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
Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208, USA
b
Institute for Economic Forecasting-NIER, Romanian Academy Casa Academiei, Calea 13 Septembrie nr.13, Sector 5, 050711 Bucharest, Romania
a b s t r a c t 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 classication:
Q57
Q56
I15
O13
Keywords:
Ecological economics
Economic development
Public health
Hydroelectric dams
The need for energy due to economic and population pressure has resulted in a great expansion of hydroelectric
damprojects around the world, especially in Asia. These hydroelectric projects have resulted in considerable en-
vironmental, economic, and social damage. Typically, the economic developmentenvironmental degradation
dynamic has been examined. However, rarely has the economic development, environmental degradation, pub-
lic healthconnection been made. This paper, using primary data collectedfromhouseholdsurveys, 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.
1. Introduction
Increased population pressure and energy demand make access
to clean freshwater more difcult. 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 (Duo and Pande, 2007). Availability of
energy resources is compulsory for economic development projects,
such as the improvement of productive sectors of the economy, educa-
tion, healthcare, and water infrastructure. However, these hydroelectric
dams have caused massive displacement of people, impacted the eco-
system, destroyed arable land due to salination and water logging, and
altered crop patterns (Duo and Pande, 2007). Typically, the most
affected are the poorest of society, leaving them, among other negative
side-effects, vulnerable to infectious disease.
The Mekong River and its tributaries, which ow from China
throughLaos, Thailand, Vietnam, andCambodia are among the most im-
portant water bodies in Asia. The Se San River, which originates in the
Central Highlands of Vietnam, ows 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 ow of the Mekong River at Stung Treng (Fisheries Ofce,
Ratanakiri Province and NTFP, 2000; Halcrow, 1999; TERRA, 1999a),
and the Se San, Sre Pok, and Se Kong Rivers contribute 16.7% of the
ow 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 signicant
social and environmental impacts, such as the displacement of people
and a signicant drop in the sh stock in the region (Chen and Narim,
2013).
Ecological Economics 98 (2014) 8189
Corresponding author.
E-mail addresses: john.polimeni@acphs.edu (J.M. Polimeni), raluca_i@lycos.com
(R.I. Iorgulescu), ray.chandrasekara@acphs.edu (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
Contents lists available at ScienceDirect
Ecological Economics
j our nal homepage: www. el sevi er . com/ l ocat e/ ecol econ
The Vietnamese government startedthe constructionof the 720 MW
Yali Falls Dam on the Se San River in 1993. The reservoir of the dam
began lling up in 1998 (Fisheries Ofce, Ratanakiri Province and
NTFP, 2000) and was fully commissioned in 2000, although some ener-
gy was produced in early 2000 (Polimeni et al., 2011). The damis 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 HanoiHai Phong area and
the Ho Chi Minh City area, each with a large number of industrial
parks serving sectors suchas nance and banking, agriculture, construc-
tion, 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). There-
fore, a major priority for Vietnam is to produce enough energy to feed
their economic engine, as well as to provide electricity to rural house-
holds, of which approximately 50% do not have access to (Energy
Probe Foundation, 2008). Clearly, the Yali Falls Dam has had some pos-
itive 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
Ofce, 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 sh. Additionally, the
oodplain on which they live is a grazing area for their livestock and
prime land for growing their crops. The Se Sanis important for transpor-
tation, 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 proles to demonstrate the negative effects of reset-
tlement on households in the Nu River area. Moreover, the land down-
stream 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 indi-
viduals 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 im-
pact of the Yali Falls Dam on these households, as well as individuals,
was collected. While much of the research on hydroelectric dams focus-
es on their economic and environmental costs (Goldsmith andHildyard,
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. Section2 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), ood control, as well as increased recrea-
tional and commercial opportunities and travel. Negative externalities
include resettlement of the population (Scudder, 1981; Scudder and
Colson, 1982), human health impacts, declines in the sh stock, lower
quality and quantity of water downstream, and reduced economic
activity, particularly in rural communities. One of the major issues relat-
ed to dams is the changed hydrology and ecology of downstream eco-
systems, with the impact varying depending upon their purpose.
Barbier (2002) developed a model to illustrate howthe economic activ-
ities downstream of the dam in the HadejiaJama'are oodplain in
Nigeria, developed to divert water largely for irrigation purposes, are
affected by a reallocation of water upstream. He found that the hydrolo-
gy of the oodplain would be irreversibly altered, substantially affecting
the economic livelihoods of rural households living downstream.
Changes in the ecology of a oodplain affect vegetation (Attwell, 1970;
Sheppe, 1985), forests (Hughes, 1988), sh (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 benets and underestimate the
costs (Adams, 2000). The economic evaluation of dams generally do
not account for costs suchas the environmental, public health and social
costs since downstream communities suffer in a variety of ways that
require an evaluation beyond economic impact analysis (Adams,
2000; Mehta and Srinivasan, 1999). Dams impact the agriculture, sh-
ing, and the environment of downstream communities which in turn
affect the natural, nancial, 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 insti-
tutional 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 develop-
ment 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 communi-
ties 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 reser-
voir, causing the water to be unhealthy for household use. Other water
quality issues also result from reservoirs. Nitrates created in the reser-
voir could cause poisoning leading to cyanosis, anoxia, stomach and in-
testinal 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
82 J.M. Polimeni et al. / Ecological Economics 98 (2014) 8189
et al. (1997), Vercruysse et al. (1994), N'Goran et al. (1997), Brantly and
Ramsey (1998), and Lerer and Scudder (1999).
3. The Regional Inuence of the Yali Falls Dam
The Mekong River is one of the longest rivers in the world, origi-
nating in China and owing 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 ows through the Ratanakiri and
Stung Treng Provinces in Cambodia. The Se San River Basin has a drain-
age area of 17,100 km
2
(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 Ofce
and NTFP, 2000; Polimeni et al., 2011; Trandem, 2008). Also, the Se San
River has been identied 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 Damhas 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 uctuations, which have
caused both ooding and water shortages. Flooding during the rainy
season did occur prior to the construction of the Yali Falls Dam though
ooding today is much different. Now, oods occur regularly, are longer
in duration, and have higher water peaks which cause considerable
damage, particularly to agricultural crops, and large-scale erosion
(Fisheries Ofce, Ratanakiri Province and NTFP, 2000). The severity
of the ooding 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 hydrolog-
ical patterns during the dry season (Fisheries Ofce, 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 Ofce,
Ratanakiri Province and NTFP, 2000). The oods have resulted in lost
lives and the destruction of personal property such as homes, cropland,
and livestock (Trandem, 2008).
Similar ndings 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 down-
stream 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 sh has decreased considerably since the construction of
the dam. This decrease is important because sh is the main source of
protein for people in the region. In percentage terms, sh 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 shing-
dependent 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 sh habitat in the Mekong River watershed. Furthermore, shallow
water contributes to the death of sh and aquatic life that feed on larvae
that transmit malaria and typhoid fever.
The downstreamhealth impacts of dams are also serious (IUCN and
World Bank, 1997). However, there is limited literature on the inuence
of hydroelectric dams on the specic waterborne diseases that impact
human health such as those the villagers were surveyed about. More-
over, 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 hydrologi-
cal 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 fromhydroelec-
tric 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 PhnomKok Brao, PhnomKok 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 SanRiver, downstreamfromthe Yali Falls Dam. Therefore, the people
living inthese 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 fty 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
and41%female respondents, inPhnomKok Lao 57%male and43%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 be-
cause villagers keep precise oral health records passed down from gen-
eration 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 hydro-
electric dams have been built.
Anemia is typically caused by an iron deciency 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
83 J.M. Polimeni et al. / Ecological Economics 98 (2014) 8189
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 signicant escalation in cases of anemia as well, increas-
ing 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 ow 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 ve
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
to the ndings 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 oodplain (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 ex-
perienced the greatest percentage increase, 64.82%. Interestingly
enough, respondents from Phnom Kok Lao said that they did not have
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).
Table 1
Detailed public health impact survey results.
Disease Phnom Kok Brao Phnom Kok Lao Pi Total
Before After Before After Before After Before After
Respondent
Anemia 2.94% 26.47% 2.04% 33.33% 11.11% 53.70% 5.88% 39.26%
Arsenicosis 10.00% 69.70% 0.00% 40.82% 22.22% 87.04% 11.36% 65.67%
Cholera 12.12% 50.00% 14.29% 37.50% 27.78% 61.11% 18.52% 50.00%
Diarrhea 19.35% 79.41% 30.43% 74.47% 40.00% 77.78% 31.82% 76.87%
Worms 17.65% 52.94% 10.42% 23.91% 7.27% 30.19% 11.03% 33.83%
Encephalitis 9.68% 35.29% 13.64% 39.58% 10.91% 23.64% 11.54% 31.62%
Malaria 21.21% 45.45% 31.11% 46.94% 59.26% 74.55% 40.15% 57.35%
Typhoid 11.54% 38.46% 10.00% 39.02% 17.78% 53.19% 13.51% 44.74%
Family
Anemia 18.75% 43.75% 14.58% 31.91% 34.55% 61.82% 23.88% 47.01%
Arsenicosis 9.68% 70.97% 4.17% 63.27% 22.22% 83.02% 12.78% 72.93%
Cholera 12.12% 39.39% 20.41% 34.69% 38.89% 73.58% 34.65% 51.11%
Diarrhea 37.50% 75.00% 40.43% 76.60% 40.74% 84.91% 40.15% 79.23%
Worms 20.69% 64.52% 15.56% 41.30% 9.43% 32.73% 14.17% 42.75%
Encephalitis 15.63% 51.52% 13.64% 47.83% 7.41% 20.75% 11.54% 37.88%
Malaria 25.00% 65.63% 26.09% 60.87% 72.73% 72.73% 45.11% 66.67%
Typhoid 8.00% 54.17% 25.58% 53.66% 28.26% 51.11% 22.81% 52.73%
84 J.M. Polimeni et al. / Ecological Economics 98 (2014) 8189
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 sawcases of arsenicosis
increase greatly, slightly more than 60% from before the dam was built
until after. The households in eachof 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 particu-
larly prevalent in areas where clean drinking water and sufcient sani-
tation 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. Householdcases of cholera increasedthe most inPi, 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 ood protected regions such as those near dams. Given that cholera is
easily spread in regions where cleanwater is not available this nding is
not surprising considering the decrease in the quality of water resulting
fromthe operation of dams and is consistent with the ndings present-
ed here.
Survey respondents were asked about incidences of diarrhea, a
condition that is common for people that are exposed to and drink con-
taminated water. Diarrhea is especially severe for children, malnour-
ished 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 diar-
rhea. 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 down-
stream 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 infect-
ed with intestinal worms through contact with soil contaminated with
human feces froman infected person or by eating tainted food. Respon-
dents 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 Hydroelec-
tric 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 trans-
mitted to a human by an infected mosquito taking a blood-meal.
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% in-
crease, the largest of the three villages. Patz et al. (2005) found that hy-
droelectric dams contributed to the increase in cases of Japanese
encephalitis in Asia.
Malaria was the next disease respondents were asked about. Trans-
mission 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 expecta-
tions 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 in-
creased risk of malaria at both the damreservoir and near the irrigation
elds. 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 hydro-
electric 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 indi-
viduals 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 respon-
dents fromPi suffered fromthe 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 in-
creased 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 aroundthe Gilgel Gibe III hydroelec-
tric 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 im-
pact of the hydroelectric project on public health and water quantity/
quality and living conditions. The signicant changes in water quality,
quantity of water, and quantity of sh 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 dis-
eases considered are not directly caused by the damitself; 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
85 J.M. Polimeni et al. / Ecological Economics 98 (2014) 8189
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 sur-
prising 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 muchof their agricultural and sh production adversely
affected and food had to be obtained fromother suppliers. Annual med-
ical expenditures also represented a signicant 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 ndings from
the health index discussed earlier. Furthermore, the results presented
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 con-
structed 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 ood (Table 3). Without question, villagers suffered
through oods and droughts prior to the construction of the dam. How-
ever, since the dam has been built ooding no longer corresponds with
heavy rain as it lasts longer and is more severe. During the dry season,
ooding can occur when there is no rain and droughts are more severe
with water levels dropping signicantly (Fisheries Ofce 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 ood. More than 84% of the respondents
have experienced a ood. Once again, the least impacted village is Pi,
with three quarters of respondents experiencing a ood. The share of
respondents with ood 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
andservices, more than73%of households reducedtheir foodconsump-
tion, and more than 66% lost assets due to droughts and oods. 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 oods
affected this village the most for all four categories.
The village of Pi experienced the least impact from droughts while
from oods it had the least reduction in consumption of goods and
services and in food consumption.
Fig. 2. Snapshot of family health index.
Fig. 3. Snapshot of individual health index.
1
Money was reported in Cambodian riels and converted to US dollars. The exchange
rate was 4000 Cambodian Riels for every US$1. Fig. 4. Snapshot of income survey results.
86 J.M. Polimeni et al. / Ecological Economics 98 (2014) 8189
PhnomKok Brao hadthe 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 con-
sumption but only slightly. In regards to oods, 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 uctuations
in the water levels of the Se San River have caused signicant environ-
mental and socio-economic damage in Cambodia (Fisheries Ofce,
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 expe-
rienced different hydrological patterns from the other two villages,
due to its positioning farther upstream and before three more tribu-
taries met the Se San River. These results are consistent with the
ndings of Trandem (2008) and Fisheries Ofce, 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 conrm these ndings; 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 sh they caught, howtheir crops were affected
(Table 4), as well as their individual consumption of food and sh
(Table 5).
Both the number of sh 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 sh caught. The village of Phnom Kok Lao
is negatively impacted the most with nearly 96% of respondents stating
a Large Decrease in their sh catch.
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 sh 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 ooding, destroying
rice crops, farmlandfor growing vegetables, andsmaller shpopulations.
As expected, the decrease in agricultural production and the number
of sh caught has resulted in a large adverse impact on the food con-
sumption of respondents. Approximately 60% of all respondents in-
dicated 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 sh, respondents
were asked how their consumption of sh has changed since the Yali
Falls Dam was built. Over 90% of respondents suffered a decrease in
their consumption of sh, stating that their consumption of sh
Completely Changed (69.78%) or there was A Little Change (21.58%).
These results are not surprising since sh 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 Ofce, 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 down-
stream 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 condi-
tions 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 occur-
rences of each of these diseases increased substantially after the dam
was built, providing signicant 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 vulner-
ability 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 2
Income survey results.
Village Annual household
income (US $)
Annual food
expenditures (US $)
Annual medical
expenditures (US $)
Phnom Kok Brao $286 $136 $89
Phnom Kok Lao $388 $166 $46
Pi $185 $145 $29
Table 3
Previous experience of droughts and oods.
Phnom
Kok Brao
Phnom
Kok Lao
Pi Total
Experienced a drought 91.18% 91.84% 55.36% 76.98%
Experienced a ood 85.29% 93.88% 75.00% 84.17%
Drought
Lost income 76.47% 81.63% 56.00% 70.68%
Reduced consumption
of goods and services
70.59% 71.43% 44.00% 60.90%
Reduced food consumption 88.24% 89.80% 50.00% 74.44%
Lost assets 85.29% 71.43% 50.00% 66.92%
Flood
Lost income 61.76% 81.63% 66.07% 70.50%
Reduced consumption
of goods and services
58.82% 73.47% 57.14% 63.31%
Reduced food consumption 70.59% 83.33% 66.07% 73.19%
Lost assets 64.71% 81.25% 66.07% 71.01%
Table 4
Fish caught and crops grown survey results.
Phnom
Kok Brao
Phnom
Kok Lao
Pi Total
Fish caught Large decrease 81.82% 95.83% 86.54% 88.64%
Small decrease 18.18% 4.17% 13.46% 11.36%
Crops grown Large decrease 50.00% 48.57% 53.33% 51.43%
Small decrease 50.00% 51.43% 46.67% 48.57%
Table 5
Food and sh consumption survey results.
Phnom
Kok Brao
Phnom
Kok Lao
Pi Total
Food consumption Completely changed 35.29% 38.78% 30.36% 34.53%
A little change 29.41% 26.53% 21.43% 25.18%
No change 35.29% 34.69% 48.21% 40.29%
Fish consumption Completely changed 52.94% 75.51% 75.00% 69.78%
A little change 38.24% 20.41% 12.50% 21.58%
No change 8.82% 4.08% 12.50% 8.63%
87 J.M. Polimeni et al. / Ecological Economics 98 (2014) 8189
These ndings are important because of the use of primary data to
establish an association between the dam and changes in quality-of-
life, environmental and economic conditions, and public health. Fur-
thermore, as countries in the region move to build more hydroelectric
dams, this study can provide meaningful insight into the potential im-
pacts on the population living downstream. The literature (Polimeni
et al., 2008; Scudder, 1999; Mehta and Srinivasan, 1999; Srinivasan,
1997; Cernea, 1996; Burshers 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 specic
health impacts have occurred.
While very signicant in their impact, these results should not come
as surprising. Even the smallest shocks to an ecosystem and/or eco-
nomic 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 damcan 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 assess-
ment. An impact assessment of a damproject only examines one aspect,
typically either environmental or economics. However, a comprehen-
sive analysis could provide important information on how to reduce
the adverse effects of the dam and allow policy-makers the opportuni-
ties to understand the environmental, economic, social, and public-
health 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 hydro-
electric 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-ow model which is part of the research program at the
Institute for Economic Forecasting-NIER, Romanian Academy.
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