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Water into waste. In Port-au-Prince, Haiti, the water supply has become a garbage dump. |
From Tierra del Fuego to the Rio Grande, Latin America's more than 400 million people face enormous challenges. Not only must the region develop economically to improve living standards, it must do so against a backdrop of serious environmental and health problems. The region is beset with difficulties including malnutrition, overpopulation, air pollution, poor or nonexistent sanitation, high disease rates, and a desperate need to improve the supply of potable water. Compounding such problems is political instability that can threaten the ability of the region's governments to improve environmental health.
Yet, in a region as large and diverse as Latin America, generalizations are difficult. The 20 nations that make up Latin America do not lend themselves to blanket characterizations. Poor people in countries like Chile and Costa Rica are pretty well off nutritionally, compared to those in countries like Guatemala and Honduras, says Jean-Pierre Habicht, a professor of nutritional epidemiology at Cornell University. Habicht has studied nutrition and malnutrition in Latin America and other regions of the world for three decades.
Other health indicators like infant mortality and life expectancy also vary widely across the region. For instance, in Chile infant mortality is 20 per 1,000, while in Bolivia it is 110 per 1,000, according to United Nations' figures. Life expectancy in the two countries also contrasts dramatically: 71 years in Chile versus 53 years in Bolivia.
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Philip Meeks--In many Latin American countries, all things related to health are typically ignored. |
Cash-strapped governments have to face influxes of rural masses into cities as a result of poverty in the countryside, according to political scientist Philip Meeks of Creighton University. "Every country in Latin America has the problem of rural exodus into cities, and then the inability of government to be able to handle demand for social services and public services directly related to the quality of life. The government cannot build enough sewers to handle these favellas [slums] that grow up around the cites," he says.
Even a country as prosperous as Argentina suffers from this problem, according to Gettysburg College economist Eileen Stillwaggon, who is writing a book on the impact of poor primary health care on the Argentine economy. "There's no income to be made in the countryside. So [people come to the city] where they live in wretched slums in the periphery of Buenos Aires. Like elsewhere in the world they're crowding into peri-urban slums," she says.
Water Problems Everywhere
Running throughout many of the environmental problems faced by Latin America is a common denominator: the lack of clean water for drinking. Wastewater treatment plants and sewers are often not working or nonexistent.
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Eileen Stillwaggon--Because there's no money to be made in the country, people are crowding into peri-urban slums. |
For example, only a small percentage of metropolitan Buenos Aires is served by a sewage system. So the rest of the sewage goes into cesspools that may not be properly constructed. Says Stillwaggon, "The sewage system itself hasn't been working for a number of years, and so what goes into the sewers leaks out in to the streets because of breaks in the mains, or it's dumped directly into the River Plate because the treatment plants are broken."
Mexico City offers another example. "Ninety-five percent of the industrial and domestic sewage is untreated. It flows through the city in an open canal," says Diane Perry of the University of California at Los Angeles. Perry, a research biologist who directs international programs at UCLA's Center of Occupational and Environmental Health, says it appears that some of the industrial compounds from this sewage are seeping into the aquifer that provides drinking water for the city's 20 million-plus inhabitants. "No one knows for sure, she says, "but there's a suspicion there could be contamination." Such conditions provide fertile ground for disease, according to Raymond Reid, regional advisor for water supply at the Pan American Health Organization (PAHO). "Cholera was reintroduced into Latin America in 1991. This was not expected, but it's one of the consequences of inadequate disposal of sewage," he says.
Diseases like yellow fever and dengue, which are resurgent in Latin America, also result from inadequate treatment of sewage, which provides the breeding ground for the Aedes aegypti mosquito, the carrier of these viral diseases. "It's such an adaptable mosquito--living in water containers in and around human habitations--that it's come back as a very serious problem," says Thomas Yuill, an infectious disease specialist at the University of Wisconsin in Madison
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Horst Otterstetter--There are one million new cases of malaria in Latin America every year. |
Malaria is also coming back. "There are one million new cases of malaria in this region every year," says Horst Otterstetter, director of the Division of Health and Environment at PAHO. "A considerable amount of these problems stems from poor environmental conditions: poor sanitation, poor drainage, poor waste collection, all this serving as a breeding ground for these mosquitoes. The accumulation of water in all these poorly planned and poorly maintained urban areas is one of the reasons why these diseases are coming back to these cities."
According to PAHO, less than 10% of the municipalities in Latin America treat sewage adequately before emptying it into natural watercourses. Ninety percent of the water is dumped into the rivers without any treatment, and these rivers function as water sources for cities downstream. The loss of quality is a constant factor throughout Latin America and "since the investments over the last 10 years were very small," says Otterstetter, "over the last 10 years this situation has worsened." Furthermore, PAHO finds that South America pollutes nearly 11 times more freshwater on a per capita basis than Europe. "Managing and treating urban wastewater is one of the major challenges that countries have to face in the coming years," states a PAHO review of environmental conditions in the region.
In 1980 the United Nations General Assembly launched the International Drinking Water Supply and Sanitation Decade with the goal of providing an adequate and safe water supply and sanitation to the world's people. According to PAHO, the effort in Latin America has fallen short of expectations. The goal of providing a safe water supply for 91% of city dwellers was not reached, nor was the goal of making sewage connections available for 71% of city residents.
On the other hand, the decade helped countries to recognize that they must come to grips with the challenge of providing safe water to their people. Yet this awareness comes up against the reality of water supply systems that deteriorated badly during the 1980s. "The countries established priorities which were in areas other than water supply and sanitation," says Otterstetter.
One of those priorities was paying off debt brought about by increased oil prices. "Most of these countries got themselves into tremendous debt. They're paying more to service their debt than they can get in new capital to keep up. So the maintenance on the [systems] they did put in in the 1970s and 1980s . . . is now deteriorating because they can't even afford to bring in the capital to do the maintenance. All the things related to health are typically ignored, or the maintenance is not done," says Meeks.
Too Many People, Not Enough Resources
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A not-so-slow leak. Drums of hazardous waste already leak their contents into soil and water in a new waste facility in Baja. |
While confronting deteriorating water infrastructure, Latin American governments also must try to rein their burgeoning populations. The growth of population in the region is a serious problem, one that is likely to continue for the next two decades, according to Cornell University sociologist Joseph Stycos, an authority on population growth in Latin America. The increasing numbers of people, he says, strain the capacity of governments to cope. "It exacerbates every other social and economic problem. If the government is trying to put in more school seats, they're rapidly taken up by the population increase. If the government is trying to provide new jobs, those jobs are overwhelmed by the increase of aspirants," says Stycos.
According to Meeks, "There is no question that the governments can't keep up with the population growth. With their growth anywhere between two and three percent a year, their economies have to grow more than advanced industrial economies . . . they have to grow between five and six percent to be able to provide any meaningful improvement."
The growth of population is most serious in Central America, says Stycos. According to figures compiled by the World Resources Institute in Washington, DC, Honduras' population is growing at a 3.18% rate; Nicaragua's at 3.36%, the highest in Central and South America. Guatemala's growth rate is 2.88%, the second highest of any South American country.
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Living on the edge. In some areas of Peru, slums are built directly on the water supplies, which soon become contaminated. |
The growth rates in Central America are high because of a combination of factors. "They started at a higher rate [than South American countries] because of very early marriage," said Stycos. "Most countries have large indigenous populations and that seems to have made progress more difficult because of ethnic differences and lower educational levels." Typically, higher education levels are linked to lower population growth rates. Chile and Argentina, with their higher overall education levels and heavy European influence, have strikingly low population growth rates compared to the rest of the region. Costa Rica's growth rate is also quite low because of a strong family planning program, says Stycos.
Typical family size has shrunk from six to four, but the problem now, says Stycos, is to get family size to drop from an average of four children to two. "But the effort it's going to take from going from four children to two is much greater than it was to go from six to four. Going from six to four was a question of providing sufficient means, the technology to let women realize the number of children they wanted. But they want around three or four. You've got to change people's minds, and that's a difficult proposition," says Stycos.
In Mexico, one nongovernmental organization working to provide family planning information to hard-to-reach rural areas is FEMAP, a Spanish acronym for Mexican Federation of Private Health and Community Development Associations. It has 44 centers throughout the country. "We provide information on family planning, and we have an education program all over Mexico. We have over 323,000 couples using modern contraceptive methods," says executive director Enrique Suarez. That compares with 3,000,000 couples who are getting contraceptive help from the Mexican government. Suarez adds that FEMAP is reaching over 4,000,000 people a year with information.
Not Enough Nourishment
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Aaron Lechtig--It is important that those who suffer the problem are also actors in the solution. |
Malnutrition is another specter haunting much of Latin America. Between one in four and one in five children suffer from chronic malnutrition, according Aaron Lechtig, UNICEF senior regional advisor for health and nutrition in Latin America. He says that figure compares favorably to other regions such as South Asia, where two thirds of the children are malnourished, and Africa, where the figure is 49%.
Though he says the chronic malnutrition rate in Latin America is the lowest in the developing world, Lechtig acknowledges there are wide variations. In Guatemala the rate is 68%, while in Costa Rica it is 8%, and in Chile it is 10%. "Chronic malnutrition has long-term impacts on the productivity on the individual and family level. [It hurts] mental development and this is reflected later in [lowered] per capita income," says Lechtig.
And malnutrition also has more immediate effects, Habicht has found. Although malnutrition doesn't increase the incidence of disease, the effects of diseases that do strike are more severe. Malnourished individuals are much more likely to die when they are sick. "There's a synergism between malnutrition and infection," Habicht says.
In Argentina, doctors at some modern children's hospitals have said that 35% of the children they treat are malnourished, according to Stillwaggon. When released from the hospital, she writes, the children "go home to the same inadequate food, contaminated water, crowded unsanitary conditions . . . that sent them to the hospital."
What should be done, Lechtig says, is a broad approach not only to make sure people have access to good health care and clean water, but also "helping people to develop their own capacity to analyze their problems and come out with decisions. A very important implication is that those who suffer the problem are also actors in the solution, not just passive recipients of [aid]. This is not a short process, but in the end it will be a sustainable one."
Clearing the Air
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Winds of change? Air pollution controls take a back seat on the economic bus in Ecuador. |
Urban air pollution is another source of serious environmental health problems in many Latin American cities. The region is the most urbanized in the developing world, with over 340 million people living in cities.
Isabelle Romieu of PAHO notes that a number of factors contribute to the problem. Writing in the September 1991 Journal of Air and Waste Management , she and her colleagues point to rapid industrialization in Latin American cities, "which was not always well-planned in terms of the protection of the environment." The debt crisis of the 1970s and 1980s also compounded the problem, leaving attempts to control pollution to compete with other priorities.
Accompanying the growth of industry has been a boom in the number of cars, trucks, and buses in cities. For example, according to Romieu, between 1975 and 1984 the number of vehicles in Venezuela, Chile, Colombia, and Mexico more than doubled, with the great majority concentrated in cities.
Attempts at controlling pollution appear to be erratic, with standards often exceeded, according to Romieu, who says that only seven countries--Brazil, Chile, Colombia, Ecuador, Peru, Mexico, and Venezuela--have air quality standards. Although the standards are similar to those in the United States, enforcement is often haphazard.
The 20 million residents of Mexico City and those in other major Latin American metropolises must breathe air laced with contaminants such as lead, particulates, ozone, and sulfur dioxide. Lead can impair development and intelligence in young children. Ozone can hamper breathing, particularly in young children and the elderly. Microscopic particulates from combustion of diesel fuel, leaded gasoline, and coal can also cause lung damage and have been linked to deaths. Sao Paulo, Santiago, and Bogota, along with Mexico City, face serious problems with particulates.
The overall health effects of such pollution are uncertain because of the lack of accurate measures of exposure and adequate control groups. Yet 30 million children and 4 million elderly people in Latin America, the people most sensitive to the harm that can be done by air pollution "are exposed to air pollutant levels that exceed WHO guidelines for adequate health protection," writes Romieu. She adds that it's important not only to learn what the direct effects of air pollutants are on human health, but to discover how they may also magnify the health problems caused by malnutrition.
There has been some progress, however. In Cubatao, an industrial coastal city approximately 40 miles from Sao Paulo, emissions controls and restrictions on new industries have cut air pollution. In 1988 the efforts have reduced air pollutants by approximately half a million pounds per day, according to data cited by Romieu.
In Mexico City, the use of unleaded gasoline has reduced the amount of lead in the air. Unleaded gas has paved the way for the use of catalytic converters to control other emissions from cars. "Catalytic converters were introduced in Mexico City in 1991," says Pablo Cicero-Fernandez, an air pollution specialist with the California Air Resources Board, who has studied air pollution problems in Mexico City. "We have also seen a reduction in the concentration of sulfur dioxide in the air of Mexico City, and this is very likely the result of the reduction of sulfur in diesel fuel for buses as well as the use of low-sulfur fuel oil in industry and in some cases the substitution of natural gas in the electric-generating plants. Air pollution in terms of lead and sulfur dioxide is getting better," he says.
Pesticide Problems
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Spraying sickness? Workers in Mexico seldom are protected when spraying hazardous herbicides. |
Another rural problem is the use of pesticides. "The fact that farmers get no guidance from agricultural authorities or from those who sell agricultural chemicals contributes to the unsafe use of these substances," according to a 1990 PAHO report. PAHO surveys of Guatemala and Costa Rica in the 1980s have turned up hundreds of cases of pesticide poisoning annually.
"There's a real need for environmental education in the use and handling of pesticides," says Richard Kiy, the former U.S. acting environmental attaché in Mexico.
"In Baja, in some of the vegetable areas south of the border, you can see people applying pesticides without any protective clothing; you can see people mixing things occasionally mixing things with their hands," says Kansas State University sociologist Scott Frey, who has studied pesticide use in the developing world.
Worker Health
Latin America safeguards the health of its workers on paper. "Our major problem is the lack of implementation," says Maritza Tennassee, the regional advisor on worker health at PAHO. Consequently, Latin American workers suffer between five and eight times more occupational accidents and illnesses than their counterparts in developed countries. Tennassee also blames a lack of knowledge and a lack of political power for the failure to better protect workers. She says that relatively few workers belong to labor unions, which usually work to protect employee health. Furthermore, unions in Latin America have tradtionally been more concerned about the economic side of work than about health issues. There has also been a failure by the government, says Tennassee, to relate such health problems as cholera to working conditions.
In Mexico, David Sanchez of the National Institute of Public Health in Cuernavaca, agrees that much needs to be done in the area of occupational health. Problems like excessive noise, high air temperatures, and safety issues need to be addressed. In response to the North American Free Trade Agreement, Mexico has increased its efforts to train factory labor-management committees in occupational safety and health issues. The effects of that training, says Sanchez, will be beneficial. "We still have an enormous way to go," he said, "but at least some industries are beginning to look at the problems.
PAHO, says Tennassee, is working with governments to "create effective policies for occupational health" through better understanding of the factors involved in occupational illnesses and by increasing the focus on the "informal economy" composed of unregistered workers who may be working at home but who contribute to a country's gross national product. In Peru, says Tennassee, 75% of the work force is part of the informal economy.
Reason for Hope
Although the environmental situation does appear grim in many instances, there are signs the situation is getting better. Between now and the end of this calendar year, Mexico will have spent in excess of $460 million for environmental infrastructure, the majority of that going for wastewater treatment. In addition, Mexico recently got a commitment from the World Bank to spend another $1.8 billion, 74% to be used for environmental infrastructure, the majority of which will be wastewater treatment plants.
The Inter-American Development Bank is planning to invest approximately $4 billion a year in social projects involving health, water supplies, and sanitation in Latin America, according Otterstetter. "That is unique, that never happened before," he says. The World Bank is also moving in that direction, he says, planning to invest about $1.5 billion annually in such projects.
Otterstetter also talks of a new attitude in Latin American governments. They are showing a new and increasing awareness of the environment and its importance in human health. Next year PAHO will be hosting a conference in Washington for Latin American ministers of environment, health, and development to discuss the relationship between all three areas in an effort to improve environmental health in the region.
Another crucial component is the need for a "human infrastructure," large numbers of skilled and trained technicians to carry out environmental programs and maintain the equipment designed to provide clean air and water to Latin Americans. To this end, grassroots organizations in Latin America are increasing their efforts to educate people about the environment and health and train indigenous people to safeguard their interests. In Argentina, the Foundation for the Defense of the Environment advocates the "creation of self-help groups who can learn to defend their right to a healthier and sustainable environment themselves." In Panama, the Dobbo-Yala Foundation, founded by descendants of indigenous people, promotes conservation of the environment and development of indigenous peoples through education.
It is clear that developing countries in Latin America must realize that the only true progress will come when the basic needs of their citizens--clean air and water, safe and nourishing food, and healthy working environments--are met.
Harvey Black
Harvey Black is a freelance journalist in Madison, Wisconsin.