[ 2 0 5]
Enviro nme ntal Manage me nt and He alth
8 / 5 [1997] 2 0 5 –2 0 7 © MCB Unive rs ity Pre s s [ISSN 0956-6163]
Some highlights of environmental health
programmes in the Western Pacific
Wai-On Phoon
Pro fe s s o r o f Oc c upatio nal He alth, Unive rs ity o f Sydne y, Pymble , NSW, Aus tralia
Describes environmental health improvements in Vietnam, the Philippines, Malaysia, Fiji and the Solomon Islands. Many of such improvements were implemented with the collab-oration of United Nations agencies or international donor partners. Describes the WHO Healthy Cities and Healthy Island programmes.
Bu ild in g on t h e wor k in it ia t ed in join t WH O/ UN DP su st a in a ble d evelop m en t p r o-ject s (1994-1996), t h e P h ilip p in es a n d Viet n a m d evelop ed op er a t ion a l fr a m ewor k s for focu s-in g on en v ir on m en t a l h ea lt h con cer n s. In t h e P h ilip p in es, a n E n v ir on m en t a l H ea lt h Ser -v ice w a s es t a blish ed in t h e De p a r t m en t of H ea lt h w it h a n in it ia l focu s on t h e d evelop -m en t of E n v ir on -m en t a l H ea lt h I-m p a ct Ass es s m en t a s a n a n a ly t ica l t ool for b ecom -in g s u b s t a n t ively -in volved -in t h e cou n t r y ’s en v ir on m en t a l im p a ct a ss es s m en t p r ocess. A N a t ion a l Dir ect ion a l P la n for E n v ir on m en t a l H ea lt h Im p a ct Asses s m en t h a s b een d evel-op ed t o gu id e im p lem en t a t ion of t h e a ss oci-a t ed op er oci-a t ion oci-a l p r ogr oci-a m m e oci-a n d h elp en s u r e a d eq u a t e in fr a s t r u ct u r e a n d h u m a n
r esou r ces d evelop m en t . T h is wor k h a s a ls o b een s u p p or t ed a n d en h a n ced t h r ou gh r ela t ed p r oject s s p on s or ed by t h e Wor ld Ba n k a n d t h e Ca n a d ia n In t er n a t ion a l Develop m en t Resea r ch Cen t r e, a n d st a n d s a s a n excellen t exa m p le of co-op er a t ion b et w een gover n m en t a n d a n u m b er of ext er n a l su p p or t a gen cies w it h com m on a r ea s of con cer n .
In Viet n a m , t h e fi r s t E n v ir on m en t a l H ea lt h P la n F r a m ewor k w a s es t a blis h ed a t t h e n a t ion a l level w it h su b s t a n t ia l in t er -s ect or a l in p u t . On a p a r a llel t r a ck a t t h e loca l level, a n E n v ir on m en t a l H ea lt h Office w a s op en ed in t h e cit y of H a ip h on g w it h in t er a gen cy op er a -t ion a l s u p p or -t . T h is office is s er v in g a s -t h e foca l p oin t gr ou p for d evelop m en t a n d im p lem en t a t ion of a H ea lt h y Cit y P la n in t h e con -t ex-t of -t h e N a -t ion a l E n v ir on m en -t a l H ea l-t h P la n F r a m ewor k .
In J a n u a r y 1997, a WH O/ UN DP su st a in a ble d evelop m en t p r oject w a s in it ia t ed in F iji. Bu ild in g on t h e on goin g H ea lt h y Is la n d s in it ia t ive in t h e cou n t r y, t h is p r oject com p le-m en t s r ela t ed su st a in a ble d evelop le-m en t wor k b ein g ca r r ied ou t by gover n m en t in colla b o-r a t ion w it h ot h eo-r ext eo-r n a l su p p oo-r t a gen cies. Over t h e n ext yea r, t h is p r oject w ill wor k t ow a r d s t h e d evelop m en t of a N a t ion a l E n v i-r on m en t a l H ea lt h Act ion P la n a s w ell a s a n u m b er of a s socia t ed Loca l E n v ir on m en t a l H ea lt h Act ion P la n s t o h elp en su r e a d eq u a t e con s id er a t ion a n d r es olu t ion of en v ir on m en t a l h ea lt h iss u es in t h e con t ext of im p lem en t -in g t h e N a t ion a l Su st a -in a ble Develop m en t Act a n d ot h er r ela t ed le gisla t ion .
Healthy Cities Malaysia – from two
projects to a national programme
In ea r ly 1994, t h e Gover n m en t of Ma lay sia r es p on d ed en t h u sia s t ica lly t o a n in v it a t ion by WH O t o b ecom e in volved in H ea lt h y Cit y in it ia t ives, d ecid in g t o b e gin in t h e cit ies of J oh or Ba h r u a n d Ku ch in g. J oh or Ba h r u is t h e sou t h er n ga t ew ay t o Ma lay sia . F r om a sm a ll v illa ge est a blish ed in 1885, com p r isin g m ost ly fi sh er m en a n d fa r m er s, it h a s gr ow n in t o a cit y of h a lf a m illion p eop le cover in g a b ou t 120 sq u a r e k ilom et r es. Ku ch in g’s h ist or y b e ga n in a b ou t 1840 w h en it w a s est a blish ed a s a t r a d in g p ost loca t ed a b ou t 12 k ilom et r es u p t h e Sa r aw a k River fr om t h e Sou t h Ch in a Sea . Tod ay, t h e cit y, com p r isin g t wo a d m in is-t r a is-t ive a r ea s (N or is-t h a n d Sou is-t h ), cover s m or e t h a n 430 sq u a r e k ilom et r es a n d h a s a p op u la -t ion of a b ou -t 252,000.
In d ecid in g w h et h er or n ot a h ea lt h y cit y p r oject wou ld b e u sefu l, b ot h cit ies h a d t o exa m in e t h e cen t r a l con ce p t s of in t er -sect or a l colla b or a t ion , p olit ica l com m it m en t a n d com m u n it y p a r t icip a t ion in r ela t ion t o t h eir ow n p a r t icu la r s it u a t ion s. T h is in volved en ga gin g n ot on ly t h e h ea lt h sect or, bu t a lso, m or e im p or t a n t ly, t h e m a n y ot h er sect or s t h a t wou ld h ave t o b e com m it t ed t o in volvem en t in p r oject d evelop volvem en t a n d ivolvem p levolvem en -t a -t ion . T h e ci-t y of Ku ch in g d escr ib es -t h e p r oblem t h is w ay : “T h e m a in d ifficu lt ies a n d d ou b t s in volved t h e wor d H E ALTH in H E ALTH y Cit y, lea d in g t o q u est ion s su ch a s, ‘Wh y sh ou ld t h e St a t e H ea lt h De p a r t m en t a sk u s t o d o t h eir job ?’ a n d ‘Wh y d o w e n eed t o h ave a H ea lt h y Cit y Ku ch in g P r oject w h en w e a r e a lr ea dy p la n n in g a n d im p lem en t in g ou r d e p a r t m en t a l p la n s for t h e cit y ?’”
An sw er in g t h ese q u est ion s w a s n ot a lw ay s ea sy. H ow ever, b eca u se t h ey w er e con sid er ed cr u cia l, m a jor effor t w a s p u t in t o s ecu r in g t op level u n d er st a n d in g, su p p or t a n d com m it -m en t . On ce t h is st r on g b a s e w a s es t a blish ed ext en sive wor k w en t in t o in volv in g t h e gen er a l p u blic a n d t h e p r iva t e sect or in t h e for -m u la t ion of t h e h ea lt h y cit y p la n s a n d t h e d evelop m en t of a com m on v is ion of w h a t ea ch com m u n it y w a n t ed it s h ea lt h y cit y t o b e.
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Wai-On Pho o n So me highlights o f e nviro nme ntal he alth pro gramme s in the We ste rn Pac ific
Enviro nme ntal Manage me nt and He alth
8 / 5 [1 9 9 7 ] 2 0 5 –2 0 7
w it h in a m a t t er of 18-24 m on t h s, a H ea lt h y Cit y P la n w a s com p let ed , s u p p or t ed by a d et a iled P la n of Act ion r efl ect in g in t e gr a t ed , m u lt i-s ect or in volvem en t in it s d evelop m en t a n d im p lem en t a t ion . T h e scop e of t h ese p la n s is q u it e b r oa d , en com p a s sin g m u ch m or e t h a n h ea lt h issu es a lon e a n d a d d r es s in g t h e econ om ic, s ocia l a n d p h y sica l d im en s ion s of t h e cit ies. T h e J oh or Ba h r u P la n of Act ion in volves 13 p a r t icip a t in g a gen cies ; a n d t h e Ku ch in g P la n r efl ect s t h e p r ogr es s ive in volve-m en t of 28 a gen cies in it s d evelop volve-m en t .
Ba s ed on t h e ver y p osit ive exp er ien ces in J oh or Ba h r u a n d Ku ch in g, t h e n a t ion a l gov -er n m en t n ow s ees t h e h ea lt h y cit y a p p r oa ch a s a p r om is in g m ech a n is m for effect ively r esolv in g t h e u r b a n s ocia l, en v ir on m en t a l, h ea lt h a n d econ om ic iss u es t h a t it s r a p id ly exp a n d in g in d u st r ia l econ om y p r es en t s. Accor d in gly, a n a t ion a l h ea lt h cit ies p r ogr a m m e fr a m ewor k is b ein g est a blis h ed t o en cou r a ge ot h er cit ies t o follow s y s t em a t i-ca lly t h e exa m p les of J oh or Ba h r u a n d Ku ch in g.
Healthy island and environmental
health in Fiji
We h ave r ea d excit in g s t or ies a b ou t ‘h ea lt h y cit ies’ in d evelop ed cou n t r ies, bu t it s con t ext a n d la n gu a ge d o n ot sp ea k t o F iji a n d ot h er P a cifi c Isla n d n a t ion s. M os t H ea lt h y Cit ies … m od els d o n ot fi t d evelop in g isla n d s lik e ou r s. Bu t t h e les son s w e lea r n fr om t h em a r e u sefu l. P a cifi c isla n d s ca n avoid som e of t h e m ist a k es t h a t d evelop ed cou n t r ies h ave m a d e … H ea lt h y Isla n d s is a ll a b ou t wor k in g t oget h er in t h e P a cifi c w ay – wor k in g t oget h er by s h a r in g in for m a t ion , t ech n ol-ogy a n d exp er t ise a im ed a t im p r ov in g t h e en v ir on m en t a n d r a is in g t h e gen er a l s t a t u s of h ea lt h .
Wit h a p op u la t ion of a lm ost 750,000, a n d 322 is la n d s cover in g a t ot a l a r ea of m or e t h a n 18,000 s q u a r e k ilom et r es, F iji is a ct ively em b r a cin g t h e h ea lt h y is la n d s v is ion a n d is u s in g en v ir on m en t a l h ea lt h a s on e of it s m a jor en t r y p oin t s t o fa cilit a t e ch a n ge.
On t h e is la n d s of Ka d av u a n d Ova la u , t h e in t r od u ct ion of t h e h ea lt h y is la n d con ce p t is seen a s a w ay t o im p r ove h u m a n r es ou r ces d evelop m en t a t t h e loca l level in or d er t o m a n a ge h ea lt h wor k r a t h er t h a n r ely in g on ou t s id er s w h o, m os t of t h e t im e, k n ow lit t le a b ou t t h e loca l s it u a t ion . E n v ir on m en t a l h ea lt h officer s a r e, a t t h is st a ge, s p ea r h ea d -in g t h e effor t t o t r a -in v illa ge m a n a ger s (tu ra ga n i k or os) a s a n ew ca d r e of en v ir on -m en t a l h ea lt h v illa ge wor k er s. T h e t r a in in g a im s t o eq u ip t h e v illa ge m a n a ger s w it h t h e b a sic en v ir on m en t a l h ea lt h k n ow led ge a n d s k ills n eed ed t o co-or d in a t e en v ir on m en t a l
h ea lt h -r ela t ed a ct iv it ies a t t h e loca l level; t o m a k e sen sible d ecision s t o p r ot ect t h eir ow n h ea lt h a n d t h e h ea lt h of t h eir v illa ge; a n d t o fa cilit a t e t h e em er gen ce of effect ive w ay s of m a k in g im p r ovem en t s in t h e cu r r en t sit u a -t ion .
T h is t y p e of t r a in in g r esu lt s in ch a n ges t o t h e t r a d it ion a l r ole of t h e en v ir on m en t a l h ea lt h officer fr om on e of in s p ect ion t o t h a t of fa cilit a t or a n d co-lea r n er. It r evolves a r ou n d a m a n a gem en t t ool t h a t focu ses on a n sw er in g fou r st r a t e gic q u est ion s: “Wh er e a r e w e n ow ?”, “Wh er e d o w e w a n t t o b e?”, “H ow ca n w e b e gin ?”, “Wh o d oes w h a t a n d w h en ?” T h e u n d er ly in g p r in cip les a r e r ela t ively sim p le: Com m u n it ies a r e r es p on sible for t h eir ow n d evelop m en t ; t ech n ica l in for m a t ion im p r oves p olicy a n d p la n n in g d ecision s; a n d a d u lt s lea r n b est t h r ou gh exp er ien ce, d iscu ssion a n d p r a ct ice. T h is t y p e of h ea lt h y isla n d s-b a sed t r a in in g is s-b ein g w ell a cce p t ed s-by t h e p eop le, a n d t h e v illa ge lea d er s a p p r ecia t e t h e n ew con ce p t s t h a t a r e b ein g in t r od u ced .
T h e p r in cip le of a “lea r n in g com m u n it y ” b ein g u s ed in v illa ges is a ls o b ein g in cor p or a t ed in t h e d evelop m en t of Loca l E n v ior on m en t a l H ea lt h Act ion P la n s in m or e u r b a n -ized isla n d set t in gs in F iji. T h e p r ocess h a s a lr ea dy com m en ced in t h e ca p it a l cit y of Su va , w h er e n ew p olicy fr a m ewor k s a r e b ein g d evelop ed a n d st r a t e gies im p lem en t ed w h ich m a t ch t h e u n iq u e h ea lt h a n d en v ir on -m en t n eed s of t h e a r ea . Ba s ed on t h e p r e-m iss t h a t ch a n ge b e gin s a t h om e, t h e E n v ir on m en -t a l H ea l-t h Ser v ice h a s em b a r k ed on a p r ocess w h ich r ev iew s, a n d r e-fr a m es cu r r en t p oli-cies a n d p r a ct ices so t h a t t h ey a r e con sist en t w it h t h e p r in cip les a n d v ision of H ea lt h y Is la n d s F iji.
All of t h e a b ove a ct iv it ies, t oget h er w it h t h ose fr om ot h er en t r y p oin t s, w ill in t im e p r ov id e t h e exp er ien ce a n d in s igh t n ecessa r y for d evelop in g a n a t ion a l h ea lt h y isla n d fr a m ewor k w h ich w ill en a ble F iji t o con t in u e t o lea r n glob a lly a n d a ct loca lly. Alr ea dy, t h ese exp er ien ces a r e b ein g sh a r ed w it h ot h er P a cifi c Is la n d cou n t r ies w h o a r e d evel-op in g t h eir ow n h ea lt h y isla n d in it ia t ives.
The Solomon Islands – malaria
control and healthy islands
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Wai-On Pho o n So me highlights o f e nviro nme ntal he alth pro gramme s in the We ste rn Pac ific
Enviro nme ntal Manage me nt and He alth
8 / 5 [1 9 9 7 ] 2 0 5 –2 0 7
for d evelop in g t h e con ce p t . In t h e Solom on Is la n d s, t h e con t r ol of m a la r ia is s u ch a n en t r y p oin t .
H on ia r a , t h e s m a ll q u iet ca p it a l of t h e Solom on Is la n d s, h a s h a d t h e d u b iou s t it le of t h e “M a la r ia Ca p it a l of t h e P a cifi c”. Du r in g 1992, t h e n u m b er of r e p or t ed ca s es exceed ed t h e t ot a l p op u la t ion . In 1995 t h e com m u n it y join ed for ces w it h t h e Ma la r ia Con t r ol P r o-gr a m m e t o m ou n t a n in t en s ive effor t t o r ed u ce m a la r ia t o a p oin t w h er e it wou ld n o lon ger b e a bu r d en . Wit h t h e in p u t of in t er n a -t ion a l d on or p a r -t n er s, in clu d in g J ICA, Br it is h ODA, Au sAID, N ew Zea la n d Gover n -m en t , Rot a r y In t er n a t ion a l, a n d Ca n a d a F u n d a n d led by WH O, a p a ck a ge of t a r get ed con t r ol m ea s u r es w a s p u t in t o p la ce t h a t cover ed t h e en t ir e p op u la t ion of 65,000. Dia g-n osis a g-n d t r ea t m eg-n t fa cilit ies w er e u p gr a d ed t o p r ov id e b et t er a n d fa s t er t r ea t m en t of m a la r ia ca ses ; in s ect icid e-t r ea t ed b ed n et s w er e d is t r ibu t ed t o ever y h ou seh old w it h a sp ecia l p r ogr a m m e t o p r ov id e n et s t o p r e g-n a g-n t wom eg-n a g-n d ig-n fa g-n t s; effect ive m ea su r es t o con t r ol m a la r ia -ca r r y in g m os q u it oes in clu d in g s p r ay in g of h ou s es a n d t h e u se of ch em ica ls a n d en v ir on m en t a l m ea su r es t o elim in a t e b r eed in g s it es w er e p u t in p la ce. T h is w a s a ccom p a n ied by a n in t en s ive p r o-gr a m m e of com m u n it y ed u ca t ion t h a t in cr ea s ed com m u n it y aw a r en es s a b ou t m a la r ia a n d w h a t cou ld b e d on e t o con t r ol t h e d is ea se. T h e com m u n it y ’s effor t s h ave su c-ceed ed in r ed u cin g m a la r ia d u r in g 1996 in t h e
m ost m a la r iou s p a r t s of H on ia r a by 78 p er cen t com p a r ed t o t h e sa m e p er iod in 1995. N ot on ly a r e t h e n u m b er of ca ses r e p or t in g t o clin ics a n d h osp it a ls less bu t t h e ch a n ge ca n b e felt by ever y fa m ily in H on ia r a .
