environmental health in mexico: current situation, challenges ......65 años y más: 3.8% menores de...

Environmental health in Mexico: current situation, challenges and

perspectivesHoracio Riojas Rodríguez, PhD.Michelle Romero Franco, MSc.

Binational Perspectives in Environmental Health April 5th, 2011

CONTENTSection I. General outlook : An overview of the problem Epidemiological transition, urban and demographic situation

Environmental distress factors Land use changes Urbanization & industry distribution

Environment, population and health in Mexico Old risks & new ones Water pollution

Chapala lake & mercury Air pollution

Outdoor & Indoor (Biomass smoke) Climate change Chemical substances

Mining exploitation, POPs: Tri-national study

CONTENTSection II. Responses to confront the problemsSuccessful interventions Multi sector efforts: climate change, PROAIRE

2011National & International agendas

AIMSIn this presentation we will provide a glimpse

of the current situation of environmental health in Mexico and some of the priorities for research and public health interventions

SECTION I. GENERAL OUTLOOK : AN OVERVIEW OF THE PROBLEM

Mexico• ≈ 2 million Km2

• 112 million people• 70% urban population• Large cities & megacities• Gulf of Mexico & Pacific

ocean• Biodiversity

Mexico (2)• Epidemiological transition

• Significative differences in social and environmental vulnerability

• Health development delays in terms on environmental issues and health

Demographic Transition

Fuente: Estimaciones de población de Conapo 2000.

Millones de personas

1975

2000

2025

85 +80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-14

5-90-4

0123456 0 1 2 3 4 5 6

Hombres Mujeres

Tasa de crecimientoannual

65 años y más: 3.8%menores de 5 años: -1.3%

Epidemiological TransitionMexico, Causes of death

Infecciones y ParasitosisDiarrea

NeumoníasLesiones acc. e inten.

Enf. DigestivasAfec. Perinatales

Enf. Sist. NerviosoEnf. CardiovascularesEnf. Respiratorias Cro.

Enf. Genio-urinariasNeoplasias Malignas

DesnutriciónMaternas

Enf. Metabólicas A. CongénitasMal definidas

0510152025 0 5 10 15 20 25

1940 2000

Environment, population & health 25-35% of the BOD is

attributable to environmental factors

Some of these

• Unsafe drinking water (scarcity, biological & chemical pollution)

• Low air quality in cities and rural areas• Exposure to chemical substances

• Persistent organic pollutants , metals (lead, manganese, chromium, mercury, arsenic)

• Emerging and re-emerging mining areas

• Climate disturbances (disasters, climate change)

• Tobacco smoke exposure• Solid waste disposal

Historical outlook

Pove

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Ongoing outlook…

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WATER

Chemical pollution (agro chemicals) per water basinIN

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Median Maximum Minimum

Carp Tilapia Other species

Water pollution: Mercury in Chapala Lake

EPA

FAO

MEX NOM 127

Water pollution diarrheic diseases, Mortality by basin

Residual water: deficit in treatment

AIR POLLUTION

0

5

10

15

20

25

1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 p 2005

REGISTERED VEHICLES IN MEXICO PER YEAR (MILLIONS)

Source: Instituto Nacional de Ecología. http://www.ine.gob.mx/

Actualizar los datos, características

AIR QUALITY MONITORING. MARCH 31st, 2011.http://sinaica.ine.gob.mx/

Trend of criteria air pollutants in the MCMA 1990 -2007

Source: Informe de la Calidad del aire en la Zona Metropolitana del Valle de México: Estado y tendencias 1990 – 2007. Secretaríadel medio Ambiente, GDF, 2008.

Lead

PM10 trends2007: 78 mcg/m3 mean annual concentration

Source: GDF. Seis medidas metropolitanas de calidad del aire, 2008

Premature deaths avoided. All ages

2, 306

1,0381,191

Cortez Lugo, et al. 2003. "Tendencia de los niveles de plomo en la atmósfera de la zona metropolitana de la Ciudad de México. 1988-1998". Salud Pública de México, pp. 196-202.

Biomass fuels use in Mexico

Source: FAO http://www.fao.org/docrep/005/y4719e/y4719e07.htm

In Mexico, around 27 million people use firewood to cook or to heat their homes (Masera 2007)

Indoor pollution affectswomen and children from thelowest socioeconomic stratawhich are located in rural andsurrounding urban areas

Biomass

Incomplete combustion

Smoke

Gas phase• CO• NOx• Several hundreds hydrocarbons

• 1,3-Butadiene*• Benzene*• Styrene• PAHs (2-4 rings)

• Oxygenated organic compounds• Formaldehyde*• Acroleyne• Methyl phenols

Particulate phase• Particles

• Inhalation• Fine particles

•PAHs (4-6 rings)

IARC Classification * Group 1 Human carcinogen

Design: Community trial

Homes with women and children (< 3 years old)in 6 communitiesn=600

Randomizedassignation

New stove(n=300)

Open fire(n=300)

Follow up

Home visit/ 1 month• Symptoms• Spirometries / 4 month• Oximetry• Anthropometry• Hemoglobine

3 months 10 months

Baseline study

• Questionnaires• Clinical tests• Spirometries

PAHs exposure urinary metabolites pre and post intervention

02

46

810

µmol

/mol

cre

a

Pre 1-Pyr Post 1-PyrPre 3-phen Post 3 phen

36% reduction1-hydroxypyrene 30% reduction

3-hydroxy phenanthrene

Pulmonary function

2.85

2.87

2.89

2.91

2.93

2.95

0 0.2 0.4 0.6 0.8 1 1.2

FEV 1

(L)

Time (years)

FEV1 average loss

Patsari user Non user

Similar effect to quit smoking

Am J Respir Crit Care Med. 2009 Oct 1;180(7):649-56. Epub 2009 Jun 25.

Studies in the North border

EXPOSURE TO CHEMICAL SUBSTANCES

Chemical substances regulation in Mexico

Worldwide

Commerce

Regulated (international)

90% of consumption

Restricted

Under international agreements for elimination

Priority substances in Mexico(As, Cd, Hg, Pb, PCBs, Dioxins, Furans)

>12 000 000>100 000±8 000±3 000±600>15±7

Insert Map

Tri N

atio

nal S

tudy

• The purpose of this initiative was to developand implement a human blood biomonitoringproject in Mexico, Canada and the United Statesin order to obtain an initial profile of contaminant levels of selected persistentorganic pollutants (POPs) and toxic metals in a random population of pregnant women.

TRINATIONAL BIOMONITORING PROJECT

Sam

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Mex

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Pollutant levels in the three countries (1)

Pollutant Country n Min Max Geometric mean (SD)

Cadmium(ug/L)

Alaska 20 ND 2.40 0.40 ( 2.30 )

Canada 64 0.1574 4.95 0.44 ( 2.32 )

Mexico 233 0.1574 1.69 0.35 ( 1.35 )

NHANES 72 ND 0.80 0.27 ( 1.79 )

Lead (ug/L)

Alaska 20 0.0500 0.23 0.10 ( 0.15 )

Canada 64 0.2694 1.20 0.57 ( 0.13 )

Mexico 233 0.5595 22.79

NHANES 72 ND 3.40 0.76 (0.20 )

Pollutant Country n Min Max Geometric mean (SD)

MercuryTotal

(ug/L )

Alaska 20 0.9000 6.70

Canada 64 ND 2.81 0.37 ( 2.7 )

Mexico 233 ND 18.05 0.85 ( 2.68 )

NHANES 72 ND 7.40 0.73 ( 3.06 )

Nickel(ug/L)

Canada 64 0.1762 5.23 2.16 ( 1.64 )

Mexico 233 1.2918 6.46 3.23 ( 1.27 )

Pollutant levels in the three countries (2)

Pollutant Country n Min Max Geometric mean (SD)

PCB 118 (ug/Kg Lipid)

Alaska 21 ND 52.30

Canada 64 1.11 12.64 2.76 ( 1.67 )

Mexico 240 ND 57.75 1.21 ( 2.07 )

NHANES 39 ND 78.80 4.53 ( 2.38 )

PCB 138 (ug/Kg Lipid)

Alaska 21 ND 97.60

Canada 70 1.33 20.78 3.76 ( 1.74 )

Mexico 240 ND 50.70 2.37 ( 2.18 )

NHANES 39 ND 136.00 8.51 ( 2.67 )

Pollutant levels in the three countries (3)

Pollutant Country n Min Max Geometric mean (SD)

PCB 153 (ug/KgLipid)

Alaska 21 ND 244.00

Canada 70 2.10 19.54 6.12 ( 1.67)

Mexico 240 ND 72.50 3.63 ( 2.16 )

NHANES 39 ND 164.00 10.50 ( 2.77 )

PCB 180(ug/KgLipid)

Alaska 21 ND 110.00

Canada 70 ND 67.90 3.48 ( 2.38 )

Mexico 240 ND 43.62 2.07 ( 2.25 )

NHANES 39 ND 90.60 6.28 ( 2.66 )

Pollutant levels in the three countries (4)

Pollutant Country n Min Max Geometric mean (SD)

Oxychlordane(ug/Kg Lipid)

Alaska 21 ND 48.50

Canada 70 1.00 10.00 2.33 ( 1.61 )

Mexico 240 ND 15.05 1.62 ( 1.92 )

NHANES 37 ND 29.00 4.55 ( 2.11 )

Beta HCH (ug/Kg Lipid)

Alaska 21 ND 26.80 8.03 ( 2.07 )

Canada 61 1.00 7.14 2.63 ( 1.55 )

Mexico 240 ND 29.68

NHANES 39 ND 45.30 3.21 ( 2.06 )

Beta HCH- subproducto de lindano

Pollutant levels in the three countries (5)

Pollutant Country n Min Max Geometric mean (SD)

Gamma HCH(ug/Kg Lipid)

Canada 70 ND 1.22 0.61 ( 1.22 )

Mexico 240 ND 6.90 0.65 ( 1.38 )

NHANES 39 ND 3.82

ppDDE (ug/KgLipid)

Alaska 21 34.50 512.00 164.53 ( 2.00 )

Canada 70 19.23 229.89 52.27 ( 1.55 )

Mexico 240 46.51 19753.09

NHANES 39 32.60 9240.00 170.30 ( 2.62 )

Pollutant levels in the three countries (6)

Conclusions• For Lead and Nickel, Mexico was the country with the highest

values although the GM for lead was below the maximum permissible level (100 ug/L).– The highest level was 227 ug/L– 4.7% got levels above 100ug/L– 15.45% were above 50 ug/L

• The main environmental source of exposure to lead in Mexico are: lead in gasoline and the use traditional glazed ceramic 1. Chandhaury et al, suggest that the lead exposure among women residing in Mexico City most likely resulted from the glazed pottery.1

• 29.6% of the mothers said that they used glazed pottery

1 Chandhaury-Webb M; Paschal D, Romieu I, Ting B, Elliot T, Hopkins H , Sanin LH, Ghazi AM. Determining lead sources in Mexico using the lead isotope ratio. Salud Publica de Mexico. 2003 45 (2):183-188

Mining exploitation: an emerging

concern

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2004 2005 2006 2007 2008 2009

TOTAL 77596.813 163940.966117960.598207017.909 151892.37 183125.81EXPLORATION 66973.984 149218.748EXPLOITATION 10622.829 14722.218

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Open pit mine Naopa

MOLANGO, HIDALGO

Rey’s complex figure & Mn exposure

9 year old girl, copy

Same girl, 5 & 30 minute recall

Exposure to lead, mercury, arsenicand manganese are still veryrelevant in Mexico(Declaration of Brescia, 2007)

CLIMATE CHANGE & HEALTH RESEARCH IN MEXICO

Prospective studiesRetrospective studies

Diagnose study on climate change and health effects in human populations in Mexico

Climate variability impact on dengue in Veracruz

Risk scenarios on health risks associated to climate change in Olmecaregion in Veracruz

Climate change scenarios to assess its possible health impacts on health in Mexico

Caracterization of vulnerability associated to climate change in Mexico and its local effects in health

Weather and Health Municipalities Analysis Regional Studies - Case studies

Climate variability impact on malaria in Chiapas

Temperature effect and its interaction with ozone on hospitaladmissions in Mexico City from 1998 to 2007: vulnerable groups

Regional scenarios of climate change, vulnerability and its potentialhealth impact

Climate change scenarios to assess the potential

health impacts in Mexico

MORBILITY RATE RATIO ACUTE DIARRHEA (AD) AUGUST 2030/99-2005

Rate Ratio 2030HADLEY MODEL

1.00

ACU

TE D

IARR

HEA

INFE

CTIO

N A

2 SC

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Temperature effect and its interaction with ozone on hospital admissions in Mexico City from 1998 to 2007

* Adjusted by O3, PM10 and Relative humidity

Época Húmed Jun-Oct

Lag

% d

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mbi

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el R

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05

10

0 1 2 3 4 5

Temperature effect and its interaction with ozone on hospital admissions in Mexico City from 1998 to 2007

* Adjusted by O3, PM10 and Relative humidity

Cumulative Risk

Respiratory diseases children under 5 (Period 200-2002)

% change in increase of hospital admissions per 1°C increase*Época Húmed Jun-Oct

Lag

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Natural disasters + poverty

SECTION II. RESPONSES

Perspectives• What are the needs in terms of research &

intervention?– Increase the efforts for capacity building

(laboratories) and human resources formation in Environmental Health

– Update the diagnose of Environmental Health in Mexico

– Increase multidisciplinary research and policy in Environmental Health

Perspectives

• Multi and transdisciplinary research in environmental health (manganese, woodsmoke)

• Ecosystem approaches to human health• Regional studies on toxics and climate change

impacts• Integration of health and environment sectors

Veracruz state program for climate change

Development of an “action plan” that aims to engage the state government with the University of Veracruz to implement the program

Process• The planning process involved different stages

that had feed back along the road

Objectives

Analysis (cost-benefit, expert

judgement…)

Opportunities & threats to

applyPublic Hearing State program

Feed back

Identification of experts

Multi disciplinary approach

Axes of actions• Detection & follow up of climate change• Greenhouse effect gases emissions mitigation• Biodiversity• Water availability• Costs• Economy• Society

Very specific actionsMainobjective

What needsto be done?

Step by step

Who needstoparticipate?

Objective• To assess the state of the art of

health effects associated to air pollution in Mexico City’s metropolitan area, to advice air quality policies to protect the general population

Air quality policies• The government of Mexico City is currently working on the air quality policies

for the upcoming years (PROAIRE 2011–2020) which main objective is to

improve the atmospheric conditions in the city and to protect the population’s

health.

Perspectives (2)• Research on:

Gene-environment interactions

Reproductive and growth effects

POPs (exposure, monitoring, effects)

Neurodevelopment Climate change & Public Health

Cardiovascular effects

Pollutants & Cancer Intervention & policy evaluation

Academic exchange with UCLA

In this photo: Michael Tsang, MPH. UCLA exchange student, 2010.

Memorandum of Understanding (MOU) between INSP and UCLA to avoid the costs of student fees and to enable us to have students travel easily in both directions

We are working on a Student Exchange Agreement

In 2010, we had one student with excellent results

Project of solid waste, risk assessment

Photos by Michael Tsang, MPH. UCLA exchange student, 2010.

The student participated in this project

THANK YOU

Land use change per water basinIN

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Economical activities per water basinIN

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Solid waste

Solid waste

Photos by Michael Tsang, MPH. UCLA exchange student, 2010.