Issues a call for action to correct the gross neglect of the health consequences of water impoundment and irrigation projects. Arguments and proposed lines of action respond to the documented magnitude of human misery and incapacity that follow when water development projects make no provision for disease control. Concentrating on parasitic diseases as the most dramatic and reliable indicators of adverse effects on health, the book aims to persuade the financiers, planners, and managers of these projects to make health concerns a central part of the development dialogue. To this end the book draws upon a large body of evidence to demonstrate both the magnitude of project-related health risks and the feasibility of their prevention and control. Citing the traditionally passive role of the health sector as a contributing factor, the book also aims to encourage health authorities to enter the project cycle with a more insistent voice. Throughout the book, emphasis is placed on recent knowledge about parasitic diseases that underscores the feasibility of formulating policies where the goal of economic progress is compatible with the protection and promotion of health. The book has nine chapters. The first provides an overview of the problem, concentrating on the reasons why the health impact of development policies continues to be neglected despite overwhelming evidence of the consequences. The authors also explain why the time is now ripe to focus on the health as well as the ecological impact of these policies. The second chapter explains the many ways in which water development projects can exacerbate parasitic diseases, and discusses the significance of these changes within the broader context of development policies and their goals. Particular attention is given to the impact of new ecological conditions on the introduction, spread or aggravation of malaria, schistosomiasis, and lymphatic filariasis. The third chapter provides a detailed review of the evidence linking specific features of projects to changes in the incidence and prevalence of these diseases. Drawing on data from studies of over 60 dams and irrigation schemes, the authors document case after case of health risks exacerbated by ecosystem changes. Although some well-planned projects are described, the overall picture is one of consistent neglect of both the short- and long-term hazards to health. The special case of small dams is covered in the fourth chapter. Having documented the urgent need for change at the policy level, the second half of the book maps out lines of action. A review of technical measures for the control of malaria, schistosomiasis, and lymphatic filariasis demonstrates that parasitic diseases are an avoidable risk in water development schemes. Subsequent chapters explore the reasons, at the policy level, why these highly effective techniques have not been implemented, and describe different approaches for achieving policy adjustment. Proposals range from the use of a proportion of gross income from the project to support the costs of health maintenance, through the development of national regulations governing the long-term operation of a project, to the use of a "debt for health" exchange to secure financial support. The remaining chapters, addressed to health authorities, offer detailed practical advice on how to negotiate effectively with other sectors and how to prepare a feasible health plan for a water resources project. Information includes a series of six key arguments that can form the basis of a persuasive negotiating strategy.

DC.

eng fre spa.

WHODOC

WHO monograph

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