Addressing air quality and health in the Eastern Mediterranean Region

PRE-REGIONAL COMMITTEE TECHNICAL MEETINGS

3-6 OCTOBER 2016, Cairo

Air pollution is the biggest environmental risk to public health

• Several air pollutants are of health concern. However, due to its big health impacts particulate matter (PM) is being considered as a proxy indicator of air pollution

• Air pollution is arising at an alarming rate, the annual average concentration of particulate matter of 2.5 microns (PM2.5) in EM countries is 2-11 times the WHO recommended level.

• Air pollution kills about 400,000 people annually in our Region (one in every ten deaths annually).

Somalia

Afghanist

an

Pakistan

Sudan

Yemen

Egypt

Tunisia

Djibouti

Iran (Is

lamic Republic

of)Lib

yaIra

q

Syria

n Arab Republic

Lebanon

Morocco

Saudi A

rabia

Jordan

KuwaitOman

Bahrai

nQatar

United Arab Em

irates

0

20

40

60

80

100

120

140

Mortality rate attributed to air pollution (indoor and outdoor)de

aths

per

100

000

capi

ta

Regional Average

WHO burden of disease estimates are conservative but accurate

Conservative• Cover ages of <5 and >25 years

• Current estimates consider only five health outcomes

• Include only impacts of:

– particulate matter for outdoor air pollution

– burning of solid fuels for indoor air pollution

• Do not include second hand tobacco smoke

• Do not include impacts of other pollutants (NOx, SOx, CO, Ozone, Lead etc.), and fuels (kerosene)

AccurateThe methods used in the assessment were developed for global reporting and using the latest available evidence and health data that complied with WHO standards (Comparative Risk Assessment)

Deaths attributable to air pollution by cause

Ischemic Heart

Disease36%

Stroke28%

Lower Respi-ratory Infec-

tion24%

COPD9%

Lung Cancer3%

Noncommunica-ble Diseases affect-ing people of > 25 years of age

Communicable (pneumonia) killing children of < 5 years of age

Air Pollution is High on the Global Agenda

• World Health Assembly Resolutions – WHA68. 8 in 2015– WHA69.19 in 2016

• 2030 SDG Agenda– Health (Goal 3)– Energy (Goal 7)– Cities (Goal 11)

• Climate Change– Paris Agreement 2015– COPE 22 Marrakesh 2016

• United Nations Environment Assembly– Resolutions 1/7 (2014) and 2/21 (2016)

• Habitat III 2016

Health, Environment and Climate Change Ministerial Meeting at the UNFCCC CoP-22 in Marrakesh, 2016

It aims at bringing together Ministers of Environment gathered at CoP-22 with selected Ministers of Health, to join forces to promote healthier environments for healthier people. The expected outcomes are:

1. Marrakech declaration on Climate & Environmental Health, based on the “Conclusions and action agenda of 2nd Conference on Health and Climate”.

2. Launch of Ministerial level coalition and associated platform on “Health, Environment & Climate Change”.

3. Agreed proposal for decision on climate, environment and health within COP22 outcome.

1- Ambient (outdoor) air pollution in the Region• Data on PM is available for 82 cities from 15 EM

countries (98% of the population of these cities breath air that does not meet the WHO recommended safe levels).

• Source apportionment studies are lacking in EMR, However, – Up to 50% of the pollution is natural (dust and sea salt),

epidemiologically natural dust may affect health same as other pollutants!

– More than 50% is anthropogenic: from transport, power generation, industry, waste burning, etc.

• In large cities transportation is causing more than 80% of the pollution

Modeled PM2.5 (WHO September 2016)

Annu

al d

eath

s per

100

000

capi

ta

Parti

cula

te m

atter

in m

g/m

3

Somalia

Morocco

Lebanon

Syria

n Arab Republic

Jordan

Djibouti

Tunisia

Iran (Is

lamic Republic

of)

Yemen

Sudan

Afghanist

anOman

Iraq

BahrainLib

ya

Pakistan

United Arab Em

irates

KuwaitEg

yptQatar

Saudi A

rabia

0

10

20

30

40

50

60

0

20

40

60

80

100

120

Particulate matter air pollution* and attributable deaths in the EMR

PM 2.5 in mg/m3 Deat Rate per 100000 capita

*Modeled based on:Ground measurements (main source)Satellite remote sensingChemical transport models

2- Household (indoor) air pollution in the Region

• Use of solid fuels and kerosene for cooking, heating and lighting is a major source of indoor air pollution – 180 million people are relying on solid fuel for cooking and

heating causing 200,000 annual deaths– Unknown number of people are relying on kerosene, and other

dirty fuels. – 2nd hand tobacco smoke impacts are not included in the 200,000

death estimate

• Other sources of indoor air pollution: construction materials, furniture, household chemicals, incense burning, etc. are neither monitored nor reported!

Somali

a

Afghan

istan

Pakist

anSu

danYe

men

Djibouti

Morocco Iraq

Egyp

t

Tunisia

Iran (Is

lamic R

epublic

of)

Leban

on

Saudi A

rabia

Libya

Syria

n Arab Rep

ublicJordan

United Arab

Emira

tesQata

r

Bahrai

nKuwait

Oman0.0

20.0

40.0

60.0

80.0

100.0

120.0

Annual deaths attributable to household air pollution in the EMR*

deat

hs p

er 1

0000

0 ca

pita

* Estimated from indoor air pollution caused by burning of solid fuel only

Health Interventions on Air Pollution• Health based air quality

standards and indicators• Strong surveillance system

to capture air pollution related health outcomes

• Health risk and impact assessment of air pollution

• Communication system to disseminate public health messages before, during and after air pollution episodes

Health Based Air Quality Index to the Public, Tehran

Kuwait Air Quality Index (KAQI)

Interventions by other SectorsClean Vehicles & Fuels

Electrical Taxis, Amman

LPG Taxis, Cairo

Public Transport Energy and Industry

Casablanca Tram

Cairo Metro

Dubai MetroClean Cock Stove, Kabul

Env. Management

Air Filter, Saudi Arabia

Solar Energy, Morocco

Solar Energy, Abu Dhabi

Open burning to be banned

Old cars to be replaced

Walking and Cycling

Issues and ChallengesNatural air pollutants, other types of household fuels, and lack of coordination between the related stakeholders are characterizing air pollution in EMR; with the following gaps. • Lack of awareness and communication on health

impacts of air pollution• Lack of capacity (and willingness) to monitor exposure

to air pollution and report its health impacts• Lack of research and evidence based information; and

poor capacities for conducting health risk and impact assessments of air pollution.

• Lack of stewardship of the health sector in multi-sectoral coordination.

Global Road Map to Address Air Pollution• Building and disseminating evidence and knowledge

relating to the impacts on health of air pollution and its mitigation interventions.

• Enhancing systems, structures and processes needed to support monitoring and reporting on health trends associated with air pollution and its sources.

• Leveraging health sector leadership and coordinated action to enable an appropriate and adequate response by related stakeholders.

• Building the capacity of the health sector, to analyze and influence policy and decision-making processes in support of joint action on air pollution and health.

Conclusion and the Way Forward• Air pollution is the biggest environmental risk in the

Region, and has serious health impacts on all of our countries

• The global road map endorsed by the WHA69 is a good vehicle to address these impacts. However, it needs to be tailored to match the needs of the region.

• With your endorsement, WHO -in consultation with countries of the region- will develop for RC64 a regional plan of action for implementation of the global road map to address the health impacts of indoor and outdoor air pollution in the Region.

18Thank you

http://maps.who.int/airpollution/