Panel 11: Improving Health, Safety, and the Environment

Thursday, November 17 (4:15-5:30)

12th Symposium on

Development and Social Transformation

Social Marketing of Health Policy: A Case Study of HIV/AIDS Programme in Thailand

Jyoti Shankar Choudhary

Panel 11: Improving Health, Safety, and the Environment

12th Symposium on

Development and Social Transformation

Need for Social Marketing

Constraints of conventional methods of

policy formulation and implementation Need for using Commercial Marketing

concepts

What is Social Marketing?

Devising strategies for Behaviour Change by using

concepts from commercial marketing4 Ps of Marketing: Product PricePlacement Promotion

HIV/AIDS in Thailand- A Situation Analysis

Statistical data in 1991 No. of HIV infections– 1% of 65m pop. No. of new HIV infections, every year

-140,000 44% of sex workers in Chiang Mai

(North Thailand) infected with AIDS ( Sentinel Survey,1989)

HIV/AIDS in Thailand- A Situation Analysis

Nation’s Response : Mode of DenialThai to Thai transmission not

evident Response geared to screen

foreigners Only $180,000 spent in 1988

HIV/AIDS in Thailand: Policy Intervention

Revised Policy Intervention-1991:Positioning Strategy

Programme under the PMOProgramme integrated into 5

yr.plan:funding implicationsTechnical/non govt. appointments

Phased ApproachThree Phases

Segmentation and Targeting Based on a nation wide research

Social Mobilisation & Advocacy an integral part of the programme

HIV/AIDS in Thailand: Policy InterventionPhase I (1991-1996)

Segmentation & Targeting: High risk GroupCSWs Injectible Drug usersSchool Children and Youth

Emphasis on creating awareness through:Mass mediaSchool ProgrammeCommunity based programme-100% condom prog.

Social Mobilisation Programmes through:MilitaryMonks

Repealed repressive policies like mandatory disclosure of identity for AIDS patients

HIV/AIDS in Thailand: Policy Intervention

Phase II: (1996-2000):

Focus on PLWHA as main target group Establishment of groups like PLA,

through out Emphasis on Mother to Child mode of

transmission Introduction of AZT drug Greater role for Media-all reports on HIV

published in media

HIV/AIDS in Thailand: Policy Intervention

Phase III (2001-2006):Consolidation of the earlier phases International Cooperation

Lessons for India

Shortcomings of the programmeInequal focus of the target groups Changing routes of transmissionSustainability not in-built in the

programme

Lessons for India

Inferences from the programmeAppropriate Positioning of the

programme Prominence of Advocacy &Social

MobilisationEmphasis on Research & its

dissemination to the public at largeRole of Media in creating the ownership

among various segments of the society

OSH Management in Indian Mining Sector—Lessons from the USA

Partha Sarathi Banerjee

Panel 11: Improving Health, Safety, and the Environment

12th Symposium on

Development and Social Transformation

PREAMBLE

• Globally mineral/mining sector is considered as a high risk industry.

• Better technology & innovative OSH management practices have brought down Injury/Fatality Rate in this sector world wide.

• However, in India, such measures have almost become asymptotic over the last two decades, even after intensified regulatory efforts.

VARIATION IN FATALITY RATE OVER LAST CENTURY

SOURCE: GOI STATISTICS

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1

DECADES

FR

1901-10

1911-20

1921-30

1931-40

1941-50

1951-60

1961-70

1971-80

1981-90

1991-00

CHALLENGES AHEAD

• The existing ‘centralized regulatory policy’ in the country is likely to face challenge in the future due to:

growing size/ complexity of the industry,

liberalization of the sector to foreign/ private participation and

down sizing of government resources for regulation.

REGULATION AS A POLICY TOOL

• Regulation as a policy tool is often in disfavor in the industry because:

the regulation cost is viewed as borne by the regulated industry while most benefits go to others.

Economists often criticize regulation as an inefficient substitution of centralized decision making for the alleged rationality of the market.

WHAT NEXT?

• Can every public problem be solved through deregulation and by relying on market/devising better incentives?

• No, Importance of coercive policy has been strongly felt after every disaster/ major failure in the industry.

• Even in US political landscape regulation-bashing remains a hardy perennial. TAMING REGULATION BY NAKAMURA & CHURCH

LIVING WITH REGULATION

• How OSH management can be made more effective?

Use of COST OF SAFETY model for analyzing costs, preparing budgets and setting realistic safety goals.

Devising positive & negative incentives in Workmen’s Compensation & Accident Insurance System based on Injury Performance Statistics.

Continued.

Shifting from existing rigid ‘centralized regulatory policy’ to a more flexible ‘co-operative self regulation’ policy- ‘regulatory pluralism'.

Self regulation may be objectively based on ‘quantitative risk assessment’ of work places and ‘injury rate goal setting’.

Example: Successful OSHA (California) experimentation on Cooperative Compliance Program during 1979-84.REFORMING THE WORKPLACE BY REES

COST OF SAFETY MODEL

COST

Prevention+ Detection Costs

Internal + External Failure Costs

Safety Level

Optimal Equilibrium Point

Explanations

• Preventive Costs to keep defects from occurring; Design, Process, Technology, Safe Material costs etc.

• Detection Costs to minimize defects; Safety Inspection, OH surveillance costs.

• Internal Failure Costs i.e; post incident costs; WC , Enquiry costs etc.

• External Failure Costs i.e; Regulatory fines, Public image Costs etc.

Analysis of Policies Regarding Disposal of Industrial Batteries in USA

Vijay Bishnoi

Panel 11: Improving Health, Safety, and the Environment

12th Symposium on

Development and Social Transformation

TYPES OF BATTERIES

WET-CELL: Lead acid batteries used to power vehicles and by industry.

DRY-CELL NON-RECHARGEABLE: These are the most common types of household alkaline battery. 

DRY-CELL RECHARGEABLE : These are general purpose rechargeable batteries and include nickel cadmium, nickel metal hydride and lithium-ion batteries used in power tools, cordless appliances, mobile phones, etc.

ENVIRONMENTAL EFFECT Batteries contain toxic heavy metals like

cadmium, mercury and lead. When thrown away, however these batteries

can cause serious harm to human health and the environment as these heavy metals enter into food chain.

Possible health effects associated with ingestion or inhalation of heavy metals through water, food, or air include headaches, adnominal discomfort, seizures, comas and even cancer.

REGULATION

In USA lead-acid batteries were regulated at state level around 1990.

In 1996 a battery act was promulgated at federal level which regulated the disposal of used rechargeable batteries.

BCI and RBRC are the two NPO’s who developed the recycle program and also monitors recycling of used batteries.

MAIN POINTS OF US LEAD ACID BATTERY RECYCLING

Used batteries are to be recycled and not disposed of in landfill or incinerated.

Manufacturers collect spent batteries from consumers/ retailers when delivery shipments of new lead-acid batteries is done.

Financial incentive given to consumer for returning old battery which varies from state to state and is between $5 to $10 for each battery.

MAIN POINTS OF US LEAD ACID BATTERY RECYCLING…

Detailed regulation exist in USA as to how lead-acid batteries be transported which was issued by department of transportation around 1994.

Sustain publicity for educating public about environmental hazard and that battery should be recycled.

Consumer mainly responsible to send used battery to collection point or retailer.

Program is highly successful as recycling rate lead acid battery for the year 1999-2003 was 99.2%.

STATUS IN INDIA

In India regulation for disposal of lead acid batteries by recycle were promulgated in 2001 and is known as batteries (management and handling) rules, 2001. no regulation is available for disposal of other types of batteries.

Hazardous Wastes (Management and Handling) Rules, promulgated in 1989 for transporting hazardous wastes.

Batteries mainly disposed off thro auction to registered recyclers by government departments after 2001.

No collection system for used automotive battery.

STATUS IN INDIA…

Lead recycling not able to meet requirement.

Total consumption: - 190,000 MT

Indigenous production: - 55,000 MT

Import of pure lead: - 65,000 MT

From secondary smelters: - 70,000 MT

It is estimated that 50% of lead recycling is done by secondary smelters who do not have MOEF clearance and create pollution.

LESSONS FOR INDIA…

Introduce legislation for disposal of all types of batteries.

Introduce legislation for collection and transportation of used batteries.

Extensive publicity for creating awareness regarding environmental risk.

LESSONS FOR INDIA…

Financial incentive to be introduced for returning used automotive battery.

Collection centers should be established at large number of places for collection of used batteries.

Alternative employment work to be arranged for workers already in business of smelting.

The Impact of Orphanhood on Health Status and Education Attainment of Children in

Uganda

Loveena Dookhony

Panel 11: Improving Health, Safety, and the Environment

12th Symposium on

Development and Social Transformation

By 2003,

Number of Orphans: 43 millions (12.3 % of

children)

Number of AIDS Orphans: 12.3 millions

Children orphaned during the year: 5.3 millions

State of Sub- Saharan Africa

HIV Prevalence Rate: 14 % in 1980 to 5 % in 2001

However, Number of Orphans continued to riseOrphans as a percent of all children:

in 1990: 10%

in 2003: 14%

Number of Orphans: 2 millions, of which 48% are AIDS Orphans

Uganda as Case Study

STUDY

Orphans vs. Non Orphans

1. What is the impact of orphanhood on health? Who have been sick in the past 30

days?

Hypothesis:

Orphans, especially AIDS Orphans is more likely to

be sick.

Explanatory Variables

Child Characteristics:– Orphanhood Status, Gender, Relationship to Head of Household

Head of Household Characteristics: – Gender, Health, Education

Household Characteristics:– Wealth Index

Sickness according to Orphan Status

23%25% 25%

34%

0

5

10

15

20

25

30

35

40

Ma Dead Pa Dead Orphan AIDS Orphan

Causes of Sickness (29% were sick)

Other, 32%

HIV/Symptoms

13%

Malaria, 55%

Table 5. Predicting Health Status (Partial Results)

  Marginal Effects

  (1) (2) (3) (4) (5) (6)

0.0527 a

(0.0216)0.0518 a

(0.0215)  Both dead

0.0459 a

(0.0118)0.0465 a

(0.0118)  One Dead

0.0444 a

(0.0171)0.0434 a

(0.0171) Ma Dead

Pa Dead 

0.0286 a

(0.0119)0.0292 a

(0.0119)

AIDS Orphan 

0.0354 b

(0.0167)0.0343 b

(0.0166)

 

Note: Number of observation is 24,912. The data comes from the Uganda National Household Survey 2002/2003Standard errors are reported beneath the coefficient estimates.a indicates significance at 1% levelb indicates significance at 5% level.c indicates significance at 10% level.

Predicting Health Status (Partial Results)

Interpretation of Results

Probability of Sickness

  Sick

Orphan 15%

AIDS Orphan 13%

Head of HH Sick 50%

Conclusion

Increasing Number of Orphans in Africa

Orphans, specially AIDS Orphans, are

disadvantaged in terms of education and health

compared to a non-orphan

Policy Implications?

Panel 11: Improving Health, Safety, and the Environment

Thursday, November 17 (4:15-5:30)

Jyoti Shankar Choudhary

Social Marketing of Health Policy

Partha Sarathi Banerjee OSH Management in Indian Mining

Vijay Bishnoi Disposal of Industrial Batteries

Loveena Dookhony Orphanhood and Education in Uganda

12th Symposium on

Development and Social Transformation