Living With Urban Environmental Health Risks

The Case of Ethiopia

Girma Kebbede

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780815390312
• eBook ISBN: 9781351153621
• Edition: 1
• Topic: Scienze biologiche
• Subtopic: Scienze ambientali

Although it still has a low urban population when compared with the rest of the world, Ethiopia nevertheless has been experiencing one of the most rapid urbanization processes of recent years. This rapid urban growth, however, has not been accompanied by a commensurate increase in basic infrastructure and amenities that are essential for a healthy urban environment. Housing, water supply, sanitation services, drainage, transport networks and health services have not been able to keep pace with the prevailing urban growth rates, resulting in a deterioration of urban living conditions and increasingly serious health problems. Living With Urban Environmental Health Risks examines the extent and nature of environmental problems in urban areas in Ethiopia and their impact on health. The book points to the economic and political causes that underlie many of the urban problems in the country. This in-depth analysis suggests ways to deal with these problems at community, municipal, and national levels.

Chapter 1
Introduction: The State and Development

The environment in which people reside has an enormous influence on their quality of health. Microorganisms—viruses, bacteria, protozoa, and helminths— are the most dreadful environmental threat to humans. Most infectious diseases are associated with conditions in the physical environment (World Bank, 1998: 18). Ill health abounds in Ethiopia because of the pitiable environmental conditions such as poor shelter, overcrowding, unsafe drinking water, poor sanitation, water pollution, and indoor and outdoor air pollution. It has been estimated that water borne pathogens responsible for cholera, typhoid, amoebic infections, bacillary dysentery, and diarrhea account for four-fifths of all disease in the country. These environmental conditions are, in return, intimately related to poverty and the general lack of economic and political progress in the country. The poor are especially exposed to the worst environmental health risks.¹

Living With Urban Environmental Health Risks examines the extent and nature of environmental problems in urban areas in Ethiopia and their impact on health. Although Ethiopia is one of the lowest urbanizing countries in the world, with about 80 percent of its people still living in the rural areas, it has been experiencing one of the most rapid urbanization processes in recent years. Between 1984 and 2000, urban areas with a population of 50,000 or more grew at an average rate of 6.7 percent per year. Such a high growth rate, however, was not accompanied by a commensurate increase in the basic urban amenities that are indispensable to an adequate and healthy urban environment. Urban governments in the country are unable to provide or facilitate investment in the necessary housing, infrastructure, and amenities to accommodate urban growth. The urban environment, particularly that of the capital, Addis Ababa, is under constant stress due to the pressures of poor environmental infrastructure, rapid population growth, and inadequate planning controls. The majority of the urban population is badly housed and lacks basic services. Housing, water supply, sanitation services, drainage, transport network, and health services have not been able to keep pace with the prevailing urban growth rates. This has resulted in deteriorating urban living conditions and increasingly serious health problems. This book argues that these problems are largely the result of ineffective urban governance and the national government's wrong land use policies that work against the interests of urban citizens and their natural and built environment.

The Focus on Urban Areas

Urban areas in Ethiopia will continue to grow not only due to the natural increase of their own populations but also due to continued rural-urban migration. While Addis Ababa will remain the most attractive destination for rural and small town migrants, the decentralization policy of the government has stimulated the growth of second-tier urban areas, especially the regional capitals. Many second-tier urban areas (for example, Adama, Mekele, Bahir Dar, and Awasa) are growing much faster than Addis Ababa. Population forecasts indicate that over the next 20 years the country's population will double. That means by the year 2025 an additional 60-65 million people will need environmental health services. Many of these services will focus on the country's rapidly growing cities and towns. By the year 2025, the country will have 20 or more cities with more than 100,000 inhabitants and 30 or more cities with populations ranging between 50,000 and 100,000. The challenge to provide essential urban amenities to the residents of the cities and smaller urban areas will be overwhelming.

Although fewer than 20 percent of Ethiopians live and work in urban areas, cities and towns account for a considerable proportion of the country's total economic activity. Urban areas represent a huge 'investment in terms of capital and human resources' (Jowsey and Kellett, 1995: 197). More than one half of the country's gross domestic product is generated in urban areas (World Bank, 2003: 238). An estimated 90 percent of the industrial activity is urban based. It is in urban areas that a disproportionate amount of resources are used and wastes detrimental to human health and the environment are produced. In spite of all this, not much attention has been given to urban areas. There exists no national policy that guides urban development. Urban areas pursue haphazard development without any guidance or systematic planning and integration to their rural hinterlands.

Urban areas, especially large ones, are exposed to health threats uncommon in rural settings. Pollution of water and air as a result of industrial and transportation activities is a prime example. The incidence of infectious diseases (for example, acute respiratory infections, tuberculosis, and other airborne infections) tends to be more prevalent in crowded urban areas than in rural environments. Urban environments, particularly poor neighborhoods with poor sanitation, water, and solid waste services, are hosts to vermin that transmit diseases. Inappropriate disposal practices of municipal solid waste and industrial and healthcare wastes imperil public health. For the most part, Ethiopian urban areas display wide ranging problems, including rapid population growth, unemployment and underemployment, inadequate shelter, poor healthcare and sanitation facilities, poorly maintained physical infrastructure, and environmental pollution.

The focus on urban environmental problems by no means suggests that rural areas suffer from fewer environmental problems, nor does it suggest that rural areas have access to adequate healthcare and essential social and economic infrastructure. A number of major studies have already documented the problems of rural Ethiopia. By comparison, few address the problems of urban areas. Nor does the focus of the book implicitly advocate an increase in rural-to-urban resource transfer. Urban areas already possess copious human and physical resources; however, poor management and misguided land use practices and development policies have squandered these resources.

Moreover, the findings of this book may have implications for the welfare of the rural population as well. Improvements in the urban environment and in the livelihood of its people will have a positive impact on the surrounding rural areas. River pollution, for instance, can contaminate downstream environments far from its sources. In this case, the proper management of solid wastes, the treatment of wastewater, and the control of pollution will therefore improve the condition of rivers, lakes, and soils that sustain the immediate rural areas. In addition, a clean urban environment will ensure a healthier population and thus incur less medical expenditures. These extra resources could then be allocated to rural areas. Improving urban livelihoods could also contribute immensely to rural development. Ideally, urban areas provide a market for rural products, produce and enhance industrial goods and services for their hinterlands, and provide non-farm employments for rural surplus labor (World Bank, 2003: 107). At present the role of urban centers as growth poles in Ethiopia remains extremely limited.

This chapter seeks to set the urban environmental problems identified and discussed in this volume within the broader context of the persistent political and economic development dilemmas that the country continues to endure. The chapter contends that the lack of genuine economic and political development in the country stems not from insufficient physical and human resources, but from unaccountable governments and development policies that have failed to respond to the needs and priorities of the people living both in the urban and the rural areas.

The Burdens of Misrule

Ethiopia has considerable resources; nevertheless, it lingers at the tail end of the social, economic, and political development continuum. One of the five or so poorest countries in the world, Ethiopia has an estimated income of just $100 a year per person (World Bank, 2003: 14).² The vast majority of the population lives in acute poverty and suffers from inadequate access to safe drinking water, sanitation facilities, decent shelter, healthcare, and education. Life expectancy is less than 52 years and is expected to decrease by the impact of the AIDS pandemic. Most preventable diseases go untreated due to scarce medical services. The annual income of the average household cannot adequately sustain the life of a single soul.³ Chronic malnutrition remains a crucial problem. The country already has basic resources, and in fact has the capacity to meet the essential necessities of its citizens. Unfortunately, throughout its modern history, Ethiopia has lacked accountable and visionary political leadership necessary to get the most out of its resources and people. Bad governance has hindered the country's development.

During the imperial regime that ended in 1974, the country experienced an extremely exploitative socioeconomic system and an oppressive political order. Unequal distribution of the country's means of production—land— deprived peasant farmers, who accounted for over four-fifths of the country's population, of the opportunity to improve their lives. The landed aristocratic rule marginalized the agrarian sector by expropriating agricultural surpluses in the form of land rent and other types of mandatory payments (Kebbede, 1992: 1). It exacted revenues from the farming population that far exceeded their actual capacity to pay. Extremely low wages and strict prohibition against the creation of autonomous trade unions kept the urban working class in an appalling state of material conditions. Recurrent hunger and devastating famines took the lives of many of the most productive forces of the country. Overall, the pre-1974 political and economic system kept the vast majority of the population trapped in poverty, ignorance, and disease.

From 1974 to 1991, Ethiopia experienced a degree of misfortune unprecedented in the modern history of the country. From the mid-1970s through the 1980s, the country experienced a pitiless regime of centralized control. All rural land became state property; farmers did not have ownership rights over the land they cultivated. The government forced farmers to collectivize and determined what crops would be grown and at what price they would be sold. Because they could not own or control either the land they farmed or the crops they yielded, farmers did not use their energy, time, or knowledge to improve their productivity and better their lives. Forced resettlement and villagization schemes wrecked the social, cultural and economic life of the rural sector. The regime's state-mandated development strategy and anti-private sector policies strangled growth and development in the urban sectors of the economy. The commercial, industrial, and urban housing sectors suffered immensely from bureaucratic control and management and restrictive state measures against private investments. The economy of the country stagnated throughout much of the 1970s and 1980s. Famine and secessionist wars took the lives of millions. Political viciousness annihilated a whole generation of young people and forced hundreds of thousands of the country's educated and skilled people into a life of exile (Kebbede, 1992).

The year 1991 presented a turning point for Ethiopia. The notorious Derg regime of Colonel Mengistu Haile Mariam collapsed like a house of cards. The Ethiopian People's Revolutionary Democratic Front (EPRDF)—largely formed from the Tigray People's Liberation Front (TPLF)—came into power in the wake of a long-drawn-out and destructive civil war. In 1993, the new government agreed to the independence of Eritrea, land-locking Ethiopia. The EPRDF argued that only in this way could the remnant of Ethiopia stay intact. The new rulers restructured the internal administration of the country from highly centralized control to decentralized autonomous regional states created largely on the basis of linguistic identities.⁴ Nine linguistic regions make up the Ethiopian Federal Union: Tigray, Afar, Amhara, Oromiya, Somali, Benishangul-Gumuz, Southern Nations, Nationalities and People's Region, Gambela, and Harari. The largest two cities of the country—Addis Ababa and Dire Dawa—are non-autonomous administrative and council states, respectively. Each of the nine regional states is, in turn, subdivided into zones, weredas, and kebeles. The country has in total 62 zones, 534 weredas or districts, and about 10,000 kebeles or neighborhoods. Under the new decentralized state structure, ethnic regions are allowed—even encouraged—to maintain their cultural identities and languages. Article 39 of the Federal Constitution also recognizes the fundamental right of self-determination for regional states up to and including secession.

In 1995, Ethiopia established a federal system of government with a two-tier parliament: the House of Federation or upper chamber with 117 seats (chosen by state assemblies, members serve five-year terms) and the House of People's Representatives or lower chamber with 548 seats (directly elected by popular vote from single-member districts, members serve five-year terms). The House of People's Representatives elects the President of the Federal Republic for a six-year term of ceremonial function while the party in power following legislative elections designates the Prime Minister to serve a five-year term.

The federal constitution accords regional states a number of rights. The regional state may restructure its internal jurisdictions (zones and weredas) on the basis of ethnic and linguistic interests where it deems necessary, establish a self-governing constitution, develop social and economic policies and strategies, administer its natural resources in accordance with the federal laws, assess and collect taxes, and establish security forces to maintain peace and order. The responsibilities of the federal government include national security (defense), foreign relations, the granting of citizenship, economic policies, the declaration of state of emergency, currency, and the establishment and overseeing of key development programs and communication networks (Gebre Egziabher, 1998: 695).

Regional states ought to have fiscal independence by generating their own revenues through taxes and fees. In reality, however, they do not. First, the unequal distribution of resources among the regions renders some states less able than others to raise adequate revenues to meet their bureaucratic and development needs. For instance, regional states such as Tigray, Afar, Somali, Gambela, and Benishangul-Gumuz command much fewer resources than the Amhara, Oromiya, and the state of Southern Nations, Nationalities and Peoples. The latter, by virtue of their physical size and resource endowment, have a strong tax base—even though they also serve a larger population. Second, many regions lack institutional capacities to develop their revenue base and efficiently collect taxes. Finally, the federal government limits the tax sources of the states (Gebre Egziabher, 1998: 695). Hence, most of the newly constituted autonomous regional states, including the resource-rich ones, suffer from a weak financial position and thus depend on the revenue of the federal government to pay salaries and to build and maintain social and economic infrastructure. The fiscal over-dependence of the regional states has a number of drawbacks that may cast doubts on the authenticity of the decentralization effort. First, because locally raised revenues constitute only a small portion of their budgets, regional governments may not have adequate fiscal control to plan their development activities. Second, too much financial dependence on the center can weaken locally designed development policies and programs. Third, regional authorities may not have the incentive to put federal funds to proper and efficient use.

The constitution grants regional states the power to form their own legislative, executive, and judiciary branches of government—mirroring the federal government's administrative structure. As a result, regional states have huge resource-consuming administrative apparatuses. After paying administrative salaries and wages, regional states find it difficult to fund development programs. Regional state administrative bureaucracies have expanded while the revenues needed to support them have not. Additionally, in many regional states—with the possible exception of Tigray—cumbersome bureaucracies and corrupt state officials thwart local and outside initiatives that seek investment opportunities. Local and regional state authorities cannot provide effective responses to local problems. Moreover, unless a hefty kickback lures them, they often place stumbling blocks against private initiatives.

In regional states, security forces (with federal security forces, in some instances) and local authorities routinely violate citizens' rights at will, without any fear of legal repercussions. Some state and local political and security authorities seem to hold the view that the law does not apply to officials. The legal and judicial system that supposedly upholds the constitutional rights of individuals is totally corrupt. The judiciary is not independent of the legislative and executive branches. The government-owned mass media often reports lawlessness and violence against poor citizens, especially women, i...

Table of contents

• Cover
• Half Title
• Dedication
• Title
• Copyright
• Contents
• List of Tables
• Preface and Acknowledgements
• List of Abbreviations
• Ethiopia: Regional States and Major Urban Centers
• 1. Introduction: The State and Development
• 2. Urban Growth and Decay
• 3. Urban Water Supply
• 4. Urban Sanitation and Waste Management
• 5. Pollution
• 6. The State of Health and Health Services
• 7. Summary and Conclusion
• Bibliography
• Index