Estimating health impacts and economic costs of air pollution in the Republic of Macedonia

Aim: This paper assesses the magnitude of health impacts and economic costs of fine particulate matter (PM) air pollution in the Republic of Macedonia. Methods: Ambient PM10 and PM2.5 monitoring data were combined with population characteristics and exposure-response functions to calculate the incidence of several health end-points known to be highly influenced by air pollution. Health impacts were converted to Disability-Adjusted Life Years (DALYs) and then translated into economic terms using three valuation approaches to form lower and higher bounds: the (adjusted) Human Capital Approach (HCA), Value of a Statistical Life (VSL) and the COI (cost of illness). Results: Fine particulate matter frequently exceeds daily and annual limit values andinfluences a person‟s day-to-day health and their ability to work. Converting lost years of life and disabilities into DALYs - these health effects represent an annual economic cost of approximately €253 million or 3.2% of GDP (midpoint estimate). Premature death accounts for over 90% of the total health burden since this represents a loss of total life-long income. A reduction of even 1μg/m3 in ambient PM10 or PM 2.5 would imply 195 fewer deaths and represent an economic savings of €34 million per year in reduced health costs. Conclusion: Interventions that reduce ambient PM10 or PM2.5 have significant economic savings in both the short and long run. Currently, these benefits (costs) are „hidden‟ due to the lack of information linking air quality and health outcomes and translating this into economic terms. Policymakers seeking ways to improve the public‟s health and lessen the burden on the health system could focus on a narrow set of air pollution sources to achieve these goal

Систематски преглед и компаративна анализа на применетиот методолошки пристап за проценка на ризиците во АД Охис Скопје

Considering complicity in ecological health and social aspects of industrial contaminated sites (ICSs), the methodologies and approaches of health impact assessments are very heterogeneous. ICSHNet together with WHO recommend two main methodological approaches: health risk assessments and epidemiological studies. Some countries have necessary experience for impact assessment of ICSs, but others have limited resources and less intensity studies. In the Republic of North Macedonia, 16 ICSs are identified, but one of them, lindane dumpsite in OHIS Plant is characterized as the most ecological and public health risk. The general aim: Systematic review of literature data about methodological approaches for health risk assessment of ICSs on international and national level in order to make comparative analysis of current methodological approaches in the Republic of North Macedonia using the case study of ICS OHIS PLANT SKOPJE. Material and methods: The review of scientific and grey literature was performed. The selected scientific studies were searched in the PubMed and Medline databases from 2000-2017, in English and Macedonian. The selected studies and data were analyzed by required information for identification of hazards, exposure assessment and risk characterization. Additionally, the review was performed on published reports of risk assessment of OHIS Plant. Results: A total of 14 original papers were investigated. Continuous monitoring systems for gathering environmental data related to ICSs were used only in two cases and in other studies the concentrations of contaminants in the source were calculated or several ad hoc monitoring campaigns were performed. Exposure assessment was conducted according to qualitative definition for the presence/absence of a source, distance to a source and biomonitoring in the study. Mortality, cancer incidence, congenital abnormalities and hospitalizations were used health data. The study of risk assessment of OHIS Plant has ecological design and indirect quantitative exposure assessment model was used. Conclusion: All investigated studies used three main methodological approaches for exposure assessment: measurement of hazard concentration, distance from source and biomonitoring. Comparable, conducted risk assessment of OHIS Plant follows the recommendations of US EPA and ATSDR with weakness of no existing continual monitoring process and also deficiency of health data and this is the reason for limitation of health impact assessment and setting up EPHT or other public health surveillance system.Имајќи ја предвид коплексноста во еколошкото здравје и социјалните аспекти на индустриски контаминирани точки (ИКТ), методологијата и пристапот во истражувањето на влијанието на ИКТ врз здравјето се многу хетерогени. ICSHNet во соработка со СЗО препорачуваат два главни методолошки приоди за истражување на ИКТ: проценка на здравствениот ризик и епидемиолошки студии. Некои земји го имаат потребното искуство за проценка на влијанието на ИКТ, а некои, пак, имаат лимитирани ресурси и помалку интензивни студии. Во Република Северна Македонија идентификувани се вкупно 16 ИКТ, од кои депонијата со линдан во АД ОХИС Скопје е оценета со највисок еколошки но и јавноздравствен ризик. Основна цел на студијата беше преку преглед на селектирани литературни податоци поврзани со методолошки приоди за проценка на здравствените ризици во индустриски контаминираните точки на меѓународно и национално ниво да се изврши компаративна анализа на спроведениот методолошки пристап во Република Северна Македонија преку примерот со ИКТ АД ОХИС Скопје. Материјал и методи: Преглед на научна и сива литература, како и селектирање на студии преку базите на податоци PubMed и Medline, изведени во периодот 2000-2017 на англиски и македонски јазик. Селектираната литература и податоци се евалуираа во однос на потребни податоци за идентификација на хазарди, проценка на експозицијата и карактеризацијата на здравствениот ризик. Дополнително, беше извршен преглед на публикувани извештаи од спроведената проценка на ризик на ИКТ АД Охис Скопје. Резултати: Беа анализирани вкупно 14 студии. Континуиран мониторинг систем бил користен само во две студии, а во останатите студии биле пресметувани контаминентите во изворот или биле спроведени краткотрајни мониторинг кампањи. Проценка на експозицијата била спроведена преку одредување на присуството на контаминентот или оддалеченост од  изворот и во една студија биомониторингот. Инциденцијата на смртност, појава на канцер и вродени аномалии и број на хоспитализации се користени здравствени податоци. Проценката на ризик на ИКТ АД Охис Скопје по својот дизајн е еколошка студија со примена на индиректна квантитативна проценка на експозицијата. Заклучок: Во сите анализирани студии се применети три главни принципи на проценка на експозицијата: преку одредување на концентрацијата на полутантот, оддалеченоста од изворот и биомониторинг. Споредбено, проценката на ризик на ИКТ АД Охис Скопје методолошки ги следи препораките на US EPA и ATSDR, со слабости во однос на недостаток на континуиран мониторинг систем и недостаток на податоци за здравствениот ефект, што ја лимитира проценката на здравствениот импакт, како и поставување на EPHT или друг систем за јавноздравствен надзор во ИКТ

ARTIFICIAL SWEETENERS IN VARIOUS FOOD PRODUCTS - QUANTIFICATION AND INTAKE ASSESSMENT

The aim of the study is to determine the content of artificial sweeteners in 133 different food products. The analytical quantification was performed by the application of a reversed-phase, validated, gradient HPLC method, with simultaneous determination of aspartame, acesulfame K and Na-saccharin content. Supelcosil 150 x 4.6 mm, 5µm was used as the stationary phase and mobile phase (buffer 0.1 M NaH2PO4, pH = 2.5 and acetonitrile), at temperature = 26 °C and flow = 1.5 mL/min. The method was applied on: non-alcoholic beverages, chewing gums, sweets, chocolates, confectionery, dietary products, food supplements, fruit yogurt, etc. Depending on the structure of the food, different extraction methods were applied. The assessment of food safety showed irregularity in 21 % of the products, of which 50 % were imported. Some of the products` declarations were not completely translated nor properly labelled. Of the irregular domestic products, 21 % exceeded the maximum permitted quantities of added sweeteners and the rest had irregular labelling. The analysis showed that the most commonly used sweetener was Na-saccharin, which along with aspartame and acesulfame K are most frequently utilized in non-alcoholic beverages. Intake of artificial sweeteners was estimated according to the mean body weight for children, adolescents and adults, under the supposition that the products contained the maximum permitted quantities. The theoretical maximum daily intake of different food products in different population groups indicates the existence of a potential health risk only with continuous "large" intake of products that contain the maximum allowable amounts of artificial sweeteners, especially for the youngest populations

Estimating health impacts and economic costs of air pollution in the Republic of Macedonia

Aim: This paper assesses the magnitude of health impacts and economic costs of fine particulate matter (PM) air pollution in the Republic of Macedonia.Methods: Ambient PM10 and PM2.5 monitoring data were combined with population characteristics and exposure-response functions to calculate the incidence of several health end-points known to be highly influenced by air pollution. Health impacts were converted to Disability-Adjusted Life Years (DALYs) and then translated into economic terms using three valuation approaches to form lower and higher bounds: the (adjusted) Human Capital Approach (HCA), Value of a Statistical Life (VSL) and the COI (cost of illness).Results: Fine particulate matter frequently exceeds daily and annual limit values andinfluences a person‟s day-to-day health and their ability to work. Converting lost years of life and disabilities into DALYs - these health effects represent an annual economic cost of approximately €253 million or 3.2% of GDP (midpoint estimate). Premature death accounts for over 90% of the total health burden since this represents a loss of total life-long income. A reduction of even 1μg/m3 in ambient PM10 or PM 2.5 would imply 195 fewer deaths and represent an economic savings of €34 million per year in reduced health costs.Conclusion: Interventions that reduce ambient PM10 or PM2.5 have significant economic savings in both the short and long run. Currently, these benefits (costs) are „hidden‟ due to the lack of information linking air quality and health outcomes and translating this into economic terms. Policymakers seeking ways to improve the public‟s health and lessen the burden on the health system could focus on a narrow set of air pollution sources to achieve these goals

Violence and Injury Prevention – Challenges For Health Promotion in Macedonia

World Health Organization estimated 5.1 million deaths from injuries in 2002 in the world or 9% of all deaths, disproportionately affecting the young. These are a leading cause of premature death and DALYs at age of 5 to 45 years. In Europe injuries are third leading cause of death, after cardiovascular diseases and cancers with 800,000 or 8.3%. Injuries can be avoided and prevented. Many effective strategies can be used to target high risk groups and to reduce health consequences for victims of injuries. The health sector can play a key role in injury and violence prevention and control, by providing care and services to victims, prevention and advocacy, and engaging in partnerships with other sectors and across all levels of government and society. Decreasing the burden from injuries will require political commitment across all government levels and with this the allocation of adequate resources to take these activities forward. Future challenges for injury and violence prevention and health promotion, that the countries including Macedonia would face are: developing national action plans for unintentional injury and violence prevention, forming an intersectoral injury prevention committee, improving national surveillance system, strengthening national capacity to respond to the burden of injuries and violence through both primary prevention and care, promoting evidence-based practice by facilitating the exchange of knowledge and experience across the Region, recognize gaps in knowledge and prioritize research and development in both primary prevention and care, as well as studies on costs

Assessing Health Impact of Air Pollution in Macedonian Cities

This article was published with missing authors 3-4

Violence and Injury Prevention – Challenges For Health Promotion in Macedonia

World Health Organization estimated 5.1 million deaths from injuries in 2002 in the world or 9% of all deaths, disproportionately affecting the young. These are a leading cause of premature death and DALYs at age of 5 to 45 years. In Europe injuries are third leading cause of death, after cardiovascular diseases and cancers with 800,000 or 8.3%. Injuries can be avoided and prevented. Many effective strategies can be used to target high risk groups and to reduce health consequences for victims of injuries. The health sector can play a key role in injury and violence prevention and control, by providing care and services to victims, prevention and advocacy, and engaging in partnerships with other sectors and across all levels of government and society. Decreasing the burden from injuries will require political commitment across all government levels and with this the allocation of adequate resources to take these activities forward. Future challenges for injury and violence prevention and health promotion, that the countries including Macedonia would face are: developing national action plans for unintentional injury and violence prevention, forming an intersectoral injury prevention committee, improving national surveillance system, strengthening national capacity to respond to the burden of injuries and violence through both primary prevention and care, promoting evidence-based practice by facilitating the exchange of knowledge and experience across the Region, recognize gaps in knowledge and prioritize research and development in both primary prevention and care, as well as studies on costs

Health Promotion Activities in the Republic of Macedonia

This course covers the following topics: definitions and basic concepts of health promotion, Macedonian health system and health indicators, the new Macedonian public health policy and priorities, health promotion activities regarding 12 key priorities, advantages and weaknesses of the process of health promotion and future developments