HABITATINTL. Vol. 17, No. 2, pp.

105421, 1993 0197-3975193

$6.00 + 0.00
Printed in Great Britain @ 1993Pergamon Press Ltd

Household Environmental Problems

in Low-income Cities
An Overview of Problems and Prospects for Improvement*

GORDON MCGRANAHAN
Stockholm Environment Institute, Sweden

ABSTRACT

This paper reviews the physical and institutional basis of some of the more severe
household environmental problems in low-income cities. Poverty is probably
the most fundamental reason for their persistence, and a frontal attack on
poverty is a prerequisite of achieving acceptable household environments.
However, like most environmental problems, they are not simply a reflection
of human preferences given scarce resources. To even achieve environmental
quality commensurate with the general deprivation of poverty requires an
understanding of underlying physical processes, and some type of collective
response. ‘Appropriate’ technologies often require more environmental aware-
ness and local cooperation than more conventional but expensive alternatives.
Moreover, different environmental problems require quite different institutional
strategies, and the appropriate role of the state, the private sector and non-
governmental organisations varies according to the physical particularities of
the problem under consideration.

BACKGROUND

The familiar city-wide environmental problems, such as outdoor air pollution,

typically only come to the fore in cities of intermediate income.1 In poor cities,
and especially their poor neighbourhoods, environmental problems tend to stay
close to home. Inadequate household water supplies are typically more critical to
people’s well-being than contaminated waterways. Air pollution in the kitchen is
often far worse than outdoors.2 Waste accumulating in the neighbourhood raises
more serious problems than at the dumps. Human excreta is the major toxic
pollutant, and unsanitary conditions at home are more threatening than industrial
pollution. City-wide environmental problems can also be severe in low-income
cities,3 but rarely cause as much human hardship as those at the household
and neighbourhoodd level. Moreover, while the burden of most environmental
problems falls more heavily on the poor, household and neighbourhood problems
are especially selective, and women and children bear an inordinate share of the
burden.

*This paper draws on Stockholm Environment Institute report entitled EtzvironmentulProblems and the
Urban Household in Third World Cormfries, and was presented at the International Workshop on Planning
for Sustainable Urban Development - Cities and Natural Resource Systems in Developing Countries,
Cardiff, 13-17 July, 1992.

105
106 Gordon McGranahan

A list of the more severe household environmental problems reads like a

list of some of the worst features of urban poverty: bad water, bad sanitation,
contaminated food, piles of garbage, pest infestation, and so on. Indeed, they
are so closely correlated with poverty that it is legitimate to ask whether there is
much point in classifying them as environmental problems, at least from a policy
perspective. They undoubtedly involve damage created by human interference
with nature, and display interrelations typical of environmental problems. But
if the inability of poor urban dwellers to obtain better household environments
were analogous to their failure to obtain enough food and other marketed
commodities, then there would be little to be gained by developing a separate
environmental strategy: the same economic opportunity enabling a household
to feed itself adequately would enable it to live in an adequate environment.
Indeed, devoting scarce funds to environmental improvement would remove
some of the more visible signs of poverty, but would be an inefficient means
of alleviating the hardship of being poor. Economics suggests that it can be both
individually and collectively rational for the ‘unacceptably’ poor to choose to live
in ‘unacceptable’ environments. It may be justifiable on health grounds alone:
more food, for example, may be more important to health than cleaner water.
Unlike marketed commodities, however, households do not choose their
environmental amenities, except to a limited extent. Few household environ-
mental problems originate within the household affected, or are the outcome
of agreements between polluters and those affected. For the most part, the
actions an individual household can take to improve its environment are
extremely limited, and more likely to be palliative (e.g. boiling drinking
water or purchasing imported water) than preventative (e.g. reducing water
pollution). Insecure land tenure, the lot of many poor urbanites, provides
yet another disincentive to invest in environmental improvement. In other
words, environmental externalities abound, and can easily prevent households
from achieving the environmental quality commensurate with their economic
situation.5
Moreover, the hazards of environmental degradation are sometimes difficult
to discern. The link between a lack of food and malnutrition is far more
perceptible than the links between poor sanitation and stomach disorders, smoke
exposure and respiratory problems, accumulations of water and malaria, and so
on. It is all too easy for well-off observers to misdiagnose problems arising
from poverty or environmental externalities, and to ascribe them to ignorance.
Nevertheless, like many environmental problems, household-level problems do
arise in part from a lack of understanding of natural processes and the human
role therein.
The ‘solutions’ most easily implemented in top-down fashion by the govern-
ment are those characteristics of rich cities and neighbourhoods: articulated
sewerage systems, piped water, door-to-door garbage collection, housing stan-
dards, and so on. Such systems do not require the households served to have
a good understanding of environmental issues, or to participate significantly
in environmental management. They are rarely the most appropriate solutions
technologically, and often intensify city-wide environmental impacts. But they
do eliminate the more local environmental externalities within the city, and
transfer the burden of environmental management from householders to the
government.
When centralised public service provision and public standards become the
principal basis for environmental improvement in a poor city, however, the
problems of a significant share of the cities households are often left unresolved.
Providing all households with high quality, individual water, sewerage and solid
waste services is not affordable when a large percentage of the population is
poor. Even when such services are subsidised, it is likely to be primarily the
 Household Environmental Problems 107

relatively well off who benefit. Similarly, environmental standards acceptable

to the government are likely to be too expensive for poor neighbourhoods to
meet. If the standards are taken seriously, the poor can be marginalised, and
realistic government-led improvements foregone. In any case, more affordable
improvements are likely to require considerable local management and coopera-
tion. Environmental externalities are more likely to arise, and a better under-
standing of local environmental impacts may be required. When, as is often
the case, many poor people are squatters, and the city gove~ment faces fiscal
problems, centralised environmental programmes are even less likely to meet
the needs of the poor.
Given the problems the ‘traditional’ private and public sectors face in
alleviating household environmental problems, it is natural to look towards
non-governmental organisations and community-based organisations for help.
There are several areas where it would be foolish to expect such institutions
to play a significant role. For example, where externalities involve actions
taken by industries or other households far removed from those actually
threatened, decentralised organisations are unlikely to be effective. Many
household environmental problems do involve neighbourhood-level extemali-
ties, however, and collective action within neighbourhoods could do much
to resolve household environmental problems. Moreover, non-govemmental
and community-based organisations can help foster a better local awareness of
household environmental problems, and place local environmental improvement
on the political agenda. However, the scope of local organisations is often
severely restricted, particularly in poor neighbourhoods. Urban neighbourhoods
find it difficult to work collectively at the best of times, and governments often
obstruct attempts to organise poor neighbourhoods for fear of the political
consequences.
In sum, it is not surprising that the household environmental problems of the
poor seem excessive, even in light of their economic poverty. Ideally, responding
to household en~ronmental problems in poor nei~bourhoods would involve
a strategic approach: one which recognised environmental complexities and
combined the strengths of markets, governments, local organisations and the
householders themselves. In practice, too much emphasis is often placed on
public services which the poor will not receive, or setting standards which they
cannot reach. Too little attention is paid to the adverse aspects of existing
property regimes and markets. And too little political space is provided to
local organisations. Typically, the poor not only face the worst environmental
problems, but an institutional framework ill adapted to their needs.
It is a commonplace that different institutional frameworks suit different
environmental problems. Just as the physical processes underlying, for example,
water and air pollution differ, so do the institutional obstacles they pose. There
are close links between the different problem areas: waste pollutes water,
water and waste provide breeding grounds for insects, insects transmit water-
related diseases, and so on. Some of the institutional obstacles are the same for
different problems: land tenure problems, for example, inhibit a wide variety of
environmental improvements. However, the differences are sufficient to warrant
a closer look at some of the more important problem areas.
The following sections review several of the principal household environmental
problem areas:
1. Water and sanitation.
2. Air pollution.
3. Food contamination.
4. Solid waste disposal.
5. Urban insects.
108 Gordon McGranahan

Particular attention is paid to the institutional obstacles posed, and the implica-
tions for government, non-governmental organisations (NGO), community-
based organisations (CBO) and private sector involvement. The goal is not
so much to generalise about what solutions are likely to be appropriate, but
to indicate how the physical characteristics of any particular environmental
problem influences the capacity of different types of institutions to help
achieve improvements. Emphasis is placed on the problems of the poor,
since this is where the problems are most severe and their environmental
aspects most apparent. No attempt is made, however, to explain why poverty
itself is so prevalent, or to place urban environmental problems within their
broader national and international context.

WATER AND SANITATION

Among the environmental problems poor urban households face, inadequate

water supplies and sanitation are probably the most important. Faecal-oral
diseases are a major killer: about five million children die every year from
diarrhoeal diseases spread primarily through the ingestion of faecally con-
taminated material.6 Insufficient water for washing, contaminated drinking
water and poor sanitation greatly facilitate the spread of these diseases, and
can lead to other health problems as well. Moreover, for many households,
even obtaining ‘bad’ water in ‘insufficient’ quantities and achieving ‘inadequate’
sanitation levels, is a considerable financial and labour burden. And personal
and household cleanliness is important in its own right.
While household water problems vary considerably between cities, it is rare
to find a poor city without serious deficiencies.7 Generally, there is at least a
small elite with indoor piped water from wells or city water supplies, though
even their water may be contaminated and subject to disruptions. At the
other end of the spectrum, collecting water from streams and other open
waterways, which are almost invariably heavily contaminated, is often the
lot of the poorest households. In between there may be a range of sources:
public standpipes, private water carriers, communal wells, private draw-wells
and rainwater collectors. Obtaining sufficient clean water from such sources is
usually difficult, and in many cases impossible. Carrying 100 kg of water home
every day from a distant standpipe is an onerous task. Buying sufficient water
from a private carrier is typically beyond the means of a household earning
just a few dollars a day. Wells, especially in densely populated areas with poor
sanitation, are typically contaminated. Rainwater is intermittent at best. And
all such sources require water storage, with the risk of further deterioration and
contamination. By using different supplies for different purposes, and doing some
washing at the water source, households often attempt to make the best of a bad
situation. But a bad situation it typically remains.
Sanitation facilities also tend to be severely inadequate. Household connec-
tions to public sewers are even less common than household water connections.
Alternatives range from septic tanks and aqua privies to pit latrines, bucket
latrines and, in the extreme, open defecation. Financing the high-cost options
can require payments equivalent to over a dollar a day, and they are largely
irrelevant to the poor majority. s Technical innovation in low-cost sanitation
technology is undoubtedly possible: improved pit latrines have already made
considerable headway, and recent developments in low-cost sewerage systems
are promising.9 However, problems often arise not only because the technology
is lacking, but also because facilities tend to be over-used, poorly maintained,
poorly situated, or poorly constructed. And with virtually all low-cost options,
good maintenance is critical if environmental problems are to be avoided.
 Household Environmental Problems 109

Reasons why people do not achieve even the level of water and sanitation
commensurate to their poverty are not hard to find. The most important reasons
were summarised in the introduction. Given the finance, it is relatively easy
for the public sector to provide households with good water and sanitation
through expensive technologies such as piped water and articulated sewerage
systems (though this creates city-level problems). A household connected to
the sewerage system does not need to know about how it works, and has
no incentive to defecate in a nearby stream, damaging a public waterway. A
household with reliable piped water does not need to know that it is easy to
contaminate water by miss-handling a water dipper, and, unless the price of
piped water is a significant burden, is unlikely to be tempted to drink from
a polluted source. As with several other household environmental problems,
once one moves to the cheaper, less centralised technologies, both externalities
and information problems emerge. Also, while women often have the primary
responsibility for household water and sanitation management, they rarely have
commensurate power, either within the household or the community at large.
Most severe water and sanitation problems arise from the combined actions of
many households, and no individual household can improve matters significantly
by reducing their own pollution, or decreasing their own water use. Thus, for
example, a household building a pit latrine has little economic incentive to be
concerned about contaminating other households’ water supplies, and unless
they are clearly the worst offenders they cannot be singled out for blame.
Even the user-benefits of improved water and sanitation may not accrue to
the improving household. Given insecure tenure, for example, a household
has even less incentive to install a good sanitation system. Moreover, in
many communities, small children spend a considerable part of their time in
neighbours’ homes, again making it difficult for a household to take effective
action on its own.1°
In circumstances where an individual household can improve its own situation,
choosing the most cost-effective option requires considerable knowledge of the
underlying problems. Trial and error reinforced by social norms is a dubious
means of developing household water and sanitation practices at the best of
times, and is particularly inappropriate in a situation of rapid demographic and
environmental transition. Especially for child minders, a better knowledge of
hygiene could do much to curb water and sanitation-related disease. There is
some indirect evidence, for example, that more literate mothers are able to
protect their children better from unsanitary conditions and use piped water
more effectively to improve hygiene. 11At times, local beliefs may interfere with
hygiene improvement: if a child minder believes a sunken fontanel or teething to
be the cause of diarrhoea, they may be less inclined to take physically appropriate
corrective action.12 However, householders may find it difficult to assimilate
hygiene information if the information is presented in terms which offend deeply
held beliefs, originates from sources which they have little reason to trust, or
invalidates socially sanctioned practices. Moreover, hygiene ‘experts’ tend to be
as ignorant of household realities as householders are of scientific principles.
Recommendations distilled by ‘experts’ from scientific principles may well not
be trustworthy. As such, the problem is probably better perceived as a need for
improved communications rather than a need to fill information gaps.
A government sincerely trying to cope with household water and sanitation
problems faces obstacles at every level. It is difficult to determine the appropriate
standards to apply. It is difficult to ensure that the facilities are built to the
standards chosen. It is even more difficult to ensure that facilities are used and
maintained properly. With regard to water quality, the tendency is to develop
a single relatively rigorous standard. In a middle-income country, this can be
progressive, raising the quality of water especially among the poor. In a poor
HAB
17:2-H
110 Gordon McGranahan

country, the same standard may be impracticable except for the elite who receive
piped water. Realistic improvements in poor areas may actually be hampered
by adherence to a single standard of water quality, especially if people use a
variety of water sources, and what is needed is more water for washing, not
better drinking water. There is also a tendency to subsidise the piped water
to make it more affordable, but this can leave the poor who still have to buy
water from private vendors actually paying considerably more for their water
than the rich.13 Subsidised sewerage systems are also likely to help only the
well off. Standpipes and communal toilets can make a considerable difference
to the poor, but can be difficult to maintain, and may be less convenient (or
more costly) than more polluted or polluting alternatives.
Perhaps equally important, the government may not be particularly concerned
about the water and sanitation problems which arise in areas not served with
piped water and sewerage systems. Since many of the externalities involving
water and sanitation arise at the neighbourhood level, the political pressure
for city-wide action tends to be muted. When waterways are polluted, this
can become a political issue encompassing all social classes. But when only
neighbourhoods are affected, the problems are easy to ignore.14
Planners as well as consumers of sanitation and water technology often lack
basic knowledge of the technologies available, and which measures are most
effective against which diseases. The environmental dimension to different
pathogens can be quite complex, and the simpler the technology, the more
important a knowledge of this environmental dimension becomes. Planners
are often ill-informed, not only about the range of technologies and their
characteristics, but also about the hydrological features of the area they are
planning for. This can be a particularly significant impediment, particularly in
areas where government services are extensive.
Most of these problems are exacerbated by rapid urban population growth,
and rural to urban migration in particular. Generally, the higher the share of new
residents, the higher the cost of providing water and sanitation facilities. Rural
migrants are likely to be particularly ill-informed as to the suitable sanitation
strategies for an urban milieu, and may actively resist changes which alter their
lifestyle. Planners find it doubly difficult to cope with the new and growing
residential areas, and often have the added uncertainty of not even knowing
where the growth areas will be. Institutional responses to open access problems
are undermined by a rapidly changing population. New residents may find it
particularly difficult to acquire secure tenancy.
Clearly, a strategy to improve water and sanitation conditions in poor
neighbourhoods must come to terms with the numerous institutional obstacles.
Ideally there should be a coordinated effort on the part of the government,
NGOs and community-based organisations, the private sector, and the people
themselves (and especially women). This may seem facile, but it is probably
more true than for virtually any other major urban problem. A division of
responsibility is required. For example, the government must be ultimately
responsible for preventing large-scale environmental impacts (e.g. salination of
household water supplies through seawater infiltration), while the urban dwellers
themselves must be ultimately responsible for their personal hygiene. There is
also a need to coordinate water and sanitation efforts with other environmental
activities. On the one hand, changes in the water and sanitation system can help
alleviate other problems (see section on insects below). On the other hand,
efforts in other areas may help improve the water and sanitation situation (see
section on solid waste).
 Household Environmental Problems 111

AIR POLLUTION

Householders are exposed to air pollution both due to concentrations in the

ambient air and from their own household cooking and heating fires. The major
sources of ambient air pollution are fuel combustion, industrial processes and
solid-waste incineration. Since all of these activities are concentrated in urban
areas, so are outdoor air pollution problems. Smoke exposure (defined to
include invisible pollutants as well as particulates) from cooking or heating
fires is particularly severe when biofuels or coal are used with poor ventilation.
Since biofuels are more prevalent in rural areas, that is where these problems
are most pervasive. However, urban crowding and the continued use of biofuels
and low-efficiency kerosene stoves in poor urban areas can lead to severe
indoor air pollution problems among certain groups. Indicative estimates of
particulate concentrations suggest that both indoor and outdoor pollution should
be considered.15 However, particularly at the household level, indoor problems
are likely to be the more severe.
Concern about the exposure to smoke from household cooking and heating
has been growing rapidly in recent years, and it is difficult to generalise from
the few studies realised to date. Emissions depend on the type and quantity
of fuel used, and the temperature of combustion. Higher emissions tend to be
associated with lower combustion temperatures and incomplete fuel combustion.
Good ventilation can greatly reduce the concentrations associated with any given
fuel. The highest concentrations are likely to arise when households cook and
heat with biofuel in unvented fireplaces, and limit the room ventilation to retain
the heat. Actual exposures depend on when and how long people spend in the
kitchen and other affected rooms, and even where in these rooms their time is
spent. Women and young children, who tend to spend more time in the kitchen,
are generally more at risk than men. Of the major urban cooking fuels (firewood,
charcoal, kerosene, LPG and electricity), firewood is likely to lead to highest
exposure to most of the critical pollutants, followed by charcoal, kerosene, LPG
and electricity.16
There are considerable differences among countries as to the percentage of
urban households using biofuels. In most poor cities a significant percentage use
either charcoal or fuelwood, and in many these are the major household fuels.
In cities where income is growing, a decline in the importance of biofuels can
be expected. There is considerable evidence of a relatively rapid ongoing fuel
transition in many Asian cities. Thus, for example, in India the fuel share of
firewood reportedly fell from 42% to 27% between 1979 and 1984.17 In most
cities in Sub-Saharan Africa, on the other hand, biofuels are likely to remain
the dominant fuel for some time to come.
The costs urban air pollution impose on households are hard to ascertain.
Polluted air tends to be unpleasant to breathe, but it is the health effects that
generate the most concern. Respiratory diseases are a major cause of death in
many Third-World cities, and especially among poor children. The link to air
pollution is complicated and difficult to verify, however. Airborne irritants can
make people more prone to respiratory infections and increase the likelihood of
secondary infections. Combined with malnutrition, overcrowding, poor hygiene,
poor circulation and a lack of sunshine, air pollution may contribute significantly
to respiratory disease. is Epidemiological confirmation of the role of air pollution
in increasing the incidence of respiratory infections exists, but it is not possible
to make general statements as to its contribution relative to other factors.19 Air
pollution can also contribute to a high incidence of other respiratory and eye
problems, as well as cancer. While such diseases do not figure so highly in the
mortality statistics of low-income cities, they are a reason for added concern.
Technical measures to curb outdoor air pollution are widely available, but
112 Gordon McGranahan

are implemented unevenly. Vehicles are often a major offender, and there
are numerous technical options for controlling vehicular pollution. Transport
distances can be decreased, cleaner transport modes can take a larger share of the
traffic, traffic flows can be improved, vehicles can be better maintained, cleaner
fuels (e.g. lead-free gasoline) and new technologies (e.g. catalytic converters)
can be introduced within existing modes. Considerable progress has already
been made in First-World countries, partially balanced by an increase in traffic.
Numerous technologies and cleaner fuels also exist for decreasing emissions
from power plants and industrial sources, and again progress has been made
in First-World countries. In poor cities, households themselves can contribute
significantly to improving ambient air quality, both through fuel consumption
(especially when low quality fuels are used) and refuse burning. Here there is
less scope for following the lead of the First-World countries: the problems and
technologies are radically different.
Lowering user-exposure to smoke from cooking and heating fires is techno-
logically even simpler. Most obvious, it is possible to switch to less polluting
fuels. Alternatively, it is possible to improve the ventilation, raise the combustion
efficiency of the stove, spend less time near the fire, and take other, similar
measures. The options tend to be more expensive when space heating is required:
better room ventilation and moving away from the fire are not always appropriate
for obvious reasons.
Reducing ambient air pollution and reducing personal exposure to air pollution
from household cooking and heating pose quite different institutional obstacles.
Both are linked with poverty, but in rather different ways. In the absence
of efforts to control pollution, the industrialisation and growth in motorised
transport often associated with economic growth will increase ambient air
pollution. On the other hand, personal income growth is likely to reduce
exposure to smoke from household fires: the less polluting fuels are preferred
for reasons other than their emissions. Turning to the question of whether
poverty may make it rational to accept relatively high pollution levels, in both
cases it is relatively easy to find reasons to expect pollution exposure in excess
of the dictates of poverty, but the reasons are not the same.
There are obvious and extensive externalities associated with ambient air
pollution. The ambient air polluter bears an insignificant fraction of the damage
incurred by his/her own pollution. Air, like water, transports the waste away
from the source, mixes it with other pollutants, and provides a crucible for
various chemical reactions. The eventual damage is removed in time, space and
chemistry from the original emission, leaving little scope for bargaining between
the polluter and the receptor. Unless there is a collective effort to prevent air
pollution, there is unlikely to be any effort at all, regardless of the benefits.
Individually, households can do little to reduce their home’s exposure to
polluted ambient air except choose a relatively less exposed place to live. The
overall result is not so much less household exposure, but a tendency for air
quality to be worse in poor neighbourhoods. To the extent that air quality is
simply one of the factors that determine where households choose to live, the
costs are shared: the rich will pay in the form of, for example, higher land
prices, and the poor in the form of higher exposure levels. (Trading wealth for
health is morally contentious, though not manifestly less fair than most trading
between economically unequal partners). If, as will often be the case, the rich
are more significant polluters, most people would probably agree that even an
equal sharing of the burden is unfair. Also, zoning laws which concentrate Itew
polluters near poor neighbourhoods clearly can place an undue burden on poor
households. Nevertheless, compared with most other household environmental
problems, the burdens of ambient air pollution fall relatively evenly across the
populace.
 Household Environmental Problems 113

The scope for community action to control ambient air pollution is almost as
limited as for individual households. Even collectively, the households in a given
neighbourhood are unlikely to be the major source of the ambient air pollution
they face.
Ultimately, government action is critical if excessive ambient air pollution is to
be avoided. There are a variety of policy options, ranging from setting standards
which individual polluters must meet (e.g. production related emissions limits
or technological requirements) to creating economic incentives (e.g. taxing
emissions or polluting inputs such as coal). It is difficult to devise policies
which lower emissions in an economically efficient manner, especially in the
absence of careful and expensive monitoring. The lack of knowledge about how
harmful air pollution really is makes it doubly difficult to devise a suitable policy
response. However, even in a poor city, some policy interventions are likely to
be warranted.
In contrast to ambient air pollution, exposure to smoke from cooking and
heating fires is inflicted by household activities, and the externalities are minimal
(except to the extent that the smoke also contributes to ambient air pollution).
As a result, the role of the government is less central.
The possibility of switching to less polluting fuels is severely constrained by
poverty. Even if the dangers of smoke exposure were well known, low polluting
fuels and associated equipment would still be viewed as too expensive by most
of the households now using biofuels or coal. Government attempts to reduce
exposure by subsidising low-polluting fuels are in danger of treating a symptom of
poverty, but doing little to reduce the hardship. In any case most of the benefits
of such subsidies will accrue to the relatively well off.
There are less expensive measures biofuel (and coal) users can take, and
here information problems are probably the major obstacle. If people truly
believed that smoke exposure was a cause of respiratory disease, smoke exposure
would probably decline significantly. The medical profession, the government
and NGOs could do a great deal more to convince people of the dangers of
smoke exposure, and also to support technological innovation in the form of
better stoves or better ventilation. But it is not just the householders who
have little understanding of the effects of smoke: even the medical profession
is woefully ignorant, particularly as regards acute respiratory infections. It is
difficult to justify a major campaign to reduce smoke exposure on the basis
of current knowledge. Improving the scientific understanding of the underlying
health relations would be internationally beneficial, and should, therefore, be
an international responsibility.
There is, however, another institutional obstacle to improvement which
deserves consideration. The notion that smoke exposure is self imposed is
potentially misleading, given that the people exposed (principally women and
children) are often not those making the decisions. Gender discrimination may
well contribute significantly to the high levels of exposure that women face.
Given these conditions, the appropriate role of both governments and non-
governmental organisations is to enable householders, and to a lesser extent
the private sector, to respond. There is still considerable need for research
on the health implications of biofuel smoke exposure. In one way or another,
this information needs to find its way into the hands of those most exposed.
Especially given the link with gender discrimination, women’s groups could play
a particularly important role.

FOOD CONTAMINATION

Microbially contaminated food contributes to the high incidence of acute

diarrhoea in Third-World countries, and food-borne diseases include cholera,
114 Gordon McGranahan

botulism, typhoid fever and parasitism. Chemical contaminants can have long-
term health effects, and toxins cause food poisoning when severe. Microbial
activity generally contributes to food spoilage, while unsafe chemicals may
deliberately be added to retard or disguise spoilage. In warm climates bacterial
multiplication is extremely rapid, making the risk of contamination and spoilage
all the greater. Furthermore, food contamination is intimately linked to the
sanitary conditions of food preparation, processing and even production. Gener-
ally, food contamination is more severe in poor countries, although there are
some food-borne diseases, such as salmonellosis and staphylococcal entero-
toxicosis, which are probably more common in richer countries.
The delay between food production and consumption is an important factor
in food contamination and spoilage. Whereas in rural areas this delay evolves
from the need to store food seasonally, in urban areas much of the delay stems
from the need to transport, process and market food before it is obtained by the
consumer. There may also be a greater tendency for urban households to store
cooked food. In a study of Monrovia ,20 it was found that most urban (slum)
households stored food, and 63% of stored food samples were contaminated
with bacteria (83% for baby foods). On the other hand, rural households were
less inclined to store cooked food, and only 39% of their food samples were
contaminated.
Among food-borne diseases, it is the bacterial agents which tend to multiply
in the food, while for viruses, protozoa and helminths, food acts primarily as
a carrier. Various methods have long been used to prevent bacterial build-up,
ranging from relatively high-cost options such as freezing and canning, to low-
cost fermentation, salting and sun-drying. Often traditional food preparation
relies on low-cost methods, whose benefits may not be recognised.
Cooking itself is the primary means of reducing the concentration of bacterial
and other microbial contaminants, though, as with water, bacterial concentra-
tions can rise again during the period between preparation and consumption.
A potentially acute problem in urban areas is the contamination of pre-cooked
food. In rich countries, the sale of pre-cooked foods is the major source of
food-borne disease. Relevant data are not generally available in poor countries,
but, at least in some Third-World countries, even poor households purchase
significant quantities of pre-cooked food.
Particularly for bacterial contamination, food handling by the final user is an
important factor in the quality of the food consumed. Washing hands prior to food
handling, rinsing fruits and vegetables with clean water, cooking foods thoroughly
and preparing foods immediately prior to eating, can reduce food contamination.
Especially for poor households without access to refrigerators, buying perishable
foods near the time of preparation, and preparing food immediately prior to
eating, can also mean safer food. Fortunately, buying small quantities of food
near the time of use coincides with the more general economic strategy of
the poor: small purchases of products not subject to spoilage are also made.
Unfortunately, retailers in poor cities may also have poor storage facilities, and
no refrigeration.
Chemicals are added to food both inadvertently and, more often, deliberately.
Pesticides and herbicides are applied during crop production, and residues
may persist in the food consumed. Preservatives, flavouring and colouring are
applied during processing. Kept within recommended limits, the health effects of
chemical additives are probably minimal. However, especially in poor countries,
the rapid growth in the number of chemicals available has not been accompanied
by effective monitoring or control. Since the effects of misuse are likely to be
long term, it is difficult to establish a clear link between health problems and
food additives and pesticide residues.
In conditions of poverty, people are naturally loath to throw away decaying
 Household Environmental Problems 115

food, even if there is a known health risk. Instead, the temptation will be to
hope for the best and, for example, to add spices to mask any unsavoury
flavour. Similarly, if dangerous chemical additives allow food to be sold more
cheaply, poor consumers will be tempted, even if they are aware of the risks.
However, poverty is at best a partial explanation of some food contamination,
and poverty itself would be slightly more bearable if more effective strategies
could be developed for coping with food contamination.
When disease-bearing food is bought or served, the consumer may be aware
of some deterioration, but does not know in advance that the food will cause
disease. The food seller may be equally unaware of the danger, or alternatively
may attempt to hide what signs there are. Thus, even if a food buyer examines
both the food and the premises of the seller, this generally will not guarantee good
food quality. There are two common institutional responses to this information
problem. First, and most common in wealthy countries, the practices of the food
handlers (up to the final point of sale) can be prescribed by the government.
Second, and most common in poor countries, personal relations can be used
to substitute the lack of visible signs of product quality with confidence in the
practices and intents of the supplier. The economic lure of future sales, and
the psychology of personal contact, can induce the vendor to avoid selling
contaminated food to regular customers. This inducement is multiplied when
the vendor works in a neighbourhood where reputations, and hence sales, rise
or fall depending on the quality of the food sold. Similar links of patronage
and reputation can work back through the food system, mitigating at least the
worst excesses which would arise in an anonymous free market. They do not,
however, extend to contaminants whose effects cannot easily be linked to the
food source.
Within the home, the relation between food quality, food handling and illness
is generally recognised throughout the world. Traditional practices and beliefs
may help improve food quality (e.g. by drinking tea rather than water, many
peoples have a visible indicator that the water was heated) or worsen it (e.g. in
parts of Latin America, the belief that it is unhealthy to wash hands perceived
of as “hot” from ironing or sewing can interfere with household food-hygiene).
But most of the contamination dangers within the home stem from unsanitary
conditions involving unclean water and the sanitation problems mentioned
above. There is considerable scope for improved information, disseminated,
for example, through public school education .2t
Chemical contaminants involve somewhat different institutional problems. The
link between the contaminated food and the health effect is difficult to detect
using scientific techniques, and cannot be ascertained by ill-informed consumers.
In most poor countries there is little point mandating that lists of chemical
additives accompany food sales: foods are rarely packaged appropriately, the
costs would be considerable, the information would be largely incomprehensible,
and the retailing system is too decentralised to enforce such a system. Prohibiting
selected food additives is administratively simpler, though still difficult to apply
in the informal sector. Also, determining which additives should be prohibited
is complicated by the diverse food needs of the population. Severe malnutrition
among the poor, for example, dictates against prohibitions which sacrifice current
food supply to possible long-term health advantages.
In sum, the appropriate role for government depends very much on the nature
of the existing food distribution system. Most urban food is marketed, and given
the importance of food availability, it is important that food safety measures do
not render the food marketing system inefficient. Care must also be taken not to
undermine the less formal means through which households attempt to safeguard
their food supplies. It may well be appropriate to target certain unsafe practices,
and to impose standards on large-scale food establishments. Food safety should
116 Gordon McGranahan

probably not, however, be used to justify attempts to control informal food

sellers. As with water and sanitation, education could be an effective means
of reducing food contamination, and NGOs as well as the government could
play a role here.

SOLID WASTE DISPOSAL

Households probably account for about half of the solid waste load generated
in Third-World cities, and the bulk of the waste that actually threatens the
household and neighbourhood environments. As a rule of thumb, Cointreau22
suggests rates of between 0.3 and 0.6 kg per capita/day for residential refuse.
Generally, a poorer city generates less waste, but a smaller share of the
waste is collected. Overall, Cointreau estimates that in Third-World cities
some 30-50% of solid wastes often remain uncollected, to rot, wash away,
burn or be scavenged. 23 The disposal sites themselves are often little more than
dumps, where the wastes are concentrated, often in the vicinity of low-income
settlements.
The solid waste which remains uncollected often creates nauseating piles of
debris on marginal land (e.g. on the edge of local road, rail and waterways).
These sites become refuges for parasites which spread disease. Organic waste in
particular provides a breeding ground for micro-organisms and disease-bearing
insects. Where faecal material is mixed with the waste, the health dangers
are compounded. Waste pickers and playing children are particularly at risk.
Uncollected waste is also a fire hazard. Alternatively, when the waste is washed
away, it not only pollutes the water, but often blocks the drainage system; in
many tropical cities this accounts for the conspicuous rise in traffic congestion at
the start of the rainy season. Finally, large quantities of household and garden
waste are burnt in low temperature fires, adding to the air pollution.
Industrial solid-waste generation typically includes hazardous wastes: in the
US about 10% of industrial solid waste is considered hazardous, and similar
percentages are likely to apply in Third-World countries. Generation rates
are lower in less-industrialised cities: based on gross manufacturing output
per capita, one would expect poor countries to have generation rates of two
or even three orders of magnitude lower than those in industrialised countries.
On the other hand, in poor countries there are more likely to be high population
densities in the immediate vicinity of the polluting industries, and the polluters
are less likely to be constrained by the complex hazardous waste regulations
typical of the industrialised countries. As such, for a segment of the population,
the danger of contamination is likely to be greater in poor countries than in more
industrialised countries.
Even with all their inadequacies, and despite relatively low costs per household
(on the order of a dollar per month), the costs of solid-waste collection and
disposal are often a significant share of the municipal budget (e.g. 1040%).
Because of the relatively high density of solid waste in poor countries, compacting
is not a major issue. On the other hand, particularly in low-income settlements,
access can be a problem, and collection points become a critical part of the
collection process. A significant share of the costs lies in the management
and maintenance, making collection susceptible to short-term fluctuations in
financing.
There is considerable potential for recycling materials from urban waste, and
waste pickers already take part of the readily recoverable material. Pickers
naturally concentrate on waste from upper-income households, where the share
of recoverable materials is greatest. Often the pickers are organised and have
informal links to the state apparatus. Superficially, the waste picking systems
 Household Environmental Problems 117

are high competitive, but often middlemen derive excess profits, creating various
inefficiencies.
As with all of the environmental problems discussed so far, inadequate disposal
of solid wastes tends to be more evident in poor cities, and especially evident
in poor neighbourhoods within poor cities. In some cases, for example when
poor people intentionally live near disposal sites so as to scavenge for recyclable
materials, poverty is virtually driving people to choose the risks of proximity to
unsanitary solid wastes. Again, however, there are good reasons to believe that
the scale of the problem is more severe than poverty alone would dictate.
As with liquid wastes, there is a severe open access problem associated with
solid waste disposal. If a household can find a nearby site simply to dump the
waste, it has solved its disposal problem, regardless of the cost this dumping may
impose on others. For rich households, door-to-door collection is a reasonable
option, both economically and physically. Poor households, on the other hand,
have less valuable waste and are more difficult to charge for collection, and
so are less likely to be covered, especially by private collection companies.
Moreover, poor households tend to be more difficult to access. If households
are requested to deposit their wastes at collection points, they still have little
incentive to comply. Some form of concern for or coercion by the neighbourhood
is necessary if the whole system is not in public hands.
Public control does not guarantee that the correct incentives are in place. The
public sector organisation in charge of garbage disposal may itself be inclined
to ignore formal guidelines. Waste disposal is often among the worst hit by
government financing problems. The low status associated with waste collection
activities often prevents the relevant authorities from taking a prominent place
in the government hierarchy. Too often, public waste collection services interpret
their role very narrowly, and make little attempt to co-ordinate their activities
with community based organisations or scavengers, to provide incentives for
individuals or communities to separate their waste, or to respond to the particular
needs of their clients. Furthermore, governments are reticent about collecting
waste from squatter settlements, just as they are about providing other public
services.
The dangers of improperly disposed solid waste are often not fully understood.
The dangers of water contamination, for example, are often not recognised until
long after contamination has reached unacceptable levels. Also, the children who
play in the garbage left on marginal land probably do not realise they are risking
their health, and their parents may be ill-informed both as to the risks and as to
their children’s habits. Nevertheless, a lack of information does not appear to
be central to solid waste disposal problems.
Overall, even if the government cannot provide a door-to-door household
waste collection service, it must at least be responsible for ensuring that solid
waste disposal does not threaten neighbouring communities or the city at large.
In areas where door-to-door collection is not feasible, externalities will arise at
the neighbourhood level, and may often be best dealt with by community-based
organisations. NGOs and CBOs can play a particularly important role in
helping devise innovative strategies for waste disposal. However, unless the
collection service, whether public or private, coordinates its activities with local
organisations and provides appropriate financial incentives, the potential for local
involvement in solving solid-waste problems is likely to be blocked. Similarly,
land tenure problems are likely to create serious obstacles to improvement.

URBAN INSECTS AND INSECTICIDE USE

In addition to being responsible for some of the most infamous diseases, insects
may facilitate the spread of excreted infections, destroy food, and cause a
118 Gordon McGranahan

number of other problems. Unlike most of the other topics described in this
paper, insect-related problems are neither particularly urban nor generally
the outcome of human interference with natural processes. Indeed, some
insect vectors are ill-suited to the urban environment, including most malarial
mosquitoes (Anopheles) and tsetse flies. However, several insect-borne diseases
once considered primarily rural are becoming endemic in urban areas. More
generally, even if urbanisation does not create insect-related problems, urban
environmental management has a role to play in alleviating them. Within cities,
homes and their environs are important sites of insect biting, feeding and even
breeding.
Mosquitoes are probably the most important insect vectors, even in urban
areas: they bear malaria, yellow fever, dengue, and filariasis, along with a
number of lesser known diseases. While mosquitoes are found throughout the
world, the incidence of disease-bearing species varies geographically. Moreover,
the particular environmental features of an urban area can make a considerable
difference. The Aedes aegypti, a day-biting vector of dengue and yellow fever,
is probably the most dangerous vector in urban areas.24 It breeds in clean
water, including water storage containers and discarded containers, and is thus
fostered by inadequate water supplies and garbage collection. The night-biting
Cules quinquefasciatus is the main vector of bancroftian filariasis. While it can
share breeding sites with the A. aegypti, in urban areas it breeds mostly in
latrines and sewerage water. Most malarial mosquitoes breed in natural sites,
and are less prevalent in urban areas than in the surrounding countryside. A
notable exception in India and the Middle East is the Anopheles stephensi,
which has adapted to breeding in wells and water storage tanks.25 Numerous
other mosquito vectors have also adapted to urban sites and have contributed
to disease outbreaks in a number of cities.
Flies may well be the next most important urban insect vector, and their
impact is even more closely tied to urban environmental features. Faeces and
other waste not only provide a breeding ground for flies, but flies breeding or
feeding in faecal material are more likely to spread infection. And the risk of
infection is heightened if the flies have access to human food. However, while
flies provide a path through which infections are transmitted, their relative
importance is difficult to ascertain.
There are four commonly employed ways of controlling insects which threaten
households. First, their breeding, feeding and resting sites can be removed.
Most households take at least some such measures to control house breeding
insects, and governments often attempt to control mosquito breeding sites.
Second, insecticides can be applied. Again both households and governments
often apply insecticides, particularly against adult mosquitoes. Third, physical
barriers such as screens and nets can be used can be used to prevent insects
from coming into contact with food, unsanitary material, or, perhaps most often,
people. Such measures are undertaken principally by the households themselves.
Fourth, various insect repellents can be employed, most commonly by personal
application to the skin. There are various other means which may become
important in the future. There are, for example, a variety of relatively untried
biological control techniques, ranging from bacteria and fungi to predatory
insects and larvivorous fish.
Insecticides bring their own environmental hazards, and in many countries
disturbingly high levels of pesticide have been found in mothers’ milk, par-
ticularly among urban dwellers .26 The role of household spraying has not been
ascertained, but it could be an important contributor.
Many of the living conditions associated with poverty are also associated
with insect concentrations. Cracked walls, mud floors, open waste containers
and dirty toilets are just some of the examples of conditions which would be
 Household Environmental Problems 119

undesirable even if they did not promote insect infestation. This will tend
to accentuate the correlation between poverty and insect problems. Also, of
course, poor households are less willing to devote their scarce resources towards
combating insects. But like most of the other environmental problems described
above, there are severe externalities which make it unlikely that households
acting individually will take appropriate actions to control insects. Perhaps more
than in any other problem area, the externalities bias the measures households
take as well as limiting the level of activity.
Externalities arise principally because insects travel, and by and large,
the further they travel the more extensive the externalities. Unfortunately,
mosquitoes and flies regularly fly between houses, and even between neigh-
bourhoods. Many breeding sites are on public land, and there is little individual
households can do about them. But people do not have much (individual)
incentive to eliminate even the breeding sites within their house compound
either: mosquitoes and flies will still come from neighbouring areas, and many
of those breeding at home will leave. Adulticides (insecticides targeted at adult
insects) are somewhat more narrowly focussed on the insects likely to be a
threat to the user, especially if used indoors. The beneficiaries of repellents
and physical screening are clearly the households who use them. If repellents,
screens and similar devices were the best means of control, one could still
expect well-informed households to take appropriate action. But in practice
it is inefficient simply to let mosquitoes and flies breed freely, and then try to
kill them off or block them when they approach their ‘victims’.
Governments too are prone to overemphasise spraying in their efforts to
control mosquitoes. The initial costs of controlling insects through environmental
management tend to be high, and it often takes some time to understand the local
ecology sufficiently to mount an efficient government programme. Most insect
control programmes in poor countries are undertaken in response to disease
outbreaks, rather than as part of a long-term effort to control disease-bearing
insects. As a result, palliative solutions relying on the heavy use of insecticides
tend to be preferred.
Externalities are somewhat less pervasive for most other insect pests. Many,
including fleas, cockroaches, bedbugs and triatomine bugs, breed in the house.
A household is more likely to be able to control these pests through its own
individual actions, and there is no obvious bias towards using insecticides and
against removing breeding sites. The actions of neighbours still make a significant
difference: there is little point in an individual household trying to eradicate
cockroaches, for example. But the scale tends to be smaller. Governments, on
the other hand, are less well placed to intervene directly. It may be hard for
a government to get households to help control mosquitoes by covering and
treating the water in their storage containers, but it is likely to be far easier
than getting them to fill in cracks and crevices in their walls.
Because of these externalities, education alone is unlikely to have a major
impact on the more serious insect-related problems. Individuals may well not
take action, for example, even when they know where mosquitoes are breeding
and that these mosquitoes are transmitting a dangerous disease. Informing
people of the particular characteristics of the mosquito vector in question is
unlikely to make much difference under such conditions. Yet once a strategy
is being devised to control insects, through a community action programme for
example, it can be critical that people be well informed. How critical depends
in part on the level of active household participation required, which can itself
depend on the vector in question. Even among mosquito vectors differences
emerge: controlling dengue mosquitoes is likely to require more household
participation than controlling malarial mosquitoes. (This is not to say that it
120 Gordon McGranahan

is a good idea to impose programmes on an ill-informed population just because

their participation is not strictly required.)
People also must be made aware of the dangers of pesticides if they are to
use them safely. Pesticide use has its own externalities: the user only bears part
of the risk. However, difficulties in assimilating information about the risks
of pesticides to the user, and the inherent uncertainty involved, are likely to
outweigh any differences between individual and social costs of pesticide use.
More generally, insect problems are so closely related with other environ-
mental problems that efforts to deal with them in isolation are bound to be
inefficient. Accumulations of solid waste, water, sewerage and even food, can
provide the breeding ground for insects. Moreover, poor sanitation makes
mechanical insect vectors far more dangerous.

CONCLUSIONS

Alleviating poverty would greatly improve household and neighbourhood

environments in Third-World cities. However, where urban poverty persists on
a large scale, it is at the household and neighbourhood levels that human
suffering due to environmental degradation will tend to be most severe. This
should not be taken to imply that the environmental problems of the poor are
simply a reflection of economic austerity. Affordable improvements are often
forgone because the underlying physical processes are poorly understood or
create problems which existing institutions do not or cannot address effectively.
It may be tempting to look towards a more affluent future when public services
and standards will take care of these problems, and to concentrate on building
up the requisite institutions and infrastructure. But as Keynes said, “in the
long run we are all dead” - idealistic visions of the future are a poor guide
to present practice. As long as poverty remains pervasive, there will be a
need for inexpensive environmental management, based on a large measure of
local cooperation and environmental awareness. In any case, the public service
model of environmental improvement may prove to be unsuitable even for
affluent cities. Most governments are finding it increasingly difficult to bear the
burdens of environmentally heedless urban dwellers. Many of the proposals for
shifting urban development onto a more sustainable path advocate a move away
from centralised service provision, and more active household and community
involvement in environmental management.
Household environmental problems pose a variety of institutional problems.
The appropriate roles for government, NGOs, CBOs, and the private sector
vary accordingly. Nevertheless, there are major drawbacks to a piecemeal
approach, wherein each problem is viewed and treated independently. First,
the problems are physically related. Solid waste, for example, cannot only
accumulate in unsanitary piles, it can also lead to water quality problems,
drainage problems, air pollution, insect problems, and even food contamination.
Second, the underlying institutional problems are inter-related. Insecurity of
home ownership, for example, can undermine attempts to improve all of the
problems cited. Finally, the difficulties in valuing the benefits of alleviating these
environmental problems are compounded by a segmented approach. Unless,
for example, air and water quality improvements are valued within the same
framework, priorities will not reflect their relative importance to the intended
beneficiaries, of which urban households in poor countries are among the most
significant.
Improving household environmental conditions in poor cities represents a
great challenge. The physical problems are severe and complex; the institutional
obstacles are daunting; there are no simple solutions, or clear divisions of
 Household Environmental Problems 121

responsibilities. Yet we should not forget that urban environmental improvement

has been, in its way, a success story. There are few fields which can provide such
clear examples of improved living standards and health arising from government
intervention. The fact that much remains to be done should not detract from
these successes.

NOTES
1. In very weaithy cities, many of these city-wide problems have themselves been alleviated or dispfaced,
and the more critical environmental issues involve the regional and global implications of urban
processes. World Bank, World Development Report (Oxford University Press, New York, 1992).
K.R. Smith, “Assessing Total Exposure in the Developing Countries”, Environment,30, 16-20, (1988),
pp. 28-35.
J.E. Hardoy and D. Satterthwaite, “Environmental problems of Third World Cities: a Global Issue
Ignored”, Public Administration and Development 11 (1991) pp. 341-361, especially pp. 346-349.
In most of the following discussion, household environmental problems are taken to include problems
which arise at the neighbourhood level.
The household is not a corporate decision-making unit. as this paragraph could be taken to imply.
However, the externalities referred to arise regardless, and are more easily expressed as arising
between households. For a discussion of the dangers of applying the concept of household uncriticalfy
in discussions of urban environmental problems, see: C. Rakodi, “Women’s Work or Household
Strategies?“, Environment and Urbanization 3, 2 (1991). pp. 39-45.
6. UNICEF, Children and ~evezopment in the 1990s: a U~t~EF Sourcebook (UNICEF, New York,
1990).
7. J.E. Hardoy, S. Cairncross and I?. Satterthwaite (Eds), The Poor Die Young: Housmg and Heahh
in the Third World (Earthscan, London, 1990).
8. J.M. Kalbermatten, D.S. Julius and C.G. Gunnerson, Appropriate Sanitation Alternatives: a Technical
and Economic Appraisal (Johns Hopkins University Press, BaItimore, 1982).
9. C. Kerr (Ed.), Community Health and Sanitation (Intermediate Technology, London, 1990).
10. H. Pickering, “Social and Environmental Factors Associated with Diar%oea and Growth in Young
Children: Child Health in Urban Africa”. Social Science and Medicine 15B (1985). no. 133-145.
11. S.A. Esrey and J.-P. Habicht, “Epidemiological Evidence for Health Benefits fro& Improved Water
and Sanitation in Developing Countries”, Epidemiological Review 8 (1986), pp. 117-128.
12. I. de Zoysa, D. Carson, R. Feachem, B. Kirkwood, E. Lindsay-Smith and R. Loewenson, “Perceptions
of Childhood Diarrhoea and its Treatment in Rural Zimbabwe”, Social Science and Medicine 19 (1984),
pp. 727-734.
13. Hardoy and Satherthwaite, 1991 {see note 3).
14. III health arising from bad water and sanitation in poor areas does affect the health of better off
urban dwetlers. Indeed, there are even global implications. A recent review of “The Origin of Plagues”
places poor urban environments at the centre of an often ignored environmental externality in claiming
that: “A new epidemic may be incubating even now in the crowded, unsanitary mega-cities of the
developing world . .” R.M. Krause, “The Origin of Plagues: Old and New”, Science 257 (1992),
pp. 1073-1078.
15. Smith, 1988 (see note 2).
16. K.R. Smith, Biofuels, Air Pollution and Health (Plenum Press, New York 1987). A. Elleglrd and
II. Egneus, Health Effects of Charcoal and Wood Fuel Use in Low-income Households in Lusaka
(Stockholm Environment Institute, Stockholm, 1992).
17. G. Leach, Household Energy in South Asia (Elsevier Applied Science, London, 1987).
18. J.A. Listorti, Environmental Health Components for Water Supply, Sanitation and Urban Projects
(World Bank Technical Paper No. 121, The World Bank, Washington, DC, 1990).
19. B.H. Chen. C.J. Hong, M.k. Pandey and K.R. Smith, “Indoor Ai; Pollution in Developing Countries”,
World Healfh Statistics Ouarterlv 43 (1990). DR. 127-138.
20. K. Molback, N. Hiijling, S. Jepsen and K.‘GaarsIev, “Bacterial Contamination of Stored Water and
Stored Food: a Potential Source of Diarrhoeal Disease in West Africa”, ~pidem~oiogy and Infections
102 (X989), pp. 309-316.
21. T. Williams, A. Moon and M. WiIIiams, Food, Environment and Health: a Guide for Primary School
Teachers (World Health Organisation, Geneva, 1990).
22. S.J. Cointreau, Environmental Management of Urban Solid Wastes in Developing Countries: a Project
Guide (The World Bank, Washington, DC, 1992).
23. J.E. Hardoy and D. Satterthwaite, Squatter Citizen (Earthscan, London, 1989). R.E. Stren and
R.R. White (Eds), African Cities in Crisis (Westview, Boulder, CO, 1989).
24. WHO, Urban Vector Pest Control, Technical Report Series No. 767 (World Health Organisation,
Geneva. 1988).
25. WHO, ibid.
26. S.A. Slorach and R. Vaz (Eds), Assessment of Human Exposure to Selected Organochlorine Compounds
Through Biological Monitoring (Swedish National Food Administration, Uppsala, 1983).
27. For an attempt to link insect-related education to community action, see: WHO, insect and Rodent
Control Through Envjronmenta~ ~a~gement (World Health Organisation, Geneva, 1991).