ROUND TABLE
Environmental health for the rich or for all?
Kirk R. Smith
Professor of Environmental Health Sciences,University of California, Berkeley 140 Earl Warren Hall, Berkeley, California, CA 94720-7360, USA
Developing countries bear the brunt of damage to health from environmental hazards. Yet most of the money the world is spending on environmental health research and on interventions to protect health from these hazards is being spent by the industrialized countries. The sheer size and intensity of this effort greatly influence the entire world agenda, sometimes in ways that do not reflect the realities of environmental risk in the developing countries and thus without due consideration of true global priorities. Two main schools of thought can be identified: one holds that the powerful environmental health movement in developed economies, by overriding needs and circumstances in less developed ones, may actually be holding back efforts to reduce damage to health; the other holds that this movement, by fostering the growth of scientific and technical knowledge, may be helping developing countries to protect their populations against environmental damage and is thereby helping to reduce global damage to health.
Examples of the harm done by the global dominance of environmental health issues by industrialized countries include the following.
There is a drive in the industrialized world to ban all use of DDT worldwide. Yet household use, which is one of the few inexpensive ways of controlling malaria in certain parts of the world, accounts for only a relatively small amount of the DDT released into the environment, compared with the environmental impact of the vast amounts sprayed in the past. If malaria were killing a million people a year in North America and Europe, would the case for globally banning DDT be argued so forcefully?
Fears are being voiced with increasing stridency in some industrialized countries that chlorination of drinking-water may result in the formation of possibly carcinogenic chloramines. The suggestion has been mooted that chlorination should be replaced by ozonation or other techniques that do not leave residues likely to contaminate down-stream water. But these alternatives do not combat waterborne diseases as effectively. Reduction of chlorination, for example, may have played a role in a cholera epidemic that occurred in Peru in the early 1990s. And even in the more developed countries, waterborne disease is still a serious risk.
Powerful environmental groups in the industrialized world are successfully putting pressure on international organizations to stop funding construction of large dams in less developed countries, thereby potentially denying these countries the kind of major spur to development that currently industrialized countries have enjoyed.
Incineration of medical waste has raised concerns in the more developed countries about the release of dioxin into the environment. These concerns have stopped international organizations from supporting hospital construction in some countries, notably India. Yet, incineration which does release dioxin into the environment but has as yet caused no documented burden of ill-health is often a vastly preferable alternative to the traditional disposal method of dumping medical waste on public rubbish tips, especially where these are scavenged for a living by poor people.
Billions of dollars are being spent in the industrialized world on dealing with hazardous waste, which cannot be more than a minor risk to public health compared with the relatively uncontrolled and substantially larger exposures to some of the same chemicals in fuel supply systems and consumer products. Developing countries are being urged to make similar costly control efforts by signing international treaties and trade agreements. Would the resources not be better spent on the many more pressing priorities of the poorer countries, including the need to reduce major risks to health?
Scientists in industrialized countries are increasingly concerned about the future long-term impact on health of climate change. This concern may be diverting attention and resources from hazards such as air pollution, water pollution, and occupational dangers, which are estimated to account for at least 15% of the current global burden of disease, mostly in the least developed countries, making them second in importance only to malnutrition. It is uncertain whether climate change would ever have such an impact on health, even in worst-case scenarios.
Examples of the benefit to be derived from the global dominance of environmental health issues by industrialized countries include the following.
The flow of information on environmental health has to make it possible for developing countries to enact far more stringent environmental legislation than the industrialized ones had at an equivalent stage of their own economic development. (Unfortunately, too little attention was paid to developing the legal, administrative, and management skills needed to implement this legislation. As a result, enforcement has often been weak and environmental conditions have not improved to the same extent as they did in the more developed economies.) The information flow has certainly fostered the growth of public and scientific awareness of environmental health problems in developing countries. It also facilitates increasingly widespread access to methods of analysis and extensive databases in the developing countries, which the industrialized countries have built up only at great cost.
Epidemiological and toxicological information from studies in industrialized countries is allowing developing countries to exert significantly more control over asbestos and lead, both of which are relatively important health hazards, earlier in the development process than would otherwise have been possible. Almost every nation in the world has taken steps to remove lead from gasoline. Even when health may not have been the primary immediate concern locally, countries have switched away from lead in order to match their energy systems to the international economy. In this sense, therefore, more rapid reduction in lead risk in developing countries has been an unintended but still real health export from developed economies.
Trade agreements, often blamed for increasing the risk of environmental damage to health, can have positive effects. In implementing the North American Free Trade Agreement (NAFTA), for example, Mexico had to upgrade its food and drug regulations substantially, with considerable health benefits to the Mexican population. Moreover, trade rules relating to pesticide and bacterial contamination in exports can lead to increased protection for populations in both developing and industrialized countries. There is also evidence that, in general, transnational corporations tend to maintain higher environmental and occupational standards in their host countries than do local companies.
There was a fear, widespread in the industrialized world of the late 1960s, that protecting the environment could stifle a countrys economy. There is now ample evidence from the more developed countries showing that this is not the case: the less developed ones can easily see that a well-protected environment is compatible with strong economic development. The question they now face is not whether they should implement strict controls, or whether such controls will work, but how soon the controls should be put in place. 