Vulnerability of Urban Populations to Ambient Air Pollution

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

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Dannenberg et al. 2011

Urban populations have always been exposed to ambient (outdoor) air pollution because urban regions have high-density industries and populations (Dannenberg et al., 2011). High levels of pollution result from the concentration of sources of combustion (Dannenberg et al., 2011). There are two types of pollutants: primary and secondary. Primary pollutants are those that are directly emitted (Dannenberg et al., 2011). These include sulfur dioxide, which is released from power plants, and carbon monoxide from fossil fuel combustion (Dannenberg et al., 2011). In contrast, secondary pollutants result from the physical and secondary conversion of other pollutants (Dannenberg et al., 2011). Tropospheric ozone is one example; it forms through the chemical reactions of anthropogenic and biogenic precursors (Dannenberg et al., 2011).

Both primary and secondary pollutants lead to negative health consequences, including eye irritation, fatigue, headaches and more severe effects such as bronchoconstriction, lung impairment and neurological damage (Dannenberg et al., 2011). Certain populations are particularly vulnerable to ambient air pollution. For example, as a result of physiological and psychological factors, children are more sensitive to ambient pollution (Vanos, 2015). Furthermore, those with less education and lower socio-economic status also face a greater risk of exposure to ambient air pollution; thus, highlighting pollution an issue of environmental justice as well (Dannenberg et al., 2011).

Since air pollution is multifaceted, it is not easy to determine a solution. More research is required, to determine the severity of ambient air pollutants in different regions and how different populations are impacted. Furthermore, it is important to develop and implement policies that will reduce the prevalence of ambient air pollutants and their health consequences. For example, in order to provide evidence-based advice on the impacts of air pollution on health, the WHO Regional Office for Europe developed two projects-the “Review of Evidence on Health Aspects of Air Pollution” (REVIHAAP) and the “Health Risks of Air Pollution in Europe” (HRAPIE), which were completed in 2013 (WHO, 2013). The findings from these projects guided changes in the EU air quality policies that were implemented that same year (WHO, 2013).

The built environment also plays an important role in mitigating air pollution. Regions should employ sustainable development practices to ensure energy-efficient land use and transportation systems to reduce emissions (Dora et al., 2015). Moreover, attention should be given to the proximity of homes and schools to sources of pollution (Dannenberg et al., 2011). Urban Structure Types (USTs) is one method that could be used, as it is a spatial indicator that describes urban regions through the assessment of land use, physical properties and environmental characteristics (Réquia Júnior et al., 2015). The UST method assesses the morphology of housing, green spaces and industrial buildings which can be compared, to assess the relationship with a health risk (Réquia Júnior et al., 2015).

Like other global health problems, air pollution is complex. It is not unique to one region because it reaches across borders. As a result, governments and organizations from various regions need to work together to mitigate this problem.

References:

Dannenberg, A. L., Frumkin, H., & Jackson, R. J. (2011). Making Healthy Places:

Designing and Building for Health, Well-Being, and Sustainability. Washington: Island Press.

Dora, C., Haines, A., Balbus, J., Fletcher, E., Adair-rohani, H., Alabaster, G., … Neira, M. (2015). Indicators linking health and sustainability in the post-2015. The Lancet, 385(9965), 380–391. doi:10.1016/S0140-6736(14)60605-X

Réquia Júnior, W. J., Roig, H. L., & Koutrakis, P. (2015). A novel land use approach for assessment of human health: The relationship between urban structure types and cardiorespiratory disease risk. Environment International, 85, 334–342. doi:10.1016/j.envint.2015.09.026

Vanos, J. K. (2015). Children’s health and vulnerability in outdoor microclimates: A comprehensive review. Environment International, 76, 1–15. doi:10.1016/j.envint.2014.11.016

World Health Organization. (2013). Health risks of air pollution in Europe-HRAPIE project

The Environmental Cost that Living in this World Puts on Our Health

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

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Source: Environmental Health, World Health Organization (WHO)

As revolting as it sounds, there are places in the world where the chances of consuming one’s neighbours’ faeces are quite high if one is not vigilant regarding sanitation and hygiene. That being the condition of many areas in low and lower-middle income countries does not mean that high and higher-middle income countries are exempt from any environmental conditions that are harmful to health.

But, what is environment health? The World Health Organization (WHO) defines the term as, “All the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours”. It, however, excludes genetics and the social and cultural environment.

In low-income settings, concerns for environmental health may arise in the context of sanitation and hygiene, as well as indoor and outdoor pollution. In high-income countries, many chronic diseases like diabetes and cardiovascular disease, are associated with sedentary lifestyles. While these might be attributed to behaviour, one must consider that such behaviours can arise from changes in the environment. Over 80% of communicable and non-communicable diseases can be attributed to environmental hazards.  Overall, conservative estimates indicate that about one quarter of the total global burden of disease is owing to this cause (WHO, 2011). Furthermore, the biggest killers of children under 5 years are all environmental-related diseases, including diarrhoea, respiratory infections, and malaria.

Other diseases of concern are helminthic infections, trachoma (a bacterial eye infection), Chagas disease, leishmaniosis, onchocerciasis, and dengue fever. All of which are associated with impoverished conditions and can be mitigated by improving sanitation, hygiene, and housing. Although conflicts and natural disasters might be catastrophic for any country, struggling economies tend to suffer more because disasters worsen the poor conditions which directly affect sanitation and hygiene practices, creating conducive conditions for various infectious diseases, and ultimately feeding into the vicious cycle of poverty.

Many interventions are underway to address these conditions, including Water, Sanitation and Hygiene (WASH) initiatives, Integrated Vector Management, Programme on Household Air Pollution, International Programme on Chemical Safety, Health and Environment Linkages Initiative, and Intersun Programme for the effects of UV radiation. The acknowledgement of the effects of the environment has grown. One of the Millennium Development Goals (MDGs) was, “To ensure environmental sustainability.” The Sustainable Development Goals (SDGs) are more extensive and thorough in placing focus on the environment. Goal 1 is to end poverty, goal 6 is to make provision of clean water and sanitation possible, and goal 13 is to stop climatic change resulting in floods and drought (United Nations, 2014).

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The Sustainable Development Goals. Source: United Nations System Staff College

It is encouraging to see steps being taken to control environmental hazards; however, the journey to measuring and eradicating such conditions still remains a challenge, which will hopefully be overcome through future endeavours.

References:

United Nations (2014). Sustainable Development Goals. doi:10.1017/CBO9781107415324.004

World Health Organization (2011). WHO Public Health & Environment Global Strategy Overview

Awaiting Death on a Heap Of Gold

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

In the far southeastern part of Pakistan lies an arid region with a gruesome past of disease and death. Despite this, it is considered a goldmine for black gold, establishing the Thar Desert as the 6th largest reserve of coal in the world. These reserves are estimated at 175 billion tonnes spanning over an area of 9000 sq. km enough to provide the country with energy for centuries to come. Perception about the treasure that lies beneath the scorching sand of Thar brings into question the existence of labour directed towards harnessing the gauged energy. It is exasperating to witness the indifference of the authorities to improving the conditions using its coal reserves, but the deaths of hundreds to date as a result of malnutrition in an area which has the potential to sustain itself and the rest of the country as well, is alarming. 

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Source: The Express Tribune

The current scenario of drought emerged in 2013 and continues to prevail beyond any hope of reprieve, natural or otherwise. But this is not the first time the region of Tharparkar has seen such unforgiving conditions. Thar experienced the worst drought in its history from 1998-2002, which affected 1.2 million people, killed 127 people and 60% of the population migrated to irrigated land. The streak of drought did not end completely, albeit lessened, for Thar experienced a moderate drought in 2004/2005. Yet another drought came along in 2009/2010 followed by one of the worst floods in Pakistan’s history.

Current statistics report worse figures than the drought of 1998-2002. Government officials have confirmed the deaths of 159 men, 168 women and 726 children under 5. Over 3000 cattle have been reported dead. The number of affected individuals is an estimated 1.1 million. 175,000 people are projected to have migrated. The numbers continue to rise as the government attempts to alleviate the situation. Locals however fear that the worst is yet to come. With inadequate rainfall to sustain the flora and fauna, and the ground water level sinking, the steps taken by the government fall short. Massive relief projects focused on purifying the saline water have been planned but despite 375 Reverse Osmosis pumps being installed, only a handful have been reported to be operational due to a lack of trained manpower. As a result, efforts made towards relief for this region have not affected the escalating numbers of lives being lost every day.

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Source: The Express Tribune

Besides the obvious malnutrition cases, another major complication is the rise in water borne diseases. These prove to be the largest contributors to mortality apart from birth asphyxia, pneumonia and sepsis. Thar has been attributed to have the highest under-five mortality rate in Pakistan with 90-100 deaths per 1000 live births. These statistics are distressing, however, doctors maintain that the figures have not changed in three decades, stressing the need for establishing a permanent solution for the region instead of episodic interest in chronic issues.

The need of the hour demands sustainable long-term development rather than multiple short bursts of temporary relief projects for an area that is recognised as prone to drought-like conditions.

Sources:

Latif A. Ray of light in Pakistan's drought-hit Thar desert (July 2015). BBC News Asia. Available at: http://www.bbc.com/news/world-asia-31851835

Hashim A. Pakistan's Thar residents living on the edge (March 2014). Aljazeera. Available at: http://www.aljazeera.com/indepth/features/2014/03/pakistan-thar-residents-living-edge-2014315121120904102.html

Climate Change and Health, Part 3: Infectious Disease

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

This is my final post of a three part series on climate change and health. The first post looked at how climate change will influence the onset and severity of droughts in some areas. The second post examined how some regions are predicted to see an increase in droughts, which would decrease food supply; thus, increasing nutrient deficiencies in those areas. This post will briefly discuss the influence of climate change on waterborne diseases.

Change in climate, including the increases in temperature and changes in rainfall patterns may lead to an increase in waterborne diseases, where insect vectors contaminate the water (Shuman, 2010). Often, higher temperatures are needed for some insects to complete their life cycle. This is the case for mosquitoes, as they live in warm, aquatic habitats (Shuman, 2010). With an increase in temperature and more flooding, there will be an increase in mosquitoes (Shuman, 2010). Thus, there may be an increase in the transfer of dengue and malaria (Ramasamy & Surendran, 2011). These warm, aquatic habitats will also be ideal for snails, which transfer schistomiasis (Ramasamy & Surendran, 2011). Furthermore, with a rise in sea levels, there is likely to be an increase in saline levels (Ramasamy & Surendran, 2011). Certain types of mosquitoes and snails have a high tolerance for salt water and are thus able to breed in water with high salt concentrations (Ramasamy & Surendran, 2011).

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Taken from: Watts N, Adger W N, Agnolucci P, Blackstock J, Byass, P, Cai W, Costello A (2015). Health and climate change: policy responses to protect public health. The Lancet, 6736(15)

The relationship between climate change and health is complex because there are many different contributing factors and there is limited scientific evidence for many regions, several of which are under-resourced (New York Times, 2015). Furthermore, areas of high-resource have not been impacted in the same way, due to advantages as simple as air conditioning (New York Times, 2015). Thus, more scientific evidence is needed, to determine more ways in which climate change could possibly influence the health of a population. More recognition also needs to be given to this issue so that contingency plans can be made for possible outbreaks of diseases that were discussed in this blog post.

References:

Shuman, E. K. (2010). Global Climate Change and Infectious Diseases. The New England Journal of Medicine , 362 (12), 1061-1063.

Ramasamy, R., & Surendran, S. (2011). Possible impact of rising sea levels on vector-borne infectious diseases. BMC Infectious Diseases , 11 (18).

Tavernise, S. (2015, July 13). Unraveling the Relationship Between Climate Change and Health. Retrieved September 10, 2015, from http://www.nytimes.com/2015/07/14/health/unraveling-the-relationship-between-climate-change-and-health.html?_r=0

Climate Change and Health, Part 2: Droughts, Food Insecurity and Culture

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

In my last blog post, I highlighted how climate change has impacted the frequency, severity and onset of floods, thus, have various impacts on the health and well-being of flood victims. In this blog, I will be discussing how food security will be impacted by climate change.

Overall, an increase in temperature would lead to a decrease in nutrient acquisition in crops and could disturb general nutrient cycling (St.Clair & Lynch, 2010). This would also cause an increase in the decomposition of soil organic matter, thus, reducing the fertility of soil and possibly impacting crop nutrition (St.Clair & Lynch, 2010).

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"Representation of the 11 Signs of Climate Change." Source: A Students Guide to Global Climate Change, Environmental Protection Agency (EPA)

Borana, Ethiopia is one region where droughts have been severe (Megersa et al., 2013). In this area, cattle ownership not only provides milk, an important part of the diet, but also indicates attaining the socio-cultural status set by the community. With an increase in temperatures, rangelands in this area have dried up. As there is less land for grazing, there has been a great loss in the number of cattle, and a reduction of milk produced by surviving cattle. This has led to negative health consequences as stunting has become more prevalent among children (Megersa et al., 2013). There has also been an increase in physical ailments among adults (Megersa et al., 2013). With this, 77 percent of households have claimed to be food insecure for over five months per year (Megersa et al., 2013).

As revealed in the above example, issues of food security can be closely associated with cultural norms, as diet is often influenced by the local tradition. Thus, when there is a decrease in what is considered to be a staple-food in the region, a diversification in diet can help alleviate food insecurity (Megersa, Markemann, Angassa, & Valle Zárate, 2013). However, adapting to dietary changes can be a difficult process, especially when diets are so deeply rooted in traditions (St.Clair & Lynch, 2010). Cultural norms also influence how vulnerable populations are impacted by food insecurity. For example, issues of food insecurity related to climate often leads to more issues for women and children because they are already lower on the “food hierarchy” (Watts et al., 2015).

The recent article on climate change and health published by the Lancet discussed many potential options for adaption (Watts et al., 2015). For example, efforts should be made to improve ecosystem management (Watts et al., 2015). Investments should also be made in agricultural research in order to increase food security for the long-term (Watts et al., 2015). Furthermore, early warning systems and food reserves also need to increase in order to potentially avoid issues of nutritional deficiencies (Watts et al., 2015).

As often, this issue is complicated, and there are several questions that can be asked. For example, how can policies be formed to alleviate the impacts on the most vulnerable populations? Furthermore, should those in high-resourced countries be concerned about how those in low-resource regions could be impacted by an increase in droughts? Or even how those living in developed countries could also be impacted by these droughts? 
Or is the problem maybe too far from home to be a concern in the first place?


References:
Megersa, B., Markemann, A., Angassa, A., & Valle Zárate, A. (2013). The role of livestock diversification in ensuring household food security under a changing climate in Borana, Ethiopia. Food Security, 6(1), 15–28. doi:10.1007/s12571-013-0314-4

St.Clair, S. B., & Lynch, J. P. (2010). The opening of Pandora’s Box: climate change impacts on soil fertility and crop nutrition in developing countries. Plant and Soil, 335(1-2), 101–115. doi:10.1007/s11104-010-0328-z

Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., … Costello, A. (2015). Health and climate change: policy responses to protect public health. The Lancet, 6736(15). doi:10.1016/S0140-6736(15)60854-6