Energy and Health

Energy Week 2006

Dr Maria Neira, DirectorDepartment for Public Health and Environment

World Health Organization

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

- Ambient and indoor air pollutionCardiovascular disease, respiratory disease, lung cancer

- Cold and damp housingRespiratory diseases, allergies

- Climate change Extreme weather events, floods, vector-borne diseases

- Accidents/firesPersonal injuries and disability

- Occupational hazards - Noise, stress- EMF

Health risks associated with energy

• 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

A disconnected response undermines health gains from transport

investments

TRAFFIC INJURIES

PHYSICAL INACTIVITY

AIR POLLUTION

HIV / AIDS

CLIMATE CHANGE

• 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.

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

1st. 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.

• 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.

2nd. To protect the health of vulnerable groups

3rd. 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

Main mode to work in Mumbai, India

0 10 20 30 40 50 60 70

On footBicycle

TrainPublic Bus

Auto-RickshawTwo-Wheeler

Car

Percent

All commuters Low income

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

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

CLIMATECHANGE

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 climatechange and health

Example: Diarrhoeal diseases

Distal causes Proximal causes Infection hazards Health outcome

TemperatureHumidityPrecipitation

Living conditions(water supply andsanitation)

Food sources andhygiene practices

Survival/ replicationof pathogens in theenvironment

Contamination ofwater sources

Contamination offood sources

Rate of personto person contact

Consumption ofcontaminated water

Consumption ofcontaminated food

Contact withinfected persons

Incidence of mortality andmorbidityattributableto diarrhoea

Vulnerability(e.g. age andnutrition)

How does climate impact on health?

05 0 01 0 0 01 5 0 02 00 025 0 030 0 0 0 5 0 0 1 0 0 0 15 00 2 00 0 2 5 0 0 30 00

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 pollutionDisability 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 havea large impact on health?

• 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

Who is most affected?

Health impacts of indoor air pollutionHealth outcome Evidence Population Relativ

e riskRelative risk (95% confidence interval)

Acute infections of the lower respiratory tract

Strong Children aged 0–5 years

2.3 1.9–2.7SUFFICIENT

Chronic obstructive pulmonary disease

Strong Women aged ≥ 30 years

3.2 2.3–4.8

Moderate I Men aged ≥ 30 years

1.8 1.0–3.2

Lung cancer (coal) Strong Women aged ≥ 30 years

1.9 1.1–3.5

Moderate I Men aged ≥ 30 years

1.5 1.0–2.5

Lung cancer (biomass) Moderate II Women aged ≥ 30 years

1.5 1.0–2.1INSUFFICIENT

Asthma Moderate II Children aged 5–14 years

1.6 1.0–2.5

Moderate II Adults aged ≥ 15 years

1.2 1.0–1.5

Cataracts Moderate II Adults aged ≥ 15 years

1.3 1.0–1.7

Tuberculosis Moderate II Adults aged ≥ 15 years

1.5 1.0–2.4

HighlyNeglected

Issue!

1.6 million annual deaths1.6 million annual deaths• in the poorest countriesin the poorest countries• mostly among young childrenmostly among young children

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

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

• 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 onHousehold Energy and Health

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 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.