Africa Case Study

Dele Ogunseitan

School of Social EcologyUniversity of California, Irvine

May 20th 2004Advanced Institute of Vulnerability to Global Environmental Change

International Institute for Applied Systems Analysis, Austria

Outline

(1) Institutional Issues: Framing and prioritizing vulnerability assessments in Africa.

(2) Thinking outside the dominant framework: Global environmental change and the African burden of disease.

(3) Proposed solutions to global environmental change will have impacts too: No-cost adaptation and the clean development mechanism in Africa.

(4) Break

(5) Group discussion/summary

Panarchy and Vulnerability

“Panarchy focuses on ecological and social systems that change abruptly. It is the process by which ecosystems and societies grow, adapt, transform, and, in the end, collapse.”

- C.S. “Buzz” Holling (2004)

Vulnerability is inevitable?

» Holling, C. S. 2004. From complex regions to complex worlds. Ecology and Society 9(1): 11. [online] URL: http://www.ecologyandsociety.org/vol9/iss1/art11

» Gunderson, L. H., and C. S. Holling. 2002. Panarchy:

understanding transformations in human and natural systems. Island Press, Washington D.C., USA.

EpidemicsExtinctionsForest firesEarthquakesWar

Several external factors contribute simultaneously to vulnerability e.g. “abrupt” climate change; emerging pathogens; global trade; how do we prioritize

assessments?

Internal vulnerability

Vt = ∑(Vi)*∑ (Ve)

Normative Issues When resources are limited, choices are typically made to focus on pre-existing stressors rather than on emerging threats, but innovative frameworks address both challenges through “no-cost” adaptation strategies.

In many African countries, the reconciliation of national development plans with international priority to mitigate global environmental change (e.g. climate change, ozone depletion, biodiversity loss) remains an intractable policy controversy. Its resolution requires conviction of vulnerability to new conditions that will exacerbate preexisting environmental stresses on society and public welfare.

Perpetual Panarchy in Africa

The Perspective of Developing Countries: The New Delhi Conference in 1989 (The equity argument).

African Perspectives: Nairobi Conference in 2-4 May 1990; Sponsored by the Woods Hole Research Center at the UNEP headquarters.

The Cost of Gaining International Financial Support: Framing, funding, and the question of intellectual hegemony.

Prioritizing GHG Inventories, Mitigation, and Vulnerability (Sensitivity + Capacity for Adaptation).

The benefits of national GHG inventories and mitigation are shared globally. Whereas the burden of adaptation to the impacts are expected to be borne nationally.

Emergence of Regional Frames of Vulnerability

Focus on deforestation, carbon sinks, and food security

Futuristic scenarios

Enhancing research and training

Strengthening the technological base

Promoting public awareness and participation

Reforming the institutional environment

Vigilance of industrialized country actions

Promotion of private sector initiatives

Adjusting UN agency framework

Policy Recommendations from the 1990 Gathering of “African Perspectives”

Framing environmental issues across

different scales

InternationalConventions;

Countryrepresentatives

Negotiation of Alternative International Frameworks

At the same scale

NationalEnvironmental

And Health Policy

Local knowledge

systems

e.g. Burden of disease estimates

e.g. CoP to UNFCCC;Ramsar

e.g. Country StudyPrograms; IPCC

_____________________________________________________________________________________________ ,,,,

Mauritius

US CSP

WHO

GEF

Netherlands CSP

German GTZ

International Support for Vulnerability Assessments in Africa

U.S.-sponsored Country Study Programson climate change inventories, mitigation, and vulnerability

assessments

Country

Coastal Resource

Agric.

Grassland

And Livestock

Water

Resource

Forests

Fishery

Wildlife

Human Health

Botswana * *# * * Cote d'Ivoire * * Egypt *# *# * * Ethiopia * * * * The Gambia *# * * * * * Kenya * * * * Malawi * * * Mauritius * * * * Mozambique * * * * * * Nigeriaa * * South Africa * * * * * * * Tanzania * * * * * Uganda * * * * Zambia * * * * * * Zimbabwe * * *Vulnerability assessment

#Adaptation assessment (Note: decoupled from vulnerability)Some assessments are jointly funded by the GEF

African Participation in the USCSP: Assessments of Vulnerability and Adaptation by Sector

Q: When USCSP started supporting national assessments in 1992-94, health was not included in the first round of vulnerability assessments -until much later in 1996-98 with the second round of assessments and national action plans. What caused the delay?

A: “We were limited mainly by the development of the science. We did not have good information or training to provide, but after we got into the program, some countries began to agitate for the inclusion of health. At about the same time, some influential scientists were beginning to produce empirical work on health impacts of climate change, and as a result of the combination of the request from participating countries and the availability of scientific expertise, we decided to include health.” I would say that, except in the health area, which really did in fact come up from a number of different countries, nothing else came completely out of the blue, because we had a big net for the issues.

- Jack Fitzgerald, Acting Director, USCSP (2000).

Agenda setting: Institutional structure, state of the science, and

advocacy

Health as a focal point for assessments of vulnerability

• Health is a common concern for African countries, and the ultimate impact of climate on crop production and water resources is population health.

• Development of “Early warning systems” for local environmental changes that currently accounts for most impact on human health and social welfare.

• Possibility of circumventing health-damaging pathways to industrial development.

• *Pre-epidemiologic transition. Therefore, burden of disease is attributable to environmental factors that are sensitive to climate change.

– *WMO-day 1999: Weather, Climate, and Health

Lake Chad

1963 1973

19871997

25,000 km2

1,250 km2

95% reduction

The Lake Chad Basin Commission has mandate over 967,000 km2 watershed. Five member states own it and contribute it's budgets. The mandates of regional organizations enable them to undertake active multipurpose infrastructural projects that could generate funds to finance of regional basin organizations.

Population migration, resource conflict, and vulnerability to AIDS in Lake Chad Basin Countries

Estimates of the number of persons living with the HIV, June 2000*

 Adults and Children

Adults Rates among adults

Women (15-49)

Children(0-14)

Cameroon 540,000 520,000 7.73% 290,000 22,000

Niger 64,000 61,000 1.35% 34,000 33,000

Nigeria 2,700,000 2,600,000 5.06% 1,400,000 120,000

C.A.R. 240,000 230,000 13.84% 130,000 8900

Chad 449,254 88,000 2.69% 49,000 4000

Total 3 993 250 3 499 000 6.13%(average

rate)

1 903 000 187 900

*Source : UNAIDS

High expectations for new cross-scale institutional arrangement

The Ramsar Convention on WetlandsMemorandum of Cooperation between Ramsar and the Lake

Chad Basin Commission (established in 1964) The signing ceremony, Valencia, Spain, 23 November

2002: Delmar Blasco and Muhammad Sani Adamu

Naivasha Lake BasinToday at 1880 m above sea level (1886 m in 1926), it is the highest of the Rift

Valley freshwater lakes, and second largest at 100 km2, but only 5 m deep; and no outlet! >400 species of birds

1980Human population 20,000

Fish harvest 68 tonnes

2000Human population 250,000

Fish harvest 14 tonnesSewage, pesticides, and

Fertilizer loading.

Ramsar Convention Designation in 1996

Optimization of institutional collaborations

• Negotiation of constraints on agenda setting and funding mechanisms to re-establish ownership of assessments and responsibility for intervention schemes).

• Technical capacity development, including qualitative and quantitative analyses.

• Re-configuration of science-policy interfaces within countries.

Every year more than US $70 billion is spent on health research and development by the public and private sectors. An estimated

10% of this is used for research into 90% of the world's health problems. This is what is called "the 10/90 gap".

Published On-line http://www.globalforumhealth.org/forum_6/sessions/

Research Approach

• It is generally assumed that potentially controllable environmental risk factors, as opposed to life style preferences, contribute most to the burden of disease in developing countries.

• Quantitative assessments of the health impacts of environmental remediation are not commonly performed because of methodological difficulties and the paucity of data that could usefully correlate investment in infrastructures for environmental protection to prevent adverse health outcomes.

– These limitations have incapacitated attempts to prioritize risk factors in the interface between the environment and human health sectors.

Objectives

• The main objective of this research was to use composite indicators of disease burden as tools for prioritizing solvable environmental problems that influence sub-regional burden of disease.

• To test the sensitivity of the composite indicators to various scenarios of global environmental change as a way to monitor population vulnerability.

Global Burden of Disease Assessment Seven Regions

WHO/WB/HSPH

Estimating local burden of diseases

• A composite measure of the combined impact of death and disability in a population is used to estimate disease burden. The Disability-Adjusted Life Years (DALY) model:

• DALYi[0,0] = YLLi + YLDi

• Where DALYi[0,0] = Undiscounted, unweighted for disease i

• YLLi = Years of Life Lost due to disease i• YLDi = Years of Life lived with Disability due to

disease i

Communicable diseases

Non-communicable diseases

Injury-related

Future projections of disease burden

ln M = C + 1lnY + 2lnHC + 3T

Where:M = projected mortality levelC = constant termY = GDP per capitaHC = Human capital (including population growth)T = Time

Estimating risks attributable to environmental factors

Attributable Risk is assessed according to the following equation, using published data on relative risks for each cause of death and disability related to the exposure, levels of exposure (prevalence), and burden of disease due to each cause of death and disability in the population:

AB = ∑AFj Bj = ∑Pj (RRj – 1) ÷ ∑Pj (RRj – 1) + 1

• Where – AB = Attributable Burden for a risk factor – AFj = Fraction of Burden from cause j – Bj = population level burden of cause j– P = Prevalence of exposure– RRj = Relative Risk of disease or injury for cause j in exposed versus unexposed

group.– n = Maximum exposure level

Combining future

projections with

attributable risk can give an estimate of avoidable

disease burden

WHO, 2002

Models and Scenarios

• In the first scenario, decadal evaluation of selected climate-driven epidemics were evaluated against projected scenarios of climate change predicted by the Intergovernmental Panel on Climate Change.

• In the second scenario, co-benefits of climate change mitigation were explored using the burden of disease approach and the abatement of lead (Pb) exposure as the dependent variable.

Rank order of population at risk for vector-borne diseases

Millions

Nigeria’s Demographic Characteristics*

Characteristics 1999 Estimate

Total Population 113,828,587

Total Population Growth Rate 2.92 %

Urban Population (Fraction of Total Population) 41 %

Urban Population Growth Rate 14%

Life Expectancy at Birth Total Population = 54.06 YearsFemale = 54.06 YearsMale = 52.55 Years

Disability-Adjusted Healthy Life Expectancy(World Health Organization, Year 2000)

Total Population = 38.3 YearsFemale = 38.4 YearsMale = 38.1 Years

Birth Rate 41.84 Births / 1,000 Population

Total Fertility Rate(Average Number of Children per Mother)

6.02 Children Born Per Woman

Death Rate 12.98 Deaths / 1,000 Population

Infant Mortality 69.46 Deaths / 1,000 Live Births

Maternal Mortality 1.0 %

Fraction of Population Below Poverty Line 34.1 %

Gender Ratio At Birth = 1.03 Male(s) / FemaleAges 15-64 Years = 1.04 Male(s) / FemaleAge 65 and Older = 1.01 Male(s) / FemaleTotal Population = 1.02 Male(s) / Female

*Source: United Nations Development Program 1999.

Socioeconomic indicators and health care status in Nigeria

Indicator Value*

Public health expenditure (Proportion of GDP) < 1%

Private health expenditures (Proportion of GDP) 1%

Urban dwellers access to improved water 80%

Rural dwellers access to improved water 39%

Urban dwellers access to improved sanitation 82%

Rural dwellers access to improved sanitation 48%

Population per doctor 5,208 (1993)**

Population per hospital bed 599 (1990)

Real GDP per capita 920 (1997)

*Values are for 1995 unless otherwise stated.Source: UNDP, 1999.

Cases of Notifiable Diseases in Nigeria 1990-1999. National Database Source: Federal Epidemiology Division, Federal Ministry of Health, Abuja, Nigeria

Disease 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999*

Cholera 4101 62418 8687 4160 3173 3364 59136 13411 9254 26358

CSM1 7804 6992 6418 4209 6119 7376 108546 39973 10793 1946

Diphtheria 1768 2849 2351 2042 1363 1556 2768 3285 6071 3769

G/Worm2 9050 5479 6749 5356 3388 1848 14388 10426 13419 9603

Hepatitis 5495 8897 8291 6312 4283 3599 5436 2664 8158 3264

Leprosy 20557 13641 14875 14706 10422 8105 7687 8524 10177 3704

Malaria 1116992 909656 1219348 981943 1175004 1133926 1149435 1148542 2122663 732170

Measles 115682 44026 85965 54734 108372 49880 102166 73735 164069 132856

Pertussis 42929 18685 22147 23800 34792 13639 26745 33729 49550 22162

Tuberculosis 20122 19626 14802 11601 15202 10040 121025 11388 19368 9329

Onchocerciasis 2002 758 2879 82634 6401 7272 5111 3125 2948 1024

Yellow fever 6035 2561 149 152 1167 0 0 0 5 0

1Cerebrospinal meningitis2Guinea worm*January - August only

Deaths from Notifiable Diseases in Nigeria 1990-1999 National Database Source: Federal Epidemiology Division, Federal Ministry of Health,

Abuja, Nigeria

Disease 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999*

Cholera 61 7869 663 266 471 140 4546 851 277 2085

CSM1 784 695 563 472 437 1388 11231 965 797 165

Diphtheria 2 64 3 0 0 5 55 166 3 15

G/Worm2 7 23 0 0 0 0 0 0 1 38

Hepatitis 69 60 48 53 33 54 38 39 42 20

Leprosy 7 17 35 0 0 1 0 0 0 0

Malaria 2284 1947 1068 719 1686 3268 4773 4603 6197 1891

Measles 1399 388 1032 373 696 671 2031 1147 1804 2751

Pertussis 184 66 1 61 65 51 186 222 216 121

Tuberculosis 213 487 230 192 379 407 380 331 454 152

Onchocerciasis 1 4 0 0 25 1 90 85 2 0

Yellow fever 421 661 8 8 415 0 0 0 3 0

1Cerebrospinal meningitis2Guinea worm*January - August only

Regional Mortality by Gender in Study Population (1990 - 1999).

0

0.5

1

1.5

2

2.5

1 2 3 4 5 6 7 8 9 10

YEARS

DEATH

S P

ER

1,0

00

MALES

FEMALES

Hospital Admissions by Gender in the Study Population (1990 - 1999).

0

5

10

15

20

25

30

35

1 2 3 4 5 6 7 8 9 10

YEARS

AD

MIS

SIO

NS

PE

R 1

,00

0

MALES

FEMALES

Disease Incidence per 1000

10- Measles 0.90

11-Malaria 18

3-Severe diarrhea 2

37-ALRI (child) 0.1

38-ALRI (adult) 1.31

4-TB 1.2

2-Typhoid 4

1-Cholera 0.19

6-Diptheria 0.03

7-Pertussis 0.03

8-Meningitis 0.22

9-Polio 0.007

13-Leprosy 0.12

15-Schistosomiasis 0.14

20-Onchoceriasis 0.30

18-Guinea Worm 0.08

30-Hookworm 19

Ascaris 10

36-Common cold-16 1000

14-Chickenpox 22

AIDS 0.12

12-STD 0.24

21-Trachoma 1.6

19-Yaws 6

22-Hepatitis 0.3

23-Trypanosomiasis 0.05

Tetanus neonate 0.5

24a-Tetanus post neo 0.75

25-Cancer (child) 0.03

26-Cancer (adult) 0.69

27-Diabetes 2

28 Malnutrition 0.02

29 Sickle Cell Disease 0.1

31-Rheumatic HD 0.3

32-Hypertensive HD 3.8

34-Congenital HD 0.07

33-Other HD 0.37

35-Cerebrovascular 2.3

39-Peptic ulcer 4.27

40-Other GI disease 2.8

41-Hernia/Int Obst 4

42-Cirrhosis 0.09

43-Chronic Renal D 0.31

44-Pregnancy Compli 1.13

Prematurity 9.6

Birth Injuries 1.6

Umbilical Sepsis 0.22

Congen Malform. 0.96

Hemolytic Dis 0.14

Birth Pneumonia 0.46

50GYN Disease 1

46-Skin Infections 2.7

47-Mental Disorders 4.06

Cataracts/Eye 0.4

49-Dental Diseases 0.28

51-ENT Diseases 0.56

Accidents/All 7.7

Epilepsy 0.48

DALY (HeaLY) model scenarios

Intervention Coverage

EPI 0.3

WATER 0.2 – 0.4

SANITATION 0.45

OPD 0.45

IPD 0.4

EDUCATION 0.1

MFU 0.9

FAMILY PLANNING 0.05

A.N.C. 0.2

VECTOR CONTROL 0.2 – 0.5

Discount Rate 0.015 - 0.045

The local burden of disease: Top categories for Years of Health Lives Lost (1990-1999)

Rank Disease YHLL per 10001 Hypertension 88.5

2 Birth Injuries 47.3

3 Premature Birth 47.2

4 Mental Disease 41.9

5 Accidents 40.3

6 Malaria 33.3

7 Diabetes 33.0

8 Cerebrovascular disease 30.6

9 Tuberculosis 24.9

10 Neonatal Tetanus 18.9

11 Typhoid 16.7

12 Cancers (adult onset) 14.9

13 Congenital Malformations 13.9

14 Hernias 13.5

15 Tetanus (Post neonatal) 11.2

22 HIV / AIDS 4.93

Sensitivity of disease burden to environmental change

Epidemic potential for climate-sensitive Vector-borne diseases

EP = reciprocal of host density threshold

Critical density for vector-borne disease transmission Mc1 = c1 (- ln (p) ÷ (b)(c)(a2)(pn))

Where p = survival probability of mosquitoa = frequency of blood feedingn = incubation period of the parasite vectorb = efficiency of infectionc1 = constant based on recovery rate and host susceptibility factors

Reproductive rate of disease = R0 = (m)(a2)(b)(c)(pn) ÷ r (-ln (p))When R0 > 1, disease will spread. n = Dm ÷ T – Tmin, m

Dm = degree-days required for parasite development T = average ambient temperature Tmin = minimum temperature required for parasite development

MIASMA Modeling framework for the health Impact ASsessment

of Man-induced Atmospheric changes

• MIASMA is an acronym devised to refer to several models dealing with health impacts of global atmospheric changes: the vector-borne diseases model.

From Shakespeare to Defoe: malaria in England in the Little Ice Age.Paul Reiter

Centers for Disease Control and Prevention, USA. ipr1@cdc.gov

• Present global temperatures are in a warming phase that began 200 to 300 years ago. Some climate models suggest that human activities may have exacerbated this phase by raising the atmospheric concentration of carbon dioxide and other greenhouse gases. Discussions of the potential effects of the weather include predictions that malaria will emerge from the tropics and become established in Europe and North America. The complex ecology and transmission dynamics of the disease, as well as accounts of its early history, refute such predictions.

Emerging scientific controversy over the linkage between climate and vector-borne diseases (e.g. Malaria)

To the Editor: The two reports from the International Panel on Climate Change (IPCC) (1,2) cited in the letter by Pim Martens (3) are widely regarded as "the standard scientific reference for all concerned with climate change and its consequences," yet the contents of these reports are often misleading…….. Repeated claims that global warming may have already led to increases in these diseases in the tropics are equally indefensible….. - Paul Reiter (Centers for Disease Control and Prevention, USA)

Vol. 6, No. 4, Jul–Aug 2000

To the Editor: I read with great interest the article "From Shakespeare to Defoe: Malaria in England in the Little Ice Age" (1). Unfortunately, the article is not as balanced as a presentation last year by Paul Reiter, which clearly illustrated that, although climate is important in the transmission of malaria, the influence of other factors (e.g., access to medical care and improved housing) is likely to be of more importance in Europe…. While Reiter's paper offers an interesting perspective on the history of malaria in Europe, it provides no illuminating information on the influence of climate change on human health. - Pim Martens (Maastricht University, Maastricht, The Netherlands)

Climate change and malaria vulnerability in Nigeria

Environmental Change and the African Burden of Disease

Projection of Disease Burden in Sub-Sahara Africa as a Function of Global Climate Change

1990 DALYsa

2000 DALYs

2010 DALYs

2020 DALYs

% of Total

African Burden

Africa’s Share of Global Burden Within

Category (%)

% of Total

African Burden

Africa’s Share of Global Burden Within

Category (%)

% of Total

African Burden

Africa’s Share of Global Burden Within

Category (%)

% of Total

African Burden

Africa’s Share of Global Burden Within

Category (%)

9 85 8 91 6 93 4 94 11 32 9 41 7 46 5 49 < 0.1 3 < 0.1 5 < 0.1 6 < 0.1 6 2 52 1 58 1 64 0.5 73 3 18 3 24 2 28 2 30 3 13 3 13 4 14 5 15 1 19 1 19 1 19 1 20 3 75 6 51 6 42 4 33

Disease

MalariaDiarrheaDengueTropical C.MalnutritionRespiratoryEyesHIV

“Less popular” health vulnerabilities to climate change

Dry Climate, Human susceptibility and the Meningitis Belt

*1.2 Million Cases/year*135,000 Fatalities*8-12 year cycles in hyper-endemic regions*Shorter and more irregular intervals since 1980s

The incidence Cerebrospinal Meningitis in Nigeria (1990 -1999). The vector-borne disease shows environment-dependent fluctuation dynamics in Nigeria. The

upsurge in cerebrospinal meningitis is linked to recent climatic events.

YEAR

20001999199819971996199519941993199219911990

Ca

ses

of

Ce

reb

rosp

ina

l Me

nin

giti

s

120000

100000

80000

60000

40000

20000

0

Desertification and Health Impacts of Sahara Dust

International focus on the trans-Atlantic movement of Sahara dust, with impacts Including the introduction of food crop pathogens in the Americas, and iron-fertilization of the oceans, leading to coral reef bleaching. Impact on respiratory health effects In Sub-Saharan Africa is understudied. Current hypothesis include the exacerbation of respiratory diseases, Meningitis burden, and blindness.

Policies to Mitigate Climate Change Will Have Global Impacts

What are the projected health effects in African countries?

Alternative Framing of Health Vulnerability in IPCC Assessments: Switching to alternative fuels will also lower

vulnerability to Pb poisoning • Current framing of health impacts of climate

change emphasizes the spread of vector-borne diseases which may have little additional impact in African countries.

• 22% of gasoline used globally contains Pb, mostly in developing countries.

• OPEC countries generally oppose shifting from carbon fuels, but they all still use leaded gasoline.

• Joint Implementation arrangements must consider the direct health benefits of assistance towards decarbonization.

Natural gas flaring in Nigeria contributes ~20-30% of global sources of greenhouse gas emissions from this source, contributing to the

causes of global warming. Nigeria subscribes to OPEC-block position on mitigation strategies

(Kyoto Protocol) SHELL'S GAS FLARE AT ITS KOLO CREEK SITE,

BAYELSA STATE IN NIGERIA'S NIGER DELTA

This picture is typical of gas flares that litter the Niger Delta. Many of them have been burning for over thirty years and blur any distinction between night and day in their range of impact.

Photo Taken By Israel Aloja of Enviromental Rights Action/Friends of the Earth Nigeria [ERA/FoEN]

In 1994, UN Commission on Sustainable Development Recommended Global Phase-out of Leaded Gasoline. In 2004, Many countries, largely in Africa and the Middle East, have no

urgent plans to eliminate lead from gasoline

Lukman’s Statement to COP-6

…………….As it stands, the Kyoto Protocol, if fully implemented, would lead to a dramatic loss of revenue for oil-exporting countries, as a result of a heavy reduction in demand for petroleum. Independent studies estimate the loss at tens of billions of US dollars per year for OPEC's Members. This would strike at the very heart of these countries' economic and social infrastructures, causing a radical scaling down of development plans and entailing huge cutbacks in such vital services as education and health care. It would also affect the ability of these countries to invest in future production capacity………….

……Finally it should not be forgotten that the established industrial nations bear the principal responsibility for the purported phenomenon of global warming, and not the developing countries. The onus, therefore, is upon the rich nations to minimize and finance the negative impact of their response measures on the poor countries of the south. Developing countries should not be roped into making commitments to emissions-reduction targets, which could have enormous cost implications for their fragile economies. Instead, every assistance should be given to them to develop their economies in an efficient, environmentally harmonious and sustainable manner.

- Rilwanu Lukman, OPEC Secretary General to Cop 6, September 2000.

Comparative costing of health impacts of Pb and economic disincentives

• In Nigeria, Pb content of regular gasoline is 0.74 g/L.

• Atmospheric Pb emission is estimated to be 2,800 metric tons/year.

• Policy analysts at the Center for Energy and Development in Ife calculate that the country cannot presently afford the cost of switching to non-leaded gasoline.

• But what is the public health cost of not switching? How many DALYs can be attributed to the burden of Pb in Nigeria?

The costs and benefits of energy de-carbonization

• Nigeria has proven reserves of 180 billion cubic feet of natural gas - the 9th largest location of this resource in the world.

• Nigeria flares 75 per cent of the gas it produces and re-injects only 12 per cent to enhance oil recovery.

• Approximately 2 billion standard cubic feet of gas is currently being flared in Nigeria - the highest in any member-nation of the Organization of Petroleum Exporting Countries (OPEC).

• Consequently, Nigeria accounts for 20-30% of the total amount of gas flared globally.

Internalized Costs of Pb-Poisoning

• Ibitoye et al. [1998] estimated a cost of $30 - $50 per ton for reduction of carbon dioxide emissions in Nigeria, according to the models and goals endorsed by the United Nations Framework Convention on Climate Change.

• A maximum reduction of 2 billion tons of carbon could be achieved within the next 40 years. Thus, the total cost of decarbonization is estimated to be $60 – 100 billion for the next generation of Nigerians.

• Meanwhile, the next generation is undergoing exposure to Pb. Assuming that most of the current sources of carbon dioxide are also sources of toxic metals and other air pollutants, more than 70 million young children in Nigeria are burdened by diseases attributable to leaded fossil fuels. At what cost?

> 30% of children (ages 1-6 yrs) in rural Otukpo region of Nigeria are lead-poisoned

Smith & Ogunseitan, 2002

Gender N Mean [B-Pb] Range SD % > 10 ug/dL

Female 138 8.9 (2.1,23.8) 4.2 32.5

Male 168 9.8 (2.2,31.8) 4.8 35.0

Total 306 9.4 (2.1,31.8) 4.2 34.3

Lead (Pb) dose in urban Nigerian children between the ages of 1 and 7 years

0

5

10

15

20

25

30

5 7 9 11 13 15 17 19 21

%

Blood lead concentration (g/dL)

Nriagu et al., 1997

Quantifying the burden attributable to the health impacts of Pb-exposure in Nigeria

• Mild mental retardation• Ischaemic heart disease• Cerebrovascular disease• Genitourinary disease• Immune suppression• Spontaneous abortion• Congenital anomalies• Hypertension• Iron deficiency anemia• Endocrine disorders• Hypertensive disorders of pregnancy

– Collectively, these conditions represent approximately 15% of the total disease burden in the SSA region (Murray & Lopez, 1996).

Calculating attributable risks for Pb-exposure

The attributable risk (AR) due to lead exposure for 10 Pb-linked Global Burden of Disease (GBD) disease categories:

• Genito-urinary disease• Spontaneous abortion • Premature birth• Dental caries• Lung cancers • Nervous system cancers • Congenital anomalies• Hypertension• Cerebrovascular disease• Low birth weight

AR was assessed according to the following equation, using published data on relative risks for each cause of death and disability related to the exposure, levels of exposure (prevalence), and burden of disease due to each cause of death and disability in the population:

AB = AFjBj

• Where – AB = Attributable Burden for a risk factor – AFj = Fraction of Burden from cause j – Bj = population level burden of cause j– P = Prevalence of exposure– RRj = Relative Risk of disease or injury for cause j in exposed versus unexposed group.

100 IQ

Per

cen

tag

e o

f su

bjec

ts

908070

72.6 73.5

50

Mild mental retardation

Shift to mild mental retardation due to Pb-induced loss of IQ points

Shift to mild mental retardation due to loss of

IQ points

Normal curve of distribution of intelligence

Fewtrell et al., [2002]

• Risk of lead exposure on mental retardation:

AR = PR – Pbaseline + PMR Standard ÷ PMR Standard

Where MR = Mental retardationPR = Region-specific prevalence of MR from

known causesPbaseline = Prevalence of MR from known, non-

congenital causes in developed countries;

PMR Standard = Prevalence of MR according to the standard distribution of IQ score

AR = Adjustment ratio.

Contribution of Lead to the Burden of Disease in the Study Population

  DALYs, 0-14Odds Ratio for PbB

(ug/dL)Attributable Risk % for

PbB (ug/dL)Attributable BoD to Pb

(%)

Pb-Disease Category malefemal

e total 5-89-15 >16 5-8 9-15 >16 5-8 9-15 >16

Genito-Urinary Disease 710 541 12510.9

5 1.9 3.8 1.7 33.5 21.9 22 419 274

Abortion 0 1000 1000 1.8 3.6 5.4 21.4 59.3 30.6 214 593 306

Prematurity 2295 2295 4590 2.2 4.3 8.6 29.0 64.9 43.2 1330 2978 1982

Dental Caries 129 127 256

6.8 (AR)

9.6 (AR)

13.5 (AR) 6.8 9.6 13.5 17 25 35

Lung Cancers 1 0 1 0.9 1.8 3.6 3.5 30.9 20.6 0 0 0

Nervous System Cancers 270 210 480 2 5.5 11 25.4 71.6 50.0 122 344 240

congenital anomalies 2455 2628 5083 0.8 1.6 3.2 7.3 25.1 18.0 371 1278 917

Hypertension 66 69 135 0.8 1.5 3 7.3 21.9 16.7 10 30 23

Cerebrovascular Disease 313 298 611 2.2 4.5 6.8 29.0 66.2 36.7 177 405 224

Low Birth Weight 9827 88731870

0 1.2 2.4 4.7 6.4 43.9 27.0 1191 8218 5050

Total SSA 160661604

13210

7             34531428

9 9050

Total Nigeria 2731 2727 5458 587 2429 1538

% SSA Burden of Disease Attributable to Pb           1.08 4.49 2.84

% SSA Burden of Disease Attributable to Pb, Ages 0-14           1.77 7.34 4.65

% Nigeria Burden of Disease Attributable to Pb           1.08 4.49 2.84

% Nigeria Burden of Disease, Attributable to Pb, Ages 0-14           1.77 7.34 4.65

Contribution of Pb Exposure to Disease Burden (Disability-Adjusted Life Years)

• Symptoms above 10 g/dL (Pb)

– Growth retardation, Hearing loss, IQ deficiency, Colic, Nephropathy, Encephalopathy, Hypertension, Decreased longevity.

• Burden of Disease Categories– Hypertensive disorders, Iron-deficiency anemia, Unipolar major

depression, Nephritis and Nephrosis, Osteoarthritis, Congenital anomalies, Perinatal conditions, Endocrine disorders, and Poisonings.

• Sub-Saharan Africa (2000 Baseline Scenario) Total DALYs = 318,560

• DALYs sensitive to metal toxicity as a risk factor = 44,050 (~4.7%)

– Compared to diarrhea (10%), or malaria (7%), this is a considerable burden.

Framing priorities

• The cost of energy decarbonization is cost-effective (approximately $10,000 per child) if the expenses are directly linked to the reduction in disease burden. This estimated cost is higher than preventive costs calculated for the toll of malaria on the national economy [Sachs, 2000], but the benefits of decarbonization and eliminating lead pollution are also distributed internationally.

Summary

(1) Institutional Issues: Framing and prioritizing vulnerability assessments in Africa.Who is going to use the results of the vulnerability assessment that you are

conducting?

(2) Thinking outside the dominant framework: Global environmental change and the African burden of disease.Health (morbidity + mortality) is the ultimate outcome of vulnerability assessments. Cumulative vulnerabilities (e.g. agricultural productivity, coastal resources, water resources, etc. may be estimated with a common conversion factor to a health index. Is this worth doing in your assessment?

(3) Proposed solutions to global environmental change will have impacts too: No-cost adaptation and the clean development mechanism in Africa.Think ahead – what are the vulnerabilities to proposed mitigation strategies in your region?

(4) Break

(5) Group discussion/summary