In the city of Cali, Colombia, about 1,900 people died in 2018 from diseases caused by air pollution adding to a cost of US$751 million each year in health impacts, the city government estimates.
In the same year, in the Aburrá Valley, a decrease in fine particulate pollution, partly explained by the launch of Plan Integral de Gestión de la Calidad del Aire del Valle de Aburrá (PIGECA, or Comprehensive Air Quality Management Plan for the Aburrá Valley), is estimated to have saved 1,600 lives and US$621 million in healthcare costs.
These were the topline findings of a project to build capacity within the two governments to use tools and processes to estimate the health impacts of air pollution in concrete terms, analyze the carbon footprint of the healthcare system, and build and strengthen local capacity to support the decision-making process.
Organized as part of the BreatheLife (RespiraVida) campaign, the Clean Air and Climate Coalition (CCAC) provided technical assistance and capacity building to Cali and the Aburrá Valley Metropolitan Area to estimate the integrated climate, environment and health benefits of their respective air quality management plans, with the collaboration of the Pan American Health Organization (PAHO), the United Nations Environment Program (UNEP) and the Clean Air Institute.
Colombian cities and regions, including Cali and the Valle de Aburrá Metropolitan Area, are among a growing number of administrations around the world that see the value in a more complete picture of the costs and benefits of policy investments, having already established and embarked on detailed policies and programmes that would draw down criteria air pollutants and greenhouse gas emissions.
To accommodate this, the Clean Air Institute provided technical support on the estimation of disease burden attributable to air pollution, analysis of co-benefits in reducing air pollutants and greenhouse gas emissions in the respective city’s climate change and clean air planning instruments, and reduction of polluting emissions in health sector activities.
Analysis and estimations were tailored to each city’s needs, the project having been developed with the close participation of the local health and environmental authorities from Cali and Aburra Valley, including the Ministries of Environment and Health. PAHO representatives gave feedback and support to the outcomes.
“Cali cares about health impacts from air pollution. Estimates provided by Clean Air Institute represent an alert that forces government, businesses and civil society to move forward in the implementation of strategies for the reduction of this number,” said Chief Executive Officer, Cali’s Administrative Department of Environmental Management, Carlos Eduardo Calderón.
National officials, who attended the workshop in late June at which Cali and the Aburrá Valley presented the findings, saw the modelling of integrated benefits as a common, rallying point.
“This progress in strengthening technical capacities at the national and sub-national levels is fundamental and strategic to support decision making and to include measurements in the planning instruments for the abatement of climate change and the enhancement of clean air in Colombian cities,” said Deputy Director of Environmental Health, Ministry of Health, Adriana Estrada Estrada.
“It is necessary and relevant to guide decision-making towards the implementation of common lines of action between the different actors involved in order to promote intersectoral coordination to protect human and environmental health,” she continued.
Fellow BreatheLife members, the cities of Barranquilla, Bogotá, Caldas and Medellín, also participated in the virtual workshop, entitled “Estimating the Integrated Climate, Environmental and Health Benefits of Air Quality Management Plans in the Metropolitan Areas of Aburrá Valley and Cali (Colombia)”, along with the officials from the national government of Colombia and representatives from UNEP, PAHO and the University of California, Davis.
Cities were the main focus of the workshop, whose objectives were to provide the tools needed to incorporate health and climate benefits considerations into comprehensive air quality management and city planning and development; demonstrate the methodologies behind the evaluation of benefits applied in Cali and Valle de Aburrá and share the results of the project, and strengthen the capacities of city staff in the use of BenMAP and AirQ+ as tools for evaluating health benefits and risks from air quality.
But a fourth objective was to get feedback from national authorities and health organizations about opportunities to extend these tools in other Colombian cities and other parts of Latin America.
“All the information generated by this study provides elements to assess the relevance and effectiveness of the current national air quality strategy and for its improvement. This information will also allow strengthening the engagement of mayors around the country to include the air quality issue in municipal development plans,” said Director of Environmental Affairs, Ministry of Environment and Sustainable Development Mauricio Gaitán.
While the workshop was intended as an opportunity to train participants in using relevant tools, it was also a chance to demonstrate and discuss their relevance to decision making and building support for policies, initiatives and interventions.
Participating regions and cities were introduced to the monitoring and evaluation instruments available to them, the matrices for the analysis of co-benefits in emissions of these pollutants in the instruments of planning for climate change and air quality management.
It was recommended that the region use reduced risk of disease, reduction of road accidents, noise reduction and increased physical activity as indicators to comprehensively assess the impacts of their measures in relation to health.
Workshop participants agreed on:
- the relevance of the study for Colombian cities and elsewhere;
- the importance of making progress in defining a nationwide standardized indicator and a methodology to report health impacts related air quality,
- the convenience of incorporating these results and tools as inputs to enrich the preparation of health-oriented air quality management programs and other relevant planning instruments; and
- the need to strengthen actions that simultaneously address air quality and climate change, to achieve health, climatic and sustainability objectives, contributing to national and local decision-making.
The project fuels ongoing efforts to address a critical gap: while scientific evidence of the deleterious health impacts of air pollution continues to expand and strengthen, many governments and relevant actors around the world have yet to systematically examine and quantify the potential or realized health effects of policies that directly or obliquely change air quality and other determinants of health, like noise levels and conditions that enable active mobility.
Fewer still look at lives and health costs saved and disability avoided as benchmarks of policy success.
The most enthusiastic first-movers in this respect have come from the ranks of city and municipal governments, a growing force as greater numbers of the world’s population live in cities.
London, for example, famously links air pollution and health, publishing information on estimated deaths attributable to air pollution, health and social care costs of air pollution, and calculating and publishing the potential savings in health costs from policy, among other things, growing an “ecosystem” that supports this approach (e.g., collaborations to develop relevant tools).
In Rennes, France, mayor Charlotte Marchandise, in a recent webinar by the Carbon Disclosure Project, described working with public health experts and the national Graduate School of Public Health to incorporate health outcomes and measures into the city’s policymaking.
In Accra, Ghana, the World Health Organization’s Urban Health Initiative recently worked with national- and city-level government officials on using health impact assessment tools to assess the environmental, health and economic co-benefits of future sustainable urban transportation action plans, the programme recently producing estimates for health impacts of transport sector changes in the Greater Accra Metropolitan region.
Meanwhile, at an interface between policy leaders and scientists at the Climate Action Summit in 2019, Mayor of Victoria, Canada, Lisa Helps, requested tools and research that would help her city estimate the health benefits of air quality improvements from converting its public bus fleet to electric.
Estimating the health benefits of better air quality gained by introducing e-buses was also something the Chicago Transit authority did at in 2014, using US EPA methodology.
This “health in all policies” approach has been advocated by the WHO, particularly at the national level, with a few governments adopting it to some degree, even if it may not be explicit, and others yet to discover or consider it.
The “how” of this approach is a subject BreatheLife partners, including the WHO, have already been tackling through the development of tools, initiatives and guidelines — both to support governments and to enable reporting on the health-related aspects and targets of many of the Sustainable Development Goals, which are forcing governments, non-governmental organizations, the private sector and all other relevant actors to coordinate across traditional disciplinary lines.
But this mindset of keeping human health and wellbeing at the core of policymaking could start to spread out and up, as governments begin thinking about what a “green recovery” from COVID-19 could look like.
A hard-hitting letter from organizations representing 40 million healthcare professionals around the world called on the leaders of the G20 countries to do precisely this:
“As you direct your attention to the post-COVID response, we ask that your chief medical officer and chief scientific advisor are directly involved in the production of all economic stimulus packages, report on the short- and long-term public health repercussions that these may have, and give their stamp of approval.
The enormous investments your governments will make over the coming months in key sectors like health care, transport, energy and agriculture must have health protection and promotion embedded at their core.”
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