1. Energy and Health Energy Week 2006 Dr Maria Neira, Director Department for Public Health and Environment World Health Organization

2. There are major opportunities for health gains from: +Household energy use - for cooking, water boiling, space-heating +Power generation – from fuel sourcing /extraction to processing, distribution and waste +Transport policies and options Energy is good for health, but its production and use can pose major health risks

3. -Ambient and indoor air pollution Cardiovascular disease, respiratory disease, lung cancer -Cold and damp housing Respiratory diseases, allergies -Climate change Extreme weather events, floods, vector-borne diseases -Accidents/fires Personal injuries and disability -Occupational hazards -Noise, stress -EMF Health risks associated with energy

4. Physical inactivity → 1.9 million deaths Traffic injuries → 1.2 million deaths Ambient air pollution → 800,000 estimated deaths in cities Climate Change → over 150,000 deaths HIV/AIDS → among truck drivers and road side populations Transport and health

5. A disconnected response undermines health gains from transport investments TRAFFIC INJURIES PHYSICAL INACTIVITY AIR POLLUTION HIV / AIDS CLIMATE CHANGE

6. Investments in transport are a unique opportunity to get this right. Transport is a public health issue and health needs to be part of the transport agenda. Governments should act to ensure health is addressed in transport. Why should they act? Millions of people at risk of transport health impacts from urbanization and new roads.

7. Society is unlikely to want to make sacrifices to eliminate all risks from transport Transport Markets fail to deliver socially optimal patterns as: Transport Costs are not all paid for the user, and the costs borne by others (external costs) are substantial. The overall use of transport, particularly more polluting modes, is then higher than socially optimal The right investments and prices (for pollution, accidents etc.) would correct these distortions 1 st. To ensure sound economic decisions The benefits from transport would be further increased if certain journeys were made by different modes, or in the need to travel long distances to meet basic needs was reduced.

8. Children are especially vulnerable to injuries, air pollution and noise, their cognitive and physical development require exploration of the neighbourhood and outdoor activity. Children and other vulnerable groups are exposed to risks from traffic but enjoy few benefits from it. These groups often do not have a voice to influence decisions. Governments need to be that voice. 2 nd. To protect the health of vulnerable groups

9. 3 rd. To promote health equity Healthy mobility for the poor reduces health risks for those in poverty, and increases their access to health services, education and jobs Need to ensure safety of people using the most common modes of T Pedestrians and cyclists do not cause pollution but are exposed to health risks caused by motor vehicle users

10. WHO's work on transport and health Knowledge, tools and technical cooperation: Good practice examples – where transport promotes health Cost benefit analysis – health costs and benefits of transport decisions Health impacts assessment – in connection with environment and social assessments Models for integrated health risk assessment from transport in urban areas – through air pollution, injuries and noise. Support to countries – how to obtain health gain from transport decisions

11. Health effects Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent- borne diseases Effects of food and water shortages Effects of population displacement Contamination pathways Transmission dynamics Agroecosystems, hydrology Socioeconomics, demographics CLIMATE CHANGE Human exposures Regional weather changes Heat waves Extreme weather Temperature Precipitation Based on Patz et al, 2000 Modulating influences Most expected impacts will be adverse but some will be beneficial. Expectations are mainly for changes in frequency or severity of familiar health risks Mapping links between climate change and health

12. Example: Diarrhoeal diseases Distal causesProximal causesInfection hazardsHealth outcome Temperature Humidity Precipitation Living conditions (water supply and sanitation) Food sources and hygiene practices Survival/ replication of pathogens in the environment Contamination of water sources Contamination of food sources Rate of person to person contact Consumption of contaminated water Consumption of contaminated food Contact with infected persons Incidence of mortality and morbidity attributable to diarrhoea Vulnerability (e.g. age and nutrition) How does climate impact on health?

13. Africa region South-East Asia region Eastern Mediterranean region Latin America and Caribbean region Western Pacific region Developed countries Burden of disease by region: Climate change and urban air pollution Disability Adjusted Life Year per million. World Health report 2002. Climate change Air pollution Cardio- pulmonary diseases Respiratory infections Trachea/ bronchus/ lung cancers Diarrhoeal diseases Malaria Unintentional injuries Protein-energy malnutrition Does climate change have a large impact on health?

14. Some 3 billion people rely on solid fuels (e.g. dung, wood, agricultural residues, charcoal, coal) for their basic energy needs. Cooking and heating with solid fuels leads to high levels of indoor air pollution (IAP), a complex mix of health-damaging pollutants (e.g. PM, CO). Women and young children, who spend most time at home, experience the largest exposures and health burdens. Household energy, indoor air pollution and health

15. Who is most affected?

16. Health impacts of indoor air pollution Health outcomeEvidencePopulationRelative risk Relative risk (95% confidence interval) Acute infections of the lower respiratory tract StrongChildren aged 0–5 years 2.31.9–2.7 SUFFICIENTSUFFICIENT Chronic obstructive pulmonary disease StrongWomen aged ≥ 30 years 3.22.3–4.8 Moderate IMen aged ≥ 30 years 1.81.0–3.2 Lung cancer (coal)StrongWomen aged ≥ 30 years 1.91.1–3.5 Moderate IMen aged ≥ 30 years 1.51.0–2.5 Lung cancer (biomass)Moderate IIWomen aged ≥ 30 years 1.51.0–2.1 INSUFFICIENTINSUFFICIENT AsthmaModerate IIChildren aged 5–14 years 1.61.0–2.5 Moderate IIAdults aged ≥ 15 years 1.21.0–1.5 CataractsModerate IIAdults aged ≥ 15 years 1.31.0–1.7 TuberculosisModerate IIAdults aged ≥ 15 years 1.51.0–2.4

17. Highly Neglected Issue! 1.6 million annual deaths in the poorest countriesin the poorest countries mostly among young childrenmostly among young children

18. Available interventions Changing the source of pollution Improving the living environment Modifying user behaviour Improved cooking devices  Improved stoves Alternative fuel–cooker combinations  Briquettes and pellets  Kerosene  Liquefied petroleum gas  Biogas  Natural gas  Producer gas  Solar cookers  Modern biofuels Reduced need for fire  Retained heat cooker  Efficient housing design  Solar water heating  Pressure cooker Improved ventilation  Smoke hoods  Eaves spaces  Windows Kitchen design and placement of the stove  Kitchen separate from house  Stove at waist height Reduced exposure by changing cooking practices  Fuel drying  Pot lids to conserve heat  Food preparation to reduce cooking time  Good maintenance Reduced exposure by avoiding smoke  Keeping children away from smoke

19. The link between household energy and the Millennium Development Goals? Household Energy MDG 1: Eradicate extreme poverty and hunger MDG 3: Promote gender equality and empower women MDG 4: Reduce child mortality MDG 7: Ensure environmental sustainability "We will spare no effort to free our fellow men, women and children from the abject and dehumanizing conditions of extreme poverty, to which more than a billion of them are currently subjected." United Nations Millennium Development Declaration, signed by all 191 Member States of the United Nations in September 2000

20. Document the health burden of indoor air pollution and household energy. Evaluate the effectiveness of technical solutions and their implementation. Act as the global advocate for health as a central component of international/ national energy policies. Monitor changes in household energy habits over time. WHO’s Programme on Household Energy and Health

21. Conclusions we must ensure energy health risks are reduced, so that society can reap the related benefits. The health sector including WHO have the basic knowldge, tools and partners to contribute to the understanding of energy health risks, including indentifying energy solutions that effectively contribute to health. There is a need to expand that work in partnership, to the range of countries and cities that need this most. The WBank can enhance health gains from energy investments by including health ussues as a key consideration for its energy lending operations, and its technical support to countries. we must ensure energy health risks are reduced, so that society can reap the related benefits. The health sector including WHO have the basic knowldge, tools and partners to contribute to the understanding of energy health risks, including indentifying energy solutions that effectively contribute to health. There is a need to expand that work in partnership, to the range of countries and cities that need this most. The WBank can enhance health gains from energy investments by including health ussues as a key consideration for its energy lending operations, and its technical support to countries. We must ensure energy health risks are reduced, so that society can reap the related benefits. The health sector (including WHO) have the knowledge, tools and partners to contribute to the understanding of energy health risks, including identifying energy solutions that effectively contribute to health. There is a need to expand that work in partnership to the range of countries and settings with the greatest need. The World Bank can enhance health gains from energy investments by including health issues as a key consideration for its energy lending operations, and its technical support to countries.