Air pollution and children's health in São Paulo (1986–1998)

doi:10.1016/S0277-9536(03)00068-6

Social Science & Medicine

Volume 57, Issue 11, December 2003, Pages 2013-2022

https://doi.org/10.1016/S0277-9536(03)00068-6 Get rights and content

Abstract

Air pollution in the conurbation of São Paulo, Brazil, with 17 million inhabitants, has been measured from air quality monitoring stations. In three contrasted sample areas, children's respiratory health parameters were collected to assess the role of air pollution in 1986. Twelve years later, in 1998, a similar study was undertaken to evaluate the impact of pollution control programs on the respiratory symptoms of children living in the same neighborhoods previously studied. Results indicated that pollution control programs were in part neutralized by increased number of cars and that the control of a single pollutant was not enough to protect children's health. In the area where both particulate matter and sulfur dioxide levels decreased, there was a reduction in the prevalence of respiratory symptoms.

Introduction

The metropolitan region of the city of São Paulo, in Brazil, comprises 39 municipalities and forms a continuous urban sprawl of 1051 km² with approximately 17 million inhabitants. It is the third most populous city in the world. In spite of the decrease in the annual growth rate in the last decades, São Paulo is responsible for 18% of the country's GDP, 11% of the Brazilian population, and 6 million jobs (Ribeiro & Assunção, 2001). More than 40,000 industries with pollution potential are located in the metropolitan region and 5.7 million vehicles (21% of the domestic fleet) are registered in the area. Of these, 3 million circulate daily and 1 million enter the city every day, including 350,000 trucks (CETESB, 2001). This situation is responsible for the delivery of large amounts of pollutants to the air.

The implementation of a strong air pollution control for fixed sources of particulate matter and sulfur dioxide since 1970s and a program of emission control for new vehicles established by federal law in 1986 had positive results on the air quality of the city as compared to previous decades (Assunção & Galvão Filho, 1999). Nevertheless, efforts have been in great part neutralized by larger numbers of cars on the streets.

Sulfur dioxide concentrations reduction was the most successful program over all the urban area and, nowadays, all 33 monitoring stations indicate that daily and yearly standards are being respected. Other pollutants concentrations, like particulate matter (total suspended particles, smoke and inhalable particles), carbon monoxide (CO), ozone (O₃), and nitrogen dioxide (NO₂) still surpass daily and yearly primary and secondary standards in some neighborhoods, during some occasions, mainly in wintertime (CETESB, 2001). During the winter, temperature inversions and lack of rainfall favor concentration of air pollutants above the city.

Since 1969, studies have been done in order to investigate health effects of air pollution in São Paulo metropolitan area. The pioneer ones found a correlation between acute episodes of air pollution and children morbidity by respiratory infection, chronic bronchitis, and asthma (Ribeiro, 1971; Wandalsen, Althertum, & Agostinho, 1975; Ribeiro et al., 1976; Mendes & Wakamatsu, 1976). In 1986, this author (Ribeiro Sobral, 1989) conducted a geographic analysis to evaluate long-term effects of air pollution on children's respiratory health.¹

The research conducted by Ribeiro Sobral, in 1986, consisted of mapping air pollution by SO₂ and by dust particles using the average of 11 years’ records for the metropolitan area of São Paulo, based on data collected by 39 monitoring stations managed by the Environment Bureau (CETESB). The mapping of carbon monoxide (CO) and photochemical pollutants was not possible because their levels were registered by only a few monitoring stations. The second step of that research was to select three areas for study; one with very low pollution level, Juquitiba, to be used as control area; one with a medium pollution level, Osasco, just lower the CETESB Air Quality Standard; and one with very high pollution all the year, Tatuapé (Ribeiro Sobral, 1989, p. 959). A survey was conducted in these areas and the results indicated a correlation between air pollution levels, due to sulfur dioxide and particulate matter, and respiratory symptoms in children from 11 to 13 years of age. In the last decade the Environment Bureau put in place several air pollution control programs. The main objective of the study presented in this paper was to evaluate, 12 years later, these programs’ impact on the pollution levels and on the respiratory symptoms of children belonging to the same age group living in the same neighborhoods.

Section snippets

Air pollution and respiratory diseases

The main adverse effects of atmospheric pollutants are: ophthalmic problems, skin injuries, gastro-intestinal, cardio-vascular and respiratory diseases, and some types of cancer. Effects on the nervous system have also been associated with high levels of carbon monoxide in the air. Indirect health effects may be related to climatic changes caused by air pollution. An increase in air temperature has impacts on the distribution of fauna and flora, thus affecting the space distribution of some

Methodology

The methodology used in the present study replicated that of the 1986 study. In the earlier research, after mapping sulfur dioxide and particulate air pollution in the metropolitan region of São Paulo, three areas were chosen: one with very high air pollution levels (Tatuapé), one with intermediate levels (Osasco), and one with low levels (Juquitiba). These areas were chosen based on the analysis of the average values of SO₂ and particulate matter obtained from 39 monitoring stations of the

Air quality

Air quality conditions for the 1973–1984 and 1984–1998 periods were compared in the areas chosen. As mentioned above, no data was available for Juquitiba in the second period. The main trends observed were:

•
Sulfur dioxide concentration decreased in both areas as a result of the industrial pollution control adopted in 1982, of new and lower standards of maximum sulfur levels in fuel oil, and of the substitution of fuel oil by natural gas. In Osasco, concentrations decreased from 79 μg/m³ in the

Results: prevalence of respiratory symptoms in 1986 and 1998

The first study, conducted in 1986, indicated that symptoms of respiratory disease tended to increase in areas with higher pollution levels (Table 1). In 1986, of the 27 symptoms listed, Tatuapé, the most polluted area, showed a higher prevalence in 18 (66.6%) of them. Osasco showed a higher prevalence in seven symptoms (25.9%) and Juquitiba, the control area, in only two symptoms (7.4%). The difference in prevalence was larger for the symptoms indicating worst health conditions, like cough

Social conditions and possible confounding factors

In the previous study, it was seen that poor housing conditions reinforced ill-health effects in the more polluted area. Thus, a comparison on housing conditions of children studied in the two periods was undertaken using as indicator the percentage of children who lived in houses with more than 1 person per room². Table 3 indicates that there was an

Conclusions

These data, when analyzed from the standpoint of the evolution of air quality in the metropolitan region of São Paulo, illustrate the influence of air pollution as an etiological factor in the development of respiratory diseases in children. The data reinforce the need for pollution control programs and also indicate that the control of a single pollutant is not enough to protect children's health. Control measures included lower standards of maximum sulfur levels in fuel oil, substitution of

Acknowledgements

CNPq-Conselho Nacional de Desenvolvimento Cientı́fico e Tecnológico for funding this research. Schools and schoolchildren who participated in this research.

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