HEALTH IMPACT OF AIR QUALITY MANAGEMENT EFFORTS

DESIREE M. NARVAEZ, MD, MPHDEPARTMENT OF HEALTHMANILA, PHILIPPINES

Air pollution and sperm cells Czech Republic: 35 young men exposed to high air

pollution due to coal burning power stations and fossil fuels; in 2 years had sperm examined in terms of shape, number, motility, damage…

Significant association between exposure to periods of high air pollution ( at or above the US air quality standards) and the percentage of sperm with DNA fragmentation---

Potentially lead to birth defects or miscarriages Chemicals in air that can cause damage to human DNA ( Czech Research Institute and US EPA)

Save the sperm cell…Prevent birth defects or miscarriages…Fight air pollution!

Public Health Monitoring of the Metro Manila Air Quality Improvement Sector

Development ProgramADB - WHO - DOH – STUDY

2002-2004

3 COMPONENTS:Health Risk AssessmentEpidemiological StudyHealth Risk Perception

Attributable number of cases = exposure-response coefficient x excess exposure level x exposed population xbaseline mortality rates

Exposure-response coefficients: from time series studies Morbidity – Kunzli et al (US/Eu) Mortality – Bangkok study

Type of Hospital Admissions

Admission Rate

Attributable Cases

Respiratory 1156 20

Cardiovascular 211 4

Estimated number of hospital admissions per million population in excess of 10 ug/m3 PM, Metro Manila, 2002

Particulate matter (PM10 and PM2.5) and trophospheric ozone are of serious concern in Metro Manila.

• Long term PM10 concentrations likely to violate National Air Quality (NAQ) guideline of 60 µg/m3.

• Long and short-term PM2.5 levels may be unhealthy for the general public.

• Ozone exceeds short-term guideline value

Impact on mortality by 10 µg/m3 PM10

reduction in Metro Manila in 2002

• 35 - 59 fewer deaths per million population from natural causes

• 5 - 28 fewer deaths per million population from cardiovascular causes

• 43 - 49 fewer deaths per million population from respiratory causes

Impact on morbidity for a uniform reduction of 10 µg/m3 PM10 in Metro Manila in 2002

reduction of >23,000 cases of acute bronchitis• reduction of >400 cases of asthma• reduction of >30 cases of chronic bronchitis• 20 respiratory cases per million population• 4 cardiovascular cases per million population

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lead gasoline

blood lead

Lead content of gasoline and mean blood lead levels among children in Metro Manila, 1993-2003

N.B. lead in gasoline not actual values but highlighted for illustration purpose only

School children

Children in high traffic area

Children 0.84

0.6

0.15 0.0 0.0

Integrated Strategies to Reduce Vehicular Emissions & Improve Air Quality in Metro Manila

Integrated Environmental Strategies (IES) Philippines

Manila Observatory with support fromthe US Agency for International Development,

US Environmental Protection Agency andUS National Renewable Energy Laboratory

2003-2004

POLICIES, TECHNOLOGIES,MEASURES Motor Vehicle Inspection System Conversion to 4-stroke tricycles Railways Diesel Particulate Trap Compressed Natural Gas - Buses CocoMethyl Ester - Jeepneys Traffic Demand Management Bikeways

Air Quality Modeling Scheme

Motor Vehicles

Factories,Power Plants

BackgroundEmissions

Dispersion Model

Air Pollution Concentration

Map

Health and Economic Costs

Health Outcomes Natural Mortality Respiratory Mortality Cardiovascular Mortality Respiratory Hospital Admissions Cardiovascular Hospital Admissions Asthma Attacks <15 years old Asthma Attacks =/> 15 years old Bronchitis Episodes < 15 years old Chronic Bronchitis > 25 years old

MORTALITY: Metro Manila Number of Deaths Averted per Policy scenario

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Asthma Attacks <15 years old: Metro ManilaNumber of Cases per Policy Scenario

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What is the cost of the health damages that can be averted by the different policy scenarios?

•Morbidity: Cost of illness method Work Loss Days Mortality: Benefits Transfer • Values are in 1995 prices• Present Value of Year 2002 Estimates• Using 12% discount rate for 2005, 2010,2015• Orbeta Study and PhilHealth data

Economic Valuation of the Health Impact per Policy Scenario (PHP)

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HEALTH SECTOR EFFORTS:

WAR AGAINST AIR POLLUTION

THE WAY FORWARD

•Establishment of Health Information System for Air Pollution related Illnesses

Status (on going)1. Identified sentinel health centers within 1 km distance from DENR’s Air monitoring stations

2. Developed data gathering forms/tools for air pollution related illnesses

3. Working with Makati City as pilot LGU for the project

4. Procurement of Computer sets for the GIS of the health information system.

•Establishment of Health Information System for Air Pollution related Illnesses

EMB Air Monitoring StnEMB Air Monitoring Stn

Sentinel sitesSentinel sites• health centerhealth center• private clinicsprivate clinics• hospitalhospital

Fig. 6.1a Monthly PM10 Level and ARI Cases, Except Bronchitis and Bronchiolitis Cases in 11 Clinics

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Average PM10 ARI, except bronchitis and bronchiolitis

Relationship between Air Quality and Health Effects

Dummy Table

HEALTH EFFORTS AGAINST AIR POLLUTION

• IEC development

Status (on going)

1. Development of Communication Plan/ Strategy

2. Prototype IEC materials (posters, leaflets, TV/radio plugs)

HEALTH EFFORTS AGAINST AIR POLLUTION

• Training on Air Sampling Strategies (to be conducted this Nov)

1. Equipped field personnel on indoor air sampling strategies

2. Development of an indoor air quality action plan for each LGU