1 präsentationstitel transport, air pollution and health in europe prof. nino künzli, md, phd...
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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
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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
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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
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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
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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
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ESCAPE study areas inEUROPE
PM+NOx
NOx only
Larger studies….
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% 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….
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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»
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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)
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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
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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
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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
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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……
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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
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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
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Combustion – the prime cause of ambient air
pollution (and climate change…) in Europe
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NOx emission trends in Europe (EU-28)
from various sources
17
Fuel household/institutional
in 1’000 tons / yr
Transport
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Fine particle emission trends in Europe (EU-28) from various sources
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Fuel household/institutional
in 1’000 tons / yr
Transport
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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)
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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
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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
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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)
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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%
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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?
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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
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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
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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
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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)
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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
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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
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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
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Transport and health…
... is also an
“urban planning” issue
(transportation
infrastructure...)
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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
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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
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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
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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
41
Vehicle Kilometers driven / year
GDP in 1990:
30‘000 Mio $
Gross Domestic Product (GDP)
in 2010:
70‘000 Mio $
… it works !
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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
[email protected] 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)