Public Disclosure Authorized Public Disclosure Authorized 10715 Environmental Hazards, Climate, and Health in Cambodia The Shield of Sanitation Sandra Aguilar-Gomez Sandra Baquie Paul Jacob Robyn Public Disclosure Authorized Public Disclosure Authorized Policy Research Working Paper Health, Nutrition and Population Global Practice March 2024 Policy Research Working Paper 10715 Abstract Environmental degradation is the largest public health challenge of the century and is likely to be exacerbated by climate change. This study undertakes a comprehensive examination of the health implications of environmental hazards in Cambodia, simultaneously addressing extreme temperatures, precipitation patterns, and air pollution. It leverages data from the Demographic and Health Surveys and satellite-derived metrics on temperature, precipitation, and fine particulate matter. The analysis identifies a positive association between temperature and the occurrence of diarrhea and cough among children and a nonlinear relationship between precipitation and these health outcomes. Furthermore, the study demonstrates that pollution significantly impacts cough incidence. To anticipate future trends, climate simulations are employed to forecast the incidence of child diarrhea in Cambodia under different climate and development scenarios. The projections indicate that diarrhea incidence could increase to 19 percent by 2040 without significant adaptation measures that would lessen the adverse impact of weather. For instance, the acceleration in toilet ownership over the last decade reduced diarrhea incidence by at least 1.2 to 1.4 percentage points. Nevertheless, the path ahead requires proactive efforts to improve sanitation and hygiene. The forecasts suggest that, without additional strategies to counter climate change’s adverse effects, only universal toilet ownership would contain the climate-driven increase in diarrhea incidence expected by 2040. This paper is a product of the Health, Nutrition and Population Global Practice. It is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world. Policy Research Working Papers are also posted on the Web at http://www.worldbank.org/prwp. The authors may be contacted at sbaquie@worldbank.org. The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent. Produced by the Research Support Team Environmental Hazards, Climate, and Health in Cambodia: The Shield of Sanitation Sandra Aguilar-Gomez∗ Sandra Baquie† Paul Jacob Robyn† Keywords: climate change, environmental health, pollution, Cambodia JEL Codes: Q54, I1, O53 ∗ Department of Economics, Universidad de los Andes. Email: s.aguilargomez@uniandes.edu.co World Bank. Corresponding authors. Email: sbaquie@worldbank.org The team is grateful for the excellent comments provided by Ajay Tandon, Marion Cros, Javier E. Baez, Katherine Anne Stapleton, Lander Bosch, Saroeun Bou, Stephen Geoffrey Dorey, and Ronald Upenyu Mutasa. Valentina Castilla-Gutierrez provided excellent research assistance. † 1 Introduction Over recent decades, the escalating climate crisis has become increasingly apparent. This crisis is characterized by extreme conditions such as a continuous rise in Earth’s temperature and extended periods of both rainfall and drought. Greenhouse gas emissions that cause climate change are part of a broader process of environmental degradation, generating unhealthy levels of air pollutants, including particulate matter. The repercussions of these hazards —extreme temperature, extreme rainfall, and hazardous air— on health outcomes, including disease spread and long-term outcomes, have been examined for some countries in the scientific literature, although their health impacts are often studied in isolation from one ano