1. NOT FOR ATTRIBUTION; FOR DISCUSSION PURPOSES ONLY

2. Environmental Health : Costs of Environmental Health Damage And Net Benefits of Priority Interventions A Contribution to the Country Environmental Analysis for the Philippines (Part 1) by Agustin L. Arcenas World Bank CEA Workshop, June 16-17, 2008

3. Environmental Health - Areas of Concern Outdoor Air Pollution (OAP) Indoor Air Pollution (IAP) Water Pollution, Sanitation and Hygiene (WSH)

4. Basic Outline of the Study (for each area of concern) I. The basic issues and state of the environment II. Level of exposure to pollutants and, sanitation and hygiene problems in the Philippines III. Morbidity Incidence IV. Economic cost of Morbidity V. Mortality Incidence due to environment VI. Economic cost of mortality VII. Suggested policy interventions VIII. Economic evaluation of policy interventions

5. How the study was done… Calculate the proportion of total cases of illnesses that are attributable to pollution, sanitation and hygiene Using WHO and Philippine data, determine the cost of treatment and foregone income from illnesses and premature deaths Aggregate the economic costs and values from these calculations

6. Total Economic Costs of Environmental Health Problems Total: PhP 9 billion

7. Morbidity-Mortality shares

8. The Economic Costs of Illnesses caused by Outdoor Air Pollution

9. Sources of PM emissions SectorAverage Emissions (tons/year) % of Total Stationary Sources1,0835.46 Mobile Sources16,72584.34 Households180.09 Solid Waste Burning2,00510.11 TOTAL19,831100 Source: Monitoring Report, 2004

10. What we know so far… There has been a drop in PM emissions in Metro Manila since 2003 The number of vehicles in the country is growing Diesel contributes more to PM than gasoline Main source of PM emissions in the country – 2 stroke-tricycles The bulk of vehicles in the country are the tricycles followed by utility vehicles

11. PM Emissions from Mobile Sources, 2006

12. Morbidity Cases - OAP Total: 119,080

13. Costs to Society of OAP-related Illnesses Total: PhP 1.9 billion

14. Costs to Households of Treatment - OAP, 2003 Total: PhP 896 million

15. Foregone Income due to OAP-related Illnesses Total: PhP 118 million

16. Cost of Premature Deaths due to OAP, 2003 Total: PhP 697 million

17. Potential Interventions to curb OAP Inspection and maintenance (I/M) programs Installation of pollution control devices Rehabilitation of Current Traffic Management System Investments in Additional Mass Transport System

18. The Economic Costs of Illnesses caused by Indoor Air Pollution

19. Primary Cooking Fuel for Households, 2004 Source: HECS, 2004

20. Households Exposed to Indoor Air Pollution (in %)

21. Morbidity Cases - IAP Total: 114,665

22. Costs to Society of IAP-related Illnesses Total: PhP 2.3 billion

23. Costs to Households of Treatment - IAP, 2003 Total: PhP 774 million

24. Foregone Income due to IAP-Illnesses, 2003 Total: PhP 82 million

25. Cost of Premature Deaths due to IAP, 2003 Total: PhP 1.4 billion

26. Potential Interventions to curb impacts of IAP Promote improved household living environment (improved ventilation) Promote use of improved stoves Effect changes in cooking practices

27. Environmental Health : Costs of Environmental Health Damage And Net Benefits of Priority Interventions A Contribution to the Country Environmental Analysis for the Philippines (Part 2) by Agustin L. Arcenas World Bank CEA Workshop, June 16-17, 2008

28. The Economic Costs of Water Pollution, Sanitation and Hygiene Issues

29. Household Access to Improved Water Supply and Sanitation, 2003 (National)

30. Morbidity Cases - WSH Total: 488,425

31. Costs to Society of WSH-related Illnesses Total: PhP 4.9 billion

32. Costs to Households of Treatment - WSH, 2003 Total: PhP 3.0 Billion

33. Foregone Income due to Illnesses from WSH, 2003 Total: PhP 465 million

34. Costs of Premature Deaths due to WSH, 2003 Total: PhP 933 million

35. Potential Interventions to eliminate illnesses from WSH Water Sanitation and Hygiene Improved water supply and quality Hygiene Promotion Construction of Sanitation Facilities (i.e. Latrines)

36. Health Benefits of Different Water and Sanitation Interventions Source: Fewtrell, et al, 2005

37. Median Construction Cost of Water Supply Facilities for Select Regions Source: Disease Control Priorities in Developing Countries, second edition, 2006, Figure 41.1

38. WHS Preferred Interventions (Ranked According to Cost-Effectiveness) Cost-Effectiveness Ranking Intervention 1st Hygiene Promotion 2ndSanitation promotion 3rdWater Sector regulation and advocacy 4thWater supply - Hand pump or standpost 5thWater supply - House connection 6thSanitation - Construction and Promotion Based on: Disease Control Priorities in Developing Countries, 2006.

39. Final Word Hygiene is two-thirds of health Lebanese Proverb