HUMAN HEALTH AND DAMS
Item
- Title
- HUMAN HEALTH AND DAMS
- extracted text
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Social Issues
4
Human Health and Dams
Draft Final Report
November 1999
Prepared for the WCD by:
World Health Organisation - Geneva
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World Commission on Dams Secretariat
P.O. Box 16002, Vlaeberg, Cape Town 8018, South Africa
Phone: 27 21 426 4000 Fax: 27 21 426 0036.
Website: http://www.dams.org E-mail: info@dams.org
This is a draft working paper of the World Commission on F
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Dams. The report published herein was'^fepired for
lhe Commission as part of its infonnauon-gathering aclivity. The views, conclusions, and recommendations
arc not intended to
represent the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
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Disclaimer
This is a working paper of the World Commission on Dams - the report published herein
was prepared for the Commission as part of its information gathering activity. The views,
conclusions, and recommendations are not intended to represent the views of the
Commission. The Commission’s views, conclusions, and recommendations will be set forth
in the Commission's own report.
World Commission on Dams
5lh Floor, Hycastle House
58 Loop Street
PO Box 16002
Vlaeberg, Cape Town
8018, SOUTH AFRICA
Telephone: +27 21 426 4000
Fax:+27 21 426 0036
Email: info@dams.org
http://www.dams.org
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This is a draft working paper of the World Commission on Dams. The report published herein was picparcd for
the Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to
represent the views of the Commission.
World Commission on Dams
Social Issues — Human Health and Dams, Draft, November, 1999
ii
DAMS AND HUMAN HEALTH - EXECUTIVE SUMMARY
1. Recommendations
The World Health Organization welcomes the independent inquiry by the World Gommission on
Dams (WCD) and the opportunity to contribute positively to the debate on dams. It offers the
following recommendations for consideration by the Commission.
. Health impact assessment (HIA)
There is an overwhelming need to include health impact assessment (HIA) as an integral component
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method and procedures, the links between Environmental Impact Assessment Soc’al
Assessment and Health Impact Assessment, and the need to incorpora e
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international conventions and in national legislation on dams.
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^rS^pX" in HIA and community bc.ttb management needs to be built both within the W
to be built both within the
health sector and in the sectors primarily responsible for dams.
are thre es ential ta
elements that need to be addressed by national capacity building activities.
A, the international lead, .be World Heald. Organization ,s the mdmated ”^"0,10 provide a
framework for the health impact assessment of large, often transboundary dam
development projects.
. Documentation of successes and efficacy of current practices
An information and education oriented data base should be compiled.
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(a) describing the limited number of health success stories based on careful dam design and
operation, and explaining the key management processes in detail.
efficacy of already implemented health risk management techniques.
(b) with an assessment of the
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knowledge bases oi tne neann issuer
integrated health risk management^
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conditions, with an emphasis on health issues determmed by environmental fac
in order io sireng.ben exiting
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recommendations
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Commission os part of its informalion-gathering activity. The views, conclusions, a
views of the Commission.
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World Commission on Danis
Social Issues - Human Health and Dams, Draft, November, 1999
iii
feasibility and effectiveness. Comprehensive documentation of the economic aspects will be crucial
for successfully transferring tested methods to routine management and operations.
• Budgeting for health
A heal4h^cqmp<jnent should be negotiated as a budgeted_ itom for all project loans in order to
safeguard and enhanceliealth.
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Any health budget allocated in the context of a dam project should be used primarily for preventative
actions, and secondarily for strengthening of health services, with the optimal balance decided on a
case by case basis. Such an investment in health should not be considered a substitute for the existing
health care system.
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• Prioritising the health issues
It is important that the health priorities are not pre-judged but allowed to emerge from the health
impact analysis and community consultation.
Development agencies may have a limited or biased understanding of the health issues associated
with a dam project in a given location. Priority setting therefore has to rely on a comprehensive and
independent HIA complemented by an expression of the risk perceptions of affected communities.
This will not only promote a correct focus on key health issues, but also enhance community
ownership of the risk management measures.
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• Prioritising dam projects for impact assessment
Screening procedures for HIA needs must be the minimum requirement for all dam projects.
- A robust screening procedure, preferably anchored in legislation, will ensure that limited financial
and human resources for HIA are used to their maximum capacity.
The cumulative effect on health of many small dams should be dealt with through strategic
assessment of representative cases.
• Transparency
The health impact assessment and planning process should be open to scrutiny by all stakeholders and
communities.
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All components of the planning process, including HIA, benefit from the inclusion of all stakeholders
at all stages of the process.
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2. GENERAL CONSIDERATIONS
As dams, large and small, continue to be planned, constructed and operated with the aim of achieving
important socio-economic development objectives, their potential to alleviate poverty can, and in
many cases will, contribute significantly to the improvement of the human health status.
It is, however, the issue of equity gaps that is at the root of the adverse health impacts of dams.
Benefits of dams are not disputed, but it is the uneven distribution of the benefits, including the health
benefits, and of the health risks that needs to be addressed in their planning, construction and
operation. A simple health accounting is not satisfactory: iLLs_Hot acceptableto simply balance out
the
^ie population against the health losses of another, to arrive at a net
health benefitoT^arnsT^lKis tliFTncreased risks for vulnerable groups that need to be identified at an
early stage and managed as an integral part of dam design and operation. The protection and
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This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent the
views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
iv
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promotion of human health in the context of dam projects can only be ensured if all potentially
affected communities have an opportunity
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to consider how dam construction and operation will affect their own health, and
to participate fully in the planning, assessment and decision making process
sector. Taking human health
into consideration at the planning stage makes good economic sense.
sense. Not
Not only
only does
does it
it allow
allow to
to keep
keep
the additional burden on the health sector limited to ia minimum,
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also permits an optimal use of
"win-win” opportunities for the dam operators and public health. Many of the health safeguardTthat
should be considered good practice can be incorporated into dam projects at minimal additional costs
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a more flexible operation. Changes in environmental
and social determinants of health, resulting from a dam project, will also provide an incentive for the
health sector to review the delivery of its services and improve performance and efficiency.
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Three requirements are essential in order to effectively protect and promote health in relation to dam
projects: (1) a supportive policy, (2) an acceptable procedure and (3) a usable method of risk
assessment.
The lack of an appropriate policy framework means:
• lack of assessment of policies, programmes and projects for health impacts;
• greater than necessary adverse impacts of development on health;
• the tendency of vertical disease control programmes to ignore environment and
• development links;
• lack of funds for research in health impact assessment.
Environmental Impact Assessment (EIA) is an established policy and procedure in many countries
and development agencies, but EIAs normally make limited reference to health. The health issue
most commonly included is poisoning due to pollution; in the case of dams, filariasis, malaria and
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schistosomiasis, are also often cited. Other important health aspects are often neglected.
In many cases, health is addressed in a strictly ‘medical’ sense rather than through a wider cross
cutting viewX^UIimui^
This tends to produc
commendations for strengthening health
services which, although important, often do not lead
oad improvements in the identification,
characterization and management of community health n.
Some health issues have physical environmental determinants, others have primarily social
determinants that will be brought to light only by a social impact assessment (SIA). Health, therefore,
has a stake in both EIA and SIA, with a number of unique features that distinguish it from either of
these. The solution favoured by WHO is to create a separate and parallel procedure for health
impact assessment (HIA). The middle way is to plan for integration while maintaining a separate
profile for health. The state-of-the-art of HIA methodology and procedures is presented in detail iin
the WHO submission. Critical action required in any dam project includes:
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Adding specific references to health to the Terms of Reference provided to the consultants
undertaking an impact assessment and indicating the method of health impact assessment to be
used.
Providing quality assurance mechanisms through appraising or evaluating the health component
of completed impact assessments.
This is a draft working paper of (lie World Commission on Dams. The report published herein was prcpaied for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent the
views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
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s The health issues associated with dams can be conveniently represented in six major categories:
communicable diseases, non-communicable diseases, injury, malnutrition, psychosocial disorder, and
lack of social well-being. The existing knowledge bases concerning the impact of dam construction
and operation vary for the different categories.
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. 3. OPTIONS FOR PREVENTATIVE AND HEALTH PROMOTIONAL ACTION
/ Many of the adverse health outcomes associated with dams and associated infrastructure
developments (e.g. irrigation schemes) can be prevented or mitigated if a broader and more holistic
view of project construction and operation is taken. Along with a range of insightful engineering
approaches should come a recognition for the need to take an integrated, multi-disciplinary approach
to environmental, social and health management. This new understanding can lead to the
implementation of a range of innovative design and operational features for water infrastructure
projects^ Such changes may be cost effective and provide the desired health outcomes that formally
were considered controllable only through medical intervention or by more drastic environmental
control procedures.
There are a number of fully or partially validated options which can mitigate the adverse effects on
human health of dam construction. These planning options fall into a number of categories including
engineering design considerations, operational water management, social and community planning.
Recommendations and suggestions for good management practice are listed in table 1. A number of
general observations need to be made first:
■ Preventative and health promotional measures tend to_be_sit£^specific. They are linked to the
geographic variation in health conditions associated with dams as well as to the relative
effectiveness of measures in different ecological and epidemiological settings.
■ The secondary effects of measures need to be taken into account and trade-offs will have to be
found to come to a final decision.
■ Whatever the technical merit of “good practice” interventions, they will only be effective and /
sustainable if the process of their design and implementation is transparent and participatory.
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views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
Table I.
Examples ol ieel.niques and Eood pr.cUees for m.oaeinE health risks
safeguard
theSves and their families from many env.romnentalhazard s ------------
Poverty reduction
In specific settings, there is a possibility of using livestock as
diversionary hosts to
Zooprophylaxis
protect people from malaria
________
------------------------ ■ e .adresses nutritional issues related to traditional
Controls some mosquito species, a
Wetting and drying of agriculture such as flood recession cultivation
_____
floodplains or streams
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danl construc,lon’
and building capacity and capability ofhealt
------
Health centres
Water
supply
sanitation
________
Reduces diarrhoea, intestinal parasites and'
and should be protected from contamination by floods------
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Domestic water supplies
May be appropriate for certain arboviruses
Vaccination
Handling
animals
Oil
wo
moribund
Canal or river flushing
Community control
Control of Rift Valley Fever
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waste, ctearing drains or flushing away
InereastaE empo«e™enland
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------------- -----------as tioodsjiealihproinoiitia ----------------------------
I Communication
-----------
Dam design
Mininrlstag h» ho” “»'> “ P'tv'”' ’e"°'
Kedeelion eleoai.el p.Hen.. «iih eemanrh-ed wa.er (sehi.^n)-----------------
channel
Irrigation!
and
improved
design l
.
hydraulic structures
Dam siting
dlspLesnren^
' SI,In. new s.ulemsMs .way Eem
Settlement planning
breeding skes--------------
Adequate design of eon—ty water supply a«d s.nli.iioa, including careful
management of wastes
___________
developmentCulturally sensitive community planning
Irrigation management
Minimise long term salinisation, siltation and water logg^g----------------- Catchment management to minimisejlo^^
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Upstream management
In-flow forecasting
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Early warning of floods---- ----- ------- ---- -------’ To enhance floodplain productivity and hencenutrition-------------------- ----------------
Water release schemes
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Reservoir management
Seasides manage,neal for b.bi,., »d«eWrco«ol---------- ----------------------------Floodplain
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Social Issues - Human Health and Dams, Draft, November, 1999
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Good operation
maintenance
and
Delivering a reliable and cost-effective service
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This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations are not intended to represent the
views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
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Table ofcon'i : ;ts
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1.
Background
1.1
1.2
1.3
1.4
1.5
1.6
Human Health in Environment and Development
Equity and health
The economic perspective.......................................................
Policy
Legislation
Integration of HIA with Environmental Impact Assessment
2.
Human health issues related to dam construction and operation
2.1
2.2
2.3
Categories of health issues
Regional differences
...................................
Differentiation on the basis of dam size and purpose
3.
Options for preventative or health promotional action
.
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3.1
3.2
3.3
3.4
General considerations
.
Good Practice - the Planning Framework
Good Practice - Design and operation options
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Good Practice - Off site management and environmental protection
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4.
Reconiniendatioiis for improving health outcomes
4.1
4.2
4.3
4.4
4.5
4.6
4.7
Health impact assessment (HIA)
Documentation of successes and efficacy of current practices
Action oriented research
Budgeting for health
Prioritising the health issues
Prioritising dam projects for impact assessment
Transparency
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5.
Health impact assessment (HIA)
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Introduction
5.1
5.2 HIA Procedures
Timing
5.2.1
Screening......................................................
5.2.2
Steering committee
5.2.3
Scoping and agreeing Terms of Reference
5.2.4
Choosing an Assessor
5.2.5
Spatial boundaries
5.2.6
Temporal boundaries
5.2.7
Appraisal and dissemination
5.2.8
Negotiation
5.2.9
5.2.10
Implementation and monitoring
HIA Methods
5.3
Stakeholders
5.3.1
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This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of ils information-gathering activity. The views, conclusions, and recommendations are not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
5.3.2
5.3.3
5.3.4
Health determinants...........................................
Weight of Evidence.............................................
Management of health risks and enhancements
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6.
Acknowledgements
36
7.
Bibliography
37
8.
References
38
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the views of the Commission.
on Dams. The report published herein was prepared for the
The views, conclusions, and recommendations arc not intended to represent
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Social Issues-Human Health and Dams, DraO, November, 1999
lablcs, figures and boxes
Table I. Principal categories of health issues and I
the extent of existing knowledge about their
association with dam projects
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Table 2. Examples of regional variation in health conditions
Table 3. Examples of health outcomes from dam construction and
management
Table 4. Might range of insect vectors
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Table 5. Typology of human circulation
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Table 6. Examples of association of health issues with timing
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Table 7. Examples of the association of health issues with different project siages
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Table 8.
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mples of local stakeholder communities and important health issues.,
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Table 9. Examples of health determi
-----rminants and their classification
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Table 10 Examples of techniq ues for managing health risks
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Figure 1. Procedures and methods used i
in health impact assessment
rigure 2. Spatial boundaries of dam health
...i assessment
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Box i.
Box 2.
Box 3.
Box 4.
Box 5.
Box 6.
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u°“iI^l-C±?.dir'CtiOnS Of the Wor,d Hcallh Organisation, September 1999
Health Opportunities
i Water Resources Development
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blushing canals for malaria control in Sri Lanka
Freshwater cyanobacteria] toxins - an emerging dam-related health issue .
Examples of health impacts from India
The compounded malaria impact of microdams in Ethiopia
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- World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
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1. Background
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1.1 Human Health in Environment and Development
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Throughout the world, especially the developing world, dams and related water infrastructure
projects continue to be planned, constructed and operated to meet human needs through energy
generation, agricultural production and the supply of drinking water. For most countries, dams are
a crucial part of economic and social development and, as such, they aim to achieve important
socio-economic development objectives. Through their potential to alleviate poverty they can
contribute significantly to the enhancement of human health.
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The intended
poverty reduction,
reduction, are invariably
. , , development objectives of dams,> including
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accompanied by a range of unintended impacts on the natural environment en on human
communities. These communities mav
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rmay be affAntArl
affected 1inn /nquite
ways and| 35 C J J '
beneficiaries, there are potential losers. It is this
' observation of health benefit inequity that forms a
central theme in the present submission. Informed action can ]protect
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vulnerable
against
increased health risks and ensure a more equitable distribution of benefits, including health
benefits.
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WHO welcomes the independent inquiry by the World Commission on
on Dams
Dams (WCD)
(WCD) and
and the
the
opportunity to contribute positively to the debate. WHO has long been concerned about the effect
o ams and other water resources development projects on human health and has catalogued their
ealth impacts, particularly on a range of communicable tropical diseases. The present WHO
contribution to the WCD advocates that health considerations should always be included alone
si e economic, environmental and social issues in decision making on dams. Furthermore it
provides an analytic framework for the incorporation of such considerations into dam planning
construction, operation, rehabilitation and disaster preparedness.
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Bearing in mind a target audience of mainly non-health specialists, this paper uses the broadest
socio-environmental definition of human health. As envisaged by the founders of WHO health is
considered to be:
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"...a state of complete physical, mental and social well-being, and not merely the absence of
disease and infirmity”.
The preservation of human health can only be ensured if all potentially affected communities have
an opportunity:
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to consider how dam construction and operation will affect their own health, and
to participate fully in the planning, assessment and decision making process
At times, this submission makes a distinction between recommended actions that are practical - in
the sense that they are ireadily achievable through realistic and feasible modifications to current
practices and planning procedures - and those actions that should be undertaken iin an ideal world.
It is understood that the WCD is interested in both, as is certainly the WHO.
At different times in the past, WHO’s concern over health in development has been expressed with
different emphases. The 1986 World Health Assembly Technical Discussions on Inter-sectoral
This Is a draft working paper of the World Commission on Dams.
The report published herein
was prepared for lhe
Commission as part of its information-gathering activity. The views, conclusions, and recommendations are
not intended to represent
lhe views of the Commission.
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World Commission or.
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Social Issues - Human Heah
•d Dams, Draft, November, 1999
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Action for Health and t!
eview of the impact of development policies
> on health (Cooper-Weil et
a/., 1990) are two of s
•al examples. Currently, the WHO Global Cabinet has defined four
strategic directions, tv. . i which address different aspects of the environment-developmenthuman health continm
(see Box 1 in bold). Along similar lines, the World Bank recently
defined one of its con. j itive advantages in the Roll Back Malaria initiative as its capacity to
include health concerns- ..i
in Infrastructure projects for which it provides loans.
Box 1. Four strategic d’rcctions of the World Health Organisation, September 1999
•
Reducing the burden of excess mortality and disability, especially that suffered by poor
and marginalised populations
•
Reducing the risk factors associated with major causes of disease and the key threats to
hui. n health that arise from environmental, economic, social and behavioural causes
Developing health systems which are managed to ensure equitable health outcomes and
cost-effectiveness; responsiveness to people’s legitimate needs; are financially and
procedurally fair; and, encourage public involvement
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Promoting an effective health dimension to social, economic and development policy.
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In addition to an international health policy framework, WHO has provided technical guidance to
its Member States in the
Guidelines for
the form
form of
of guidelines
for the
the resolution
resolution of
of thee#*
these nrnM»»mc
problems inrduriirvrr*
including:
■ Guidelines for forecasting the vector-bome disease implications of water resources
development (Birley 1991);
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Parasitic diseases in water resources development (Hunter et al. 1993).
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It has also been instrumental, through its Collaborating Centre arrangements with the Liverpool
School of Tropical Medicine, in stimulating a wider debate, including the publication of:
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- The Health Impact Assessment of Development Projects (Birlcy 1995);
WHO and its Collaborating Centres the Danish Bilharziasis Laboratory and the Liverpool School
of Tropical Medicine have a long-term commitment to building national managerial capacities in
inter-sectoral planning of development projects and including health considerations. Together,
they have developed and tested a task oriented problem-based learning course entitled Health
opportunities in Water Resources Development, and the next phase will be course implementation
and institutionalisation in Africa.
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1.2 Equity and health
As already noted, the development and economic objectives of dams are often not fully’
compatible with an equitable distribution of the benefits and stresses between different stakeholder
and community groups. For example, with dams for hydropower generation or drinking water
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This is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
3
supply the beneficiaries may be hundreds of kilometres away in urban centres, while the local and
downstream communities may suffer from the adverse health effects of environmental change and
ocial disruption, n irrigation schemes, those living in the tail end of the system and relying on
res dr
Addv ' V'r the‘r domestic needs may be exP°sed t° increased levels of pesticide
ransmis's
\
iS laCking’
m3y be exP0Sed to lncreased
arndeH T °f,Ve't0r’dome d,seases- Downstream impacts on water availability and quality,
Z en e
Pr°dUCtlOn’ 11VeStOck and flsheries
Icad ‘0 Persistent malnutrition and communal
Clearly, improved health is inherent to the general poverty reduction objectives of dams but it is
ie issue of equity gaps that is at the root of the adverse health impacts of dams For this reason a
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health benefit, as one might do in an economic or financial analysis.
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process. Benefits of dams, also for health, are not disputed. It is the risks to health however
of d md
t0 bC identir,ed at an early
8= and
ariy Sta
stage
and ™™ged
managed as
as an
an integral
integral pari
part
of dam design, construction and operation.
P
I
I
1.3 The economic perspective
The economic arguments in favour of including health concerns in dam projects are clear.
on°the h76 hh*118 <;0Unlrie.S and most deveIoPment agencies spend about 5% of their budget
seJices A e" 7’ m
hCallh budeCt " SpCnt On lhe delivery of health
sZnt on (t d
f
7
87 Part °f tHe nati0na‘ budget or of development loans is
spent on the development and management of infrastructure projects, including dams
however'mad ’e^fiZdeVel°pment that may be critical
People's health status arc,
, made without proper consultation of health authorities and experts.
I
0
J
3
Zhthe h3h sec’tor'wiiZt0'!
°f the pr°jeCt lhat is
pain suffe inland 7
r a "
Pr0V1S1°n
alleviati°"- W ^0 represent an increase in
Improving Ih!! health t °f e Z’011 aChieVement and of Productivity for the affected community,
efficient wav to hel f
d^
C°immlJn'ty throu8h preventative action by other sectors is an '
m^ltipfier effe t bv fn ,°
Z
°n
heaIth SeC,°r' 11 is a“d
b- *
at the construction nhas ""f that relatlvely sma11 ’"vestments for health protection and promotion
the construction phase will produce substantial health improvements.
Xv "<ii>XXn“ded ” ‘,rd'r 10 P""“' “d
LXj n herffT I P'rC
'' ‘"b (iS) ’
"’'t,»d «f
(0 « supportive
None of"esc is
I
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eoofcie .he he.Rh risks
1.4 Policy
The in.ema.ioml developmenl aid policy of many industrialised nations aims Io reduce poverty
and improve the qua.,ty of life of poor communities. The aid Hows through many hila,omi"!d
I
This is
the views of the Commission.
'
C uslons’ an^ rccommcndalions arc not intended to represent
11
J
'v oriii Commission on Darns
---------- ^ues~Human Health and Dams, DraO, November, 1999
4
commmifa. 1>|.„„|„S proo’cdures’l.av'"™onn,CT1 orscakcholder
impacts of
limited.
is
ZhZZZX d p°'.icy fram™ork f”
■■
• 1x7?;°iEno"
k of funds for research in health impact assessment
pr°sr""me! (kno™,s v“fa|
jS” ,7 ZZZr ta’ihZZ™ '”2nn “7 rP'C ■'
“nlre of d'™|opmen,
environmental and health impact assessment (UN 1993) I pPment ^C'eS
recommends
and the Amsterdam Treaty, 1999, require that the EC shah Ur°pe;.the MaastTICht Treaty, 1992,
adverse impact on health or create eonHit■
L 5° ? enSUre ,at ProP°sals do not have an
Policy for Health advocates multisectoral
nndermine health Promotion. The European
both internal and foreign policies (WHO 1998C)COt?thr°n®h health impact assessment for
and Health recognises the need for h^t,
’
EuroPean Charler on Transport, Environment
h.S published a Whi p" ,
T"”’"” ‘Z
T"e UK
policies for the assessmenl of health imoscls of^il Z
'"'Wilies that establish
Secretary ofState for Health 1999)
government policies (Acheson et al. 1998;
the need "<Xv"ronm^^
°n Malaria P™ention and Control stresses
countries where health impact'.3^ '^ 7D0 iJiesT'0;1 'n 'r'"*’-"1
>997).
1'">' °bj“‘
d"n“ or
»> «CD
e,™
■oe.e.y groups „pliciUy ci,cd
rvifc ' ?“' ™*"“ ■»
s
c
M'aM.
■M
tea
Other
el al. 11992),
---- Canada (Kwiatkowski 1996) NinCludc Australia (Ewan
~
ine LvironXa! S Se^ l^7/ C H
1995)Philippines (Philippi
(Koivusalo et al. ]1998) and Netherlands (Putters 1998). ’ TlXe'are, nTZbt’Tany'othe'i
initiatives.
society groups cite
risks
olhcr development^prajeoK
For health
Jx’.mpfe
fed
p!
III
•wi
Ml
S
»>
tfarmerS may be Slven subsidies to
extract groundwater for irrigation with the resuk thar
drinking water from the same diminishing sunn y
C0I™lty must pay more to obtain
regions in order to establish a national presence in a hZ
SOmet,lneS be !ocated m remote
includ^the'ZarTofPhSXvX^
VT^
too . neighbouring
"p “
Z heZ't’ nddeY'o',
b ,he!e
motivations may
""es’h" tT^s^b'^dd'"’® 7 P°l”y ‘'i”"1'
10
or. .nd no, de,,0 beni.i,, .nT'o’ n “eZu''b- d“'S
“topori.ee
is
fci
fell
S=2S7 AZ. ™ sz. i
TI,,C ,C,’orl published I,Zin was prepared for th?
—J recommcndalions arc not intended to represent
L-its
World Commission on Dams
DamS'
November, 1999
5
1.5 Legislation
conventions, natio^al^llfion^
instru,nents-
These include international
8U' “ lOns- Not a11 the instruments are, however, legal in
dePartmen!al practices, and r—
agreements with local and
USed> SUch as those
---- e associated
support health. These include IS09000 n
>
ln'ernat10nal standards that could be used to
protection.
’ on quality assurance, and 15014000, on
environmental
nature; they may also lnclude ch
regmnal communities. Existing «
with environmental laws. There ar!
pXt
convenhon, or national legis|afon for °™s
-""—»r-.,0Pment
"be
™ommend the develops.
P
'nient of international
Mode;^^Xn^X"0” °f <‘an’S—' • WHO would like
S“ '’*'1
1-6 Integration ofHIA with Environmental Impact Assessment
many countries
1998)
health aspects are oilen neglected, such as:
.
0S°m,asis are frequently
frequently cited.
cited.
Other important
4
f0C°P'C t0 lar8e ^raNTm wLtXion project diSCaSC5 aSSOciated whh the movement of
i
everyday life and health culture.
I'"
l
agencies make limited reference to hr
1997). In most cases, health is add essed'n
°n
cross-cutting view of
aaresscd m a strictly ‘medical’ strengthening of health serviceTwhich'aShou^^
'b6"
n-Sen,e... „fc„mmun|,y
•
health (Bid
11
3.X"%”lce’n'' X" n”*'"1'” ',,r7h'
■ I'
eXon
I'i
teft
proeedXnSr“L“|d,°"Sera!l^
fe
-impact assessment is to give health a stronger
Ho-ever.
all
p|
•sseaament (SlA)'''ZlX^
d«»™i™nls
•_«*. in E1A and 'a atakf'loTT".'.'”'!
i"W(
number of unique features
-- a separate and parallel
-d negated and .h7^
--impact assessment may be lost.
Pera" ™
in” hi
ra a 995, Scott-Samuel e/a/. 1998);
t'”"'"8.1 SeP“te
IF
16
Health
Y requiring the following steps (Birley and
fc
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Prepared for (he
—I to represent
i
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F•
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Social Issues-Hum
V<1 JL/auii
Health and Dams, Drah, November, 1999
6
•
Add specific :efcrcncrc
i
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t .
consultants -fe|
.......... -
■
component of f 3mpIeted impLTssesZnts.
aPPraisi"8
or e valuaiing the health
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2 1 S S a draf( working paper of (he World
------- T";------------- -----------------Comm.ssionaspartofitsinfonnation-gaiheriLarr 5 ""’IS5,On 0,1 Danis. The
the views of the Commission.
8
report published herein was
Uy- Thc v,ews- conclusions, and recommendations
prepared for Ihc
arc not intended to represent
R
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I®
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fet
-'J i
World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
81
7
8
2. Human health issues related to dam construction and
operation
2.1
I
I
Categories of health issues
The health issues associated with dams can be conveniently represented in six major categories.
The existing knowledge bases concerning the impact of dam construction and operation vary for
the different categories. Table 1 provides an overview. Each knowledge base has been described
according to the volume of knowledge (large or limited), the reliability of that knowledge, the
transferability between projects or regions and the quantifiability of the knowledge in terms of
epidemiological statistics. The basis for characterisation of the knowledge bases was a limited
amount of expert opinion and further refinement is desirable.
A method is required to attribute these risks to particular dam project components.
provided by health impact assessment (HIA), which is described below.
This is
It is difficult to provide a measure of the size of the problem. The total annual global mortality
from floods is probably relatively small (perhaps 100,000 -Miller, 1997). Such deaths are vivid
because they affect large groups of people simultaneously, have an element of dread, are outside
the control of the individual and arc not part of everyday life. In contrast, communicable diseases
such as malaria and diarrhoea kill far larger numbers of people and especially children (World
Bank, 1993). Transport injury rates are also very high and there is widespread malnutrition
associated with protein-energy deficit or diet. There is a substantial difference between the
perception of risk and the statistical measurement of risk. It is thus usually the case that familiar
voluntary risks (e.g. drowning during normal recreational swimming) are not given the same
weight as unfamiliar, often dramatic, involuntary ones (e.g. drowning during a once-in-a-hundrcd
years flood event). The choice of priority is a matter for the community.
Bl
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This Is a draft working paper of (lie World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
b-.s
World Commission on Dams
Social Issues —Human Health and Dams, Draft, November, 1999
__
__
8
__ ___________________________________________________________________
11
5
Table 1. Principal categories of health issues and the extent of existing knowledge about their t
association with dam projects
Health Issue
Examples
Knowledge base
Communicable
disease
vector-bome, water-borne,
sexually transmitted, zoonoses,
other parasitic
large, reliable, ecosystem specific,
some quantification
Non-communicable
disease
poisoning by minerals, biological
toxins, pesticide residues,
industrial effluent
Geographically limited, reliable,
generalisable, and frequently well
quantified
Injury
drowning, construction injuries,
communal and domestic violence,
catastrophic failures, seismic
activity, traffic injury
limited, reliable, transferable, some
statistics
Nutrition
lack of protein, carbohydrate or
essential elements
limited and controversial, limited
transferability, reasonably
quantified, limited reliability
Psychosocial disorder
stress, suicide, substance abuse,
social disruption, unrest violence,
decreased tolerance
low volume, of poor reliability with
little quantification and cultural
variation
Social well-being
quality of life, social cohesion
and support structures, selfdetermination, human rights,
equity
low volume, of variable reliability
and quantification and considerable
cultural variation
There is a considerable body of evidence about the global burden of disease and a measurement
unit has been constructed to compare pain, suffering, disability and loss of productivity from
different illnesses. This unit is known as the disability-adjusted life year, or DALY. It is designed
to assist in the allocation of scarce resources within the health sector (World Bank 1993). While
useful in evaluating the relative burden of many diseases and illnesses, further research is needed
before it can be used to analyse the health issues associated with dam projects and serve as a basis
for the selection of health safeguards.
H
Ihti
■
H
iffl
2.2 Regional differences
There is regional variation in the prevalence rate of certain health conditions. This variation is
most obvious when the condition depends on ecological factors such as the presence of insect
vectors, which in turn depends on environmental determinants such as vegetation type or rainfall.
Clear differences are observed between hot tropical climates and cooler temperate climates in the
transmission of many vector-bome diseases, or in the occurrence of toxic cyanobacterial blooms,
for example. Some of the more generalisable regional differences in health conditions throughout
the world are described in .
This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations are not intended to represent
the views of the Commission.
It®
.VJ:-
' :A
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■ iWorld Commission on Dams
Social Issues-Human Health and Dams, Drafl, November, 1999
9
■is
Table 3. Examples of regional variation in health conditions
Warm v cold
climates
Various communicable diseases depend on a pathogen lifecycle
which has a stage in the environment and transmission is then
temperature, rainfall and water cycle dependent, e.g. malaria,
schistosomiasis and cholera. Toxic algal blooms more prevalent in
warmer climates.
Africa v Asia
Communicable diseases such as yellow fever, rift valley fever,
onchocerciasis, trypanosomiasis are not found in Asia.
Schistosomiasis has a very limited distribution in Asia but a wide
distribution in Africa. The malaria vectors of Asia have different
habits to those in Africa. Communicable diseases such as Japanese
encephalitis and dengue fever are found in the Asian region.
S E Asia
America
I
r
[it?
bK
Opistorchiasis is an example of a parasitic disease that is most
common here. Schistosomiasis is restricted to a belt of China,
Philippines, a valley in Sulawesi and a small section of the Mekong
river. The habits of the snail host are considerably different to
Africa and S America. The malaria vectors tend to be associated
with the forest fringe.
B
Malaria is sometimes associated with forests but there are many
different habitats, schistosomiasis is focal, zoonoses include Chagas
disease and leishmaniasis.
2.3 Differentiation on the basis of dam
1 f'
size and purpose
i|
ecause many health concerns are associated with the interface between land and water the health
impacts of many small dams may be equal to or greater than the impact of a few large dams of
volume FV
PT
t0
inCreaSed rati° °f overa11 shoreline water storage
smnTd
bvreedlng S'teS f°r mosc!uitoes tend ‘o be in shallow backwaters. Hence
num e
f
I"
3
heaIth COntext- Particularly where significant
numbers ofsuch dams exist or are planned.
^mneant
'fe
■
c
q his w illhnvf*snpoll~
■
•
■ fe
villiitaiid in its operation.
ii
fe
Each will
have a range of positive and negative health impacts on a range of stakeholder
... ----communities.
'IS
te
■fi
B’
the views of the Commission.
8
Tr,ss,on
on ,7,s- tik
pubiishcd h-in - p-p-'
V’CWS’ COnclus,ons’ and recommendations arc not intended to represem
' ij--'
’?
!
.p
■
■ *
T
World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
10
3. Options for preventative or health promotional action
3.1 General considerations
The minimum requirement for any development project should be that it does not adversely affect
the health of local communities. Unfortunately this largely remains a distant objective. The health
impacts can be difficult to quantify but they can be categorised as an increase, decrease or no
change in the risk of disease and in opportunities and enhancements for health. The ideal
objective is that the health of all communities should be enhanced and promoted by the project. In
the search for procedures, methods and technical solutions that assist in achieving these objectives,
many technical solutions can be found to the problems of negative impacts of dam construction good practices as Table 4 and illustrate.
Table 4. Examples of health outcomes from dam construction and management
Successful
Panama Canal
Health was accepted as an integral objective of the river
Authority
basin development and the most important problem,
malaria, was quickly controlled around dam sites. The
Tennessee Valley
success of carefully planned engineering measures has
Authority
been sustained for almost a century along the Panama
Canal and half a century in Tennessee.
Not
successful
Mushandike
Irrigation Scheme,
Zimbabwe
Rehabil: .alion of this scheme in the 1980s included
health concerns into the planning, design, construction
and management. It included the development of new,
self draining hydraulic structures, improved canal
infrastructure with optimal gradients and reduced risks
of seepage, and the provision of ventilated improved pit
latrines in the Fields, deployed according to a grid
pattern.
Senegal Valley
Authority (OMVS)
Health was not accepted as an integral part of planning
for the Diama and Manantali dams. An epidemic of Rift
Valley Fever occurred when the dams were Filled,
schistosomiasis prevalence rates reached record levels
and riverside inhabitants experienced diarrhoeal disease,
malnutrition and malaria.
Recommendations for good management practice are listed below,
observations need to be made:
•
•
First, a number of general
Preventative and health promotional measures tend to be site specific. They are linked to the
geographic variation in health conditions associated with dams as well as to the relative
effectiveness of measures in different ecological and epidemiological settings.
The secondary effects of measures need to be taken into account and trade-offs will have to be
found to come to a final decision. The reliance on swamp drainage for malaria vector control,
This is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its infomiation-galhcring activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
'H
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1930s- wou'd currently bcl
192°S
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1C ,lnpor(nncc ntfnr.hrd
sustainable if the i
«/. x: "b"',e9X7 ‘"’ue"
» 800d praclice (WH0 , 982.
■
■
Oomen el ]
3.2 Good Practice
- the Planning Framework
Many dams around the world have I
prob ems. The reasons for this are , been associated with significant, and
but the fact that dams are noi even serious, health
large y on hydro-engineering criteriacomplex
;
■rmally designed based
ealth outcomes associated with dams ,S \contnbuting factor. Fortunately, many of’'the'
---- j’, many of the adverse
hemes) can be ameliorated if a b™• and associated infrastructure d<evelopments (e.g. irrigation >
operation is taken.
*
andJ more holistic view of
- —
=- project construction and < $
Oil
fel
take an integrated, mluXoMna”8'"''™8 "pp™cl“! !l,ould
*
ills
-
' recognition
™S new understanding e.„ fLd to Z'im'1,'nVir"m“l»l. s-ci.l
and he.'ithfor
r the -need to
management. e
operational features for water infrastructure P ementatlon of a range of innovative desfgn and |
provide the desired health outcomes that fo^ll S’ SUCh Chan8eS may be
cost effective and
remedial medical interventions.
a"y Were widened controllable
only through 1
■
_>
wl
«
M
Impact Assessment (HllVTnTetontext'of ‘"CreaSed Understanding is the integrated Health
•mportant that the IIIA is implemented as eariv
°V"all.dam Panning framework, it is very
of the HIA, such as the gathering of baseline hum
CyClc' Ccrlam aspect!
da‘a’ may reClUire more time to
be co Heeled across different seasons because of the s
aSSeSSment Process' O^n this data must
rePr
and “'iVl,y’ “
‘mP-CU on hnZnXiXiXl”1 CyCle
VtCte
beTo^Vr01^35^15^1^0^
few
few
WHO or by'nXTIX Xmte.Uo^nTX”?8 2“' me",od<"°Si“ “ "ullined by fete®
regulatory backing (See section 5 for details) In adriT ’
be identified between the HIA and environmental feco?
From a health perspective, it will usually be annarent
environmental impacts, also lead to clearlv id . r m
opportonlden .re to be iden.iUed .nd .ddres.ed
W'1 PrOper instilutl'onal and/or
3pS .and ^^gies will be usually
SOciaI .imPact assessments,
many °f lhe idenM>ed social and
fix xh tzcx,2z:, t
com„,2 <i2CL'":?b,oP.d™t'n.E„dCyt;X' tad^
m erest in or be affected by the construction if the da 7
HIA process, and generally in ail aspXXng
* -
2 *"
of ,h' Ctakeholder
? T3" 0nyO"e Wl’° niay have a”
°f th"
fe
H
fel
tew?
.tewy
C—0^
•he views of,he Commission
8
Cnns
Thc vi^ conclusions, .nd , report published herein was prepared for lhe
recommendations arc not intended to represent
pi
pi- ■--t>
W’.'
Ip: .• ■;■
•'■'
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;. 3
. World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
12
b-i
B'!
3.3 Good Practice - Design and operation options
There are a number of fully or partially validated options, which can mitigate the adverse effects
on human health of, dam construction. These planning options fall into a number of categories
including engineering design considerations, operational water management, social and
community planning. Some examples are:
■
■
■
■
■
■
■
■
■
■
■
Multiple depth off-takes which allow release of first flush inflows that may contain
high levels of contaminants and nutrients, and allow a high control of variation in
operational water level (which can be advantageous in the control of disease vectors
such as snails and mosquitoes).
Minimising low flow zones in artificial channel networks to minimise habitats for
development of disease vectors.
Siting dams in areas that require minimal population displacement.
At all potential sites, ensuring careful examination of reservoir bathymetry so as to avoid darp
sites that have extensive shallow areas conducive for insect and snail breeding. While shallow
margins can never be totally avoided, catchment topographies that give rise to large reservoirs
of low average depth (and therefore large wetted perimeter) should be avoided (such
reservoirs will also be undesirable from an evaporative loss point of view).
Provision of simple infrastructure at critical places along the reservoir shore to reduce water
contact for specific target groups (fishermen, women, and children).
In-reservoir management to prevent eutrophication and excessive growth of problematic
organisms such as toxic cyanobacteria and aquatic weeds. The, development of massive
blooms of toxic cyanobacteria is an area of increasing concern, especially in poorer countries
where safe drinking water treatment is less common or absent, and where exposure to toxic
blooms may go unmanaged or unreported (see text Box 4).
Careful settlement planning that ensures that, whereever possible, and in balance with other
planning and social needs, population settlement occurs away from areas of impounded and
slow flowing water. This will minimise human exposure to disease carrying vectors (see table
4 for more information).
Adequate planning for, and design of, community water supply and sanitation, including
careful management of sewage and waste.
This will reduce the rate of reservoir
eutrophication and the occurrence and severity of toxic cyanobacteria! blooms, as well as
generally reducing water pollution.
Management of cropping systems to maintain seasonal wetting and drying cycles (while
ensuring efficiency in water use), crop diversification and synchronisation of cropping
patterns. In particular, there should be no agricultural advocacy or economic analysis carried
out that encourages excessive multiple cropping within a single production year. Extended
crop drying periods are important controls on the development of water borne insect disease
vectors in irrigation areas.
Staged and planned controls over population movement into and out of the affected region e.g.
planned community infrastructure construction, culturally sensitive community planning.
Well formulated dam environmental management plans that will support sustainable fisheries
practices, enhance the growth of natural predators of animal disease vectors, and minimise
excessive growth of aquatic weeds and animal pest species.
I
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This Is a draft working paper of the World Commission on Danis.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended lo represent
the vlewi of the Coimnliilon.
■p;..
World Commission on Dams
Social Issues-Human Health and Dams. Draft, November, 1999
I
13
3.4 Good Practice - Off site management and environmental
■to I
protection
The spatial boundaries of the health impact of dams generally extend beyond the confines of the
reservoir and the immediate downstream area.
Therefore a number of offsite environmental
management measures may also be considered.
■
■
■
■
Catchment management to minimise negative impacts on the impoundment including
population and agricultural growth in the upper catchment and pollutant in-flow
Adequate in-flow forecasting for disaster preve con because of increased settlement on the
downstream floodplain and heavy dependence c ■ velihood on the new production system
Water release regimes that minimise impact, on downstream ecology and productivity
especially in regions where there is a significant nutritional reliance on the downstream river
production
Management plans for irrigation areas that minimise long term salinisation and water logging
and therefore impact on community nutrition and viability
Sensitive management of Hood plain wetlands and water resources to ensure wetland
protection, but al the same time minimising excessive growth of water borne diseases vectors.
As with irrigation cropping developments, natural seasonal wetting and drying cycles will be
an important management tool. Traditional irrigation and drainage practices often lead to
permanent inundation and wetting of previously ephemeral wetlands. The outcome of this is
both the degradation of the wetland and an increase in the growth of disease vectors.
w
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This is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations are not intended to represent
the views of the Commission.
h
'J •
1
World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
I
14
4. Recommendations for improving health outcomes
4.1
I
Health impact assessment (HIA)
There is an overwhelming need to include health impact assessment (HIA) as an integral
component in the planning of dams and other major water infrastructure projects
I
HIA is an instrument for safeguarding the health of stakeholder communities. Prospective health
impact assessment provides a mechanism for scrutinising and comparing the health outcomes of
different project plans. Changes may then be included in the plans and operations so as to
safeguard and promote human health. This recommendation is seminal and is discussed in detail
in the next section.
1
Ideally HIA should be integrated with Environmental Impact Assessment (EIA) and Social Impact
Assessment (SIA) as much as possible, while at the same time ensuring that the importance of
human health as an assessment parameter is not lost in the integration process.
Furthermore, the HIA should be commissioned as early in the project planning cycle as possible,
when alternative designs are being discussed. This will allow a comparative assessment to be
made of the health impacts of each design, and importantly, it will allow time for baseline data to
be collected throughout a full annual climatic cycle (see sec. 3.2).
The imperative need for HIA should be incorporated in any future international conventions and in
national legislation on dams.
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Capacity building
Appropriate capacity in HIA and community health management needs to be built both within the
health sector and in the sectors primarily responsible for dams.
National authorities cannot use instruments such as HIA to their full potential until there is a
significant body of trained personnel, and this is clearly lacking throughout the world at the
present time. Health sector personnel will benefit from training in impact assessment procedures
and methods, and will be better placed to appreciate the concerns of other sectors. In turn, other
important sectors, in particular the dam design and construction (engineering) sector, should work
towards the development of an understanding of the association between their decisions and
human health.
Where lacking, all groups should develop skills and training in inter-sectoral communication and
collaboration. This training should include an appreciation of the principles of health impact
assessment. These are generic skills that apply equally to all development policies, programmes
and projects. Training courses need to be self-sustaining and widely available in all countries and
regions as optional components of post-graduate degrees as well as free standing short courses.
The participants of such courses need to be empowered by their managers to implement the skills
that they acquire. This includes career rewards for engaging in inter-sectoral activity that may go
beyond their original job specifications. Wherever possible, this new expertise should be
established and maintained local to the project. Orientation courses are also required for different
stake holders, especially policy makers and elected members of local administrative bodies (See
Box 2 for more details).
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Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues-Human Health and Dams, Draft, November, 1999
15
Institutional support is required to ivoivi
foster these
uiwu training
uauHij^ programmes
piugioiiuiicb and
unu provide
piuviuc quality
quality assurance?,
assurance
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mechanisms. ----The World Health Organisation could be one institution to provide that support
through its headquarters, Regional Offices and country representations. It can also provide the
international framework for health impact assessment of large development projects, as a service i
to the World Bank, Regional Development Banks and bilateral agencies.
A programme of;
training and re-orientation is then needed within WHO to build its own capacity to undertake such-^^^^'
functions. On a longer term a self-sustaining financial mechanism as well a local institutional t
basis should be found to support this framework and the associated activities.
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Box 2. Health Opportunities in Water Resources Development
Capacity and skills to break through the barriers that exist between public sectors are
critically important for health to be considered effectively in the planning, design and
implementation of infrastructure projects. Formal secondary and tertiary education generally
aims at the formation of specialists. Adult learning is most effective when it is problem
based and allows participants to learn from each other rather than through passive information
transfer such as formal lectures. The World Health Organisation, the Danish Bilharziasis
Laboratory and the Liverpool School of Tropical Medicine have developed and tested a threeweek training course for mid-level managers in ministries and other public authorities. In the
context of water resources development -fully documented real projects are used- the
participants work, in inter-sectoral groups, through a series of tasks representing crucial
decision making moments in the project cycle. To a large extent, these tasks revolve around
HIA. Evaluations of five courses (three in Africa, one each in the Americas and Asia)
suggest high levels of acceptability, effectiveness and efficiency. The value of such training
efforts is highly enhanced when simultaneously policy reform is promoted allowing for the
trained staff to effectively engage in inter-sectoral collaboration (Birlcy et al. 1996)
4.2 Documentation
practices
of
successes
and
efficacy
of
wi
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current
An information and education oriented data base should be compiled:
■
■
describing the limited number of health success stories based on careful dam design and
operation, and explaining the key management processes in detail.
with an assessment of the efficacy of already implemented health risk management
techniques.
This information will lead to a considerable improvement in the existing health management
knowledge base and will streamline health-sensitive dam planning
Examples of good health planning in dam and water infrastructure construction include: Panama
Canal, Tennessee Valley Authority, Owens Falls in Uganda, Puerto Rico small dams,
simplification of the Gorgol irrigation project in Mauritania, and remedial action on the Dez
Project
Scheme in Zimbabwe. There are also dams that
u in Iran and the Mushandike Irrigation
o
have included engineering measures for safeguarding health that have not been evaluated. These
include water supply reservoirs in Katsina and Kaduna States, Nigeria, the Ghazi-Barotha Power
Canal in Pakistan, Manantali reservoir in Mali.
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This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as pari of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues-Human Health and Dams, Draft, November, 1999
16
Post construction evaluations of dam projects should routinely include a retrospective health
assessment as well as a prospective health impact assessment that takes into account the long-term
(50-100 years) temporal boundaries (also see section 5 for more details).
4.3 Action oriented research
Special funding should be directed towards action oriented research in existing and planned dam
construction projects in order to strengthen existing knowledgebases and improve health outcomes
I
There are a number of well-documented health problems associated with dams that require
remedial action, with examples including dams in the Senegal, Blue Nile and Volta river
basins. There is good reason to believe that the adverse health, social and environmental
impacts could be alleviated by changes in dam operation. Such projects should be given
priority attention for funding and implementation of health management strategies.
!
Similarly, there are a number of incompletely tested ideas for environmental management
methods for vector control. One example involves fluctuating reservoir outflows. There is
a shortage of funds to support such research because it falls between environmental and
health budgets.
Box 3. Flushing canals for malaria control in Sri Lanka
The synergistic potential of multidisciplinary research on malaria in a specific ecological
setting was recently demonstrated by the work done in the Huruluwcwa watershed,
Anuradhapura District, Sri Lanka. The joint efforts of Peradeniya University and the
International Water Management Institute (IWMI) focused on a strategic assessment of the
local ecology of malaria vector mosquitoes and a water balance estimation/flow measurement
in the irrigation scheme. The primary vector species in Sri Lanka is Anopheles culicifacies,
known to use stream and riverbed pools as its main breeding sites. The water management
options suggested by the research include flushing of streams and irrigation canals at critical
times to reduce mosquito densities and malaria transmission. Routinely applied, this will
require new decision making criteria for irrigation water management, and further feasibility
studies involving both government institutions and farmers. The availability of existing
reservoirs to manage water levels in streams/canals, and the capacity to recapture the released
water downstream are important factors contributing to the feasibility of the proposed water
management regime. Further testing of different options for flushing regimes can provide an
optimal combination with both health and agricultural benefits (van der Hoek et al. 1998Matsuno et al. 1999).
’
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4.4 Budgeting for health
A health component should be negotiated as a budgeted item for all project loans in order to
safeguard and enhance health.
Economic assessments of dam projects that do not include the consideration of health
issues tend to transfer a hidden cost to the health sector. That is, the cost of providing
health and medical support to communities for illnesses that arise because of unforeseen
(though avoidable) consequences of dam construction. The health budget, which is not
This IS a draft working paper af the World Commission on Dams. The report published herein was prepared for the
Commission as part of its mrormaUon-galhcr.ng activity. The views, conclusions, and recommendations arc not intended Io represent
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
17
be considered as a substdute for the existing health care system
S
4.5 Prioritising the health issues
■
It is important that the health priorities are not pre-judged but allowed to emerge from the health O'
impact analysis and community consultation.
The HIA will identify a wide range of health changes attributable to the project. Many of these Si
to the project. Many of these
positive health enhancements, while others will be negative health
nm, impacts
;____ _ that have to ibe
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prioritised for preventative
action.
'Table i1 (sec. 2.1) indicated..the range of health issues that
may
be affected. by a dam project. Development
agencies
are often
aware of—
one
-------------J or two major issues - j
examples include schistosomiasis and AIDS - and assume 1*that these have over-riding priority, ’
sometimes to the neglect of other potentially very important health
issues.
-----------Boxes 4 and 5
highlight !some important health risks that do not always receive the attention they deserve in Wl
eSSment nrOCerllirPS
fnr rlnm
health assessment
procedures for
dam construction.
Box 4. Freshwater cyanobacterial toxins — an emerging dam-related health issue
In tropical, sub-tropical and arid regions of the world it is almost inevitable that new dams
will become eutrophied (nutrient enriched) rather quickly, often within the first few years
of filling and operation. Eutrophication brings with it problems of excessive aquatic weed
growth or ‘blooms’ of toxic cyanobacteria (cyanobacteria are a type of microscopic algae).
Arid zones of the world are particularly at risk, where the artificial impoundment of water
in the hot climate creates the perfect ecological environment for the growth of toxic
cyanobacteria. Added to this natural climatic effect is the enhanced rate of nutrient
pollution that accompanies the growth of towns and agriculture in the catchment around a
dam, often with inadequate effluent collection and treatment facilities.
Blooms of freshwater algae and cyanobacteria have always occurred in eutrophied
waterways, but the toxicity of these organisms has only been elucidated in recent years.
There are several types of cyanobacterial toxins found throughout the world, all of which
are potentially dangerous to humans and animals if consumed in sufficient quantities.
Additionally, some cyanobacterial toxins can promote liver cancer during chronic low
level exposure, and most cyanobacteria can cause a range of gastrointestinal and allergenic
illnesses in humans exposed to toxins in drinking water, food or during swimming (Chorus
and Bartram (WHO), 1999). A drinking water guideline concentration for the common
cyanobacterial toxin microcystin has recently been developed by the WHO.
The most severe and well-documented case of human poisoning due to cyanobacterial
toxins occurred in the Brazilian city of Curaru in 1996. Inadequately treated water from a
local reservoir was used for patients in a local kidney dialysis clinic. As a consequence,
more than 50 people died due to direct exposure of the cyanobacterial toxin to their, blood
stream during dialysis. Elsewhere in South America, in 1988, more than 80 deaths and
2,000 illnesses due to severe gastroenteritis have also been linked with toxic cyanobacteria
in a newly constructed dam. In China, a high incidence of primary liver cancer has been
linked to the presence of cyanobacterial toxins in drinking water (Chorus and Bartram
(WHO), 1999).
This is a draft working paper of the World Commission on Dams.
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The report published herein was prepared for the
Commission as part of its informalion-gathering activity. The views, conclusions, and recommendations arc not iintended to represent
the views of the Commission.
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World Commission on Dams
Social Issues-Human Health and Dams, Draft, November, 1999
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In addition, there are often differences in perception of risk between subject experts (health
specialists) and affected communities. Such differences in opinion can not simply dismissed out
of hand as subjective or emotive. There are various approaches to establishing priorities,
including the following:
■
■
■
estimating the frequency, severity and probability of health impacts;
conducting an economic analysis that compares the cost of all health outcomes;
determining the subjective perception of risk expressed by the stakeholder community;
negotiation of opportunities for mutual gain;
comparison with standards;
reducing health inequalities.
Box 5. Examples of health impacts from India
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Downstream: monsoon dryness
When dams obstruct a river, the protection provided to aquifers and soil by the outward
freshwater flow disappears, and tidal surges may invade the rivers and cause Hooding. This
is already evident along Western state of Gujarat's long Saurashtra coast. Reports by
independent experts, including a World Bank-instituted independent review, expressed
similar fears regarding the Narmada (Anon, 1982)
Water pollution
The impounding of river water in reservoirs has dramatically reduced flow in many rivers,
rendering them incapable of diluting effluents or sustaining much of their natural fauna and
flora. The diversion of the river Yamuna's water into Upper and Lower Yamuna Canal at
the Tajewalc barrage at the Himalayan baseline constricts the downstream flow. Industries
and towns in the North Indian state of Haryana's and later Delhi itself seriously pollutes the
remaining insubstantial flow. The health of downstream communities is placed at risk
1997)SC °f lhC hl8h leVC1S °f t0XiC pollutants and Path°genic micro-organisms (Anon.
Fluorosis
Large reservoirs and the irrigation they bring in command areas elevate sub-soil water,
c langing the levels of calcium and trace metals, and can increase fluorosis. The Nagar
Junasagar dam in South Indian Andhra Pradesh triggered a crippling syndrome of knockknees (Genu valgum') among villagers in the command area.
KT .
.
.
—- —---- --------- - According to Hyderabad's
National Institute of Nutrition, seepage from the reservoir and canals increased the level of
su -soil water. This in turn elevated the molybdenum uptake of sorghum plants, and
augmented soil alkalinity. Genu valgum has been found in villages in Coimbatore district,
situated within a radius of 30 km from the Parambikulam-Aliyar dam, and from villages
near Karnataka's Hospet dam (Anon. 1982).
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
19
5
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4.6 Prioritising dam projects for impact assessment
Screening procedures for HIA needs must be the minimum requirement for all dam projects.
There are often more projects that require health assessment than there are resources
available. Typical screening criteria include number of people affected, location in
sensitive sites, and use of unusual technologies and procedures. Multiple screening
procedures can be used and these are equivalent to rapid health assessments. Several of the
largest dams in the world have serious health impacts. Because of their unique size and
nature, such dams should be evaluated as a special category.
The cumulative effect of many small dams may be more important than the effect of one large
dam. It is impractical to conduct separate assessments for each small dam. A preferred approach
is to conduct a strategic assessment of the small dam construction programme.
Box 6. The compounded malaria impact of microdams in Ethiopia
Recent studies in Ethiopia using community based incidence surveys revealed a 7.3 fold
increase of malaria incidence associated with the presence of microdams. The study sites
were all at altitudes where malaria transmission is seasonal (in association with the rains).
The increase was more pronounced for dams below 1900 meters of altitude, and less above
that altitude. In addition, observed trends in incidence suggest that dams increase the
established pattern of transmission throughout the year, which leads to greatly increased
levels of malaria at the end of the transmission season (Ghebreyesus 1999).
4.7 Transparency
The health impact assessment and planning process should be open to scrutiny by all stakeholders
and communities.
As with all forms of impact assessment, and indeed the entire planning process, it is crucial to
include all stakeholders at all stages of the process. This is good practice for all kinds of
assessment and development activities, not just HIA. Health concerns simply provide a specific
' example. In addition, the community is the critical source and repository of health knowledge and
information.
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This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
1
World Commission on Dams
Social Issues - Human Health and-DamsrDraft, November, 1999
20
5. Health impact assessment (HIA)
5.1 Introduction
Much of the preceding discussion points to the need to include health impact assessment (HIA)
when dam projects are designed or changed. HIA is an instrument for safeguarding the health of
stakeholder communities. A recent broad definition of HIA is the estimation of the effects of
specified actions on the health of defined populations (Scott-Samuel et al. 1998).
For the purpose of this paper WHO prefers a more operational definition: a health impact is a
change in health risk reasonably attributable to a project, programme or policy. A health risk is
the likelihood of a health hazard affecting a particular community at a particular time.
Assessments can be retrospective or prospective. The retrospective kind is the business of normal
science and serves to enlarge our knowledge base. It measures and records what has happened.
The prospective kind is part of the development planning and project assessment procedure. It
projects the likely consequences of a future project based on available evidence. The health
impacts themselves may be positive or negative. It is expected that most development projects
have mostly positive impacts and these include reductions in health risks as well as positive health
enhancements.
The various components of health impact assessment have been debated over the past 15 years
especially in the context of water resource development. They can broadly be classified as policy,
procedure and method. The policy context was described earlier in this document. The distinction
between procedure and method is important. At the early stages of HIA development
methodological questions were considered more important. Experience proved otherwise. The
problem is not so much technical as knowing when and where to conduct the assessment. This
section of the document starts by providing a summary of the procedure so that each stakeholder is
informed of the framework in which the assessment should be carried out. See Figure 1.
5.2 HIA Procedures
The procedure that is describe here and in Figure 1 will be familiar to anyone who is already
informed about impact assessment, such as environmental assessment specialists. It may not be
familiar to many members of the health community who wish to have a role in future assessments.
In addition, there should be community participation by involving stakeholder representatives in
all stages of the procedure. The main components of procedure are as follows.
1. Timing
2.
Screening
3. Establishing a steering committee
4.
Scoping
5. Agreeing Terms of Reference
6.
Choosing an assessor
7. Undertaking an assessment (see method)
8.
Appraising
9. Disseminating
10. Negotiating
11. Agreeing actions
12. Implementing
13. Monitoring and evaluating
This is a draft working paper, of the. World Commission on Dams. The report published herein was prepared for (he
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
World Commission on Dams
Social Issues - Human Health and Dams', Draft, November, 1999
21
Figure 1. Procedures and me ..ods used in health impact assessment
Procedures
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Methods
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Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
22
5.2.1 Timing
liming - when to commence the HIA - is crucial because of the frequent observation that impact
assessments are commissioned too late, sometimes even when the first concrete has already been
poured. They should be commissioned when alternative designs are being discussed so that a
comparative assessment can be made of the health impacts of each design. The timing should also
allow the health assessor to interact with other members of the design and assessment team.
Additionally, time should be allowed for seasonal differences in baseline community health
conditions to observed and recorded (see also sec. 3.2).
II
5.2.2 Screening
Screening procedures are used to decide which projects should receive a particular level of HIA,
or whether indeed a HIA is necessary at all (as discussed in sec. 4.7). However, it is difficult to
conceive of any large dam project for which a health assessment would prove unnecessary.
Individual small dam projects may not, upon initial consideration, seem likely to require an HIA.
However, as already noted, small dam developments need to be examined strategically and in a
regional context. In particular whether several other such dams already exist in an area whose
cumulative health impact may be similar to or even worse than that of a large dam of identical
total storage capacity.
.
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5.2.3 Steering committee
Following screening a multidisciplinary Steering Group should be established to determine the
scope and Terms of Reference of the assessment and to provide advice and support as it develops.
Its membership should include representatives of the commissioners of the HIA, the assessors
carrying it out, the proponents (i.e. those developing, planning or working on the dam project),
affected communities, and other stakeholders as appropriate. Members should ideally be able to
take decisions on behalf of those that they represent. A single committee that takes charge of all
assessment and feasibility studies is the preferred option. This broad committee should include a
specialist health representative.
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5.2.4 Scoping and agreeing Terms of Reference
The outcome of the screening procedure should be the starting point for scoping and the
formulation oflerms of Reference (TOR). Scoping serves to define the health issues that should
be considered in detail (generically listed in Table 1), the stakeholders, and the boundaries of the
assessment in time and space. Based on the scoping exercise, TOR are formulated.
The purpose of the TOR is to provide a basis for a quality assurance procedure for the
work being undertaken. The TOR is project specific, but should include the following
elements.
■
■
Steering Group membership should be listed in the TOR, together with members’ roles,
including those of Chair and Secretary.
The nature and frequency of feedback to the Steering Group should be specified.
1 he methods to be used in the assessment should be described in adequate detail.
lhe TOR should outline the form and content of the policy, programme or project's outputs,
and any conditions associated with their production and publication. Issues associated with
publication of outputs include ownership, confidentiality and copyright.
The scope of the work should be outlined - what is to be included and excluded, and the
boundaries of the HIA in time and space. Positive as well as negative health impacts should
be included in the assessment (see sec. 2.1, table 1).
This is a draft working paper of the World Commission on Danis.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
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23
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An outline programme - including any deadlines - should be provided.
The budget and source(s) of funding should be specified.
is
The TOR is a crucial element of the HIA procedure, with the quality of the assessment being
determined in part by the quality of the TOR. In the case of dam projects, it should be written by <
an expert with experience/ expertise in community health and/or environmental sciences and with
definite experience in working with displaced people. It will need to be agreed by the Steering ■.
Committee. It is important that the TOR has a broad view of health issues as outlined in Table 1.
When the assessment report is complete, it is appraised by the Steering Group to determine
1
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whether it satisfies the TOR.
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5.2.5 Choosing an Assessor
Project proponents who are commissioning work on health impacts are frequently unclear about
the kind of person that they should commission to carry out the HIA. This is made more difficult
by the general lack of availability of special training or expertise. In an ideal world, a team •
encompassing all the requisite skills and knowledge would undertake the assessment, but in
reality, some compromise will usually be necessary. The following list is provided for guidance.
The person or team contracted to undertake the HIA should ideally have the following
i
qualifications, education and experience:
■ Experience with prospective health/ environment / environmental health impact assessment.
■ Training in public health, environmental health or equivalent.
■ Familiarity with both environmental and social determinants of health
■ Able to adopt a holistic perspective of health issues (see Table 1).
■ A record of publication or experience linking environmental change and health issues.
■ Able to carry out key informant interviews and produce an analytic report that cites sources and
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indicates assumptions.
■ An understanding of water resource development issues.
■ Familiarity with disease ecology, for example the ecology of vectors associated with the
floodplain.
An involvement with field based health research such as epidemiology or human ecology.
A number of training courses have now been pilot tested in both developing and developed
countries (Birley et al. 1996; Birley et al. in prep). But they have not yet been widely
disseminated or institutionalised (see for more details sec. 4.2, Box 2).
5.2.6 Spatial boundaries
.
•
It is common that administrative, ecological and hydrological boundaries do not coincide. Rivers
may flow through several countries, regions and local government districts. The boundaries used
in different kinds of impact assessment need to be integrated. Health impacts are sometimes
associated with boundary problems and confusions over jurisdiction.
Figure 2 illustrates the various geographical boundaries and components of dam projects. They
include reservoir, upper catchment, irrigation scheme, floodplain, estuary, urban slums, and coast.
The health impacts cover the whole river basin both upstream and downstream of the dam wall
and ultimately, it is the extent of human movement that determines the lateral extent of the zone of
interest rather than any particular biogeographic zones (e.g. catchment boundaries). This includes
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
24
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seasonal movement by pastoralists, displacement to urban slums, and circulation between river
basins by fishing folk. Communities displaced by reservoirs may migrate to the upper catchments
and change the local land use. Others will be formally resettled in newly designed and constructed
villages, with all the difficulties that this entails. Increased deforestation in the upper catchment
area to increase water yields into the reservoir may also have local health impacts, as well as
negative impacts on water quality in the dam itself due to increased sediment and nutrient run-off,
hence contributing to the risk of toxic algal blooms. The displaced communities also migrate to
distant cities where they swell the peri-urban slums.
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The association between human circulation and health issues is illustrated in Table 5. At a smaller
scale and depending on the specific river system, the river floodplain includes a flood recession
zone that may extend 50 km and the reservoir has a draw-down zone that may extend 5 km
laterally around the perimeter of the dam. At an even smaller scale, the local flight range of insect
This Is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
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Social Issues-Human Health and Dams, Draft, November, 1999
h
24
I
I
seasonal movement by pastoralists, displacement to urban slums, and circulation between river
basins by fishing folk. Communities displaced by reservoirs may migrate to the upper catchments
and change the local land use. Others will be formally resettled in newly designed and constructed
villages, with all the difficulties that this entails. Increased deforestation in the upper catchment
area to increase water yields into the reservoir may also have local health impacts, as well as
negative impacts on water quality in the dam itself due to increased sediment and nutrient run-off,
hence contributing to the risk of toxic algal blooms. The displaced communities also migrate to
distant cities where they swell the peri-urban slums.
100 kms
◄-
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catchment
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^rgseryplr
resettlement x-s Atl
\
circulation
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rrlgatlon
displacement,
circulation,
migration
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t
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flood
recession
I
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floodplain
P''
I
human
circulation
I
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estuary
coastal plain
■mm ■■
sea
!
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Figure 2. Spatial boundaries of dam health assessment
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The association between human circulation and health issues is illustrated in Table 5. At a smaller
scale and depending on the specific river system, the river floodplain includes a flood recession
zone that may extend 50 km and the reservoir has a draw-down zone that may extend 5 km
laterally around the perimeter of the dam. At an even smaller scale, the local flight range of insect
&
I
This is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
■
I ...
World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
25
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vectors between breeding and feeding sites ranges from 0.1-10 km as Table 5 indicates. Longer
migratory flights or long-range transport of insects by prevailing winds imply that if a project
creates new insect breeding sites then sooner or later they will be colonised.
fem
Table 5. Flight range of insect vectors
Vector
Local movement
(km)
Migration (km)
Simuliid blackflies
4-10
400
Anopheline mosquitoes
1.5-2.0
50
Culicine mosquitoes
0.1-8.0
50
Tsetse flies
2-4
1
M
H
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Table 6. Typology of human circulation
Circulation
Migration
—If
________
Regular
Daily
Periodic
Seasonal
Long-term
Irregular
Rural/rural
Cultivating!
Hunting!
Pastoralism!>2
Labouring!
Nomadism! >2
Rural/urban
Commuting!
Trading! ,2,3
Labouring!
Labouring
3
Drought! »2,3
Labou.
Urban/rural
Cultivating!
Trading!
Labouring!
Trading!.^
Refugees! »2,3
Retirement!
Urban/urban
Commuting!
Trading!*’
Tradingl
Relocation^
Refugees^
3
-Resetllemenl'^^^a
-- WOi
1 communicable disease (e.g. vector-borne diseases, STDs)
malnutrition/injury
3 psychosocial (e.g. alcoholism, stress, depression, violence)
■ffl
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(after Birley 1995) '
5.2.7 Temporal boundaries
in
The temporal boundaries consist of the stages of the project cycle: planning, design, construction,
operation, rehabilitation, decommissioning. In the case of dams the complete time-span may be
50-100
years
and the health
impacts
differ in each stage.
Some health problems «
are
--------- ------------------ -------------- will
--------------------------------- --------------------immediate, rapid or acute in onset while others are slow, delayed or chronic. See Table 7 and
Table 8 for more details. The baseline conditions, before construction, usually only provide a
partial basis for an accurate forecast of later conditions because of the environmental and
demographic change that occurs. The experience of similar projects in comparable eco-settings is
a more reliable basis for forecasts.
teg
few
5.2.8
Appraisal and dissemination
The completed HIA report must be appraised by the steering committee to ensure its quality.
Before final acceptance the report should also be disseminated to all major stakeholder
communities and their feedback should be incorporated. The appraisal includes both technical and
This is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the vicwi of the Commiiiion.
M
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
29
9^
5.3.2 Health determinants
Health determinants are the factors that are known or postulated to be causally related to states of
health. Health determinants can be listed and classified. The direction of change of health
determinants associated with a project can be inferred. They can be divided into those that can be
managed, such as housing, and those that cannot be managed, such as age. Some health
determinants are listed and classified in this paper but the list is not yet complete. The causal
relationship between determinants and health outcomes is well demonstrated in some cases but
further work is required in other cases. The relationship is clear in some cases while in others it is
multifactorial and complex. In the past there has often been a tendency to focus on the bio
physical environment using a life-cycle model of disease and to ignore social detenninants such as
poverty and loss of health culture.
Table 11 indicates examples of health determinants. Some of these will be changed by the project.
The change may be positive or negative in terms of their likely health outcomes. It is not always
possible to associate a change in health determinants with a change in health outcome. Generally,
the risk of a change in health requires several health determinants to act together. For example,
numerous mosquitoes only increase the incidence of disease if people do not protect themselves
from the bites, immunity is low and the health services fail to provide vector control, prompt
diagnosis and treatment. Similarly, the spread of H1V-AIDS may be mitigated substantially
through local education on safe sex practices, distribution of condoms to construction and site
workers and empowerment of local communities to manage the influx of temporary workers.
Personal protection depends on poverty, housing design, knowledge, attitude and belief,
occupation. In seasonal climates vector-bome diseases often have seasonal changes in incidence.
The artificial flood may extend or reduce the transmission season.
11
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This is a draft working paper of the World Commission on Dams.
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Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
Social lssues-Human Health and Dams, Dran, Novcmbcri
28
5.2.10 Implementation and monitoring
a tool for ens^ringThaVknpIementatio^pro^Pd’P^316 Sta8^S
Pr0JeC*' Monitorin8 Provides
unforeseen health effects. It is likely to be b^ J 35 a8,^
t0 deteCt the 0CCUITence of any
often well placed to scrutinise those indicAtc/56
1C^tOrS and the affected communities are
example, they can report whether domestic pr°Vldlng that they are empowered to do so. For
insect bites are more numerous food security i
h SUPPand heaIth centres are functioning,
the sense of well-being is improved The I
enhanced’ fear of '"juries decreased, and whether
some of their concerns. Part o the n
,°f communi‘y Baders can capture
community infrastructure and salaries for fare providers.5
373113616
maintenance of
5.3 HIA Methods
i
consists of inferring changes in health deta?
aSSeSSmcnt can ,ake P>ace. It
and that could affect each stakeholder communZd h3t
I,eaSOnably attr‘butable to the project
taken together, produce health outcomes or ch^ Unng Sa<;h stage of the Project. The changes,
minimum of three ranks: no change increased86 h eTit J
/a16*' TheSC
eXpreSSed in a
Quantification is generally difficult either bpra
m a risk’ lncreased health enhancement,
known functional relationships between cause aTd eff ^^p’5
b6CaUSe
are n0
exception, because the doseTesnonse mni I
d
ct' Polson'ng and contamination are an
needed to improve the predictive ZelsZ olhXtLTntms0"31 re,ali°nShip*
' !
ah*pris"" his’<”y orwiia'» similar projects in
Cooper Weil et al. 1990; Birley 1995; Z^TiT)01
are available (e.g.
I
t
brine rover 3 period °f - *-
“
communities, their environment, seasonatht
t.,T
3 pr°flle °f the existing
cycles) and the capabilities of their instituf^
11 nSkS ^e’8’ due t0 vector breeding
project was operational and the difference wtld
COlleCt'On Would be repeated after the
causes. The record would add to the available iZZ 3
°f health imPact and ils likely
future projects.
available knowledge base and improve the assessment of
extensive data, but they must be oerstiacivp Th
and best practice (see section below on Evide^e6)3'8™6"'
!
—< —a to
tCeS may nOt aIways be founded on
preCautionary Pri™ple
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5.3.1 Stakeholders
cTmmuimpact ass“t
Pl-ing the human
impacts which are largely focused on rhe I
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and gender and ceonTmic s
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information about the size of each enrr)11
pntlfy Iocal sta}<ebolders. Demographic
still be impoetan for the .„a ' T .
Ch“e'
b“>
t»o or
e.mmu„^XaS:Z^3ZX:Xt 1'7 ^“1 ™
eonsrstetrt with other arrays of distributions, effects and withl.^" S “searT' " “
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
27
Table 8. Examples of the association of health issues with different project stages
Communicable
disease
Noncoinmunicable disease
Injury
Nutrition
Stress, fear,
anxiety
Planning
Construction
Psychosocial
disorder/
social well
being
STD’s, malaria
Dust-induced
respiratory
tract problems
construction
related
Loss of
subsistence
uncertainty
and
disempower
ment
displaced •
communities
lose
coherence
Early
operation
schistosomiasis,
diarrhoea,
malaria,
zoonoses
toxic algal
blooms
disputes
between
communities
drowning
loss of
subsistence
crops and
grazing
Late operation
schistosomiasis,
diarrhoeal
diseases,
malaria,
onchocerciasis
contamination
of drinking
water, mineral
variation of
soils
drowning
loss of
agricultural
lands
drowning
loss of
irrigation
Decommissioning
ta
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depression -
Hl
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5.2.9 Negotiation
The usefulness of the assessment lies in the weight that it provides to the commissioners of the
HIA during the period of negotiation with the project proponents to ensure that health is
safeguarded and/or enhanced. The negotiators will seek to argue that the predicted health impacts
and the recommendations for mitigating risk and safeguarding health are, indeed, realistic. They
will also agree priorities.
'Once a HIA has been carried out, the consideration of alternative options (or the undertaking of a
formal option appraisal) does not conclude the process. Even when there appear to be clear
messages regarding the best way forward, it cannot be assumed that these will automatically be
adopted. Political imperatives, either within or beyond the Steering Group may ultimately
determine the outcome. Disagreements or power inequalities between different stakeholder
factions may be similarly important. In these and other such cases, the quality of leadership
shown by the Steering Group Chair and members can prove crucial. Achieving agreement on
options for mitigating or enhancing predicted health impacts might require skilful negotiation on
Mi
HH
st
if
the part of those involved.
The outcome of negotiation will be a budget and an intersectoral agreement for implementation of
recommended risk management measures.
pi
Mi
This is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
World Commission on Dams
Social Issues - Human Health and Dams,
Draft, November, 1999
26
fteCtaTUTbas™'„aTe ^.1'"“’:'.1““ “
“,,h lh' ”«'»< "r—en,.
procedural assessment is concerned with .n
rT
lnference that
been used. The
Terms of Reference and the extent to which^TOR ha^h'6™5 °f “H’j"8, the adequacy of the
which
the TOR
scrutmy of the conclusions of the to
HIA
renort
T has beenjmet- Following a satisfactory
report, the recommendations
technical feasibility, social acceptance —
and4 economi<i^soZnTsT
and economic soundness.
S XX”ort0™deZrdt'h.Tm«
»■« &.I H1A report shoeU be .greed to be
whether or not it represents a consensus opinion.
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V
“’•t S““iard "nd
h°lderS aS the basis for father negotiation,
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Table 7. Examples of association of health issues with timing
Acute or rapid onset
Communicable disease
Malaria
Non-communicable
disease
acute poisoning such as during
pesticide
application,
algal
toxins
Injury
Nutrition
Psychosocial disorder /
social well-being
Chronic or delayed onset
schistosomiasis
drowning, trauma
wasting
chronic poisoning such as dustinduced lung disease, algal toxins
hearing
workers
loss
of
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construction
stunting
communal violence
depression
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World Commission on Dams
Social Issues-Human Health and Dam^bran, November, 1999
30
Table 10. Examples of local stakeholder communities and important health issues
Communicable
disease
Noncommunic
able
disease
STDs, lung
diseases, vectorbome diseases
JtDs,
diarrhoeal
disease
deafness
Settlers
vector-home
diseases
pesticide
poisoning,
algal toxins
Displaced
diarrhoeal
disease
Stakeholders
Construction
workers
Camp
followers
alcoholism
communal
violence
alcoholism
communal
violence,
agricultural
injury
algal toxins
Downstream
floodplain
dependent
communities
Fishing folk
schistosomiasis,
other vectorbome diseases
Nomadic
herders
zoonoses
Professional
groups
associated with
project
management
Project
beneficiaries,
such as
electricity
consumers
vector-bome
diseases
Psychosocial
disorder /
well-being
occupational
injury
communal
violence
Peripheral
communities
Nutrition
Transitional
malnutrition,
food entitle
ment
problems in
household
communal
violence
Recipient
communities of
the displaced
Service staff
such as
Injury
dis
empowerment
and
uncertainty
stress,
depression,
suicide, loss
of tolerance,
violence,
divorce,
school drop
outs
Decreased
access to
natural
resources
i
Loss of
tolerance and
increase in
hostilities and
violence over
a period of
time.
I
Decreased
access to
natural
resources
poisoning
from
contaminate
d water
drowning
algal toxins
drowning
communal
violence
!
loss of
subsistence
loss of
grazing
stress
4
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Improved water
supply
vector-borne
diseases
Reduced air
pollution
Reduced fire
risks
Improved
cooking fuels
Improved •
quality of life
alienation
This is a draft working paper of the World Commission on D...... 7,.w
.u,l?11_ herein was prcpaicd for the
Dams. The report KV
published
Commission as [part‘ of its infonnation-gathcring
activity. The views, conclusions,
and ,re—
commend
's
---------. —
......ore alio
not hIntended
to represent
the vlewi of the Commlnlon.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
such as
teachers
diseases
Seasonal
labourers
STDs, vectorborne diseases
Table 11.
Environmental
Institutional
agricultural
and transport
injury
Examples of health determinants and their classification
Principal
categories
Individual/family
pesticide
poisoning
31
Fields
■11
IS
IS
Hi
Examples of health determinants
Biological
Genetics, age, senses, gender, immunity, nutritional status
Behavioural/Lifestyle
Risk acceptance and behaviour, occupation, education
Circumstantial
Poverty, empowerment, family structure
Physical
Air, water and soil media, infrastructure, vectors, housing,
energy, land use, pollution, crops and foods, traffic
Social
Community structure, culture, crime, discrimination, social
cohesion
Economic/Financial
Unemployment rate, investment rate, interest rate, inflation
rate
Health services
Primary care, specialist services, access, drug supply
Other services
Police, transport, public works, municipal authorities, local
goverrunent, project sector ministry, local community
organisations, NGOs, emergency services, access
Public policy
Regulations, jurisdictions, laws, goals, diresholds, priorities,
standards, targets
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5.3.3 Weight of Evidence
The HIA assembles evidence from many sources about the changes in health determinants. The
evidence may be qualitative and based on key informants and community opinion. It will often be
incomplete, inconclusive, imprecise, and will usually be probabilistic rather than absolute. At first
it may not seem totally credible to bio-medical scientists and engineers who are used to working
'with hard facts and numbers. Because of the uncertainties and difficulty of dealing with large and
highly variable human populations, the type of information that will be gathered has more in
common with legal evidence than scientific evidence.
Nonetheless, the analysis seeks to establish a chain of inference between the project, the health
determinants and health outcomes. Assumptions have to be made, but if these are explicit, readers
can make their own judgements about the chain of inference. The priorities assigned to the
changes in health outcomes and the associated perceptions of risk are a political matter and outside
the judgement of the assessor.
’ i was prepared for the
This is a draft working paper of (he World Commission on Dams. The report published herein
Commission as part of its information-gathering activity. The views, conclusions, and recommendations are not
t intended to represent
the views of the Commission.
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32
I
5 3.4 Management of health risks and enhancements
I he final stage of the assessment is to recommend and budget socially acceptable measures to
saleguard, mitigate and promote human health. These measures are designed to influence the
direction of change of some of the health determinants. The budget can be negotiated as part of
the project loan agreement. Decisions about which recommendations to implement are then an
outcome of the negotiating stage.
The most important principle for health promotion is dialogue between project proponents, health
professionals and stakeholder communities at the planning stage. The technical recommendations
for managing health risks are diverse. A broad classification is:
•
•
•
•
•
•
•
.
.
Appropriate health regulations and enforcement;
Modifications to project plans and operations;
Improved management and maintenance;
Supportive infrastructure such as domestic water supply;
Timely provision of accessible health care including diagnosis and treatment;
Special disease control operations;
Individual protective measures;
Redistribution of risk through insurance schemes.
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Some general principles for managing health risks include poverty reduction, community
empowerment, removal of uncertainties, multiple barriers to safeguard health, accessible and
functional primary health centres and a series of environmental measures. Projects that deliver a
reliable and cost-effective service are likely to be health enhancing. The environmental measures
used to mitigate health risks include manipulation of the timing and duration of the Hood to flush
vector breeding sites; the movement of domestic animals so as to avoid zoonoses or to provide
diversionaiy hosts; management of catchment effluents and pollution to minimise the water
quality degradation (see for more details). Many environmental measures are site specific. It is
inappropriate to rely exclusively on curative medicine or pesticides as the mitigating measure.
Drugs and pesticides are expensive and resistance seems inevitable.
Hie most appropriate safeguards improve the project outcome as well as improving human health
- the ‘‘win-win solution”. In some cases this can be achieved without additional project costs by
simply improving communication between stakeholders during the early planning stages.
Recommendations to change individual behaviour are unrealistic. They are also based on a model
of individual responsibility for health. Health determinants are multi-factorial; public policy and
social nonns are of equal importance to individual behaviour. Education is valuable because it is
empowering and increases choice. Accessible medical care is very important, but only as an
additional protective barrier rather than as an alternative- to preventative community health.
Projects may often provide too little health care and too late. For example, in one dam
resettlement project in S.E. Asia, the health centre was constructed more than a year after the
community was already resettled, and was then built much smaller than planned because of cost
overruns. Health centres should be operational, accessible and stocked with drugs before
important events take place, not afterwards. They should be of an appropriate size for the
projected population and staffed and equipped accordingly.
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..s are not intended Xo.rccrftsciit
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
33
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Table 13. Examples of techniques for managing health risks
Poverty reduction
Poverty reduction empowers and enables people to make choices and to
safeguard themselves and their families from many environmental hazards
Zooprophylaxis
There is a possibility of using livestock as diversionary hosts to protect
people from malaria
____________
_________
Wetting and drying of
floodplains or streams
Controls some mosquito species
Health centres
and functional before dam
Ensuring that health centres are <equipped
, ,t
construction, and building capacity and capability of health personnel
and
Water supply
sanitation
i||
B
May be appropriate for certain arboviruses
Vaccination
Handling
animals
________
Reduces diarrhoea, intestinal parasites and schistosomiasis. Domestic water
supplies should be protected from contamination by flood waters.
;
moribund
Control of Rift Valley Fever
Canal or river flushing
Floods have a flushing effect on stagnant waters, removing pollutants such as
human waste, clearing drains or flushing away mosquito larvae.
Community control
Increasing empowerment and reducing uncertainty enhance health
Communication
Early warning of critical events such as floods, health promotion
Dam design
Dam off-takes that release first flush inflows with high levels of pollutants
Structures that enable extensive control of operational water levels
Irrigation
design
channel
Minimising low flow zones to prevent vector breeding
Dam siting
Siting dams in areas that require minimum population and livestock
displacement
Settlement planning
Siting new settlements away from vector breeding sites
Adequate design of community water supply and sanitation, including
careful management of wastes
Staged resettlement linked to infrastructure development
Culturally sensitive community planning
Management of cropping systems to enable wetting and drying cycles and to
use water efficiently
___________________
Irrigation
management
Minimise long term salinisation, siltation and water logging
Upstream
management
Catchment management to minimise flood and pollution risks
In-flow forecasting
Early warning of floods
Water
schemes
release
Reservoir
management
To enhance floodplain productivity and hence nutrition
Prevent excessive growth of aquatic weeds and toxic cyanobacteria
This is a (IndT^orking paper of the World Commission on Dams. The report published herein was prepared for the
ComnXn os part of its information-gathering activity. The views, conclusions, and reconrmendat.ons ate not intended to represent
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World Commission on Dams
Social Issues-Human Health and Dams, Draft, November. 1999
34
Maintain shallow de-weeded reservoir margins near settlements
5
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Floodplain
Sensitive management for habitat and vector control
Good operation and
maintenance
Delivering a reliable and cost-effective service
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World Commission on Dams
Social Issues-Human Health and Dams, Draft, November, 1999
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35
• <1:
6. Acknowledgements
The World Health Organisation wishes to acknowledge and to express its appreciation in the
preparation of this submission to the World Commission on Dams for the contributions and efforts
of:
Dr M.H. Birley, Liverpool School of Tropical Medicine, Liverpool, UK
Dr M. Diop, Planification environnementale TROPICA, Dakar, Senegal
Dr G. Jones, CSIRO Land and Water, Brisbane, Australia
Dr P.V. Unnikrishnan, OXFAM, Delhi, India
, »J
Dr R. Zimmerman, Consultant, Gainesville, Florida, USA
Also, the support and inputs provided by Dr J. Bartram (WHO), Dr G. Bcrgkamp (IUCN), Mr R.
Bos (WHO), Mr P. Furu (DBL), Mr P. Murchie (USEPA), Professor S. Parasuraman (WCD), Dr
T. Satoh (WHO), Dr J. Vapnek (FAO), Dr Y. Von Schirnding (WHO) ar.e gratefully
acknowledged.
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Commission as part of its information-gathering activity. The views, conclusions, and recommendations are not intended to represent
the views of the Commission.
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World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
36
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7. Bibliography
General website for health impact assessment: www.liv.ac.uk/-mhb.
There are a number of books and reports on the health impacts of dams stretching back many
years. In addition to the references below, recent texts include the following.
Kay, B. H., Ed. (1999). Water resources: health, environment and development. London and
New York, E and F N Spon and Routledge.
Oomen, J. M. V., J. de Wolf and W. R. Jobin (1988). Health and Irrigation. Incorporation of
disease control measures in irrigation, a multi-faceted task in design, construction, operation Volume 2.
Wageningen, Netherlands, International Institute for Land Reclamation and
Improvement.
Jobins, W. R. (1998). Sustainable management for dams and waters. Lewis Press, boca Raton,
Florida.
This is a draft working paper of the World Commission on Dams.
The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended (0 represent
the views of the Commission.
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World Commission on Dams
Social Issues-Human Health and Dams, Draft, November, 1999
37
8. References
Acheson, D., D. Barker, et al. (1998). Independent inquiry into inequalities in health report.
London, The Stationery Office.Anon (1982) State of India's Environment: The First Citizens"
Report, Centre for Science and Environment, New Delhi.
Anon (1997) Central Pollution Control Board's (CPCB) 1997 Report, India.
Bercnsson, K. (1998). “Focusing on health in the political arena.” Eurohealth 4(3): 3437.
Birley, M. H. (1991). Guidelines for forecasting the vector-borne disease implications of
w_ater resources development. Geneva, World Health Organisation.
Birley, M. H. (1995). The health impact assessment of development projects. London,
HMSO.
Birley, M. H., A. Boland et al. (1998). Health and environmental impact assessment: an
integrated approach. London, Earthscan / British Medical Association.
Birley, M. H., R. Bos et al. (1996). “A multi-sectoral task-based course: Health
opportunities in water resources development.” Education for Health: Change in Training
and Practice 91: 71-83.
T
Birley, M. H., M. Gomes et al. (1997). Health aspects of environmental assessment.
Washington DC, Environmental Division,The World Bank.
Birley, M. H. and G. L. Peralta (1995). The health impact assessment of development
projects. Environmental and Social Impact Assessment. F. Vanclay and D. A.
Bronstein. New York, Wiley.
Birley, M. H., A. Scott-Samuel et al. (in prep). Report of the first UK training course in
health impact assessment. Liverpool, University of Liverpool.
Chorus, I. And J. Bartram (1999) Toxic Cyanobacteria in Water: A Guide to their Public
Health Consequences, Monitoring and Management, World Health Organisation, E & FN
Spon
Cooper Weil, D. E. C., A. P. Alicbusan et al. (1990). The Impact of Development
Policies on Health: A Review of the Literature. Geneva, World Health Organisation.
Department for International Development (1999). DFID environmental guide. London,
Department for International Development.
Ewan, C., A. Young et al. (1992). National Framework for Health Impact Assessment in
Environmental Impact Assessment.
Volume 1: Executive Summary and
Recommendations and Volume 2: Background Document, University of Wollongong.
This is a draft working paper of (he World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
World Commission on Dams
Social Issues - Human Health and Dams, Draft, November, 1999
38
CI,ebroy«u;,T. A M. Ilnile, cl ..I, (|999). "Incidence or.n.taiu
JoumnBlVwTsM"'
“m",Uni'y b’sed incid'"“
cllikll.e„ |ivi„„
BridsLMedieal
Geneva WHO’L Rey Gt aL (1993;)' £gJasilic diseases in water resources development.
fea
Jobin, W. R. (1999). Dams and Disease. London, Routledge.
li
Koivusalo, M, P. Santalahti, et al.
Eurohealth 43: 32-34.
(1998).
“Healthy public policies in Finland.
Kwiatkowski, R. (1996). The role of health professionals in environmental assessment
consolidated workshop
orkshop proceedings. Ottawa, Environmental Health Centre Health
Canada.
a
Matsuno, Y., F. Konradsen, M. Tasumi, W. van der Hoek, F.P. Amerasinghe and P.H.
Amerasinghe (1999). Control of malaria mosquito breeding through irrigation water
management. Water Resources Development 15:93-105
Miller, J. B. (1997). Floods: people at risk, strategies for prevention. New York, United
Nations.
Oomen, J.M.V., J. de Wolf and W.R. Jobin (1990). Health and Irrigation. Incoproation of
disease control
• -I measures in irrigation, a multifaceted task in design, construction,
operation. JILRI
’'
publication 45, International Institute for Land Reclamation and
Improvement, Wageningen, the Netherlands
Organisation of African Unity (1997). Harare Declaration on Malaria Prevention and
Control in the context of African economic recovery and development.
Harare,
Organisation of African Unity Assembly of Heads of State and Govermnent.
Philippine Environmental Health Services (1997). National Framework and Guidelines for
Environmental Health Impact Assessment. Manila, Department of Health.
Public Health Commission, N. Z. (1995). A Guide to Health Impact Assessment.
Wellington, Public Health Commission, Rangapu Hauora Tumatanui, New Zealand.
Putters, K. (1998). “Health impact screening, the administrative function of a health
policy instrument.” Eurohealth 43: 29-31.
fa
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Scott-Samuel, A., M. H. Birley el al. (1998). The Merseyside guidelines for health
impact assessment. Liverpool, The University of Liverpool.
P
Secretary of State for Health (1999). Saving lives: our healthier nation. London, The
Stationary Office.
fefe
Ibis is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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World Commission on Dams
'Social Issues-Human Health and Dams, Dratt, November, 1999
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Secretary of State for International Development (1997). Eliminating World Poverty: A
Challenge for the 21st Century, White Paper on International Development. London
Department for International Development.
-The Global Partnership for Environment and Development a guide to Agenda
21 Post Rio edition. New York, United Nations.
’
Van der Hoek, W., F.P. /Amerasinghe, F. Konradsen and P.H. Amerasinghe (1998).
Characteristics of malariaa ’vector breeding habitats in Sri Lanka: relevance for
environmental management. ------------------------Southeast Asian J, Trop,
Med. Public Health 29: 168-172
I
I
WHO (1982). Manual on jEnvironmental Management for Mosquito Control, with special
emphasis on malaria vectors. WHO Offset Publication
----- —.----------------- 1 no. 66, World Health Organization,
Geneva
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WHO (1998). Health 21 - health for all in the 21st century, an introduction. World Health
Organisation, Europe.
WHO (1999). Draft charter on transport, environment and health. Copenhagen, World
Health Organisation: 32.
r
Ia
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World Bank (1991a). Envi
T ‘ ronmental Assessment Sourcebook, Volume I - Policies,
Procedures, and Cross-Sectoral Issues.
Wash
Washington, The International Bank for
Reconstruction and Development/The World Bank.
1
World Bank (1991b). Environmental Assessment Sourcebook, Volume II - Sectoral
Guidelines. Washington, The International Bank for Reconstruction and Development/The
World Bank.
F
World Bank (1991c). Environmental Assessment Sourcebook, Volume III - Guidelines for
Environmental Assessment of Energy and Industry Projects.
Washington, The
International Bank for Reconstruction and Development/The World Bank.
World Bank (1993).
Press.
World development report 1993.
New York, Oxford University
&
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Tins is a draft working paper of the World Commission on Dams. The report published herein was prepared for the
Commission as part of its information-gathering activity. The views, conclusions, and recommendations arc not intended to represent
the views of the Commission.
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