Challenges in decision-making: from barriers to synergies
Transforming institutional barriers into synergies
A dearth of institutional resources, human capacity and "enabling" legal frameworks impedes adequate assessment of the complex links between health, environment, poverty and development options. For instance, irrigation schemes may yield benefits in terms of food security and health. But when irrigation and dam design is not sensitive to the surrounding ecosystem, the scheme may enhance the conditions necessary for disease vectors to thrive and thereby create new health impacts. Agricultural chemicals can be used constructively to increase yields, but they also can kill or maim farm workers and children, and infiltrate water sources, when chemical regulation and education is inadequate. A complex series of tasks is required to translate scientific evidence about such issues into policy.
Common institutional barriers to the effective use of scientific information may include weak technical capacity, limited or ineffective legal and regulatory frameworks and debate driven by interest group pressures rather than by evidence. Data collected systematically according to scientifically acceptable criteria rarely determine policy on their own.
Large infrastructure projects that are popular symbols of development (e.g. urban highways, water purification plants) may be regarded as evidence or indicators of good policy even when alternative strategies (e.g. improved public transport and bike lanes, better ecosystem protection of drinking water resources) might contribute to a more cost-effective package of solutions. The cost and benefit of alternative strategies, in terms of impacts on health and environment, may not be fully considered.
In the division of routine governmental tasks, health ministries are focused on health care services and policies, which may not systematically address broader environment and development agendas. Environment ministries, for their part, often are newer entities lacking sufficient influence and resources to promote, proactively, government investment in sustainable development policies. As a result, they tend to remain focused more upon "sectoral" concerns related to nature conservation and pollution.
This institutional context generates barriers to coordinated action. Thus, governments may make crucial policy and economic development decisions without substantive input on either health or environment issues and impacts.
International institutions also have operated with separate and unlinked agendas. Agreements at recent international conferences and summits all emphasize the need to improve coherence and enhance the coordination of work at country level that promotes economic development, the environment, health and poverty-reduction.
At national as well as global levels, environment and health sectors possess complementary skills and knowledge vital both to ecosystem preservation and to human health. Intersectoral policy assessment and action is thus essential. As one informant in the HELI review had noted: "If environment and health sectors do not work together, the assessment of impacts on sheep will be better than the assessment of impacts on humans."
Health and environment actors must recognize the institutional barriers that exist to coordinated action, and also the powerful complementarities of skills and knowledge that the two sectors possess. Working together, health and environment sectors have the potential to design mutually reinforcing strategies. Capitalizing on synergies, the two sectors can promote common agendas and policy actions that benefit both health and environment.