1. Energy, Environment and Poverty Serbia and Montenegro STUCK IN THE PAST Indoor pollution and health effects Dragana Vujanovic

2. OUTDOOR POLLUTION INDOOR POLLUTION US EPA – “Indoor levels of pollutants may be 2-5 times, and occasionally more than 100 times higher than outdoor levels.” What is indoor pollution?

3. OUTDOOR POLLUTION Thermal power plant Industrial energy use Household heating devices Residential heating plants Traffic

5. Air pollution indications in 2000 Townm siteSO 2 sootNO 2 sum.air pollution degree Beograd 10.21.00.71.9 Unhealthy 20.10.50.61.6 Unhealthy 30.10.40.30.8Slight Novi Sad 10.40.1 0.6Slight 20.60.10.061.3Moderately 30.50.1 0.7Slight Niš 10.1 0.20.6Slight 20.20.80.51.5 Unhealthy Subotica 10.040.1 0.2Favourable 20.060.1 0.3Favourable Š abac 10.30.90.41.6 Unhealthy 20.41.00.41.8Unhealthy Zrenjanin 10.30.50.31.1Moderately 20.40.30.11.0Moderately Kru š evac 10.20.30.61.1Moderately 20.20.40.20.8Slight Pan č evo 10.10.30.20.6Slight 20.10.30.20.6Slight Kikinda 10.30.1 0.5Slight 21.00.1-1.1Moderately API –Air pollution index

6. Air pollution record  Urban air is in bad conditions (according to the air pollution index):  5 monitoring locations – very polluted areas  3 towns – unhealthy air  3 towns – medium…  30% of population in Serbia breath unhealthy air  Urban air in Montenegro is satisfactory except Pljevlja, Podgorica and Niksic  Health consequences…

7. Health risk assessment -epidemiological studies -chronic effect studies -control human exposure (exposure - effect relationship)

8. Air pollution – health consequences  The households from ecologically polluted area more frequently have breathing problems, more frequently have asthma, sinusitis, malignant diseases and allergic diseases, than other surveyed households from other, less polluted regions.  Pljevlja in Montenegro has acute respiratory diseases (23 -50%), obstructive and inflammatory diseases (3 -11%), premature birds, psychosomatic diseases and malignant diseases increased in the period of 1985 –2001.

9. Indoor pollution reports  US EPA -1987. – indoor air pollution as a fourth cause in cancer risk among 13 environmental problems.  The WHO Report-2002. - indoor air pollution from solid fuels is the fourth most important health risk factor in the least developed countries, where 40% of the world’s population lives.  Indoor air pollution is responsible for at least 1.6 million deaths annually.  Indoor air pollution is a key risk factor for asthma and bronchitis, lung cancer and especially acute respiratory infections in children and a cause for stillbirths...

10. OUTDOOR POLLUTION What is indoor pollution? 1.Combustion 2. Tobacco smoking 3. Space heating 4.Ventilation & humidity

11. Outdoor - indoor equalization Suspended particulate matter 70 –80 % of outdoor levels + indoor sources (indoor - much higher than outdoor levels) Sulfur dioxideIndoor levels – lower than outdoors Nitric oxidesIndoor – lower than outdoor Photo-oxidantsO 3 (product in reaction of HC and NOx)– lower than outdoor Volatile organic compounds Usually higher than outdoor levels Carbon monoxide Indoor levels – close to outdoor levels

12. Indoor contamination and potential health effects Suspended particulate matter Eye, nose and throat irritation; headache; respiratory infections and bronchitis; lung cancer Sulfur dioxideRespiratory irritation, increased resp. infections in children Nitric oxidesRespiratory irritation, increased resp. infections in children Photo-oxidantsHigher incidence of infection; decrements in pulmonary function in children, allergic reactions; Volatile organic compounds Resp. irritation, headache and loss of co ordination; damage to liver, kidney and brain, cancer… Carbon monoxideheadache; impaired vision and mental functioning and vascular changes, angina pectoris status.

13. 1. COMBUSTION Indoor pollution from inefficient heating devices  53% (Serbia) and 66% (Montenegro) of all households use wood and lignite as considerable source of energy for space heating, domestic hot water and cooking!  * tab. (emission of 1kg wood/hour in 40 m 3 of area) CO (carbon monoxide) 15 times higher than WHO guidelines TSP (Total suspended particulate matter) 33 X higher Benzene400 X higher Formaldehyd e 7 X higher

14. 1.COMBUSTION different heating devices- health problems Oil burning stoves56% Solid fuels light cooking stoves42.1% Gas heaters41.9% Wood39.6% Central heating26.3% Solid fuels masonry stoves 36.7% * Electricity masonry stoves 8.7% * Air conditioners18.4% Residential heating electricity12.2%

15. 2. TABACCO SMOKING  Environmental tobacco smoke (ETS) – combination of exhaled smoke from active smokers and the smoke coming from smoldering tobacco between puffs  our dates: about 63% members of households smoking …

16. 3. Space heating and reduction of living space during winter time “Temperature is insufficient in the rooms” – 19 % of householders; “It is worm, but stuffy” – 6% of householders; (worse in Montenegro) * Reduction of living space between poor/insecure households ranges to more than 50% of available space! Over 30% of building does not provide sufficient average indoor temperature during winter months.

17. Reduction of heating area and low temperature – health consequences Heating area Households with health problems (%) Up to10 m 2 41% More than 10 m 2 30.2% Quality of heating Households with health problems (%) Very poor-only one room 49.5% Warm and comfortable 38.5%

18. Reduction of heating area and low temperature – mortality  Mortality – much higher during winter time;  Two times higher than in Ireland  Mortality: December-February is higher than March –November (highest seasonal variation during the year 2000. – electricity “black-outs”)  Increase seasonal mortality is related to deaths of chronic patients with cardiovascular and chronic decrease;  Child mortality is correlated with living space, indoor living conditions and poverty…

19. Economic impacts  Health care costs  Lost productivity  Legal costs  Human welfare impacts

20. Interventions to reduce indoor air pollution  Access to clean fuels  Improved technologies  Improved ventilation  Behavioral change

21. How to make the interventions effective  Suitable policies  Increase awareness and community participation

22. Conclusion  1. Indoor air pollution is obvious in SaM - Bad urban air quality (30% of population in Serbia breath unhealthy outdoor air); -60% of population uses wood and lignite as source of energy; -Reduction of living space (more than 50%) during winter time;  2. Health problems and winter mortality are closely affiliated to above factors