Un Programme sur les Interactions entre Population, Développement, et Environnement

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This research was designed to test the hypothesis that health levels in urban places are importantly influenced by the local neighbourhood environment, including the nature of the built environment (buildings and infrastructure), the socio-economic environment (including average levels of income and education as well as the availability and judicious use of resources), and the location of a neighbourhood within the broader urban environment (including its proximity to health clinics and hospitals). This is also tied to the kind of institutional arrangements that regulate resource allocation from the centre to the local level. The Accra Metropolitan Area (AMA), in Ghana was selected for this study.

We drew from the 2000 census, the 2003 DHS survey and most importantly, the Women’s Health in Accra survey of 2003 (WHS), a sample of 3,200 women aged 18 and over living in the Accra Metropolitan Area. These data were supplemented by the cause of death data for 1999-2001 which we recoded to ICD-10 standards and by the Quickbird multi-spectral satellite image which allowed independent classification of the urban micro-environments. Some new data recently acquired on malaria incidence and parasitaemia in young children will be incorporated into the analysis.

In the second phase, the project examined in detail the perceptions of the risks inherent in the local level environment in a poor neighbourhood, Nima-Maamobi, where the Legal Resources Centre, a local NGO, has been active in health promotion at the community level for over five years. The LRC, staffed by lawyers from the Faculty of Law, other lawyers and environmental scientists, has formed solid working relations with women’s groups, the gender action committees and local political, religious and traditional leaders to promote health through improved water and sanitation and the payment of exemptions from user fees for health services. Working with the local community, the project produced a subjective assessment of environmental risks and compared this with assessments based on the statistical evidence. The Medical Officer for Public Health for the AMA was part of the project to ensure good connection to policy and action. The assessment of local perceptions of environmental risks within communities in Nima and Maamobi is based on the premise that health levels in urban areas especially in poor urban neighbourhoods are importantly influenced by the local neighbourhood environmental characteristics.