not for attribution; for discussion purposes only

NOT FOR ATTRIBUTION;

FOR DISCUSSION PURPOSES ONLY

Environmental Health :Costs of Environmental Health

DamageAnd Net Benefits of Priority

Interventions

A Contribution to theCountry Environmental Analysis for

the Philippines(Part 1)

byAgustin L. Arcenas

World Bank CEA Workshop, June 16-17, 2008

Environmental Health - Areas of Concern

Outdoor Air Pollution (OAP)

Indoor Air Pollution (IAP)

Water Pollution, Sanitation and Hygiene (WSH)

Basic Outline of the Study (for each area of concern)I. The basic issues and state of the environmentII. Level of exposure to pollutants and, sanitation

and hygiene problems in the PhilippinesIII. Morbidity IncidenceIV. Economic cost of MorbidityV. Mortality Incidence due to environmentVI. Economic cost of mortalityVII. Suggested policy interventionsVIII. Economic evaluation of policy interventions

How the study was done… Calculate the proportion of total cases of illnesses

that are attributable to pollution, sanitation and hygiene

Using WHO and Philippine data, determine the cost of treatment and foregone income from illnesses and premature deaths

Aggregate the economic costs and values from these calculations

Total Economic Costs of Environmental Health Problems

Total: PhP 9 billion

Water, Sanitation

and Hygiene4.869 B

54%

Indoor Air Pollution2.303 B

25%

Outdoor Air Pollution1.868 B

21%

Morbidity-Mortality shares

MORTALITYPhP 3 B

33%

MORBIDITYPhP 6 B

67%

0

3

5

8

10

1

The Economic Costs of Illnesses caused by Outdoor

Air Pollution

Sources of PM emissions

Sector Average Emissions (tons/year)

% of Total

Stationary Sources 1,083 5.46

Mobile Sources 16,725 84.34

Households 18 0.09

Solid Waste Burning 2,005 10.11

TOTAL 19,831 100

Source: Monitoring Report, 2004

What we know so far… There has been a drop in PM emissions in Metro

Manila since 2003

The number of vehicles in the country is growing

Diesel contributes more to PM than gasoline

Main source of PM emissions in the country – 2 stroke-tricycles

The bulk of vehicles in the country are the tricycles followed by utility vehicles

PM Emissions from Mobile Sources, 2006

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

2006 PM Emissions from MobileSources

Cars

Jeeps/UV

SUV

Trucks

Buses

Motorcyles/Tricyles

Trailers

Morbidity Cases - OAP

Urban22,732

19%

Metro Manila30,23625%

Rural66,112

56%

Total: 119,080

Costs to Society of OAP-related Illnesses

Direct Cost to Households

896 M49%

Lost Income Due to

Premature Deaths697 M37%

Lost Income Due to Illness

118 M6%

Philhealth Subsidy156 M

8%

Total: PhP 1.9 billion

Costs to Households of Treatment - OAP, 2003

Total: PhP 896 million

Metro Manila205 M23%

Urban 152 M17%

Rural539 M60%

Foregone Income due to OAP-related Illnesses

Total: PhP 118 million

Rural55 M47%

Urban 22 M19%

Metro Manila41 M34%

Cost of Premature Deaths due to OAP, 2003

45

124

236

292

0 75 150 225 300

Lost Income (in PhP millions)

Under 1-19

20-34

35-49

50-64

Age Group

Total: PhP 697 million

Potential Interventions to curb OAP Inspection and maintenance (I/M) programs

Installation of pollution control devices

Rehabilitation of Current Traffic Management System

Investments in Additional Mass Transport System

The Economic Costs of Illnesses caused by Indoor

Air Pollution

Primary Cooking Fuel for Households, 2004

Primary Cooking Fuel for Households, 2004 (percentage of households)

LPG, 42.68

Kerosene, 4.81

Fuelwood, 41.98

Charcoal, 7.17

Others, 2.06Electricity, 1.29

Source: HECS, 2004

Households Exposed to Indoor Air Pollution (in %)

14.0%

1.1%

11.5%

20.4%

0% 5% 10% 15% 20% 25%

National

Metro Manila

Urban

Rural

Morbidity Cases - IAP

Urban13,938

12%

Metro Manila1,4121%

Rural99,315

87%

Total: 114,665

Costs to Society of IAP-related Illnesses

Direct Cost to Households

774 M34%

Philhealth Subsidy

81 M4%

Lost Income Due to Illness

82 M4%

Lost Income Due to

Premature Deaths1.366 B

58%

Total: PhP 2.3 billion

Costs to Households of Treatment - IAP, 2003

Metro Manila8 M1%

Rural683 M88%

Urban 83 M11%

Total: PhP 774 million

Foregone Income due to IAP-Illnesses, 2003

Total: PhP 82 million

Urban 12 M14%

Metro Manila3 M4%

Rural67 M82%

Cost of Premature Deaths due to IAP, 2003

129

176

510

551

0 150 300 450 600

Lost Income (in PhP millions)

Under 1-19

20-34

35-49

50-64

Age Group

Total: PhP 1.4 billion

Potential Interventions to curb impacts of IAP

Promote improved household living environment (improved ventilation)

Promote use of “improved” stoves

Effect changes in cooking practices

Environmental Health :Costs of Environmental Health

DamageAnd Net Benefits of Priority

Interventions

A Contribution to theCountry Environmental Analysis for

the Philippines(Part 2)

byAgustin L. Arcenas

World Bank CEA Workshop, June 16-17, 2008

The Economic Costs of Water Pollution, Sanitation

and Hygiene Issues

Household Access to Improved Water Supply and Sanitation, 2003 (National)

VaImproved sanitation, unimproved water

supply10.81%

VbImproved water

supply, unimproved

sanitation9.80%

VIUnimproved water

supply and sanitation5.18%

IV Improved water

supply and sanitation74.21%

Morbidity Cases - WSH

Rural341,164

70%

Urban84,868

17%

Metro Manila62,39313%

Total: 488,425

Costs to Society of WSH-related Illnesses

Total: PhP 4.9 billion

Philhealth Subsidy426 M

9%

Lost Income Due to Illness

465 M10%

Lost Income Due to

Premature Deaths933 M19%

Direct Cost to Households

3 B62%

Costs to Households of Treatment - WSH, 2003

Rural2.255 B

74%

Metro Manila330 M11%

Urban 458 M15%

Total: PhP 3.0 Billion

Foregone Income due to Illnesses from WSH, 2003

Rural293 M63%

Urban 87 M19%

Metro Manila85 M18%

Total: PhP 465 million

Costs of Premature Deaths due to WSH, 2003

Total: PhP 933 million

392

171

233

137

0 100 200 300 400

Lost Income (in PhP millions)

Under 1-19

20-34

35-49

50-64

Age Group

Potential Interventions to eliminate illnesses from WSH Water Sanitation and Hygiene

Improved water supply and quality

Hygiene Promotion

Construction of Sanitation Facilities (i.e. Latrines)

Health Benefits of Different Water and Sanitation Interventions

25

32

45

39

0

5

10

15

20

25

30

35

40

45

50

Improved drinkingw ater

Improved sanitation Improved hygiene Household w atertreatment

% R

ed

ucti

on

Source: Fewtrell, et al, 2005

Median Construction Cost of Water Supply Facilities for Select Regions

102

31 23 21

49

92

64

17 2234

144

4155 48

36

0

40

80

120

160

HouseConnection

Standpost Borehole Dug Well Rainwater

Africa Asia Latin America/ Caribbean

Source: Disease Control Priorities in Developing Countries, second edition, 2006, Figure 41.1

WHS Preferred Interventions (Ranked According to Cost-Effectiveness) Cost-Effectiveness Ranking

Intervention

1st Hygiene Promotion

2nd Sanitation promotion

3rd Water Sector regulation and advocacy

4th Water supply - Hand pump or standpost

5th Water supply - House connection

6th Sanitation - Construction and Promotion

Based on: Disease Control Priorities in Developing Countries, 2006.

Final Word

Hygiene is two-thirds of health

Lebanese Proverb