WHO Air Quality Guidelines WHO Air Quality Guidelines WHO Air Quality Guidelines WHO Air Quality Guidelines Emerging Issues Emerging Issues

Carlos DoraCarlos Dora

World Health OrganizationWorld Health Organization

GenevaGeneva

This presentationThis presentation

��The WHO ambient air quality The WHO ambient air quality guidelinesguidelines

��AQG use in policy makingAQG use in policy making

��Emerging issues in air quality and Emerging issues in air quality and ��Emerging issues in air quality and Emerging issues in air quality and healthhealth

–– Evidence on the impact of interventionsEvidence on the impact of interventions

–– CoCo--benefits benefits –– linking climate change and local air linking climate change and local air pollutionpollution

–– Indoor air quality Indoor air quality -- development of WHO development of WHO guidelines guidelines

WHO AQG TeamWHO AQG Team

http://www.euro.who.int/air

Air Quality Guidelines: Air Quality Guidelines: contents part contents part 1 1

N. Janssen (The Netherlands), S. Mehta (US) Human exposure to air pollution3

B. Sivertsen (Norway) Air pollution levels2

R. Harrison (UK) Sources of air pollution1

Part 1. Application of AQG for policy development and risk reduction

AuthorsTitleChapter

K. Balakrishnan (India), NG Bruce (UK) Indoor air quality: special issues in risk assessment and management

9

A. Fernandez (Mexico), M. Zuk (Mexico) Applications of guidelines in policy formulation

8

B. Ostro (US) Health impact assessment7

P. Kinney (US), MS O’Neill (US) Environmental equity6

M. Utell (US), M. Frampton (US) Determinants of susceptibility5

N. Gouveia (Brazil), M. Maisonet (PAHO/Chile) Health effects of air pollution4

N. Janssen (The Netherlands), S. Mehta (US) Human exposure to air pollution3

Air Quality Guidelines: Air Quality Guidelines: contents part contents part 22

P. Saldiva (Brazil), N. Künzli (US / Switzerland) Ozone11

J. Samet (US), M. Brauer (Canada) R.Schlesinger (US)

Particulate matter10

Part 2. Risk assessment of selected pollutants

AuthorsTitleChapter

M. Lippmann (US), K. Ito (US) Sulfur dioxide13

F. Forastiere (Italy), A. Peters (Germany) F. Kelly (UK), ST Holgate (UK)

Nitrogen dioxide12

Scientific Advisory Group:RH Anderson (UK), B. Brunekreef (The Netherlands), B. Chen (China), A. Cohen (USA) R. Maynard (UK), I. Romieu (Mexico), KR. Smith (USA), S. Wangwongwatana (Thailand)

WHO coordination: Michal Krzyzanowski

Air Pollution and Health

All Deaths

Cardio-respiratory

Hospital admissions

Asthma e bronchitis casesSeverity

Visits to emergency rooms

Medical consultations

Reduction in physical capacity

Use of medicaments

Symptoms

Changes in lung function

Sub-clinical effects

Proportion of the population

affected

Long term exposure and Long term exposure and healthhealth

Pope et al, 2002

Short term exposures and Short term exposures and healthhealth

0.46

0.62

0.49

0.4

0.5

0.6

0.7

Percent Increase in Mortality per 10 ug/m3 PM10

0.61

* Estimates Using Pre-GAM Results (without revision)

0

0.1

0.2

0.3

0.4

US(90

Cities)*

Eur(21

Cities)*

Asia (4

Cities)

PAHO (3

Cities)

Curtesy: A. Cohen /HEI

Ozone health effectsOzone health effects

��Respiratory effectsRespiratory effects

�� Cardiovascular Cardiovascular effectseffects

�� Immune effectsImmune effects�� Immune effectsImmune effects

�� Susceptible Susceptible subgroups :subgroups :–– AsthmaticsAsthmatics

–– ChildrenChildren

–– The elderlyThe elderly

–– Those with certain Those with certain underlying diseasesunderlying diseases

Systematic review of the Systematic review of the evidenceevidence

SummaryFull text

Oct Oct –– Nov Nov 20042004: : Steering Group Steering Group established; established;

Jan Jan -- Sept Sept 20052005: : review of the review of the evidence (ca evidence (ca 80 80 experts involved);experts involved);

http://www.who.int/phe/air/aqg2006execsum.pdf

experts involved);experts involved);

1818--20 20 October October 20052005: : WG meeting, BonnWG meeting, Bonn(report published Feb (report published Feb 20062006););

5 5 October October 2006 2006 ––formal announcement formal announcement of AQGof AQG

WHO editing/printing WHO editing/printing

April April 2007 2007 publicationpublication

WHO AQG for particulate matterWHO AQG for particulate matter

Risk of premature mortality decreased by approximately 6% compared to IT1

2550Interim target-2 (IT-2)

Levels associated with about 15% higher long-term mortality than at AQG

3570Interim target-1 (IT-1)

Basis for the selected levelPM2.5(µg/m3)

PM10 (µg/m3) Annual mean level

Lowest levels at which total, CP and LCA mortality have been shown to increase (Pope et al., 2002). The use of PM2.5guideline is preferred.

1020Air quality guideline (AQG)

Mortality risk reduced by approximately 6% compared to IT2 levels.

1530Interim target-3 (IT-3)

AQG 2000: no guideline value

• There is considerable toxicological evidence of potential detrimental effects of UF particles on human health,

• The existing body of epidemiological evidence is insufficient to reach a conclusion on the exposure–

WHO AQG: Global update: WHO AQG: Global update: The role of ultrafine particlesThe role of ultrafine particles

insufficient to reach a conclusion on the exposure–response relationship of UF particles.

No recommendations can be provided as to guideline concentrations of UF particles at this point in time.

Significant health effects, substantial proportion of vulnerable population affected.

240 µg/m3High level

Effects at the selected ozone levelDaily

maximum 8-hour mean

WHO AQG: Global update: WHO AQG: Global update: Ozone: daily maximum Ozone: daily maximum 88--h meanh mean

This concentration will provide adequate protection of public health, though some health effects may occur below this level.

100 µg/m3Air quality guideline (AQG)

Important health effects, an intermediate target for populations with ozone concentrations above this level. Does not provide adequate protection of public health.

160 µg/m3

Interim target-1 (IT-1)

AQG 2000: 120 µg/m3

The guideline values remain unchanged at the

following levels:

40 µg/m3 for annual mean;

WHO AQG: Global update: WHO AQG: Global update: Nitrogen dioxideNitrogen dioxide

200 µg/m3 for 1-hour mean.

Rationale:• Experimental data: NO2 toxic above 200 µg/m3 • Epi studies: NO2 – marker of mixture of combustion related pollution• Precursor of ozone and PM2.5

-50 µg/m3

Intermediate goal based on controlling either (1) motor vehicle (2) industrial emissions and/or (3)

Interim target-2 (IT-2)

-125 µg/m3Interim target-1 (IT-1) (2000 AQG level)

10-minute average SO224-hour average SO2

WHO AQG: Global update: Sulfur dioxideWHO AQG: Global update: Sulfur dioxide

500 µg/m320 µg/m3Air quality guidelines (AQG)

(2) industrial emissions and/or (3) power production; feasible goal to be achieved leading to significant health improvements that would justify further improvements

Summary of WHO AQGSummary of WHO AQG

10 µg/m3

25 µg/m3

20 µg/m3

50 µg/m3

1 year24 hour (99th percentile)

1 year24 hour (99th percentile)

Particulate matterPM2.5

PM10

AQG valueAveraging timePollutant

20 µg/m3

500 µg/m324 hour10 minute

Sulfur dioxide, SO2

40 µg/m3

200 µg/m31 year1 hour

Nitrogen dioxide, NO2

100 µg/m38 hour, daily maximumOzone, O3

50 µg/m324 hour (99th percentile)

Using the Guidelines in Using the Guidelines in establishing policy establishing policy

�� Norms and standardsNorms and standards

�� TargetsTargets

�� Quantification of expected benefits from Quantification of expected benefits from achieving the targets (lives, disability, achieving the targets (lives, disability, achieving the targets (lives, disability, achieving the targets (lives, disability, economic)economic)

Reduce the exposure Reduce the exposure to cut the health effect to cut the health effect

Effect

Exposure

AQG IT-2 IT-1

PMPM10 10 ITIT--11: challenge to : challenge to somesome cities in Asiacities in Asia

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WHO 2005 PM10 Interim Target – 1 = 70 µg/m3

Source: CAI-Asia

PMPM10 10 ITIT--22: challenge to : challenge to mostmost cities in Asiacities in Asia

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WHO 2005 PM10 Interim Target – 2 = 50 µg/m3

Source: CAI-Asia

PMPM10 10 ITIT--33: challenge to : challenge to allall cities in Asiacities in Asia

WHO 2005 PM10 Interim Target – 3 = 30 µg/m3

Source: CAI-Asia

PMPM10 10 AQG: the future for AQG: the future for all cities in Asiaall cities in Asia

WHO WHO 2005 2005 PMPM10 10 AQG = AQG = 2020 µg/mµg/m33

Source: CAI-Asia

Climate change: • Immediate and long term threats to health

• Health systems will need to adapt

• Mitigation measures will be developed

City populations more vulnerable to Climate Change Health Impacts

1. Heatwaves: urban heat islands, interaction with air pollution

Deaths During 2003 Summer Heatwave.

Paris Funeral Services (2003)

A deadly combination: Temperature, PM10 and Mortality

Stafoggia et al, AJE in press

Air pollution emissions in the Air pollution emissions in the EUEU--2727

80%

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2000 2005 2010 2015 2020R

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-40% SO2

-15% NOx

-12% PM

PRIMES energy scenariowith climate measures

(-20% CO2 in 2020)

Business-as-usualnational energy projections(+3% CO2 in 2020)

Wildfires

Thanks to Bert Brunekreef

Probability of exceeding ozone Probability of exceeding ozone concentrations with increasing concentrations with increasing

temperaturestemperatures

Denmann, Brasseur et al, IPCC

Massive Scale Urbanization Massive Scale Urbanization ––new buildingsnew buildings

China:

• Double proportion of people in urban areas 1980-2005areas 1980-2005

• 1,6% Increase a year

• An extra 280 million people in cities by 2025 (baseline = 2000)

Emerging issues in air Emerging issues in air quality and healthquality and health

––Evidence on the impact of interventions Evidence on the impact of interventions to reduce air pollutionto reduce air pollution

CoCo--benefits benefits –– linking climate change and linking climate change and ––CoCo--benefits benefits –– linking climate change and linking climate change and local air pollutionlocal air pollution

––Indoor air quality Indoor air quality -- development of WHO development of WHO guidelines guidelines

Combustion quality

Allergens

Naphthalene

Household ventilationVentilation

Benzene

Stove ventingDampness and mouldFormaldehyde

Indoor combustion Biological agents Pollutants

Development of WHO Guidelines for Indoor Air QualityDevelopment of WHO Guidelines for Indoor Air QualityWG Meeting, Bonn, 23WG Meeting, Bonn, 23--24 October 200624 October 2006

PAH², especially BaP³

Halogenated compounds

Particulate matter¹

Radon (Rn)

- from pets

Carbon monoxide (CO)

Fuels - from house dust mitesNitrogen dioxide (NO2)

Allergens

Summary of the health risk evaluation (selected items)

- Sufficient epidemiologic evidence from studies conducted in different countries in

different climatic conditions showing that occupants of damp or mouldy buildings,

both homes and public buildings, are at increased risk of experiencing respiratory

symptoms, respiratory infections, and exacerbations of asthma.

- Some evidence suggests an increased risk of developing allergic rhinitis and

asthma.

WHO Guidelines for Indoor AQ: Dampness and MouldWHO Guidelines for Indoor AQ: Dampness and MouldWG Meeting, Bonn, WG Meeting, Bonn, 1717--18 18 October October 20072007

- remediation of dampness problems leads to reduction in adverse health

outcomes.

- Clinical evidence shows that exposures to moulds and other dampness-related

microbial agents increase the risk of rare conditions, such as hypersensitivity

pneumonitis/allergic alveolitis, chronic rhinosinusitis and the allergic fungal

sinusitis.

- Toxicological evidence both in vivo and vitro support these findings by showing

diverse inflammatory and toxic responses after exposure to specific micro-

organisms isolated from damp buildings, including their spores, metabolites and

components.

Persistent dampness and microbial growth on interior surfaces and in building structures should be avoided (or minimized) as they may lead to adverse health effects.

• Indicators of dampness and microbial growth include presence of condensation on surfaces or in structures, visible mould, perceived mould odour, and a history of water damage, leakage or water penetration. Thorough inspection and – if needed – appropriate measurements may be used for confirmation of indoor problems related to moisture and microbial growth.

• Currently, the relationship between dampness, microbial exposure and health effects cannot be

WHO Guidelines for Indoor AQ: Dampness and MouldWHO Guidelines for Indoor AQ: Dampness and MouldWG Meeting, Bonn, WG Meeting, Bonn, 1717--18 18 October October 20072007

• Currently, the relationship between dampness, microbial exposure and health effects cannot be precisely quantified, and therefore no quantitative health based guideline values or thresholds can be recommended for acceptable levels of specific micro-organism contamination. Instead it is recommended that dampness and mould-related problems should be prevented. When they do occur, they should be remediated because of the increased risk of adverse microbial and chemical exposures.

• Well-designed, constructed, and maintained building envelopes are critical to the prevention and control of excess moisture and microbial growth by avoiding thermal bridges and preventing intrusion by liquid or vapour phase water.

• Management of moisture requires proper control of temperatures and ventilation to avoid high humidity, condensation on surfaces, and excess moisture in materials. Ventilation should be distributed effectively in spaces and stagnant air zones should be avoided.

OpportunitiesOpportunities

�� International leadership and collaboration International leadership and collaboration with WHO and others on indoor air quality, with WHO and others on indoor air quality, building energy efficiency and healthbuilding energy efficiency and health

�� Within a broad view of health aspects of Within a broad view of health aspects of buildings (air, injuries, noise, other)buildings (air, injuries, noise, other) buildings (air, injuries, noise, other)buildings (air, injuries, noise, other)

�� To contribute to direct health impacts and to To contribute to direct health impacts and to climate change mitigation knowledge/ climate change mitigation knowledge/ strategies strategies

�� A clear focus on documenting the health A clear focus on documenting the health impacts of internventions impacts of internventions