Presentation by Barbara Britton COMPARATIVE RISK ASSESSMENT: SETTING PRIORITIES FOR URBAN ENVIRONMENTAL MANAGEMENT IN DEVELOPING COUNTRIES Presentation by Barbara Britton January 18, 2000

OUTLINE OF PRESENTATION Part I Introduction and Background Part II International Experience with CRA Part III Methodology

PART I: INTRODUCTION AND BACKGROUND

HISTORY OF COMPARATIVE RISK ASSESSMENT First used in the U.S. in 1987 “Unfinished Business” evaluated 31 problems and changed USEPA priorities Many projects completed for regions, states, and cities Used outside the U.S. by USAID and USEPA First assessment was in Bangkok, 1990 Assessments completed for about 10 cities and regions

What DID EPA Learn From Comparative Risk Efforts? Chemical-Specific, Media-Specific, Technology-Based Approaches have Limitations Policies Based on Comparative Risk Assessments Could Lead to More Efficient Use of Resources and Greater Protection of Public Health and the Environment

ENVIRONMENTAL MANAGEMENT Comparative Health Risk Assessment is used to set priorities for environmental management. Identify and evaluate risks, set priorities among problems. Risk Assessment Develop and implement solutions for high priority problems Risk Management

ENVIRONMENTAL RISKS Environmental damage may have three types of negative effects.  Public Health--illness, injuries, deaths Ecological--loss of species and habitat Quality of Life--economic and social costs

TYPES OF “RISK ASSESSMENT” Health Risk Assessment: evaluates the potential public health impacts of an environmental condition Comparative Health Risk Assessment: evaluates and compares the potential health impacts of several environmental conditions Comparative Risk Assessment: evaluates and compares the potential health, ecological, and quality-of-life impacts of several environmental conditions

PART II: INTERNATIONAL EXPERIENCE WITH COMPARATIVE RISK ASSESSMENT

International Experience With Comparative Risk Assessment Bangkok: Accelerated plans for banning lead in gasoline Cairo: USAID projects to reduce air pollution and lead contamination Ahmedabad: Municipal program to reduce air pollution from transport Lima: USAID environmental health project under design Silesia: USAID technical assistance to high risk industrial facilities

“HIGH RISK” PROBLEMS FROM FIVE CRAs Environmental Problem Categories Bangkok Quito Cairo Ahmedabad Lima Water, Sanitation, or Microbial Diseases     Ambient PM     Indoor Air  Lead   Air Pollution from Transport  Solid Waste 

CRA RESULTS: BANGKOK Bangkok, Thailand (1990) Airborne Particulate Matter Lead Contamination Microbiological Diseases Carbon Monoxide (CO) Other Metals Toxic Air Pollutants Surface Water Contamination Ground Water Contamination Pesticides & Metals in Food Solid & Hazardous Wastes High Moderate Low Other Gaseous Air Pollutants (SO2, NO2, O3)

CRA RESULTS: CAIRO Cairo, Egypt (1994) Airborne Particulate Matter High Moderate Moderate/Low Low Airborne Particulate Matter Lead (all media) Microbiological Diseases Microbiological Contamination of Food Ozone Other Gaseous Air Pollutants (SO2, CO) Indoor Air Pollution Drinking Water (microbes, chemicals) Solid and Hazardous Wastes Toxic Air Pollutants Other Water Pathways (e.g. fish, irrigation)

CRA RESULTS: AHMEDABAD Ahmedabad, India (1995) High Moderate Low Air Pollution from Mobile Sources Ambient Air Pollution (all sources) Indoor Air Pollution Drinking Water Wastewater Occupational Hazards Traffic Hazards Food Contamination

CRA RESULTS: LIMA Lima, Peru (1997) Inadequate Water Supply High Moderate Low Inadequate Water Supply Inadequate Sanitation Solid Waste Surface and Groundwater Contamination Food Contamination Air Pollution Water Pollution (marine) Hazardous Waste Toxic Substances Indoor Air Pollution Loss of Landscaped Areas & Farm Land

PART III: COMPARATIVE RISK ASSESSMENT METHODOLOGY

STEPS IN RISK ASSESSMENT Health risk assessment is quantitative, based on experimental and observational data. Hazard Identification-- identify health risks associated with exposure Dose-Response Assessment-- model the relationship between dose and effects Exposure Assessment-- estimate a group’s exposure (amount, duration) Risk Characterization-- estimate the probability and severity of effects

CONCEPTUAL MODEL LINKING ENVIRONMENTAL CONDITIONS AND HEALTH Source Transport and Fate in the Body Discharge Transport and Fate in the Environment Dose Target Organs Exposure Intake Damage, Disease, or Death

EXAMPLE: HEALTH RISK ASSESSMENT Health Risk Assessment in Bangkok: Population: 5.9 million Airborne particulates: 90 - 200 g/m3 Health effects (per year): 9 - 51 million restricted activity days 300 - 1400 deaths

EXAMPLE: HEALTH RISK ASSESSMENT Health Risk Assessment in Quito, Ecuador: Population: 1.1 million Pesticides in food: 44.3 g/day intake of heptachlor 11.0 g/day intake of aldrin Health Effects: 0.3 to 9.1 x 10-3 lifetime cancer risk Up to 150 excess cancer cases/year

EXAMPLE: COMPARATIVE HEALTH RISK ASSESSMENT Quito, Ecuador (1993) Risk Metropolitan Area Asentamientos Populares Microbiological Diseases (Food) Microbiological Diseases (Food) High Airborne Particulate Matter Airborne Particulate Matter Indoor Air Quality Occupational Disease and Injuries Drinking Water and Wastewater Traffic Injuries Traffic Injuries Moderate Drinking Water and Wastewater Solid & Hazardous Waste Disposal Indoor Air Quality Occupational Disease and Injuries Solid & Hazardous Waste Disposal Pesticides in Food Low Pesticides in Food

CRA METHODOLOGY Four Phases of Comparative Risk Assessment Planning Determine scope of the study Select and organize the team Identify data types and sources Data Collection and Analysis Identify and gather data Analyze data to estimate risks Priority Setting Interpret and compare risks Debate and agree on priorities Reporting Prepare report as input to risk management planning

FUNCTIONS AND RESPONSIBILITIES The organization of a CRA must address five necessary functions: Function Typical Unit Project Management and oversight Project Manager Policy direction and project mandate Steering Committee Public participation Public Advisory Committee Final risk ranking Steering Committee or Public Advisory Committee Technical analysis--data collection, risk assessment, preliminary ranking Technical Committees

PARTICIPATORY ASPECTS OF CRAs Broad participation is critical because: Analysis is multi-disciplinary and highly complex Setting priorities are ultimately based on values of the community Broad participation is linked to acceptance of CRA results and implementation of actions to reduce risks

TECHNICAL ANALYSIS Identify and evaluate health impacts of many environmental conditions water and food sanitation, drainage, and wastewater ambient and indoor air, gases and particles solid and hazardous wastes occupational injuries and exposures infectious, vector-borne, and pollutant-related diseases

ADAPTING TECHNICAL ANALYSIS FOR CRA IN DEVELOPING COUNTRIES ISSUE RESPONSE Scope includes infectious diseases, outside traditional risk assessment methods Use health data from clinics and local survey to estimate disease rates. Limited information and many data gaps. Use environmental, health, and qualitative data Data are not computerized and are aggregated at inappropriate geographic levels. Reorganize information; use assumptions and extrapolation where necessary. Some standard exposure assumptions are inappropriate due to culture or conditions. Adjust assumptions; conduct special studies if possible.

PRIORITY SETTING Categorize each health impact by magnitude and severity magnitude -- number of people affected severity -- of effect, and importance of group affected Combine magnitude and severity scores Compare and categorize environmental problems high, medium, and low risk

CRA Risk Ranking Risk ranking requires judgments based on values Comparing health effects: acute vs. chronic disease vs accidents Comparing effects among groups: children vs. working adults vs. elderly poor vs. middle income voluntarily exposed vs. involuntary exposed women vs. men

Conclusion CRA’s can form an effective basis for urban environmental management planning Allow cities to address worst environmental problems first Broad-based participation is crucial to ensure risk ranking reflects views of entire community Stakeholder involvement is pivotal to ensuring risk assessment results translate into management action