“Population, Health and Human Settlements” is the second chapter in the Rwandan government’s Rwanda State of Environment and Outlook. The chapter highlights the Rwandan government’s recognition of the interconnections between population, health, and environment, noting that population “can influence the state of the environment” and pose strains “on available public infrastructure, limited land, and natural resources.” The chapter examines Rwanda’s population growth and distribution, the state of “environmental health” in rural and urban areas, and health indicators relating to child and maternal health and HIV/AIDS. It goes on to describe government strategies to “improve settlements and human welfare.” “As population pressure is one of the key drivers of environmental degradation and poverty,” the chapter’s authors write, “the implementation of the population policy, especially aspects that address high fertility rates, gender and reproductive health, migration and human settlements” is increasingly important.

Celebrating World Health Day, the World Health Organization, with its partners around the globe, today launched an initiative for healthly lives in urban settings, through the theme “1000 Cities, 1000 Lives.” “We are at a critical turning point in history where we can make a difference,” said Dr Ala Alwan, assistant director-general for noncommunicable diseases and mental health.

Since the first World Health Day 60 years ago, the world has seen a dramatic rural exodus. Today, more people live in urban areas than anywhere else. Providing healthy livelihoods for the urban poor is a challenge, as poverty-stricken urban centers face a number of health obstacles, from high child mortality rates, environmental pollution, and widespread disease, to a lack of access to basic water, sanitation, and health care.

“In general, urban populations are better off than their rural counterparts,” said WHO Director-General Margaret Chan. “They tend to have greater access to social and health services and their life expectancy is longer. But cities can also concentrate threats to health such as inadequate sanitation and refuse collection, pollution, road traffic accidents, outbreaks of infectious diseases and also unhealthy lifestyles.”

The 1000 Cities campaign hopes to encourage all cities to promote healthy activities during the week following World Health Day (4/7-4/11). Through a new website, the WHO is collecting profiles and pictures in an easy-to-navigate map. Notable activities include HIV/AIDS-awareness flashmobs, skateboarding and cycling competitions, car-free days, outdoor sports events, and dance performances,  in cities as diverse as Mandalgobi, Mongolia; Bangalore, India; and Luanda, Angola.

The Wilson Center’s Environmental Change and Security Program and its Comparative Urban Studies Program have collaborated on urbanization events and publications that examine the strong and critical connections between healthy urban populations and environmental sustainability.

With proper attention paid to delivering population, health, and environmental services in our urban centers, it may be possible to leverage the benefits of higher urban densities—such as lower aid dispersion costs, communication access, infrastructure services, and fertile environments for ideas and productivity—to ensure urban sustainability for the future.

The WWF and Equilibrium Research released a report on the interplay between the environment and human health. Vital Sites: The Contribution of Protected Areas to Human Health documents the environmental-human health connection, provides case studies from both the developed and developing worlds, and offers recommendations to enhance the health outcomes that can be gained from environmental good governance. “[P]rotected areas are not a luxury but are key sites to protect not only biodiversity, but also ecosystem services and our wider well-being,” the World Bank’s Kathy MacKinnon writes in the foreword.

Pekka Haavisto, a Member of the Finnish Parliament, thinks an objective scientific investigation of rumored toxic waste in Somalia would be both doable and politically useful. Haavisto, the former Finnish minister of environment, visited the Woodrow Wilson Center last week and spoke with the Environmental Change and Security Program’s director Geoff Dabelko.

In our latest video interview about PHE programs in Ethiopia, Zuna–a village elder from the Mettu Woreda region of Ethiopia—describes how an integrated intervention by the Ethio-Wetlands and Natural Resources Association (EWNRA) has benefited her community.

“Even in the hardest moments of conflict there are opportunities for cooperation, and they need to be seized,” said Juan Dumas, senior advisor of Fundación Futuro Latinamericano during the Pathways to Peace: Stories of Environment, Health, and Conflict roundtable event co-hosted by the Wilson Center’s Environmental Change and Security Program and the Fetzer Institute on January 13th.

“Even as you were talking about the conflict potential,” said Aaron Wolf, professor of Geoscience at Oregon State University, “everywhere you looked there were people talking about water uniting together across boundaries and being able to share… [and] people being willing to talk about water when they wont talk about anything else.”

Dumas and Wolf were joined by Gidon Bromberg, co-director of Friends of the Earth Middle East (FoEME); Shewaye Deribe, project coordinator for the Ethio Wetlands and Natural Resources Association (EWNRA); and Joan Regina L. Castro, executive vice president of the PATH Foundation Philippines, Inc. (PFPI) to discuss work that demonstrates the positive impact multi-dimensional development and peacebuilding programs can have on environmental conflict arenas.

Water as an Entry Point

“In the academic world, there’s a growing documentation about the coming wars of the 21st century are going to be about water resources,” said Wolf, discussing how water resources are inherently intertwined with the Arab-Israeli and other regional conflicts. His research, however, suggests the opposite. In recent history, he said, cooperation for the resource, not conflict, was observed in nearly two-thirds of the world’s cross-boundary watersheds.

“Water is a wonderful way to have regional dialogue,” he continued, discussing how technical data and modeling are only part of any successful water conflict resolution. “A language that people have in common, and when we talk about water—because it’s connected to everything we do—we end up talking about our shared vision of the future.”

“We came out with a vision that is a shared vision,” echoed Bromberg in describing the Good Water Neighbors (GWN) project—a FoEME program seeking to improve water scarcity and quality in the Jordan River watershed by fostering cooperation between Israeli, Palestinian, and Jordanian leaders. “The Jordan office advocates that vision to the Jordanian government, the Israeli office to Israeli government, the Palestinian office to the Palestinian authority. That’s proven to be very effective because it’s the same vision.”

While hesitant to say the program could lead to or be a model for peace in the Middle East, Bromberg did underscore how multi-dimensional methods used in GWN could productively serve future peacebuilding efforts in the region.

“By empowering young people to go out and improve their own water reality with their own hands [through rainwater harvesting and grey water collection] they learn together, and then they build the facilities within their own communities,” said Bromberg. “…Not only does it empower the youths but it helps create peacemakers.”

Integrated PHE and Conflict Avoidance

“Water is common for all of us because it is the base of our life, of our survival,” said Deribe, linking ENWRA’s integrated population, health, and environment (PHE) wetland restoration program in Ethiopia to the greater discussion. “I think it is a lack of altruism, a lack of mutualistic thinking which leads us to this kind of conflict.”

Ethiopia’s 12 river basins serve more than 200 million people. Managing local wetlands and waterways with PHE approaches can therefore play an integral role in maintaining environmental quality and productivity for current and future generations while avoiding conditions that contribute to conflict, according to Deribe.

Castro, pointing to her own PHE experience with PFPI, found that multi-sectoral programs promote improved environmental quality and community stability. In the Philippines, her program targeted local youth, fishermen, and policymakers to promote food security through sustainable resource management, improved medical and family planning services, and expanded livelihood training.

Castro found that a PHE program could continue even after funding ran out. “A project can be sustained and can be owned by the local governments and local communities if they are provided the capacity to be able to continue to implement the programs and that they see the value of the programs that they do,” she said.

Lessons in Conflict Resolution

Funding, said Dumas, is the biggest limiting operating factor for organizations that facilitate dialogue in environmental conflict areas. The ability to travel across Latin America on short notice to help resolve conflict has been extremely beneficial to Dumas’ organization; but in an arena where funders require full proposals with specific outcomes and indicators, such availability over the long-term is “not financially sustainable.”

Dumas did, however, suggest ways to reduce the need for conflict resolution while opening accessibility to funding. He recommended that institutions mainstream environmental considerations into all sectors of decision-making, thereby improving capacity to respond to environmental conflicts within the given population. He also suggested the creation of “early action funds” – pools of money that his and other organizations can use on short notice for dialogue facilitation support.

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The PHE Toolkit, launched by Building Actors and Leaders for Advancing Community Excellence in Development (BALANCED), is a new source of information and resources on Population, Health, and Environment (PHE).

The interactive online library of documents, videos, and other resources will provide “one-stop shopping” for the target audience of program managers working on health, family planning, development, and conservation programs—as well as policymakers, researchers, academics, and educators. All users can contribute resources and participate in discussions through the toolkit.

The Environmental Change and Security Program, along with several PHE partner organizations, helped build the framework and will contribute its PHE resources to the toolkit. ECSP is also a member of the PHE Gateway, which can be accessed through the toolkit.

The PHE toolkit is one of five public toolkits housed on the Knowledge for Health (K4Health) website, which is supported by USAID’s Bureau of Global Health. Together, the current and forthcoming toolkits will form an updated and vibrant community for information on health, including family planning, HIV/AIDS, and reproductive health.

The PHE toolkit is made possible through the collaboration of Johns Hopkins University Center for Communication Programs (JHU/CCP) and the BALANCED Project. BALANCED is spearheaded by the Coastal Resources Center (CRC) at the University of Rhode Island and its partners, PATH Foundation Philippines Inc. and Conservation International.

“Water shortages,” warns South Asia scholar Anatol Lieven, “present the greatest future threat to the viability of Pakistan as a state and a society.

This warning may be overstated, but Pakistan’s water situation is deeply troubling, as described in a new report from the Woodrow Wilson Center’s Asia Program, Running on Empty: Pakistan’s Water Crisis.

Water availability has plummeted from about 5,000 m3 per capita in the early 1950s to less than 1,500 m3 per capita today. As Simi Kamal reports in the first chapter of Running on Empty, Pakistan is expected to become “water-scarce” (below 1,000 m3 per capita) by 2035—though some experts project this could happen in 2020, if not earlier.

In an unstable nation like Pakistan, water shortages can easily become security threats. In April 2009, alarm bells sounded when the Taliban pushed southeast of Swat into the Buner district of the Northwest Frontier Province. Not only is Buner close to Islamabad, it lies just 60 kilometers from the prized Tarbela Dam, which provides Pakistan with billions of cubic meters of precious water for irrigation each year.

Soaked, Salty, Dirty, and Dry

According to Kamal, Pakistan faces significant and widespread water challenges:

• Inefficient irrigation.
• Abysmal urban sanitation.
• Catastrophic environmental degradation.
• Lack of water laws to define water rights.
• Lack of a sound policy on large dams.

An arid country dependent on agriculture, Pakistan allocates more than 90 percent of its water resources to irrigation and other agricultural needs. Unfortunately, intensive irrigation and poor drainage practices have waterlogged and salinized the soil.

Women and Water in Rural Pakistan

Rural women and small farmers are particularly affected by Pakistan’s water crisis. Women bear the primary responsibility for obtaining water, but have been traditionally been shut out of government water-planning and decision-making processes. However, government and media initiatives, described by Sarah Halvorson in Running on Empty’s chapter on water and gender, are increasingly highlighting the importance of women’s participation.

Meanwhile, Adrien Couton reports that Islamabad’s water projects mainly benefit large and wealthy farmers—even though Pakistan has approximately four million farms smaller than two hectares.

Pakistan’s Thirsty Cities

With most of Pakistan’s water dedicated to agriculture, less than 10 percent is left for drinking water and sanitation. A quarter of Pakistanis lack access to safe drinking water—and many of them reside in the country’s teeming cities.

Worse, the drinking water that does exist is quickly disappearing. Lahore, which relies on groundwater, faces water table declines of up to 65 feet, as described by Anita Chaudhry and Rabia M. Chaudhry in their chapter on the city.

The scarcity of clean water in the cities—exacerbated by a lack of wastewater treatment—is a leading cause of deadly epidemics. At least 30,000 Karachiites (of whom 20,000 are children) perish each year from unsafe water.

Pakistan Must Act Now To Solve the Water Crisis

Pakistan arguably has the technological and financial resources to provide clean water. So what’s the hold-up? In her chapter on public health, Samia Altaf argues that the problem is the absence of a strong political lobby to advocate for water—and that no one holds Islamabad accountable for fixing the problem.

The report offers more recommendations for addressing Pakistan’s water:

• Invest in existing infrastructure and in modest, indigenous technology.
• Strike appropriate balances between centralized and decentralized management.
• Devote more attention to water allocation and distribution on local/individual levels.
• Understand the links between agricultural and urban water pressures.
• Embrace the role of the private sector.
• Conserve by favoring water-saving technology; less water-intensive crops; and water-conserving urban building design.
• Address structural obstacles like systemic inequality and gender discrimination.
• Take immediate action. Tremendous population growth and rapidly melting glaciers in the Himalayas ensure that the crisis will deepen before it eases.

The need for immediate action cannot be overstated. While Pakistan’s water crisis may not threaten its viability, it is undeniable that so long as the crisis rages on, essential components of the nation—such as the vital agricultural economy, the health of the population, and political and economic stability—lie very much in the balance.

Michael Kugelman is the Wilson Center’s South Asia specialist. He is co-editor, with Robert M. Hathaway, of the recently published Wilson Center book Running on Empty: Pakistan’s Water Crisis, on which this post is based. Much of his work has focused on resource shortages in Pakistan and India.

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