Health Should Not Pay the Price for Infrastructure Development in Asia

A man collecting garbage on the side of the road in Cambodia.
A man collecting garbage on the side of the road in Cambodia.

By Susann Roth, Jane Parry

Health impact assessments can seize the opportunity to attain positive health outcomes that would otherwise not happen, as we are seeing in the Greater Mekong Subregion.

"Health is not everything, but without health, everything is nothing,” said 19th century German philosopher Arthur Schopenhauer.

His words are as true as ever today, and nowhere more so than in megacities like Manila and Hong Kong, where we both have to live with heavy roadside pollution and a seemingly endless process of infrastructure development and construction. This creates at times a hostile living environment in which one is constantly assailed by noise, dust, traffic congestion and disruption to daily life.

Infrastructure projects positively contribute to a country’s economic development and prosperity, but inevitably they also have negative social, environmental and health impacts. These impacts can be systematically assessed and mitigated, but first there has to be a political commitment to do so. For health, the concept of ‘health in all policies’ by conducting health impact assessments (HIAs) is fast gaining traction, and directly reflects Schopenhauer’s observation.

Using HIA tools and processes helps governments not only understand and mitigate potential negative health impacts of development projects – they can also seize the opportunity to attain positive health outcomes that would otherwise not happen.

HIAs are a huge challenge for countries in the Greater Mekong Subregion (GMS) undergoing rapid urbanization and infrastructure development. For instance, normally the first step is to have open lines of communication across the different government agencies involved such as the ministries of health, environment, or planning. Given the obvious common ground these ministries share, it is startling to find how little they talk to each other, although most countries actually have HIA policies and procedures in place.

At a recent workshop on HIA organized by ADB, we were astonished to find that senior staff from participating ministries in the same country had no previous contact with each other. Participants from Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam all said that it was the preparation for the event that gave them their first point of contact. At the meeting itself, they were able to spend time face-to-face having practical, in-depth discussions about HIAs, with their national colleagues as well as their regional counterparts. The discussions were the beginning of a network, a community of practice that can share experiences and lessons learned, and offer mutual support and advice. This was very gratifying for us.

The meeting was part of a wider technical assistance program on HIAs already underway to expand leadership beyond the health sector in GMS countries by maximizing the health benefits of infrastructure projects, and minimizing their harm. It aims to strengthen HIAs of large infrastructure projects in the region, especially in areas where malaria and other communicable diseases are endemic.

The project also signals a sea change in ADB’s commitment to ensuring health in all policies regains its rightful place as a core part of impact assessment. Each infrastructure project that ADB supports undergoes a social and environmental impact assessment, but attention for comprehensive HIAs had dropped off the radar of ADB and other multilateral development banks. HIA is a mandatory part of the overall social and environmental impact assessment but only the bar minimum is often done.

This issue was also raised at this year’s International Association for Impact Assessment Conference in Nagoya, where HIA experts were glad to see that ADB’s increased commitment to health also includes a focus on improving health outcomes from infrastructure project, and how multilateral development banks, the private sector and regional and local training institutes are discussing how to join forces to establish capacity for HIAs.

With that goal in mind, we are now working with other departments to strengthen HIAs within the bank’s bread-and-butter business of infrastructure. Hopefully this means that communities affected by the massive drive for infrastructure development amid rapid urbanization across Asia and the Pacific is sustainable, and does not trade health for economic development.