Air Pollution, Poverty and Health in Ho Chi Minh City

1
Air Pollution, Poverty and Health in Ho Chi Minh
City
Stakeholder Forum 3 February, 2004 Ho Chi Minh
City, Vietnam
2

• Background

3
Who Are We - ADB

• Asian Development Bank is a regional development
  bank, which provides loans and grants to
  governments in support of economic and social
  development.
• The overarching objective of ADB is poverty
  reduction in Asia.
• ADB supports a range of projects in Vietnam,
  which are coordinated by its Resident Mission in
  Hanoi.

http//www.adb.org
4
Who Are We CAI-Asia

• CAI-Asia is a multi-stakeholder initiative set up
  by ADB, World Bank and USAEP to promote better
  air quality management in Asia
• Currently CAI-Asia has 120 institutional members
  including Ho Chi Minh City, Hanoi, Vietnam
  Register
• CAI-Asia undertakes knowledge management,
  capacity building, regional dialogues, promotion
  of air quality management policies, pilot
  programs and workshops.
• In Vietnam USAEP is acting as the local
  coordinator of CAI-Asia and the local CAI-Asia
  network

http//www.cleanairnet.org/caiasia
5
Who Are We -The Health Effects Institute

• Founded in 1980 to provide impartial,
  high-quality science on health effects of vehicle
  and other emissions
• Joint and Equal Core Funding from Public and
  Private Sources
• Independent Board and Expert Science Committees
  oversee and review all research
• Over 200 studies - Americas, Asia, Europe -
  ozone, carbon monoxide, particulate matter,
  diesel exhaust, benzene, butadiene, methanol,
  others
• Program on Public Health and Air Pollution in
  Asia (PAPA) to inform regional decisions about
  improving Asian air quality (map shows study
  sites as of January 2005)

http//www.healtheffects.org/
6
Who Are We - NILU

• Norwegian Institute for Air Research (NILU)
  conducts environmental research with emphasis on
  the sources of airborne pollution, atmospheric
  transport, transformation and deposition and is
  also involved in the assessment of the effects of
  pollution on ecosystems, human health and
  materials.
• NILU has implemented a range of air quality
  monitoring and management projects in Asia.
• NILU currently implements the NORAD funded HCMC
  air quality monitoring project with its local
  partner HEPA

http//www.nilu.no/
7
Air pollution and health

• Air pollution is a growing environmental problem
  in Asian cities due to growing urbanization,
  motorization and industrialization
• Health impacts of air pollution are considerable.
  World Health Organization estimates that about
  480,000 people die prematurely in Asia each year
  due to exposure to ambient air pollution.
• Many hundreds of thousands develop health
  problems or experience decreased health because
  of pollution. They miss work or school because of
  air pollution.
• Air pollution costs Asian cities hundreds of
  millions of dollars per year.

8
Why a program on air pollution, poverty and
health?

• Asian Development Bank is the main regional
  developmental organization in Asia. The main
  mandate is poverty reduction through sustainable
  development.
• Air pollution is a substantive developmental
  problem.
• Evidence from Europe, USA and Latin America
  indicates that there is a linkage between air
  pollution and poverty in terms of health impacts.
• Clean Air Initiative for Asian Cities took the
  initiative to develop a program that will
  research the linkage between air pollution,
  poverty and health in Asia.
• HCMC proposed relatively good quality data on
  air, health, and poverty and enthusiastic local
  counterpart organizations

9
Main Hypotheses

• The poor are subject to higher exposures of air
  pollution.
• The poor are more susceptible to air pollution
  e.g. due to poorer nutrition, access to medical
  care and other factors.
• Air pollution exacerbates or perpetuates the
  conditions of poverty.

10
Outputs

• The proposed project in HCMC will give answers on
  the linkage between air pollution and poverty in
  HCMC.
• The project will result in a methodology that can
  be used to study the linkage between air
  pollution and poverty in other Asian cities.
• Capacity building

11
Main components of the Project

• Study of the impact of air pollution on
  respiratory health of children in HCMC
• a) Exposure assessment to multiple sources of air
  pollution.
• b) Health prevalence survey
• c) Survey of perceptions and economic costs
• 3. Policy implications and awareness raising

12

• Air Quality Monitoring In HCMC

13
AQ Monitoring Sites
4 sites funded by Danida 5 sites funded by
NORAD AQMS installed by NILU As part of NORAD
14
Automatic transfer QA/QC
15
Suspended particles main problem
PM10 measured since 2001
16
Ozone 27 October 2004
17
(No Transcript)
18
Average diurnal variation
CO
19
(No Transcript)
20
Model applications
Wind fields
Model tests HCMC Vietnam
Main traffic routes impact
21
Ho Chi Minh City Emission inventory, traffic
22
The NILU Now-cast model
23
Exposure models
24

• Component 1. Impact of air pollution on acute
  lower respiratory infection (ALRI) in children of
  HCMC

25
Proposed Objectives of the Childrens Study

• Estimate the effect of short-term exposure to air
  pollution on hospital admissions for ALRI in
  young children (lt5 years) in HCMC
• Compare the magnitude of the effect of air
  pollution on poor children vs. other children

26
Proposed Methods of the Childrens Study (1)

• Case ascertainment
• Identification of ALRI admissions, clinical and
  socio-demographic characteristics from
  computerized records at Pediatric Hospitals 1 and
  2
• Poverty status determined by access to free care
  (health card)
• Exposure assessment
• Estimates of daily average exposure for each case
  using data from the HEPA air monitoring network

27
Proposed Methods of the Childrens Study (2)

• Statistical Analysis
• Estimate relative risk of admission to hospital
  for ALRI using case-crossover analysis
• Collaborators
• Biostatisticians TBN, HEPA/NILU, DOH/Pediatric
  Hospitals 1 and 2

28
Overview Case-crossover Methodology

• Used to study impact of short-term time-varying
  exposures on acute events
• Cases of disease are identified
• The exposure of each case is estimated during an
  effect and a control period
• Relative risk is calculated based on contrasting
  the exposure levels in the effect and control
  periods

29
Major Design Decisions

• Why short-term effects?
• Much of the existing global literature is
  comprised of studies using comparable methods
• Why children?
• We care about this vulnerable sub-population
• Health data on children are available in HCMC
• Why ALRI?
• A major public health issue in developing
  countries two recent literature reviews on the
  effects of air pollution on ALRI

30
Some Outstanding Issues

• Should hospital admissions for asthma be studied?
• Adequacy of data quality?
• What should be the timeframe for the study
  (retrospective and/or prospective)?
• Should very young children (lt1 year) be included?

31

• Component 2. Household Survey of Exposure, Health
  Perceptions and Costs

32
Household Survey

• Survey of households from poorer and wealthier
  wards
• Households with young children identified, but
  all household members included
• Three sets of activities
• Exposure assessment (HEPA, CASE, EWC, UC
  Berkeley)
• Health prevalence survey (HCMC DPH, Medical
  University)
• Public perceptions and economic burden of air
  pollution (TBN, EWC)

33
Exposure Assessment

• Aims to estimate pollution actually inhaled
• Assesses impact of local hot-spots/
  microenvironments for exposures
• Exposure to traffic related pollution (roadside
  exposures, commuting)
• Cooking with solid fuels (wood, coal) and/or
  poorly combusted kerosene
• Environmental tobacco smoke (ETS)
• Occupational exposures (roadside vendors, small
  scale industries, etc.)
• Assesses difference between household
  concentrations and individual exposures

34
Approaches to reach human exposure

• Ambient concentrations in a variety of
  microenvironments,
• Neighbourhood concentrations,
• Outdoor/indoor concentrations, and /or
• Personal (individual) exposures assessed by time
  and location

35
Exposure and health
When
hour of day day of week season of year
Diary Method
Individualair pollutionexposureestimate
What
Where
activity levels which affectsrespiratoryventila
tion
Indoor/outdoor (windowopen/closed)Geographicall
ocation
36
Health Prevalence Survey

• Assess respiratory health symptoms of all
  household members
• Based on internationally accepted survey
  instruments
• In conjunction with exposure results, may provide
  information on risk factors for respiratory
  illness
• Possibility additional health assessment (PFT)
  of householders

37
Public Perceptions and Economic Burdens of Air
Pollution

• Assesses peoples opinion how air pollution
  impacts their lives
• Understanding perceptions can help predict the
  publics willingness to modify lifestyle to
  improve environment
• Cost of treatment, Lost income, Lost Time, school
  absenteeism
• Differential impact of policies to remediate air
  pollution exposures (relocation of roadside
  vendors)

38
Some outstanding issues

• Proper definition and identification of poorer
  and wealthier wards to be included in the survey
• Sample determination (size and distribution
  across city)
• Identification of capacity building needs (skills
  and equipment)
• Degree of linkage with Component 1

39

• Component 3. Policy implications and awareness
  raising

40
Policy relevance

• The results of the project may indicate a linkage
  between air pollution, poverty and health in HCMC
• If they do ..

41
Policy Implications

• Results may justify interventions targeted to
  poorer households and sources that affect
  especially the poorer households
• In identifying the policy implications it will be
  important to distinguish between national and
  local level policy issues
• Policy implications can be aimed at decision
  makers on air quality management, public health,
  city planners, or poverty.

42
Examples of methodologies to assess policy
implications

• Assess the impact of different AQM policy
  measures on the spatial distribution of air
  pollution in HCMC, and the impact on different
  population groups
• Assess the impact of different health or poverty
  policy measures (e.g. access to healthcare) on
  health of population groups affected by air
  pollution
• Assess the impact of urban renewal measures on
  exposure to air pollution by different population
  groups
• Assess the required institutional response
  capacity

43
Awareness Raising

• Progress of the study will be documented on the
  CAI-Asia website and the PAPA website
• Important outputs of the project will be
  translated in Vietnamese
• An international workshop is planned for 2007 to
  present the findings of the project.

44

• Institutional set-up of project and
  implementation arrangements

45
Overall Project Structure

• Project is a grant from ADB to the government of
  Vietnam. Recipient of the grant will be HCMC
  Peoples Committee.
• HCMC Peoples Committee to issue a decision to set
  up the project, project office, and Steering
  Committee.
• ADB will enter into a partnership with HEI for
  the implementation of the program.
• APPH Project will become part of the Public
  Health and Air Pollution in Asia (PAPA) Program,
  which HEI implements on behalf of CAI-Asia.
• The International Oversight Committee from PAPA
  program will be requested to provide scientific
  oversight of the project.

46
Project running time and budget

• Project expected to run for 30 months or 2.5
  years.
• Proposed start date for the Project 15 June 2005
• ADB expected to contribute 600,000 from Poverty
  Reduction Fund
• HEI expected to contribute 200,000
• Vietnamese government agencies to contribute
  120,000 (in kind staff time, office space,
  local transport, etc.) 20 of official ADB
  contribution

47
Methodology development

• This is a pioneering program for Asia. The HCMC
  project aims to develop a methodology which will
  be tested in the HCMC project
• Visiting researchers from other Asian cities will
  be invited during the project to visit HCMC to
  observe the study. Participants from HCMC project
  will be invited by CAI-Asia to conferences and
  workshops to make presentations on the project.

48
Suggested Executing and Implementing Agencies

• Executing Agency DONRE, based on its overall
  mandate for environmental protection and air
  quality management
• Implementing Agencies
• HEPA air pollution related aspects
• DoH health related aspects
• DOLISA poverty related aspects
• All implementing agencies will be required to
  make information available and to assist in
  assessment of policy and discuss policy relevance
• Program will actively contribute towards capacity
  building of the implementing agencies
• Additional services will be contracted in
  consultation with Executing and Implementing
  Agencies from e.g. NILU on air quality monitoring
  and CASE on sample analysis.

49
Next Steps

• Draft Memorandum of Agreement (MoA) on the
  Project, circulate for comments to DONRE, DOH,
  DOLISA and get endorsement (covering agreement)
  of MoA from HCMC PC and MPI
• Draft TA paper to get formal approval for project
  within ADB
• Coordinate with DONRE and HEPA the steps to be
  taken to get approval from Vietnams side
• Detailed technical planning coordinated by HEI to
  prepare draft research protocols
• Sign TA letter between GoV and ADB
• Sign Partnership Agreement between ADB and HEI

50
Thank Youfor your timefor your ideasand your
support for the Project.