Urban Health Initiative: Accra story

24 May 2021

A city’s most important asset is the health of its citizens. Yet 7 million premature deaths annually are attributed to air pollution, most in developing cities with rapid growth. In Ghana, WHO estimates over 28 000 premature deaths are due to the combined effects of household and ambient air pollution. Led by WHO, Urban Health Initiative in Accra equipped local and national stakeholders, within and beyond the health sector, with tools for the comprehensive assessment of policies related to air pollution – driving demand for multi-sector action on health at the local level.

WHO/Blink Media/Nana Kofi Acquah

Health is an urban planning issue

Accra, Ghana – one of Africa’s fastest growing cities, has been a proving ground for the WHO Urban Health Initiative. Stakeholders assessed policies and investments in key sectors that are the biggest emitters of urban air pollution – transport, energy, waste and industry. Meeting WHO air quality guidelines of 10 μg/m³ for PM_2.5 could prevent 1790 deaths annually in Greater Accra, corresponding to an estimated health economic burden of approximately US$ 247 million.

WHO

Levels of air pollution in Accra are significantly high

Concentrations of PM_2.5, on average, after conversion from PM₁₀ from ground monitoring stations, are approximately 49.47 μg/m³.

WHO

Transport is responsible for a large and growing proportion of air pollutants

Air quality data indicate that 75% of roadside samples in Accra exceed the national 24-hour mean particulate matter (PM10) limit of 70 μg/m³. Greater Accra Metropolitan Area has over 7500 km of roads, with limited pedestrian and cycling infrastructure. Car ownership has outpaced population growth as personal incomes have risen. Yet walking makes up 37.6% of all passenger-kilometers travelled – an opportunity to include and prioritize safe, active mobility in urban and transport planning. The Initiative found that 5500 premature deaths from air pollution can be averted over 35 years by increasing public transport, fleet fuel economy and infrastructure for walking and cycling. An additional 33 000 premature deaths can be averted from increased physical activity. This represents an estimated US $15 billion in health economic savings.

WHO

Household air pollution

In Ghana, household air pollution alone led to 20 988 premature deaths in 2016, and 60% of the estimated 7100 child deaths from acute lower respiratory infections in Ghana are attributable to household air pollution, mainly from cooking with polluting stoves paired with fuels like charcoal or firewood. In Greater Accra Metropolitan Area only 11% of households exclusively use clean cooking fuels and technologies. Urban Health Initiative's household energy analysis found over 1900 premature deaths avoided annually and a reduction of 35% in personal exposure under the most aggressive household energy policy scenario, which would promote a shift to cleaner fuels and technologies such as LPG, biogas or electricity as substitutes for wood and charcoal.

WHO

Waste management

Waste management has not kept pace with Accra’s surging population and the corresponding rise in waste generation; and the informal waste sector has grown rapidly because of low labour costs and weak enforcement of existing legislation. Waste burning is a major contributor of black carbon (BC) emissions – a significant short-lived climate pollutant. In 2020, 67 517 metric tonnes of BC were emitted, and this is projected to reach 133 561 metric tonnes in 2050 under the business-as-usual (BAU) scenario. 120 premature deaths can be prevented every year in Accra by stopping waste burning by 2030.

WHO

Sustainable land-use and green spaces

Sustainable land-use and green spaces can promote health in Greater Accra Metropolitan Area. The current availability of green spaces in Accra is highly limited and has only a small impact on health. Less than 20% of Accra’s population lives within 300 meters of a green space. Even modest increases of green spaces could result in annual prevented mortality cases, improve mental health and provide spaces for physical activity and active mobility. Green spaces can also mitigate environmental stressors such as air pollution, heat waves and noise.

WHO/Kobby Blay

Communications and outreach

Communications and outreach to policy-makers and the wider public are essential to mobilize and sustain support for policy solutions to air pollution and bring the needed health, environment and economic benefits. Awareness raising of community members on the health impacts of air pollution from polluting household fuels and technology, illegal dumping and waste burning is critical to inspire behaviour change and build political momentum for policy change in Accra. In Accra WHO-UHI outreach has been focused on health worker engagement, community schools, town hall meetings and community theatre, and outreach to informal sector workers.

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Monitoring framework and policy tracking mechanism

Urban Health Initiative in Accra has developed a policy monitoring framework and tracking mechanism to measure the impacts of policy changes and city initiatives on air pollution. The main areas of urban policies, and the main environmental risk factors for health are interconnected. Therefore, projects and Interventions aimed at improving urban health need policy tracking mechanisms. In Accra the Initiative has worked with different methods and practices (e.g. stakeholder engagements, indicators to monitor policies, media analysis and surveys) to provide an example that can be used in other African cities.

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