Daniel EsselJoseph V Spadaro

Health and economic impacts of transport interventions in Accra, Ghana

w h o u r b a n h e a l t h i n i t i a t i v e

w h o u r b a n h e a l t h i n i t i a t i v e

Daniel EsselJoseph V Spadaro

Health and economic impacts of transport interventions in Accra, Ghana

Health and economic impacts of transport interventions in Accra, Ghana / Daniel Essel, Joseph V Spadaro

ISBN 978-92-4-001730-6 (electronic version)ISBN 978-92-4-001731-3 (print version)

© World Health Organization, 2020

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CONTENTS

Preface iv

Acknowledgements vi

Abbreviations vii

1. Introduction 1

2. Assessing the impact of transport mitigation measures 2

2.1 Current transport sector policies 22.2 iSThAT sustainable transport tool 3

3. Baseline and alternative scenarios 5

3.1 Baseline scenario 53.2 Alternative pathways 73.3 Exposure calculation 10

4. Results and discussion 11

5. Conclusion 15

References 16

i i i

PREFACE

Globally, in 2010, the transport sector accounted for 14% of the greenhouse gases (GHG) budget (1). In developing countries, the rapid pace of motorization and limited investment in sustainable mass transportation and energy efficient mobility systems have led to widespread traffic congestion and degradation of urban air quality levels, with consequential negative impacts to the environment and human health.

The WHO Urban Health Initiative (UHI) has rolled out a programme to support national- and city-level government officials in the use of health impact assessment tools that can be used to assess the environmental, health and economic co-benefits of future sustainable urban transportation action plans that can lead to reduced environmental emissions, improved air quality levels, and, thus, contribute to positive changes in the quality of life of citizens. Gains in health and well-being involve avoided pain and suffering from illnesses and reduced risk of premature death, while economic benefits consist of averted private and public health care costs, and gains in productivity output.

This report includes discussions on transport and health data availability, and analysis for specific transport scenarios for the Greater Accra Metropolitan Area (GAMA), using the Integrated Sustainable Transport Health Assessment Tool (iSThAT). The tool provides a framework for rapid assessment of health and economic benefits. Three mitigation scenarios have been modelled to compare the effects of different policy interventions with regard to land use, transport mode, energy efficiency and demand, and their relative impacts on public health and associated costs.

Over 2015–2050, in the Business-As-Usual (BAU) Scenario, the demand for transport is predicted to increase three-fold, personal car ownership is expected to double, and there will be greater utilization of the public transport system (higher ridership of urban buses, for example). The fleet of private vehicles consists mainly of conventional petrol cars, which account for 60% to 67% of the transport modal share. Compared with 2015, car fuel economy improves around 20% by 2050; meanwhile exhaust emissions decrease as a result of stock turnover favouring vehicles with enhanced pollution control technologies and a shift to low sulfur content fuels. Over time, walking and cycling combined contribute approximately 1 in 3 of total passenger-kilometres (pkm) travelled.

In Alternative Scenario #1, future transport demand is the same as in the BAU Scenario, though a slight decrease in passenger car use is expected due to measures outlined in the revised national transport policy (2020). The demand for conventional buses is expected to be steady, but there is a slight shift to electrified mass transport. In Alternative Scenario #2, a 31% decrease in transport activity is forecast due to land-use and spatial planning reforms that focus on creating secondary “hub centres” of economic and social activity closer to where people live. Finally, in Alternative Scenario #3, a significant shift from the use of passenger cars to electrified public transport (up to 10% of transport demand by 2050) is envisaged. Further, there will be an increase in walking and cycling (up to 45% of total pkm in 2050), and a switch to the purchasing of hybrid cars and battery electric vehicles (BEV). These assumptions are based on current discussions around national- and city-level policies.

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANAiv

Alternative Scenario #3 is the most ambitious intervention plan among the three urban transportation development pathways. Compared with BAU, the number of postponed premature deaths over the entire period (2015–2050) ranges between 1800 and 5500 deaths related to reduced air pollution (improvements in air quality) plus an additional health benefit of 33 000 avoided deaths attributable to increased physical activity (active travel). In addition to health gains, Alternative Scenario #3 reduced carbon emissions by 159 million tonnes of CO2 compared with BAU. In economic terms, the combined benefit from reduced mortality and morbidity ranges between US$ 14 and 16 billion (2011 prices at a 5% discount rate). By comparison, the economic value of the health gains under Alternative Scenario #1, the least ambitious transport action plan, is about 15% of those calculated for Alternative Scenario #3. It is worth noting that the economic benefit is very sensitive to the discount rate. In fact, the health benefit under Alternative Scenario #3 would increase by 80% if the discount rate was changed to 3% versus a reduction of 50% if the discount rate choice was 7.5%.

The estimates of the health and economic impacts of transport scenarios for GAMA allow policy-makers to make science-based decisions regarding whether planned transport programmes and projects are likely to prevent diseases and deliver health gains while achieving sustainability goals over the medium- to long-term time horizon.

v

ACKNOWLEDGEMENTS

This report was prepared by Daniel Essel (Senior Planning Officer, Coordinator of Road Transport Services and Focal Point for Climate Change, Directorate of Policy Planning, Monitoring and Evaluation, Ministry of Transport, Republic of Ghana) and Joseph V Spadaro (Research Scientist, Spadaro Environmental Research Consultants), under the coordination of Thiago Hérick de Sá (Technical Officer, WHO Department of Environment, Climate Change and Health), and with inputs and support in data collection and analysis from the Ghana Transport Working Group at the WHO Urban Health Initiative (UHI) Data Analysis Workshop held in Ghana 3–6 July 2018.

Ghana Transport Working Group: Hanatu Abdulai (National Road Safety Authority), Issahaku Algore Abubakari (Driver and Vehicle Licensing Authority), Desmond Appiah (Accra Metropolitan Assembly), Emmanuel Appoh (Environmental Protection Agency), James Derry (Building and Road Research Institute), Alex Johnson (Accra Metropolitan Assembly), Emmanuel Karah (Ghana Health Service), Angelina Mensah (Environmental Protection Agency), Victor Owusu (Ghana Statistical Services), Reginald Quansah (University of Ghana, School of Public Health), Ferdinand Yali (Department of Urban Roads), Dzifa Zordeh (Energy Commission).

The report was reviewed by and received inputs from Gordon Dakuu (National Professional Officer, WHO Ghana); Pierpaolo Mudu (Technical Officer, WHO Department of Environment, Climate Change and Health); and Andreia Santos (Health Economist, London School of Hygiene and Tropical Medicine). A further review was provided by Michael Hinsch and Abraham Mwaura (WHO Department of Environment, Climate Change and Health).

The preliminary results of the analysis were presented and discussed with a wide group of relevant stakeholders at the Accra Metropolitan Assembly in August 2018, within the US Environmental Protection Agency (EPA) Megacities, Climate and Clean Air Coalition (CCAC) UHI, World Bank Joint Workshop Series.

This work was supported by the Climate and Clean Air Coalition through the grant provided for the Urban Health and SLCP Reduction project in Accra.

Support was also provided by the Government of Norway through its financial contribution to advance WHO’s work on air pollution and health, which contributed to the completion of this report.

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANAvi

ABBREVIATIONS

BAU business as usual

BEV battery electric vehicle

BRT bus rapid transit

CCAC Climate and Clean Air Coalition

CNG compressed natural gas

CRD cardiorespiratory disease

EPA Environmental Protection Agency (USA)

EV electric vehicle

GAMA Greater Accra Metropolitan Area

GHG greenhouse gases

HEAT Health and Economic Assessment tool for walking and cycling

HEV hybrid electric vehicle

iSThAT Integrated Sustainable Transport Health Assessment Tool (WHO)

kWh kilowatt hour

LDV light duty vehicle

LNT linear no-threshold

LPG liquefied petroleum gas

M$ million US dollars

NMT non-motorized transport

NO2 nitrogen dioxide

PHEV plug-in hybrid electric vehicle

pkm passenger-kilometres (equal to vehicle-km multiplied by the vehicle occupancy)

PM particulate matter

ppm parts per million

SCC social cost of carbon

SO2 sulfur dioxide

UHI Urban Health Initiative

vkm vehicle-kilometres

VOLY value of life year

VSL value of statistical life

WHO World Health Organization

YLL years of life lost

vii

1. INTRODUCTION

A major problem facing many cities around the world, particularly those located in rapidly developing countries, is transport related emissions, which have been increasing at a much faster rate than previously anticipated (2). The rapid pace of motorization and urbanization in developing countries, coupled with unplanned and uncontrolled urban expansion, have led to widespread traffic congestion. Meanwhile, traffic emissions have seriously worsened urban air quality. Accra is one of the fastest urbanizing cities in Africa, with an annual population growth rate of around 2% since the mid-2000s (3). More than 4.5 million people live in the Greater Accra Metropolitan Area (GAMA), with a daily influx of 2.5 million business commuters (4). Over the years, car ownership in the city has increased as personal incomes have risen. The number of passenger cars registered in the region was almost 1 250 000 in 2017 (or 60% of the national registration), with an average annual increase of 8.4% over the past 10 years (5).

Road transport accounts for over 95% of all domestic journeys in Ghana, with rail, air transport and inland water transport contributing the remaining 5% (6). Road transport can be further divided into journeys involving small to medium-sized buses (trotro, as they are known in popular culture, which mainly provide paratransit services) and large urban buses, which together account for 48.2% of the number of motorized trips, while the remaining share of 51.8% is split between travel by personal cars, taxis, motorcycles (13.7%), walking and cycling (37.6%) and commuter rail (0.5%).

In Accra and the surrounding cities, air quality levels have been deteriorating. Available air quality data indicate that 75% of the samples collected at roadside locations in Accra exceeded the national 24-hour mean PM10 limit value of 70 μg/m3 (7). Although the WHO air quality guidance level for the annual mean for PM10 is 20 μg/m3, it should be noted that current epidemiological evidence has revealed no safe level of particulate matter ambient air pollution (8, 9). For nitrogen dioxide (NO2), 40% of the collected samples exceeded the annual WHO guideline (10) of 40 μg/m3.

To mitigate the transport-related environmental and health burdens, appropriate investments and incentives are needed to facilitate the emergence of greener, more efficient and more sustainable transport modes in Accra. Such measures would focus on a technological shift away from conventional fossil fuels to:

• more environmentally friendly alternatives;

• policies linked to land-use planning and controlled development;

• encouraging walking and cycling instead of driving;

• putting greater emphasis on sustainable mass public transportation systems; and

• implementing car-sharing and car-pooling schemes.

1

2. ASSESSING THE IMPACT OF TRANSPORT MITIGATION MEASURES

2.1 Current transport sector policies

Government policies play a pivotal role in changing transport sector development, business planning and consumer preferences. The intended response is to deliver services through a combination of improvements in organization, management and service quality on top of improved regulatory measures. The national transport policy (2008) lays out the broad policy framework for transport sector development (11). The overall goal of the policy is to make Ghana a transport hub and gateway to the West Africa subregion. Based on a holistic vision, the policy addresses the constraints in road, rail, air, maritime and inland water transport. More specifically, in the context of urban transport, strategies aim to:

• Develop a more efficient and sustainable public transport system to help alleviate congestion in urban areas.

• Promote a road-based mass transportation system, including extending bus rapid transit (BRT) corridors.

• Develop standards for public transport vehicles in line with international best practices.

• Develop and promote the efficient and safe use of non-motorized transport (NMT) infrastructure such as bicycle lanes and pedestrian walkways in congested central business districts.

• Rehabilitate, modernize and extend the rail-based mass transport system in major urban areas.

• Develop integrated light rail transit systems in major cities to connect main business districts to suburban residential areas.

To date, however, implementation has been well below initial expectations. For instance, to promote mass transit systems, a pilot BRT project was launched in Accra in 2016. However, operations were suspended in late 2018 due to operational and financial challenges. With respect to commuter railways, two lines are operational, but service levels and frequencies are low. There have also been efforts to promote walking and cycling, including cycle lanes at Tetteh Quarshie-Madina on Legon East Road and new disability friendly footbridges on major arterial roads in GAMA, but these have been limited in the city by the lack of infrastructure, such as pedestrian walkways and cycle lanes, to support the increased demand for NMT (12).

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA2

With respect to motorization, to reduce the influx of used cars and the associated environmental hazards, an import ban on vehicles older than 10 years (13) was implemented in 1998. The ban was revised in 2002 to allow for the payment of progressive penalties on vehicles older than 10 years. For a vehicle older than 10 years but less than 12 years, for example, a 5% penalty charge is applied on the vehicle delivery insurance freight cost. For vehicles older than 12 years but less than 15 years, the imposed penalty is 20%, whereas vehicles older than 15 years are levied a 50% surcharge. The ban revision, unfortunately, has had the unintended consequence of a higher than expected influx of older vehicles into the country, which has prompted some critics to argue that the imposed penalties are not high enough to discourage buyers from purchasing older cars.

A bus fleet renewal policy was introduced in 2010 with the aim to replace ageing and highly polluting mini-buses (14). By 2016, this policy had contributed to the rollout of over 1000 high-occupancy vehicles (with a seating and standing capacity of 80–120 passengers), which were operated by private operators and informal government transport companies (Metro Mass Transit Limited and the Intercity STC Coaches Limited). Despite the early success of the programme, it failed to have a long-term impact on urban air quality because the vehicles were poorly maintained and relied on high-sulfur content fuels (as high as 3000 ppm). Recent transformative policy initiatives in the transport sector include the 2016 low-sulfur fuel reduction strategy (15), which mandated fuel sulfur content to be reduced to 50 ppm by 2020. Subsequently, policies have levied penalties on high-polluting vehicles, and, especially, cars with large engine sizes (over 3000 cc). Buses that transport more than 10 people and commercial vehicles, however, are exempted. To encourage local manufacturing and assembly of vehicles and also to discourage the import of vehicles over 10 years, a new regulation came into effect in April, 2020 (16). The regulation bans the importation of light duty vehicles (LDV) older than 10 years as well as salvage vehicles. The new framework is a revision to the Customs Act of 2015. Implementation is set to commence in October 2020. Restrictions on import of salvage vehicles is to commence with the launch of the first locally manufactured or assembled LDV.

There has also been a push through policy incentives to replace the current bus fleet by vehicles that are more efficient and less polluting (soot-free).

2.2 iSThAT sustainable transport tool

The WHO UHI uses an integrated environmental impact assessment tool to guide decision-makers in appraising health co-benefits of interventions and strategies in the transport sector. The iSThAT (expected release in 2021) is an Excel-based tool for quantifying the health benefits of reduced urban air pollution and increased physical mobility and provides economic valuations of alternative transport development scenarios over a time horizon extending out to 2050 (Fig. 2.1). The specific outputs of the tool include:

• Health impacts on the exposed population in terms of deaths and their equivalent years of life lost (YLL) and other health morbidity affecting children and adults (e.g. days of restricted activity, including work days lost, hospital admissions and incidences of respiratory diseases).

3

• Economic health benefits achieved through a combination of the cost of illness or death plus productivity and welfare loss. Current and future health costs are projected over time.

• Saved carbon emissions, which are then valued economically by applying a carbon price (market cost per tonne of carbon); while a second approach uses the social cost of carbon (SCC), which reflects the expected environmental cost related to climate change.

• Health benefits of active travel using the methodology of the WHO HEAT (Health Economic Assessment Tool for walking and cycling) (17).

In this work, iSThAT has been applied to evaluate future transport scenarios for the GAMA. The iSThAT tool requires urban data on background pollution levels, transport activity by mode of travel (private cars and public transport), input data on transport fleet characteristics, including fuel/technology split, tailpipe emission factors and vehicle fuel consumption rates. For health impact calculations, iSThAT includes default data for Ghana on historical and projected socioeconomic trends (up to 2050), projected mortality statistics and unit health costs (cost per incidence of illness or premature death). Specific data for GAMA were used in the assessment, and whenever necessary, national statistics were downscaled to reflect local urban conditions.

Since country-specific data on fuel consumption were lacking, this study relied on a 2013 European Commission report (18), which provides European Union default data on fuel consumption and emission values. Information on average trip distance and occupancy rates for vehicles was also unavailable. For these data, we relied on the transport fare model (19), which catalogued average trip distance and occupancy rate parameters for taxis and urban buses in Ghana. For taxis, the fare model assumes 14 trips per day covering an average round trip distance of 17.2 km per journey with an assumed occupancy rate of four passengers. Thus, on an annual basis, a taxi driver would cover a distance exceeding 70 000 vehicle-kilometres (vkm).

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA4

Feedback

Health benefits , physical activity

Carbon values

Background concentration

Air pollution health impact assessment

Epi data Life tables

Source: iSThAT manual (draft version).

Fig. 2.1iSThAT transport tool flowchart

Scenario definitionKey user intputs

• Socioeconomic data

• Modal share (private, public, active travel)

• Fleet specifics and emission factors

Default data given

Charts Summary tables

Key outputs

• Carbon emissions

• Health benefits of reduced air pollution and physical activity

• Economic valuation

3. BASELINE AND ALTERNATIVE SCENARIOS

The iSThAT transport tool calculates the health and economic consequences of urban road transport mitigation measures that are intended to improve urban air quality and reduce road-related carbon emissions. Alternative future pathways are compared against expected BAU (baseline) transportation sector development. In addition to changes in transport activity, expressed in pkm, energy demand and ambient air emissions, intervention benefits are assessed in physical terms as changes in mortality and health morbidity outcomes, which, in turn, are valued in economic terms.

3.1 Baseline scenario

Demographic dataThe GAMA population is expected to grow from 4.5 million in 2015 (20) to 6.34 million by 2030 (equivalent to a 2.14% annual growth rate). By 2050, the population is expected to reach 9.62 million. Currently, 51% of the population is younger than 25 years, 45% is aged 25 to 64 years, and 4% is 65 and older (Fig. 3.1). The male to female ratio at the population level is 0.93.

5

l100 000

l200 000

l300 000

l300 000

l200 000

l100 000

65+

60–64

55–59

50–54

45–49

40–44

35–39

30–34

25–29

20–24

15–19

10–14

5–9

0–4

YearsFig. 3.1Population age profile of GAMA in 2010 (4.01 million people)

Source: Elaborated by the authors; Ghana Statistical Services (21).

Males Females

Passenger cars, taxis and motorcycles Compared with the base year (2015), the number of cars per 1000 population (22) is projected to increase by 55% by 2030, and, thereafter, more than double by 2050. The mean motorization growth rate over this period is 3.5% per annum. In this work, we have represented private passenger cars, taxis and motorcycles by a single “car-equivalent” category covering an annual driving distance of 21 900 vkm, with an assumed average occupancy rate of 1.5 persons per vehicle. Thus, the annual travel distance expressed in pkm is 32 850. Data on transport demand (pkm) by mode are shown in Fig. 3.2. Over the near term (up to 2030), the combined effects of a higher vehicle ownership rate and increased population size will result in a two-fold increase in transport demand compared with 2015, whereas a three-fold increase is anticipated by 2050. As a share of total transport demand, passenger cars contributed 13.7% (or 9 billion pkm) in 2015, 21.2% in 2030 and 31.1% by 2050 (an increase of 126% relative to 2015). Over the entire time of the analysis, bus use (measured in pkm) remains the most popular mode of travel, followed by walking. By 2050, cars, buses and walking modes each account for around one third of total pkm. The contribution from tram and rail travel is around 0.4%, while cycling only contributes 0.1%.

In 2015, conventional petrol cars account for the largest share of vehicles on the road, contributing around 60% of traffic volume, followed by conventional diesel cars with 28% of pkm (decreasing to 22% by 2050), while liquified petroleum gas (LPG) fuelled vehicles (primarily taxis) account for 11% of pkm (share maintained constant over the entire period of the analysis). Fuel economy of the current fleet is 10.4 L per 100 vkm and is expected to improve by 10% in 2030, and by nearly 20% by 2050. Fuel economy and exhaust emissions, including greenhouse gas (GHG) and sulfur dioxide (SO2) emissions, will decrease over time as newer vehicles are expected to be more fuel efficient, will incorporate enhanced pollution control technologies (replacing vehicles with lower Euro standards), and there will be a shift to low-sulfur content fuels (50 ppm by 2020). There is no market penetration of electric vehicles – battery (BEV) or plug-in hybrid (PHEV).

BusesAlmost all urban buses are of the conventional type and operate on diesel fuel. Existing vehicles will be replaced with more fuel-efficient buses over time (fleet fuel economy improves 6% by 2030 to 15% by 2050, compared with the current fleet average). Bus occupancy increases steadily over time, reaching 20% higher ridership by mid-century. As a share of total transport demand, buses contribute 48% of total pkm in 2015, but this share decreases to 43% by 2030 and 36% by 2050 (Fig. 3.2).

Tram/rail – electrified public transportThe share of total pkm is assumed to remain constant (< 0.5%). The carbon intensity of electricity production remains steady at 310 g of CO2 per kWh (24).

100

20

40

60

80

2015 2030 2050Year

Cycling 0.10 0.10 0.12

Walking 37.60 35.30 32.34

Electric mass transit 0.50 0.40 0.38

Urban buses 48.10 42.90 36.08

Cars/taxis/motorcycles 13.70 21.20 31.10

% M

ode

shar

e

Source: Elaborated by the authors; estimates for 2015 derived using data from Ministry of Transport (22) and Urban Roads Department (23).

Fig. 3.2Modal share by pkm for select years in the Baseline BAU Scenario

0

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA6

Walking and cyclingThe share of total pkm associated with active travel is expected to reduce over time, from 37.7% in 2015 to 32.5% by 2050.

3.2 Alternative pathways

Alternative Scenario #1 In Alternative Scenario #1, future transport demand in GAMA is the same as predicted under the baseline BAU Scenario (Table 3.1). Total annual activity increases from 98.42 billion pkm in 2015 (22 000 pkm per capita) to over 231 billion pkm by 2050 (24 000 pkm per capita). The current share of total pkm by passenger cars decreases from 13.7% to just under 9.6% by 2050. This change reflects restrictions on the use of cars, especially with the introduction of cordon charges and other measures as captured in the revised national transport policy of 2020 (25).

Baseline Alternative 1 Alternative 2 Alternative 3

Year 2015 2050 2050 2050 2050

Population (million) 4.5 9.6 9.6 9.6 9.6

Transport activity (all modes, billion pkm) 98 231 231 158 158

Cars, taxis and motorcycles(% total pkm) 13.7 31.1 9.6 9.6 6.9

Cars (% modal split)Petrol – conventionalPetrol – HEVPetrol – PHEVDiesel – conventionalDiesel – HEVDiesel – PHEVLPGBEV

61.000

28.000

11.00

66.700

22.300

11.00

52.600

36.400

11.00

52.600

36.400

11.00

41.55.03.0

35.01.51.5

11.01.5

Cars iSThAT outputEnergy efficiency (kJ/pkm)Carbon (tCO2 /pkm)

1910168

1730149

1610139

1610139

1470 126

Urban buses(% total pkm) 48.1 36.1 45.7 45.7 37.8

Urban buses (% split)DieselHEVCNG

10000

10000

10000

10000

57.52.5

40.0

Electric mass transit (tram and rail)Total pkm (%)Carbon (gCO2 /kWh)

0.1310

0.4310

0.4310

3.0310

10 78

Active travel (% total pkm)WalkingCycling

37.60.1

32.30.1

41.4 0.4

41.4 0.4

41.4 4.0

All-modes iSThAT outputEnergy efficiency (kJ/pkm)Carbon (tCO2 /person)

4400.83

6341.30

2490.51

249 0.35

235 0.28

Table 3.1Select input parameters for base year 2015 and 2050 in the iSThAT transport tool

7

Most of the decrease in car use is compensated by a marginal increase in demand for walking and cycling (41.4% by 2050 compared with 37.6% in 2015). The demand for mass transit is steady, although there is a slight shift from buses to electrified mobility. The introduction of light rail transport systems in Accra, for which procurement process is ongoing, would facilitate this transition.

The pkm ratio of conventional petrol to diesel cars is about two-to-one, with 11% of pkm allocated to LPG-fuelled vehicles. There are few to no hybrid vehicles in circulation. All buses run on conventional diesel technology. In conformity with the Roadmap for the promotion of cleaner buses in Accra, Ghana (26), in future years, fuel economy is expected to improve, and fleet-averaged emission factors decrease as older technologies are replaced by newer vehicles having stricter emission standards (Euro IV and later).

Alternative Scenario #2 Under Alternative Scenario #2, transport demand in 2050 decreases by 31% compared with Alternative Scenario #1 (Fig. 3.3). The decrease comes following reforms related to land-use and spatial planning, with greater emphasis on creating secondary “hub centres” of economic and social activity closer to where people live. For example, the development of shopping malls in satellite cities of Accra, such as Kasoa, Achimota, and Sakumono, avoid travel to the central business district of Accra. It is expected that such developments would be expanded to cover new growth centres. All other inputs are the same as Alternative Scenario #1.

Cycling

Walking

Electric mass transit

Urban buses

Car/taxis/motorcycles

Fig. 3.3Transport demand by travel mode in Alternative Scenario #2

Source: iSThAT tool.

250

50

100

150

200

Billi

on p

km

Baseline BAU Alternative #2

Year 2030

Baseline BAU Alternative #2

Year 2040

Baseline BAU Alternative #2

Year 2050

0

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA8

Alternative Scenario #3Alternative Scenario #3 envisions a future where there is a significant shift from use of passenger cars to electrified public transport (a 15-fold increase over the baseline), walking (+5% compared with the baseline) and cycling (2.2% of cumulative pkm) (Fig. 3.4).

Baseline BAU

23.6%

41.2%

34.6%

0.1%

0.4%

Alternative #3

2.2%

10.0%

42.5%

39.6%

5.6%

Fig. 3.4Aggregate modal share of Baseline BAU Scenario and Alternative Scenario #3

Cycling

Walking

Electric mass transit

Urban buses

Car/taxis/motorcycles

Source: iSThAT tool.

As illustrated in Fig. 3.5, purchase of hybrid electric vehicles (HEV) – conventional and PHEV – in both the private and public transport sectors, begins as early as 2025, while fully autonomous BEV sales contribute to market share in a significant way starting in 2030. These developments, of course, would be influenced by both national- and city-level policies. In particular, the Environmental Fiscal Reforms Policy, whose mandate is to update vehicle import regulations with an emphasis on encouraging cleaner technologies, would impact which kinds of vehicles would be imported into Ghana. Further tightening of emission standards is also expected in the coming years.

Fig. 3.5Breakdown of activity by passenger vehicle technology in Alternative Scenario #3

Source: iSThAT tool.

BEV

HEV

Plug-in HEV

LPG

Diesel (conventional)

Petrol (conventional)

12

10

2

4

6

8

Billi

on p

km

0

14

Year 2015 Year 2030 Year 2040 Year 2050

9

As far as buses are concerned (Fig. 3.6), this scenario is based on efforts to build compressed natural gas (CNG) infrastructure. A feasibility study has already been completed for the first pilot of 200 buses, which will be upscaled to over 3000 vehicles in the future.

Source: iSThAT tool.

Fig. 3.6Urban bus demand by technology type

CNG

HEV

Diesel (conventional)50

10

20

30

40

Billi

on p

km

Baseline BAU

Alternative#3

Year 2015

0

90

60

70

80

Baseline BAU

Alternative#3

Year 2030

Baseline BAU

Alternative#3

Year 2040

Baseline BAU

Alternative#3

Year 2050

By 2050, 40% of buses run on CNG and 2.5% are HEV. Already, there are efforts by the Government of Ghana to attract funds to pilot electric buses on selected corridors in GAMA.

3.3 Exposure calculation

Key input variables used in the exposure modelling are summarized in Table 3.2. The PM2.5 background concentration in GAMA is assumed to be 47.8 μg/m3. The dilution rate, as its name implies, is related to the pollutant dilution rate in the atmosphere (mixing with the surrounding air mass). The pollutant depletion velocity is a parameter that characterizes pollutant removal from the air due to deposition and chemical transformation processes (without removal processes, the air concentration would increase without bound). Concentration multipliers are used to downscale regional exposure estimates to the urban scale. Recommendations and default values for these input variables are available in iSThAT.

Parameter Unit Value

Background PM2.5 concentration (2015) μg/m3 47.8

Ratio PM2.5 to PM10 (mass basis) − 0.65

Anthropogenic share of emissions − 68%

Urban footprint (equivalent circle radius) km 25.0

Dilution rate m2/s 1550

Depletion velocity − PM2.5 cm/s 0.59

Depletion velocity – sulfates cm/s 2.03

Depletion velocity – nitrates cm/s 1.29

Urban adjustment multiplier − PM2.5 − 6.0

Urban adjustment multiplier – sulfates − 4.0

Urban adjustment multiplier – nitrates − 3.0

Socioeconomic development: shared socioeconomic pathway 5 (SSP5) − 1.0

Table 3.2Parameters used in iSThAT tool

Source: Elaborated by the authors.

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA10

4. RESULTS AND DISCUSSION

iSThAT output on health gains and economic benefit are summarized in Table 4.1. Results have been aggregated over the time period starting from 2015 through to 2050. The number of avoided air pollution attributable deaths has been calculated using two exposure-risk relationships. The first approach assumes a linear no-threshold (LNT) risk function applied to all-cause mortality, excluding accidental deaths (natural mortality). On the other hand, the second association assesses the mortality benefit considering only cardiorespiratory disease (CRD), such as ischaemic heart disease, strokes, chronic obstructive pulmonary disease, lung cancer and children pneumonia (lower respiratory disease).

Economic costs are present values expressed in millions of dollars (M$) (2011 prices) using a discount rate of 5%. Additional results for different discount rates are shown in Table 4.2. Mortality has been valued using two costing approaches:

• value of statistical life (VSL), which is applied to the number of estimated avoided deaths;

• while the value of a life year (VOLY) is used to value changes in lifetime expectancy (life years gained) across the exposed population as a result of improved air quality from transport interventions.

1 Deaths related to CRD include the following cause-specific diseases: lower respiratory infections, chronic obstructive pulmonary disease, lung cancer, ischaemic heart disease and strokes.

2 Economic costs are expressed in US$ (2011 purchasing power parity prices). All costs are discounted at 5%.3 VSL – value of statistical life (US$ 450 000 per averted premature deaths in 2015); VOLY – value of a life year (US$ 12 400 per year of life gained

in 2015). Unit reference costs (cost per incidence of disease or death) are values used in Europe which have been adjusted to the GAMA location considering income differences between Europe and GAMA. Further details may be found in the publication: Valuing mortality risk reductions in regulatory analysis of environmental, health and transport policies: policy implications. OECD Publications, Paris; 2012.

4 SCC – social cost of carbon (US$ 53 per tonne of CO2 in 2015). Source: iSThAT tool.

Future scenario Health benefits of reduced air pollution

Life years gained Physical activity (deaths avoided)

Carbon reductions (million tonnes)

Total economic health benefit (based on VSL)

Alternative Scenario #1 1046 deaths (CRD)1

3221 deaths (LNT)562–1509 M$2 (VSL)3

16 687 (CRD)58 102 (LNT)279–847 M$ (VOLY)3

3339 deaths 1362 M$ (VSL)

113 tCO2 3146 M$ (SCC)4

1924–2871 M$

Alternative Scenario #2 1524 deaths (CRD)4695 deaths (LNT)819–2199 M$ (VSL)

24 321 (CRD)84 700 (LNT)406–1235 M$ (VOLY)

1955 deaths 796 M$ (VSL)

148 tCO2 4182 M$ (SCC)

1615–2995 M$

Alternative Scenario #3 1790 deaths (CRD)5500 deaths (LNT)962–2577 M$ (VSL)

28 537 (CRD)99 154 (LNT)476–1446 M$ (VOLY)

33 042 deaths 13 452 M$ (VSL)

159 tCO2 4492 M$ (SCC)

14 414–16 029 M$

Table 4.1Health gains, saved carbon emissions and economic benefits of alternative transport sector scenarios compared with projected BAU (baseline) development (aggregate results for 2015–2050)

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In addition to mortality impacts, iSThAT also calculates the benefits of air pollution reduction from reduced morbidity outcomes (e.g. respiratory diseases in children and adults). These costs represent 7–15% of the total benefit calculated from reductions in air pollutant emissions. It is worth noting that depending on the mitigation scenario, the economic benefits from increased physical activity are comparable to and up to several times larger than the health benefits potentially achieved through reductions in air pollutant emissions.

Carbon reductions are expressed as tonnes CO2 (tCO2) saved and have been valued using the social cost of carbon (SCC) (the marginal benefit starts at US$ 53 [2011 prices] per tonne of CO2 saved for year 2015, reaching US$ 114 [2011 price, undiscounted] per tCO2 by 2050). Carbon savings have been discounted at 5%.

Fig. 4.1 shows pollutant emission trends in tonnes per year for Alternative Scenarios #1, #2 and #3. The advantages of Alternative Scenario #3 are clear. PM2.5 emissions, for instance, decrease from 556 tonnes in 2015 to 324 tonnes in 2050, representing a reduction of 42%. For SO2, NOX and CO2, the reduction in 2050 being 51%, 66% and 28%, respectively, by comparison with 2015.

Fig. 4.1Evolution of ambient air emissions by scenario

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SO2 (kt/yr)

Source: iSThAT tool.

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA12

Fig. 4.2 shows the time trend of the health benefits (reduced mortality and economic costs) projected over the period from 2015 to 2050 for each alternative scenario. Deaths are based on the all-cause mortality (LNT exposure-risk relationship; top row charts) and cause-specific mortality (CRD; bottom row charts). Future economic benefits are present values (2011 prices) discounted at 5%, and include mortality (valued using VSL) plus morbidity outcomes.

Alternative Scenario #3 delivers the highest benefit of the three future scenarios (Table 4.1), with an estimated avoided mortality in the range 1800 to 5500 deaths, or 70% higher than in Alternative Scenario #1. In economic terms, the present value of the health benefit is between US$ 1–2.6 billion when valuing mortality using the VSL, and about half that much when considering the VOLY (US$ 0.5–1.4 billion). In Alternative Scenario #3, the benefit of physical activity is 10 times higher than that predicted in Alternative Scenario #1. In terms of saved carbon emissions, Alternative Scenario #3 achieves the most savings: 159 million vs 113 million tonnes in Alternative Scenario #1 and 148 million tonnes in Alternative Scenario #2.

Alternative #1

Tot: 3221

Alternative #2

Tot: 4695

Alternative #3

Tot: 5500

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Avoided deathsAll-cause mortality (LNT)

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Tot: 1509

Alternative #2

Tot: 2199

Alternative #3

Tot: 2577

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Health benefits, M$/yrAll-cause mortality (LNT)

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Tot: 562

Alternative #2

Tot: 819

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Fig. 4.2Health benefits from reductions in air pollution by scenario

Source: iSThAT tool.

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Results are very sensitive to the choice of the discount rate. Table 4.2 shows the impact of the choice of the social discount rate on the predicted health benefits under Alternative Scenario #3. Lowering the discount rate from 5% to 3% would increase the health benefit by nearly 80%, whereas an increase from 5% to 7.5% would halve the benefit. The choice of the discount rate would therefore have a significant impact on the trade-off between the cost of mitigation measures and the health benefits achieved. Other economic parameters affecting the valuation of health benefits include the choice of VSL (a value of US$ 450 000 has been assumed per avoided death in 2015) and the VOLY (US$ 12 500 per year of life gained in 2015). Long-term income growth per capita is another influential parameter of the analysis. iSThAT allows the user to vary these economic inputs by carrying out sensitivity analyses.

Table 4.2Sensitivity of total economic health benefit to discount rate in Alternative Scenario #3

* Mortality has been monetized using the VSL.Source: Elaborated by the authors.

Discount rate M$ (2011)* Change relative to 5% case

3% 24 849–28 516 +78%

5% 14 414–16 029 –

7.5% 7085–8186 -51%

HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA14

5. CONCLUSION

In conclusion, in order to achieve the expected health and economic benefits envisaged under the various alternative scenarios, up to 5500 averted premature deaths from improvements in air quality plus an additional 33 000 saved lives due to increased physical activity during the time period between now and 2050 for Alternative Scenario #3, it will be necessary to improve the efficiency and effectiveness of transport infrastructure and services. In particular, provide consumers with greater access to greener vehicle technologies, while also aiming to develop a more comprehensive and decarbonized public transportation system, such as the BRT and light railway in GAMA. Appropriate government incentives and financial investments are needed to facilitate the transformation to more efficient and greener sustainable transport modes. Investing in walking and cycling infrastructure, as well as other sustainable alternatives, eliminates emissions, improves urban air quality, contributes to significant gains in quality of life of individuals, and reduces the mortality risk among all age groups in the population of GAMA.

The current transportation system in GAMA, which remains in the hands of sole proprietor operators who mostly operate paratransit and minibus services through informal operations, needs to be properly regulated. Government efforts should aim to develop regulations for urban transport that ensure oversight and responsibility-sharing, and prescribe standards for operations of all commercial road transport services.

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HEALTH AND ECONOMIC IMPACTS OF TRANSPORT INTERVENTIONS IN ACCRA, GHANA16

Contact: urbanhealth@who.int

Further information:www.who.int/urbanhealthinitiative

Department of Environment Climate Change and Health (ECH)Division of Universal Health Coverage / Healthier PopulationsWorld Health Organization