Air Pollution, Poverty and Health in Ho Chi Minh City Nguyen Dinh Tuan HCMC Environmental Protection Agency BAQ 2006 Yogyakarta - Indonesia

Ho Chi Minh city Ho Chi Minh City, the former Saigon, the largest city in Vietnam, has more than 6 million people Northeast of the Mekong river, 910 square miles of flat land. Mean temperature between the high 80 to high 90 degrees Farenheit

Ho Chi Minh city The urban area occupies 10% of total land and is divided into 19 urban districts and 5 rural districts. The main industries consist of production of sea food, textiles, chemicals, plastics, and building materials, food processing. There are more than 1,000 large-scale enterprises, and over 30,000 small factories. Rapid economic development has also brought more migrants to the city, contributing to the traffic congestion and urban crowding There are more than 2.5 millions motorcycles, and 260,000 automobiles. The city has 38 hospitals and clinics, and there are about 9 medical doctors per 100,000 people

Ho Chi Minh city

Map of air quality monitoring sites in HCMC

Air Pollutants

Mannual air quality monitoring Three sites were installed since 1993: Hang Xanh cross road, Dinh Tien Hoang – Dien Bien Phu corner, Phu Lam cross road. Three sites were installed since 2005: Go Vap cross road, Tan Thuan cross road, An Suong cross road. Monitoring frequency: 10 days per month. Monitoring times: Samples were collected in 7 am, 10 am and 3 pm. Measured variables: CO, TSP, Pb, NO2, noise

Urban background air quality (residential areas)

Roadside air quality (Automatic) Annual average PM10 from 2002 to 06/2006 20 40 60 80 100 120 140 Thoáng Nhaát Bình Chaùnh ug/m3 2002 2003 2004 2005 2006 The annual average PM10 concentration measured at road side- traffic stations have reduced lightly through years

Roadside air quality (Automatic) Annual average CO from 2002 to 06/2006 1 2 3 4 5 6 DOSTE HB Thoáng Nhaát Bình Chaùnh mg/m3 2002 2003 2004 2005 2006 The annual average CO concentration measured at road side- traffic stations have increased lightly through years

Roadside air quality The CO concentration measured at the manual air quality monitoring sites fluctuated from 9.4 –16mg/m3 that met the Vietnam Standard. (TCVN 5937 – 1995 CO: 40 mg/m3)

Roadside air quality The TSP concentration measured at the manual air quality monitoring sites fluctuated from 0.45 – 0.96 mg/m3. All the TSP concentration exceeded the Vietnam Standard (300mg/m3). TSP concentration (2000-2006) 0.00 300.00 600.00 900.00 VX HX ÑTH - ÑBP VX PL Ngaõ tö AS Ngaõ saùu GV NVL - HTP ug/m 3 2000 2001 2002 2003 2004 2005 7 thaùng ñaàu 2006 TCVN

The NO2 concentration measured at manual air quality monitoring sites fluctuated from 0.12 – 0.26 mg/m3. All the NO2 concentration met the Vietnam Standard (400mg/m3). Roadside air quality

Roadside air quality The Pb concentration measured at manual air quality monitoring sites have reduced remarkable from 06/2001. All the Pb concentration met the Vietnam Standard (5ug/m3).

Admissions for Respiratory Illness, HCMC Children’s Hospital 1 cases year There was relation between diseases and air pollution Asthma increased quickly

DISTRIBUTION BY AGE - DISEASES RELATED TO AIR POLLUTION %

Poverty District-level poverty status was derived using mid-term census data and data from the longitudinal Vietnam Household and Living Standard Survey (VHLSS), and small-area estimation method

Studying Air Pollution, Poverty, and Health in HCMC Overall Objectives: Develop feasible approaches to studying air pollution, poverty, and health Methods appropriate for HCMC context Methods suitable for use in other cities - promote building an evidence base across Asian cities Develop infrastructure for future studies of the health effects of air pollution in HCMC Technical capacity (epidemiologic methods, exposure assessment, analysis) Resources (data integration, equipment)

Proposed Methods Component 1 (C1): Hospital-based study Estimate the effect of short-term exposure to air pollution on hospital admissions for ALRI in young children (<5 years) in HCMC Compare the magnitude of the effect of air pollution on poor children vs. other children Component 2 (C2): Household-based study Estimate personal exposures to air pollution among the poor and the non-poor ambient air pollution other sources (cooking with solid fuels, cottage industries) Estimate prevalence of respiratory symptoms in HCMC Survey of perceptions and economic costs Component 3 (C3): Policy Analysis; Capacity Building; Awareness Building

Hypotheses to be tested H1: the poor experience greater health impacts from ambient air pollution (C1 and C2) H2: the poor are more exposed to air pollution (C2) H3: exposures of the poor are more correlated with ambient air pollution (C2) H4: the poor are more vulnerable to ambient air pollution (C1)

Methods development and dissemination This is the first project of its kind in Asia! Targeted technical assistance and capacity building will be provided Necessary infrastructure will be provided (example: equipment for air quality monitoring and analysis) Collaborators will make presentations at international workshops and conferences (CAI-Asia, technical conferences) Researchers from other Asian cities will be invited to learn more about the study

Motivation and Structure of Collaboration Vietnam serves as a good model for future studies in similar regions (including capacity building) HEI & ADB HCMC Health Department International Collaborators HCMC HEPA HCMC Hospitals HCMC Bureau of Statistics HCMC DOLISA

Interdisciplinary team of collaborators Organization(s) Responsibilities Department of Public Health (DPH) Local leadership, management, and coordination Other local collaborating agencies: CH1, CH2, HEPA, CASE, Bureau of Statistics, DOLISA Provide retrospective data, assess respiratory health prevalence, exposure monitoring and modeling, environmental sample analysis, administer household survey, assessment of socio-economic position Health Effects Institute (HEI) Overall study management and technical assistance (study design, epidemiologic methods, exposure assessment) International Scientific Oversight Committee (ISOC) Technical guidance and scientific oversight External Consultants Technical assistance (biostatistics)

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