By Sonja Spitzer,research assistant in the IIASA World Population Program
Sonja Spitzer discusses how survey data often fails to capture all socioeconomic groups and explains how to ensure health information used by policymakers is based on accurate statistics.
Life expectancy continues to increase in Europe. We live longer, but do we live healthier? One way of tackling this question is by analysing health expectancy: a widely used indicator that counts the number of years an average person can expect to live in good health. To create this indicator researchers usually combine information about mortality with health data from surveys – and this is where many problems begin.
Survey participation is shaped by socioeconomic differences
Surveys do not always correctly represent the countries they seek to describe. A common deviation is that highly educated individuals are more likely to participate in surveys than less-educated individuals This is problematic for health research in particular, because highly educated people tend to be healthier than those who are less educated. Overrepresenting healthy and better educated individuals in surveys makes countries appear to have healthier populations than is the actual case. A recent study I conducted, that focused on European countries, showed that health expectancy measures are frequently upward biased, because less-educated people are underrepresented in the underlying data. The results of this study reflect the outcomes of other research; for example, estimates of rates of diabetes and asthma in Belgium are too low because individuals with a high level of education are overrepresented in the core data. In the Netherlands, the underrepresentation of those with lower levels of education has led to underestimating smoking prevalence, alcohol intake, and low levels of physical activity.
Make everyone count with statistical weights
Are you now wondering if you can ever trust health measures again? Do not despair! Surveys can still be a very useful source for answering health-related questions if the appropriate statistical tools are used. It is possible to account for the misrepresentation of participants with lower levels of education in surveys. The only thing needed is accurate information about the education structure of the population, that is: How many highly educated versus less-educated individuals live in a given country? In Europe, this information is readily available via censuses. Using information from censuses makes it possible to calculate statistical weights for surveys. If the less educated are underrepresented in surveys, each observation of a less educated individual is weighted relatively more than those with a higher level of education to account for the misrepresentation. This weighting enables surveys to resemble the population in the real world and the health measures that are based on them to no longer be biased by educational differences in survey participation.
Why do the less educated not participate in surveys?
Using survey methods such as statistical weights might become even more necessary in the future – it appears that the gap in survey participation between the higher and the less-educated is increasing year upon year. Those with low levels of education are frequently more difficult to engage, for example, less educated people can have less stable life paths and thus more often change their address. They may be less likely to provide requested information in surveys because they are too sick to participate or are less aware of the details of their health and financial situation. Finally, survey participation is usually voluntary and those with lower levels of education are more likely to refuse participation. One could speculate that this refusal to participate is because we, as researchers fail to engage with, or reach out to, less-educated individuals and the “value” of participating in surveys is therefore not well-communicated. This concern seems particularly important in the age of ‘fake news’. If less-educated individuals were better represented in surveys, this would make official statistics more reliable and might also lead to a better appreciation of statistics and how they can be more profound indicators than, for example, an opinion posed by someone on TV.
 Demarest, S., Van Der Heyden, J., Charafeddine, R., Tafforeau, J., Van Oyen, H., Van Hal, G.: Socio economic differences in participation of households in a Belgian national health survey. European Journal of Public Health. 23, 981–985 (2013). DOI:10.1093/eurpub/cks158
 Korkeila, K., Suominen, S., Ahvenainen, J., Ojanlatva, A., Helenius, H.: Non-response and related factors in a nation-wide health survey. European Journal of Epidemiology 17, 991–999 (2001)
 Reinikainen, J., Tolonen, H., Borodulin, K., Härkänen, T., Jousilahti, P., Karvanen, J., Koskinen, S., Kuulasmaa, K., Männistö, S., Rissanen, H., Vartiainen, E.: Participation rates by educational levels have diverged during 25 years in Finnish health examination surveys. European Journal of Public Health. 28, 237–243 (2018). DOI:10.1093/eurpub/ckx151
 Spitzer, S., Biases in health expectancies due to educational differences in survey participation of older Europeans: It’s worth weighting for. The European Journal of Health Economics. (2020) IIASA doi:10.1007/s10198-019-01152-0. http://pure.iiasa.ac.at/id/eprint/16281/
Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.
By Prakash Khadka, IIASA Guest Research Assistant and Wei Liu, Guest Research Scholar in the IIASA Equity and Justice Research Group
Prakash Khadka and Wei Liu explain how unbridled, unplanned infrastructure expansion in Nepal is increasing the risk of landslides.
Worldwide, mountains cover a quarter of total land area and are home to 12% of the world’s population, most of whom live in developing countries. Overpopulation and the unsustainable use of these fragile landscapes often result in a vicious cycle of natural disaster and poverty. Protecting, restoring, and sustainably using mountain landscapes is an important component of Sustainable Development Goal 15 ̶ Life on Land ̶ and the key is to strike a balance between development and disaster risk management.
Nepal is among the world’s most mountainous countries and faces the daunting challenge of landslides and flood risk. Landslide events and fatalities have been increasing dramatically in the country due to a complex combination of earthquakes, climate change, and land use, especially the construction of informal roads that destabilize slopes during the monsoon.
According to Nepal government data, 476 incidents of landslides and 293 fatalities were recorded during the 2020 monsoon season – the highest number in the last ten years, mostly triggered by high-intensity rainfall – a trend which is increasing due to climate variations. According to one study, by mid-July 2020, the number of fatal landslides for the year had already exceeded the average annual total for 2004–2019.
Figure 1: A map of landslide events in Nepal from June to September 2020. Source: bipadportal.gov.np
Landslides are not a new phenomenon in the country where hills and mountains cover nearly 83% of the total land area. While being destructive, landslides are complex natural processes of land development. The Gangetic plain, situated in the foothills of the Himalayas, was formed by the great Himalayan river system to which soil is continually added by landslides and deposited at the base by rivers. Mountain land changes via natural geo-tectonic and ecological processes has been happening for millions of years, but fast population growth and climate change in recent decades substantially altered the fate of these mountain landscapes. Road expansion, often in the name of development, plays a key role.
Many mountain areas in Nepal are physically and economically marginalized and efforts to improve access are common. Poverty, food insecurity, and social inequity are severe, and many rural laborers opt to migrate for better economic opportunities. This motivates road network expansion. Since the turn of the century, Nepalese road networks has almost quadrupled to the current level of ~50 km per 100 km2, among which rural roads (fair-weather roads) increased more than blacktop and gravel roads.
Figure 2: Mountains carved just above Jay Prithvi Highway in Bajhang district of Sudurpaschim province to build a road
Nepalese mountain roads are treacherous and subject to accidents and landslides. Rural roads, which are often called “dozer roads”, are constructed by bulldozer owners in collaboration with politicians at the request of communities (also as part of the election manifesto in which politicians promised road access in exchange for votes and support to win), often without proper technical guidance, surveying, drainage, or structural protection measures. In addition, mountains are sometimes damaged by heavy earthmovers (so-called “bulldozer terrorism”) that cut out roads that lead from nowhere to nowhere, or where no roads are needed, at the expense of economic and environmental degradation. Such rapid and ineffective road expansion happens throughout the country, particularly in the middle hills where roads are known to be the major manmade driver of landslides.
To tackle these complexities, we need to rethink how we approach development in light of climate change. This has to be done with sufficient investigation into our past actions. The Nepalese Community forestry management program, which emerged as one of the big success stories in the world, encompasses well defined policies, institutions, and practices. The program is hailed as a sustainable development success with almost one-third of the country’s forests (1.6 million hectares) currently managed by community forest user groups representing over a third of the country’s households. Another successful example is the innovation of ropeways and its introduction in the Bhattedanda region South of Kathmandu. The ropeways were instrumental in transforming farmers’ lives and livelihoods by connecting them with markets. Locals quickly mastered the operation and management of the ropeway technology, which was a lifesaver following the 2002 rainfall that washed away the road that had made the ropeway redundant until then.
These two examples show that it is possible to generate ecological livelihoods for several households in Nepal without adversely affecting land use and land cover, which in turn contributes to increased landslide risk in the country, as mentioned above.
A rugged landscape is the greatest hindrance to the remote communities in a mountainous country like Nepal. It cannot be denied that the country needs roads that serve as the main arteries for development, while local innovations like ropeways can well complement the roads with great benefits, by linking remote mountain villages to the markets to foster economic activities and reduce poverty. Such a hybrid transportation model is more sustainable economically as well as environmentally.
It is a pity that despite strong evidence of the cost-effectiveness of alternative local solutions, Nepal’s development is still mainly driven by “dozer constructed roads”. Mountain lives and livelihoods will remain at risk of landslides until development tools become more diverse and compatible.
By Xu Wang, IIASA Young Scientists Summer Program (YSSP) alumnus and Assistant Professor at Beijing University of Technology and Pallav Purohit, researcher in the IIASA Air Quality and Greenhouse Gases Program.
Xu Wang and Pallav Purohit write about their recent study in which they found that accelerating the transition to climate-friendly and energy-efficient air conditioning in the Chinese residential building sector could expedite building a low-carbon society in China.
China saw the fastest growth worldwide in energy demand for space cooling in buildings over the last two decades, increasing at 13% per year since 2000 and reaching nearly 400 terawatt-hours (TWh) of electricity consumption in 2017. This growth was largely driven by increasing income and growing demand for thermal comfort. As a result, space cooling accounted for more than 10% of total electricity growth in China since 2010 and around 16% of peak electricity load in 2017. That share can reach as much as 50% of peak electricity demand on extremely hot days, as seen in recent summers. Cooling-related carbon dioxide (CO2) emissions from electricity consumption consequently increased fivefold between 2000 and 2017, given the strong reliance on coal-fired power generation in China .
In our recent publication in the journal Environmental Science and Technology, we used a bottom-up modeling approach to predict the penetration rate of room air conditioners in the residential building sector of China at the provincial level, taking urban-rural heterogeneity into account. Our results reveal that increasing income, growing demand for thermal comfort, and warmer climatic conditions, could drive an increase in the stock of room air conditioners in China from 568 million units in 2015 to 997 million units in 2030, and 1.1 billion units in 2050. In urban China, room air conditioner ownership per 100 households is expected to increase from 114 units in 2015 to 219 units in 2030, and 225 units in 2050, with slow growth after 2040 due to the saturation of room air conditioners in the country’s urban households. Ownership of room air conditioners per 100 households in rural China could increase from 48 units in 2015 to 147 units in 2030 and 208 units in 2050 .
The Kigali Amendment to the Montreal Protocol on Substances that Deplete the Ozone Layer will help protect the climate by phasing down high global warming potential (GWP) hydrofluorocarbons (HFCs), which are commonly used as refrigerants in cooling technologies . Promoting energy efficiency of cooling technologies together with HFC phase-down under the amendment can significantly increase those climate co-benefits. It is in this context that we assessed the co-benefits associated with enhanced energy efficiency improvement of room air conditioners (e.g., using efficient compressors, heat exchangers, valves, etc.) and the adoption of low-GWP refrigerants in air conditioning systems. The annual electricity saving from switching to more efficient room air conditioners using low-GWP refrigerants is estimated at almost 1000 TWh in 2050 when taking account of the full technical energy efficiency potential. This is equivalent to approximately 4% of the expected total energy consumption in the Chinese building sector in 2050, or the avoidance of 284 new coal-fired power plants of 500 MW each.
Our results indicate that the cumulative greenhouse gas mitigation associated with both the electricity savings and the substitution of high-GWP refrigerants makes up 2.6% of total business-as-usual CO2 equivalent emissions in China over the period 2020 to 2050. Therefore, the transition towards the uptake of low-GWP refrigerants is as vital as the energy efficiency improvement of new room air conditioners, which can help and accelerate the ultimate objective of building a low-carbon society in China. The findings further show that reduced electricity consumption could mean lower air pollution emissions in the power sector, estimated at about 8.8% for sulfur dioxide (SO2), 9.4% for nitrogen oxides (NOx), and 9% for fine particulate matter (PM2.5) emissions by 2050 compared with a pre-Kigali baseline.
China can deliver significant energy savings and associated reductions in greenhouse gas and air pollution emissions in the building sector by developing and implementing a comprehensive national policy framework, including legislation and regulation, information programs, and incentives for industry. Energy efficiency and refrigerant standards for room air conditioning systems should be an integral part of such a framework. Training and awareness raising can also ensure proper installation, operation, and maintenance of air conditioning equipment and systems, and mandatory good practice with leakage control of the refrigerant during the use and end-of-life recovery. Improved data collection, research, and cooperation with manufacturers can equally help to identify emerging trends, technology needs, and energy efficiency opportunities that enable sustainable cooling.
 IEA (2019). The Future of Cooling in China: Delivering on Action Plans for Sustainable Air Conditioning, International Energy agency (IEA), Paris.
 Wang X, Purohit P, Höglund Isaksson L, Zhang S, Fang H (2020). Co-benefits of energy-efficient air conditioners in the residential building sector of China, Environmental Science & Technology, 54 (20): 13217–13227 [pure.iiasa.ac.at/16823]
 Purohit P, Höglund-Isaksson L, Dulac J, Shah N, Wei M, Rafaj P, Schöpp W (2020). Electricity savings and greenhouse gas emission reductions from global phase-down of hydrofluorocarbons, Atmospheric Chemistry and Physics, 20 (19): 11305-11327 [pure.iiasa.ac.at/16768]
Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis (IIASA).
By Finn Laurien, researcher in the IIASA Risk and Resilience Program and Reinhard Mechler, Acting Program Director IIASA Risk and Resilience Program
The global COVID-19 crisis is challenging the social fabric of countries and communities across the globe. Interventions such as lockdowns, social distancing measures, and economic stimulus packages have been introduced to reinforce societal resilience. The resilience of national health systems is particularly in the spotlight – primarily keeping occupancy numbers of intensive care beds under a critical threshold, as well as improving access to basic health services for people infected with the virus, and ensuring that infections do not spread further.
At the same time, many COVID-19 affected regions and communities are confronted with additional multiple threats, including disaster and climate risks like flooding. For example, South Asia will be facing the monsoon season soon, and cyclones have already ravaged islands in the Pacific. So the question becomes, how do we support communities in preparing for and building resilience to such compound events like disasters AND infectious diseases?
Resilience has emerged as a system-based concept that explains how systems respond to shocks. IIASA has a long history of conceptualizing and assessing resilience. In partnership with members of the Zurich Flood Resilience Alliance (ZFRA), IIASA has co-developed an innovative approach called the Flood Resilience Measurement for Communities (FRMC) that measures the various facets of what builds resilience against flood risk at community levels. The FRMC consists of a holistic framework and an indicator-based assessment tool. It measures resilience before and after disasters at the community level – where people feel the impacts acutely and work together to take action. We define resilience widely in terms of a systems-thinking and development-centric conceptualization: “The ability of a system, community or society to pursue its social, ecological and economic development and growth objectives, while managing its disaster risk over time in a mutually reinforcing way.”
The FRMC measures resilience across a number of indicators that are collected through humanitarian and development NGO Alliance partners in communities in Asia, Europe, Latin America, and North America. It provides vital information for decision makers by prioritizing the resilience-building measures most needed by a community. At community and higher decision-making levels, measuring resilience also provides a basis for improving the design of public or privately funded programs to strengthen disaster resilience.
One of the seven themes that has been defined as a key aspect from the FRMC systems thinking approach is “Life and Health”, which is also relevant when looking at COVID-19 and includes access to and availability of healthcare facilities; strategies to maintain or quickly resume interrupted healthcare services; safety knowledge and Water and Sanitation (WASH).
Insights into dealing with COVID-19
In a recent research paper we analyzed FRMC data collected in 118 communities across nine countries in Asia, Latin America, and the US and explored which capacities or capitals contribute most to community disaster resilience. We identified multiple interactions, for instance, how action on bolstering health also contributes to social capital. There are two takeaways from this research that are relevant to other compound events, including the COVID-19 pandemic.
First, fair and functioning health systems play a key role in building resilience against compound risk – against flood as well as against other stresses that lead to negative health outcomes. Strategies that enable interrupted health systems to quickly resume are critical, and need to be in place before a disaster strikes.
In the communities where ZFRA conducted FRMC studies, disaster resilience and the health component scored relatively low at the beginning. However, when interventions such as household health-related trainings in Mexico, or hospital capacity assessments in Nepal, were implemented (with our measurement tool running), the health component increased for almost all countries (except for the USA) (see blue line in Figure 1). As the health component is a key part of resilience it contributed to disaster resilience overall, including ‘compound risks’ (green line in Figure 1). This means that (further) accelerating investments into health services (e.g., as part of COVID-19 response and recovery packages) leads to additional benefits for other shocks.
Figure 1: Between 2013 and 2018, increased community resilience can be attributed to resilience against compound risk (green line) and includes a health component (blue line). The difference between the two lines indicates the attribution of the increase in specific resilience to flood hazard.
A second takeaway is that through a so-called ‘multifunctionality’ effect, co-benefits are induced. This provides evidence of a virtuous cycle effect where higher resilient capacity in one area fosters communities’ resilience capacity for other functions. As community functions and outcomes are connected in a community system, improved access to health services can generate co-benefits (e.g., healthier individuals attain higher levels of livelihoods and build more social networks, which again build resilience during a shock). This has been well understood in the theoretical literature, and our analysis for the first time provides needed evidence at community level for flood and disaster risk.
If these co-benefit effects are taken into account, we find evidence that Food and Water strategies (see Figure 2) can be most efficient in building resilience to both adverse flood and health events. In fact, our sources of resilience indicate that the capacity in the Food and Water dimensions also foster health resilience.
Risk awareness is hazard-specific but can be integrated into packages that tackle risk generally. For example, health relevant interventions for infectious diseases (e.g., appropriate hygiene measures) can be integrated into flood evacuation plans. A best-practice example from our work are the campaigns and fairs carried out in Mexico and Nepal targeting educational awareness on health-related impacts during flood events.
Going forward with resilience thinking
Figure 2: Attribution of flood resilience to health component. Some dimensions show a similar pattern in building both flood and health resilience. Other flood-related efforts are too specific and cannot be attributed to resilience against COVID-19.
There is growing recognition by researchers, policymakers, and practitioners of the need to address compound risks in a development-centric way, tackling multiple threats with a focus on human wellbeing, rather than on hazards only. The COVID-19 crisis calls for donors, national governments, civil society, and communities to invest in comprehensive approaches that create multiple benefits.
Our system-based resilience research shows that using a systems resilience assessment at community level can identify direct short- and longer-term benefits. Investing in capacities builds resilience against compound risk such as flooding and infectious diseases. Investment into programs that ramp up health systems and WASH creates multiple benefits in terms of tackling COVID-19 and disaster and climate risks simultaneously. In the context of the upcoming monsoon and hurricane season, this means COVID-19 response and recovery packages need to invest in measures that also reduce social and economic impacts from COVID-19 under flood hazards. Additionally, diversifying household income strategies is high among the measures that unlock multiple co-benefits against compound risks. As action on COVID-19 (hopefully) moves from crisis response to recovery, such measures should be part and parcel of a post-COVID-19 recovery process, reducing the risk of vulnerable groups falling into poverty traps.
Keating, A., Campbell, K., Mechler, R., Magnuszewski, P.,Mochizuki, J.,Liu, W., Szoenyi, M., McQuistan, C. (2016). Disaster resilience: What it is and how it can engender a meaningful change in development policy. Development Policy Review 35 (1): 65-91
Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.
About 2.9 billion people depend on burning traditional fuels like firewood rather than modern cooking fuels like gas and electricity to cook their daily meals. The household air pollution caused when these fuels are burned, along with the resultant exposure to kitchen smoke causes several respiratory and other diseases. It is estimated that between 2 and 3.6 million people die every year due to lack of access to clean cooking fuels. It also has severe environmental effects like forest degradation and contributes to climate change. To address these challenges, the Indian Government launched a massive program called Pradhan Mantri Ujjwala Yojana (PMUY, or Ujjwala) to scale up household access to Liquefied Petroleum Gas (LPG) in May 2016.
My IIASA Young Scientists Summer Program (YSSP) project under Shonali Pachauri’s supervision was about analyzing consumption patterns of LPG in rural India. We looked at whether there was any differences in consumption patterns between the Ujjwala beneficiaries and general consumers. The analysis formed part of my PhD research and was eventually published as the cover story for the September 2019 issue of the journal, Nature Energy. The journal also invited us to write a policy brief, which was published in January 2020. The study’s findings received widespread media attention, especially in India. When I talk to journalists, they often ask whether the Ujjwala program is a success or a failure. I would like to use this opportunity to clear common misconceptions and share my thoughts.
The Ujjwala program’s original mandate was to tackle the challenge of “lack of access to clean fuel” and to make LPG affordable for poor women. The program provided capital subsidies to this end. Unfortunately, the policy document neither discussed usage of LPG as an exclusive or primary cooking fuel, nor did it provide any incentive for regular use (barring the universal LPG cylinder subsidy that is provided to everyone). The program was ambitious in terms of both scale and timeline, and fulfilled its original aim of providing LPG connections for millions of poor women.
Current debates around the program’s failure to result in smokeless kitchens are happening only because Ujjwala succeeded in fulfilling its original mandate of ensuring physical access. In my opinion, it is truly a remarkable achievement to have reached out to 80 million poor women within 40 months. The process not only involved massive awareness generation and community mobilization, but also ramping up the supply chain to meet increased demand. While I have a lot to say about how Ujjwala can be improved, I think it would be unfair to call it a failure. Access is the first step towards transition to clean fuels, and at least in this respect, it was an extraordinary success, making it a model of energy access for developing countries.
Our research shows that Ujjwala was able to attract new consumers rapidly, but those consumers did not start using LPG on a regular basis. Based on the literature and my own experience, there are five reasons why regular LPG use is a challenge for Ujjwala consumers, and the scheme did not have any specific provisions to effectively address them.
First, rural communities generally have easy access to free firewood, crop residues, cattle dung, etc. So why would they start paying for commercial fuel, when free fuel is readily available for cooking?
Secondly, Ujjwala (bravely) targeted poor women, who generally have limited disposable cash and seasonal, agriculture linked fluctuations in income. If there is no additional income, what costs would a poor family on an already tight budget have to cut to afford such a regular additional expense? While the program has made a 5 kg cylinder option available in response to this issue, the impact on LPG sales is still unknown.
Thirdly, home delivery of LPG cylinders is a challenge in most rural areas, as the cost of delivery for LPG distributors often outweighs the commission they receive. If there is no delivery option, poor rural families who often don’t have access to transport would need to arrange for a cylinder to be picked up from a far-off retail outlet. Oil Marketing Companies have vigorously been pushing for home delivery, but unless there are explicit incentives for this, the situation is unlikely to improve.
In the fourth place, gender dynamics make the situation even more complicated. Men are often financial decision makers who have to make budget cuts, while women are the primary beneficiaries of LPG in terms of a quick and smokeless cooking experience, with the side benefit of avoiding the drudgery of fuelwood collection. The laudable effort of the LPG panchayat platform, where women share their success stories and strategies to overcome opposition within their homes, is a step in the right direction, but it is unlikely that this will be sufficient to tackle a deep-rooted societal problem.
Lastly, and perhaps most importantly, people will have to stop using mud stoves and start using LPG stoves, which may involve real (or, perceived) changes in the taste, texture, look, and size of food items. As a student of habit change literature, I am surprised that anyone expected that such a switch would not be accompanied by behavior change interventions.
Ultimately, the Ujjwala scheme provided incentives to reduce the burden of the capital cost of LPG connections, and poor female consumers responded to it positively. This is a successful first step towards clean cooking energy transition. However, there were no scheme incentives to promote use, except general LPG subsidies, which is available to all, including the urban middle class. Consumers simply decided that the transition to LPG through regular purchase of LPG refills was not worth it, and did not take the next step. I would however not call this a failure of Ujjwala, as that was never the original program objective.
We have to acknowledge that Ujjwala’s phenomenal success in providing access to clean fuel has put the spotlight on its ineffectiveness to ensure sustained regular use. If you ask me, this is a classic case of the glass half-full or half-empty scenario. Or, as my PhD supervisor at the University of British Columbia, Hisham Zerrifi, puts it: “It depends!”
 Kar A, Pachauri S, Bailis R, & Zerriffi H (2019). Using sales data to assess cooking gas adoption and the impact of India’s Ujjwala program in rural Karnataka. Nature Energy DOI: 10.1038/s41560-019-0429-8 [pure.iiasa.ac.at/15994]
Note: This article gives the views of the author, and not the position of the Nexus blog, nor of the International Institute for Applied Systems Analysis.