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HEALTH RISK ASSESSMENT DUE TO HOUSEHOLD AIR POLLUTION IN INDIA : Case Study By Dr. J. K. MOITRA Emtrc Consultants Pvt Ltd, Delhi [email protected], [email protected], 9810032481 IAAPC Workshop on Household Air Pollution & Its Effect on Human Health 4 th March 2014

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HEALTH RISK ASSESSMENT DUE TO HOUSEHOLD AIR

POLLUTION IN INDIA : Case Study

By

Dr. J. K. MOITRA

Emtrc Consultants Pvt Ltd, Delhi

[email protected], [email protected], 9810032481

IAAPC Workshop on Household Air Pollution & Its Effect on Human Health

4th March 2014

INTRODUCTION TO A PECULIAR PROBLEM

o Indoor air pollution is widespread peculiar problem in Rural India. It is

due to domestic burning of biomass or coal in unscientific manner

(use of chulha / sigri inside house having inadequate ventilation).

o WHO estimated 3-4 lakhs deaths /year due to household air pollution.

o Even after 34 years of enactment of Air Act and declaring entire

country as air pollution control area, the problem remains / increasing.

o Even after 28 years of enactment of Environment Protection Act, the

issue did not get noticed as peculiar problem.

o India consumed 148.7 million tons of coal replacement worth of fuel

wood in 2011.

o Environmental Performance Index 2013: Rank of India 155/178

(Poor Index because of Indoor Air Pollution)

Condition of census house in India (2011)

Percentage

Total Rural Urban Total Rural Urban

1 Good 131019820 77041343 53978477 53.1 45.9 68.4

2 Livable 102470426 79855814 22614612 41.5 47.6 28.7

3 Dilapidated 13202421 10929573 2272848 5.4 0.5 2.9

4 Total

Households

246692667 167826730 78865937 100 100 100

Condition of Houses in Rural India lags behind Urban India

They do not have adequate ventilation, have dampness and overcrowded

They have roof predominantly made of thatch, bamboo, plastic, tin, tiles.

About 38% houses do not have separate kitchen for cooking

About 86% households use biomass as fuel.

Predominant Material of Roof (2011)

Absolute number Percentage

Total Rural Urban Total Rural Urban

1 Grass/thatch/bamboo/wood/

mud etc.

37123567 33484330 3639237 15.0 20 4.6

2 Plastic /Polyethylene 1557231 1054830 502401 0.6 0.6 0.6

3 Hand made tiles 35675903 30778543 4897360 14.5 18.3 6.2

4 Machine Made Tiles 22967460 17441452 5526008 9.3 10.4 7.0

5 Burnt bricks 16381118 12111943 4269175 6.6 7.2 5.4

6 Stone/ Slate 21127976 14860863 6267113 8.6 8.9 7.9

7 G.I./ Metal/ Asbestos sheets 39273252 26733862 12539390 15.9 15.9 15.9

8 Concrete 71659299 30746938 40912361 29.0 18.3 51.9

9 Any other material 926861 613969 312892 0.4 0.4 0.4

1 Total no. of Households 246692667 167826730 78865937 100 100 100

Households by Availability of Kitchen Facility (2011)

Absolute number Percentage

Total Rural Urban Total Rural Urban

1 Cooking inside house 215412336 139853780 75558556 87.3 83.3 95.8

(a) Has kitchen 137594123 76238077 61356046 55.8 45.4 77.8

(b) Does not have

kitchen

7781821 63615703 14202510 31.5 37.9 18.0

2 Cooking outside house 30483366 27578343 2905023 12.4 16.4 3.7

(a) Has kitchen 13597879 12302453 1295426 5.5 7.3 1.6

(b) Does not have

kitchen

16885487 15275890 1609597 6.8 9.1 2.0

3 No cooking 796965 394607 402358 0.3 0.2 0.5

Households by Fuel used for Cooking (2011)

Absolute number Percentage

Total Rural Urban Total Rural Urban

1 Fire wood 120834388 104963972 15870416 49.0 62.5 20.1

2 Crop Residue 21836915 20696938 1139977 8.9 12.3 1.4

3 Cow dung cake 19609328 18252466 1356862 7.9 10.9 1.7

4 Coal, Lignite etc. 3577035 1298968 2278067 1.4 0.8 2.9

5 Kerosene 7164589 1229476 5935113 2.9 0.7 7.5

6 LPG/PNG 70422883 19137351 51285532 28.5 11.4 65.0

7 Electricity 235527 118030 117497 0.1 0.1 0.1

8 Biogas 1018978 694384 324594 0.4 0.4 0.4

9 Any other 1196059 1040538 155521 0.5 0.6 0.2

10 No Cooking 796965 394607 402358 0.3 0.2 0.5

Study done by Researchers from CPCB (Dr. Nandita & Dr. Trivedi) found

that SPM level in indoor air of middle class household (n=1200, East Delhi)

was 3-5 times more than outdoor air (Published by TERI)

Time activity pattern: Women, elderly and child: more than 22 hours indoor.

Men and school going children: about 12 hours indoors

Study done by EMTRC in 10 houses of carpet weavers in Rampur village

and Ramnagar village of Bhadohi / Jaunpur district (UP) found that SPM,

CO, SO2, NO2 level in indoor air was 3-4 times more than the national

standard. The weavers were using biomass as cooking fuel inside houses

and using dibris (kerosene lanterns) in till late night (where carpets are

woven). Winrock International used the findings to distribute 1000+ solar

lanterns to the weavers.

Time activity pattern: Women, elderly and child: more than 22 hours indoor.

Men and children: about 20 hours indoors

Initial Case Studies

Raigarh: Industrialised area, AAQ - Very High to Critical

Domestic fuel of low SEG: Coal in chulha / sigri

Ventilation of houses of low SEG: Poor

Time activity pattern: Women, elderly and child: more than 22 hours

indoor. Men and school going children: about 12 hours indoors

EMTRC engaged CNCI –Kolkata to do the health study.

Sample size: 252 (Rural)

Tightness of chest, chest pain, chest discomfort symptom more

prevalent in women than in men (30% Vs 22%)

Recurrent head ache symptom more prevalent in women than in

men (68% Vs 46.5%);

63% in low SEG, 39% in medium SEG, 28% in high SEG (Raigarh)

Case Study 1 (Raigarh)

Case Study (Raigarh)

Prevalence of LRS in

adults

Low SEG (%)

Medium SEG (%) High SEG (%)

Dry cough 43 26 34.5

Cough with phlegm 34 26 24

Breathlessness 47 26 41

Wheeze 15 4.3 10.3

Chest discomfort 28 26 7.0

Prevalence of URS in

adults

Low SEG

Medium SEG High SEG

URS 69.5% 65.2% 65.5%

URS: Sinusitis, runny or stuffy nose, sore throat, common cold with fever

Lung function by spirometry; n=234

Reduced lung function: 63.4% adults (64% women, 62% men)

Restrictive type: 45.6% female, 36.7% male

Reduced lung function was more prevalent in low SEG

Mean FVC was 74.8% of predicted value in low SEG

FEV1 was 81.5% of predicted value in low SEG (against 94% of

predicted value in medium and high SEG)

Case Study (Raigarh)

Structured HHRA

study conducted at

3 locations

1. Singrauli (UP)

2. Seepat (CG)

3. Anta (Rajasthan)

Case Study 2

(Comparative)

Location Map

Singrauli: Heavily Industrialised area, AAQ-Very High to Severe

Coal is available in plenty

Domestic fuel of low and medium SEG: Coal in chulha / sigri.

Ventilation of houses of low SEG: Poor

Time activity pattern: Women, elderly and child: more than 22 hours

indoor. Men and school going children: about 12 hours indoors

EMTRC engaged NSCB Medical College (Dept of Community

Medicine) –Jabalpur to do the health study.

Sample size: 200 (Rural)

Case Study (Singrauli-UP)

Seepat: Rural Area, AQI-Pollution within NAAQS

Domestic fuel of low and medium SEG: Biomass in chulha / sigri.

Ventilation of houses of low SEG: Poor

Time activity pattern: Women, elderly and child: more than 22 hours

indoor. Men and school going children: about 12 hours indoors

EMTRC engaged Maulana Azad Medical College (COEH) –Delhi to do

the health study.

Sample size: 160 (Rural)

Case Study (Seepat-CG)

Anta: Rural Area, AQI- Low Pollution

Domestic fuel of low and medium SEG: Biomass in chulha / sigri.

Ventilation of houses of low SEG: Poor

Time activity pattern: Women, elderly and child: more than 22 hours

indoor. Men and school going children: about 12 hours indoors

EMTRC engaged Maulana Azad Medical College (COEH) – Delhi to

do the health study.

Sample size: 160 (Rural)

Case Study (Anta-Rajasthan)

Seepat

Seepat

Singrauli

Singrauli

Singrauli

Singrauli

Seepat

Singrauli

Seepat

Anta

House condition, fuel use and dietary intake

Case Study

Location Pollution

Status

Poor

Ventilation

Domestic fuel

use

Dietary Habits

Singrauli Severe

exposure

83%

household

Coal (95%

household)

Low BMI, BMR: Inadequate

Addictions: Very High

Diet quality: Poor

Rice and vegetables only

Seepat Moderate

Exposure

92%

household

Cow dung

& Wood

(97% household)

Low BMI, BMR: Inadequate

Addictions: Low

Diet quality: poor

Rice and vegetables only

Anta Low

exposure

41%

household

Cow dung

& Wood

(75% household)

Good BMI, BMR: Adequate

Addictions: Low

Diet quality: good

Wheat, pulses, maize, fruits,

milk, vegetables

Coal Quality (Ash: 40-45%; Moisture 10-11%, VM: 25–30%)

Prevalence of disease

Case Study

Location Prevalence of disease

Singrauli Incidence of TB, asthma, bronchitis, skin disease very

common. Women suffer more from TB & PSOD

Seepat Cough and expectoration : prevalent in approx 15% children.

Cough, breathlessness, wheeze & chest pain: prevalent in

approx 20% adults

Anta COPD, Hypertension, Asthma: Less than 1%

Pulmonary Function Test: OK in 99% subjects

Urine status: OK in all subjects

Common Sufferers in above three location

Women suffer more due to URS & LRS, Reduced Lung Function

People from low SEG suffer more from above diseases

Considering following Ambient Air Quality, impact predictions

done for Indoor and Outdoor Health Risk using RISC5 Model

Health Risk Impact Assessment

Sr.

No

Parameters Unit Results National Standard

Date of Sampling 09-10-2012 10-10-2012

1 PM10 µg/m3 84 80 100(24-hours average)

2 PM2.5 µg/m3 42 41 60(24-hours average)

3 NO2 µg/m3 17.2 15.8 80(24-hours average)

4 SO2 µg/m3 8.9 8.2 80(24-hours average)

5 Carbon Monoxide (CO) mg/m3 0.75 0.68 4 (1-hours average)

6 Ozone (O3) g/m3 52 47 180 (1-hours average)

7 Benzene g/m3 0.33 0.32 05(Annual Basis)

8 Benzo(a)Pyrene, BaP ng/m3 0.22 0.25 01(Annual Basis)

9 Arsenic (As) ng/m3 0.22 0.19 06(Annual Basis)

10 Mercury(Hg) ng/m3 0.14 0.15 -------

11 Nickel (Ni) ng/m3 1.9 1.8 20(Annual Basis)

12 Lead (Pb) g/m3 0.24 0.22 1(24-hours average)

13 Ammonia (NH3) g/m3 26 24 400(24-hours average)

Inference: Health Risk is more in Indoor than Outdoor

Risk Assessment using RISC5 Model

NON CARCINOGENIC RISK DUE TO INDOOR AIR QUALITY

Category of Risk Adult Population Child Population Acceptable Limit

Maximum Risk 0.049 0.049 1

Mean Risk 0.028 0.030 1

CARCINOGENIC RISK DUE TO INDOOR AIR QUALITY

Category of Risk Adult Population Child Population Acceptable Limit

Maximum Risk 0.0000013 0.0000015 0.0001

Mean Risk 0.00000029 0.00000044 0.0001

CARCINOGENIC RISK DUE TO OUTDOOR AIR QUALITY

Category of Risk Adult Population Child Population Acceptable Limit

Maximum Risk 0.00000035 0.0000029 0.0001

Mean Risk 0.00000000529 0.000000058 0.0001

NON CARCINOGENIC RISK DUE TO OUTDOOR AIR QUALITY

Category of Risk Adult Population Child Population Acceptable Limit

Maximum Risk 0.0051 0.049 1

Mean Risk 0.00019 0.001 1

IMPACT ASSESSMENT

o People of low Socio Economic Group in Rural Area burn biomass or

coal as fuel in sigris or chulhas, that gives rise to household air pollution

o Burning ROM coal in sigris or chulhas give rise to serious pollution

o Due to absence of separate kitchen and proper ventilation, the air

pollutants gets trapped inside the house, circulates within and dissipates

at low rate. The concentration of pollutants is therefore more than outdoor

o Women, infants and child spend almost all the time indoor.

o Women of low SEG therefore suffer from URS and LRS.

o Confounding factors are poor nutrition and unhygienic surroundings

o Health Risk Impact due to indoor air pollution is > outdoor air pollution.

REASONS FOR THE PROBLEM

o In industrialized areas, all adult family members work. They have little

time to collect firewood & depend upon coal from black market for fuel.

o Developed nations do not face such problem. Otherwise they would

have solved the problem, which India could emulate sooner or later.

o Indoor air quality market is not lucrative for developed nations (because

stakeholders are all poor illiterate people without any voice)

o Indian decision makers and scientific researchers are skewed towards

Urban Pollution that gives them more credit and rewards.

o Agency established by Indian law did nothing even after 34 years of

enactment of Air Act. (business as usual scenario).

o Awareness campaign highlighting “Indoor Air Pollution” never appeared

in any newspaper / Electronic Media.

IS THERE A SOLUTION

o Scientist like Prof Kirk Smith, TERI, CSE, etc did outstanding work to

highlight the problem of indoor air pollution in India. The decision

makers know that indoor air pollution due to coal or biomass burning

is an issue pertaining to health of rural people.

o Decision makers are aware that indoor air pollution is directly

proportional to expenditure incurred on health program.

o The fuel giving rise to indoor air pollution or clean fuel is owned,

regulated and run by the Government.

o Indian public or Scientific organizations have very little role to play to

prevent, control or abate such pollution.

DO WE NEED NEW LAW

o Legal framework is in place:

o Air Act 1981: Act to provide for the preservation, control and abatement

of air pollution. Objective : Preservation of the quality of air and control

of air pollution.

o Environment Protection Act 1986: Enacted with the objective of

providing for the protection and improvement of the environment.

Preventing environmental pollution in all its forms and tackle specific

environmental problems that are peculiar to different parts of the

country.

o Solution exists because: we understand the peculiar issue, we have

legal framework, we have enforcement institutions.

o Prioritization and Concrete Action by Government is lacking.

Long Term Action

MSW Rules and Regulations, Vehicular Standards, Fuel Quality Standards

are framed by CPCB but implemented by other government agencies.

CPCB may formulate Guidelines for prevention, control and abatement of

Indoor (Household) Air Pollution

Implementing agencies: Rural Development, Urban Development, Social

Development Ministry

Short Term Action: Creating awareness among rural population about

health impacts of indoor air pollution

RECOMMENDATIONS

Separate kitchen or kitchen outside house where biomass is used

(distinctly separating the living room and bed room)

Switch over to improved / scientifically designed chulhas/ sigris

Improving the ventilation / air circulation in rural houses

Stop use of ROM coal in sigris / chulhas. (Coal after removing the volatile

matter could be used [in places where coal is plenty])

Stop black marketing ROM coal

Make available subsidized LPG, PNG, electricity in rural areas

Make available Solar Lanterns, Solar Cookers in rural areas

Maximize the use of Biogas Plants in rural areas

Apply true SEIA study and need based development CSR plans for rural

areas

RECOMMENDATIONS

EMTRC Team:

G.K.Mendiratta, Ratnesh Kotiyal, Mukesh Kumar, Ashok Kumar, sandeep

Shukla

Dr. Nandita Moitra, Dr. R.C.Trivedi

Prof. T.K.Joshi, MAMC, Ms. Pallavi, Ms. Deepika

Prof. Toppo, Prof. Tiwari, Dr. Jyoti (Medical College – JBP)

Prof. T. Lahiri (Chittaranjan National Cancer Institute-Kolkata

ACKNOWLEDGEMENT

THANK YOU

(बहुजन सुखाय बहुजन हहताय च)

Gandhiji and Swami Vivekananda identified themselves

with the poorest people of the society and served them

as Daridra Narayana — "God in the form of poor and

downtrodden people"