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NATURAL RESOURCES FORUM. 1997; 21(3):161-7.This article offers a framework for developing viable drinking water services and institutional development in developing countries. The framework evolved from the authors' research and field experience in transition and developing economies. Viability is related to operative technology, appropriate organizations, and adequate cost recovery within the context of water resources, human and economic resources, sociocultural conditions, and other constraints. The ability of institutions to solve the problems of coordination and production depends upon player motivation, the complexity of the environment, and the ability of the players to control the environment. Third party enforcement of agreements are essential to reduce gains from opportunism, cheating, and shirking. Empirical research finds that per capita water production costs are 4 times higher in centralized systems and lowest in decentralized systems with coordination from a central party. Three-tiered systems of governments, regulators, and service providers are recommended. Management options must be consumer driven. The worst case scenario is consumer's reliance on vending and reselling with no alternative source of supply. Policies should have a strong focus on institutional reforms in the water sector, the development of a consumer driven water sector, facilitation of appropriate private-public partnerships, sound management of existing capital assets, a system for building viability into national strategies for the water sector, and financially self-sufficient and consumer responsible water supply organizations.
In: Population and environment: rethinking the debate, edited by Lourdes Arizpe, M. Priscilla Stone, and David C. Major. Boulder, Colorado, Westview Press, 1994. 15-40.The chapter aim was to present new directions for constructing comprehensive social, political, and economic models of the environment and population links. Variables should include not just population size, but density, rate of increase, age distribution, sex ratios, access to resources, livelihoods, social dimensions of gender, and power structures. Sustainability must account for sustainable livelihoods. Today's challenges are on much larger scale without precedence. Out-migration is not now possible due to ecological mismanagement. The natural inequalities in geographic resource distribution are exacerbated by the economic power of capital in industrialized nations and elite groups in less developed countries. Solutions are not possible when the debate is deadlocked. Population growth is an "accelerating force" and interrelated with socioeconomic transitions. Consumption of natural and human made resources must be tied to population growth. Sustainable development must occur nationally, regionally, and globally. Demographic transition today has been occurring in ways different from the developed country models of socioeconomic change. The momentum of population growth, the age structure, and the consumption and impact of new persons on social and ecological systems must be accounted for. Carrying capacity concepts are difficult to estimate, in part because needs are determined by culture. Population growth has been used to obscure existing disparities and inequalities. Various theoretical postures have emerged: population growth as a cause of environmental depletion, technology as a solution spurred on population growth, consumption disparities as a cause, income inequality as a cause, and measurement deficits in determining the differential effects of population growth. Environmental change has always occurred in tandem with population change. Examples from the Lacandon rainforest illustrated the complexity of interactions.
TROPICAL AND GEOGRAPHICAL MEDICINE. 1990 Jul; 42(3):197-206.An exposition of the ethical arguments for placing sustainability as a priority in implementation of public health programs is made, considering the definition of sustainability, theories of the demographic transition, the ecological transition, the relationship between sustainability of the ecosystem and the human birth rate, types of ethical conflicts over the issue of child survival interventions, a suggested way of resolving the dilemma and a possible paradigm shift constituting a scientific revolution in the field of international health. Sustainability means maintenance of the capacity to support life in quantity and variety. Although most demographers are familiar with Notestein's classic definition of the demographic transition, many are unaware of the likelihood that many countries will become entrapped in stage 2, to the extent that they destroy their ecosystem and thus their population, the "demographic trap." The 3 stages of the ecological transition are 1) expanding human demands with sustainable yield; 2) excess human demands with consumption of biological reserves; 3) ecosystem collapse and death or exit of the human population. An early sign of the 3rd phase is a rise in infant mortality. Sustainability can be increased by adjusting the environment or by lowering human birth rate, with Chinese rigor in need be, or by adding sustainable elements to the system that outweigh de-sustaining ones. Unfortunately there are too many unremovable constraints, and not enough time to wait for socioeconomic gains to lower birth rates. The current attempt by UNICEF to lower the child death rate to effect a demographic transition is attractive but unsound, since it has been proven that numbers of child deaths do not affect family fertility sufficiently. Reducing child deaths will only make population pressure worse. Ethical principles arguing for lowering child deaths have been articulated in Western culture, but now the challenge of sustainability may outweigh them all. It may be possible to apply sustaining measures to countries where possible, but for others, it is argued that child survival measures should not be instituted. These would only make the demographic transition impossible and prolong human misery for larger numbers. For these societies, only the kind of care Mother Teresa gives is appropriate. Finally, residents of developed countries must assume a "deep green" behavior code, a sustainable consumption level. WHO's definition of health should be updated to "Health is a sustainable state of complete...well-being."