air pollution effects -...

Chapter – 4 -An Analysis of Cost Of Illness Of Air Pollution

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AIR POLLUTION EFFECTS

Exposures to environmental pollution remain a major source of health risk

throughout the world, though risks are generally higher in developing countries,

where poverty, lack of investment in modern technology and weak environmental

legislation combine to cause high pollution levels. Associations between

environmental pollution and health outcome are, however, complex and often poorly

characterized. Levels of exposure, for example, are often uncertain or unknown as a

result of the lack of detailed monitoring and inevitable variations within any

population group. Exposures may occur via a range of pathways and exposure

processes. Individual pollutants may be implicated in a wide range of health effects,

whereas few diseases are directly attributable to single pollutants. Long latency

times, the effects of cumulative exposures, and multiple exposures to different

pollutants which might act synergistically all create difficulties in unravelling

associations between environmental pollution and health. Nevertheless, in recent

years, several attempts have been made to assess the global burden of disease as a

result of environmental pollution, either in terms of mortality or disability-adjusted life

years (DALYs). About 8–9% of the total disease burden may be attributed to

pollution, but considerably more in developing countries. Unsafe water, poor

sanitation and poor hygiene are seen to be the major sources of exposure, along

with indoor air pollution.

Air pollution is a serious threat to the human being all around the world. The

deteriorating air quality through the various source of air pollution has posed serious

health related problems and contributed to tremendous economic loss. A large

number of studies support an association between air pollutants and various health

effects. Exposure to the ambient air pollutants has caused health problems leading

to increase respiratory symptoms, reduce lungs function, cardiovascular disease,

chronic disease, allergy and infection, etc. A large amount of financial resources are

required for providing medical assistance and treatment of these diseases.

India also faces the same challenges of air pollution after United States of America

(USA), China, and United Kingdom (UK). In most of the large city in India the air

quality has deteriorated. The major source of air pollution, which includes road dust,

construction activities, diesel combustion, biomass burning and certain contribution


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of gasoline has polluted city like, Delhi, Mumbai, Chennai, Kolkata, Howrah,

Bangalore, Noida, Faridabad, Ghaziabad, Kanpur, Firozabad, Agra, etc.

Agra, located in the state of Uttar Pradesh of northern India, is well known for Taj

Mahal, one of the wonders of the world. The Agra city spreads over an area of

approximately 140 sq. km. As per recent census, Agra has a population of about 20

lakhs excluding the daily floating population of 30,000 (approx). The city of Agra is

favorably situated commanding administrative, economic, and cultural influence over

a very large area. Besides its recent development as an international tourist centre

and manufacturing centre, since centuries Agra had flourished with trade, commerce

and household industries. The urban area of Agra is divided into Nagar Mahapalika

(renamed as Municipal Corporation in 1994), Agra Cantonment area and the

Dayalbagh and Swamibagh Panchayat. The municipal area is further divided into

three parts viz. the main city, the Trans Yamuna and the Tajganj. The municipal area

is divided into 90 wards. The jurisdiction of the Agra Urban Area is under the Agra

Development Authority (ADA).

The sources of pollutants in the city are domestic, industrial, vehicular, DG Sets and

natural sources. The air pollution from the industries is mainly due to fuel used in the

manufacturing process. The majority of industries in Agra comprise of foundries.

Besides a number of petha industries are operating in the city, which mainly use coal

as fuel. In foundries, the principal source of emission is cupola. The volume of gas

exhausted and its concentration depends on the cupola, operations, melting rates,

characteristic of charging material and the coke. Gases escape while drawing the hot

metal and during casting. In the pit type of cupola, emissions are fugitive type. The

main pollutants are SPM, sulphur dioxide and carbon monoxide. Agra is famous for

‘Petha’ (a type of sweet). There are large numbers of petha manufacturing units.

Besides these, there are halwaiis, kumhars and bharbhujas who use coal, cow dung

and wood. Kumhars have to use cow dung because of the type of firing adopted by

them.

The vehicular emissions are one of the major sources of air pollution affecting the

urban population in Agra. Unlike industrial emissions, vehicular pollutants are

released at ground level and hence the impact on recipient population will be more.


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The vehicular growth in the city is high and with high growth, the impact of the air

pollution from vehicular growth would be tremendous. Due to power breaks daily, a

number of DG sets are used in the city. The fuel consumed by the DG Sets by

different sectors and the average consumption of diesel varies as per the capacity of

the generators.

In order to prevent and control air pollution Government of India notified the Taj

Trapezium Zone (Pollution Prevention and Control) Authority for protection and

improvement of the environment in the Trapezium. A lot of serious steps and action

were initiated to control pollution in the city. The salient features of actions taken to

control pollution are as follows:

· In different zone more than 110 industries are drawing natural gas for use in

production processes.

· Strict vigil on compliance of 292 industries that were directed by the Supreme

Court not to use coal or coke. Out of 292 industries 87 has been connection

for CNG by GAIL.

· All the brick kilns within the radius of 20 kms of significant monuments of Agra

city have been closed.

· New Industries using coal and coke are not being allowed to set up in Agra

Trapezium zone in Uttar Pradesh.

· Regular monitoring of ambient air quality in the Agra city. Currently four

monitoring stations are there in the Agra city.

· Phasing out of grossly polluting vehicles plying within the city area. Age limits

for different categories of vehicles has already been fixed by RTA.

· Diesel driven Seven seater tempos fitted with scrubber only are being issued

registration. Till now 205 such vehicles have been fitted with the scrubbers.

· Restriction on plying diesel driven tempo-taxi and auto rickshaws on MG road

and prohibition of all type of commercial vehicles within the radius of 500

meters of Taj Mahal.

· Supply of diesel having sulphur content 0.05% since April 2003.

· Strict checking of vehicular emissions for in-use vehicles, etc.

Inspite of these actions being taken in Agra, the city is still considered as one of the

most polluted city in the world. The residents residing in the boundaries of Agra and


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its outskirts are heavily exposed to the various air pollutants and suffer from various

disease caused due to various pollutants. In the present chapter a demographic

analysis of respondents.

DEMOGRAPHIC ANALYSIS OF RESPONDENT

To analyze the health effect of air pollution a questionnaire was served to 3000

patients. The questionnaire was served to the patients who visited the OPD at SN

Medical College and District Hospital, Agra during the study period.

TABLE: 4.1 DEMOGRAPHIC CHARACTERISTIC OF POPULATION

(AS PER GENDER)

In the sample size 68.4% of the patients were males and 31.6% patients were

females. The average age of males was higher as compared to females. The above

table reveals that the males are largely affected by air pollution as compared to

females in Agra city. The reason for the males being highly exposed to air pollution is

understandable that the responsibility for providing bread and butter for their family

and female are less exposed to air pollution because they remain indoor for the

maximum time.

GENDER NUMBER OF

PATIENTS PERCENTAGE

AVERAGE AGE

MALE 2052 68.4% 35.1

FEMALE 948 31.6% 29.6

TOTAL 3,000 100%


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TABLE- 4.2

DEMOGRAPHIC CHARACTERISTIC OF POPULATION

(AS PER AGE)

The patients were classified into four age groups as indicated above. Among the

male the highest number of patient were identified in the age group of 26-45 and

similar was in the case of females. The next to follow were the patients in the age

group of 10- 25 for both male and females. However in the age group of 46-60 there

was a significant difference among the number of patients affected due to pollution in

the category of males and females. In this category 87.5% were males and 12.5%

were females.

The males and females in the age group of 10 to 25 have to travel to their schools

and college for their studies hence, they are exposed more to the air pollution.

Similarly in the age group of 26- 45 males and females are in large number exposed

to air pollution to meet out their employment and job responsibilities. It has been

found in the age group of 46 to 60 the males (371) are in higher number exposed to

air pollution then females (53). Here it can be said that the number for males being

higher is due to the fact that in this group the males have to spend more time

outdoor for earning their livelihood whereas females in this group generally spend

more time indoor. The number of respondent in the age group of above 60 is very

less, as in this age group the people live a retired life and generally stay indoors.

AGE MALE FEMALE TOTAL

10-25 574

(62.19%)

349

(37.81%)

923

(100%)

26-45 1079

(67.02%)

531

(32.98)

1610

(100%)

46-60 371

(87.5%)

53

(12.5%)

424

(100%)

Above 60 28

(65.12%)

15

(34.88%)

43

(100%)

TOTAL 2052 948 3000


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FIGURE : 4.1

RESIDENTIAL AREA

The above figure reveals the residential status of the respondents. The figure clearly

shows that the persons residing in the urban area are largely affected by air pollution

followed by the person living in semi urban area as compare to rural area. It can be

well understood that pollution level in urban and semi urban area is much higher

due to various industrial activities, emission from vehicles and DG Sets, etc, whereas

the pollution in rural areas are mainly due to burning of cow dung, wood and coal

for domestic purposes.

FIGURE : 4.2

OCCUPATION OF RESPONDENTS

Rural Urban Semi Urban

Number of Person 302 2028 670

0

500

1000

1500

2000

2500

Nu

mb

er o

f P

erso

n

Factory Offices Student Self Employed

Others

Number of Person 1021 957 305 108 609

0

200

400

600

800

1000

1200

Nu

mb

er o

f P

erso

n


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The above figure shows the work place of the respondents in the sample survey. As

large number of respondents are working in factory hence they are directly exposed

to air pollution as compared to other respondents. The students and self employed

persons are found to be low because they are less exposed to air pollution as they

spend lot of time in a particular place and have lesser traveling. The number of other

is high because it includes rickshaw puller, auto drivers and housewives, etc.

Aside from exposures while travelling inside a vehicle, a significant proportion of the

population are exposed through occupations that lead to extended periods of time on

or near roads and highways or close to traffic like asphalt workers (Randem et al.

2004), traffic officers (de Paula et al. 2005; Dragonieri et al. 2006; Tamura et al.

2003; Tomao et al. 2002; Tomei et al. 2001), street cleaners (Raachou-Nielsen et al.

1995), street vendors, and tollbooth workers. Health impacts are greater for these

groups who work close to traffic than for those that are not occupationally exposed.

TABLE: 4.3

EDUACTION LEVEL AND AWARENESS OF AIR POLLUTION EFFECTS

EDUCATION LEVEL AWARE NOT AWARE TOTAL

METRIC 1017

(51%) 970

(49%) 1987

(100%)

INTERMEDIATE 509

(69%) 219

(31%) 728

(100%)

GRADUATION/ DIPLOMA 194 (74%)

67 (26%)

261 (100%)

POST GRADUATE 21 (87.5%)

3 (12.5)

24 (100%)

TOTAL 1741 (58%)

1259 (42%)

3000

The above table shows the education level and the awareness towards air pollution

of respondents in the sample size. Around two third of the sample size are metric

and about 49% percent of respondent are not aware about the air pollution effects.

Similarly in Intermediate level 31% are not aware from air pollution effects. Among

graduates and post graduates it has been found that the level of awareness about

the air pollution effects. It can be concluded that education can be a strong means of

creating awareness among people.

The above figure depicts

large number of respondent

compared to users of motor bikes/ Scooter

air pollution for a longer time

respondents using their own cars ar

more safe and less exposed to pollution during traveling. It is also evident that a

large number of respondent use public transport as a means of traveling. As these

public transports have to pass through th

stoppage time at traffic signals and

traveling by the means of this transport are exposed to greater vehicles emissions.

can also be concluded these public transport are

hence there is every chance of being

Number of Person

0

200

400

600

800

1000

1200

1400


FIGURE : 4.3

MODE OF TRANSPORT

The above figure depicts the mode of transportation used by the respondent

large number of respondents use cycle for their traveling consume more

motor bikes/ Scooter. Thus the users of cycle are exposed to

air pollution for a longer time period; hence their number is large in the sample. The

respondents using their own cars are less exposed to air pollution because they are



have to pass through the heart of the city and has a greater

stoppage time at traffic signals and their respective stands, therefore the person

by the means of this transport are exposed to greater vehicles emissions.

can also be concluded these public transport are less covered as compare to cars,

there is every chance of being exposed to pollution.

CycleMotor bike/

ScooterCar

1280 709 9

f Cost Of Illness Of Air Pollution

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used by the respondents. A

consume more time as

Thus the users of cycle are exposed to

hence their number is large in the sample. The

e less exposed to air pollution because they are



e heart of the city and has a greater

their respective stands, therefore the person

by the means of this transport are exposed to greater vehicles emissions. It

less covered as compare to cars,

Public Transport

1002


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TABLE: 4.4

TOTAL DISTANCE TRAVELED

DISTANCE TRAVELED

(KILOMETER)

NUMBER OF PERSON

AVERAGE JOURNEY IN (KILOMETER) (IN A WEEK)

EXPOSURE HOURS TO POLLUTION (IN A WEEK)*

0-200 1821 (60%) 135.12* 7-11

201-400 939

(31%) 306.02* 15-25

401-600 137 (4.5%)

487.02* 25-30

601-800 34 (1.5%)

710** 35-40

801-1000 35 (1.5)

924** 45-47

Above 1000 34 (1.5)

1417**. 70-72

* 1 Km travel in 3/ 5 Min. ** 1 Km travel in 2 Min.

The table represents the average journey traveled by the respondents either on foot,

by vehicle and the estimated time taken to cover the average journey during the

week. The total journey covered during the week has been classified into six

categories with an interval of 200 Km. In first category from 0 to 200 km, around 60

percent of the sample size traveled on an average 135 Km in a week. The exposure

time is nearly 7 to 11 hours in a week considering a distance of 1 Km. being traveled

with in 3 to 5 min. considering the condition of roads, slow traffic and traffic signals

at a shorter distance. In second interval i.e. of 201 to 400Km, 31% of the respondent

traveled an average journey of 306 km. per week with an exposure time of 15-25

hours in a week. In the next category from 401 to 600 Km covers 137 respondents

were exposed to around 25 to 30 hours in a week. For the persons who traveled a

distance above 600 Km or more during a week are assumed to cover a distance of 1

Km. within a time span of 2 min. per Km. In this category we have included auto

drivers, bus driver, conductors, truck drivers and their helpers, etc.

The short and long distance exposure to the polluted environment leads to higher

rates of throat pain, phlegm, chronic rhinitis, and chronic pharyngitis. It also leads to

increased problems of lung function and respiratory symptoms.


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The evidence supports an association between driving or being a passenger in a

vehicle and adverse health outcomes, there are several factors that influence the

degree and magnitude of this association. For example, different ages of vehicles

contribute differently to individual levels of exposure. Older and more poorly

maintained vehicles are typically associated with higher levels of emissions (White et

al. 2006). Time of day of travel also has an influencing effect on exposure to vehicle

emissions. There is evidence to suggest that exposure levels to CO and ultrafine

particle counts are highest during the morning and at lower levels later in the day,

increasing again in the early evening (Kaur et al. 2005b). However, it has been

suggested that this is due to the greater traffic density at this time of day, during

typical commute rush-hours resulting in a greater number of vehicles, possibly

travelling at a lower speed and emitting a higher concentration of pollutants. Longer

trip times have been associated with higher levels of exposure (Peace et al. 2004).

TABLE : 4.5

CLASSIFICATION OF DISEASES

S.No NAME OF THE DISEASES

BROAD CLASSIFICATION

TOTAL NUMBER

1 Cold

Cold and ENT Infection (CEI) 92 2 Cold and Headache

3 ENT

4 Asthma

Respiratory and Bronchitis (RB) 2,339

5 Chest Pain

6 Cough and Phlegm

7 Respiratory Problems

8 Influenza

9 Bronchitis

10 Skin Problem Allergic & Infection (AI) 569 11 Allergy


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During the survey the respondents were found to be affected by the above diseases.

For the purpose of the study these diseases were classified into three broad

categories with the discussion of penal of medical experts as cold and ENT Infection

(CEI) which covered all the diseases related with cold headache and ENT,

Respiratory and Bronchitis (RB) which included diseases related to asthma, chest

pain, cough and phlegm, respiratory problems, influenza and bronchitis and lastly

Allergic & Infection (AI) which covered skin and allergy related problems. In this

study 3000 cases has been taken as consideration out of which 92 cases were

registered for CEI, 2,339 cases for RB followed by 569 cases for AI.

TABLE: 4.6

WARD WISE HEALTH EFFECT CASES

S.NO WARDS/

PANCHAYAT NAME

RB CEI AI TOTAL NUMBER

1 Hariparwat 721 19 143 883

2 Loha Mandi 349 11 61 421

3 Kotwali 556 14 103 673

4 Chatta &

Rakabganj 246 17 103 366

5 Taj Ganj 92 6 30 128

6 Sahaganj 158 10 33 201

7 Cantonment Area 42 2 18 62

8 Dayalbagh 83 3 61 147

9 Out of Agra 92 10 17 119

Total 2,339 92 569 3,000

The above table reveals the ward wise classification of the patients in the three

broad categories of from RB, CEI, and AI. As per Municipal corporation Agra city has

been divided into in 7 wards and two panchayats (Dayalbagh & Soamibagh mainly

known as Dayalbagh). Patients of out of Agra city were also found to be consulted at


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the respective hospital hence, these patients were also taken into consideration for

the purpose of study. These patients were mainly from cities like Firozabad, Tundla

Sikhobad, Fathepursikari, Etmadpur, etc. The maximum cases reported from

Hariparwat ward follwed by Kotwali, Lohamandi and Chatta & Rakabganj. These

area lies in the heart of the city where all the major markets and various offices

operates from these area where DG sets are used while their is failure of power,

maximum traffic operates in this areas, leather & shoe industries are situated , petha

manufacturing units are also located. are located in these area. The lowest number

of patients were reported in Cantonment ward followd by Dayalbagh panchayat.

These two area are lush green with tall trees and hardly any industry operates in

these area. The residents use bicycles as a means of transport.

TABLE: 4.7 WARD WISE HEALTH EFFECT CASES AS PER GENDER

S. No

Ward Name RB CEI AI

Male Female Male Female Male Female

1 Hariparwat 535 186 7 12 86 57

2 Loha Mandi 265 84 4 7 41 20

3 Kotwali 387 169 8 6 74 29

4 Chatta &

Rakabganj 181 65 9 8 56 47

5 Taj Ganj 60 32 3 3 25 5

6 Sahaganj 88 70 6 4 28 5

7 Cantonment Area

22 20 1 1 12 6

8 Dayalbagh 43 40 1 2 43 18

9 Out of Agra 51 41 6 4 11 6

Total 1632 707 45 47 376 193


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The above table shows the gender wise classification of respondents in different

wards and panchayat. In all the wards the number of males are more than females,

which clearly shows that the males are more exposed to the polluted environment

than females. The highest number of males were registered in Haripawat followed by

Kotwali, Lohamandi and Chatta & Rakabganj were a large number of males from the

city live and are employed. In these wards the level of pollution is very high due to

the reason stated above.

POLLUTION AND HEALTH EFFECTS

The link between pollution and health is both a complex and contingent process. For

pollutants to have an effect on health, susceptible individuals must receive doses of

the pollutant, or its decomposition products, sufficient to trigger detectable

symptoms. For this to occur, these individuals must have been exposed to the

pollutant, often over relatively long periods of time or on repeated occasions. Such

exposures require that the susceptible individuals and pollutants shared the same

environments at the same time. For this to happen, the pollutants must not only be

released into the environment, but then be dispersed through it in media used by, or

accessible to, humans. Health consequences of environmental pollution are thus far

from inevitable, even for pollutants that are inherently toxic; they depend on the

coincidence of both the emission and dispersion processes that determine where

and when the pollutant occurs in the environment, and the human behaviours that

determine where and when they occupy those same locations (Briggs D, 2003)1.

The whole process can simply be represented as a causal chain, from source to

effect. As this indicates, most pollutants are of human origin. They derive from

human activities such as industry, energy production and use, transport, domestic

activities, waste disposal, agriculture and recreation. In some cases, however,

natural sources of pollution may also be significant.

1 http://bmb.oxfordjournals.org/content/68/1/1.full#F1

SOURCE OF AIR POLLUTION AND ITS EFFECTS

Source: Br Med Bull (2003) 68

COST ANALYSIS OF

On the basis of the past studies

PM10 and TSPM on various diseases has been classified for the purpose of

under three broad categories of Cold and ENT Infection

Bronchitis (RB) and Allergic and

In order to assess the monetary burden of the illnesses the cost of illness (COI)

approach has been adopted which is based on accounting of cost. The cost

approach measures both direct and indirect cost of illness. The direct cost

represents direct medical cost and direct non medical cost. Direct medical cost

includes expenditure incurred on

hematology, radiology, cytology

consultation fees through not charged for the patients directly, but are assumed to be


FIGURE 4.4


68 (1): 1-24. doi: 10.1093/bmb/ldg019

COST ANALYSIS OF AIR POLLUTION ON HUMAN HEALTH

On the basis of the past studies the effect of the selected pollutant namely SO

and TSPM on various diseases has been classified for the purpose of

under three broad categories of Cold and ENT Infection (CEI), Respiratory and

ronchitis (RB) and Allergic and Infection (AI).


approach has been adopted which is based on accounting of cost. The cost

both direct and indirect cost of illness. The direct cost


includes expenditure incurred on medicines and drugs, diagnostics test related to

hematology, radiology, cytology and pathology test and consultation fees. The


f Cost Of Illness Of Air Pollution

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AIR POLLUTION ON HUMAN HEALTH

of the selected pollutant namely SO2, NO2,

and TSPM on various diseases has been classified for the purpose of the study

(CEI), Respiratory and


approach has been adopted which is based on accounting of cost. The cost of illness

both direct and indirect cost of illness. The direct cost


medicines and drugs, diagnostics test related to

and pathology test and consultation fees. The



Page | 90

a burden to the government in form of salary being paid to the experts (doctors).

Hence half of the fees charged generally by private doctor medical practitioners has

been taken as the cost of treatment and has been included in direct medical cost,

medicines, etc. The cost of medicine and drugs was considered on the basis as

prescribed in the prescription and the prices of medicines and drugs as reported by

the retailer. The practitioners provided the list of the drugs and duration of the

treatment. The cost of laboratory was considered as the average cost of five test

centers near to the hospitals. Direct non medical cost includes expenditures incurred

on transportation, lodging, and meals during treatment and recovery. The direct non

medical cost was taken to be the approximate cost as stated by the patient. Indirect

costs represent cost for which no expenses were incurred but are associated with

illness. This can be defined as the value of production lost to society due to

temporary absence from work caused by illness. The cost of productivity lost has

been determined by considering as per day income and the number of day lost due

to sickness of the patient. For determining the number of days lost in the age group

of 0 to 25 and 60 and above, the number of days lost by the accompanying person

and their earnings (if any) has been taken into consideration.

TABLE- 4.8

COST ANALYSIS

S. NO

DISEASES

TOTAL CASES

DIRECT MEDICAL

COST ` DIRECT

NON MEDICAL

COST ` INDIRECT

COST `

TOTAL COST `

1 Cold and ENT Infection (CEI)

92 82,480 24,300 34,931 1,41,711 (2.86%)

2 Respiratory and Bronchitis (RB)

2,339 17,21,985 7,66,785 12,88,575 37,77,345 (76.38%)

3 Allergic &

Infection (AI) 569 5,70,465 2,23,690 2,32,328 10,26,483 (20.76%)

TOTAL 3,000 23,74,930 (48.02%)

10,14,775 (20.52%)

15,55,834 (31.46%)

49,45,539 (100%)


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The per episode total economic cost of the health affects during the period under the

study for all diseases resulted from the various pollutants is estimated to be INR ` 49,45,539/- On comparing the economic cost of air pollution of various diseases,

RB accounted for a higher economic cost INR ` 37,77,345/- being 76.38% of the

total cost. The economic cost of AI INR ` 10, 26,483/- as compared to RB are much

lower being 20.76% of the total cost. The economic cost of CEI INR ` 1,41,711/-

being 2.86% of the total cost which is very insignificant as compared to other

diseases.

On comparing the economic cost of the air pollution on the basis of direct and

indirect cost component of COI it has been found that the direct medical cost

estimated to be 48.02% of the total cost followed by indirect cost being 31.46% of

the total cost.

TABLE: 4.9

DIRECT COST CLASSIFICATION

DISEASES NO OF

CASES

MEDICINE

&

DRUG COST

DIAGNOSTIC SPECIALIST

FEES* TOTAL

CEI 92 57,410 15,870 9,200 82,480

RB 2339 11,34,685 3,53,400 2,33,900 17,21,985

AI 569 3,60,415 1,53,150 56,900 5,70,465

Total 3000 15,52,510 522420 3,00,000 2347930

* Half of the private medical expert fees prevailed in Agra.

The above table reveals the components of direct cost which includes the cost of

medicines & drugs, diagnosis, and medical expert fees. Around two third amount of

total direct cost incurred on purchase of medicines and drugs. The diagnosis cost

involved hematology, radiology, cytology and pathology test. Some of the major tests

prescribed were as follows:


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· RB Spirometry (to asses lungs function),Peak flow meter test ( to asses lungs

function), Sputum examination(for Grams staining &A.F.B.) Echo-cardiograph.

Sleep Test (for snoring & apnoea)

· AI Skin allergy Tests(by multiple pricks over skin of fore arms)

· CEI, X-ray P.N.S.(for paranasal sinus), CT.Scan & MRI. (Chest PNS & Ears)

TABLE: 4.10

INDIRECT COST CLASSIFICATION

DISEASES NO. OF

CASES

TRAVEL

COST

HEALTH

CARE &

DIETS COST

OTHER TOTAL

CEI 92 6100 15200 3000 24300

RB 2339 235185 440300 91300 766785

AI 569 20000 167690 36000 223690

Total 3000 270385 614090 130300 1014775

The above table shows the classification of indirect cost which includes cost incurred

on traveling (during the visit), Health care, & diet cost and some other expenses.

The maximum expenses have been incurred on health care and diets cost followed

by travel cost.

TABLE - 4.11

DIRECT AND NON DIRECT MEDICAL COST (PER PATIENT COST)

The direct medical cost per patient is too high in AI as compared to RB and CEI. The

per patient cost of AI amounts to INR `1,002.57/- in respect to direct medical cost

followed by CEI which amounted to INR ` 896.52/- as direct medical cost. The per

S. NO

DISEASES

TOTAL CASES

DIRECT MEDICAL

COST ` DIRECT NON

MEDICAL COST ` 1 Cold and ENT Infection 92 896.52 264.13 2 Respiratory and

Bronchitis 2,339 736.20 327.82

3 Allergic & Infection 569 1,002.57 393.12


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patient non medical cost was higher in AI which amounted to INR ` 393.12/- followed

by RB which accounted to INR ` 327.82/-. Thus the total direct cost of treatment of AI

diseases appears to be more costly as compared to other diseases due to costly

medicine and tests.

TABLE - 4.12

INDIRECT COST

The indirect cost of illness includes the cost of productivity lost due to absence from

work of the patient or their attendants. The indirect cost is higher in RB which

amounts to INR ` 240. The number of days lost during sickness is greater in RB as

compared to AI and CEI. This can also be reconciled with the fact that the patient of

RB were bound to pay more visit for the purpose of treatment and also the treatment

was carried for a longer period which resulted into higher cost of treatment as

depicted in table – 4.9

COLD AND ENT INFECTION CASE

Under this category 92 patient were identified as affected by CEI diseases. In the

sample size 48.9% of the selected sample was male and 51.1% of the samples were

female.

S. NO DISEASES

Total Cases

Total Days Lost

(`) Total Wage Loss

(`) Per Day

Lost (`)

1 Cold and ENT Infection 92 164 34,931 212

2 Respiratory and Bronchitis 2,339 5,364 12,88,575 240

3 Allergic & Infection 569 1,104 2,32,328 210

Total 3,000 6,632 15,55,834 234


Page | 94

TABLE-4.13

DEMOGRAPHIC CHARACTERISTIC

Under this category the average age of males was 22.1 yr. and that of females was

32.6 yr. The females were older in age as compare to males.

TABLE – 4.14

DEMOGRAPHIC CHARACTERISTIC OF STUDY POPULATION (AS PER AGE)

The patients were classified into four age groups as indicated above. Among the

male the highest number of patient were identified in the age group of 10-25 and

female was in the age group of 26-45. However in the age groups of 46-60 and

above 60 there was a significant difference among the number of patients. In these

categories only male members were recorded in the sample survey.

ALLERGIC & INFECTION

Under the category AI of a total of 569 patients were identified out of 3,000 patients.

Under this sample size 66.0% of the selected sample was male and 44.0% of the

samples were female.

GENDER NUMBER OF PATIENTS

PERCENTAGE AVERAGE AGE

MALE 45 48.9% 22.1

FEMALE 47 51.1% 32.6

TOTAL 92 100%

AGE MALE FEMALE

TOTAL

10-25 27

(86.4%) 5

(13.6%) 32

(100%)

26-45 5

(11.11%) 42

(89.37) 47

(100%)

46-60 12

(100%) - 12

(100%)

Above 60 1

(100%) - 1

(100%) Total 45 47 92


Page | 95

TABLE – 4.15

DEMOGRAPHIC CHARACTERISTIC

The males were older in age as compare to females. The average age of males was

33.1 yr. and that of females was 26.0 yr. The table reveals that in the affected cases

the proportion of males are more than females. The reason for this can be explained

as greater degree of exposure of males to allergens at their work place and outer

atmosphere while discharging their family and social obligations. The females

generally remain indoor and they are comparatively less exposed to occupational

and atmospheric hazards, however the females are exposed to cow dung, cock,

coal, and wood which are used for domestic purpose. It has also been reported that

females are more exposed to zoonatic disease (from animals to human beings and

human to animals).

TABLE – 4.16


GENDER NUMBER OF PATIENTS PERCENTAGE

AVERAGE AGE

MALE 376 66.0% 33.1

FEMALE 193 44.0% 26.0

TOTAL 569 100%

AGE MALE FEMALE

TOTAL

10-25 150

(60.7%) 97

(39.3%) 247

(100%)

26-45 144

(62.3%) 87

(37.7%) 231

(100%)

46-60 75

(97.4%) 2

(2.6%) 77

(100%)

Above 60 7 (50.0%)

7 (50.0%)

14 (100%)

Total 376 193 569 (100%)


Page | 96

Under this category the highest number of male patient were identified in the age

group of 10-25 similar was in the case of females. The next to follow were the

patients in the age group of 26- 45 for both male and females. However in the age

group of 46-60 there was a significant difference among the number of patients

affected due to pollution in the category of males and females. In this category

97.4% were males and 2.6% were females.

RESPIRATORY AND BRONCHITIS CASES

TABLE - 4.17 DEMOGRAPHIC CHARACTERISTIC

A total of 2339 patient out of 3,000 patients were recorded under this category during

the study period which is almost 78% of the total sample size. In the selected sample

size 68.7% of were male and 30.3% of the samples were female. As the above trend

the males were older in age as compare to females. The average age of males was

35.2 yr. and that of females was 30.2 yr.

The table reveals that in the affected cases the proportion of males are more than

females. The reason for this can be explained as greater degree of exposure of

males to allergens at their occupational place and exposure to environment stimuli

and pollution due to greater outdoor activities. Another reason for males being

affected is due to less physical exercise being performed. The proportion of females

is low because they are confined to home and perform physical exercise. Even

there are some social issues due to which they hesitate to spell out their disease.

However, the females are exposed to indoor pollution such as house dust and

kitchen fumes from various sources.

GENDER NUMBER

OF PATIENTS

PERCENTAGE AVERAGE

AGE

MALE 1632 69.7% 35.2

FEMALE 707 30.3% 30.2

TOTAL 2339 100%


Page | 97

TABLE – 4.18


Under this category the highest number of male patient were identified in the age

group of 26-45 and similar was in the case of females. The next to follow were the

patients in the age group of 10- 25 for both male and females. However in the age

groups of 46-60 and 60 and above there was a significant difference among the

number of patients which was affected in the category of males and females.

AGE

MALE FEMALE TOTAL

10-25 397

(61.6%) 247

(33.4%) 644

(100%)

26-45 929

(69.8%) 402

(30.2%) 1331

(100%)

46-60 286 (84.9%)

51 (15.1%)

337 (100%)

Above 60 20

(74.0%) 7

(26.0%) 27

(100%) TOTAL 1,632 707 2339


Page | 98

SYSTEM DYNAMICS APPROACH FOR FORECASTING OF AIR POLLUTION EFFECTS AND COST OF ILLNESS System dynamics (SD) is an approach to understand the behaviour of complex systems over

time. It deals with internal feedback loops and time delays that affect the behaviour of the

entire system. What makes using system dynamics different from other approaches to

studying complex systems is the use of feedback loops and stocks and flows. It is a

methodology and mathematical modeling technique for framing, understanding, and

discussing complex issues and problems. Originally developed in the 1950s to help

corporate managers improve their understanding of industrial processes, system dynamics

is currently being used throughout the public and private sector for policy analysis and

design.

SD is an aspect of systems theory as a method for understanding the dynamic behavior of

complex systems. The basis of the method is the recognition that the structure of any system

— the many circular, interlocking, sometimes time-delayed relationships among its

components — is often just as important in determining its behavior as the individual

components themselves. Examples are chaos theory and social dynamics. It is also claimed

that because there are often properties-of-the-whole which cannot be found among the

properties-of-the-elements, in some cases the behavior of the whole cannot be explained in

terms of the behavior of the parts. In this study to measure the growth of the level of

pollutants in the city and compare the effects of the disease a dynamic model has been

developed.(See Figure – 4.5). With the help of this model forecasting has been made up to

2025, considering with the same trend of air pollution and cost has also been estimated.

STATEMENT OF PROBLEM

An increase in one or more types of the mentioned pollutants will raise the general air

pollution index. This air pollution index is calculated with the help of NAAQ standard and the

pollution level of Agra city for last five year (2006-10). There are some other variables which

have also been considered for the model like,

· The total infection by air pollution.

· The total cure of patient by medical treatment.

· Effected rate between infection and cure rate

· Total sick population which is affected by pollution by the sample survey.

· Total Cost effect by the disease incurred by air pollution. It is considered both type of

cost direct cost, indirect cost.


Page | 76

SO2 Growth Rate NO2 Growth Rate PM10 Growth Rate TSPM Growth Rate

Total Cost

SO2 NO2 PM10 TSPM

SO2 Level NO2 Level PM10 Level TSPM Level

Air PollutionEffected

Rates-Cure Rates

Infection Rate+

Sick CaseCold &ENT

Sick CaseResp &Bronh.

Sick CaseAllergic &Infection

Initial case Cold& ENT

Initial caseResp. & Bronh

Initial CaseAllergic &Infection

Direct Cost Cold& ENT

Indirect CostCold & ENT

Direct CostResp& Bronh

Indirect CostResp& Bronh

Direct Cost Allergic& Infection

Indirect CostAllergic & Infection

Total CostCold & ENT

Total CostResp &Bronch.

Total Allergic& Infection

ProductivityLossCE

ProductivityLoss RB

ProductivityLoss AI


Page | 100

FIGURE 4.6 AIR POLLUTION LEVEL FROM 2011-2025

Air Pollution800

750

700

650

600

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

Ugm

3

Air Pollution : Current

SO2 Level7

6.25

5.5

4.75

42011 2013 2015 2017 2019 2021 2023 2025

Time (Month)

Ugm

3

SO2 Level : Current

PM10 Level300

250

200

150

100

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

Ug

m3

PM10 Level : Current

TSPM Level600

550

500

450

400

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

Ugm

3

TSPM Level : Current

NO2 Level24

23.5

23

22.5

22

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

Ug

m3

NO2 Level : Current


Page | 101

FIGURE 4.7 AIR POLLUTION EFFECT ON DIFFERENT DISEASES

Sick Case Cold & ENT200

175

150

125

100

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

peso

n

"Sick Case Cold & ENT" : Current

Sick Case Resp & Bronh.2,500

2,475

2,450

2,425

2,4002011 2013 2015 2017 2019 2021 2023 2025

Time (Month)

peso

n

"Sick Case Resp & Bronh." : Current

Sick Case Allergic & Infection700

675

650

625

600

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

pes

on

"Sick Case Allergic & Infection" : Current


Page | 102

FIGURE 4.8 COST FORECASTING

Total Cost Cold & ENT400,000

350,000

300,000

250,000

200,000

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

Rs/p

esro

n

"Total Cost Cold & ENT" : Current

Total Cost Resp & Bronch.3.2 M

3.175 M

3.15 M

3.125 M

3.1 M2011 2013 2015 2017 2019 2021 2023 2025

Time (Month)

Rs/

pesr

on

"Total Cost Resp & Bronch." : Current

Total Allergic & Infection1.1 M

1.075 M

1.05 M

1.025 M

1 M2011 2013 2015 2017 2019 2021 2023 2025

Time (Month)

Rs/

pes

ron

"Total Allergic & Infection" : Current


Page | 103

FIGURE 4.9 COST FORECASTING (COMPONENT WISE)

Current

"Total Cost Cold & ENT"400,000

350,000

300,000250,000

200,000"Direct Cost Cold & ENT"200,000175,000

150,000

125,000

100,000"Indirect Cost Cold & ENT"

60,000

55,000

50,00045,000

40,000Productivity LossCE

40,00035,000

30,00025,000

20,0002011 2018 2025

Time (Month)

Current

"Total Cost Resp & Bronch."3.2 M

3.175 M

3.15 M

3.125 M

3.1 M"Direct Cost Resp& Bronh"

1.8 M

1.775 M

1.75 M

1.725 M

1.7 M"Indirect Cost Resp& Bronh"800,000

795,000

790,000

785,000

780,000Productivity Loss RB590,000585,000

580,000

575,000

570,0002011 2018 2025

Time (Month)

Current

"Total Allergic & Infection"1.1 M

1.075 M

1.05 M

1.025 M

1 M"Direct Cost Allergic & Infection"700,000

675,000

650,000

625,000

600,000"Indirect Cost Allergic & Infection"270,000

265,000

260,000

255,000

250,000Productivity Loss AI140,000

137,500

135,000

132,500

130,0002011 2018 2025

Time (Month)


Page | 104

FIGURE 4.10

TOTAL COSTING

As shown above, model of air pollution in Agra, we can infer the following results as

the conclusion (fig. 4.5 to 4.10):

· A downfall in SO2 level is recorded due to reduction of sulphur in diesel,

implementation of stricter emission norms and commensurate fuel quality.

· An increase in NO2 level is due to increase in motor vehicles, use of

generators in power generation etc.

· PM10and TSPM are major key players for the increase in pollution in Agra

city. The study shows the highest effect of air pollution is just because of

these two pollutants. The reason of high level of these air pollutants may be

vehicles, engine gensets, small scale industries, biomass incineration, boilers,

resuspension of traffic dust, commercial and domestic use of fuels, etc.

· The sick population will likely be doubled within the gap of just fifteen years.

· The economic cost of air pollution is also estimated to get double in the span

of fifteen years.

______________

Total Cost4.5 M

4.475 M

4.45 M

4.425 M

4.4 M

2011 2013 2015 2017 2019 2021 2023 2025Time (Month)

Rs/p

esro

n

Total Cost : Current

air pollution effects -...

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