Public Health. 2011 Mar;125(3):157-64.
Monetary burden of health impacts of air pollution in Mumbai, India: Implications for public health policy.
Patankar AM, Trivedi PL. K.J. Somaiya Institute of Management Studies and Research, Vidyavihar (East), Mumbai 400077, India.
OBJECTIVES: Mumbai, a mega city with a population of more than 12 million, is experiencing acute air pollution due to commercial activity, a boom in construction and vehicular traffic. This study was undertaken to investigate the link between air pollution and health impacts for Mumbai, and estimate the monetary burden of these impacts.
STUDY DESIGN: Cross-sectional data were subjected to logistic regression to analyse the link between air pollution and health impacts, and the cost of illness approach was used to measure the monetary burden of these impacts.
METHODS: Data collected by the Environmental Pollution Research Centre at King Edward Memorial Hospital in Mumbai were analysed using logistic regression toinvestigate the link between air pollution and morbidity impacts. The monetary burden of morbidity was estimated through the cost of illness approach. For this purpose, information on treatment costs and foregone earnings due to illness was obtained through the household survey and interviews with medical practitioners.
RESULTS: Particulate matter (PM(10)) and nitrogen dioxide (NO(2)) emerged as the critical pollutants for a range of health impacts, including symptoms such as cough, breathlessness, wheezing and cold, and illnesses such as allergic rhinitis and chronic obstructive pulmonary disease (COPD). This study developed the concentration-response coefficients for these health impacts. The total monetary burden of these impacts, including personal burden, government expenditure and societal cost, is estimated at 4522.96 million Indian Rupees (INR) or US$ 113.08 million for a 50-μg/m(3) increase in PM(10), and INR 8723.59 million or US$ 218.10 million for a similar increase in NO(2).
CONCLUSIONS: The estimated monetary burden of health impacts associated with air pollution in Mumbai mainly comprises out-of-pocket expenses of city residents. These expenses form a sizable proportion of the annual income of individuals, particularly those belonging to poor households. These findings have implications for public health policy, particularly accessibility and affordability of health care for poor households in Mumbai. The study provides a rationale for strengthening the public health services in the city to make them more accessible to poor households, especially those living in the slums of Mumbai.
MONGOLIA: ULAANBAATAR GRAPPLES WITH SMOG PROBLEM
Mongolia calls itself the land of blue sky, but for seven long months each year, a thick cloud of smog hangs over the capital, Ulaanbaatar. Seeking to improve the quality of life for the city’s approximately 1 million inhabitants, local bankers and development organizations are striving to combat pollution at its main source – suburban family homes.
From October to April each year, 60 percent of Ulaanbaatar‘s air pollution is generated by residents of the city’s sprawling ger districts, according to World Bank data. These residential areas on the outskirts of Ulaanbaatar are home to an estimated 150,000 households, with most living in traditional Mongolian gers, also known as yurts, and single-family homes that can resemble log cabins. These neighborhoods are not linked to the city’s central system that heats apartments and office buildings. Thus, most families in the ger districts burn a combination of wood and coal for heating and cooking. The poorest burn tires, trash, and whatever else they can find to stay warm during Mongolia’s frigid winters.
Coal-fired ger stoves release high levels of ash and other particulate matter (PM). When inhaled, these particles can settle in the lungs and respiratory tract and cause health problems. At two to 10 times above Mongolian and international air quality standards, Ulaanbaatar’s PM rates are among the worst in the world, according to a December 2009 World Bank report. The Asian Development Bank (ADB) estimates that health costs related to this air pollution account for as much as 4 percent of Mongolia’s GDP.
At the government’s urging, several major development organizations, including the World Bank and GTZ, the development arm of the German government, joined by Mongolian institutions, including micro-finance lender Xac Bank, have launched a project to improve ger stove designs. The aim is to make new stoves widely available, thereby reducing fuel consumption and emissions.
In the past, similar programs have met with mixed success. Some fuel-efficient stoves required specific fuel types; those fuels were often expensive or subject to unreliable availability. Others simply were not an improvement. “In 2006, 2007, there were not good stoves on the market,” says Ruth Erlbeck, GTZ’s Integrated Urban Development Program Manager.
GTZ developed a new ger stove model, which includes insulating bricks to retain heat – and thus use less fuel – and two air intake channels to raise the combustion temperature and cut emissions. The stoves can burn all types of fuel, even high quality semi-coke coal.
Last year, Xac Bank adopted the fifth generation of GTZ’s stove design for an eco-loan program. Xac Bank and GTZ claim that the stove cuts fuel use by more than 50 percent, although customer feedback indicates a less stellar performance, admits Matthew Kuzio, an American who works on the project in Xac Bank’s consumer banking department. “Most [customers] are saying it’s a 30 to 40 percent reduction of fuel,” he told EurasiaNet.org.
A traditional stove can use up 40 percent of a family’s monthly income in winter, according to Xac Bank estimates. Less fuel used means less spending. Even so, high consumer costs appear to be hindering the spread of the improved stoves, which cost 152,000 tugrik (approximately $110). GTZ’s Erlbeck suggested that many Mongolians cannot afford the new stoves.
“The people who are creating the mass of the pollution are [living] in poverty,” added Munkhbaatar Tsagaadai, a Xac Bank product officer.
Proponents of the fuel-efficient stoves are now searching for ways to improve distribution. Xac Bank maintains that its eco-loan borrowers who receive their loans and buy their stoves directly from bank branches save money from reduced fuel consumption, even while re-paying the loan.
The bank’s sales pitch does not focus on the environmental benefits. “We don’t even talk about the environment – just money and warmth,” says Kuzio.
But the environmental benefits nevertheless help the bank finance the program: Xac sells carbon credits based on stove sales on the voluntary carbon offset market via an American company called MicroEnergy Credits.
Only a few hundred families have obtained loans for the stoves, along with other eco-products, from Xac Bank since the lending program began last December. The bank and GTZ officials have opposing views on how to get enough stoves into Ulaanbaatar’s ger districts to make an environmental difference. GTZ’s Erlbeck says a subsidy program is necessary to cut consumer costs to reasonable levels; Xac Bank’s Kuzio argues that NGO programs often end before they become sustainable.
Despite the differences, both institutions are optimistic that progress can be made, in part because $30 million in Mongolia’s Millennium Challenge Account is earmarked for clean energy initiatives over the next three years. “We can solve the ger problem in two years if donors work together,” says Erlbeck. “The problem is manageable.”
The chances of success are greater if the people creating the problem start to see themselves as a viable part of the solution as well, says Gomb, a 76-year-old retired finance administrator. After purchasing a fuel-efficient stove with a Xac Bank eco-loan, he seemed pleased that his ger, located far from the city center, was warmer and less smoky. And he welcomed the fact that he was saving money on fuel. “Individuals need to be responsible for air pollution,” he said.
HEALTH-BRAZIL: When the City Makes You Sick
RIO DE JANEIRO, Feb 22 (IPS) – Limiting your cholesterol through diet may not be enough to maintain cardiovascular health in polluted cities like São Paulo in Brazil: the particulates suspended in the air alter the molecular composition of LDL, popularly known as “bad cholesterol,” making it even more dangerous.
The structure of LDL (low density lipoprotein) facilitates the accumulation of fat in the arteries, in other words, arteriosclerosis. This process ultimately restricts blood flow and can damage vital organs like the heart and brain.
The study that confirmed this risk is the doctoral thesis of biomedical scientist Sandra Castro Soares, of the University of São Paulo’s medical school. The research was conducted using mice. But for the first time they were placed in the real environment, breathing the same air as humans, near a busy avenue in this densely populated city in southern Brazil.
One group of mice was exposed to smog on the streets, which comes mainly from vehicle exhaust, during their first four months of life – equivalent to 40 human years. Another group of mice was kept in chambers with filtered air.
The first group ended the period with symptoms like thickened arterial walls, altered LDL, and production of antibodies to fight that change – all of which are indicators of a higher risk of heart attack.
The problem lies with the microparticulates that “cross the nasal and pulmonary barriers, entering the blood system,” Soares explained in an interview with Tierramérica.
“They don’t change the quantity of fat, but rather its quality” of adhering to the artery walls, she said. The change attracts more antibodies, which in turn attract more LDL, in a vicious circle that aggravates the problem.
In the last few decades, São Paulo has cut in half the quantity of polluting particulates in the city air.
But the research revealed that even with the improvement, which meets the standard recommended by the World Health Organisation of less than 50 micrograms of particulate per cubic metre, the air is not clean enough, said Lucía García, who advised Soares on her thesis in the air pollution lab at the university.
The particulates are oxidants, and oxidised LDL intensifies arteriosclerosis, increasing vascular health risks for those who live in the world’s big cities. Even exercising, such as jogging, in polluted areas can be very bad for your health, García said.
In fact, there are many recent studies in São Paulo that reveal numerous and varied effects of urban pollution: more girls are born than boys, there are more premature births and underweight newborns, male infertility is on the rise, and deaths from respiratory illnesses are increasing. Childhood cancer and hypothyroidism are other possible consequences.
Low birth weight is not just a matter of size, but means “a less mature foetus,” with organs that are not fully developed, which can lead to future health problems or premature death, according to Dr. Paulo Saldiva, who coordinates the University of São Paulo’s (USP) air pollution lab.
The USP is today “among the five universities in the world producing the most knowledge” about the links between health and the environment, says Saldiva proudly, though he laments that the findings have had little influence on public policy in Brazil.
Air pollution as a serious public health matter has so far failed to mobilise the health authorities, who are more concerned about fighting infectious diseases like H1N1 influenza (swine flu), HIV/AIDS, and dengue, he said.
Furthermore, environmental officials and activists pay little attention to the relationship between the environment and human health, he added.
In contrast, the tobacco industry is apparently content with the conclusions about the effects of urban air pollution, because they can use them to play down the health effects of smoking, like lung cancer. But in any case, “cigarettes are worse for your health than smog,” the researcher stressed.
The problem is that while tobacco affects only those who decide to smoke or live with smokers, nobody can escape air pollution, Saldiva said. The poor are the most vulnerable to the risks because they travel for hours on buses on congested streets to get to their jobs, while the wealthy have their own enclosed cars with air conditioning, he pointed out.
Social inequalities compound other environmental injustices, given that the poorest of the poor live in unsuitable areas, vulnerable to floods and landslides, with a lack of clean water and heavy pollution, said Saldiva.
The situation is getting worse in São Paulo, where more cars are added each day to the six million vehicles circulating on the metropolitan area’s streets. This slows down traffic and forces people to breathe the polluted air for longer periods, increasing the risk of contracting one of the many pollution related diseases, he said.
The USP air pollution lab research is focusing now on studying the effects on people who spend a great deal of time in the more polluted areas of São Paulo, such as traffic controllers at the busiest intersections.
Particulate matter and “perhaps ozone” are the elements of greatest concern in terms of urban health, said Saldiva.
(AP) Researchers for the first time have linked air pollution exposure before birth with lower IQ scores in childhood, bolstering evidence that smog may harm the developing brain.
The results are in a study of 249 children of New York City women who wore backpack air monitors for 48 hours during the last few months of pregnancy. They lived in mostly low-income neighborhoods in northern Manhattan and the South Bronx. They had varying levels of exposure to typical kinds of urban air pollution, mostly from car, bus and truck exhaust.
At age 5, before starting school, the children were given IQ tests. Those exposed to the most pollution before birth scored on average four to five points lower than children with less exposure.
That’s a big enough difference that it could affect children’s performance in school, said Frederica Perera, the study’s lead author and director of the Columbia Center for Children’s Environmental Health.
Dr. Michael Msall, a University of Chicago pediatrician not involved in the research, said the study doesn’t mean that children living in congested cities “aren’t going to learn to read and write and spell.”
But it does suggest that you don’t have to live right next door to a belching factory to face pollution health risks, and that there may be more dangers from typical urban air pollution than previously thought, he said.
“We are learning more and more about low-dose exposure and how things we take for granted may not be a free ride,” he said.
While future research is needed to confirm the new results, the findings suggest exposure to air pollution before birth could have the same harmful effects on the developing brain as exposure to lead, said Patrick Breysse, an environmental health specialist at Johns Hopkins’ school of public health.
And along with other environmental harms and disadvantages low-income children are exposed to, it could help explain why they often do worse academically than children from wealthier families, Breysse said.
“It’s a profound observation,” he said. “This paper is going to open a lot of eyes.”
The study in the August edition of Pediatrics was released Monday.
In earlier research, involving some of the same children and others, Perera linked prenatal exposure to air pollution with genetic abnormalities at birth that could increase risks for cancer; smaller newborn head size and reduced birth weight. Her research team also has linked it with developmental delays at age 3 and with children’s asthma.
The researchers studied pollutants that can cross the placenta and are known scientifically as polycyclic aromatic hydrocarbons. Main sources include vehicle exhaust and factory emissions. Tobacco smoke is another source, but mothers in the study were nonsmokers.
A total of 140 study children, 56 percent, were in the high exposure group. That means their mothers likely lived close to heavily congested streets, bus depots and other typical sources of city air pollution; the researchers are still examining data to confirm that, Perera said. The mothers were black or Dominican-American; the results likely apply to other groups, researchers said.
The researchers took into account other factors that could influence IQ, including secondhand smoke exposure, the home learning environment and air pollution exposure after birth, and still found a strong influence from prenatal exposure, Perera said.
Dr. Robert Geller, an Emory University pediatrician and toxicologist, said the study can’t completely rule out that pollution exposure during early childhood might have contributed. He also noted fewer mothers in the high exposure group had graduated from high school. While that might also have contributed to the high-dose children’s lower IQ scores, the study still provides compelling evidence implicating prenatal pollution exposure that should prompt additional studies, Geller said.
The researchers said they plan to continuing monitoring and testing the children to learn whether school performance is affected and if there are any additional long-term effects.
Major Cities in Africa are grappling with monumental challenges that are placing hurdles in the move towards green economy.
Rapid industrialization and population growth in these Cities has constrained the ability to cope with high levels of air and water pollution, hence the slow pace in greening these cities.
A panel of experts roundtable held at the ongoing UNEP Governing Council meeting in Nairobi noted that Cities are critical in catalyzing the move towards low carbon economy in Africa.
However, this can only be made possible through increased investments, development of sound policies and political goodwill, required to raise the bar in limiting greenhouse gas emissions in Africa’s burgeoning cities.
Angela Cropper, UNEP Deputy Executive Director noted that Cities presents huge potential in realization of green goals among African Countries” if only authorities move urgently to tackle basic challenges revolving around poor infrastructure, high levels of pollution and overstretched capacity of basic amenities such as water and sanitation to meet growing population.”
She reiterated that Cities are the next frontier for greening the planet and Africa must capture this opportunity by scaling up efforts that would add impetus on the move towards low carbon economy. Cropper observed that one half of the total global population live in Cities.
“African Cities are the new frontiers for industrial growth in the light of influx of rural population that have moved to the cities in search of better livelihoods.”
She says As a result, informal settlements have mushroomed in these Cities. Poor urban planning and poverty has created setbacks in efforts to restore ecological health in the Cities.
For Cities in Africa to attain green goals, greater efforts must be devoted towards improved solid and liquid waste management, as well as construction of ecofriendly low cost houses, says. CropperCities emit 75% of carbon dioxide in the atmosphere.
In Africa, Cities are responsible for atmospheric pollution whose ripple effects are being felt in the rural areas as evidenced by rising health and ecological disasters.
Africa governments must therefore invest in innovative but less costly technologies to curb greenhouse gas emissions in major Cities; this is according to Sylvie Lemmet, Director, UNEP Division for Technology, Industry and Economics Lemmet contends that African Cities can be transformed to boost their capacity in greening the economy.
“This can be realized through engaging the citizens, private sector and civic authorities in the application of green technologies while developing physical infrastructure such as housing, energy, water and sanitation”.
She said mutual partnership among these key stakeholders can assist in development of low cost houses fitted with solar panels. “Ecosanitation projects, recycling of liquid and solid waste are critical in development of renewable energy in these cities”, she says.
The Mayor of Entebbe, Stephen Kabuye reiterated that Africa Cities can provide the required impetus to green the Countries` economies.
“This can be realized through prudent use of natural resources to meet the demand on the population and maintain ecological balance”, he says.
Kabuye notes that high population growth has exerted pressure on Lake Victoria natural resources and is as well responsible for pollution on the Worlds second largest fresh water body. “Uganda government has therefore imposed a ban on illegal fishing in the lake”, says Kabuye.
The government of Uganda is assisting communities living in cities and Municipalities adjacent to Lake Victoria to implement pollution control programmes.
“The government is encouraging energy efficiency by helping communities acquire energy saving stoves to minimize firewood use. Other measures include promotion of renewable energy such as solar and wind”, says Kabuye.
Recycling of solid and liquid waste at the local level to curb pollution is being encouraged. Entebbe Municipality is promoting use of broken bottles in security fences. Cattle, fish bones and food peelings are being used to manufacture animal feed, he adds.
MEXICO CITY (AP) — Mexicans would live an average of two months longer if they breathed cleaner air, Harvard researchers conclude in a study published Monday. The study found that some 7,600 people’s lives were cut short each year by diseases related to air pollution between 2001-2005, representing about 1.6 percent of annual deaths in Mexico.
The highest proportion of those deaths — 38 percent — were in Mexico City, a mountain-ringed valley long known for its dense layer of smog.
Mexico’s average life expectancy — 72.3 years for men and 77.8 for women — would be longer by 2.4 months if urban air quality were improved, according to the study published in Proceedings of the National Academy of Sciences.
The researchers — Gretchen Stevens, Rodrigo Dias and Majid Ezzati of the Harvard Initiative for Global Health — used death records and air quality monitoring data to estimate the number of people who died from lung cancer, cardiopulmonary diseases, respiratory infections and other illnesses as a result of breathing heavily polluted air. Then they estimated what Mexico’s average life expectancy rate would be if those people had not died early.
The researchers also studied the effect on mortality rates from the use of solid fuels, like coal and wood burning, and from unsafe water sanitation in Mexican homes.