Trans-border public health vulnerability and hydroelectric projects: The case of Yali Falls Dam

Ecological Economics 98 (2014) 81–89

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Analysis

Trans-border public health vulnerability and hydroelectric projects: The case of Yali Falls Dam John M. Polimeni a,⁎, Raluca I. Iorgulescu b, Ray Chandrasekara a a b

Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208, USA Institute for Economic Forecasting-NIER, Romanian Academy Casa Academiei, Calea 13 Septembrie nr.13, Sector 5, 050711 Bucharest, Romania

a r t i c l e

i n f o

Article history: Received 13 July 2013 Received in revised form 20 November 2013 Accepted 27 December 2013 Available online 24 January 2014 JEL classification: Q57 Q56 I15 O13

a b s t r a c t The need for energy due to economic and population pressure has resulted in a great expansion of hydroelectric dam projects around the world, especially in Asia. These hydroelectric projects have resulted in considerable environmental, economic, and social damage. Typically, the economic development—environmental degradation dynamic has been examined. However, rarely has the economic development, environmental degradation, public health connection been made. This paper, using primary data collected from household surveys, completes the economic, environment, public health circle by examining how economic and environmental changes from the Yali Falls dam in Vietnam has impacted the health of people living in three remote villages in Cambodia. © 2014 Elsevier B.V. All rights reserved.

Keywords: Ecological economics Economic development Public health Hydroelectric dams

1. Introduction Increased population pressure and energy demand make access to clean freshwater more difficult. This statement is particularly true for Southeast Asia where population growth is among the highest in the world and the need for additional energy supply will lead to increased pressure on water resources as countries move quickly to develop hydroelectric power. For example, due to rapid economic growth in Southeast Asia, the annual energy demand for that region is estimated to be 6% to 8% (Alauddin, 2004; Alauddin and Quiggin, 2008). International organizations such as the World Bank have made major investments in hydroelectric dam construction in the belief that increasing irrigation and hydroelectric power can stimulate economic growth and lower poverty (Duflo and Pande, 2007). Availability of energy resources is compulsory for economic development projects, such as the improvement of productive sectors of the economy, education, healthcare, and water infrastructure. However, these hydroelectric dams have caused massive displacement of people, impacted the ecosystem, destroyed arable land due to salination and water logging, and altered crop patterns (Duflo and Pande, 2007). Typically, the most

⁎ Corresponding author. E-mail addresses: [email protected] (J.M. Polimeni), [email protected] (R.I. Iorgulescu), [email protected] (R. Chandrasekara). 0921-8009/$ – see front matter © 2014 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ecolecon.2013.12.013

affected are the poorest of society, leaving them, among other negative side-effects, vulnerable to infectious disease. The Mekong River and its tributaries, which flow from China through Laos, Thailand, Vietnam, and Cambodia are among the most important water bodies in Asia. The Se San River, which originates in the Central Highlands of Vietnam, flows south into northeast Cambodia, connects with the Sre Pok and Se Kong Rivers, and then runs down to the Stung Treng Province and into the Mekong River, is arguably the most important tributary of the Mekong. More than 60% of the Se San River drains within Vietnam, with the remainder draining within Cambodia (Asian Development Bank, 1995). The Se San is important to Cambodia, for example, the Se San and Sre Pok rivers provide 10.4% of the flow of the Mekong River at Stung Treng (Fisheries Office, Ratanakiri Province and NTFP, 2000; Halcrow, 1999; TERRA, 1999a), and the Se San, Sre Pok, and Se Kong Rivers contribute 16.7% of the flow of the Mekong River at Kratie (TERRA, 1999b). Therefore, the Se San is one of the top rivers for potential hydropower development in Southeast Asia (TERRA, 2000). For example, the 400 MW Lower Se San 2 hydroelectric dam is a newer controversial project that has been approved by the Cambodian government. This hydroelectric project, combined with the Xayaburi dam and the Don Sahong dam in Laos, are expected to impact more than 50,000 people and have significant social and environmental impacts, such as the displacement of people and a significant drop in the fish stock in the region (Chen and Narim, 2013).

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The Vietnamese government started the construction of the 720 MW Yali Falls Dam on the Se San River in 1993. The reservoir of the dam began filling up in 1998 (Fisheries Office, Ratanakiri Province and NTFP, 2000) and was fully commissioned in 2000, although some energy was produced in early 2000 (Polimeni et al., 2011). The dam is part of the Vietnamese strategy of developing renewable energy, especially hydropower which the government projects will generate up to 62% of the country's energy supply by 2020 (Sinh, 2008). The two main markets for electricity in Vietnam are the Hanoi–Hai Phong area and the Ho Chi Minh City area, each with a large number of industrial parks serving sectors such as finance and banking, agriculture, construction, and technology. A survey by the Electricity Corporation of Vietnam found that nearly 100 industrial users of electricity consume more than 1000 kWh per day (Energy Probe Research Foundation, 2008). Therefore, a major priority for Vietnam is to produce enough energy to feed their economic engine, as well as to provide electricity to rural households, of which approximately 50% do not have access to (Energy Probe Foundation, 2008). Clearly, the Yali Falls Dam has had some positive impacts for the Vietnamese society and economy. However, there are transboundary issues that must be explored. The dam, currently the largest in the lower Mekong basin (Fisheries Office, Ratanakiri Province and NTFP, 2000), is located approximately 70 km from the Cambodian border and impacts an estimated 100,000 people living in the river basin. These people, largely rural villagers, are heavily dependent upon the river for its services, such as drinking water, water for cooking and agriculture, and fish. Additionally, the floodplain on which they live is a grazing area for their livestock and prime land for growing their crops. The Se San is important for transportation, as well as for bathing and washing clothes. Brown, Magee and Xu (2008) explored the vulnerabilities of the poor due to hydroelectric dams in China. They used interviews and detailed economic profiles to demonstrate the negative effects of resettlement on households in the Nu River area. Moreover, the land downstream from hydroelectric dams, and thus the livelihoods of many individuals, is also vulnerable (Mohammadpour et al., 2008). The effect of the Yali Falls Dam in Vietnam on villagers in three northeast Cambodian villages (Phnom Kok Brao, Phnom Kok Lao, and Pi) is no exception. A majority of the poor in Cambodia live in rural communities, similar to other developing countries. As such, these individuals are vulnerable to even the smallest changes in economic, environmental, and public health conditions. Therefore, village-level primary data, as opposed to national macroeconomic data, is important because the economic structures and dynamics in these communities are fundamentally different from the national economy (FAO, 2005, p. 16). The primary data collected provides information about the three villages. Furthermore, information about households and the impact of the Yali Falls Dam on these households, as well as individuals, was collected. While much of the research on hydroelectric dams focuses on their economic and environmental costs (Goldsmith and Hildyard, 1984; McCully, 1996), this paper differs by examining how human health is affected through the impact on water quantity and quality. The paper is structured as follows. Section 2 reviews the literature on the impact of dams on public health. Section 3 describes the Yali Falls Dam in Southeast Asia. Section 4 presents the results of the survey of the rural villages of Phnom Kok Brao, Phnom Kok Lao, and Pi, the case studies for the paper. Section 5 discusses those results while Section 6 concludes the paper. 2. Impact of Dams on Public Health The impacts of dams are complex and can be both positive and negative. Positive externalities from dams include irrigation water for agriculture, increased energy production (Biswas and El-Habr, 1993; British Dam Society, 1999), flood control, as well as increased recreational and commercial opportunities and travel. Negative externalities include resettlement of the population (Scudder, 1981; Scudder and

Colson, 1982), human health impacts, declines in the fish stock, lower quality and quantity of water downstream, and reduced economic activity, particularly in rural communities. One of the major issues related to dams is the changed hydrology and ecology of downstream ecosystems, with the impact varying depending upon their purpose. Barbier (2002) developed a model to illustrate how the economic activities downstream of the dam in the Hadejia–Jama'are floodplain in Nigeria, developed to divert water largely for irrigation purposes, are affected by a reallocation of water upstream. He found that the hydrology of the floodplain would be irreversibly altered, substantially affecting the economic livelihoods of rural households living downstream. Changes in the ecology of a floodplain affect vegetation (Attwell, 1970; Sheppe, 1985), forests (Hughes, 1988), fish (Hyslop, 1988), and animals (Dunham, 1994; Nilsson and Dynesius, 1994; Obrdlik et al., 1989). The long-term changes to an ecosystem also vary greatly (Petts, 1984; Petts, 1987; Richards, 1982, Thomas and Adams, 1999). Although ecosystem functions are invaluable and changes to these systems could be irreversible, the evaluation of dams has typically focused on their economic costs (Ojeda et al., 2008). However, these evaluations tend to overestimate the benefits and underestimate the costs (Adams, 2000). The economic evaluation of dams generally do not account for costs such as the environmental, public health and social costs since downstream communities suffer in a variety of ways that õrequire an evaluation beyond economic impact analysis (Adams, 2000; Mehta and Srinivasan, 1999). Dams impact the agriculture, fishing, and the environment of downstream communities which in turn affect the natural, financial, physical, human, and social capital of the region in which the dam is located (Acreman et al., 2000). The negative impact of dams on public health is related to their environmental and economic externalities. For example, Uyigue (2007) explores the correlation between the incidence of schistosomiasis and communities hosting dams in Nigeria, as well as the legal and institutional framework that exists for water resource management in the country. She reviewed the data in the literature on forty-seven dams that were tested for schistosomiasis. She found that human infection was tested for in eleven of those dams, of which ten tested positive. Furthermore, while dams have contributed to the economic development of Nigeria there has been a negative impact on the environmental conditions and on the human health of the communities hosting the dams. Perhaps more compelling is a study by Ghebreyesus et al. (1999) which explores the incidence of malaria in children living in communities located near dams in Ethiopia. Over four quarterly cycles, they took malaria incidence surveys that lasted thirty days each in eight high-risk communities in the Tigray region in northern Ethiopia. Altogether, they obtained information on approximately 7000 children ten years or younger that live within 3 km of a dam and in control villages 8 to 10 km from the dam. They found that while malaria was prevalent in both communities, the rate of incidence in the villages near the dams was 14.0 episodes per 1000 child months at risk as compared to 1.9 in the control villages; an incidence rate seven times higher. Often, the health impacts are less severe than schistosomiasis and malaria. McCully (1996) found that algae are likely to multiply near the surface of euthrophic reservoirs, similar to the Yali Falls Dam reservoir, causing the water to be unhealthy for household use. Other water quality issues also result from reservoirs. Nitrates created in the reservoir could cause poisoning leading to cyanosis, anoxia, stomach and intestinal disorders, dizziness, hypertension, respiratory failure, and coma (Robertson, 1992). Additionally, methylmercury poisoning, common in many large reservoirs, can lead to serious long-term health effects (McCully, 1996). Lastly, high mineral levels of hydrogen sulphate, iron, or manganese are typical in large reservoirs (Bergkam et al., 2000; McCully, 1996; Schouten, 1998) and can lead to liver and kidney problems. For more information on the impact of dams on public health, we suggest Stanley and Alpers (1975), Brinkman et al. (1988), Parent

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et al. (1997), Vercruysse et al. (1994), N'Goran et al. (1997), Brantly and Ramsey (1998), and Lerer and Scudder (1999).

3. The Regional Influence of the Yali Falls Dam The Mekong River is one of the longest rivers in the world, originating in China and flowing through Cambodia and Vietnam before draining into the South China Sea. As the main river in a region starving for additional energy supplies, the Mekong and its tributaries have more than two hundred hydroelectric dams built, under construction, or planned (Ferguson et al., 2011). One of the largest tributaries of the Mekong is the Se San River which flows through the Ratanakiri and Stung Treng Provinces in Cambodia. The Se San River Basin has a drainage area of 17,100 km2 (Asian Development Bank, 1995). As a major water body in the region, the Se San River is a source of biodiversity and provides a supply of food, water, and economic activity for approximately 50,000 people living along the river (Fisheries Office and NTFP, 2000; Polimeni et al., 2011; Trandem, 2008). Also, the Se San River has been identified as one of the most important rivers in Vietnam in terms of hydropower potential (TERRA, 2000). Arguably the most important hydroelectric dam built on the Se San River is the Yali Falls Dam, although the energy produced is consumed by Vietnam to feed its growing economy and population, with none of the energy going to those living downstream in other countries while the negative impacts are ‘shared’ with trans-border communities. As discussed previously, the Se San River provides vast ecosystem resources while the Yali Falls Dam has adversely affected the population in the region, particularly those living downstream of the dam such as villagers in northeastern Cambodia. For example, the people in the region have reported intense erratic water fluctuations, which have caused both flooding and water shortages. Flooding during the rainy season did occur prior to the construction of the Yali Falls Dam though flooding today is much different. Now, floods occur regularly, are longer in duration, and have higher water peaks which cause considerable damage, particularly to agricultural crops, and large-scale erosion (Fisheries Office, Ratanakiri Province and NTFP, 2000). The severity of the flooding after the construction of the dam is likely a result of a combination of water released from the dam, as well as the regular water accumulation and runoff from the rains. Changes in the water quantity in the region are not restricted to the rainy season. People in the region have experienced irregular hydrological patterns during the dry season (Fisheries Office, Ratanakiri Province and NTFP, 2000). The reason for the drastic variations in water levels is thought to be due to the dam upstream. Furthermore, the unnatural changes in the hydrological patterns, large increases in water levels when the sky is clear upstream and low water levels when there are rain clouds upstream, have confused the locals who previously relied on their ancestral knowledge of weather patterns (Fisheries Office, Ratanakiri Province and NTFP, 2000). The floods have resulted in lost lives and the destruction of personal property such as homes, cropland, and livestock (Trandem, 2008). Similar findings were obtained by the Center for Natural Resources and Environmental Studies (CRES) at the Vietnam National University (2001). They found that irregular water releases from the Yali Falls Dam have substantially changed the hydrological regime and downstream water quality of the Se San River. As a result, the quality-of-life of people downstream has been negatively affected. For example, the quantity of fish has decreased considerably since the construction of the dam. This decrease is important because fish is the main source of protein for people in the region. In percentage terms, fish is estimated to provide animal protein ranging from 40% to 60% (Csavas et al., 1994), to 75% (Degen et al., 2000, Nao and Ly, 1997), to 90% in fishingdependent regions (Ahmed et al., 1998) for Cambodians. CRES found that changes in the upper part of the Se San River have an impact on the fish habitat in the Mekong River watershed. Furthermore, shallow

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water contributes to the death of fish and aquatic life that feed on larvae that transmit malaria and typhoid fever. The downstream health impacts of dams are also serious (IUCN and World Bank, 1997). However, there is limited literature on the influence of hydroelectric dams on the specific waterborne diseases that impact human health such as those the villagers were surveyed about. Moreover, there is little research and data on the Yali Falls Dam and the health impact on the people living in the region. Therefore, this study provides important insight on the variety of effects dams have on public health, the environment, and local economies. Arguably, the hydrological interdependence in the region of the Yali Falls Dam has negatively impacted individuals downstream from the dam the most, especially the villagers living in northeast Cambodia. The following sections present and discuss the health impact survey results for households in three rural villages in the Se San watershed in Cambodia. Although there is limited literature on the human health impacts from hydroelectric dams, when possible the results of this paper will be compared to the existing literature on the impact of hydroelectric dams in other parts of the world. 4. Survey Results Household surveys were administered in the Ratanakiri Province in the rural Cambodian villages of Phnom Kok Brao, Phnom Kok Lao, and Pi within the districts of Veun Sai and Oyadav (Fig. 1). Households were chosen randomly to be surveyed. Cambodian university students were hired to administer the surveys because they spoke the local language and also to guard against any potential bias of survey respondents providing incorrect or exaggerated answers to researchers. The three villages were chosen because they are along the Se San River, downstream from the Yali Falls Dam. Therefore, the people living in these villages have their quality-of-life directly impacted by the dam. All three of the rural villages have a population of a few hundred people with approximately forty to fifty households; 34 surveys were completed in Phnom Kok Brao, 49 in Phnom Kok Lao, and 56 in Pi. The total sample size is split nearly evenly between men (70) and women (69) respondents. In Phnom Kok Brao there were 59% male and 41% female respondents, in Phnom Kok Lao 57% male and 43% female respondents, and 39% male and 61% female respondents in Pi. The average age of all the respondents is 38 years old. The average age of respondents decreases from 43 years for Phnom Kok Brao, to 36 years in Pi and 35 years in Phnom Kok Lao. Villagers were asked about whether they or any one member or members of their household contracted water-related diseases before and after the construction of the Yali Falls Dam (Table 1). The survey was administered nearly twenty years after the start of construction of the Dam. While few, if any, formal medical records exist, the data obtained on health issues are deemed to be accurate because villagers keep precise oral health records passed down from generation to generation. Other data, such as changes in household income and annual household and medical expenditures were not collected as formal or informal records were not kept by villagers, and, as a result, the numbers presented are a representation of the current condition of villagers. Despite their detailed accounting of family medical issues, some caution of the results should be taken as the symptoms of some diseases are similar and the respondents could mistakenly believe they had one disease when they had a different one. However, cases of mistaken diagnosis are believed to be small in number. The diseases that the villagers were asked about were anemia, arsenicosis, cholera, diarrhea, encephalitis, malaria, typhoid, and worms. Each of these diseases is known to be common to areas where hydroelectric dams have been built. Anemia is typically caused by an iron deficiency which results in a lack of hemoglobin in red blood cells. Although anemia is not directly caused by water-related activities, the disease is caused by infections

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Source: Baird and Mean, 2005 (with our changes) Fig. 1. Research villages in Ratanakiri province, Northeast Cambodia. Source: Baird and Mean, 2005 (with our changes).

to the findings of Wolde-Gebriel et al. (1993) in their study of 14,740 children in central Ethiopia. Survey respondents were then asked about arsenicosis. The cases of the disease explored here are most likely caused by exposure to arsenic in the water. The disease causes a variety of health issues such as skin discoloration and hardening, cancer, vascular disease, high blood pressure, diabetes, and reproductive disorders. Arsenicosis can also be exacerbated by malnutrition. Arsenic has been discovered in the groundwater in the Mekong River floodplain (Buschmann et al., 2007; Buschmann et al., 2008) as well as in Vietnam (Berg, 2002). In this study, cases of arsenicosis increased the most of any of the diseases asked about in the survey. The respondents stated that they had a 54.31% increase in cases of arsensicosis. Once again, the village of Pi experienced the greatest percentage increase, 64.82%. Interestingly enough, respondents from Phnom Kok Lao said that they did not have

linked to contact with unsanitary conditions and contaminated water. Anemia increased nearly seven-fold for the respondents of the survey, increasing from 5.88% before the dam to 39.26% after the dam was built. The village of Pi has suffered through the largest percentage increase, 42.59%. However, both Phnom Kok Lao and Phnom Kok Brao experienced a significant escalation in cases of anemia as well, increasing 31.29% and 23.53% respectively. Household cases of anemia did not increase as dramatically, although they did nearly double since the dam was built. One explanation might be the increased Se San flow by the three tributaries that meet it after Pi and before Phnom Kok Lao. These results are comparable to those of studies in other countries. Deribew et al. (2010) conducted a study of 2410 children under the age of five in the region near the Gilgel Gibe Hydroelectric Dam in southwestern Ethiopia to explore the connection between malaria and malnutrition. They found that 32.4% of children had anemia. This result is also similar Table 1 Detailed public health impact survey results. Disease

Phnom Kok Brao Before

Phnom Kok Lao

Pi

Total

After

Before

After

Before

After

Before

After

26.47% 69.70% 50.00% 79.41% 52.94% 35.29% 45.45% 38.46%

2.04% 0.00% 14.29% 30.43% 10.42% 13.64% 31.11% 10.00%

33.33% 40.82% 37.50% 74.47% 23.91% 39.58% 46.94% 39.02%

11.11% 22.22% 27.78% 40.00% 7.27% 10.91% 59.26% 17.78%

53.70% 87.04% 61.11% 77.78% 30.19% 23.64% 74.55% 53.19%

5.88% 11.36% 18.52% 31.82% 11.03% 11.54% 40.15% 13.51%

39.26% 65.67% 50.00% 76.87% 33.83% 31.62% 57.35% 44.74%

43.75% 70.97% 39.39% 75.00% 64.52% 51.52% 65.63% 54.17%

14.58% 4.17% 20.41% 40.43% 15.56% 13.64% 26.09% 25.58%

31.91% 63.27% 34.69% 76.60% 41.30% 47.83% 60.87% 53.66%

34.55% 22.22% 38.89% 40.74% 9.43% 7.41% 72.73% 28.26%

61.82% 83.02% 73.58% 84.91% 32.73% 20.75% 72.73% 51.11%

23.88% 12.78% 34.65% 40.15% 14.17% 11.54% 45.11% 22.81%

47.01% 72.93% 51.11% 79.23% 42.75% 37.88% 66.67% 52.73%

Respondent Anemia Arsenicosis Cholera Diarrhea Worms Encephalitis Malaria Typhoid Anemia Arsenicosis Cholera Diarrhea Worms Encephalitis Malaria Typhoid

2.94% 10.00% 12.12% 19.35% 17.65% 9.68% 21.21% 11.54% Family 18.75% 9.68% 12.12% 37.50% 20.69% 15.63% 25.00% 8.00%

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arsenicosis prior to the dam but after the dam was built 40.82% had the disease. The other villages also experienced major increases in individual respondent cases of the disease. Households also saw cases of arsenicosis increase greatly, slightly more than 60% from before the dam was built until after. The households in each of the three villages also experienced an increase of approximately 60% in cases of arsenicosis. Childress (2009), Ball et al. (2005), and Stokes and Wren (1987) have all found arsenic to be prevalent in areas near hydroelectric dams and in the groundwater in the Mekong River valley. Bai et al. (2009), Xiao et al. (2013), and Zhao et al. (2013) all found high levels of arsenic and other heavy metals in the water bodies near hydroelectric dams in China. Although none of these studies provide a direct comparison to the results of the study presented in this paper, they do suggest that they might be similar. The villagers were next asked about cholera, a disease caused by an intestinal bacterium Vibrio cholera ingested through food or drinking water contaminated by the feces of infected people. Cholera is particularly prevalent in areas where clean drinking water and sufficient sanitation are not readily available. Cases of cholera for the individual respondents increased 31.48% and households saw incidents of the disease increase 16.46%. The village of Phnom Kok Brao experienced nearly a 38% increase in cases of cholera by the survey respondents, the most of any of the three villages. The respondents from Pi also saw a substantial increase in cases of cholera with approximately a 33% increase. Household cases of cholera increased the most in Pi, nearly doubling going from 38.89% to 73.58%. Carrel et al. (2010) conducted a study in Bangladesh and found that there is an increased risk of cholera in flood protected regions such as those near dams. Given that cholera is easily spread in regions where clean water is not available this finding is not surprising considering the decrease in the quality of water resulting from the operation of dams and is consistent with the findings presented here. Survey respondents were asked about incidences of diarrhea, a condition that is common for people that are exposed to and drink contaminated water. Diarrhea is especially severe for children, malnourished individuals, and for those that have impaired immune systems. Since the construction of the dam cases of diarrhea for the individual respondents increased 45% and 39% for their households. Incidences of diarrhea increased the most for respondents in the village of Phnom Kok Brao, rising 60%. The respondents from the other two villages also stated that they suffered through additional cases of diarrhea. Household occurrences of diarrhea nearly doubled in Phnom Kok Lao, doubled in Phnom Kok Brao, and more than doubled in Pi. Sayboualaven (2004) found that cases of diarrhea of villagers downstream of dams in the Boloven Plateau in Laos increased after the dam was built. Lanza (2011) found similar results in his environmental impact assessment of the Xayaburi Hydroelectric Dam in Laos. Related to diarrhea are intestinal worms. Individuals become infected with intestinal worms through contact with soil contaminated with human feces from an infected person or by eating tainted food. Respondents stated that their cases of intestinal worms more than tripled since the dam was built. The village affected the most is Phnom Kok Brao, experiencing an increase from 17.65% to 52.94%. Household incidents of intestinal worms also tripled and increased the most in Phnom Kok Brao. This increase is consistent with a study of the GIBE III Hydroelectric Project in Ethiopia which found intestinal parasites to be one of the most prevalent diseases of inhabitants in the region (Ethiopian Electric Power Corporation, 2009). Alemayehu et al. (1998) surveyed villages near forty-one microdams in Tigray, Ethiopia. At each site, ten households were randomly selected and all the family members were tested for malaria and intestinal parasites. They found that hookworm was detected more than 66% of the time and that the rate of infection was as high as 78% in some villages. Therefore, the results of our study are reliable. An increase in encephalitis was also found. This disease is transmitted to a human by an infected mosquito taking a blood-meal.

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Occurrences of encephalitis for the survey respondents increased 20.08% after the dam was constructed. In both Phnom Kok Brao and Phnom Kok Lao cases of encephalitis for the respondents increased nearly 26%, while in Pi the increase is approximately 12.7%. According to the survey respondents their households experienced an increase of 26.34% in cases of encephalitis. Phnom Kok Brao has a 35.89% increase, the largest of the three villages. Patz et al. (2005) found that hydroelectric dams contributed to the increase in cases of Japanese encephalitis in Asia. Malaria was the next disease respondents were asked about. Transmission of malaria occurs when infected mosquitos take blood-meals from a human and is often spread by stagnate pools of water. Cases of malaria were expected to have among the largest percentage increases; however, incidents of malaria increased the least of any of the diseases that survey respondents were asked about. The less than expected increase is likely due to the immense efforts of policy makers and other stakeholders to eliminate the disease and to educate people how to prevent malaria. Cases of malaria for the survey respondents increased 17.2% and 21.56% for their households. Occurrences of malaria increased the most for survey respondents and their households in Phnom Kok Brao. The other villages saw a lesser increase in cases of malaria for the survey respondents. For households, Phnom Kok Lao experienced a large increase of 34.78%, however, households in Pi did not suffer from any increase at all. These results are similar to expectations of cases of malaria near dams in other parts of the world. For example, Renshaw et al. (1998) conducted a health impact assessment of the Turkwel Gorge Dam in Kenya. They found that there is an increased risk of malaria at both the dam reservoir and near the irrigation fields. Due to this increased risk, they also concluded that the incidence of malaria will surge. Yewhalaw et al. (2010) also found malaria to be the most serious health problem in villages near the Gilgel Gibe hydroelectric dam in Ethiopia, as compared to villages further away from the dam. The last disease villagers were asked about was typhoid. Typhoid is an infection that is caused by bacteria transmitted from infected individuals to non-infected people through ingestion, typically by water contaminated by the feces and urine of infected people. Cases of typhoid increased 31.23% for the survey respondents. The individual respondents from Pi suffered from the greatest percentage increase in typhoid, 35.41%. Respondents from Phnom Kok Brao experienced an increase of 26.92% and those from Phnom Kok Lao a 29.02% increase. Household cases of typhoid increased 29.92% after the dam was built. Survey respondents stated that their households from Phnom Kok Brao increased the most at 46.17%. Incidents of the disease for households in Phnom Kok Lao increased 28.08% and 22.85% in Pi. These results are consistent with the literature. The CEE Bankwatch Network (2008) found that the incidence of typhoid around the Gilgel Gibe III hydroelectric project increased around the reservoir but there are no baseline statistics for comparison. 5. Analysis The quality-of-life survey results illustrate the link between the impact of the hydroelectric project on public health and water quantity/ quality and living conditions. The significant changes in water quality, quantity of water, and quantity of fish caught support the assertion that the three Cambodian villages have likely been negatively affected by the Yali Falls Dam. Before proceeding to explain the intricacies of the various impacts of the dam on public health, it should be emphasized that care must be taken regarding the weight attributed to various explanations. The diseases considered are not directly caused by the dam itself; the infections are caused by hygiene, sanitation, and mostly clean water and water management problems largely augmented by the construction of the dam. The survey results presented in the previous section are valuable from a public health point of view considering that several of those

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Fig. 3. Snapshot of individual health index.

Fig. 2. Snapshot of family health index.

diseases contribute to contracting or exacerbating other diseases (for example, malaria and intestinal worms are factors in anemia). Thus, while direct causation cannot be claimed there is obviously a strong correlation between the hydroelectric project and worsening of the public health. An aggregated health index was constructed for family level and individual level to offer a synthesis of dam's impact on villagers' health. The health index is the average of the summations of all the positive responses from an individual and household perspective for the diseases asked about. As a result, the health index provides a measure of the health history of the survey respondents, and, also the potential health status of each individual and household. The maximum possible value for the health index is 8. Figs. 2 and 3 present the health indices for each village from both a household perspective and an individual perspective. Consistent with the previous results, the village of Pi has suffered the worst health of the three villages. However, Phnom Kok Brao experienced the greatest increase in the health index. As expected, respondents from Phnom Kok Lao have the highest annual household income with an average of US$388.1 Respondents from Phnom Kok Brao and Pi reported annual household incomes of US$286 and US$185 respectively (Fig. 4.). The annual household income levels of the three villages, not surprising since they are rural, are much less than the annual GDP per capita (current 2012 US $946) and annual GNI per capita (current 2012 US $880) for Cambodia (World Bank, 2013). While these data are not directly comparable, they do provide an indication of the income levels in the three villages. The majority of respondents' household income is spent on food and medical expenditures (Table 2). Respondents from the village of Pi spend the highest percentage of their income (78%) on food. The respondents in Phnom Kok Brao and Phnom Kok Lao reported spending 47.56% and 42.76%, respectively, of their household incomes on food. The reason that respondents from Pi spend a higher percentage of their household income on food, besides a very low income, is that the village has seen much of their agricultural and fish production adversely affected and food had to be obtained from other suppliers. Annual medical expenditures also represented a significant portion of household income. Respondents from Phnom Kok Brao stated that 31.12% of household income was spent on medical care. This percentage is much higher than for the other two villages, 11.85% for Phnom Kok Lao and 15.68% for Pi. One reason for this disparity could be age, since these respondents are, on average, nearly seven years older than the next oldest village. These results are consistent with the findings from the health index discussed earlier. Furthermore, the results presented 1 Money was reported in Cambodian riels and converted to US dollars. The exchange rate was 4000 Cambodian Riels for every US$1.

are consistent with the literature on poverty and health effects from hydroelectric dams (Hunter et al., 1993; Taha and Merghani, 1990). People living in the three villages were asked a series of questions about their quality-of-life before and after the Yali Falls Dam was constructed to obtain as comprehensive as possible a comparative analysis of the full impact of the dam. To ensure the validity of the results presented, respondents were asked if they have previously experienced a drought or a flood (Table 3). Without question, villagers suffered through floods and droughts prior to the construction of the dam. However, since the dam has been built flooding no longer corresponds with heavy rain as it lasts longer and is more severe. During the dry season, flooding can occur when there is no rain and droughts are more severe with water levels dropping significantly (Fisheries Office and NTFP, 2000). Approximately 77% of the respondents said that they have suffered through a drought. The three villages faced different conditions. Pi is the least affected with slightly over 55% of respondents claiming they experienced a drought. The other two villages, Phnom Kok Brao and Phnom Kok Lao both have over 91% of respondents stating they have experienced a drought. While many respondents have undergone the pain of a drought, more of them suffered from a flood. More than 84% of the respondents have experienced a flood. Once again, the least impacted village is Pi, with three quarters of respondents experiencing a flood. The share of respondents with flood experience increases 10% for Phnom Kok Brao and almost 19% for Phnom Kok Lao. Slightly more than 70% of respondents stated they have lost income, more than 60% of households had to reduce their consumption of goods and services, more than 73% of households reduced their food consumption, and more than 66% lost assets due to droughts and floods. The village of Phnom Kok Lao has suffered the most of the three villages from drought as the percentage of households that lost income, had to reduce their consumption of goods and services, and that reduced their food consumption was greatest in this village. Similarly floods affected this village the most for all four categories. The village of Pi experienced the least impact from droughts while from floods it had the least reduction in consumption of goods and services and in food consumption.

Fig. 4. Snapshot of income survey results.

J.M. Polimeni et al. / Ecological Economics 98 (2014) 81–89 Table 2 Income survey results.

Table 4 Fish caught and crops grown survey results.

Village

Annual household income (US $)

Annual food expenditures (US $)

Annual medical expenditures (US $)

Phnom Kok Brao Phnom Kok Lao Pi

$286 $388 $185

$136 $166 $145

$89 $46 $29

Fish caught Crops grown

Phnom Kok Brao had the greatest percentage of households reporting lost assets from drought and was second most affected in lost income, reduced consumption of goods and services, and reduced food consumption but only slightly. In regards to floods, Phnom Kok Brao suffered the least in lost income and lost assets and was only slightly more affected than Pi for reduced consumption of goods and services and reduced food consumption. Villagers were asked to provide information on the change in the quantity of water during the dry and rainy seasons. Large fluctuations in the water levels of the Se San River have caused significant environmental and socio-economic damage in Cambodia (Fisheries Office, Ratanakiri Province and NTFP, 2000). Respondents overwhelmingly stated that the quantity of water has increased since the construction of the dam, particularly during the rainy season. The village of Pi experienced different hydrological patterns from the other two villages, due to its positioning farther upstream and before three more tributaries met the Se San River. These results are consistent with the findings of Trandem (2008) and Fisheries Office, Ratanakiri Province and NTFP (2000). Unfortunately, in the case of these three villages more water does not mean more quality water. The build-up in the reservoir lake cause physical, chemical, and biological changes to the water (Bergkam et al., 2000) triggering severe water quality issues downstream when water is released from the dam (Bergkam et al., 2000; McCully, 1996; Schouten, 1998). Our survey results confirm these findings; more than 97% of respondents stated that the quality of water is either ‘Much Worse’ or ‘Worse’ since the dam was built. Since water is such an important aspect of the lives of the villagers, one might expect that other aspects of life are also impacted. Therefore, survey respondents were asked a series of questions on how the dam impacted the number of fish they caught, how their crops were affected (Table 4), as well as their individual consumption of food and fish (Table 5). Both the number of fish caught and the amount of crops grown have decreased since the construction of the dam. In fact, all respondents overwhelmingly stated (88.64%) that they have experienced a ‘Large Decrease’ in the number of fish caught. The village of Phnom Kok Lao is negatively impacted the most with nearly 96% of respondents stating a ‘Large Decrease’ in their fish catch. Table 3 Previous experience of droughts and floods.

Experienced a drought Experienced a flood Lost income Reduced consumption of goods and services Reduced food consumption Lost assets Lost income Reduced consumption of goods and services Reduced food consumption Lost assets

87

Phnom Kok Brao

Phnom Kok Lao

Pi

Total

91.18% 85.29% Drought 76.47% 70.59%

91.84% 93.88%

55.36% 75.00%

76.98% 84.17%

81.63% 71.43%

56.00% 44.00%

70.68% 60.90%

88.24% 85.29% Flood 61.76% 58.82%

89.80% 71.43%

50.00% 50.00%

74.44% 66.92%

81.63% 73.47%

66.07% 57.14%

70.50% 63.31%

70.59% 64.71%

83.33% 81.25%

66.07% 66.07%

73.19% 71.01%

Large decrease Small decrease Large decrease Small decrease

Phnom Kok Brao

Phnom Kok Lao

Pi

Total

81.82% 18.18% 50.00% 50.00%

95.83% 4.17% 48.57% 51.43%

86.54% 13.46% 53.33% 46.67%

88.64% 11.36% 51.43% 48.57%

Although all respondents also stated that there was a decrease in agricultural crops grown, the level of that decrease was not at the level of reported decrease in the fish catch. Respondents indicated that the decrease in crops grown is nearly evenly split between a ‘Large Decrease’ at 51.43% and a ‘Small Decrease’ at 48.57%. The village of Pi experienced the most adverse effects on their crop production with 53.33% of respondents stating a ‘Large Decrease’. These responses are expected due to the loss of agricultural land from flooding, destroying rice crops, farmland for growing vegetables, and smaller fish populations. As expected, the decrease in agricultural production and the number of fish caught has resulted in a large adverse impact on the food consumption of respondents. Approximately 60% of all respondents indicated that their food consumption has either ‘Completely Changed’ or ‘Changed a Little’. These responses are referring to a decrease in consumption. Since the main source of protein for villagers is fish, respondents were asked how their consumption of fish has changed since the Yali Falls Dam was built. Over 90% of respondents suffered a decrease in their consumption of fish, stating that their consumption of fish ‘Completely Changed’ (69.78%) or there was ‘A Little Change’ (21.58%). These results are not surprising since fish species in Ratanakiri are known to be sensitive to changes in water quality, turbidity, and algae levels. The impacts include tolerance, reproduction, and migratory behavior (Baird, 1995; Baird et al., 1999; Fisheries Office, Ratanakiri Province and NTFP, 2000; Rainboth, 1996). 6. Conclusion The Yali Falls Dam impacts, both positively and negatively, the people living in the region of the dam and those communities downstream as well. To understand this association requires a multifaceted approach because the dam resides in Vietnam and many of the effects impact people living in Cambodia. As shown in this paper the economic and environmental impacts of the Yali Falls Dam have added to the deteriorating public health conditions of people living in three northeast Cambodian villages, possibly more. The villagers in this area were asked about the incidence of eight diseases before and after the construction of the dam. The occurrences of each of these diseases increased substantially after the dam was built, providing significant evidence of a possible link between the Yali Falls Dam in Vietnam and increased incidents of waterborne disease in Cambodia. A clear link, but not direct causation, of the vulnerability of the people in this region to the Yali Falls Dam has been established by the results of the survey presented in this paper.

Table 5 Food and fish consumption survey results.

Food consumption

Fish consumption

Completely changed A little change No change Completely changed A little change No change

Phnom Kok Brao

Phnom Kok Lao

Pi

Total

35.29% 29.41% 35.29% 52.94% 38.24% 8.82%

38.78% 26.53% 34.69% 75.51% 20.41% 4.08%

30.36% 21.43% 48.21% 75.00% 12.50% 12.50%

34.53% 25.18% 40.29% 69.78% 21.58% 8.63%

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These findings are important because of the use of primary data to establish an association between the dam and changes in quality-oflife, environmental and economic conditions, and public health. Furthermore, as countries in the region move to build more hydroelectric dams, this study can provide meaningful insight into the potential impacts on the population living downstream. The literature (Polimeni et al., 2008; Scudder, 1999; Mehta and Srinivasan, 1999; Srinivasan, 1997; Cernea, 1996; Burfishers and Horestein, 1985) has shown that the health of women, in particular, is impacted by hydroelectric dams. Future research on the Yali Falls Dam will examine if gender specific health impacts have occurred. While very significant in their impact, these results should not come as surprising. Even the smallest shocks to an ecosystem and/or economic system will have a large impact on the public health of people in the region. However, the situation presented in this paper which addresses cross-boundary issues, such as water rights and adverse public health effects, is complex. In fact, the effect of the Yali Falls Dam in Vietnam on Cambodians has the potential to severely diminish already strained relations between Cambodia and Vietnam. Therefore, all the stakeholders in the Yali Falls Dam project should be involved in the decision-making processes of the operation of the dam. Such an approach would create local participation in a democratic process of water rights and usage (Bruns et al., 2005). Furthermore, information could be provided to villagers so the effects of the operations of the dam could be known. For example, the dam operators could notify people downstream when water will be released. Thus, a democratic approach involving all the key stakeholders would ensure that all parties are heard and that all the information is publicly available. This type of process would enable the concerns of the villagers to be heard. Although the Yali Falls Dam has already been built and in operation for several years, the adverse effects of the dam can still be mitigated to limit the negative externalities on people in the region, particularly downstream. Ideally, any economic, environmental, and social impact assessment that would be conducted prior to the start of projects, such as the Yali Falls Dam, would also include a public health assessment. An impact assessment of a dam project only examines one aspect, typically either environmental or economics. However, a comprehensive analysis could provide important information on how to reduce the adverse effects of the dam and allow policy-makers the opportunities to understand the environmental, economic, social, and publichealth impacts of the Yali Falls Dam. Future research will attempt to develop this modeling tool. This information would provide useful data on the potential impacts of the construction of additional hydroelectric dams in the region. Acknowledgments The authors would like to thank the people of Phnom Kok Brao, Phnom Kok Lao, and Pi villages for their patience and hospitality. They are indebted to our survey assistants for all their effort during the research in the Ratanakiri Province. We would also like to thank the two anonymous reviewers for their insightful comments. Finally, they are also grateful to Professor Kozo Mayumi for helpful comments on an earlier draft. This paper presents work from “Poverty analysis and forecasting models: From econometric modeling to multi-scale integrated analysis with a fund-flow model” which is part of the research program at the Institute for Economic Forecasting-NIER, Romanian Academy. References Acreman, M.C., Farquharson, F.A.K., McCartney, M.P., Sullivan, C., Campbell, K., Hodgson, N., Morton, J., Smith, D., Birley, M., Knott, D., Lazenby, J., Wingfield, R., Barbier, E.B., 2000. Managed Flood Releases From Reservoirs: Issues and Guidance. Report to DFID and the World Commission on Dams. Centre for Ecology and Hydrology, Wallingford, UK. Adams, W., 2000. Downstream Impacts of Dams. University of Cambridge, UK. Contributing Paper, Thematic Review: Social Impacts of Large Dams Equity and Distributional Issues.

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