the effects of environmental degradation on pulic health

Azliza Asri Individual Project: Final Paper – May 17, 2007 Dr. Mike Demchik & Dr. Holly Petrillo

NRES 323: International Resource Management

1

The Effects of Environmental Degradation on Public Health

Introduction Dependence on the abundant natural resources in a country has always been part of

the human population. Society build communities along the coastline so that they are able to reap the benefits from food resources like fishes, fertile land, abundant water sources that enable agricultural production and also the access of a trading route. As food production meets the demands of the society, additional food production are sold off in the markets for income. Subsequently, the society will see immigration into the area and expansion on its agricultural production in hopes, to meet these increases in demand. Subsequently, social infrastructures begin to increase to connect communities in the area - either in the construction of schools, hospitals, roads or basic telephone lines. These social needs tend to increase with population growths and the local government need to address such issues with diligence. Thus ultimately, enabling the society to meet their daily food intake and providing them with adequate healthcare services, too. Ideally, these foundations allow societies to seek agricultural production in order to sustain their livelihood and increasing their economic well-being through the sale of these agricultural products.

This dependence on agricultural production as a source of food supplies and for income has been a way of life for most communities around the world. Either as subsistence farming or to make a profit from selling the agricultural product, peoples’ dependence on natural resources is unquestionable. However such dependence comes with a high degree of risk as environmental degradation from events out of farmers’ control will disrupt agricultural production. These include catastrophic events such as the outbreak of a war or the onset of a natural disaster like the tsunami is detrimental to the livelihood of farmers’. Soil erosion, decreased soil fertility, damaged ecosystems can result from such devastating events that reduce and even cease agricultural production in affected areas. Consequently, people face food shortages that will eventually lead to deterioration in their health levels, such as malnutrition – if the situation is not dealt with in the shortest time possible. The destruction from these events also affects the infrastructure to facilitate agricultural production and its maintenance. The destruction from the war and the tsunami destroys the social and agricultural infrastructure in place – such as roads, communication lines, fishing boats, agricultural tools and equipment; to name a few. These destructions will cripple the agricultural sector and place a high burden on farmers to revive their economic sector in the quickest time possible.

It is, therefore, crucial to understand the effects of environmental degradation on public health in order for communities to sustain a healthy lifestyle for agricultural production and as means to receive income to support their families. Failure to do so, it can destroy society’s ability to manage their resources in a sustainable way.

Literature Review

This paper analyzes the effects of environmental degradation on public health in the war-affected country of Bosnia-Herzegovina and the tsunami-affected region of Aceh,



2

Indonesia. This research draws on three areas of literature; the role of the agricultural sector on sustaining income levels, the effect of damaged ecosystems on the agricultural production and its effects on its communities’ health levels. These points reiterate how the impact of the tsunami on a nation’s public health is vast. Further, the environmental degradation that disrupted its agricultural production affects the overall economic well-being of the society and greatly affects both countries’ health status. Deterioration in a society’s health levels is important to note as these conditions do hamper agricultural production.

The World Health Organization (WHO), the key United Nations agency concerned with global health matters, prominently displays its definition of health as, “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity”.1 Sufficient food resources like potatoes, maize, wheat, fishes and the availability of clean and safe drinking water plays a crucial role in providing communities with the necessary intake for nourished food supplies. Fertile and safe agricultural environments are, thus needed to facilitate these food productions. In countries like Bosnia-Herzegovina and Indonesia – dependence on local agricultural production for both subsistence farming and commercial trade have greatly succeeded in providing these nations with ample food supplies. Further, governments’ role in enabling clean and safe drinking water to its citizens have contributed to their stable livelihood up to the period of devastating events of war and natural disasters.

But why are the less developed countries greatly affected by these disturbances in the agricultural sector than do developed countries? Such a notion can be looked at from the structure of less developed countries. Several factors contribute to the “structural diversity” of less developed countries and can provide a general trend among these countries. The “structural diversity” characteristics of less developed countries are – size of the country, historical background, physical and human resources, ethnic and religion composition, the relative importance of public and private goods, and its industrial sectors.2 In this framework, developing countries tend to be large in size with high population rates that devote a greater amount of time to local production but with large potential markets. However, the role of the government in stimulating the agricultural sector is an important point to consider. It enables farmers to generate enough production yields both for subsistence farming and for income generation. Fertile agricultural lands and a farmer’s health are also factors that contribute to the success of the agricultural sector. As outlined in Appendix 1, less developed countries devote close to 60% of its labor force in the agricultural sector while developed countries only devote a mere 5%. Thus, the high dependence on agricultural production creates a higher risk for less developed countries to sustain its livelihood.

Consequently, environmental degradation such as decreased soil fertility, lack of water sources for agricultural production, soil erosion and damaged ecosystems has a high impact on a society’s ability to farm.

These also include deforestation, disposal of waste materials into water sources and decreased arable land due to human activities can hamper a farmer’s ability to produce adequate food resources to maintain their health. This is especially so in less developed countries (LDCs) that tend to devote a greater percentage of its population and resources to

1 Michael Todaro & Stephen Smith “Economic Development” (pg. 392) 2 Michael Todaro & Stephen Smith “Economic Development” (pg. 41)



3

agricultural production - either for subsistence farming or for income generation. Yet it is in these developing countries that communities are facing decreasing agricultural production and thus, affecting their nutrient-levels that is shown in the graphs on Appendix 2.3 “In countries where more than 34 percent of the population is undernourished, agriculture represents 30 percent of gross domestic product (GDP), and nearly 70 percent of the people rely on agriculture for their livelihoods”.4

There is a high correlation between agricultural production and percentage of the population who are malnourished. Countries who devote a greater percentage of its resources to agricultural production tend to be in developing countries where a high percentage of farming are for subsistence farming. Moreover, the lack of infrastructure and greater levels of poverty in developing countries as that of developed countries makes it difficult to reap higher yields and may hinder maximum production and development in the region. For example, minimal arable land to farm, sub-standard living conditions, limited access to farming tools and equipment for maximum agricultural production with limited access to water for farming and worsening economic policies that exclude local farming products hamper agricultural production. The lack of infrastructure like roads & communication networks to facilitate trade between neighboring communities can continue to prevent countries from sustainable maximization of its agricultural sector.

The graphs on appendix 2 show that with higher agricultural GDP as a share of total GDP, there is a higher percentage of the population who are undernourished. This can be due to the lack of equipment and tools that enable farmers to reap a greater yield. Rather than giving up their production yield mainly for income generation. The prices for these agricultural products are generally much lower and minimal for these farmers to meet their daily food purchases. There is a general trend that shows with a higher percentage of the agricultural employment as a share of total employment, there seems to be a higher percentage of the population undernourished. This can be related to the notion that individuals employed in the agricultural sector tend to face greater challenges in receiving an adequate income (solely from farming) to purchase food resources for their families. The income from their agricultural products like selling rice, potatoes, tomatoes or fruits tend to be channeled through the ‘middle-men’ that usually is relatively lesser than the actual market price of these goods, so the ‘middle-men’ will reap a greater amount of the sale. This is commonly seen as farmers lacking the full information of the current market price and is vulnerable to the decisions of the “middle-men” as farmers highly depend on them to sell their goods.

Additionally, in countries where its agricultural GDP contributes the highest to total GDP refers to countries with high poverty levels that could possibly be living below the $1 poverty-line. This conclusion is based on the notion that industrialized countries such as those in Europe & North America devote only 10% of the labor force in agriculture as shown in the table on appendix 3. It shows that almost 50% of the world’s labor force is in the agricultural sector but only contributes a mere 5% of total GDP. It is in the developing countries that almost 60% of its labor force is in the agricultural production with an only contribution of 14% to the total GDP in agricultural production.

3 The State of Food Security in the World 2003 – FAO 4 The State of Food Security in the World 2003 – FAO



4

According to the World Bank 2005 data, the percentage of arable land is only 10.6% of land area while the percentage of permanent cropland is only 1.1% of land area throughout the world.5 It is estimated that over 60% of the poorest people residing in developing countries struggle for survival on agriculturally marginal soils.6 With a shortage of arable land, the agricultural sector is struggling to meet the demands of crop production both for subsistence farming & income generation. This creates additional challenge for nations where most of its labor force is in the agricultural sector and with the growing demand from population growth to meet food demands.

A shift of the possibilities production frontier (PPF) of a country’s “various combinations of output that its economy can possibly produce given the available factors of production and technology” (Sankaran’s class notes: Econ 362), to a new PPF shows an increase in the output of a given good and thus, have the ability to increase the country’s GDP & therefore, the GDPpc ppp . This can be illustrated in the graphs on appendix 5. “An outward shift in the PPF represents economic growth, the increase in the country’s output. Countries attempt to accelerate growth because it can raise their standard of living”.7 However, when a country experiences natural disasters such as the tsunami or tornados, decline in the health status of its society (tuberculosis, bird-flu or malaria) and even the outbreak of social unrests and war, will shift the PPF leftward. This then represents the destruction of resources that is, then available for the production of goods in the country as shown in the second graph on appendix 5.

Basic infrastructure necessary to facilitate maximum agricultural production such as roads, safe & fertile agricultural land, government policies, industrial food factories, communication networks and clean water pipes are needed. These basic infrastructures enable the communities (especially farmers) to expand their market-based economy to other communities in neighboring villages, thus being less dependable on the local village’s market for selling its agricultural goods. Several ways that basic communication networks like dirt roads, vehicles, and the telephone-lines can help provide farmers the needed market expansion. It stimulates the local agricultural sector by providing added income and thus, facilitating the probability to provide for their families adequate food, and clean and safe drinking water – limiting health problems.

These food supplies can help maintain the required supplements to nourish an individual’s lifestyle to agricultural production. Sufficient foods and clean water are needed to supply the society with adequate physical & mental health to function in their everyday lives. “We need the nutrients to maintain the body’s functions and to grow. We need water and carbohydrates, proteins, fats, vitamins and minerals. A person must take in enough calories…to supply that energy (and) vitamins and minerals for metabolism and to regulate the many body processes”. 8 Additionally, an adult requires 2 liters of water each day to meet our daily water requirement & to above dehydration levels.9 However, physical activity especially in hot & dry climates like Indonesia & India will require more water intake. To illustrate, the table in appendix 4 identifies the required water intake by females, females who

5 Agriculture data 2005 – World Bank 6 “Economic Development” – Todaro & Smith (475) 7 Sankaran’s Class notes; 2007 8 “Meeting patients’ nutritional needs” - World Health Organization 9 “Nutrients in Drinking Water” – World Health Organization



5

are pregnant, males and children. These water intakes are either in the form of drinking plain water, water in beverages, or water in food like soups, potato or meat dishes.

Adequate intake of food & water supplies can provide societies with an abundance of vitamins and minerals needed by the human body to function daily – for example, selenium, calcium, Vitamin A, Vitamin C, protein, magnesium, iron, sodium, and zinc. These vitamins and minerals can be found in water and food resources like potato, milk, rice, spinach, fishes or bananas. These provide energy for the society to carry out agricultural production to sustain their livelihood.

In the absence of nutritious food supplies, clean and safe drinking water, the society is faced with deteriorating health conditions such as malaria, anemia, increased morbidity rates and mortality rates, impaired physical and mental development (especially in children) and parasite worms – to name a few. “One third of the world’s children fail to reach their physical & mental potentials and many are vulnerable to infectious diseases that account for half of all child deaths”.10 The lack of nutritious food such as wheat, rice, potatoes, or vegetables have a greater likelihood of contracting infectious diseases as the body has a low immune defense system to fight off simple colds, coughs and fevers.

According to Michael Todaro and Stephen Smith in their book “Economic Development”, “some 900 million cases of diarrhea diseases, 200 million cases of schistosomiasis, and 900 million cases of hookworm occur each year. Provision of clean water and sanitation can greatly reduce mortality rates. Children in households with adequate facilities are 60% less likely to die from diarrhea than those in household without such facilities”. Also, diseases such as malaria and the bird-flu can cripple the social infrastructure necessary for development progress in a country. According to Michael Todaro and Stephen Smith, there have been an increasing number of infectious diseases especially in developing countries in regions of sub-Saharan Africa and Asia – malaria and parasites. Because these diseases, in most cases, can be preventable through increasing clean and safe water and basic sanitation, “it has been rightly claimed that their real underlying disease was poverty”.11

“From 1950 to 1990, a dramatic progress in the fight against infectious diseases raised life expectancy from 40 to 63 years in developing countries, narrowing the gap between these countries and industrial countries from 25 to 13 years”.12 (Meier, Rauch; 233). Furthermore, the lack of basic sanitation provided its people with sub-standard living conditions that ultimately, affected their overall health status. These conditions are apparent in overcrowded living conditions when a large part of a country’s population are forced out of their homes in the cases of war in Bosnia-Herzegovina & when the tsunami hit the home of thousands in Indonesia. For example, the need for clean & safe drinking water will provide its people with the basic need for survival. Furthermore, living conditions can be worsened when large numbers of the society are living in sub-standard living conditions. Additionally, overcrowding in household units can increase the probability of cases from infectious diseases like malaria, bird-flu and tuberculosis. Such conditions are the result of government policies neglecting the basic social needs for its citizens that further dampen agricultural production & thus, increasing malnutrition in the society. In 2000, 42% of people in sub-Saharan Africa had no access to an improved water source…with over 1,000

10 “Nutrients in Drinking Water” – World Health Organization 11 Michael Todaro & Stephen Smith “Economic Development” (pg. 394) 12 Gerald Meier & James Rauch “Leading Issues in Economic Development” (pg. 233)



6

residents at a considerable distance from their homes (while) in South Asia, over 60% of the population had no access to improved sanitation facilities.13

Water-related diseases such cholera have seen a dramatic increase in developing countries. “Human migration has disseminated infectious disease or brought people into contact with new pathogens; global environmental change has expanded the range of known pathogens or created the conditions for indigenous micro-organisms to emerge as significant human pathogens”.14 Such deteriorating conditions are made worse when countries face deteriorating social infrastructure that disables the government’s function to provide for safe agricultural land, nourished foods, clean and safe drinking water, and healthcare services. Water is arguably the most limited resources in most areas of the world with about 40% of the people on earth have inadequate or contaminated drinking water – about half are in the least-developed countries (LDCs).15

In the publication by World Health Organization entitled “Emerging Issues in Water & Infectious Diseases”, the study shows that environmental changes caused by human activities as one of the causes for the emerge and transmission of human pathogens that leads to decrease in health status of its communities. “Irrigation malaria” becomes apparent with poorly maintained irrigation system, lack of health impact assessment, uncontrolled irrigation, seepages and poor drainage and a rise in water tables.16

Case Studies: Bosnia-Herzegovina & Indonesia War in Bosnia-Herzegovina

For decades since the inclusion of Bosnia-Herzegovina into the former Yugoslavia in 1918 (after the World War I), the country enjoyed economic wealth that progressed till the death of its President Josip Broz Tito in 1980. The country was mainly able to produce the adequate food supplies for its society with limited imports to the country under the mild-communists reign of President Tito. According to the Food and Agricultural Organization of the United Nations (FAO), the main crops in Bosnia-Herzegovina are maize, wheat, forage, and fodder crops, barley, potatoes, vegetables and fruits with 0.7 million hectare of arable lands and permanent crops and permanent pastures cover 1.2 million hectare.17 “In the pre-war period, Bosnia and Herzegovina provided the largest part of agricultural products through its own production, with its production capacities and resources of raw material. Around 50 percent of the population lived in the rural areas where agriculture is the main activity. Agriculture suffered enormous losses during the war, and the estimated direct and indirect damage amounts to US$10 billion. The suffering of the population, especially in the rural areas, was enormous. The number of inhabitants in those areas is decreasing. Livestock has been decimated, agricultural infrastructure, buildings, machines, fields, forests, vineyards and orchards have been ruined”, as presented by His Excellency Jozo Krizanovic, Member of the Presidency of Bosnia and Herzegovina during a speech he gave at the FAO Summit. 13 Michael Todaro & Stephen Smith “Economic Development” (pg. 491) 14 “Emerging Issues in Water & Infectious Diseases” – World Health Organization 15 Houghton’s Class Notes 2007 16 Petrillo’s Class Notes; 2007 17 FAO Corporate Document Repository – FAO webpage



7

While many have argued that the structural adjustments made necessary by Yugoslavia’s debt crisis of the 1980s led to the internal strife between ethnic groups, it cannot be reasonably argued that this was the impact of natural resource exports or a concerned policy by the west to fracture Yugoslavia in order to attain them. 18

The war in 1992 that drew across ethnic lines still leaves a deep scar in the minds and hearts of the population in the Balkan region and one that is not easy to forget. This still remains the fundamental challenge for the region to develop both in the agricultural and economic sector - to boost its fragile economy.

The Bosnian war that damaged several social infrastructure and that disrupted the lives of thousands of its population, ended with the 1995 Dayton Peace Accord. Many war atrocities took place around the country that crippled the necessary infrastructure for agricultural production that destroyed hectares of farming lands either through military deployment, landmines or the use of fertile agricultural land as mass burial sites. The table in appendix 6 illustrates the agricultural data on Bosnia-Herzegovina. The data shows that there seem to be a decrease in the percent of agricultural production as a contribution to the country’s GDP in the year 2000 to 2005. Furthermore, according to the World Bank 2005 data, there was a 0% growth rate in the agricultural sector. This can be due to several reasons – increasing need for housing facilities (returning displaced refugees back to their homes), need for basic sanitation, rising unemployment rates, unstable political structure, falling GDP and damaging social infrastructure.

Agriculture a percentage of its GDP has dropped over the years since 1995 to 2005 – from 20.7% in 1995 to 11.8% in 2004 & 11.5% in 2005.19 During the war valuable agricultural land was infested with landmines that further complicated the agricultural land that could have been used for farming. According to the FAO data, about 10% to 15% of agricultural land in Bosnia-Herzegovina is still infested with landmines.20 Landmines remain the largest constraint in the country’s ability for agricultural farming. “The average daily availability of calories per caput in 1995-97 was 2 347, with a high variability from year to year. In November 1999, Bosnia and Herzegovina was one of the 34 countries with a shortage in food supplies requiring exceptional and /or emergency assistance”.21

Aside from the problem of landmines, Bosnia also faced the decreasing number of its population to the war. According to the data on population collected by the Agency for Statistics as presented in the publication of “Environmental Security in Post-Dayton Bosnia and Herzegovina” by Associate Professor Peter Stoett, he mentioned that there is a significant decrease a “net loss in population (when the country ) peak at approximately 4.3 million in 1991 to 3.7 million on 2001. This can be due directly to loss of lives during the military invasion, the act of genocide, lack of food resources that brought about diseases that had limited chances of cure under these devastating circumstances, emigration of its population as refugees to neighboring countries, death fighting the ‘enemies’ or the loss of lives on the landmines. According to the research conducted by Hamid Custovic; an Agricultural Faculty at the University of Sarajevo and Esad Bukalo from the Institute for 18 Environmental Security in Post-Dayton Bosnia-Herzegovina - 2005 19 HNP Stats – World Bank 20 “State of land Issues in Bosnia & Herzegovina” – FAO 21 FAO Corporate Document Repository – FAO webpage



8

Agropedology in Sarajevo, “the total area of BiH is 5.11 million ha, of which 50.3% is agricultural land (2,572,000,000 ha) and 48.3% forest land. Total arable land in Bosnia-Herzegovina amounts to 1,585,000 ha or 63% from total agricultural land”.22 With over 50.3% of its land used as agricultural, Bosnia’s labor force contribute to approximately 40% of its labor force in agricultural production.23

Several hectares of fertile agricultural land are mined during the war and will still remain a problem for the nation for many years to come. Estimates do suggest that at the current rates of de-mining, it might take several generations before rural areas are again safe.24 When the war began in 1992, a larger percentage of its population was forced to out of their homes and the farm fields that are used are heavily mined. This was especially evident in areas where heavy-confrontation took place – Maglaj, Vitusa-Jedrenje in Mostar, Brvnik and Samac in Republic of Srpska, and Srebrenica are some examples. 25 These sites were found to be heavily-mined during the war as minefields are used as one of the ways to eliminate their so-called ‘enemies’. These lands homed thousands of it communities and provided fertile agricultural land that till to this day still remained unsafe for agricultural production. Families are slowly moving back to their homes and cultivating their lands despite demining efforts has yet to be complete. This is due to the increase need for food & shelter in the Balkan region especially in the rural areas. With demining efforts from the local government and the international community (NGOs-nongovernmental organizations), people are slowly reclaiming the land back. For example in Maglaj, a location where it became one of many confrontation lines saw highly infested landmines in the area. In Brvnik and Samac, an area with ample fertile agricultural land and with no record of landmines in the area saw two “mine-related injuries with one killed in 1999” after refugees began returning to their homes. In Dobrosevci and Novi grad in Sarajevo, the landmines affected the water supply system to as many as “2,000 households in the Ahatovci and Dobrosevci communities”.26 In most instances during the war, villagers were destroyed. Houses require adequate funding to rebuild and intense demining efforts are needed to clear fertile agricultural land of minefields.

“During the war about 45% of its industrial plants, including about 75% of its oil refineries, were destroyed, damaged and plundered. The transport infrastructure suffered similar destruction and approximately 35% of the main roads and 40% of the bridges were damaged or destroyed” as presented in the publication “Environmental security in post-Dayton Bosnia & Herzegovina”. This has proven to create added challenge for the nation as the country is still marred from the war. The government still faces high unemployment rates of close to 50% & is struggling to boost its economy. 27 “Yet if the notion of environment is expanded to mean the human environment – the social, economic, and physical structures that constitute the niche in which human beings live and thrive – then it is evident that classic discussions of war have touched upon some of these factors (such as disease, famine, and exposure) that constitute secondary assaults on human health induced

22 “State of land issues in Bosnia & Herzegovina” – FAO 23 “Participatory Land Use development in Bosnia & Herzegovina” – FAO 24 “State of land issues in Bosnia & Herzegovina” – FAO 25 Adopt-A-Minefield webpage 26 Adopt-A-Minefield webpage 27 “Backing Business in Kosovo” – the World Bank



9

by the environmental damage of war”, Jennifer Learning in her publication of “War and the Environment: Human health consequences of the environmental damage of war”.28

These situations pose a threat to the stable livelihood of Bosnia’s population and also pose a high risk of health problems in the region. With disruptions in agricultural production for subsistence and sub-standard living conditions in refugee camps, parts of the population suffer incredible physical and mental trauma due to the devastation of the war. The population suffers rapid increase in malnutrition among children and rapid increases in tuberculosis in 2001.29 Such incidences can be an indirect result to the intense bombings, shootings and fires in the Balkan region during the war. Several cases of hypertension &and diabetes are also evident in Bosnia-Herzegovina which can be seen as preventable through the supply of sufficient food resources that carry the required proteins and minerals.

In Bosnia-Herzegovina, public health services suffered an almost complete breakdown, leading to an increased number of deaths from many common, treatable conditions.30 In a recent data from the World Bank in 2005 shown in appendix 8, only 1 physician is available for every 1,000 patients in the country. While only a small percentage of about 8.3% of its GDP are channeled to health expenditure in the country. Tsunami in Indonesia When on March 28, 2005, the tsunami hit the town of Aceh in Indonesia; many felt that such incident will further cripple the economic sector of the region. With approximately 50% (between the years of 2002 to 2003, as collected by the World Bank) of its labor force is devoted to agricultural production, it is undeniably crucial to understand the need to revitalize its agricultural sector in Aceh.31 Close to 70% of the population in Aceh are dependent on the natural resources in the region with farming in the rice fields (padi fields), agricultural production of fruits & vegetables, cattle-grazing and fishing.32 This high-dependence on the natural resources in the region for both subsistence farming and income generation poses a very high risk to Aceh’s population for economic failure. Farmers’ dependence for the cultivation of rice and the fishing sector in Aceh hampers economic development in the region and further, places the population in the poverty trap. With a population of “approximately 4 million…Banda Aceh, the capital city, has a population of 230,000. The population along the severely affected western coast of Aceh was approximately 450,000. Virtually all of those living in Banda Aceh and the western coasts have died or been displaced”.33 The populations who are forced to flee their homes during the tsunami seek refuge in temporary tents provided by the local government and from the international aid. The estimated cost of relief aids is approximately $474 million directly to Indonesia. 34

28 “War and the environment: human health consequences of the environmental damage of war” by Jennifer Leaning : Critical condition: human health & the environment; Chivian, McCally, Hu & Haines 29 Public Health Reviews – “Health in south-eastern Europe: a troubled past, an uncertain future” - WHO 30 Public Health Reviews – “Health in south-eastern Europe: a troubled past, an uncertain future” - WHO 31 Agricultural Inputs: Environment – the World Bank (table 3.2) 32 The Jakarta Post – May 6, 2007 33 WHO Recommendations for Mental Health in Aceh – WHO 34 “After the Tsunami: Rapid Environmental Assessment” – Indonesia



10

According to the publication “Food security & nutrition on the tsunami crisis” presented at the World Health Organization (WHO) Conference on Health Aspects of the Tsunami Disaster in Asia in Phuket – Thailand on May 4 to 6 of 2005, “given the damage to infrastructure, in particular roads, and the lack of suitable transportation means, logistical difficulties have hampered the distribution of food and health services to the affected population”. Furthermore, the President of Indonesia has issued a state of emergency in the region shortly after the tsunami. Such incidences of severe food & health services create undue pressure on the community. The damaged infrastructure especially to the damaged water pipes and sanitation structures present added challenge as the impact from the tsunami bears a high risk of waterborne diseases. In a recent national assessment of the effect of the tsunami on agricultural production, it was concluded that “in many areas soils were inundated with salt water. Rice crops in the western islands were seen to be yellowing in the fields within three weeks of being inundated”. 35 According to initial assessment figures from FAO, approximately 30 per cent of farmland is affected on the north east coast, and 70 per cent is affected on the west coast – with general estimate of 20 per cent of affected land overall as permanently damaged.36 Authorities are struggling to provide clean & safe drinking water to the population as standing water alone includes risks of “water-borne diseases, gastric complaints, typhoid & cholera.” - with an increasing percentage suffering from anemia.

When the tsunami hit Aceh, it forces its people to be displaced form their homes and suffer the sub-standard living conditions in the temporary shelter. Within days since the tsunami hit Aceh, thousands of people found shelter in these tents that undeniably became overcrowded with minimal food & water resources. The local communities will suffer severe food and water shortages leading to high burden of malnutrition and other communicable diseases. The mental trauma is often difficult to detect and overcome during these times. With limited healthcare services available immediately in the aftermath, people became destitute with severe hunger and mental trauma conditions. In the 2005 World Bank data in the table on appendix 9, Indonesia is only contributing 2.3% of its total GDP to health expenditure with health expenditure per capita of $33. This is an alarmingly low amount of government expenditure in the health sector as Indonesia has population of 220.6 million as shown on appendix 1. With the additional resources and monies needed to rebuild the Aceh region after the devastation of the tsunami, the nation is put under undue pressure to be able to revitalize its agricultural production to the previous economic state. Consequently, the role of the international community to assist in the nation’s rebuilding will contribute to the expedite success in Aceh. However, a problem that its government needs to address first is the relocation of its refugee population that suffers severe food and water shortages with high probability of contracting waterborne diseases such as cholera and typhoid or the increasing malnutrition among children in Aceh. Consequently, the severe hunger experienced in Aceh hampers the agricultural production and cripples the agricultural economy in the region.

35 “After the Tsunami: Rapid Environmental Assessment” – Indonesia 36 “After the Tsunami: Rapid Environmental Assessment” – Indonesia



11

Critique

The infrastructure for clean, safe water and for agricultural production is disrupted in countries facing internal conflicts & war, natural disasters and the careless behavior of international companies in their quest for globalization – Bosnia, Indonesia & India. Chronic water shortages are apparent to 450 million people in the world, and with prediction that by 2025 the population suffering from water shortages will increase to 2.6 billion.37 Though current world agricultural production meets the food demands, it still does not reach all parts of the world. It is even more difficult to reach populations who are suffering during wartime in Bosnia, and being hit after the tsunami in Indonesia whose clean water needs are immensely neglected. Such issues have emerged in the past decade in countries around the world with differing degree of environmental degradation & effect on the health status of its citizens. These situations further complicate the country’s rate of agricultural production and also cripple the social infrastructure in place. The available resources for agricultural production will be damaged during war & internal conflicts, and natural disasters.

It is the destruction of the available natural resources and even human resources that have supplied the nations with their food supply that undeniably create a massive problem. Communities affected by these devastating situations are not able to revive their economy through agricultural production within the shortest period possible. This is because the country’s resources are diverted from the agricultural production to military expenditure in Bosnia-Herzegovina, and reconstruction of houses in Indonesia.

Bosnia-Herzegovina and Indonesia face such situations within the past decade and are still trying to rebuild its nation to prior level of agricultural production and health status. In most instances, when a country is facing or has been marred with war or internal conflicts for a period of time or been hit by a natural disaster, the infrastructure necessary for agricultural production and healthcare services are disrupted for many years after the incident. Because in times like this, other pressing issues takes precedence over the need for farming; such as providing security for oneself & family, being able to locate shelter if displacement from homes occur (displaced refugees or refugees into another country), allocating and distributing basic food supplies (clean drinking water, food) than gaining access to healthcare services. The infrastructure that was in place prior to these complex emergencies are mostly destroyed by Bosnia’s ‘enemies’ and thus, the lack or no infrastructure available after the 4-year war crippled the efficient process of farming. It will require incredible effort and monies to rebuild the infrastructure necessary for agricultural production as well as to employ individuals who have the ability and knowledge to carry out the task.

The war that has plagued Bosnia-Herzegovina even a decade after it ended, still face social and economic issues to rebuild its nation. Such concerns of rebuilding its infrastructure for social well being (basic sanitation, relocation of its citizens to safer grounds, health services) and for agricultural production will be a challenge for its governments. The displacement of its people will be a critical concern that needs to be resolved first. Healthcare services under these dire circumstances also provide a challenge for the governments. This relates to the government’s need to rebuild its inner governmental policies especially since the Bosnian war was based on ethnic divisions and Indonesia has its

37 Demchik’s Class notes; 2007



12

share of social conflicts arising from ethnic differences as well. A reshuffling of its policies may prove to provide better living conditions for its people in the future.

The war that lasted from 1992 to 1996 crippled the infrastructure necessary for agricultural development. The government and non-governmental organizations (NGOs) must understand the crucial need to allocate funds into the agricultural sector – as Bosnia-Herzegovina has potential in future projects such as hydro-power developments, and most importantly the government need to provide a safe farming environment for its society. This will allow for the elimination of resource scarcity with increasing production and thus, stimulating economic productivity. With the adequate funding for food production (including clean and safe water) and sanitation programs, critical health issues will arise and further dampened development in the region. Managing its refugee population is also another issue that must be addressed with urgency in order to facilitate maximum agricultural production.

When the tsunami hit Indonesia, it destroyed the homes of thousands of its community. With almost 70% of Aceh’s population devoted to agricultural production as a form of livelihood, the region saw rapid decline in agricultural production & an increase in unemployment. Additionally, food scarcity & providing adequate shelter remained a critical issue for months after the incident. Over-crowded conditions, lack of nutritious food and clean water with limited healthcare services create added problems for the community to rebuild its agricultural production. Thus, creating a lost of income to the families who largely depend on agricultural production for income generation. Moreover, mental trauma remained an issue that is most often neglected in dealing with the rebuilding of the society after the tsunami.

These social and health problems prevent people from continuing with their agricultural production. It limits their ability to fully work in the farming fields and thus, reduces the output yield. Executive summary

Under these dire circumstances, the agricultural sector lacks the necessary funds for production – either as subsistence farming or for income generation. Environmental harm such as decreased soil fertility, high levels of pollution, discharge of waste materials into water sources, & thus damaging the ecosystems – pose a threat to the health status of its society. The health in the society begins to deteriorate due to malnutrition, malaria, cholera, tuberculosis, parasite worms, anemia, and vitamin deficiency as well as mental trauma. The destruction of health care facilities and other infrastructure slow the process of rebuilding in these communities. Both adults and children who suffer from malnutrition, malaria & mental trauma can be preventable with the security of food supply the provide nutrients in the food and clean water.

The management of resources in these countries seemed to provide the notion that the extraction of these resources require not only knowledge and tools but are also govern by the socioeconomic and political drama in the country. The current state of the economy plays a very crucial indicator into the rate of dependence on the environment for basic survival. Governments need to provide expedite aid to affected communities in order to limit the impact of resource scarcity in these areas. While basic social infrastructure like roads and heath care services are mostly damaged & destroyed, local governments need to



13

address issues of food & clean water distribution. It is crucial to meet these basic standard needs in order to revitalize the agricultural sector after such incidences. As without rapid deployment for food distribution, health problems may soon rise within a short period of time.

The cooperation of the local government with international NGOs will aid and alleviate such worsening conditions in a much shorter time frame. Several programs in cooperation from the both the local government and NGOs like United Nations, the World Bank, the FAO, United Nations Children’s Fund (UNICEF), United Nations Environment Program (UNEP) and also the local NGOs can provide tremendous successes to a greater improvement in these countries. Monetary aid is still widely needed in cases of Bosnia-Herzegovina and Indonesia for reconstruction of its infrastructure. The welfare and health of its population would require a prime priority that will subsequently, enable these countries to rebuild its communities. It is vastly important for nations to provide sufficient healthcare services for the population. This immediately enhances the need societies to rebuild its agricultural sector for both subsistence farming & for income generation.

“The old notion of ‘development versus environment’ has given way to a new view in which …better environmental stewardship is essential

to sustain development”. - World Bank, World Bank Atlas, 1997



14

APPENDIX 1 Table

Country Population, total (millions)

Population growth (annual %)

Surface are (sq. km) (thousands)

GDP (per capita) ($)

Bosnia-Herzegovina 3.9 -0.1 51.2 2,700 Indonesia 220.6 1.4 1904.6 1,280

Sources: the World Bank; 2005



15

APPENDIX 2 Graph 138

Graph 239

38 FAO webpage 39 FAO webpage



16

APPENDIX 3 Table: Population, Labor Force, and Production in Developed & Less Developed Regions, 2002-2003 Region Population Urban Rural Labor Force in Agricultural Share (millions) (%) (%) Agriculture (%) of GDP (%) ________________________________________________________________________ World 6,314 47 53 49 5 Developed Countries 1,202 75 25 5 3 Europe 727 73 27 7 3 North America 323 79 21 3 2 Japan 127 78 22 7 2 Less Developed Countries 5,112 40 60 58 14 Africa 861 33 67 68 20 South Asia 1,480 30 70 64 30 East Asia 1,918 40 60 70 18 Latin America 540 75 25 25 10 Sources: Population Reference Bureau, 2003 World Population Data Sheet (Washington DC: Population Reference Bureau, 2003); World Bank, World Development indicators, 2004 (New York: Oxford University Press,2004). Tabs. 4 & 12, Agriculture labor force figures are based on 1997 World Bank estimates. Table-chart A: by World, Developed countries & less developed countries

% of Labor Force in the Agrciultural Sector, 2002-2003

010

20304050

6070

World Developedcountries

Less Developedcountries

Labor force in agriculure(%)Agriculture share of GDP(%)



17

Table-chart B: by region

% of Labor force in the Agricultural sector, 2002-2003

01020304050607080

Europe

North A

merica

Japa

n

Africa

South

Asia

East A

sia

Latin

America

Country

Per

cent

age Labor force in

agriculure (%)Agriculture share ofGDP (%)



18

APPENDIX 4 Table: Volumes (liters/day) of Water Required for Hydration – Reference value estimates, WHO 2003 40 Average Manual Labor in High Total Needs in Conditions Temperature Pregnancy/Lactation ________________________________________________________________________ Female 2.2 4.5 4.8 (pregnancy) Adult 3.3 (lactation) Male Adult 2.9 4.5 Children 1.0 4.5 ________________________________________________________________________

40 “Nutrients in Drinking Water” – World Health Organization (WHO)



19

APPENDIX 5



20

APPENDIX 6

Table: Structure of the Economy – Bosnia-Herzegovina

Agricultural land (% of land) GDP growth(%) Agricultural(% of GDP)

2000 41.6 5.5 11.7

2005 41.9 5.0 10.1

*Source: World Development Indicators database, April 2007

*Note: Data during the war was not available

Table-chart A

Structure of the Economy-Bosnia

0 5 10 15 20 25 30 35 40 45

agricultural land(% of land)

GDP growth (%)

Agricultural (%of GDP)

20052000



21

APPENDIX 8 Table – BiH Bosnia-Herzegovina (2005) Health Health expenditure per capita (current US$) 198 Health expenditure, total (% of GDP) 8.3 Hospital beds (per 1,000 people) 3 Immunization, DPT (% of children ages 12-23 months) 93 Immunization, measles (% of children ages 12-23 months) 90 Malnutrition prevalance, weight for age (% of children under 5) Mortality rate, under-5 (per 1,000) 15 Physicians (per 1,000 people) 1

Sources: the World Bank health indicators Table – Chart Comparing both the health & agriculture as a % of GDP

% of GDP - Health & Agriculture

0

2

4

6

8

10

12

Health expenditure, total (% ofGDP)

Agricultural (% of GDP)

% Series1



22

APPENDIX 9 Table: Indonesia – Health indicators Indonesia (2005) Health Health expenditure per capita (current US$) 33 Health expenditure, total (% of GDP) 2.8 Hospital beds (per 1,000 people) - Immunization, DPT (% of children ages 12-23 months) 70 Immunization, measles (% of children ages 12-23 months) 72 Malnutrition prevalance, weight for age (% of children under 5) 28.2 Mortality rate, under-5 (per 1,000) 36 Physicians (per 1,000 people) 0

Sources: the World Bank health indicators



23

Cited Sources

Todaro, Michael; Smith, Stephen “Economic Development” Pearson – Addison Wesley: 2006 Chivian, Eric; McCally, Michael; Hu, Howard; Haines, Andrew “Critical Condition: Human Health & the Environment” The Massachusetts Institute of Technology Press: 1994 Meier, Gerald: Rauch, James. “Leading Issues in Economic Development” Oxford University Press: 2005 “Meeting Patients’ Needs” – World Health Organization (http://www.wpro.who.int/internet/files/pub/85/143-148.pdf; visited on 5/1/07) “Nutrients in Drinking Water” – World Health Organization (http://www.who.int/water_sanitation_health/dwq/nutrientsindw.pdf; visited on 5/1/07) “Emerging Issues in Water & Infectious Diseases” – World Health Organization (http://www.who.int/water_sanitation_health/emerging/emerging.pdf; visited on 5/1/07) “Preventing & Controlling Micronutrient Defficiencies in people affected by the Asian Tsunami” – UNICEF (http://www.who.int/topics/nutrition/publications/emergencies/Tsunami%20May%2005.pdf; visited on 5/1/07) Agricultural Production in 2005 – Earth Trends Data (http://earthtrends.wri.org/pdf_library/data_tables/agr2_2005.pdf; visited on 5/1/07) The State of Security in the World 2003 – FAO (http://www.fao.org/docrep/006/j0083e/j0083e04.htm; visited on 5/1/07) Growth of output – Table 4.1: the World Bank (http://siteresources.worldbank.org/DATASTATISTICS/Resources/table4-1.pdf; visited on 5/1/07) HNP Stats – World Bank (http://devdata.worldbank.org/hnpstats/cg.asp; visited on 5/1/07)



24

FAO Corporate Document Repository – FAO (http://www.fao.org/DOCREP/005/Y2722E/y2722e0l.htm; visited on 5/1/07) “State of land Issues in Bosnia & Herzegovina” – FAO (http://www.fao.org/Regional/seur/events/landcons/docs/Bosnia_Herzegovina.pdf; visited on 5/1/07) “Participatory Land Use development in Bosnia & Herzegovina” – FAO (http://www.fao.org/Regional/SEUR/events/landcons2/docs/Bosnia.pdf; visited on 5/1/07) “Backing business in Kosovo” – the World Bank (http://econ.worldbank.org/WBSITE/EXTERNAL/EXTDEC/EXTRESEARCH/EXTPROGRAMS/EXTTRADERESEARCH/0,,contentMDK:20019071~menuPK:181053~pagePK:210083~piPK:152538~theSitePK:544849,00.html; visited on 5/1/07) Public Health Reviews – “Health in south-eastern Europe: a troubled past, an uncertain future” – WHO (http://whqlibdoc.who.int/bulletin/2004/Vol82-No7/bulletin_2004_82(7)_539-546.pdf; visited on 4/10/07) Data & Statistics – Health: the World Bank (http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20394822~menuPK:1192714~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html; visited on 4/10/07) “Challenges – No calm after the Sea” – WHO (http://www.searo.who.int/LinkFiles/Water,_Sanitation_and_Health_2_Challenges_No_calm_after_the_storm.pdf; visited on 4/13/07) Agricultural Inputs: Environment – the World Bank data (table 3.2) (http://siteresources.worldbank.org/DATASTATISTICS/Resources/table3-2.pdf; visited on 4/12/07) The Jakarta Post – May 6, 2007 “Developing rural economy in Aceh” by Richard Beresford (http://www.thejakartapost.com/yesterdaydetail.asp?fileid=20070424.E04; visited on 5/6/07)



25

“Rehabilitation of agricultural production & fishery, food security” - FAO (ftp://ftp.fao.org/FI/DOCUMENT/tsunamis_05/FAO_Agency_Reports/FAOAgencyReports21January.pdf; visited on 5/4/07) WHO Recommendation for Mental Health in Aceh (http://www.who.or.id/eng/contents/aceh/WHO_Recommendations_Mental_Health_Aceh.pdf; visited on 5/12/07) Dr. Mike Demchik – International Resource Management: Class Notes 2007 University of Wisconsin, Stevens Point Dr. John Houghton – People, Resources & the Biosphere: Class Notes 2007 University of Wisconsin, Stevens Point Dr. Holly Petrillo – International Resource Management: Class Notes 2007 University of Wisconsin, Stevens Point Dr. Chandini Sankaran – Economic Development: Class Notes 2007 University of Wisconsin, Stevens Point

the effects of environmental degradation on pulic health

Documents