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

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Generally, we have shown that there are very marked differentials in health and mortality in Accra which have a clear spatial expression. There are in addition very clear differentials in income with a similarly strong spatial pattern. Contrary to our expectations, at this ecological level of analysis, poverty was not very highly predictive of health. We did find a strong effect of ethnicity which serves as a measure for the strong effect of other sorting processes. We also found that using data from the satellite imagery showed that a lack of vegetation is associated with poverty but since poverty levels at the locality level are only weakly associated with health, the lack of vegetation is similarly not very predictive of poor health. Our conclusion is that to be effective, some new interventions must deal with the processes by which people are sorted to particular neighbourhoods as well as the levels of service provision in these neighbourhoods. There are barriers to land ownership, for example the established chieftaincy system, which inhibit local initiatives and allocate sub-groups to particular parts of the city, many of them the least salubrious.

The local-level investigation in Nima-Maamobi reveal a strong awareness of the importance of environmental effects on health and welfare but very often the mechanisms linking environmental concerns and health were poorly understood. As with the miasma theory at the beginning of the 20th century in Europe, much can still be accomplished despite imperfections in knowledge. The main barrier to improvement of the local environment was the inability of local communities, many recent immigrants and so not part of the older urban power structures, to influence government spending to invest in expensive environmental improvements, most notably potable water and main sewage. This frustration is notable given Ghana’s open and democratic system of government not seen in many African countries. Moving environmental and health concerns to the centre of the political arena is the next challenge but the country is ready to consider evidence-based cases as the Legal Resources Centre has demonstrated with reference to user fees and other interactions between local communities and the state.