Assessing environmental health risks in India

Missing pieces of the puzzle?Missing pieces of the puzzle?OrOr

The missing puzzle?The missing puzzle?

Kalpana Balakrishnan, Sankar Sambandam, P.JayachandranKalpana Balakrishnan, Sankar Sambandam, P.JayachandranR. Padmavathi, V. ThanasekaraanR. Padmavathi, V. Thanasekaraan

SRMC & RI, ChennaiSRMC & RI, Chennai

Ground reality !

Areas of focus

Environmental quality assessments (65%)Environmental quality assessments (65%) Exposure assessments(20%)Exposure assessments(20%) Health outcome assessments with exposure indicators / Health outcome assessments with exposure indicators /

“exposure proxy”s (10%)“exposure proxy”s (10%) Toxicology (

Risks addressed

Outdoor (criteria pollutants)(60%)Outdoor (criteria pollutants)(60%) Indoor (PM) (15%)Indoor (PM) (15%) Occupational (PM,fibers) (15%) Occupational (PM,fibers) (15%) Select air toxics (10%)Select air toxics (10%)

Nature of study outputs

DescriptiveDescriptive AnalyticalAnalytical ConclusiveConclusive

% foreign citationIndia 87%

US 37%

Pakistan 96%

University 25% of all but over 80% of all peer reviewed publications

Others including 70% of all but less than 20% peer reviewed publicationsNational Research Organisations

Results from select studies (Environmental quality)

More than 50 studies describing status of ambient air quality More than 50 studies describing status of ambient air quality

Most describe yearly or monthly city wide averages with a Most describe yearly or monthly city wide averages with a few describing temporal and spatial variations/ distributionsfew describing temporal and spatial variations/ distributions

Very few organised to allow time –series analysesVery few organised to allow time –series analyses

Fewer organised to allow easy importation across Fewer organised to allow easy importation across investigators and/or statistical packages investigators and/or statistical packages

MOEF CRA study among the few multi-centric ones MOEF CRA study among the few multi-centric ones

Results from select studies (Exposure Assessment) Focus of many recent indoor studiesFocus of many recent indoor studies State level exposure atlas generation in progress in TN, State level exposure atlas generation in progress in TN,

AP (Lead by SRMC under UNDP Cap21,World Bank, AP (Lead by SRMC under UNDP Cap21,World Bank, USEPA funded projects)USEPA funded projects)

Links with health assessments in many states (IGIDR Links with health assessments in many states (IGIDR under UNDP Cap 21;TERI/SRMC under the “HEED” under UNDP Cap 21;TERI/SRMC under the “HEED” project) project)

Has allowed “intervention effectiveness” Has allowed “intervention effectiveness” assessments in assessments in AP (SRMC/ TERI under USEPA funding)AP (SRMC/ TERI under USEPA funding)

Considerable pool of expertise in large scale field Considerable pool of expertise in large scale field intensive assessments intensive assessments

Recent urban studies also addressing indoor and other Recent urban studies also addressing indoor and other exposure contributions exposure contributions

District level emissions of health damaging pollutants from household fuel use (SRMC/TERI study funded by USEPA)

Andhra Pradesh

Tamil Nadu

288 834 7040 232256N =

Andhra PradeshTamil Nadu

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r ave

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eter

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800

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400

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Wood

Dung/Wood chips/

Agricultural w aste

Kerosene

LPG

290105 34763 308130 228173N =

Andhra PradeshTamil Nadu

24-h

r ave

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exp

osur

e (m

icro

gram

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ic m

eter

)

1200

1000

800

600

400

200

0

Indoor kitchen w /o

partition

Indoor kitchen w /

partition

Enclosed kitchen

outside the house

Outdoor cooking

Daily average exposures stratified across exposure

determinants in rural households of AP and TN

Balakrishnan et. al. 2002

BOD attributable to IAP across districts (SRMC/TERI study funded by USEPA)

020000400006000080000

100000120000140000

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TB ARI COPD

DALYS

DEATHS

Alternative scenarios for exposure reduction in Andhra Pradesh (SRMC/TERI study funded by USEPA)

Concentration profiles for fuel and kitchen switches

150

200

250

300

350

400

450

500

550

600

Average KitchenConc.

Average Living Conc.

Average kitchen fuelsw itch

Average living fuelsw itch

Average Kitchen(NSKto SK)

Average living(NSK toSK)

Average kitchen (Fuel+kitchen)

Average living(fuel+kitchen)

TERI/ SRMC/ UCB/University of Maryland study funded by NIH)

0

5

10

15

20

25

30

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Time

CO

(ppm

)

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Fine Particulates (mg/m

3)

CO Draeger Monitor UCB Particle Monitor

Results from select studies (Health impact assessments)

Chennai (W. Bank 1992) Rs.275/person

Chennai – Manali (SRMC/IGIDR 2002) Rs.1626/person

Chennai (W. Bank 2002)  Rs125/person

Bombay (W. Bank 1992) Rs.734/person

Bombay(URBAIR, W. Bank) Rs.1840/person

Results from select studies (Epidemiology)

HEI special report cites 15 studies including 1 time series HEI special report cites 15 studies including 1 time series study prior to PAPAstudy prior to PAPA

MOEF CRA nine city study under compilationMOEF CRA nine city study under compilation 3 time series studies underway3 time series studies underway Several indoor air studies on respiratory morbidity, TB, Several indoor air studies on respiratory morbidity, TB,

cataract associated with solid fuel smoke exposure cataract associated with solid fuel smoke exposure underwayunderway

Indo –US consortium on occupational and environmental Indo –US consortium on occupational and environmental health has a special focus on environmental epidemiology health has a special focus on environmental epidemiology

Results from select studies (Molecular Epidemiology)

Biomarker studies in Delhi and Calcutta (CCI) Biomarker studies in Delhi and Calcutta (CCI) Recent new mechanistic studies on endocrine disruption Recent new mechanistic studies on endocrine disruption

associated with community exposures to pesticides associated with community exposures to pesticides (reported by NIOH) (reported by NIOH)

Single-nucleotide polymorphisms being examined for lead Single-nucleotide polymorphisms being examined for lead (SRMC/Fogarty; ITRC),PAHs (ITRC),Arsenic(ROC)(SRMC/Fogarty; ITRC),PAHs (ITRC),Arsenic(ROC)

Infra-structure for toxico-genomics and high throughput Infra-structure for toxico-genomics and high throughput genomic analyses available at several centres but not genomic analyses available at several centres but not widely used for environmental genomics applications widely used for environmental genomics applications

Important considerations for next steps

Engaging in QA audits for data qualityEngaging in QA audits for data quality Setting up accessible databases for pooled Setting up accessible databases for pooled

analysesanalyses Specifying a research agenda Specifying a research agenda Setting realistic budgetsSetting realistic budgets Establishing a strong peer-review mechanism for Establishing a strong peer-review mechanism for

outputs generated from funded projects outputs generated from funded projects

Choices of paradigms?

More evidence for policy vs. more policy for More evidence for policy vs. more policy for evidence?evidence?

Regulate and monitor vs. monitor and Regulate and monitor vs. monitor and regulate?regulate?

Model to fit or fit to models?Model to fit or fit to models? Numbers for credibility vs. credibility for Numbers for credibility vs. credibility for

numbers?numbers?

Feasible

Effective

vs.

Realistic target setting

makes the feasible more effective

Holistic capacity building

makes the effective more feasible