Past, present and future perspectives


Environmental damage-whether it is water or air pollution, or waste and sanitation-has serious consequences for human health. Generally, most countries in Africa face high environmental threats to health (WRI and others, 1999), a situation which poses a profound challenge to the region.

Pollution of water and air, and their impact on human health, is of immediate concern. Water pollution and contamination impact on people in the region, resulting in the predominance of water-borne diseases. Air pollution-from industrial and car exhaust emissions, and the burning of traditional fuels in homes-kills a large number of people each year. People die from respiratory damage, heart and lung diseases, and cancer. Urban air pollution causes close to 1 million premature deaths worldwide every year, primarily due to respiratory diseases (World Bank 2000e) affecting mostly the poor. About 4 million people die annually due to overcrowding, and from indoor pollution caused by burning biomass fuels for cooking and heating (WRI 1998). As many as 25 million poor agricultural workers in the developing world (11 million in Africa alone) are poisoned by pesticides every year, and hundreds of thousands die.

In Africa, human vulnerability is exacerbated by poor health caused by unmitigated or heightened exposure to disease, malnourishment and undernourishment, and weak public health institutions and interventions. Linked to this is poverty and the coping capacities of the population at risk to effectively reduce their vulnerability to infectious diseases, poor or irregular nutrition, and the myriad of health conditions that are associated with poverty in urban and rural areas. The survival indices which are a reflection of the general health situation in Africa are summarized in Table 3.3.

Table 3.3 Health progress and setbacks in African countries
Sub-region Life expectancy at birth (years) Infant mortality (per 1 000 live births) Under-five mortality rate (per 1 000 live births)
1970-75 1995-2000 1970 1999 1970 1999
Northern Africa (6) 52 66.1 123.8 38.7 190.7 51.2
Western Africa (16-1) 42.7 49.7 161.3 106.3 273.3 174.2
Central Africa (8-1) 43.7 49.1 139.6 103.6 233.3 163.2
Eastern Africa (8-1) 44.7 50.1 133.6 94.7 212 147.9
Southern Africa (11) 47.7 46.2 127.6 91.3 205.1 142.2
IOC (4.1) - - - - - -
Source: JES-Preparation WSSD 2001

Poor health, lack of or inadequate access to health services, low or skewed investment in health services (concentration in few urban centres) and dysfunctional health policies all contribute to lower life expectancy and high mortality rates in African countries, as indicated in the table. Health-related interventions may also contribute to vulnerability by, for example, contributing to the evolution of drug-resistant organisms, or by exposing food webs and people, through the process of bioaccumulation, to toxins such as DDT.

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Infectious diseases such as HIV/AIDS, tuberculosis and malaria can thrive in poorly maintained communities, and the limited access to health-care services means mortality rates are high in many regions.


The effects of infectious diseases-such as HIV/AIDS, tuberculosis and malaria-are felt throughout society and, if unchecked, they damage the social fabric of the community, diminish agricultural and industrial production, undermine political, social and economic stability, and contribute to regional and global insecurity (WHO 2000a). The linkages between environmental change, poverty, reduced quality of health and vulnerability are complex, and their individual impacts and causal effects are not easy to isolate. However, the lack of scientifically proven evidence of such causal changes in Africa does not mean that these changes do not exist; rather, it may reflect the lack of available epidemiological data as a result of poor or absent surveillance and health information systems (IPCC 1998). There is, consequently, a pressing need for scientific investigation on the assumptions about environmental change and its impacts on human health and vulnerability.

The HIV/AIDS epidemic has spread with devastating speed. It is among the leading causes of death in sub- Saharan Africa (World Bank 2001), where 2.4 million adults and children are estimated to have died due to HIV/AIDS in 2000 alone (UNAIDS/WHO 2000). The HIV/AIDS epidemic is not only the most significant public health problem affecting large parts of sub-Saharan Africa; it is also an unprecedented threat to the region's development (World Bank 2000c). More than 95 per cent of the 36 million people in the world living with HIV/AIDS are in developing countries, and 25.3 million of them are in sub-Saharan Africa (World Bank/UNAIDS 2001, UNAIDS/WHO 2000). In Africa, HIV/AIDS is largely a rural/urban poor issue, where a matrix of socioeconomic, cultural and gender-related vulnerabilities indicate that the links between AIDS, food insecurity and poverty are strong and deadly (FAO undated).

HIV/AIDS is a threat to sustainable agriculture and rural development through its systemic impact (FAO/UNAIDS 1999). At the household level, HIV/AIDS can result in labour shortages and declining productivity, reduced income, increased expenditure on medical treatments and an increase in the dependency ratio due to the rise in the number of dependents relying on a smaller number of productive family members. Smallholder agriculture is a vital sector for rural households and national economies in many African countries. HIV/AIDS is affecting agricultural production through the decimation of household labour, the disruption of traditional social mechanisms, and the forced disposal of productive assets to meet the costs of medical care and funerals. The disease also results in the loss of traditional farming methods, inter-generational knowledge, and specialized skills, practices and customs.