The South Durban Industrial Basin is a residential-industrial complex that has one of the highest concentrations of industrial activity in Africa. Plans exist to greatly expand the port area and increase industrialization. Earlier studies indicate high levels of respiratory disease among children in the area and strong evidence that air pollutants are associated with acute changes in health status for children with moderate to severe asthma. This study will evaluate the relationships between air pollutants, health outcomes, larger quality of life impacts, and economic activity in south Durban in order to identify the information and institutional structures needed for policy and decision-making that promotes sustainable development and ultimately improves health outcomes. Specific aims include (1) determining effects of pollutants on respiratory health in children and adults in Durban; (2) estimating socio-economic impacts and direct and indirect costs of diseases associated with pollutants, including perceptions of environmentally-related illness and overall quality of life; (3) understanding the information, values and decision-making processes used by residents to cope with pollutant impacts; (4) identifying factors affecting land use, economic development and environmental policies in Durban; (5) determining whether institutional frameworks and financial mechanisms exist to implement and fund sustainable development initiatives in south Durban; and (6) developing appropriate socio-economic-health indicators to track progress, assess impacts, and guide decision-making. An ongoing epidemiologic investigation will be used to estimate impacts of air pollutant levels on respiratory outcomes in a population-based sample of 4th grade students and their households in seven neighborhoods across Durban. Socio-economic costs of health impacts, health services utilization, and other direct and indirect costs caused by changing pollution levels will be estimated using interviews and daily logs for the study cohorts (490 children, 420 households, 1400 adults). Interviews and focus groups will be conducted with key informants, decision and policy makers in government, industry and nongovernmental organizations, to evaluate their perceptions and knowledge regarding impacts and linkages between environment, development, health and socio-economic impacts. Using results from the health and socio-economic studies in a consultative stakeholder process, indicators will be developed that capture health-socio-economic impacts related to pollution and development. Follow-up interviews and focus groups with key informants will assess participants' concerns, preferences, information needs and potential utilization of the indicators. Lastly, the current policy framework will be assessed and critiqued, together with an assessment of policy choices and development options. These tasks will be incorporated into Durban's Multi-Point Plan, a new government agreement that recognizes the importance of continued economic development as well as the need to address critical health issues. The plan provides for a unified decision-making structure, stakeholder input and substantial resources to sponsor several complementary studies, and it provides tremendous leverage for this study. The multidisciplinary team is dedicated to building research capacity and includes experts in public and environmental health, science and engineering, epidemiology, sociology, law, planning, sustainable development, and economics. The study is designed to respond to Durban's needs and serve as a model for other cities undergoing rapid urbanization and industrial development.