THE REGIONAL SITUATION

CHAPTER two

THE REGIONAL SITUATION 2.1 THE URBANIZATION PROCESS IN LATIN AMERICA AND THE CARIBBEAN The still accelerated population growth and its concentration in urban areas, industrial development and the changes in the levels of consumption have given place to an increase in the amount and variety of solid waste generated by the LAC Region s population, with the accompanying demand of services for its adequate management. The LAC Region population has had a considerable increase in the last decades going from 209 million in 1960 to 518 million in the year 2001, as is shown in Figure 1 and Table 2. Figure 1. Latin America and Caribbean Region: Urban and rural population evolution 1960-2001 9 Source: Urban and Rural Population: United Nations. World Urbanization Prospects: The 2001 Revision. The 2001 population was obtained from the Solid Waste Evaluation. The urban and rural population definitions were provided by each country and may vary with regards to those used by United Nations.

REPORT ON THE REGIONAL EVALUATION OF MUNICIPAL SOLID WASTE MANAGEMENT SERVICES IN LATIN AMERICA AND THE CARIBBEAN A gradual but very fast population concentration has been produced in urban centers in the LAC Region. In 1975, 61% of the population was urban. In 2001, this percentage increased to 78.3%, which means that approximately 406 million people live in cities. The Region is one of the most urbanized in the planet and its population increases in 8.4 million per year. As can be seen in Table 3, the major concentration in the Region can be seen for the year 2002 in Mexico City (18.2 million inhabitants), Sao Paulo (18.1 million), Buenos Aires (close to 13 million) and Rio de Janeiro (10 million). Likewise, the metropolitan areas of Buenos Aires and Santiago concentrate around 35% of the population of Argentina and Chile respectively. Lima concentrates 30% of Peru s total population and more than 40% of its urban population. On the other hand, countries such as Guatemala, Costa Rica, Haiti and Honduras present an initial and even slow urban transition compared to the rest of the Region with less than 60% of urban population. It is estimated that by the year 2005, Guatemala will be the only country in the Region that would not have exceeded the 50% urban population threshold and its rural nature will continue to stand out from the other countries in the next quinquenniums. In the Caribbean, at a country level, the percentage of urban population varies between a minimum of 24% in Saint Vincent and the Grenadines and a maximum of 100% in Barbados and the Cayman Islands, with a 64.3% average in the Caribbean countries. However, the urban and rural distinction in the Caribbean is very subtle and usually the country is considered as a whole. 10

CHAPTER 2 - THE REGIONAL SITUATION Table 2. Latin America and the Caribbean Population December 2001 (In thousands of inhabitants) Country Urban Population % Urban Rural Population % Rural Total Population Anguila a 12 100 0 0 12 Antigua and Barbuda a 24 32.0 51 68.0 75 Netherlands Antilles b 153 70.7 64 29.3 217 Argentina a 32,316 89.2 3,908 10.8 36,224 Aruba b 104 100 0,0 0.0 104 Bahamas 271 88.0 37 12,0 308 Barbados 269 100.0 0,00 0.0 269 Belize 117 47.7 128 52.3 245 Bermuda b 63 100.0 0,0 0.0 63 Bolivia a 5,166 62.4 3,108 37.6 8,274 Brazil 140,959 81.8 31,426 18.2 172,386 Chile 13,216 85.8 2,186 14.2 15,402 Colombia 30,676 71.5 12,218 28.5 42,894 Costa Rica 2,372 59.0 1,648 41.0 4,020 Cuba 8,462 75.3 2,781 24.7 11,243 Dominica 15 21.1 56 78.9 71 Dominican Republic 4,992 58.4 3,550 41.6 8,541 Ecuador a 7,431 61.1 4,725 38.9 12,156 El Salvador 3,387 54.0 2,889 46.0 6,276 Grenada a 37 35.7 67 64.3 104 Guadalupe b 430 99.7 1 0.3 431 Guatemala 4,495 40.0 6,742 60.0 11,237 French Guyana b 133 78.4 37 21.6 170 Guyana 293 37.9 479 62.1 772 Haiti 2,947 36.2 5,184 63.8 8,131 Honduras a 2,979 45.6 3,557 54.4 6,536 Cayman Islands 42 100.0 0 0.0 42 Turks and Caicos Islands b 8 45.6 9 54.4 17 British Virgin Islands a 21 100.0 0 0.0 21 US Virgin Islands b 57 46.8 65 53.2 122 Jamaica 1,354 52.1 1,245 47.9 2,599 Martinique b 367 95.1 19 4.9 386 Mexico 90,438 91.6 8.27 8.4 98,708 Montserrat b 2 18.9 6 81.1 8 Nicaragua 2,993 57.5 2,212 42.5 5,205 Panama 1.83 63.1 1,071 36.9 2,901 Paraguay 3,147 54.0 2,683 46.0 5,830 Peru 18,263 69.3 8,084 30.7 26,347 Saint Kitts and Nevis a 46 100.0 0 0.0 46 Saint Vincent and the Grenadines a 29 24.8 88 75.2 117 Saint Lucia a 80 50.3 79 49.7 159 Surinam 303 68.9 137 31.1 440 Trinidad & Tobago 1,267 100.0 0 0.0 1,267 Uruguay 3,158 94.5 183 5.5 3,341 Venezuela 21,055 87.1 3,114 12.9 24,169 Total 405,703 78.3 111,933 21.7 517,886 11 Note: The definition of the term urban and rural corresponds to the one used in each country. The values indicated by the countries are submitted as official data from the 2001 Census or projections from the round of the 2000 and estimates in force in those countries. Some population values of the Solid Waste Evaluation can be different from PAHO s Basic Indicators for 2001. a 2001 Census carried out in these countries, which information was included in the Solid Waste Evaluation. Source: Solid Waste Evaluation and b PAHO, Health Analysis Special Program, Health Situation in the Americas: 2001 Basic Indicators, Washington, D.C., 2001.

REPORT ON THE REGIONAL EVALUATION OF MUNICIPAL SOLID WASTE MANAGEMENT SERVICES IN LATIN AMERICA AND THE CARIBBEAN City Table 3. The 12 most populated cities in Latin America (*) 1996 Population (thousands) 2002 Population (thousands) 2008 Population (thousands) Mexico City 16,876 18,259 19,371 Sao Paulo 16,777 18,182 18,590 Buenos Aires 12,003 12,819 13,519 Rio de Janeiro 10,261 10,756 11,304 Lima 6,827 7,740 8,580 Bogota 5,762 6,543 7,276 Santiago de Chile 5,131 5,709 6,183 Belo Horizonte 3,854 4,308 4,689 Guadalajara 3,526 3,991 4,209 Porto Alegre 3,418-4,182 Santo Domingo - 3,759 4,219 Guatemala - - 4,273 (*) The populations correspond to the respective regions or metropolitan areas. Source: Health in the Americas, PAHO, Scientific and Technical Publication No. 587, 2002 (taken from United Nations. World Population Prospects: The 2000 Revision. 12 The highest development percentage can be seen in South America (83%), followed by Central America (62%) and the Caribbean (56%). This table is the result of national development policies that benefit large cities, where financial centers, media, the best medical care and employment opportunities are located. Likewise, migration has also had its effects on urban population distribution. Other migration flows have joined the intensive migration processes of destitute populations from rural zones to the main urban centers in search of better economic conditions, as is the case of one urban area to the other, migration within the cities themselves and international and interregional migration. Even though the development process tends to concentrate people in large urban centers, about 47% of LAC urban population still lives in small and medium size cities of less than 500,000 inhabitants, concentrating in the prior ones 35% of the Region s total population. In the last two decades, the medium size cities have had high growth rates and a number of these cities have started having the same problems as large cities, due to its larger economic activity and demographic pressures. It is estimated that by the year 2015, 80% of Latin America will be urban with the following distribution: 16% of the total population will live in nine large metropolitan zones over five million inhabitants (with a stabilized ratio.) 28% will live in 122 large cities between 500,000 and five million (with increase in ratios.) 36% will live in small and medium size cities up to 500,000 inhabitants (with ratio increase), including tens of thousands of small towns with less than 20,000 inhabitants. 20% will live in rural zones (with the ratio in a sustained descending from.) The greatest growth will be experienced by medium and small cities, which are the ones that have greater problems with regards to solid waste management due to the limited availability of economic, technical and administrative resources that they have. The Caribbean countries face an unusual growth and development situation due to their limited surface area and their strong dependency on tourism for economic survival. The lack of land resources in the Caribbean islands creates a serious competition between housing, traffic infrastructure, traditional agriculture and tourism. In recent years, some Caribbean islands have experienced an explosive economic growth due to the

CHAPTER 2 - THE REGIONAL SITUATION tourism industry putting great pressure in providing basic services and on the environment. Countries such as Barbados, with a stable population of 269,000 receives 800,000 tourists annually with lay days and some 500,000 from cruises, which puts a great demand on renewable and non renewable natural resources. Barbados is one of 10 countries in the world with more water scarcity, and places it within the six small countries in a risk situation (ECLAC, September 2002). Other smaller countries such as the British Virgin Islands, that with a total permanent population of 20,647, has a temporary population that exceeds 38% of its stable population, with the consequent increase in solid waste generation and serious difficulties for their disposal. These small island states are distinguished for their fragile and vulnerable ecology, therefore, they are easily affected by the dumping of solid waste and wastewater in the environment, situation that is taking these countries to look for solid waste management ecologically feasible alternatives, in order to maintain their natural heritage which is the foundation of their economies. In 1995, the urban population in LAC was estimated in 357 million people of a total of 474 million and the amount of urban solid waste generated totaled 275,000 tons per day. In 2001, the urban population in the LAC Region reached 406 million people of a total of 518 million persons and the Solid Waste Evaluation estimates municipal solid waste generation in 369,000 tons per day. It is projected that by the year 2015 the Region s population will reach 627 million, of which about 501 million will be urban (approximately 80%), and assuming that the amount of waste generated daily per person does not increase, more than 446,000 tons of municipal solid waste would be generated daily. With regards to hazardous waste, the situation is still more critical in some LAC countries. It is estimated that only in Mexico the total generation of industrial hazardous waste amounts to an approximate volume of eight million tons annually, which does not include mining waste 5. Even countries with a smaller area and population are in a critical situation, such is the case of Trinidad and Tobago and Jamaica, whose economies are strongly linked to industrial processes in the energy sector related to the oil industry and natural gas, that carry a large amount of hazardous and non biodegradable wastes. With regards to hospital hazardous waste, a study carried out by PAHO in 21 LAC countries in 1993 estimated that a total of 220,547 tons daily of this type of wastes 6 was generated. Frequently, hazardous wastes are disposed of jointly with municipal solid wastes without any prior treatment, its indiscriminate disposal being even more severe to the environment. Economic and urban development in the Region leads to a greater demand of urban sanitation services, which pose an enormous challenge for countries to provide the conditions conducive to the adequate management of waste, therefore minimizing related environmental and sanitation problems. While development itself does not have to have negative socioeconomic or environmental effects, it is the disorderly urban growth, with no adequate planning, especially in poor areas inside and outside of the cities, what creates greater problems related to solid waste and makes it difficult to provide adequate basic services. 2.2 SOCIOECONOMIC TRENDS IN THE REGION According to estimates from the Economic Commission for Latin America and the Caribbean (ECLAC, March 2003), during the decade of the nineties, Latin America underwent a new economic growth compared to the previous decade. The Gross National Product (GNP) grew from 3.2% per year between 1990 and 2000, compared to 1% during the eighties. The Caribbean underwent a similar phenomenon, although its average growth rate has continued being lower, in the order of 2% in the nineties, compared to 0.1% during the eighties. However, this growth has not been sufficient to overcome the gap that exists between the countries in the Region and the more developed countries or to overcome poverty in LAC. 13 5 Mexico. National Ecology Institute (INE for its Spanish acronym). Secretariat of the Environment and Natural Resources. Program for the minimization and integrated management of industrial hazardous waste in Mexico 1996-2000, Mexico, D.F. INE, 1996. Mexico, D.F. Metropolitan Environmental Commission. Minimization, treatment and disposal manual: hazardous and industrial waste management for the chemical field. September 1998. 6 PAHO. Hazardous and biological wastes in Latin America and the Caribbean. PAHO environmental series 14. Washington, D.C. 1994.

REPORT ON THE REGIONAL EVALUATION OF MUNICIPAL SOLID WASTE MANAGEMENT SERVICES IN LATIN AMERICA AND THE CARIBBEAN 14 At the same time, a considerable progress has been accomplished in the opening of the economies in the LAC Region. In spite of the fact that the Region only represents 5% of the global exports, the current volume of exports has grown at the fastest rate in the history of the Region, at a rate of 8.9% per year between 1990 and 1999. Likewise, the liberalization of the economy and globalization, marked by the deregulation of activities from the intensive resource sectors, the privatization of activities of the sectors that had traditionally been reserved for the State and the use of free trade agreements, specifically the Southern Common Market (MERCOSUR for its Spanish acronym), the Andean Community, the Central American Common Market and the Caribbean Community (CARICOM for its Spanish acronym) have contributed to the integration of the economy in the Region. This economic opening has brought as a consequence an increase in the use of goods, with the resulting generation of solid waste. With a few exceptions, the majority of the countries in the Region are differentiated by the low quality of solid waste final disposal that translates into an environmental liability expressed in the growing deterioration of land and urban environments, aquifer and air contamination, as well as negative effects on the health of the population. This situation has a high economic cost not only at a national level, but also at an international level, because of the contamination that some technological processes could represent from sectors such as mining, forestry or fishery, that are not guided towards cleaner production processes or their wastes are not disposed of adequately. The economies of the countries can be at a disadvantage by not complying with international trade requirements, environmental in nature. Likewise, countries whose economies are based on tourism can be seriously affected by inadequate waste management practices. The Region has maintained their export patterns based on the intensive use of labor force and the exploitation of natural resources that influence the vulnerability of the national economies by being highly dependent on a few products or markets. In general, three patterns of export specialization take place in LAC: (i) manufacturing commerce (maquila, assemblies of parts, pieces and components) predominantly in Mexico, some countries in Central America and the Caribbean; (ii) trade of homogeneous products for marketing (several products) in Andean countries, (medium and high technology manufacturing) in Brazil; and (iii) export of services (tourism, financial and transportation services) in some countries in the Caribbean and Panama. As the Region s economies have been transforming into an integral part of the global economy, the urban growth patterns have resulted in structural and morphologic changes of the cities, which have been influenced by the deregulation and privatization of certain production and service areas, the reduction of the State s investments and the decentralization or deconcentration of the areas of responsibility. These changes are not foreign to urban sanitation services, which represent a great potential for the participation of the private sector that could have significant repercussions on national development through its effects on employment and earnings from decreasing the cost of importing raw material for recycling purposes. On the other hand, the change in the Region s economies has resulted in an increase in the amount of solid waste and a change in their composition, becoming less biodegradable and with a greater content of hazardous contaminants. During the decade of the nineties, in the majority of the countries in the Region the GNP growth rates per capita were positive, even though the improvements in relation to the decade of the eighties were rather lower. However, the Region is far from being homogeneous. As is shown in Table 4, by 1999, the GNP per capita fluctuated between US$435 in Haiti and US$7,435 in Argentina (before the crisis). This situation does not change too much by the year 2001, in which the GNP for Haiti decreased to US$424 and Argentina still has a greater GNP per capita in Latin America with US$6,875. A similar fluctuation occurs in the Caribbean in which by 2001 Barbados registers a GNP per capita of US$6,722 and US$735 for Guyana (ECLAC, March 2003). By 2003 the English speaking Caribbean has an average GNP per capita of US$7,540, being the highest for the British Virgin Islands with US$16,000, followed by Antigua and Barbuda with US$11,000 and Anguila with US$8,600 and the lowest for Saint Vincent and the Grenadines with US$2,900. LAC continue suffering from one of the most disproportionate income distributions in the world, a distinction that has not changed in several decades. These differences are

CHAPTER 2 - THE REGIONAL SITUATION also strong within the countries, notable in countries such as Brazil, which on one hand is identified by its high technological development patterns, in comparison with the absolute misery of some rural regions and indigenous populations, and in the outskirts of large urban centers. The per capita income levels and the income distribution affect the health of the population, as can be seen in the sanitation indicators (life expectancy at birth, infant mortality, among others), and education indicators (degree of illiteracy), with a direct relationship between these components. Depending on the country, in recent years, high levels of open unemployment can be observed and/or a subunemployment growth and from the informal sector. In 2001, open unemployment in LAC was estimated at 8.4%, which constituted a substantial increase compared to the 1997 and 1990 values in which unemployment was in the order of 7.8% and 5.8% respectively (ECLAC, 2002). Figure 2 shows the urban open unemployment percentage for some countries in LAC for the year 2001. For comparative purposes, that year the unemployment rate in the United States was 4.8% According to data from ECLAC (2002), unemployment has a greater effect on young people, women and members of poor households. It is estimated that one third of the growth of informal work was generated by micro companies, of which a small percentage corresponds to solid waste collection and recycling micro companies. At the same time in countries such as Argentina, Colombia and Peru a significant increase in the waste segregators ratio has been observed, product of a disproportionate increase of poverty and indigence indexes, coupled with a critical unemployment situation. In terms of occupational structure, the change in employment from the production of goods to the production of services has continued. In 1998, the tertiary sector represented 73% of the labor force in the urban area, and the work ratio in the industrial sector has decreased to similar values in the early nineties (ECLAC, 2000). Figure 2. Urban open unemployment rate in selected countries in Latin America and the Caribbean 2001 15 Source: Data ECLAC, Latin America and Caribbean Statistics Annual Report, 2002

REPORT ON THE REGIONAL EVALUATION OF MUNICIPAL SOLID WASTE MANAGEMENT SERVICES IN LATIN AMERICA AND THE CARIBBEAN Table 4. Socioeconomic indicators selected for Latin America and the Caribbean 16 Country GNP per capita (a) (1) (dollars per year 1999) GNP per capita (a) (1) (dollars per year 2001) Human Development Index (2) 2001 Poverty (b)(2) (%) Indigence (c)(2) Country (%) Gini Coefficient (2)(3) (1999) Illiteracy Rate (2) (%) Anguila 8.6 18.0 2.0 0,31 2.0 Antigua and Barbuda 11 0,798 0,52 15.0 Argentina 7,435 6,875 0,849 34.8 19.5 0,53 3.1 Bahamas 0,812 4.5 Barbados 6,713 6,722 0,888 9.0. 0,39 3.0 Belize 1,546 2,825 0,776 25.3 9.6 0,51 6.3 Bolivia 952 943 0,672 58.6 37.3 0,6 13.3 Brazil 4,216 4,335 0,779 36.5 12.3 0,64 13.6 Chile 5,618 5,883 0,831 16.2 4.2 0,58 4.0 Colombia 2,271 2,273 0,779 39 15 0,57 8.2 Costa Rica 3,701 3,654 0,832 21.1 6.4 0,49 4.8 Cuba 3,878 4,156 0,806 3.8 Dominica 3,7 0,776 29 10 0,45 6.0 Dominican Republic 1,940 1,067 0,737 50.0 15.0 0,57 17.2 Ecuador 1.428 1,492 0,731 60.2 28.1 0,54 9.0 El Salvador 1,754 1,756 0,719 49.9 22.5 0,52 20.8 Grenada 5 0,652 24 2.6 0,5 2.0 Guatemala 1,551 1,558 0,652 77 30 0,58 35.8 Guyana 741 735 0,74 35 19 1.3 Haiti 435 424 0,467 90.4 58.7 35.0 Honduras 694 709 0,657 66 49 0,57 22.7 Jamaica 2,4 2,8 0,757 17 6 14.2 Mexico 4,576 4,722 0,8 31.3 12.2 0,57 5.5 Nicaragua 473 492 0,643 67.5 41.4 0,59 32.3 Panama 3,274 3,271 0,788 27.5 12.3 0,56 7.9 Paraguay 1,602 1,55 0,751 33.7 15.5 0,54 6.5 Peru 2,309 2,309 0,752 41.5 15.7 0,5 10.1 Saint Kitts and Nevis 8,7 0,808 16 6.4 0,44 2.5 Saint Lucia 4,4 0,775 19 0.9 0,47 27.0 Saint Vincent and 2,9 0,755 31 20 0,44 4.0 Grenadines Suriname 1,35 0,762 0,45 5.8 Trinidad and Tobago 5,116 5,773 0,802 31.0 0,4 6.2 Uruguay 5,983 5,587 0,834 16.0 1.0 0,44 2.4 Venezuela 3,036 3,121 0,775 53.7 16.6 0,49 6.8 (a) Constant prices for 1995. (b) Corresponds to the population that spends per capita less than what is equivalent to basic needs (basic basket of goods) which takes into consideration food and non-food expenses. Percentages in relation to the total population. (c) When the total expense per capita is less than the basic needs (basic basket of goods) cost per capita of the basic needs (basic basket of goods) for food. Percentage in relation to the total population. Information not available. Fuentes: 1 ECLAC, Latin America and the Caribbean Annual Report, 2002. 2 Solid Waste Evaluation. The numbers for Human Development Index were obtained from the United Nations Development Program (UNDP), Human Development Report 2003. The poverty amounts and the Gini Coefficient are based on surveys of homes. 3 UNDP, ECLAC and the Institute of Applied Economic Application (IPEA). Towards the objective of the millennium of reducing poverty in Latin America and the Caribbean, Santiago de Chile, February 2003.

CHAPTER 2 - THE REGIONAL SITUATION Poverty in the Region It is estimated that about 150 million people, or close to one out of three individuals, are below the poverty line in LAC, considering the income criteria at less than two dollars daily 7. The strong economic crisis that some Latin American countries have experienced have contributed to the increase of poverty in the Region with the emergence of the new poor phenomena, generated by the sudden impoverishment of the middle segments of the population, which has been the case in Argentina and Uruguay. The extreme poverty or indigence component affects close to half the homes in poverty situation in the Region. The poor people in the Region constitute a heterogeneous group, within the countries and more so when the Region is considered as a whole. Between the end of the 1980s and mid 1990s, the poverty incidence decreased slightly in the majority of the countries in the Region, with the exception of Venezuela and the area of the Great Buenos Aires in Argentina, where the poverty incidence increased, and Mexico where there have been no changes. In spite of the efforts carried out recently by the LAC countries to reduce poverty, the results have been discouraging due to the high levels of inequality in the Region. With regards to the evolution of inequality in the distribution of household income through Latin America, during the last decade the disparities were relatively less and the levels of inequality, measured by the Gini 8 coefficient have remained stable, with the exception of Bolivia, Ecuador, Paraguay and Venezuela where said coefficient went through a brief increase. In contrast, Honduras recorded a substantial decrease of around 8.3% 9 in the inequality. The Caribbean countries on the other hand have not suffered great variations in this aspect. LAC is the Region with the most unequal income distribution in the world, a distinction that continues being unaltered for several decades. The disparity in the distribution of income is large not only among the countries but within them (Table 4), as can be seen by the high values of the Gini coefficient in countries such as Brazil (0.64), Bolivia (0.60), Mexico (0.59) and Grenada (0.58). Even the Gini coefficient for Uruguay (0.44) is considered high according to international averages when compared to countries with a high income, whose average in the 90 s was 0.34 (ECLAC, 2003). About 35% of the urban households are in a poverty situation, concentrated in poor urban neighborhoods and in the urban outskirt areas. In countries such as Brazil and Chile, the poor in urban areas constitute the largest percentage of the poor in the Region. However, poverty is still concentrated in rural zones. In several countries in LAC, more than 50% of the poor live in rural areas. In countries such as Bolivia, El Salvador, Ecuador, Haiti, Guatemala and Nicaragua, poverty exceeds 50% of the population and one fourth of the population is in extreme poverty (Figure 3). Likewise, the indigenous groups are disproportionately represented among the poor, specifically in those of extreme poverty. Often, the poor are at a disadvantage with regards to formal education, health care and essential basic services, and for many the informal sector is a source of employment. Even though the consequences of inadequate solid waste management or the lack of it is attributed to the whole population, the poor and especially women and children are the ones that suffer the most because of these problems. Collection services in the most indigent areas have low priority in relation to the more affluent areas. Accessibility in the most indigent places tends to be a problem because of bad traffic and housing conditions, and the lack of infrastructure to store and collect waste. Furthermore, the poor because of necessity are many times obligated to economically subsist from waste without any sanitary control, being exposed to a series of health risks and themselves acting as vectors of diseases. The challenges are still marked by inequalities, in coverage as well as quality of the services provided, present in the different regions within the same country, in different economic stratum of the population and sometimes in different technical groups. 17 7 Based on income as a poverty measure, the poverty line corresponds to an income of two dollars daily and the extreme poverty or indigence is equal to one dollar per day. 8 The Gini coefficient measures the disparity on the whole distribution of the income or consumption. A value of 0 represents perfect equality and a value of 100 represents a perfect inequality. 9 United Nations Development Program (UNDP), the Economic Commission for Latin America (ECLAC) and the Institute of Applied Economic Application). Towards the objective of the millennium to reduce in Latin America and the Caribbean, Santiago de Chile, February 2003.

REPORT ON THE REGIONAL EVALUATION OF MUNICIPAL SOLID WASTE MANAGEMENT SERVICES IN LATIN AMERICA AND THE CARIBBEAN Figure 3. Poverty and indigence percentages in Latin American and Caribbean countries Source: Solid Waste Evaluation: Solid Waste Evaluation AL database corresponding to official information registered by the countries. Note: Indigence information for Trinidad and Tobago is not available. The British Virgin Islands and Barbados do not report indigence. 18 2.3 HEALTH AND EDUCATION The majority of the countries in the LAC Region have been able to reduce infant mortality to a regional average of 24.8 per 10,000 live births for the 1995 to 2000 period (PAHO, 2002a). However, there are still marked differences in the countries. Likewise, life expectancy at birth has increased to more than 70 years, even though not in a uniform manner in every country. A common denominator that influences mortality and morbidity rates is the level of income in the countries, corroborated when the poor quintiles are compared to the more affluent. Tables 5 to 7 show infant mortality indicators, life expectancy at birth and illiteracy for countries in the LAC Region for the year 2001. Even though a direct relationship has not been established between inadequate solid waste management, health and education of the population because of lack of adequate epidemiological studies, the unhealthy conditions that waste represents constitutes a real and potential threat to human health and the environment. Waste not collected that is deposited without any control in the environment originates a broad range of sanitary problems that translate into an increase in the prevalence of diseases such as dengue, leptospirosis and gastrointestinal diseases. Specifically, waste is a means conducive to the proliferation of the dengue vector, especially objects that trap water and provide a breeding place for mosquitoes; such is the case of used tires and discarded vessels or containers. The incidence of dengue has

CHAPTER 2 - THE REGIONAL SITUATION increased gradually in the LAC Region since 1981 and the outbreak reached its critical peak in 1998, with a total of 741,794 cases, among them 12,396 hemorrhagic dengue and 151 fatalities (PAHO 2002a). Between 2000 and 2001, countries such as Brazil, Ecuador, Cuba, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Peru notified dengue outbreaks. In that same year in the Caribbean, countries such as Anguila, Bahamas, Barbados, Belize, Suriname and Trinidad and Tobago recorded dengue cases. It is considered that vector control is the most effective means to prevent and control this disease, which should include an education component that leads to a change in the behavior of the population and reduction at the sources. In this aspect, it is relevant to take appropriate prophylactic measures to prevent the indiscriminate disposal of wastes in open-air dumps, as well as in households. Intestinal infections constitute the third cause of the mortality in the 0 to 4 years age group in countries with low income, in the low as well as high-income bracket and the fourth cause of mortality in the high-income bracket (PAHO, 2002a). Table 5. Infant mortality Rate (*) for the year 2001 by groups of countries Infant mortality rate Countries Less than 10.0 Between 10.0 and 20.0 Anguila, Chile, British Virgin Islands, Cayman Islands, Cuba Antigua and Barbuda, Argentina, Bahamas, Barbados, Costa Rica, Dominica, Grenada, Mexico, Panama, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, Uruguay, Venezuela Between 20.0 and 30.0 Belize, Brazil, Colombia, Guyana, Jamaica, Paraguay, Suriname Between 30.0 and 40.0 Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Peru Between 40.0 and 50.0 - Between 50.0 and 60.0 Bolivia Between 60.0 and 70.0 - More than 70.0 Haiti (*) Fatalities of children 1 year of age and less for each one thousand children born alive. Source: Solid Waste Evaluation. Table 6. Life expectancy at birth (*) in 2001 in Latin America and the Caribbean Life expectancy at birth Countries 50.0 to 59.9 Haiti 60.0 to 64.9 Bolivia, Guyana, 65.0 to 69.9 Bahamas, Brazil, Dominican Republic, Grenada, Guatemala, Honduras, Nicaragua, Peru, Saint Kitts and Nevis 70.0 to 74.9 Antigua and Barbuda, Argentina, Belize, Colombia, Dominican Republic, Ecuador, El Salvador, Mexico, Panama, Paraguay, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Uruguay, Venezuela 19 75.0 and more Anguila, Barbados, Dominica, British Virgin Islands, Cayman Islands, Chile, Costa Rica, Cuba, Jamaica (*) Number of years of life remaining if a person would be submitted to the current mortality conditions. Source: Solid Waste Evaluation

REPORT ON THE REGIONAL EVALUATION OF MUNICIPAL SOLID WASTE MANAGEMENT SERVICES IN LATIN AMERICA AND THE CARIBBEAN Table 7. Illiterate population 15 years and older in Latin America and the Caribbean grouped by countries to the year 2001 Less than 5 Illiterate population percentage (%) Between 5 and 10 Between 10 and 15 Between 15 and 20 Between 20 and 30 More than 30 Source: Solid Waste Evaluation. Countries Anguila, Argentina, Bahamas, Barbados, Chile, Costa Rica, Cuba, Grenada, Guyana, Cayman Islands, British Virgin Islands, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Uruguay Belize, Colombia, Dominica, Ecuador, Mexico, Panama, Paraguay, Suriname, Trinidad and Tobago, Venezuela Antigua and Barbuda, Brazil, Bolivia, Jamaica, Peru Dominican Republic El Salvador, Honduras, Panama, Saint Lucia Guatemala, Nicaragua, Haiti 20 The cause and effect of these diseases is complex and factors of different nature have an influence on it. It is acknowledged that poverty conditions and the level of education have a predominant role in the level of mortality and morbidity of the population, due greatly to the lack, and sometimes nil, access that the most indigent people have to basic health services, dignified housing and basic sanitation, the difficulty in following hygiene habits and ignorance regarding the risks that they face, mainly individuals who work and live in contact with waste. Solid waste management is closely related to the population s level of education in this regard. The Solid Waste Evaluation showed that the majority of the countries in the Region have, in greater or lesser degree, some sanitation/environmental education component related to solid waste, either at a school level (primary and secondary education), such as programs and campaigns at a municipal and national level guided towards different age groups. The detailed information by country on education is found in the Solid Waste Evaluation database and in the corresponding analytical reports from the countries. Usually, this education tends to be more informal and only a few countries like Colombia, Costa Rica, Chile, Cuba, El Salvador, Guyana, Cayman Islands and Jamaica include it in their syllabus. Even when there is a great variety of ecological programs and campaigns, the population in general has not yet absorbed the concept of accountability that it has with regards to solid waste management and it appears indifferent regarding their consumption styles. The illiterate population 15 years and older has been decreasing in the Region. However, countries such as Dominican Republic, El Salvador, Haiti, Honduras, Guatemala, Jamaica, Nicaragua, Panama, and Saint Lucia still have illiteracy rates of 20% and higher (Figure 4). The importance of the educational level of the population lies in the great interference it has in personal hygiene and the cleaning habits of households and public area, as well as the environmental awareness that translates into the demand for better services, and a better prepared community to assume their participation in waste management.

CHAPTER 2 - THE REGIONAL SITUATION Figure 4. Illiteracy rate in persons 15 years and older in Latin American and Caribbean countries 2001 Source: Solid Waste Evaluation. 21