-ernments, public and private health care service providers, andindividuals to look for solutions that will address risks ratherthan treating the consequences. This will mean a major para-digm shift in terms of our understanding of what constituteshealth and how we can best protect it. It will mean that we donot collectively and individually close our eyes to known risksand that we change behavior, and that public authorities willissue regulations and provide policy incentives that promotebehavioral changes.

Health interventions have increased life expectancy around theworld to unprecedented levels, although the AIDS pandemichas set many countries back in this regard. Nevertheless, thechallenge now is to promote the knowledge that people can,with due precaution, live not only a long but also a long andhealthy life.

00.511.52 0 10 20 30 40 50 60

Million DALYs

Climatechange

Leadexposure

Urbanoutdoor

air pollution

Indoorsmoke fromsolid fuels

Unsafe water,sanitation,

and hygiene

Million deaths Males Females

0

Source: Adapted from WHO 2002 World Health Report.

Policymakers need to know the approximate magnitude of health impacts, which are expected to be the greatest, in which regions, and what actions are required to minimize such impacts.

Attributable mortality and DALYs for selected environmental risk factors — 2000


I n Bogotá, Colombia, we have been trying to create a sharedvision for our 7 million inhabitants. The vision has a num-ber of characteristics. We want a dense city, yet with build-ings no higher than six or seven stories, where low-cost,high-frequency public transport is viable; abundant cul-

tural offerings; people in public spaces; severe limits on pri-vate car use during rush hours, so that pedestrians and bicyclistsencounter low pollution levels and low risk of being hit by amotor vehicle; sports facilities, libraries, parks, and plazas nearall homes; an ample exclusively pedestrian road network; andwide, tree-lined, well-lit sidewalks. We want dynamic orga-nized communities, with a sense of belonging. We want a citythat will not increase road space in response to traffic jams, butrather will further restrict private car use. We want a city thatclearly devotes more space and resources to children than tomotor vehicles.

Every Sunday in Bogotá, 120 kilometers of main arteries areclosed to motor vehicles for a period of seven hours. The lengthof the streets being closed more than doubled between 1996and 2000. More than 1.5 million people, from upper- to low-income classes come out to bicycle, jog, walk, and socialize.

For decades, the main Bogotá avenues had been built withoutsidewalks. In the streets where there were sidewalks, parkingbays had been carved out, or cars would simply park on thesidewalks. A campaign to get cars off sidewalk space becamean intense crusade that almost led to my impeachment. Hun-dreds of kilometers of quality sidewalks were built, sometimes

narrowing road space and crossing street intersections at grade,so that cars have to slow and drive onto the sidewalk insteadof pedestrians stepping down to the street level. One ofdowntown’s most important avenues was turned into an ex-clusively pedestrian street, with a water course that flows downfrom the mountain through the middle of it.

Another project to bring downtown back from near collapseincluded recovering as public space a large plaza that had beencompletely taken over by vendors, with crime as a consequence.And 22 hectares of what was probably the most deterioratedurban space in the world—teeming with drug distribution,criminal organizations and drug addicts—was demolished inorder to make room for a massive park. Although this was onlytwo blocks away from the Presidential Palace and the histori-cal and institutional center of the country, it had the highestmurder rates in the country, which plummeted after the demo-lition. The aim is to attract families and children once again todowntown.

More than 1,200 parks (from very large to extremely small) werebuilt all over the city. Three large new libraries (and 14 smallerones) linked to surrounding areas by large sidewalks and bi-cycle paths act as places that lend the city character and showrespect for all citizens. Those libraries received more than 9million visitors in 2002. Two formidable pedestrian structuresmarked a radical change in priorities. The Alameda Porvenir, a14-kilometer tree-lined pedestrian street with a bicycle pathacross some of the poorest areas of the city, where there are

A HEALTHIERAND

HAPPIER CITY

Enrique Peñalosaformer Mayor of Bogotá, ColombiaFounder of the Country We Wish and Want Foundation

fundación por el país que queremos

San Victorino Plaza.

E. Pe

ñalos

a



almost no paved motor-vehicle roads, became a powerful sym-bol of respect for the community and of the new city model. Asculpture by an important Colombian artist was placed on thepedestrian street, something not usually found in developing-world poor neighborhoods. And along creeks and drainagecanals, as part of a project to separate sewage waters that pre-viously flowed in the open into a box culvert, a 45-kilometergreenway with more than 400 hectares of park—including pro-tected lakes and wetlands—was built. This is a large feat for adense city. The greenway links poor and wealthy neighbor-hoods, even though some of the wealthy neighborhoods madelarge efforts to block it.

Urban transport is a difficult challenge because instead of im-proving with economic development it tends to get worse un-less a completely different model is adopted.

Every day, 40 percent of cars in Bogotá must stay off the streetsduring two hours in the morning and two hours in the after-noon peak hours. The measure significantly reduces traffic jamsand pollution. And in a city where only 28 percent of homesown cars and only 13 percent of people use private cars fortheir daily transport, it is quite evident that the public goodwould be served by banning car use during peak transporthours. Less traffic would mean faster rides on public transportfor the majority, while those who walk or ride bicycles woulddo it more safely and breathe cleaner air. Demand for road in-frastructure investment and maintenance would lessen, free-ing resources for other, more important social needs. Andsprawl would be avoided.

While cars tend to be means for social differentiation, bicyclesintegrate. In Dutch and Danish cities, more than 35 percent ofthe population uses the bicycle for transport, while the per-centages are insignificant in cities in the developing world,where the weather is more favorable and bicycles are the onlyindividual means of transport that most of the population canafford. The main reason is that developing-world cities aredesigned and built for the wealthier minorities. Costly elevatedhighways are built for the benefit of a few, while bikeways andeven sidewalks are frequently absent. In Bogotá, we built morethan 300 kilometers of physically isolated bicycle paths in lessthan three years. From nearly none, more than 4.5 percent ofthe population now use a bicycle for daily transport needs. Andmany more use it sporadically.

The single project that most contributed to improved quality oflife was a bus-based transit system called TransMilenio. Inspiredby the Curitiba system in Brazil, we were able to design, buildthe infrastructure, create the private partners that would oper-ate it, get out the thousands of buses that previously operatedthere, and put the system in operation in three years. Today,with only 66 kilometers the system moves more than 1 millionpeople every day, with a public investment of $270 million.TransMilenio users are saving on average 223 hours annually;21 percent of them used to go to work by car. It is an expandingsystem financed by a gasoline tax, and it should be moving morethan 85 percent of the city’s population by 2018.

Although the system is bus-based, its operation is closer to thatof a rail-based system. Articulated buses operate on exclusivebusways, using one or two lanes in each direction. Passengersboard the buses only at stations. In this way, when the bus ar-rives and opens its two doors simultaneously with the stationdoors, a hundred passengers can exit and a hundred enter inseconds. The bus floor is at the same level as that of the station,making entering and exiting the bus a rapid and safe operation,as well as making the buses fully accessible to the handicapped.

Passengers can change from a local to an express bus with thesame ticket. They can also change from a bus on one route toanother on a different one without any extra cost. Feeder buses,not on exclusive lanes but sharing streets with the rest of thetraffic, give people in marginal neighborhoods access to thesystem. TransMilenio buses run in the middle of avenues andnot on the sides, so that vehicles entering and exiting drive-ways, or delivery vehicles, do not become obstacles.

In short, it is time to give more importance to children’s happi-ness than to motor vehicles. A different, more appropriate modelis necessary, as much for equality and environment as for cul-tural identity and self-esteem.

. . . it is time to give more importance to children’s happiness than to motor vehicles.

TransMilenio bus system.

S. Ga

depa

lli


W aterAid is an international NGO dedicatedexclusively to the provision of safe domesticwater, sanitation, and hygiene education tothe world’s poorest people. WaterAidprojects are set up by local organizations and

managed by the community. WaterAid also seeks to influencegovernments’ water and sanitation policies. This article willfocus on sanitation as the forgotten environmental health prob-lem and will use the experience of WaterAid and its partnersto look at some of the factors influencing the success of attemptsto address the world sanitation crisis.

The ProblemGlobally, some 1.1 billion people lack access to safe water and2.6 billion lack access to safe sanitation. One of the well-knownenvironmental health consequences of this situation is that thereare about 4 billion cases of diarrhea per year, which cause 1.8million deaths, mostly among children under five.1

Sanitation is very much a forgotten problem globally.Spending in 2000 was estimated at only $1 billion, less than 10percent of the $13 billion spent on water, even though twice asmany people lack basic sanitation.2 And in many countries, thescale of the problem is increasing.

This article concentrates on overcoming some of the morepractical barriers to achieving coverage, but there are also sig-nificant institutional barriers to scaling up sanitation solutions.Some of these include:

Confusion over whether sanitation is a private or a publicgood. Whereas water supply is generally acknowledged to

be a public good, sanitation is sometimes seen as a privategood, because the solution (particularly in the case of ruralsanitation) is a household latrine. This can lead to an over-reliance on self-financing and reluctance on the part ofgovernments or donors to invest beyond “demonstrationlatrines.” The health benefits from sanitation are clearlypublic, however.The lack of an institutional home in government forsanitation in many countries, which leads to a lack ofownership for the problem or accountability withingovernment.The search for a “silver bullet”—“It’s a health problem, sowhy can’t there be a technical fix like a vaccine or atechnology that we can just roll out?” This approach tosanitation by some donors and governments misses thepoint that the technology (usually a latrine or a seweredconnection) needs to be accompanied by a behavioralchange if it is to reap the intended health benefits.Although there are many barriers to overcome, some of

WaterAid’s work with its partners in Sub-Saharan Africa andSouth Asia suggest that solutions can be found. Some of thekey drivers influencing the success of sanitation programs thatWaterAid has identified to date can be summarized under twoheadings: “creating demand” and “meeting demand.”

Creating DemandWhether one looks at demand for sanitation as something thathas to be created from scratch or whether it is a question of

SANITATION

No Silver Bullets, butReasons for Hope

Simon TraceDirectorStrategic DevelopmentWaterAid



unlocking a pre-existing, latent demand, there is no questionthat much work has to be done to ensure demand for sanita-tion is expressed. In WaterAid’s experience, successful sanita-tion programs invoke two ways—hygiene promotion andmarketing—of stimulating demandfor sanitation services.

Hygiene promotion. An under-standing of the health consequencesof unsafe or no sanitation is generallyrecognized as an essential componentof developing demand for sanitationservices. Although a wide range of personal hygiene issuescould be looked at, the principal barriers that need to be erect-ed to break the fecal oral cycle are generally hand washing atcritical times (e.g. after defecation and before eating) and safe

developing efficient and responsive “supply-side” deliverysystems.

Technology choice. Too many sanitation programs focus ona single technical solution (often, in rural areas, the ventilated

improved pit latrine), which may beunaffordable—both for certain indi-vidual households or for governmentsto subsidizes—and may not meet oth-er user requirements. Successful pro-grams tend to adopt a “sanitationladder approach,” which promotes aminimum basic safe disposal and an

upgrade path for people to follow as they can afford it. Thisrequires thought in developing and offering a range of techni-cal solutions at different costs.

Creative financing. There is probably no such thing as a suc-cessful “no subsidy” approach for sanitation for the poor. WithinWaterAid, some successful programs spend money on bothcapital subsidies and hygiene promotion/marketing activities.Others concentrate just on the hygiene and marketing activi-ties and eliminate capital subsidies (probably spending moreon promotion and marketing in the process, however). To reachthe poorest, in many places it seems that some sort of partialcapital subsidy or access to subsidized credit facilities will berequired. The key issue to scaling up coverage seems to be mak-ing these subsidies “smart”— targeted where they are neededand not universal.

Efficient and responsive delivery systems. Functional deliv-ery systems are needed to ensure “supply” to meet demand.WaterAid’s experience to date suggests that support to devel-op small-scale private sector suppliers is essential to ensuringthe sustainability of the “supply” side of the equation.

Closing the global sanitation gap is one of the world’sgreatest environmental health challenges. To meet it success-fully will require a lot more commitment and imagination thanhas been displayed in the past by governments, donor agen-cies, and other actors in the sector. Affordable solutions arepossible, however, if some of the above drivers are borne inmind during program design.

Notes1. Unicef Website: <www.unicef.org/wes/index_health

andeducation.html>.2. “Framework for Action,” Global Water Partnership, 2000.

Globally, some 1.1 billion people lack

access to safe water and 2.6 billion lack

access to safe sanitation.

disposal of all human feces. Keys to success at hygiene promo-tion seem to include an understanding of people’s unsafe hy-giene behavior and a process for monitoring hygiene behavioralchange.

Marketing. An understanding of the health benefits of san-itation is a necessary, but often not sufficient, condition for pri-oritizing sanitation in households. Successful programs havetended to actively market sanitation as having other wider ben-efits, focusing on ideas such as convenience and dignity or con-cepts of what people aspire to in modern life.

Meeting DemandThe quickest way to kill a sanitation program is to create de-mand for products that are unavailable or unaffordable. Criti-cal factors affecting capacity to meet expressed demand includeensuring technology choice, getting the financing right, and

Water

Aid/Ji

m Ho

lmes

Helping families build latrines is not enough on its own to solve sanitationproblems—WaterAid also runs hygiene promotion sessions, such the one abovein Nepal, to raise awareness of the importance of safely using latrines and washinghands afterwards.

For more information please visitwww.wateraid.org

www.unicef.org/wes/index_healthandeducation.html

www.unicef.org/wes/index_healthandeducation.html

www.wateraid.org


T he impact of air pollution on health depends on

howmuch pollution people actually experience

during their daily lives, which is called their “ex-

posure.” Exposures can be great even when emis-

sions do not affect the outdoor environment sig-

nificantly, if the source of emissions is close to the population.

It has been estimated that nearly half the world’s population

still uses solid fuels (biomass and coal) for household cooking

and spaceheating, mostly in developing countries. In the proper

conditions, biomass (wood and agricultural residues) can be

burned quite cleanly, producing mostly carbon dioxide and

water. Such conditions are difficult to achieve in small-scale

inexpensive stoves, however, and the actual emissions of health-

damaging pollutants are quite large per unit fuel, although the

total emissions are not large in the context of overall fuel use.

Studies in India and China, for example, show that the per-

centage of fuel carbon fully burned to carbon dioxide is typi-

cally only 90 percent, with some fuel/stove combinations doing

as poorly as 80 percent. This means that 10 to 20 percent of the

fuel carbon is diverted into products of incomplete combus-

tion—primarily carbon monoxide, but including benzene, buta-

diene, formaldehyde, polyaromatic hydrocarbons, and many

other compounds posing health hazards. The best single indi-

cator of the health hazard of combustion smoke is thought to

be small particles, which contain many chemicals. Household

coal use, largely found in China today, can present additional

hazards because of the intrinsic toxic contaminants in some

coals, including sulfur, arsenic, fluorine, mercury, and selenium.

This combination of being used in an activity in close daily

proximity to a large population with significant emissions of

health-damaging pollutants per unit activity means that house-

hold solid fuel use produces substantial total population expo-

sures to important pollutants. The exposures are highest in poor

women and young children of developing countries, both ru-

ral and urban, who are the groups most often present during

cooking with solid fuels.

Since the mid-1980s and more frequently since the mid-1990s,

there have been many dozens of published epidemiological

studies examining a range of health effects from indoor air pol-

lution due to solid fuel use. Because of the difficulty and ex-

pense of exposure assessment in households, however, most

have used a surrogate for true exposure, often simply whether

the households are using solid fuels or not. Even with such an

imprecise measure, however, health effects of several sorts have

repeatedly been found. The best evidence is for (a) acute lower

respiratory infections (pneumonia) in young children, the chief

INDOOR AIRPOLLUTION

Update on theImpacts of Household

Solid Fuels

Kirk R. SmithProfessorUniversity of California, Berkeley



killer of children worldwide and the disease responsible for

the most lost life years in the world; (b) chronic obstructive

pulmonary disease, such as chronic bronchitis and emphysema,

in adult women who have cooked over unvented solid fuel

stoves for many years; and (c) lung cancer, though the best evi-

dence is only for coal smoke.

The World Health Organization, in a risk assessment that com-

bined the results of many studies, compared the burden of ill-

ness and premature death from solid fuel use along with other

major risk factors, including outdoor air pollution, tobacco

smoking, and hypertension among others. The results indicate

that solid fuel use may be responsible for 0.8–2.4 million pre-

mature deaths each year. As shown in the Figure below, using

the central (“best”) estimates for the risk factors examined puts

solid fuel use approximately tenth among major health risks in

the world in terms of potentially preventable lost life-years.

More recent studies indicate that the past studies of solid fuel

use and pneumonia in young children probably overestimated

the risks due partly to confusion of upper and lower respira-

tory infections, the former not bringing a death risk but being

quite difficult to distinguish in field research from dangerous

lower respiratory infections. On the other hand, there is now

growing evidence of health effects of other kinds, including

tuberculosis, cataracts, several other cancers, low birthweight,

and heart disease. Effects in men are also being seen. Thus, while

the estimated impact on childhood pneumonia may decrease

in future risk assessments, the impact of other diseases will

probably be added.

It is one thing to determine that ill health is associated with a

particular risk factor, but quite another sometimes to show that

reduction in the risk factor will actually produce an improve-

ment in health. This has only been done in two cases to date,

one in south China with coal and another in Guatemala with

wood. The China study, done in retrospect, showed reduction

in lung cancer and chronic obstructive pulmonary disease due

to introduction of improved stoves in the late 1970s. The other,

a randomized trial of improved stoves in highland Guatemala,

is just now being completed. It focused on childhood pneumo-

nia but also examined heart and lung effects in women.

Although the risk estimates will continue to be refined

and new health effects probably will be added, the chal-

lenge in a development context is to find a viable inter-

vention that can be relied on to reduce exposures and

improve health cost-effectively. Improved fuels, such as

LPG, undoubtedly produce fewer emissions and exposure

themselves, but they are expensive and, at least at first,

people generally do not completely switch away from

solid fuels but continue to use them for some tasks. Well-

designed, built, and used improved stoves with chimneys

do reduce kitchen pollution substantially, but they pro-

duce much lower reductions in human exposures because

the smoke is still released in the vicinity of the household.

In addition, successful dissemination of well-operating

and durable stoves in large populations has not been easy.

That such stoves may also have social and economic ben-

efits, however, encourages further work to find ways to

disseminate them widely.

Climate change

Urban outdoor air pollution

Lead (Pb) pollution

Physical inactivity

Road traffic accidents*

Occupational hazards (5 kinds)

Overweight

Indoor smoke from solid fuels

Lack of malaria control*

Cholesterol

Child cluster vaccination*

Unsafe water/sanitation

Alcohol

Tobacco

Blood pressure

Unsafe sex

Underweight

Global Burden of Disease from Top 10 Risk Factorsplus selected other risk factors

0 2 4 6 8 10Percent of all DALYs in 2000

Environmental factors

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 onoutcomes in the Global Burden of Disease database of the World Health Organiza-tion (WHO). The remaining estimates are from the Comparative Risk Assessmentmanaged by WHO (Ezzati and others 2004).


It is perhaps surprising that biomass stoves also contribute to

global warming even when the fuel is harvested renewably and

is thus “carbon neutral,” that is, the fuel carbon released into

the atmosphere is captured by re-

growth of the biomass. This is because

the products of incomplete combus-

tion are more powerful greenhouse

pollutants than CO2, the primary

greenhouse gas. In addition to meth-

ane and other gases, a particularly

powerful greenhouse pollutant from small-scale biomass com-

bustion is now thought to be black carbon particles. Thus, the

10–20 percent of carbon diverted to non-CO2 pollutants means

that there is a net contribution to global warming even if the

CO2 is completely recycled in a renewable fuel cycle. To be truly

greenhouse-neutral, a biomass fuel cycle must not only be re-

newable but also combusted efficiently, which is not the case

in simple biomass stoves. With the high diversion of carbon to

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.

The attractiveness of this approach, however, depends on as-

sumptions related to discount rates and atmospheric warming

potentials of the different pollutants involved.

This is not to say that the growing risk of global climate change

is due to the stoves of the poor. Far from it! However, since the

high greenhouse emissions from small stoves per unit fuel have

the same cause as the health-damaging pollutants (incomplete

combustion), it raises intriguing possibilities for introducing

improved stoves and fuels that reduce both risks at once, i.e.,

produce substantial “co-benefits.” The costs of reducing car-

bon emissions from stoves with higher combustion efficiency

look to be well within those now being considered in various

carbon trading or Clean Development Mechanism schemes.

Thus, it may be possible to purchase carbon savings at a rea-

sonable price and achieve substantial health benefits as a side

product, or vice versa. What has not been shown, however, is

whether it is possible to introduce high-efficiency stoves to large

populations such that they are built, operated, and maintained

for long-term reliable performance.

The only large-scale successful improved stove effort to date

was in China, which facilitated the introduction of perhaps 180

million improved stoves in the 1980s and 1990s without any

foreign involvement. It focused on

fuel savings but did apparently

achieve some reduction in pollution

exposures as well by use of chimneys,

although little if any improvement in

combustion efficiencies. Nepal is cur-

rently engaged in a national program,

but no air pollution or health assessments of the results have

been done to date. Since better standard methods and new

equipment for assessing the pollution and health implications

of improved stove programs are now being developed and field-

tested, however, there should be reliable information soon about

the actual changes produced by this and other improved stove

and fuel programs around the world.

Recent ReferencesEzzati, M., and others, eds. 2004. Comparative Quantification of

Health Risks: Global and Regional Burden of Disease due to

Selected Major Risk Factors. Geneva: World Health

Organization, 2 vols.

Sinton, J.E., and others. 2004. “An Assessment of Programs to

Promote Improved Household Stoves in China.” Energy

for Sustainable Development 8(3):33-52.

Smith, K.R., and others. 2004. “Indoor Smoke from Household

Solid Fuels,” in Ezzati, M., and others (eds.), op cit., pp.

1435-93.

Smith, K.R., J. Rogers, and S.C. Cowlin. 2005. Household Fuels

and Ill-Health in Developing Countries: What Improvements

Can Be Brought by LP Gas (LPG)? Paris: World LP Gas

Association and Intermediate Technology Development

Group (in press).

Smith-Siversten, T., and others. 2004. Reducing Indoor Air

Pollution with a Randomized Intervention Design — A

Presentation of the Stove Intervention Study in the

Guatemalan Highlands. Norsk Epidemiologi 14(2): 137-143.

Venkataraman, C., and others. 2005. Residential Biofuels in

South Asia: Carbonaceous Aerosol Emissions and Climate

Impacts. Science 307: 1454-1456.

To blunt global warming, it is the world’s

use of fossil fuels that needs to be ad-

dressed.


Bank-Wide Review

T he World Bank’s “safe-guard” policies (seeTable 1) require that

potentially adverse environ-mental impacts and selectedsocial impacts of Bank invest-

ment projects should be iden-tified, avoided, or minimizedwhere feasible, and mitigated,compensated, and monitored.The broad objective is to inte-grate issues into the decision-

making and implementationprocesses to support environ-mentally and socially sustain-able development.

During fiscal 2005, the Bank

approved 289 new projects, in-cluding 24 grants from the GEFand 10 Pilot Carbon Fundprojects. Funding for invest-ment lending, to which safe-guard policies apply, has

reached $15.7 billion vs. $6.6billion of policy-based lending.

See Table 1 for a breakdown ofthe applicable safeguards andTable 2 for the EA categories ofinvestment projects supportedin fiscal 2005.

Two major events dominatedthe environmental and socialsafeguard agenda over the lastyear: (1) development and ap-proval of a policy for the pilot-ing of country systems and (2)the revision of the IndigenousPeoples policy. In addition,there were major efforts to sup-port safeguards training forBank staff, borrowers, and oth-er interested parties. This arti-cle also gives an update on theInspection Panel.

Use of countrysystemsAfter extensive consultationwith stakeholders, the Bank

afeguards

Table 1. The safeguard policies of the World Bank(IBRD and IDA) during fiscal 2005 (application ofsafeguards to investments supported in fiscal 2005, in percentages)

OP/BP 4.01 Environmental Assessment (73 percent)a

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 usedfor projects that are likely to have significant adverse environmental impacts,while category B is used for projects with less adverse impacts. FI is used inprojects with financial intermediaries. Category C does not require an EA.

b. Replaced OD 4.20 Indigenous Peoples on July 1, 2005.

S

C. Ca

rnem

ark

Mali.


ENVIRONMENT MATTERS • 200518

has initiated a pilot program(OP/BP 4.00) on the use ofcountry systems for environ-mental and social safeguards.This pilot program recognizesthat there are important oppor-tunities to increase countryownership and developmentimpact of environmental andsocial safeguards by workingdirectly with the laws, policies,and procedures and the insti-tutions of the borrower. Acountry systems approach hasalready been in place on a se-lective basis for financial man-agement and in nationalcompetitive bidding for pro-curement. The country sys-tems approach supportsbroader efforts to harmonizedevelopment assistance amongdonors by aligning prioritiesand programs of recipientcountries, thus increasing cost-effectiveness.1

Eight of the ten environmentaland social safeguard policies2

will be eligible for potential usein the pilot program. It is an-ticipated that 14 pilots will beundertaken during the two-year program encompassing arange of regions, income lev-els, and project structures, in-cluding individual invest-ments as well as sector-wideapproaches. The Bank’s nor-mal due diligence, supervi-sion, and disclosure proce-

dures would be appliedto the pilot program. TheInspection Panel mecha-nism would also apply tothe pilots. The current setof 10 safeguard policieswould remain in place

and be applied to all otherBank-supported investmentlending. Please refer to theWorld Bank “Country Sys-tems” website for additionaldetails.

Revised IndigenousPeoples policyThe revised policy on Indige-nous Peoples (OP/BP 4.10)was approved by the Board onMay 10, 2005 and went into ef-

fect on July 1, 2005. The revisedpolicy could potentially bene-fit (directly or indirectly) 250million Indigenous Peoplesaround the world. The policywas the outcome of a multi-

year consultation process thatinvolved government repre-sentatives, Indigenous Peo-ples’ leaders and organiza-tions, civil society organiza-tions, and nongovernmental

organizations (NGOs).

The revised Indigenous Peo-ples Policy has retained thepolicy requirements of the pre-viously used OD 4.20 that

Bank-financed projects are de-signed not only to avoid ad-verse impacts but, equallyimportant, to provide cultural-ly appropriate benefits. Therevised policy improves on OD

4.20 in three critical ways. First,it clarifies (a) Bank policy re-

lated to screening by the Bankto determine whether Indige-nous Peoples are present in aproject area; (b) the need forsocial assessment; (c) equitablesharing by Indigenous Peoplesin the commercial develop-ment of natural and culturalresources on lands they havetraditionally owned, used, oroccupied; (d) Indigenous Peo-ples’ rights of access to legallydesignated parks and protect-ed areas; and (e) non-coverageof the revised policy with re-spect to economic migrants tourban areas. Second, it simpli-fies the project processing re-quirement by establishing fiveclear steps: (1) screening; (2)social assessment; (3) “free, pri-or and informed consultation”with affected communities; (4)preparation of Indigenous Peo-ples Plans or Frameworks; and(5) public disclosure. Incorpo-ration of the principle of “free,prior informed consultation”represents the first applicationinto Bank policy of this impor-tant outcome of the ExtractiveIndustries Review.3 Third, itadds flexibility into the projectprocessing requirements byspecifying that the level of de-tail is proportional to the com-plexity of the proposed projectand commensurate with thenature and scale of the pro-posed project’s potential ef-fects and by proposing aplanning framework (insteadof an up-front plan) for projectsthat involve preparation andimplementation of annual in-vestment programs and mul-tiple subprojects, as well as aprocess framework for projects

involving parks and protectedareas.

Safeguards trainingThe Quality Assurance and

Compliance Unit (QACU) and

the Regional Safeguard Units

have continued to provide

training on safeguard policies

for staff from the Bank, bor-

rowers, consulting firms, and

NGOs. During fiscal 2005, for

example, 32 training sessions

were held and over 650 Bank

staff and consultants were

trained by QACU on individ-

ual safeguard policies and the

application of these policies to

various sectors and themes. A

new course was developed

and run twice on the integra-

tion of disabilities issues in the

application of safeguard poli-

cies. Brazil and other field of-

fices held training via

videoconferences—an ap-

proach that will be expanded

significantly during the new

fiscal year. The Bank Regions

also developed their own safe-

guards training courses for

headquarters staff, field staff,

and borrowers. After AFR in

2004, Joint QACU/regional pi-

lots were conducted with ECA,

LCR, MNA, and SAR to train

task managers in the new re-

gional safeguards manage-

ment process. A noteworthy

trend has also been combined

client training on safeguards

and Strategic Environmental

Assessment, notably in Latin

America and the Caribbean

Region.

Table 2. EA categories ofinvestment projects in fiscal2005 (percentages)

Category A B C FI

9.8 57.0 26.6 6.6


Bank-Wide Review

A new joint committee forKnowledge Sharing andLearning has fostered greatersynergies and impacts from acombined approach to trainingto be shared by the Environ-ment, Social Development,and Rural Development De-partments. It has, in particu-lar, been instrumental inhelping mobilize seed resourc-es for the creation of a commu-nity of practitioners in ImpactAssessment in Manila (Philip-pines).

The World Bank Group took anactive role in the 2005 meetingof the International Associa-tion for Impact Assessment inBoston, where it presented re-cent policy and procedural de-velopments within the Bank,IFC, and MIGA as well as cli-ent safeguards capacity build-ing with WBIEN. Moreinformation is available at<www.iaia.org>.

Inspection PanelThe World Bank’s InspectionPanel, created in 1993 by theBoard of Executive Directors,is an independent mechanismto ensure accountability inBank operations with respectto its policies and procedures.Groups of two or more privatecitizens who believe that theyor their interests have been orcould be harmed by Bank-fi-nanced activities can presenttheir concerns through a Re-quest for Inspection.

In fiscal year 2005, the Inspec-tion Panel registered two new

Requests for Inspection forwhich the Bank prepared Eli-gibility Phase ManagementResponses. These requests con-cerned the Pakistan NationalDrainage Program and the

Cambodia Forest ConcessionManagement and Control Pi-lot Project. As required by theprocedures governing Inspec-tion Panel cases, the Panel sub-sequently prepared its reports,which recommended proceed-ing to the Investigation Phasein each case. In early fiscal year2005, the Panel recommendedinvestigation of the MumbaiUrban Transport Project,which had been the subject ofrequests during the previousfiscal year. The Board of Exec-utive Directors agreed to thePanel’s recommendations inall three cases, and these pro-jects are currently being inves-tigated by the Panel. TheBank’s Management Respons-es and the Panel’s Reports andRecommendations are avail-able to the public at <www.inspectionpanel.org>.

As reported in Environment

Matters 2004, the InspectionPanel had recommended andthe Board had approved an in-vestigation of the ColombiaCartagena Water Supply, Sew-

erage, and EnvironmentalManagement Project. The Pan-el pursued this investigationduring fiscal year 2005. In June2005, after receiving the Pan-el’s report, Bank Management

initiated its Management Re-sponse to the Panel’s findingson the Cartagena project.

Based on the Board’s requestconcerning the 2001 India CoalSector Environmental and So-cial Mitigation Project, man-agement provided a technicalbriefing to Board members inSeptember 2004 and a formalreport to the full Board inMarch 2005 on the status of theManagement Action Plan. Sub-sequent to the Board’s May2004 approval of the Manage-ment Action Plan regardingthe 2002 Inspection Panel casefor the Yacyreta HydroelectricProject in Paraguay and Argen-tina, management reported onprogress in implementing theplan to the Board (at its request)in August 2004 and will do soagain in the next fiscal year.The reports to the Board forboth projects can be found at<www.inspectionpanel.org>.

Notes1. Paris Declaration on Aid

Effectiveness: Ownership,Harmonization, Align-ment, Results and MutualAccountability, March 2,2005 <www.adb.org/Doc-uments/Per iodica ls/MfDR/mar-2005.pdf>.

2. OP/BP 4.01, Environmen-tal Assessment; OP/BP4.04 Natural Habitats;OP/BP 4.09 Pest Manage-ment; OP/BP 4.12 Invol-untary Resettlement; OP4.10 Indigenous Peoples;OP/BP 4.36 Forests; OP/BP 4.37 Safety of Dams;and OPN 11.03 CulturalProperty.

This article was written by the Qual-ity Assurance and ComplianceUnit—Charlotte Bingham, HarveyHimberg, Stephen Lintner, Jean-Roger Mercier, Navin Rai, PanneerSelvam, and Banu Setlur.

3. Striking a Better Balance —The World Bank Group andExtractive Industries: TheFinal Report of the ExtractiveIndustries Review, WorldBank Group ManagementResponse, September 17,2004, page 7.

For more information, pleasecontact:

Use of Country Systems —L. Panneer Selvam(202) 458-2728,[email protected] Peoples Policy —Navin Rai (202) 458-1298,[email protected] Training —Jean-Roger Mercier(202) 473-5565,[email protected] Panel —Alexandra Bezeredi(202) 458-5055,[email protected]

Website: <www.worldbank.org/safeguards>.

www.iaia.org

www.inspectionpanel.org



www.adb.org/Documents/Periodicals/MfDR/mar-2005.pdf



www.worldbank.org/safeguards

www.worldbank.org/safeguards


We have continuedto make signifcantprogress in imple-

menting our EnvironmentStrategy by addressing thelinks among the environment,poverty, and development,with a particular emphasis onhealth, livelihoods, and thevulnerability of poor people.

Protecting people’s healthfrom environmental risks andpollution to reduce the diseaseburden was highlighted as animportant focus in the Strate-gy. Both lending projects andanalytical work are now sys-tematically exploring environ-mental health issues relating toair and water pollution, toxicchemicals, and so on. A newEnvironmental Health AnchorProgram has been establishedin the Environment Depart-ment to facilitate a better un-derstanding of, and developtools to address, environmen-tal health linkages.

New ENRM lendingIn fiscal 2005, the World Bankapproved 73 projects with En-vironment and Natural Re-sources Management (ENRM)content in 47 countries,amounting to $2.5 billion incommitments. This representsabout 11.3 percent of total Banknew lending in the year, an in-crease from 6.5 percent in fis-cal 2004. This near-doubling ofnew lending is mainly attrib-uted to the approval of twolarge environmental develop-ment policy lending projects(in Brazil and Colombia) in fis-cal 2005.

Of these new projects, asmany as 25 have objectives re-lating to pollution management

and environmental health.These investment projects are di-versified among key sectors,such as water, urban develop-ment, transport, energy andmining, and agriculture. Theseprojects cover various areas suchas providing safe water supply(for example in Armenia, Iran);expanding sanitation access(such as in Brazil, China, Colom-bia); improving air quality (forexample in Romania); and con-trolling industrial wastewaterpollution (for example in China).

The ENRM portfolioAt the end of 2005, the totalactive portfolio of projects withENRM content amounted to$10.7 billion—representing11.5 percent of the Bank’s totalactive portfolio. Of the $10.7billion, the core ENRM portfo-lio (projects with more than 65percent ENRM content) con-sists of 53 projects representing$ 2.7 billion in ENRM commit-ments.

In terms of thematic distri-bution, pollution managementand environmental health ac-tivities account for the largestshare of the active ENRM port-folio (34 percent). Another 27percent focuses on water re-source management activitieswithin projects.

In terms of regional distri-bution, projects in the East Asiaand Pacific Region account forthe largest portion of the activeenvironmental portfolio (39percent). This is followed byENRM portfolios in the SouthAsia, and the Europe and Cen-tral Asia Regions (15 percentand 16 percent respectively).

he Environment andNatural Resources

Management Portfolio

Figure 3. Active ENRM portfolio —thematic distribution, end FY05

Figure 1. Lending trend, end FY05

Figure 2. World Bank project portfolioby thematic distribution, end FY05

0

500

1,000

1,500

2,000

2,500

3,000

FY01 FY02 FY03 FY04 FY05

US$ M

illio

ns

0

2

4

6

8

10

12

Perc

enta

ge

Public sector government

8% Rule of law2%

Trade & integration

4%

Social protectionand risk

8%Social

dev/gender9%

Urban development

12%

Human development

14%

Economic management

1%Environment & natural resources

12%

Rural development

14%

Finance & private sector development

17%

Climate change, 10%

($1,054)

Environ policy & institutions, 10% ($ 1,043)

Biodiversity, 2% ($222)Other environ

mgmt, 3% ($308)

Water resource

mgmt, 27% ($2,853)

Land admin & mgmt, 14%

($1,546)Pollution mgmt & env. health, 34% ($3,653)

Figure 4. Active ENRM portfolio —Regional distribution, end FY05

Sub-Saharan Africa (AFR)

9%

East Europe and Central Asia (ECA)

16%

Latin America and Caribbean

(LCR)13%

Middle East and North

Africa (MNA)7%

South Asia (SAR)15%

East Asia and the Pacific

(EAP)39%

Percentages based oncommitment amounts.


Figures in $ millions.


T Environment Matters 2005 — The World Bank Group


Bank-Wide Review

Within the active ENRMportfolio, there are as many as155 projects with pollutionmanagement and environmen-tal themes, associated withcommitments amounting to$3.7 billion. Of this, more than40 percent are concentrated inthe East Asia and Pacific Re-gion.

Analytical workA recent qualitative analysis ofenvironmental analytical workbetween FY02–04 identifiesgood practice and highlightsstudies and reports that arealigned with the objectives ofthe Environment Strategy. Thisreview also shows a sustainedincrease in the number of ana-lytical products with ENRMthemes since the endorsementof the Environment Strategy in2001.

In fiscal 2005, the Bankprepared 60 economic and sec-tor work (ESW) products (pol-icy notes and reports) withprimary ENRM objectives. Ex-amples are Country Environ-mental Analyses (in Domini-can Republic and Egypt); En-ergy-Environment Reviews (inECA); and other environmen-tal studies (in Bangladesh andBulgaria).

Of these ESWs, about 18percent of products containpollution management and en-vironmental health activities.Examples include assessingthe cost of environmental deg-radation (in China and Iran);and identifying health hazardsfrom inadequate solid wastemanagement (in the Philip-pines). In addition, some stud-ies looked at detrimentalhealth effects of environmen-tal exposure to arsenic (inSouth Asia), and improper san-itation (in Middle East andNorth Africa).

Protecting theGlobal EnvironmentSince the inception of the Glo-bal Environment Facility(GEF), the World Bank Grouphas mobilized $14 billion inpublic and private funds forbiodiversity conservation, cli-mate change, ozone depletingsubstances, and internationalwaters. In fiscal 2005, 47 newGEF projects were approvedfor $264 million in GEF financ-ing and additional Bank fi-nancing of $571 million.

As an implementationagency of the GEF, the Bank ispreparing projects and studiesin the new area of persistent or-ganic pollutants (POPs). POPs

are substances released intothe environment through a va-riety of human activities hav-ing a significant impact onhuman health. Ongoing workincludes baseline studies ofPOPs (in Uruguay and Cambo-dia), and the Africa StockpilesProgram (in seven Africancountries in the first phase).Other studies look at findingalternatives to POPs in malar-ia control activities (in Ecua-dor), and termite control (inChina).

The Bank’s Montreal Pro-tocol program, now active for14 years, has partnered with 21countries for investment

This article was prepared by AnjaliAcharya, (202) 458-5298, [email protected], and Eri Tsutsui,(202) 458-5766, [email protected], of the Environment Depart-ment. On the global environment,GEF data from Ayesha Aparakka;Montreal Protocol data from ElaineFeister; and Carbon Finance datafrom Laura Bruce, all of the Environ-ment Department. EnvironmentStrategy website: <www.worldbank.org/environmentstrategy>.

Figure 7. Active GEFportfolio — Thematicdistribution, end FY05

Figure 5. Pollution management andenvironmental health —Active portfolio by Region, end FY05

280

1,578

634

308 277

576

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

AFR EAP ECA LCR MNA SAR

$ Mill

ions

Total amount: $3.7 billion

Biodiversity48%

Land degradation

2%

POPs10%

Climate change

28%

International waters

11%

Ozone depletion

1%

Figure 6. ESW and nonlending TAwith primary ENRM themes, FY02–05

Notes: Figures exclude supplementals. ESW=Economic andSector work; TA= technical assistance.

25

42

51

60

4339 39

66

0

10

20

30

40

50

60

70

FY02 FY03 FY04 FY05

Nu

mb

er o

f pro

ject

s

ESW (Reports and Policy Notes)

TA total

Carbon FinanceThe World Bank’s carbon finance initiatives are part of the global effort tocombat climate change. The Bank’s carbon finance business manages about$858m through 8 different carbon funds, including the Prototype CarbonFund, the Community Development Carbon Fund, and the BioCarbon Fund(see Table below). The Bank has also established a number of technical as-sistance facilities for capacity building and project preparation. The newState of the Carbon Market 2005 report shows that the carbon finance mar-ket is expanding steadily; 107 million metric tons of carbon dioxide equiv-alents (tCO2e) were exchanged through projects in 2004, a 38 percentincrease compared with 2003. The report estimates that the volume ex-changed in 2005 (as of May) was 43 million tCO2e.

Note: * These include BioCarbon Funds, the Netherlands Clean Development Facility,the Italian Carbon Fund, the Netherlands European Carbon Facility, the Spanish Car-

bon Fund, and the Danish Carbon Fund.

Percentages based onnumber of projects.

Fund Name

No. of Emission Reductions Purchase Agreements (ERPA)

contracts signed

Contract in dollarsmillions

ERPA Emission Reductions

(million tCO2e) Prototype Carbon Fund 21 117.25 29.63 Community Development Fund

4 3.62 0.78

Other Funds *

5 N/A

3.99

Carbon Finance at the World Bank (as of June 2005)

projects and has facilitated thephase-out of over 172,520ozone depleting potential tonsat a cost of roughly $750 mil-lion. Over 454 projects havereached completion as of theend of calendar year 2004.

wb22004

Underline


How much is goodhealth or human lifeworth? Once the

question is on the table youcannot easily walk away. Manyargue it is not possible or evenethical to put a dollar value onhealth. Economists, on the oth-er hand, argue that this is pos-sible and, more important,desirable.

For the sake of brevity, econo-mists refer to the “value of astatistical life” simply as “thevalue of a life.” The differencethe word “statistical” makes iscrucial and should be ex-plained. As in any other pub-lic policy consideration, whenscientists try to value healthoutcomes, they are not consid-ering a particular human be-ing, such as a relative or bestfriend. They are rather lookingat a statistical occurrence. Thefact that scientists are able tocalculate the average height ofa population does not tellwhether individuals in thatpopulation feel they are tooshort or oversized.

A second key aspect is that ev-ery day we take bets about ourhealth; the premium we pay isthe information used to valuestatistical lives. Valuation cap-tures individuals’ preferencesfor reducing small risks ofdeath. An individual knowsthat driving a car may be lethaland hence is willing to paymore for safer cars. Every daydecisions provide informationthat embrace much more thanthe simple value of the per-son’s future earnings.

EFinally, imagine you are a pol-icy maker and you have thechoice of spending part of thenational budget on providingwater and sanitation in ruralareas or investing in foreignassets that provide a return of15 percent. With the returns, inone year you may be able toprovide water and sanitation-cover to a larger share of thepopulation. However, waitinga year has other costs: newbornchildren may die due to unsan-itary conditions. As a govern-ment official, you will have toimplicitly put budget fundsand lives in the balance, and asa good government officialyou want to have the bestavailable information.

Making it workThe valuation of health im-pacts looks at two major ele-ments: the disability caused bydeath or illness, and the cost ofillness. Starting from the easi-est item, the cost of illness mea-sures actual payments toremediate health problems as-sociated with pollution. Underthis category, items such asdoctor visit costs, medical ex-penditures, and loss of caregiv-er’s time will appear.

But illness also causes tempo-rary or permanent loss in theproductive functions of indi-viduals. When death is in-volved, two major valuationmethods are available. A low-er-bound value can be ob-tained by calculating theearnings lost. An upper-boundvalue goes beyond labor pro-ductivity and takes into ac-

conomicValuation of

EnvironmentalHealth

Impacts ofPollution

Benefits and costs of the U.S. Clean Air Act2010 Clean Air Act Monetized Benefits

0 20 40 60 80 100 120

Agriculture

Visibility

Productivity

Other Morbidity

Chronic Bronchitis

Mortality

Costs

Billions of 1990 dollars

2010 Clean Air Act Monetized Benefits

0 20 40 60 80 100 120

Agriculture

Visibility

Productivity

Other Morbidity

Chronic Bronchitis

Mortality

Costs

Billions of 1990 dollars

Source: USEPA, 1999. “The Benefits and Costs of the Clean Air Act:1990 to 2010.” Report to Congress: EPA-410-R-99-001.

22



Feature Articles

count individuals’ preferences.The Value of a Statistical Lifemethod captures individuals’willingness to pay through theanalysis of markets in whichpeople trade off money andhealth. For example, manystudies analyze wage differen-tials in job markets involvingdifferent health risks.

Often, what we are really in-terested in is comparing alter-native policies and select theone that minimizes negativehealth impacts. The issue iscomplex when we have tocompare, for instance, a reduc-tion in the cases of asthma witha reduction in heart diseaseprevalence. The World HealthOrganization established a rig-orous methodology to measurethe health gap under differenttypes of illness. Disability Ad-justed Life Years (DALY) mea-sure equivalent years of“healthy” life lost by virtue ofbeing in poor health, disabledor, in the extreme case, dead.The common unit of measure-ment allows cost-effective de-cisions.

From the tools tothe resultsHow can valuing life savelives? Imagine you are a mem-ber of parliament asked to passa new law to regulate activitiesthat cause air pollution. Thelaw will impose high costs onsociety through more expen-sive transport, among otherthings. The Figure on page 22measures the monetary costsand benefits of the introduc-tion in 1990 of the United States

Clean Air Act. Implementingthe act is estimated to cost over$25 billion between 1990 and2010. Under a cost-benefitanalysis framework, the bene-fits to agriculture, visibility,and productivity do not justi-fy the new act. After healthimpacts (in particular, mortal-ity) are considered, the netgains from the new law areevident.

Economic valuation of healthimpacts can prove particular-ly useful in developing coun-tries, where attention toenvironmental problems isovershadowed by other issuesor lack of information. In Co-lombia, a recent Country En-vironmental Analysis showswaterborne disease representsthe highest environmental bur-den to the economy. The costsfall most heavily on vulnera-ble segments of the popula-tion, especially poor childrenunder the age of five. Similarstudies are being undertakenin China, Iran, and Nigeria (forexample, see the Box on Iran,at right).

Some countries have success-fully engaged in policy dia-logue following health valu-ation studies. The results forAlgeria were applied at thehighest political levels and ledto an increase in the budget forenvironmental protection by$450 million. In Morocco, thevaluation of health impacts re-lated to waterborne diseaseshas encouraged the govern-ment to focus future interven-tions in the water sector. Thisbecame one of the four pillars

of the new Country Assistance

Strategy.

If you want to read more . . .Homedes, N. 1996. “The Dis-

ability Adjusted Life Year

(DALY) Definition, Mea-

surement and Potential

Use.” Human Capital De-

velopment Working Papers.

Washington, D.C.: World

Bank.Mrozek, J. R., and L. O. Taylor.

2002. “What Determinesthe Value of Life? A Meta-analysis.” Journal of PolicyAnalysis and Management21(2): 253-70.

Viscusi, W. K. 1993. “The Val-ue of Risks to Life andHealth.” Journal of Econom-ic Literature 31: 1912–46.

COST OF ENVIRONMENTAL DEGRADATION IN IRAN

In the Islamic Republic of Iran, a recent study has revealed thatthe annual health impacts related to inadequate water supplyand sanitation services and hygiene practices cause a loss ofaround 2.2 percent of GDP (World Bank, 2005). Health impactsrelated to air pollution in large urban cities such as Tehran,Mashad, and Isfahan were estimated at an additional 1.3 per-cent of GDP annually. These numbers are not just a strong sig-nal about the need for serious actions, they are also a powerfultool to raise awareness about environmental issues and facili-tate progress toward sustainable development.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Perc

enta

ge

Water Land,Forest

Air Waste Coastal0.0

0.5

1.0

1.5

2.0

2.5

3.0

Perc

enta

ge

Water Land,Forest

Air Waste Coastal

(mean annual estimate, percentage of GDP, 2002)

World Bank. 2003. “Royaumedu Maroc: Evaluation duCoût de la Dégradation del’Environnement.” SectorNote No. 25992-MOR.Washington, D.C.

World Bank. (forthcoming).“Islamic Republic of Iran:Cost Assessment of Envi-ronmental Degradation.”Sector Note No. 32043-IR.Washington, D.C.

This article was prepared byGiovanni Ruta, (202) 473-9388,[email protected] from the Envi-ronment Department and MariaSarraf (202) 473-0726, [email protected], of the EnvironmentUnit of the Middle East and NorthAfrica Region, with assistance fromBjorn Larsen.


Every year, some 2 mil-lion people die fromdiarrheal diseases, ac-

cording to UNICEF and WHOestimates. Much of this diseaseburden is caused by contami-nated drinking water and in-adequate sanitation. Althoughthe vital role of safe water andsanitation in maintaininghealth has been recognized forcenturies, many families—especially those in the devel-oping world—still lack ade-quate services (see Table, atleft). Increasing coverage is akey development priority. TheMillennium DevelopmentGoals targets include halvingthe number of people withoutsustainable access to safe wa-ter and basic sanitation by theyear 2015.

Having safe drinking wateris usually defined as having an“improved” water supply—that is, a water supply that isprotected from contaminationby pathogens and other illness-causing contaminants. Thesemight include, for example,rainwater; a protected spring,borehole, or dug well; or sur-face water that is filtered andtreated to kill pathogens.

Sanitation is also importantto prevent excreta from con-taminating water sources. Andgood hygiene is important sothat contaminants cannot trav-el via hands, insects, and im-plements into a family’s foodand water.

Given the known impor-tance of water, sanitation, andhygiene, a key question iswhich interventions in theseareas work best to bring aboutsustainable improvements inhealth. To answer this ques-tion, the World Bank commis-sioned a review and meta-

analysis of interventions innon-outbreak conditions.

A meta-analysis differsfrom a standard literature re-view in that, in addition to ex-amining the impacts of variousprojects individually, it thenstatistically combines the re-sults of similar interventions toproduce summary measures ofeffect. It enables comparisonsof intervention types and canhelp to clarify which approachis optimal for a given situation.

This effort included a re-view of all published paperslisted in computer-searchabledatabases through June of 2003(when the search was conduct-ed). After screening 2,120 arti-cles that included essential keywords, 50 papers describing 46different interventions in 24countries were identified. Ofthese, 38 had quantified theimpact of the interventions onhealth and could be used in themeta-analysis.

The interventions wereclassed into five categories: (1)hygiene (health education andencouragement of specific be-haviors such as handwashing);(2) sanitation (means of excre-ta disposal, often a latrine); (3)water supply (provision of anew source or improved distri-bution system, such as a hand-pump or household instal-lation); (4) water quality (treat-ment to remove pathogens, ei-ther at the source or in thehousehold); and (5) multipleinterventions (hygiene, sanita-tion, and water elements).

The meta-analysis con-firmed that all of these inter-ventions can be effective inimproving health. The inter-ventions reduced diarrhealdisease by 25 to 37 percent.This reduction was measuredusing a statistic called “relative

Region Water supply (percentage)

Sanitation (percentage)

Africa 85 85 Asia 93 78 Latin America and the Caribbean

93 87

Oceania 98 99 Europe 100 98 North America 100 100

Urban

Region Africa Asia Latin America and the Caribbean Oceania Europe North America

Water supply (percentage)

Sanitation (percentage)

47 45 74 31 62 49

63 81 87 74

100 100

Rural

Regional coverage (percent) of improvedwater supply and sanitation facilities in2000*

Note: *Adapted from WHO/UNICEF 2000.

ater,Sanitation

and HygieneInterventionsfor Health —What Works?

W

24



Feature Articles

HygieneExcluding poor quality studies

Handwashing

Education

Multiple

Sanitation

0·4 0·6 0·8 1·0

Pooled effect

Water supply

Diarrhoea only

Household connection

Standpipe or community connection

Water qualitySource treatment only

Household treatment only

Household treatment

• Excluding poor quality studies

• Urban/periurban locations

risk,” which compares the like-lihood of illness in people whoreceived the intervention to thelikelihood in people whodidn’t. A relative risk of 1means that both groups haveequal rates of illness, while arelative risk of 0.75 means thatthe intervention reduced theillness rate by 25 percent.

Although all the interven-tions were broadly effective,the results indicate some pos-sible differences and some sur-prises. In general, the strongestinterventions were those thataddressed water quality andhygiene (see Figure at right).Note, however, that the differ-ences in effects were not statis-tically significant.

For hygiene, both healtheducation and handwashingpromotion—an area that is cur-rently receiving much atten-tion—were effective, reducingdisease risk by 37 percent. Ex-cluding the poorer-qualitystudies from the meta-analysismade the impact even stron-ger.

For water quality, the im-pact depended strongly uponwhether the intervention wascarried out at the source or atthe point of use (that is, in thehousehold). Treating water in thehousehold—whether throughboiling, chemical disinfection,or solar disinfection—was veryeffective, reducing diarrhearisk by 35 percent. The effectwas slightly stronger if theanalysis was limited to better-quality studies—according tocriteria defined in Fewtrell andColford (2004)—or rural areastudies. But disinfection at thesource only reduced risk by 11percent. This could be due to acouple of factors. First, pipedwater can become recontami-nated after source treatment if

the pipes have breaks or lackconstant water pressure fromless than 24-hour service. Sec-ond, families who lack in-home connections or 24-hourservice must transport waterfrom the collection point and/or store it in their home. Watercan easily become contaminat-ed during transport and stor-age, especially if hygiene issuboptimal. Source treatmentcannot address these risks, butpoint-of-use treatment can en-sure that water is made safejust before it is consumed.

For sanitation, only twostudies were eligible to be in-cluded in the analysis. Al-though these showed a goodeffect (32 percent disease re-duction), more information isneeded to fully assess the im-pacts of various types of sani-tation.

The water supply studiesshowed a positive impact over-all (25 percent disease reduc-tion), but a more stringentre-analysis that removed lessrelevant studies decreased theimpact. This was true for bothstandpipe and household con-nections, a result that may besurprising to some.

Another surprising findingwas that multiple interven-tions, with a 33 percent diseasereduction impact, were notnecessarily more effective thaninterventions aimed at a singleissue. The reasons for this arenot immediately clear, but it istempting to speculate that pro-grams involving multiple in-terventions tend to focus onone component and give rela-tively less attention to others.Because many of the programscurrently sponsored by theWorld Bank and others are ofthis type, it is important toclosely examine these pro-

grams to determine if, andhow, they could have a great-er impact.

In sum, the meta-analysisresults confirm that while ac-cess to basic water and sanita-tion are necessary, importantadditional health gains may bepossible if we ensure that wa-ter quality is high at the pointof use and that hygiene behav-iors are maintained.

As these interventions areimplemented, it will be impor-tant for future studies to takenote of not just immediate ef-fectiveness, but also sustain-ability and costs. Noting base-line conditions is also useful,because the optimal interven-tion may vary according to thelocal situation. Ultimately, weshould have the tools to enableeach population to choose themost feasible, cost-effective,and desirable program forthem.

ReferencesFewtrell, L., and J.M Colford, Jr.

2004. “Water, Sanitation andHygiene: Interventions andDiarrhoea — A SystematicReview and Meta-analysis.”Washington, D.C.: WorldBank. Available at <www1.worldbank.org/hnp/P u b s _ D i s c u s s i o n /F e w t re l l & C o l f o r d J u l y2004.pdf>.

Fewtrell, L., and others. 2005. TheLancet Infectious Diseases 5:42–52.

WHO/UNICEF. 2000. Global Wa-ter Supply and Sanitation As-sessment 2000 Report. WaterSupply and Sanitation Col-laborative Council. Geneva:World Health Organiza-tion/United Nations Chil-dren’s Fund.

Summary of meta-analysis results

Note: The colored blocks are the effect estimates for each intervention, and eachhorizontal 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-tions were repeated 100 times, we would expect that 95 of them would result invalues captured by the range. The vertical line indicates a relative risk of 1.0. Re-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 (diseaserates increased).

This article was written by RachelKaufmann from Centers for DiseaseControl and Prevention, (678) 938-9737, [email protected]. For moreinformation, please visit <www.cdc.gov>.

www1.worldbank.org/hnp/Pubs_Discussion/Fewtrell&ColfordJuly2004.pdf





www.cdc.gov

www.cdc.gov


In rural areas, burning tra-ditional fuels, such as fire-wood in open fires for

cooking and heating, exposespoor women and children toindoor air pollution (IAP) pri-marily from harmful concen-trations of particulate matter(PM) and other pollutants.Health impacts include acuterespiratory infection (ARI)1—notably pneumonia—in chil-dren and chronic bronchitis inwomen.

In Guatemala, government sta-tistics indicate that ARI was thecountry’s single most impor-tant cause of morbidity andmortality between 1997 and2000. On average, ARI causedtwo to three times as manydeaths as acute diarrhea, thesecond cause of mortality. Fur-thermore, in 1997–2000 pneu-monia represented the mostimportant single cause of in-fant death in Guatemala, ac-counting for 36 percent of allregistered infant deaths.

Fuelwood is the dominantcooking fuel in 97 percent ofrural Guatemalan households.The rural population accountsfor over 60 percent of the totalpopulation. As documented inthe Poverty Assessment Re-port (2003), over half of allGuatemalans were living inpoverty in 2000.Three-quartersof rural residents fall below thefull poverty line, and one-quar-ter live in extreme poverty.Rural electrification rates arelow, with electricity connec-tions in fewer than 40 percentof the poorest households.

Study designThe Ministry of Energy andMines (MEM) requested theWorld Bank, with supportfrom the Energy Sector Man-agement Assistance Program,to conduct a study to estimatethe health impacts of tradition-al fuel use in Guatemala andto outline strategies and poli-cies for mitigating environ-mental health damage due tohousehold energy. The studywas initiated with a workshopin November 2001 attended bya wide spectrum of Guatema-lan stakeholders, includingrepresentatives from the ener-gy, health and environmentsector ministries; women’s andindigenous groups; the privatesector; NGOs; and local andinternational researchers.

After the study was complet-ed, stakeholders came togeth-er again in April 2003 todiscuss findings and considerthe reality of the Guatemalancontext. There was consensusthat IAP needed to be ad-dressed in the short term, giv-en the close links with povertyreduction and with the fourthand fifth Millennium Develop-ment Goals related to reducingchild mortality and improvingmaternal health. Barriers tosuccessfully reducing IAP inrural homes included the ab-sence of a constituency pre-pared to act (in part due to lackof information and educationon this subject) and a corre-sponding lack of policies, re-sources, and institutionalmechanisms to facilitatechange.

Indonesia

nvironmentalHealth andTraditionalFuel Use inGuatemala

E

Energy options, ranked by increasing effectivenessin mitigating the health impacts of IAP

Incr

easi

ng P

M co

ncen

tratio

n

Must be properly maintained to achieve effectiveness in mitigating health impacts of IAP.

Use is affected by cultural and cooking practices.

Less polluting options. May alter food taste. Unsuitable for certain foods. Acceptabilityand hence effectiveness in mitigating health impacts of IAP may be affected bycultural and cooking preferences and costs of LPG/electricity.

Electricity

LPG/Fuelwood mix

Improved wood-burning stove

Only LPG stove

Open fire

PM = particulate matterLPG = liquefied petroleum gas

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Feature Articles

Estimates of healthimpacts of IAP inGuatemalaThe study was not able to con-clusively determine how manypeople were affected by pollu-tion from burning traditionalfuels.2 Estimates, applyingfindings from other IAP healthstudies worldwide, indicatedthat the number of annual cas-es of ALRI among childrenunder age five in the Guatema-lan highlands (where the im-pact is most severe) couldpotentially be reduced by asmany as 24,000, and annualdeaths by about 1,000, throughthe reduction of PM10 levels toless than 200 µg/m3. (This isthe reference exposure catego-ry, which in theory is achiev-able by a well-maintainedimproved stove or by relianceon a gas stove. Based on theliterature, studies generallyassume that children in house-holds that use open fires fall inthe exposure range of 1,000–2,000 µg/m3). This would beabout a 60 percent reduction inthe annual cases of ALRI mor-bidity and mortality, amongthe 400,000 children under theage of five in the Guatemalanhighlands who live in house-holds in which open fires areused for cooking.

Recommendationsfor addressing IAPin GuatemalaThe literature and experiencefrom various countries indicatethat mitigation of the health

impacts of IAP can be achievedas households move up theenergy ladder (see Figure, atleft). Equally important is anunderstanding of health im-pacts of IAP and behavioralchange that reflects this under-standing.

The study recommended fourtypes of broad interventions toimprove the effectiveness andefficiency of current arrange-ments to combat IAP. In addi-tion to better targeting existingbudgetary resources, the in-creased costs of such a pro-gram are expected to be offsetin the longer term by healthimprovements.

Monitor the problem and im-prove understanding of thelinks between health and pov-erty reduction in order toguide the development ofthe national poverty re-duction agenda and for-mulate national policiesassociated with reducinghealth impacts of IAP.Greater interinstitutional co-ordination is a crucial inter-vention, since tackling theissue of IAP is spreadacross the mandates of dif-ferent government institu-tions. Equally important iscoordination among gov-ernment, the private sec-tor, NGOs, academia, andhouseholds—particularlythe women who use thestoves and the men whobuy them and often collectfirewood for them.Making people aware of theproblem to promote behavior-al change. A striking find-ing of the study was that

women did not see thelink between health andsmoke. Women’s groupsand NGOs—as well as re-vised government trainingand health outreach pro-grams—can play an im-portant role in getting themessage to the final users.Implementing technical op-tions. The study found thatmost of the existing stovesprograms focused on fuelefficiency, are highly sub-sidized, offer limitedchoice to the user, and areimplemented in a modu-lar manner, without inter-action between the gov-ernment and its policiesand the different suppli-ers. It is essential that thegovernment take a moreproactive role in establish-ing policies that empha-size both fuel efficiencyand health impact as thekey criteria for improvedstove design, and promotea market-based systemthat targets stove subsi-dies to the poorest and of-fers choice and training forthe user. Creation of amultistakeholder coordi-nation group on ruralhousehold energy couldfacilitate this approach. Asa complement to such agroup, MEM could estab-lish and lead a technicalstoves unit that acts onbehalf of the consumer, tocertify stoves on bothefficiency and healthgrounds and facilitate awider offering of certifiedstoves.

In summary, IAP has closelinks to child mortality andmaternal health and affectsparticularly vulnerable groupsof the population such as poorchildren and women. There isa strong case that Guatemalansneed to act to address this is-sue.

ReferencesAhmed, K., Y. Awe, D. Barnes,

M. Cropper, and M. Koji-ma. 2005. EnvironmentalHealth and Traditional FuelUse in Guatemala. Direc-tions in Development.Washington, D.C.: WorldBank.

Notes1. Acute respiratory infec-

tion, ARI, may includeacute lower respiratorytract infection (ALRI) oracute upper respiratorytract infection (AURI).

2. Based on statistics ob-tained from the Ministryof Health in Guatemala,ALRI incidence rates andmortality rates for chil-dren under five years oldin each department in thestudy area ranged be-tween 533 and 1,450 per10,000 and between 1.91and 5.77 per 1,000 respec-tively.

This article was prepared by KulsumAhmed, (202) 473-1130, [email protected], of the EnvironmentDepartment and Yewande Awe, (202)458-5795, [email protected]., ofthe Environment Unit of the LatinAmerica and Caribbean Region.


I n three regions—Africa,South and East Asia, andLatin America—the Clean

Air Initiative (CAI) is support-ing innovative ways to addressthe growing impact of air pol-lution on human health andimprove people’s quality oflife, especially the poor in de-veloping countries. The CAIcombines training, research,and actions on the ground.Recent examples include a dis-tance learning course in LatinAmerica, a project focusing onair pollution in Asia, and thephaseout of leaded gasoline inSub-Saharan Africa.

On May 24, 2005, some 500specialists, practitioners,and policy makers acrossdifferent parts of Brazilparticipated in a distancelearning module on healthimpact assessment orga-nized by the Clean Air Ini-tiative in Latin AmericanCities. Based at their localtraining centers, theywatched a live presenta-tion via videoconferenceand web where presentersin Brasilia and São Paulodiscussed major healthand economic costs of airpollution and benefits ofmitigation measures.Last year, the PublicHealth and Air Pollutionin Asia (PAPA) project,under the umbrella of theClean Air Initiative forAsian Cities, reviewedover 160 existing healtheffect studies from over 30organizations across Asia.It carried out a detailedmeta-analysis of 28 stud-

ies of daily changes in airpollution and health andreported the results in thecontext of broader air pol-lution and health science.A major finding was thenoticeable increase in dai-ly mortality for PM10,which was similar to west-ern studies using compa-rable methods.In Sub-Saharan Africa, theClean Air Initiative spear-headed a successful pro-gram focusing on the com-plete phaseout of leadedgasoline in the entire re-gion by December 2005, asstated in the Dakar Decla-ration of June 2001 (seeBox 1). Studies show thatthe introduction of un-leaded gasoline has directhealth benefits.

There are major World Bankprojects that are the direct re-sult of (or are benefiting from)CAI. Concrete examples areurban transport and air pollu-tion projects in Latin America(Bogotá, Lima, Mexico, SãoPaulo, Santiago), Asia (Dhaka,Colombo, Bangkok, Hanoi,Manila, and many cities inChina), and Africa (Dakar, Cot-onou, Ouagadougou, Lagos).Many of these cities are receiv-ing Global Environment Facil-ity (GEF) support.

Air pollution healthimpactsUrban air pollution, which hasworsened in most large citiesin the developing world overthe last few decades, imposes

BOX 1REDUCTION OF PARTICULATE

POLLUTION FROM 2-STROKE ENGINES

In Dhaka, a successful program was imple-mented to build awareness by disseminat-ing information on the health impact of2-stroke emissions; the types of engines,fuel, and lubricant that reduce emissions;the importance of regular maintenance;and the advantages and disadvantages ofvarious measures for mitigating air pollu-tion. Lessons learned have been sharedwith CAI partners in Africa, and several cit-ies are now implementing projects withsupport from CAI.

BOX 2DIESEL PROJECT

Diesel emissions are complex mixturescontaining both fine particulate matter(such as PM10) and precursors for the for-mation of secondary particulates. The par-ticles emitted by diesel engines are oftenvery small (90 percent are less than 1µmin size), making them readily respirable byhuman beings. The World Bank, in part-nership with the Pollution Control Depart-ment in Thailand, launched the DIESELprogram to better understand factors af-fecting in-use diesel vehicle emissions,quantify emissions, and assess alternativeemission reduction options to assist deci-sionmaking.

he CleanAir InitiativeT

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a heavy burden on the healthof urban populations through-out the developing world. Insome cases, the health effectsof air pollution exceed the im-pacts of poor water quality andsanitation problems in urbanareas.1

Indoor air pollution is respon-sible for over 1.6 million annu-al deaths and 2.7 percent of theglobal burden of disease (inDisability-Adjusted Life Yearsor DALYs).2 The impact of in-door air pollution on humanhealth varies considerably ac-cording to the level of devel-opment. Children under fiveyears of age account for morethan 50 percent of deaths dueto indoor solid fuel use.

There are also important link-ages between local pollutantemissions and greenhouse gasemissions. A recent study3 infour cities—New York, Mexi-co, São Paulo, and Santiago—estimated that the adoption ofenergy efficiency and alterna-tive energy policies for reduc-ing greenhouse gas (GHG)emissions will also reduce par-ticulate matter and ozone.From 2000 to 2020, it wouldavoid approximately 64,000premature deaths (includinginfant deaths), 65,000 chronicbronchitis cases, and 37 millionperson-days of work loss orother restricted activity.

CAI approachThe CAI—an integrated, mul-tidisciplinary, and multi-orga-nization network involvingcity governments, private sec-tor companies, international

development agencies andfoundations, nongovernmen-tal organizations, and academ-ic institutions—is widelyrecognized as the regionalframework for addressing airpollution problems in LatinAmerican, Asian, and Sub-Sa-haran African cities. The WorldBank co-founded the Clean AirInitiative for Latin AmericanCities at a launching workshopin December 1998. As a resultof its success, it was alsolaunched in Asia in 2001 andsubsequently in Sub-SaharanAfrica later that year.

Today, the World Bank is aleading player in all three CAInetworks. The Air Quality The-matic Group, chaired by theEnvironment Department andwith representatives of all in-volved units, coordinates andadvises on the direction of theregional initiatives. Activitiesare guided by regional priori-ties and formulated through aparticipatory process. Majoractivities include:

Knowledge Management andTraining. The CAI has pre-pared and delivered anumber of very successfuland cost-effective coursesusing the wealth of tech-nical and institutionalknowledge available atpartner institutions. Thedistance learning courseprepared by WBI has beenone of the most successfuland widely recognized ac-tivities in Latin Americaand Asia.Policy Dialogue. Throughfield visits and targetedmeetings, the CAI has fos-

tered dialogue amongdecisionmakers at localand national levels. Thishas raised awareness ofthe relationships amongair quality, transport, andenergy policies and result-ed in specific urban trans-port projects in cities andimproved fuel quality.Dissemination and Out-reach. The CAI website(<www.cleanair net.org/>)has been instrumental inthe exchange of informa-tion and as a forum for dis-cussion. Communicationactivities, using televisionnetworks and printedmedia, have raised publicawareness. Documenta-ries based on existingprojects are being success-fully disseminated throughthe network and are re-sulting in replicationprojects.Project level. CAI has fos-tered the formulation andimplementation of specif-ic action plans and majorprojects across the threeregions (see Box 2). Specialemphasis has been givento health and poverty re-duction, lead phaseout,and sustainable transport.

FutureAs the Clean Air Initiative’sthree regional programsevolve and grow, there is aneed to continue strengtheningcross-fertilization and sharingknowledge within the Bankand at the global level. The Ini-tiative will focus more on theimplementation of projects on

the ground, especially to re-duce GHG emissions and im-prove air quality by promotingsustainable transport policiesand sound land-use manage-ment. Technical assistance(studies, workshops, experts,surveys) and pilot invest-ments—in areas such as non-motorized transport facilities,improvement of urban land-scape/facilities in transportcorridors, and mobility manage-ment systems—are plannedfor delivery in the next phase.

Notes1. As shown by the Country

Environmental Analysesin LAC for countries suchas Brazil, Colombia, Mex-ico, and Peru, where largeurban centers experiencelarger numbers of morbid-ity and mortality cases as-sociated with air pollu-tion.

2. Global Burden of Disease,from <www.who.int>.

3. Cifuentes, Luis A., andothers. 2001. “ClimateChange: Hidden HealthBenefits of GreenhouseGas Mitigation.” Science293:1257–1259.

This article was prepared bySamantha Constant and Paul Proceefrom the World Bank’s Environmen-tally and Socially Sustainable Devel-opment Division (WBIEN). For moreinformation about CAI, please con-tact Paul Procee at (202) 458-2472,<[email protected]>.

www.cleanairnet.org

www.who.int


Chemicals of manykinds have become aglobal issue affecting

human and environmentalhealth across the boundaries ofcountries, regions, and econo-mies. With an estimated $1.5trillion in sales in 1998, the glo-bal chemical industry employsmore than 10 million peopleand accounts for 7 percent ofglobal income. In the develop-ing world, the impact of chem-icals on the lives of poorpeople is growing, as produc-tion of chemicals—as well asprocessing and formulation—steadily increases. Once re-leased into the environment,chemicals may undergo short-or long-range transport as a re-sult of natural environmentalprocesses. They may be trans-formed into other chemicalsand may cause local, regional,and/or global contamination,expose humans and wildlifeand, in some cases, have toxiceffects.

Exposure and effectsExposure to toxic chemicalscan be “direct,” when thechemical moves straight fromthe source to the person, or“indirect,” when the chemicalgoes through intermediatepathways. Impacts can beacute, caused by single expo-sures to toxic levels of chemi-cals (for example, pesticidepoisonings) or chronic, involv-ing exposure to lower concen-trations over long terms.Chronic exposure is gradualand often not obvious to de-tect, but it can have significanthealth impacts, such as de-grading neurological and

physical function and capaci-ty (for example, heavy metalspoisoning).

In terms of human health, per-sistent organic pollutants(POPs) are of particular con-cern because they can movegreat distances from theirsource, degrade very slowly inthe environment, and accumu-late in wildlife and humans.Other substances prevalent inthe environment are heavymetals such as mercury (fromcoal-fired power plants, indus-trial plants, medical equip-ment, and mining), lead (fromleaded gasoline, consumerproducts), and cadmium (frombatteries, sewage waste, fertil-izers). Some chemicals workindirectly; for example, chlo-rofluorocarbons and otherozone-depleting substancescreated a hole in Earth’s pro-tective ozone layer, which hasincreased the incidence of skincancer and cataracts.

Some statistics have quantifiedthe number of these exposures.A survey of child labor in sev-eral developing countries con-sidered biological, chemical,and environmental hazards.Nine out of ten working chil-dren are in agriculture, and thestudy found that over 60 per-cent of economically activechildren were exposed to haz-ardous conditions, and over 25percent of these hazards weredue to exposure to chemicals(Ashagrie 1998). In Mexico,studies of children exposed tolead have shown 40 to 90 per-cent of children in certain com-munities with levels up to 10micrograms/dL per day, and

oxicChemicals —

A GrowingGlobal Threat

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Feature Articles

close to 10 percent in somecommunities had levels of upto 50 micrograms/dL perday—a level that requires hos-pitalization in the UnitedStates (Romieu, and others1994, 1995). Finally, there arean estimated 3 million cases ofacute, severe pesticide poison-ings worldwide, includingabout 250,000 deaths. Almostall of these cases are in devel-oping countries (Jeyaratnam1996).

Impact on poorpeopleOf the chemicals discussedabove, lead, pesticides, andmercury affect people living inpoverty the most. Exposure tolead may occur through a va-riety of informal sector activi-ties such as making ceramics,recycling batteries, and scav-enging or through exposure tovehicular fumes in countriesthat still use leaded gasoline.Exposure to mercury can bethrough poorly disposed mer-cury waste or as part of theprocessing in artisanal goldmining.

The World Health Organiza-tion expects the burden fromchronic disease in developingeconomies to outweigh theburden from infectious diseaseby 2020. Only a subset ofchronic disease is associatedwith chemicals, but the healtheffects of these substances areworse among those who aremost vulnerable—those withpoor nutrition, with concur-rent disease, and children.Lead, for example, is known to

be more toxic to children whoare malnourished. In the strug-gle for a better quality of lifeand development, the neuro-logical and health effects onchildren in these countries canhave serious long-term effects.

POPs exposure also dispropor-tionately affects the poor. POPsand other pesticides contributeto both acute and long-termimpacts on human health. Pes-ticide poisonings can occurthrough direct exposure, dueto lack of training or inade-quate safety equipment. Pesti-cide drums and containers areoften reused for water andfood in poor communitiesacross the globe, exposing chil-dren and others to the effectsof the chemicals. When poorlystored or disposed of, obsoletepesticides (many of which arePOPs) can create long-termtoxic effects on the environ-ment, creating a long-lastingand global threat to humanhealth. People who scavenge atlandfills and municipal wastedumps are often exposed todioxins and furans, two high-ly toxic POPs that are emittedfrom incomplete combustionof waste from fires that typical-ly occur at disposal sites.

Taking actionAt the international level, ap-proaches to these problemsrange from global treaties onthe control of chemicals—suchas the Montreal Protocol onChemicals that Deplete theOzone Layer and the Stock-holm Convention on POPs—tospecific projects to remove tox-ic chemicals from the environ-

ment, such as the Africa Stock-piles Programme (ASP). (Seepage 49 for a description of theASP.) The Montreal Protocolshows how the global commu-nity can work together to de-velop a solution to a chemicalthreat. The Montreal ProtocolMultilateral Fund providedfunding to developing coun-tries to convert to cleaner, non-ozone-depleting technologies.The Stockholm Conventionhopes to follow a similar mod-el. The Bank is working withthe Global Environment Facil-ity and clients to provide stra-tegic guidance on how to stopusing POPs and develop alter-natives.

At the local level, the Bank andits partners are working to helpcountries understand and as-sess the impact of chemicals onhuman health. Studies includean investigation of the healthimpacts of pesticides in An-dean farming communities inPeru, blood monitoring stud-ies in China, and breast milkmonitoring studies in Mexico.Results from these studies willallow countries like China andMexico to be better equippedfor the design of successful in-terventions and solutions. Atthe project level, through itssafeguards policies, the Bankworks to reduce the impact ofpesticides (including DDT)and other chemicals in itscountry work programs.

Finally, the global communityis working together to devel-op a Strategic Approach to In-ternational Chemicals Man-agement. The World Bank seesthis as a key step in the ability

of countries to coordinate ob-ligations under a range ofchemicals conventions; to inte-grate national, regional, andglobal objectives for soundchemicals management intonational plans for sustainablegrowth; and to build capacityto reduce the risks of chemicalsexposure to their populationsand environment.

ReferencesAshagrie, K. 1998. Statistics on

Working Children and Hazard-ous Child Labor in Brief. Inter-national Labour Organisa-tion: Geneva.

Buccini, John. 2004. The GlobalPursuit of the Sound Manage-ment of Chemicals. Washing-ton, D.C.: World Bank.

Goldman, Lyn, and Nga Tran.2002. Toxics and Poverty: TheImpact of Toxic Substances onthe Poor in Developing Coun-tries . Washington, D.C.:World Bank.

Jeyaratnam, J., and D. Koh. 1996.“Pesticides Hazards in De-veloping Countries.” Scienceof the Total Environment 188Suppl 1: S78–85.

Romieu I., E. Palazuelos, M. Her-nandez-Avila, C. Rios, I. Mu-noz, C. Jimenez, and G. Ca-hero. 1994. “Sources of LeadExposure in Mexico City.”Environmental Health Perspec-tives 102(4): 384–389.

Romieu, I., T. Carreon, L. Lopez,E. Palazuelos, C. Rios, Y.Manuel, and M. Hernandez-Avila. 1995. “EnvironmentalUrban Lead Exposure andBlood Lead Levels in Chil-dren in Mexico City.” Envi-ronmental Health Perspectives103 (11): 1036–1040.

This article was prepared by EllenTynan, (202) 473-8201, [email protected], of the EnvironmentDepartment.


South Africa

Mali NigerChad

Sudan

Ethiopia

Eritrea

C.A.R.Somalia

Kenya

Uganda

Tanzania

Madagascar

Zambia

Zimbabwe

Botswana

SouthAfrica

MozambiqueSwazilandLesotho

Mauritius

Comoros

Seychelles

NigeriaBenin

Togo

BurkinaFaso

MauritaniaCapeVerde

Senegal

Cameroon

Congo

Malawi

Namibia

Angola

D.R. ofCongo

RwandaBurundi

GuineaSierra Leone

Liberia

GhanaEquatorial Guinea

São Tomé and PríncipeGabon

Côte d'Ivoire

Guinea-BissauThe Gambia

IBRD 31567R SEPTEMBER 2005IBRD 31567R SEPTEMBER 2005

Sub-Saharan Africa Region

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Environment and health in Africaub-Saharan Africa faces many challenges tosustainable development, including some ofthe highest population growth rates in theworld, growing formal and informal urban-ization, widespread poverty, a pandemicAIDS crisis, and a high degree of political

fragmentation. The region has 10 percent of the global popu-lation, but had 24 percent of the global burden of disease in2000.

According to a draft World Bank study (Doumani 2005), 360–400 million people are living in malaria-prone areas. More than200 million episodes of clinical disease resulted in 1 milliondeaths from malaria in 2000. The Bank has engaged in a boosterprogram for malaria control in Africa and will apply a multi-pronged approach including provision of insecticide-treatedbednets and integrated vector management (see Box 1).

BOX 1ROLLING BACK MALARIA —

ENVIRONMENTAL ISSUES AND OPPORTUNITIES

According to the World Bank’s Global Strategy & Booster Program(2005), if at least 60 percent of children under five slept underinsecticide-treated bednets there could be as much as a 20 per-cent reduction in mortality and morbidity in children. But, as oftoday, countries are far from reaching this level of coverage, duein part to production and distribution-related bottlenecks, as wellas significant financing gaps.

In the long term, it is important to raise awareness about howvector-borne disease spreads, and what behavioral change isrequired to stop it, and to set plans for how vectors will be man-aged in urban and rural settings. Resistance to insecticides alsomust be addressed. Continued monitoring of resistance and iden-tification of alternative products for vector management is oneof the areas in which the international community can play a rolein assisting countries.



SUB-SAHARAN AFRICA REGION

Diarrheal death has fallen dramatically inthe last decade, largely as a result of bet-ter curative services. Nevertheless, watersupply and sanitation services coveredjust over half the population in Sub-Sa-haran Africa in 2000. More investmentsin infrastructure are required, but simpleand more cost-effective interventions fordisease control deserve attention as well.For instance, in Ghana the Bank is sup-porting a public-private partnership forhandwashing with soap; early results in-dicate that diseases have already beenreduced (see Box 2).

About 80 percent of the population inSub-Saharan Africa relies on biomass,coal, and charcoal for cooking (mostly intraditional unimproved stoves), heating,lighting, and as mosquito repellent. Theresulting indoor air pollution plays a sig-nificant role in child mortality; in 2000, itis estimated that 730,000 children underfive years of age died from respiratorydisease. Outdoor air pollution also is a

significant environmental health issue(see Box 3).

In 2000, over 24 million people were af-fected by natural disasters such asdrought, high winds, and floods (see Box4). Global climate change is likely to in-crease the frequency and intensity of suchevents. In addition to causing major eco-nomic losses, these disasters exacerbatecommunicable diseases such as malaria,diarrhea, and meningitis, increasing theburden on the poor. A major locust inva-sion in the Sahel in 2004 proved again thatthe region is very vulnerable to suchshocks. The Bank’s response included theAfrica Emergency Locust Project, whichpromotes coordination among donorsand supports coordinated efforts to pre-vent the recurrence of a major locust in-vasion and to obtain pesticides.

The international community is also as-sisting in the management of hazardssuch as obsolete and hazardous pesti-

BOX 2THE GLOBAL PUBLIC-PRIVATE PARTNERSHIP FOR HANDWASHING WITH SOAP

The Public-Private Partnership for Handwashing is a global initiative to promote handwash-ing with soap to reduce diarrhea, a major cause of child mortality in many countries today.Ghana is one of four participating pilot countries, along with Senegal, Peru, and Nepal. Aninitial study of the soap market showed that while Ghanaians are major consumers of soapper capita, with handwashing widely practiced, soap use is not yet a habit.

The program’s objectives in Ghana for the years 2003–05 are to increase the practice ofhandwashing with soap among mothers and caregivers from 16 percent to 50 percent andto increase the number of schoolchildren aged 6–15 who wash their hands with soap froman estimated 20 percent to 50 percent.

In 2004, the National Handwashing Campaign launched an intensive media campaignthrough three television networks and 17 radio stations throughout the 10 regions of thecountry. These public service announcements were complemented by a number of radioand 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 showedmarked improvement over baseline rates. Exposure to all campaign materials was also veryhigh, with over 80 percent of children and adults reporting positive behavior change sincethe campaign launch.

BOX 3CLEAN AIR INITIATIVE IN

SUB-SAHARAN AFRICAN CITIES

Urbanization and increasing motorizationin Sub-Saharan Africa have resulted in sig-nificant degradation of air quality. TheClean Air Initiative in Sub-Saharan AfricanCities (CAI-SSA), sponsored by the WorldBank in collaboration with a number ofpartners, is part of a global effort to pro-tect the urban environment. CAI-SSA hashelped a number of governments tophase out the use of leaded gasoline andhas raised public awareness on the effectsof pollution from motorized transport.

At a regional conference financed by CAI-SSA in June 2001 in Dakar, governments,the oil industry, and civil society agreedto eliminate lead in gasoline throughoutSub-Saharan Africa by the end of 2005. TheBank has concentrated on providing tech-nical assistance. A May 2005 review ofprogress in the lead phase-out effort in-dicated that the main objective of theDakar agreement has been accomplished.By January 2006, virtually the entire regionis expected to have phased out leadedgasoline. Several factors contributed tothis achievement, including effective col-laboration among CAI partners; the strat-egy’s emphasis on a swift changeover;price changes in countries that importtheir transport fuels, such that unleadedgasoline was typically less expensive thanleaded gasoline; and improved under-standing of the negative health impactsof even small amounts of lead.

Y. Fia

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Children on their way to sell fish at a nearbymarket in Ghana.


Water resource management

19%

Landmanagement

11%

Environmentalpolicy and institutions

16%

Climate change12%

Biodiversity5%

Other environmentalmanagement

9%

Pollutionmanagement and

environmental health28%

Percentages based on commitment amounts.


19%

Landmanagement

11%


16%

Climate change12%

Biodiversity5%


9%



Percentages based on commitment amounts.cides. For example, the Bank-supportedAfrica Stockpiles Program is a partner-ship of NGOs, donors, and industry as-sisting countries with the cleanup ofobsolete pesticides.

Lessons from World Bank projects havedemonstrated that very simple mea-sures—like judicious handwashing withsoap, awareness of how vector-borne dis-ease are transmitted, ventilation, or en-vironmental cleanup—can greatly reducethe burden of disease in Sub-Saharan Af-rica, especially within the framework ofcommunity-driven development.

Challenges andopportunitiesMinistries of health have traditionallybeen responsible for health outcomes, but

BOX 4CASE OF ENVIRONMENT AND HEALTH IN BENIN

Completed in 2004, the Benin First Decentralized City Management Project helped deliverbetter quality and cost-effective basic services to urban residents, especially the poor, inBenin’s three main cities. The project was a response to rapid and unplanned urban growth,often on environmentally vulnerable land with poor infrastructure. In areas lacking accessto primary drainage, the project also contributed to significantly and sustainably reducingthe effects of periodic flooding on public health. Some 17,000 households—about 85,000people—gained access to roads. The project also supported installation of new drains, pro-tecting about 400,000 people from periodic flooding. The project’s second phase (a pro-posed $35 million IDA Credit) will further strengthen urban management in Benin.

achieving the Millennium DevelopmentGoals requires a multisector effort thatencompasses several ministries, the pri-vate sector, and civil society. Internation-al organizations and donors can play animportant role in ensuring seamless co-ordination and multidonor support togovernments in Africa. As shown by theBank’s Locust Project in 2004, it is impor-tant at an early stage to bring countries,donors, and technical agencies togetherto agree on institutional responsibilitiesand priorities for action. This should bereplicated in other sectors.

Africa is a very poor region and will haveto be strategic in addressing its enormousenvironment-health challenges. Indoorair pollution is a priority environmentalhealth issue. Finding alternative energysources or educating families to minimizethe health effects from exposure to solid

fuel burning is a major challenge for theregion. Similarly, a combination of edu-cation and awareness, as well as signifi-cant investments in water infrastructure,is direly needed to minimize the hugeburden of waterborne diseases. Theseand other environmental health problemshave to be tackled jointly, because manyof their underlying causes are poor socio-economic conditions. There are also manysynergies to be captured by integratedapproaches. This calls for good sectoralcoordination and targeted investments inthe most cost-effective interventions.

PortfolioThe Bank-financed portfolio related toenvironment and health is primarily im-plemented through the financing of (a)projects focusing on environmental is-sues, (b) health projects with environmen-tal components, or (c) projects focusingon water and urban issues. In addition,the Bank is undertaking studies and sup-porting capacity building activities. Atthe end of fiscal 2005, the Africa RegionEnvironment portfolio represented a to-tal commitment of about $ 1 billion.

The $240 million portfolio of the GlobalEnvironment Facility includes invest-ments in biodiversity, climate change,international waters, integrated ecosys-

THE AFR REGIONAL

ENVIRONMENT PORTFOLIO

At the end of June 2005 the active portfolio ofWorld Bank environmental lending in the AFRRegion was $1.0 billion.

Arusha, Tanzania.

S. Za

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SUB-SAHARAN AFRICA REGION

This article was prepared by Peter Kristensen,(202) 473-4789, [email protected], ofthe Environment and Social Development Unitfor Western Africa, with contributions fromFadi Doumani, Karan Capoor, Franck Bousquet,John Lambert, Sergio Margulis, Suprotik Basu,and Tracy Hart—all of the Africa Region; andRama Chandra Reddy and Sushenjit Bandyo-pahyay—both of the Environment Departmentof the World Bank.AFR website: <www.worldbank.org/afr>.

BOX 5MOTHER NATURE — THE SOURCE

OF MEDICINE FOR POOR PEOPLE

Multipurpose medicinal plants can play animportant role in land rehabilitation pro-grams, according to a World Bank reviewpaper (Lambert and others, 2005). Whatlooks like a problem actually provides aniche opportunity for countries with dry-lands to reverse land degradation andadvance rural development. These plants,although not necessarily adding to biodi-versity, benefit health, food, and incomeneeds. The review builds on the recogni-tion that by combining indigenousknowledge and modern appropriate tech-nology, communities and researchers canidentify cultivation practices that offernew sustainable land management prac-tices to halt desertification. At the sametime, if communities can derive a greatershare of the increasing annual global val-ue of medicinal plants ($65 billion), thenactions to rehabilitate degraded lands willimprove their quality of life.

tem management, persistent organic pol-lutants, and land degradation (see Box 5).The Bank also is managing several car-bon funds as part of the global effort tomitigate climate change. In 2004, the Af-rica Region developed 19 carbon projectopportunities—including Nigeria EnergyEfficiency, Sierra Leone Hydro, andMadagascar Biodiversity Corridor—aswell as a range of projects in collabora-tion with the IFC and the DevelopmentBank of Southern Africa. The Clean De-velopment Mechanism also provides amarket-based opportunity for Africancountries to reduce the risk of global cli-mate change while mobilizing invest-ments in better infrastructure.

ReferencesDoumani, Fadi M. 2005. Environmental

Health in Sub-Saharan Africa: EffectiveInterventions. (draft) Washington,D.C.: World Bank.

Lambert, John D. H., Per A. Ryden, andEnos E. Esikuri. 2005. Bio-economicValue of Multipurpose Medicinal Plantsfor the Rehabilitation of Drylands inSub-Saharan Africa. Washington,D.C.: World Bank.

Reddy, Rama Chandra, and SushenjitBandyopadhyay. 2004. Household En-ergy Use and Respiratory Health of Chil-dren in Ethiopia and Zambia: Evidencefrom DHS and LSMS Data. Washing-ton, D.C.: World Bank.

C. Ca

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IBRD 31562R SEPTEMBER 2005

Vietnam

Solomon Is.

Mongolia

China

Rep. of Korea

Philippines

Myanmar

Indonesia

Thailand

Malaysia Palau Fed. States ofMicronesia

PapuaNewGuinea

Vanuatu Fiji

Kiribati

MarshallIslands

Samoa

Tonga

Timor-Leste

Lao P.D.R.VietnamCambodia

East Asia and Pacific Region

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he East Asia and Pacific (EAP) region is achiev-ing impressive rates of poverty reduction,around 35 million people annually. Butgrowth—a complex process that includes fac-tors such as urbanization, industrialization,

institutional and governance issues—has been accompaniedand reinforced by a wide range of fundamental changes in theregion’s environmental conditions. A growing body of evidenceis showing that the region’s environment is under consider-able strain and the services it provides are increasingly threat-ened. For example, natural forest cover has declinedsignificantly in many countries; in the Philippines, Indonesia,and Malaysia, declines ranged from 1 to 2 percent annuallyduring the 1990s.

Regional environmental prioritiesA variety of environmental health implications are linked withexposure to polluted air and water. Ongoing Bank research

indicates that improvements in water quality could reducetyphoid infection in China by 50 percent and would signifi-cantly reduce the spread of Hepatitis A, 70–90 percent of whichis transmitted by dirty water. Air quality is also a serious con-cern in most major cities in the region; for example, particu-late (PM10) concentrations in Jakarta and Beijing rangedbetween 110 and 140 µg/m3 in 2002–03 (WHO and U.S. EPAguidance is for maximum levels of 50–70 µg/m3 in any 24 hourperiod). The situation is critical in areas such as northeast Chi-na and Mongolia, where coal burning in small and mediumboilers, dispersed through low stacks, directly contributes topeople’s exposure. Indoor air pollution is also a leading causeof respiratory infection, pulmonary diseases, and lung cancer,and Bank research suggests that death rates from chronic res-piratory disease and respiratory infections in children are 4and 44 times higher in China than in the western world.

In Cambodia, Lao PDR, and Vietnam, Bank studies have iden-tified strong linkages among poverty, dirty water, and illness.



EAST ASIA AND PACIFIC REGION

These findings underline the importanceof establishing environmental manage-ment systems at an early stage in the de-velopment process. Increasing pressureon the environment is exposing the lim-ited capacity of many of the region’s in-stitutions, especially in the context ofdecentralization, which is ongoing inmany areas.

While at present East Asia is relativelyunder-urbanized, the situation is rapidlychanging. Between 2000 and 2025, accord-ing to the UN Population Division, theurban population is forecast to increaseby 65 percent, or by 500 million, largelyin poorly managed peri-urban areas. Theenvironmental challenges created by thistransition place a massive strain on pub-lic resources and environmental servic-es; for example, in Vietnam the generationof urban solid waste is expected to in-crease from 6 million tons to 12.6 milliontons between 2004 and 2010 (World Bank2004). Furthermore, transboundary, re-gional, and global challenges will inten-sify as EAP countries become increa-singly integrated into the regional andglobal economy.

The Bank’s regional Environment Strate-gy, published in March 2005, reviews keytrends, priorities, and Bank activities (see

cover below, left). The Strategy and in-formation on related activities is availableat the new EAP environment website(www. worldbank.org/eapenvironment).

RecentaccomplishmentsFinancing EnvironmentalImprovementsThe region’s Environment and NaturalResource Management (ENRM) portfoliostands at $5.15 billion, with $498 millionof new lending. A thematic breakdownhighlights the importance of the pollutionand water resource management compo-nents. The Bank recently approved theLao PDR Nam Theun 2 HydropowerProject and the linked Lao Environmentand Social Project (LENS) (see Box). Oth-er new ENRM projects include the Phil-ippines Land Administration andManagement Project (II) and the PearlRiver Watershed Rehabilitation Project inChina. The former is designed to improveland tenure security, land administrationservices, and property valuation systems,in order to develop more efficient landmarkets. The objective of the latter is toestablish an integrated rural developmentmodel in highly degraded watersheds of

southern China, with activities designedto increase productive land area, affores-tation, sedimentation retention, and ba-sic infrastructure development.

The Global Environment Facility (GEF)recently approved a $40 million grant fora Renewable Energy Scale-Up Programin China, a joint initiative supporting

At the end of June 2005 the active portfolio ofWorld Bank environmental lending in the EAPRegion was $4.2 billion.

THE EAP REGIONAL



23%

Landmanagement

14%


8%

Climate change13%

Biodiversity2%


2%





23%

Landmanagement

14%


8%

Climate change13%

Biodiversity2%


2%




NAM THEUN 2 AND LENS —A WINDOW TO THE FUTURE

The Nam Theun 2 Hydropower Project,

which provides for the construction of a

large dam on the Nam Theun River in Lao

PDR, was approved for implementation in

early 2005. The facility will produce 6,000

GWh of electricity annually and generate

$2 billion in revenue over a concession pe-

riod of 25 years. Thereafter, the dam will

be entirely owned by the Government of

Lao PDR.

Potential environmental and social im-

pacts have been subjected to careful

study for many years, and meticulous at-

tention has been paid to ensure that the

project meets, and often exceeds, interna-

tional environmental and social criteria.

Analytical preparation included impact

studies on dam safety, indigenous and af-

fected people, resettlement, cultural prop-

erty, and socioeconomic and environ-

mental impacts. These studies were aug-

mented by a comprehensive consultation

process to ensure that affected people

were fully informed. The Bank has also pre-

pared complementary projects to support

NT2 implementation, aimed at enhancing

livelihood opportunities for local people

and improving the conservation of biodi-

versity in the area. The Lao Environment

and Social Project (LENS) is a development

grant designed to strengthen the man-

agement of environmental and social is-

sues and the use of natural assets around

the NT2 project area. Activities include in-

stitutional strengthening and investment

in community environmental manage-

ment.

World Bank EnvironmentStrategy for the EAP Region

www.worldbank.org/eapenvironment


China’s plan to produce 10 percent of itselectricity from renewable sources by2020. The project will include wind andbiomass power investments and supportfor capacity building. In Kiribati, EAP ishelping prepare a climate change adap-tation project, one of the first efforts to

help a client country adjust its compre-

hensive development strategy to the po-

tential impacts of climate change. Other

recently approved EAP-GEF projects in-

clude the China Building Heat Reform

and Energy Efficiency Project and the

Vietnam Sustainable Forestry Develop-

ment Project. The former will reform res-

idential apartment heat supply policy and

demonstrate energy efficient heating sys-

tems. EAP also facilitated approval of an

$11 million GEF grant for a global Coral

Reef Management Research Project to

coordinate applied coral reef manage-

ment research work and develop capaci-

ty in coral-rich countries.

In China, two large GEF-supported dem-

onstration projects are under preparation

to phase out persistent organic pollutants

(POPs). Activities to address POPs have

been scaled up to include a study on PCB

and DDT toxicity, assessment of PCB

management, and integrated pest man-

agement approaches as alternatives to the

use of chemicals in termite control.

The region’s successful ozone depleting

substance (ODS) phaseout program,

which is the largest in the world, received

new commitments for programs worth

$39.8 million during fiscal 2005. This in-

cluded the CFC/Halon Accelerated Phase-

out Plan in China, and National MethylBromide Phaseout Plans in the Philippinesand Thailand. In the context of Bank-sup-ported programs, 16,750 (ozone depletionpotential) tons of ODS emissions wereeliminated during fiscal 2005.

Analytical andtechnical assistanceThe Bank provides an extensive range ofanalytical and technical assistance to sup-port enhanced environmental manage-ment and policy development. Examplesinclude analyses of poverty-environmentlinkages in Cambodia, Lao PDR, and Viet-nam, which have uncovered a number ofmutually reinforcing linkages amongpoverty, environmental damage, and en-vironmental health factors; for example,poor indoor air and water quality lead toincreased rates of respiratory and diarrhe-al illness. Work in China, in close collab-oration with a number of governmentministries, is addressing issues such asenvironmental administration, water pol-lution control, green accounting, andcosts and health risks from pollution. Thiswork contributed to significant strength-ening of China’s State EnvironmentalProtection Authority following the Bank’srecommendations, as well as detailedguidance for the next five-year plan.

Other areas of engagement include par-ticipation in the decentralization of envi-ronmental management. In Indonesia, theBank has been involved in extensive pol-icy dialogue with the government andprivate sector stakeholders on decentral-ization and improvement of environmen-tal management systems, culminating inthe development of a technical assistancepackage to strengthen the institutionaland policy framework and support thedevelopment of new regulations.

The Environment Monitor series, whichdisseminates information on environ-mental trends to a wide range of stake-holders, remained a key component of theBank’s analytical work. New monitorswere launched in Lao PDR (environmen-tal overview), Mongolia (challenges ofurban development), the Philippines (as-

sessing progress), Thailand (biodi-versity), and Vietnam (solid waste man-agement).

Developing EnvironmentalPartnershipsThe cross-sectoral nature and number ofstakeholders involved in many environ-mental issues underlines the need for ef-fective partnerships. One example of theBank’s efforts to engage with civil soci-ety groups is the Initiative on Faith andEnvironment, which engages faith-basedgroups in conservation throughout theregion. The June 2005 Northern BuddhistConference on Ecology and Development(in Ulaanbaatar, Mongolia) brought to-gether 250 representatives of monasticcommunities, NGOs, government, anddevelopment institutions to developenvironment and development ideas(<www.arcworld.org>).

The EAP Region hosted several importantevents, including IUCN’s World Con-gress in Bangkok, Thailand (November2004); the 5th Ministerial Conference onEnvironment and Development in Seoul,Korea (March 2005); and the Eco-AsiaCongress in Gifu, Japan (June 2005). TheBank actively participated in these events.The Bank has also continued its involve-ment in the successful Clean Air Initia-tive for Asian Cities (CAI-Asia), the ForestLaw Enforcement and Governance(FLEG) Initiative, and others.

The Bank has been actively developingnew partnerships to address emergingenvironmental issues. During the post-tsunami recovery process, a Multi-DonorTrust Fund for the Aceh and NorthernSumatra region was established address-ing both environmental and natural re-source issues. Partnerships with theGovernments of Italy and the Republicof Korea have been established to supportanalytical work in China, Vietnam, and

www.arcworld.org


EAST ASIA AND PACIFIC REGION

the Philippines on (a) national climatechange strategy; (b) green accounting; (c)the circular economy; and (d) the trans-fer of lessons learned on managing indus-trial pollution, as well as financingenvironmental improvements. In Mongo-lia, a new environmental partnership wasestablished with the Government of theNetherlands to support technical assis-tance and project development for im-proved environmental and naturalresource management.

The challenges aheadAlongside many long-standing issues,new environmental challenges are contin-uously emerging. The tragic tsunamievent served as a stark reminder of theregion’s vulnerability to natural disastersand underlined the importance of theBank’s activities to support effectivecoastal resource management. In thewake of the disaster, the Bank made rap-id assessments of environmental damag-es and made adjustments to ongoing andplanned projects. New EnvironmentMonitors in the Philippines and Thailandare also focusing on coastal resource man-agement.

This article was prepared by Magda Lovei,(202) 473-3986, [email protected];Andrew Murray, (202) 473-4580, [email protected]; and Jian Xie, (202) 473-2766,jxie@worldbankorg—all of the Environmentand Social Development Sector Unit of the EastAsia and the Pacific Region. EAP website:<www.worldbank.org/eapenvironment>.

Reducing carbon emissions remains ahigh priority. There is increasing evidencethat climate change is already occurring,including rising sea temperatures, an ex-tended range of malaria occurrence, andincreasingly frequent natural disasterssuch as flash floods. The Bank has alsobeen instrumental in developing the re-gion’s carbon market, which currentlystands at around $41 million. The marketis expected to grow rapidly, with a rangeof new projects being developed, such asHFC-23 and bio-carbon initiatives.

Other new environment challenges in-clude the growing threat to biodiversityfrom the illegal wildlife trade. East andSoutheast Asia are key suppliers to inter-national wildlife markets. Demand forwildlife, plant, and mineral derivatives isleading to unsustainable levels of exploi-tation for many of the region’s most char-ismatic and endangered species. Thistrade was estimated to be worth $66.5million in Vietnam alone in 2002 (VanSong 2003).

Countries in the region are increasinglyinterested in the environmental implica-tions of sectoral and macroeconomic pol-icy reforms and development plans. The

application of strategic environmentalassessments (SEA) is now required by leg-islation in several countries, and practi-cal examples are emerging in differentcontexts. The international SEA work-shop, organized by OECD’s Develop-ment Assistance Committee and theGovernment of Vietnam in Halong Bay,Vietnam (January 2005), provided a fo-rum for sharing regional and internation-al experiences. However, much remainsto be done, since both regulations and thecapacity to undertake these assessmentsare weak in many countries.

ReferencesWorld Bank. 2004. Vietnam Environment

Monitor. Washington, D.C.: WorldBank.

Van Song, N. 2003. Wildlife Trading in Viet-nam: Why it Flourishes. Singapore:Singapore Economy and Environ-ment Program for Southeast Asia.

Engaging faith communities at Northern Buddhist Conference on Ecology and Development.

M. Lo

vei

www.worldbank.org/eapenvironment


Turkey

IBRD 31563R2 SEPTEMBER 2005

Russian Federation

KazakhstanUkraine

Moldova

Belarus

EstoniaLatviaLithuania

Romania

Bulgaria

Turkey

Cyprus

Uzbekistan

Turkmenistan

GeorgiaAzerbaijanArmenia

Poland

FYR MacedoniaAlbaniaSerbia and MontenegroBosnia and HerzegovinaCroatiaSlovenia

Slovak Rep.Czech Rep.

Hungary

KyrgyzRep.

Tajikistan

Russian Federation

KazakhstanUkraine

Moldova

Belarus

EstoniaLatviaLithuania

Romania

Bulgaria

Turkey

Cyprus

Uzbekistan

Turkmenistan

GeorgiaAzerbaijanArmenia

Poland

FYR MacedoniaAlbaniaSerbia and MontenegroBosnia and HerzegovinaCroatiaSlovenia

Slovak Rep.Czech Rep.

Hungary

KyrgyzRep.

Tajikistan

Europe and Central Asia Region

nvironmental health issues in the countriesof the Europe and Central Asia (ECA) regionreflect the attributes of the Soviet era, as wellas the rapid political transition and associ-ated economic disruptions that followed.

Prior to the 1990s, people enjoyed generally good (often highlysubsidized) access to water, heat, housing, and health servic-es, and related mortality and morbidity rates were compara-ble to those in the industrialized countries belonging to theOrganisation for Economic Co-operation and Development.At the same time, however, the region experienced rapid in-dustrialization based on highly polluting technologies. Thecollapse of state systems and subsidies for utilities and ser-vices left most ECA countries with a deteriorating stock ofenergy, housing, and water supply infrastructure, with obso-lete and inefficient industrial plants and utilities, and with awidespread legacy of polluted soil and water.

With economic recovery ongoing over much of the region,the challenge for ECA countries now is to restore the quality

of life for their citizens and to become competitive in the in-

ternational marketplace. Key elements include restoring util-

ities and services with due regard to quality, efficiency,

affordability, and sustainability; cleaning up “legacy” pollu-

tion; and incorporating modern environmental and health

standards in industrial and agricultural sectors to meet new

internal and external market demands for safety and hygiene.

Many aim for compliance with the European Union’s (EU)

acquis communautaire, although often a phased approach is nec-

essary because of the high cost of upgrading to meet such

strict requirements. Environmental management must also be

addressed within the context of important ongoing changes

in institutional structures and responsibilities, including priva-

tization of state-owned enterprises and a growing emphasis

on cost recovery for basic services. The World Bank is assist-

ing ECA client countries in all these areas through direct in-

vestment and through financial and technical assistance for

policy and institutional reform.

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EUROPE AND CENTRAL ASIA REGION

Utilities and socialservicesOne of the unfortunate outcomes of thetransition was a dramatic deterioration inthe “built environment,” including hous-ing stock and environmental/social ser-vices such as energy, water supply, andsanitation. Slums were virtually un-known in the former Soviet Union, butthey have become a concern in the newlyindependent states due to lack of main-tenance, as well as the growth of infor-mal settlements resulting from strongrural-urban migration and other popula-tion displacements. There is also a dispar-ity in access to utilities and services, asinfrastructure in secondary towns and ru-ral areas has broken down and not beenrepaired (see Figure 1). The MillenniumDevelopment Goals (MDGs) for watersupply and sanitation are based on for-mal connections to “improved” watersupply sources and sanitation facilities.They do not address the situation in manyECA countries, in which connections tosuch systems that were put in place dur-ing the Soviet era still exist but have de-teriorated and are no longer functional.The World Bank is carrying out a region-al study on “Tailoring MDG7 Goals toLocal Conditions in ECA” to identify in-dicators and monitoring methods thatwill better capture the reality on theground.

Governments are making the restorationof environmental and other basic servic-es a high priority, both in response todomestic demand and to facilitate tour-ism development, which is seen as animportant area for future economicgrowth in many ECA countries. This isreflected in World Bank assistance inthe ECA Region, which includes manyprojects for water supply, wastewater,and solid waste management. Bank-financed investments for safe water sup-ply include “end of pipeline” cleanup

BOX 1INVESTING IN SUSTAINABLE SAFE WATER

Building upon earlier projects that focused narrowly on water supply and sanitation, theBosnia and Herzegovina Urban Infrastructure and Service Delivery Project is supporting abroad, integrated approach to improving the quality and efficiency of basic infrastructureand service delivery in urban areas. Activities include developing strategic urban planningprocesses and preparing urban management plans, strengthening local institutions, im-proving revenue collection and management, and making strategic investments in select-ed service sectors.

In Croatia, the Bank is using anAdaptable Program Loan tosupport the implementation ofa comprehensive governmentprogram to clean up pollutionin coastal cities in order to meetEU ambient quality standards.The Croatia Coastal Cities Pol-lution Control Pro-ject focuses on institutionalstrengthening and on-site in-vestment to develop financial-ly and operationally sustainablesystems for wastewater collec-tion, treatment, and disposal.The Albania Coastal Zone Project also supports wastewater management as part of a broaderprogram of coastal cleanup and integrated coastal zone management, including wetlandrestoration.

Discharge of untreated animal wastes and manure is a major source of pollution of Moldo-va’s ground and surface water, threatening both local health, the Danube River, and theBlack Sea. Some 70 percent of the nation’s shallow wells—from which much of the popula-tion draws its drinking water—contain excessive nitrate concentrations. The Moldova Agri-cultural Pollution Control Project aims to promote the use of environmentally friendlyagricultural practices by farmers and agro-industry to reduce nutrient discharges and tostrengthen policies and regulatory capacity for agricultural nutrient pollution control. Itwill also support planting of shrubs and trees to protect water bodies.

Figure 1. Access to infrastructure and energy services in ECA in theearly 2000s by location (percentage of households reporting access)

Note: Average among 20 ECA countries for water connection, 19 ECA countries for district heating and telephoneconnection, 15 ECA countries for natural gas, 10 ECA countries for electricity.Source: Dimensions of Urban Poverty in ECA (World Bank 2004).

0

20

40

60

80

100

Waterconnection

District heatingconnection

Natural gasconnection

Electricityconnection

Telephoneconnection

Perce

ntage

Capital Other urban Rural

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Nura River cleanup.


operations, reducing point and nonpointsources of pollution, and integrated wa-tershed and coastal zone management.Particular targets include coastal areasand secondary towns, with an emphasison strengthening local capacity to devel-op sustainable service delivery systems,including community involvement, pub-lic/private partnerships, and at least par-tial cost recovery. Box 1 provides detailson several projects approved in 2004 or2005. Similar municipal services projectsare under way or at an advanced stage ofpreparation in Tajikistan, Turkey, Roma-nia, and Montenegro.

Indoor heating is essential for health andquality of life in most ECA countries, butthe widespread collapse of subsidized,state-provided systems has left manypeople with inadequate or unhealthyheating options. The Bank is supportinga variety of projects to improve the ac-

cessibility and efficiency of heating ser-vices and reduce negative environmen-tal and health impacts (see Box 2). Homeheating was also the focus of one of thewinning proposals in the 2005 Develop-ment Marketplace competition: the Bos-nia and Herzogovina “Green Wool”Project, which converts the unspinnablewool of a locally adapted breed of sheepinto material for home insulation. Whilenot always thought of in this context, thequality and safety of transport and hous-ing infrastructure are also important ele-ments for physical and mental health.Bank projects targeting these aspects in-clude the Albania Road MaintenanceProject and the Turkey Seismic Risk Mit-igation Project.

Industry and miningResponsibility for the pollution legacyfrom past state-run industry and mining

operations—including toxic wastedumps, contaminated land and water,and orphaned hazardous waste sites—usually remains with the governments inthe region. Where enterprises cannot beprivatized, but closure is unacceptablebecause of potential economic and em-ployment impacts, the challenge is to bal-ance economic realities with the need toreduce adverse environmental and healthimpacts.

Many governments in the region havemade it a priority to address both legacyand current pollution in response to pres-sure from increasingly informed andempowered citizens and in order to meetstrict EU emissions and health standards.The World Bank is assisting with directinvestment and with financial and tech-nical assistance for cleanup operations,replacement of obsolete technologies, andimproved regulation, monitoring, andcompliance. Box 3 provides examples ofBank-financed operations addressing leg-acy pollution issues in the mining, indus-trial, and oil sectors. Projects aimed atreducing pollution in ongoing industrialactivities include the Russian FederationEnvironmental Management Project andthe proposed Ukraine Aligning Industri-al Development with European Environ-mental Standards Project.

AgricultureImportant environmental health issues inthe agriculture sector include excessnitrates and other nutrients and agro-chemicals discharged to surface andgroundwater (including threats to inter-national water bodies such as the DanubeRiver, Black Sea, Adriatic Sea, and Caspi-an Sea), and the need to meet internation-al standards for food safety in order toaccess new markets. Growing local de-mand for safe food and water is comple-mented by the incentive of achievingcompliance with the EU agricultural andenvironmental acquis and access to inter-

BOX 2ENVIRONMENTALLY HEALTHY HEATING

The Poland Geothermal and Environment Project, now near-ing completion, aimed to reduce air pollution from localfossil fuel-fired space-heating boilers by developing a geo-thermal district heating system to serve seven municipalities.Monitoring indicates that SO

2 and PM10 levels now meet both

Polish and EU emissions standards, while NOx emissions are

approaching the EU standard.

In Armenia, urban district heating systems have now largelycollapsed and most urban apartment dwellers now dependsolely on individual heating by wood or coal, putting them atrisk of chronic respiratory diseases and fires. The Urban Heat-ing Project will support a community and private sector ledapproach by removing barriers and creating market condi-tions for commercial provision of heating services, includinginvestment in efficient and safe boilers and monitoring equipment.

The Serbia Energy Efficiency Project will support replacement of inefficient lignite and heavyoil-fired boilers with a gas-fired co-generation plant at a clinical center and energy efficien-cy improvements at schools and hospitals.

In Belarus, about 1.6 million people living near the Chernobyl nuclear disaster face specialhazards, such as the burning of radiation-contaminated wood for home heating and thedisposal of the ash in their gardens. The proposed Post Chernobyl Recovery Project wouldhelp alleviate this problem by connecting an estimated 12,000 homes to a gas pipeline.

Gyumri school boiler (ArmeniaUrban Heating Project).

G. Sa

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EUROPE AND CENTRAL ASIA REGION

national markets. Bank-financed projectsin this sector include improving agricul-tural practices to reduce agrochemicalrunoff from fields and to reduce residuesin meat and produce, and improvingwaste management at animal rearing fa-cilities, slaughterhouses, and other agro-processing enterprises. Examples includethe Romania Agricultural Pollution Con-trol and Romania Environmental Man-agement Projects, Serbia Danube RiverEnterprise Pollution Reduction Project,Moldova Agricultural Pollution ControlProject, Bosnia and Herzegovina SmallScale Commercial Agricultural Develop-ment Project, Ukraine Agricultural Com-

This article was prepared by Agi Kiss, (202)458-7180, [email protected], of theEnvironment and Social Development Unit ofthe Europe and Central Asia Region, and JaneO. Ebinger, (202) 473-0204, jebinger@ worldbank.org of the Infrastructure and EnergyServices Department of the Europe and CentralAsia Region.ECA website: <www.worldbank.org/eca/environment>.

BOX 3CLEANING UP “LEGACY” POLLUTION

The environmental legacy of abandoned mines represents a major health hazard in manycountries; the risks include contamination of soil and of surface and groundwater and therisk of toxic spills from the failure of mine tailings dams. The Poland Hard Coal Mine Clo-sure Project is supporting implementation of a sector reform program in southern Polandinvolving both government and mining companies. Environmental Action Plans have beenprepared for each mine to be closed. The project is also supporting environmental improve-ments at operating mines and building government capacity to enforce regulations andmonitor performance in anticipation of the plan to privatize all mines by 2007. The Roma-nia Mine Closure, Environment, and Social Regeneration Project will improve environmen-tal performance of the mining sector to meet EU accession requirements, build capacity forclosing uneconomic mines in an environmentally sustainable manner, and support socio-economic regeneration of mining regions. The Romania Hazard Risk Mitigation and Emer-gency Preparedness Project is improving management and safety of toxic tailings damsand waste dump facilities and strengthening capacity for disaster management and emer-gency response.

In many ECA countries, large quantities of hazardous wastes generated by metallurgical,machine-building, and energy industries are stored in unsafe conditions, with leakage oftoxic materials into surrounding water, soil, and air. The Kazakhstan Nura River CleanupProject and Ust-Kamenogorsk Environmental Remediation Projects support isolation, ex-cavation, safe storage, and cleanup of existing contamination and implementation of mea-sures to prevent future contamination.

Remediation of oil-contaminated land and water is an urgent is-sue in a number of ECA countries. In Azerbaijan, more than 10,000hectares in the Absheron Peninsula are contaminated with oilfrom over 100 years of oil extraction activities, threatening theCaspian Sea and constraining development in the capital city ofBaku. The Urgent Environmental Investment Project (UEIP) as-sisted the state-owned oil company (SOCAR) to carry out pilotcleanup activities to test the feasibility and efficiency of severaltechnologies (for example soil washing, bioremediation) and todevelop a long-term cleanup strategy.

THE ECA REGIONAL


At the end of June 2005 the active portfolio ofWorld Bank environmental lending in the ECARegion was $1.8 billion.


24%

Landmanagement

20%


7%

Climate change9%

Biodiversity1%


2%





24%

Landmanagement

20%


7%

Climate change9%

Biodiversity1%


2%




petitiveness and Food Safety, and Roma-nia and Croatia Agricultural Acquis Sup-port Projects.

Development policylendingDevelopment Policy Lending (DPL) isbecoming a major element of World Bankfinancing and presents a new set of chal-lenges for addressing environmental is-sues within the context of the revisedOperational Policy 8.60. In one pilot ini-tiative, the Bank is assisting the Govern-ment of Bosnia and Herzegovina to

prepare a rapid Country EnvironmentalAnalysis for three upcoming program-matic development policy credits. Theanalysis will prioritize policies and sec-tors in relation to environmental impli-cations and risks, assess national and localcapacity to mitigate negative impacts,and identify key indicators to trackprogress in environmental mitigation.The main focus will be on componentssupporting enterprise sector restructur-ing and privatization, with particularemphasis on addressing past and presentimpacts of industrial pollution, as well aswastewater management, waste dispos-al, and industrial pollution, where im-provements are needed to meet therequirements of the EU’s environmentalacquis communitaire.

This article is dedicated

to the memory of

Jane Holt

Cleanup of oil contaminatedsite on Apsheron Peninsula,Azerbaijan.

F. Va

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Brazil

Falkland Islands (Islas Malvinas)A dispute concerning sovereigntyover the islands exists betweenArgentina which claims thissovereignty and the U.K. whichadministers the islands.IBRD 31564R SEPTEMBER 2005

Mexico

GuatemalaEl SalvadorNicaraguaCosta Rica

PanamaColombia

EcuadorBrazil

Argentina

Uruguay

Chile

Guyana Suriname

BelizeHonduras

Jamaica

The BahamasHaitiDominican Rep.St. Kitts and NevisAntigua and BarbudaDominicaSt. LuciaBarbadosSt. Vincent and the GrenadinesGrenadaTrinidad and Tobago

Bolivia

Paraguay

Peru

R.B. deVenezuela

Mexico

GuatemalaEl SalvadorNicaraguaCosta Rica

PanamaColombia

EcuadorBrazil

Argentina

Uruguay

Chile

Guyana Suriname

BelizeHonduras

Jamaica

The BahamasHaitiDominican Rep.St. Kitts and NevisAntigua and BarbudaDominicaSt. LuciaBarbadosSt. Vincent and the GrenadinesGrenadaTrinidad and Tobago

Bolivia

Paraguay

Peru

R.B. deVenezuela

Latin America and Caribbean Region

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n spite of notable progress lowering the mor-tality rate of children under five, the impactof environmental factors on health remainsan important problem in the Latin Americaand the Caribbean region (LCR). Environ-

mental problems are a substantial part of the burden of dis-ease in developing countries, and Latin America and theCaribbean are no exception. Polluted water, lack of sanitationand hygiene, urban air pollution, and indoor smoke from sol-id fuels cause tens of thousands of premature deaths, and theyare major contributors to the region’s illnesses and disabili-ties (see Table at right).

Studies indicate that the monetary costs of environment-related health problems can reach several percentage pointsof GDP. In 2004, the cost of the damage caused by particulateemissions in Latin America and the Caribbean was 0.5 per-cent of the regional GNI (World Bank 2004). The distribu-

Attributable mortality in Latin America and theCaribbean for selected environmental factors, 2000

Note: The DALY is a summary indicator that combines the impact of illness, disability,and mortality on population health.Source: WHO 2002.

Sector

Deaths (thousands)

Disability Adjusted Life Years (DALYs)

(thousands) Water, sanitation, and hygiene

54 2,045

Urban air pollution 58 507 Indoor air pollution 26 773

tional aspects of environment-related health problems alsodeserve attention. The poor, and especially poor children, beara disproportionate share of the burden of environment-relat-ed diseases. Some 117 million children live in poverty in Lat-in America and the Caribbean. Most live in crowded,substandard housing in areas that lack basic infrastructure.This exposes them to respiratory tract infections and diarrhea-



LATIN AMERICA AND CARIBBEAN REGION

related illnesses, which are among the topcauses of death among children underfive in the region (PAHO 2003). The poorare disproportionately affected for severalreasons: (a) they are typically more ex-posed; (b) they are frequently exposed tomultiple risks; (c) they are more vulnera-ble; (d) their lack of resources limits treat-ment possibilities and increases lengthand severity of impacts; and (e) humancapital is their most important asset (fre-quently the only one), and pollution-in-duced diseases lower productivity andimpair learning ability.

Because environmental degradation hassuch important impacts on human health,the Latin America and Caribbean Re-gion’s Environment Strategy—consistentwith the Bank’s Environment Strategy—identified the improvement of people’shealth by reducing exposure to harmfulenvironmental factors as one of its fourkey development objectives.

What is LAC doing toaddress these issues?The Colombia Country Environmental Anal-ysis (CEA). The Colombia Country Envi-ronmental Analysis (CEA) estimates thecost of environmental degradation in thatcountry using standard economic valua-tion techniques (see article by Ruta andSarraf on pages 22–23). The analysis

shows that the environment-relatedhealth problems with the highest costs arewaterborne diseases (1 percent of GDP),urban air pollution (0.8 percent of GDP),and indoor air pollution (0.2 percent ofGDP). The burden of these costs falls mostheavily on vulnerable segments of thepopulation, especially poor children un-der the age of five. The analysis providesseparate estimates of environmentalhealth costs in urban and rural areas. Inurban areas, air pollution is the most cost-

ly environmental health problem, fol-lowed by problems related to water, san-itation, and hygiene. In rural areas,problems related to water, sanitation andhygiene are the most costly, followed byindoor air pollution. The CEA also in-cludes the results of a 2004 survey ofpublic perceptions about Colombia’s en-vironmental problems. Of the 2,600 re-spondents, 79 percent identified airpollution as the top environmental prob-lem. There were significant differences inpriorities among income groups; for ex-ample, low-income groups identified airpollution, noise, and natural disasters asmajor problems, while upper-incomegroups tended to perceive global environ-mental impacts (such as global warmingand loss of biodiversity) and inappropri-ate land use in urban areas as high prior-ities. Finally, the CEA found that currentexpenditures are not well aligned withthe priorities of the lower-income groupsor with the most costly environmental im-pacts. The analysis supports the view thatthe most vulnerable groups, who bear thegreatest costs of environmental degrada-tion, traditionally have not been taken

into account in policy making and lack

an effective voice as a constituency.

The Clean Air Initiative in Latin America

(CAI-LAC). The Bank is scaling up the

scope and number of operations to reduce

air pollution in urban areas. Urban air

pollution has worsened in most large cit-

ies in the developing world over the last

few decades and imposes a heavy bur-

den on the health of urban populations.

The Bank has scaled up its work in Latin

America through three main avenues.

First, the Bank is mainstreaming the pro-

motion of sound air quality management

practice into operations, particularly

those dealing with transport. Besides the

ongoing operations in Santiago, Lima,

and Mexico, the Bank is preparing new

GEF projects for São Paulo, Bogotá and

other Colombian cities, and other cities

in the region. The latter category will have

$40 million to be allocated on a competi-

tive basis for urban transport proposals

that promote the reduction of greenhouse

gas emissions and air pollutants. Second,

a Washington-based institution is being

created to better respond to the main chal-

lenges and tasks ahead, such as (a) attend-

ing to a much wider and more diverse

audience, including all interested cities in

the region and key sectors such as envi-

ronment, transport, and energy; (b)

strengthening participation of partners

and members; (c) ensuring financial sus-

tainability; (d) better disseminating expe-

rience and knowledge about air quality

management; and (e) allowing for more

extensive and easier exchange of servic-

es and cooperation among the initiative’s

members and partners. Third, the Bank

is coordinating its efforts to better dissem-

inate and exchange the experience of the

Clean Air Initiative chapters in LAC, Asia,and Africa.

S. Pa

giola

Ahuachapan, El Salvador.


Analytical Work on Indoor Air Pollution.Exposure to indoor air pollution (IAP)—largely from burning solid fuels in poor-ly designed stoves—increases the risk ofa range of common and serious diseasesin children and adults, notably acute res-piratory infection (ARI), chronic obstruc-tive pulmonary disease, and lung cancer.Children under the age of five and thewomen who look after them and spendlong hours cooking are the most vulner-able to IAP’s adverse health effects. ARIs,mostly pneumonia, are the second lead-ing cause of death in children under fiveyears (after neonatal causes). Worldwide,ARIs account for 2 million deaths (19 per-cent) among children under five (WHO2002). In Latin America and the Caribbe-an alone, ARIs are responsible for 53,000deaths (14 percent) of children under theage of five annually.

A study on environmental health and tra-ditional fuel use in Guatemala pioneeredthe region’s efforts to estimate the healthimpacts of IAP from traditional fuel useand to outline strategies and policies formitigating environmental health damagedue to household energy. The lessonslearned through that study have the po-tential for replication elsewhere in theregion.1

Solid Waste Management Strategy. In spiteof progress in collecting solid waste, fi-nal disposal remains largely unresolved.At the regional level, 65 percent of wasteis unsafely disposed of in open dumps.Increased generation of solid waste andmajor deficiencies in final disposal prac-tices cause significant human health im-pacts and environmental problems.Furthermore, sanitation and environmen-tal health, particularly solid waste man-agement (SWM), are top priorities forenvironmental agencies in client coun-tries. To respond to these challenges, LCRlaunched a regional strategy in 2004. The

strategy involves technical assistance andinvestment lending combined with car-bon finance operations.

The strategy’s main objectives are con-struction of safe final disposal facilities,closing of open dumps, and cost-recov-ery improvement to make the SWM sys-tem economically sustainable. Thestrategy is based on (a) development ofnational and provincial SWM plans; (b)regionalization of final disposal facilities;(c) incremental increases in recycling andminimization; (d) inclusion of wastehaulers in the design of the projects; and(e) carbon revenues to assist in the financ-ing of O&M costs. The strategy is beingimplemented in five priority countries:Argentina, Brazil, Colombia, Mexico, andUruguay.

The LCR RegionalEnvironment PortfolioDevelopment Policy Loans. LAC has devel-oped the first generation of developmentpolicy loans (DPLs, formerly known asstructural adjustment loans or SALs) tofocus on the environment sector and themainstreaming of environmental con-cerns in key economic sectors. Brazil,Colombia, and Mexico currently haveDPLs. In Mexico, EnvSAL I supportedthe Government of Mexico in main-streaming environmental issues in keysectors through the establishment ofhigh-level coordination mechanisms be-tween the environment sector and theenergy, forestry, water and tourism sec-tors. EnvDPL II (currently in operation)built on these coordination mechanismsto support activities related to the link-ages between health and environment.In one initiative, the environment sectorworked together with the health andtourism sectors to monitor water qualityon the beaches of the country’s most pop-

ular tourism destinations, with the results

disclosed to the public. In another initia-

tive, the energy and environment sectors

have strengthened the national clean fu-

els policy by promoting renewable fuels

and improving fuel quality; for example,

the sulfur content of gasoline consumed

in the Mexico City Metropolitan Area,

Monterrey, and Guadalajara went from

1,000 to 300 parts per million.

The Colombia Sustainable DPL (Sus-

DevDPL) will support the Government

of Colombia’s efforts to improve environ-

mental management, particularly in ur-

ban areas, by developing a results-based

framework for planning and monitoring

progress toward goals directly linked to

sustainable development and achieve-

ment of the MDGs. The preparation of

critical policies and laws related to air

quality, water quality, solid waste man-

agement, and environmental licensing

will improve air and water quality in ur-

ban centers, leading to decreased morbid-

ity and mortality from diarrheal diseases,

acute respiratory illnesses, and other

health effects. It will also help reduce pro-

tective expenditures for avoiding health

risks.


29%

Landmanagement

23%


15%

Climate change 2%

Biodiversity 3%Other environmentalmanagement

5%





29%

Landmanagement

23%


15%

Climate change 2%

Biodiversity 3%Other environmentalmanagement

5%




THE LCR REGIONAL


At the end of June 2005 the active portfolio ofWorld Bank environmental lending in the LCRRegion was $1.4 billion.


LATIN AMERICA AND CARIBBEAN REGION

This article was prepared by Juan C. Belauste-guigoitia, (202) 473-8809, [email protected], of the Environment and SocialDevelopment Sector Unit of the Latin Americaand Caribbean Region.LCR website: <www.worldbank.org/lacenviron ment>.

The Brazil Programmatic Reform Loanfor Environmental Sustainability’s (En-vPRL I, $505 million) is intended to sup-port the country’s goal of balancingeconomic growth with social develop-ment and the maintenance and improve-

ment of environmental quality. This is thefirst operation in a series of up to threeloans 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 aninterministerial working group on inte-gration of environmental sanitation ac-tions.

Country Environmental Analyses. TheCountry Environmental Analysis (CEA)is the Bank’s main analytical tool to as-sess a country’s environmental challeng-es, its capacity to address these challenges(in the context of poverty reduction andsustainable growth), and the environ-mental implications of broader develop-ment policies and programs. CEAs assessthree components: the state of the envi-ronment and priorities for development,environmental policies, and institutionalcapacity. Environmental health consider-ations figure prominently in all compo-nents. The next CEAs will be conductedin Peru, El Salvador, and Guatemala.

Institutionalchallenges aheadThe LAC Environment Strategy has tar-geted the following objectives: (a) im-provement of people’s health by reducingexposure to harmful environmental fac-tors; (b) enhancement of livelihoodsthrough sustainable management of nat-ural resources; (c) development of en-abling frameworks for sound environ-

mental management; and (d) facilitationof equitable solutions to regional and glo-bal challenges so that future generationsare guaranteed at least the same oppor-tunities as the present generation. Meet-ing these objectives, and solving environ-mental health problems in particular, re-quires institutional coordination.

The first institutional challenge is the lackof effective mechanisms to pick upsignals about the importance of environ-mental health. Estimating the cost ofenvironment-related health problems re-quires information (on emissions, expo-sure, dose-response functions, and valu-ation parameters) that is not available inmost countries in the region. Second, frag-mentation of responsibilities amongagencies can transform environmentalhealth into an institutional “orphan” thatno agency adopts as a priority or focalpoint. Multisectoral problems requiremultisectoral solutions. Coordinating awide range of agencies and balancingstakeholders’ interests to reach agree-ments requires robust and competent in-stitutions. Third, executing agreements(following through on what has been de-

cided) requires commitment, accountabil-ity, and learning ability. The Bank hasdeveloped and is continuously upgrad-ing lending and nonlending tools to helpclient countries meet these difficult chal-lenges.

ReferencesAhmed, K., Y. Awe, D. F. Barnes, M. L. Crop-

per, and M. Kojima. 2005. EnvironmentalHealth and Traditional Fuel Use in Guate-mala. Washington, D.C.: World Bank.

Pan American Health Organization. 2003.Perspectives in Health. Vol. 8, No. 1.

WHO. (World Health Organization). 2002. TheWorld Health Report 2002: Reducing Risks,Promoting Healthy Life. Geneva: WorldHealth Organization.

World Bank. 2004. The Little Green Data Book.Washington, D.C.

Note1. K. Ahmed, and others (2005). See also

separate article by Ahmed and Awe onindoor air pollution in Guatemala onpage 26.

Both

imag

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Country-side farmers’ market with abundant herbsand seeds. Bolivia.

Butterfly found in the Quindio Province of Colombianear the area of a silvopastoral project that aims to

improve the natural habitat of species.

www.worldbank.org/lacenvironment

www.worldbank.org/lacenvironment


Tunisia

AlgeriaLibya Arab

Rep. ofEgypt

SaudiArabia Oman

U.A.E.Qatar

Bahrain

Malta

Kuwait

Rep. ofYemen

Morocco West Bank and Gaza Iraq

SyrianA.R.

I.R.of Iran

Lebanon

Djibouti


Tunisia

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Tunisia

Jordan

overnments in the Middle East and NorthAfrica (MNA) region are coming to the real-ization that ignoring the region’s environ-mental challenges might become a sig-nificant barrier to development. As a result, preparation and implemen-

tation of a growing infrastructure portfolio in the MNA Re-gion has included careful attention to both safeguards andenvironmental mainstreaming issues. The portfolio includesthe transport sector, energy sector (power plants), and watersector (water supply and sanitation).

Several ongoing and new activities will significantly im-prove living conditions in some of the region’s biggest cities.For example, the Bank and the Government of Morocco re-cently completed a successful series of investments in sanita-tion and wastewater pretreatment in the city of Fez, includingthe ancient Medina. Another project would expand and re-habilitate sewerage and wastewater treatment in greater Tunis,Tunisia. In 2005, the Bank’s board approved two operations

that will invest in wastewater collection and treatment: theNorthern Cities Water Supply and Sanitation Project in theIslamic Republic of Iran, which will improve living conditionsin Rasht, Anzali, Sari and Babol, and the North Gaza Emer-gency Sewage Treatment Project in West Bank and Gaza.

The region also faces serious challenges in areas such assolid waste management and handling stockpiles of obsoletepesticides. The Bank is providing assistance through a rangeof investment projects, technical assistance projects, research,and analytical and advisory activities. Moreover, the MNASafeguards team ensures that a fair level of environmentaland social safeguards occurs during project preparation.

The solid and hazardous wasteagendaDuring fiscal 2005, the MNA Region started many initiativesin the area of solid waste management in countries such as

Middle East and North Africa Region

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Tunisia, Iran, Algeria, Egypt, Morocco,and Jordan. This focus was motivated byincreasing regional awareness of the im-portance of proper solid waste manage-ment, as well progress resulting from theRegional Solid Waste ManagementProject under the METAP program (seeBox 1). These initiatives were based on anew approach integrating the emergingcarbon finance market, which has growntremendously in recent years, especiallysince the Kyoto Protocol entered intoforce in February 2005.

At the request of the Tunisian gov-ernment, the MNA Region is currentlypreparing a solid waste managementproject aiming at rehabilitating ninedump sites, as well as expanding and ret-rofitting (with gas collection and flaringsystems and a leachate treatment system)the large Djebel Chekir landfill servingthe greater Tunis area. In the process ofretrofitting the old dumps and the land-fill, it will be possible to claim benefitsfrom emission reductions achieved in ac-cordance with the Clean DevelopmentMechanism rules set forth by the KyotoProtocol. A portion of these emission re-ductions will be purchased by the WorldBank, and the corresponding revenueswill serve to offset the cost of the loanfrom the World Bank.

The MediterraneanEnvironmental Tech-nical Assistance Pro-gramMNA countries are suffering serious en-vironmental and health risks associatedwith poor solid waste management prac-tices. In response, the MediterraneanEnvironmental Technical Assistance Pro-gram (METAP) initiated a four-year Re-gional Solid Waste Management Projectserving eight MNA countries, which isfinanced in partnership with the Europe-an Commission (see Box 1).

Other Regional wastemanagement programsUnder the Trust Fund for Environmen-tally and Socially Sustainable Develop-ment (TFESSD), the World Bank obtaineda grant to prepare a regional activity thatincluded (a) the development of new ge-neric legal and procurement documentsfor implementation of waste disposal fa-cilities through a Design-Build-Operateconcept; (b) preparation of a Manual ofGood Practice for Management of HealthCare Wastes (HCW) suitable for imple-mentation at the health care establish-ment level; (c) preparation of model/generic regulations or bylaws on healthcare waste management suitable for sub-national and/or municipal levels; and (d)development of a regional awareness pro-gram on HCW management. The region-al awareness program’s main objective isto assist national and health care institu-tions to raise the awareness of decisionmakers, community activists, and thestaffs of medical and health care facilitiesregarding the environmental impacts and

public health risks associated with poorHCW management and treatment.

The Africa StockpilesProgrammeAt least 50,000 tons of obsolete pesticides,many including persistent organic pollut-ants (POPs), have accumulated in stock-piles throughout the African continent.Most of these stockpiles are poorly main-tained, with some leaking chemical tox-ins into the ground, water, and air. POPsare particularly harmful to global as wellas local health and the environment, andthus the resulting pollution is an urgentenvironmental hazard and growingthreat to public health.

In Morocco, it is estimated that thereare 700 tons of POPs and other obsoletepesticides (initially used for locust con-trol) that have accumulated over the yearson 225 different sites. In Tunisia, it is es-timated that 1,200 tons have been accu-mulated and are now stored in 17 sites.

The Africa Stockpiles Programme(ASP) is a partnership among the WorldBank, FAO, NGOs (headed by the WorldWildlife Fund and Pesticide Action Net-work-UK), the crop protection industry,and concerned governments. These part-ners have agreed to pool resources andexpertise in a collaborative, comprehen-sive effort to rid Africa of polluting stock-piles and, of equal importance, to put inplace the institutional and training infra-structure needed to prevent their recur-

MIDDLE EAST AND NORTH AFRICA REGION

BOX 1THE REGIONAL SOLID WASTE MANAGEMENT PROJECT

The Regional Solid Waste Management Project is intended to provide the necessary toolsto the MNA countries to design, develop, and implement the main elements of integratedsolid waste management; promote the exchange of information and experience within theregion in the solid waste field; and establish a Regional Solid Waste Management Centre ofExpertise in Tunisia to coordinate the project’s activities and programs. The project alsoincludes a national activity in each of the beneficiary countries that will address priorityissues and emphasize the “learning by doing” approach. To ensure dissemination of projectresults and lessons learned, regional and national workshops are organized during the courseof the project with the participation of all stakeholders.

Abandoned drums in Tunisia.

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rence. The ASP is currently managed bythe Bank’s MNA Region, but ASP activi-ties in the region will be gradually trans-ferred to a project coordination unit,which will be hosted by the New Part-nership for Africa’s Development.

The total cost of cleanup, disposal,and prevention in Africa is estimated at$250 million over a period of 15 years.Seven countries (Ethiopia, Mali, Moroc-co, Nigeria, South Africa, Tanzania, andTunisia) are participating in the ASP’s firstproject (ASP-P1, see map below), a four-year activity to implement preventionmeasures and then inventory and fullydispose of existing stocks. Another eightcountries (from among Benin, Botswana,Cameroon, Côte d’Ivoire, Ghana, Leso-tho, Namibia, Niger, Rwanda, Senegal,Sudan, and Swaziland) are scheduled tobegin preparation and prevention activi-ties during this first phase of operations.Financial support to the ASP from theGlobal Environment Facility, the AfricanDevelopment Bank, the European Union,the World Bank’s Development GrantFacility, Belgium, Canada, Denmark, Fin-land, France, Japan, Sweden, Switzerland,and the participating African countrieshas already reached $60 million, morethan adequate to cover the $50 million es-timated for ASP-P1. The ASP will belaunched in late 2005, starting with Tuni-

sia and followed by the other ASP-P1countries as soon as they are ready toimplement.

Egypt Country Envi-ronmental AnalysisDuring this fiscal year, the MNA Regioncompleted a Country EnvironmentalAnalysis (CEA) for Egypt that included acomprehensive in-country consultation.

The CEA, which spanned the period1992–2002, proved to be a valuable exer-cise that put into perspective Egypt’s ef-forts to address its environmentalchallenges and underscored the need fora new paradigm for stepping up these ef-forts.

The CEA focused particularly on fourmajor environmental issues—air quality,water quality, solid waste, and coastalzone management—during the period1992–2002. It assessed progress, trends,expenditures, and challenges. Since 2002,several notable achievements addressingthese issues were made by the Govern-ment of Egypt.

Despite large public and donor invest-ments during the last decade (totaling LE231.8 billion), including subsidies forwater, energy, and transport amounting

to approximately LE 200 billion, Egyptcontinues to face serious environmen-tal issues. Irrespective of whether theseinvestments were fully justified, thereis strong evidence that such expendi-ture levels cannot be sustained. Theenvironment cannot therefore remaina liability but should become an assetto improve socioeconomic develop-ment.

At present, the social cost of environ-mental degradation is already quitesignificant, and it will continue to in-crease if policies and institutional mea-sures are not provided, which are thenfollowed by targeted priority invest-ments. The direct health and resourcedegradation has been conservatively

estimated (in a study published by theWorld Bank in 2002) at LE 14.5 billion, or4.8 percent of GDP (1999 data). Air, soil,and water pollution have inflicted thelargest damage. At 48.8, Egypt’s Envi-ronment Sustainability Indicator ranks74th among 145 nations. The AdjustedNet Savings (ANS) measure, which ad-justs national savings with respect to nat-ural resources depletion, pollution, andinvestment in human capital, showedthat Egypt maintained a modest level ofANS of 3.4 percent of Gross National In-come in 2001. Environment degradationwas found to affect mostly the poor inEgypt. Furthermore, it is Egypt’s poorthat suffer most from indoor air pollutionand from lack of clean water and sanita-tion and municipal waste collection anddisposal. Environmental issues in Egyptare more prevalent in regions with highpoverty relevance. These issues are pre-dominantly rural and account for morethan 55 percent of damage costs, withurban air pollution accounting for more

BOX 2EGYPT’S PROGRESS IN

ACHIEVING ITS MDG TARGETS

In terms of eradicating extreme povertyand hunger (MDG #1), significant reduc-tions from 1.7 percent to 0.4 percent wereachieved in the last decade for populationliving below $1/day. However, 17 percentof the population still lives below $2/day.Egypt made improvements in youth liter-acy and net primary enrollment (MDG #2),though 43 percent of the populationabove age 15 is still illiterate. Genderequality (MDG #3) is being promoted withsignificant improvements in the educa-tion of females and in job opportunities.Significant reductions in the children-un-der-five mortality rate (MDG #4) wereachieved (85.0/1000 to 52.2), as well as inthe infant mortality rate (67.8/1000 to41.8). There are also indications of improv-ing maternal health (MDG #5); however,there are still incomplete data on combat-ing HIV/AIDS and other diseases.

Africa Stockpiles Programme



45%

Landmanagement

7%

Environmental policy and institutions 11%


1%





45%

Landmanagement

7%

Environmental policy and institutions 11%


1%




MIDDLE EAST AND NORTH AFRICA REGION

THE MNA REGIONAL


At the end of June 2005 the active portfolio ofWorld Bank environmental lending in the MNARegion was $779 million.

than 40 percent. These social costs arelikely to offset some of the nation’s eco-nomic growth gains over time and couldundermine the effectiveness of the gov-ernment’s economic reform program.

The analysis suggests the need for anew approach so that Egypt moves (a)from a focus on inputs (projects, laws) tooutput-oriented outcomes (impacts ofprojects and legal changes); (b) from atop-down approach and centralized de-cisionmaking to a system of informationsharing and improved governance; (c)from a dependence on external assistanceto national resource mobilization; and (d)to a process of measuring performance totrack actions and accommodate learning.

The two main objectives of the CEAare to facilitate mainstreaming of select-ed environmental issues into relevant sec-tor activities for improving developmentand poverty alleviation, and sustainingthe capacity strengthening process of en-vironmental mainstreaming.

Environmental healthin Djibouti, Egypt, andYemenThe environmental health (EH) burden ofdisease reached 20 percent in the MNAregion in 2002. Surprisingly, the burden

of communicable diseases such as diar-rheal and respiratory diseases is relative-ly close to global figures (see Figure,below). Diarrheal diseases are exacerbat-ed by inadequate water supply, sanitationand hygiene practices, and respiratorydiseases by indoor air pollution due toboth unclean cooking and heating fuels,and poor ventilation. Collectively, thesediseases occur mainly at the householdand environs levels in rural areas, wherethey are steadily eroding the well-beingof the poor, especially women and chil-dren.

Environmental health is being pilot-ed in Djibouti, Egypt, and Yemen to im-prove the well-being of the rural poor.This approach is meant to empower com-munities to identify effective and sustain-able interventions to reduce critical EHrisks. The activity in Egypt is focusing onfour issues (identified on the basis of thecost of environmental degradation at thegovernorate level) that will address theenvironment-poverty-health nexus. A vil-lage focus is being pursued in Djibouti(two semi-nomadic villages) and Yemen(nine villages).

Preliminary results emerging fromDjibouti show (a) an excessive genderbias in terms of domestic and pastoraloverwork; (b) infrastructure in both vil-lages that is in disarray, dwindlinglivestock, poorly managed land use, in-

Four leading causes of communicable diseases per 100,000 population,2002

creasingly scarce natural resources suchas water, overgrazed pastures, and over-exploited fuelwood, creating conflictswith nomads over resource sharing; (c) agradual collapse of the semi-nomadic sin-gle source of wealth, the livestock exclu-sively earmarked for domestic use, whichis being substituted by transfers from ur-ban migrant workers; and (d) water quan-tity and quality contributing to the highincidence of diarrheal diseases (24.8 per-cent), fuelwood contributing to the highincidence of respiratory diseases (29.1percent), and vector-borne diseases suchas dengue remaining high (21.5 percent).

Environmental health proved to bean effective entry point to redefine the re-lationship between the semi-nomads andtheir living space in terms of basic infra-structure, land use management, hygienepractices, and production/consumptionpatterns.

Note: TB and malaria rank fourth in terms of the communicable global leading cause of death and burden of diseaserespectively.Source: Doumani, Bjerde, and Kirchner 2005. Rural Water Supply, Sanitation, and Hygiene Adviosry Note, World Bank.

This article was prepared by Hocine Chalal,(202) 458-2153, [email protected], withinput from Sherif Arif, Allan Rotman, StefanieBrackman, Steve Maber, Julia Bucknall, andAhmed Mostafa of the Water, Environment,Rural, and Social Development Sector; and PierFrancesco Mantovani of the Infrastructure andPrivate Sector Development Department—all ofthe Bank’s Middle East and North AfricaRegion; and Fadi Doumani and MurrayNewton, consultants.MNA website: <www.worldbank.org/mna>.

Mortality by Top Four Global Causes(Deaths per 100,000 Population)

010203040506070

HIV/AIDS

ARLI

Diarrhea

TB

MNAGlobal

Mortality & Morbidity by Top Four Global Causes(DALYs lost per 100,000 Population)

0200400600800

1,0001,2001,400

HIV/AIDS

ARLI

Diarrhea

Malaria

MNAGlobal

www.worldbank.org/mna


Nepal

Pakistan

India

Bhutan

Sri Lanka

Maldives


Bangladesh

Nepal

Afghanistan


Bangladesh

Nepal

Afghanistan

South Asia Region

C. C

arne

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C. C

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C. C

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C. C

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ith about 40 percent of the world’s poor,

South Asia is faced with high environmen-

tal health risks that account for one-fifth of

its total burden of disease—comparable to

malnutrition and larger than all other preventable factors and

groups of disease causes. Poverty and the lack of basic infra-

structure, such as lack of safe water and sanitation, clean

household energy, and waste disposal options play by far the

largest role in environmental health risks. Other concerns in-

clude the growing contribution of the infrastructure and in-

dustry sectors to the disease burden. The disease and mortality

associated with poor environmental health impose both a

heavy human as well as an economic burden, with lost pro-

ductivity and livelihoods, increased health care costs, and de-

teriorating quality of life.

Addressing environmental healthrisks through multisectoralapproachesEnvironmental health is a top priority of the South Asia Envi-ronment Strategy and a major element in achieving severalMillennium Development Goals (MDGs), such as those relat-ed to child and maternal mortality, child nutritional status,infectious diseases, and environmental sustainability. TheBank promotes a holistic approach to health in Country As-sistance Strategies, analytical work, and lending through avariety of development projects that have the potential to in-crease health outcomes. The multidisciplinary nature of envi-ronmental health has led to a Regional focus on four primaryareas: (a) poor water supply and sanitation, (b) indoor airpollution, (c) urban air quality and industrial toxics, and (d)inadequate waste disposal.



SOUTH ASIA REGION

The range of activities supported in-clude analytical work to understand andinfluence policies and actions that ad-dress health risks and damages, lendingsupport for targeted interventions, andbuilding of good governance structuresthat are capable of safeguarding the en-vironment and responding to the needsof the poor. Environmental healthachievements over the past year and fu-ture plans are described below.

Strengthening Health Con-siderations in Water andSanitation ProgramsMore than one out of three people in theregion do not have access to adequatesanitation and more than one out of sixpeople do not have access to safe drink-ing water. In rural areas, access levels arefar less, with sanitation virtually nonex-istent in most countries. Over the pastfew decades, the region has made signif-icant strides in scaling up rural water sup-ply and sanitation (WSS); however,despite these improvements, water-relat-ed diseases continue to be a common oc-currence and account for a large numberof child deaths every year.

The Bank is supporting a rigorousevaluation of the health outcomes of ru-ral water supply, sanitation, and hygieneinterventions in two Indian states—Ma-harashtra and Orissa—to evaluate andquantitatively demonstrate, using localdata, the effects of improved water sup-ply and sanitation on childhood diarrheaand growth. The studies are expected todevelop monitoring indicators and makethem workable and user friendly in theWSS sector and also to examine the con-tribution of factors, such as household ed-ucation and good village governance, inmaximizing child health and other non-health benefits, so that optimal servicepackages can be promoted to communi-ties. The design of this evaluation isaimed at not only establishing whetherkey interventions achieve their stated

uated options for operational responsesto arsenic mitigation in Asian countries,ranging from Bangladesh and India, themost well-known cases, to China, Cam-bodia, and Vietnam (see Box, below).

To more effectively scale up the pro-vision of safe water, the Bank has initiat-ed the Bangladesh Water Supply ProgramProject, which is piloting innovative mea-sures for the provision of safe water sup-ply free from arsenic and pathogens inrural areas and small towns. The projectincludes the following components: (a)promoting rural piped water supply withprivate sector participation; (b) promot-ing private sector participation in watersupply in municipalities; (c) implement-ing arsenic mitigation measures in ar-senic-affected villages; (d) supportingdevelopment of adequate regulations,monitoring, capacity building, and train-ing; (e) supporting development of a lo-cal credit market for village piped watersupply; and (f) implementing a monitor-ing and evaluation system for the project.

outcomes, but also shaping future projectdesign and policy to maximize healthbenefits and increase overall cost effec-tiveness.

The Bangladesh Country Environ-mental Assessment (CEA) found that 10–11 percent of the total burden of diseaseis attributable to unsafe water and poorsanitation and excessive arsenic ingroundwater. The study concluded thatimproved water supply requires greaterinvolvement of local governments, high-er levels of investment, improved O&Mservices through the private sector, andan independent regulatory framework tosupervise and monitor performance. Fur-ther, improved sanitation technologiesand low-cost community effluent treat-ment facilities are essential steps neededto realize the health gains from sanitationcoverage.

The Bank has also completed a morecomprehensive regional assessment ofthe current knowledge regarding arseniccontamination of groundwater and eval-

RESPONDING TO ARSENIC CONTAMINATION OF GROUNDWATER IN ASIA

A recently released policy report by the Bank, “Towards a More Effective Operational Response: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 foroperational effectiveness.

Significant strides have been made since arsenic was first detected in drinking water tube-wells in Eastern India in the early 1980s and Bangladesh in the1990s. However, a range offactors—including projected population growth in the region, continuing private invest-ment in shallow tubewells, and the drive toward achievement of the MDG related to safewater supply—add to the urgency of adopting a more strategic approach for effective ac-tion at the project, national, and international levels.

Although the characteristics of arsenic contamination are unique to each affected country,the study results suggest that three simple steps would help governments more effectivelyaddress the problem. At national and local levels, there is a clear need to go beyond datacollection and to actively integrate available knowledge into the water supply sector, such asavailable mitigation technologies, areas of arsenic occurrence, and so forth. This also goes forthe health sector (e.g., teaching health professionals about arsenic), education (ensuring thatwhen schools are built in arsenic-prone areas, wells are tested for arsenic), and for irrigationwells used for drinking (people need to be informed about their safety).

Globally, there is a need for more cohesion in scientific and medical research, and for thedevelopment and funding of a strategic research agenda, to provide a more concrete un-derstanding of the epidemiology of arsenic in the Asian context.


On the urban side, the Bank is exam-ining the reasons for the relatively smallpercentage of urban India served by san-itation and the low level of investmentmade in this sector. It is estimated thatonly 30 to 40 percent of India’s urbanpopulation are currently served by a wa-ter sanitation system. The Urban Sanita-tion and Waste Management Reportfound that there is good technical engi-neering capability in India to design andimplement sanitation facilities; however,there is a lack of coherent urban sanita-tion policies and project planning. In con-junction with the report, the Bank isproducing a new manual and policy noteson “Policy and Planning Principles andIssues Related to Urban Sanitation.”These documents will complement theexisting and widely used government“Manual on Sewerage and Sewage Treat-ment” and will also support the Bank’spreparation of an operational strategy forurban sanitation.

Reducing Indoor Air PollutionThe Bank has been active in indoor airpollution programs in the region due tothe alarming public health consequencesof the use of traditional biomass fuels forcooking and heating. According to theWorld Health Organization (WHO), in-door air pollution from solid fuels ranksfourth among risks to human health indeveloping countries and ranks third inSouth Asia, just below malnutrition and

lack of safe sanitation and drinking wa-ter.

In India, a three-year strategic ana-lytical study undertaken by the Bank wasinstrumental in putting indoor air pollu-tion on the government agenda and help-ing to mainstream these issues in healthresearch and rural energy programs. Thefocus of Bank work in India is now onsupporting initiatives put forward by theGovernment of India and the states, suchas a new program to help rural commu-nities meet their total energy require-ments (for productive use, lighting, andclean cooking) through indigenous, local-ly available renewable resources andtechnologies. The program places empha-sis on community involvement andcreating opportunities for rural employ-ment. In addition, the Bank—through itsEnergy Sector Management AssistanceProgram—initiated the evaluation of theimpact of terminating the central fund-ing of improved stove programs.

In Nepal, indoor air pollution levelsare particularly high as traditional biom-ass energy is used not only for cookingbut also for heating. The Bank is support-ing the Government of Nepal’s BiogasProgram through Carbon Finance. TheCommunity Development Carbon Fundwill purchase Carbon Emissions Reduc-tion credits and allow for full implemen-tation of Phase IV of the program, whichhas a goal of supporting the installationof an additional 162,000–200,000 units by2009. During the earlier phases of the pro-gram, the country achieved installationof over 100,000 biogas reactors through apublic-private partnership to promoteuse of biogas for cooking and lighting inrural areas. In addition to global benefits,the program will produce local benefitsranging from reduced indoor air pollu-tion levels in homes to enhanced agricul-tural productivity and improved forestrypractices.

Expanding its involvement in otherSouth Asia countries, the Bank has sup-ported exposure assessment studies inBangladesh to identify (a) the actual lev-

els of indoor air pollution in rural house-holds with different kitchen and fueltypes, (b) the people who are harmed themost, and (c) the circumstances underwhich they are harmed. As a result, in-door air pollution emerged as one of thekey areas in the Bangladesh CEA, pav-ing the way for follow-up dialogue andassistance, particularly exploring oppor-tunities for replicating the Nepal experi-ence.

Management of Urban AirQualitySouth Asian cities record some of thehighest levels of ambient particulate mat-ter. Small particles less than 2.5 micronin diameter (PM2.5) are particularlyknown to have linkages with respiratoryand cardiovascular ailments, includingpremature mortality and morbidity. Ac-cording to a recent WHO estimate, urbanparticulate air pollution is responsible fornearly 150,000 deaths every year in SouthAsia. Presently, the Bank is active in ur-ban air pollution in India, Bangladesh,and Pakistan, where transport and indus-try sectors are likely among the dominantsources of urban pollution.

Most significant efforts and achieve-ments in strengthening policies and in-stitutions in tackling vehicular pollutionhave been made in Bangladesh throughthe Bank-supported Air Quality Manage-ment Project, which is evaluating policiesand action for mitigating the risks fromtransport-related pollution including airquality monitoring, setting of standards,vehicle emissions, enforcement, trainingand capacity building, public awarenessand stakeholder participation, and insti-tutional sustainability.

In India, following completion of astudy on urban air quality managemententitled For a Breath of Fresh Air: Ten Yearsof Progress and Challenges in Urban AirQuality Management in India 1993–2002,the Bank is finding effective ways to as-sist Central and State Pollution ControlBoards (CPCB and SPCBs) through tech-Indoor cooking in India.

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SOUTH ASIA REGION

nical assistance for institutional capacitybuilding and direct interventions acrossrelevant sectors. A workshop on UrbanAir Quality Management in India—orga-nized jointly by the World Bank andCPCB in October 2004—brought togeth-er state governments that are developing“action plans” for addressing urban airpollution in critically polluted cities.

In Pakistan, the Bank is supporting astrategic CEA that will help determineareas for future engagement based on anongoing compilation and analysis of thestatus of urban air pollution and assess-ment of policies and required actions. TheBank also supported the first nationalworkshop on Urban Air Quality Manage-ment in partnership with Clean Air Ini-tiative-Asia in Lahore in December 2004.

Improving Solid Waste Man-agement and DisposalAs the rate of urbanization increases, is-sues of solid waste need particular atten-tion in the region. Management of solidwaste is a broad topic, covering not onlymunicipal waste but also industrial, haz-ardous, and biomedical waste. In India,for example, larger cities have solid wastecollection systems in place that achievereasonable levels of performance; how-ever, treatment and disposal of the col-lected wastes typically lags behind,and—despite some innovative schemes—most of the waste ends up in offensiveand polluting dumps. Recent legislativeand judicial pressure have put pressureon public sector providers (municipali-ties) to introduce upgraded and accept-able alternatives to these dumps, butthere are institutional capacity, technical,and financial challenges that must be ad-dressed.

To address the problem in India, theBank is supporting municipal authoritiesin improving the environmental qualityof urban areas, with consequent health,environment, and economic benefits.Based on specific requests from the stategovernments of Karnataka and Andhra

Pradesh, the Bank has helped municipal-ities to develop municipal action plans asa basis for identifying future sector in-vestments and attracting private sectorfinance. This work supports the munici-pal reform efforts in these states, particu-larly in areas such as efficiency, the roleof the private sector, performance assess-ment, and increasing emphasis on com-munity-led solutions.

Future plans to buildon present accom-plishmentsThe Bank is aspiring to increasingly ap-ply existing knowledge in the fieldthrough its ability to design and imple-ment multidisciplinary projects with thebreadth required to have an impact onhealth. Building on the environmentalhealth accomplishments of the past year,the Bank has launched several new initi-atives to provide future support for theregion’s efforts in reducing environmen-tal health risks.

In India, the Capacity Building for In-dustrial Pollution Management Projectwill enhance the national- and state-level systems for the effective control andmanagement of urban and industrial pol-lution. The project will support the de-velopment and implementation of aNational Rehabilitation Plan for contam-inated sites, strengthen institutional ca-pacity building for improved enforce-ment of environmental regulations, andsupport the implementation of pollutionreduction and waste minimization inter-ventions through investments particular-ly in hazardous and solid waste manage-ment.

The Bank continues to have a highlevel of commitment to address issues ofindoor air pollution through demand-ori-ented renewable energy projects, build-ing on synergies with global environment

benefits and financing instruments.Though such programs have not beentried in the region and are faced with anumber of institutional, economic, social,and technological challenges, they canhelp to achieve significant health gains ifsuccessfully implemented.

New and important opportunities forengagement are emerging from the recentanalytical work in Bangladesh and Paki-stan. The Dhaka Environment Projectunder preparation holds significantpromise in the demonstration of goodpractices for institutions to manage urbanwatersheds, including water qualitymonitoring, water treatment processes,and public awareness. Now that solidanalytical findings are at hand and clientgovernments are requesting follow-up,the South Asia Region is actively explor-ing opportunities for environmentalmainstreaming in the areas of urban airquality management, indoor air pollu-tion, and institutional capacity enhance-ment measures.

This article was prepared by Jane T. Nishida,(202) 458-9562, [email protected], andPriti Kumar, [email protected]—both ofthe Environment and Social DevelopmentSector Unit of the South Asia Region.SAR website: <www.worldbank.org/sar>.

THE SAR REGIONAL


At the end of June 2005 the active portfolio ofWorld Bank environmental lending in the SARRegion was $1.6 billion.


33%Land

management8%


7%

Climate change 13%

Biodiversity 1%Other environmental

management1%

Pollution management and environmental health

37%



33%Land

management8%


7%

Climate change 13%

Biodiversity 1%Other environmental

management1%

Pollution management and environmental health

37%


www.worldbank.org/sar


The role of theprivate sector

The private sector is the

engine of growth in the

majority of the world’s

economies. A healthy, sustain-

able private sector has the abil-

ity to lift millions out of

poverty and in doing so, im-

prove their lives. This is the

mission of the International

Finance Corporation (IFC),

which in fiscal 2004 committed

over $5.6 billion of financing to

companies operating in emerg-

ing markets.

Yet capital alone and good fi-

nancial performance will not

solve the problems facing

many of our clients. Poor

worker health and environ-

mentally harmful business

practices can have a significant

impact on the sustainability of

communities and private busi-

nesses, as can lack of access to

basic infrastructure, education,

local financing, or pragmatic

advice on environmental and

social dimensions of business

operations. IFC’s strategy is

based on addressing these con-

cerns.

Adding valuethrough leadershipIFC’s environmental and social

leadership has a broad impact

on the private sector. IFC’s per-

PRIVATE RESPONSES

TO PUBLIC PROBLEMSIFC AND

ENVIRONMENTAL HEALTH

formance standards and envi-

ronmental and social guide-

lines are industry benchmarks

for practitioners worldwide.

Adopted by the Equator Banks,

which represent approximate-

ly 85 percent of the global

project finance market, the per-

formance standards provide a

comprehensive environmental

and social risk management

framework, including the

health and safety of workers

and surrounding communi-

ties. By focusing our clients on

community and environmen-

tal health issues, IFC continues

to play a leadership role, en-

couraging clients to move be-

yond traditional concepts of

compliance and instead adopt

a broader strategy of corporate

social responsibility. Such an

approach reflects our mission

as a development institution,

as well as simply making good

business sense.

New businessmodels for publichealthAccording to the World Health

Organization, diseases result-

ing from polluted drinking

water still account for 1.7 mil-

lion deaths per year. In many

countries, the private sector is

stepping into the breach to pro-

vide basic services to commu-

nities. IFC is working with a

number of clients to finance



Institutional Articles

water services through main-

stream investments, in addi-

tion to work through our

sustainable business facilities,

small and medium enterpris-

es, and grassroots programs.

In the Philippines, an IFC cli-

ent, the Manila Water Compa-

ny (MWC), is one of two

private companies providing

water and sanitation services

to Metropolitan Manila since

utility privatization in 1997.

MWC serves over 4.7 million

residents in the city. Under the

company’s watch, many poor

and underserved consumers

now enjoy lower prices and

improved access to water ser-

vices. The company now pro-

vides 24-hour water service to

87 percent of the consumers

within its central distribution

network, compared with just

26 percent when it took over

the concession.

IFC is also supporting an

American company, Water-

Health International (WHI), in

presenting its commercial

model for decentralized water

purification systems in the de-

veloping world. With low cap-

ital expenditures and opera-

ting costs, the company can

provide drinking water to

communities at an annual cost

of $2 per person. In line with

our goal of overcoming barri-

ers to investments and moving

projects toward commercial

viability, the IFC is providing

a $1.2 million equity invest-ment to WaterHealth to helpexpand its operations in Gha-na, India, Mexico, and the Phil-ippines. It is estimated thatthrough this expansion, plus

its emergency response to SriLanka following the tsunami,WHI is reaching 150,000 peo-ple with IFC’s financing andsupport.

In addition, IFC and the World

Bank have established theMunicipal Fund, a joint initia-tive to make investments inmunicipalities, municipal enti-ties, and other tiers of local

government, without takingsovereign guarantees. The ob-jective is to strengthen munic-ipalities’ ability to deliver key

infrastructure services, such aswater and sanitation, by im-proving their access to private

capital markets.

Investing in cleanenergy solutionsThe list of cities with the mostsevere air pollution is dominat-ed by the capitals of develop-

ing nations. Air pollution hasa profound impact on health,especially among children. Thelocal effects of this pollutionare further compounded by cli-mate change.

As the Kyoto Protocol enters

into force, IFC’s goal is to en-

courage and support emerging

market private sector partici-

pation in the carbon market.

IFC is well positioned to assist

project sponsors with partici-

pation in the rapidly growing

market for carbon credits. One

way of doing this is to link

clean energy producers in

emerging markets with buyers

of carbon credits under the

flexible trading mechanisms of

the Kyoto Protocol.

The IFC has already begun

purchasing emission reduc-

tions on behalf of the Dutch

government from companies

in emerging markets that are

This article was written on behalf ofIFC by Louise Gardiner, who is alsothe editor of IFC’s Sustainability Re-port. IFC Sustainability website:<www.ifc.org/sustainability>.

For further information, please con-tact: Vikram Widge, (202) 473-1368(Carbon Finance), and Jeffrey Liebert,(202) 458-7885 (Water Purification).

utilizing clean energy solu-

tions. In Brazil, for instance,

Brascan Energetica S.A (BESA)

has more than 100 MW of op-

erating run-of-river hydro-

power generation assets in six

locations. Similarly, Balrampur

Chini Mills Limited (BCML),

one of the largest sugar pro-

ducers in India, has developed

two cogeneration projects with

a total capacity of nearly 40

MW, which it supplies to the

Uttar Pradesh power grid.

Both are helping reduce their

countries’ dependence on fos-

sil fuels.

There are many other invest-

ments in IFC’s portfolio that

improve public health, wheth-

er they be directly related, such

as new hospitals and emission-

free vehicles, or indirectly re-

lated, such as awareness

campaigns for employees re-

garding HIV/AIDS and other

diseases. Directed by our mis-

sion, our strategy, and the Mil-

lennium Development Goals,

IFC will continue to look for

opportunities to foster private

sector innovation to address

social and environmental con-cerns.

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Brazil.

www.ifc.org/sustainability


The social and environ-mental standards ofIFC are the building

blocks for our approach to sus-tainability and are embodiedin IFC’s Safeguard Policies, itsEnvironmental, Health andSafety Guidelines, and its Dis-closure Policy. Together, theseprovide a framework to helpour clients manage projectrisks and improve their perfor-mance, and they help IFC max-imize the development impactof our investments.

From Safeguards toPerformanceStandardsTo date, the Safeguard Policieshave been the basis for IFC’s

leadership and approach to

environmental and social sus-

tainability. Based largely on

the World Bank’s operational

policies, IFC adopted its cur-

rent Safeguard Policies in 1998

in order to manage environ-

mental and social issues in the

private sector in emerging

markets. IFC’s Compliance

Advisor/ Ombudsman (CAO)

completed a review of the Safe-

guard Policies in April 2003

and recommended that IFC

take a number of steps to im-

prove them. Consistent with

the recommendations of the

CAO, IFC embarked on a two-

year process in fiscal year 2004

to update all of its Safeguard

Policies.

UPDATING AND

IMPROVING OUR

ENVIRONMENTAL

AND SOCIAL

STANDARDS

Following an intensive reviewand analysis of the SafeguardPolicies, IFC has recast theSafeguards as Policy and Per-formance Standards on Socialand Environmental Sustain-ability. The Policy and Perfor-mance Standards improve andexpand upon the existing Safe-guards and represent a newapproach to social and envi-ronmental standards for pri-vate sector performance inemerging markets. Throughthe Policy and PerformanceStandards, IFC is creating con-cise and comprehensive poli-cies that articulate requiredenvironmental and social out-comes, clarify the roles and re-sponsibilities of IFC and itsclient companies, and providea framework for managing en-vironmental and social perfor-mance throughout the life ofan investment.

The Performance Standards (a)place new emphasis on imple-mentation through manage-ment systems; (b) includespecific requirements for ap-propriate community engage-ment; (c) deal with social andenvironmental issues in a moreintegrated manner; and (d)strengthen policy coverage ofissues such as pollution, cli-

mate change, and biodiversity.Central to this approach is theclient’s responsibility to man-age social and environmentalimpacts and improve projectoutcomes. In addition, the Per-formance Standards address anumber of additional subjectsof direct concern to the privatesector, such as labor and work-ing conditions and communi-ty health and safety. To helpIFC’s clients implement andmeet these new standards, thePerformance Standards willalso be supported by a set ofGuidance Notes and goodpractice publications.

Consultation on the NewPolicyBeginning with the public re-lease of the draft Policy andPerformance Standards in Au-gust 2004, IFC conducted anextensive public consultationprocess to consult a wide rangeof stakeholders on the newdraft standards—includingIFC’s clients, other private sec-tor companies and industrygroups, international financialinstitutions, labor organiza-tions, governments, academia,and civil society organizations.IFC staff met with almost 1,000stakeholders through four re-

IFC’S PERFORMANCE STANDARDS

Social & Environmental Assessment and Management SystemLabor and Working ConditionsPollution Prevention and AbatementCommunity Health and SafetyLand Acquisition and Involuntary ResettlementConservation of Biodiversity and Sustainable Natural ResourceManagementIndigenous PeoplesCultural Heritage




gional consultation workshopsand numerous informal, the-matic, and open stakeholdermeetings around the world,and they obtained additionalfeedback through a web-basedconsultation tool and otherwritten submissions.

Public consultation on thedraft policy documents endedApril 29, 2005 and a reviseddraft will be produced for fur-ther public comment in August2005. Once approved by theBoard, the Policy and Perfor-mance Standards are expectedto become effective January 1,2006.

Challenges AheadSuccessful implementation ofthe Policy and PerformanceStandards by January 2006 willrequire extensive internal andexternal communication andtraining. IFC is developing acomprehensive communica-tions initiative and is begin-ning to train staff in bothheadquarters and field officesto implement the new stan-dards. Recognizing our re-sponsibility to maintain aglobal benchmark for the fi-nancial sector in emergingmarkets, IFC will also contin-ue to work closely with otherinstitutions that intend to ap-ply the Performance Standardsto their operations.

IFC Disclosure PolicyIFC’s current Disclosure Poli-cy, also prepared in 1998, isunder review. The new policywill address institutional dis-closure issues. IFC require-

ments regarding client disclo-sures will be included in thePerformance Standards. Whilecontinuing to respect clientconfidentiality, the new Disclo-sure Policy will expand theamount of project informationthat IFC makes public beforegoing to the Board, includingstatements on anticipated de-velopment impact and IFC’sexpected development contri-bution. In addition, the newpolicy will clarify the othertypes of institutional informa-tion that will be made availableand establish a basis for im-proved access. The DisclosurePolicy is expected to be ap-proved by the Board and be-come operational at the sametime as the Policy and Perfor-mance Standards.

The EnvironmentalHealth and SafetyGuidelinesIFC’s policy review also in-cludes a two-year program torevise the Environmental,Health and Safety Guidelines,a set of technical reference doc-uments that establish IFC’sexpectations for managing in-dustrial impacts. The Guide-lines cover a wide range ofsectors, including oil, mining,chemicals, forestry, and infra-structure, among others, andare articulated in the followingtwo sources: (a) the industrysector environmental guide-lines published in Part III of theWorld Bank Group’s 1998 Pol-lution Prevention and Abate-ment Handbook; and (b) IFC’sEnvironmental, Health and

Safety (EHS) guidelines, pub-lished on IFC’s website since1998.

The Guidelines have become aglobally applied technical ref-erence for private sector devel-opment. Their use extendswell beyond IFC clients to adiverse external community ofusers such as other internation-al financial institutions, regu-lators, industry, academics,and commercial banks, includ-ing those banks that haveadopted the Equator Princi-ples.

The UpdateThough the Guidelines wereintended to be “living docu-ments” at their inception, theyhave not been updated since1998. The objective of theGuidelines update is to ensuretheir continued applicability asa valued technical referencesource and to support the im-plementation of IFC’s newPolicy and Performance Stan-dards, notably those related tothe prevention and control ofindustrial pollution and occu-pational health and safety.

IFC is actively consulting withtechnical experts to maintainthe high standard and applica-bility of the Guidelines acrossthe diverse market sectors wefinance. The update of theGuidelines will incorporateconcepts of sustainable devel-opment, cleaner production,and environmental and occu-pational health and safety as-pects, with an emphasis ongood management practices.The process will streamline the

Guidelines and improve theirapplicability to projects, incor-porating the use of perfor-mance indicators andbenchmarks to improve theirutility to the diverse commu-nity of external users.

The total body of environmen-tal guidelines published as ofAugust 1, 2004 (as listed onIFC’s website at <www.ifc.org/enviro> will be reviewedover a two-year period, withpublication of the updatedGuidelines scheduled for Au-gust 2006. Extensive publicconsultation on the revisedGuidelines will coincide witha structured peer review pro-cess to ensure that the Guide-lines continue to provideglobally applicable good prac-tice.

Additional information on theupdating of IFC’s policies andguidelines is available at:<www.ifc.org/policyreview>.

This article was prepared by JonRichart and Chris Frankel of IFC’sEnvironment and Social Develop-ment Department with input fromthe policy and guidelines reviewteam. Policy review website: <www.ifc.org/policyreview>.

For further information, please con-tact: Motoko Aizawa (202) 473-0803(Safeguards Update), Bill Bulmer(202) 473-8750 (Disclosure Review),and Alex Indorf (202) 473-1492(EHS Guidelines update).

www.ifc.org/enviro

www.ifc.org/enviro

www.ifc.org/policyreview




During the past year,the World Bank Insti-tute (WBI) has col-

laborated closely with theWorld Bank’s country teamsand with partners in develop-ing demand-driven learningprograms and activities thatare aligned with World Bankoperations and that focus onlong-term institution building.Learning program content iscustomized to meet specificcountry needs and priorities inclient countries. This country-focused work is complement-ed by regional and globalactivities.

WBI helps countries share andapply global and local knowl-edge to meet their povertyreduction and sustainable de-velopment challenges. We dothis through courses and sem-inars, policy advice, and otherlearning products and servic-es on a range of topics, includ-ing environment, health, andsustainable development. Ouractivities reach targeted audi-ences that include policymak-ers, academics, journalists,nongovernmental organiza-tions, and leaders of civil soci-ety.

Environment andnatural resourcesmanagementWBI’s Environment and Nat-ural Resources Management(ENRM) learning programhelps client countries buildtheir capacity to manage scarcenatural resources and improveenvironmental quality in the

CAPACITY

DEVELOPMENT

AND

INSTITUTIONAL

STRENGTHENING

broader context of sustainabledevelopment and poverty re-duction. The ENRM programbuilds the skills of individualsand the capacity of institutionsthat influence the design ofnew policies or have responsi-bility for the management ofenvironment and natural re-sources.

The ENRM program (a) helpsimprove clients’ understand-ing of the linkages among eco-nomic growth and povertyreduction, natural resources,ecosystem services, and insti-tutions; (b) fosters the acquisi-tion of skills and practical toolsnecessary to reconcile econom-ic growth with the challengesof promoting clean air, improv-ing the urban environment,conserving biodiversity andnatural resources, and mitigat-ing and adapting to climatechange; and (c) strengthens thecapacity of institutions to bet-ter manage environmental andnatural resources in more sus-tainable ways that take local,national, and regional factorsinto account.

Assessingenvironmental health& economic costsWBI’s ENRM program helps todevelop skills in environmen-tal and natural resource eco-nomics, including training intools for assessing changes inenvironmental health; exam-ples include the global courseon Environmental Economicsfor Development Policy andmore intensive courses imple-

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ANNUAL REVIEW • JULY 2004–JUNE 2005 (FY05)ANNUAL REVIEW • JULY 2003–JUNE 2004 (FY04) 61

mented by regional and coun-try-level institutions. Pollutionimpacts on health, such as pre-mature death and disabilityfrom illness, are examinedthrough a multidisciplinaryframework that combines airpollution dispersion modeling,epidemiologic results, technol-ogy choices, and economic val-uation methods. These areused to examine a range of en-vironmental health issues, in-cluding the monetary coststhat result from deteriorationof health and the cost effective-ness of alternative approachesto reduce impacts from pollu-tion.

Illustrative cases of applyingeconomic analysis to environ-mental health are used aslearning tools in WBI capaci-ty-building activities. Theseinclude benefit-cost analysis ofamendments to the 1990 U.S.Clean Air Act; World Bankstudies that have examinedcleanup of the Ganges River inIndia; cost-effectiveness anal-ysis of air quality improve-ments in Mexico; and assess-ments of improving stoves forcooking and heating in thehighlands of Guatemala.

CapacitydevelopmentIn fiscal 2005, 10 courses in-cluded modules on environ-mental health issues. Some 230individuals on average spentone-and-a-half days learningspecific economic tools direct-ly related to environmentalhealth concerns. The moduleswere either part of environ-

ment and natural resource eco-nomics courses or were target-ed sessions, such as the twothat were conducted under theClean Air Asia Initiative. Theywere implemented at variouslevels: one global event; sevenregional events for Africa, EastAsia, Latin America, and SouthAsia; and two country-levelworkshops for China and Rus-sia. In addition, environmen-tal health issues werediscussed in venues such as theBetter Air Quality Conferencefor Asia and at regular univer-sity courses on environmentaleconomics in China. Courseparticipants were either con-ducting environmental healthstudies themselves or wereengaged in policy discussionson the management of pollu-tion in their respective institu-tions. Plans are under way toassess the results of enhancedcapacity on environmentalhealth issues and improve theeffectiveness and impact of fu-ture events.

Emergingenvironmentalhealth-relatedprogram activitiesWBI is starting a new solidwaste management trainingand knowledge sharing pro-gram in Africa and India thatwill help develop the capacityof governments at the country,provincial, and local levels toprovide adequate and sustain-able solid waste management.Case studies and other trainingmaterials are being prepared toaddress some of the most com-

mon problems faced by manymunicipalities, including pri-vatization, contracting, cost re-covery, and finance issues.Training activities (face-to-face,multimedia, and web-based),including certification courses,will be complemented and re-inforced by local and regionalnetworks of institutions andexpertise.

Training materials on indoorair pollution, including a mul-tisectoral case study of China,are being developed for a newcourse—on “AcceleratingProgress toward the HealthMillennium DevelopmentGoals (MDGs) and otherHealth Outcomes”—to be of-fered by WBI’s Health & AIDSlearning program in 2005. TheChina case study is part of thecourse’s focus on cross-sectoraldeterminants and approachesto achieving the MDGs. Thecase study describes the healthimpacts of indoor air pollutionand explores how China is ap-proaching the reduction of in-door air pollution, includingpossible interventions. Thecourse highlights the need toinvolve many sectors in devel-oping policies and actions andthe fact that the country con-text remains critical.

Partnerships &expanding reachThrough these and our otherlearning programs, WBI worksin partnership to increase ourreach, impact, and effective-ness. Partners include aca-demia, the public and privatesectors, nongovernmental or-

ganizations, and foundationsin client countries. Partner-ships are often multiyear pro-grams developed in collabo-ration with local capacity-building or service delivery in-stitutions that will eventuallydeliver learning and knowl-edge sharing programs ontheir own.

For example, a partnershipthat includes the State Environ-mental Protection Administra-tion of China, WBI, the Inter-national Association of ImpactAssessment, and the UnitedStates Environmental Protec-tion Agency is helping to ex-pand training activities inChina on strategic environ-mental assessment and envi-ronmental economics.

WBI expands its reach by us-ing communications technolo-gy as appropriate for eachactivity and audience, includ-ing video conferencing throughthe Global Development Learn-ing Network, the Internet,web-based e-learning andfacilitated online courses, e-discussions, and digital radio.Our learning products includeweb sites, CD-Rom libraries,case studies, and other trainingmaterials.

This article was prepared by MarianDelos Angeles and Bonnie Bradfordof the World Bank Institute’s Envi-ronmentally and Socially SustainableDevelopment Division. Fax: (202)676-0978. E-mail: <[email protected]>. Website:< w w w . w o r l d b a n k . o r g / w b i /sustainabledevelopment>.

www.worldbank.org/wbi/sustainabledevelopment

www.worldbank.org/wbi/sustainabledevelopment


The World Bank’s De-velopment Market-place (DM) is a com-

petitive grant program thatidentifies and directly supportsinnovative development ideas.Since 1998, the DevelopmentMarketplace has awarded al-most $35 million to over 570groundbreaking projectsin more than 70 countriesthrough global competitionsand country-level and region-al development marketplaces.

Open to all, DM draws togeth-er a variety of individuals andinstitutions (NGOs, govern-ment agencies, donor agencies,academic institutions, and pri-vate sector companies) to findunique solutions for commonproblems in the developingworld, which can then be ex-panded or replicated else-where.

This year’s DM theme was In-novations for Livelihoods in aSustainable Environment, whichreflects the Bank’s commit-ment to support ideas and in-novations that demonstratelocal leadership in promoting

environmentally sound eco-nomic development.

Out of the 2,600 applicationsreceived, 78 finalists came toWashington, D.C., for the two-day competition to showcasetheir unique ideas in areas suchas bringing renewable energyto small communities, reduc-ing air and water pollution,promoting sustainable agricul-ture, and raising environmen-tal awareness. The jury selec-ted 31 projects and awardedclose to $4 million in grants.Their winning ideas rangedfrom a radio soap opera inVietnam that educates farmerson environmentally soundfarming practices to re-usingcleansing water from mosquesfor irrigation in water-scarceYemen.

WinningEnvironmentalHealth ProjectsTwo winners of $150,000awards—a project to providelow-cost, jetted wells in Mada-

THE DEVELOPMENT

MARKETPLACE –WINNERS IN THE

ENVIRONMENTAL

HEALTH CATEGORY

Former Bank President Wolfensohn at the awards ceremony with the 31 winners of this year’s Development Marketplace.

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gascar and another designed tocollect used engine oil inNairobi—are highlighted herebecause of their important po-tential environmental healthbenefits.

Jetted wells. Interviewed at theWorld Bank, Adriaan Mol ofBushProof explained that theproject in Madagascar was de-signed to provide clean waterto rural, coastal areas by rap-idly constructing low-cost, jet-ted wells with hand pumps.Such projects are badly need-ed in Madagascar, where ac-cess to safe water in rural areasis only 14 percent and drops tozero in many isolated villages.The people living in many ofthese rural areas now useheavily contaminated surfacewater from rivers, ponds, orrice fields for drinking. A shal-low, sandy aquifer with safedrinking water lies a fewmeters below their feet, butlocal communities lack themeans to tap into this source.

The project combines two low-cost technologies: well jetting,which directs a powerfulstream of water to cut a well,and the plastic Canzee handpump to draw water out of thewell. Mol said that the projectteam expects to construct 150wells in a matter of weeks,proving that a large number ofwells can be constructed veryrapidly—sometimes at a rate of50 wells per week. The teamwould also use the wells’ nat-ural sand filtration to clean thewater, thus avoiding the use ofcostly disinfectant chemicals.Moreover, the Canzee pump—

which was personally demon-strated by Mol at the market-place—will be manufacturedlocally so that it would bewidely available and afford-able. The project expects toprovide more than 15,000 vil-lagers with access to safedrinking water. The techniquehas the potential to reach 1million people in Madagas-car’s coastal areas.

Used engine oil. The objective ofthis project in Nairobi, Kenya,is to clean the Mukuru-NgongRiver by encouraging vehiclemechanics to collect used en-gine oil instead of dumping itinto the river, said CollinsApuoyo, who enthusiasticallyrepresented the project on thefloor of the Development Mar-ketplace.

He explained that about 13million liters of lubricating oilare used annually in Kenya,most of which eventually endsup in the water system. InNairobi, many motor vehiclemechanics change vehicle oilalong the banks of the Muku-ru-Ngong River and dispose ofthe used oil directly into theriver; used engine oil accountsfor about 90 percent of oil pol-lutants in the river. The low-income neighborhoods alongthe Mukuru-Ngong River thenuse this polluted water fordrinking and cooking, result-ing in a high incidence ofwaterborne disease. Moreover,the oily water has severely re-duced the river’s wildlife.

The project converts used oilinto cash and/or loans througha credit points system, turning

a pollutant into an income sup-plement and encouraging me-chanics to collect used oilinstead of discarding it. Theproject would then sell the col-lected oil to recycling and re-processing centers. Prelimi-nary market surveys indicatepotential for selling up to60,000 liters of reprocessed oil.Recycling just one automobileoil change protects 1 to 4 mil-lion liters of water. The projectexpects 100 vehicle mechanicsto participate directly in theprogram, thereby improvingwater quality and health forthe 5,000 households who livealong the river. “If we can re-duce the amount of disposedoil in the river, it will be goodfor the health of people whoswim in the river and use its

This article was prepared by BobLivernash on the basis of interviewsby Debra Beattie and backgrounddocumentation researched by Alex-andra Sears. For further informationabout the projects, contact AdriaanMol (adriaanmol@bush proof.com) orCollins Apuoyo ([email protected]).The Development Marketplacewebsite: <www.developmentmarketplace.org>.

The Development Marketplace winner for cleaningengine oil from the Mukuru-Ngong River, Mr. CollinsApuoyo, of Kenya.

water for drinking and cook-ing,” said Apuoyo.

The project also could haveother important benefits. Ac-cording to Apuoyo, “If we areable to stop the oil from gettinginto the river, we may improveaquatic life, and that may endup encouraging the communi-ty to use the fish for nutrition-al purposes.”

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www.developmentmarketplace.org

www.developmentmarketplace.org

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All $ = U.S. dollars except where noted.All tons = metric tons.

Thanks to Kirk Hamilton and the WorldBank Photo Library for the images found inthe photo bar on pages 22 through 31.

IBRD maps numbered 31562 through31567 contained in the Regional section ofthe magazine were produced by the MapDesign Unit of the World Bank. Theboundaries, colors, denominations, andany other information shown on thesemaps do not imply, on the part of theWorld Bank Group, any judgment on thelegal status of any territory, or anyendorsement or acceptance of suchboundaries. The countries identified byname on these maps are countries towhich the Bank provides developmentassistance in the form of loans or advisoryservices, and for which the Bank has adesignated official responsible for thecountry.

Environment Matters is a magazine of theWorld Bank Group. You may also find themagazine on the Bank’s website — http://

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Environmentally and Socially SustainableDevelopment Network Managers

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Environment

James Warren Evans

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Kevin M. Cleaver

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Steen Lau Jorgensen

Environment Matters is produced by theWorld Bank’s Environment staff.

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Cover: A typical kitchenin rural households ofSouth Asia. Thephotograph was takenin August 2004 inBangladesh.

In line with one of the major themes in the World Bank’s Environment Strategy, this year’s editionis devoted to the theme of environmental health. We also provide a broader, annual review of thepast fiscal year from an environmental perspective, captured most directly in the Director’s Over-view and supported by regional contributions in the latter part of this edition.

Viewpoint articles in this edition reflect several external perspectives. WHO lays out the panoramaof environmental risk factors; a successful example of combating urban air pollution is provided bythe former mayor of Bogotá; successful strategies to enhance sanitation among poor people aresuggested 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 aBank-wide review of our safeguard policies and conveys the latest data on our environmentallending and analytical work.

This year’s feature articles all cluster around the main theme of environmental health: Ruta andSarraf explain the basics of economic valuation of health impacts of environmental risks; Kaufmannsummarizes a recent study that provides an overview of what we know about the effectiveness ofinterventions in water & sanitation; Ahmed and Awe return to the theme of indoor air pollutionwith a study from Guatemala; Constant and Procee explain how the Bank’s Clean Air Initiativeworks in several regions; and Tynan concludes the section with an article on the risks that chemicalspose to human health.

A major part of this edition—as in the past—consists of reviews of each of the Bank’s Regions. Withattention to the environmental health theme, each Region has chosen a number of issues andprojects to feature in their annual review. This section provides ample illustration of the diversity ofissues that the Bank is confronting in collaboration with client countries. The regional reviews arecomplemented by the institutional perspectives of the International Finance Corporation, whichdeals with private sector development, and the World Bank Institute, which is responsible forcapacity building in client countries.

The Bank’s Development Marketplace focused on environment this year, and two winning projectsare 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 oursubscriber database. It also provides an important opportunity for you to provide feedback to us,so that next year’s Environment Matters can be even better.

Jan BojöLead Environmental Economist, Environment Department,

and Technical Editor for Environment Matters 2005

© 2005 The International Bank for Reconstructionand Development / The World Bank1818 H Street, NWWashington, DC 20433All rights reserved Welcome to

matters. . .

Photographer: Prabir Mallik

Integrating Environmental Considerations in Policy Formula-tion — Lessons from Policy-Based SEA ExperienceReport No. 32783Forthcoming

Lessons for Managing Lake Basins for Sustainable UseReport No. 32877Forthcoming

Local Approaches to Environmental Compliance —Japanese Case Studies and Lessons for Developing Countries(WBI Learning Resource Series)Adriana Bianchi, Wilfrido Cruz, and MasahisaNakamuraFebruary 2005ISBN 0-8213-6101-5 $20.00

Tools for Civil Society Action to Reduce Forest Corruption —Drawing Lessons from Transparency InternationalKenneth L. RosenbaumJanuary 2005

The Little Green Data Book 2005April 2005(ISBN 0-8213-6076-0)$15.00

Responsible Growth to 2050Kirk Hamilton and Ian JohnsonOctober 2004

Disseminat ion NotesDisseminat ion NotesDisseminat ion NotesDisseminat ion NotesDisseminat ion Notes

Guidance on Waste ManagementJanuary 2005, No. 66

Environment Monitors 2004Environment Monitors 2004Environment Monitors 2004Environment Monitors 2004Environment Monitors 2004

Vietnam: Solid WasteThailand: BiodiversityPhilippines: Assessing Projects

Environment Strategy NotesEnvironment Strategy NotesEnvironment Strategy NotesEnvironment Strategy NotesEnvironment Strategy Notes

Strategic Environmental Assessment —Concept and PracticeESN No. 14Kulsum Ahmed, Jean-Roger Mercier, and Rob VerheemJune 2005

Mitigating Drought – Long Term Planning to ReduceVulnerabilityESN No. 13Enos E. EsikuriJune 2005

Integrating Environmental Issues into PRSPsin ECA CountriesESN No. 12Nicholas James DaleMay 2005

Rethinking the World Bank’s Environmental PortfolioDistribution — Adjusting for Threats and Country RiskESN No. 11Craig Meisner, Susmita Dasgupta, and David WheelerNovember 2004

Environment Strategy PapersEnvironment Strategy PapersEnvironment Strategy PapersEnvironment Strategy PapersEnvironment Strategy Papers

Analytical and Advisory Activities in Environmentaland Natural Resource Management —A Review of Fiscal 2002–04 ActivitiesESP No. 10Anjali Acharya, Milen Dyoulgerov, and Eri TsutsuiForthcoming

Environment Department PapersEnvironment Department PapersEnvironment Department PapersEnvironment Department PapersEnvironment Department Papers

Devolution of Resource Rights, Poverty, andNatural Resource Management — A ReviewEnvironment Department Paper No. 104Priya Shyamsundar, Eduardo Araral, andSuranjan WeeraratneMay 2005

Scaling Up Biomass Gasifier Use —Applications, Barriers, and InterventionsEnvironment Department Paper No. 103Debyani Ghosh, Ambuj Sagar, and V.V.N. KishoreNovember 2004

Environment in Poverty Reduction Strategiesand Poverty Reduction Support CreditsEnvironment Department Paper No. 102Jan Bojo, Kenneth Green, Sunanda Kishore, SumithPilapitiya, and Rama Chandra ReddyNovember 2004

Assessing the Economic Value of Ecosystem ConservationEnvironment Department Paper No. 101Stefano Pagiola, Konrad von Ritter, and Joshua BishopIn collaboration with The Nature Conservancy and IUCNOctober 2004

Cl imate ChangeCl imate ChangeCl imate ChangeCl imate ChangeCl imate Change

Disaster Risk Management in a Challenging ClimateFrank Sperling and Francisco SzekelyMay 2005

PUBLIC

ATIONS

A Selection of World Bank Group Environmental PublicationsThe following publications may be obtained by sending an email to [email protected], or by phoning the EnvironmentDepartment Publications Unit at (202) 473-3641.
