Transcript Africa Case Study - global change SysTem for Analysis, Research

Africa Case Study
Dele Ogunseitan
School of Social Ecology
University of California, Irvine
May 20th 2004
Advanced Institute of Vulnerability to Global Environmental Change
International Institute for Applied Systems Analysis, Austria
Outline
(1) Institutional Issues: Framing and prioritizing vulnerability
assessments in Africa.
(2) Thinking outside the dominant framework: Global
environmental change and the African burden of disease.
(3) Proposed solutions to global environmental change will
have impacts too: No-cost adaptation and the clean
development mechanism in Africa.
(4) Break
(5) Group discussion/summary
Panarchy and Vulnerability
“Panarchy focuses on ecological and social
systems that change abruptly. It is the process
by which ecosystems and societies grow, adapt,
transform, and, in the end, collapse.”
- C.S. “Buzz” Holling (2004)
Vulnerability is inevitable?
Epidemics
Extinctions
Forest fires
Earthquakes
War
» Holling, C. S. 2004. From complex regions to complex
worlds. Ecology and Society 9(1): 11. [online] URL:
http://www.ecologyandsociety.org/vol9/iss1/art11
» Gunderson, L. H., and C. S. Holling. 2002. Panarchy:
understanding transformations in human and natural
systems. Island Press, Washington D.C., USA.
Several external factors contribute simultaneously to vulnerability
e.g. “abrupt” climate change; emerging pathogens; global trade; how do we
prioritize assessments?
Vt = ∑(Vi)*∑ (Ve)
Internal vulnerability
Perpetual Panarchy in Africa
Normative Issues
When resources are limited, choices are typically made to focus
on pre-existing stressors rather than on emerging threats, but
innovative frameworks address both challenges through “nocost” adaptation strategies.
In many African countries, the reconciliation of national
development plans with international priority to mitigate global
environmental change (e.g. climate change, ozone depletion,
biodiversity loss) remains an intractable policy controversy. Its
resolution requires conviction of vulnerability to new conditions
that will exacerbate preexisting environmental stresses on society
and public welfare.
Emergence of Regional Frames of Vulnerability
The Perspective of Developing Countries: The New Delhi Conference in
1989 (The equity argument).
African Perspectives: Nairobi Conference in 2-4 May 1990; Sponsored by
the Woods Hole Research Center at the UNEP headquarters.
The Cost of Gaining International Financial Support: Framing, funding,
and the question of intellectual hegemony.
Prioritizing GHG Inventories, Mitigation, and Vulnerability (Sensitivity
+ Capacity for Adaptation).
The benefits of national GHG inventories and mitigation are shared
globally. Whereas the burden of adaptation to the impacts are expected to
be borne nationally.
Policy Recommendations from the 1990 Gathering of
“African Perspectives”
Focus on deforestation, carbon sinks, and food security
Futuristic scenarios
Enhancing research and training
Strengthening the technological base
Promoting public awareness and participation
Reforming the institutional environment
Vigilance of industrialized country actions
Promotion of private sector initiatives
Adjusting UN agency framework
e.g. CoP to
UNFCCC;
Ramsar
e.g. Country Study
Programs; IPCC
e.g. Burden of
disease estimates
International
Conventions;
Country
representatives
Negotiation of Alternative
International Frameworks
At the same scale
National
Environmental
And
Health Policy
Local
knowledge
systems
Framing
environmental
issues across
different scales
International Support for Vulnerability
Assessments in Africa
_____________________________________________________________________________________________
,,,,
US CSP
GEF
Netherlands CSP
German GTZ
WHO
Mauritius
U.S.-sponsored Country Study Programs
on climate change inventories, mitigation, and vulnerability
assessments
African Participation in the USCSP:
Assessments of Vulnerability and Adaptation by Sector
Country
Botswana
Cote d'Ivoire
Egypt
Ethiopia
The Gambia
Kenya
Malawi
Mauritius
Mozambique
a
Nigeria
South Africa
Tanzania
Uganda
Zambia
Zimbabwe
Coastal
Resource
*#
*#
*
*
*
*
Agric.
*#
*
*
*
*
*
*
*
*
*
*
Grassland
And
Livestock
Water
Resource
Forests
Fishery
*
*
*
*
*
*#
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Wildlife
Human
Health
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*Vulnerability assessment
#Adaptation assessment (Note: decoupled from vulnerability)
Some assessments are jointly funded by the GEF
*
*
*
*
*
*
Agenda setting:
Institutional structure, state of the science, and
advocacy
Q: When USCSP started supporting national assessments in 1992-94, health was
not included in the first round of vulnerability assessments -until much later in
1996-98 with the second round of assessments and national action plans. What
caused the delay?
A: “We were limited mainly by the development of the science. We did not have
good information or training to provide, but after we got into the program, some
countries began to agitate for the inclusion of health. At about the same time,
some influential scientists were beginning to produce empirical work on health
impacts of climate change, and as a result of the combination of the request from
participating countries and the availability of scientific expertise, we decided to
include health.” I would say that, except in the health area, which really did in
fact come up from a number of different countries, nothing else came completely
out of the blue, because we had a big net for the issues.
- Jack Fitzgerald, Acting Director, USCSP (2000).
Health as a focal point for assessments of
vulnerability
• Health is a common concern for African countries, and the ultimate
impact of climate on crop production and water resources is
population health.
• Development of “Early warning systems” for local environmental
changes that currently accounts for most impact on human health
and social welfare.
• Possibility of circumventing health-damaging pathways to industrial
development.
• *Pre-epidemiologic transition. Therefore, burden of disease is
attributable to environmental factors that are sensitive to climate
change.
– *WMO-day 1999: Weather, Climate, and Health
1963
1973
25,000 km2
95% reduction
Lake Chad
1,250 km2
1997
1987
The Lake Chad Basin Commission
has mandate over 967,000 km2
watershed. Five member states own
it and contribute it's budgets. The
mandates of regional organizations
enable them to undertake active
multipurpose infrastructural projects
that could generate funds to finance
of regional basin organizations.
Population migration, resource conflict, and vulnerability to
AIDS in Lake Chad Basin Countries
Estimates of the number of persons living with the HIV, June 2000*
Adults and
Children
Cameroon
Adults
Rates
among
adults
Women (1549)
Children
(0-14)
540,000
520,000
7.73%
290,000
22,000
64,000
61,000
1.35%
34,000
33,000
2,700,000
2,600,000
5.06%
1,400,000
120,000
C.A.R.
240,000
230,000
13.84%
130,000
8900
Chad
449,254
88,000
2.69%
49,000
4000
Total
3 993 250
3 499 000
6.13%
(average
rate)
1 903 000
187 900
Niger
Nigeria
*Source : UNAIDS
High expectations for new cross-scale institutional
arrangement
The Ramsar Convention on Wetlands
Memorandum of Cooperation between Ramsar and the Lake
Chad Basin Commission (established in 1964)
The signing ceremony, Valencia, Spain, 23 November
2002: Delmar Blasco and Muhammad Sani Adamu
Naivasha Lake Basin
Today at 1880 m above sea level (1886 m in 1926), it is the highest of the Rift
Valley freshwater lakes, and second largest at 100 km2, but only 5 m deep; and
no outlet! >400 species of birds
1980
Human population 20,000
Fish harvest 68 tonnes
Ramsar Convention
Designation in 1996
2000
Human population 250,000
Fish harvest 14 tonnes
Sewage, pesticides, and
Fertilizer loading.
Optimization of institutional collaborations
• Negotiation of constraints on agenda setting
and funding mechanisms to re-establish
ownership of assessments and responsibility for
intervention schemes).
• Technical capacity development, including
qualitative and quantitative analyses.
• Re-configuration of science-policy interfaces
within countries.
Published On-line http://www.globalforumhealth.org/forum_6/sessions/
Every year more than US $70 billion is spent on health research
and development by the public and private sectors. An estimated
10% of this is used for research into 90% of the world's health
problems. This is what is called "the 10/90 gap".
Research Approach
• It is generally assumed that potentially controllable
environmental risk factors, as opposed to life style
preferences, contribute most to the burden of disease
in developing countries.
• Quantitative assessments of the health impacts of
environmental remediation are not commonly
performed because of methodological difficulties and
the paucity of data that could usefully correlate
investment in infrastructures for environmental
protection to prevent adverse health outcomes.
– These limitations have incapacitated attempts to prioritize
risk factors in the interface between the environment and
human health sectors.
Objectives
• The main objective of this research was to use
composite indicators of disease burden as tools
for prioritizing solvable environmental problems
that influence sub-regional burden of disease.
• To test the sensitivity of the composite indicators
to various scenarios of global environmental
change as a way to monitor population
vulnerability.
Global Burden of Disease Assessment
Seven Regions
WHO/WB/HSPH
Estimating local burden of diseases
• A composite measure of the combined impact of
death and disability in a population is used to
estimate disease burden. The Disability-Adjusted
Life Years (DALY) model:
• DALYi[0,0] = YLLi + YLDi
• Where DALYi[0,0] = Undiscounted, unweighted for
disease i
• YLLi = Years of Life Lost due to disease i
• YLDi = Years of Life lived with Disability due to
disease i
Communicable diseases
Non-communicable diseases
Injury-related
Future projections of disease burden
ln M = C + b1lnY + b2lnHC + b3T
Where:
M = projected mortality level
C = constant term
Y = GDP per capita
HC = Human capital (including population growth)
T = Time
Estimating risks attributable to
environmental factors
Attributable Risk is assessed according to the following equation, using
published data on relative risks for each cause of death and disability
related to the exposure, levels of exposure (prevalence), and burden of
disease due to each cause of death and disability in the population:
AB = ∑ AFj Bj = ∑Pj (RRj – 1) ÷ ∑Pj (RRj – 1) + 1
•
Where
–
–
–
–
–
AB = Attributable Burden for a risk factor
AFj = Fraction of Burden from cause j
Bj = population level burden of cause j
P = Prevalence of exposure
RRj = Relative Risk of disease or injury for cause j in exposed versus unexposed
group.
– n = Maximum exposure level
Combining
future
projections
with
attributable
risk can give
an estimate
of avoidable
disease
burden
WHO, 2002
Models and Scenarios
• In the first scenario, decadal evaluation of
selected climate-driven epidemics were
evaluated against projected scenarios of climate
change predicted by the Intergovernmental
Panel on Climate Change.
• In the second scenario, co-benefits of climate
change mitigation were explored using the
burden of disease approach and the abatement
of lead (Pb) exposure as the dependent
variable.
Rank order of population at risk for vector-borne diseases
Millions
Nigeria’s Demographic Characteristics*
Characteristics
1999 Estimate
Total Population
113,828,587
Total Population Growth Rate
2.92 %
Urban Population (Fraction of Total Population)
41 %
Urban Population Growth Rate
14%
Life Expectancy at Birth
Total Population = 54.06 Years
Female = 54.06 Years
Male = 52.55 Years
Disability-Adjusted Healthy Life Expectancy
(World Health Organization, Year 2000)
Total Population = 38.3 Years
Female = 38.4 Years
Male = 38.1 Years
Birth Rate
41.84 Births / 1,000 Population
Total Fertility Rate
(Average Number of Children per Mother)
6.02 Children Born Per Woman
Death Rate
12.98 Deaths / 1,000 Population
Infant Mortality
69.46 Deaths / 1,000 Live Births
Maternal Mortality
1.0 %
Fraction of Population Below Poverty Line
34.1 %
Gender Ratio
At Birth = 1.03 Male(s) / Female
Ages 15-64 Years = 1.04 Male(s) / Female
Age 65 and Older = 1.01 Male(s) / Female
Total Population = 1.02 Male(s) / Female
*Source: United Nations Development Program 1999.
Socioeconomic indicators and health care status in
Nigeria
Indicator
Public health expenditure (Proportion of GDP)
Value*
< 1%
Private health expenditures (Proportion of GDP)
1%
Urban dwellers access to improved water
80%
Rural dwellers access to improved water
39%
Urban dwellers access to improved sanitation
82%
Rural dwellers access to improved sanitation
48%
Population per doctor
5,208 (1993)**
Population per hospital bed
599 (1990)
Real GDP per capita
920 (1997)
*Values are for 1995 unless otherwise stated.
Source: UNDP, 1999.
Cases of Notifiable Diseases in Nigeria 1990-1999.
National Database Source: Federal Epidemiology Division, Federal Ministry of Health, Abuja, Nigeria
Disease
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999*
Cholera
4101
62418
8687
4160
3173
3364
59136
13411
9254
26358
CSM1
7804
6992
6418
4209
6119
7376
108546
39973
10793
1946
Diphtheria
1768
2849
2351
2042
1363
1556
2768
3285
6071
3769
G/Worm2
9050
5479
6749
5356
3388
1848
14388
10426
13419
9603
Hepatitis
5495
8897
8291
6312
4283
3599
5436
2664
8158
3264
Leprosy
20557
13641
14875
14706
10422
8105
7687
8524
10177
3704
Malaria
1116992
909656
1219348
981943
1175004
1133926
1149435
1148542
2122663
732170
Measles
115682
44026
85965
54734
108372
49880
102166
73735
164069
132856
Pertussis
42929
18685
22147
23800
34792
13639
26745
33729
49550
22162
Tuberculosis
20122
19626
14802
11601
15202
10040
121025
11388
19368
9329
Onchocerciasis
2002
758
2879
82634
6401
7272
5111
3125
2948
1024
Yellow fever
6035
2561
149
152
1167
0
0
0
5
0
1Cerebrospinal
meningitis
worm
*January - August only
2Guinea
Deaths from Notifiable Diseases in Nigeria 1990-1999
National Database Source: Federal Epidemiology Division, Federal Ministry of Health,
Abuja, Nigeria
Disease
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999*
Cholera
61
7869
663
266
471
140
4546
851
277
2085
CSM1
784
695
563
472
437
1388
11231
965
797
165
Diphtheria
2
64
3
0
0
5
55
166
3
15
G/Worm2
7
23
0
0
0
0
0
0
1
38
Hepatitis
69
60
48
53
33
54
38
39
42
20
Leprosy
7
17
35
0
0
1
0
0
0
0
Malaria
2284
1947
1068
719
1686
3268
4773
4603
6197
1891
Measles
1399
388
1032
373
696
671
2031
1147
1804
2751
Pertussis
184
66
1
61
65
51
186
222
216
121
Tuberculosis
213
487
230
192
379
407
380
331
454
152
Onchocerciasis
1
4
0
0
25
1
90
85
2
0
Yellow fever
421
661
8
8
415
0
0
0
3
0
1Cerebrospinal
meningitis
worm
*January - August only
2Guinea
Regional Mortality by Gender in Study Population (1990 - 1999).
DEATHS PER 1,000
2.5
2
1.5
MALES
FEMALES
1
0.5
0
1
2
3
4
5
6
YEARS
7
8
9
10
ADMISSIONS PER 1,000
Hospital Admissions by Gender in the Study Population
(1990 - 1999).
35
30
25
MALES
20
FEMALES
15
10
5
0
1
2
3
4
5
6
YEARS
7
8
9
10
10- Measles
11-Malaria
3-Severe diarrhea
0.90
18
2
37-ALRI (child)
0.1
38-ALRI (adult)
1.31
4-TB
Disease Incidence
per 1000
1.2
2-Typhoid
4
1-Cholera
0.19
6-Diptheria
0.03
7-Pertussis
0.03
19-Yaws
8-Meningitis
0.22
22-Hepatitis
9-Polio
0.007
23-Trypanosomiasis
6
0.3
0.05
13-Leprosy
0.12
Tetanus neonate
15-Schistosomiasis
0.14
24a-Tetanus post neo
0.75
20-Onchoceriasis
0.30
25-Cancer (child)
0.03
18-Guinea Worm
0.08
26-Cancer (adult)
0.69
30-Hookworm
19
27-Diabetes
Ascaris
10
28 Malnutrition
36-Common cold-16
14-Chickenpox
1000
22
0.02
0.1
31-Rheumatic HD
0.3
3.8
0.12
32-Hypertensive HD
12-STD
0.24
34-Congenital HD
1.6
2
29 Sickle Cell Disease
AIDS
21-Trachoma
0.5
0.07
33-Other HD
35-Cerebrovascular
39-Peptic ulcer
40-Other GI disease
41-Hernia/Int Obst
0.37
2.3
4.27
2.8
4
42-Cirrhosis
0.09
43-Chronic Renal D
0.31
44-Pregnancy Compli
1.13
Prematurity
9.6
Birth Injuries
1.6
Umbilical Sepsis
0.22
Congen Malform.
0.96
Hemolytic Dis
0.14
Birth Pneumonia
0.46
50GYN Disease
1
46-Skin Infections
47-Mental Disorders
Cataracts/Eye
2.7
4.06
0.4
49-Dental Diseases
0.28
51-ENT Diseases
0.56
Accidents/All
Epilepsy
7.7
0.48
DALY (HeaLY) model scenarios
Discount Rate
0.015 - 0.045
Intervention
Coverage
EPI
0.3
WATER
0.2 – 0.4
SANITATION
0.45
OPD
0.45
IPD
0.4
EDUCATION
0.1
MFU
0.9
FAMILY PLANNING
0.05
A.N.C.
0.2
VECTOR CONTROL
0.2 – 0.5
The local burden of disease:
Top categories for Years of Health Lives Lost (1990-1999)
Rank
Disease
YHLL per 1000
1
Hypertension
88.5
2
Birth Injuries
47.3
3
Premature Birth
47.2
4
Mental Disease
41.9
5
Accidents
40.3
6
Malaria
33.3
7
Diabetes
33.0
8
Cerebrovascular disease
30.6
9
Tuberculosis
24.9
10
Neonatal Tetanus
18.9
11
Typhoid
16.7
12
Cancers (adult onset)
14.9
13
Congenital Malformations
13.9
14
Hernias
13.5
15
Tetanus (Post neonatal)
11.2
22
HIV / AIDS
4.93
Sensitivity of disease burden to
environmental change
Epidemic potential for climate-sensitive
Vector-borne diseases
EP = reciprocal of host density threshold
Critical density for vector-borne disease transmission
Mc1 = c1 (- ln (p) ÷ (b)(c)(a2)(pn))
Where p = survival probability of mosquito
a = frequency of blood feeding
n = incubation period of the parasite vector
b = efficiency of infection
c1 = constant based on recovery rate and host susceptibility factors
Reproductive rate of disease =
R0 = (m)(a2)(b)(c)(pn) ÷ r (-ln (p))
When R0 > 1, disease will spread.
n = Dm ÷ T – Tmin, m
Dm = degree-days required for parasite development
T = average ambient temperature
Tmin = minimum temperature required for parasite development
MIASMA
Modeling framework for the health Impact ASsessment
of Man-induced Atmospheric changes
• MIASMA is an acronym devised to refer to
several models dealing with health
impacts of global atmospheric changes:
the vector-borne diseases model.
From Shakespeare to Defoe: malaria in England in the Little Ice Age.
Paul Reiter
Centers for Disease Control and Prevention, USA. [email protected]
• Present global temperatures are in a warming phase that
began 200 to 300 years ago. Some climate models
suggest that human activities may have exacerbated this
phase by raising the atmospheric concentration of
carbon dioxide and other greenhouse gases.
Discussions of the potential effects of the weather
include predictions that malaria will emerge from the
tropics and become established in Europe and North
America. The complex ecology and transmission
dynamics of the disease, as well as accounts of its early
history, refute such predictions.
Emerging scientific controversy over the linkage between
climate and vector-borne diseases (e.g. Malaria)
Vol. 6, No. 4, Jul–Aug 2000
To the Editor: I read with great interest the article "From Shakespeare to Defoe:
Malaria in England in the Little Ice Age" (1). Unfortunately, the article is not as
balanced as a presentation last year by Paul Reiter, which clearly illustrated that,
although climate is important in the transmission of malaria, the influence of other
factors (e.g., access to medical care and improved housing) is likely to be of more
importance in Europe…. While Reiter's paper offers an interesting perspective on
the history of malaria in Europe, it provides no illuminating information on the
influence of climate change on human health.
- Pim Martens (Maastricht University, Maastricht, The Netherlands)
To the Editor: The two reports from the International Panel on Climate Change
(IPCC) (1,2) cited in the letter by Pim Martens (3) are widely regarded as "the
standard scientific reference for all concerned with climate change and its
consequences," yet the contents of these reports are often misleading……..
Repeated claims that global warming may have already led to increases in these
diseases in the tropics are equally indefensible…..
- Paul Reiter (Centers for Disease Control and Prevention, USA)
Climate change and malaria vulnerability in Nigeria
Environmental Change and the African Burden of Disease
Projection of Disease Burden in Sub-Sahara Africa
as a Function of Global Climate Change
1990 D A LY s
Disease
Malaria
Diarrhea
Dengue
Tropical C.
Malnutrition
Respiratory
Eyes
HIV
a
2000 D A LY s
2010 D A LY s
2020 D A LY s
% of
T o ta l
A fric a n
B u rd e n
A fr ic a ’s
Share of
G lo b a l
B urden
W ith in
C a te g o r y
(% )
% of
T o ta l
A fric a n
B u rd e n
A fr ic a ’s
Share of
G lo b a l
B urden
W ith in
C a te g o r y
(% )
% of
T o ta l
A fric a n
B u rd e n
A fr ic a ’s
Share of
G lo b a l
B urden
W ith in
C a te g o r y
(% )
% of
T o ta l
A fric a n
B u rd e n
A fr ic a ’s
Share of
G lo b a l
B urden
W ith in
C a te g o r y
(% )
9
85
32
3
52
18
13
19
75
8
9
< 0 .1
1
3
3
1
6
91
41
5
58
24
13
19
51
6
7
< 0 .1
1
2
4
1
6
93
46
6
64
28
14
19
42
4
5
< 0 .1
0 .5
2
5
1
4
94
49
6
73
30
15
20
33
11
< 0 .1
2
3
3
1
3
“Less popular” health
vulnerabilities to climate change
Dry Climate, Human susceptibility and
the Meningitis Belt
*1.2 Million Cases/year
*135,000 Fatalities
*8-12 year cycles in hyper-endemic regions
*Shorter and more irregular intervals since
1980s
The incidence Cerebrospinal Meningitis in Nigeria (1990 -1999).
The vector-borne disease shows environment-dependent fluctuation dynamics in Nigeria. The
upsurge in cerebrospinal meningitis is linked to recent climatic events.
120000
100000
80000
60000
40000
20000
0
1990
1991
1992
1993
1994
1995
YEAR
1996
1997
1998
1999
2000
Desertification and Health Impacts of
Sahara Dust
International focus on the trans-Atlantic movement of Sahara dust, with impacts
Including the introduction of food crop pathogens in the Americas, and ironfertilization of the oceans, leading to coral reef bleaching. Impact on respiratory
health effects In Sub-Saharan Africa is understudied.
Current hypothesis include the exacerbation of respiratory diseases, Meningitis
burden, and blindness.
Policies to Mitigate Climate Change
Will Have Global Impacts
What are the projected health
effects in African countries?
Alternative Framing of Health Vulnerability in IPCC
Assessments: Switching to alternative fuels will also lower
vulnerability to Pb poisoning
• Current framing of health impacts of climate
change emphasizes the spread of vectorborne diseases which may have little
additional impact in African countries.
• 22% of gasoline used globally contains Pb,
mostly in developing countries.
• OPEC countries generally oppose shifting
from carbon fuels, but they all still use leaded
gasoline.
• Joint Implementation arrangements must
consider the direct health benefits of
assistance towards decarbonization.
Natural gas flaring in Nigeria contributes ~20-30% of global sources
of greenhouse gas emissions from this source, contributing to the
causes of global warming.
Nigeria subscribes to OPEC-block position on mitigation strategies
(Kyoto Protocol)
SHELL'S GAS FLARE AT ITS KOLO CREEK SITE,
BAYELSA STATE IN NIGERIA'S NIGER DELTA
This picture is typical of gas
flares that litter the Niger
Delta. Many of them have been
burning for over thirty years
and blur any distinction
between night and day in their
range of impact.
Photo Taken By Israel Aloja of Enviromental Rights Action/Friends of the Earth Nigeria [ERA/FoEN]
In 1994, UN Commission on Sustainable Development
Recommended Global Phase-out of Leaded Gasoline. In 2004,
Many countries, largely in Africa and the Middle East, have no
urgent plans to eliminate lead from gasoline
Lukman’s Statement to COP-6
…………….As it stands, the Kyoto Protocol, if fully
implemented, would lead to a dramatic loss of revenue
for oil-exporting countries, as a result of a heavy
reduction in demand for petroleum. Independent studies
estimate the loss at tens of billions of US dollars per year
for OPEC's Members. This would strike at the very heart
of these countries' economic and social infrastructures,
causing a radical scaling down of development plans and
entailing huge cutbacks in such vital services as education
and health care. It would also affect the ability of these
countries to invest in future production
capacity………….
……Finally it should not be forgotten that the
established industrial nations bear the principal
responsibility for the purported phenomenon of global
warming, and not the developing countries. The onus,
therefore, is upon the rich nations to minimize and finance
the negative impact of their response measures on the poor
countries of the south. Developing countries should not be
roped into making commitments to emissions-reduction
targets, which could have enormous cost implications for
their fragile economies. Instead, every assistance should be
given to them to develop their economies in an efficient,
environmentally harmonious and sustainable manner.
- Rilwanu Lukman, OPEC Secretary General to Cop 6,
September 2000.
Comparative costing of health impacts of Pb and
economic disincentives
• In Nigeria, Pb content of regular gasoline is 0.74 g/L.
• Atmospheric Pb emission is estimated to be 2,800 metric
tons/year.
• Policy analysts at the Center for Energy and Development in
Ife calculate that the country cannot presently afford the cost
of switching to non-leaded gasoline.
• But what is the public health cost of not switching? How
many DALYs can be attributed to the burden of Pb in
Nigeria?
The costs and benefits of energy
de-carbonization
• Nigeria has proven reserves of 180 billion cubic feet of
natural gas - the 9th largest location of this resource in the
world.
• Nigeria flares 75 per cent of the gas it produces and reinjects only 12 per cent to enhance oil recovery.
• Approximately 2 billion standard cubic feet of gas is
currently being flared in Nigeria - the highest in any
member-nation of the Organization of Petroleum Exporting
Countries (OPEC).
• Consequently, Nigeria accounts for 20-30% of the total
amount of gas flared globally.
Internalized Costs of Pb-Poisoning
• Ibitoye et al. [1998] estimated a cost of $30 - $50 per ton for
reduction of carbon dioxide emissions in Nigeria, according
to the models and goals endorsed by the United Nations
Framework Convention on Climate Change.
• A maximum reduction of 2 billion tons of carbon could be
achieved within the next 40 years. Thus, the total cost of
decarbonization is estimated to be $60 – 100 billion for the
next generation of Nigerians.
• Meanwhile, the next generation is undergoing exposure to
Pb. Assuming that most of the current sources of carbon
dioxide are also sources of toxic metals and other air
pollutants, more than 70 million young children in Nigeria
are burdened by diseases attributable to leaded fossil fuels.
At what cost?
> 30% of children (ages 1-6 yrs) in rural Otukpo
region of Nigeria are lead-poisoned
Smith & Ogunseitan, 2002
Gender
N
Mean [B-Pb]
Range
SD
% > 10 ug/dL
Female
138
8.9
(2.1,23.8)
4.2
32.5
Male
168
9.8
(2.2,31.8)
4.8
35.0
Total
306
9.4
(2.1,31.8)
4.2
34.3
Lead (Pb) dose in urban Nigerian children
between the ages of 1 and 7 years
30
25
20
%
15
10
5
0
5
7
9
11
13
15
17
19
21
Blood lead concentration (mg/dL)
Nriagu et al., 1997
Quantifying the burden attributable to the
health impacts of Pb-exposure in Nigeria
•
•
•
•
•
•
•
•
•
•
•
Mild mental retardation
Ischaemic heart disease
Cerebrovascular disease
Genitourinary disease
Immune suppression
Spontaneous abortion
Congenital anomalies
Hypertension
Iron deficiency anemia
Endocrine disorders
Hypertensive disorders of pregnancy
– Collectively, these conditions represent approximately 15% of the total
disease burden in the SSA region (Murray & Lopez, 1996).
Calculating attributable risks for Pb-exposure
The attributable risk (AR) due to lead exposure for 10 Pb-linked Global Burden of Disease (GBD) disease
categories:
•
Genito-urinary disease
•
Spontaneous abortion
•
Premature birth
•
Dental caries
•
Lung cancers
•
Nervous system cancers
•
Congenital anomalies
•
Hypertension
•
Cerebrovascular disease
•
Low birth weight
AR was assessed according to the following equation, using published data on relative risks for each
cause of death and disability related to the exposure, levels of exposure (prevalence), and burden of
disease due to each cause of death and disability in the population:
AB = SAFjBj
•
Where
–
–
–
–
–
AB = Attributable Burden for a risk factor
AFj = Fraction of Burden from cause j
Bj = population level burden of cause j
P = Prevalence of exposure
RRj = Relative Risk of disease or injury for cause j in exposed versus unexposed group.
Shift to mild mental retardation due to Pb-induced loss of
IQ points
Percentage of subjects
Normal curve of
distribution of
intelligence
Shift to mild mental
retardation due to loss of
IQ points
Mild mental
retardation
50
70
72.6
80
90
100
IQ
73.5
Fewtrell et al., [2002]
• Risk of lead exposure on mental retardation:
AR = PR – Pbaseline + PMR Standard ÷ PMR Standard
Where
MR
PR
= Mental retardation
= Region-specific prevalence of MR from
known causes
Pbaseline = Prevalence of MR from known, noncongenital causes in developed countries;
PMR Standard = Prevalence of MR according to the standard
distribution of IQ score
AR
= Adjustment ratio.
Contribution of Lead to the Burden of Disease in the Study Population
Odds Ratio for PbB
(ug/dL)
DALYs, 0-14
Pb-Disease Category
male
female
total
5-8
9-15
Attributable Risk % for PbB
(ug/dL)
>16
5-8
9-15
>16
Attributable BoD to Pb (%)
5-8
9-15
>16
710
541
1251
0.9
5
1.9
3.8
1.7
33.5
21.9
22
419
274
0
1000
1000
1.8
3.6
5.4
21.4
59.3
30.6
214
593
306
2295
2295
4590
2.2
4.3
8.6
29.0
64.9
43.2
1330
2978
1982
6.8
9.6
Dental Caries
129
127
256
(AR)
(AR)
6.8
9.6
13.5
17
25
35
Lung Cancers
1
0
1
0.9
1.8
3.6
3.5
30.9
20.6
0
0
0
270
210
480
2
5.5
11
25.4
71.6
50.0
122
344
240
2455
2628
5083
0.8
1.6
3.2
7.3
25.1
18.0
371
1278
917
66
69
135
0.8
1.5
3
7.3
21.9
16.7
10
30
23
313
298
611
2.2
4.5
6.8
29.0
66.2
36.7
177
405
224
9827
8873
18700
1.2
2.4
4.7
6.4
43.9
27.0
1191
8218
5050
16066
16041
32107
3453
14289
9050
2731
2727
5458
587
2429
1538
% SSA Burden of Disease Attributable to Pb
1.08
4.49
2.84
% SSA Burden of Disease Attributable to Pb, Ages 0-14
1.77
7.34
4.65
% Nigeria Burden of Disease Attributable to Pb
1.08
4.49
2.84
% Nigeria Burden of Disease, Attributable to Pb, Ages 0-14
1.77
7.34
4.65
Genito-Urinary Disease
Abortion
Prematurity
Nervous System Cancers
congenital anomalies
Hypertension
Cerebrovascular Disease
Low Birth Weight
Total SSA
Total Nigeria
13.5
(AR)
Contribution of Pb Exposure to Disease Burden
(Disability-Adjusted Life Years)
• Symptoms above 10 mg/dL (Pb)
– Growth retardation, Hearing loss, IQ deficiency, Colic, Nephropathy,
Encephalopathy, Hypertension, Decreased longevity.
• Burden of Disease Categories
– Hypertensive disorders, Iron-deficiency anemia, Unipolar major
depression, Nephritis and Nephrosis, Osteoarthritis, Congenital
anomalies, Perinatal conditions, Endocrine disorders, and Poisonings.
• Sub-Saharan Africa (2000 Baseline Scenario) Total DALYs =
318,560
• DALYs sensitive to metal toxicity as a risk factor = 44,050
(~4.7%)
– Compared to diarrhea (10%), or malaria (7%), this is a considerable
burden.
Framing priorities
• The cost of energy decarbonization is
cost-effective (approximately $10,000 per
child) if the expenses are directly linked to
the reduction in disease burden. This
estimated cost is higher than preventive
costs calculated for the toll of malaria on
the national economy [Sachs, 2000], but
the benefits of decarbonization and
eliminating lead pollution are also
distributed internationally.
Summary
(1) Institutional Issues: Framing and prioritizing vulnerability assessments in Africa.
Who is going to use the results of the vulnerability assessment that you are
conducting?
(2) Thinking outside the dominant framework: Global environmental change and the
African burden of disease.
Health (morbidity + mortality) is the ultimate outcome of vulnerability
assessments. Cumulative vulnerabilities (e.g. agricultural productivity, coastal
resources, water resources, etc. may be estimated with a common conversion
factor to a health index. Is this worth doing in your assessment?
(3) Proposed solutions to global environmental change will have impacts too: Nocost adaptation and the clean development mechanism in Africa.
Think ahead – what are the vulnerabilities to proposed mitigation strategies in
your region?
(4) Break
(5) Group discussion/summary