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Analytical summary - The physical environment

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The environment influences our health in many ways - through exposures to physical, chemical and biological risk factors, and through related changes in our behaviour in response to those factors. With increased globalization, climate change, increased population mobility, Namibia’s physical environment is being affected and so too is the health of its citizens.

Data on the urban environment is sparse. There are two major urban areas, namely the capital city, Windhoek and the centre of the fishing industry, Walvis Bay. According to the National Population Census of 2001, Windhoek’s total population was estimated at 233,529 people, which accounted for about 39% of Namibia’s total urban population at that time. (City of Windhoek, August 2011) W

hile urbanization brings along development and other good opportunities, it is associated with health challenges such as overcrowding, pollution, poor sanitation, unhealthy lifestyles and all these contribute to poor health for the citizens. In Namibia, children from the poorest urban quintile are 2.7 times more likely to die before the age of 5 than children from the wealthiest urban quintile, and 5 times more likely to be chronically malnourished. They are also more likely to be malnourished than children from rural areas. (WHO Urban Health Profile)

Urbanization is a major challenge for public health in Namibia given increasing migration. According to the City of Windhoek estimates the city is growing at a rate of approximately 4.4% per annum, but the informal settlement population is growing at a much higher rate of 9.5% per annum. This translates to about 10,000 people moving to the city every year. Up to 25% of the Namibian population of two million are living in informal settlements. (Informal Settlement Communities & the Shack Dwellers Federation of Namibia, March 2009)

The City of Windhoek adopted the World Health Organization’s of Healthy City initiative in 2002. The Healthy City Project (HCP) strategy advocates an inter-sectoral approach to health development that focuses on the environmental, social and economic determinants of health, and aims to put health issues onto urban agendas. (City of Windhoek, August 2011)

Water-borne sewerage is the main sanitation system used in Namibia with 57.8% of the population living in urban areas and 13.3 % living in rural areas connected to sewers. On-site sanitation systems - wet and dry - are not well developed and cover only a few percent of the population. Shared toilets are used by 18% of the urban population, while 67% of Namibians do not have access to sanitation and practise open defecation. Sanitation awareness has not been created among the population.

Most sanitation facilities have been built through housing programmes, while sanitation-specific projects implemented with government or donors support have been limited. The annual number of sanitation facilities built each year may reach a few thousand, compared to the 25,000 that need to be built to reach MDGs in 2015. Access to safe water has improved for the poorest 40% in urban areas, but has decreased among the wealthiest 20% between 1992 and 2006. Small local authorities have difficulties in properly managing sanitation systems and water treatment plants.

Regulations and national standards required for the protection of public health and environment lack resources for enforcement. Lack of coordination and involvement of key ministries, as well as inadequate budget allocation, are major reasons for the poor achievement of the sub-sector. The Ministry of Agriculture, Water and Forestry is responsible for the overall management and regulation of the water cycle and water resources in the country within the Water Resources Management Act. In total, six ministries are involved in sanitation issues.

The directorate of Water Supply and Sanitation Coordination coordinates water supply and sanitation services. Local Authorities and Regional Councils are responsible for water supply and sanitation in urbanised areas and rural settlements, where demand is continually increasing and a growing backlog exists. The Regional Councils implement and support communal rural water supply and sanitation. (Ministry of Agriculture, Water and Forestry, July 2008)

Among the policies that needed to be updated is the Public Health Act (as the country is currently using that of 1919) to provide guidance for sanitation and hygiene amongst others. The Water Supply and Sanitation Policy was developed in 2008 to ensure equitable access to services. The policy stresses community involvement and participation as well as environmental sustainability. (MoHSS and Macro, August 2008; Namibia Sanitation - Situational Analysis Report Second Draft, April 2009; Ministry of Agriculture, Water and Forestry, July 2008; WHO)

Air pollution is not currently considered and important issue in Namibia. There are few industrial sources and vehicle density and use in the urban areas is not currently sufficient to lead to major problems. The north of the country does experience high background ozone levels due to vegetation burning, and aerosols from this source and mineral dust can be high elsewhere as well. Water pollution is a concern, given the relative scarcity of potable water in the country (FAO).

Water pollution in Namibia is largely of two types: toxic chemicals (pesticides, heavy metals and chemicals) and organic material (largely sewage but also silt and soil from run-off). A major threat to groundwater comes from rainwater flowing through landfill sites. The fishing industry is a major polluter of the seawater in Walvis Bay due to lack of discharge treatment measures. Legislation from 1956 and 1958, along with the Sea Fisheries Act of 1992, regulates pollution and places the responsibility for protecting Namibia's harbours and fishing grounds from pollution with the Government (NIED).

Indoor air pollution is another major concern, given that majority of Namibians do not have access to electricity and rely on solid fuels for cooking. Accordingly, the MoHSS, Health and Social Systems Review (2008) noted that Acute Respiratory Infections (ARI) are among the leading causes of morbidity and mortality in children under-five. Pneumonia is a major cause of infant and child (1-5 years) mortality, accounting for 29% and 24% of deaths respectively (MoHSS, 2008).

The NDHS 2006/07 found that children living in households that use wood/straw for cooking fuel are more likely to exhibit symptoms of ARI than children living in households with other sources of cooking fuel (MoHSS and Macro, August 2008). The aims of the Energy Policy of the Ministry of Mines and Energy include the promotion and resourcing of renewable energy (RE). This includes encouraging communities to make use of solar stoves and cookers. (New Era, 2010) Charcoal production takes place for commercial purposes in Namibia, often through the activities of NGOs aimed at reducing exposure to indoor air pollution. (United Nations Environment Programme (UNEP), 2006)

Namibia is among the countries most vulnerable to climate change, as it is one of the driest countries south of the Sahara. Moreover, it is highly dependent on climate change-sensitive sectors such as agriculture, livestock management and fishing. Hence, climate change impact could be catastrophic to Namibians, especially in lower income groups. (Irene !Hoaës, 23 November 2011) It is predicted that the country will become hotter throughout the year (with an increase in temperatures of between 1°C and 3,5°C in summer and 1°C to 4°C in winter in the period 2046 - 2065).

Rainfall is likely to become more intense and variable. Wetlands are likely to provide reduced ecosystem services such as water retention, flood attenuation and water purification. The dominant vegetation type termed grassy savanna is projected to give way to more desert and arid shrubland vegetation types, with projected increases in bush encroachment for the north-eastern parts of the country. Impacts on crop production have been difficult to estimate, but cattle breeding is likely to be negatively affected.

Overall, projected climate change poses a major challenge to both food security in rural households, and sustainable development in Namibia at large, against a predicted decline of between 1,1% and 3,1% in Namibian GDP due to climate change losses. (Desert Research Foundation of Namibia & Climate Systems Analysis Group, March 2008)

The 2011 National Climate Change Policy provides a framework for resource mobilisation for the country to embark upon adaptation and mitigation measures. It calls for transfer of technology, capacity building and the provision of financial resources, while promoting and enhancing synergies amongst stakeholders across sectors. The Ministry of Environment and Tourism will oversee the implementation of the policy through a new division for climate change activities. (Irene !Hoaës, 23 November 2011).

With such volatile weather patterns, the country is at risk of diseases outbreaks such as cholera, vector-borne diseases such as malaria. The vector-borne disease of major concern in Namibia is malaria, which is confined along the northern border of the country (MoHSS, December 2010). The transmission risk is currently estimated between 15% in low risk areas and 55% in high risk areas (MoHSS, December 2010).

The National Vector-borne Diseases Control Programme (NVDCP) has successfully introduced and rapidly scaled up all malaria control interventions, prioritizing high risk districts and achieving overall MDG targets of halving morbidity and mortality. Trends in outpatient cases, inpatient cases, and deaths exhibit a decline of 78 percent, 87 percent, and 88 percent respectively between 2001 and 2008. As a result, Namibia has been targeted for elimination by 2020. (MoHSS, November 2010)