PUBLIC HEALTH AND ECOSYSTEM INTEGRITY IN THE 21 ST CENTURY: THE WAY FORWARD IN NIGERIA

1. PUBLIC HEALTH AND ECOSYSTEM INTEGRITY IN THE 21ST CENTURY: THE WAY FORWARD IN NIGERIA By Dr. (Mrs.) Ngeri S. Benebo, JP, MD, MPH, FMCPH NPMA, MFR Director General/Chief Executive Officer, National Environmental Standards and Regulations Enforcement Agency (NESREA) Paper presented as Keynote Speaker for the Isaac Oluwole Memorial Lecture, at the Scientific Conference and Annual General Meeting of the Association of Public Health Physicians of Nigeria (APHPN) Port Harcourt, Rivers State, 9-14 March 2014 … ensuring a cleaner and healthier environment for Nigerians

2. OUTLINE • Introduction • Environmental Health • Celebrating An Icon • The 2014 Dr. Isaac Oluwole Memorial Lecture • The 1992 Earth Summit • Public Health • Ecosystem Integrity • Millennium Summit • Millennium Ecosystem Assessment • Impacts Of Human Activities On Ecosystem Integrity • Government Efforts • Way Forward • Conclusion

3. INTRODUCTION • I would like to congratulate the Association of Public Health Physicians of Nigeria (APHPN) on its 30th National Scientific Conference and Annual General Meeting and to commend the Association for her choice of theme for this year’s Conference – “Environmental Health Strategies for National Development”. • The choice of the theme is most apt at this critical time in our national development, as it provides a veritable discourse in putting public health issues on the front burner of our national development agenda. • I would also like to commend the Local Organizing Committee for a job well done.

4. ENVIRONMENTAL HEALTH Environment and Health are inseparable. They are intricately linked and are both very key to a nation’s socio-economic development. The natural environment consists of the air we breathe, the water we drink, the land/space we occupy, and biodiversity, including wildlife. Environmental Health is the control of all factors in man’s environment which exercise or may exercise a deleterious effect on his development, health or survival.

5. CELEBRATING AN ICON Today’s memorial lecture is in honour of the father of Public Health in Nigeria, Dr. Isaac Ladipo Oluwole (1892–1953): At the time he died in 1953, he was justifiably regarded as the Father of Public Health in Nigeria. Dr. Isaac Oluwole

6. THE 2014 DR. ISAAC OLUWOLE MEMORIAL LECTURE The title of my lecture is ‘Public Health and Ecosystem Integrity in the 21st Century: The Way Forward in Nigeria.’ The choice of my title is informed by my work and experience in the health and environment sectors over the years and my firm conviction that public health and environmental protection are inseparable if we are to achieve sustainable development in Nigeria. The lecture explains the concept and principles of ecosystem integrity. It discusses the linkages and interactions between public health and the ecosystem. It highlights the national and global efforts at the turn of the 21st Century to protect the ecosystem and explains how public health including human wellbeing is impacted by changes in ecosystems, at local, national, regional, and global levels. Finally, the lecture proffers some concrete recommendations for a way forward towards protecting the ecosystem and public health in Nigeria.

7. THE 1992 EARTH SUMMIT Brundtland Commission defined SD as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs”. The Global Agenda for Change adopted at the 1992 Earth Summit heralded a new approach to environment and development which is known as Sustainable Development (SD) The United Nations Conference on Sustainable Development (Rio+20 Summit) in 2012, adopted an Outcome Document, ‘The Future We Want’ which provides a global framework to protect ecosystem integrity.

8. PUBLIC HEALTH

9. ECOSYSTEM INTEGRITY

10. MILLENNIUM SUMMIT …I To address ecosystem stress, 149 world leaders came together in a Millennium Summit and adopted the Millennium Declaration. The world leaders committed their nations to a new global partnership to reduce extreme poverty, and set out a series of time-bound targets, with a deadline of 2015, that have become known as the Millennium Development Goals (MDGs).

11. MILLENNIUM SUMMIT … II HEADS OF STATE AND GOVERNMENT AT THE MILLENNIUM SUMMIT IN NEW YORK IN 2000

12. MILLENNIUM SUMMIT … III MDGs 4, 5 and 6 deal directly with health. MDG 7 is focused on environmental protection and ecosystem integrity. It is tagged the most important goal because the environment is our natural resource base and all life on earth depends on its sustainability. Without fulfilling MDG 7, MDGs 4, 5, and 6 would not be achieved. For example, improvement in sanitation and provision of water in adequate quantity and quality will aid the reduction in the incidences of childhood diseases, maternal death and communicable diseases.

13. MILLENNIUM ECOSYSTEM ASSESSMENT To assess the consequences of ecosystem change for human well-being and the scientific basis for action needed to enhance the conservation and sustainable use of those systems and their contribution to human well-being. The Global Millennium Ecosystem Assessment (MA) was commissioned by the United Nations in 2000. Human actions were depleting Earth’s natural capital and are putting such strain on the environment such that the ability of the planet’s ecosystems to sustain future generations could no longer be taken for granted. OBJECTIVES MILLENNIUM ASSESSMENT (MA) BOTTOM LINE

14. IMPACTS OF HUMAN ACTIVITES ON ECOSYSTEM INTEGRITY Human activities are altering the capacity of ecosystems to provide their goods (e.g. freshwater, food, medicinal products, etc) and services (e.g. purification of air, water, soil, sequestration of pollutants, etc). Some specific examples include:

15. Biodiversity Loss Biodiversity Loss Rich Biodiversity

16. Health Effects of Biodiversity Loss Biodiversity Loss Rich Biodiversity

17. Food and Agriculture PLANT LOSS AND AGRICULTURAL DAMAGE AS A RESULT OF IMPROPER USE OF PESTICIDES

18. Persistent Organic Pollutants (POPs) • Persistent Organic Pollutants (POPs) (e.g. pesticides) are organic compounds that are resistant to environmental degradation capable of long-range transport, and they bioaccumulate in human and animal tissue, biomagnify in food chain, and have potential significant impacts on the environment and public health. • POPs include DDT, polychlorinated biphenyls, furans, chlordane, heptachlor, aldrin, dieldrin and endrin. • Exposure to POPs can take place through diet, environmental exposure, or accidents. • Health effects include skin irritation and cancer.

19. Some Health Effects of Persistent Organic Pollutants SKIN INFECTIONS FROM UNPROTECTED LONG TERM CONTACT WITH POLYCHLORINATED BIPHENYLS (PCBs) SKIN INFECTION FROM UNPROTECTED LONG TERMCONTACT WITH ENDOSULFAN

20. Electronic and Hazardous Waste … I When e-wastes are dismantled inappropriately, these chemical substances are released, thereby impacting on the environment and the health of the operator or handler. Open burning of e-waste to recover precious metals especially copper, or open burning of circuit boards to melt the lead solder, results in exposure to toxic fumes. Electronic/electrical equipment (EEE) contains useful substances such as lead, mercury, cadmium, etc, which when packaged in the equipment pose no danger. At the end of its functional life, the electronic/electrical equipment, becomes electronic waste (e-waste).

21. Electronic and Hazardous Waste … II EXPOSURE TO THE HAZARDOUS SUBSTANCES IN E-WASTE HANDLING OF BALKANIZED E-WASTE

22. Health Effects of Hazardous Substances in E-waste CANCERS ENDOCRINE DISRUPTION AND BIRTH DEFECTS

23. Energy Fossil fuels are the single largest source of atmospheric pollution. When burnt, they release into the air particulate matter, carbon monoxide, carbon dioxide, oxides of nitrogen and sulfur, and metal compounds associated with respiratory diseases and increased mortality. Biomass fuels (wood or crop waste) are burnt in open fires or inefficient stoves in poorly ventilated houses, and could give off smoke and chemicals. WOOD AS A SOURCE OF ENERGY FOR COOKING

24. Energy - Hydropower Flowing water creates energy that can be captured and turned into electricity. Impacts of hydropower on the environment and public health include: • Stress and other impacts on populations displaced by the filling of reservoirs; • Catastrophic floods in case of dam failure; and • Prevalence of water borne diseases resulting from the creation of conducive environmental conditions for the disease vectors.

25. Energy - Nuclear Power This is the use of exothermic (heat generating) nuclear processes to generate useful heat and electricity. The principal environmental concerns in connection with nuclear power systems are: • The potential for reactor accidents releasing large amounts of radioactive materials, as occurred at Chernobyl in 1986; • The potential diversion of material from the nuclear fuel cycle for production of weapons of mass destruction; and • The radioactive releases from long-term disposal of nuclear waste.

26. Vehicular Emission • Emissions from vehicle exhausts pollute the air with carbon monoxide and lead. Vehicular emissions also contribute to the formation of ozone and photochemical smog, which may decrease lung performance. VEHICULAR EMISSIONS

27. Flood … I Flood results from unusually heavy downpour of rains. It could be exacerbated by man as a result of not adhering to town planning laws; building on flood plains; absence of drainage system; blockage of existing water channels; storm drains and drainage system. The most devastating flood disaster was experienced in August 2012 as a result of heavy downpour, release of water from Lagdo Dam, Cameroon, inadequate drainage system, blocking of water channels and building on flood plains. Floods damage property and endanger the lives of humans and animals.

28. Flood … II DRAINAGE BLOCKED WITH WASTE DAMAGING EFFECTS OF FLOODING

29. Coastal and Marine Degradation Pollution sources from municipal, industrial and agricultural wastes and run-off, as well as atmospheric deposition, derived from land-based activities affect the marine environment. The very survival of people living in coastal areas are closely tied to the condition of coastal ecosystems (estuaries and wetlands), and their associated water-sheds, drainage basins and near-shore coastal waters. Coastal and marine degradation pose threats to marine life and human health.

30. Industry Industrialization is central to economic development and improved prospects for human well-being. Industry is a major consumer of natural resources - mineral and non-mineral ores, agricultural produce and energy in different forms. They are major sources of air and water pollution, hazardous wastes, etc, if proper abatement technology is not incorporated into their Environmental Management Plans..The environmental impact of industrial activities extend over the entire chain – from raw material extraction or pre-processing, through the manufacturing process, right up to the disposal of wastes. Lack of use of personal protective equipment by industry workers increases their exposure to toxic substances at the work place and leads to disease conditions. Highly toxic heavy metals, etc are discharged into the environment with serious environmental and health consequences. TOXIC INDUSTRIAL EMISSIONS These toxic pollutants are often associated with various cancers. Little wonder, cancers have been observed occurring at relatively younger age groups.

31. Mining … I

32. Mining … II Deep exploration for lead and zinc in Nasarawa State Typical Illegal mining sites in several States of the Federation Locally fabricated grinding machine for crushing of gold in Zamfara State. Excavation of lead-contaminated soil to be replaced with clean laterite in Zamfara State. A typical house plastered (wall and floor) with lead contaminated soil in Zamfara

33. Water … I

34. Water … II INDUSTRIAL EFFLUENT DISCHARGE INTO WATER COURSES POLLUTED POND, NATURAL HABITAT FOR VECTORS

35. Solid Wastes and Sewage IMPROPER WASTE DISPOSAL

36. Human Settlements and Urbanization SQUATTER SETTLEMENT

37. Climate Change

38. Human Health and Ecosystem Integrity HUMAN HEALTH AND ECOSYSTEM INTEGRITY – THE KEY LINKAGES

39. Health Effects of Pollution

40. The Driving Forces and Pressure of Environmental Degradation and Pollution Although exposure to a pollutant or other environmental hazards may be the immediate cause of ill-health, the driving forces and pressures leading to environmental degradation and pollution may be the most effective ways for controlling the hazard. The driving forces create conditions in which environmental health hazards can develop or be averted and they include policies that determine trends in economic development, technological development, consumption and production patterns, e.t.c. Preventive interventions can be implemented to reduce or control the environmental hazards at the source, for example, by limiting emissions or installing flood-control systems, by eliminating the breeding sites of mosquitoes through effective environmental management. Therefore the most effective long-term interventions should aim at eliminating or reducing the effects of driving forces and the ecological stresses that produce the hazards.

41. GOVERNMENT EFFORTS … I Government has made tremendous efforts to address the daunting challenges facing ecosystem integrity and public health, in line with its Transformation Agenda. Some of the notable actions of government are: • Establishment of relevant institutional and legal mechanisms in an effort to strengthen environmental governance in line with the nation’s Vision 20:2020; • Strengthening of established institutions to discharge their mandates; • Establishment of an Office within the Presidency for the effective implementation of MDG projects; • Implementation of National Strategic Health Development Plan (NSHDP) towards achieving the human capital development goal of the Vision 20:2020; • Implementation of the National Policy on Environment that seeks to secure for all Nigerians a quality environment adequate for their health and well-being; • Adoption of the National Environment Pledge titled “Our Environment, Our Heritage, Our Today and Tomorrow” signed by Mr. President and all State Governors; • Implementation of the National Housing and Urban Development Policy to ensure sustainable housing, urban renewal and better living conditions for all Nigerians;

42. GOVERNMENT EFFORTS … II • Emphasis on the rational utilization of agricultural resources and the general preservation of the environment for the sustainability of agricultural production; • Establishment of a Department of Mines Environmental Compliance in the Federal Ministry of Mines and Steel Development to ensure environmentally sound, safe and sustainable mining development and operations in the country; • Designation of relevant Departments and Units in the Transport Sector to collaborate with the Environment Sector towards a cleaner and more sustainable transport development and operations across the nation; • Establishment of the National Oil Spill Detection and Response Agency (NOSDRA) to address the persistent environmental degradation and devastation of the coastal ecosystem resulting from oil and gas activities; and • Establishment of the National Environmental Standards and Regulations Enforcement Agency (NESREA) with the mandate to enforce all environmental laws, guidelines, policies, standards and regulations in Nigeria; and to prohibit processes and the use of equipment or technology that undermine environmental quality.

43. WAY FORWARD … I • Improving Institutional Mechanisms and Arrangements There is need to reinforce the existing relevant institutional mechanisms and arrangements bearing on public health and the environment. There should be more cooperation, collaboration and partnerships between APHPN and all MDAs at Federal and State levels. APHPN should undertake a critical study of the enabling Act or policy instruments establishing key MDAs whose actions or inactions can directly or indirectly impact on ecosystem integrity. It should identify a niche and collaborate closely with them in implementing their programmes and projects. • Implementation of Relevant Environmental and Health Laws, Regulations and Standards Any laws and regulations that are not effectively enforced are as good as not promulgated in the first instance. Many health and environment laws and regulations have been promulgated, and there is need for concerted efforts at enforcing them. • Capacity Building and Human Resources Development Public health is multidisplinary. There is need to thoroughly review the current educational curriculum of our tertiary institutions in this regard. The programmes should be more broad-based, touching on all key environment-health linkages and interactions, including the emerging issues.

44. WAY FORWARD … II • Improvement of Research and Development For us to fully understand the root causes of certain illnesses, including those we know and those we are yet to know, there is need for scientific studies and research. APHPN should conduct well thought-out epidemiological studies and research to define and understand the disease driving forces and pressures in the community, growth trend and linkages to other diseases. Such research efforts will assist Government in creating new policies and channeling the required resources, as well as attracting meaningful technical assistance from the international community. All research findings should not be allowed to gather dust in one obscure corner of an office. The research findings should be widely publicized, disseminated and discussed at various relevant fora like this Annual General Meeting and Scientific Conference. • Intensification of Public Education and Awareness Since human beings are the key drivers of the forces that impact on ecosystem integrity and hence public health, they must be adequately informed on the consequences of their actions and inactions. Such information should be properly packaged to address specific issues for specific target audience. There should be innovative approaches to communicate the key messages through radio and TV talk-shows, jingles and advertorials, civil society and local community engagements and consultations, including through our religious institutions.

45. WAY FORWARD … III • Promotion of Public Private Partnerships Addressing public health problems is not the responsibility of the Government alone. Private sector has a key role to play since industry and business are among the greatest polluters of the environment; and yet they still make their money from the same people and their environment. There is need for industry and business to imbibe the spirit of – “My Neighbours’ Keeper” and carry out appropriate Corporate Social Responsibility (CSR) initiatives. They should identify and implement programmes and projects to protect and improve the health and environment of their host communities. They should sponsor research studies bearing on the operations of their facilities that impact on the environment and human health. APHPN should drive this process by making appropriate proposals to the private sector for research funding. • Contribution to National Discourse The APHPN should be proactive and make presentations at every opportunity to propagate the course of Public Health at the Federal and State levels of the Executive, Legislature and Judiciary arms of government. There should be a “think tank” which, even at short notice, can submit memoranda and defend same at any public hearing.

46. CONCLUSION … I • As we advance within the second decade of the 21st century and fully aware of the implications on public health of a fragile ecosystem whose integrity has been severely affected by anthropogenic activities, it is necessary for us to have a rethink of how we protect the ecosystem integrity, and hence public health. • Therefore, the effective collaboration and partnership between the health and the environment sectors should continue to be intensified in recognition of the intricate linkage between public health and the environment. • There is no gain saying that Nigeria, like most developing countries is still grappling with basic access to water and sanitation to prevent primary environmental health problems. This calls for an urgent need not to allow secondary environmental health problems of pollution, land degradation and climate change, among others to bedevil us too. • For the public health sector, the indices are clear and there is need to strengthen the implementation of the sound strategies already identified within the National Strategic Heath Development Plan (NSHDP) 2010-2015, through the participatory approach involving all relevant stakeholders. • For the environment sector, implementation of the National Policy on Environment and adherence to the tenets of the National Environment Pledge by all tiers of Government will promote ecosystem integrity.

47. CONCLUSION … II • The Association of Public Health Physicians of Nigeria as a major stakeholder in ensuring optimum public health should be interested in the driving forces and pressures leading to environmental degradation. It is not enough to provide management for the neglected tropical diseases through training of health workers, provision of drugs, etc, we should source for research grants and tackle the underlying driving forces and pressures in the environment promoting the disease conditions. • I, therefore, urge you as a statutory Professional Association of this great nation, to intensify actions on your part as able partners with Government towards the achievement of healthy people in a healthy environment. • The present day public health is not only multidisciplinary, it is multisectoral and it is a total package that should consider all determinants of the health of the populace. • Let us take cue from the international community. Let us work and share information to appreciate best practices, with their attendant success stories and buy into such. • I have no doubt that as we commit ourselves to the implementation of sound strategies for Public Health and Ecosystem Integrity, as true patriots of our fatherland, we would have played a worthy part in the “Health for All” for the 21st Century and in bequeathing to the next generation a worthy legacy and equitable share of this ‘One Earth’ for a sustainable future.

48. THANK YOU NESREA… ensuring a cleaner and healthier environment for Nigerians