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Environmental health in Mexico: current situation, challenges and
perspectivesHoracio Riojas Rodríguez, PhD.Michelle Romero Franco, MSc.
Binational Perspectives in Environmental Health April 5th, 2011
CONTENTSection I. General outlook : An overview of the problem Epidemiological transition, urban and demographic situation
Environmental distress factors Land use changes Urbanization & industry distribution
Environment, population and health in Mexico Old risks & new ones Water pollution
Chapala lake & mercury Air pollution
Outdoor & Indoor (Biomass smoke) Climate change Chemical substances
Mining exploitation, POPs: Tri-national study
CONTENTSection II. Responses to confront the problemsSuccessful interventions Multi sector efforts: climate change, PROAIRE
2011National & International agendas
AIMSIn this presentation we will provide a glimpse
of the current situation of environmental health in Mexico and some of the priorities for research and public health interventions
SECTION I. GENERAL OUTLOOK : AN OVERVIEW OF THE PROBLEM
Mexico• ≈ 2 million Km2
• 112 million people• 70% urban population• Large cities & megacities• Gulf of Mexico & Pacific
ocean• Biodiversity
Mexico (2)• Epidemiological transition
• Significative differences in social and environmental vulnerability
• Health development delays in terms on environmental issues and health
Demographic Transition
Fuente: Estimaciones de población de Conapo 2000.
Millones de personas
1975
2000
2025
85 +80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-14
5-90-4
0123456 0 1 2 3 4 5 6
Hombres Mujeres
Tasa de crecimientoannual
65 años y más: 3.8%menores de 5 años: -1.3%
Epidemiological TransitionMexico, Causes of death
Infecciones y ParasitosisDiarrea
NeumoníasLesiones acc. e inten.
Enf. DigestivasAfec. Perinatales
Enf. Sist. NerviosoEnf. CardiovascularesEnf. Respiratorias Cro.
Enf. Genio-urinariasNeoplasias Malignas
DesnutriciónMaternas
Enf. Metabólicas A. CongénitasMal definidas
0510152025 0 5 10 15 20 25
1940 2000
Environment, population & health 25-35% of the BOD is
attributable to environmental factors
Some of these
• Unsafe drinking water (scarcity, biological & chemical pollution)
• Low air quality in cities and rural areas• Exposure to chemical substances
• Persistent organic pollutants , metals (lead, manganese, chromium, mercury, arsenic)
• Emerging and re-emerging mining areas
• Climate disturbances (disasters, climate change)
• Tobacco smoke exposure• Solid waste disposal
Historical outlook
Pove
rty,
gen
der &
eth
nici
ty
Ongoing outlook…
Pove
rty,
gen
der &
eth
nici
ty,
mig
ratio
n, cl
imat
e ch
ange
…
WATER
Chemical pollution (agro chemicals) per water basinIN
E 20
10. L
as cu
enca
s hid
rogr
áfic
as d
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iagn
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Coo
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0.5
0.22
0.39
0.04 0.03
0.33
2.44
0.47
0.90
0.19
0.76
0.25
0.040.160 0.19
0
0.5
1
1.5
2
2.5
A B C A B B
Conc
entr
atio
ns H
g (p
pm)
Median Maximum Minimum
Carp Tilapia Other species
Water pollution: Mercury in Chapala Lake
EPA
FAO
MEX NOM 127
Water pollution diarrheic diseases, Mortality by basin
Residual water: deficit in treatment
AIR POLLUTION
0
5
10
15
20
25
1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 p 2005
REGISTERED VEHICLES IN MEXICO PER YEAR (MILLIONS)
Source: Instituto Nacional de Ecología. http://www.ine.gob.mx/
Actualizar los datos, características
AIR QUALITY MONITORING. MARCH 31st, 2011.http://sinaica.ine.gob.mx/
Trend of criteria air pollutants in the MCMA 1990 -2007
Source: Informe de la Calidad del aire en la Zona Metropolitana del Valle de México: Estado y tendencias 1990 – 2007. Secretaríadel medio Ambiente, GDF, 2008.
Lead
PM10 trends2007: 78 mcg/m3 mean annual concentration
Source: GDF. Seis medidas metropolitanas de calidad del aire, 2008
Premature deaths avoided. All ages
2, 306
1,0381,191
Cortez Lugo, et al. 2003. "Tendencia de los niveles de plomo en la atmósfera de la zona metropolitana de la Ciudad de México. 1988-1998". Salud Pública de México, pp. 196-202.
Biomass fuels use in Mexico
Source: FAO http://www.fao.org/docrep/005/y4719e/y4719e07.htm
In Mexico, around 27 million people use firewood to cook or to heat their homes (Masera 2007)
Indoor pollution affectswomen and children from thelowest socioeconomic stratawhich are located in rural andsurrounding urban areas
Biomass
Incomplete combustion
Smoke
Gas phase• CO• NOx• Several hundreds hydrocarbons
• 1,3-Butadiene*• Benzene*• Styrene• PAHs (2-4 rings)
• Oxygenated organic compounds• Formaldehyde*• Acroleyne• Methyl phenols
Particulate phase• Particles
• Inhalation• Fine particles
•PAHs (4-6 rings)
IARC Classification * Group 1 Human carcinogen
Design: Community trial
Homes with women and children (< 3 years old)in 6 communitiesn=600
Randomizedassignation
New stove(n=300)
Open fire(n=300)
Follow up
Home visit/ 1 month• Symptoms• Spirometries / 4 month• Oximetry• Anthropometry• Hemoglobine
3 months 10 months
Baseline study
• Questionnaires• Clinical tests• Spirometries
PAHs exposure urinary metabolites pre and post intervention
02
46
810
µmol
/mol
cre
a
Pre 1-Pyr Post 1-PyrPre 3-phen Post 3 phen
36% reduction1-hydroxypyrene 30% reduction
3-hydroxy phenanthrene
Pulmonary function
2.85
2.87
2.89
2.91
2.93
2.95
0 0.2 0.4 0.6 0.8 1 1.2
FEV 1
(L)
Time (years)
FEV1 average loss
Patsari user Non user
Similar effect to quit smoking
Am J Respir Crit Care Med. 2009 Oct 1;180(7):649-56. Epub 2009 Jun 25.
Studies in the North border
EXPOSURE TO CHEMICAL SUBSTANCES
Chemical substances regulation in Mexico
Worldwide
Commerce
Regulated (international)
90% of consumption
Restricted
Under international agreements for elimination
Priority substances in Mexico(As, Cd, Hg, Pb, PCBs, Dioxins, Furans)
>12 000 000>100 000±8 000±3 000±600>15±7
Insert Map
Tri N
atio
nal S
tudy
• The purpose of this initiative was to developand implement a human blood biomonitoringproject in Mexico, Canada and the United Statesin order to obtain an initial profile of contaminant levels of selected persistentorganic pollutants (POPs) and toxic metals in a random population of pregnant women.
TRINATIONAL BIOMONITORING PROJECT
Sam
plin
g lo
catio
ns in
Mex
ico
Pollutant levels in the three countries (1)
Pollutant Country n Min Max Geometric mean (SD)
Cadmium(ug/L)
Alaska 20 ND 2.40 0.40 ( 2.30 )
Canada 64 0.1574 4.95 0.44 ( 2.32 )
Mexico 233 0.1574 1.69 0.35 ( 1.35 )
NHANES 72 ND 0.80 0.27 ( 1.79 )
Lead (ug/L)
Alaska 20 0.0500 0.23 0.10 ( 0.15 )
Canada 64 0.2694 1.20 0.57 ( 0.13 )
Mexico 233 0.5595 22.79
NHANES 72 ND 3.40 0.76 (0.20 )
Pollutant Country n Min Max Geometric mean (SD)
MercuryTotal
(ug/L )
Alaska 20 0.9000 6.70
Canada 64 ND 2.81 0.37 ( 2.7 )
Mexico 233 ND 18.05 0.85 ( 2.68 )
NHANES 72 ND 7.40 0.73 ( 3.06 )
Nickel(ug/L)
Canada 64 0.1762 5.23 2.16 ( 1.64 )
Mexico 233 1.2918 6.46 3.23 ( 1.27 )
Pollutant levels in the three countries (2)
Pollutant Country n Min Max Geometric mean (SD)
PCB 118 (ug/Kg Lipid)
Alaska 21 ND 52.30
Canada 64 1.11 12.64 2.76 ( 1.67 )
Mexico 240 ND 57.75 1.21 ( 2.07 )
NHANES 39 ND 78.80 4.53 ( 2.38 )
PCB 138 (ug/Kg Lipid)
Alaska 21 ND 97.60
Canada 70 1.33 20.78 3.76 ( 1.74 )
Mexico 240 ND 50.70 2.37 ( 2.18 )
NHANES 39 ND 136.00 8.51 ( 2.67 )
Pollutant levels in the three countries (3)
Pollutant Country n Min Max Geometric mean (SD)
PCB 153 (ug/KgLipid)
Alaska 21 ND 244.00
Canada 70 2.10 19.54 6.12 ( 1.67)
Mexico 240 ND 72.50 3.63 ( 2.16 )
NHANES 39 ND 164.00 10.50 ( 2.77 )
PCB 180(ug/KgLipid)
Alaska 21 ND 110.00
Canada 70 ND 67.90 3.48 ( 2.38 )
Mexico 240 ND 43.62 2.07 ( 2.25 )
NHANES 39 ND 90.60 6.28 ( 2.66 )
Pollutant levels in the three countries (4)
Pollutant Country n Min Max Geometric mean (SD)
Oxychlordane(ug/Kg Lipid)
Alaska 21 ND 48.50
Canada 70 1.00 10.00 2.33 ( 1.61 )
Mexico 240 ND 15.05 1.62 ( 1.92 )
NHANES 37 ND 29.00 4.55 ( 2.11 )
Beta HCH (ug/Kg Lipid)
Alaska 21 ND 26.80 8.03 ( 2.07 )
Canada 61 1.00 7.14 2.63 ( 1.55 )
Mexico 240 ND 29.68
NHANES 39 ND 45.30 3.21 ( 2.06 )
Beta HCH- subproducto de lindano
Pollutant levels in the three countries (5)
Pollutant Country n Min Max Geometric mean (SD)
Gamma HCH(ug/Kg Lipid)
Canada 70 ND 1.22 0.61 ( 1.22 )
Mexico 240 ND 6.90 0.65 ( 1.38 )
NHANES 39 ND 3.82
ppDDE (ug/KgLipid)
Alaska 21 34.50 512.00 164.53 ( 2.00 )
Canada 70 19.23 229.89 52.27 ( 1.55 )
Mexico 240 46.51 19753.09
NHANES 39 32.60 9240.00 170.30 ( 2.62 )
Pollutant levels in the three countries (6)
Conclusions• For Lead and Nickel, Mexico was the country with the highest
values although the GM for lead was below the maximum permissible level (100 ug/L).– The highest level was 227 ug/L– 4.7% got levels above 100ug/L– 15.45% were above 50 ug/L
• The main environmental source of exposure to lead in Mexico are: lead in gasoline and the use traditional glazed ceramic 1. Chandhaury et al, suggest that the lead exposure among women residing in Mexico City most likely resulted from the glazed pottery.1
• 29.6% of the mothers said that they used glazed pottery
1 Chandhaury-Webb M; Paschal D, Romieu I, Ting B, Elliot T, Hopkins H , Sanin LH, Ghazi AM. Determining lead sources in Mexico using the lead isotope ratio. Salud Publica de Mexico. 2003 45 (2):183-188
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2004 2005 2006 2007 2008 2009
TOTAL 77596.813 163940.966117960.598207017.909 151892.37 183125.81EXPLORATION 66973.984 149218.748EXPLOITATION 10622.829 14722.218
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200000
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Open pit mine Naopa
MOLANGO, HIDALGO
Rey’s complex figure & Mn exposure
9 year old girl, copy
Same girl, 5 & 30 minute recall
Exposure to lead, mercury, arsenicand manganese are still veryrelevant in Mexico(Declaration of Brescia, 2007)
CLIMATE CHANGE & HEALTH RESEARCH IN MEXICO
Prospective studiesRetrospective studies
Diagnose study on climate change and health effects in human populations in Mexico
Climate variability impact on dengue in Veracruz
Risk scenarios on health risks associated to climate change in Olmecaregion in Veracruz
Climate change scenarios to assess its possible health impacts on health in Mexico
Caracterization of vulnerability associated to climate change in Mexico and its local effects in health
Weather and Health Municipalities Analysis Regional Studies - Case studies
Climate variability impact on malaria in Chiapas
Temperature effect and its interaction with ozone on hospitaladmissions in Mexico City from 1998 to 2007: vulnerable groups
Regional scenarios of climate change, vulnerability and its potentialhealth impact
Climate change scenarios to assess the potential
health impacts in Mexico
MORBILITY RATE RATIO ACUTE DIARRHEA (AD) AUGUST 2030/99-2005
Rate Ratio 2030HADLEY MODEL
1.00
ACU
TE D
IARR
HEA
INFE
CTIO
N A
2 SC
ENAR
IO
Temperature effect and its interaction with ozone on hospital admissions in Mexico City from 1998 to 2007
* Adjusted by O3, PM10 and Relative humidity
Época Húmed Jun-Oct
Lag
% d
e ca
mbi
o en
el R
iesg
o-5
05
10
0 1 2 3 4 5
Temperature effect and its interaction with ozone on hospital admissions in Mexico City from 1998 to 2007
* Adjusted by O3, PM10 and Relative humidity
Cumulative Risk
Respiratory diseases children under 5 (Period 200-2002)
% change in increase of hospital admissions per 1°C increase*Época Húmed Jun-Oct
Lag
% d
e ca
mbio
en
el Ri
esgo
-50
510
0 1 2 3 4 5
Natural disasters + poverty
SECTION II. RESPONSES
Perspectives• What are the needs in terms of research &
intervention?– Increase the efforts for capacity building
(laboratories) and human resources formation in Environmental Health
– Update the diagnose of Environmental Health in Mexico
– Increase multidisciplinary research and policy in Environmental Health
Perspectives
• Multi and transdisciplinary research in environmental health (manganese, woodsmoke)
• Ecosystem approaches to human health• Regional studies on toxics and climate change
impacts• Integration of health and environment sectors
Veracruz state program for climate change
Development of an “action plan” that aims to engage the state government with the University of Veracruz to implement the program
Process• The planning process involved different stages
that had feed back along the road
Objectives
Analysis (cost-benefit, expert
judgement…)
Opportunities & threats to
applyPublic Hearing State program
Feed back
Identification of experts
Multi disciplinary approach
Axes of actions• Detection & follow up of climate change• Greenhouse effect gases emissions mitigation• Biodiversity• Water availability• Costs• Economy• Society
Very specific actionsMainobjective
What needsto be done?
Step by step
Who needstoparticipate?
Objective• To assess the state of the art of
health effects associated to air pollution in Mexico City’s metropolitan area, to advice air quality policies to protect the general population
Air quality policies• The government of Mexico City is currently working on the air quality policies
for the upcoming years (PROAIRE 2011–2020) which main objective is to
improve the atmospheric conditions in the city and to protect the population’s
health.
Perspectives (2)• Research on:
Gene-environment interactions
Reproductive and growth effects
POPs (exposure, monitoring, effects)
Neurodevelopment Climate change & Public Health
Cardiovascular effects
Pollutants & Cancer Intervention & policy evaluation
Academic exchange with UCLA
In this photo: Michael Tsang, MPH. UCLA exchange student, 2010.
Memorandum of Understanding (MOU) between INSP and UCLA to avoid the costs of student fees and to enable us to have students travel easily in both directions
We are working on a Student Exchange Agreement
In 2010, we had one student with excellent results
Project of solid waste, risk assessment
Photos by Michael Tsang, MPH. UCLA exchange student, 2010.
The student participated in this project
THANK YOU
Land use change per water basinIN
E 20
10. L
as cu
enca
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Coo
rd. H
elen
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Economical activities per water basinIN
E 20
10. L
as cu
enca
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as d
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Solid waste
Solid waste
Photos by Michael Tsang, MPH. UCLA exchange student, 2010.
