Health is an urban planning issue. Over 90% of people living in urban areas are exposed to polluted air – with an estimated 7 million premature deaths each year —one of the most direct health impacts of climate emissions. This health burden has been estimated by the World Bank to represent almost 5% of global GDP, with some countries sacrificing as much as 15% of their GDP.1
Led by WHO, the Urban Health Initiative (UHI) model process2 supports cities in producing contextual information on the health and economic impacts of policies, by assessing and testing alternative scenarios. The model process has been tested in Accra, Ghana and Kathmandu, Nepal in two groundbreaking pilot projects for interventions to tackle poor air quality and mitigate climate change.
Accra is one of the fastest growing cities in Africa, with an annual population increase of around 2%. More than 4 million people live in the Greater Accra Metropolitan Area, with a daily influx of 2.5 million business commuters. The population is expected to grow to 9.6 million by 2050.3 This makes for an ideal context to test the model process and overcome a myriad of implementation challenges. The Initiative worked with international and local government to integrate health into transport, household energy, land-use and solid waste management policies.
-Mohammed Adjei Sowah, Mayor of Accra
The Initiative started by assessing air quality in the city including short-lived climate pollutants, sources, related policies and initiatives. The policy mapping, conducted by UN-Habitat and ICLEI Local Governments for Sustainability, looked at legislative acts, budgets, policies and plans.
The team identified four main sectors impacting air quality: transport (including walking and cycling), energy (household energy for cooking and lighting), solid waste management (including open burning and e-waste) and urban land-use and spatial planning. The information collected was used to support the development of scenarios – examining existing and future plans, along with the development of alternative scenarios – to assess the health and economic impacts and devise appropriate policies.
The second step was to build the communication capacities of the health, environment and other city sectors. Experts were trained to engage in cross-sector policy-making and communicate effectively with the public on links between climate, air pollutants and health. This step also involved placing the assessment tools into government protocol, with Ghanaian experts in each sector trained on AirQ+ (a software tool for health risk assessment of ambient and household air pollution); HEAT (Health and economic assessment tool for walking and cycling) and WHO’s Household Multiple Emission Sources (HOMES) model among other tools.
The tools provided urban leaders with estimates of the impact of air pollution and short-lived climate pollutants (e.g. black carbon and methane) on human health. The tools were also used to support scenario modelling of cleaner developments in land use, waste, energy and transport.
Alternative scenarios were tested to identify preferred policy interventions. These scenarios were used to develop city-level action plans and roadmaps, allowing local data and expertise to be unlocked and helping to ensure the sustainability of the work at the country and city level.
The Initiative in Accra used a range of different approaches to assess the economic impact of air pollution. It trained Ghanaian economists and collected data on air pollution-related deaths and disease, determined the costs of inaction and calculated potential savings for families and health care systems. Data showed that when ambient air pollution is reduced to WHO guideline levels, 1790 premature deaths could be prevented every year in Accra4 and around USD 247 million in welfare costs saved (2018 figure).5
Analysis of household air pollution found over 1900 averted deaths and a reduction of 35% in exposure under the most aggressive scenario through the promotion of LPG, biogas or electricity as substitutes for wood and charcoal.6 It is important to note that the use of gaseous fossil fuels are considered vital transition fuels to reduce the burden of disease from polluting household energy.
Assessments of solid waste management (SWM) also found that better public health —and a reduction in greenhouse gases and short-lived climate pollutants— can be achieved through improved waste management. Accra suffers from inadequate SWM despite being one the lowest quantity of waste per capita cities in the world. Waste burning is a major contributor of black carbon (BC) emissions – a significant short-lived climate pollutant. In 2020, more than 67,000 metric tonnes of BC were emitted; projected to reach 133,500 metric tonnes by 2050 under the business-as-usual scenario. Ceasing open burning will lead to a 50% reduction in emissions and 19% capture of landfill gas by 2050.
In 2018, Accra became the first African city to join the BreatheLife campaign.7 Media training to engage editors and publishers led seven media houses to make long-term commitments to follow the air pollution, climate change and health story. Community outreach in eight sub-metro areas using education, theatre groups, activities at local schools and workshops with traditional Chiefs and Queen Mothers led to joint efforts between communities and regulators to mitigate air pollution sources.
The final step of the Initiative has been to develop a policy-monitoring framework to track policy changes and understand the climate and health outcomes of Accra’s initiatives. Recommendations from the Initiative have been included in Accra’s local strategies, including the Air Quality Management Plan, the Accra Resilience Strategy and the city’s 2020 Climate Action Plan. Accra has also pledged to cut carbon emissions to zero by 2050. Media tracking found that there were over 300 newspaper articles highlighting the links between air pollution, climate change and health over the two-year period from June 2019. The increased focus on health impacts of transport policies led the Ghana Ministry of Transport to consider integrating health analytics as part of their regulatory frameworks.
The success of the Initiative in Accra has led other cities in Ghana to express interest in applying the model process and representatives from several African cities travelling to Accra to learn from the city’s approach. The Urban Health Initiative in Accra has shown how equipping the health sector with the data, tools and capacity can unlock the full range of economic and climate benefits for cities through health-informed policies.
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