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The Health Effects Institute

HEI International

In keeping with its Strategic Plan 2010-2015, HEI is paying continued attention to global opportunities to conduct science that is relevant to the developed world, and selected further efforts in Asia and the Americas.  

For more than a decade, HEI has drawn the world’s best air pollution and health researchers into its strategic research program through its competitive research selection process. The results of those efforts – policy-relevant studies on particulate matter, diesel exhaust, air toxics, and other topics – are an integral part of our scientific program, and can be found in our Publications Database.

This page will provide information on international initiatives as it becomes available.

Public Health and Air Pollution in Asia (PAPA)
Multicity Time-Series Study in Latin America (ESCALA)
Air Pollution, Poverty, and Health in Ho Chi Minh City

News from HEI’s Current International Initiatives:

Estimates of Population Exposure to Traffic-related Air Pollution in Beijing, China and New Delhi, India
Dr. Michael Jerrett and colleagues at the University of California, Berkeley School of Public Health have extended the exposure analyses reported in HEI Special Report 17 to estimate exposure to traffic in two Asian megacities, Beijing, China, and New Delhi, India, where high levels of pollution and dense populations can result in high exposures and significant health effects. To download these analyses, click here.

HEI publishes report on air pollution and mortality in India
Research Report 157, Public Health and Air Pollution in Asia (PAPA): Coordinated Studies of Short-Term Exposure to Air Pollution and Daily Mortality in Two Indian Cities, contains studies in Chennai and Delhi led by Dr. Kalpana Balakrishnan and Dr. Uma Rajarathnam, respectively. These time-series studies of air pollution and mortality in India were funded under HEI’s PAPA Program to provide information to inform regulatory and other decisions that would be relevant to local populations, with the added goal of supporting scientific capacity building in the region. The studies followed a first wave of four studies in China and Thailand (recently published as HEI Research Report 154) and explore key aspects of the epidemiology of exposure to air pollution — issues of local as well as global relevance — including the effects of exposure at high concentrations and at high temperatures. The investigators based their approaches on the common protocol of the first-wave PAPA studies but developed city-specific approaches due to differences in the availability and completeness of data in the Indian cities. To download HEI Research Report 157, including a Critique by the HEI Review Committee, click here.

HEI Science in Forefront at Better Air Quality Meeting in Singapore
HEI's Public Health and Air Pollution in Asia (PAPA) program served as the leading source of information on the health effects of air pollution in Asia at the November 2010 Better Air Quality (BAQ) meeting, hosted in Singapore by the Clean Air Initiative for Asian Cities (CAI-Asia). BAQ, held biannually in Asia, is the preeminent forum for discussing the science and policy of air pollution across the continent. This year's meeting, with a theme of "Air Quality in a Changing Climate," attracted more than 600 participants from more than 35 countries, including representatives of government and nongovernmental organizations, the private sector, academia, and intergovernmental agencies. For more details, click here. To download conference presentations, and for more information about BAQ 2010, click here.

HEI publishes comprehensive review of outdoor air pollution and health in Asia
Special Report 18, Outdoor Air Pollution and Health in the Developing Countries of Asia: A Comprehensive Review, is the first comprehensive literature review to come out of HEI's Public Health and Air Pollution in Asia (PAPA) program. The review builds on an initial assessment conducted in 2004 and describes the current scope of the Asian literature on the health effects of outdoor air pollution, enumerating and classifying more than 400 studies. In addition, the report includes a systematic and quantitative assessment of 82 time-series studies of daily mortality and hospital admissions for cardiovascular and respiratory disease. The studies covered in the current review include the PAPA time-series studies in four Asian cities (Research Report 154, below), as well as a first-ever critical and qualitative analysis of Asian studies of long-term exposure to air pollution and chronic respiratory disease, lung cancer, and adverse reproductive outcomes that describes both what the studies tell us and the continuing uncertainties and research needs. The report also provides a broad overview of the status of and trends in air pollution sources, emissions, and exposures in the developing countries of Asia, as well as factors related to urban development, population health, and public policy that set the context for the public health effects of air pollution. The review concludes by placing the Asian health effects studies in the context of the worldwide literature, identifies gaps in knowledge, and recommends approaches by which to address them. To download Special Report 18 or its Executive Summary (in English or Chinese), click here.

HEI publishes new report on time-series studies of air pollution and mortality in Asia
Research Report 154, Public Health and Air Pollution in Asia (PAPA): Coordinated Studies of Short-Term Exposure to Air Pollution and Daily Mortality in Four Cities, describes the first set of coordinated time-series studies ever undertaken in Asian cities: four time-series studies of the health effects of air pollution in Bangkok, Hong Kong, Shanghai, and Wuhan. These studies were intended to help bridge the gaps between studies conducted in different locations around the globe. They explored key aspects of the epidemiology of exposure to air pollution in each location — issues of local as well as global relevance — including the effects of exposure at high concentrations and at high temperatures, the potential influence of influenza epidemics on the relations between air pollution and health, and the ways in which social class might modify risks associated with air pollution. Research Report 154 comprises the four individual studies by Kan et al. (Shanghai), Qian et al. (Wuhan), Vichit-Vadakan et al. (Bangkok), and Wong et al. (Hong Kong), a combined analysis conducted by Wong on behalf of the PAPA teams, and the commentaries by the HEI Review Committee. To download HEI Research Report 154 or its Executive Summary, click here.

New studies of air pollution and adverse pregnancy outcomes
With supplemental funding from the William and Flora Hewlett Foundation, HEI's Board of Directors recently approved two studies that will investigate the relation between ambient air pollution and adverse pregnancy outcomes in Asia.

  • Zhengmin Qian of Saint Louis University will evaluate whether air pollutants at levels typically found in the developing countries of Asia are related to increased rates of preterm birth, low birth weight, and intrauterine growth retardation in neonates born in Wuhan, China, in 2009 through 2012.
  • Yungling Leo Lee of the National Taiwan University and colleagues will assess the effects of air pollution in Taiwan on adverse pregnancy outcomes, including low birth weight, preterm delivery, and specific birth defects.

For more details about these studies, click here.

Public Health and Air Pollution in Asia (PAPA)

Among its broader international activities, HEI is implementing Public Health and Air Pollution in Asia (PAPA) — a program to build better understanding of the effects of air pollution on health in Asia. PAPA was launched at the Better Air Quality Conference and annual meeting of the Clean Air Initiative for Asian Cities held in Hong Kong in December of 2002 and has been actively engaged in identifying and working with science and scientists in the region.

For the latest on PAPA, check the following:

  • HEI PAPA Progress: Public Health and Air Pollution in Asia, Summer 2010
    The summer 2010 issue of PAPA Progress highlights the most recent accomplishments and future activities of the Public Health and Air Pollution in Asia (PAPA) program:
    • New Science for Asian Decisions: New studies of air pollution and birth outcomes initiated in Taiwan and Wuhan, China; Workshop on coordinated methods for time-series studies at the Joint ISES – ISEE Conference in September 2010.
    • Latest Asian Studies on Air Pollution and Health: Fall release of HEI’s comprehensive review of the Asian science literature; Over 100 new studies added to PAPA-SAN, HEI’s comprehensive web based compendium of over 400 Asian studies of air pollution and health.  
    • HEI Science At Work: Beijing workshop on air quality standards and climate; Washington, D.C., US Capitol Hill Forum on Climate Change, Air Quality and Health; Chandigarh and Delhi, meetings with featured presentations of the HEI Traffic Literature Review and Beijing Olympic Games study.
    This edition of PAPA Progress also highlights the renewed commitment of the Hewlett Foundation to HEI’s work in Asia and Latin America; details upcoming meetings at the Better Air Quality Conference (November 9–11, 2010) and Joint ISES-ISEE Conference (August 28–September 1, 2010); and recognizes Kalpana Balakrishnan of Sri Ramachandra University for her role in establishing India’s first Master of Public Health (M.P.H.) program in Occupational and Environmental Health.
  • Public Health and Air Pollution in Chinese Cities: Local Research with Global Relevance
    HEI’s Public Health and Air Pollution in Asia (PAPA) program contributed a commentary to the China Environment Series, a publication of the Woodrow Wilson Center’s China Environment Forum, summarizing evidence on the health effects of outdoor air pollution in China, and highlighting HEI funded work in Chinese cities. To download China Environment Series 10 (2008/2009), including HEI’s commentary on pages 65-71, please click here (, 6.4 MB).
  • PAPA-SAN (Public Health and Air Pollution in Asia—Science Access on the Net) is the world’s largest database of research reports on the health effects of air pollution in Asia. It was systematically compiled from the peer-reviewed scientific literature in English, Chinese, Japanese, and Korean. PAPA-SAN is a unique resource for scientists, policy-makers, international lending organizations, and other stakeholders seeking access to the latest air pollution research from across the region. This new version of PAPA-SAN has been expanded by the addition of more than 140 new reports and now includes 421 reports from 11 Asian countries, published between 1980 and September 2007. For the first time, reports from Bangladesh, Pakistan, and Sri Lanka are included, as well as reports on studies of biomarkers of exposure to benzene and lead. For each report, PAPA-SAN provides the citation, a summary of findings, other key data and, when available, a link to the abstract. Results are presented in table form, sorted by country or region, study design, pollutant, and health outcome as well as in written form by country.

    PAPA-SAN was produced by HEI’s Public Health and Air Pollution in Asia (PAPA) program in partnership with the Clean Air Initiative for Asian Cities (CAI-Asia). It is the latest update of a database originally published in HEI’s Special Report 15: Health Effects of Outdoor Air Pollution in Developing Countries of Asia (2004). We will continue to search the literature periodically to make sure PAPA-SAN is up to date. Please visit PAPA-SAN to learn more about the project, download the result tables, and read the summaries.

To learn more about PAPA follow these links:

HEI-funded PAPA Studies

Ongoing studies ( * = in review, † = in press)

Vietnam
†HEI Collaborative Working Group on Air Pollution, Poverty, and Public Health in Ho Chi Minh City
The effects of short-term exposure on hospital admissions for acute lower respiratory infections in young children of Ho Chi Minh City

HEI Collaborative Working Group on Air Pollution, Poverty, and Public Health in Ho Chi Minh City
The relationship between personal and ambient exposures in Ho Chi Minh City

Taiwan
Yungling Leo Lee, National Taiwan University College of Public Health, Taiwan
Impact of outdoor air pollution on infant and children's health in Taiwan

Published Studies

India
"Short-Term Effects of Air Pollution on Mortality: Results from a Time-Series Analysis in Chennai, India" 2011
Dr. Kalpana Balakrishnan, Sri Ramachandra Medical College & Research Institute, Chennai, India
To download the report, click here

"Time-Series Study on Air Pollution and Mortality in Delhi" 2011
Dr. Uma Rajarathnam, The Energy and Resources Institute, Delhi, India
To download the report, click here

Thailand
"Estimating the Mortality Effects of Air Pollution in Bangkok, Thailand" 2010
Dr. Nuntavarn Vichit-Vadakan, Chulalongkorn University, Bangkok, Thailand
To download the report, click here.

China
"Interaction Between Air Pollution and Respiratory Viruses: Time-series Studies for Daily Mortality and Hospital Admission" 2010
Dr. Chit-Ming Wong, University of Hong Kong, Hong Kong, China
To download the report, click here.

"A Time-series Study of Ambient Air Pollution and Daily Mortality in Shanghai, China" 2010
Dr. Haidong Kan, Fudan University, Shanghai, China
To download the report, click here.

"Ambient Air Pollution and Daily Mortality in Wuhan" 2010
Dr. Zhengmin Qian, Pennsylvania State University, College Park, USA
To download the report, click here.

Other PAPA Publications

  • Communication 13: Public Health and Air Pollution in Asia (PAPA): Key Results from Bangkok, Hong Kong, Shanghai, and Wuhan, 2008.
    The September issue of Environmental Health Perspectives published the first systemic presentation of the HEI-funded PAPA studies in Bangkok, Hong Kong, Shanghai, and Wuhan, as well as a combined analysis and accompanying editorial. These articles have been reprinted and are currently available as HEI Communication 13. To access Communication 13, please click here. The detailed studies and accompanying HEI commentaries have been published by the Institute as Research Report 154. To download Research Report 154, click here.

These studies comprise the first coordinated and combined analyses of air pollution and daily mortality in Asia, and were designed and conducted by local investigators in concert with local air pollution and public health officials and international experts. Investigators developed and followed a common, state-of-the-art time-series protocol, allowing for comparison both within Asia and between Asia and other regions (such as North America and Europe) which have a larger body of evidence. This common protocol also facilitated a combined analysis including all cities. To download a copy of the PAPA Protocol for Coordinated Time-Series Studies of Daily Mortality in Asian Cities, please click here.

  • Special Report 15: Health Effects of Outdoor Air Pollution in Developing Countries of Asia, 2004. This first publication to come from the PAPA Program was undertaken to help inform the Clean Air Initiative for Asian Cities. This special report has identified and summarized more than 135 studies of air pollution and health conducted across Asia. In addition, it critically reviews for the first time a key subset of these studies: 28 studies of daily mortality. The report is a valuable resource for policy makers in Asia and beyond. Please click here to access Special Report 15. 

Multicity Time-Series Study in Latin America (in press)

ESCALA (Estudio de Salud y Contaminación del Aire en Latinoamérica), led by Dr. Romieu and colleagues, used a common analytic framework to examine the association between daily levels of air pollution and mortality in Mexican, Brazilian, and Chilean cities, with special attention to the impact of air pollution on infants and young children. This study also evaluated whether socio-economic status influences the relation between air pollution and mortality.

For additional information please see:
Winter 2007-2008 Newsletter
Spring 2006 Newsletter
Summer 2005 Newsletter

Air Pollution, Poverty, and Health in Ho Chi Minh City

The program entitled Air Pollution, Poverty, and Health in Ho Chi Minh City (HCMC) is being jointly funded by the Asian Development Bank through its Poverty Reduction Cooperation Fund, by HEI, and by the HCMC government. The conduct of the studies has been led by an interdisciplinary collaborative working group, which has been refining feasible approaches to assess the health impact of air pollution among poor families in HCMC. The project has two main research components:
  1. a hospital-based study to estimate effects of short-term exposure to air pollution on hospital admissions for acute lower respiratory infections (ALRI) in children younger than 5 years, and to compare the magnitude of the effects of air pollution on poor children compared with children who are not poor (in press); and
  2. a household-based study to estimate personal exposures to air pollution and to evaluate the association between ambient air pollutant concentrations and personal exposures in poor families and families who are not poor (in progress).

For additional information please see articles in:
Winter 2006-2007 Newsletter
Summer 2005 Newsletter

For more information on these studies, please contact Aaron Cohen (+1-617-488-2325)

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May 5, 2011