Eva Rehfuess

Urban Environmental Health Hazards and Health Equity

This paper outlines briefly how the living environment can affect health. It explains the links between social and environmental determinants of health in urban settings. Interventions to improve health equity through the environment include actions and policies that deal with proximal risk factors in deprived urban areas, such as safe drinking water supply, reduced air pollution from household cooking and heating as well as from vehicles and industry, reduced traffic injury hazards and noise, improved working environment, and reduced heat stress because of global climate change. The urban environment involves health hazards with an inequitable distribution of exposures and vulnerabilities, but it also involves opportunities for implementing interventions for health equity. The high population density in many poor urban areas means that interventions at a small scale level can assist many people, and existing infrastructure can sometimes be upgraded to meet health demands. Interventions at higher policy levels that will create more sustainable and equitable living conditions and environments include improved city planning and policies that take health aspects into account in every sector. Health equity also implies policies and actions that improve the global living environment, for instance, limiting greenhouse gas emissions. In a global equity perspective, improving the living environment and health of the poor in developing country cities requires actions to be taken in the most affluent urban areas of the world. This includes making financial and technical resources available from high-income countries to be applied in low-income countries for urgent interventions for health equity. This is an abbreviated version of a paper on “Improving the living environment” prepared for the World Health Organization Commission on Social Determinants of Health, Knowledge Network on Urban Settings.

Evaluation of the costs and benefits of interventions to reduce indoor air pollution

Worldwide, more than three billion people cook with wood, coal and other solid fuels on open fires or traditional stoves, contributing to more than 1.5 million deaths annually and a multitude of negative economic and environmental impacts. The aim of this article is to present the costs and benefits of interventions to reduce indoor air pollution by halving the global population currently lacking access to (1) cleaner fuels (liquefied petroleum gas (LPG)) and (2) cleaner-burning and more efficient stoves. Results are presented for 11 world subregions. Annual costs and benefits of the two interventions are modelled from 2005 until 2015. Intervention costs include fuel, stove, and programme costs, from which monetary fuel cost savings are subtracted to estimate net costs. Economic benefits include less expenditure on health care, health-related productivity gains, fuel collection and cooking time savings, and environmental impacts. Globally, annual economic benefits of halving the population without access to LPG amount to (US)

Modeling household solid fuel use towards reporting of the Millennium Development Goal indicator

91 billion at a net cost of

Indoor air pollution: 4000 deaths a day must no longer be ignored

13 billion. The improved stove intervention generates

Global Solar UV Index: a physician's tool for fighting the skin cancer epidemic.

105 billion in economic benefits at a negative net cost of

Evaluation of the costs and benefits of household energy and health Interventions at global and regional levels: summary

34 billion. The resulting benefit—cost ratios (BCR) for both interventions are favourable. The BCR for LPG ranges from 1.5 to 21.2 in rural areas, and from 2.6 to negative in urban areas. The BCR for improved stoves is negative in all sub-regions, as fuel cost savings exceed intervention costs, thus giving net negative costs. Investments in interventions to reduce indoor air pollution are potentially cost-beneficial.

Guidelines for conducting cost-benefit analysis of household energy and health interventions

Household use of solid fuels, such as dung, wood, agricultural residues, charcoal, and coal, is likely to be the largest indoor source of air pollution in developing countries. Combustion of solid fuels in inefficient stoves under poor ventilation conditions can result in large exposure burdens, particularly for women and young children, who spend the major part of their time at home. The importance of this public health and environmental issue is reflected in the inclusion of the percentage of households using solid fuels as an indicator towards the achievement of the Millennium Development Goal (MDG) for environmental sustainability. This article outlines the model used for completing missing country data for household use of solid fuels. Out of a total of 181 country data points reported, data were available for 94 countries. These included estimates from 42 countries where household solid fuel use was previously unknown, largely from the recently conducted World Health Survey. Based on the data available for these countries, using step-wise regression, a model to predict household solid fuel use based on rural population, gross national income (GNI) and geographic regional variables was developed. Thirty-five data points were estimated using this model. In general, household solid fuel use seems to be lower in 2003 than in 2000. Yet, even with increases in economic development and urbanization, drastic reductions in household solid fuel use are unlikely to occur in the absence of targeted programs to promote cleaner fuels.

United Nations Commission on Sustainable Development – a missed opportunity for action on indoor air pollution?

The United Nations Commission for Sustainable Development may not appear, at first sight, to be a major playing field for public health. Nevertheless, when environment, energy and development ministers from around the world assembled in New York on 1-12 May 2006 for the Commissions 14th session, health concerns in relation to energy production and consumption emerged as a prominent argument in discussions on energy for sustainable development. In his opening speech, Secretary General Kofi Annan called attention to the fact that indoor air pollution from solid fuel use is one of the worlds ten major causes of mortality and morbidity. (1) More than half the worlds population--3.2 billion people--still burn coal and biomass fuels such as wood, dung and crop residues to meet their basic energy needs. (2) Indoor air pollution from burning these solid fuels on open fires or traditional stoves comprises a variety of health-damaging pollutants including particles, carbon monoxide and different carcinogens (3) and is the cause of a public health tragedy. Every year, 1.5 million people die from inhaling indoor pollutants that often exceed accepted guideline limits for outdoor air: in the case of fine particles, the limit is exceeded by 100 times or more. (4, 5) Children and women are disproportionately affected, with nearly 800 000 deaths attributable to indoor air pollution occurring among children under five years of age and more than 500 000 such deaths occurring among women. (5) Preventing deaths caused by polluted indoor air must no longer be delayed. In the short term, stoves that burn more cleanly and use fuel more efficiently, ventilation that is improved through smoke hoods or enlarged spaces in the eaves, and changes in housing design can substantially reduce pollutant levels. In the longer term, the use of cleaner fuels, such as liquefied petroleum gas, biogas or other modern biofuels, can eliminate the current indoor air pollution epidemic. Improving access to modern energy services--including electricity and modern cooking fuels and appliances--is essential if the world is to achieve its Millennium Development Goals (MDGs). The United Nations Millennium Project recommends an additional MDG target to halve, by 2015, the number of people without effective access to modern cooking fuels, and to make improved cooking stoves widely available. (6) The challenge in working towards this target is enormous: every day for the next 10 years, 485 000 people will need to gain access to cleaner fuels or improved stoves. Even if the target is realized, 1.5 billion people will still be left on the sidelines of development in 2015. (5) Effective solutions exist and the economic case for taking practical solutions to scale is just as strong as the humanitarian case, emphasized the late Dr LEE Jong-wook, Director-General of WHO. …

Promoting safe and effective sun protection strategies.

To reduce the global burden of disease resulting from exposure to ultraviolet radiation (UVR) and in recognition of the scope of the educational and investigative challenges, the World Health Organization (WHO) in partnership with the World Meteorological Organization (WMO), the United Nations Environment Program (UNEP), the International Agency for Cancer Research (IARC), the International Commission on Non-Ionizing Radiation Protection (ICNIRP) and other specialist agencies founded Intersun , the Global UV Project. 1 The program promotes and evaluates research that fills gaps in scientific knowledge, assesses and quantifies health risks, and develops public health advice through guidelines, recommendations and information dissemination. Beyond its scientific objectives, Intersun provides guidance to national authorities and other agencies about effective sun awareness programs. These address different target audiences such as workers, tourists, school children and the general public. Excess UVR exposure damages the skin and eyes, suppresses cutaneous and systemic immunity, predisposing people to microbial infections, exacerbation of latent disease and impaired endogenous tumor rejection. UVR is held to be the single most important preventable risk factor for melanoma and nonmelanoma skin cancer. Millions of skin cancers are diagnosed each year worldwide, and nonmelanoma skin cancer is more frequent than lung cancer, breast cancer, prostate cancer and colon cancer combined. 2,3 The incidence of malignant melanoma, an aggressive malignancy with poor response to systemic therapy and a poor prognosis if metastasized, 4 has increased continuously for the last three decades and today number an estimated 53,600 cases in the United States 3 and more than 200,000 cases worldwide. 5 Abating the skin cancer epidemic will require people to exercise proper sun protection measures. These include avoiding the sun around solar noon, wearing sun-protective clothing, using sunscreen with a sun-protection factor (SPF) of 15 or higher, and avoiding artificial sources of UVR. 6 Children and teenagers are especially at risk from the long-term adverse effects of UVR. 3,6