1. BRIEFING MINISTER – HEALTH STUDIES IN THE DECLARED PRIORITY AREAS
Climate Change and Air Quality

2. POLICY FRAMEWORK
The Air Quality Act of South Africa is pivoted on the Bill of Rights contained in the Constitution;
Section 24 of the Constitution states that everyone have a right:
- environment that is not harmful to their health;
- prevent pollution and ecological degradation;
- promote conservation and
- secure ecologically sustainable development and the use of natural resources while promoting justifiable economic and social development;

3. POLICY FRAMEWORK & STRATEGY
STRATEGY TO ADDRESS AIR POLLUTION IN DENSE LOW-INCOME SETTLEMENT
Establish a coordinating structure, the national coordination committee on residential air pollution;
Ensure through the NCC, that interventions aimed at reducing air pollution in dense low-income settlements are effectively prioritized;
Provision of affordable or subsidised clean energy initiatives;
Ensure that low income household are energy efficient;
Influence development planning initiatives to take into account air quality;
Encourage social upliftment programmes with air quality benefits;
Create public awareness on air pollution;
Monitoring and evaluation and reporting

4. Priority Areas
The Minister of Environmental Affairs has to date declared three (3) National Priority Areas in terms of Section 18(1) of the National Environmental Management: Air Quality Act, 2004 (Act No. 39 of 2004) (AQA) namely, the:
Vaal Triangle-Airshed Priority Area (VTAPA) in 2006,
Highveld Priority Area (HPA) in 2007, and
Waterberg-Bojanala Priority Area (WBPA) in 2012.
The declaration of the VTAPA and the HPA came about as a result of poor air quality due to industrial activities, domestic fuel burning, waste burning, and mining activities in these areas. The WBPA declaration was in line with the precautionary principle of the National Environmental Management Act (Act No. 107 of 1998) due to planned developments for the area.

6. Priority Area Structures
As part of the implementation of the Priority Area (PA) Air Quality Management Plan (AQMP) as required by Section (19)(6)(c) of the Air Quality Act, the Department has established the Multi-Stakeholder Reference Groups (MSRGs) and Implementation Task Teams (ITTs) for each priority area. These structures consist of representatives from:
Relevant national departments, affected provincial department, district and local municipalities,
Non-Government Organisations and Community Based Organisations
Industries,
academia,
Interested and affected parties identified during the implementation of the Air Quality Management Plan.

7. Priority Area Structures
The Multi-Stakeholder Reference Groups and Implementation Task Teams play a crucial role in the implementation of each of the priority area Air Quality Management Plans. They do this by:
Creating a platform for stakeholders to share information and to report on their air quality management, interventions, performance, practices, strategies, and goals to other stakeholders,
Enabling government, industries, non-governmental organisation and other stakeholders to maximize opportunities for improving and leveraging available resource,
Establishing a mechanism for an improved understanding of stakeholder’s priorities and to respond to emerging stakeholder concerns
Providing a platform for stakeholders to discuss priority issues together, thereby building trust and promoting collaboration through dialogue.

8. Projects Health Studies
A number of projects have been implemented by the Department in collaboration with stakeholders since the declaration of the first priority area. Below are some of the projects:
Health Studies
Source Apportionment Study
Air Quality Awareness Fun Run
Air Quality Offset projects
Alternative fuels pilot project
Tyre management project

9. VTAPA HEALTH STUDY The study consist of three parts namely:
Human health risk assessment (HHRA)
Community health survey
Child respiratory health survey

10. HUMAN HEALTH RISK ASSESSMENT
HHRA
Desktop study: Based on the prevailing ambient air quality in the area, what is the level of risk (with respect to each pollutant)
Uses Hazard quotient (HQ) as a measure of relative risk
HQ of 1 and above indicates the potential for adverse heath effects

11. Areas around Diepkloof are at relatively higher risk for NO2
HHRA RESULTS
Areas around Diepkloof are at relatively higher risk for NO2

12. HHRA RESULTS
Areas around Sebokeng, Sharpville and Zamdela are at relatively higher risk for PM10

13. HHRA RESULTS Human Health Risk Assessment
SO2 (hourly and daily standard) - unlikely to pose any health risk. SO2 standards are generally being met.

14. HHRA - VULNERABILITY ASSESSMENTS
Vulnerability was assessed using population sensitivity (children and elderly) and socio-economic status (the unemployed, living below the poverty level of R400 per person per month and people who live in informal houses)
The most vulnerable sub-places are those with a vulnerability score of 6 and above

15. Vulnerability Assessment - RESULTS
Most vulnerable people are those situated in the Diepkloof, Evaton, Zamdela, and Sharpeville spheres of influence

16. COMMUNITY SURVEY Approach
Household survey using questionnaires to determine association between health endpoints and air pollution
The study was conducted in Zamdela, Sharpeville, Sebokeng and Diepkloof within a 3km radius of the monitoring station
Total households were : 319 in Diepkloof, 337 in Sebokeng, 277 in Sharpeville and 286 in Zamdela
Study looked at acute and chronic health outcomes

17. COMMUNITY SURVEY – ACUTE HEALTH OUTCOMES
The prevalence of acute health outcomes for individuals were all below 5%
The highest prevalence of bronchitis (0.3%), and ear infection (1.85%) was recorded for Diepkloof
The highest prevalence for hay fever(2.5%) and sinusitis (1.6%) was recorded for Zamdela

18. COMMUNITY SURVEY - ACUTE ILLNESSES
Diagnosis (past 2 weeks)
Symptoms (past 2 weeks)
Study site
Bronchitis
Ear infection
Hay fever
Sinusitis
Runny nose with body ache
Runny nose without body ache
Ear ache
Coughing (no fever, night sweats)
Diepkloof
0.43%
1.85%
0.93%
0.78%
0.64%
1.07%
2.14%
2.99%
Sebokeng
0.30%
0.52%
1.49%
1.41%
1.63%
3.12%
3.27%
3.86%
Sharpeville
0.23%
0.81%
0.35%
1.27%
1.39%
0.69%
Zamdela
0.09%
1.13%
2.54%
1.69%
0.38%
0.56%
0.47%
Chronic results
Diagnosed vs experienced

19. HEALTH OUTCOMES
The prevalence of illnesses were relatively low – not different from country-wide prevalence
Highest prevalence bronchitis was 0.4% (Diepkloof)
Highest prevalence of asthma was 1.41% (Zamdela)
Highest prevalence of TB was 1.85% (Sharpeville)
Highest prevalence of cancer was 0.69% (Sharpeville
Highest prevalence of hospitalization for lung infection was 0.37% (Sebokeng)
Highest prevalence of cough/night sweat was 3.6% in (Diepkloof & Sebokeng)
Highest prevalence of TB was 2.5% in (Diepkloof)
***Interpretation of these results is limited due to the unavailability of hospital/clinical records

20. COMMUNITY SURVEY - CHRONIC
Ever diagnosed
Diagnosed in past year
Symptoms past year
Study site
Chronic bronchitis
Asthma TB
Cancer
Pneumonia
Hospital for lung infection
Cough (no fever, night sweats)
Wheezing at night or after exercise
Puss from ear
Diepkloof
0.43%
1.28%
1.50%
0.28%
3.56%
2.56%
0.71%
Sebokeng
0.07%
1.34%
1.11%
0.30%
0.37%
3.64%
2.15%
0.67%
Sharpeville 0%
0.46%
1.85%
0.69%
0.23%
0.12%
Zamdela
0.09%
1.41%
0.75%
0.19%
0.85%
0.38%
South Africa
2.3%***
0.8%**
0.5%***
>25 years

21. CHILD RESPIRATORY HEALTH STUDY
Targeted school children: Grades 3-6 children (8-12yrs old) - Sebokeng, Sharpeville, Zamdela and Diepkloof
Performed lung function test [peak expiratory flow (PEF) and forced expiratory volume (FEV)]
Number of respondents was 282 (82% of selected sample)

22. RESULTS: QUESTIONNAIRES ON CAREGIVETRS
The prevalence of doctor-diagnosed asthma was 3.6%
(The Durban respiratory health study had a prevalence of %)

23. RESULTS: AIR POLLUTION VS RESP HEALTH
There was no relationship between pollution changes and FVE (deep breath measurements)

24. RESULTS: AIR POLLUTION VS RESP HEALTH
There was a relationship between pollution changes and PEFR (maximum normal breath) for PM 2.5 only

25. RESULTS: AIR POLLUTION VS RESP HEALTH
There was a relationship between pollution changes and the odds of getting a cough

26. HIGHVELD PRIORITY AREA (HPA) HEALTH STUDY
The Department has initiated a health Study in the Highveld. Similar to the VTAPA health study
The study will be undertaken in
Mpumalanga
Emalahleni
Secunda
Middleburg
Ermelo
Gauteng province
Etwata
Tembisa

27. Challenges: HPA HEALTH STUDY
Although all departments in Mpumalanga have provided support;
The Gauteng Department of Education and Gauteng Department of Social Development are not in support of the study
This has caused delays to the study that was supposed to have commenced in January. Solution: Proceed without the inclusion of Gauteng Schools

28. CONCLUSION
Risk factors for respiratory illnesses related mostly to energy use (coal for cooking and paraffin for heating), overcrowding and hygiene practices (burning or burying of refuse or failure to regularly remove refuse) as well as lifestyle (active and passive smoking and alcohol use;
The main vulnerable areas of concern were those north of the Sebokeng and Sharpeville monitoring stations and south-east of the Zamdela monitoring station;
There is reason for concern that air pollution in the VTAPA may be affecting children’s health;
Study is regarded as a baseline study and it will thus be beneficial to reproduce it in other similar areas;