1.  HEALTH IMPACT OF AIR QUALITY MANAGEMENT EFFORTS DESIREE M. NARVAEZ, MD, MPH DEPARTMENT OF HEALTH MANILA, PHILIPPINES

2. Air pollution and sperm cells  Czech Republic: 35 young men exposed to high air pollution due to coal burning power stations and fossil fuels; in 2 years had sperm examined in terms of shape, number, motility, damage…  Significant association between exposure to periods of high air pollution ( at or above the US air quality standards) and the percentage of sperm with DNA fragmentation---  Potentially lead to birth defects or miscarriages  Chemicals in air that can cause damage to human DNA ( Czech Research Institute and US EPA)

3. Save the sperm cell…Prevent birth defects or miscarriages…Fight air pollution!

4. Public Health Monitoring of the Metro Manila Air Quality Improvement Sector Development Program ADB - WHO - DOH – STUDY 2002-2004 3 COMPONENTS: Health Risk Assessment Epidemiological Study Health Risk Perception

5. Attributable number of cases = exposure-response coefficient x excess exposure level x exposed population x baseline mortality rates Exposure-response coefficients: from time series studies Morbidity – Kunzli et al (US/Eu) Mortality – Bangkok study

6. Type of Hospital Admissions Admission Rate Attributable Cases Respiratory115620 Cardiovascular2114 Estimated number of hospital admissions per million population in excess of 10 ug/m3 PM, Metro Manila, 2002

7. Particulate matter (PM 10 and PM 2.5 ) and trophospheric ozone are of serious concern in Metro Manila. Long term PM 10 concentrations likely to violate National Air Quality (NAQ) guideline of 60 µg/m 3. Long and short-term PM 2.5 levels may be unhealthy for the general public. Ozone exceeds short-term guideline value

8. Impact on mortality by 10 µg/m 3 PM 10 reduction in Metro Manila in 2002 35 - 59 fewer deaths per million population from natural causes 5 - 28 fewer deaths per million population from cardiovascular causes 43 - 49 fewer deaths per million population from respiratory causes

9. Impact on morbidity for a uniform reduction of 10 µg/m 3 PM 10 in Metro Manila in 2002 reduction of >23,000 cases of acute bronchitis reduction of >400 cases of asthma reduction of >30 cases of chronic bronchitis 20 respiratory cases per million population 4 cardiovascular cases per million population

10. Lead content of gasoline and mean blood lead levels among children in Metro Manila, 1993-2003 N.B. lead in gasoline not actual values but highlighted for illustration purpose only School children Children in high traffic area Children 0.84 0.6 0.150.0

11. Integrated Strategies to Reduce Vehicular Emissions & Improve Air Quality in Metro Manila Integrated Environmental Strategies (IES) Philippines Manila Observatory with support from the US Agency for International Development, US Environmental Protection Agency and US National Renewable Energy Laboratory 2003-2004

12. POLICIES, TECHNOLOGIES,MEASURES  Motor Vehicle Inspection System  Conversion to 4-stroke tricycles  Railways  Diesel Particulate Trap  Compressed Natural Gas - Buses  CocoMethyl Ester - Jeepneys  Traffic Demand Management  Bikeways

13. Air Quality Modeling Scheme Motor Vehicles Factories, Power Plants Background Emissions Dispersion Model Air Pollution Concentration Map Health and Economic Costs

14. Health Outcomes  Natural Mortality  Respiratory Mortality  Cardiovascular Mortality  Respiratory Hospital Admissions  Cardiovascular Hospital Admissions  Asthma Attacks <15 years old  Asthma Attacks =/> 15 years old  Bronchitis Episodes < 15 years old  Chronic Bronchitis > 25 years old

15. MORTALITY: Metro Manila Number of Deaths Averted per Policy scenario

16. Asthma Attacks <15 years old: Metro Manila Number of Cases per Policy Scenario

17. What is the cost of the health damages that can be averted by the different policy scenarios? Morbidity: Cost of illness method Work Loss Days Mortality: Benefits Transfer Values are in 1995 prices Present Value of Year 2002 Estimates Using 12% discount rate for 2005, 2010,2015 Orbeta Study and PhilHealth data

18. Economic Valuation of the Health Impact per Policy Scenario (PHP)

19. HEALTH SECTOR EFFORTS: WAR AGAINST AIR POLLUTION THE WAY FORWARD

20. Establishment of Health Information System for Air Pollution related Illnesses Status (on going) 1. Identified sentinel health centers within 1 km distance from DENR’s Air monitoring stations 2. Developed data gathering forms/tools for air pollution related illnesses 3. Working with Makati City as pilot LGU for the project 4. Procurement of Computer sets for the GIS of the health information system.

21. Establishment of Health Information System for Air Pollution related Illnesses EMB Air Monitoring Stn Sentinel sites health center health center private clinics private clinics hospital hospital

23. Relationship between Air Quality and Health Effects Dummy Table

24. HEALTH EFFORTS AGAINST AIR POLLUTION IEC development Status (on going) 1. Development of Communication Plan/ Strategy 2. Prototype IEC materials (posters, leaflets, TV/radio plugs)

25. HEALTH EFFORTS AGAINST AIR POLLUTION Training on Air Sampling Strategies (to be conducted this Nov) 1. Equipped field personnel on indoor air sampling strategies 2. Development of an indoor air quality action plan for each LGU