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Human and environmental health linkages in Ghana: A case study of Bibiani-Bekwai and Sefwi Wiawso Districts

von Prof. Dr. E. Boon (Autor) A. Ahenkan (Autor) K. A. Domfeh (Autor)

Wissenschaftliche Studie 2008 47 Seiten



Table of Contents

0. Abstract

1. Introduction
1.1 Environment and Health in Developing Countries
1.2 Health and Sanitation

2. Problem Under Investigation, Objectives and Study Area

3. Conceptual Framework
3.1 Health and Environment
3.2 Environmental Health
3.3 Human and Environment Health Interactions and Linkages

4. Materials and Methods
4.1 Study Location
4.1.1 Bibiani-Bekwai District
4.1.2 Sefwi Wiawso District
4.2 Methodology
4.2.1 Indicators of the Research
4.3 Data Analysis
4.3.1 Environment and Human Health in Ghana
4.3.2 Environmental Sanitation Problems and Constraints in Ghana
4.3.3 Environmental Health Challenges in Ghana
4.3.4 Poverty, Human and Environment Health Linkages in Ghana
4.3.5 Environmental Degradation, Changing Ecosystemand Diseases in Ghana Ecosystem Changes Habitat Destruction Emergence of New Pathogens and Diseases

5. Discussions of Results
5.1 Human Health in Bibiani-Bekwai and Sefwi Wiawso District
5.2 Sanitation in Bibiani-Bekwai and Sefwi Wiawso Districts
5.3 Solid Waste Management
5.4 Liquid Waste Management
5.5 Drinking Water in BBD and SWD
5.6 Pollution in BBD and SWD

6. Strategies for Improving Human and Environmental Health in BBD and

6.1 Provision of Portable Drinking Water
6.2 Provision of Sanitary Facilities
6.3 Provision of Waste Collection Bins
6.4 Sanitation and Hygiene Education
6.5 Enforcement of Environmental Laws
6.6 Poverty Reduction Activities

7. Conclusion

8. Bibliography

List of Tables

Table 1: Environmental Health Challenges in Ghana

Table 2: Environmental Challenges, Causes, Effects and Indicators in Ghana

Table 3: Top 10 Diseases Recorded in BBD and SWD (2005-2007)

Table 4: Trends of OPD, Admissions and Death Caused by Malaria in BBD and SWD

Table 5: Ten Top Causes of Death in BBD and SWD

Table 6: Sanitary Facilities and Coverage in BBD and SWD, 2007

Table 7: Solid Waste Management in the District

Table 8: Liquid Waste Disposal Systems in the District

Table 9: Sources of Drinking Water in SWD and BBD

Table 10:Comparison between Human and Environmental Health in BBD and SWD

List of Figures

Figure 1: Interaction between Human Health and the Environment

Figure 2: Map of Ghana Showing the Western Region and the Study Area

Figure 3: Environmental Health Challenges in Ghana

Figure 4: Relationships between Changing Ecosystem and Infectious Diseases

Figure 5: Solid Waste Management in BBD and SWD

Figure 6: Liquid Waste Disposal Systems in BBD and SWD

Figure 7: Choked gutter in the Sefwi Wiawso: A potential breeding ground for Mosquitoes

Figure 8: Source of drinking water for a section of the residents of Sui near Sefwi

Figure 9: Picture of Uncovered Hand-dug Well in Bibiani

List of Boxes

Box 1: Common Water and Poor Sanitation Related Diseases in Developing Countries

Box 2: Drinking Water, Sanitation, Health and Disease in Developing Countries


Health, environment and poverty are closely interrelated and inseparable, particularly in developing countries. WHO estimates that environmental factors are the root cause of 25% of the total burden of disease worldwide and account for about 35% in sub-Saharan Africa (SSA). Effective environmental management is the key to avoiding a quarter of all preventable illnesses which are directly caused by environmental factors. In the Bibiani-Bekwai and Sefwi Wiawso Districts of the Western Region of Ghana, the environment has been altered by complex human induced factors, which have negatively impacted on the health of the population. This paper seeks to establish the major causes of environmental and human health degradation and whether there is a direct link between environmental degradation and human health in Bibiani-Bekwai and the Sefwi Wiawso Districts in the Western Region of Ghana. F our complementary approaches were used during the investigation: extensive literature review, consultations with key informants, the administration of questionnaires, and stakeholder consultations. The data was analyzed using SPSS to establish the linkages between environmental deterioration and human health in the two districts. The results clearly suggest that environmental degradation seriously affects human health in the two districts. 80% of the ailments in Bibiani-Bekwai and Sefwi Wiawso Districts are attributable to poor environmental health and sanitation and lack of access to good drinking water.

Key Words: Ecosystems, environment, environmental degradation, desertification, environmental health , forests, human health, degradation, pollution, poverty, vulnerability

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1. Introduction

Never in the history of mankind has greater attention been given to environment and health (Agyemang et al., 2007). It is estimated that 80 percent of all sickness in the world is attributable to poor environmental factors (WHO, 2007; Housewright and Mihelcic, 2002; Shimkim et al., 2005). Environmental related diseases represent an enormous global public health challenge, particularly in developing countries and impoverished communities (WHO, 2007; Shimkim et a l., 2005). Health and well being of humans cannot be separated from the natural environment (Millennium Ecosystem Assessment, 2005; WHO, 2008). Human health and environmental issues have become a major concern in the world and have received considerable political recognition since the 1970s. In its broadest sense, environmental health comprises those aspects of human health, diseases, and injury that are determined or influenced by factors in the environment (WHO, 1997). Many of the threats to human health are an intrinsic part of ecosystems (WHO, 2008). The impact of a transformed environment causes considerable harm to the sustainability of human health (Rapport et al., 1998). WHO (2007) estimated that 13 million deaths recorded annually are due to preventable environmental causes. Proper environmental management is the key to avoiding the quarter of all preventable illnesses, which are directly caused by environmental factors.

1.1 Environment and Health in Developing Countries

Health and environment are interrelated and inseparable, particularly in developing countries (WHO, 2002; WHO, 1997; WHO, 2008, World Bank, 2001). The lack of clean water resources and sanitation facilities are the most serious environmental health problems facing the global community, especially those living in developing regions (Housewright and Mihelcic, 2002, WHO, 2000; Hutton et al., 2004). The World Health Organization (WHO) has estimated that 1.2 billion people globally lack basic access to drinking water resources, while 2.4 billion people have inadequate sanitation facilities, which account for many water related acute and chronic diseases. Some 3.4 million people, many of them young children, die each year from water-borne and poor sanitation diseases, such as intestinal diarrhea (cholera, typhoid fever, dysentery etc,) caused by microbial-contaminated water supplies and poor sanitation and sewage disposal facilities in developing countries (WHO, 2005; UNICEF, 2008).

Protecting human health is the principal objective of protecting the environment. No segment of humanity depends more directly on environmental resources and services than the rural poor, who make up an estimated 80 percent of the world’s 800 million hungry people in developing countries (FAO, 2005; Jeffrey Barber, 2001). Traditional environmental risk factors such as unsafe drinking water, poor sanitation and exposure to disease vectors have a significant impact on health outcomes in developing countries.

The health of the populations in the developing countries is interwoven with the surrounding environment in ways that make them both particularly valuable as custodians of environmental resources and also vulnerable to environmental degradation (FAO, 2005). A large proportion of the hungry are concentrated in areas that are highly vulnerable to environmental degradation, poverty and poor health (FAO, 2005). Recent estimates suggest that premature death and illness due to major environmental risks account for one-fifth of total burden of diseases in the developing countries (World Bank, 2001; WHO, 2004; UNEP 2000). Environmental factors such as pollution, poor sanitation, lack of drinking water, poor housing, and transport are a root cause of nearly 35% of the total burden of diseases in Sub-Saharan Africa (SSA).

Wastewater is treated in less than 35% of cities in the developing countries, and between one-third and one-half of the solid waste generated within most cities in developing countries is not collected (Gopalan, 2003). The Health and the Environment Linkages Initiative (HELI) of WHO encourages countries to address health and environment linkages as an integral component of sustainable development.

Box 1: Common Water and Poor Sanitation Related Diseases in Developing Countries

Cholera is a world-wide problem, especially in emergency situations. It can be prevented by access to safe drinking water, sanitation and good hygiene behaviour (including food hygiene).

Diarrhoea is the most important public health problem directly related to water and sanitation. The simple act of washing hands with soap and water can cut diarrhoeal disease by one-third. Next to providing adequate sanitation facilities, it is the key to preventing waterborne diseases. About 4 billion cases of diarrhoea per year cause 1.8 million deaths, over 90 per cent of them (1.6 million) among children under five.

Guinea worm disease. People contract the disease when drinking water contaminated with Dracunculus larvae. The larvae mature into large (up to a metre long) adult Guinea worms and leave the body after about a year, causing debilitating ulcers.

Intestinal worms. People become infected with intestinal parasitic worms (also know as helminths) through contact with soil that has been contaminated with human faeces from an infected person, or by eating contaminated food. Intestinal worms infect about 10 per cent of the population in the developing world and, depending upon the severity of the infection, lead to malnutrition, anaemia or retarded growth. Children are particularly susceptible and typically have the largest number of worms. About 400 million school-age children are infected by roundworm, whipworm and/or hookworm. In fact, roundworm and whipworm alone are estimated to affect one-quarter of the world’s population.

Malaria is a serious disease caused by a parasite carried by certain types of mosquitoes. Humans are infected when bitten by the mosquitoes. Each year, there are 300 million to 500 million cases of malaria throughout the world and about 1 million child deaths. Reducing the mosquito population in households and communities by eliminating standing water (caused by poor drainage and uncovered water tanks) can be an important factor in reducing malaria cases.

Schistosomiasis (also known as bilharzia) is a disease caused by parasitic worms. At various stages of the life cycle, worms and their eggs live in certain types of freshwater snails, water (where they can survive for 48 hours) and human hosts. They penetrate the skin of people swimming, bathing or washing in contaminated water.

Trachoma is an eye infection spread mainly through poor hygiene caused by lack of adequate water supplies and unsafe environmental sanitation conditions. About 6 million people are blind today because of trachoma. It affects women two to three times more than men. Children are also especially susceptible. Studies have found that providing adequate water supplies could reduce infection rates by 25 per cent.

Typhoid fever is a bacterial infection caused by ingesting contaminated food or water. Symptoms are characterized by headaches, nausea and loss of appetite.

Source: UNICEF (2008). Water, environment and sanitation: Common water and sanitation-related diseases

Box 2: Drinking Water, Sanitation, Health and Disease in Developing Countries

About 2.6 billion people – half the developing world – lack even a simple ‘improved’ latrine and 1.1 billion people have no access to any type of improved drinking source of water. As a direct consequence:1.6 million people die every year from diarrhoea diseases (including cholera) attributable to lack of access to safe drinking water and basic sanitation and 90% of these are children under 5, mostly in developing countries. 160 million people are infected with schistosomiasis causing tens of thousands of deaths yearly. 500 million people are at risk of trachoma from which 146 million are threatened by blindness and 6 million are visually impaired; intestinal helminths (ascariasis, trichuriasis and hookworm infection) are plaguing the developing world due to inadequate drinking water, sanitation and hygiene with 133 million suffering from high intensity intestinal helminths infections.

WHO, 2007; WHO, 2002

1.2 Health and Sanitation

Access to sanitation is one of the most overlooked human needs in the world today (UNDP, 2005, UN, 2007). Access to sanitation is nothing less than a fundamental issue of human dignity and human rights and a cornerstone of economic development and environmental protection. Today, about 2.6 billion people in the developing world lack access to basic sanitation and about two-thirds of the population in developing world have no hygienic means of disposing of excreta with even a greater number lacking adequate means of disposing of wastewater (UNDP, 2005; UN, 2007, WHO/UNICEF, 2000). In Ghana, less than 10% of solid waste generated is properly disposed of (Larbi, 2005).

It is important to note that virtually all the Millennium Development Goals, in particular those involving the environment, education, gender equality and the reduction of child mortality and poverty (United Nations, 2007) are concerned with health and sanitation. Increasing access to sanitation is a key component of development and poverty reduction, as it has major health benefits as well as associated social, economic and environmental gains. Today, more than 2 billion people around the world lack access to basic sanitation services (UN, 2007; UNDP, 2005). Some 90 percent of sewage in developing countries is discharged into water courses without treatment, often polluting the usable water supply. An estimated 42,000 people die every week from diseases related to low water quality and an absence of adequate sanitation (UN, 2007).

2. Problem Under Investigation, Objectives and Study Area

The Poverty Reduction Strategy Paper (PRSP) of Ghana recognizes that improving the health status of the poor is crucial for poverty reduction, given that ill health is both a consequence and cause of poverty through lack of funds and knowledge to prevent illness and productivity and income losses (GPRS, 2003). An important challenge to improving the health status of the poor is how to ensure a balance between direct health care and the preventive aspects, especially in the provision of safe water and sanitation, given the close relationship between diseases that affect the poor and poor environmental health (GPRS, 2003).

Despite the surge in national and local recognition of the close link between the environment and human health and the plans defined to improve environmental health and sanitation in Ghana, the burden of disease is increasing and environmental health and sanitation situation are becoming very appalling. Available data indicate that more than 60% of all morbidity and mortality cases in Ghana are water and sanitation-related (MOH, 2007; Daily Graphic, 2008). Environmental health problems in Ghana are multisectoral in character and involve all sectors (i.e. agriculture, energy, environment, health, housing, water, industry and planning). The state of environment and its degradation have a direct impact on the health of the populations. The extent of human health impact is a function of the extent of damage to the environment and the level of vulnerability of the population. The greater the damage to the environment and the less resistant the population, the greater the impacts and effects. This paper seeks to establish the relationship between environmental degradation and human health in Bibiani-Bekwai and the Sefwi Wiawso Districts in the Western Region of Ghana. The environmental influences and effects on human health are identified and the causal linkages between environmental deterioration and human health in the district established. A number of recommendations are put forward for strengthening the relationship between the human and environmental health in the two districts.

3. Conceptual Framework

The linkages between human health and the environment cannot be over emphasized since these tend to act together to reinforce each other. The concepts and theories of human health and environment are described in this section.

3.1 Health and Environment

WHO (1948) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition was updated in the 1986 WHO "Ottawa Charter for Health Promotion" by saying health is a "resource for everyday life, not the objective of living", and "health is a positive concept emphasizing social and personal resources, as well as physical capacities. Health promotion is the process of enabling people to increase control over, and to improve, their health (WHO, 1986).

To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment (WHO, 1986). Health is, therefore, seen as a resource for everyday life, not the objective of living. The fundamental conditions and resources for health are: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity.

It is difficult to define environment (Nasreen et al., 2006). The word ‘environment’ is a vast one: ranging from microbic action to the size of world population (Nasreen, 2000). Environment has been defined as “the aggregate of all the external conditions and influences affecting the life and development of an organism” (The Webster’s New Collegiate Dictionary, 1995). In the context of health, environment includes ‘‘all that which is external to the individual human host’’ (Hens et al., 1998).

3.2 Environmental Health

The definition of environmental health is still evolving (Kseniya, 2001) due to the increasing knowledge of the links between environmental influences on human health, and the impacts of human activities on the environment (Gosselin et al., 2001). In its broadest sense, environmental health comprises those aspects of human health, disease, and injury that are determined or influenced by factors in the environment. This includes the study of both the direct pathological effects of various chemical, physical, and biological agents, as well as the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture (WHO,1997).

Environmental health focuses on the health interrelationships between people and their environment. These relationships between human health and environmental influences are central to the definition of environmental health (Gosselin et al., 2001). The factors that influence the health of human populations can be divided into physical, biological, social, cultural, etc., and any or all. Environmental health therefore refers to those aspects of human health, including quality of life, that are determined by physical, biological, social and psychological factors in the environment (Kseniya, 2001).

3.3 Human and Environment Health Interactions and Linkages

It is becoming increasingly obvious that the degradation of ecosystems and poor environmental conditions are the root causes of many of the sufferings within human communities (Rapport, 1998; Klaus, 1999). These causal links are complex because often they are indirect, displaced in space and time and dependent on a number of modifying forces. An ecosystem is a functioning unit of nature that combines biotic communities and the abiotic environments with which they interact (LaRoe et al., 1995; UNEP, 2001). The status of human health is a reflection of a whole variety of complex interactions between the internal biological and the total external environmental system.

Health effects of one particular change in the environment should be assessed within the context of other co-existing environmental effects and occurrences, such as rapid urbanization, human population density, resource exhaustion, pollution, desertification etc (Feola et al., 2001). Poverty, poor sanitation, poor living conditions, and the lack of education have been repeatedly identified as major impediments to good human health. As Figure 1 illustrates, human health ultimately depends on a society’s capacity to manage the interactions between human activities and the physical, chemical and biological environments. It must do this in ways that safeguard and promote human health, yet does not threaten the integrity of the natural systems on which both human and the environment depends.



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Titel: Human and environmental health linkages in Ghana: A case study of Bibiani-Bekwai and Sefwi Wiawso Districts