Minimal Dissolved Oxygen Requirements of Aquatic Life With Emphasis on Canadian Species a Review

Environmental pollution has many facets, and the resultant health 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 (capacity 25 and 35), cancers (chapter 29), neurological disorders (chapter 32), and cardiovascular illness (affiliate 33), equally well equally with a number of chapters dealing with health care bug.

Nature, Causes, and Burden of Air and Water Pollution

Each pollutant has its own wellness risk profile, which makes summarizing all relevant information into a brusque chapter difficult. Nevertheless, public health practitioners and decision makers in developing countries need to be aware of the potential health risks caused past air and water pollution and to know where to detect the more detailed information required to handle a specific situation. This affiliate volition not repeat the discussion most indoor air pollution acquired by biomass called-for (affiliate 42) and water pollution caused by poor sanitation at the household level (affiliate 41), but it will focus on the problems acquired by air and water pollution at the community, country, and global levels.

Estimates signal that the proportion of the global brunt of disease associated with environmental pollution hazards ranges from 23 pct (WHO-1997) to 30 percent (Smith, Corvalan, and Kjellstrom 1999). These estimates include infectious diseases related to drinking water, sanitation, and food hygiene; respiratory diseases related to severe indoor air pollution from biomass burning; and vectorborne diseases with a major environmental component, such as malaria. These 3 types of diseases each contribute approximately 6 percent to the updated estimate of the global burden of affliction (WHO 2002).

As the World Health System (WHO) points out, outdoor air pollution contributes as much as 0.6 to i.four percent of the burden of disease in developing regions, and other pollution, such as lead in water, air, and soil, may contribute 0.9 percentage (WHO 2002). These numbers may look small, but the contribution from nigh risk factors other than the "top 10" is within the 0.v to one.0 percent range (WHO 2002).

Considering of space limitations, this affiliate tin can give only selected examples of air and water pollution health concerns. Other information sources on environmental health include Yassi and others (2001) and the Web sites of or major reference works past WHO, the United Nations Environment Programme (UNEP), Division of Technology, Industry, and Economic science (http://www.uneptie.org/); the International Labour System (ILO), the United Nations Industrial Development Organization (UNIDO; http://www.unido.org/), and other relevant agencies.

Table 43.ane indicates some of the industrial sectors that tin pose significant environmental and occupational health risks to populations in developing countries. Clearly, disease control measures for people working in or living effectually a smelter may exist quite different from those for people living near a tannery or a brewery. For detailed data about industry-specific pollution control methods, see the Web sites of manufacture sector organizations, relevant international trade 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 unremarkably classified into suspended particulate matter (PM) (dusts, fumes, mists, and smokes); gaseous pollutants (gases and vapors); and odors.

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

Gaseous pollutants include sulfur compounds such as Then_ii and sulfur trioxide; carbon monoxide; nitrogen compounds such as nitric oxide, NO_two, and ammonia; organic compounds such as hydrocarbons; volatile organic compounds; polycyclic aromatic hydrocarbons and halogen derivatives such as aldehydes; and odorous substances. Volatile organic compounds are released from burning fuel (gasoline, oil, coal, wood, charcoal, natural gas, and then on); solvents; paints; glues; and other products commonly used at work or at habitation. 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 basis level. Ozone at this level creates health concerns, unlike ozone in the upper atmosphere, which occurs naturally and protects life by filtering out ultraviolet radiations from the sun.

Sources of Outdoor Air Pollution

Outdoor air pollution is caused mainly by the combustion of petroleum products or coal by motor vehicles, manufacture, and power stations. In some countries, the combustion of wood or agricultural waste is another major source. Pollution can as well originate from industrial processes that involve dust formation (for example, from cement factories and metal smelters) or gas releases (for example, from chemicals production). 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 NO₂ (together referred to equally 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 utilize leaded gasoline. Mandating the use of lead-free gasoline is an of import intervention in relation to health. Information technology eliminates vehicle-related atomic number 82 pollution and permits the use of catalytic converters, which reduce emissions of other pollutants.

Catastrophic emissions of organic chemicals, equally occurred in Bhopal, India, in 1984 (box 43.ane), can also have major wellness consequences (McGranahan and Murray 2003; WHO 1999).

Box 43.i

The Bhopal Catastrophe. The Bhopal plant, endemic by the Union Carbide Corporation, produced methyl isocyanate, an intermediate in the production of the insecticide carbaryl. On December ii, 1984, a 150,000-gallon storage tank containing methyl isocyanate (more...)

Another type of air pollution that tin can have disastrous consequences is radioactive pollution from a malfunctioning nuclear power station, as occurred in Chernobyl in 1986 (WHO 1996). Radioactive isotopes emitted from the burning reactor spread over large areas of what are at present the countries of Belarus, the Russian Federation, and Ukraine, causing thousands of cases of thyroid cancer in children and threatening to cause many cancer cases in later decades.

Exposure to Air Pollutants

The extent of the health effects of air pollution depends on actual exposure. Total daily exposure is determined past people's time and action patterns, and information technology combines indoor and outdoor exposures. Young children and elderly people may travel less during the day than working adults, and their exposure may therefore be closely correlated with air pollution levels in their homes. Children are particularly vulnerable to ecology toxicants because of their maybe greater relative exposure and the effects on their growth and physiological development.

Meteorological factors, such every bit wind 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 likely air pollution levels on a specific 24-hour interval.

Workplace air is another important source of air pollution exposure (chapter 60). Resources extraction and processing industries, which are common in developing countries, emit dust or hazardous fumes at the worksite (table 43.1). Such industries include coalmining, mineral mining, quarrying, and cement production. Adult countries have shifted much of their hazardous production to developing countries (LaDou 1992). This shift creates jobs in the developing countries, but at the toll of exposure to air pollution resulting from outdated engineering science. In addition, specific hazardous compounds, such equally asbestos, take been banned in developed countries (Kazan-Allen 2004), only their utilize may still be mutual in developing countries.

Impacts on Wellness

Epidemiological analysis is needed to quantify the health impact in an exposed population. The major pollutants emitted by combustion take all been associated with increased respiratory and cardiovascular morbidity and bloodshed (Brunekreef and Holgate 2002). The most famous illness outbreak of this blazon occurred in London in 1952 (U.K. Ministry of Health 1954), when 4,000 people died prematurely in a single week because of severe air pollution, followed by another viii,000 deaths during the next few months (Bell and Davis 2001).

In the 1970s and 1980s, new statistical methods and improved computer technology immune investigators to study mortality increases at much lower concentrations of pollutants. A key question is the extent to which life has been shortened. Early loss of life in elderly people, who would have died soon regardless of the air pollution, has been labeled mortality 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-year follow-up of a accomplice of 500,000 Americans living in different cities found that the associations were strongest with PM_2.5 and also established an association with lung cancer bloodshed (Pope and others 2002). Some other approach is ecological studies of small-scale areas based on census information, air pollution information, and health events information (Scoggins and others 2004), with adjustments for potential misreckoning factors, including socioeconomic status. Such studies indicate that the mortality increment for every 10 micrograms per cubic meter(μg per 1000³) of PM_2.5 ranges from iv to 8 percent for cities in developed countries where average almanac PM_2.v levels are 10 to xxx μg/m³. Many urban areas of developing countries have similar or greater levels of air pollution.

The major urban air pollutants can also give rise to pregnant respiratory morbidity (WHO 2000). For instance, Romieu and others (1996) report an exacerbation of asthma amid children in United mexican states Urban center, and Xu and Wang (1993) note an increased gamble of respiratory symptoms in eye-aged non-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) notice that air pollution increased intrauterine bloodshed in São Paulo.

Other effects of ambient air pollution are postneonatal mortality and mortality caused past acute respiratory infections, equally well equally effects on children's lung function, cardiovascular and respiratory hospital admissions in the elderly, and markers for functional impairment of the heart muscle (WHO 2000). Asthma is another disease that researchers have linked to urban air pollution (McConnell and others 2002; Rios and others 2004). Ozone exposure equally a trigger of asthma attacks is of item concern. The mechanism behind an air pollution and asthma link is not fully known, merely early childhood NO_ii exposure may be important (come across, for case, Ponsonby and others 2000).

Leaded gasoline creates loftier lead exposure conditions in urban areas, with a take a chance for pb poisoning, primarily in young children. The main concern is furnishings on the brain from depression-level exposure leading to behavioral aberrations and reduced or delayed development of intellectual or motoric ability (WHO 1995). Lead exposure has been implicated in hypertension in adults, and this effect may be the near 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 past 2 recent epidemiological studies (Nyberg and others 2000; Pope and others 2002).

Urban air pollution and lead exposure are two of the ecology hazards that WHO (2002) assessed as part of its brunt-of-disease calculations for the World Health Report 2002. The study estimates that pollution by urban PM causes as much as 5 percent of the global cases of lung cancer, 2 per centum of deaths from cardiovascular and respiratory conditions, and 1 percentage of respiratory infections, adding up to 7.9 million disability-adjusted life years based on mortality only. This burden of illness occurs primarily in developing countries, with People's republic of china and Republic of india contributing the most to the global brunt. Eastern Europe also has major air pollution problems, and in some countries, air pollution accounts for 0.vi to 1.4 percent of the total disability-adjusted life years from mortality.

The global burden of disease caused by pb exposure includes subtle changes in learning ability and behavior and other signs of central nervous system harm (Fewthrell, Kaufmann, and Preuss 2003). WHO (2002) concludes that 0.4 percent of deaths and 0.nine pct (12.ix million) of all inability-adjusted life years may exist due to lead exposure.

Water Pollution

Chemical pollution of surface water can create health risks, because such waterways are oft used directly as drinking water sources or connected with shallow wells used for drinking water. In addition, waterways have important roles for washing and cleaning, for line-fishing and fish farming, and for recreation.

Some other major source of drinking h2o is groundwater, which oft has low concentrations of pathogens because the water is filtered during its transit through underground layers of sand, clay, or rocks. Nevertheless, toxic chemicals such as arsenic and fluoride tin be dissolved from the soil or stone layers into groundwater. Directly contamination tin can also occur from badly designed hazardous waste sites or from industrial sites. In the United States in the 1980s, the government set in motion the Superfund Program, a major investigation and cleanup programme to bargain with such sites (U.South. Environmental Protection Agency 2000).

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

Sources of Chemic Water Pollution

Chemicals tin can enter waterways from a point source or a nonpoint source. Point-source pollution is due to discharges from a single source, such equally an industrial site. Nonpoint-source pollution involves many minor sources that combine to cause significant pollution. For instance, the movement of pelting or irrigation water over state picks upwards pollutants such every bit fertilizers, herbicides, and insecticides and carries them into rivers, lakes, reservoirs, coastal waters, or groundwater. Some other nonpoint source is storm-water that collects on roads and eventually reaches rivers or lakes. Table 43.1 shows examples of point-source industrial chemic pollution.

Paper and pulp mills eat large volumes of water and discharge liquid and solid waste products into the environs. The liquid waste is usually high in biological oxygen demand, suspended solids, and chlorinated organic compounds such as dioxins (World Banking concern 1999). The storage and ship of the resulting solid waste (wastewater treatment sludge, lime sludge, and ash) may also contaminate surface waters. Saccharide mills are associated with effluent characterized by biological oxygen demand and suspended solids, and the effluent is high in ammonium content. In addition, the sugarcane rinse liquid may comprise pesticide residues. Leather tanneries produce a significant corporeality of solid waste, including hibernate, hair, and sludge. The wastewater contains chromium, acids, sulfides, and chlorides. Textile and dye industries emit a liquid effluent that contains toxic residues from the cleaning of equipment. Waste from petrochemical manufacturing plants contains suspended solids, oils and grease, phenols, and benzene. Solid waste generated by petrochemical processes contains spent caustic and other hazardous 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 use of sedimentation ponds. Pb and zinc ores ordinarily contain the much more toxic cadmium as a small component. If the cadmium is not retrieved, major water pollution tin can occur. Mining was the source of most of the widespread cadmium poisoning (Itai-Itai disease) in Japan in 1940–50 (Kjellstrom 1986).

Other metals, such as copper, nickel, and chromium, are essential micronutrients, but in loftier levels these metals can be harmful to health. Wastewater from mines or stainless steel product can be a source of exposure to these metals. The presence of copper in water can as well be due to corrosion of drinking water pipes. Soft water or low pH makes corrosion more likely. Loftier levels of copper may brand water announced blue green and give it a metallic taste. Flushing the first water out of the tap can minimize exposure to copper. The use of lead pipes and plumbing equipment may consequence in high levels of pb in piped water.

Mercury can enter waterways from mining and industrial premises. Incineration of medical waste product containing cleaved medical equipment is a source of ecology contagion with mercury. Metallic mercury is besides hands transported through the temper considering of its highly volatile nature. Sulfate-reducing leaner and sure other micro-organisms in lake, river, or coastal underwater sediments can methylate mercury, increasing its toxicity. Methylmercury accumulates and concentrates in the food chain and tin lead to serious neurological disease or more than subtle functional damage to the nervous organisation (Murata and others 2004).

Runoff from farmland, in add-on to carrying soil and sediments that contribute to increased turbidity, also carries nutrients such as nitrogen and phosphates, which are oft added in the form of animal manure or fertilizers. These chemicals cause eutrophication (excessive nutrient levels in h2o), which increases the growth of algae and plants in waterways, leading to an increase in cyanobacteria (bluish-green algae). The toxics released during their decay are harmful to humans.

The use of nitrogen fertilizers can exist a problem in areas where agriculture is becoming increasingly intensified. These fertilizers increment the concentration of nitrates in groundwater, leading to loftier nitrate levels in hugger-mugger drinking h2o sources, which can 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 direct on soil to impale pests in the soil or on the basis. This practice tin 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 tin create spray migrate when the wind 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, but the rules for their use in developing countries may exist more permissive, and the rules of application may not exist known or enforced. Hence, health risks from pesticide water pollution are higher in such countries (WHO 1990).

Naturally occurring toxic chemicals tin can also contaminate groundwater, such as the high metallic concentrations in underground water sources in mining areas. The about extensive trouble of this blazon is the arsenic contamination of groundwater in Argentina, Bangladesh (box 43.ii), Chile, Communist china, India, Mexico, 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, Republic of india, Sri Lanka, Africa, and the eastern Mediterranean. Although fluoride helps foreclose dental decay, exposure to levels greater than one.5 milligrams per liter in drinking h2o can cause pitting of tooth enamel and deposits in bones. Exposure to levels greater than 10 milligrams per liter can cause crippling skeletal fluorosis (Smith 2003).

Box 43.2

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

Water disinfection using chemicals is some other source of chemical contagion of water. Chlorination is currently the almost widely practiced and almost cost-effective method of disinfecting large community water supplies. This success in disinfecting h2o supplies has contributed significantly to public health by reducing the transmission of waterborne disease. However, chlorine reacts with naturally occurring organic matter in water to form potentially toxic chemical compounds, known collectively equally disinfection past-products (International Agency for Research on Cancer 2004).

Exposure to Chemical Water Pollution

Drinking contaminated water is the near direct route of exposure to pollutants in h2o. The actual exposure via drinking water depends on the corporeality of h2o consumed, usually two to iii liters per solar day for an adult, with higher amounts for people living in hot areas or people engaged in heavy concrete work. Use of contaminated water in food preparation tin result in contaminated food, considering high cooking temperatures practise not affect the toxicity of most chemical contaminants.

Inhalation exposure to volatile compounds during hot showers and skin exposure while bathing or using water for recreation are as well potential routes of exposure to water pollutants. Toxic chemicals in h2o tin can affect unborn or immature children by crossing the placenta or being ingested through breast milk.

Estimating actual 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 tin can be a precise tool for measuring total exposure from water, food, and air (Yassi and others 2001).

Wellness 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, as in the example cited in box 43.2 of arsenic in drinking water in People's republic of bangladesh. Other examples of a loftier local burden of disease are the nervous system diseases of methylmercury poisoning (Minamata disease), the kidney and bone diseases of chronic cadmium poisoning (Itai-Itai disease), and the circulatory organisation diseases of nitrate exposure (methemoglobinemia) and lead exposure (anemia and hypertension).

Astute exposure to contaminants in drinking water tin can cause irritation or inflammation of the eyes and olfactory organ, skin, and gastrointestinal system; however, the most 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 furnishings, as seen with chemicals such as cadmium, copper, mercury, and chlorobenzene (WHO 2003).

Pesticides and other chemical contaminants that enter waterways through agricultural runoff, stormwater drains, and industrial discharges may persist in the environment for long periods and be transported past water or air over long distances. They may disrupt the part of the endocrine system, 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 effects on the developing nervous system can include dumb mental and psychomotor evolution, as well as cerebral impairment and behavior abnormalities (WHO and International Plan on Chemical Safety 2002). Examples of endocrine disruptors include organochlorines, PCBs, alkylphenols, phytoestrogens (natural estrogens in plants), and pharmaceuticals such as antibiotics and synthetic sex activity hormones from contraceptives. Chemicals in drinking water can also be carcinogenic. Disinfection by-products and arsenic have been a particular concern (International Agency for Research on Cancer 2004).

Interventions

The diverseness of chancy pollutants that can occur in air or water also leads to many different interventions. Interventions pertaining to ecology hazards are often more sustainable if they address the driving forces backside the pollution at the customs level rather than endeavour to deal with specific exposures at the private level. In addition, constructive methods to prevent exposure to chemic hazards in the air or h2o may non exist at the individual level, and the just feasible individual-level intervention may be treating cases of illness.

Figure 43.1 shows 5 levels at which actions can be taken to prevent the wellness effects of environmental hazards. Some would characterization interventions at the driving forcefulness level as policy instruments. These include legal restrictions on the utilise of a toxic substance, such equally banning the apply of lead in gasoline, or customs-level policies, such as boosting public transportation and reducing individual employ of motor vehicles.

Effigy 43.1

Framework for Environmental Health Interventions

Interventions to reduce pressures on environmental 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 state of the surround would include air quality monitoring linked to local actions to reduce pollution during peculiarly polluted periods (for instance, banning vehicle use when pollution levels achieve predetermined thresholds). Interventions at the exposure level include using household water filters to reduce arsenic in drinking h2o every bit washed in Bangladesh. Finally, interventions at the event level would include deportment past health 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 issue. Technologies to reduce pollution at its source are plentiful, as are technologies that reduce pollution past filtering it away from the emission source (cease-of-pipe solutions; see, for case, Gwilliam, Kojima, and Johnson 2004). Getting these technologies applied in do requires government or corporate policies that guide technical decision making in the right direction. Such policies could involve outright bans (such as requiring lead-gratis gasoline or asbestos-free vehicle brake linings or building materials); guidance on desirable technologies (for example, providing best-practice manuals); or economic instruments that make using more polluting technologies more expensive than using less polluting technologies (an example of the polluter pays principle).

Examples of technologies to reduce air pollution include the utilize of pb-free gasoline, which allows the apply of catalytic converters on vehicles' exhaust systems. Such technologies significantly reduce the emissions of several air pollutants from vehicles (box 43.3). For trucks, buses, and an increasing number of smaller vehicles that use diesel fuel fuel, improving the quality of the diesel itself past lowering its sulfur content is another manner to reduce air pollution at the source. More fuel-efficient vehicles, such as hybrid gas-electric vehicles, are some other way forward. These vehicles can reduce gasoline consumption by about 50 per centum during city driving. Policies that reduce "unnecessary" driving, or traffic demand management, tin can also reduce air pollution in urban areas. A arrangement of congestion fees, in which drivers take to pay before 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 United mexican states Metropolis. Mexico City is one of the world's largest megacities, with nearly 20 million inhabitants. Local authorities have acknowledged its air quality problems since the 1970s. The emissions from several million motor vehicles (more...)

Power plants and industrial plants that burn fossil fuels utilize a variety of filtering methods to reduce particles and scrubbing methods to reduce gases, although no effective method is currently available for the greenhouse gas carbon dioxide. High chimneys dilute pollutants, but the combined input of pollutants from a number of smokestacks tin nonetheless lead to an overload of pollutants. An important example is acid rain, which is caused by SO_two and NO_x emissions that make water vapor in the temper acidic (WHO 2000). Large combined emissions from industry and power stations in the eastern United States drift north with the winds and cause harm to Canadian ecosystems. In Europe, emissions from the industrial chugalug across Belgium, Germany, and Poland drift north to Sweden and take damaged many lakes there. The convergence of air pollutants from many sources and the associated wellness effects accept too been documented in relation to the multiple fires in Indonesia'southward pelting forest in 1997 (Brauer and Hisham-Hashim 1998); the brownish cloud over big areas of Asia, which is mainly related to coal burning; and a similar chocolate-brown deject over primal 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 constitute a specific population's boilerplate exposure to pollution. Sophisticated modeling in combination with monitoring has fabricated it possible to start producing detailed estimates and maps of air pollution levels in cardinal urban areas (Earth Bank 2004), thus providing a powerful tool for assessing current health impacts and estimated changes in the health impacts brought nigh by divers air pollution interventions.

Interventions to Reduce Water Pollution

Water pollution command requires activity at all levels of the hierarchical framework shown in figure 43.one. The ideal method to abate diffuse chemical pollution of waterways is to minimize or avoid the use of chemicals for industrial, agricultural, and domestic purposes. Adapting practices such as organic farming and integrated pest management could assist protect waterways (Scheierling 1995). Chemical contagion of waterways from industrial emissions could be reduced by cleaner production processes (UNEP 2002). Box 43.4 describes one project aimed at effectively reducing pollution.

Box 43.4

H2o Pollution Control in Bharat. In 1993, the Demonstration in Small Industries for Reducing Wastes Project was started in India with back up from the United nations Industrial Development Organization. International and local experts initiated waste product (more than...)

Other interventions include proper handling of hazardous waste matter and recycling of chemical containers and discarded products containing chemicals to reduce solid waste buildup and leaching of toxic chemicals into waterways. A multifariousness of technical solutions are available to filter out chemical waste product from industrial processes or otherwise return them harmless. Irresolute the pH of wastewater or adding chemicals that flocculate the toxic chemicals so that they settle in sedimentation ponds are mutual methods. The aforementioned principle can be used at the individual household level. 1 example is the use of iron fries to filter out arsenic from contaminated well h2o in Bangladeshi households (Kinniburgh and Smedley 2001).

Intervention Costs and Cost-Effectiveness

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

Comparison of Interventions

A review of more than 1,000 reports on cost per life yr saved in the United States for 587 interventions in the environment and other fields (tabular array 43.2) evaluated costs from a societal perspective. The net costs included only straight costs and savings. Indirect costs, such every bit forgone earnings, were excluded. Future costs and life years saved were discounted at v percent per twelvemonth. Interventions with a cost per life year saved of less than or equal to zero cost less to implement than the value of the lives saved. Each of three categories of interventions (toxin command, fatal injury reduction, and medicine) presented in table 43.2 includes several extremely price-constructive interventions.

Table 43.2

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

The cost-constructive interventions in the air pollution surface area could be of value in developing countries as their industrial and transportation pollution situations go similar to the United States in the 1960s. The review by Tengs and others (1995) does not written report the extent to which the various interventions were implemented in existing pollution control or public wellness programs, and many of the most cost-constructive interventions are probably already in wide apply. The review did create a good deal of controversy in the U.s., because professionals and nongovernmental organizations active in the ecology field accused the authors of overestimating the costs and underestimating the benefits of controls over chemicals (see, for example, U.S. Congress 1999).

Costs and Savings in Relation to Pollution Control

A number of publications review and hash out the evidence on the costs and benefits of different pollution command interventions in industrial countries (see, for example, U.S. Environmental Protection Agency 1999). For developing countries, specific data on this topic are found primarily in the so-called grey literature: government reports, consultant reports, or reports by the international banks.

Air Pollution

Examples of cost-effectiveness analysis for assessing air quality policy include studies carried out in Jakarta, Kathmandu, Manila, and Mumbai under the Globe Bank's Urban Air Quality Direction 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 PM_ten and health impacts were examined in terms of reductions in tons of PM₁₀ emitted, cost of implementation, time frame for implementation, and health benefits and their associated cost savings. Some of the abatement measures that have been implemented include introducing unleaded gasoline, tightening standards, introducing depression-smoke lubricants for ii-stroke engine vehicles, implementing inspections of vehicle exhaust emissions to address gross polluters, and reducing garbage burning.

Transportation policies and industrial evolution do not ordinarily have air quality considerations equally their primary objective, but the World Bank has developed a method to have 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 will indicate the price-effectiveness of each policy. The World Bank has worked out this "overlay" approach in some detail for the energy and forestry sectors in the analogous case of greenhouse gas reduction strategies (World Depository financial institution 2004).

Water Pollution

The costs and benefits associated with interventions to remove chemical contaminants from water need to be assessed on a local or national ground to determine specific needs, available resource, environmental atmospheric condition (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).

Another country with major concerns virtually chemicals (arsenic) in water is Bangladesh. The arsenic mitigation programs have applied various arsenic removal technologies, but the costs and benefits are non well established. Bangladesh has adopted a drinking water standard of 50 μg/L (micrograms per liter) for arsenic in drinking water. The price of achieving the lower WHO guideline value of 10 μg/L would be significant. An evaluation of the price of lowering arsenic levels in drinking water in the U.s.a. predicts that a reduction from 50 to ten μg/50 would prevent a limited number of deaths from bladder and lung cancer at a cost of several 1000000 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, free of chemicals and micro-organisms, simply contamination from roofs and storage tanks needs to be considered. Rainwater collection is relatively inexpensive.

Economic Benefits of Interventions

One of the early on examples of cost-benefit assay for chemical pollution control is the Nippon Environment Agency's (1991) study of three Japanese classical pollution diseases: Yokkaichi asthma, Minamata disease, and Itai-Itai disease (table 43.three). This analysis was intended to highlight the economic 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 business relationship the 20 or 30 years that take elapsed since the illness outbreaks occurred and annualize the costs and benefits over a 30-year period. The pollution damage costs are the actual payments for victims' compensation and the toll of ecology remediation. The bounty costs are based on court cases or authorities decisions and can be seen as a valid representation of the economic value of the health impairment in each case. As tabular array 43.iii shows, controlling the relevant pollutants would take cost far less than paying for damage acquired by the pollution.

Tabular array 43.3

Comparison of Actual Pollution Damage Costs and the Pollution Control Costs That Would Have Prevented the Damage, for Three Pollution-related Disease Outbreaks, Japan (¥ 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 betwixt doses and responses. Voorhees and others (2001) discover that most studies that analyzed the state of affairs in specific urban areas used health bear upon assessment to estimate impacts avoided by interventions. Investigators have used dissimilar methods for valuing the economical benefits of wellness improvements, including market valuation, stated preference methods, and revealed preference methods. The choice of assumptions and inputs substantially affected the resulting price and benefit valuations.

One of the few detailed studies of the costs and benefits of air pollution control in a specific urban expanse (Voorhees and others 2000) used irresolute nitric oxide and NO₂ emissions in Tokyo during 1973–94 as a ground for the calculations. The report did not utilise actual wellness comeback information only calculated likely health improvements from estimated reductions in NO₂ levels and published dose-response curves. The health effects included respiratory morbidity (equally 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's 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 ane to 44. The estimated economic benefits of reductions in nitric oxide and NO₂ emissions between 1973 and 1994 were considerable: United states of america$6.78 billion for avoided medical costs, US$6.33 billion for avoided lost wages of ill adults, and US$0.83 billion for avoided lost wages of mothers with sick children.

Blackman and others' (2000) price-do good analysis of iv practical strategies for reducing PM_ten emissions from traditional brick kilns in Ciudad Juárez in Mexico suggests that, given a wide range of modeling assumptions, the benefits of iii command strategies would be considerably higher than the costs. Reduced bloodshed was by far the largest component of benefits, accounting for more than 80 percent of the total.

Pandey and Nathwani (2003) applied cost-benefit analysis to a pollution control program in Canada. Their report proposed using the life quality alphabetize equally a tool for quantifying the level of public expenditure beyond which the use of resources is not justified. The written report estimated total pollution control costs at U.s.$two.5 billion per year confronting a monetary benefit of Us$7.5 billion per yr, using 1996 equally the base year for all cost and do good estimates. The do good estimated in terms of avoided bloodshed was about ane,800 deaths per year.

El-Fadel and Massoud's (2000) report of urban areas in Lebanon shows that the health benefits and economic benefits of reducing PM concentration in the air tin range from US$4.53 million to United states of america$172.50 million per yr using a willingness-to-pay approach. In that study, the major monetized benefits resulted from reduced bloodshed costs.

Aunan and others (1998) assessed the costs and benefits of implementing an energy saving and air pollution control program in Hungary. They based their monetary evaluation of benefits on local monitoring and population data and took exposure-response functions and valuation estimates from Canadian, U.South., and European studies. The authors valued the boilerplate total benefits of the interventions at Us$1.56 billion per year (with 1994 every bit the base year), with high and depression bounds at US$7.half-dozen, billion and United states$0.four billion, respectively. They estimated the cost-benefit ratio at 1 to 3.4, given a full toll 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 water pollution abatement for a cluster of 250 small-scale industries in Gujarat, India. Misra's assessment looked at command-and-command, market-based solutions and at effluent treatment every bit alternatives. In a cost-do good assay, Misra estimated the cyberspace present social benefits from h2o pollution abatement at the Nandesari Industrial Estate at Rs 0.550 billion at 1995–96 market prices using a 12 percent social discount rate. After making corrections for the prices of foreign exchange, unskilled labor, and investment, the figure rose to Rs 0.62 billion. Information technology rose even so further to about Rs 3.one billion when distributional effects were taken into account.

Implementation of Command Strategies: Lessons of Experience

The foregoing examples demonstrate that interventions to protect wellness that use chemic pollution control tin have an bonny cost-do good ratio. The Japan Surroundings Agency (1991) estimates the national economical impact of pollution control legislation and associated interventions. During the 1960s and early 1970s, when the government made many of the major decisions about intensified pollution control interventions, Nihon's gross domestic product (Gdp) per capita was growing at an almanac rate of about 10 per centum, similar to that of the quickly industrializing countries in the early 21st century. At that fourth dimension, Japan'due south economic policies aimed at eliminating bottlenecks to high economical growth, and in the mid 1960s, industry was spending less than ¥l billion per year on pollution control equipment. By 1976, this spending had increased to almost ¥ane trillion per year. The ¥5 trillion invested in pollution control between 1965 and 1975 accounted for about 0.9 percent of the increment in Gdp per capita during this flow. The Japan Environment Bureau concluded that the stricter environmental protection legislation and associated major investment in pollution control had little effect on the overall economic system, merely that the resulting health benefits are likely cumulative.

Air

The broadest analysis of the implementation of control strategies for air pollution was conducted past the U.S. Environmental Protection Agency in the late 1990s (Krupnick and Morgenstern 2002). The analysis developed a hypothetical scenario for 1970 to 1990, assuming that the real costs for pollution command during this menstruum could be compared with the benefits of reduced mortality and morbidity and avoided damage to agricultural crops brought nearly by the reduction of major air pollutant levels across the land during this menstruum. 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 cost of morbidity in relation to estimated health service utilization. The study used a multifariousness of costing methods to reach the range of probable nowadays values presented in table 43.4. It causeless that the reduction of air pollution resulted from the implementation of the federal Clean Air Act of 1970 and associated state-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 Act, 1970–xc (1990 US$ billions).

The analysis showed a dramatically loftier toll-benefit ratio and inspired debate almost the methodologies used and the results. I major criticism was of the use of the value of statistical life for each death potentially avoided by the reduced air pollution. A recalculation using the life-years-lost method reduced the benefits for deaths caused by PM from US$sixteen,632 billion to Us$9,100 billion (Krupnick and Morgenstern 2002). The recalculated figure is still well to a higher place the 5th percentile guess of benefits and does not undermine the positive toll-benefit ratio reported. Thus, if a developing country were to implement an appropriate control strategy for urban air pollution, it might derive significant economical benefits over the subsequent decades. The land'due south level of economical development, local costs, and local benefit valuations will be of import for any toll-benefit assessment. WHO'south (2000) air quality guidelines are among the documents that provide advice on analytical approaches.

Water

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

WHO has analyzed control strategies for biological water pollution and water and sanitation improvements in relation to the Millennium Development Goals (Hutton and Haller 2004). The analysis demonstrated the considerable benefits of h2o and sanitation improvements: for every United states of america$1 invested, the economical return was in the range of United states$5 to U.s.a.$28 for a number of intervention options. Conscientious analysis of the same blazon is required for populations particularly vulnerable to chemic water pollution to assess whether control of chemic pollution tin can as well yield meaning benefits.

Research and Development Calendar

Even though a good deal of information is available about the health risks of common 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 notwithstanding major bug in developing countries; however, direct application of the experiences of developed countries may not be appropriate, because 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 different levels of economic evolution and for diverse geographic conditions would therefore be valuable for assessing risks and targeting interventions. In improver, global chemical exposure concerns, such every bit endocrine disruptors in air, water, and nutrient, require urgent enquiry to establish the need for interventions in both industrial and developing countries.

An of import research topic is to clearly describe and quantify the long-term health effects of exposure to air pollution. The existing literature indicates that long-term exposure may accept more adverse health furnishings than short-term exposure and, hence, have higher toll implications. Another topic is to appraise the health upshot pertaining to greenhouse gases and climate change, which are related to the same sources as urban air pollution (Intergovernmental Console on Climate Modify 2001). Research and policy analysis on how best to develop interventions to reduce health risks related to climatic change need to exist considered together with the assay of other air pollutants.

In addition, to ameliorate analysis of the economic costs of wellness impacts, better estimates are needed of the burden of affliction related to chemical air and water pollution at local, national, and global levels. Cost-effectiveness analysis of air and water pollution control measures in developing countries needs to be supported past further research, every bit cost levels and benefit valuations will vary from state to land, and solutions that are valid in industrial countries may not work as well in developing countries. Strategies for constructive air and water resources direction should include inquiry on the potential side effects of an intervention, such as in Bangladesh, where tube wells drilled to supply water turned out to be contaminated with arsenic (meet box 43.2). Enquiry is likewise needed that would link methodologies for assessing adverse health furnishings with exposure and epidemiological studies in different settings to permit the evolution of more than precise forecasting of the health and economic benefits of interventions.

The multifariousness of health effects of urban air pollution and the diverseness of sources create opportunities for ancillary effects that need to be taken into account in economic cost-effectiveness and cost-benefit analysis. These are the beneficial furnishings of reducing air pollution on other wellness 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 refuse (Kjellstrom and others 2003).

One of the central challenges for policies and actions is to find means to avoid a rapid buildup of urban air pollution in countries that do not nonetheless take a major trouble. The wellness sector needs to exist 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 being built into cities.

Decades of economical and industrial growth have resulted in lifestyles that increment the demands on water resources simultaneous with increases in water pollution levels. Conflicts between household, industrial, and agronomical water apply are a common public health problem (UNESCO 2003). The developing countries need to avoid the experiences of water pollution and associated disease outbreaks in industrial countries. Strategies to ensure sufficient pollution control must exist identified at the aforementioned fourth dimension as strategies to reduce water consumption. High water use depletes supplies and increases salinity in groundwater aquifers, especially in coastal regions. The impact of climate change must as well be taken into consideration (Vorosmarty and others 2000).

Conclusion: Promises and Pitfalls

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

Developing countries face major water quantity and quality challenges, compounded by the effects of rapid industrialization. Concerted actions are needed to safely manage the use of toxic chemicals and to develop monitoring and regulatory guidelines. Recycling and the use of biodegradable products must be 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 too worthwhile. The growing number of private motor vehicles in developing countries brings certain benefits, but alternative means of transportation, particularly in rapidly growing urban areas, need to be considered at an early on stage, as the negative health and economical impacts of high concentrations of motor vehicles are well established. The principles and practices of sustainable development, coupled with local research, will help contain 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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