nteg rated
nvironmental
Strategies

Final Summary Report: Climate, Air Pollution and Public
Health: Estimating Morbidity and Mortality from Fossil Fuel
Consumption in Major Urban Areas in Developing Countries

World Resources Institute, for U.S. EPA

May 2004


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Climate, Air Pollution and Public Health: Estimating Morbidity and Mortality from
Fossil Fuel Consumption in Major Urban Areas in Developing Countries
EPA Cooperative Agreement CR826980-01

Final Summary Report

In 1998 the World Resources Institute (WRI) and the US EPA Office of Policy entered
into a multi-year Cooperative Agreement CR826980-01: Climate Policy, Air Pollution
and Public Health: Estimating Mortality and Morbidity From Fossil Fuel Consumption in
Major Urban Areas in Developing Countries. The broad goal of the project was to
address the climate change, air pollution and public health implications of energy use in
major urban areas, especially the very large "megacities", of developing countries. The
project activity was organized around studies with developing country experts to
document the co-benefits that would follow from adopting less carbon-intensive energy
and urban transportation policies in order to: (a) lessen the impact of greenhouse gases
from fossil fuel combustion, and (b) significantly reduce current and future public health
impacts from exposure to combustion-related air pollutants. This involved the
development and adaptation of methods, working with technical experts in the target
countries, and technical support to these experts in carrying out the assessments. In
addition, results of the methods development, case studies and other technical
information were synthesized and disseminated to a variety of important audiences
including the relevant technical communities (e.g., health researchers, air quality
management officials), policy makers, and the interested public. During the roughly four
year duration of this project, the cooperative agreement was amended twice and the scope
expanded to include assessment of a broader range of ancillary effects (co-benefits or
costs) of climate change policies, and development of corporate level GHG inventory
methodology.

The project produced a significant body of technical work that was disseminated as
available through reports, journal articles, briefing materials and other media. This work
made a substantial contribution to the technical and policy literature and was generally
successful in achieving the goals established by EPA and WRI for the project. This final
report provides an overview of the principle activities and products of the project but
does not attempt to reproduce the detailed technical content produced over several years.
Rather it summarizes briefly the major achievements and products, and attaches copies of
these products.

Background.

The use of fossil fuels will increase greatly in future decades throughout the world,
especially in many rapidly developing countries in Asia, Africa and Latin America.
Analyses that quantitatively document the short-term impacts on public health of
continuing current patterns of fuel use can serve as critical tools for policy makers. This
information can galvanize public support for efforts to promote more efficient growth and
the use of less carbon-intensive fuels. The documentation and awareness of the public

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health impacts of current energy patterns provides clear, empirical information that can
guide the policy process regarding greenhouse gases and lessen the impact of associated
air pollution on public health. In some key regions that are projected to grow
substantially in the first few decades of this century, there were no readily available data
on country-wide exposures to particulate matter and other air pollutants at the outset of
this project. Moreover, the available data on public health impacts from such exposures
were uneven and incomplete. As a consequence, estimates of health consequences of
fossil fuel combustion were usually absent from the international policy-planning
discussions such as those related to international climate treaty negotiations.

Prior to the inception of this project, key WRI staff played a leading role in a broad
working group which pulled together one of the first preliminary global estimates of the
near-term "co-benefits" of reductions in fossil-fuel combustion which could result from
global climate change mitigation. These benefits were based on the ancillary reductions
in emissions of traditional air pollution and related public health impacts that would
accompany climate change policies. The results were published in The Lancet, a highly
influential medical journal in November 1997. This preliminary study provided the
starting point for methods development under the EPA-WRI Cooperative Agreement and
also helped raised awareness of these issues around the world, which greatly assisted the
efforts to identify partners in key developing country megacities.

The project was designed to produce estimates of potential public health benefits and
capital savings that can be derived from various climate control policies that will reduce
the use of fossil fuels. In each of the selected urban regions, partnerships were formed
with key public health and policy-making institutions, including government agencies,
academia and NGOs, in order to produce collaborative assessment reports. WRI
proposed to publish the results of this work jointly with its partners in both general and
specialized, national and international publications.

Activities

The agreement and its two subsequent amendments identified five major areas of activity:

1)	the development of methods for climate, air pollution and public health
assessment;

2)	support for case studies in key megacities, working with local expert teams;

3)	development and dissemination of reports and synthesis products;

4)	support for a broad evaluation of the state of knowledge on ancillary benefits
and costs of climate policies, and recommendations for further work in this
area; and

5)	development of methods for corporate-level GHG inventories.

In each of these areas, the WRI project was able to make substantial progress and to
contribute results which have enriched the scientific understanding and technical
literature, encouraged cost-effective responses in developing countries and private
companies, and stimulated considerable related work by researchers around the world.

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1)	Methods development for climate, air pollution and public health assessment

The project staff built on the methods and experience of the Working Group that
produced the groundbreaking Lancet article in 1997 and refined these methods working
with partners in key developing countries. After consultation with a number of key US
and international experts, WRI staff developed an initial template for case studies in
selected megacities.

This methodology was then discussed and adapted working with expert teams in Brazil
and China. Key interim products were:

•	In March 1998, a major international workshop was held in Sao Paolo, Brazil,
hosted by the State Environmental Agency. Representatives from WRI, EPA,
USAID, and the World Health Organization (WHO), as well as other experts from
the US and Latin America attended and commented on the proposed methodology
and its application in Sao Paolo.

•	In April 1998, WRI staff produced Chinese Language materials (copy attached)
summarizing the results of the Lancet Article:

"Short-Term Improvements in Public Health from Global Climate Policies
on Fossil Fuel Combustion: an Interim Report", Working Group on Public
Health and Fossil-Fuel Combustion, November 8, 1997
These materials were disseminated as background for discussion of the
application or the proposed methods to Shanghai and Beijing.

Results of the methods development work and its adaptation to specific city situations are
reflected in the workplans and results of the Brazil and China case studies discussed
below.

In addition, the World Resources Institute's (WRI) project raised international awareness
concerning the growing problems posed by current patterns of fossil fuel use, by devising
a straightforward indicator of population at risk from hazardous levels of air pollution in
major cities and urban areas of the world. As part of its overall objective in producing
informed public discussion of climate relevant policies, the project published an
approach for comparing urban air pollution risks to children in specific cities:

•	Urban Air Pollution Risks to Children: A Global Environmental Health Indicator,
Principal authors, Devra L. Davis and Paulo H. N. Saldiva, WRI Environmental
Health Notes, September 1999 (copy attached).

2)	Case Studies in Specific Urban Areas

The project was successful in identifying and engaging leading technical experts in Brazil
and China, and in working effectively with and supporting those experts in carrying out
groundbreaking case studies projecting the likely co-benefits of reductions in fossil fuel

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use in reducing air pollution and public health impacts and greenhouse gas emissions
simultaneously.

The WRI project focused direct case study support in 3 megacities, though technical
advice and review were provided to additional cities. Progress in these studies was
marked by several important milestones:

•	Sao Paolo — Based on the results of the March 1998, methods workshop, the case
team was established — . A joint working group of WRI, Brazilian and other
experts—the case study was designed and launched in late 1998. The first report was
produced in 1999 with more refined results included in a journal article published in
2001. This journal article also included results from some megacities which were
advised but not directly supported by WRI. The assessment work in Sao Paolo has
continued after the completion of the WRI agreement through a related EPA research
project. Key products were:

•	Public health Impacts of Fossil Fuels in Sao Paolo: a Preliminary Assessment.
August, 1999, produced by the Sao Paolo study team (copy attached).

•	"Assessing the Health Benefits of Urban Air Pollution Reductions Associated
with Climate Change Mitigation (2000-2020): Santiago, Sao Paulo, Mexico City
and New York City" Cifuentes, Boija-Aburto, Gouveia, Thurston and Davis.
Environmental Health Perspectives, June 2001. (copy attached)

•	Shanghai — In April, 1999, WRI President Jonathon Lash signed a Memorandum of
Understanding (MOU) with Dr. Qu Geping, member of the State Council and Co-
Chair, Pollution Control Working Group of the China Council for International
Cooperation on Environment and Development (CCICED). (copy attached). This
MOU established the basic structure and work program for the Shanghai case study,
the first of it's kind in China. The study team included experts from the Shanghai
Academy of Environmental Sciences, and the Shanghai Medical University (later
reorganized into the Fudan University School of Public Health), WRI staff and other
US experts. The team developed its own version of the methodology and applied it to
produce a first report in 2000 (copy attached). This study was further developed and
refined to produce a second report in 2001. Results of the study were provided to the
Shanghai Environmental Protection Bureau and other policy officials, and was
credited with significantly influencing and improving the cities tenth 5-year plan for
air pollution which set goals and broad strategies for air quality management from
2000-2005. Major products were:

•	Shanghai Energy Option and Health Impact, Shanghai Academy of
Environmental Sciences and Shanghai Medical University, August 2000. (copy
attached).

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• The Integrated Assessment of Energy Options and Health Benefit, Shanghai
Academy of Environmental Sciences and School of Public Health, Fudan
University, December 2001. (copy attached)

•	Beijing - Shortly after initiating the Shanghai case study, the WRI staff worked with
policy makers and technical experts in Beijing to establish study team for that city.
This team included experts from Tsinghua University, Beijing Medical University,
the Beijing Environmental Monitoring Center and the National Center for
Environmental Analysis and Measurement, with support form WRI staff and other
US experts. In December, 1999, the Beijing technical team produced the workplan
for the initial study of that city, (copy attached) The work was initiated under the
WRI agreement and has been carried on since the completion of the WRI agreement
through another EPA supported project. Interim results and tools based on work
initiated under the WRI agreement are being used to support the Beijing Organizing
Committee for the Olympic Games (BOCOG) and the Chinese and local governments
in their efforts to design and implement strategies to meet ambitious air quality goals
for the 2008 Games.

3) Reporting and Outreach

Throughout this project the WRI staff disseminated information on co-benefits of climate
change mitigation and air pollution, public health and economic improvements,
particularly related to the large urban areas in developing countries. This included,
briefings, speeches, workshops, and interviews, as well as targeted and general interest
publications. Some of the most significant results in this area are:

Workshops

•	June 2000, WRI staff were instrumental in organizing a session titled "Co-Benefits
Analysis: Integration of Air Pollution, Health and Climate Change Priorities" at the
Air and Waste Management Associations 2nd Annual International Urban
Environmental Infrastructure Forum in Salt Lake City, Utah. Dr. Devra Davis of WRI
also gave the luncheon speech at the Forum. These efforts showcased results and
methods from the project and related activities to the air quality management
technical community.

•	September 2001, WRI staff helped organize and run an expert workshop on economic
and public health impacts of air pollution, held in conjunction with the annual
meeting of the International Society for Environmental Epidemiology, in Garmisch-
Partenkirchen, Germany. This meeting brought together experts from key developing
countries as well as public health researchers and highlighted the concepts and
preliminary results of co-benefits and related air pollution health effects research in
developing countries to the health research community. A report of this workshop
was later published:

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"International Expert Workshop on the Analysis of the Economic and Public
Health Impacts of Air Pollution: Workshop Summary", Michelle L. Bell, Devra
Davis, et al., Environmental Health Perspective, v. 110, n.ll, November 2002.
(copy attached)

Publications

•	June 1998 China's Health and Environment, Chapter in World Resources 1998-
99, A Guide to the Global Environment; (copy attached)

•	"Hidden Health Benefits of Greenhouse Gas Mitigation", Cifuentes, Borja-
Aburto, Gouveia, Thurston and Davis, Policy Forum: Climate Change, Science,
August 17, 2001 (copy attached)

4) Assessing the Ancillary Benefits and Cost of Greenhouse Gas Mitigation

With the second amendment to the agreement, a new task was added to provide for broad
evaluation and synthesis of the global state of knowledge on ancillary benefits and costs
of climate change policies. This stocktaking was timely and critically important for
several reasons. First, it provided a valuable opportunity to showcase work on co-control
benefits in developing country megacities, to stimulate discussion of early results and to
plan and coordinate further work in developing countries. Second, it provided a synthesis
of the research, case studies and scientific understanding of a wide range of ancillary
benefits and costs, that was a major foundation for the discussions of these impacts in the
United Nations sponsored Intergovernmental Panel on Climate Change (IPCC) Third
Assessment Report published in 2001. Finally, the effort provided a basis for
establishing priorities and technical approaches for further research on ancillary impacts
of climate policies.

The centerpiece of the effort to evaluate and synthesize the understanding of ancillary
impacts was a global Experts Workshop on Assessing the Ancillary Benefits and Costs of
Greenhouse Gas (GHG) Mitigation Strategies. This workshop was co-sponsored by the
IPCC, The organization for Economic Cooperation and Development (OECD),

Resources for the Future (RFF), Statistics Norway, US Department of Energy (DOE), US
EPA and WRI, and was organized in Washington, D.C., 27-29 March 2000. Its
objectives were to gather experts from around the world to seek to:

•	establish a common basis of understanding about the conceptual and empirical
elements of ancillary benefits and costs of climate change policies;

•	identify options for integrating ancillary benefits/costs into policy design and
analysis;

•	and identify research gaps and fruitful areas for further research to narrow
uncertainties about this issue and make the analysis more useful for policy-
makers, with a special focus on domestic U.S. research priorities.

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While the workshop left many issues for further work, it advanced understanding on
common elements of an analytic framework for addressing ancillary benefits and costs
and facilitated a dialogue between analysts in the field. Products from the workshop
include:

•	Ancillary Benefits and Costs of Greenhouse Gas Mitigation, Proceedings of an
IPCC Co-Sponsored Workshop 27-29 March, 2000, Washington D.C. published
by the Organization for Economic Cooperation and Development, Paris, France
2000. Excerpts are attached, full report is available at

http://oecdpublications.gfi-nb.com/cgi-bin/OECDBookShop.storefront/EN/product/97200Q121Pl

•	Ancillary Effects of Climate Change Policies: Frameworks and Methodologies,
published by the Organization for Economic Cooperation and Development,
Paris, France 2000. (copy attached)

•	"Understanding the Ancillary Effects of Climate Change Policies: a Research
Agenda", Anthony Janetos and Amy Wagener, WRI Policy Brief (May 2002)
(copy attached).

The workshop activities and products also served as support for participation by staff of
this project in the IPCC process. Dr. Devra Davis, with support from this project, was
one of the lead authors for chapters 8 and 9 of the IPCC Third Assessment Report (TAR)
on the ancillary benefits and costs of mitigation:

Climate Change 2001: Mitigation. Intergovernmental Panel on Climate Change,
Working Group III, 2001. Chapters 8 and 9 are attached, full report available at:

http://www.grida.no/climate/ipcc tar/wg3/index.htm

5) Development of methods for corporate-level GHG inventories

The last task was also added in the third amendment to the agreement. It recognized the
need to promote action to reduce GHG emissions at the corporate level as well as
national and facility level measures. This methods effort accounted for the role of the
private sector as a vehicle for promoting GHG mitigation strategies and associate
ancillary benefits. WRI's GHG Protocol Initiative (GHGP) team laid the foundation for
the development of the standards and tools to measure and evaluate those impacts.
Partnering with the World Business Council for Sustainable Development (WBCSD),
WRI structured a multi-stakeholder process that brought together key policy makers,
NGOs, businesses and business associations to build these standards and tools.

In the last quarter of 2001, the GHG Protocol published the first edition of the corporate
accounting and reporting standard. The standards, guidance and calculation tools help
companies and others prepare a GHG emissions inventory - a critical step in establishing
credible and meaningful reduction commitments, as well as tracking progress over time.
Over 350 individuals from corporations, non-profits, and governments contributed to the
creation of this document. An extensive structured feedback process was implemented to

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solicit feedback from companies using the protocol to compile an emissions inventory, as
well as other key stakeholders. A second edition has just recently been published. (Both
editions are attached).

Conclusions

This brief review of the major activities and products carried out under the EPA-WRI
Cooperative Agreement CR826980-01: Climate Policy, Air Pollution and Public Health:
Estimating Mortality and Morbidity From Fossil Fuel Consumption in Major Urban
Areas in Developing Countries, demonstrates the broad scope and importance of the
work carried out in this successful collaboration of WRI and the US EPA. Despite
occasional setbacks and delays inherent in a groundbreaking project, set in developing
countries, the project was successful in significantly advancing the state of knowledge in
each of the five major technical areas identified in the original project proposal and two
amendments. It produced valuable contributions to the technical literature as well as
practical results practical results on the ground in key partner cities and developing
countries. In addition, the project disseminated information to the general public and
various technical communities through a through series of reports, briefings, workshops,
etc. The methods, tools and initial results produced in this project have been used as
foundations for several ongoing projects which have continued the work with developing
countries and other partners on co-benefits of climate policies, and GHG inventory
methods. These activities are not only improving the scientific and technical
understanding in these important areas, but are already influencing development and
implementation of constrictive policies and measures in developing and developed
countries, international organizations and corporate management.

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Attachments

1)	Chinese Language materials summarizing the results of the Lancet Article:

"Short-Term Improvements in Public Health from Global Climate Policies on Fossil Fuel

Combustion: an Interim Report"

2)	Urban Air Pollution Risks to Children: A Global Environmental Health Indicator,
Principal authors, Devra L. Davis and Paulo H. N. Saldiva, WRI Environmental
Health Notes, September 1999

3)	Public health Impacts of Fossil Fuels in Sao Paolo: a Preliminary Assessment.
August, 1999

4)	"Assessing the Health Benefits of Urban Air Pollution Reductions Associated with
Climate Change Mitigation (2000-2020): Santiago, Sao Paulo, Mexico City and New
York City" Cifuentes, Borja-Aburto, Gouveia, Thurston and Davis. Environmental
Health Perspectives, June 2001

5)	Memorandum of Understanding (MOU) with Dr. Qu Geping, member of the State
Council and Co-Chair, Pollution Control Working Group of the China Council for
International Cooperation on Environment and Development (CCICED), April, 1999.

6)	Shanghai Energy Option and Health Impact, Shanghai Academy of Environmental
Sciences and Shanghai Medical University, August 2000.

7)	The Integrated Assessment of Energy Options and Health Benefit, Shanghai Academy
of Environmental Sciences and School of Public Health, Fudan University, December
2001.

8)	The Co-Benefit Project II: Energy Options and Public Health Benefits: the Case of
Beijing. Tsinghua University, Beijing Medical University, Beijing Environmental
Monitoring Center, National Research Center for Environmental Analysis and
Measurement, December, 1999.

9)	"International Expert Workshop on the Analysis of the Economic and Public Health
Impacts of Air Pollution: Workshop Summary", Michelle L. Bell, Devra Davis, et al.,
Environmental Health Perspective, v. 110, n. 11, November 2002.

10)	China's Health and Environment, Chapter in World Resources 1998-99, A Guide to
the Global Environment, June 1998

11)	"Hidden Health Benefits of Greenhouse Gas Mitigation", Cifuentes, Borja-Aburto,
Gouveia, Thurston and Davis, Policy Forum: Climate Change, Science, August 17,
2001

12)	Ancillary Benefits and Costs of Greenhouse Gas Mitigation, Proceedings of an IPCC
Co-Sponsored Workshop 27-29 March, 2000, Washington D.C. published by the
Organization for Economic Cooperation and Development, Paris, France 2000.
(Excerpts)

13)	Ancillary Effects of Climate Change Policies: Frameworks and Methodologies,
published by the Organization for Economic Cooperation and Development, Paris,
France 2000.

14)	"Understanding the Ancillary Effects of Climate Change Policies: a Research
Agenda", Anthony Janetos and Amy Wagener, WRI Policy Brief (May 2002).

15)	Climate Change 2001: Mitigation. Intergovernmental Panel on Climate Change,
Working Group III, 2001. Chapters 8 and 9

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16)	The Greenhouse Gas Protocol: a Corporate Accounting and Reporting Standard.
World Business Council for Sustainable Development and World Resources Institute,
2001.

17)	The Greenhouse Gas Protocol, a Corporate Accounting and Reporting Standard,
Revised Edition. World Business Council for Sustainable Development and World
Resources Institute, 2004.

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