Public Health and Air Pollution in Asia PAPA Program Update The Next Phase

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Public Health and Air Pollution in Asia
(PAPA)Program Update /The Next Phase

• Bob OKeefe
• Secretariat Coordinating Meeting
• July 2005
• Bangkok,

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PAPA Program

• Partnership with CAI-ASIA to understand the
  health effects of air pollution in Asia, now and
  in the future
• Supported by US AID, foundations, industry,
  others
• Active effort underway
• Published Scientific Review and Meta Analysis of
  what is known today about health effects in Asian
  cities
• Conducting series of epidemiological studies in
  representative Asian cities
• Understand local impact
• Combine to provide Asia-wide understanding
• Publish a Comprehensive Assessment of the state
  of air pollution and health across Asian cities
• Build capacity of local scientists
• Regular Communication of results to policy makers
  
• Overall Goal
• Quality science to inform key Asian regulatory
  policy decisions

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Health Effects of Outdoor Air Pollution in
Developing Countries of Asia A Literature Review

• Systematic identification of 140 peer-reviewed
  Asian studies 1980-2003
• Special focus on studies of daily changes in air
  pollution and health
• Conduct first ever Asian meta analysis
  quantifying risks, finding initial similarities
  with West
• Identify knowledge gaps to guide future research
• Active communication to policy makers

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Meta-Analysis of Asian Studies of Daily
Mortality/Hospital Admissions

• 28 recent daily time series studies examined in
  depth
• Studies find effects of air pollution on rate of
  death, illness
• 0.5 increase per 10 µg/m3 of PM10
• High levels of air pollution in Asian cities
  (gt100 µg/m3), imply a substantial public health
  impact
• Limitations
• Small number of cities
• Not geographically representative (poorest, most
  polluted countries under-represented)

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New Research in Asian Cities

• Eight new studies of air pollution and health now
  underway in Asian Cities
• Acute Effects (initial cities)
• Bangkok, Hong Kong, Shanghai, Wuhan
• Strong teams, quality data
• Long Term (chronic) Effects
• Guangzhou, China pilot study in elderly cohort
• New!
• Study teams now identified and Approved in India
  following extensive investigator competition

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New PAPA Studies in India

• Goal Understand air pollution health effects in
  less-studied areas
• Representative time series studies of pollution
  and daily death
• Diverse, highly populated regions
• Public health impact could be significant
• Significant data challenges (air quality,
  morbidity, mortality - frequency, access,
  quality)

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PAPA in India
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Proposed Milestones 2005

• Actively communicate results of Asia Review and
  Analysis in key regional and international policy
  forums
• Begin full implementation of 3 new studies in
  India
• Provide ongoing oversight, QA\QC for PAPA studies
• Conduct at least two additional capacity building
  workshops in partnership with Fogarty, ISEE
• Continue periodic inventory of new Asia studies
  web post results
• Initiate, in partnership with Vietnam, ADB, NILU,
  and East-West, the HCMC Air Pollution and
  Poverty Assessment
• Develop Final Poverty Study Design
• Select local investigators
• Launch study and capacity building
• And always, always keep an eye on Cornie..

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Recent Accomplishments I(Capacity Policy
Communication)

• II. Support for researchers at international
  conferences ( denotes PAPA symposia)
• HEI Annual Conferences (Boston, May 2004 and
  Baltimore, April 2005)
• International Society of Environmental
  Epidemiology (New York, August 2004)
• Better Air Quality Conference (Agra, December
  2004) Largest non Bank Group !
• International Epidemiological Association World
  Congress on Epidemiology (Bangkok, August 2005)
• Japan Society of Atmospheric Environment
  (Nagoya, September 2005)

• Strengthening the network
• PAPA investigator workshops ( denotes workshops
  involving international researchers from Europe,
  North America, and Latin America)
• February 2004 (Bangkok)
• May 2004 (Boston)
• December 2004 (Agra)
• April 2005 (Boston)
• November 2005 (location to be determined)
• Formation of first Asian regional chapter (South
  Asia) of International Society of Environmental
  Epidemiology (ISEE)

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Recent Accomplishments II(Capacity and Quality)

• III. Training Workshops
• (in addition to collaboration with international
  experts, all workshops include PAPA investigators
  as trainers and trainees)
• Time Series Training Workshop 1 included
  participants from India, Indonesia, Malaysia,
  Philippines, and Vietnam (Delhi, December 2004)
• Workshop on Assessing Health Effects of Short
  Term Exposures to Air Pollution (Ho Chi Minh
  City, anticipated August / September, 2005)
• Time Series Training Workshop 2 (Chennai,
  anticipated September, 2005)
• IV. QA/QC
• Ensuring Internationally Accepted Standards of
  Excellence in Research
• QA Site Visits (Hong Kong, Shanghai, Wuhan,
  Bangkok, May 2005)
• QA Site Visits (Chennai, Delhi, Ludhiana,
  anticipated Fall 2005)

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Recent Accomplishments III(Presenting
PAPA\global science to policy makers)

• Multi stakeholder regional presentations
  
  (Nov 04-present, partial list)
• Quantifying Effects of Air Pollution in Asian
  Cities
• Adverse Effects of Air Pollution in India
• Command and Control Strategies fro Asia
• Public Health and Air Pollution
• Poverty Air Pollution and Health
• PAPA Review Presentations
• In Pakistan China India Vietnam Japan
  Indonesia US Europe
• To Industry (auto, oil, others), Government
  (National EPAs CDCs NGOs Science and medical
  communities International agencies UNEP etc)
  Press
• -Presentations often in context or regulatory
  decisions
• -With or by PAPA local expert (ISOC\local PI)
• Multi language Reviews Presentations
• Upcoming
• Beijing (new fuel standards) Vietnam (Euro II)

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PAPA Looking Ahead

• A Special Challenge Understanding the
  interaction among air pollution, poverty, and
  health
• In Asia high levels of air pollution, dense
  population, extensive poverty are prevalent
• Some initial evidence (mostly from West) that the
  poor face worse effects from air pollution
• Potential Public health implications could be
  significant

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Higher Risks Among the Less Educated

• Evidence from HEI Reanalysis
• Attained education inversely associated with PM
  relative risk in ACS and Six-Cities studies
• An indicator of social class
• Due to differences in true exposure?
• Sensitivity to air pollution?

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Why the Poor May Suffer More Health Effects From
Air Pollution

• Likely higher exposures to air pollution
• Living close to traffic
• Roadside occupational exposures
• Small and medium scale enterprises / Cottage
  industries
• Use of solid fuels for cooking (indoor air)
• The poor may be more susceptible to air pollution
• Poor nutrition / immunosuppression
• Higher incidence of diseases of poverty (TB,
  ALRI)
• Lack of timely access to health care
• Limited evidence from the West, but with
• - high pollution, high urban population density
  significant poverty
• -Clear need to explore this issue in the Asian
  context

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New! HEI Partnership in HCMC to understand
Poverty, Air Pollution and Health

• HEI-PAPA, as part of Clean Air Initiative for
  Asian Cities (CAI-ASIA)
• Nhu partnership with HCMC Dept of Health (lead)
  Department of Natural Resources and Environment
  (DONRE) Department of Labor Invalids and Social
  Affairs (DOLISA)
• International experts from East-West Center UC
  Berkeley Norwegian Institute for Air Research
  ADB, USAEP
• To plan and carry out a new study in Ho Chi Minh
  City to assess poverty-air pollution-health
  intersection
• Are the poor are exposed to higher levels of air
  pollution?
• Are the poor more susceptible to its effects?
• Study results inform Vietnam policy decisions
• Study design transportable\replicable in other
  cites

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Air Pollution, Poverty and Health Key elements
of initiative

• I Assessment of respiratory health of children
  (ALRI others) of different SES
• Designing targeted case-control and panel studies
  to provide quality local data of poverty effects
• II Household survey to assess
• exposure to multiple sources of air pollution
• health prevalence (status)
• Perceptions, coping mechanism and economic burden
• III Policy impact study (integrating above for
  policy making)
• Strong commitment to capacity building throughout

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Roadside Monitoring Station Maintained by HEPA,
with assistance from NILU
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• Collaborators
• ADB
• PAPA
• NILU
• East-West Center
• UC Berkeley
• HEPA
• US AEP
• Multiple Vietnam Government Agencies

Kirk Smith, Sumi Mehta, Aaron Cohen, Le Van Khoa,
Vo Tan Dam, Bjarne Sivertsen, Mr. The, Phan
Quynh Nhu, Ms. Van
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Thank You!