Analytical summary - The physical environment
Air, water, land, geography and climate all exert a powerful impact on disease patterns and the health of humans and other species on which they depend. Although environmental factors take their toll on both rural and urban dwellers, the rapid but unplanned urbanization process that has overtaken the WHO African Region has had significant impact on health.
The natural elements serve as vectors for a wide variety of infectious and noncommunicable diseases in African countries, from malaria to malnutrition, and pneumonia to poisoning. Where environments are degraded, a disease or health issue once vanquished can appear again, wiping out gains previously made at high cost. This is exemplified in the resurgence of indoor spraying to control vectors, and in particular to reduce the high malaria disease burden.
Other essential environmental measures relate to expanding the energy supply, providing electricity to boost economic and social development, and replacing dirty fuels with clean ones. At the bottom of the energy ladder, biomass fuels or coal users need to acquire improved cooking stoves, to reduce the health effects of exposure to indoor air pollution in the shape of child pneumonia, chronic obstructive lung disease and lung cancer.
The importance of water and sanitation to health is evident. Following recommendations of the WHO Guidelines on Drinking Water Quality, countries are focusing on creating context-specific water safety plans to expand safe supplies from catchment to consumer. Measures to improve safe use and storage of water in homes are being widely promoted in the Region. Systematic trend monitoring of access to drinking water and hygienic sanitation is carried out by WHO and the United Nations Children's Fund, in response to Millennium Development Goal target 7c, and African countries provide their data to this biennial process. Two reports dedicated to the African drinking water and sanitation situation were produced in 2008.
The Region faces strong impacts from climate change, and a framework for action on health protection from climate risks is in preparation. The measures envisaged require a strongly intersectoral approach, as is common with most environmental health measures.
Occupational diseases are commonplace in African countries, as few have standards or regulatory systems that can adequately control hazards and exposures. Workers’ health is inadequately protected in most countries and chemicals are widely used across the African continent for agricultural and industrial purposes, as well as in homes.
Safe management of chemicals remains problematic, not least due to low levels of literacy and high levels of informal sector employment. African countries are not yet adequately engaged with the international instruments that could assist them in this domain. Better management of waste and health care waste is also essential to reduce high levels of risk and in some countries electronic waste has been identified as an emerging hazard.
Environmental health norms and standards are rarely adequately enforced due to lack of capacity and resources, and the heavy proportion of poor people who live and work beyond the reach of official measures. Environmental health surveillance is weak everywhere and should be introduced or strengthened in all countries, in line with recommendations of the Libreville Inter-ministerial Conference, so that the outputs can inform the necessary intersectoral policies and strategies in health interests.