World Bank Group

1. The Challenge of Managing Crisesin a Rapidly Changing WorldDr. Stephen F. LintnerSenior Technical Advisor, World BankandPresident Elect, International Association for Impact Assessment (IAIA)XI International HealthImpactAssessmentConferenceGranada, SpainApril 2011

2. World Bank Group • Founded 1944 • Over 185 Countries as Members Represented by a Board of Executive Directors • Headquarters in Washington, DC • An Extensive Network of Offices Throughout the World • Includes: • International Bank for Reconstruction and Development (IBRD) • International Development Association (IDA) • International Finance Corporation (IFC) • Multilateral Investment Guarantee Agency (MIGA)

3. World Bank • Focus on Poverty Reduction, including the Millennium Development Goals • Commitment to Environmentally and Socially Sustainable Development, supporting outcome of Rio and Johannesburg Summits • Addressing Climate Change – both Mitigation and Adaptation – as a Development Issue Uses an Interdisciplinary Approach in Providing Support for Policies, Plans, Programs, Projects and Capacity Building

4. World Bank • Since 1989 the World Bank has had a Board Approved Policy on Environmental Assessment – Including Project Related Health Impacts • Making Extensive Use of Strategic Assessments at Multiple Levels • Process for Updating and Consolidation of Policies in Process – Will Broaden Range of Instruments – Including Specific Reference to Health Impact Assessment as an Option

5. The Challenge of Managing Crises in a Rapidly Changing World • Facing a threefold global crisis: • Economic • Food • Climate. • Need to understand: • Vital importance of inter-linkages among them • Identify missed opportunities in putting these pieces together • Undertaking complementary proactive and preventive measures

6. Health Sector Fiscal Year 2011 Approved and Planned Health Sector Support: US $ 3.1 Billion • Child Health • Communicable and Non-Communicable Diseases Health System Performance • Human Development • Nutrition and Food Security   • HIV/AIDS     Malaria • Tuberculosis Complemented by National and Thematic Studies

7. Protecting Pro-Poor Health Services During Financial Crisis • Poor nutrition and lower level use of health care when needed • Women, children, poor and informal sector workers are most at risk • A special risk exists in many low-income countries in maintaining access to essential health commodities that are often imported

8. Protecting Pro-Poor Health Services During Financial Crisis • Real spending per capacity can decline due to reduced revenues, currency devaluation and potential reductions in aid flows • Low-income Countries with weak fiscal policies are most vulnerable • Minimize adverse impact on health outcomes and health expenditures

9. Protecting Pro-Poor Health Services During Financial Crisis • Broad strategies that maintain overall levels of Government spending on health tend not be successful, failing to protect access to quality health services especially for the poor • Targeted demand-side approaches like conditional cash transfers may be more effective broader approaches • Import to make effective use of social safety net programs which include support for nutrition and health

10. Cost of EnvironmentalDegradation • 2000-2010: Cost of Environmental Degradation (COED) in Algeria, Egypt, Iran, Jordan, Lebanon, Morocco, Syria and Tunisia • Estimates the annual COED in selected countries (% of the countries’ GDP) • Summarizes their impacts at national and regional levels • Training manual in French, Arabic, English

11. Overview: Six Categories • Agricultural Land - Agricultural productivity on croplands and rangelands • Forests - Wood, grazing, watershed protection, biodiversity • Water - Systemic impacts of water salinity, contamination, sedimentation, groundwater overexploitation • Air Quality - Systemic impacts of air pollution on health and environment • Waste - Impacts of inappropriate waste collection on the environment and public welfare • Coastal Zone - Losses of recreational and landscape value due to unsustainable coastal activities

12. COED Can Vary Substantially …

13. Tunisia - Costof water degradation = 0.6% of GDP Health (18%) Groundwater (21%) Agriculture (33%) 1.2% in Morocco, 2.8% in Iran

14. Impact on Investments Algeria • First Economic Recovery Program included institutional reforms and pilot investments in the environment sector for 2001-2004 (US$450 million) Egypt • Second Pollution Abatement project to reduce pollution from energy and industrial sectors (US$198 million) Morocco: • First Water Sector Development Policy Loan (US$100 million) • Solid Waste Sector Development Policy Loan (US$132 million) • Investments in pollution control in the Sebou basin (US$25 million)

15. Three Major Themes • Integration • Innovation • Implementation Importance of Addressing Both Major New Challenges and Continuing Challenges

16. Information on World Bank Group Environmental and Social Safeguard Policies • Safeguards Website www.worldbank.org/safeguards • Use of Country Systems Website www.worldbank.org/countrysystems • Strategic Environmental Assessment (SEA) Tool Kit Website www.worldbank.org/seatoolkit • IFC’s Sustainability Policy Framework www.ifc.org • Environmental Health and Safety www.ifc.org/ifcext/enviro.nsf/context/EnvironmentalGuidelines

17. International Association for Impact Assessment (IAIA) • Annual Meeting – “Impact Assessment and Responsible Development for Infrastructure, Business and Industry” – Puebla, Mexico (May 28 – June 6, 2011) • Special Symposium on SEA Implementation and Practice: Making a Difference? – Prague, Czech Republic (September 21-23, 2011) • Special Symposium on Climate Change and Impact Assessment – Beijing, China (proposed for December 2011) Contact: www.iaia.org

18. Contact Dr. Stephen F. Lintner Senior Technical Advisor World Bank 1818 H Street, NW Washington, DC 20433 USA E-Mail: slintner@worldbank.org