Air quality management: Health...
Transcript of Air quality management: Health...
Air quality management:Air quality management:Health implicationsHealth implications
Marco Martuzzi
World Health Organization, Regional Office for Europe
European Centre for Environment and Health, Rome Division
WHO Regional Office for Europe
Role of air pollution on healthRole of air pollution on health
§ Large amount of data§ Important role established§ Mortality, morbidity and hospital admission, lung
development and function, respiratory symptoms§ Short- and long-term effects§ Adults, children, elderly, other susceptible groups
WHO Monograph: The effects of air pollution on children’s health and development: a review of the evidence
Proportion of population affected
Severity
Air pollution and health: health effects “pyramid”
Early mortalityCardio-respiratory disease
Hospital admissionAsthma exacerbationDoctor consultancy
Impaired physical conditionPharmaceuticals use
Symptoms, discomfortReduced lung function
Sub-clinical effects
Early mortalityCardio-respiratory disease
Hospital admissionAsthma exacerbationDoctor consultancy
Impaired physical conditionPharmaceuticals use
Symptoms, discomfortReduced lung function
Sub-clinical effects
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Some questionsSome questions
§ Independent and combined effects of various pollutants§ Interaction with other risk factors and allergens§ Particles size and composition§ Relevant time window for exposures
§ Sources (especially from transport, which vehicles)§ Exposure assessment and distribution in the population§ Assessment of health impact and costs§ Development of protective and preventive policies in
different countries
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Assessing the health impact of air pollutionAssessing the health impact of air pollution
§ Risks have been identified, and dose-response relationships have been characterised for several pollutants and health endpoints§ Compared to other risk factors risks are small§ Exposure is ubiquitous, majority of people exposed§ Need to assess overall public health relevance of
air pollution§ Air quality monitoring data increasingly available
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Assessing the impactAssessing the impact
§ Policy makers under growing pressure§ Underlying cost-benefit type question, “what would
we gain if we could reduce concentrations to X?Ӥ Metrics for health impact: attributable risks (risk
assessment studies), years of life lost (YLL), and economic evaluations§ Air pollution impact studies have been published,
e.g., France-Switzerland-Austria (Kuenzli 2000); UK (Hurley 2000), Italy (2001), US, …
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APHEIS recent resultsAPHEIS recent results
§ Air Pollution and Health: A European Information System § 23 cities in Europe, 36 million people§ 3rd phase of project (results released 6 Sept)§ “11 375 deaths, including 8 053 cardiopulmonary
and 1 296 lung cancer deaths, could be prevented annually if long-term exposure to the annual mean of converted PM2.5 levels were reduced to 20 µg/m3 in each city”
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Methods for air pollution HIAMethods for air pollution HIA
§ Use PM as a summary indicator of all pollutants (cannot evaluate separate roles); recent studies include ozone§ Risk functions for selected outcomes§ Exposure estimates, usually average
concentrations for large population§ Observed rates or prevalence§ “Prudent” estimates, i.e., identify part of the health
effects effectively attributable to AP
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8 Italian Cities8 Italian Cities
§ PM10 data from monitoring stations§ Mortality, morbidity, hospital admission§ Average concentration in 52.6 µg/m3
§ Estimate rates or prevalences predicted at lower concentrations§ Compare with observed rates§ Reference PM10 levels: 20, 30, 40 µg/m3
§ “Conservative” risk coefficients, e.g. for long term mortality: 1.026 / 10 µg/m3 (95% CI 1.009 – 1.043)
Reference PM10 level: 30µg/m3
Reference PM10 level: 20µg/m3
Cause Attr prop (%) (95% CI)
Nr attr cases
Attr prop (%) (95% CI)
Nr attr cases
Mortality (Adults aged 30+,
excluding accidental causes)
4.7
(1.7, 7.5)
3 472 7.0
(2.6, 10.9)
5 108
Hospital admissions for CVD
causes
1.7
(1.2, 2.5)
2 710 2.6
(1.7, 3.7)
4 057
Hospital admissions for
respiratory disease
3.0
(2.5, 3.7)
1 887 4.5
(3.7, 5.5)
2 803
Acute bronchitis (aged <15) 28.6
(18.4,32.9)
31 524 36.3
(25.1, 39.7)
40 036
Asthma exacerbation (aged
<15)
8.7
(8.1, 9.2)
29 730 12.5
(11.7, 13.3)
42 870
Asthma exacerbation (aged
15+)
0.8
(0, 1.5)
11 360 1.2
(0, 2.3)
17 047
Restricted activity days (aged
20+)
14.3
(12.5, 15.9)
2 702 461 20.0
(17.7, 22.1)
3 776 387
Occurrence of respiratory
symptoms
11.3
(3.7, 16.0)
10 409 836 16.1
(5.5, 22.2)
14 788 287
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MortalityMortality
§ Long term vs short term§ Who dies? When? (Important especially for
economic evaluation)§ Estimate effects on life expectancy
Predicted total gain in life-years (millions) under various assumed reductions in ambient PM10 pollution in England and Wales, by delay to full effect and population
Delay to full effect (years) Population
Reduction in PM10 concentration,
µg.m–3 0 5 10 20 30
5 8.94 8.20 7.58 6.30 4.97 10 17.89 16.41 15.17 12.61 9.96 15 26.85 24.64 22.78 18.94 14.97
Alive at start of 2000
25 44.81 41.13 38.03 31.63 25.01
5 8.02 8.00 7.96 7.87 7.76 10 16.02 15.95 15.88 15.72 15.48 15 23.97 23.88 23.77 23.52 23.17
Born 2001 to 2135
25 39.77 39.61 39.45 39.04 38.46
From Hurley et al 2000
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Health Impact studiesHealth Impact studies
§ “First generation” studies§ Rough approximations involved, generally
thought to be “conservative”§ Work is needed on:
1. Methods for risk assessment of air pollution2. Interpretation and use of results in public health and risk
management
MORTALITY Total Mortality Cardiovascular Mortality Respiratory Mortality MORBIDITY Hospital Admissions Respiratory Disease Hospital Admissions Respiratory Dis <15 Years Hospital Admissions Respiratory Dis 15-64 Years Hospital Admissions Respiratory Dis 65+ Years Hospital Admissions Asthma <15 Years Hospital Admissions Asthma >15-64 Years Hospital Admissions COPD Hospital Admissions Cardiovascular Disease Hospital Admissions Congestive Heart Elderly Acute Myocardial Infarction Chronic Bronchitis Chronic Bronchitis >25 Years Acute Bronchitis < 15 Years Asthma Attacks Children Asthma Attacks Adults
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ConclusionsConclusions
§ Need to fill the knowledge gap between laboratory, clinical, epidemiological evidence and policy§ Make action on AP more compelling§ Need to improve methodology and evaluate
implications more thoroughly § HIA transport: Noise, accidents, cycling and
walking, psychosocial effects
www.euro.who.int/healthimpactwww.euro.who.int/hearts