in the Latin American countries

The purpose of this chapter is to provide an updated snapshot of the water and sanitation sector across Latin American countries, focusing on its key policy characteristics. Access to water and sanitation in the region has improved since the 1990s, a decade in which almost every country adopted major reforms of the sector, consisting mainly in increasing private sector participation and the creation of autonomous regulatory bodies. We find that challenges remain in tariff design, service quality, financial health, and governance issues related to lack of coordination between policymaking, regulation at national and subnational levels, and the operators.


POLLUTION in the Latin American countries a public health concern
Air pollution is the largest environmental risk for public health in the Americas. According to the WHO, more than 150 million people in Latin America and the Caribbean (LAC) live in cities with levels of air pollution exceeding WHO air quality guidelines of 2005.
According to an expert report by the Natural Resources Defense Council (NRDC), "between January to May 2019, Mexico suffered terrible air pollution from raging wildfires throughout the country. These wildfires burned almost 849,000 acres in 32 different jurisdictions. As a result, the air quality in Mexico reached toxic levels in various states, and the government closed schools and recommended that people stay inside. Around the same time, Chile was preparing for winter, the time of year when air pollution is at its worst due to the widespread use of wood for heating and cooking in homes and other buildings. Because of this, cities in central and southern Chile typically have air quality levels that are among the worst in the Western Hemisphere. Ten million Chileans live in areas categorized as 'saturated' due to the high levels of fine particulate matter in the air. " Those living in Chile's heavily industrialized regions, also known as "sacrifice zones" are particularly vulnerable to the adverse effects of environmental contamination including air pollution. According to reports, the health risks of sacrifice zones in Chile were highlighted in mid-2018 when hundreds of people were hospitalized in the Quintero-Puchuncavi area for symptoms that health authorities said were caused by toxic gas leaks.
The NRDC report also states that, "most countries and cities in the LAC region do not have standards for fuel efficiency, vehicle emissions, or fuel quality, which are generally considered to be the basic standards for creating a cleaner transportation sector. This means that the majority of light-and heavy-duty vehicles in the region emit high levels of carbon dioxide and particulate matter, worsening air pollution-and at a rate that is growing due to the increasing number of vehicles in the region. " In addition, household air pollution (HAP) is associated with the inefficient combustion of solid fuels and kerosene, and is one of the leading environmental risk factors for death and disability in the world. Household combustion devices, motor vehicles, waste burning, industrial facilities, refineries, and forest fires are common sources of air pollution in the LAC region.

OIL & GAS FACILITIES
Petroleum refineries are a major source of commonly found air pollutants: Particulate matter (PM), Nitrogen oxides (NOx), Carbon monoxide (CO), Hydrogen sulfide (H2S), Sulfur dioxide (SO2), and hazardous and toxic air pollutants, as well as Volatile Organic Compounds such as BTEX compounds (benzene, toluene, ethylbenzene, and xylene). The combination of volatile organic compounds and oxides of nitrogen also contributes to ground-level ozone formation. These gasses can wreak havoc on communities that live near the production, transmission, and storage of fossil fuels. Some of the chemicals released are known or suspected cancer-causing agents, responsible for developmental and reproductive problems. They may also aggravate certain respiratory conditions such as childhood asthma.
Stack or vent emissions are often identified as the most significant sources of emissions in a refinery. However, fugitive emissions from storage tanks, cooling tanks, pipe connectors, valves, equipment leaks, flanges, pumps, compressors, pressure release devices, transfer of raw materials, etc. can violate the ambient air quality standards and even exceed the stack emissions. Pollution control agencies often do not monitor fugitive emissions. There is a robust association between several adverse health effects and ambient air particulate matter levels. Very small (fine) particles exert disproportionately more adverse health effects than larger particles.
According to the United States Environmental Protection Agency: "Particles less than 10 micrometers in diameter (PM10) pose a health concern because they can be inhaled into and accumulate in the respiratory system. Particles less than 2.5 micrometers in diameter (PM2.5) are referred to as 'fine' particles and are believed to pose the largest health risks. Because of their small size (less than one-seventh the average width of a human hair), fine particles can lodge deeply into the lungs.
"Health studies have shown a significant association between exposure to fine particles and premature mortality. Other important effects include aggravation of respiratory and cardiovascular disease (as indicated by increased hospital admissions, emergency room visits, absence from school or work, and restricted activity days), lung disease, decreased lung function, asthma attacks, and certain cardiovascular problems such as heart attacks and cardiac arrhythmia. Individuals particularly sensitive to fine particle exposure include older adults, people with heart and lung disease, and children." Sulfur dioxide is produced when oil and coal containing sulfur burns. It can cause health issues, especially in people with existing heart or lung conditions. Sulfur dioxide irritates the respiratory tract and increases the risk of tract infections. It causes coughing and mucus secretion and aggravates conditions such as asthma and chronic bronchitis. Sulfur dioxide mixes with water to produce sulfuric acid (known as acid rain) which can impact urban infrastructure, forests, waterbodies, and aquatic life. Nitrogen dioxide (NO2) is one of a group of highly reactive gasses known as oxides of nitrogen or nitrogen oxides (NOx). Other nitrogen oxides include nitrous acid and nitric acid. NO2 is used as the indicator for the larger group of nitrogen oxides. NO2 primarily gets in the air from the burning of fuel. NO2 forms from emissions from cars, trucks and buses, power plants, and off-road equipment.
Breathing air with a high concentration of NO2 can irritate airways in the human respiratory system. Such exposures over short periods can aggravate respiratory diseases, particularly asthma, leading to respiratory symptoms (such as coughing, wheezing, or difficulty breathing), hospital admissions, and visits to emergency rooms. Longer exposures to elevated concentrations of NO2 may contribute to the development of asthma and potentially increase susceptibility to respiratory infections.
Nitrogen dioxide along with other NOx reacts with other chemicals in the air to form both particulate matter and ozone. Both are also harmful when inhaled due to their effects on the respiratory system.
Volatile organic compounds (VOCs) are chemicals that contain carbon and can quickly turn into vapors or gasses. These VOCs can be released by several products or items in everyday life. The simplest way to determine the presence of VOCs in the air is through their distinct odors.

Benzene Toluene
Benzene is a known carcinogen (cancercausing chemical) and it is particularly known to cause leukemia. The main effect of benzene from long-term exposure is on the blood. It causes harmful effects on the bone marrow and can cause a decrease in red blood cells leading to anemia. It can also cause excessive bleeding and can affect the immune system, increasing the chance of infection. Prolonged exposure may result in blood disorders like leukemia, reproductive and developmental disorders, and other cancers.
Low to moderate levels can cause headaches, dizziness, tiredness, confusion, weakness, drunken-type actions, memory loss, nausea, and loss of appetite. These symptoms usually disappear when exposure stops. Toluene may affect the nervous system. Long-term daily exposure to toluene in the workplace may cause some hearing and color vision loss. Repeatedly breathing toluene from glue or paint thinners may permanently damage the brain. Exposure to high levels of toluene during pregnancy, such as those associated with solvent abuse, may lead to developmental effects, such as reduced mental abilities and growth in children. High levels of exposure for short or long periods can cause headaches, lack of muscle coordination, dizziness, confusion, and changes in one's sense of balance. Exposure of people to high levels of xylene for short periods can also cause irritation of the skin, eyes, nose, and throat; difficulty in breathing; problems with the lungs; delayed reaction time; memory difficulties; stomach discomfort; and possibly changes in the liver and kidneys. It can cause unconsciousness and even death at very high levels.

Ethylbenzene Xylene
Exposure to high levels of ethylbenzene in the air for short periods can cause eye and throat irritation. Exposure to higher levels can result in dizziness. Animal studies have reported effects on the blood, liver, and kidneys from chronic inhalation exposure to ethylbenzene.
Ozone can be "good" or "bad" for health and the environment depending on where it is found in the atmosphere. Stratospheric ozone (found 32 kms above ground) is "good" because it protects living things from ultraviolet radiation from the sun. Ground-level ozone, also known as tropospheric ozone, is "bad" because it is a greenhouse gas and air pollutant, which is harmful to human and ecosystem health. It can trigger a variety of health problems, particularly for children, the older adults, and people who have lung diseases such as asthma. It is also a major component of urban smog.

METHANE AND HEALTH
Methane is a colorless, odorless, and highly flammable gas, which is the primary component of natural gas, biogas, and marsh gas. Depending on its origin it may be referred to as either of these. It is a powerful greenhouse gas emitted by human activities such as oil and gas production, waste landfills, and the raising of livestock, as well as by natural sources such as wetlands and volcanoes.
Methane is used for domestic cooking and heating, in energy generation, and in industry to refine petrochemicals and to produce plastics, fertilizers, anti-freeze, and fabrics.
Methane is present in the atmosphere (and its levels are increasing); therefore, the public may be exposed to very low levels when breathing in the air. Lowlevel exposure to methane can also occur from the use of natural gas products or gas appliances in the home. Low-level exposure would not be expected to cause adverse health effects.
Occupational exposure to methane may occur in the workplace where it is extracted, produced, or used. Exposure to high levels of methane can reduce the amount of oxygen breathed from the air. This can result in mood changes, slurred speech, vision problems, memory loss, nausea, vomiting, facial flushing, and headache. In severe cases, there may be changes in breathing and heart rate, balance problems, numbness, and unconsciousness. If exposure to methane is large or continues for a longer period, it can result in death.
Methane is a key precursor gas of the harmful air pollutant, tropospheric ozone. Globally, increased methane emissions are responsible for half of the observed rise in tropospheric ozone levels. While low-level methane does not cause direct harm to human health or crop production, ozone is responsible for about 1 million premature respiratory deaths globally. Methane is responsible for about half of these deaths.

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Methane has a global warming potential at least 84 times greater than CO2. Reducing its emissions is not only necessary to limit global temperature rise to 1.5 C, but it is also essential for the prevention of its numerous effects on human health.

BLACK CARBON
Black carbon is the sooty black material emitted from gas and diesel engines, coal-fired power plants, and other sources that burn fossil fuel. It comprises a significant portion of particulate matter or PM, which is an air pollutant. Black carbon is a global environmental problem that has negative implications for both human health and our climate. Inhalation of black carbon is associated with health problems including respiratory and cardiovascular disease, cancer, and even birth defects. And because of its ability to absorb light as heat, it also contributes to climate change. For example, as black carbon warms the air, rapid changes in patterns of rain and clouds can occur.
While air pollution is a problem that affects everyone, some groups of people are more vulnerable than others. These groups are multiple and may be overlapping; they include children, pregnant women and other pregnant people, fetus, older adults, economically disadvantaged people, people with respiratory ailments (asthma and chronic bronchitis), and people with cardiovascular disease or diabetes When ambient air quality standards are set, special attention needs to be paid to ensure that the levels established are stringent enough to protect these vulnerable populations and not only those who are fully grown and in good health.

AT RISK
| 12 1. Highlight the health impacts of pollution and humanize the issue in the media, with the public and policymakers or with other colleagues and within professional medical associations.
2. Generate local health evidence from their clinics and communities on the health impacts of air pollution.
3. Provide health advisories for protecting their patients and the vulnerable population from the dangers of air pollution.
4. Highlight the health co-benefits of clean air and advocate for actions that promote clean air to their patients, communities, and policymakers.
5. Advocate for robust health adaptation and mitigation plans to combat the adverse health impacts of poor air quality, especially on the economically disadvantaged and marginalized populations.
6. Advocate for a just transition from dependence on fossil fuels to an economy that values health and is based on clean, renewable, healthy energy.

HOW CAN HEALTH CARE PROFESSIONALS ADVOCATE FOR CLEAN AIR?
Health professionals are usually the most trusted voices in their communities. Country leadership looks to them for advice, families confide in them, and citizens want to adhere to what the country's leading medical professionals have to say about their health. When doctors, nurses, hospitals, and health systems take public stances on air pollution and climate change, it can reframe these issues as questions of public health and help move public opinion and policy. The voices of health workers are critical in promoting actions that address air pollution and its impacts on health. Health care professionals can make a big difference -with their patients, in their practices, and in their health care institutions.