Panel 11: Improving Health, Safety, and the Environment Thursday, November 17 (4:15-5:30)

1. 12th Symposium on Development and Social Transformation Panel 11: Improving Health, Safety, and the EnvironmentThursday, November 17 (4:15-5:30)

2. 12th Symposium on Development and Social Transformation Panel 11: Improving Health, Safety, and the Environment Social Marketing of Health Policy: A Case Study of HIV/AIDS Programme in ThailandJyoti Shankar Choudhary

3. Need for Social Marketing • Constraints of conventional methods of policy formulation and implementation • Need for using Commercial Marketing concepts

4. What is Social Marketing? • Devising strategies for Behaviour Change by using concepts from commercial marketing • 4 Ps of Marketing: • Product • Price • Placement • Promotion

5. HIV/AIDS in Thailand- A Situation Analysis Statistical data in 1991 • No. of HIV infections– 1% of 65m pop. • No. of new HIV infections, every year -140,000 • 44% of sex workers in Chiang Mai (North Thailand) infected with AIDS ( Sentinel Survey,1989)

6. HIV/AIDS in Thailand- A Situation Analysis Nation’s Response : Mode of Denial • Thai to Thai transmission not evident • Response geared to screen foreigners • Only $180,000 spent in 1988

7. HIV/AIDS in Thailand: Policy Intervention Revised Policy Intervention-1991: • Positioning Strategy • Programme under the PMO • Programme integrated into 5 yr.plan:funding implications • Technical/non govt. appointments • Phased Approach • Three Phases • Segmentation and Targeting • Based on a nation wide research • Social Mobilisation & Advocacy an integral part of the programme

8. HIV/AIDS in Thailand: Policy Intervention Phase I (1991-1996) • Segmentation & Targeting: High risk Group • CSWs • Injectible Drug users • School Children and Youth • Emphasis on creating awareness through: • Mass media • School Programme • Community based programme-100% condom prog. • Social Mobilisation Programmes through: • Military • Monks • Repealed repressive policies like mandatory disclosure of identity for AIDS patients

9. HIV/AIDS in Thailand: Policy Intervention Phase II: (1996-2000): • Focus on PLWHA as main target group • Establishment of groups like PLA, through out • Emphasis on Mother to Child mode of transmission • Introduction of AZT drug • Greater role for Media-all reports on HIV published in media

10. HIV/AIDS in Thailand: Policy Intervention Phase III (2001-2006): • Consolidation of the earlier phases • International Cooperation

11. Lessons for India Shortcomings of the programme • Inequal focus of the target groups • Changing routes of transmission • Sustainability not in-built in the programme

12. Lessons for India Inferences from the programme • Appropriate Positioning of the programme • Prominence of Advocacy &Social Mobilisation • Emphasis on Research & its dissemination to the public at large • Role of Media in creating the ownership among various segments of the society

13. 12th Symposium on Development and Social Transformation Panel 11: Improving Health, Safety, and the Environment OSH Management in Indian Mining Sector—Lessons from the USAPartha Sarathi Banerjee

14. PREAMBLE • Globally mineral/mining sector is considered as a high risk industry. • Better technology & innovative OSH management practices have brought down Injury/Fatality Rate in this sector world wide. • However, in India, such measures have almost become asymptotic over the last two decades, even after intensified regulatory efforts.

15. VARIATION IN FATALITY RATE OVER LAST CENTURYSOURCE: GOI STATISTICS

16. CHALLENGES AHEAD • The existing ‘centralized regulatory policy’ in the country is likely to face challenge in the future due to: • growing size/ complexity of the industry, • liberalization of the sector to foreign/ private participation and • down sizing of government resources for regulation.

17. REGULATION AS A POLICY TOOL • Regulation as a policy tool is often in disfavor in the industry because: • the regulation cost is viewed as borne by the regulated industry while most benefits go to others. • Economists often criticize regulation as an inefficient substitution of centralized decision making for the alleged rationality of the market.

18. WHAT NEXT? • Can every public problem be solved through deregulation and by relying on market/devising better incentives? • No, Importance of coercive policy has been strongly felt after every disaster/ major failure in the industry. • Even in US political landscape regulation-bashing remains a hardy perennial. TAMING REGULATION BY NAKAMURA & CHURCH

19. LIVING WITH REGULATION • How OSH management can be made more effective? • Use of COST OF SAFETY model for analyzing costs, preparing budgets and setting realistic safety goals. • Devising positive & negative incentives in Workmen’s Compensation & Accident Insurance System based on Injury Performance Statistics.

20. Continued. • Shifting from existing rigid ‘centralized regulatory policy’ to a more flexible ‘co-operative self regulation’ policy- ‘regulatory pluralism'. • Self regulation may be objectively based on ‘quantitative risk assessment’ of work places and ‘injury rate goal setting’. • Example: Successful OSHA (California) experimentation on Cooperative Compliance Program during 1979-84. REFORMING THE WORKPLACE BY REES

21. Internal + External Failure Costs Prevention+ Detection Costs COST Optimal Equilibrium Point Safety Level COST OF SAFETY MODEL

22. Explanations • Preventive Costs to keep defects from occurring; Design, Process, Technology, Safe Material costs etc. • Detection Costs to minimize defects; Safety Inspection, OH surveillance costs. • Internal Failure Costs i.e; post incident costs; WC , Enquiry costs etc. • External Failure Costs i.e; Regulatory fines, Public image Costs etc.

23. 12th Symposium on Development and Social Transformation Panel 11: Improving Health, Safety, and the Environment Analysis of Policies Regarding Disposal of Industrial Batteries in USAVijay Bishnoi

24. TYPES OF BATTERIES • WET-CELL:Lead acid batteries used to power vehicles and by industry. • DRY-CELL NON-RECHARGEABLE: These are the most common types of household alkaline battery.  • DRY-CELL RECHARGEABLE: These are general purpose rechargeable batteries and include nickel cadmium, nickel metal hydride and lithium-ion batteries used in power tools, cordless appliances, mobile phones, etc.

25. ENVIRONMENTAL EFFECT • Batteries contain toxic heavy metals like cadmium, mercury and lead. • When thrown away, however these batteries can cause serious harm to human health and the environment as these heavy metals enter into food chain. • Possible health effects associated with ingestion or inhalation of heavy metals through water, food, or air include headaches, adnominal discomfort, seizures, comas and even cancer.

26. REGULATION • In USA lead-acid batteries were regulated at state level around 1990. • In 1996 a battery act was promulgated at federal level which regulated the disposal of used rechargeable batteries. • BCI and RBRC are the two NPO’s who developed the recycle program and also monitors recycling of used batteries.

27. MAIN POINTS OF US LEAD ACID BATTERY RECYCLING • Used batteries are to be recycled and not disposed of in landfill or incinerated. • Manufacturers collect spent batteries from consumers/ retailers when delivery shipments of new lead-acid batteries is done. • Financial incentive given to consumer for returning old battery which varies from state to state and is between $5 to $10 for each battery.

28. MAIN POINTS OF US LEAD ACID BATTERY RECYCLING… • Detailed regulation exist in USA as to how lead-acid batteries be transported which was issued by department of transportation around 1994. • Sustain publicity for educating public about environmental hazard and that battery should be recycled. • Consumer mainly responsible to send used battery to collection point or retailer. • Program is highly successful as recycling rate lead acid battery for the year 1999-2003 was 99.2%.

29. STATUS IN INDIA • In India regulation for disposal of lead acid batteries by recycle were promulgated in 2001 and is known as batteries (management and handling) rules, 2001. no regulation is available for disposal of other types of batteries. • Hazardous Wastes (Management and Handling) Rules, promulgated in 1989 for transporting hazardous wastes. • Batteries mainly disposed off thro auction to registered recyclers by government departments after 2001. • No collection system for used automotive battery.

30. STATUS IN INDIA… • Lead recycling not able to meet requirement. Total consumption: - 190,000 MT Indigenous production: - 55,000 MT Import of pure lead: - 65,000 MT From secondary smelters: - 70,000 MT • It is estimated that 50% of lead recycling is done by secondary smelters who do not have MOEF clearance and create pollution.

31. LESSONS FOR INDIA… • Introduce legislation for disposal of all types of batteries. • Introduce legislation for collection and transportationof used batteries. • Extensive publicity for creating awareness regarding environmental risk.

32. LESSONS FOR INDIA… • Financial incentive to be introduced for returning used automotive battery. • Collection centers should be established at large number of places for collection of used batteries. • Alternative employment work to be arranged for workers already in business of smelting.

33. 12th Symposium on Development and Social Transformation Panel 11: Improving Health, Safety, and the Environment The Impact of Orphanhood on Health Status and Education Attainment of Children in UgandaLoveena Dookhony

34. By 2003, • Number of Orphans: 43 millions (12.3 % of children) • Number of AIDS Orphans: 12.3 millions • Children orphaned during the year: 5.3 millions State of Sub- Saharan Africa

35. HIV Prevalence Rate: 14 % in 1980 to 5 % in 2001 However, • Number of Orphans continued to rise • Orphans as a percent of all children: in 1990: 10% in 2003: 14% Number of Orphans: 2 millions, of which 48% are AIDS Orphans Uganda as Case Study

36. STUDY Orphans vs. Non Orphans • What is the impact of orphanhood on health? • Who have been sick in the past 30 days? Hypothesis: Orphans, especially AIDS Orphans is more likely to be sick.

37. Explanatory Variables • Child Characteristics: • Orphanhood Status, Gender, Relationship to Head of Household • Head of Household Characteristics: • Gender, Health, Education • Household Characteristics: • Wealth Index

38. 40 34% 35 30 25% 25% 23% 25 20 15 10 5 0 Ma Dead Pa Dead Orphan AIDS Orphan Sickness according to Orphan Status

39. Causes of Sickness (29% were sick)

40. Table 5. Predicting Health Status (Partial Results) Predicting Health Status (Partial Results) Note: Number of observation is 24,912. The data comes from the Uganda National Household Survey 2002/2003 Standard errors are reported beneath the coefficient estimates. a indicates significance at 1% level b indicates significance at 5% level. c indicates significance at 10% level.

41. Interpretation of Results

42. Conclusion • Increasing Number of Orphans in Africa • Orphans, specially AIDS Orphans, are disadvantaged in terms of education and health compared to a non-orphan • Policy Implications?

43. 12th Symposium on Development and Social Transformation Panel 11: Improving Health, Safety, and the Environment Thursday, November 17 (4:15-5:30)