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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
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Ground reality !
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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 (
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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%)
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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
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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
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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
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District level emissions of health damaging pollutants from
household fuel use (SRMC/TERI study funded by USEPA)
Andhra Pradesh
Tamil Nadu
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288 834 7040 232256N =
Andhra PradeshTamil Nadu
24-h
r ave
rage
exp
osur
e (m
icrog
ram
/cub
ic m
eter
)
1000
800
600
400
200
0
Wood
Dung/Wood chips/
Agricultural w aste
Kerosene
LPG
290105 34763 308130 228173N =
Andhra PradeshTamil Nadu
24-h
r ave
rage
exp
osur
e (m
icro
gram
/cub
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
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BOD attributable to IAP across districts (SRMC/TERI study funded
by USEPA)
020000400006000080000
100000120000140000
Adila
bad
Srika
kulam
Vizia
ngar
am
Vish
akap
atnam
East
Goda
vari
Wes
t God
avar
iKr
ishna
Guntu
rPr
akas
amNe
llore
Chitto
orCu
ddap
ahAn
antap
urKu
rnoo
l
Mahb
ubna
gar
Rang
ared
dyMe
dak
Nizam
abad
Karim
naga
rW
aran
gal
Kham
mam
Nalgo
nda
ARI COPD
0500
1000150020002500300035004000
Adilab
adSr
ikaku
lamViz
ianga
ram
Visha
kapa
tnam
East
Goda
vari
West
Goda
vari
Krish
naGu
ntur
Prak
asam
Nellor
eCh
ittoor
Cudd
apah
Anan
tapur
Kurno
ol
Mahb
ubna
gar
Rang
aredd
yMe
dak
Nizam
abad
Karim
naga
rWa
ranga
lKh
amma
mNa
lgond
a
TB ARI COPD
DALYS
DEATHS
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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)
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TERI/ SRMC/ UCB/University of Maryland study funded by NIH)
0
5
10
15
20
25
30
35
11/2
1/04
09:
26:0
011
/21/
04 1
0:17
:00
11/2
1/04
11:
08:0
011
/21/
04 1
1:59
:00
11/2
1/04
12:
50:0
011
/21/
04 1
3:41
:00
11/2
1/04
14:
32:0
011
/21/
04 1
5:23
:00
11/2
1/04
16:
14:0
011
/21/
04 1
7:05
:00
11/2
1/04
17:
56:0
011
/21/
04 1
8:47
:00
11/2
1/04
19:
38:0
011
/21/
04 2
0:29
:00
11/2
1/04
21:
20:0
011
/21/
04 2
2:11
:00
11/2
1/04
23:
02:0
011
/21/
04 2
3:53
:00
11/2
2/04
00:
44:0
011
/22/
04 0
1:35
:00
11/2
2/04
02:
26:0
011
/22/
04 0
3:17
:00
11/2
2/04
04:
08:0
011
/22/
04 0
4:59
:00
11/2
2/04
05:
50:0
011
/22/
04 0
6:41
:00
11/2
2/04
07:
32:0
011
/22/
04 0
8:23
:00
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
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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
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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
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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
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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
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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?
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Feasible
Effective
vs.
Realistic target setting
makes the feasible more effective
Holistic capacity building
makes the effective more feasible