A macro- and micro-level analysis. A presentation on an emerging research on the effects of air pollution on children UNICEF Innocenti JULY 2019

1. Air Pollution and Child Welfare
A Macro and Micro Level Analysis of Associations
Presenting Team: Damoah K. A & Otchere F.
UNICEF Office of Research, Innocenti
July 2, 2019

2. for every child, answersMotivation
 Air pollution is bad for everyone
 Causally linked to pneumonia, stroke, asthma, lung cancer, otitis media, ischaemic heart diseases,
chronic obstructive pulmonary disease (COPD):
• About 4 million premature deaths annually (WHO, 2018)
 SDG 3.9 aims to: “substantially reduce the number of deaths and illnesses from hazardous chemicals and
air, water and soil pollution and contamination”; SDG 11.6 seeks to “Reduce the adverse per capita
environmental impact of cities, including paying special attention to air quality….”
 Particularly bad for children due to increased vulnerability
 Premature birth, low birth weight, impaired neurodevelopment and cognitive ability
 Higher case fatality due to less developed lungs and immune system
 Major contributor to global health inequity: L/M ICS, women and children are
disproportionately at risk

3. for every child, answers
Two broad categories
 Household/Indoor air pollution  Primarily emanating from type of
household fuel for cooking and lighting
 Ambient/Outdoor air pollution  Externally generated with covariate
geographic exposure
Types/measures of air pollution
 Fine Particulate Matter (PM2.5)
 Coarse Particulate Matter (PM10)
 Sulfur Dioxide (SO2)
 Nitrogen Oxides (NOx)
 Ozone (O3)
 Carbon Monoxide (CO)

4. for every child, answersObjective
 To understand how bad pollution is for child welfare in general
 Explore benefit to cost ratios of low hanging interventions for children
 Provide additional inputs for advocacy to tackle the higher level political interventions
Potential for contribution
 Admittedly there is a lot of work being done on pollution and health – led by the WHO
 Much of the work here focus on the direct heath effects (Morbidity, mortality, DALY’s)
 General economic impacts are estimated from these health impacts
 We seek to explore additional pathways in which air pollution affect child welfare in general
and do more cost benefit analysis of potential interventions in various settings. Suggestive
link to obesity under explored

5. for every child, answers
Pathways of impact of pollution on child welfare
Pollution
Particulate Matter (PM2.5)
Sulfur Dioxide (SO2)
Nitrogen Oxides (NOx)
Ozone (O3)
Carbon Monoxide (CO)
Child Health
Pneumonia
Stroke
Asthma
Lung function (including ARI)
Otitis Media
Adverse Birth Outcomes
Health Outcomes
- Neonatal and Under 5 Mortality
- Child morbidity
- Disability & Chronic Conditions
Other potential pathways
Human Capital Development
o-School attendance and participation
-Cognitive development and productivity
HH Production and Productivity
-Caregiver absence from work
-Time use and number of hours worked
Impact on Household Income and Poverty
-Induced income reallocation for healthcare
-Household poverty
Pollution
Particulate Matter (PM2.5)
Sulfur Dioxide (SO2)
Nitrogen Oxides (NOx)
Ozone (O3)
Carbon Monoxide (CO)
Child Health
Pneumonia
Stroke
Asthma
Lung function (including ARI)
Otitis Media
Adverse Birth Outcomes
Health Outcomes
- Neonatal and Under 5 Mortality
- Child morbidity
- Disability & Chronic Conditions
Other potential pathways
Human Capital Development
o-School attendance and participation
-Cognitive development and productivity
HH Production and Productivity
-Caregiver absence from work
-Time use and number of hours worked
Impact on Household Income and Poverty
-Induced income reallocation for healthcare
-Household poverty

6. for every child, answers
Preliminary work on PM2.5 pollution, pneumonia and
under 5 mobility at the macro level
• Sources of data:
Pollution data → van Donkelaar et al. (2016) Global Estimates of Fine Particulate
Matter using a Combined Geophysical-Statistical Method with Information from
Satellites, Weather, and Station Monitors
Child health data → Under 5 mortality data compiled by UNICEF and WHO as
part of the joint Global Action Plan for Pneumonia and Diarrhoea (GAPPD)
Health expenditure data → World Bank WDI database
UN Population database  WPP, 2019 revisions
Household micro-level data → UNICEF MICS 5

7. Level of Fine Particulate Matter Concentration, 2016

8. for every child, answers

9. for every child, answers

10. for every child, answers
(1) (2)
VARIABLES
Under 5 Pneumonia Mortality per 1000 live
births
Fine particulate matter 0.0309*** 0.0150***
(0.00205) (0.00173)
Log GDP per capita -0.250***
(0.0544)
Log health expenditure per capita -0.340***
(0.0514)
Constant -0.0443 3.060***
(0.0924) (0.225)
Observations 1,984 1,903
R-squared 0.543 0.690
Region FE Yes Yes
Year FE Yes Yes
Robust standard errors in parentheses
*** p<0.01, ** p<0.05, * p<0.1
Under 5 Mortality and Ambient Air Pollution
(Pooled OLS from 2000-2015)

11. for every child, answers
Under 5 Mortality and Ambient Air Pollution
• The correlation between Under 5 mortality and fine particulate
pollution is positive and significant.
• A 1-unit increase in the level of fine particulate matter concentration
correlates with an increase in Under 5 mortality due to pneumonia by
0.03 per 1000
• We control for GDP per capita and health expenditure per capita to
check for the robustness of the relationship.
• Not enough to talk of causality, there remains other cofounding issues to
address.

12. for every child, answers
ACTUAL VERSUS POTENTIAL UNDER 5 DEATHS DUE TO PNEUMONIA
Approximately 5 out of 10 Under 5 deaths due to pneumonia can be prevented if all
countries achieved the WHO recommend ambient air recommended standard
974,620
509,170 465,450
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
Actual Pollution Level WHO Reccomended Level Excess Deaths due to Pollution

13. Region Actual deaths Preventable Lives saved (%)
EAPRO 56,100 8,410 15
ECARO 8,930 3,130 35
ESARO 114,590 52,710 46
LACRO 14,660 4,840 33
MENA 47,420 17,540 37
ROSA 595,310 315,520 53
WCARO 137,610 63,300 46
Total 974,620 465,450 0.48
REGIONAL DISPARITIES IN THE POTENTIAL FOR IMPACT

14. for every child, answers
Micro level analysis
Uses data from MICS wave 5 for 14 different countries across different
regions
Key indicators are type of fuel used for cooking and incidence of
breathing difficulty during cough
We control for ambient air pollution to try and isolate the effect of the
household air pollution alone

15. for every child, answers
Data Overview
Country ISO Region Wave Year #. HHs #. Under 5
Bangladesh BD South Asia 5 2012/2013 51895 20903
Kenya KE Eastern and Southern Africa 5 2013/2014 3744 2719
Kyrgyzstan KG Europe and Central Asia 5 2014 6934 4577
Mali ML West and Central Africa 5 2015 11830 16202
Malawi MW Eastern and Southern Africa 5 2013/2014 26713 18981
Mexico MX Latin America and Caribbean 5 2015 10760 8066
Nigeria NG West and Central Africa 5 2016/2017 33901 28085
Nepal NP South Asia 5 2014 12405 5349
Palestine PS Middle East and North Africa 5 2014 10182 7816
Paraguay PY Latin America and Caribbean 5 2016 7313 4625
Sudan SD Middle East and North Africa 5 2014 16801 14081
Thailand TH East Asia and the Pacific 5 2015/2016 28652 12250
Turkmenistan TM Europe and Central Asia 5 2015/2016 5861 3765
Vietnam VN East Asia and the Pacific 5 2013/2014 9979 3316

16. for every child, answers
Energy use for household cooking
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
Bangladesh
Kenya
Kyrgyzstan
Malawi
Mali
Mexico
Nepal
Nigeria
Palestine
Paraguay
Sudan
Thailand
Turkmenistan
Vietnam
Energy ladder by country
Lev. 1: Dung, Waste, Shrubs Lev. 2: Wood Lev. 3: Charcoal, Coal Lev. 4: Kerosene Lev. 5: Eletricity, LPG, Biogas

17. for every child, answers
Incidence of breathing difficulty during cough
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Paraguay Vietnam Malawi Palestine Sudan Kenya Bangladesh Total Nepal Thailand Mexico Nigeria Mali Kyrgyzstan Turkmenistan
Breathing difficulty during cough
No Yes

18. for every child, answers
Energy ladder and breathing difficulty during cough
.1.2.3.4.5
2 3 4 5
Energy ladder
mncough Fitted values
0
.05
.1
.15
.2
.25
Sharewithbreathingdifficulty
2 3 4 5
Energy ladder
mnbreath Fitted values

19. for every child, answers
Next steps
 Combine the micro and macro level data to assess the
relative contributions of indoor and ambient air
pollution in different context
 To produce country level estimates of potential life
and DALY savings from improved air quality
 Examine the benefit to cost ratios of various
interventions

20. for every child, answers
Next steps
Pollution
Particulate Matter (PM2.5)
Sulfur Dioxide (SO2)
Nitrogen Oxides (NOx)
Ozone (O3)
Carbon Monoxide (CO)
Child Health
Pneumonia
Stroke
Asthma
Lung function (including
ARI)
Otitis Media
Adverse Birth Outcomes
Health Outcomes
- Neonatal and Under 5 Mortality
- Child morbidity
- Disability & Chronic Conditions
Other potential pathways
Human Capital Development
o-School attendance and participation
-Cognitive development and productivity
HH Production and Productivity
-Caregiver absence from work
-Time use and number of hours worked
Impact on Household Income and Poverty
-Induced income reallocation for healthcare
-Household poverty

21. for every child, answers
Grazie mille
https://news.nationalgeographic.com/2017/03/environment-
pollution-child-deaths-who/
https://www.nationalgeographic.org/video/air-pollution-101/