THE APPROACH ADOPTED in developing the assessment technique presented in this report builds upon a study of household environmental problems in Accra in 1991 by the Department of Geography and Resource Development of the University of Ghana and the Stockholm Environment Institute. A three-step process was developed to enable the study team to produce a list of proxy environmental health indicators that reflects informed expert opinion in the Greater Accra Metropolitan Area. These steps include the development of a profile of “proxy” environmental health Indicators, the development of a method for weighting the indicators by the study team in consultation with a statistical expert, and informal consultations between the study team and an inter-sectoral network of environmental health experts to discuss and validate the indicators and weighting procedure. The group also developed a general set of indicators, appropriately weighted for application in the field.

The Introduction gives a background of environmental health issues and the context of the study, with some conceptual issues being discussed in relation to environment and health, and the case for “proxy” environmental health indicators being put forward. Chapter 2 gives a summary of the approach, giving a detailed profile of “proxy” environmental health indicators based on three major themes: sociodemographic conditions, environmental hazards, and major health problems that can be attributed to environmental hazards, which in effect organizes a preliminary set of indicators. The next step of developing a system for weighting them and combining them into an index is then discussed, with a methodology emerging as a result. In Chapter 3, the process and aims of consultation are outlined, a final standard list of weighted proxy indicators for field testing is developed and a list of key environment-related diseases, together with their symptoms for monitoring, is compiled. Section I of this chapter provides the background sociodemographic context to be observed; Section II, which is the most important for the model of rapid assessment developed, gives the environmental indicators/hazards desired, and Section III provides a listing of the most critical environment-related health problems in the metropolis and their symptoms. Chapter 4 discusses the application of the programme and the process of field testing, the results of the testing and the comparative nature of their research. In conclusion, the authors discuss the potential of this approach in urban environmental health management, as tools for public education and participation and as an adaptable method for use in other human settlements. Weaknesses of the rapid assessment method are also identified. Annex 1 provides contact details of those members of the network who participated in the scoring; Annexes 2 and 3 provide statistical information compiled in the case, whilst Annex 4 provides statistical details and indicator information of the four settlements used in the case in question.