Haze and Health
Ahmad Filza Ismail, MD
Community Medicine Department
School of Medical Sciences
13 Jan 2016
Outline
Introduction
Haze and outdoor air quality
Impact haze on health
Factors influence the impact
(Disaster) Management Cycle
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Prevention
Preparedness
Response
Recovery
• Researches
www.greatermalaysia.com
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Introduction
• What is fog?
Vapor condensed to fine particles of water suspended in the
lower atmosphere
• What is smoke?
The gaseous products of burning materials especially of
organic origin made visible by the presence of small particles of
carbon
• What is smog?
A photochemical haze caused by the action of solar ultraviolet
radiation on atmosphere polluted with hydrocarbons and oxides
of nitrogen
– Smoke + Fog
• What is haze?
Atmospheric moisture, dust, smoke, and vapor that diminishes
visibility
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www.thefreedictionary.com
• Haze is traditionally an atmospheric phenomenon where dust,
smoke and other dry particles obscure the clarity of the sky
• The haze events were classified as biomass burning,
complicated and secondary pollutions
• Main constituents of haze:
1. The high concentrations of PM10 due to the intrusion of
particles arising from forest fire
2. The high concentrations of NO3− and SO42−  acidic rain
3. The high concentration of Fe due to land clearing activities
and exposed soil
Norela, S., Saidah, M.S. and Mahmud, M., (2013). Chemical composition of the haze in Malaysia
2005. Atmospheric Environment, 77, 1005-1010.
Du, H., Kong, L., Cheng, T., Chen, J., Du, J., Li, L., Xia, X., Leng, C. and Huang, G., (2011). Insights into
summertime haze pollution events over Shanghai based on online water-soluble ionic composition
of aerosols. Atmospheric Environment, 45(29), 5131-5137
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Haze and Outdoor Air Quality
Air Quality Index or Air Pollutant Index
API system includes 5 major air pollutants which could
cause potential harm to human health should they reach
unhealthy levels.
The air pollutants included in Malaysia's API:
1. Ozone (O3),
2. Carbon monoxide (CO)
3. Nitrogen dioxide (NO2)
4. Sulphur dioxide (SO2)
5. Particulate matter with a diameter of less than 10
micron (PM10).
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DOE, 1997
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DOE, 1997
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DOE, 1997
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DOE, 1997
What is health?
http://www.csum.edu/
• Health is a state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity
www.who.int/about/definition/en/print.html
World Health Organization
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Impact of Haze on Health
Short term effects
• Respiratory symptoms
• Irritation of the eyes, nose, and throat
• Irritation of the skin
Long term effects
• Contributed to a higher risk of:
http://asthma.bsd.uchicago.edu/
– Shortness of breath, wheezing
– cardiovascular effects
– reduced lung development
– the development of chronic respiratory diseases, such as asthma,
in children
MOH, 2007
Psychological effects?
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https://www.studyblue.com/notes/note/n/phlt-150-study-guide-2013-14-barcellos/deck/11182105
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Factors Influence the Impact
• Host
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Age (too old and too young)
Pre-existing health problem / co-morbid condition
Immunocompromised individual
Occupation / Activities involved
Knowledge, attitude and practice
Route of transmission
Smoking / Vaping
http://www.aqhi.gov.hk/en/health-advice/health-effects-of-air-pollutants6193.html
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• Environment
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Location
Time of exposure / Type of exposure
Temperature
Humidity
Home design
Pressure
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• Agent / Substance
– The chemicals / particles involved
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Ozone (O3),
Carbon monoxide (CO)
Nitrogen dioxide (NO2)
Sulphur dioxide (SO2)
Particulate matter with a diameter of less than 10 micron (PM10)
Others
– Concentration
– Chemical and physical properties
– Toxic level
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Prevention
• The measures taken to eliminate the root causes that
make people vulnerable to disaster
• Prevention planning is based on two issues:
1.hazard identification (identifying the actual threats
facing a community)
2.vulnerability assessment (evaluating the risk and
capacity of a community to handle the consequences
of the disaster)
http://www.cartercenter.org/resources/
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Mitigation
• Referred to reduction of the risk of a disaster
• Primary mitigation refers to reducing the resistance of
the hazard and reducing vulnerability
• Secondary mitigation refers to reducing the effects of
the hazard (preparedness).
• Mitigation includes recognizing that disasters will
occur; attempts are made to reduce the harmful effects
of a disaster, and to limit their impact on human
suffering and economic assets
• In haze?
http://www.cartercenter.org/resources/
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Hierarchy in Prevention and Control
http://www.e-hazard.com/blog/hierarchy-of-controls-approach-to-workplace-hazards/
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Preparedness
• Disaster preparedness refers to measures taken to
prepare for and reduce the effects of disasters. That is,
to predict and, where possible, prevent disasters,
mitigate their impact on vulnerable populations, and
respond to and effectively cope with their
consequences
• Example: The children, the elderly, those with existing
lung and heart diseases, advice, stock of face mask,
evacuation plan
http://www.ifrc.org/en/
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Response
• The primary aims of disaster response are rescue from
immediate danger and stabilization of the physical and
emotional condition of survivors
• Example: face mask distribution, evacuation, treatment
of patients
http://www.ifrc.org/en/
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Recovery
• Recovery refers to those programmes which go
beyond the provision of immediate relief to assist
those who have suffered the full impact of a disaster to
rebuild their homes, lives and services and to
strengthen their capacity to cope with future disasters
• Example: lung rehabilitation, redesign the home,
educate the public
http://www.ifrc.org/en/
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Researches
• Abas, M.R.B., Rahman, N.A., Omar, N.Y.M., Maah, M.J., Samah,
A.A., Oros, D.R., Otto, A. and Simoneit, B.R., (2004). Organic
composition of aerosol particulate matter during a haze episode in
Kuala Lumpur, Malaysia. Atmospheric Environment, 38(25), 42234241
• Highlights
– Samples were collected by high-volume air filtration during the haze episode
of 1997 around the University of Malaya campus near Petaling Jaya
– These results show that the samples contain n-alkanes, n-alkan-2-ones, nalkanols, methyl n-alkanoates, n-alkyl nitriles, n-alkanals, n-alkanoic acids,
levoglucosan, PAHs, and UCM as the dominant components, with minor
amounts of terpenoids, glyceryl esters and sterols, all derived from natural
biogenic sources (vascular plant wax), from burning of biomass, and from
anthropogenic utilization of fossil fuel products (lubricating oil, vehicle
emissions, etc.).
– The results interpreted in terms of major sources are due to local build-up of
organic contaminants from vehicular emissions, smoke from biomass
burning, and natural background as a result of the atmospheric stability
during the haze episodes
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• Omar, N.Y.M., Mon, T.C., Rahman, N.A. and Abas, M.R.B.,
(2006). Distributions and health risks of polycyclic aromatic
hydrocarbons (PAHs) in atmospheric aerosols of Kuala
Lumpur, Malaysia. Science of the total
environment, 369(1), 76-81
• Highlights
– Ambient and street level distributions of PAHs were similar and
their occurrence was attributed to vehicular emissions.
– However, in haze particles, a different pattern of PAHs was
observed, characterized by relatively low levels of benzo[a]pyrene
(BaP) and high levels of benzofluoranthenes (BFs).
– The BaP equivalency results showed that the potential health risk
associated with haze smoke particles was 4 times higher than that
of street level particles whereas the lowest health risk was
associated with ambient atmospheric particles.
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• Awang, M.B., Jaafar, A.B., Abdullah, A.M., Ismail, M.B., Hassan,
M.N., Abdullah, R., Johan, S. and Noor, H., (2000). Air quality in
Malaysia: impacts, management issues and future
challenges. Respirology, 5(2), 183-196
• Highlights:
– Observations on major air pollutants in Malaysia including nitrogen
dioxide, carbon monoxide, the ozone and total suspended particulate
matter (particularly PM10), and sulfur dioxide, emitted from industrial and
urban areas from early 1970s until late 1998.
– Total suspended particulate matter was the main pollutant
– Since 1980, six major haze episodes were officially reported in Malaysia:
April 1983, August 1990, June 1991, October 1991, August to October
1994, and July to October 1997.
– Studies have shown that should no effective countermeasures be
introduced, the emissions of sulfur dioxide, nitrogen oxides, particulate
matter, hydrocarbons and carbon monoxide in the year 2005 would
increase by 1.4, 2.12, 1.47 and 2.27 times, respectively, from the 1992
levels
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• Sahani, M., Zainon, N.A., Mahiyuddin, W.R.W., Latif, M.T., Hod,
R., Khan, M.F., Tahir, N.M. and Chan, C.C., (2014). A casecrossover analysis of forest fire haze events and mortality in
Malaysia. Atmospheric Environment, 96, 257-265
• Highlights:
– We modelled association of haze events and daily mortality using a casecrossover study design.
– Days with daily PM10 > 100 μg/m3 were defined as haze events.
– Haze events were significantly associated with natural and respiratory
mortality at various lags.
– Immediate effects of haze were particularly seen among males.
– Children and adult females mortalities were associated with delayed
effects.
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• Forsyth, T., (2014). Public concerns about
transboundary haze: a comparison of Indonesia,
Singapore, and Malaysia. Global Environmental
Change, 25, 76-86
• Highlights
– The paper analyzes public concerns about haze in Indonesia,
Singapore and Malaysia
– It compares crises in 1997, 2005, and 2013, using newspaper
content analysis
– Public debate is increasingly critical of Indonesia and palm oil
companies
– The Association of South East Asian Nations (ASEAN) treaty on
haze is criticized
– Public criticism is becoming more overt despite media controls
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• Othman, J., Sahani, M., Mahmud, M. and Ahmad, M.K.S.,
(2014). Transboundary smoke haze pollution in Malaysia:
inpatient health impacts and economic
valuation. Environmental Pollution, 189, 194-201
• Highlights
– Transboundary smoke haze is an annual phenomenon in
Malaysia.
– No evidence of seasonal factors in smoke haze related inpatient
cases.
– Inpatient rates during a haze event increased by 31% relative to
normal days.
– Annual economic loss due to inpatient health impact of haze
valued at $91,000.
– Present value of economic loss estimated at $1.1 million to $1.7
million.
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• Aditama, T.Y., 2000. Impact of haze from forest fire to
respiratory health: Indonesian experience.
Respirology, 5(2), 169-174
• Highlights:
– There was a significant impact of haze to the human lung.
– There was a significant increase in respiratory conditions,
lung function complaints and other related impacts.
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• Emmanuel, S.C., (2000). Impact to lung health of haze from
forest fires: the Singapore experience. Respirology. 5(2). 175182
• Highlights:
- There was a 30% increase in outpatient attendance for haze-related
conditions.
- An increase in PM10 levels from 50 μg/m3 to 150 μg/m3 was significantly
associated with increases of 12% of upper respiratory tract illness, 19%
asthma and 26% rhinitis.
- Supplementary findings from scanning the electron microscopic sizing of
the haze particles showed that 94% of the particles in the haze were
below 2.5 μm in diameter. This was consistent with emissions from
combustion sources originating over 500 km from Singapore.
- During the same period, there was also an increase in accident and
emergency attendance for haze-related conditions.
- There was no significant increase in hospital admissions or in mortality.
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Summary
• The main concern is haze from anthropogenic
activities
• The main pollutant is PM10
• The health impact is due to the several factors
• To minimize the impact, proper management is
important
• The phenomenon is expected to reoccur and the air
quality is worsening
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• Prof Dr Baharudin Abdullah
ENT Surgeon, Otorhinolaryngologist
• Assoc Prof Dr Nor Azwany Yaacob
Public Health Physician, Epidemiologist and Biostatistician
• Dr Mohd Zarawi Mohd Nor
Counselor, Medical Education
• Dr Nik Rosmawati Nik Husain
Public Health Physician, Environmental Health
• Dr Fahisham Taib
Paediatrician
• Dr Ahmad Filza Ismail
Public Health Physician, Environmental Health
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Thank You
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