A Study on the Effect of Applying Different Measures on the Number of Health Impact

Cases in Quezon, Makati and Taguig City Using the Roll-back and Box Models

R.A. Benavidez1, P.M. Encarnacion1

1
Environmental Science Department, Ateneo de Manila University

27 March 2011

Submitted to Gemma T. Narisma, Ph.D.

Abstract

Respiratory diseases are mostly due to the PM10 component of air pollution. Vehicular
emissions are the main source of PM10. The Roll back and Box models were used to determine
the change in health impacts cases in Quezon, Makati and Taguig cities according to a change in
the following: number of vehicles (reduce by half), population (increase the number through
trends) and mortality rates (increasing the value through trends). The baseline situation is when
the number of vehicles is reduced. Comparing the baseline situation to the second situation
(reduced number of vehicles and increased population), there is an observed decrease in the
number mortality cases, adult restricted activity days and asthma exacerbation cases. Comparing
the baseline situation to the third situation (reduced number of vehicles and increased mortality
rates), there is a decrease in the number of mortality cases due to cutting back of vehicles and
emissions.

Keywords: air quality, health impacts, emissions, population, mortality cases

 I. Introduction

Air pollution has been present in the world ever since man was able to discover fire
(Brimblecombe, 1987 as cited in Harrop, 2002). Air pollution is therefore defined as “the
presence in the external atmosphere of one or more contaminants (pollutants), or combinations
thereof, in such quantities and of such duration as may be or may cause injury to human health,
plant or animal life, or property (materials), or which unreasonably interfere with the
comfortable enjoyment of life, or property of the conduct of business” (Canter, 1996 as cited in
Harrop, 2002). Examples of pollutants include carbon monoxide, carbon dioxide, lead, ozone,
nitrogen dioxide and particulates.

These pollutants, specifically particulate matter (PM), contribute greatly to respiratory

illnesses in both the young and the elderly. The illnesses can be classified into two: chronic and
acute. Chronic diseases are those that progress slowly throughout a person’s lifetime and are
recurrent (World Health Organization, 2011). Asthma is an example of this. Asthma is an
inflammatory lung disease caused by an obstruction in the airway. Some symptoms include
coughing, wheezing and difficulty in breathing (“Asthma Symptoms”). Chronic Obstructive
Pulmonary Disease is another example.

Acute diseases on the other hand are those that appear suddenly and its symptoms have a
short duration (Stedman’s Medical Dictionary for the Health Professions and Nursing). The
inflammation of the bronchial tubes’ mucous membrane, otherwise known as bronchitis, can
either be chronic or acute (Stedman’s Medical Dictionary for the Health Professions and
Nursing). Bronchitis may be hard to distinguish from a common cold. The development of a sore
throat, runny nose, aching muscles, dry cough evolving to cough with mucus, among others
should help identify the onset of bronchitis (“Bronchitis Symptoms”)

From here, it is clear that air quality or dispersion modelling must be utilized. These
models aim to calculate the impacts of pollution. The results taken from these models serve as
scientific basis for the new guidelines and policies that the government will draft. The first
models were made during the 1960s when there was an increase in greenhouse gas
concentrations, acid deposition, among others (“Air Quality Modelling”). Some examples of air
quality models are SIM-Air, which tries to simulate the interactions of different parameters such
as emissions, sources and management. The Air Quality Index (AQI) Calculator determines the
air quality classification of a particular area by the concentrations of the six primary causes of air
pollution.

The model used in the paper is an AQ model that relates the change of emissions to the
change in the number of health cases. There are three essential components of the model: the
dose-response coefficient (), the baseline population (Ho) and change in pollution concentration
(A).

The dose-response coefficient () shows the relationship between a specific health impact
and pollution. As defined in AQ Book, “The dose is the amount of pollution that is inhaled by
the population, and the response is the number of the population that will develop the health
effect.” It is computed by using this formula:

These values may be acquired through a series of epidemiological studies although there are

values already set by UN Habitat Toolkit, World Bank and Cleaning the Air.

Figure 1. Table of D-R coefficients for low, moderate and high responses (AQ Book)
 Mortality is the ratio of the number of deaths in a population to the number of people at
risk of dying within a specific time period (Washington State Department of Health). Respiratory
symptoms, chronic and acute bronchitis and asthma have been defined in the other paragraphs.

The baseline population (Ho) is the number of cases per health effect prior to the
application of control measures (AQ Book). It is just the fraction of the population, the number
of people who inhabit a particular area (The Merriam Webster Dictionary). The population
should be taken from areas with similar atmospheric conditions to reduce any discrepancies in
computation (i.e. there is less air pollution in the provinces compared to the city). The baseline
population can be acquired by assessing the spatial region, then dividing the population by age
group after determining the overall population and lastly determining the incidence rates of the
different health impacts since not everyone is affected by the air pollution. A summary of
incidence rates is listed in the table below

Figure 2. Table of baseline population (AQ Book).

The change in pollution concentrations (A) is the number of avoided cases when new
measures are applied. The roll back model, box model and SIM-air results may be used to
determine these values.
 In roll back modelling, it assumes that the air quality of an area is directly related to the
concentration of air pollutants of the same area. The formula used to compute for this is

where k is some factor that can be used to compute for DA of any area. The average value range
of this is 4000-6000 ug/m3/(ton/day/km2).

In box modelling, the basic assumption is that the concentration is dispersed evenly
within an enclosed space like a box. The box would have a volume equivalent to the region’s
area times mixing height. The area is the extent of the region occupied by the population. The
mixing layer height is the level in the atmosphere where there is mixing of hot air as it rises then
drops as it cools.

It also requires the amount of emissions in the atmosphere at a given time (Q). The
wind speed, which has an average value of 2 m/s, and the distance it can cover over the city
(usually the square root of the area), and the amount of emissions can be used for this.

The
 When only one health effect and area is considered, the equation above can be simplified
and intake fractions can be used instead. According to AQ book, an intake fraction is a “fraction
of emissions being released that are ingested by the population”. In the final equation to be used,
the population and emission concentration are irrelevant because these are already taken into
consideration.

This paper aims to determine the change in the number

of health cases in Quezon City, Makati City and Taguig City of three scenarios:

a. Based on the researchers’ previous case study: vehicular emissions are reduced by
half

b. Based on population projections in the year 2020

c. Based on changing mortality rates.

II. Methodology

First, data from the previous project had to be retrieved into order to
be used for this project. This data came from SIM-Air, which gave the
emissions of PM10 in terms of tons per year for each of the grid boxes.
However, since this study needed to be done for three cities, we picked
Quezon City, Makati City and Taguig City. Using weighted averages, the
emissions of PM10 (tons/year) for each city could be computed, and once
divided by 365 days, the emissions of PM10 in tons per day was computed.
Figure 3. A map
of Metro Manila
The model also assumes that there was some kind of control as used in SIM-
measure imposed to change the amount of emissions. The control measure Air.
that we used in the previous project was removing half of the public
transportation vehicles (taxis and buses) and the trucks.

City Before (tons/day) After (tons/day) Change (tons/day)

Quezon City 37.54 32.91 - 4.63
 Makati City 58.96 49.97 - 8.99
Taguig City 50.18 44.28 - 5.90
Table 1. A table of the change in emissions in the three cities according to the previous
SIM-Air study
Next, the following factors had to be known for each of the cities:
 Area of region (km2)
o This was obtained from literature.
 Total Population
o This was obtained from the National Statistics Office.
 Adult Population (over 18)
o The NSO did a survey of the entire Metro Manila, and it was found that the
percentage of people aged 15 to 64 was 65.2% and the percentage of people over
65 was 2.9%.
o In order to calculate the adult population, the percentage of people aged 15 to 64
and the percentage of people over 65 was added together to give 68.1%. This
percentage was then taken from the total population to give the adult population.
 Adult Population (over 25)
o It was assumed at the 65.2% portion that was given to the 15 to 64 age group was
divided equally among the 49 ages in that age group. 65.2% divided by 49 would
give the percentage for one age group, and then multiplied by 39 would give the
percentage of people above 25.
o This percentage was then added to the percentage of people over 65 and then
taken from the total population to give the adult population over 25.
 Mortality Rate, base case
o According to the NSO, the mortality rate for Metro Manila is 5.1 per 1000 deaths
or 0.0051. This was used for all the three cities.
 Asthmatic Population
o According to a study done by students from the ASMPH, the Philippines has
approximately 5.5 million asthma sufferers. Given that the total population of the
Philippines is 88,566,732, it means that about 6.21% of people suffer from asthma
and this was the percentage used to get the number of asthmatics for the model.
Several kinds of health effects needed to be examined, and each of these health effects will affect
a different part of the population therefore, a baseline case (H0) was calculated.

For the dose-response (ß) part of the model, the Medium Response was chosen. The
change in concentration (ΔA) was calculated through two ways: the rollback model and the box
model.

 Rollback model:
o A k of approximately 4000 to 6000 μg/m3/ton/day/km2 was used for this
calculation. The ΔA was calculated through the following formula:
 ΔA(μg/m3) = (k * ΔQ (tons/day)) / Area (km2))
 Box model:
o A mixing height of approximately 0.5km to 2.5km was used and the wind speed
was assumed to be 1m/s. The ΔA was calculated through the following formula:
 ΔA(μg/m3) = (ΔQ) * (1/(Area (km2) * Height (km)) * (1km/1000m)3 *
(106μg/1g)
Lastly, for the change in cases (ΔA), the formula is as follows:

 ΔH = ΔA * H0 * ß
Therefore, the final data that was input into the model is as follows:

Variable Quezon City Makati City Taguig

Area (km2) 166.20 27.36 47.88
Vehicle emissions 37.54 58.96 50.18
before measures
(tons/day)
Vehicle emissions 32.91 49.97 44.28
after measures
(tons/day)
Change in emissions - 4.63 - 8.99 -5.90
due to control
measures (ΔQ in
tons/day)
Total population 2,679,450 510,383 613,343
Adult population 1,824,705 347,571 417,687
(over 18)
Adult population 1,468,071 279,639 336,051
(over 25)
 Mortality Rate, base 0.0051
case
Asthmatic 166,394 31,695 38.089
population
Table 2. A table stating the number of health cases for the three cities.

There were three scenarios that were carried out using this dataset:
 Scenario 1: ΔH from change in SIM-Air only
o This scenario uses the data above, and assumes that the measure is that the
number of public transportation vehicles and trucks was halved.
 Scenario 2: ΔH given an increase in population
o For this scenario, only the population was changed. Using historical data, the
population was projected to sometime in the future to simulate an increase in
exposure.
 Scenario 3: ΔH given a change in the mortality rate
o This scenario uses the data above (no projections), but the mortality rate was
changed in order to simulate either an improvement or a degradation of the
medical care in each city.

III. Results

Scenario 1: Change in cases based on the measures in SIM-Air

According to the model, the changes in the cases were all negative. This basically means that for
all the cases, given the change that was imposed, the number of cases will decrease.

Quezon City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -5,139 -184
Respiratory Hospital Admission -4,479 -160
Emergency Room Visits -87,707 -3,141
Adult Restricted Activity Days -14,487,301 -518,801
Respiratory Symptoms -67,179,712 -2,405,754
Chronic Bronchitis -12,515 -448
Acute Bronchitis in Children -190,492 -6,822
Asthma Exacerbation -1,367,444 -48,969
Table 4. A table of the change in number of cases of each health effect using the roll back
and box method for Quezon City in Scenario 1

Makati City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -11,546 -168
Respiratory Hospital Admission -10,062 -146
Emergency Room Visits -197,051 -2,863
Adult Restricted Activity Days -32,548,576 -472,920
Respiratory Symptoms -150,932,341 -2,192,996
Chronic Bronchitis -28,117 -409
Acute Bronchitis in Children -427,977 -6,218
Asthma Exacerbation -3,072,249 -44,639
Table 4. A table of the change in number of cases of each health effect using the roll back
and box method for Makati City in Scenario 1

Taguig City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -5,204 -100
Respiratory Hospital Admission -4,535 -87
Emergency Room Visits -88,805 -1,707
Adult Restricted Activity Days -14,668,770 -281,948
Respiratory Symptoms -68,021,122 -1,307,430
Chronic Bronchitis -12,671 -244
Acute Bronchitis in Children -192,877 -3,707
Asthma Exacerbation -1,384,584 -26,613
Table 5. A table of the change in number of cases of each health effect using the roll back
and box method for Taguig City in Scenario 1

It can be seen from all these that the number of cases will definitely decrease if the control
measures are implemented. The results for the Makati City and Taguig City are particularly
interesting because the number of deaths can decrease by approximately 11,000. Meanwhile the
number of respiratory symptom cases can decrease by the millions if the measures are imposed.

Scenario 2: Change in health cases based on population projections

This scenario is meant to simulate what would happen if the number of people living in each city
would increase. To do this, historical data was first collected from the National Statistics Office:

Quezon City Makati City Taguig City

2000 2,173,831 2000 471,379 2000 467,375
2004 2,413,221 2004 501,999 2004 550,135
2007 2,679,450 2007 567,349 2007 613,343
Table 6. A table of the populations during the years 2000, 2004 and 2007 for the three
cities.

Given this data, the annual growth rates for each city were then found to be 3.67% for
Quezon City, 3.25% for Makati City, and 4.87% for Taguig City. Using these, the population for
each city was projected to 2020.
Quezon City Makati City Taguig City
2020 4,283,097 2020 903,217 2020 991,701
Table 7. A table of the predicted populations of the three cities in the year 2020

This data was then used to calculate the other inputs that were dependent on total population.
The change in emissions from the control measures was still held constant, as well as the
mortality rate. The Input Data can be seen in the appendix.
Quezon City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -8,215 -294
Respiratory Hospital Admission -7,159 -256
Emergency Room Visits -140,199 -5,021
Adult Restricted Activity Days -23,157,936 -829,302
Respiratory Symptoms -107,386,674 -3,845,594
Chronic Bronchitis -20,005 -716
Acute Bronchitis in Children -304,501 -10,904
Asthma Exacerbation -2,185,856 -78,277
Table 8. A table of the change in number of cases of each health effect using the roll back
and box method for Quezon City in scenario 2

Makati City:
 Health Effect ΔH (Rollback) ΔH (Box)
Mortality -20,433 -297
Respiratory Hospital Admission -17,807 -259
Emergency Room Visits -348,717 -5,067
Adult Restricted Activity Days -57,600,688 -836,919
Respiratory Symptoms -267,102,659 -3,880,912
Chronic Bronchitis -49,757 -723
Acute Bronchitis in Children -757,384 -11,005
Asthma Exacerbation -5,436,875 -78,996
Table 9. A table of the change in number of cases of each health effect using the roll back
and box method for Makati City in scenario 2

Taguig City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -8,414 -162
Respiratory Hospital Admission -7,332 -141
Emergency Room Visits -143,587 -2,760
Adult Restricted Activity Days -23,717,592 -455,874
Respiratory Symptoms -109,981,878 -2,113,955
Chronic Bronchitis -20,488 -394
Acute Bronchitis in Children -311,860 -5,994
Asthma Exacerbation -2,238,681 -43,030
Table 10. A table of the change in number of cases of each health effect using the roll back
and box method for Taguig City in scenario 2

It can be seen that the change is still negative, and that the change in cases will increase if the
population increases.

Scenario 3: Change in health cases based on changing mortality rates

According to the NSO, the mortality rate for 2015 to 2020 is projected to be approximately 5.45
per 1000 deaths. This means that the projected mortality rate is approximately 0.00545. Once
this new value was input into the models, the change in cases was still seen to be negative. Since
mortality rate will only affect mortality, only those results will be reported.

Quezon City:
 Health Effect ΔH (Rollback) ΔH (Box)
Mortality -5,492 -197
Table 11. A table of the change in number of cases of mortality using the roll back and box
method for Quezon City in scenario 3

Makati City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -12,339 -179
Table 12. A table of the change in number of cases of mortality using the roll back and box
method for Makati City in scenario 3

Taguig City:

Health Effect ΔH (Rollback) ΔH (Box)

Mortality -5,561 -107
Table 13. A table of the change in number of cases of mortality using the roll back and box
method for Taguig City in scenario 3

Comparisons:

Scenario 1 against Scenario 2

It was chosen to compare Scenario 1 against Scenario 2 because Scenario 1 is the baseline, and
Scenario 2 uses the same data as Scenario 1 except for the increase in population. Out of the
health effects, only three will be compared:

 Mortality: This health effect is particularly important because it deals with the actual
deaths of the person.
 Adult Restricted Activity Days: This health effect is important because it deals with the
days that the adults will have to stay home from work, thus not earning as much income.
 Asthma Exacerbation: Asthma is a problem due to air pollution, and this health effect
should be looked at because of that.
Mortality:

  Rollback Box
 City S1 S2 S1 S2
QC -5,139 -8,215 -184 -294
Makati -11,546 -20,433 -168 -297
Taguig -5,204 -8,414 -100 -162
Table 14. A table comparing the change in mortality cases when there is a population
increase for the 3 cities using the roll back and box models

Change in Mortality Cases (Rollback) Change in Mortality Cases (Box)

0 0
QC Makati Taguig QC Makati Taguig
-50
-5,000
Change in Cases

Change in Cases
-100
-10,000 -150
S1 S1
S2 -200 S2
-15,000
-250
-20,000
-300

-25,000 -350
Cities Cities

Figure 4 and 5. Graphs showing the comparison between the number of cases of mortality
in the three cities using the rollback model (figure 4) and box model (figure 5) given an
increase in population

Using the rollback model, it can be seen that the change in mortality cases will be larger if the
population increases. This means that given a higher population, cutting back the vehicles that
cause pollution will mean more lives can be saved. The result is the same for the box model.
Given a higher population, cutting back the vehicles that cause pollution will mean more lives
can be saved.

Adult Restricted Activity Days:

  Rollback Box
City S1 S2 S1 S2
QC -14,487,301 -23,157,936 -518,801 -829,302
Makati -32,548,576 -57,600,688 -472,920 -836,919
Taguig -14,668,770 -23,717,592 -281,948 -455,874

Table 15. A table comparing the change in adult restricted activity days when there is a
population increase for the 3 cities using the roll back and box models
 Change in Adult Restricted Activity Days Cases Change in Adult Restricted Activity Days Cases

0 0
QC Makati Taguig -100,000 QC Makati Taguig
-10,000,000
-200,000
Change in Cases

Change in Cases
-20,000,000
-300,000
-30,000,000 S1 -400,000 S1
-40,000,000 S2 -500,000 S2
-600,000
-50,000,000
-700,000
-60,000,000 -800,000
-70,000,000 -900,000
Cities Cities

Figure 6 and 7. Graphs showing the comparison between the change in the number of adult
restricted activity days in the three cities using the rollback model (figure 6) and box model
(figure 7) given an increase in population
Using both models, it can be seen that given a higher population, the change in cases for adult
restricted activity days will be higher. The number of cases will decrease more dramatically if
the control measures are imposed.

Asthma Exacerbation:

  Rollback Box
City S1 S2 S1 S2
QC -1,367,444 -2,185,856 -48,969 -78,277
Makati -3,072,249 -5,436,875 -44,639 -78,996
Taguig -1,384,584 -2,238,681 -26,613 -43,030
Table 16. A table comparing the change in asthma exacerbation cases when there is a
population increase for the 3 cities using the roll back and box models

Change in Asthma Exacerbation Cases (Rollback) Change in Asthma Exacerbation Cases (Box)

0 0
QC Makati Taguig -10,000 QC Makati Taguig
-1,000,000
-20,000
Change in Cases
Change in Cases

-2,000,000 -30,000
S1 -40,000 S1
-3,000,000
S2 -50,000 S2
-4,000,000 -60,000
-70,000
-5,000,000
-80,000
-6,000,000 -90,000
Cities Cities

Figure 8 and 9. Graphs showing the comparison between the change in the number of cases
of asthma exacerbation in the three cities using the rollback model (figure 8) and box
model (figure 9) given an increase in population
Using both models, it can be seen that given a higher population, the change in cases for asthma
exacerbation will be higher. The number of cases will decrease more dramatically if the control
measures are imposed.

Scenario 1 against Scenario 3

It was chosen to compare Scenario 1 against Scenario 3 because Scenario 1 is the baseline, and
Scenario 3 uses the same data as Scenario 1 except for an increase in the death rate.

  Rollback Box
City S1 S3 S1 S3
QC -5,139 -5,492 -184 -197
Makati -11,546 -12,339 -168 -179
Taguig -5,204 -5,561 -100 -107
Table 17. A table comparing the change in mortality cases when there is also a mortality
rate increase for the 3 cities using the roll back and box models

Change in Mortality Cases (Rollback) Change in Mortality Cases (Box)

0 0
QC Makati Taguig QC Makati Taguig
-2,000
-50
Change in cases

Change in cases

-4,000

-6,000 -100
S1 S1
-8,000 S3 S3
-150
-10,000
-200
-12,000

-14,000 -250
Cities Cities

Figure 10 and 11. Graphs showing the comparison between the change in the number of
cases of mortality cases in the three cities using the rollback model (figure 10) and box
model (figure 11) given a change in mortality

Using the rollback model, it can be seen that the change in mortality cases will be larger
if the mortality rate is higher. This means that given a higher mortality rate, cutting back the
vehicles that cause pollution will mean more lives can be saved. The result is the same for the
box model. Given a higher mortality rate, cutting back the vehicles that cause pollution will
mean more lives can be saved.
 IV. Conclusion

Compared to cutting back in vehicular emissions alone, an increase in population as well

would save a greater number of lives. The number of cases of adult restricted activity days and
asthma exacerbation also decreased.

Compared to cutting back in vehicular emissions alone, an increase in mortality cases as

well would entail a greater number of saved lives. This is because the vehicles and emissions
decreased.

All of these are applicable to the three cities (Quezon, Makati and Taguig Cities) and in
both models (roll back and box).

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<http://www.quezoncity.gov.ph/index.php?
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