health impact assessment of communities in areas

HealthImpactAssessmentofcommunitiesinareassurroundingKorbaThermalPowerStations

StateHealthResourceCenter,Chhattisgarh

March2020

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Index

ExecutiveSummary 4

1.0Background 7

1.1Aboutkeycoal-firedthermalpowerplantsinKorba 7

1.1.1NTPCKorbaSuperThermalpower 7

1.1.2LancoAmarkantakPowerPlant 8

1.1.3CSEBKorbaEastandWestPowerPlant:ChhattisgarhStatePowerGenerationCompanyLimited

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1.1.4BALCOThermalPowerPlant 8

1.2SomeofthesuspectedsourcesofpollutioninKorba 8

2.0HypothesisoftheStudy 10

2.1PrimaryAim 10

2.2Objectivesofthestudy 10

2.2.1SecondaryObjectives 10

3.1Environmentalsampling 11

3.1MethodologyforAir,Water,andSoilsampling 11

3.1.1Description 11

4.0 Results of the Environmental Sampling and Exceedance fromNorms

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4.1AirSamples 11

4.2WaterSamples 13

4.2.1Heavymetalpollutionindex-basedwaterqualityassessment 13

4.2.2Non-carcinogenicandcarcinogenichealthriskassessmentofwatersamples

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4.2.3Overallfindingsofwateranalysis 14

4.3SoilSamples 14

4.3.1Overallfindingsofsoilanalysis 14

4.4SummaryoftheEnvironmentalMonitoring 15

5.0HealthStudy 16

5.1HealthStudyDesign 16

5.2SamplingMethod 16

5.3SampleSize 16

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5.3.1RefusaltoParticipate 17

6.0DetailsofStudymethodology 17

6.1HealthSurvey 17

6.1.1HealthInformationTools–INSEARCHandDASS21Questionnaires

17

6.1.2Spirometry–Using 18

6.2EthicsApproval 18

6.3HealthDataCollection–Timelines 18

7.0HealthDiscussions 20

7.1Comparisonofprevalenceofdiseaseinexposedversusunexposed

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7.1.1Asthma 20

7.1.2Bronchitis 20

7.1.3ComparisonofrespiratorydiseaseprevalenceinstudyareawithregionalestimatesfromINSEARCH

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7.1.4Breathlessness 22

7.1.5Limitations 22

7.1.6RefusalsinKorba 23

7.1.7Comparisonofothermorbiditieswithregionalestimates 23

7.1.8HealthEffectsoftheChemicalsfoundintheEnvironmentalSamples

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8.0Conclusions 26

8.1InterpretationofFindings 26

8.2Recommendations 26

8.3Limitations 27

8.4ConflictofInterest 27

Appendix1-EnvironmentalMeasurementsDetails 28

Appendix2-Factsheetonhealthimpactsofthechemicalsfoundintheenvironment

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ExecutiveSummary

Korba, the power capital of Chhattisgarh hasmore than 10 coal-fired thermal powerplantsproducing6000MWofelectricity. Italsoholdsworld’ssecondlargestopencastcoalminesGevraandothermajoropencastcoalminessuchasKusmundaminesandDipkamines.Thecityislocatedapproximately200kmfromthestate’scapitalRaipur.Itis ranked as fifth among the 'critically polluted area' category among 88 industrialclusters1inastudyconductedbytheCentralPollutionControlBoard(CPCB)in2009.Themost common causes of pollution in the locality are the emissions from thermalpower plant; dumping of fly ash and ash slurry; outflow of coolant water into riverimpacting the flora, fauna and fish resources; and ground water contamination fromcoalstorageyardsandashponds.The polluted ambient have impacted various life forms especially human beings. Theindividualsresidinginthevillagesaroundthethermalpowerplantshavecomplainedofvarioushealthproblemsmainlyofskinproblems,lungproblemsandasthma.Thelocalfarmers have also complained of crop damages due to toxic fly ash and have beenreportedlyabandoningtheirlandsowntolackofproductivity.Consequently,thecurrentstudywasplannedtotestthehypothesisthatthepopulationlivingnearthermalpowerplantshasgreaterexposuretoparticulatematterresultinginhigherrespiratoryillnessesthanthegeneralpopulation.Theprimaryaimofthestudywas to assess the respiratory health status of the population residing in a definedgeographical area around the power plant as well as to measure the PM 2.5 levelsaroundthethermalpowerplant.Toattain theprimaryobjectives, environmental samplingandhumanhealth samplingwerecarriedoutintheselectedareas.As a part of environmental sampling, air, water and soil samples were collected inthree industrial clusters which are dominated by thermal power plants during thesummerseasonof2018.ParticulateMatterwithaerodynamicdiameter≤2.5µm(PM2.5)levels were monitored in neighborhoods located in the downwind direction of thepowerplants,whilesoilandwatersampleswerecollectedinmultiplebufferzones(0-10km)aroundthepowerplants.The air samplingwas carried out in 9 locations in Korba between 4th and 12th April2019.

1 �PollutedIndustrialClusters;PressInformationBureau,GovernmentofIndia,PressReleasedated28November2011;https://pib.gov.in/newsite/PrintRelease.aspx?relid=77761

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Theresults indicatethat5 locationsoutof9 locationshadPM2.5 levelsabovethestatutorylimitsof60ug/m3asprescribedbytheMinistryofEnvironmentForestandClimate Change (MoEFCC). In addition to this sampling, Community representativeshavetakensevenairsamplestotestforPM2.5andpresenceofheavymetalsinthedustinJanuary–February2016.Accordingtothefindingsoftheexercise,inallthesamples,PM2.5levelswere1.66to4.98timeshigherthantheIndianMoEFstandardof60µg/m3;Levelsofmanganeseexceeded in6outof7samplesby2.2 to6.03 times; samplesresults of Lead in on location (Kharmora) is 1.02 times above the health-basedlevels;thelevelsofarsenicintwosamples(DariNagoikharandKharmora)exceedthe Indian MoEF by 1.01 and 1.51 times respectively; and levels of nickel in fivesamplesis2.05to3.0timesabovethehealth-basedlevels.Basedonthepresenceofstrikinglyhighfractionoffourelementsnamelyaluminum,calcium,iron,andsiliconoftotalPM2.5inthefilteredairsamples,onecanthereforeconcludethatoverallPM2.5inthesesamplesarelikelyimpactedbysourcesofcoalashemissions.Water samples were taken from five sites in Korba. Three out of five locations hadaluminum concentrations higher than the permissible limits (Korba 1, Korba 2 andKorba3).SurfacewatersamplesofKorba2,alsoshowed levelsofmanganesebeyondthe permissible limits. Heavy metal Pollution Index (HPI) were reported for all thelocationsandallwerefoundtobeof~170,whichimpliedpossiblehealthriskstothosewhoregularlyingestthecontaminatedwater.Therefore,tohavesubstantialclarificationonthehealthrisksassociatedwithexposureofhumanstocontaminatedwaterandairsamples,carcinogenicandnon-carcinogenichealthriskassessmentwasdone.Soil sampleswere taken from6sites inKorba.Theconcentrationof theheavymetalswere comparedwith the permissible limits set byDEFRA and Environmental Agency(2004) for the different areas i.e., agricultural, commercial, residential and industrial,revealedthatallthesampleswerewithintheprescribedlimits.Healthstudy:Thisstudyisacross-sectionalcomparativestudy.Theexposedgroupisthepopulationresiding within 10km radius of thermal power plants in Korba and the comparisongroupwerechosenfromthevillageKatghorawhichis20kmawayfromtheKorba.Thetotalvillagesinandaroundthethermalpowerplantweredividedintotwostratabasedon proximity -a)within 5km of radius and b) 6km and 10km from the plant cluster.Fromeachstrataabout325householdswerechosenusingsystematicrandomsamplingusingthehouseholdlistingofPulsePolioPlans.Datawascollectedusing INSEARCHandDASS21questionnaires fromtheheadof thefamilyoraresponsiblememberfromthehouseholds.Medicalrecordsforanyillnessoftheresidents, ifavailable,wereseen forverificationofmorbidconditions. Inaddition,spirometrytestswereperformedforsymptomaticassessmentoftherespondents.The findings from the health study shows significantly elevated prevalence ofrespiratory diseases among the exposed population inKorba than the unexposedgroupinKatghora.Asthma symptoms and bronchitis were 11.79% and 2.96% among the exposedgroup,whileitwas5.46%and0.99%intheunexposedgroup.

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Toconclude,thepresentcrosssectionalcomparativestudyhasmadeanassessmentofthediseaseburdenincommunitiesresidingaroundthethermalpowerplants,whichisin principle good for hypothesis generation and healthcare planning. The studyhighlightstheenvironmentalpollutionandlaysspecialemphasisonrespiratoryhealthstatusofthepopulation. Recommendations:Basedonthefindingsofourstudy:A)Health:

1. Facilities like spirometry at thedistrict level hospitals tobe strengthenedwithprovision of technical expertise, adequate provision of respiratory and othermedicinesandincreasetrainedstaffandotherinfrastructure.

2. State agencies provide for long-term health monitoring by initiating healthstudiesamongtheresidentsofKorba.

3. State Government should conduct a cumulative health impact study of the

various industriesonthehealthof theresidentsofKorbaandthenformulateanecessaryhealthmitigationplanfortheregion.

4. StateGovernmentshouldsetupspecializedhealthcare infrastructureoperated

by the State health departments at polluters’ cost, under the “polluter pays”principle,tocatertohealthissuesofresidentsintheregionofKorba.

B)Environment:

1. MandatoryHIAsaspartofcommissioningofindustrialclustersalongwithEIAs,bothatbaselineandatinterimtime-points.

2. StateandCentralPollutionControlBoard initiatecontinuousmonitoringheavymetals indust andpublish resultsperiodically.Health advisoriesby consultingreputedhealthagenciesshouldalsobeissuedregularly.

3. A pollution cess is levied on units and activities not conformingwithNationalAmbientAirQualityStandards(NAAQS).

4. Agenciesusethepollutiondatatoapprehendpollutersandtakecorrectiveactionto bring levels of dust and heavy metals in dust to below detection limits inresidentialareas.

5. Areascontaminatedbyflyashshouldbeassessedforthedepthandspreadofthecontamination and remedied with full scientific oversight at the cost of thepollutingfacilitiesunderpolluterpayprinciple.

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1.0BackgroundHometomorethan10thermalpowerplantswith6,000megawattscapacity,Korba isknown as power capital or power hub ofChhattisgarh2. It issituated about 200k.m.fromthecapitalcityRaipur.TheriversHasdeo3andAhiran4flowthroughKorba.Korbaisalsoahubofcoalmines,KorbaCoalfields5wasinoperationsince1941butlarge-scaleproductioncouldbeinitiatedonlyoncompletionoftheChampa-Korbaraillinkin1955.GevramineisanopencastminecomplexatthetownofGevra,ontheoutskirtsofKorba,which is the largest open castmine in India and Asia, as well as theworld’s secondlargest. Korbaisoneofthemostpollutedcitiesinthecountry.Accordingtoastudyconductedby the Central Pollution Control Board (CPCB) in 2009, Korba ranked fifth in the'criticallypollutedarea'categoryamong88industrialclusters6.1.1 Aboutkeycoal-firedthermalpowerplantsinKorba:

1.1.1 NTPC Korba Super Thermal power: NTPC Korba Thermal Power Stationis a2100MWcapacityplantownedandoperatedbyChhattisgarhStatePowerGenerationCompany.

2 �http://www.merinews.com/country/india/state/chhattisgarh3 �https://en.wikipedia.org/w/index.php?title=Hasdeo&action=edit&redlink=14 �https://en.wikipedia.org/wiki/Ahiran5 �https://en.wikipedia.org/wiki/Korba_Coalfield6 �PollutedIndustrialClusters;PressInformationBureau,GovernmentofIndia,PressReleasedated28November2011;https://pib.gov.in/newsite/PrintRelease.aspx?relid=77761

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1.1.2ACB(India)LimitedpowerPlant:ACB (India) Limited, along with itssubsidiaries and associates, is one ofthe largest coal washery company inthe private sector with an aggregatedesigned beneficiation capacity, on aproportional basis, of 65.61 milliontonsperannum1.1.2 Lanco AmarkantakPowerPlant: Lanco Amarkantak PowerislocatednearPathadiVillageonKorba-ChampaStateHighwayinChhattisgarh.Currently Lanco Infratech operates a600 MW plant in the region. Twoadditional units of 660 MW each areunderconstructionat thesamesiteastheexistingplant.1.1.3 CSEB Korba East and WestPowerPlant: Chhattisgarh State PowerGeneration Company Limited(CSPGCL) istheelectricitygenerationcompanyoftheGovernmentofChhattisgarhstateinIndia.

• Hasdeo Thermal Power Stationalso known asKorba West Thermal Power

Station,an840MW(4x210MW)coal-based thermalpowerplant.Capacityadditionof500MW(2x250MW)isongoingatthesite,thisphaseisknownasKorbaWestExtensionThermalPowerPlant.

• Dr Shyama Prasad Mukharjee Thermal Power Station, a 500 MW (2x250MW)coal-basedthermalpowerplant.

• Korba Thermal Power Stationalso known asKorba East Thermal PowerStation,a440MW(4x50MW,2x120MW)coal-basedthermalpowerplant.

1.1.4BALCOThermalPowerPlant:BharatAluminumCompanyhasplantwhichisoneoftheAsia'slargestaluminumproductionindustries.Thecompanyhasacaptivepowerplant.BALCOKorbapowerstationconsistsof threecoal-firedpowerstationsnear theBALCOAluminumPlantinKorba.Balco-1isa270-megawatt(MW)coalplant;Balco-2isa540MWcoalplant;andBalco-3isa1200MWcoalplant,whichisunderconstruction.All togethermore than1,00,000metric tonnesof fly-ash is generatedannuallyby thetencoal-firedthermalpowerplantsinKorba.1.2SomeofthesuspectedsourcesofpollutioninKorbaare:

• AirPollutionfromThermalPowerPlant;• Dumpingofflyashandashslurry;• Outflowofcoolantwaterintoriverimpactingtheflora,faunaandfishresources.• Groundwatercontaminationfromcoalstorageyardsandashponds.

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TherehavebeencomplaintsofhealthproblemsamongthevillageslocatedaroundthepowerplantofKorbaperipheryespeciallyvillagesChurri,Lotlota,CharBhhatti,ChurriKordh and Jamini Palli and Durri. Anecdotal reports from the villagers indicateincreasedprevalenceofskinproblems,lungproblemsandasthmaintheregion. Local Farmers report crop damages due to toxic fly ash and breaches in the fly ashpondsofthefromplants.Theirrigationwaterisalsocontaminatedwithflyashandthusitaffectstheirpaddyfields.Manyfarmershavebeenreportedlyabandoningtheirlandsowntolackofproductivity.

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2.0HypothesisoftheStudyThepopulationlivingnearthermalpowerplantshasgreaterexposuretoparticulatematterresultinginhigherrespiratoryillnessesthanthegeneralpopulation.2.1PrimaryAim:

1. Toassesstherespiratoryhealthstatusofthepopulationresidinginadefinedgeographicalareaaroundthepowerplant.

2. TomeasurethePM2.5levelsaroundthethermalpowerplant

2.2Objectivesofthestudy:

a) To understand the general health status of the population of villageswithin adefined geographical area (within 10 km radius) around the Thermal PowerPlants in Korba, Chhattisgarh when compared to an area within the regionwithoutpowerplants

b) To understand the toxic profile of the area by studying the chemicals andpollutantsemittedintotheenvironmentbyfactoriesthroughwater,soilandairqualityassessments.

c) To understand the potential ways in which communities are exposed to thesepollutantsbystudyingtheirlivelihoodandlifestylepatterns.

d) Tounderstandtheimpactofpollutionfromthermalpowerplant,coalyardsandashpondsinthevicinityonphysicalandmentalhealthofthepopulation.

2.2.1SecondaryObjectives:a) Tomeasuretheconcentrationofselectedheavymetalsinflyash,air,waterand

soil.

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3.0Environmentalsampling The study areawaswithin 10 km radius of the Thermal Power Plants in Korba. ThepopulationofKorbaruralwas1,33,033andurbanwas13,407asperthe2011Census.Comparisonarea,withoutpowerplants,wasinthetownofKatghoraabout40kmNorthWestofKorba.ThepopulationofKatghoraruralwas99,506andurbanwas5,892asperthe2011Census.Samplesofair,water,soil,andflyashadheringtostandardprotocolstakenattheareaswerecollectedfrom5locationsineachoftheselectedareas.3.1MethodologyforAir,Water,andSoilsampling3.1.1Description Air,water,andsoilsampleswerecollectedinthreeindustrialclustersofIndia(Figure1)dominated by thermal power plants during the summer season of 2018. ParticulateMatter with aerodynamic diameter ≤ 2.5µm (PM2.5) levels were monitored inneighborhoods located in thedownwinddirectionof thepowerplants,while soil andwater sampleswere collected inmultiplebuffer zones (0 - 10km) around thepowerplants.Appendix1containsadetaileddescriptionofthemethodologyfollowedforthesampling. 4.0ResultsoftheEnvironmentalSamplingandExceedancefromNorms 4.1AirSamplesAirsamplesweretakenfromKorbabetween4thto12thApril2018.TheresultsofthesampleindicatethatlevelsofPM2.5in5outofthe9samplesareabovethestatutorylimitsof60ug/m3asprescribedbytheMinistryofEnvironmentForestandClimateChange(MoEFCC).

DateAverage (ug/m3)

Stdev (ug/m3) Minutes

04/04/2018 71.42330723 74.72646726 145305/04/2018 60.13777347 54.31365943 145106/04/2018 66.80303148 61.58096163 145807/04/2018 54.14297216 47.17919437 145508/04/2018 55.8233 39.56453635 141009/04/2018 42.49754298 34.47523964 144010/04/2018 63.06686449 62.23223983 144211/04/2018 45.72562949 50.38565615 145412/04/2018 80.99668943 95.07605122 971

Table(X):ResultfromtheairsamplesfromApril2019PM2.5waspoortoSevere(>90)in549of3433samplesfromAtmosmonitorsinApril2019inKorba

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MetalsinAir

CommunityrepresentativeshavetakenairsamplestotestforPM2.5andpresenceofheavymetalsinthedustinJanuary–February2016.Accordingtothefindingsoftheexercise:

1. PM2.5:Allofthelevelsofveryfineparticulatematterinthefilteredairsample(PM2.5) greatly exceed the 24-hour WHO standard of 25 µg/m3; the 24-hourUSEPAstandardof35µg/m3;andtheIndianMoEFstandardof60µg/m3.Theselevelsexceeded the Indianstandardsby1.66 to4.98 times. It ismuch lower inApril2018andinCSEBreports

2. Manganese Results: Levels of manganese (which cause adverseneurodevelopmental and neurobehavioral health effects) exceed health-basedguidelinesforlong-termexposurein6outof7samples[seeyellowshadedcells]by2.2to6.03times.Itremainshighin2018

3. Lead Results: Levels of lead (which cause adverse neurodevelopmental and

neurobehavioralhealtheffects)inonesampleexceedhealth-basedguidelinesforlong-term exposure [see yellow shaded cells – Kharmora]. Samples results ofLead in Kharmora is 1.02 times above the health-based levels. Lead is muchhigherin2018

4. Arsenic results: The levels of arsenic in two samples at Dari Nagoikhar and

Kharmora exceed the Indian MoEF annual standard of 0.006µg/m3 [see redshadedcells]by1.01and1.51timesrespectively.

5. Nickelresults:The levelsofnickel (whichcausesadverse immunesystemand

respiratorysystemimpacts)infivesamples(Khodia,Rathakhaar,DariNagoikhar,Dari Basti and Abhinandan Complex) exceed health-based guidelines for long-termexposure[seeyellowshadedcells]by2.05to3.0times.Itismuchhigherinthe2018sample

6. Fly ash as source of pollution: The four elements that occur in the highestlevels in coal ash are aluminum, calcium, iron, and silicon, with somewhatvaryingcompositions.ThesefourelementscompriseastrikinglyhighfractionoftotalPM2.5inthefilteredairsamples,varyingfrom20.4%to57.6%(average=33.1%). By contrast, these same four elements comprised only 1.3% of totalPM2.5 levels of a typical urban area in the U.S. (Wilmington, DE).7 One can

7 �"AnalysisofSpeciationTrendsNetworkDataMeasuredattheStateofDelaware"

Area Date Pb Ni As Mn Si Fe Al Ca Pm2.5 QualityPatharipara 30/01/16 0.0165 0.0038 0.0033 0.0786 10.71 3.483 5.471 5.725 100.1 25.4 UnhealthyKohdiya 01/02/16 0.067 0.0287 0 0.2265 33.82 9.596 19.73 11.55 235.7 31.7 VeryUnhealthyRaatakhar 02/02/16 0.0863 0.0341 0 0.1766 47.43 9.534 27.92 7.405 269.2 34.3 HazardousNagoikhar 03/02/16 0.065 0.315 0.0061 0.2136 32.85 8.612 19.26 9.765 241.5 29.2 VeryUnhealthyKharmora 04/02/16 0.1535 0.0034 0.0091 0.199 35.52 8.29 22.21 8.01 247.1 30 VeryUnhealthyDarri 07/02/16 0.0585 0.0317 0.0035 0.3618 42.31 12.66 23.73 17.75 291.5 33.1 HazardousAbhinandan 08/02/16 0.1263 0.0421 0 0.2726 39.44 10.61 23.31 12.15 299 28.6 HazardousDustrak 05/04/18 0.4104 0.3791 0.4107 0.2521 NA 0.49 0.92 NA 59.29 0.50 Moderate

Si+Fe+Al+Ca/ pm2.5%

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thereforeconcludethatoverallPM2.5 inthesesamplesare likely impactedbysourcesofcoalashemissionsandnotsignificantlyimpactedbysourcesof liquid fuel combustion (e.g. vehicle emissions and diesel generators)alone.

4.2WaterSamplesOut of five water samples taken from Korba region, aluminum concentrations werehigher than the permissible limits in three (Korba 1, Korba 2 and Korba 3). Surfacewater samples of Korba 2, also showed levels of manganese beyond the permissiblelimits.4.2.1Heavymetalpollutionindex-basedwaterqualityassessmentHPI for all the locationswere reported to be of ~170,which implied possible healthrisks to those who regularly ingest the contaminated water. Therefore, to havesubstantial clarification on the health risks associated with exposure of humans tocontaminated water and air samples, carcinogenic and non-carcinogenic health riskassessmentwasdone.4.2.2Non-carcinogenicandcarcinogenichealthriskassessmentofwatersamplesArea-wise,non-carcinogenicandcarcinogenichealthriskassessmentofwatersamplesis described in Table X and Table Y. The readings crossing the prescribed limits arepresentedinredfont.ItcanbeobservedfromTable5and6noneofthewatersampleshadnon-carcinogenichealthissues.Table(X).Non-Carcinogenicityforwatersamples TableY.CarcinogenicityforwatersampleTable(X)

Korba

(adults) (children)Cr 9.10E-07 3.67E-06Zn 5.46E-08 2.20E-07Ni 2.73E-07 1.10E-06Cu 2.05E-07 8.25E-07Cd 0.00E+00 0.00E+00Pb 7.80E-07 3.14E-06Co 2.73E-07 1.10E-06As 2.73E-05 1.10E-04

http://regulations.delaware.gov/register/november2008/general/Appendix9-11.pdf

TableY Korba (adults) (children)Cr 1.14E-07 4.62E-07Ni 4.58E-09 1.85E-08Cd - -Pb 1.15E-09 0.46E-09As 1.23E-08 4.95E-08

Type of Water Lat Long Li Mg Al Cr Mn Fe Co Ni Cu Zn As Cd Hg Pb

Korba 1 From de-centralized water distribution system 22.353869 82.748569 4 0 0 1 29.8 152 5.3 7.6 0 15.6 0 0.1 0 0.1

Korba 2 Surface 22.33746 82.718479 1 0 83.1 1 135.7 116.1 0.9 1.7 1.2 7.7 7.9 0.2 0 1

Korba 4 From centralized water distribution system 22.336496 82.724084 1.2 0 195.9 0.7 2.3 7.4 0 0 1.4 0 0.8 0.1 0 0.4

Korba 5 Surface 22.367267 82.697612 3.2 0 52.1 0.7 39.3 59.5 0 0 8.4 0 1.6 0.1 0 0.7

Water Sample ID (ppb)

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4.2.3Overallfindingsofwateranalysis:a. SurfaceWater (Water 2) has 135.7 ppmManganese and 116.1 ppm Iron, Zinc

7.9ppm,Arsenic7.9ppm;b. Cadmiumis0.2ppminSurface(Water2)andallothersampleshaves0.1ppm;c. Centralizedwaterdistribution(Water4)has195.9ppmAluminium;d. Surface(water5)hashighLithium3.2ppmandCopper8.4ppm;e. DecentralizedWaterDistributionsystem(KorbaWater1)hasLithium4ppmand

Zinc15.6ppm;f. Manganeseisparticularlyhighinsurfacewater2,asisiron,thisissimilartothe

findingsofthesoilsamples(Seesection4.3below);g. Mercuryandmagnesiumseemtobeabsent;h. Lithium is very high in Surface 4 and the decentralized water system (Korba

Water1).4.3SoilsamplesTheconcentrationofheavymetalsinthesoilsamplescollectedfromthestudyareasisshowninTable(X).Thecomparisonoftheconcentrationoftheheavymetalswiththepermissible limits in Soil Guideline Values based on those scenarios presented inUpdated technical background to the CLEA model. Science Report SC050021/SR3.Bristol: Environment Agency, 2009 and those set in Model procedures for themanagement of land contamination. Contaminated Land Report 11. Bristol:Environment Agency by DEFRA and ENVIRONMENT AGENCY, 2004. for the differentareas i.e., agricultural, commercial, residential and industrial, revealed that all thesampleswerewithintheprescribedlimits.

4.3.1Overallfindingsofsoilanalysis:

a. Iron in thesoil reaches29,936ppm in theareanearDarri (SoilSample4)and29,186ppmin(SoilSample1);

b. Nickelis45.9and64ppminSoilSample4and1respectively;c. Leadis29.9and28.4ppminthesetwoplacesrespectivelyand37.5in(Sample

5);d. Mercuryis29.8inKorba3and28.5ppminKorba5;e. Arsenicis9.9ppminKorba5;f. Cobalt is 18.4 ppm, Lithium15.2 ppm, Chromium32.1 ppm, Zinc 83.7 ppm in

Darri(SoilSample4);g. Mercuryishigh29.8ppminSoilSample2and28.5ppminSoilSample5;h. Cadmiumis0.3ppminSoilSample5and0.1ppminallothersamples.i. SoilSample4isaFlyAshPondsamplewithobviouslyhigherquantitiesofevery

chemical.Iron,NickelandManganesestandoutinthisandinSoilSample1.Only

KorbaSampleID Li Cr Mn Fe Co Ni Cu Zn As Cd Hg PbKorba1 0.0081 0.036 0.6335 29.1865 0.019 0.064 0.0335 0.052 0.0089 0.0001 0.0018 0.0284Korba2 0.0041 0.05 0.4663 28.1576 0.0086 0.0449 0.0237 0.0645 0.0069 0.0001 0.0298 0.0257Korba3 0.0029 0.0104 0.1279 8.6058 0.0033 0.0107 0.0138 0.0284 0.0099 0.0001 0.0011 0.011Korba4 0.0152 0.0321 0.6073 29.9369 0.0184 0.0459 0.041 0.0837 0.0061 0.0001 0.0068 0.0299Korba5 0.0023 0.0159 0.5501 11.4006 0.0077 0.0264 0.04 0.0735 0.0047 0.0003 0.0285 0.0375Korba6 0.0036 0.0199 0.2342 10.0326 0.0032 0.0355 0.0215 0.0317 0.0036 0.0001 0.0126 0.0138Mean 0.006 0.027 0.436 19.553 0.011 0.038 0.028 0.055 0.007 0.0001 0.013 0.024

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Arsenic and Cadmium

arelowerinthissample.

TheNickelandMercuryguidelinesofUKnvironmentAgencyarecurrentlyunderreview [Ref Environment agency, 2009]https://www.claire.co.uk/home/news/44-risk-assessment/178-soil-guideline-values?start=1Location of Soil and Water Samples on a Map (http://arcg.is/0SPzPi)

4.4SummaryoftheEnvironmentalMonitoring:Thestatusofenvironmentalpollution(air,water,soil)ascomparedtopermissiblelimits- PM2.5 is high.Aluminium ishigher thanpermissible limits in3water samples andManganeseishighinone.SoillevelsappeartobewithinpermissiblelimitsaccordingtoPGIMER’s analysis when compared with standards set by Derby and EnvironmentalAgency (2004) for the different areas i.e., agricultural, commercial, residential andindustrial.Itseemshoweverthatthepresenceofflyashhasaffectedthesoil,waterandairinKorba.

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5.0HealthStudy Thehealthsurveyareawaswithin10kmradiusoftheThermalPowerPlantsinKorbaandKatghora.5.1HealthStudyDesign: Acrosssectionalcomparativedesignwasusedtoevaluateadministeredsurveyanswersto a health questionaire in six areas around the thermal power plants all within 5kilometersofthemultipleplantsatKorba. These were compared with unexposed control population from the Katghora area.Katghora is a small block (sub-district) town 35km from the district headquartersKorba.Theclosestindustryisthenon-operationalVandanaVidyutThermalPowerPlantatSalora7.6kmaway.Therearesmallshops,schools,bank,smalladministrativeoffice.However most residents are engaged in farm related activities or farming in thesurroundingvillages

5.2SamplingMethod:Thetotalvillages/slumsinandaroundthethermalpowerplantweredividedintotwostratabasedonproximity-a)atKorbawithin5kmofradiusfromtheplantclusterandb)atKatghoraover6kmsfromapowerplant.Fromeachstrataabout325householdswererequired for thestudy.PulsePolioplanswere obtained for household listing since they have a standard method of listinghouseholds.Six areas within 5 km radius and with previous air sampling (done by communitiesthemselves),weretakenasareasofstudyfromKorbaTown.Inordernottobiasthefieldsurveyors and supervisors, the air sample results were not revealed to them.WithineachclusterarandomteamofpoliomicroplanofKorba(Urban)2017-18wasselectedandallhousesinthatteamareaweresurveyed.InKatghorathecomparisonarea,arandomnumberbetweenoneand10wasselectedandeverytenthteamwassurveyed.Twoweresurveyedintheperiodofinitialtraining(not included in analysis). Twowere surveyed in Katghora July 2019 after the Korbadatacollection.Data was collected from the head of the family or a responsible member from thehouseholdswhoconsentedtobepartofthestudy.Informationwascollectedaboutallconsenting permanent residents over 18 years whowere living in the household formorethan6months.Medicalrecordsforanyillnessoftheresidents,ifavailable,wereseenforverificationofmorbid conditions. In addition, spirometry tests were performed for symptomaticassessmentoftherespondents.5.3Samplesize:Astheinformationonthecurrenthealthstatusofthestudypopulationwasnotreadily

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available,thesamplesizewascalculatedbyassumingtheprevalencerateas50%foradesiredprecisionof5%as384ineacharm.If322householdsaresurveyedtherewillbebetween650to1000adultsand2000populationineacharm-affectedfromKorbaandcomparisonfromKatghoraarea.ThiswillproduceastudywithapproximatelyPowerof80%andanAlphaerrorof0.05.

5.3.1RefusaltoParticipate:Thepercentofthosesurveyedthatrefusedtoparticipatewere: TotalRefusedOthers(Locked/Atwork/Partial) Korba240948920%190.78% Katghora563153%376.57% RefusalsinKorbawerecommonamongthosewithdailywageemploymentattheplant-therebeingsomefearofbeingvictimised.WorkinKatghorarelatedtoagriculture,primarilypaddyplanting.

6.0DetailsofStudymethodology: 6.1HealthSurvey:The duration of the Korba arm of the study was from June to October 2018. Twoexperiencedresearchassistantsandaphysicianwereappointedforthestudy.Briefingon tools and activitieswere carried out. Kobo Collectwas used onmobile phones tocollectdata.Inaddition,supervisoryvisitsanddatascrutinywereconductedbythePIandCo-PI.TheoveralldataanalysiswasdoneinEpiInfoinitially.6.1.1HealthInformationTools–INSEARCHandDASS21QuestionnairesInformation on various respiratory symptoms were collected using a pre-validatedHindi translation of the Indian Study on the Epidemiology of Asthma, RespiratorySymptomsandChronicBronchitis(INSEARCH)questionnaire.

a) The diagnosis of bronchial asthma and chronic bronchitis was established asinstructed in the INSEARCH questionnaire. This diagnosis was established byaffirmativeresponsestoahistoryofwheezingortightnessofthechest,plusoneof the following:ahistoryofpreviousdiagnosisofasthma,anattackofasthmaand/oruseofmedicationforasthmainthepast12months.

b) Diagnosis of chronic bronchitis was based on presence of cough with

expectorationfor>3monthsandatleastoneofthefollowing:coughfirstthingin the morning and/or ejecting phlegm from the chest in the morning.Breathlessness was defined as an affirmative response to at least one of thefollowing four criteria: breathlessness in the morning, breathlessness onexertion,breathlessnesswithoutexertion,and/orbreathlessnessatnight.Coughwasdefinedasthereportofcougheitherinthemorningoratnight.

DASS21Questionnaire:The21itemDepressionAnxietyStressScalequestionnaireisused as a quantitative measure of distress along the 3 axes of depression, anxiety

18

andstress reactions and management8. Each of the questions is rated from 0 to 3.Therefore, each of the axes presents partial scores of 0 to 18-24 depending on thenumberofquestionsassigned.

There have been created cut off points for each of the severity categories. These aredescribed in the tablebelow.Thecutoffs shouldbe cautiouslyused in conjunction tootherclinicalandobservationaldata:Level/Disorder

Depression Anxiety Stress

Normal 0-4 0-3 0-7

Mild 5-6 4-5 8-9

Moderate 7-10 6-7 10-12

Severe 11-13 8-9 13-16

Extremelysevere ≥14 ≥10 ≥17

6.1.2Spirometry-UsingcomputerlinkedSpirometryforLungFunctiontests(PeakFlowandFEV1).ThisisprofessionalmedicalequipmenttfromMedicalInternationalResearch(MIR).WeusedMIRSpirobankIIAdvancedpurchasedforthisprojectwithapprovedsoftware.Whenthepatientblowsintothetubetheirbreathspinsapropeller.Opticalsensorsintheunitmeasuretherpmanddurationtodeterminemeasurements.Itisaccuratewhentestedagainstmechanicalpeakflowmeters.Connectseasilyandgivesdataandmetricsthatcanbesaved.FirstreadingsinthefieldtestareaweretakenbytechnicianwhocameforacampwiththeAIIMSRaipurteam.TwoinvestigatorswerethentrainedatAIIMSRaipurandconductedtherestofthetests6.2Ethicsapproval: EthicalclearancefromtheInstitutionalEthicsCommitteewasobtainedpriortothis.AcopyofStudyInformationwasgiventoparticipants.Physicalcopiesofconsentweresigned,andthesignedconsentwasretainedbysurveyteam.Forilliterateparticipants–informationwas read out inHindi (local language), explained by a person chosen byparticipantandthethumbimpressionofrespondentobtainedalongwithdeclarationoftheliteratewitnesschosenbythem.6.3HealthDatacollection:Timelines

• Pre-testOctober2017onwardstillJanuary2018usingpaperandthenEpiCollectmobilesurveymethods

• Field testing of the questionnaire was done from February to March 2018 onKobocollectinDipraparacommunity

8 �https://www.thecalculator.co/personality/Stress-Management-Test-626.html#_blank

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• Writtenconsentwastakenfromtheparticipants(literateandilliterate).

• Health survey was conducted for the selected sample of subjects from theDipraparacommunitybyDrAjoyBeheraAIIMSRaipuralongwiththespirometrytestincoordinationwithDistrictHospitalKorba.

• KorbastudydatacollectionwasconductedfromApril2018toNovember2018.

• ComparativedatacollectionwasconductedinKatghorainAugust2019.

• Community education was conducted by Dr Ajoy Behera AIIMS Raipur and

DistrictHospitalKorba.

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7.0HealthDiscussion:7.1Comparisonofprevalenceofdiseaseinexposedversusunexposed:Rrespiratorysymptomsandreportsofdiseaseweresignificantlyelevatedinexposedpopulations (of Dari Basti, Puraini Basti/ near Abhinandan complex, Raatakhar andKohdiya) and the less exposed population (DingapurRisdi and Patharipara) in Korbaand still further below those from the unexposed group inKatghora (Hunkara andTulsiChowk). 7.1.1Asthma:Asthmasymptomssuchaswheezingandtightnessofchestare11.79%in exposed population,while it is 5.46% in the unexposed populations. This trend issimilarinmalesandinfemalesintheareaandAsthmaisseenincreasingwithageandisconsistently higher in the exposed than in the unexposed one. In addition, diagnosedasthmapatientswerefoundmoreintheexposedgroupandonceagainthistrendwassimilarinbothmaleandfemales. 7.1.2Bronchitis:ThereportedprevalenceofChronicBronchitis(3monthscoughwithexpectorationplusoneothersymptominthemorning)is2.96%inexposedand0.99%inunexposedgroups. 7.1.3 Comparison of respiratory disease prevalence in study areawith regionalestimatesfromINSEARCH TheoriginalINSEARCHstudyreportedtheprevalenceofasthmaandchronicbronchitisin adults as 2.05% and 3.49% respectively. In a study on Epidemiology of Asthma,quoted below, we see that Nagpur had less than 5% of either Chronic Bronchitis orAsthma,whetherUrbanorRural.Kolkatahadmuchmorethan5%,nearly10%inUrbanareasusingINSEARCH.

JindalSK1,AggarwalAN,GuptaD,AgarwalR,KumarR,KaurT,ChaudhryK,ShahB.IndianStudyonEpidemiologyofAsthma,Respiratory:1270-7DOI:10.5588/ijtld.12.0005

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Inthisstudy(Korba2018)wefoundasthmatobeas1.55%inExposedpopulationand0.45%inunexposed. PARAMETERS:Odds-based

Estimate

Lower Upper

OddsRatio(crossproduct)3.5090

1.31279.3806(T)

Bronchitisis2.96%inexposedand0.99%inunexposedgroups SingleTableAnalysis

Thedifferenceisstatisticallysignificant,thoughratesarelessthaninotherstudies. Onestudyof121shopkeepers in Indiaworking formorethanayear inshops locatedwithin100mof thenationalhighway inBangalorehadaprevalenceof cough32.2%,breathlessnessof31.4%,andasthmaof12.4%. (RameshN.Prevalenceofrespiratorymorbidityamongshopkeepersinthevicinityofanational highway, Bangalore. Int J Occup Saf Health [Internet]. 2017[cited 2019 Jan26];5(1):17-21. Available from: https://doi.org/10.3126/ijosh.v5i1.12985) quoted inSajalDeetal. In the same study of shopkeepers in Bhopal the prevalence of bronchial asthmawas3.6%(95%confidence interval (CI):1.9-6.7),chronicbronchitis13.9%(95%CI:10.2-18.8),breathlessness,41.8%(95%CI:35.9-48.0),andcough18.3%(95%CI:14.0-23.6),respectively. The adjusted risk ratios of bronchial asthma2.17 (95%CI: 0.35- 13.41),chronic bronchitis 1.42 (95%CI: 0.58-3.48), breathlessness 1.71 (95%CI: 0.94-3.11),andcough0.97(95%CI:0.47-2.03)inastudyofshopkeepersinBhopal. (Sajal De,Gagan Deep Singh Kushwah,Dharmendra Dharwey, andDevikaShanmugasundaram(2019)RespiratoryMorbidityofRoadsideShopkeepersExposedtoTraffic-related Air Pollution in Bhopal, India. Journal of Health and Pollution: March2019,Vol.9,No.21,190305. https://www.journalhealthpollution.org/doi/pdf/10.5696/2156-9614-9.21.190305Accessedon20August2019.)

Point 95% Confidence Interval Estimate Lower Upper

PARAMETERS: Odds-based Odds Ratio (cross product) 3.0612 1.5572 6.0179 (T)

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7.1.4Breathlessness:InBreathlessnesscategory,Question16(breathlessnessafterfinishingexercise)showsthehighestpercentagesofpositiveresponsesinthesurvey.

Breathlessafterfinishingexerciseis23.85%inwomeninexposedareasand11.5%innon-exposedareas.OddsRatio2.4106(95%CI1.7704-3.2822)

PARAMETERS: Odds-basedEstimate Lower UpperOdds Ratio (cross product) 2.4106 1.7704 3.2822 (T)Itis19.06%inmeninExposedareasand8.86%innon-exposedareas OddsRatio2.4229(95%CI1.6863-3.4812)

PARAMETERS: Odds-basedEstimate Lower UpperOdds Ratio (cross product) 2.4229 1.6863 3.4812 (T)This increase inbreathlessness is consistentacrossdifferentagegroupsand it is alsoconsistentacrossdifferentsocioeconomicgroupsafterincludingtheTulsiChowkareaofKatghora(seelimitations)

SUMMARY INFORMATION Point 95%Confidence Interval

Parameters Estimate Lower UpperOdds Ratio Estimates

Crude OR (cross product) 2.4391 1.9290, 3.0842 (T)Crude (MLE) 2.4382 1.9317, 3.0908 (M)

1.9192, 3.1125 (F)Adjusted OR (MH) 2.4157 1.9098, 3.0556 (R)

(T=Taylor series; R=RGB; M=Exact mid-P; F=Fisher exact) 7.1.5Limitations:InQ23wefacedadoubtduetopoorunderstandingofthesurveyor.The48responsesrecordedas(c)inKatghora(Breathingnevercompletelyrecovers)–werefoundtohaveadurationof0yearsinmostcases.Mainvariable:_EXPOSEDvsMainvariable:23Includemissing:False

_EXPOSED (a)Ihardlyexperience (b)Iusuallygetshort (c)Mybreathingisneve 0 TOTAL KatghoraNo 331 19 48 0 398KorbaNo 588 20 1 115724Yes 1161 127 4 3911683TOTAL 2080 166 53 5062805

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Wethereforeexcludedcasesthatshowed0yearsofreply(c)fromtheanalysis.Wealsocombinedb)andc)ashavingbreathingissues. 7.1.6RefusalsinKorbawerecommonamongthosewithdailywageemploymentattheplant-therebeingsomefearofbeingvictimised.Theresearchersdonotexpectthe20%refusalstoimpactthefindingsandtheymaynotcauseapositivebias.Thismighthavebeenexpectediftheyrefusedduetoalackofsymptoms/healthproblems.Howeverweseethatagoodnumberofworkersrefusedorwenttoworkinthecontrolarea(3+6.57=9.57%)7.1.7Comparisonofothermorbiditieswithregionalestimates:

1. Allergies19to22%inexposedpopulationand 9.57to9.78%innon-exposedpopulation. (Odds Ratio 2.2294, 95% CI 1.5956 to 3.1150) Further analysis iscertainlywarranted. The exposure to dustmay be the cause of these allergies.However,thiscouldbealsobeaconfounder

2. Depression(moderateandsevere)4.26%inexposedmalepopulation,3.92%

in non-exposed male population; 7.11% in exposed female population and8.33% in non-exposed female population (higher). This is not consistent norsignificant.

3. Anxiety(moderateandsevere)2.77%inexposedfemalepopulationand4.41%innon-exposedfemalepopulation(higher);3.18%inexposedmalepopulationas opposed to 4.47 in unexposedmale population (higher). Theremay not besignificantdifferencesbetweengroups

4. Stress (moderate and severe) 1.02% in exposed population and 0.53% innon-exposed population. There may not be significant differences betweengroupsinthis2018study.

5. Depression(mild,moderateandsevere)19.18%inexposedpopulationand15.86%innon-exposedpopulation.Notsignificant

6. Anxiety (mild,moderate and severe) 17.75 % in exposed population and15.21%innon-exposedpopulation.Notsignificant

7. Stress(mild,moderateandsevere)12.83%inexposedpopulationand12.55%innon-exposedwhichisnotsignificant

A study of 500 adolescentswas done in Ranchi.Cut-offincludedallwithmildtoextremelyseveresymptoms.Symptomsofdepressionwerepresentin18.5%,ofanxietyin24.4%,andstressin20%. (J Nerv Ment Dis.2010 Dec;198(12):901-4. doi:10.1097/NMD.0b013e3181fe75dc. Prevalence ofdepression, anxiety, and stress among youngmale adults in India: a dimensional and

Chi-square df Probability 4.1554 2 0.1252

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categoricaldiagnoses-basedstudy.SahooS1,KhessCR.)AstudyofindustrialworkersinBangaloremade tables of all symptomatic includingmild category. Below 30 years ageindustrial workers had 0% Stress and33% Anxiety (this is the lowest anxietyvalueamongdifferentagegroupsofindustrialworkersinaBangalorestudy).Anxietysymptoms were found in 30.8% in workers who were employed over 20 years. Just10.3%workerswithlessthantenyearsemploymenthadsymptomsofStress. Ind Psychiatry J. 2015 Jan-Jun; 24(1): 23–28. doi:10.4103/0972-6748.160927PMCID:PMC4525427 PMID:26257479 Depression, anxiety and stress levels inindustrialworkers:ApilotstudyinBangalore,IndiaSheldonRaoandNaveenRamesh1

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7.1.8HealthEffectsoftheChemicalsfoundintheEnvironmentalSamples

AluminumManganeseLead

Arsenic Lead

AluminumCadmiumChromiumNickel

LeadPM2.5Arsenic Manganese

NickelManganese

ChromiumCadmiumManganese

ArsenicCadmiumManganeseZinc

Chromium

NickelLeadCadmium

ArsenicPM2.5

ChromiumLead

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8.0Conclusions The present cross sectional study has made an assessment of the disease burden incommunities surrounding thermal power plants, which is in principle good forhypothesisgenerationandhealthcareplanning.Thestudyhighlightstheenvironmentalpollutionandlaysspecialemphasisonrespiratoryhealthstatusofthepopulation. 8.1Interpretationoffindings Health problems are more common close to the Hasdeo (KorbaWest) Power Plant ,especiallyinPuraniBastiandinDarri,thisincludesobstructivelungdiseaseandlargepercentage of symptoms of breathing difficulty. Symptoms in housewives are alsopresentinthisregion,andalsoinmenwhodonotworkinthefactories/plants,donotsmokeanddonotcook,butwholiveclosetotheareaswhereflyashresidueisfoundin(top)soilandwater.ThisisincontrasttoKatghora-anurbanareainthesamedistrict,whichhasnothermalpowerplantsortheirashponds.Thestatusofenvironmentalpollution(air,water,soil)ascomparedtopermissiblelimits-pm 2.5 is high. Aluminium is higher than permissible limits in 3 water samples andManganeseishighinone.SoillevelsappeartobewithinpermissiblelimitsaccordingtoPGIMER’s analysis when compared with standards set by Derby and EnvironmentalAgency (2004) for the different areas i.e., agricultural, commercial, residential andindustrial.Itseemshoweverthatthepresenceofflyashhasaffectedthesoil,waterandairinKorba. 8.2Recommendations Basedonthefindingsofourstudy,wewouldrecommendthefollowing:A)Health:

1. StateGovernmentshouldsetupspecializedhealthcare infrastructureoperatedby the State health departments at polluters’ cost, under the “polluter pays”principle,tocatertohealthissuesofresidentsintheregionofKorba.

2. This should include facilities like spirometryat thedistrict levelhospitalswithprovision of technical expertise, adequate provision of respiratory and othermedicinesandtrainedstaffandotherinfrastructure.

3. State agencies provide for long-term health monitoring by initiating healthstudiesamongtheresidentsofKorba.

4. State Government should conduct a cumulative health impact study of thevarious industriesonthehealthof theresidentsofKorbaandthenformulateanecessaryhealthmitigationplanfortheregion

B)Environment:

1. MandatoryHIAsaspartofcommissioningofindustrialclustersalongwithEIAs,bothatbaselineandatinterimtime-points.

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2. StateandCentralPollutionControlBoard initiatecontinuousmonitoringheavymetals indust andpublish resultsperiodically.Health advisoriesby consultingreputedhealthagenciesshouldalsobeissuedregularly.

3. A pollution cess is levied on units and activities not conformingwithNationalAmbientAirQualityStandards(NAAQS).

4. Agenciesusethepollutiondatatoapprehendpollutersandtakecorrectiveactionto bring levels of dust and heavy metals in dust to below detection limits inresidentialareas.

5. Areascontaminatedbyflyashshouldbeassessedforthedepthandspreadofthecontamination and remedied with full scientific oversight at the cost of thepollutingfacilitiesunderpolluterpayprinciple.

8.3Limitationsofthiscross-sectionalstudy:Thisstudyisexploratoryinnature. Aswithanystudiesofthissort,theremaybeasurvivoreffectthathasdepressedresponserates in the exposed areas and the voluntary nature of participation aswell as smallsamplesizemayinflatetheeffectsdemonstrated. In addition, due to inconsistent responses.We excluded cases that showed0 years ofreply(c)fromtheanalysis.Wealsocombinedb)andc)ashavingbreathingissues.Afterthis,theresultappearstoagreewithotherrespiratoryresults(forthefinalvaluesafterTulsiChowksee“comparisonofprevalenceofdisease”above).8.4ConflictofInterest:AsthisstudyisapartofmulticentricstudywhichisfundedbyCentreforChronicDiseaseControl(CCDC),NewDelhi.Weacknowledgetheirteamandlaboratory services provided by PGIMER Chandigarh. We also express our deepgratitudetolocaladministrationfortheirkindcooperationinconductingthestudy.

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APPENDIX1ENVIRONMENTALMEASUREMENTSDETAILS

a)PM2.5measurements. DustTrakaerosolmonitor(Model:8530,Make:TSIInc.,Shoreview,MN)wasusedforrealtimeandgravimetricbasedPM2.5massconcentrationmeasurements.DustTraksusealaserphotometertoestimatePM2.5massconcentrationsbasedon90˚lightscattering(TSI2014). Asheathairsystem isprovidedwithin the instrument tokeep theopticsclean for improved reliability and low maintenance. We employed manufacturer-suppliedPM2.5inletnozzlesandimpactors,with1minsamplingintervaland3Lpmflowrate(correspondingto2.5µmcut-point).WecorrectedtheDustTrak-recordedrealtimePM2.5 concentrations for real-time relative humidity (Both et al. 2011) and dailyaveragelocalaerosolproperties;.Oneminaveragedrelativehumidity(RH)valuesweremeasuredusingHobomonitor(Make:Onset,ModelRH481). b)RHCorrection. Ambient conditions above 60% RH are favorable for hygroscopic growth of particlesleadingtooverestimationofPM2.5measurementsbyDustTrak;.Weusedtheequationsdeveloped (equations 1 and 2) by to correct 1 min averaged DustTrak PM2.5 massmeasurements sampled in atmospheric conditions withmore than 60% RH. Further,ambient conditions above 95% RH result in very large distortions in DustTrak dataandhencethecorrespondingdatahasbeenelectedtoignore.

)c)ReferenceCorrection.The DustTraks are factory calibrated against Arizona dust (A1) which is reported tohave a density of around 2.6 g/cm3 . However, ambient aerosols contain both crustal(density >2 g/cm3) and combustion (density <1 g/cm3) particles, with an averagedensity between 1.5 and 1.7 g/cm3. Thus, it requires a mandatory comparison ofDustTrakmeasurementstoalocallyoperatedreferenceaerosolmonitormeasurementsforderivingacorrectionfactortoaccountthelocalaerosolcharacteristicstoDustTrakmeasurements ; ; . In the present study, we compared and regressed DustTrak’s RHcorrected24haveragedphotometricbasedrealtimemeasurementswith24haveragedgravimetricbasedmeasurementstoderiverelationshipbetweenopticalandgravimetric(federalreferencemethod)methods. d)QualityAssuranceandQualityControl.WeregularlyinspectedtheDustTraktocheckforanyinstrumentalerrors.Kimwipes ,isopropylalcoholandcompressedairwereusedforcleaningDustTrakaccessories.WecleanedPM2.5inletnozzleandimpactoronceeveryweekandlubricatedimpactorplatewith adropof impactoroil suppliedby themanufacturer to ensure thedepositionoflarger particles (>2.5 µm) over it. We regularly calibrated the instrument zero pointusinganexternalHepafilter.Theflowrateoftheinstrumentwasmaintainedat3Lpmusingadigitalflowmeter(Model:MassFlowMeter4040,Make:TSIInc.,Shoreview,MN).Further,weperiodicallyreplacedinternalcylindricalfilterstoavoidflowandfilter

CF= 1+0.25 RH2(1− RH ) (1)

2

PM2.5RH− Corrected=PM 2.5

CF ¿

29

errors in the instrument.We downloaded data from all instruments everyweek andarchivedinthreestoragemedia.e)Filterhandling.We used 37 mm Glass fibre filters (Grade GF/A, Cat no. 1820-037, Whatmann,Maidstone Kent, ME) for gravimetric based PM2.5 measurements. The filters werestored and transported in 37mm diameter filter cassettes (Model: 225-2-25LF, SKC,Eighty-Four, PA). The filters were desiccated for a 24h period before pre and postsamplingweighinginPGIMER.3.1.4SoilSampling.HanddrivenAuger(Udipi)andcorecutter(KorbaandChennai)wereusedtocollectsoilsamplesatfivelocationsineachofthreecities.Ateachlocation,sampleswerecollectedfrom2 sites (separatedby a distance of atleast 50m tomaintain representability) atdepths between 0-15cm and 15-30cm, which were later pooled together to obtain acompositesample(Lindeetal.,2001;Zhangetal.,2018).Thesampleswerecollectedinair tightbags,properly labelledandtransported in iceboxes to thecentral location(PHFI). The soilwas then dried at 60°C for a 24 h period to removemoisture, laterpulverized and sieved (2 mm sieve) (Orroño and Lavado, 2009; Kamunda et al.,2016).Thesampleswerestoredin4°CrefrigeratoratthePHFIlabuntilitstransfertoPGIMERfortheanalysis(Ratnakar,2018).3.1.5WaterSampling.Fivesamplesofsurfaceandgroundwaterwerecollectedinthethreestudycities.Allthesampleswerecollectedandstoredinborosilicatebottles(Model:1501;Productcode:1501029,BorosolGlass,Mumbai).Thebottleswerewashedwithdistilledwater,NitricAcid(HNO3)andfinallyrinsedwiththesamplewaterbeforecollectingasampleof500ml(USEPA,1984;Cobbinaetal.,2015).~2mlofconc.HNO3wasimmediatelyaddedtoittomaintainitsPHinacidicrange(USEPA,1984).Thesamplescollectedwereproperlylabelled and transported in ice boxes to the central location. The sampleswere thenfiltered using 6 µm filters (Model: 1003-125, Product code: Grade 3, Whatman,MaidstoneKent,ME)toremovedustandothersuspendedparticlesinwaterandwerelaterstoredin4°CrefrigeratorinPHFIlabuntilitstransfertoPGIMERfortheanalysis(USEPA,1984).

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Appendix 2: Factsheet on health impacts of the chemicals found in theenvironment Aluminum AcuteHealthEffects Contactcanirritateskinandeyes

Exposure to Aluminum can cause “metal fume fever.” This is a flu-likeillnesswithsymptomsofmetallic taste inthemouth,headache, feverandchills,aches,chesttightnessandcough.Thesymptomsmaybedelayedforseveralhoursafterexposureandusuallylastforadayortwo.

ChronicHealthEffects CancerHazard NotacarcinogenReproductiveHazard NoadverseeffectOtherLong-TermEffects Exposuretofinddustcancausescarringoflungs(pulmonaryfibrosis)with

symptomsofcoughandshortnessofbreath.Whilethereisnoevidencetosuggestthatingestionoffoodsorbeveragesthatnaturallycontaintracesofaluminumisharmful,severalinvestigatorshaverecentlyreportedcasesinwhichshort-termexposurestohighaluminumlevelsindrinkingwaterordialysisfluidresultedinclinicaldiagnosesofdementia.Inadditiontothesereports,researchersinFranceandCanadahavereportedslightlyhigherratesofAlzheimer’sDiseaseamongresidentsofcommunitiesthathadelevatedaluminumlevelsintheirwatersupplies.BecauseAlzheimer’sDiseasehasastronggeneticcomponent,theeffectofaluminumonitsdevelopmentiscontroversialandneedsfurtherstudy.Infantsandolderpeoplewhosufferfromdiseasesthataffectkidneyorliverfunctionmaybeespeciallysensitivetotheeffectsofingestedaluminum.

Moredetailsat:http://www.nj.gov/health/eoh/rtkweb/documents/fs/0054.pdfhttps://www.dhs.wisconsin.gov/publications/p0/p00261.pdf

Arsenic AcuteHealthEffects Eyecontactcancauseirritation,burnsandred,wateryeyes.Inhaling

Arseniccanirritatethenoseandthroatcausingcoughingandwheezing.ExposuretoArseniccancauseweakness,poorappetite,nausea,vomiting,headache,musclecrampsandevendeath.

ChronicHealthEffects CancerHazard ArsenicisaCARCINOGENinhumans.Ithasbeenshowntocauseskinand

lungcancer.Manyscientistsbelievethereisnosafelevelofexposuretoacarcinogen

ReproductiveHazard ChronicArsenicexposurehasbeenassociatedwithspontaneousabortionsandstillbirths.ThereislimitedevidencethatArsenicisateratogeninanimals.Untilfurthertestinghasbeendone,itshouldbetreatedasapossibleteratogeninhumans.

OtherLong-TermEffects Repeatedskincontactcancausethickenedskinand/orpatchyareasofdarkeningandlossofpigment.Somepersonsmaydevelopwhitelinesonthenails.Long-termexposurecancauseanulcerorholeinthe“bone”(septum)dividingtheinnernose,hoarsenessandsoreeyes.

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Arsenicmaydamagethenervoussystemcausingnumbness,“pinsandneedles,”and/orweaknessinthehandsandfeet.Arsenicmaydamagetheliver.

Moredetailsat:http://www.nj.gov/health/eoh/rtkweb/documents/fs/0152.pdf

Cadmium AcuteHealthEffects Contactcanirritatetheskinandeyes.

Exposure to Cadmiummay cause “metal fume fever.” This is a flu-likeillnesswithsymptomsofmetallic taste inthemouth,headache, feverandchills,aches,chesttightnessandcough.Thesymptomsmaybedelayedforseveralhoursafterexposureandusuallylastforadayortwo.Cadmiumcancausenausea,vomiting,diarrheaandabdominalpain.Inhaling Cadmium can irritate the lungs causing coughing and/orshortnessofbreath.Higherexposuresmaycauseabuild-upoffluidinthelungs(pulmonaryedema),amedicalemergency,withsevereshortnessofbreath.

ChronicHealthEffects CancerHazard Cadmium isaCARCINOGEN inhumans. Ithasbeenshowntocause lung

and prostate cancer. Many scientists believe there is no safe level ofexposuretoacarcinogen.

ReproductiveHazard CadmiumisaPROBABLETERATOGENinhumans.Cadmiummaydamagethemale reproductive system (testes) andaffect the female reproductivecycle.

OtherLong-TermEffects Cadmiumcan irritatethe lungs.Repeatedexposuremaycausebronchitistodevelopwithcoughing,phlegm,and/orshortnessofbreath.Repeatedlowexposurescancauseliverandkidneydamage.Cadmium can cause anemia, loss of sense of smell (anosmia) and/ordiscolorationofteeth.


Chromuim AcuteHealthEffects Contactcanirritateandburntheskinandeyeswithpossibleeyedamage.

InhalingChromiumcanirritatethenoseandthroatcausingcoughingandwheezing.Exposure toChromium fumescancause “metal fume fever.”This is a flu-like illnesswithsymptomsofmetallic taste inthemouth,headache, feverandchills,aches,chesttightnessandcough.Thesymptomsmaybedelayedforseveralhoursafterexposureandusuallylastforadayortwo.

ChronicHealthEffects CancerHazard NotacarcinogenReproductiveHazard NoadverseeffectOtherLong-TermEffects InhalingChromiumcancauseasoreand/oraholeinthe“bone”(septum)

dividing the inner nose, sometimes with bleeding, discharge, and/orformationofacrust.Chromiummay cause a skin allergy. If allergy develops, very low futureexposurecancauseitchingandaskinrash.

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Chromiummay cause an asthma-like allergy. Future exposure can causeasthmaattackswithshortnessofbreath,wheezing,coughing,and/orchesttightness.Prolongedskincontactcancauseburns,blistersanddeepulcers.Chromiummayaffecttheliverandkidneys.


Lead AcuteHealthEffects Contactcanirritatetheeyes.

Lead can cause headache, irritability, reduced memory, disturbed sleep,andmoodandpersonalitychanges.Exposurecancauseupsetstomach,poorappetite,weaknessandfatigue.

ChronicHealthEffects CancerHazard Lead is aPROBABLE CARCINOGEN in humans. There is some evidence

that Lead and Lead compounds cause lung, stomach, brain and kidneycancers in humans and they have been shown to cause kidney cancer inanimals. Many scientists believe there is no safe level of exposure to acarcinogen.

ReproductiveHazard LeadmaybeaTERATOGENinhumanssinceitisateratogeninanimals.Itmaydecreasefertilityinmalesandfemales,anddamagethedevelopingfetusandthetestes(malereproductiveglands).

OtherLong-TermEffects Repeated exposure toLead can causeLead poisoning. Symptoms includemetallic taste, poor appetite, weight loss, colic, nausea, vomiting, andmusclecramps.LeadisaneurotoxinandisknowntocauselowIQamongchildren.Higherlevelscancausemuscleandjointpain,andweakness.Highorrepeatedexposuremaydamagethenervescausingweakness,“pinsandneedles,”andpoorcoordinationinthearmsandlegs.Leadexposureincreasestheriskofhighbloodpressure.Leadmaycausekidneyandbraindamage,anddamageto thebloodcellscausinganemia.Repeated exposure causes Lead to accumulate in the body. It can takeyearsforthebodytogetridofexcessLead.


Manganese AcuteHealthEffects Contactcanirritatetheskinandeyes.

Inhaling Manganese can irritate the nose, throat and lungs causingcoughing,wheezing and/or shortness of breath. Exposure toManganesecan cause “metal fume fever.” This is a flu-like illness with symptoms ofmetallic taste in the mouth, headache, fever and chills, aches, chest

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tightnessandcough.Thesymptomsmaybedelayedforseveralhoursafterexposureandusuallylastforadayortwo.

ChronicHealthEffects CancerHazard NotacarcinogenReproductiveHazard Manganesemay damage the testes (male reproductive glands) andmay

decreasefertilityinmales.OtherLong-TermEffects Manganese is a neurotoxin and repeated exposure can cause permanent

braindamage.Early symptoms include poor appetite, weakness and sleepiness. Latereffects include changes in speech, balance,mood and personality, loss offacialexpressions,poormusclecoordination,musclecramps,twitchingandtremors.ThelatersymptomsareidenticaltoParkinson’sdisease.Prolongedorrepeatedexposurecanleadtopermanentlungdamage.Manganesemayaffecttheliverandmaycauseanemia.


Nickel AcuteHealthEffects Contact can irritate andmayburn the skinandeyes. InhalingNickelcan

irritatethenose,throatandlungs.Exposure toNickelmaycause“metal fume fever.”This isa flu-like illnesswith symptomsofmetallic taste in themouth,headache, feverandchills,aches,chesttightnessandcough.Thesymptomsmaybedelayedforseveralhoursafterexposureandusuallylastforadayortwo.Nickelcancauseheadache,dizziness,nauseaandvomiting

ChronicHealthEffects CancerHazard NickelisaPROBABLECARCINOGENinhumans.Thereisevidencethatit

causeslungcancerinhumansandithasbeenshowntocauselungcancerinanimals.Many scientistsbelieve there isno safe levelof exposure toacarcinogen. Such substances may also have the potential for causingreproductivedamageinhumans.

ReproductiveHazard While Nickel has not been identified as a teratogen or a reproductivehazard,NickelsaltsandcertainNickelcompoundsareteratogensandmayalso cause reproductive damage. Nickel should be handled WITHEXTREMECAUTION.

OtherLong-TermEffects Exposure toNickelmaycauseaskinallergy. Ifallergydevelops,very lowfutureexposurecancauseitchingandaskinrash.Nickelmaycauseanasthma-likeallergy.Futureexposurecancauseasthmaattacks with shortness of breath, wheezing, coughing, and/or chesttightness.Inhaling Nickel can cause a sore and/or a hole in the “bone” (septum)dividing the inner nose, sometimes with bleeding, discharge and loss ofsmell(anosmia).Nickelcancausechronicbronchitisandmaycausescarringofthelungs.Nickelmayaffecttheliverandkidneys.


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Zinc AcuteHealthEffects Contactcanirritatetheskinandeyes.

Inhaling Zinc can irritate the nose and throat causing coughing andwheezing.ExposuretoZinccancause“metalfumefever.”Thisisaflu-likeillnesswithsymptomsofmetallictasteinthemouth,headache,feverandchills,aches,chesttightnessandcough.Thesymptomsmaybedelayedforseveralhoursafterexposureandusuallylastforadayortwo.

ChronicHealthEffects CancerHazard NotacarcinogenReproductiveHazard Zinc appears to affect the male reproductive system (including sperm

count). Further testing is required to assess its potential to causereproductiveharm.

OtherLong-TermEffects Prolonged or repeated contact can cause dermatitis with drying andcrackingoftheskinandredness.


PM2.5 HealthEffects Particleslessthan2.5micrometersindiameter(PM2.5)arereferredtoas

"fine"particlesandarebelievedtoposethelargesthealthrisks.Becauseoftheirsmallsize(lessthanone-sevenththeaveragewidthofahumanhair),fineparticlescanlodgedeepintothelungs.“Healthstudieshaveshownasignificantassociationbetweenexposuretofine particles and premature mortality. Other important effects includeaggravation of respiratory and cardiovascular disease (as indicated byincreased hospital admissions, emergency room visits, absences fromschoolorwork,andrestrictedactivitydays), lungdisease,decreasedlungfunction, asthma attacks, and certain cardiovascular problems such asheartattacksandcardiacarrhythmia. Individualsparticularlysensitive tofine particle exposure include older adults, people with heart and lungdisease,andchildren.”(RefUSEPA)

Moredetailsat:http://www.epa.gov/ttn/naaqs/pm/pm25_index.html

health impact assessment of communities in areas

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