A price too high

South China’s smoggy skies have a grave impact on human health. The benefits of pollution control in southern China far outweigh the costs, finds a new study by Christine Loh, Anthony Hedley, Wong Tze Wai and Alexis Lau.

New research conducted in Hong Kong, Macao and the Pearl River Delta (PRD) region of Guangdong province has for the first time identified and quantified the direct risks to public health caused by air pollution. According to the Civic Exchange report, A Price Too High: The Health Impacts of Air Pollution in Southern China, annual deaths attributable to the 2006 air pollution levels are estimated at 10,000 in southern China, with the majority (94%) occurring in the PRD. In addition, air pollution is also responsible for 440,000 annual hospital bed-days and 11 million annual outpatient visits throughout the region.

In financial terms, the hospital bed-days, lost productivity and doctor visits associated with this health impact amount to 1.8 billion yuan (US$262 million) a year in the PRD, HK$1.1 billion (US$140 million) in Hong Kong, and HK$18 million (US$2.3 million) in Macao. Adjusted for differences in gross domestic product across the region, the health-related monetary costs of air pollution in the PRD amount to 6.7 billion yuan (US$976 million) yuan. However, it should be noted that these figures do not take into account pain or suffering, or put a value on life, nor do they account for undiagnosed harm to people suffering from more minor ailments which were not consciously connected with air pollution.

These figures were made possible because for the first time direct comparisons could be drawn between emission levels of key toxins (sulphur dioxide, nitrogen oxides, respirable suspended particles and ozone) across the whole airshed that covers Hong Kong, Shenzhen and Macao. For the first time, this data could be correlated with similarly robust statistics on public health impacts. It should be noted that all these costs, both human and financial, are considered to be lower-end estimates.

There is a growing public awareness and concern about the harmful effects of air pollution. Hazy days have increased dramatically throughout the PRD over the last two decades. And in the last few years there has been growing concern that not only are pollution levels consistently higher than World Health Organization (WHO) guidelines (which are based on preventing negative impacts to human health), but local air quality also often fails to meet less stringent local standards. This is particularly true in PRD industrial areas such as Foshan, where at one station annual particulate matter (of 10 micrometres or less, PM10) levels were recently 600% above WHO guidelines. Satellite images from 2007 also indicate that conditions have worsened considerably since the last joint regional review in 2003.

The report also highlights the consequences of deeply inadequate research into regional air pollution, noting that it is difficult for governments to make policy and implement strategies to tackle air pollution and related declines in public health without sufficient information. It is equally difficult for the public to take steps to protect itself from the harmful effects of air pollution, in particular by expressing concern to government. Previously just 37 studies have been published on the public health effects of air pollution in the last 25 years.

While such a comprehensive study has never previously been prepared, many stakeholders in the region have been frustrated with the slow pace of government action in controlling air pollution over the years, and point to successful steps that have been taken elsewhere in the world. Moreover, recent data has highlighted the health-related costs of pollution and the possible threat of air quality to economic competitiveness appears to be substantial. A June 2006 report provided an initial assessment of the public health costs of air pollution in Hong Kong, conservatively concluding that, “the reduction of pollution to the levels in other world cities, such as London, Paris and New York, would avoid over 1,600 deaths” annually.

Looking forward

It is very much hoped that the fast-approaching East Asian Games, planned for Hong Kong in 2009, and the much larger Asian Games, which are due to take place in Guangzhou in 2010 will provide the stimulus to address air pollution more seriously, especially after noting the great difficulties Beijing has faced in trying to improve air quality ahead of the Olympic Games in August 2008.

There have been recent signs of increased government commitment, including the 2003 establishment of the cross-border Pearl River Delta Regional Air Quality Management Plan and the current review by the Hong Kong Government, to its 20-year-old Air Quality Objectives. However, other signs point to business-as-usual, such as the “best-effort basis” rather than a stronger policy commitment to targets set by the Hong Kong and Guangdong governments.

Some of the pieces for finding the answers are in place. The ongoing provision of real-time data to the public across the PRD from the existing regional monitoring network could increase awareness and understanding of daily conditions, facilitate greater research and allow for immediate feedback on the success of government policy. It is also vitally important that the same dataset for 2007 be provided so that direct assessment can be made and year-on year trends identified.

Hong Kong’s current Air Pollution Index is not only insufficient but also misleading, as it is not directly linked with health protection. Revising its Air Quality Objectives to be in line with WHO guidelines, thereby honestly revealing the scale of the problem would provide the Hong Kong Government with a powerful driver to improve air quality and public health.

Most importantly the report lays down a complete strategy that would enable the authorities in the PRD Hong Kong and Macau to exercise leadership by taking immediate efforts to deal comprehensively with the air quality problem. Abandoning the existing piecemeal approach ad adopting a total air quality management framework is the necessary first step, as it has proven most successful in controlling air pollution in other urban regions around the world.  

Christine Loh is the CEO of Civic Exchange

Anthony Hedley is chair professor in the department of community medicine, School of Public Health, Hong Kong University

Wong Tze Wai is professor in the department of community and family medicine, Chinese University of Hong Kong

Alexis Lau is associate professor in the civic engineering department and director of the environmental central facility, Hong Kong University of Science and Technology