The most pressing environmental health problems today, in terms of death and illness worldwide, are those associated with poor households and communities in the developing world. In rural areas and in the peri-urban slums of the developing world, inadequate shelter, overcrowding, lack of adequate safe water and sanitation, contaminated food, and indoor pollution are by far the greatest environmental threats to human health (12). These conditions are often compounded by poor nutrition and lack of education, which make people more vulnerable to, and less able to cope with, environmental threats.
According to WHO and the World Bank, environmental improvements at the household and community level would make the greatest difference for global health (13) (14). Specifically, the World Bank has calculated that improvements in local environmental conditions facing the poor could lower the incidence of major killer diseases by up to 40 percent (15).
Given the strong correlation between environmental health risks and poverty, one strategy to reduce these risks is to raise incomes and improve the distribution of wealth (16). Without question, reducing poverty and closing the gap between rich and poor would drastically lower the toll of death and disability from many diseases. Implementing policies to eradicate poverty remains a top priority for improving health, and many organizations – including national governments, the United Nations (U.N.), numerous nongovernmental organizations (NGOs), and foundations–have marshaled considerable force toward this end. The United Nations Development Programme (UNDP) Human Development Report 1997, for instance, outlines six priorities for action –anging from empowering the poor to carefully managing globalization trends to ensure fair terms of trade and more equal economic growth (17).
Environmental management need not wait until economic development reaches a certain level, however; it is a critical tool for improving public health both today and in the future. By targeting policies that help to reduce environmental threats that contribute both to ill health and poverty, it is possible to produce good health long before income growth could do so on its own. Improving the conditions of daily life may by itself help to reduce poverty. In other words, removing the environmental hazards that make people sick could keep people working and raise incomes (18).
Many of the interventions described in the following sections rely on changes in behavior and improvements in the environment at the household level, because a large share of disease is incurred in or around the home environment. For instance, even if water supplies are clean at the public tap, they can become contaminated if stored in an unhygienic manner. This reality makes the role of public policy difficult, since policies are generally directed toward the public domain (19). One key role for public action is investment in health and hygiene education. Several studies have shown that the promotion of hand washing, for instance, can drastically reduce the incidence of diarrheal diseases (20). In addition, abundant evidence has made clear that educating women more broadly has an immediate, positive effect on health.
Policy actions should not be limited to education alone. Governments can also help facilitate changes at the household level by removing many of the institutional and financial barriers that keep poor households from protecting themselves (21). As one scholar has explained, “The poor do not lack healthy water systems only because they cannot afford them, but also because they lack the political space to organize, and the political leverage to make the public sector respond to their needs” (22). To remove such barriers, governments can develop financing schemes that offset the initial investments needed to improve coverage of basic infrastructure for low-income communities. In addition, both governmental and development agencies should ensure that primary health care packages include environmental interventions as a key component. In other words, health care packages should provide access to water filters, polystyrene beads, and bed nets – all useful to prevent exposure to infectious agents – as well as to vaccines and drugs.