1Präsentationstitel

Transport, Air Pollution and Health in Europe Prof. Nino Künzli, MD, PhD

Deputy-Director Swiss Tropical and Public Health Institute Basel

Dean of the Swiss School of Public Health (SSPH+)

Professor of Public Health, University Basel, Switzerland

Prepared for 13th Session

Transport, Health and Environment Pan-European Programme (THE PEP) 2015 Symposium

Reducing transport-related emissions for a better environment and human health

WHO Regional Office for Europe and Economic Commission for Europe

Geneva November 17th, 2015 - 15-18h Policy Briefing – 15:30-16:00

Department of Epidemiology & Public Health

Swiss TPH is an associated Institute of University of Basel

Content

1. Health effects: up-dates & trends

2. Emission trends

3. Concentrations & exposure

4. Health and economic impact

5. Transport & noise

6. Communication issues

2

Scientific Advisory Committee: Hugh Ross Anderson, Bert Brunekreef, Aaron Cohen, Klea Katsouyanni, Dan Krewski, Wolfgang Kreyling,

Nino Künzli, Xavier Querol

LINK: http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/air-quality/activities/health-aspects-of-air-pollution-and-review-of-eu-policies-the-revihaap-and-hrapie-projects

PDF: http://www.euro.who.int/__data/assets/pdf_file/0004/193108/REVIHAAP-Final-technical-report-final-version.pdf?ua=1

2013

Health Effects of air pollutionAcute Effects• Daily mortality

• Respiratory & cardiovascular problems

Hospital Admissions

Emergency room visits

Primary care visits

Additional medication / self medication

Days of restricted activities

Work & school absenteism

• Physiologic changes (e.g. lung function)

Long-term effects• Chronic diseases

Life expectancy

Chronic obstructive lung disease

Asthma

Lung cancer

Faster aging & loss of lung function

• Atherosclerosis cardiovascular diseases

More to come…

• Diabetes

• Neurodevelopment, cognitive function

• Pre-term birth

• Low birth weight

4

Relevant trends in science and evidence

o Larger studies, better power, detection of sensitive subgroups, evaluation of thresholds

o Better understanding of mechanisms

o Insights into pollutant- , source-, subject- and life period-specific effects (e.g. pregnancy)

o New health outcomes of interest: diabetes, metabolic syndrom, neurodevelopment, cognitive function etc.

5A few examples

ESCAPE study areas inEUROPE

PM+NOx

NOx only

Larger studies….

7

% change in death

All subjects: (N=322’159;19 cohorts)

7% (2 to 13%)

Distribution of home outdoor PM2.5 among participants of 19 European cohort studies and effect of a 5µg/m³ increase in

home outdoor PM2.5 on mortality (ESCAPE Study – Beelen et al, Lancet 2013)

Larger studies….

8

Only subjects <20µg/m³

(N=304’759; 17 studies):

7% (1 to 13%)

% change in death

All subjects: (N=322’159;19 studies)

7% (2 to 13%)

No thresholds of «no effect»

Traffic density (per 5’000 vehilces per day) is associated with the prevalence of hypertension in 12 ESCAPE cohorts

Fuks et al, EHP, Sept 2014

Source related effect (traffic)

Prevalence of hypertension

increased 2% per 5’000 vehicles passing in front of the home

(per day)

Living close to busy roads increases exposure to ultrafine particles (UFP), soot, black smoke (BS),

elemental carbon (EC)

These toxic constituencies affect health too, for example:

• Carcinogenic ( lung cancer)

• Death ( shorter life expectancy)

• Morbidity (cardio-respiratory)

• Neurodevelopment

If traffic pollution management plans reduce «black smoke» concentration by 10µg/m³

Life expectancy increases ~3-4 monthsJannsen et al, Env Health Perspect, Dec 2011

10

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Environmental International, 2015

novel health outcomes

Prevalence of DIABETES is associated with home outdoor air quality (PM10) in the Swiss

SAPALDIA study (and in other studies too)Eze et al, Env Internat 2015

Air Pollution and Neuropsychological Development:

A Review of the Latest EvidenceSuades-González,et al, Endocrinology, 2015

“Sufficient evidence” for detrimental effects of pre- or postnatal exposure to

• Polycyclic aromatic hydrocarbons intelligence

quotient (IQ)

• PM2.5 autism

spectrum disorder

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novel health outcomes

pollutant specific effects: diesel soot

BUT: there is no «magic bullet»!

ALL ARE HEALTH RELEVANT:

soot, ultrafine particles, coarse

particles, PM2.5, PM10, NOx,

Ozone, SO2 etc……

low normal increased obese

Body-mass-index

Att

enu

atio

n o

f lu

ng

fu

nct

ion

loss

p

er 1

0 u

g/m

3 im

pro

vem

ent

in f

ine

par

ticl

es

benefit

Obese did not profit from beneficial effect of better air quality on attenuation of lung function loss

(Schikowski et al, Swiss SAPALDIA Study, 2014)

susceptibility factors

Content

1. Health effects: up-dates & trends

2. Emission trends

3. Concentrations & exposure

4. Health and economic impact

5. Transport & noise

6. Communication issues

15

16

Combustion – the prime cause of ambient air

pollution (and climate change…) in Europe

NOx emission trends in Europe (EU-28)

from various sources

17

Fuel household/institutional

in 1’000 tons / yr

Transport

Fine particle emission trends in Europe (EU-28) from various sources

18

Fuel household/institutional

in 1’000 tons / yr

Transport

19

Trends in black carbon emissions from surface transportation (teragrams per yr) (World Bank Report. 2014)

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Trends in vehicle activity (World Bank Report. 2014)

Content

1. Health effects: up-dates & trends

2. Emission trends

3. Concentrations & exposure

4. Health and economic impact

5. Transport & noise

6. Communication issues

21

EU annual mean limit value

WHO annual mean limit value

The lack of attainment situation in the EU-28 as compared to science-based WHO annual mean limit values

91-93%of EU citizens live where home outdoor

PM2.5 levels are higher than recommended by WHO to protect health

(i.e. > 10 µg/m³)

Large percentage of EU citizens live close to busy roads (> 10’000 vehicles per day)

Perez at al (APHEKOM Team) – Eur Respir J 2013

City Population (Million in habitants)

% population within 75m

(average 29%)

% population within 150m

(average 52%)

Granada 0.24 14% 28%

Ljubljana 0.27 23% 47%

Bilbao 0.31 29% 59%

Sevilla 0.7 20% 38%

Valencia 0.74 44% 71%

Brussels 1.03 37% 64%

Stockholm 1.3 14% 30%

Barcelona 1.53 56% 77%

Vienna 1.66 36% 62%

Rome 2.81 22% 43%

1. High income (or education) is not necessarily associated with better air quality home outdoors !

2. Associations vary across European cities and possibly even within cities

3. BUT: poverty correlates with poorer health and nutrition status, which may increase susceptibility to air pollution

Does socio-economic status determine exposure?

Content

1. Health effects: up-dates & trends

2. Emission trends

3. Concentrations & exposure

4. Health and economic impact

5. Transport & noise

6. Communication issues

26

Premature mortality attributable to ambient air pollution (PM2.5 & Ozone) in Europe

Lelieveld et al, Nature 2015

2010381’000 death

2050530’000 death

Largest source :traffic (30-40%)(assuming carbonecous PM toxicity

to be 5x higher; else ~20%)27

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Primary source of air pollution attributable mortality

(Lelieveld et al, Nature 2015)

biomassresidential comb. agriculture

TRANSPORT

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Percent of diseases attributed to traffic-related air pollution in 10 EU cities (6 countries) with 1.89 mio

children and 1.85 mio. adults >65 yrs

Attributable to near-road pollution: Asthma cases in children

14% Coronary heart diseases

28%

Attributable to urban air pollution (including from traffic)

Episodes with asthma symptoms 15% Asthma hospitalisations

15% Non-fatal myocardial infarctions 31% Hospital admission for infarctions 29% Hospital admission for stroke 27%Perez at al (APHEKOM Team) – Eur Respir J 2013; Chanel et al, Eur J Health Economics, 2015 in press

...translates into costs of

370 million Euro / yr

Economic impact of air pollution in 48 member states of European Region(OECD report 2015)

• Morbidity and premature mortality costs:

1.575 tril. US$/yr

• >1% of Gross Domestic Product (in 44 out of 48 countries)

• Road transport fraction: ~50% of total

• Benefits of Commission proposal B7 to costs

42 : 1

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Content

1. Health effects: up-dates & trends

2. Emission trends

3. Concentrations & exposure

4. Health and economic impact

5. Transport & noise

6. Communication issues

31

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Shared biologic mechanisms of action !

Noise Air pollution

Blood pressureCardiac function

Serum cholesterol

TriglyceridesFree faty acids

Fibrinogen

AcutePulmonary

reflexes

Chronic: Pulmonary

inflam. / Oxidative stress

Autonomic Nervous System

Systemic inflammation

Atherosclerosis

Myocardial Infarction,

Stroke

ThrombosisSerum Glucose

Stress response

Modified after Henry, 1992; Devlin and Wayne, US EPA

Indirect pathwayConscious

Cortical perception

Emotional stress

Direct pathwayUnconsciousPhysiological

stress

Autonomic nervous systemEndocrine system

Deregulation­ Adrenaline, NA­ Fatty acids­ Glycogenolysis

Glucocorticoids

(cortisol)

Health effects of traffic noise

• Sleep deprivation

• Cardiovascular health (blood pressure)

• Cognitive function

• Other chronic ailments related to psycho stress and sleep disorders

• High expenditures to cope with noise

Pollutant Transport costs

Air pollution health costs * 1,756

Noise & health * & annoyance costs 1,799

CO2 (climate change) 1,959

External costs of transport, Switzerland 2010in millions of Swiss Francs (per yr)

Vienneau et al, 2015

* medical treatment costs, net lost output, replacement recruitment costs, intangible costs

Content

1. Health effects: up-dates & trends

2. Emission trends

3. Concentrations & exposure

4. Health and economic impact

5. Transport & noise

6. Communication issues

35

Transport and health…

... is also an

“urban planning” issue

(transportation

infrastructure...)

Progress expected: Policy roadmap for Light Duty and Heavy Duty Diesel Engines PM emission standards

Light Duty Heavy Duty

on track:

pro-active EU

emission

control

EU – absence of science based ambient air quality standards

• EU «air quality standards» accept large health burden

• EU misleads public in communicating that «only 10-14% of the population» live in unhealthy air (i.e. rest is «in compliance» with EU standards)

• BUT: 91-93% of EU population live at levels above science-based limit values proposed by WHO

WHO Guide-

line

Iran Swissstan-dards

State of

Cali-fornia

U.S.A.Fede-

ral

E.U.

PM2.5

annual

mean

10 µg/m3

10 µg/m3

(10 µg/m3)Proposed by Federal Commis-

sion

12 µg/m3

12 µg/m3

25 µg/m3

Interest-based rulesScience based standards

For a Table with National standards: see Künzli et al, IJPH Editorial Aug 2015 and Swiss TPH web site - http://ludok.swisstph.ch/

Not at all on

track:

EU air quality

standards

VW Scandal in context

• In Europe not (primarily) an «air pollution health» but an ethical and legal scandal (industry grossly misleading authorities and the public

• Reminder for high relevance of strong regulations of emissions coupled with independent emission control strategies, science-based ambient air quality standards, and monitoring to protect public health

• Health damage caused by inadequate air quality standard setting of EU Commission is MUCH LARGER than what (health damage) of VW scandal can ever be!

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not on track:

global

science-based

policies

NOx emissions, traffic and gross domestic product development in Switzerland, 1990 - 2010

1990 2010

70‘000 tons NOx / yr

10‘000 tons NOx / yr

NOx emissions from traffic

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Vehicle Kilometers driven / year

GDP in 1990:

30‘000 Mio $

Gross Domestic Product (GDP)

in 2010:

70‘000 Mio $

… it works !

CONCLUSION• Transport related pollutants and noise affect HEALTH

and the climate

• Clean air policies DO WORK - air pollution is NOT the «price to pay» for economic progress

• Air pollution and noise cause a large economic health burden

• EU air quality standards ignore science: >90% of EU inhabitants live in places not complying with WHO air quality recommendations

• WHO Guideline values are NOT NEGOTIABLE and must be globalized

• Strong emission standards, control, and monitoring crucial

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Thank you for your attention

Nino.Kuenzli@unibas.chDeputy Director Swiss Tropical and Public Health Institute Basel and

Dean Swiss School of Public Health SSPH+ (Universities of Basel, Bern, Geneva, Lausanne, Lugano, Luzern, Neuchâtel, Zürich)