P ublic Health and A ir P ollution in A sia “PAPA” Project Case study

1. Public Health and Air Pollution in Asia“PAPA” Project Case study Bob O’Keefe Health Effects Institute RAQ Initiatives Meeting Bangkok

2. Overview slide • HEI • PAPA Overview • Advancement & Extension of Knowledge Base • Capacity Building • Policy Relevance • Regional Exchange & Coordination

3. HEI-The Idea • A non-profit research institute founded in 1980 • To provide high quality, impartial and relevant science on the health effects of air pollution….. • ….To guide public and private decision makers, often in controversial circumstances” • Jointly and equally funded by worldwide auto industry & US EPA • Other partners: WHO, EC, CARB, USAID, ADB, Industries in North America, Europe and Asia (e.g. fuels, chemical, engines) • Foundations and environmental NGOs • Over 220 studies completed to date: • Americas, Asia, Europe • Ozone, carbon monoxide, particulate matter, Air Toxics (diesel exhaust, benzene, butadiene, metals, others) Fuels and additives • Epidemiology, toxicology, exposure assessment and related areas

4. Potential Drivers for Change Drivers for Change Decision Makers Change Fuels Public Concern • Parliaments • National Agencies • International Agencies • Lenders • Industries • NGOs and Other Stakeholders I&M Visibility Controls Health Planning Ecosystems

5. The Main Driver - Public Health • Many Potentially Sensitive Populations • Children • Elderly • Growing number of asthmatics • Air pollution has widespread exposure • WHO Global burden of disease identified potentially very large impacts • Thousands of Premature Deaths, Tens of Thousands of Hospitalizations, Days of work and school lost • Western studies basis for analysis

6. PAPA Program • Partnership with CAI-ASIAto understand the health effects of air pollution in local Asia populations, now and in the future • (Support USAID, Hewlett, industry) • Effort actively underway: • Scientific Review of what is known today about health effects in Asian cities published in April, 2004 • New health studies in representative Asian cities (Bangkok, Hong Kong, Shanghai, Wuhan) underway, Chennai, Guangzhou and others to follow • Understand local impact, inform extrapolation, poverty impact • Comprehensive assessment of the state of air pollution and health across Asian cities at study conclusion • Build capacity of local scientists • Overall Goal: • Inform key Asian regulatory & policy decisions

7. Advancement of Knowledge • 2004 Review: Assembles for the first time studies of air pollution and health from across Asia • ~140 studies from Asia region evaluating multiple pollutants & health effects • Creates new resource for policy makers • First-ever meta (combined) analysis to measure “acute” air pollution health effects across Asian cities (results later) • New studies underway in four cities (Bangkok, Hong Kong, Shanghai, Wuhan) to fill gaps in understanding • Targeted studies added in Chennai, other cities less well studied where pollution levels, population density is high (India, Indonesia, Philippines, Vietnam, (others) • Key future focus: air pollution’s effects on the poor • Comprehensive assessment of air pollution and health in 2006 • Authoritative: many types of studies, populations • Translated to multiple languages

8. Capacity Building • Capacity building formed around actual new research (not only workshops): • From outset selection criteria stressed: • Selection of Asia led & staffed investigator teams • Strong linkages to local health, regulatory officials to enhance systemic data access & drive quality (policy relevance) • For all selected investigators: • Paired with highly qualified international science teams to design studies • Key element: Coordinated study design drives capacity building regular interrelationships among scientists from diverse regions to produce a real product (e.g. integrated health study) • Periodic regional visits by ISOC to provide technical assistance, QA\QC, • HEI Peer review to provide technical feedback, guidance on honing science, and effective communication to regional policy makers • Phase 2 studies (promising teams in understudied areas needing additional skills) • Join subset of workshops with goal of submitting fundable proposals in year • Fogarty workshops in India “How to prepare successful scientific applications’

9. Regional Exchange & Coordination • Studies Designed for Asia-Wide Coordination and exchange: • Building strong networks of health scientists across Asia (along with their respective air pollution and health agencies) • Hosting both regional & international technical workshops to build network • Bangkok ISOC workshop in February – 7 Asia science teams, regulators • HEI Annual Meeting (latest global science) • ISEE (professional development, networking, PAPA session in 05 to foster interest in regional issues of air pollution & health) • PAPA methodology designed to facilitate use in other Asian cities, to systematically build a health database for Asia • HEI established dedicated web “message board” to facilitate education, communication • All PAPA studies widely distributed, web posted • Briefings of agencies, stakeholders across Asia on all PAPA studies and reports • Key studies translated into multiple languages

10. Policy Relevance & Impact • The Special Challenge in Asia: • Can what we know about air pollution in the West be applied to decisions in Asia? • Although well done, WHO GBD based on western studies. relevance to Asia has been questioned • HEI-PAPA approach: • Quality, independent science; • From outset strong linkages to local health, regulatory officials required in scientific proposals so that policy makers support, trust science (regular early briefings for industry, government, NGOs); • Results presented in lay terms, in context of existing science from WHO, IARC, others • As a result, HEI science regularly highlighted in key standard setting processes across the globe, in scientific journals, press • Enhancing PAPA’s impact: • Maintain high-quality science throughout • Active involvement of leading Asian scientists on PAPA ISOC • Advisory Board with key Asian representatives for guidance on identifying key local officials, relevant policy forums • Regular regional visits to report results to key stakeholders across region –”No surprises” • Continuing communication as key policy decisions are being made (e.g. Vietnam workshop, WHO forums) • Integration of Policy makers –Scientists (BAQ-PAPA Health forum December 04)

11. Thank You! • rokeefe@healtheffects.org