Water, Air and Soil Pollution Read the Book

Ecology pollution has many facets, and the resultant wellness risks include diseases in almost all organ systems. Thus, a chapter on air and water pollution control links with chapters on, for instance, diarrheal diseases (chapter 19), respiratory diseases in children and adults (chapters 25 and 35), cancers (chapter 29), neurological disorders (chapter 32), and cardiovascular disease (chapter 33), besides equally with a number of capacity dealing with health care issues.

Nature, Causes, and Burden of Air and Water Pollution

Each pollutant has its own health gamble profile, which makes summarizing all relevant information into a brusque chapter difficult. Nevertheless, public wellness practitioners and determination makers in developing countries need to be aware of the potential health risks caused past air and water pollution and to know where to observe the more than detailed information required to handle a specific situation. This chapter will not echo the give-and-take about indoor air pollution caused by biomass burning (affiliate 42) and water pollution caused by poor sanitation at the household level (chapter 41), only it will focus on the problems caused past air and water pollution at the community, country, and global levels.

Estimates bespeak that the proportion of the global burden of disease associated with environmental pollution hazards ranges from 23 percent (WHO-1997) to 30 pct (Smith, Corvalan, and Kjellstrom 1999). These estimates include infectious diseases related to drinking h2o, sanitation, and food hygiene; respiratory diseases related to severe indoor air pollution from biomass called-for; and vectorborne diseases with a major environmental component, such as malaria. These three types of diseases each contribute approximately 6 percent to the updated estimate of the global burden of disease (WHO 2002).

As the Earth Health Organization (WHO) points out, outdoor air pollution contributes as much as 0.6 to 1.4 percent of the burden of disease in developing regions, and other pollution, such as pb in water, air, and soil, may contribute 0.9 percent (WHO 2002). These numbers may look small, but the contribution from most risk factors other than the "top 10" is within the 0.five to 1.0 per centum range (WHO 2002).

Considering of infinite limitations, this chapter tin give just selected examples of air and water pollution wellness concerns. Other information sources on ecology health include Yassi and others (2001) and the Web sites of or major reference works by WHO, the United Nations Environment Program (UNEP), Partition of Engineering, Manufacture, and Economics (http://world wide web.uneptie.org/); the International Labour Organisation (ILO), the United Nations Industrial Development Organization (UNIDO; http://www.unido.org/), and other relevant agencies.

Table 43.1 indicates some of the industrial sectors that can pose significant environmental and occupational health risks to populations in developing countries. Clearly, illness control measures for people working in or living around a smelter may exist quite dissimilar from those for people living about a tannery or a brewery. For detailed information about manufacture-specific pollution control methods, see the Web sites of manufacture sector organizations, relevant international merchandise union organizations, and the organizations listed above.

Table 43.1

Selected Industrial Sectors and Their Contribution to Air and Water Pollution and to Workplace Hazards.

Air Pollution

Air pollutants are usually classified into suspended particulate matter (PM) (dusts, fumes, mists, and smokes); gaseous pollutants (gases and vapors); and odors.

Suspended PM tin be categorized according to full suspended particles: the finer fraction, PM₁₀, which can reach the alveoli, and the nearly hazardous, PM_2.v (median aerodynamic diameters of less than 10.0 microns and 2.5 microns, respectively). Much of the secondary pollutants PM_two.5 consists of created by the condensation of gaseous pollutants—for example, sulfur dioxide (And so₂) and nitrogen dioxide (NO₂). Types of suspended PM include diesel fuel exhaust particles; coal fly ash; wood smoke; mineral dusts, such as coal, asbestos, limestone, and cement; metal dusts and fumes; acid mists (for case, sulfuric acid); and pesticide mists.

Gaseous pollutants include sulfur compounds such equally SO_two and sulfur trioxide; carbon monoxide; nitrogen compounds such every bit nitric oxide, NO₂, and ammonia; organic compounds such as hydrocarbons; volatile organic compounds; polycyclic aromatic hydrocarbons and element of group vii derivatives such equally aldehydes; and odorous substances. Volatile organic compounds are released from burning fuel (gasoline, oil, coal, wood, charcoal, natural gas, and so on); solvents; paints; glues; and other products commonly used at work or at home. Volatile organic compounds include such chemicals as benzene, toluene, methylene chloride, and methyl chloroform. Emissions of nitrogen oxides and hydrocarbons react with sunlight to eventually form another secondary pollutant, ozone, at ground level. Ozone at this level creates health concerns, dissimilar ozone in the upper temper, which occurs naturally and protects life by filtering out ultraviolet radiation from the sun.

Sources of Outdoor Air Pollution

Outdoor air pollution is caused mainly past the combustion of petroleum products or coal by motor vehicles, industry, and power stations. In some countries, the combustion of wood or agronomical waste is another major source. Pollution tin can also originate from industrial processes that involve dust germination (for example, from cement factories and metal smelters) or gas releases (for example, from chemicals product). Indoor sources too contribute to outdoor air pollution, and in heavily populated areas, the contribution from indoor sources can create extremely loftier levels of outdoor air pollution.

Motor vehicles emit PM, nitric oxide and NO_ii (together referred to as NO_x), carbon monoxide, organic compounds, and lead. Lead is a gasoline additive that has been phased out in industrial countries, but some developing countries nonetheless use leaded gasoline. Mandating the use of pb-gratuitous gasoline is an important intervention in relation to wellness. It eliminates vehicle-related lead pollution and permits the use of catalytic converters, which reduce emissions of other pollutants.

Catastrophic emissions of organic chemicals, every bit occurred in Bhopal, India, in 1984 (box 43.1), can also have major health consequences (McGranahan and Murray 2003; WHO 1999).

Box 43.1

The Bhopal Ending. The Bhopal plant, owned past the Spousal relationship Carbide Corporation, produced methyl isocyanate, an intermediate in the production of the insecticide carbaryl. On December 2, 1984, a 150,000-gallon storage tank containing methyl isocyanate (more...)

Another type of air pollution that tin take disastrous consequences is radioactive pollution from a malfunctioning nuclear power station, as occurred in Chernobyl in 1986 (WHO 1996). Radioactive isotopes emitted from the called-for reactor spread over big areas of what are now the countries of Belarus, the Russian Federation, and Ukraine, causing thousands of cases of thyroid cancer in children and threatening to crusade many cancer cases in afterward decades.

Exposure to Air Pollutants

The extent of the health effects of air pollution depends on actual exposure. Full daily exposure is adamant past people's fourth dimension and activeness patterns, and information technology combines indoor and outdoor exposures. Immature children and elderly people may travel less during the twenty-four hours than working adults, and their exposure may therefore be closely correlated with air pollution levels in their homes. Children are especially vulnerable to ecology toxicants because of their possibly greater relative exposure and the furnishings on their growth and physiological evolution.

Meteorological factors, such as current of air speed and direction, are usually the strongest determinants of variations in air pollution, along with topography and temperature inversions. Therefore, weather reports can be a guide to probable air pollution levels on a specific twenty-four hours.

Workplace air is another important source of air pollution exposure (chapter lx). Resources extraction and processing industries, which are common in developing countries, emit dust or hazardous fumes at the worksite (table 43.one). Such industries include coalmining, mineral mining, quarrying, and cement production. Developed countries accept shifted much of their hazardous production to developing countries (LaDou 1992). This shift creates jobs in the developing countries, simply at the price of exposure to air pollution resulting from outdated engineering. In addition, specific hazardous compounds, such as asbestos, accept been banned in developed countries (Kazan-Allen 2004), but their use may still exist common in developing countries.

Impacts on Health

Epidemiological assay is needed to quantify the health impact in an exposed population. The major pollutants emitted by combustion have all been associated with increased respiratory and cardiovascular morbidity and bloodshed (Brunekreef and Holgate 2002). The about famous illness outbreak of this type occurred in London in 1952 (U.1000. Ministry of Health 1954), when four,000 people died prematurely in a single week because of severe air pollution, followed by another eight,000 deaths during the next few months (Bell and Davis 2001).

In the 1970s and 1980s, new statistical methods and improved reckoner engineering science immune investigators to study bloodshed increases at much lower concentrations of pollutants. A fundamental question is the extent to which life has been shortened. Early loss of life in elderly people, who would have died presently regardless of the air pollution, has been labeled bloodshed displacement, because it contributes little to the overall burden of disease (McMichael and others 1998).

Long-term studies have documented the increased cardiovascular and respiratory mortality associated with exposure to PM (Dockery and others 1993; Pope and others 1995). A 16-twelvemonth follow-up of a accomplice of 500,000 Americans living in different cities institute that the associations were strongest with PM_2.5 and also established an association with lung cancer mortality (Pope and others 2002). Another approach is ecological studies of small areas based on census data, air pollution data, and health events data (Scoggins and others 2004), with adjustments for potential confounding factors, including socioeconomic status. Such studies indicate that the mortality increase for every 10 micrograms per cubic meter(μg per m³) of PM_2.5 ranges from 4 to 8 percent for cities in adult countries where average almanac PM_2.five levels are x to 30 μg/one thousand³. Many urban areas of developing countries have similar or greater levels of air pollution.

The major urban air pollutants can also give rise to significant respiratory morbidity (WHO 2000). For instance, Romieu and others (1996) report an exacerbation of asthma among children in Mexico City, and Xu and Wang (1993) note an increased take chances of respiratory symptoms in middle-aged not-smokers in Beijing.

In relation to the very young, Wang and others (1997) find that PM exposure, And then₂ exposure, or both increased the risk of low birthweight in Beijing, and Pereira and others (1998) discover that air pollution increased intrauterine bloodshed in São Paulo.

Other furnishings of ambient air pollution are postneonatal bloodshed and mortality caused by acute respiratory infections, as well as effects on children's lung part, cardiovascular and respiratory hospital admissions in the elderly, and markers for functional damage of the heart musculus (WHO 2000). Asthma is another disease that researchers have linked to urban air pollution (McConnell and others 2002; Rios and others 2004). Ozone exposure as a trigger of asthma attacks is of particular business organisation. The mechanism behind an air pollution and asthma link is not fully known, but early childhood NO_two exposure may exist important (run into, for example, Ponsonby and others 2000).

Leaded gasoline creates loftier pb exposure atmospheric condition in urban areas, with a risk for lead poisoning, primarily in young children. The primary concern is effects on the encephalon from low-level exposure leading to behavioral aberrations and reduced or delayed development of intellectual or motoric ability (WHO 1995). Atomic number 82 exposure has been implicated in hypertension in adults, and this event may be the most important for the atomic number 82 burden of illness at a population level (WHO 2002). Other pollutants of business are the carcinogenic volatile organic compounds, which may be related to an increase in lung cancer, as reported by ii recent epidemiological studies (Nyberg and others 2000; Pope and others 2002).

Urban air pollution and atomic number 82 exposure are 2 of the environmental hazards that WHO (2002) assessed as part of its burden-of-affliction calculations for the Earth Health Written report 2002. The written report estimates that pollution past urban PM causes as much as five percent of the global cases of lung cancer, 2 percent of deaths from cardiovascular and respiratory conditions, and ane percent of respiratory infections, adding upward to vii.9 one thousand thousand disability-adjusted life years based on bloodshed just. This burden of disease occurs primarily in developing countries, with China and India contributing the most to the global burden. Eastern Europe besides has major air pollution problems, and in some countries, air pollution accounts for 0.half-dozen to 1.4 percentage of the full disability-adjusted life years from mortality.

The global burden of illness caused by lead exposure includes subtle changes in learning power and behavior and other signs of central nervous system damage (Fewthrell, Kaufmann, and Preuss 2003). WHO (2002) concludes that 0.4 percent of deaths and 0.9 percent (12.9 meg) of all disability-adjusted life years may be due to lead exposure.

Water Pollution

Chemic pollution of surface water can create health risks, because such waterways are often used straight every bit drinking h2o sources or continued with shallow wells used for drinking water. In addition, waterways have important roles for washing and cleaning, for fishing and fish farming, and for recreation.

Some other major source of drinking water is groundwater, which often has depression concentrations of pathogens because the water is filtered during its transit through clandestine layers of sand, dirt, or rocks. However, toxic chemicals such as arsenic and fluoride can be dissolved from the soil or stone layers into groundwater. Direct contamination can too occur from badly designed hazardous waste product sites or from industrial sites. In the United states in the 1980s, the regime set in move the Superfund Program, a major investigation and cleanup plan to deal with such sites (U.S. Environmental Protection Agency 2000).

Coastal pollution of seawater may give rise to health hazards because of local contamination of fish or shellfish—for case, the mercury contamination of fish in the infamous Minamata disease outbreak in Japan in 1956 (WHO 1976). Seawater pollution with persistent chemicals, such equally polychlorinated biphenyls (PCBs) and dioxins, can also be a pregnant health take chances even at extremely low concentrations (Yassi and others 2001).

Sources of Chemic Water Pollution

Chemicals can enter waterways from a bespeak source or a nonpoint source. Point-source pollution is due to discharges from a unmarried source, such equally an industrial site. Nonpoint-source pollution involves many small sources that combine to crusade significant pollution. For example, the motility of rain or irrigation water over country picks upwardly pollutants such as fertilizers, herbicides, and insecticides and carries them into rivers, lakes, reservoirs, coastal waters, or groundwater. Some other nonpoint source is tempest-water that collects on roads and eventually reaches rivers or lakes. Table 43.1 shows examples of bespeak-source industrial chemical pollution.

Newspaper and lurid mills consume large volumes of water and discharge liquid and solid waste products into the surroundings. The liquid waste is usually loftier in biological oxygen demand, suspended solids, and chlorinated organic compounds such as dioxins (Globe Bank 1999). The storage and transport of the resulting solid waste material (wastewater treatment sludge, lime sludge, and ash) may also contaminate surface waters. Sugar mills are associated with effluent characterized by biological oxygen demand and suspended solids, and the effluent is loftier in ammonium content. In improver, the sugarcane rinse liquid may contain pesticide residues. Leather tanneries produce a meaning amount of solid waste material, including hide, hair, and sludge. The wastewater contains chromium, acids, sulfides, and chlorides. Cloth and dye industries emit a liquid effluent that contains toxic residues from the cleaning of equipment. Waste matter from petrochemical manufacturing plants contains suspended solids, oils and grease, phenols, and benzene. Solid waste generated by petrochemical processes contains spent caustic and other chancy chemicals implicated in cancer.

Another major source of industrial water pollution is mining. The grinding of ores and the subsequent processing with water lead to discharges of fine silt with toxic metals into waterways unless proper precautions are taken, such as the utilize of sedimentation ponds. Lead and zinc ores normally contain the much more than toxic cadmium every bit a small-scale component. If the cadmium is not retrieved, major water pollution tin occur. Mining was the source of most of the widespread cadmium poisoning (Itai-Itai disease) in Nippon in 1940–50 (Kjellstrom 1986).

Other metals, such as copper, nickel, and chromium, are essential micronutrients, but in high levels these metals can be harmful to wellness. Wastewater from mines or stainless steel production can be a source of exposure to these metals. The presence of copper in water can also be due to corrosion of drinking h2o pipes. Soft h2o or low pH makes corrosion more likely. Loftier levels of copper may make water appear blue greenish and give it a metallic taste. Flushing the offset water out of the tap tin minimize exposure to copper. The use of pb pipes and plumbing fixtures may consequence in high levels of pb in piped water.

Mercury tin can enter waterways from mining and industrial premises. Incineration of medical waste containing broken medical equipment is a source of environmental contamination with mercury. Metal mercury is also easily transported through the atmosphere considering of its highly volatile nature. Sulfate-reducing bacteria and certain other micro-organisms in lake, river, or coastal underwater sediments can methylate mercury, increasing its toxicity. Methylmercury accumulates and concentrates in the food concatenation and can atomic number 82 to serious neurological disease or more subtle functional impairment to the nervous system (Murata and others 2004).

Runoff from farmland, in improver to conveying soil and sediments that contribute to increased turbidity, also carries nutrients such as nitrogen and phosphates, which are frequently added in the form of fauna manure or fertilizers. These chemicals crusade eutrophication (excessive nutrient levels in water), which increases the growth of algae and plants in waterways, leading to an increase in blue-green alga (blue-green algae). The toxics released during their decay are harmful to humans.

The utilise of nitrogen fertilizers tin be a problem in areas where agronomics is becoming increasingly intensified. These fertilizers increase the concentration of nitrates in groundwater, leading to loftier nitrate levels in cloak-and-dagger drinking water sources, which tin cause methemoglobinemia, the life-threatening "bluish baby" syndrome, in very young children, which is a significant problem in parts of rural Eastern Europe (Yassi and others 2001).

Some pesticides are applied directly on soil to kill pests in the soil or on the footing. This do can create seepage to groundwater or runoff to surface waters. Some pesticides are applied to plants by spraying from a distance—even from airplanes. This practice can create spray drift when the current of air carries the materials to nearby waterways. Efforts to reduce the use of the most toxic and long-lasting pesticides in industrial countries have largely been successful, simply the rules for their use in developing countries may exist more than permissive, and the rules of application may not be known or enforced. Hence, health risks from pesticide water pollution are higher in such countries (WHO 1990).

Naturally occurring toxic chemicals can too contaminate groundwater, such as the high metal concentrations in hole-and-corner water sources in mining areas. The most extensive problem of this type is the arsenic contamination of groundwater in Argentina, Bangladesh (box 43.2), Chile, China, India, United mexican states, Nepal, Taiwan (Mainland china), and parts of Eastern Europe and the United States (WHO 2001). Fluoride is another substance that may occur naturally at high concentrations in parts of China, India, Sri Lanka, Africa, and the eastern Mediterranean. Although fluoride helps preclude dental decay, exposure to levels greater than ane.five milligrams per liter in drinking water tin can cause pitting of tooth enamel and deposits in basic. Exposure to levels greater than x milligrams per liter can crusade crippling skeletal fluorosis (Smith 2003).

Box 43.2

Arsenic in Bangladesh. The presence of arsenic in tube wells in People's republic of bangladesh because of natural contamination from underground geological layers was first confirmed in 1993. Ironically, the United Nations Children's Fund had introduced the wells in the (more than...)

Water disinfection using chemicals is another source of chemical contagion of water. Chlorination is currently the most widely practiced and about cost-constructive method of disinfecting large customs water supplies. This success in disinfecting water supplies has contributed significantly to public health by reducing the transmission of waterborne disease. However, chlorine reacts with naturally occurring organic thing in water to form potentially toxic chemical compounds, known collectively equally disinfection by-products (International Bureau for Research on Cancer 2004).

Exposure to Chemical Water Pollution

Drinking contaminated h2o is the most direct route of exposure to pollutants in water. The actual exposure via drinking water depends on the amount of h2o consumed, usually 2 to 3 liters per day for an developed, with higher amounts for people living in hot areas or people engaged in heavy physical piece of work. Use of contaminated water in food training tin result in contaminated food, considering high cooking temperatures practice not affect the toxicity of near chemical contaminants.

Inhalation exposure to volatile compounds during hot showers and peel exposure while bathing or using water for recreation are also potential routes of exposure to water pollutants. Toxic chemicals in water can bear upon unborn or immature children past crossing the placenta or being ingested through breast milk.

Estimating bodily exposure via h2o involves analyzing the level of the contaminant in the water consumed and assessing daily water intake (WHO 2003). Biological monitoring using blood or urine samples can be a precise tool for measuring total exposure from water, food, and air (Yassi and others 2001).

Health Effects

No published estimates are available of the global burden of disease resulting from the overall effects of chemical pollutants in h2o. The burden in specific local areas may be large, every bit in the example cited in box 43.2 of arsenic in drinking water in People's republic of bangladesh. Other examples of a high local burden of disease are the nervous arrangement diseases of methylmercury poisoning (Minamata disease), the kidney and os diseases of chronic cadmium poisoning (Itai-Itai illness), and the circulatory system diseases of nitrate exposure (methemoglobinemia) and atomic number 82 exposure (anemia and hypertension).

Acute exposure to contaminants in drinking water can cause irritation or inflammation of the eyes and nose, skin, and gastrointestinal arrangement; however, the almost important health effects are due to chronic exposure (for example, liver toxicity) to copper, arsenic, or chromium in drinking water. Excretion of chemicals through the kidney targets the kidney for toxic effects, as seen with chemicals such as cadmium, copper, mercury, and chlorobenzene (WHO 2003).

Pesticides and other chemic contaminants that enter waterways through agricultural runoff, stormwater drains, and industrial discharges may persist in the environment for long periods and be transported by water or air over long distances. They may disrupt the office of the endocrine organisation, resulting in reproductive, developmental, and behavioral problems. The endocrine disruptors can reduce fertility and increase the occurrence of stillbirths, birth defects, and hormonally dependent cancers such as breast, testicular, and prostate cancers. The furnishings on the developing nervous system can include impaired mental and psychomotor development, likewise as cognitive impairment and behavior abnormalities (WHO and International Programme on Chemical Safety 2002). Examples of endocrine disruptors include organochlorines, PCBs, alkylphenols, phytoestrogens (natural estrogens in plants), and pharmaceuticals such every bit antibiotics and synthetic sex hormones from contraceptives. Chemicals in drinking water tin can also exist carcinogenic. Disinfection by-products and arsenic take been a particular concern (International Agency for Research on Cancer 2004).

Interventions

The variety of chancy pollutants that can occur in air or water also leads to many unlike interventions. Interventions pertaining to environmental hazards are oftentimes more sustainable if they address the driving forces behind the pollution at the community level rather than attempt to deal with specific exposures at the private level. In improver, constructive methods to prevent exposure to chemic hazards in the air or water may not exist at the individual level, and the just feasible individual-level intervention may be treating cases of illness.

Figure 43.1 shows five levels at which actions can be taken to preclude the wellness effects of ecology hazards. Some would label interventions at the driving force level equally policy instruments. These include legal restrictions on the employ of a toxic substance, such as banning the apply of lead in gasoline, or customs-level policies, such as boosting public transportation and reducing private employ of motor vehicles.

Figure 43.1

Framework for Environmental Wellness Interventions

Interventions to reduce pressures on ecology quality include those that limit hazardous waste disposal past recycling hazardous substances at their site of use or replacing them with less hazardous materials. Interventions at the level of the country of the environs would include air quality monitoring linked to local actions to reduce pollution during especially polluted periods (for example, banning vehicle utilise when pollution levels reach predetermined thresholds). Interventions at the exposure level include using household water filters to reduce arsenic in drinking h2o equally done in People's republic of bangladesh. Finally, interventions at the effect level would include deportment by wellness services to protect or restore the health of people already showing signs of an adverse effect.

Interventions to Reduce Air Pollution

Reducing air pollution exposure is largely a technical event. Technologies to reduce pollution at its source are plentiful, as are technologies that reduce pollution by filtering it away from the emission source (end-of-pipe solutions; see, for example, Gwilliam, Kojima, and Johnson 2004). Getting these technologies applied in practice requires government or corporate policies that guide technical decision making in the right direction. Such policies could involve outright bans (such every bit requiring lead-gratuitous gasoline or asbestos-gratuitous vehicle brake linings or building materials); guidance on desirable technologies (for instance, providing best-practice manuals); or economic instruments that make using more polluting technologies more than expensive than using less polluting technologies (an example of the polluter pays principle).

Examples of technologies to reduce air pollution include the use of lead-complimentary gasoline, which allows the use of catalytic converters on vehicles' exhaust systems. Such technologies significantly reduce the emissions of several air pollutants from vehicles (box 43.iii). For trucks, buses, and an increasing number of smaller vehicles that utilize diesel, improving the quality of the diesel itself by lowering its sulfur content is another style to reduce air pollution at the source. More fuel-efficient vehicles, such as hybrid gas-electric vehicles, are another way forward. These vehicles can reduce gasoline consumption by about l per centum during city driving. Policies that reduce "unnecessary" driving, or traffic need management, tin can also reduce air pollution in urban areas. A organisation of congestion fees, in which drivers take to pay earlier inbound central urban areas, was introduced in Singapore, Oslo, and London and has been effective in this respect.

Box 43.three

Air Pollution Reduction in Mexico City. Mexico City is one of the world's largest megacities, with most 20 million inhabitants. Local authorities have acknowledged its air quality issues since the 1970s. The emissions from several million motor vehicles (more...)

Power plants and industrial plants that burn fossil fuels use a variety of filtering methods to reduce particles and scrubbing methods to reduce gases, although no constructive method is currently available for the greenhouse gas carbon dioxide. High chimneys dilute pollutants, merely the combined input of pollutants from a number of smokestacks can notwithstanding lead to an overload of pollutants. An of import instance is acid rain, which is caused by SO₂ and NO_x emissions that make water vapor in the atmosphere acidic (WHO 2000). Large combined emissions from industry and power stations in the eastern The states drift northward with the winds and cause impairment to Canadian ecosystems. In Europe, emissions from the industrial belt across Belgium, Deutschland, and Poland drift n to Sweden and have damaged many lakes at that place. The convergence of air pollutants from many sources and the associated health furnishings have also been documented in relation to the multiple fires in Republic of indonesia's rain woods in 1997 (Brauer and Hisham-Hashim 1998); the brown cloud over big areas of Asia, which is mainly related to coal called-for; and a similar brown cloud over fundamental Europe in the summer, which is caused primarily by vehicle emissions.

Managing air pollution interventions involves monitoring air quality, which may focus on exceedances of air quality guidelines in specific hotspots or on attempts to establish a specific population'due south average exposure to pollution. Sophisticated modeling in combination with monitoring has made it possible to start producing detailed estimates and maps of air pollution levels in cardinal urban areas (World Bank 2004), thus providing a powerful tool for assessing current health impacts and estimated changes in the health impacts brought about by divers air pollution interventions.

Interventions to Reduce H2o Pollution

Water pollution control requires activity at all levels of the hierarchical framework shown in effigy 43.1. The platonic method to abate diffuse chemical pollution of waterways is to minimize or avoid the utilise of chemicals for industrial, agricultural, and domestic purposes. Adapting practices such equally organic farming and integrated pest direction could aid protect waterways (Scheierling 1995). Chemical contamination of waterways from industrial emissions could be reduced past cleaner production processes (UNEP 2002). Box 43.four describes one projection aimed at effectively reducing pollution.

Box 43.4

Water Pollution Command in India. In 1993, the Demonstration in Small Industries for Reducing Wastes Project was started in India with back up from the Un Industrial Development Organisation. International and local experts initiated waste product (more...)

Other interventions include proper treatment of chancy waste material and recycling of chemic containers and discarded products containing chemicals to reduce solid waste material buildup and leaching of toxic chemicals into waterways. A variety of technical solutions are bachelor to filter out chemical waste product from industrial processes or otherwise render them harmless. Changing the pH of wastewater or adding chemicals that flocculate the toxic chemicals then that they settle in sedimentation ponds are common methods. The same principle tin be used at the individual household level. I case is the apply of iron fries to filter out arsenic from contaminated well water in Bangladeshi households (Kinniburgh and Smedley 2001).

Intervention Costs and Toll-Effectiveness

This affiliate cannot follow the detailed format for the economic analysis of different preventive interventions devised for the disease-specific chapters, because the exposures, health effects, and interventions are as well varied and because of the lack of overarching examples of economic assessments. Nevertheless, it does present a few examples of the types of analyses available.

Comparing of Interventions

A review of more 1,000 reports on cost per life year saved in the U.s. for 587 interventions in the environment and other fields (table 43.2) evaluated costs from a societal perspective. The net costs included simply directly costs and savings. Indirect costs, such as forgone earnings, were excluded. Future costs and life years saved were discounted at 5 percent per year. Interventions with a cost per life twelvemonth saved of less than or equal to nada toll less to implement than the value of the lives saved. Each of 3 categories of interventions (toxin control, fatal injury reduction, and medicine) presented in table 43.ii includes several extremely cost-effective interventions.

Table 43.2

Median Cost per Life Year Saved, Selected Relatively Low-Cost Interventions (1993 U.S. dollars).

The cost-effective interventions in the air pollution area could exist of value in developing countries equally their industrial and transportation pollution situations go like to the United States in the 1960s. The review by Tengs and others (1995) does not report the extent to which the various interventions were implemented in existing pollution control or public health programs, and many of the near cost-constructive interventions are probably already in broad apply. The review did create a adept deal of controversy in the United States, because professionals and nongovernmental organizations active in the environmental field accused the authors of overestimating the costs and underestimating the benefits of controls over chemicals (run into, for case, U.S. Congress 1999).

Costs and Savings in Relation to Pollution Command

A number of publications review and talk over the evidence on the costs and benefits of different pollution control interventions in industrial countries (see, for case, U.S. Environmental Protection Agency 1999). For developing countries, specific data on this topic are found primarily in the and then-called gray literature: authorities reports, consultant reports, or reports by the international banks.

Air Pollution

Examples of cost-effectiveness assay for assessing air quality policy include studies carried out in Jakarta, Kathmandu, Manila, and Mumbai nether the World Bank'south Urban Air Quality Management Strategy in Asia (Grønskei and others 1996a, 1996b; Larssen and others 1996a, 1996b; Shah, Nagpal, and Brandon 1997). In each city, an emissions inventory was established, and rudimentary dispersion modeling was carried out. Various mitigation measures for reducing PM₁₀ and health impacts were examined in terms of reductions in tons of PM₁₀ emitted, cost of implementation, fourth dimension frame for implementation, and wellness benefits and their associated toll savings. Some of the abatement measures that accept been implemented include introducing unleaded gasoline, tightening standards, introducing low-fume lubricants for two-stroke engine vehicles, implementing inspections of vehicle exhaust emissions to address gross polluters, and reducing garbage burning.

Transportation policies and industrial development do non usually take air quality considerations every bit their primary objective, merely the World Bank has adult a method to take these considerations into account. The costs of different air quality improvement policies are explored in relation to a baseline investment and the estimated health furnishings of air pollution. A comparison volition indicate the cost-effectiveness of each policy. The World Bank has worked out this "overlay" approach in some detail for the energy and forestry sectors in the coordinating case of greenhouse gas reduction strategies (World Bank 2004).

Water Pollution

The costs and benefits associated with interventions to remove chemical contaminants from water need to exist assessed on a local or national basis to determine specific needs, available resource, environmental conditions (including climate), and sustainability. A developing country for which substantial economic analysis of interventions has been carried out is China (Dasgupta, Wang, and Wheeler 1997; Zhang and others 1996).

Some other country with major concerns about chemicals (arsenic) in water is Bangladesh. The arsenic mitigation programs take practical various arsenic removal technologies, merely the costs and benefits are not well established. Bangladesh has adopted a drinking h2o standard of 50 μg/L (micrograms per liter) for arsenic in drinking water. The toll of achieving the lower WHO guideline value of x μg/Fifty would be significant. An evaluation of the toll of lowering arsenic levels in drinking water in the United States predicts that a reduction from 50 to 10 μg/L would prevent a express number of deaths from bladder and lung cancer at a cost of several million dollars per death prevented (Frost and others 2002).

Alternative water supplies need to be considered when the costs of improving existing water sources outweigh the benefits. Harvesting rainwater may provide communities with safe drinking water, gratis of chemicals and micro-organisms, but contagion from roofs and storage tanks needs to be considered. Rainwater drove is relatively inexpensive.

Economical Benefits of Interventions

One of the early examples of toll-benefit analysis for chemic pollution command is the Japan Environment Bureau'due south (1991) study of 3 Japanese classical pollution diseases: Yokkaichi asthma, Minamata disease, and Itai-Itai illness (table 43.3). This analysis was intended to highlight the economical aspects of pollution control and to encourage governments in developing countries to consider both the costs and the benefits of industrial development. The calculations accept into account the 20 or thirty years that have elapsed since the affliction outbreaks occurred and annualize the costs and benefits over a 30-twelvemonth period. The pollution damage costs are the actual payments for victims' compensation and the toll of ecology remediation. The compensation costs are based on court cases or regime decisions and can be seen as a valid representation of the economic value of the wellness damage in each case. As table 43.three shows, controlling the relevant pollutants would accept cost far less than paying for damage acquired past the pollution.

Table 43.three

Comparison of Actual Pollution Damage Costs and the Pollution Control Costs That Would Have Prevented the Damage, for Three Pollution-related Affliction Outbreaks, Nihon (¥ millions, 1989 equivalents).

A few studies accept analyzed cost-benefit aspects of air pollution control in specific cities. Those analyses are based mainly on modeling health impacts from exposure and relationships between doses and responses. Voorhees and others (2001) observe that most studies that analyzed the situation in specific urban areas used health impact assessment to gauge impacts avoided past interventions. Investigators have used different methods for valuing the economic benefits of health improvements, including market valuation, stated preference methods, and revealed preference methods. The choice of assumptions and inputs substantially affected the resulting cost and benefit valuations.

One of the few detailed studies of the costs and benefits of air pollution control in a specific urban area (Voorhees and others 2000) used changing nitric oxide and NO₂ emissions in Tokyo during 1973–94 as a basis for the calculations. The study did not use actual health comeback data but calculated likely wellness improvements from estimated reductions in NO_ii levels and published dose-response curves. The health effects included respiratory morbidity (as determined by hospital admissions and medical expenses), and working days lost for sick adults, and maternal working days lost in the case of a child'southward illness. The results indicated an average cost-benefit ratio of 1 to 6, with a large range from a lower limit of 3 to one to an upper limit of 1 to 44. The estimated economic benefits of reductions in nitric oxide and NO_two emissions between 1973 and 1994 were considerable: The states$6.78 billion for avoided medical costs, US$6.33 billion for avoided lost wages of sick adults, and US$0.83 billion for avoided lost wages of mothers with sick children.

Blackman and others' (2000) cost-do good analysis of four practical strategies for reducing PM₁₀ emissions from traditional brick kilns in Ciudad Juárez in United mexican states suggests that, given a broad range of modeling assumptions, the benefits of 3 command strategies would exist considerably higher than the costs. Reduced bloodshed was by far the largest component of benefits, accounting for more than lxxx percent of the total.

Pandey and Nathwani (2003) practical toll-benefit analysis to a pollution command program in Canada. Their study proposed using the life quality index as a tool for quantifying the level of public expenditure beyond which the use of resources is not justified. The report estimated total pollution control costs at United states of america$two.5 billion per year against a monetary benefit of US$7.five billion per year, using 1996 every bit the base year for all cost and benefit estimates. The do good estimated in terms of avoided bloodshed was about 1,800 deaths per year.

El-Fadel and Massoud'south (2000) study of urban areas in Lebanon shows that the health benefits and economic benefits of reducing PM concentration in the air can range from U.s.$4.53 million to US$172.50 one thousand thousand per year using a willingness-to-pay arroyo. In that written report, the major monetized benefits resulted from reduced mortality costs.

Aunan and others (1998) assessed the costs and benefits of implementing an energy saving and air pollution control plan in Hungary. They based their budgetary evaluation of benefits on local monitoring and population information and took exposure-response functions and valuation estimates from Canadian, U.Due south., and European studies. The authors valued the average total benefits of the interventions at US$i.56 billion per year (with 1994 every bit the base year), with high and depression bounds at Us$seven.vi, billion and US$0.four billion, respectively. They estimated the cost-benefit ratio at 1 to 3.4, given a full price of interventions of US$0.46 billion per year. Many of the benefits resulted from reduced mortality in the elderly population and from reduced asthma morbidity costs.

Misra (2002) examined the costs and benefits of h2o pollution abatement for a cluster of 250 minor-scale industries in Gujarat, India. Misra'south assessment looked at command-and-control, market place-based solutions and at effluent treatment as alternatives. In a cost-benefit analysis, Misra estimated the net present social benefits from water pollution abatement at the Nandesari Industrial Estate at Rs 0.550 billion at 1995–96 market prices using a 12 pct social discount charge per unit. After making corrections for the prices of strange exchange, unskilled labor, and investment, the effigy rose to Rs 0.62 billion. It rose still further to most Rs 3.ane billion when distributional furnishings were taken into business relationship.

Implementation of Command Strategies: Lessons of Feel

The foregoing examples demonstrate that interventions to protect health that use chemic pollution control tin can take an attractive cost-benefit ratio. The Japan Environment Agency (1991) estimates the national economic impact of pollution control legislation and associated interventions. During the 1960s and early 1970s, when the regime made many of the major decisions about intensified pollution command interventions, Nippon's gross domestic production (GDP) per capita was growing at an almanac rate of about 10 percentage, similar to that of the rapidly industrializing countries in the early 21st century. At that time, Japan's economic policies aimed at eliminating bottlenecks to high economic growth, and in the mid 1960s, industry was spending less than ¥50 billion per yr on pollution control equipment. Past 1976, this spending had increased to almost ¥1 trillion per year. The ¥5 trillion invested in pollution control between 1965 and 1975 accounted for well-nigh 0.ix percentage of the increase in Gdp per capita during this flow. The Japan Environs Bureau concluded that the stricter environmental protection legislation and associated major investment in pollution command had lilliputian effect on the overall economy, but that the resulting health benefits are likely cumulative.

Air

The broadest analysis of the implementation of command strategies for air pollution was conducted by the U.Due south. Environmental Protection Agency in the belatedly 1990s (Krupnick and Morgenstern 2002). The analysis developed a hypothetical scenario for 1970 to 1990, assuming that the real costs for pollution control during this catamenia could be compared with the benefits of reduced mortality and morbidity and avoided harm to agricultural crops brought about by the reduction of major air pollutant levels across the land during this catamenia. The report estimated reduced mortality from dose-response relationships for the major air pollutants, assigning the cost of each death at the value of statistical life and the toll of morbidity in relation to estimated health service utilization. The study used a variety of costing methods to accomplish the range of likely nowadays values presented in tabular array 43.4. It assumed that the reduction of air pollution resulted from the implementation of the federal Clean Air Act of 1970 and associated land-level regulations and air pollution limits.

Table 43.4

Present Value of Monetary Benefits and Costs Associated with Implementation of the U.S. Clean Air Deed, 1970–90 (1990 United states of america$ billions).

The analysis showed a dramatically high cost-benefit ratio and inspired argue virtually the methodologies used and the results. 1 major criticism was of the utilise of the value of statistical life for each decease potentially avoided past the reduced air pollution. A recalculation using the life-years-lost method reduced the benefits for deaths caused by PM from Usa$16,632 billion to US$9,100 billion (Krupnick and Morgenstern 2002). The recalculated effigy is still well higher up the 5th percentile judge of benefits and does not undermine the positive cost-benefit ratio reported. Thus, if a developing country were to implement an appropriate control strategy for urban air pollution, it might derive significant economic benefits over the subsequent decades. The land'southward level of economic development, local costs, and local benefit valuations will be important for whatever cost-benefit cess. WHO's (2000) air quality guidelines are amidst the documents that provide advice on analytical approaches.

Water

We were unable to find an assay for water similar to the broad assay presented for air, but the examples of water pollution with mercury, cadmium, and arsenic described earlier indicate the economic benefits that tin can be reaped from effective interventions against chemical water pollution. Since the pollution disease outbreaks of mercury and cadmium poisoning in Nippon, serious mercury pollution situations have been identified in Brazil, China, and the Philippines, and serious cadmium pollution has occurred in Cambodia, China, the Lao People's Democratic Commonwealth, and Thailand. Arsenic in groundwater is an ongoing, serious problem in Bangladesh, Bharat, and Nepal and a less serious problem in a number of other countries.

WHO has analyzed control strategies for biological water pollution and h2o and sanitation improvements in relation to the Millennium Development Goals (Hutton and Haller 2004). The analysis demonstrated the considerable benefits of water and sanitation improvements: for every United states of america$i invested, the economical return was in the range of US$5 to US$28 for a number of intervention options. Careful analysis of the same type is required for populations particularly vulnerable to chemic water pollution to assess whether control of chemic pollution can also yield significant benefits.

Research and Development Agenda

Even though a good bargain of information is available near the health risks of mutual air and water pollutants, further research is needed to guide regulations and interventions. The pollutants that were most common in developed countries in the past are withal major problems in developing countries; still, direct application of the experiences of developed countries may not exist appropriate, considering exposed populations in developing countries may accept a different burden of preexisting diseases, malnutrition, and other factors related to poverty. Research on specific vulnerabilities and on relevant dose-response relationships for dissimilar levels of economic development and for various geographic conditions would therefore be valuable for assessing risks and targeting interventions. In addition, global chemical exposure concerns, such as endocrine disruptors in air, h2o, and food, crave urgent research to found the need for interventions in both industrial and developing countries.

An important research topic is to clearly describe and quantify the long-term health furnishings of exposure to air pollution. The existing literature indicates that long-term exposure may take more adverse health effects than curt-term exposure and, hence, accept college cost implications. Another topic is to assess the wellness outcome pertaining to greenhouse gases and climate change, which are related to the same sources as urban air pollution (Intergovernmental Console on Climate Change 2001). Research and policy analysis on how all-time to develop interventions to reduce health risks related to climate change demand to be considered together with the assay of other air pollutants.

In addition, to improve assay of the economic costs of health impacts, better estimates are needed of the burden of illness related to chemic air and water pollution at local, national, and global levels. Price-effectiveness assay of air and water pollution control measures in developing countries needs to be supported by further research, equally cost levels and benefit valuations will vary from country to country, and solutions that are valid in industrial countries may not work also in developing countries. Strategies for effective air and water resource management should include research on the potential side effects of an intervention, such every bit in Bangladesh, where tube wells drilled to supply water turned out to exist contaminated with arsenic (see box 43.2). Research is also needed that would link methodologies for assessing adverse health effects with exposure and epidemiological studies in unlike settings to permit the evolution of more precise forecasting of the health and economic benefits of interventions.

The variety of health effects of urban air pollution and the variety of sources create opportunities for ancillary furnishings that need to exist taken into account in economic cost-effectiveness and toll-benefit assay. These are the beneficial effects of reducing air pollution on other health risks associated with the sources of air pollution. For example, if the air pollution from transportation emissions is reduced by actions that reduce the use of private motor vehicles by, say, providing public transportation, not only are carbon dioxide levels reduced; traffic crash injuries, noise, and physical inactivity related to the widespread use of motor vehicles also decline (Kjellstrom and others 2003).

One of the key challenges for policies and deportment is to detect means to avoid a rapid buildup of urban air pollution in countries that do not notwithstanding have a major problem. The health sector needs to be involved in assessing urban planning, the location of industries, and the development of transportation systems and needs to encourage those designing public transportation and housing to ensure that new sources of air pollution are not existence built into cities.

Decades of economic and industrial growth have resulted in lifestyles that increment the demands on h2o resources simultaneous with increases in water pollution levels. Conflicts between household, industrial, and agricultural water use are a common public health problem (UNESCO 2003). The developing countries need to avoid the experiences of h2o pollution and associated disease outbreaks in industrial countries. Strategies to ensure sufficient pollution command must exist identified at the aforementioned time as strategies to reduce h2o consumption. High water use depletes supplies and increases salinity in groundwater aquifers, particularly in littoral regions. The impact of climatic change must also exist taken into consideration (Vorosmarty and others 2000).

Conclusion: Promises and Pitfalls

Evidence shows that a number of chemicals that may be released into the air or h2o tin can cause agin health effects. The associated burden of disease can be substantial, and investment in research on wellness furnishings and interventions in specific populations and exposure situations is of import for the development of control strategies. Pollution control is therefore an important component of disease control, and wellness professionals and authorities need to develop partnerships with other sectors to place and implement priority interventions.

Developing countries face up major water quantity and quality challenges, compounded by the furnishings of rapid industrialization. Concerted actions are needed to safely manage the employ of toxic chemicals and to develop monitoring and regulatory guidelines. Recycling and the use of biodegradable products must exist encouraged. Technologies to reduce air pollution at the source are well established and should be used in all new industrial development. Retrofitting of existing industries and power plants is also worthwhile. The growing number of individual motor vehicles in developing countries brings sure benefits, but alternative ways of transportation, especially in rapidly growing urban areas, need to be considered at an early phase, as the negative health and economic impacts of loftier concentrations of motor vehicles are well established. The principles and practices of sustainable development, coupled with local research, volition help comprise or eliminate health risks resulting from chemical pollution. International collaboration involving both governmental and nongovernmental organizations can guide this highly interdisciplinary and intersectoral area of disease control.

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