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Extreme weather events are known to have serious consequences for human health and are predicted to increase in frequency as a result of climate change. Africa is one of the regions that risks being most seriously affected. This paper quantifies the impact of extreme rainfall and temperature events on the incidence of diarrhea, malnutrition and mortality in young children in Sub-Saharan Africa. The panel data set is constructed from Demographic and Health Surveys for 108 regions from 19 Sub-Saharan African countries between 1992 and 2001 and climate data from the Africa Rainfall and Temperature Evaluation System from 1980 to 2001. The results show that both excess rainfall and extreme temperatures significantly raise the incidence of diarrhea and weight-for-height malnutrition among children under the age of three, but have little impact on the long-term health indicators, including height-for-age malnutrition and the under-five mortality rate. The authors use the results to simulate the additional health cost as a proportion of gross domestic product caused by increased climate variability. The projected health cost of increased diarrhea attributable to climate change in 2020 is in the range of 0.2 to 0.5 percent of gross domestic product in Africa.

Aging --- Antenatal care --- Epidemiology --- Food poisoning --- Health care --- Health effects --- Health indicators --- Health interventions --- Health Monitoring and Evaluation --- Health outcomes --- Health policy --- Health services --- Health, Nutrition and Population --- Isolation --- Morbidity --- Mortality --- Nutrition --- Nutritional status --- Public health --- Vaccination --- Victims

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Empirical studies on health at a disaggregate level-by socioeconomic group or geographic location-can provide useful information for designing poverty-focused interventions. Using Demographic and Health Survey (DHS) data, Wang investigates the determinants of health outcomes in low-income countries both at the national level, and for rural and urban areas separately. DHS data from more than 60 low-income countries between 1990 and 1999 reveal two interesting observations. First is the negative association between the level and inequality in child mortality. Second is the significant gap in child mortality between urban and rural areas, with the rural population having a much slower reduction in mortality compared with the urban population. Given that the poor are mainly concentrated in rural areas, the evidence suggests that health interventions implemented in the past decade may not have been as effective as intended in reaching the poor. The empirical findings in this study consolidate results from earlier studies and add new evidence. Wang finds that at the national level access to electricity, vaccination in the first year of life, and public health expenditure can significantly reduce child mortality. The electricity effect is shown to be independent of income. In urban areas only access to electricity has a significant health impact, while in rural areas increasing vaccination coverage is important for mortality reduction. This paper-a product of the Environment Department-is part of a larger effort in the department to better understand health-environment linkages. Please contact Limin Wang, room MC5-208, telephone 202-473-7596, fax 202-522-1735, email address lwang1@worldbank.org.

Child Nutrition --- Children --- Health --- Health Indicators --- Health Interventions --- Health Monitoring and Evaluation --- Health Outcomes --- Health, Nutrition and Population --- Immunization --- International Organizations --- Knowledge --- Life Expectancy --- Measurement --- Morbidity --- Mortality --- Nutrition --- Observation --- Population Policies --- Public Health --- Registration --- Risks --- Vaccination --- Weight

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This paper reviews the effectiveness and efficiency of key policy instruments for the achievement of the Millennium Development Goals (MDG). Based on a simple cross-country regression analysis, the paper argues that average Millennium Development Goal progress is likely to be too slow to meet education and health sector targets in a number of developing countries. The paper further shows that MDG achievement can be described by a transition path with declining rates of progress. More detailed analysis reveals that the transition toward universal primary school enrollment in poor countries with low initial enrollment has accelerated considerably in the more recent past. The main part of the paper then focuses on the role of demand versus supply-side factors in social service utilization in education and health. The review arrives at the following rules of thumb that reflect some of the key determinants of achievement of the Millennium Development Goals: First, specific single policy interventions can have a considerable impact on social service utilization and specific human development outcomes. For example, improving access to basic health services, in particular to vaccination, has been a key factor in reducing child mortality rates in a number of very poor countries. Second, demand-side policies have proved extremely effective, for example in raising school enrollment and attainment levels. However, there may be more scope for targeting the demand-side in the health sector. Third, policy effectiveness and efficiency are highly dependent on initial conditions and the specificities of the respective policy. Fourth, complementarities between MDG targets, in particular social service utilization, are likely to be very important.

Aged --- Breastfeeding --- Clinics --- Education --- Education For All --- Exercises --- Families --- Health --- Health care --- Health interventions --- Health Monitoring & Evaluation --- Health outcomes --- Health policy --- Health services --- Health Systems Development & Reform --- Immunization --- Infant health --- Intervention --- Mortality --- Nutrition --- Nutrition and Population --- Pregnancy --- Primary Education --- Primary schools --- Public health --- Social services --- Teaching and Learning --- Vaccination

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This paper reviews the effectiveness and efficiency of key policy instruments for the achievement of the Millennium Development Goals (MDG). Based on a simple cross-country regression analysis, the paper argues that average Millennium Development Goal progress is likely to be too slow to meet education and health sector targets in a number of developing countries. The paper further shows that MDG achievement can be described by a transition path with declining rates of progress. More detailed analysis reveals that the transition toward universal primary school enrollment in poor countries with low initial enrollment has accelerated considerably in the more recent past. The main part of the paper then focuses on the role of demand versus supply-side factors in social service utilization in education and health. The review arrives at the following rules of thumb that reflect some of the key determinants of achievement of the Millennium Development Goals: First, specific single policy interventions can have a considerable impact on social service utilization and specific human development outcomes. For example, improving access to basic health services, in particular to vaccination, has been a key factor in reducing child mortality rates in a number of very poor countries. Second, demand-side policies have proved extremely effective, for example in raising school enrollment and attainment levels. However, there may be more scope for targeting the demand-side in the health sector. Third, policy effectiveness and efficiency are highly dependent on initial conditions and the specificities of the respective policy. Fourth, complementarities between MDG targets, in particular social service utilization, are likely to be very important.

Aged --- Breastfeeding --- Clinics --- Education --- Education For All --- Exercises --- Families --- Health --- Health care --- Health interventions --- Health Monitoring & Evaluation --- Health outcomes --- Health policy --- Health services --- Health Systems Development & Reform --- Immunization --- Infant health --- Intervention --- Mortality --- Nutrition --- Nutrition and Population --- Pregnancy --- Primary Education --- Primary schools --- Public health --- Social services --- Teaching and Learning --- Vaccination

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The central government's policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry's capacity for stewardship of the nation's public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship, and re-vitalizing the states' public health managerial cadres as well as the grassroots public health workers. The central government could consider linking its fiscal support to states with phased progress in four areas: (1) the enactment of state Public Health Acts; (2) the establishment by states of separate public health directorates; (3) the re-vitalization of grassroots public health workers; and (4) health department engagement in ensuring municipal public health. The central focal point could provide the needed support, oversight, incentives, and sanctions to ensure that states build robust public health systems. These measures can do much to help governments use public funds more effectively for protecting people's health.

Child health services --- Communicable Diseases --- Environmental health --- Food storage --- Health interventions --- Health Monitoring and Evaluation --- Health outcomes --- Health planning --- Health Policy --- Health regulations --- Health services --- Health, Nutrition and Population --- Injuries --- Life expectancy --- Migrants --- Morbidity --- Mortality --- Public Health --- Screening --- Vaccination --- Waste --- Workers