Fighting ambient air pollution and its impact on health: from human rights to the right to a clean environment

Clean air is one of the basic requirements of human health and well-being. However, almost nine out of 10 individuals living in urban areas are affected by air pollution. Populations living in Africa, South-East Asia, and in low- and middle-income countries across all regions are the most exposed. Exposure to outdoor air pollution ranks as the ninth leading risk factor for mortality, killing 3.2 million people each year, especially young children, the elderly, persons with lung or cardiovascular disease, those who work or exercise outdoors and low-income populations. In October 2013, the International Agency for Research on Cancer (IARC) classified outdoor air pollution as carcinogenic to humans, calling air pollution 'a major environmental health problem'. Human rights and environmental norms are powerful tools to combat air pollution and its impact on health. The dependence of human rights on environmental quality has been recognised in international texts and by human rights treaty bodies. The growing awareness of the environment has already yielded considerable legislative and regulatory output. However, the implementation of standards remains a pervasive problem. In the fight against violations of norms, citizens have a crucial role to play. We discuss the relevance of a yet to be proclaimed standalone right to a healthy environment.

Does research through Structured Operational Research and Training (SORT IT) courses impact policy and practice?

SETTING

Structured Operational Research and Training Initiative (SORT IT) courses are well known for their output, with nearly 90% of participants completing the course and publishing in scientific journals.

OBJECTIVE

We assessed the impact of research papers on policy and practice that resulted from six SORT IT courses initiated between July 2012 and March 2013.

DESIGN

This was a cross-sectional study involving e-mail-based, self-administered questionnaires and telephone/skype/in-person responses from first and/or senior co-authors of course papers. A descriptive content analysis of the responses was performed and categorised into themes.

RESULTS

Of 72 participants, 63 (88%) completed the course. Course output included 81 submitted papers, of which 76 (94%) were published. Of the 81 papers assessed, 45 (55%) contributed to a change in policy and/or practice: 29 contributed to government policy/practice change (20 at national, 4 at subnational and 5 at hospital level), 11 to non-government organisational policy change and 5 to reinforcing existing policy. The changes ranged from modifications of monitoring and evaluation tools, to redrafting of national guidelines, to scaling up existing policies.

CONCLUSION

More than half of the SORT IT course papers contributed to a change in policy and/or practice. Future assessments should include more robust and independent verification of the reported change(s) with all stakeholders.

Research output after participants complete a Structured Operational Research and Training (SORT IT) course

Eighteen months after successfully completing one of six Structured Operational Research and Training Initiative (SORT IT) courses, e-mail questionnaires assessing post-course research output were returned by 63 participants (100% response rate). Thirty-two (51%) participants had completed new research projects, 24 (38%) had published papers, 28 (44%) had presented abstracts at conferences, 15 (24%) had facilitated at further OR courses, and 21 (33%) had reviewed scientific papers. Seven (11%) had secured further research funding and 22 (35%) stated that their institutions were involved in implementation or capacity building in operational research. Significant research output continues beyond course completion, further endorsing the value of the SORT IT model.

What happens after participants complete a Union-MSF structured operational research training course?

SETTING

Eight operational research (OR) courses run by the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) for participants from low- and middle-income countries. There is a knowledge gap about whether participants continue OR after course completion.

OBJECTIVES

To determine 1) the research output of participants and their institutions after course completion; 2) the influence of OR fellowships on output; and 3) the output of non-OR fellows stratified by sex, region and staff position.

DESIGN

A self-administered e-mail questionnaire survey.

RESULTS

Of 83 participants who completed a course, 76 (92%) responded to the questionnaire. Following course completion, 47 (62%) participants completed new research projects, 38 (50%) published papers (vs. 25 [33%] who had published before the course), 42 (55%) presented posters or oral abstracts at conferences, 33 (43%) facilitated at further OR courses, 29 (38%) reviewed scientific papers, 25 (33%) secured further OR funding and 55 (72%) said their institutions were involved in OR implementation or capacity building. OR fellows performed better than non-OR fellows. Among the latter, males and participants from Asia had better output than females and participants from Africa (P < 0.05).

CONCLUSION

The significant proportion of participants continuing to engage in OR after course completion provides encouraging evidence of the long-term value of this capacity building model.