Accra Shines as Pilot City to Reduce Air Pollution Through Healthcare Sector Engagement

The Climate and Clean Air Coalition (CCAC) supported Accra, Ghana as it transformed its urban planning by engaging the health sector on the extraordinary health benefits of air pollution reductions while demonstrating the power of cities to fight climate change and create cleaner skies.

Since 2017, the CCAC’s Urban Health Initiative, led by the World Health Organization (WHO) with co-funding from the Norwegian government, worked with public health professionals and municipal government officials in Accra to illuminate the links between air pollution, premature mortality, healthcare costs, and climate change.This work supported local action in the transport, waste, and household energy sectors by providing healthcare workers, city planners, and citizens with information they need to demand and implement climate and clean air policies. Accra is using the improved capacity created by the program to measure and integrate cost-benefit analyses of the health and economic impacts from air pollution into urban planning policies.

“It is tremendously important that people in the healthcare industry understand the links to air pollution because they are some of our most trusted and valued messengers with the public,” said Gary Kleiman, a senior environmental consultant working with the World Bank’s Pollution Management and Environmental Health Program, which worked with the Urban Health Initiative. “Air pollution is killing millions of individuals globally every year and we need to do something about it.” 

In Ghana, an estimated 11,739 people die prematurely  each year from ambient air pollution. Reducing short-lived climate pollutants (SLCPs) like black carbon and methane, which are both climate forcers and air pollutants, can dramatically reduce these deaths while decreasing national healthcare costs and reducing climate change impacts.

“Air pollution is a silent killer because people don’t see it, which means they think it doesn’t affect them negatively. So when the health impacts are introduced it makes the links clearer to everyone— what you think doesn’t impact you actually does,” said Desmond Appiah, the Chief Sustainability Advisor at the Accra Metropolitan Assembly. “It’s one of the advantages of framing the problem around air pollution rather than just climate change, because it’s individualized. It's easier for people to understand that they may get cardiovascular disease whereas climate change can feel larger, more systemic, and removed.”

The Urban Health Initiative has six components for urban transformation: first, map existing structures and individuals, then adapt health and economic tools to the local context, next develop policy scenarios, then engage policy makers, improve communication and outreach, and finally monitor results and refine interventions. The initiative has two pilot projects, the recently concluded one in Accra and another in Kathmandu, Nepal.

An outcome of the project is increased engagement from Ghana’s Ministry of Transport to incorporate health assessment tools into its regulatory framework and the continued development of materials to increase health workers’ capacity and knowledge of the connections between air pollution and health.

Accra was selected because of its air pollution challenges and because it was a U.S. Environmental Protection Agency’s Megacities Partnership city. There was also strong interest from Ghana Health Services and the Ghana Environmental Protection Agency. Through the Urban Health Initiative, Accra became a role model in the BreatheLife Campaign, raising awareness within local communities to reduce waste burning and promote green space development.

The priority sectors for policy action, identified during initial stakeholder engagement, were household energy, transport, waste management, and land-use.

A major accomplishment of the Urban Health Initiative and the World Bank’s work, said Kleiman, is that the EPA Ghana staff can now continuously monitor particulate matter and black carbon in multiple areas of the city, and produce high quality and reliable data to more accurately identify sources of air pollution.

“This project took Accra from having ambient air pollution measurements every six days, to having minute by minute measurements, 24 hours a day, seven days a week, 365 days a year—that just fundamentally changes their understanding of pollution episodes and how severe and frequent they are,” said Kleiman.

The Urban Health Initiative also helped Ghanaian authorities identify the most effective interventions for improving air pollution in the city, including ending the burning of waste, using cleaner cooking methods, and elevating fuel and vehicle standards.

“It's one thing to know there's bad air pollution, it's another to know what to do about it,” said Kleiman, “Now they have the ability to target the most effective solutions.”

Appiah and Kleiman both point to the project’s collaborative nature as a major part of its success, with Ghana’s EPA, the Ghana Health Service, the Ghana Education Service, the City of Accra, and academics all pulling together to work with the international organizations.

Six different community engagement sessions, some of which had well over 100 attendees, brought together community leaders, chiefs, local assembly members, and religious leaders to teach citizens about health and clean air. In these meetings, the project distributed dust bins for proper waste disposal and explained key sources of air pollution, such as cooking on wood burning stoves and burning trash, while explaining alternatives like efficient cookstoves and cleaner cooking fuels.

Some of these community workshops targeted people most vulnerable to air pollution, including street vendors, informal sector public transportation workers, and communities living close to landfills. Connecting them with academics meant improved data collection plus education about air pollution prevention.

As a result of one of these workshops, one community worked with the Ghana EPA to shut down a chronic industrial polluter.

A variety of efforts helped deliver this project, including a report by UN-Habitat and ICLEI Local Governments for Sustainability that mapped local clean air policies and actors. The Ghana Health Services and Ghana Environmental Protection Agency also convened a steering committee of local experts who adapted and tested existing tools to measure the health and economic impacts of air pollution policies. 

The project employed  cutting edge tools developed by WHO, CCAC, and the U.S. EPA, including  AirQ+, ITHIM, and SWEET, which help provide rapid and accurate information for scientific analysis and public awareness. This kind of information is not often available in African cities and implementers hope that the project’s success will spread to other cities on the continent.

“We hope that environmental and public health authorities use the tool to evaluate policies and build scenarios of emissions reductions, we also hope that groups of citizens use the tool to pressure the government to change their policies, and we hope that the use of such tools will be part of university curricula on climate change and air pollution,” said Pierpaolo Mudu, of the World Health Organization, who worked on this project and coordinated the development of the AirQ+ tool. “More sustainable development can be achieved only if different stakeholders are able to change power relations in the city where they live using information and tools based on scientific evidence to counteract the unsustainability of current policies.”

It’s a challenging process, adds Mudu, that must be modified on a city by city basis as this work scales across the continent. However, in all cities, media coverage, community engagement, and cooperation across institutions are vital to success.

With the project in Accra concluding, partners are collaborating to make sure the work sticks. 

“The second phase of this kind of project, after such a huge effort from many people, is the most difficult one,” said Mudu. “We have decided to use policy tracking activities which means that we will keep people mobilized to track the policy changes that are expected to happen.”

The completed results of this policy tracking, developed by the University of Ghana to help measure the initiative’s impact, will be available next year along with testing results of the capacity building course for clinicians. 

Appiah is confident of the continued progress of the project, since there is now an air quality steering committee that includes the EPA and city of Accra, an air quality management plan, and a communication plan to disseminate the project’s work.

As the project’s success spreads, so will the number of citizens capable of influencing the media, pressuring politicians, and mobilizing communities most harmed by air pollution to demand change.