GAHP and the SDGs

Proposed Indicators to Measure SDG Target 3.9

The problem of pollution and mismanagement of chemicals and waste is a critical crosscutting issue that impacts all areas of sustainable development.   It is therefore important to ensure integration of the sound management of chemicals, wastes and pollution into the Declaration as part of the Post-2015 Development Agenda. 

Target 3.9 is the most important given the large impact of pollution on human health.

The existing language states:

  • Goal 3, Target 3.9: “by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination”

The currently proposed indicator for this target — Population in urban areas exposed to outdoor air pollution levels above WHO guideline values — only concerns general population exposed to outdoor air pollution, but the target clearly refers to pollution and contamination of air, water and soil. The proposed indicator only proposes to measure particulate matter (PM) 2.5.  This is insufficient even in relation to air pollution, and does not include mercury, POPs and other trans-boundary air pollutants. Furthermore, it does it address pollution in water or soil. 

The WHO and IHME have been collecting data on deaths and disabilities caused by outdoor and indoor air pollution, as well as water and sanitation issues, using well-established and accepted Global Burden of Disease estimates. These methodologies can be extended to cover heavy metal and other toxicants contaminating soil. A significant amount of data on soil pollution is now available through the Toxic Sites Identification Program database run by the Global Alliance on Health and Pollution (GAHP). 

It is therefore important to ensure that measurable and technically rigorous indicators for all types of pollution, chemicals and wastes are included in the SDGs monitoring framework, and that the existing indicator under 3.9 is replaced with a more comprehensive indicator.

 

Proposed Indicator:

“Death and disability from indoor and outdoor air pollution, polluted water and sanitation, and contaminated sites versus 2012 baseline measured by WHO/IHME Global Burden of Disease methodology”

The use of Global Burden of Disease methodology is desirable because it is:

  • Specific and Measurable: It measures death and disability directly. GBD data capture premature death and disability (all-cause mortality, deaths by cause, years of life lost (YLLs), years lived with disability (YLDs), and disability adjusted life years (DALYs)) from more than 300 diseases and injuries, by age and sex, from 1990 to the present, allowing comparisons over time, across age groups, and among populations. 
  • Applicable, Relevant and Comprehensive: Applies directly to all aspects of the target (air, water and soil pollution/contamination)  
  • Accepted Internationally: It employs a well-developed metrics ontology used in public health circles by WHO, IHME and others, and has been an internationally accepted methodology for measuring disability and death since 1990
  • Feasible and Realistic: Is already being measured in 188 countries using data collected and analyzed by a consortium of more than 1,000 researchers. Data collection protocols are well established.
  • Time-bound: Data is collected annual, since 1990. It is a tool that can be used at the global, national, and local levels to understand health trends over time
  • Flexible: Is a process that continues to be refined and improved, and therefore can adapt as knowledge on pollution and health develops: its flexible design allows for regular updates as new data and epidemiological studies are made available.
  • Accessible: GBD data is publically available
  • Assignable: IHME works with an established network of in-country experts and government agencies who collect and provide data directly to IHME for compilation and analysis.

 

Technical overview of the methodology behind proposed indicators for Target 3.9.

Target 3.9: by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination”

This indicator can be broken down into three areas to enable better technical understanding of what each proposes to measure.

Part 1 – Death and disability from indoor and ambient air quality

Part 2 – Death and disability from water/sanitation

Part 3 – Death and disability from contaminated sites

 

Part 1 – Death and disability from indoor and ambient air quality

According to a recent WHO report (25 March 2014) “…. in 2012, around 7 million people died – one in eight of the total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save million of lives.”

Diseases associated with outdoor (ambient) air pollution includes ischemic heart disease at 40%, stroke at 40%, chronic obstructive heart disease at 11%, lung cancer at 6% and acute lower respiratory infections in children at 3%. The numbers for indoor air pollution exposures are similar with the exception being 12% mortality associated with acute lower respiratory infections in children.

  • Baseline Data for Health – 2012 (WHO GBD data)

The baseline starting point metric for adverse health effects attributable to indoor and ambient air quality is the 2012 World Health Organizations disease statistics for (1) chronic obstructive pulmonary diseases, (2) rates of childhood asthma and (3) specific cancer rates associated with environmental agents; namely lung, liver, kidney and various leukemia’s. This data is publically available at the WHO Global Burden of Disease (GBD) website (http://www.who.int/healthinfo/global_burden_disease/en/). Where necessary, or should missing years or conditions be encountered, the GBD database at the Institute for Health Metrics and Evaluation at the University of Washington shall be accessed. This ensures all relevant baseline data will be retrieved and monitored.

  • Methodology to Monitor Improvements

The WHO Global Burden of Disease reports on disease statistics, such as incidence, prevalence and mortality rates for numerous diseases and syndromes. Incidence rates are most desirable monitoring measures however, given the difficulty in obtaining incidence rates for LMICs, mortality (death) rates may be monitored instead. Mortality and morbidity data also allows us to report on Disability Adjusted Life Years (DALYs), which will also be systematically tracked. These databases will be accessed annually to ensure continuous monitoring of disease statistics.

  • Focal Areas

Three focal areas shall be used to monitor part one of proposed indicator for Target 3.9 to ensure successful achievement by 2030.

  1. Incidence/deaths of Chronic Obstructive Pulmonary Disease in adults and children
  2. Lower respiratory infections in children associated with indoor air pollution
  3. Incidence of childhood asthma
  4. Cancer DALYs associated with environmental exposures (i.e. lung, liver and kidney)

 

Part 2 – Death and disability from water borne chemical agents (formally, water/sanitation)

This section addresses toxic agents in community water supplies and does not address viral, bacterial, protozoal or parasitic agents known to cause human disease (i.e. cholera, schistosomiasis, giardia etc.) Reductions of these microbial agents and applicable targets are listed under, Goal 6 “Ensure Availability and Sustainable Management of Water and Sanitation for All”. Additionally, while Target 6.3 states “by 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater, and increasing recycling and safe reuse by x% globally” there are no health targets offered.

This indicator specifically looks at the morbidity and mortality impact on human populations from chemical agents in potable water supplies. The agent with the highest global impact is arsenic in groundwater. It is estimated that 70 countries have arsenic related drinking water problems affecting almost 135 million people. Arsenic is a carcinogenic agent and also known to cause acute health effects such as hyperkeratosis. However, this goal will extend beyond arsenic and include other important chemical agents such as lead, chromium, cadmium, nitrates/nitrites and various POPs.

  • Baseline Data – 2012 (WHO data) and Survey Data

The availability of country specific water quality surveys is limited. While high-income countries have such routine survey monitoring data, low- and middle-income countries generally do not. As a result, a select group of agents widely tested (i.e. lead and arsenic) will be chosen as surrogate agents. For countries where no water quality data is available, an algorithm shall be collaboratively developed to ensure extrapolation of data to these countries.

  • Methodology / Metric – Global Burden of Disease (GBD/DALYs).

A select group of agents widely tested (i.e. lead and arsenic) will be chosen as surrogate agents to measure success. For countries where no water quality data is available, an algorithm shall be collaboratively developed to ensure extrapolation of data to these countries. For arsenic, regional areas sharing groundwater aquifer with high arsenic levels will enable scientific extrapolation in the absence of available chemical levels.

  • Focal areas:
    • Health impact (as measure by DALYs) for cognitive damage (lead)
    • Health impact (as measure by DALYs) for hyperkeratosis (arsenic)
    • Health impact (as measure by DALYs) for GI and Kidney cancers
    • Health impact (as measure by DALYs) for chromium related diseases

 

Part 3 – Death and disability from contaminated sites

According to a recent report from the Global Alliance for Health and Pollution (GAHP) “contaminated land (sites) contributed to 10% of all environmentally related deaths in 2012”.   Morbidity and mortality from contaminated sites is often disguised and elusive to enumerate. Lead contaminated soil causes childhood cognitive impairment and increases susceptibility to other diseases and infections. Mercury exposures cause neurologic and nephrotic damage. Organic pesticides are often carcinogenic.

  • Baseline Data – 2014 (GAHP data)

The GAHP has access to a worldwide toxic waste site inventory database with specific information on contaminants present and soil levels of toxic agents. With this data, GAHP has assisted or actively published over a dozen scientific papers in the general field of toxic waste site health assessment. In addition, a landmark paper on the GBD from toxic waste sites will be the basis of setting baseline data[1]. Using the same approach from previously published work, a systematic methodology will be implemented to quantify 2014 GBD levels originating from contaminated sites for each country. This baseline data shall be the comparison metric for future assessments.

  • Methodology to Monitor Improvements

The availability of country specific toxic waste site inventories is limited. While high-income countries have such inventories, most low- and middle-income countries do not. The GAHP Toxic Sites Identification Program has been implemented in roughly 50 countries, but data is not yet comprehensive.

Given the variability in data quality and quantity, the GAHP database should be the dominant methodological monitoring network. Baseline data from above shall be the comparison metric for future assessments. Periodic review of a standardized database will enable careful and uniform assessment of improvements. For countries where no waste site inventory has been completed, an algorithm shall be collaboratively developed to ensure extrapolation of data to these countries. Finally, given the high prevalence of specific toxic agents, namely; chromium, lead and mercury within these sites; specific sites may be chosen as compliance surrogates. Meaning, lead contaminated sites may be used as the monitoring unit for compliance with all contaminated land sites.

  • Focal Areas
    • GBD (as measured in DALYs) related to contaminated sites
    • GBD (as measure in DALYs) related to contaminated lead (Pb) exposure
    • Rate of lead induced Mild Mental Retardation, and blood lead levels in children
    • GBD (DALYs) associated with mercury exposure due to artisanal and small scale gold mining operations
    • Prevalence of lead contaminated sites associated with battery breaking and recycling
    • Population exposed to toxic agents at contaminated waste sites

[1] Chatham-Stephens, K., Caravanos, J., Ericson, B., Sunga-Amparo, J., Susilorini, B., Sharma, P., … & Fuller, R. (2013). Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010. Environmental health perspectives, 121(7), 791.