15.9 News Feat Jakarta NEW MH 12/9/05 3:11 PM Page 312

NEWS FEATURE NATURE|Vol 437|15 September 2005

J. MARSHALL J. Megacity, mega mess… The creaking infrastructure of Indonesia’s capital is overwhelmed by people, vehicles and pollution. As urbanization gathers pace across the developing world, Jessica Marshall visits Jakarta to witness its stomach-churning consequences.

n the streets of this city, you can pick lived in Jakarta for more than two decades. 23 kilometres that can take almost two hours. your poison. Clouds of black and With a population of about 12 million — Some two million people commute into the blue-white smoke billow from the rising to 21 million if you include the wider city each day. From a ninth floor window, Oexhaust pipes of buses and motor- conurbation of surrounding towns — Jakarta Haryanto and I look down on a highway on cycles. Thirteen rivers flow northwards to is already one of the world’s largest urban which stalled head- and tail-lights extend as far Jakarta Bay, each a slurry of human waste and areas. The population of this ‘megacity’ is pre- as we can see in either direction. garbage. Scavengers pick through the city’s dicted to grow by a third in the next decade, “Jakarta is getting worse,” says Haryanto. rubbish looking for recyclable plastic and part of a global trend towards urbanization. By Traffic is responsible for more than 70% of the cardboard. What they can’t sell, they burn — 2007, the balance of the world’s population will nitrogen oxides and particulate matter emitted batteries, rubber shoes and all. Rising smoke tip to give a majority residing in towns and into the city’s air2. Haryanto is frustrated that from burning garbage wafts between the city’s cities1. Most of the fastest-growing cities are in the government is not doing more to monitor skyscrapers. developing countries (see Chart, opposite). So and reduce the thick, nostril-burning smog, or Pollution in Indonesia’s capital, Jakarta, is Jakarta may provide a pointer to a future in to characterize its effects on health. “The Min- easy to see, and the causes are not hard to pin- which urban pollution becomes a main player istry of Health doesn’t care,” he laments, noting point. But the effects on its inhabitants’ well- in the disease burden of the developing world. that it is dissolving its subdirectorate dealing being are harder to quantify. Official data are “The urban physical environment is going to with air pollution. scant, studies of environmental health are few, represent a major health threat,” says David The limited available data paint an ugly pic- and those worst affected — the urban poor — Vlahov, an epidemiologist at Columbia Uni- ture. Respiratory inflammation accounts for are the least likely to be included in city versity in New York, and president of the Inter- 12.6% of deaths in Jakarta, twice the propor- records. Environmental scientists say that national Society for Urban Health. tion in the rest of the country3. And estimates much could be done to improve living condi- based on reported pollution levels attribute tions for those most at risk from pollution. But Gridlock more than a million asthma attacks and sev- without a stronger emphasis on research into In Jakarta, air quality is already at crisis point. eral thousand premature deaths per year in the urban public health, and the political will to To get an overview, I meet Budi Haryanto in city to airborne soot and other particles2. act on its findings, experts are pessimistic his wife’s office building on a Friday evening in Aside from the sheer volume of traffic, the about making rapid progress. “In the near late July. Haryanto, a professor of public health main problems are poor fuel quality, and a fail- future, there will be more environmental at the University of Indonesia, is waiting for ure to equip vehicles with emissions-control problems,” says James Woodcock, a waste- the worst of the traffic to subside before dri- technologies such as catalytic converters. water consultant to the World Bank who has ving home to a Jakarta suburb, a journey of There have been some small steps forward:

NATURE|Vol 437|15 September 2005 NEWS FEATURE

before 2001, many vehicles in Jakarta MEGACITIES WITH MORE THAN used leaded fuel. At that time, about 10 MILLION PEOPLE 35% of Jakartan elementary school (population in millions) MARSHALL J. SOURCE: REF. 1 REF. SOURCE: students had levels of lead in their blood above the World Health Orga- 1975 nization (WHO) safety guideline of Tokyo, Japan 26.6 10 micrograms per decilitre4. This New York, US 15.9 Shanghai, China 11.4 has now dropped to less than 3%, Mexico City, Mexico 10.7 according to Haryanto’s preliminary measurements. But he is concerned that the compound that replaced lead 2003 creates emissions of benzene, a Tokyo, Japan 35.0 known carcinogen. “I suggested to Mexico City, Mexico 18.7 New York, US 18.3 the government that they monitor São Paulo, Brazil 17.9 benzene in the air,” says Haryanto. Mumbai, India 17.4 “But they said: ‘No funding’.” Delhi, India 14.1 Although Jakarta’s horrendous air Calcutta, India 13.8 quality is evident from a high-rise Buenos Aires, Argentina 13.0 Shanghai, China 12.8 window, experiencing the city’s prob- Jakarta, Indonesia 12.3 lems with water pollution and solid Los Angeles, US 12.0 waste requires an excursion to street Dhaka, Bangladesh 11.6 level. Kampung Kandang, a north Osaka-Kobe, Japan 11.2 Rio de Janeiro, Brazil 11.2 Scavengers scale the massive landfill at Bantar Jakartan slum, faces a river and backs Karachi, Pakistan 11.1 on to a swamp. I stand on the river- Beijing, China 10.8 Gebang seeking things they can recycle and sell. bank, watching the eerily still water Cairo, Egypt 10.8 slip by. A film of grease coats the sur- Moscow, Russian Federation 10.5 with faecal coliform bacteria. What’s more, face, broken by plastic bags and other Metro Manila, Philippines 10.4 truck drivers hired to pump the tanks often Lagos, Nigeria 10.1 detritus. To avoid paying for garbage dump their loads, untreated, into waterways. collection — which is intermittent, Solid-waste management is similarly anyway — people drop their rubbish 2015 chaotic. The city’s Bantar Gebang landfill is a in the river. Downstream, a barrage of Tokyo, Japan 36.2 case in point — soil is applied only every few trash has collected on an obstacle. The Mumbai, India 22.6 weeks and leachate is inadequately treated, Delhi, India 20.9 sulphurous smell is overpowering. Mexico City, Mexico 20.6 says Widhi Handoko, an instructor in solid- Next to me, a man flings a wokful of São Paulo, Brazil 20.0 waste management at the Ministry of Public oil into the water. New York, US 19.7 Works. An army of 6,000 scavengers works the Dhaka, Bangladesh 17.9 mountains of garbage. Like post-apocalyptic Dirty old town Jakarta, Indonesia 17.5 sherpas, clad in rubber boots and with wicker Lagos, Nigeria 17.0 Kampung Kandang is typical of the Calcutta, India 16.8 baskets strapped to their backs, they travel in illegal squatter settlements that line Karachi, Pakistan 16.2 the wake of bulldozers, plucking recyclables rivers and railway tracks throughout Buenos Aires, Argentina 14.6 from the stinking heap. Jakarta, or sit tucked beneath the Cairo, Egypt 13.1 city’s flyovers. It is a microcosm of Los Angeles, US 12.9 Heaps of trouble Shanghai, China 12.7 the city’s problems with water, Metro Manila, Philippines 12.6 Although Bantar Gebang is nearing the end of sewage and solid waste. To the rear of Rio de Janeiro, Brazil 12.4 its 20-year design lifetime, its representatives the settlement, I watch a chicken in Osaka-Kobe, Japan 11.4 say that there is no option but to keep it open the swamp, scratching on an undu- Istanbul, Turkey 11.3 while the city seeks alternatives. A private Beijing, China 11.1 lating surface of garbage, oblivious Moscow, Russian Federation 10.9 company has developed land for a new waste- that it isn’t on solid ground. The Paris, France 10.0 disposal site, but local residents have protested communal water tap opens into a loudly. The municipal government recently bucket that hangs right above the swamp water have led many residents to tap into ground- announced it will build four incinerators. But that residents use as a latrine. Nearby, an water beneath the city. As a result, salt water is this is an expensive option, and may cause elderly woman wades in the water, collecting seeping into the aquifer, and subsidence has other environmental and health hazards. swamp plants to sell for wicker. caused parts of the city to sink by a metre or so Many people in Jakarta’s poor neighbour- The public toilet in Kampung Kandang over the past decade. hoods say their health is fine, despite the filth costs up to US$0.10 to use — no small sum for Garbage-clogged waterways and the fact that surrounds them. But experts believe that a family living on about US$2.50 a day. “So that about 40% of Jakarta now lies below sea poor sanitation is a serious health issue. Min- people just do it everywhere,” says community level conspire to cause annual floods. These hit istry of Health records show gastroenteritis is by leader Miftahul Falah. Water pressure from the poor, low-lying north of the city particu- far the most frequent disease diagnosis at local the tap is low, Falah adds, so the villagers rely larly hard, bringing a litany of health problems. clinics and hospitals. The incidence of dengue on water vendors, who sell 60 litres of water for “If the flood lasts a long time, maybe three fever has also exploded in recent years. “It is not about US$0.20 — several times what wealthy days,” says Falah, “people start to get sick with normally an urban health issue,” says Jan Speets, Jakartans pay for water from a utility company. diarrhoea and rashes.” an adviser with the WHO in Jakarta. But flood- Even for legal residents, supplies are limited. Less than 3% of the 1.3 million cubic metres ing and the piles of rubbish throughout the city Piped water reaches less than 60% of Jakartans, of sewage generated each day in greater Jakarta have created breeding opportunities for the and is safe for drinking only after being boiled. reaches a treatment plant. More than a million mosquitoes that spread the disease. About half of the supply is lost because of ille- septic tanks are buried beneath the city, and Experts in public health urge more and gal connections and leaks. Water shortages these have contaminated most of the city’s wells better research to quantify the health problems

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caused by poor sanitation and waste management. “There are no real studies available to reveal what’s going on in the city,” complains J. MARSHALL J. Jaap van Dissel, an infectious-disease special- ist at the Leiden University Medical Center in the Netherlands. His recent investigation of the food- and water-borne diseases typhoid and paratyphoid in east Jakarta found that doctors over-diagnose the former by up to ten- fold because blood cultures that confirm the infection are not normally done5. This illus- trates the need to improve clinical diagnoses before attempting potentially expensive cam- paigns to address problems with public health, says van Dissel: “It’s important to know your enemies before you start shooting.” Many of Jakarta’s problems are shared by other megacities in the developing world. Most have large illegal shanty towns, and face similar issues with pollution and waste management. For instance, recent flooding in and around Mumbai in India, attributed in part to clogged drainage throughout the city, killed more than a thousand people, and brought water-borne diseases in its wake.

Scrubbing up Some developing-world megacities have taken steps to clean themselves up. Mexico City’s appalling smog is now beginning to clear thanks to the introduction of catalytic converters and improvements in fuel quality6. And the Indian capital of New Delhi is experiencing similar gains after converting its public transport to run on compressed natural gas. So what are the chances of Jakarta following suit? Experts say that solving the city’s problems with environmental health will require genuine political commitment to pay for Kampung Kandang’s communal tap opens into a bucket by the trash-choked swamp that doubles as a toilet. research and monitoring to characterize the problems, and spending on the infrastructure Jakarta, defends the municipal government’s more immediate priorities than reducing pol- needed to solve them. Given a legacy of official record, pointing to developments such as a lution. “Income is still low,” says Basah Her- corruption, and the continuing hangover from recently built busway, which will later incor- nowo, director of settlements and housing at the Asian economic crisis of 1997, the obsta- porate new buses running on compressed nat- the National Development Planning Agency, cles are formidable — public spending on ural gas. Tasmaya blames continuing problems an arm of the central government. “People do infrastructure is running at 80% less than dur- with environmental health on insufficient not care about environmental quality. They are ing the heady days of the mid-1990s, when budgets and limits to the city government’s still thinking about their stomachs.” But prob- Asia’s economy was booming7. authority — rivers, he notes, remain the lems such as flooding and waste mismanage- So far, politicians seem more interested responsibility of the national government. ment are getting so bad that people are in sweeping pollution under the carpet, “Jakarta as a capital city needs special support beginning to call for change. As democracy rather than tackling the problems it causes from the central government,” Tasmaya con- takes root, environmental health may slowly head-on. After the WHO labelled Jakarta the cludes. “The infrastructure must be good move up the list of political priorities. “In the world’s third most polluted metropolis in the enough so that people who come here for busi- end,” Woodcock says, “I feel optimistic that early 1990s, air-quality monitoring equipment ness, tourism and investment can be served.” there will be progress.” ■ was moved to residential areas with lower Foreign specialists say that significant Jessica Marshall is a science writer currently levels of pollution. progress could be made if existing environ- travelling in Asia. Ritola Tasmaya, secretary to the governor of mental regulations were properly enforced. 1. World Urbanization Prospects: The 2003 Revision (United “It’s very difficult for a government that’s Nations Department of Economic and Social Affairs, New known to be corrupt to enforce laws,” says York, 2004). “A film of grease coats the river’s 2. Integrated Vehicle Emission Reduction Strategy for Greater Woodcock. But the good news is that, after Jakarta, Indonesia (Asian Development Bank, Jakarta, 2002). surface, broken by plastic bags and years of dictatorship and corruption, Indone- 3. Indonesia Environment Monitor 2003 (World Bank, Jakarta, sia is slowly becoming more democratic. Last 2003). other detritus. To avoid paying for 4. Albalak, R. et al. Sci. Total Environ. 301, 75–85 (2003). garbage collection people drop year, the country gained its first directly 5. Vollaard. A. M. et al. J. Am. Med. Assoc. 291, 2607–2615 elected president, Susilo Bambang Yudhoy- (2004). their rubbish in the river. The ono. And 2007 will see the first direct election 6. Molina, M. J. & Molina, L. T. J. Air Waste Manage. Assoc. 54, 644–680 (2004). sulphurous smell is overpowering.” for the governor of Jakarta. 7. Averting an Infrastructure Crisis: A Framework for Policy and For now, many of the city’s residents have Action (World Bank, Jakarta, 2004).