Household Air Pollution Global, Regional & Country Action Plans. Lesley Onyon, Regional Advisor, WHO SEARO

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1 Household Air Pollution Global, Regional & Country Action Plans Lesley Onyon, Regional Advisor, WHO SEARO

2 Outline of presentation l Non-Communicable Disease (NCD) Ø Shifting burdens of disease attributable to environmental factors Ø Global NCD Action Plans l Air Pollution household & ambient air pollution l Action on Household Air Pollution as component of NCD Action Plans l Progress on NCD/HAP Action Plans at Regional Level l Finalization of NCD/HAP Action Plan for Bhutan

3 New estimates of the burden of disease attributable to environment l New WHO Report 15 March 16 l Environmental risks account for 23% of all deaths and 22% of the global disease burden l Total environmental deaths unchanged since 2006 but show a strong shift to Noncommunicable diseases

4 Key recent WHO evidence Health impacts of air pollution Global Burden of Disease Estimates 2012 March 2014 Global database on Outdoor Air Pollution in cities - May 2014 Global databases on Household Energy Use & Household Air Pollution November 2014 New Guidelines for Household Fuel Combustion December 2014

5 Burden of disease from Air Pollution l Outdoor air pollution 3.7 million deaths/yr large proportion urban exposures l Household air pollution 4,3 million deaths/yr use of solid fuel for cooking purposes

6 Particular impacts on vulnerable with household air pollution Breakdown of 4.3 million deaths by disease l 54% of all pneumonia deaths among children < 5 yr l ~30 % of all chronic obstructive pulmonary disease (COPD) deaths l ~15% of all deaths from ischaemic heart disease (IHD)

7 Household air pollution in Bhutan l Rural areas 56% Burden of disease in Bhutan 29% all disease burden =HAP l Urban areas <5% l National average 36% 22% COPD 19% Cataracts 27% IHD 28% Lung cancer 31% Stroke 39% ALRI <5 yrs

8 WHO action Expected Roadmap for an enhanced global response (May 2016) MONITORING AND REPORTING: Some global monitoring and reporting on health trends associated with exposure to air pollution is being carried out by a few actors. There as a need for harmonization of data instruments and for more national level information. GLOBAL LEADERSHIP AND COORDINATION - SDG Coordination INSTITUTIONAL CAPACITY STRENGTHENING - Implementation of guidelines recommendatons

9 Global NCD Action Plans l NCD (incl heart disease, stoke, cancer, diabetes and chronic lung disease) collectively responsible for almost 70% of all deaths worldwide. l Rise of NCDs driven by four major risk factors - tobacco use, physical inactivity, harmful use of alcohol & unhealthy diets. l Global action plan adopted at 66 th World Health Assembly in May Follows commitments made in UN political declaration on prevention & control of NCD l Provides a road map, policy options for MS, UN orgs, IGOs, NGOs & private sector. 9 voluntary targets to achieve 25% relative reduction in premature deaths

10 Regional NCD Action Plan South-East Asia

11 Additional SEAR target for HAP 50% reduction in the proportion of households with solid fuel as the primary source of cooking

12 Progress on NCD Action Plans in WHO SEAR Progress of Multisectoral NCD Action Plan Development by Member States in line with the 2025 NCD Voluntary targets: lmultisectoral NCD Action Plans endorsed: Bhutan, Maldives, Nepal, Sri Lanka, DPRK, Timor Leste (6/11) lplans developed but waiting for government endorsement: India, Bangladesh, Myanmar (3/11) leither using previous plans or at the stage of development: Thailand, Indonesia

13 NCD Action Plan for Bhutan endorsed 6 July 2015 Two action areas for reducing household air pollution ( ) l Establish standards for indoor air quality promotion, monitoring and identify communities with exposure to poor indoor air quality, educate communities l Expand community-based programs aimed at encouraging the use of improved cookstoves, good cooking practices and use of alternative energy sources for households to improve indoor air quality

14 Planned activities in Bhutan ( ) Action area 2.61 l Adapt national guideline and standards for indoor air quality l Mapping of communities with potential high exposure to indoor air pollution l Conduct study of indoor air quality in identified high risk communities l Set up services and equipment for monitoring indoor air quality in selected areas

15 Planned activities in Bhutan ( ) Action area 2.62 l Introduce electric bulk cookers for the common dining programme in the monastic institutions l Deliver additional 5000 improved cookstoves for high risk communities l Expand additional domestic 2000 biogas plants l Explore the program options for providing subsidies for improved cooking appliances and stove in high risk poor communities l Design and conduct community targeted awareness programmes in priority high risk communities

16 Key messages l Household air pollution recognized as leading cause of premature mortality and morbidity l Particular priority in South-East Asia l Additional Target in Regional NCD Action Plan l Solid commitments in national multi-sectoral action plans by Governments bring possibility for whole of government approach coordinated and led by health sector

17 Thank you

18 WHO works globally, regionally at country levels l South-East Asia 11 Member States: Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor- Leste

19 The role of WHO l l l l l l providing leadership on matters critical to health shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; providing technical support, catalyzing change, and building sustainable institutional capacity; and monitoring the health situation and assessing health trends

20 Particulate matter (PM 10 ) levels by region for the last available year in the period PM10 [mg/m3] PM10: Fine particulate matter of 10 microns or less; Afr: Africa; Amr: America; Emr: Eastern Mediterranean; Eur: Europe; Sear: South-East Asia; Wpr: Western Pacific; LMI: Low- and middle-income; HI: high-income.

21 Air quality in cities is worsening % of assessed urban population 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% exceed AQG meet AQG 12% Afr: Africa; Amr: America; Emr: Eastern Mediterranean; Eur: Europe; Sear: South-East Asia; Wpr: Western Pacific; LMI: Low- and middle-income; HI: high-income; AQG: WHO Air Quality Guidelines : Annual mean PM10: 20 mg/m3; Annual mean PM2.5: 10 m g/m3.

22 India Household Air Pollution Solid Fuel Combustion India l 40% of all disease burden l 37% of all deaths l By outcomes Ø 39% all COPD Ø 33% IHD Ø 38% Lung cancer Ø 37% stroke Ø More than 50% ALRI in children

23 Outdoor Air Pollution in India

24 World Health Assembly Resolution May 2015 Addressing the health impact of air pollution l l l l Highlights the key role health authorities in raising awareness about the potential to save lives and reduce health costs, if air pollution is addressed effectively. Need for strong cooperation between different sectors and integration of health concerns into all national, regional and local air pollution-related policies. It urges Member States to develop air quality monitoring systems and health registries to improve surveillance for all illnesses related to air pollution; It urges Member States to strengthen international transfer of expertise, technologies and scientific data in the field of air pollution

25 World Health Assembly Resolution A68.8 Member States request WHO l To build capacity to implement the "WHO air quality guidelines" and "WHO indoor air quality guidelines; l Regularly update the WHO air quality guidelines l Compile and analyse data on air quality, health l Conduct cost-benefit assessment of mitigation measures; l Disseminate evidence-based best practices on effective indoor and ambient air quality interventions and policies related to health l Advance research into air pollution s health effects and effectiveness. l Propose a road map for an enhanced global response by the health sector that reduces the adverse health effects of air pollution

26 Progress in SE Asia Targets for tackling NCDs include HAP

27 Initial workshop in SEARO Region December 2014 Main outcomes l Provided an opportunity for discussion of relevant issues in South- East Asia in which health and environment sectors. l Emphasized the need for increased participation of ministries of health Ø Engaging in the debate with other sectors e.g. urban development, transport, environment for healthy decision making Ø Advocating for inclusion of health goals & use of health based guidelines in development of regional national & subnational air quality policies Ø Linking monitoring data with health outcome data Ø Strengthening monitoring & evaluation though development of appropriate indicators

28 Future Road Map to be considered WHO Assembly 2016 MONITORING AND REPORTING: Some global monitoring and reporting on health trends associated with exposure to air pollution is being carried out by a few actors. There as a need for harmonization of data instruments and for more national level information. GLOBAL LEADERSHIP AND COORDINATION - SDG Coordination INSTITUTIONAL CAPACITY STRENGTHENING - Implementation of guidelines recommendatons

29 Supporting implementation in countries Needs assessment and mapping Survey and AQ measurement tools COUNTRY M&E strategy, capacity and resources Intervention options assessment ACTION PLAN Multisectoral task group Policy (finance, market, &c.) for adoption and sustained use HAPIT tool Standards, testing and certification Emissions model

30 WHO Resources for Member States to Address & Prevent Health Impacts of Air Pollution l l WHO Ambient Air Pollution in Cities Database Ø Data for over 1600 cities Global Platform on Air Quality and Health Ø Provides estimates of air pollution in urban and rural areas using satellites, chemical transport models calibrated by ground-level monitoring l WHO Household Energy Database based on over 800 household surveys, being upgraded to include: fuels and technologies for lighting, heating and cooking as well as fuel stacking l Household air pollution database - includes studies with actual measurements of indoor air quality l WHO Clean Home Energy Policy Planning Tool (under development) Tool kit for policy makers in implementing the indoor air quality guidelines l Urban Health Tools (planned) Health and economic tools to inform policy planning and implementation

31 Thank you

32 WHO Guidelines for Air Quality l Normative work Ø WHO Air Quality Guidelines: provide the scientific evidence on the health impacts of air pollution as well as recommendations on pollutant levels safe for health Ø WHO Indoor air quality guidelines for household fuel combustion: provide guidance on policies and the impact of different fuels/technologies (for cooking, heating & lighting) on health

33 WHO Air Quality Guidelines: PM 2.5 and carbon monoxide (CO) Pollutant PM 2.5 (2005) Pollutant Carbon monoxide (2010) Guideline or target Exposure period Guideline Annual 10 IT-3 average 15 IT-2 25 IT-1 35 Guideline or target Exposure period Guideline 8-hour 10 Guideline 24-hour 7 Level (µg/m 3 ) Level (mg/m 3 )

34 Global Platform on Air Quality and Health l Established in January 2014 l l l Main purpose: Strengthening countries capacity to address air pollution and related health risks through enhanced estimates of air pollution exposure Availability of information about exposure of population to air pollution is the key for: Ø risk assessment Ø communication Ø development and implementation of effective policies. A wide collaboration with international agencies including UNECE, WMO, UNEP, JRC, IIASA, World Bank, space research agencies (e.g. NASA, JAXA), as well as national agencies and research institutions. Brauer M, Ammann M, Burnett R et al. GBD 2010 Outdoor Air Pollution Expert Group 2011

35 Global Platform on Air Quality and Health (cont d) l l Some examples of the upcoming work of the Platform s tasks forces include: Ø Improving methods of integrating air pollution data from satellite, ground monitoring and chemical models (Data fusion & synthesis) Ø Further characterizing air pollution sources such as transport, industry and agriculture (Source apportionment) Ø Enhancing data collection on air pollution exposures resulting from cooking, heating and lighting in the home Ø Guidance/protocols for the collection of ground measurement data Ø Surface monitoring: key air pollution indicators to be monitored, minimum data sets for health purposes; systematic data collection and display The Global Platform will be Internet-based allowing open-access to data and information to stimulate policy development, facilitating monitoring and evaluation, and assisting in building capacity to prevent diseases associated with air pollution in all countries of the world.

36 New WHO Guidelines for Indoor Air Quality l Launched globally November 2014 l What they tell us: How clean is clean enough What fuels shouldn t be used All end-uses (e.g. cooking, heating, lighting) need to be clean Transition to clean will take time & vary across settings Climate co-benefits

37 Early steps toward implementation of Global WHO resolution l raise awareness of the public health risks of air pollution and the multiple benefits of improved air quality, in particular in the context of the discussions on the post development agenda l support and guidance for Member States in implementing the WHO air quality guidelines and WHO indoor air quality guidelines; ; advise and support tools to assist the health and other sectors at all levels of government, especially the local level and in urban areas, taking into account different sources of pollution in tackling air pollution and their health effects; collaborate, as appropriate, with relevant international, regional and national stakeholders, to compile and analyse data on air quality, with particular emphasis on health-related aspects of air quality

38 Urban Health Project Outputs l Develop health and economic tools to provide evidence on health cobenefits of measures and policies to reduce air pollution, and by providing a model process for implementation on local level. l Using and training of tools will build local capacity so as to address local policy making on air pollution and their sources, while demonstrating health co-benefits linked to action on air pollution reduction that can be achieved at policy level. l Tools, methods and procedures will be tested at city level to be scaled for wider use.. l Project aims to reduce deaths and diseases associated with air pollutants, as well as the realisation of climate and health co-benefits (e.g. less injuries and vector borne diseases), from policies and measures to tackle air pollution.