Dr. Carlos Dora, PhD

Former Coordinator Environment and Health, WHO, GenevaProfessor Environment and Health Governance and Justice, Columbia University, New YOrk

Energy and Public Health

Energy and Health in Urban AreasClean Air, few traffic injuries/ burns/intoxications,

physical activity, waste managed, access to electricity

Climate Change

• Clean Energy

• Housing

• Transport

• WasteManagement

Local health

impacts

Integrating energy, health and climate into urban policies:

synergies and co-benefits

Air pollution

Injuries, physical activity, noise, diet

Global health impacts

How to identify relevant Health Impacts?

Health Impact Assessment

of urban policies (transport,

housing, energy production

waste etc.)

HIA procedure similar to EIAs

1 Screening

2 Scoping

3 Appraisal

4 Reporting

5 Monitoring

Quickly establishes "health relevance" of

the policy or project. Is HIA required?

Identifies key health issues & public

concerns, establishes ToR, sets

boundaries.

Rapid or in-depth assessment of health

impacts using available evidence – who

will be affected, baseline, prediction,

significance, mitigation.

Conclusions and recommendations to

remove/mitigate negative impacts on

health or to enhance positive.

Action, where appropriate, to monitor

actual impacts on health to enhance

existing evidence base.

Sta

ke

ho

lde

r co

ns

ulta

tion

• PS 1: S&E Assessment and Management Systems

• PS 2: Labour and Working Conditions

• PS 3: Pollution Prevention and Abatement

• PS 4: Community Health, Safety & Security

• PS 5: Land Acquisition and Involuntary Resettlement

• PS 6: Biodiversity Conservation and Sustainable Natural Resource Management

• PS 7: Indigenous Peoples

• PS 8: Cultural Heritage

Part of Development Banks safeguards procedures

(IFC example)

Modelling Transport scenarios for Sao Paulo, Brazil:Changes in DALYs for each scenario attributable to changes from

air quality, physical activity and road injuries

-3.237 -5.608

34.291

-34.363-33.911-23.400

-31.146

-47.620

596 12.810

17.877

-15.290

-110.000

-100.000

-90.000

-80.000

-70.000

-60.000

-50.000

-40.000

-30.000

-20.000

-10.000

0

10.000

20.000

30.000

40.000

50.000

60.000

SP EC London 2012 SP California SP 2040

Injury Air pollution

Physical activity Total

Savings to health systems

Reduction in out of pocket $

Estimate costs of inaction - of not having a

sustainable transport and

land use policy

Health in the New Urban Agenda Habitat III

Engaging people in exploring policies and opportunities for health and urban development

Air Pollution is a major risk to health

Scientific evidence showing that particles smaller than

2.5mm penetrate deep into the lungs and blood stream and

affects many body organs causing stroke, heart disease,

cancers, COPD, pneumonia and other diseases (e.g.

dementia, diabetes).

Health Impacts: Air PollutantsProducts of incomplete combustion

Outdoor Air Pollution• CO2 emissions are not a direct problem for health---rather it

is a mixture of pollutants that are released during the

incomplete combustion of carbon-based fuels that have direct

impacts on health.

•The products of incomplete combustion (PICS) include but

are not limited to things like methane, poly-aromatic

hydrocarbons, carbon monoxide, etc.

PAH COCH4 NMVOCs

NOxSOx

CH2O

CO2

It also affects the vascular systems

causing strokes and heart attacks

Physiopathology e.g. calcification of artery walls

Air pollution causes lung diseases

Lungs exposed to tobacco and to Indoor air pollution

Pathology slides - Courtesy Prof. Saldiva, São Paulo, Brazil

WHO Interactive Maps – Air

Pollution Exposure to PM2.5

http://maps.who.int/airpollution/

• Data integration:

• Satellite remote

sensing

• Ground

measurements

• Emission

inventories

• Air transport models

Country mean : 62 mg/m3

Air Pollution in Cities Low and Middle Income Cities are Getting Worse

Trend in PM2.5 or PM10 based on cities available in several versions of the database, by region1.

Region Trend over the mean

period 2008-20132

Africa (Sub-Saharan) NA

America, LMI

America, HI

Eastern Mediterranean, LMI

Eastern Mediterranean, HI

Europe, LMI

Europe, HI

South-East Asia

Western Pacific, LMI

Western Pacific, HI

World3

1 Criteria for inclusion: cities with measured PM2.5 or PM10 values in the three database versions covering a period of 3 years or more, or in two versions and covering a period of 4 years or more. 2 : No more than 5% change over the

five-year period;: More than 5% decrease over the

five-year period; : More than 5% increase over the

five-year period.3 The mean for the World is based on weighting by regional urban population.

LMI: Low- and middle-income countries; HI: High-income; NA: Not available.Results are based on 795 cities and are to be interpreted with caution, as 1) cities included might not ensure representativeness, 2) yearly variations due for example to climatic changes can be important and 3) a 5-year comparison does not necessarily represent trends, in particular when changes are limited.

Energy and Health Care

Facilities

Importance of energy to health services (in particular access to electricity)

Energy

Medical Services

Administration

and logistics

Health and safety

Disease prevention

and treatment

Staff recruitment

and retention

Source: WHO & World Bank (2015). Access to Modern Energy Services for Health Facilities in Resource – Constrained Settings.

• Prolonged opening hours

• Wider range of services

• Better functionality of medical

devices

• Better

communication

• Improved

records

management

• General hygiene

improved

• Enhanced safety

• Staff and patient

sense of security

and safety

• Easier

recruitment and

training

• Better staff

morale

• Continued

medical

education

• Improved cold

chain

• Laboratory

testing

• E-health

21-59% of health clinics in six African

countries had NO electricity at all. Women

give birth in the dark, by candlelight, by car

headlights.

5-12% of clinics surveyed in the same six

countries lacked access to clean water

(from an "improved" protected well or

piped source).

Small solar panels generate basic

electricity for lights, cold chain/vaccines,

diagnostics, telecommunications, water

pumps.

'Greening' health facilities can expand coverage of maternal, child & emergency services

Strategic assessments – Policies

that can provide clean household

energy & protect public health

Global data on Household Energy

cooking, lighting and heating – Indoor air pollution

– Burns from fires,

– Intoxications from kerosene use

– Time use by children in homes using polluting fuels 15hs vs 5 hs

WHO Indoor Air Quality Guidelines: for fuels and technologies used for cooking, heating and lighting in

the home:

1. Don't use Kerosene

2. Don't use Coal

3. Use only very efficient

cookstoves

4. Follow emission rates

provided by the

guidelines

5. Use clean fuels – LPG,

Biogas, ethanol…in the

transition

Energy Efficient Housing

• More climate friendly

housing, and better

siting/planning can:

reduce deaths and illness

from extreme heat/cold

exposures & urban heat

island effect;

• Improved natural

ventilation and screening

measures can protect

health from: vector borne

and respiratory

diseases/TB; asthmas and

allergies.

Health impacts of the Extractive industry

Health impacts associated with extractive industries activities

Resulting health

impacts

Environmental, social, or institutional

determinant of health affected

Project induced

pressures

Change in diet,

nutritional status

Increased risk for

infectious diseases

Non-communicable

diseases

Stress and mental

health disorders

Substance abuse,

alcoholism

Violence, crime,

conflict

Accidents and injuries

Competition for resources or livelihood

opportunities

Competition for project related benefits

Change in household/individual purchasing

power

Strain on infrastructure/social services

Change in social demographics

Exposure to environmental risk factors

(chemicals, noise, air pollution, etc.)

Loss of access to land

Loss of biodiversity, ecosystems services

Population influx

Rapid

development

High expectation

of benefits

Land use

changes

Environmental

degradation or

pollution

Health in the extractive industries (oil and gas, mining)

• Extractive industries vital economic sector for many developing countries

– few able to convert this wealth into social benefit

• Health impacts substantial, negative,

– often disproportionately borne by vulnerable segments of population

• Health impacts documented (known) and can be predicted, monitored, and managed

– if the appropriate systems are put in place

Transport and Health

Outdoor urban air pollution → 3.7 million deaths

Physical inactivity → 3.2 million deaths; 19 million healthy life years lost

Traffic injuries → 1.3 million deaths

Traffic noise → stress, memory loss and analytical impairment

Climate change → over 150 000 deaths

Access to vital goods and services, social networks/equity/cohesion →

under reported

Evidence synthesis What are the transport policies with excellent health

performance?

Walking, Cycling, Public Transport

HOUSING

Urban Health in SDGs

MARCH 2016

A global campaign to protect our health

and climate by improving air quality

29

Example: air

pollution and

climate change

Visualize a healthier future