Air Pollution, Poverty and Air Pollution, Poverty and Health in Ho Chi Minh CityHealth in Ho Chi Minh City

Stakeholder Forum 3 February, 2004Ho Chi Minh City, Vietnam

BackgroundBackground

Who Are We - ADBWho Are We - ADB• Asian Development Bank is a regional Asian Development Bank is a regional

development bank, which provides development bank, which provides loans and grants to governments in loans and grants to governments in support of economic and social support of economic and social development.development.

• The overarching objective of ADB is The overarching objective of ADB is poverty reduction in Asia.poverty reduction in Asia.

• ADB supports a range of projects in ADB supports a range of projects in Vietnam, which are coordinated by its Vietnam, which are coordinated by its Resident Mission in Hanoi.Resident Mission in Hanoi.

http://www.adb.org

Who Are We: CAI-AsiaWho Are We: CAI-Asia• CAI-Asia is a multi-stakeholder initiative set up by CAI-Asia is a multi-stakeholder initiative set up by

ADB, World Bank and USAEP to promote better air ADB, World Bank and USAEP to promote better air quality management in Asiaquality management in Asia

• Currently CAI-Asia has 120+ institutional members Currently CAI-Asia has 120+ institutional members including Ho Chi Minh City, Hanoi, Vietnam including Ho Chi Minh City, Hanoi, Vietnam RegisterRegister

• CAI-Asia undertakes knowledge management, CAI-Asia undertakes knowledge management, capacity building, regional dialogues, promotion of capacity building, regional dialogues, promotion of air quality management policies, pilot programs air quality management policies, pilot programs and workshops.and workshops.

• In Vietnam USAEP is acting as the local coordinator In Vietnam USAEP is acting as the local coordinator of CAI-Asia and the local CAI-Asia networkof CAI-Asia and the local CAI-Asia network

http://www.cleanairnet.org/caiasia

Who Are We -The Health Who Are We -The Health Effects InstituteEffects Institute

• Founded in 1980 to provide Founded in 1980 to provide impartial, high-quality science on impartial, high-quality science on health effects of vehicle and other health effects of vehicle and other emissionsemissions• Joint and Equal Core Funding from Joint and Equal Core Funding from Public and Private Sources Public and Private Sources • Independent Board and Expert Independent Board and Expert Science Committees oversee and Science Committees oversee and review all researchreview all research• Over 200 studies - Americas, Asia, Over 200 studies - Americas, Asia, Europe - ozone, carbon monoxide, Europe - ozone, carbon monoxide, particulate matter, diesel exhaust, particulate matter, diesel exhaust, benzene, butadiene, methanol, othersbenzene, butadiene, methanol, others• Program on Public Health and Air Program on Public Health and Air Pollution in Asia (PAPA) to inform Pollution in Asia (PAPA) to inform regional decisions about improving regional decisions about improving Asian air quality (map shows study Asian air quality (map shows study sites as of January 2005)sites as of January 2005)

http://www.healtheffects.org/

Who Are We - NILUWho Are We - NILU• Norwegian Institute for Air Research (NILU) conducts Norwegian Institute for Air Research (NILU) conducts

environmental research with emphasis on the environmental research with emphasis on the sources of airborne pollution, atmospheric transport, sources of airborne pollution, atmospheric transport, transformation and deposition and is also involved in transformation and deposition and is also involved in the assessment of the effects of pollution on the assessment of the effects of pollution on ecosystems, human health and materials.ecosystems, human health and materials.

• NILU has implemented a range of air quality NILU has implemented a range of air quality monitoring and management projects in Asia.monitoring and management projects in Asia.

• NILU currently implements the NORAD funded HCMC NILU currently implements the NORAD funded HCMC air quality monitoring project with its local partner air quality monitoring project with its local partner HEPA HEPA

http://www.nilu.no/

• Air pollution is a growing environmental problem Air pollution is a growing environmental problem in Asian cities due to growing urbanization, in Asian cities due to growing urbanization, motorization and industrializationmotorization and industrialization

• Health impacts of air pollution are considerable. Health impacts of air pollution are considerable. World Health Organization estimates that about World Health Organization estimates that about 480,000 people die prematurely in Asia each year 480,000 people die prematurely in Asia each year due to exposure to ambient air pollution. due to exposure to ambient air pollution.

• Many hundreds of thousands develop health Many hundreds of thousands develop health problems or experience decreased health because problems or experience decreased health because of pollution. They miss work or school because of of pollution. They miss work or school because of air pollution.air pollution.

• Air pollution costs Asian cities hundreds of millions Air pollution costs Asian cities hundreds of millions of dollars per year.of dollars per year.

Air pollution and healthAir pollution and health

Why a program on air Why a program on air pollution, poverty and pollution, poverty and

health?health?

• Asian Development Bank is the main regional Asian Development Bank is the main regional developmental organization in Asia. The main developmental organization in Asia. The main mandate is poverty reduction through sustainable mandate is poverty reduction through sustainable development.development.

• Air pollution is a substantive developmental problem. Air pollution is a substantive developmental problem. • Evidence from Europe, USA and Latin America Evidence from Europe, USA and Latin America

indicates that there is a linkage between air pollution indicates that there is a linkage between air pollution and poverty in terms of health impacts.and poverty in terms of health impacts.

• Clean Air Initiative for Asian Cities took the initiative Clean Air Initiative for Asian Cities took the initiative to develop a program that will research the linkage to develop a program that will research the linkage between air pollution, poverty and health in Asia. between air pollution, poverty and health in Asia.

• HCMC proposed: relatively good quality data on air, HCMC proposed: relatively good quality data on air, health, and poverty and enthusiastic local health, and poverty and enthusiastic local counterpart organizationscounterpart organizations

Main Hypotheses Main Hypotheses 1.1. The poor are subject to higher The poor are subject to higher

exposures of air pollution.exposures of air pollution.

2.2. The poor are more susceptible to air The poor are more susceptible to air pollution e.g. due to poorer pollution e.g. due to poorer nutrition, access to medical care nutrition, access to medical care and other factors.and other factors.

3.3. Air pollution exacerbates or Air pollution exacerbates or perpetuates the conditions of perpetuates the conditions of poverty.poverty.

Outputs Outputs • The proposed project in HCMC will The proposed project in HCMC will

give answers on the linkage between give answers on the linkage between air pollution and poverty in HCMC. air pollution and poverty in HCMC.

• The project will result in a The project will result in a methodology that can be used to methodology that can be used to study the linkage between air study the linkage between air pollution and poverty in other Asian pollution and poverty in other Asian cities.cities.

• Capacity building Capacity building

Main components of the Main components of the ProjectProject

1.1. Study of the impact of air pollution on Study of the impact of air pollution on respiratory health of children in HCMCrespiratory health of children in HCMC

2.2. a) a) Exposure assessment to multiple Exposure assessment to multiple sources of air pollution.sources of air pollution.

b) Health prevalence survey Health prevalence survey

c)c) Survey of perceptions and economic Survey of perceptions and economic costscosts

3.3. Policy implications and awareness Policy implications and awareness raisingraising

Air Quality Monitoring In Air Quality Monitoring In HCMCHCMC

4 sites funded by Danida5 sites funded by NORAD

AQMS installed by NILUAs part of NORAD

Station UTM 84 N

ID Code Name Charact.

X coordinate (m)

Y coordinate (m)

1 DO DOSTE Traf 684,430 1,192,220 2 HB Hong Bang Traf 681,620 1,189,460 3 TD Thu duc Res/Ind 693,640 1,199,790 4 TS Tan Son Hoa Urb Bkg 682,830 1,193,930 5 TN Thong Nhat Traf 680,690 1,193,530 6 BC Binh Chanh Traf 674,500 1,183,000 7 ZO Zoo Urb Bkg 686,420 1,193,370 8 D2 District 2 Res/ind 691,160 1,193,510 9 QT Quang Trung Urb Bkg 677,940 1,200,080

AQ Monitoring Sites

Automatic transfer + QA/QCAutomatic transfer + QA/QC

PM10 measured since 2001

Suspended particles = main problem

Ozone 27 October 2004

Dien BienPhu street

Fence Shelter Office10 m

20

40

60

80Concentrations (µg/m3)

SO2

NO2

1 m 100 m

distance from the road

Dien BienPhu street

Fence Shelter Office10 m

20

40

60

80Concentrations (µg/m3)

SO2

NO2

1 m 100 m

distance from the road

Concentration decrease with distance from street

Short term sampling on the streetHX and DBP 3 hourly samples 10 days a monthPhuLam: 12 h sample 10 days a month

Average diurnal variation

CO

T=1.4xU

Model applications

Model tests HCMC Vietnam

Wind fields

Main traffic routes impact

The NILU Now-cast model

Exposure models

Component 1. Impact of air Component 1. Impact of air pollution on acute lower pollution on acute lower

respiratory infection (ALRI) respiratory infection (ALRI) in children of HCMCin children of HCMC

Proposed Objectives of the Proposed Objectives of the Childrens’ StudyChildrens’ Study

• Estimate the effect of short-term Estimate the effect of short-term exposure to air pollution on exposure to air pollution on hospital admissions for ALRI in hospital admissions for ALRI in young children (<5 years) in HCMCyoung children (<5 years) in HCMC

• Compare the magnitude of the Compare the magnitude of the effect of air pollution on poor effect of air pollution on poor children vs. other childrenchildren vs. other children

Proposed Methods of the Proposed Methods of the Childrens’ Study (1)Childrens’ Study (1)

Case ascertainmentCase ascertainment• Identification of ALRI admissions, clinical Identification of ALRI admissions, clinical

and socio-demographic characteristics and socio-demographic characteristics from computerized records at Pediatric from computerized records at Pediatric Hospitals 1 and 2Hospitals 1 and 2

• Poverty status determined by access to Poverty status determined by access to free care (health card)free care (health card)

Exposure assessmentExposure assessment• Estimates of daily average exposure for Estimates of daily average exposure for

each case using data from the HEPA air each case using data from the HEPA air monitoring networkmonitoring network

Proposed Methods of the Proposed Methods of the Childrens’ Study (2)Childrens’ Study (2)

Statistical Analysis:Statistical Analysis:• Estimate relative risk of Estimate relative risk of

admission to hospital for ALRI admission to hospital for ALRI using case-crossover analysisusing case-crossover analysis

Collaborators:Collaborators: • Biostatisticians TBN, HEPA/NILU, Biostatisticians TBN, HEPA/NILU,

DOH/Pediatric Hospitals 1 and 2DOH/Pediatric Hospitals 1 and 2

Overview: Case-crossover Overview: Case-crossover MethodologyMethodology

• Used to study impact of short-term Used to study impact of short-term time-varying exposures on acute eventstime-varying exposures on acute events

• Cases of disease are identifiedCases of disease are identified• The exposure of each case is estimated The exposure of each case is estimated

during an effect and a control periodduring an effect and a control period• Relative risk is calculated based on Relative risk is calculated based on

contrasting the exposure levels in the contrasting the exposure levels in the effect and control periodseffect and control periods

Major Design DecisionsMajor Design Decisions

Why short-term effects?Why short-term effects?• Much of the existing global literature is Much of the existing global literature is

comprised of studies using comparable methodscomprised of studies using comparable methods

Why children?Why children?• We care about this vulnerable sub-populationWe care about this vulnerable sub-population• Health data on children are available in HCMCHealth data on children are available in HCMC

Why ALRI?Why ALRI?• A major public health issue in developing A major public health issue in developing

countries – two recent literature reviews on the countries – two recent literature reviews on the effects of air pollution on ALRIeffects of air pollution on ALRI

Some Outstanding IssuesSome Outstanding Issues

• Should hospital admissions for Should hospital admissions for asthma be studied?asthma be studied?

• Adequacy of data quality?Adequacy of data quality?

• What should be the timeframe for What should be the timeframe for the study (retrospective and/or the study (retrospective and/or prospective)?prospective)?

• Should very young children (<1 Should very young children (<1 year) be included?year) be included?

Component 2. Household Component 2. Household Survey of Exposure, Survey of Exposure,

Health Perceptions and Health Perceptions and CostsCosts

Household Survey

• Survey of households from poorer and wealthier wards

• Households with young children identified, but all household members included

• Three sets of activities:

1. Exposure assessment (HEPA, CASE, EWC, UC Berkeley)

2. Health prevalence survey (HCMC DPH, Medical University)

3. Public perceptions and economic burden of air pollution (TBN, EWC)

Exposure Exposure AssessmentAssessment• Aims to estimate pollution actually inhaled

• Assesses impact of local ‘hot-spots’/ microenvironments for exposures Exposure to traffic related pollution

(roadside exposures, commuting)Cooking with solid fuels (wood, coal) and/or

poorly combusted keroseneEnvironmental tobacco smoke (ETS)Occupational exposures (roadside vendors,

small scale industries, etc.)

• Assesses difference between household concentrations and individual exposures

• Ambient concentrations in a variety of microenvironments,

• Neighbourhood concentrations,

• Outdoor/indoor concentrations, and /or

• Personal (individual) exposures assessed by time and location

Exposure assessment in specified receptor points (outdoor and indoor?)

Exposure assessment for populations with high roadside exposures

Total exposure studies (micro environmental modelling) of high-risk sub-populations

We may perform:

Approaches to reach human exposure

Diary MethodDiary

Method

WhenWhen

hour of dayhour of dayday of weekday of week

season of yearseason of year

IndividualIndividualair pollutionair pollution

exposureexposureestimateestimate

WhatWhatactivity levels activity levels which affectswhich affects

respiratoryrespiratoryventilationventilation

WhereWhereIndoor/outdoorIndoor/outdoor

(window(windowopen/closed)open/closed)GeographicalGeographical

locationlocation

Exposure and healthExposure and health

Health Prevalence Health Prevalence SurveySurvey

• Assess respiratory health symptoms of all household members

• Based on internationally accepted survey instruments

• In conjunction with exposure results, may provide information on risk factors for respiratory illness

• Possibility: additional health Possibility: additional health assessment (PFT) of householdersassessment (PFT) of householders

Public Perceptions and Public Perceptions and Economic Burdens of Air Economic Burdens of Air

PollutionPollution• Assesses people’s opinion how air Assesses people’s opinion how air

pollution impacts their lives pollution impacts their lives • Understanding perceptions can help Understanding perceptions can help

predict the public’s willingness to predict the public’s willingness to modify lifestyle to improve modify lifestyle to improve environmentenvironment

• Cost of treatment, Lost income, Lost Cost of treatment, Lost income, Lost Time, school absenteeismTime, school absenteeism

• Differential impact of policies to Differential impact of policies to remediate air pollution exposures remediate air pollution exposures (relocation of roadside vendors)(relocation of roadside vendors)

Some outstanding Some outstanding issuesissues

• Proper definition and identification of Proper definition and identification of poorer and wealthier wards to be poorer and wealthier wards to be included in the surveyincluded in the survey

• Sample determination (size and Sample determination (size and distribution across city)distribution across city)

• Identification of capacity building needs Identification of capacity building needs (skills and equipment)(skills and equipment)

• Degree of linkage with Component 1Degree of linkage with Component 1

Component 3. Policy Component 3. Policy implications and implications and awareness raisingawareness raising

Policy relevancePolicy relevance• The results of the project may The results of the project may

indicate a linkage between air indicate a linkage between air pollution, poverty and health in pollution, poverty and health in HCMCHCMC

If they do …..If they do …..

Policy ImplicationsPolicy Implications

• Results may justify interventions targeted Results may justify interventions targeted to poorer households and sources that to poorer households and sources that affect especially the poorer householdsaffect especially the poorer households

• In identifying the policy implications it will In identifying the policy implications it will be important to distinguish between be important to distinguish between national and local level policy issuesnational and local level policy issues

• Policy implications can be aimed at Policy implications can be aimed at decision makers on air quality decision makers on air quality management, public health, city planners, management, public health, city planners, or poverty.or poverty.

Examples of Examples of methodologies to assess methodologies to assess

policy implicationspolicy implications• Assess the impact of different AQM policy Assess the impact of different AQM policy

measures on the spatial distribution of air measures on the spatial distribution of air pollution in HCMC, and the impact on different pollution in HCMC, and the impact on different population groupspopulation groups

• Assess the impact of different health or poverty Assess the impact of different health or poverty policy measures (e.g. access to healthcare) on policy measures (e.g. access to healthcare) on health of population groups affected by air health of population groups affected by air pollutionpollution

• Assess the impact of urban renewal measures on Assess the impact of urban renewal measures on exposure to air pollution by different population exposure to air pollution by different population groupsgroups

• Assess the required institutional response Assess the required institutional response capacitycapacity

Awareness RaisingAwareness Raising

• Progress of the study will be Progress of the study will be documented on the CAI-Asia documented on the CAI-Asia website and the PAPA websitewebsite and the PAPA website

• Important outputs of the project Important outputs of the project will be translated in Vietnamesewill be translated in Vietnamese

• An international workshop is An international workshop is planned for 2007 to present the planned for 2007 to present the findings of the project.findings of the project.

Institutional set-up of Institutional set-up of project and project and

implementation implementation arrangementsarrangements

Overall Project Overall Project StructureStructure

• Project is a grant from ADB to the government Project is a grant from ADB to the government of Vietnam. Recipient of the grant will be HCMC of Vietnam. Recipient of the grant will be HCMC Peoples Committee.Peoples Committee.

• HCMC Peoples Committee to issue a decision to HCMC Peoples Committee to issue a decision to set up the project, project office, and Steering set up the project, project office, and Steering Committee.Committee.

• ADB will enter into a partnership with HEI for ADB will enter into a partnership with HEI for the implementation of the program. the implementation of the program.

• APPH Project will become part of the Public APPH Project will become part of the Public Health and Air Pollution in Asia (PAPA) Program, Health and Air Pollution in Asia (PAPA) Program, which HEI implements on behalf of CAI-Asia.which HEI implements on behalf of CAI-Asia.

• The International Oversight Committee from The International Oversight Committee from PAPA program will be requested to provide PAPA program will be requested to provide scientific oversight of the project.scientific oversight of the project.

Project running time and Project running time and budgetbudget

• Project expected to run for 30 months or Project expected to run for 30 months or 2.5 years.2.5 years.

• Proposed start date for the Project 15 June Proposed start date for the Project 15 June 20052005

• ADB expected to contribute $ 600,000 ADB expected to contribute $ 600,000 from Poverty Reduction Fundfrom Poverty Reduction Fund

• HEI expected to contribute $ 200,000 HEI expected to contribute $ 200,000 • Vietnamese government agencies to Vietnamese government agencies to

contribute $120,000 (in kind – staff time, contribute $120,000 (in kind – staff time, office space, local transport, etc.) – 20% of office space, local transport, etc.) – 20% of official ADB contributionofficial ADB contribution

Methodology Methodology developmentdevelopment

• This is a pioneering program for Asia. The This is a pioneering program for Asia. The HCMC project aims to develop a HCMC project aims to develop a methodology which will be tested in the methodology which will be tested in the HCMC projectHCMC project

• Visiting researchers from other Asian cities Visiting researchers from other Asian cities will be invited during the project to visit will be invited during the project to visit HCMC to observe the study. Participants HCMC to observe the study. Participants from HCMC project will be invited by CAI-from HCMC project will be invited by CAI-Asia to conferences and workshops to Asia to conferences and workshops to make presentations on the project.make presentations on the project.

Suggested Executing and Suggested Executing and Implementing AgenciesImplementing Agencies

• Executing Agency: DONRE, based on its overall mandate for Executing Agency: DONRE, based on its overall mandate for environmental protection and air quality managementenvironmental protection and air quality management

• Implementing Agencies:Implementing Agencies: HEPA: air pollution related aspectsHEPA: air pollution related aspects DoH: health related aspects DoH: health related aspects DOLISA: poverty related aspectsDOLISA: poverty related aspects

• All implementing agencies will be required to make All implementing agencies will be required to make information available and to assist in assessment of policy information available and to assist in assessment of policy and discuss policy relevanceand discuss policy relevance

• Program will actively contribute towards capacity building of Program will actively contribute towards capacity building of the implementing agenciesthe implementing agencies

• Additional services will be contracted in consultation with Additional services will be contracted in consultation with Executing and Implementing Agencies from e.g. NILU on air Executing and Implementing Agencies from e.g. NILU on air quality monitoring and CASE on sample analysis.quality monitoring and CASE on sample analysis.

Next StepsNext Steps• Draft Memorandum of Agreement (MoA) on the Draft Memorandum of Agreement (MoA) on the

Project, circulate for comments to DONRE, DOH, Project, circulate for comments to DONRE, DOH, DOLISA and get endorsement (covering DOLISA and get endorsement (covering agreement) of MoA from HCMC PC and MPIagreement) of MoA from HCMC PC and MPI

• Draft TA paper to get formal approval for project Draft TA paper to get formal approval for project within ADBwithin ADB

• Coordinate with DONRE and HEPA the steps to be Coordinate with DONRE and HEPA the steps to be taken to get approval from Vietnam’s sidetaken to get approval from Vietnam’s side

• Detailed technical planning coordinated by HEI to Detailed technical planning coordinated by HEI to prepare draft research protocolsprepare draft research protocols

• Sign TA letter between GoV and ADBSign TA letter between GoV and ADB• Sign Partnership Agreement between ADB and HEISign Partnership Agreement between ADB and HEI

Thank YouThank You

for your timefor your timefor your ideasfor your ideas

and your support for the and your support for the Project.Project.