ifpri 2020 panel discussion "understanding the interactions between agriculture &...

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Public Health and Environment

Agriculture-Nutrition-HealthAgriculture-Nutrition-HealthFrom Framework to ActionFrom Framework to Action

IFPRI Washington DC, 28 October 2010IFPRI Washington DC, 28 October 2010

Robert Bos, Robert Bos, CoordinatorCoordinatorWater, Sanitation, Hygiene and HealthWater, Sanitation, Hygiene and HealthWorld Health OrganizationWorld Health Organization

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Today’s presentationToday’s presentation

• Where were we four years ago?

• Frameworks and models in the health sector

• The local perspective: safe use of wastewater

• New opportunities

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Public Health and EnvironmentKey messages for policy and programme changeKey messages for policy and programme change

(1) Allocate resources to public health actions that, by independent criteria, are truly intersectoral.

(2) Initiate a process of joint review, reformulation and harmonization of agriculture and health policies.

(3) Anchor the methods and procedures for health impact assessment in the planning of agricultural development.

(4) Re-structure and strengthen the health sector to enable it to collaborate effectively in an agriculture/health framework.

(5) Analyse and document the economics of joint agriculture and health actions as opposed to single sector approaches.

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THE GLOBAL HEALTH PICTURETHE GLOBAL HEALTH PICTUREGlobal mortality rates from water-, sanitation- and hygiene-related diseasesGlobal mortality rates from water-, sanitation- and hygiene-related diseases

Disease Cases per year

Deaths per year (year)

Cholera 131 943 2 272 (2005)

Typhoid fever

16 million 600 000 (2000)

Diarrhoeal disease

4.6 billion 2.2 million (2004)

90% of the toll of diarrhoeal disease is borne by children under five

(WHO 2000, 2006, 2007 and Prüss-Üstün et al. 2008)

WHO/Carolos Gaggero

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The insidious impact of morbidity: billions of diarrhoeal disease and malaria episodes; hyper-endemic intestinal worm infections; chronic under- and malnutrition; chronic effect of exposure to arsenic or pesticides …

What is prevention?

What are the economic dimensions of managing determinants of health rather than managing disease?

Do emerging diseases take prevalence over long-time health crises to which we have become accustomed?

THE GLOBAL HEALTH PICTURETHE GLOBAL HEALTH PICTUREFor other sectors: poor living standards, lost productivity, For other sectors: poor living standards, lost productivity, missed development opportunitiesmissed development opportunities

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Linkages between agriculture and health: a conceptual frameworkLinkages between agriculture and health: a conceptual framework

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Development policy and healthDevelopment policy and health

Social determinants

Environmentaldeterminants

Healthsystem

Health

HealthPolicy

DevelopmentPolicy

Poverty

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Social determinants

Environmentaldeterminants

Healthsystem

Health

HealthPolicy

Agricultural Development Policy

Poverty

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Improved land tenure;Increased income;Enhanced farmer education;

Intensified and expanded irrigation; changed livestockmanagement; increased chemical inputs; introduction new crop varieties; mechanization

Healthsystem

Health

HealthPolicy


Poverty

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Improved land tenure;Increased income;Enhanced farmer education;

Intensified and expanded irrigation; changed livestockmanagement; increased chemical inputs; introduction new crop varieties; mechanization

Healthsystem

Communicable diseasesNon-communicable diseases

MalnutritionInjuries and accidents

Psycho-social disorders

HealthPolicy


Poverty

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Development

Driving forces

Action

We change the world

We change the world

Environmental

Pressure

Environmental State

Human Exposure

Health Effect The DPSEEA model

Modified from WHO, 1997

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EnvironmentalEnvironmental

PPressureressureConsumption

patternsProduction

manufacturingWaste release

Driving Forces Population growthEconomic

developmentTechnology

EnvironmentalEnvironmental

SStatetateNatural hazards

Resource availability

Pollution levels

DPSEEA

Development

We change the world

We change the world

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Human

Exposure

Health

Effect

Level of external exposure to hazards

Level of hazards absorbed

Target organ dose

Well-being Morbidity Mortality

ActionTo reduce burden of disease and

increase well-being

DPSEEA

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Modified from WHO, 1997

DevelopmentDevelopment

Driving forces

Actionction

Environmental

Pressure

Environmental Statee

Human Exposure

Health Effect

Environmental improvement, pollution monitoring and control

Education, awareness raising

Treatment, rehabilitation

Economics, social policies, clean technology

Hazard management

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Water Safety Plans Water Safety Plans Integrated risk assessment & incremental risk managementIntegrated risk assessment & incremental risk management

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Managing hazards and risks along agricultural value chainsManaging hazards and risks along agricultural value chains

• Establish health-based targets for your outcome for vulnerable groups

• Identify hazards and assess risks at each critical point along the chain

• Design safeguards and risk mitigation measures along your chain that add up to achieve your health-based target

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Wastewater use in agriculture: Wastewater use in agriculture: Situation and trendsSituation and trends

• Fresh water resources are rapidly becoming scarce. • Rapid urbanization is resulting in increasing outflows of domestic wastewater.• There is a growing market of urban workers looking for fast food with “green”

ingredients • Fertilizers are a costly input into the agricultural production system.

Result: Farmers in rural and peri-urban areas are turning to the use of wastewater, excreta and greywater in agriculture and aquaculture in increasing numbers.

Without effective risk assessment and management, such use incurs important health hazards. The associated water-borne disease risks affect farmers and their families, those who market the produce and consumers.

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Informal, shifting urban Informal, shifting urban agriculture using agriculture using wastewater in and wastewater in and

around Accra, Ghanaaround Accra, Ghana

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Disposal of septic Disposal of septic tank sludge at tank sludge at Lavender Hill, Lavender Hill, Accra GhanaAccra Ghana

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Cooperative peri-urban Cooperative peri-urban agriculture in Pikine, agriculture in Pikine, near Dakar, Senegalnear Dakar, Senegal

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Wastewater use in agriculture is extensive worldwide,Wastewater use in agriculture is extensive worldwide,and on the increaseand on the increase

• Ten percent of the world’s population is thought to consume wastewater irrigated foods.

• Twenty million hectares in 50 countries are irrigated with raw or partially treated wastewater.

• The use of excreta (faeces, urine) is important worldwide, but the extent has not been quantified.

• The use of greywater is growing in both developed and less-developed countries – it is culturally more acceptable in some societies.

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Irrigation water use in cities around the worldIrrigation water use in cities around the world

Wastewater use is extensive worldwide, and increasing

• Ten percent of the world’s population is thought to consume wastewater irrigated foods.

• Twenty million hectares in 50 countries are irrigated with raw or partially treated wastewater.

• The use of excreta (faeces, urine) is important worldwide, but the extent has not been quantified.

• The use of greywater is growing in both developed and less-developed countries – it is culturally more acceptable in some societies.

0

5

10

15

20

25

30

Dilutedwastewateror polluted

water

Untreatedwastewater

Groundwater Treatedwastewater

River Othersurface

water bodies

Rainfed Irrigationcanal

Opendrainage

Nu

mb

er o

f ci

ties

Source: IWMI 2007

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Public Health and EnvironmentKey messages for policy and programme change revisitedKey messages for policy and programme change revisited

(1). Allocate resources to public health actions that, by independent criteria, are truly intersectoral.

Explore whether recent re-structuring in bilateral donor agencies (from sectoral to thematic approaches) offers new opportunities to put multidisciplinary/intersectoral issues on the agenda.

Generate new and more compelling evidence for ministers of planning and of finance about the potential to improve agriculture-associated health status through targeted investment in agriculture.

Mainstream health impact assessment in investment planning for the agriculture sector.

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Enlist a number of interested governments in an exercise of reviewing, reformulating and harmonizing agriculture, health and nutrition policies.

Develop ways to translate the harmonized policies into functional institutional arrangements between the different public sectors.

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(Covered under 1 from a more effective resource allocation perspective).

Combine the creation of an enabling policy environment for HIA with institution strengthening and human resource development.

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Boost the environmental health and health promotion components in health sector programmes.

Generate evidence of how other sectors can assist in overcoming health sector constraints (drug resistance, insecticide resistance, infrastructure and human resource deficiencies, outbreak and crisis pressures).

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(5) Analyse and document the economics of joint agriculture and health actions as opposed to single sector approaches.

Implement economic evaluations in a number of settings and for a range of agriculture/nutrition/health issues, comparing singular and integrated interventions in terms of their efficiency.

Promote the concept of Disability-Adjusted Life Years outside of the health sector.

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Thank you for your attentionThank you for your attention

For more information

www.who.int/phe