Environmental health--for the rich or for all?

Developing countries bear the brunt of damage to health from environmental hazards. Yet most of the money the world is spending on environmental health research and on interventions to protect health from these hazards is being spent by the industrialized countries. The sheer size and intensity of this effort greatly influence the entire world agenda, sometimes in ways that do not reflect the realities of environmental risk in the developing countries and thus without due consideration of true global priorities. Two main schools of thought can be identified: one holds that the powerful environmental health movement in developed economies, by overriding needs and circumstances in less developed ones, may actually be holding back efforts to reduce damage to health; the other holds that this movement, by fostering the growth of scientific and technical knowledge, may be helping developing countries to protect their populations against environmental damage and is thereby helping to reduce global damage to health. Examples of the harm done by the global dominance of environmental health issues by industrialized countries include the following. – There is a drive in the industrialized world to ban all use of DDT worldwide. Yet household use, which is one of the few inexpensive ways of controlling malaria in certain parts of the world, accounts for only a relatively small amount of the DDT released into the environment, compared with the environmental impact of the vast amounts sprayed in the past. If malaria were killing a million people a year in North America and Europe, would the case for globally banning DDT be argued so forcefully? – Fears are being voiced with increasing stridency in some industrialized countries that chlorination of drinking-water may result in the formation of possibly carcinogenic chloramines. The suggestion has been mooted that chlorination should be replaced by ozonation or other techniques that do not leave residues likely to contaminate downstream water. But these alternatives do not combat waterborne diseases as effectively. Reduction of chlorination, for example, may have played a role in a cholera epidemic that occurred in Peru in the early 1990s. And even in the more developed countries, waterborne disease is still a serious risk. – Powerful environmental groups in the industrialized world are successfully putting pressure on international organizations to stop funding construction of large dams in less developed countries, thereby potentially denying these countries the kind of major spur to development that currently industrialized countries have enjoyed. – Incineration of medical waste has raised concerns in the more developed countries about the release of dioxin into the environment. These concerns have stopped international organizations from supporting hospital construction in some countries, notably India. Yet, incineration — which does release dioxin into the environment but has as yet caused no documented burden of ill-health — is often a vastly preferable alternative to the traditional disposal method of dumping medical waste on public rubbish tips, especially where these are scavenged for a living by poor people. – Billions of dollars are being spent in the industrialized world on dealing with hazardous waste, which cannot be more than a minor risk to public health compared with the relatively uncontrolled and substantially larger exposures to some of the same chemicals in fuel supply systems and consumer products. Developing countries are being urged to make similar costly control efforts by signing international treaties and trade agreements. Would the resources not be better spent on the many more pressing priorities of the poorer countries, including the need to reduce major risks to health? – Scientists in industrialized countries are increasingly concerned about the future long-term impact on health of climate change. This concern may be diverting attention and resources from hazards such as air pollution, water pollution, and occupational dangers, which are estimated to account for at least 15% of the current global burden of disease, mostly in the least developed countries, making them second in importance only to malnutrition. It is uncertain whether climate change would ever have such an impact on health, even in worst-case scenarios.