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.