Climate Change, Health, and Costs 13 At a national level, the Government of Nepal recognizes the health impacts of climate change as a key threat to the people of Nepal and as such, is the topic of one of the six multi-stakeholder Thematic Working Groups (TWGs) supporting Nepal’s National Adaptation Programme of Action (NAPA). However, none of the other TWGs (such as “agriculture and food security” and “water and energy”) are explicitly required to account for the potential health impacts of their sector interventions on health, and none are explicitly required to include the possible health benefits of adaptation investments in their respective sector (Box 2). Box 1 Health Impacts in Asian Development Bank Project Cost–Benefit Analysis Excerpts from: Suzhou Creek Rehabilitation Project (People’s Republic of China) Report and Recommendation to the President (PRC 32121); May 1999 “Suzhou Creek is a water source for irrigation and industrial processing, and receives large discharges of untreated agricultural, industrial, and municipal wastewater and solid waste. As a result, Suzhou Creek has become severely polluted with high concentrations of biochemical oxygen demand and chemical oxygen demand. The direct beneficiaries will be the 3 million people living in the project area who will have improved living conditions and public health standards (…). Important benefits not valued in the economic analysis include (…) health benefits.” Excerpts from: Karnataka Urban Development and Coastal Environmental Management Project (India) Report and Recommendation to the President (IND 29120); November 1999 “The project will support the Government’s priority investment in the urban sector, based on an urban sector development strategy that focuses on improving the welfare of the urban poor and the devolution of municipal management responsibility from states to cities. The Project will significantly improve the health and welfare of the urban poor who currently suffer from inadequate and unsafe water supplies and sanitation conditions. Health benefits, due to cleaner living environments (…) were not valued.” Excerpts from: Water Supply and Sanitation Investment Program (Azerbaijan) Report and Recommendation to the President (AZE 42408); September 2009 “Following the dissolution of the Soviet Union, the quality and efficiency of water service delivery declined in Azerbaijan, due to poor management and inadequate investments. The existing [water supply and sanitation] WSS system is over 50 years old. Water supply sources are in a poor state of repair, and other modes of supply (e.g., through private vendors) are expensive and/or unreliable. Water treatment facilities in secondary and small towns are either absent or largely dysfunctional. Poor sanitation and leaking sewers create serious health risks and environmental hazards. The Investment Program will improve public health and environment in areas having about 500,000 residents total. Some key benefits that do not lend to quantitative analysis due to lack of information include (…) health impacts.” Excerpts from: Metropolitan Sanitation Management and Health Project (Indonesia) Report and Recommendation to the President (INO 39071); June 2010 “Many urban and peri-urban areas in Indonesia have priority disease profiles linked to water supply and sanitation: diarrhea, skin disease, intestinal worms, malaria, and dengue. Poor people in urban slum areas, particularly children, women, and elderly people, are more affected than others. The impact [of the project] will be reduced environmental pollution of surface water and shallow groundwater in Medan and Yogyakarta. Reduced environmental pollution will benefit public health and improve the quality of life in these cities. The economic benefits of the project are significant, especially in the densely populated parts of the participating cities, where population pressure is high and surface and groundwater pollution pose major public health hazards. The expected benefits consist largely of reduced mortality and morbidity, followed by the avoided cost of septic tank desludging.” Authors: These economic benefits are not quantified nor monetized in the above report.