1. Public Health and Air Pollution in Asia “PAPA” Project Case study Bob O’Keefe Health Effects Institute RAQ Initiatives Meeting Bangkok

2. Overview slide HEIHEI PAPA OverviewPAPA Overview Advancement & Extension of Knowledge BaseAdvancement & Extension of Knowledge Base Capacity BuildingCapacity Building Policy RelevancePolicy Relevance Regional Exchange & CoordinationRegional Exchange & Coordination

3. HEI-The Idea A non-profit research institute founded in 1980A non-profit research institute founded in 1980 To provide high quality, impartial and relevant science on the health effects of air pollution…..To provide high quality, impartial and relevant science on the health effects of air pollution….. ….To guide public and private decision makers, often in controversial circumstances”….To guide public and private decision makers, often in controversial circumstances” Jointly and equally funded by worldwide auto industry & US EPAJointly and equally funded by worldwide auto industry & US EPA Other partners: WHO, EC, CARB, USAID, ADB, Industries in North America, Europe and Asia (e.g. fuels, chemical, engines)Other partners: WHO, EC, CARB, USAID, ADB, Industries in North America, Europe and Asia (e.g. fuels, chemical, engines) Foundations and environmental NGOsFoundations and environmental NGOs Over 220 studies completed to date: Over 220 studies completed to date: Americas, Asia, EuropeAmericas, Asia, Europe Ozone, carbon monoxide, particulate matter, Air Toxics (diesel exhaust, benzene, butadiene, metals, others) Fuels and additivesOzone, carbon monoxide, particulate matter, Air Toxics (diesel exhaust, benzene, butadiene, metals, others) Fuels and additives Epidemiology, toxicology, exposure assessment and related areasEpidemiology, toxicology, exposure assessment and related areas

4. Potential Drivers for Change Drivers for Change PublicConcern Visibility Health Ecosystems Decision Makers Change Parliaments Parliaments National Agencies National Agencies International Agencies International Agencies Lenders Lenders Industries Industries NGOs and Other Stakeholders NGOs and Other Stakeholders Fuels I&M Planning Controls

5. The Main Driver - Public Health Many Potentially Sensitive PopulationsMany Potentially Sensitive Populations ChildrenChildren ElderlyElderly Growing number of asthmaticsGrowing number of asthmatics Air pollution has widespread exposureAir pollution has widespread exposure WHO Global burden of disease identified potentially very large impactsWHO Global burden of disease identified potentially very large impacts Thousands of Premature Deaths, Tens of Thousands of Hospitalizations, Days of work and school lostThousands of Premature Deaths, Tens of Thousands of Hospitalizations, Days of work and school lost Western studies basis for analysisWestern studies basis for analysis

6. PAPA Program Partnership with CAI-ASIA to understand the health effects of air pollution in local Asia populations, now and in the futurePartnership with CAI-ASIA to understand the health effects of air pollution in local Asia populations, now and in the future (Support USAID, Hewlett, industry)(Support USAID, Hewlett, industry) Effort actively underway:Effort actively underway: Scientific Review of what is known today about health effects in Asian cities published in April, 2004Scientific Review of what is known today about health effects in Asian cities published in April, 2004 New health studies in representative Asian cities (Bangkok, Hong Kong, Shanghai, Wuhan) underway, Chennai, Guangzhou and others to followNew health studies in representative Asian cities (Bangkok, Hong Kong, Shanghai, Wuhan) underway, Chennai, Guangzhou and others to follow Understand local impact, inform extrapolation, poverty impactUnderstand local impact, inform extrapolation, poverty impact Comprehensive assessment of the state of air pollution and health across Asian cities at study conclusionComprehensive assessment of the state of air pollution and health across Asian cities at study conclusion Build capacity of local scientistsBuild capacity of local scientists Overall Goal:Overall Goal: Inform key Asian regulatory & policy decisionsInform key Asian regulatory & policy decisions

7. Advancement of Knowledge 2004 Review: Assembles for the first time studies of air pollution and health from across Asia2004 Review: Assembles for the first time studies of air pollution and health from across Asia ~140 studies from Asia region evaluating multiple pollutants & health effects~140 studies from Asia region evaluating multiple pollutants & health effects Creates new resource for policy makersCreates new resource for policy makers First-ever meta (combined) analysis to measure “acute” air pollution health effects across Asian cities (results later)First-ever meta (combined) analysis to measure “acute” air pollution health effects across Asian cities (results later) New studies underway in four cities (Bangkok, Hong Kong, Shanghai, Wuhan) to fill gaps in understandingNew studies underway in four cities (Bangkok, Hong Kong, Shanghai, Wuhan) to fill gaps in understanding Targeted studies added in Chennai, other cities less well studied where pollution levels, population density is high (India, Indonesia, Philippines, Vietnam, (others)Targeted studies added in Chennai, other cities less well studied where pollution levels, population density is high (India, Indonesia, Philippines, Vietnam, (others) Key future focus: air pollution’s effects on the poorKey future focus: air pollution’s effects on the poor Comprehensive assessment of air pollution and health in 2006Comprehensive assessment of air pollution and health in 2006 Authoritative: many types of studies, populationsAuthoritative: many types of studies, populations Translated to multiple languagesTranslated to multiple languages

8. Capacity Building Capacity building formed around actual new research (not only workshops):Capacity building formed around actual new research (not only workshops): From outset selection criteria stressed:From outset selection criteria stressed: –Selection of Asia led & staffed investigator teams –Strong linkages to local health, regulatory officials to enhance systemic data access & drive quality (policy relevance) For all selected investigators:For all selected investigators: –Paired with highly qualified international science teams to design studies –Key element: Coordinated study design drives capacity building regular interrelationships among scientists from diverse regions to produce a real product (e.g. integrated health study) –Periodic regional visits by ISOC to provide technical assistance, QA\QC, –HEI Peer review to provide technical feedback, guidance on honing science, and effective communication to regional policy makers Phase 2 studies (promising teams in understudied areas needing additional skills)Phase 2 studies (promising teams in understudied areas needing additional skills) –Join subset of workshops with goal of submitting fundable proposals in year –Fogarty workshops in India “How to prepare successful scientific applications’

9. Regional Exchange & Coordination Studies Designed for Asia-Wide Coordination and exchange:Studies Designed for Asia-Wide Coordination and exchange: Building strong networks of health scientists across Asia (along with their respective air pollution and health agencies)Building strong networks of health scientists across Asia (along with their respective air pollution and health agencies) Hosting both regional & international technical workshops to build networkHosting both regional & international technical workshops to build network –Bangkok ISOC workshop in February – 7 Asia science teams, regulators –HEI Annual Meeting (latest global science) –ISEE (professional development, networking, PAPA session in 05 to foster interest in regional issues of air pollution & health) PAPA methodology designed to facilitate use in other Asian cities, to systematically build a health database for AsiaPAPA methodology designed to facilitate use in other Asian cities, to systematically build a health database for Asia HEI established dedicated web “message board” to facilitate education, communicationHEI established dedicated web “message board” to facilitate education, communication All PAPA studies widely distributed, web postedAll PAPA studies widely distributed, web posted Briefings of agencies, stakeholders across Asia on all PAPA studies and reportsBriefings of agencies, stakeholders across Asia on all PAPA studies and reports Key studies translated into multiple languagesKey studies translated into multiple languages

10. Policy Relevance & Impact The Special Challenge in Asia:The Special Challenge in Asia: Can what we know about air pollution in the West be applied to decisions in Asia?Can what we know about air pollution in the West be applied to decisions in Asia? Although well done, WHO GBD based on western studies. relevance to Asia has been questionedAlthough well done, WHO GBD based on western studies. relevance to Asia has been questioned HEI-PAPA approach:HEI-PAPA approach: Quality, independent science;Quality, independent science; From outset strong linkages to local health, regulatory officials required in scientific proposals so that policy makers support, trust science (regular early briefings for industry, government, NGOs);From outset strong linkages to local health, regulatory officials required in scientific proposals so that policy makers support, trust science (regular early briefings for industry, government, NGOs); Results presented in lay terms, in context of existing science from WHO, IARC, othersResults presented in lay terms, in context of existing science from WHO, IARC, others As a result, HEI science regularly highlighted in key standard setting processes across the globe, in scientific journals, pressAs a result, HEI science regularly highlighted in key standard setting processes across the globe, in scientific journals, press Enhancing PAPA’s impact:Enhancing PAPA’s impact: Maintain high-quality science throughoutMaintain high-quality science throughout Active involvement of leading Asian scientists on PAPA ISOCActive involvement of leading Asian scientists on PAPA ISOC Advisory Board with key Asian representatives for guidance on identifying key local officials, relevant policy forumsAdvisory Board with key Asian representatives for guidance on identifying key local officials, relevant policy forums Regular regional visits to report results to key stakeholders across region –”No surprises”Regular regional visits to report results to key stakeholders across region –”No surprises” Continuing communication as key policy decisions are being made (e.g. Vietnam workshop, WHO forums)Continuing communication as key policy decisions are being made (e.g. Vietnam workshop, WHO forums) Integration of Policy makers –Scientists (BAQ-PAPA Health forum December 04)Integration of Policy makers –Scientists (BAQ-PAPA Health forum December 04)

11. »Thank You! rokeefe@healtheffects.orgrokeefe@healtheffects.org