The Effects of Environmental Degradation On Pulic Health

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Individual Project: Final Paper – May 17, 2007

Dr. Mike Demchik & Dr. Holly Petrillo
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,
NRES 323: International Resource Management

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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

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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

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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

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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
11
12
Gerald Meier & James Rauch “Leading Issues in Economic Development” (pg. 233)

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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
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

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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

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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

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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

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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
36

Azliza Asri 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

Azliza Asri 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

Azliza Asri 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

Azliza Asri 14
APPENDIX 1
Table
Population, total Population growth Surface are (sq. km) GDP (per
Country (millions) (annual %) (thousands) 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

Azliza Asri 15
APPENDIX 2
Graph 138
Graph 239
38
FAO webpage
39
FAO webpage

Azliza Asri 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
70
60
50 Labor force in agriculure
40 (%)
30 Agriculture share of GDP
20 (%)
10
0
World Developed Less Developed
countries countries

Azliza Asri 17
Table-chart B: by region
% of Labor force in the Agricultural sector, 2002-

2003
80
70
Percentage
60 Labor force in
50 agriculure (%)
40
30 Agriculture share of
20 GDP (%)
10
0
pe ica an a ia ia ica
ro er ap ri c As As er
u J Af h t
E Am ut Ea
s Am
th So tin
or La
N
Country

Azliza Asri 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)

Azliza Asri 19
APPENDIX 5

Azliza Asri 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
Agricultural (%
of GDP)
2005
GDP growth (%)
2000
agricultural land
(% of land)
0 5 10 15 20 25 30 35 40 45

Azliza Asri 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
12
10
8
%
6 Series1
0
Health expenditure, total (% of Agricultural (% of GDP)
GDP)

Azliza Asri 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

Azliza Asri 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)

(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)

Azliza Asri 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.pd
f; 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~menuP
K: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,,conten
tMDK:20394822~menuPK:1192714~pagePK:64133150~piPK:64133175~theSiteP
K: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)

Azliza Asri 25
“Rehabilitation of agricultural production & fishery, food security” - FAO

(ftp://ftp.fao.org/FI/DOCUMENT/tsunamis_05/FAO_Agency_Reports/FAOAg
encyReports21January.pdf; visited on 5/4/07)
WHO Recommendation for Mental Health in Aceh

(http://www.who.or.id/eng/contents/aceh/WHO_Recommendations_Mental_Heal
th_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
Dr. Holly Petrillo – International Resource Management: Class Notes 2007

Dr. Chandini Sankaran – Economic Development: Class Notes 2007


The Effects of Environmental Degradation On Pulic Health

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Azliza Asri 1

Individual Project: Final Paper – May 17, 2007

The Effects of Environmental Degradation

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

Case Studies: Bosnia-Herzegovina & Indonesia

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

NRES 323: International Resource Management

“The old notion of ‘development versus environment’ has given way to a

NRES 323: International Resource Management

Sources: the World Bank; 2005

NRES 323: International Resource Management

NRES 323: International Resource Management

Table-chart A: by World, Developed countries & less developed countries

% of Labor Force in the Agrciultural Sector, 2002-

NRES 323: International Resource Management

% of Labor force in the Agricultural sector, 2002-

NRES 323: International Resource Management

Table: Volumes (liters/day) of Water Required for Hydration – Reference value

Average Manual Labor in High Total Needs in

Male Adult 2.9 4.5

Children 1.0 4.5

NRES 323: International Resource Management

NRES 323: International Resource Management

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

Structure of the Economy-Bosnia

NRES 323: International Resource Management

% of GDP - Health & Agriculture

NRES 323: International Resource Management

Table: Indonesia – Health indicators

NRES 323: International Resource Management

Todaro, Michael; Smith, Stephen “Economic Development” Pearson – Addison Wesley:

Meier, Gerald: Rauch, James. “Leading Issues in Economic Development” Oxford

“Meeting Patients’ Needs” – World Health Organization

“Nutrients in Drinking Water” – World Health Organization

“Emerging Issues in Water & Infectious Diseases” – World Health Organization

“Preventing & Controlling Micronutrient Defficiencies in people affected by the

Agricultural Production in 2005 – Earth Trends Data

The State of Security in the World 2003 – FAO

Growth of output – Table 4.1: the World Bank

HNP Stats – World Bank

NRES 323: International Resource Management

FAO Corporate Document Repository – FAO

“State of land Issues in Bosnia & Herzegovina” – FAO

“Participatory Land Use development in Bosnia & Herzegovina” – FAO

“Backing business in Kosovo” – the World Bank

Public Health Reviews – “Health in south-eastern Europe: a troubled past, an

Data & Statistics – Health: the World Bank

“Challenges – No calm after the Sea” – WHO

Agricultural Inputs: Environment – the World Bank data (table 3.2)