A medical doctor and epidemiologist (MD-PhD) by training, Dr Carlos Dora, has a distinguished career in public health and environmental issues. At the World Health Organization (WHO), he is the coordinator of the unit ‘Interventions for Healthy Environments’ which is a part of the Department of Public Health and Environment. In this capacity, he has spearheaded efforts to bring together various types of Health Impact Assessment (HIA) at the global level.
He was recently in Kathmandu to hold meetings with the concerned stakeholders to implement a new project concerning the minimization of air pollution. Republica briefly caught up Dr Carlos at the sideline of his meeting with the office bearers of Nepal Medical Association (NMA) last Friday to talk about his works and air pollution in Kathmandu. Excerpts:
What brings you in Kathmandu this time?
We are starting a project to help develop healthy Kathmandu. We are going to do this in the next year or two. We are articulating and doing analysis of the local data, looking for local policy options to create scenario I described here. We will work with the local institutions. Because air pollution is a big issue globally. We are currently working in this area.
In this project, we will work with cities. What a city can do or what health sector can do to provide the cities with information they need are good solutions in terms of reducing air pollution. So what we do is analyze the level of pollution, sources of pollution, and we talk to people who can do something about them.
How did you find the condition of air pollution in Kathmandu?
I think Kathmandu is not amongst the worse cities in the world and it is not nearly amongst the best. So you are among the middle. What is noticeable about air pollution in Kathmandu is that there are many sources which could be easily resolved. For example, the whole amount of waste burning. That’s something seen everywhere in other parts of the world. There is relatively simple solution to this. When I was here in December we went to a rural area which shares the same thing. There was a lot of solid fuel burning.
There was a lot of smoke inside home and near the homes for cooking for animals. This could affect even Kathmandu because it is nearby. So, burning is a big problem. The indoor air pollution is a very big problem even if it is not inside the city. Then the traffic in the road sector is very noticeable. Obviously, there are a lot of problems. Some are very polluting and some are very clean.
You have some electric vehicles which is very positive. But I think what is important is you really need to think about your environment and how it can become pollution-free, dust-free and healthy.
What are the implications of air pollution for public health?
It has a great implication for public health. In Nepal, the number of deaths caused by air pollution -indoor and outdoor- is 30,000 a year. This is twice as much as the number of deaths caused by tobacco. Tobacco kills 16,000 people in Kathmandu.
Traffic injury is 5,000. So you have really many more deaths from air pollution. That means there is a great opportunity. Resolving this will not only help to have a better city but a pleasant city to walk or cycle. You would also have health benefits as well.
What do you think all concerned stakeholders should be doing to address this problem?
The government has some roles to play and the private sector has other roles. So, if you talk about transportation and urban environment, many people who own land and those who run the public transport system, also have some roles.
The role of the health sector is to clarify one of the options that exist in urban environment regarding public transport in Kathmandu. We can then provide details of different scenarios. This is to empower or clarify different policy options. We are all in charge of our health. This is important for our health.
What do you think the government in particular should be doing in this regard?
I think the role of the government is to monitor or carry out good monitoring, and disseminate information widely so that everybody could use them. But there is also a role for the citizens’ side. You can do this. Your monitors go out in the streets. We know that these monitors are less reliable.
They need 150,000 dollar machine that measures very precisely. We understand that. What you need to do is calibrate your machine against the big equipment in a regular basis because that improves the quality of your measures. So you should be doing that regularly. But I think there is a role for the citizens’ side. We have satellite information at the WHO. Look at our map. We use the best information we can from satellite map, air traffic model, from inventory, and from monitoring stations, and we employ the best people who can synthesize these information.
Do you have any specific recommendations for the government to minimize air pollution?
We publish lots of documents in WHO about good practices. One of the policies is to improve health. If you go to our website we have books and enormous amount of information on transport and health, energy and health, and transport, and household energy. I think our recommendations are same for all the governments around the world which are in our guidelines. Sustainable transport is one.
If you go to the WHO website, we have mentioned about the transport system that is good for health. It is public transport of high quality and cycling route that is safe are some things that we say very clearly to everybody. This is the way to go forward if you want to have healthy transport. That is the general recommendation just because there is lower rate of accidents, lower pollution, less noise and more physical exercises. So the great solution for public health is sustainable transport system.
Finally, do you have anything to say to our readers?
I want to say that Kathmandu is a great city, very attractive one. Everybody loves to come here to breathe well, to breathe freely and to enjoy the city. The way land is being used in Kathmandu stops people to enjoy this because of the safety risk and because of the pollution. So outsiders like I would like to come here with my children. But there are some impediments. Maybe backpackers are more risk takers. Middle aged men like I want little more comfort.
I think many people in Kathmandu want to see Kathmandu with more trees, more space for pedestrians to walk on the streets, more safety on the road. I think those issues, as coming from outside, are what strike first. Being a tourist city, being a city with UNESCO Heritage Sites, I want to see these spaces much more usable in the future.