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HEALTH IMPACT OF AIR QUALITY MANAGEMENTEFFORTS
DESIREE M. NARVAEZ, MD, MPHDEPARTMENT OF HEALTHMANILA, PHILIPPINES
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Air pollution and sperm cellsCzech Republic: 35 young men exposed to high air
pollution due to coal burning power stations and fossilfuels; in 2 years had sperm examined in terms of shape,number, motility, damageSignificant association between exposure to periods of high air pollution ( at or above the US air qualitystandards) and the percentage of sperm with DNAfragmentation---Potentially lead to birth defects or miscarriagesChemicals in air that can cause damage to human DNA( Czech Research Institute and US EPA)
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Save the sperm cellPrevent birth defects or miscarriagesFight air pollution!
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Public Health Monitoring of the MetroManila Air Quality Improvement Sector
Development ProgramADB - WHO - DOH STUDY
2002-2004
3 COMPONENTS:
Health Risk AssessmentEpidemiological StudyHealth Risk Perception
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Attributable number of cases =exposure-response coefficient xexcess exposure level xexposed population x
baseline mortality rates
Exposure-response coefficients:
from time series studiesMorbidity Kunzli et al (US/Eu)Mortality Bangkok study
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Type of Hospital Admissions
AdmissionRate
AttributableCases
Respiratory 1156 20
Cardiovascular 211 4
Estimated number of hospital admissionsper million population in excess of 10ug/m3 PM,Metro Manila, 2002
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P articulate matter ( P M10 and P M2.5 ) andtrophospheric ozone are of serious
concern in Metro Manila. Long term P M10 concentrations likely toviolate National Air Quality (NAQ)guideline of 60 g/m 3. Long and short-term P M2.5 levels maybe unhealthy for the general public. Ozone exceeds short-term guideline
value
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Impact on mortality by 10 g/m 3 P M10reduction in Metro Manila in 2002
35 - 59 fewer deaths per million populationfrom natural causes
5 - 28 fewer deaths per million population
from cardiovascular causes
43 - 49 fewer deaths per million populationfrom respiratory causes
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Impact on morbidity for a uniform reductionof 10 g/m 3 P M10 in Metro Manila in2002
reduction of >23,000 cases of acute bronchitisreduction of >400 cases of asthmareduction of >30 cases of chronic
bronchitis20 respiratory cases per million population4 cardiovascular cases per million
population
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4
8
12
16
20
1991 1992 1993 2000 2003
b l o o d
l e a d
l e v e l ( u g / d l )
lead gasolineblood lead
Lead c o nt e nt o f ga s ol in e a n d m ea n blood lead level s a m o n gchi ld r e n in Me tr o Ma ni la , 1993-2003
N.B. lead in ga s ol in e n o t a ct ual value s bu t hi g h lig ht ed f o r illu str a tio n p u rp o s e o n ly
Sch ool chi ld r e n
Chi ld r e n in hi g h tr a ffic a r ea
Chi ld r e n 0.84
0.6
0.15 0.0 0.0
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Integrated Strategies to Reduce Vehicular Emissions & Improve Air Quality in Metro Manila
Integrated Environmental Strategies ( IES)P hilippines
Manila Observatory with support fromthe US Agency for International Development,
US Environmental Protection Agency and US National Renewable Energy Laboratory
2003-2004
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POLICIES, TECHNOLOGIES,MEASURES
Motor Vehicle Inspection SystemConversion to 4-stroke tricycles
RailwaysDiesel Particulate TrapCompressed Natural Gas - BusesCocoMethyl Ester - JeepneysTraffic Demand ManagementBikeways
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Air Quality Modeling Scheme
Motor Vehicles
F actories,P ower P lants
BackgroundEmissions
Dispersion Model
Air PollutionConcentration
Map
HealthandEconomicCosts
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Health Outcomes Natural MortalityRespiratory MortalityCardiovascular MortalityRespiratory Hospital AdmissionsCardiovascular Hospital AdmissionsAsthma Attacks 15 years oldBronchitis Episodes < 15 years oldChronic Bronchitis > 25 years old
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MORTALITY: Metro Manila
Number of Deaths Averted per Policy scenario
0
100
200
300400
500
600
700
M V I S
C N G B H
C M E J H
R A I L W
A Y S
D I E S E
L T R A P S
B I K E M
M
T C 4 S
T R O K E T D M
C O M B
O - 1
C O M B
O - 2
C O M B
O - 3 200520 10
20 15
TOTALS
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Asthma Attacks
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What is the cost of the health damagesthat can be averted by the
different policy scenarios?Morbidity:
Cost of illness methodWork Loss Days
Mortality:Benefits Transfer
Values are in 1995 pricesP resent Value of Year 2002 EstimatesUsing 12% discount rate for 2005, 2010,2015Orbeta Study and P hilHealth data
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Economic Valuation of the Health Impact per
Policy Scenario (PHP)
0
500
1000
1500
2000
2500
3000
3500
M V I S
C N G B
H
C M E J
H
R A I L W
A Y S
D I E S E
L T R A
P S
B I K E M
M
T C 4 S
T R O K
E T D
M
C O M B
O - 1
C O M B
O - 2
C O M B
O - 3
M i l l i o n s
2005
20 10
20 15
TOTALS
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HEALTH SECTOR
EFFORTS:WAR AGAINSTAIR POLLUTION
THE WAY FORWARD
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Establishment of Health Information System for Air Pollution related Illnesses
Status (on going)1. Identified sentinel health centers within 1 km
distance from DENRs 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.
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Establishment of Health Information System for Air Pollutirelated Illnesses
EMB Air Monitoring StnEMB Air Monitoring Stn
Sentinel sitesSentinel siteshealth center health center
private clinics private clinicshospitalhospital
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F ig. 6.1a Monthly PM 10 Level and ARI Cases, Except Bronchitis andBronchiolitis Cases in 11 Clinics
0
20
40
60
80
100
120
January F ebruary March April May
u g
/ c u m
0
50
100
150
200
250
300
350
400
450
500
N u m
b e r o
f c a s e s
Average P M10 AR I, except bronchitis an d bronchio litis
Relationship between Air Quality and Health Effects
Dummy Table
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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)
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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 qualityaction plan for each LGU
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