1. Economic valuation of health concerns in North Chennai using a Comparative risk assessment framework Sri Ramachandra Medical College & Research Institute Chennai

2. Overall Aim To use the comparative risk assessment framework to quantify and rank environmental health risks faced by an industrial municipal zone in North Chennai.

3. Specific Objectives  To quantify population exposures to select air and water pollutants.  To estimate health risks using dose – response information established specifically for developing countries.  To collect primary data on the prevalence of respiratory, gastro- intestinal and vector-borne diseases within the resident population of the study zone.  To assess economic costs of the health damage through collection of local information on costs of hospital visits, treatment and work-loss days specifically attributable to environmental exposures.

4. Specific Objectives  To compare the health and economic risks associated with each environmental problem and rank them accordingly.  To strengthen institutional capacity for CRA analyses through administration of training.  To provide the framework for the design of an environmental management plan for the zone based on the heath risk assessment, the economic costs and community perceptions.

5. List of Environmental Concerns  Air  Particulates (Total / Respirable)  Indoor air pollutants (From use of biomass fuels)  SOX  NOX  Lead  Ozone

6. List of Environmental Concerns  Water  Microbial contamination  Heavy metals  Solid waste  Access to sanitation  Proximity to solid waste dump sites

7. Methodology Sources Emissions/Discharges Ambient Concentrations Doses of pollutants Health Effects Control Technologies Fate & Transport Locations & patterns of activity Dose-Response relationships

8. Methodology  Predictive  Use dose- response information established in previous studies  Value using local economic information  Observational  Use Cross- sectional Epidemiological (recorded/reported) information to establish point prevalence  Value using locally recorded/reported costs

16. PMD=0.00112*(PM10-41)*Population*0.0076 RHD=1.2*(PM10-41)*Population/100000 ERV=23.54*(PM10-41)*Population/100000 RAD*1000=0.0575*(PM10-41)*Population/1000 RSD*1000=0.183*(PM10-41)*Population/1000 COPD=6.12*(PM10-41)*Population/100000 LRI in children=0.00169*0.4*(PM10-41)*Population Asthma=0.0326*0.07*(PM10-41)*Population Dose response functions

17. Health End point Impact on study population(211100) Pre mature deaths 202.45 Respiratory hospital admissions 285.41 ERV 5598.8 RAD/1000 1367.59 RSD/1000 4352.51 COPD 1455.59 LRI in Children 16,078.13 Asthma 54275.58

18. Health End pointUnit costs(Rs) Total costs(in lakhs of rupees ) Pre mature deaths393,879797.41 Respiratory hospital admisssions1713.54.89 ERV228.312.78 RAD41.2563.45 RSD20870.50 COPD699971018.87 LRI in Children34655.63 Asthma200108.55 Rs. 3432.08 Lakhs

19. Comparison of economic estimates Study zone(NAAQ Data)Rs.865/person Study zone (Using both NAAQ and primary sampling data)Rs.1626/person Chennai (NAAQ Data-W. Bank estimates) Rs275/person Bombay Average (NAAQ Data-W. Bank estimates)Rs.734/person Bombay(URBAIR, W. Bank)Rs.1840/person

20. Risks from gases released during biofuel combustion Percent of homes exceeding WHO Short – term guide lines wile cooking COSO2NO2 Wood67%21%19% Wood + Kerosene54%16%17%

21. Blood lead levels in children under 12

22. Blood lead levels in adults

23. Risks from lead Loss of IQ points2 points/child Reduction in infant mortality4.5deaths/year Reduction in Blood pressure Men2.6 - 3.2 mm Hg Women1.6 - 1.8 mm Hg Cardiovascular illness Heart Attacks114/year Strokes 14/year Premature deaths 110/year

24. Economic valuation for risks from lead Loss of IQ pointsRs. 373 lakhs (Using a cost $1248/child for an IQ loss of 2 points and a Per capita GNP ratio of.0133) Premature deathsRs.433.26 lakhs (VSL Rs.393,879/-)

25. Comparison of risks between air/water/solid waste (%prevalence of symptoms) RespiratoryGastrointestinalVector-borne Thangal 11.4 16.06 8.31 Ernavoor 12.7 16.59 7.46 Sathangadu 8.6 9.49 5.47 Kuppam 19.8 19.07 5.00 Thiruvottiyur 14.2 14.6 7.8

26. Assessment of costs from Household Data(Air related) Direct Per capita Health Expenditure(Rs) Income loss (WLD)(Rs.) Per capita costs borne by the Municipality(Rs.) Total Per capita Costs(Rs.)Total costs Thangal441.48194.106.17641.7528878709 Ernavoor365.64555.896.17 927.7046385040 Sathangadu122.88442.396.17 571.4428571950 Kuppam467.16706.866.171180.19 46027410 Thiruvottiyur266.52295.026.17567.71 15384951 Rs.1652.48Lakhs PMD Rs. 797.41 Lakhs TOTAL Rs.2449.89 Lakhs

27. Assessment of costs from Household Data(Water Related) Direct Per capita Health Expenditure(Rs) Income loss (WLD)(Rs.) Per capita costs borne by the Municipality(Rs.) Total Per capita Costs(Rs.)Total costs Thangal482.64459.8412.18954.6542959128 Ernavoor1138.56835.30 12.181986.0399301540 Sathangadu318.6492.5812.18 823.3541167450 Kuppam122.04376.312.18 510.5119909851 Thiruvottiyur546.48345.3412.18903.99 24498110 Rs.2278.36Lakhs Defensive Expenditure Rs. 85.42 Lakhs TOTAL Rs.2363.42 Lakhs

28. Assessment of costs from Household Data(Solid waste Related) Direct Per capita Health Expenditure(Rs) Income loss (WLD)(Rs.) Per capita costs borne by the Municipality(Rs.) Total Per capita Costs(Rs.)Total costs Thangal120183.6954.6358.2916123050 Ernavoor174.6955.89 54.61185.0959254500 Sathangadu30.72301.1454.6 386.4619323000 Kuppam102.00856.5554.6 1033.1939512772 Thiruvottiyur100.08482.5154.6637.19 17267849 Rs.1514.81Lakhs Defensive Expenditure Rs. 243.13 Lakhs TOTAL Rs.1757.94 Lakhs

29. Comparison of costs (other than PMD) from risks related to air, water and solid waste (Lakhs of Rupees) TreatmentWage lossDefensiveTotal Air 710942.001652 Water1167111185.422363 Solid waste11753382431757

30. Conclusions  The study has been able to document population exposures to particulate matter(PM10) including indoor sources.  Risks from PM10 are the greatest followed by lead.  Risks from CO are likely to be high in homes using biofuels.  Risks from air concerns are however outweighed by water concerns.

31. Conclusions ( continued)  Data collected thus far would allow the generation of an emissions inventory and thereby the assessment of source attribution.  The study has been done with significant stakeholder participation and therefore has great potential to be used in the design of an EMP for the zone.  The study has allowed identification of areas where the largest data gaps in exposure assessment are likely to be and therefore future studies in the city could perhaps be executed with less uncertainties.!!