Population, Health and the Environment

East Africa PHE coalition building workshopLynne Gaffikin, DrPH

Nov 12, 2007Addis Ababa

Credit: Sections adapted in part from presentations by RM DeSouza, E Kleinau,

What is PHE?

• A framework

• A response to global understanding of the complexity of development

• An approach to development solutions

The PHE framework supports the belief that:

– People, nature and the environment are interrelated and interdependent

– Changes in the nature, number and/or distribution of any of the above affects the others

“Human needs and a healthy environment … are inexorably linked by chains of cause and effect.”

“We need a healthy environment because we need clean water, clean air, wood and food.”

Jared Diamond – author of Guns, Germs and Steel and Collapse

People in their numbers, distribution and practices can have both positive and irreversible negative

effects on the environment and other species

•Increased agricultural production has greatly enhanced human well being•Building of dams has provided source of energy to run industries

• Other human made-changes (e.g. loss of fisheries, increased soil erosion) have not been beneficial.

• Human gains have often been at the cost of environmental (ecosystem service) degradation– Approximately 60% of

ecosystem services are being critically degraded or used unsustainably

• Environmental degradation has led to:– exacerbation of human poverty– increased inequities among

populations within and between countries

Photos: Photovault

PHE recognizes that:

People with limited resources, especially in rural areas, cannot exercise adequate stewardship over natural resources upon which theirlives depend unless their basic needs are met for:

– health, – nutrition,– livelihood

The challenge of equitable and sustainable development

Global Recognition

• 1987: UN World Commission on Environment and Development – defined sustainable development as “meeting the

needs of present generations without compromising the ability of future generations to meet their own needs”

• 1992: UN Conference on Environment and Development (Rio Earth Summit) – developed an action program (Agenda 21) – demanded new ways of investing in the future

to reach global sustainable development while minimizing impact on global natural resources

1992 Rio Earth Summit: Agenda 21

• Combating Poverty– factors creating policies of development, resource management,

and poverty should be integrated • Population and Sustainability

– governments should develop and implement population policies integral with their economic development programs

– Health services should emphasize ..stabilizing world population at a sustainable number by the end of the century

• Protecting and Promoting Human Health– meet basic health needs of all populations and provide necessary

specialized environmental health services

1994: Cairo, International Conference on Population and Development (ICPD)

• Themes include: population, sustained economic growth and sustainable development

• Participants adopted a 20-year Programme of Action including advocating FP be universally available by 2015 as part of a broad-based RH strategy.

Programme of Action Section C/Chapter 3: Interrelationships between Population, Sustained Economic Growth and Sustainable Development

• Aim of Section C– (a) to ensure that population, environmental

and poverty-eradication factors are integratedinto sustainable development policies, plans and programs; and

– (b) to reduce both unsustainable consumption and production patterns as well as negative impacts of demographic factors.

PHE responds to global recognition of sectoralinterdependencies by:

– Explaining how population dynamics, health and NRM/conservation are conceptually linked

– Supporting action in the form of an integrated approach to development

• interventions are conceptually linked and • operationally coordinated in time and space

– ideally, in the context of a given geographic area or ecosystem (e.g. landscape, watershed) critical to all stakeholders

Ethiopian proverb

• “ When spider webs unite, they can tie up a lion.”

Rationale for an integrated approach:

• “The sum is greater than the whole of the parts”

• Synergies produced by integrating e.g., FP and other key health interventions with conservation/NRM into community-based projects makes interventions:– more effective, – more acceptable, and – more sustainable than if pursued sector-specifically.

• Responds more adequately to community needs

Value-added of an integrated PHE approach to RH/FP programs:

• Greater access to men and adolescent boys• Economic activities involving women (e.g. micro-

credit) improve their social status and self-esteem• FP better received when “packaged” with other

health benefits such as improved water supply and child immunizations

Value-added of an integrated PHE approach to NRM/conservation programs

• Greater female involvement in NRM• Increased participation of adolescents of

both sexes• Community health often a 1st priority,

excellent “entry point”• Economic/livelihood component as part of

PHE brings greater community participation and commitment

Value-added of an integrated PHE approach to NGO operations

• Reduced operating costs (e.g. “piggy-backing”or shared transport, training, personnel)

• Participation time savings for villagers, expanded audiences

• Management efficiencies for local leadership

History of cross-sectoral field projects

• 1970s-1980s: Integrated rural development• 1980s-1990s: Integrated conservation and

development project (ICDPs) • 21st century: PHE projects

– First generation – Second generation

First Generation PHE efforts

• More than 40 PE fellows placed in more than 20 countries

• 50 projects initiated with USAID and other donor support

• Implemented by various types of organizations– Environmental/conservation– Health/RH service delivery– Community-based organizations– Universities/research institutions

• Some involving coalitions/networks• Some focused around a specific issue e.g. food security

How PHE has been operationalized

• Research activities– Promote research around key PHE interactions including food and

water security, and environmental/ecosystem health• Developing leadership and capacity building

– Increase collaboration and leadership on interdisciplinary topictopics

• Advocacy – Use mass media and targeted campaigns to increase the public and

policymakers’ awareness of the linkages, interdependencies and solutions

• Field Projects– Implement coordinated, integrated activities in the field

Different PHE operational field models

• Staggered: – Single sector first, then introduce other sector (s)

• Simultaneous introduction:

– Introduce multisectoral approaches at same time

• Bridge approach:

– Activities depend on one another

• Partnership or develop staff expertise ??

Slash and burn agriculture

3% per year

MigrationIncreasing population

Significant deforestation

Change in rainfall ErosionDecreased soil

fertility Species extinction

200-400 tons/ha/year

Silting up of rice fields =

10 000 ha

Threatened species

Intersect:community factors affecting quality of life: Madagascar

Food Insecurity – Malnutrition –DiseaseCredit: MFreudenberger/ERI

Community Centered InterventionsCommunity Centered InterventionsCommunity Centered Interventions

Rice Rice cultivationcultivation

AntiAnti--erosion erosion measuresmeasures

Fruit Fruit TreesTrees

Plant Plant nurseriesnurseries

ReforestationReforestation

Off season Off season gardeninggardening

Forage CropsForage Crops

Fish Fish cultureculture

BeekeepingBeekeeping

Animal Animal husbandryhusbandry

Vaccination, Diarrheal Disease, Vaccination, Diarrheal Disease, MalariaMalaria

NutritionNutrition

Safe motherhoodSafe motherhoodReproductive healthReproductive health

Potable Potable waterwater

Sanitation & Sanitation & HygieneHygiene

Sustainable use Sustainable use of natural of natural resourcesresources

Protected Protected ecosystemsecosystems

Market Market gardengarden

Income Income generationgenerationMicrocreditMicrocredit

Photo: Dan W

hyner/Mark Freudenberger

Second Generation PHE initiatives

• Scaling up/replication • Tying PHE to development priorities

– Philippines– Madagascar– Others?

Current Challenges with PHE

• Measuring synergies and cost-effectiveness of integration is challenging

• Continued dependence on donor support – local governments adding support in select

countries • Advocacy and good evaluations needed to

determine how best to scale-up past the community level

Opportunities• PHE can be seen as a useful, long-term approach to

poverty alleviation and economic growth incorporating – NRM– gender equality– various dimensions of health

• Need to embrace flexible definitions of/ names for an approach like PHE in light of new contexts: – MDGs– urban growth, – food security– sustainable development– ecosystem health