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Posts tagged “health”

Clear communication: NYU's Céline Gounder on the Ezra Klein Show

Ezra Klein, early in the interview:

Wonderful. Thank you for talking with me, Dr. Gounder. I'm going to go walk into the ocean now.

and then, a bit later:

Céline Gounder
... one of the problems we've had throughout this pandemic, is we've looked for silver bullets, simple solutions, and there's not one simple solution here. You really do have to combine multiple different public health measures. So that includes encouraging people to mask up again indoors, especially if there's a lot of transmission, while at the same time, incentivizing people who are not yet vaccinated to get vaccinated for them to be able to return to a more normal life, for all of us to be able to return to a more normal life.

Deregulation in the Trump era - and rolling it back

A lot has been made, rightly so, in recent days of President Biden's rollbacks of the Trump Administration's gleeful dismantling of environmental, health, and other regulatory safeguards. Both the NYT and Brookings have been keeping track of what's happening on the regulatory front, with Brookings doing so since at least 2018 if not earlier.

Brookings breaks down the regulatory changes into 12 discrete categories, spanning topics from COVID to Environment to Telecommunications.

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NYT focuses on >100 Environmental regulations and rules rolled back by the Trump administration.

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Both sources are interesting and useful. I'm looking for an analog for the current administration -- a rollback of rollbacks tracker, if you will.

Energy and Health in the 2019 BJP Manifesto

The BJP’s Manifesto was released in the last few days. A little hard to hunt down, initially, though a PDF is hosted at documentcloud.

In a section that is partly a list of achievements and partly a description of next steps:

We have evolved technologically better strategies and devices to map the level of pollution in cities and rivers and have taken effective steps to reduce the level of pollution in major cities, including the national capital. We will convert the National Clean Air Plan into a Mission and we will focus on 102 most polluted cities in the country. Through concerted action, we will reduce the level of pollution in each of the mission cities by at least 35% over the next five years.

Another part of he Manifesto is framed around 75 milestones for India’s 75th anniversary, including some focusing on health, energy, air pollution, and water & sanitation.

Under Infrastructure:

Ensure a pucca house to every family. Ensure the LPG gas cylinder connection to all poor rural households. Ensure 100% electrification of all households. Ensure a toilet in every household. Ensure access to safe and potable drinking water for all households. Bharat Mission to achieve ODF+ (Open Defecation Free) and ODF++ in cities and villages. Ensure ODF status for all villages and cities.

Under good governance:

Work towards substantially reducing the current levels of air pollution. Work towards completely eliminating crop residue burning to reduce air pollution.

Air Pollution and Impact Analysis of a Pilot Stove Intervention: Report to the Ministry of Health and Inter-Ministerial Clean Stove Initiative of the Lao People's Democratic Republic

Hill LD, Pillarisetti A, Delapena S, Garland C, Jagoe K, Koetting P, Pelletreau A, Boatman MR, Pennise D, Smith KR. 2015. Air Pollution and Impact Analysis of a Pilot Stove Intervention: Report to the Ministry of Health and Inter-Ministerial Clean Stove Initiative of the Lao People’s Democratic Republic.

Quantification of a saleable health product (aDALYs) from household cooking interventions

Smith KR, Pillarisetti A, Hill LD, Charron D, Delapena S, Garland C, Pennise D. 2015. Quantification of a saleable health product (aDALYs) from household cooking interventions. World Bank.

Household Air Pollution and Noncommunicable Disease

HEI Household Air Pollution Working Group. 2018. Household Air Pollution and Noncommunicable Disease. Communication 18. Boston, MA: Health Effects Institute. peer reviewed.

Household Air Pollution Intervention Tool (HAPIT)

HAPIT screenshot

Access HAPIT. HAPIT estimates health changes due to interventions designed to lower exposures to household air pollution (HAP) of household members currently using unclean fuels (wood, dung, coal, kerosene, and others). These interventions could be due to cleaner burning stoves, cleaner fuels, other ventilation changes, motivating changes in behavior, etc. HAPIT currently uses background disease rates and relationships between exposure to PM2.5 and health outcomes described as part of the Institute for Health Metrics and Evaluation’s 2013 Global Burden of Disease and Comparative Risk Assessment efforts.

Household fuel use and pulmonary tuberculosis in Nepal: A case-control study

Bates MN, Pope K, Sijali TR, Pokhrel A, Pillarisetti A, Lam N, Verma S. 2019. Household fuel use and pulmonary tuberculosis in Nepal: A case-control study. Environmental Research 168: 193-205. doi.org/10.1016/j.envres.2018.09.036

Using personal exposure measurements of particulate matter to estimate health impacts associated with cooking in peri-urban Accra, Ghana

Delapena S, Piedrahita R, Pillarisetti A, Garland C, Rossanese M, Pennise D. 2018. Using personal exposure measurements of particulate matter to estimate health impacts associated with cooking in peri-urban Accra, Ghana. Energy for Sustainable Development 45: 190:197. doi.org/10.1016/j.esd.2018.05.013

Clean Cooking and the SDGs: integrated analytical approaches to guide energy interventions for health and environment goals

Rosenthal J, Quinn A, Grieshop AP, Pillarisetti A, Glass R. 2018. Clean Cooking and the SDGs: integrated analytical approaches to guide energy interventions for health and environment goals. Submitted to Energy for Sustainable Development. 42: 152-159. doi.org/10.1016/j.esd.2017.11.003

The potential health benefits of lower household air pollution after a liquefied petroleum gas (LPG) cookstove intervention

Steenland K, Pillarisetti A, Kirby M, Peel J, Clark M, Checkley W, Chang H, Clasen T. 2018. The potential health benefits of lower household air pollution after a liquefied petroleum gas (LPG) cookstove intervention. Environment International 111:71-79. doi.org/10.1016/j.envint.2017.11.018

The Impact of Household Energy Interventions on Health and Finances in Haryana, India: An Extended Cost-Effectiveness Analysis

Pillarisetti A*, Jamison D, Smith KR. 2017. The Impact of Household Energy Interventions on Health and Finances in Haryana, India: An Extended Cost-Effectiveness Analysis. In C. Mock, O. Kobusingye, R. Nugent, K. R. Smith (Eds.), Injury Prevention & Environmental Health, Disease Control Priorities, third edition, volume 7. Washington, DC: World Bank.

ousehold Air Pollution from Solid Cookfuels and Health

Smith KR, Pillarisetti A. 2017. Household Air Pollution from Solid Cookfuels and Health. In C. Mock, O. Kobusingye, R. Nugent, K. R. Smith (Eds.), Injury Prevention & Environmental Health, Disease Control Priorities, third edition, volume 7. Washington, DC: World Bank.

Air pollution-related health and climate benefits of clean cookstove programs in Mozambique

Anenberg SC, Henze DK, Lacey F, Irfan A, Kinney P, Kleiman G, Pillarisetti A. 2016. Air pollution-related health and climate benefits of clean cookstove programs in Mozambique. Environmental Research Letters. doi: 10.1088/1748-9326/aa5557

The Return of London's Fog

London’s fogs may be about to make a comeback. Christine Corton, in the NYT:

In January, researchers at King’s College London announced that pollution levels on Oxford Street, in central London, had exceeded limits set for the entire year in just the first four days of 2015. Similarly alarming numbers have been recorded for other streets in the city — and yet the mayor, Boris Johnson, has delayed implementation of stricter air-quality measures until 2020.

What’s happening in London is being played out in cities worldwide, as efforts to curtail the onslaught of air pollution are stymied by short-term vested interests, with potentially disastrous results.

I just experienced a particular, particulate version of this hell first-hand in Delhi. For the last few days of my trip, a dense, thick haze - clearly not an innocuous fog - permeated the city and surrounding environs. On one trip back to our flat, all of my fellow taxi passengers complained of burning eyes and sore throats.

The closest PM monitor during that drive back — actually quite far from us — read over 250 µg/m3. That’s around 10x higher than a ‘bad’ day in the US. Moreover, we guessed that the levels we were experiencing were closer to 350 µg/m3. As a point of reference, the maximum mean hourly PM2.5 concentration in London since 2008 was approximately 30 µg/m3.

Corton points to a behavioral component to the historic London Fog episodes — a parallel I find particularly interesting:

There was a cultural component, too. The British were wedded to their open fires. Closed stoves, popular throughout much of Europe, especially in Germany, were shunned by Londoners. During World War I, Britons were exhorted, in the words of the famous song, to “keep the home fires burning.” Politicians were simply not willing to risk unpopularity by forcing Londoners to stop using coal and go over to gas or electric heating instead. In Britain today, in an echo of these earlier concerns, the government is cutting subsidies for onshore wind and solar farms, anxious not to offend voters in rural areas where such facilities would be built.

It took a disaster to force London to change direction. In 1952, a “great killer fog” lasted five days and killed an estimated 4,000 people. In a Britain trying to turn a corner after the death and destruction of the Blitz, this was unacceptable. A Clean Air Act was passed in 1956, forcing Londoners to burn smokeless fuel or switch to gas or electricity, power sources that had become much cheaper as these industries expanded.

Let’s hope that policy levers and momentum — not a disaster — can help transition away from solid fuels in India and beyond.

Conditional cash transfers for energy poverty... and murder reduction

Conditional cash transfers — paying people to change behavior, usually to spur positive ‘social’ outcomes — continue to be in the news. Much of the focus is on their use as poverty reduction tools (Bolsa Familia in Brazil, JSY in India) through encouraging behaviors like antenatal care visits and sending children to school.

Two recent article — one in the NYT, one in Mother Jones — highlighted the use of CCTs and other targeted cash transfer tools for dramatically different outcomes.

In the NYT, poverty and energy issues were at the fore:

The Indian government subsidizes households’ purchases of cooking gas; these subsidies amounted to about $8 billion last year. Until recently, subsidies were provided by selling cylinders to beneficiaries at below-market prices. Now, prices have been deregulated, and the subsidy is delivered by depositing cash directly into beneficiaries’ bank accounts, which are linked to cellphones, so that only eligible beneficiaries — not “ghost” intermediaries — receive transfers.

Under the previous arrangement, the large gap between subsidized and unsubsidized prices created a thriving black market, where distributors diverted subsidized gas away from households to businesses for a premium. In new research with Prabhat Barnwal, an economist at Columbia University, we find that cash transfers reduced these “leakages,” resulting in estimated fiscal savings of about $2 billion.

There’s even more “smart” targeting coming soon. My advisor and colleagues in India have been working to “[describe] how the LPG subsidy could be even more completely targeted to the poor without any actual ‘taking away’ of the subsidy from the rich and middle class, which would likely trigger heavy political push back. As a result, several hundred million additional poor Indians could have affordable access in the next decade without increasing subsidy costs to the government (indeed probably reducing them) or LPG imports — both not likely to be popular.”

In Mother Jones, CCTs were being used to reduce murders:

Richmond hired consultants to come up with ideas, and in turn, the consultants approached [Devone] Boggan. It was obvious that heavy-handed tactics like police sweeps weren’t the solution. More than anything, Boggan, who’d been working to keep teen offenders out of prison, was struck by the pettiness of it all. The things that could get someone shot in Richmond were as trivial as stepping out to buy a bag of chips at the wrong time or in the wrong place. Boggan wondered: What if we identified the most likely perpetrators and paid them to stay out of trouble?

It seems to be working.

It was a crazy idea. But since ONS was established, the city’s murder rate has plunged steadily. In 2013, it dropped to 15 homicides per 100,000 residents—a 33 year low. In 2014, it dropped again. Boggan and his staff maintained that their program was responsible for a lot of that drop-off by keeping the highest-risk young men alive—and out of prison. Now they have a study to back them up.

On Monday, researchers from the National Council on Crime and Delinquency, a non-profit, published a process evaluation of ONS, studying its impact seven years in. The conclusion was positive: “While a number of factors including policy changes, policing efforts, an improving economic climate, and an overall decline in crime may have helped to facilitate this shift, many individuals interviewed for this evaluation cite the work of the ONS, which began in late 2007, as a strong contributing factor in a collaborative effort to decrease violence in Richmond.”

HAPIT, the Household Air Pollution Intervention Tool, to evaluate the health benefits and cost-effectiveness of clean cooking interventions

Pillarisetti A*, Mehta S, Smith KR. 2015. HAPIT, the Household Air Pollution Intervention Tool, to evaluate the health benefits and cost-effectiveness of clean cooking interventions. In E. A. Thomas (Ed.), Broken Pumps and Promises - Incentivizing Impact in Environmental Health. Switzerland: Springer,.

EIA: World petroleum use sets record high in 2012 despite declines in North America and Europe

U.S. Energy Information Administration:

The world’s consumption of gasoline, diesel fuel, jet fuel, heating oil, and other petroleum products reached a record high of 88.9 million barrels per day (bbl/d) in 2012, as declining consumption in North America and Europe was more than outpaced by growth in Asia and other regions (see animated map). A previous article examined regional trends in petroleum consumption between 1980 and 2010; today’s article extends that analysis through 2012.

Some other specific points of interest:

Between 2008 and 2012, Asia’s consumption increased by 4.4 million bbl/d. The rapidly industrializing economies of China and India fueled much of Asia’s demand increase, growing 2.8 million bbl/d and 800,000 bbl/d, respectively. If China’s use of petroleum continues to grow as projected, it is expected to replace the United States as the world’s largest net oil importer this fall.

Petroleum use in Europe has declined in every year since 2006. Part of this decline was related to a reduction in overall energy intensity and government policies that encourage energy efficiency. Europe’s weak economic performance has also affected its petroleum use, with declines of 780,000 bbl/d in 2009 and 570,000 bbl/d in 2012 occurring at a time of slow growth and/or recessions in many European countries.

Air Pollution Linked to 1.2 Million Premature Deaths in China

As Kirk pointed out in an email this morning, the NYT missed half of the problem. He wrote:

Remarkable narrow vision to fail even to mention that household air pollution has about an equal impact in the country. Even though the GBD study shows both on the same graphs, journalists and policy makers see one, but not the other. These is also an estimated 0.2 million overlap, what we call secondhand cookfire smoke, which is the portion of outdoor air due to cooking fuels in the country. If you account that to household air pollution, than the total impact of household air pollution is greater than that from outdoor air pollution due to all other sources combined (1.2 million premature deaths compared to 1.0 million).

Our work has been showing — in India and in China — that outdoor air pollution isn’t just an urban problem; it is simply measured most commonly (and thus identified most easily) in urban areas. We’re working to quantify that contribution and to make the case that cleaning up households can help clean up ambient air — in urban and rural areas.

Assessing Willingness to Pay for Environmental Health Interventions

Attended a great lecture today by Isha Ray and Jack Colford as part of a new BERC IdeaWorks series. It was a discussion of "Water resources for sustainability and health", focusing mainly on water quality issues in the developing world. A number of interesting studies were described (amazingly clearly, given the complexity of them on the ground) by Dr. Ray and Dr. Colford - both masterful professors. Dr. Colford's undertaking a multi-country assessment of water, sanitation, and hygiene interventions (individually and combined) to see their effects on height, weight, diarrhea. The challenge of doing this kind of randomized trial is not to be underestimated; they plan a year of pilots before the full study begins. A heady undertaking.

Dr. Ray described a couple studies that try to understand how people use these services, how they pay for them, and how they weigh options for water and sanitation. The most striking example she gave is a study kicking off shortly in Tanzania. Her research team is assessing how willing people are to use and pay for six commercially available point-of-use water treatments (like chlorine, a safe-water bucket, a UV filter, a biosand filter, etc). Her approach is novel. As with all studies of this sort, intervention devices will be given to participants. At the end of the study, she'll try one of the following two things: (1) randomly give participants an envelope with a cash amount her team will pay to buy back the point-of-use device or (2) plan the study so that at its conclusion all devices are returned to the researchers; participants are given the option to buy the device back, again at a randomized price. Its an elegant solution to figuring out how much a person would be willing to pay for a technology that is available on the local market.

Our work in the stove world needs to look towards these kinds of assessments to help us frame the issue of poor uptake and compliance of cookstove usage. Both of these types of environmental health interventions often run into the same issues - the technology is poorly designed for the target population, or the population doesn't perceive a need for it. Trying out locally available technologies and helping NGOs and governments figure out which ones people are willing to pay for -- which we hope is a proxy for willing to use -- is one step in the right direction.

This discussion ignores the impact of the devices on the market -- it assumes they work. That's a second, additional wrinkle that plays into the technology adoption.