LEARNING –
AND TALKING –
ABOUT RISKS:
AIR QUALITY AND HEALTH
MICHAL KRZYZANOWSKI, Sc.D.
EH Basel, 19-23 August 2013 1
John Goldsmith Lecture
Retired Head, WHO European Centre for Environment and Health, Bonn
Visiting Professor, Environmental Research Group, King´s College London
EH Basel, 19-23 August 2013 2
We, the environmental epidemiologists of the
world, are the canaries, capable of giving warning
of impending environmental disaster in time for
remedial steps to be taken.
John Goldsmith
Arch Env Health 1988
Fortunately, our fate is not to have to die as the
unfortunate canaries of the coal mines did, but to
sing, to call out in clear tones the nature and type
of impending health danger that threatens. …
Knowledge on AQ and health –
1980-2013
EH Basel, 19-23 August 2013 4
Time
Knowledge
(arbitrary
scale)
AQG 1987 AQG 2005 AQG 2000
GBD 2010
1980 2013
WHO Air quality guidelines for
Europe, 1987 (µg/m3)
Averaging
time
SO2 Black
smoke
TSP PM10
24 hours 125 125 120 70
1 year 50 50 - -
EH Basel, 19-23 August 2013 6
An arbitrary safety factor of 2 used for mortality and morbidity,
factor 1.5 for the decrement in lung function
Epi studies on short-term effects
of PM, 1990-1994
EH Basel, 19-23 August 2013 7
EHP 1995 Draft presented at 5th ISEE Conference,
Stockholm, 1993
Estimated health impacts of
suspended particulate matter in
Europe
Health effect Number of cases /year
Premature deaths (short term PM)* 27000-48000
>5% decrement of pulmonary function 4.5 million
New cases of obstructive airways disease 183000
New cases of asthma 176000
Episodes of respiratory illness, children* 22-31 million
EH Basel, 19-23 August 2013 8
“Concern for Europe´s Tomorrow”, WHO 1995
*24-h SPM>120 µg/m3
Survival and PM:
Harvard Six-cities study
EH Basel, 19-23 August 2013 9
Dockery et al, NEJM 1993
Confirmed in American Cancer Society cohort (Pope et al, AJRCCM 1995)
Selected activities of
research groups, 1990s
COST 613/2 Concerted Action on Air Pollution
Epidemiology (1990-94)
Committee on Research Priorities for Airborne
Particulate Matter, National Research Council,
1998
Health Effects Institute - projects and reports
ISEE Conferences
International collaborative research projects
(APHEA, CESAR, PEACE, …)
EH Basel, 19-23 August 2013 10
WHO Air Quality Guidelines for
Europe, 2nd
edition (2000)
EH Basel, 19-23 August 2013 11
Reduction of the number of survivors exposed to pollution increased by 10 µg/m3
(PM10) in a birth cohort of 100,000 people with mortality structure of Dutch men:
By age of 50: 383
By age of 60: 1250
By age of 70: 3148
Risk increase for all-cause mortality
per 10 µg/m3 daily PM10 in Europe
EH Basel, 19-23 August 2013 12
WHO 2004
(%)
Short term exposures to PM10
and mortality – global overview
EH Basel, 19-23 August 2013 13 Curtesy: A.Cohen, HEI 2004
Long term exposure to PM and risk of
mortality in ACS cohort (ca. 0.5
million people followed for 16 years)
EH Basel, 19-23 August 2013 14
Pope et al, JAMA 2002
Comparative Quantification
of Health Risks, 2004
EH Basel, 19-23 August 2013 15
Globally (in urban population):
0.8 million premature deaths / year
6.4 million YLL / year
WHO 2004
Loss of life expectancy due to PM2.5
from anthropogenic sources in Europe
(in months)
EH Basel, 19-23 August 2013 16
Source: IIASA 2004
Ischemic and thrombotic effects of
dilute diesel exhaust inhalation in
men with coronary heart disease
EH Basel, 19-23 August 2013 18
Myocardial ischemia during 15-minute intervals of exercise-induced
stress and exposure to diesel exhaust or filtered air in the 20 subjects
Mills et al, NEJM 2007
Carotid artery wall thickness (=risk of
atherosclerosis) and long-term PM2.5
exposure
AQG EU LV
Bauer et al, JACC 2010
% c
hange
in a
rtery
wall
thic
kness
Home outdoor PM2.5 (µg/m3)
19
Heinz Nixdorf RECALL study, Ruhr region, Germany
LAQN Seminar, London, 21 June 2013
Biological pathways linking PM
exposure with CVD
EH Basel, 19-23 August 2013 20
Brook et al, Circulation 2010
Mortality and long-term PM2.5 exposure
Results of a Canadian cohort study (2.1 million adults, 1991-2001)
LAQN Seminar, London, 21 June 2013 21
Crouse et al, EHP 2012
All non-accidental Cardiovascular
Ischemic heart
disease Cerebrovascular
PM2.5 estimated from satellite observations + monitoring
Mortality and long-term exposure to PM2.5
Ce
sa
ron
i e
t a
l. E
HP
20
13
c= % increase in risk per 10 µg/m3
c=10% c=6% c=4%
AQG EU LV
22
Results of a cohort study in Rome
(1.3 million adults followed from
2001 to 2010)
PM2.5: 3-dimensional Eulerian model (1x1 km)
LAQN Seminar, London, 21 June 2013
Reduction in PM and in mortality risk
– extended Harvard Six Cities study
EH Basel, 19-23 August 2013 23
WHO evaluation of recent evidence
to support EU air quality policies
(2011-2013)
• WHO – EC project “Review of evidence on
health aspects of air pollution - REVIHAAP”
http://www.euro.who.int/__data/assets/pdf_file/0
020/182432/e96762-final.pdf
• WHO – EC project ““Health risks of air
pollution in Europe – HRAPIE”
LAQN Seminar, London, 21 June 2013 24
Expected decrease of health impacts of PM
due to European policies on emission
reduction
EH Basel, 19-23 August 2013 25
Amann et al (eds). TSAP Report 10. IIASA 2013
Life expectancy lost due to anthropogenic PM2.5
8.5 months
5.3 months
3.6 months
2005 estimate
2030 under “Maximum
Technically Feasible
Reductions scenario”
2025 under “Current
Legislation” scenario
REVIHAAP contributors:
Scientific Advisory Committee
H. Ross Anderson, United Kingdom
Bert Brunekreef, The Netherlands
Aaron Cohen, United States
Klea Katsouyanni, Greece
Daniel Krewski, Canada
Wolfgang G. Kreyling, Germany
Nino Künzli, Switzerland
Xavier Querol, Spain
Authors of background text
Richard Atkinson, United Kingdom
Lars Barregård, Sweden
Tom Bellander, Sweden
Rick Burnett, Canada
Flemming Cassee, The Netherlands
E. de Oliveira Fernandes, Portugal
Francesco Forastiere, Italy
Bertil Forsberg, Sweden
Susann Henschel, Ireland
Gerard Hoek, The Netherlands
Stephen T Holgate, United Kingdom
Nicole Janssen, The Netherlands
Matti Jantunen, Finland
Frank Kelly, United Kingdom
Timo Lanki, Finland
Inga Mills, United Kingdom
Ian Mudway, United Kingdom
Mark Nieuwenhuijsen, Spain
Bart Ostro, United States
Annette Peters, Germany
David Phillips, United Kingdom
C. Arden Pope III, United States
Regula Rapp, Switzerland
Gerd Sällsten, Sweden
Evi Samoli, Greece
Peter Straehl, Switzerland
Annemoon van Erp, United States
Heather Walton, United Kingdom
Martin Williams, United Kingdom
External revievers
Joseph Antó, Spain
Alena Bartonova, Norway
Vanessa Beaulac, Canada
Michael Brauer, Canada
Hyunok Choi, United States
Bruce Fowler, United States
Sandro Fuzzi, Italy
Krystal Godri, Canada
Patrick Goodman, Ireland
Dan Greenbaum, United States
Jonathan Grigg, United Kingdom
Otto Hänninen, Finland
Roy Harrison, United Kingdom
Peter Hoet, Belgium
Barbara Hoffmann, Germany
Phil Hopke, United States
Fintan Hurley, United Kingdom
Barry Jessiman, Canada
Haidong Kan, China
Thomas Kuhlbusch, Germany
Morton Lippmann, United States
Robert Maynard, United Kingdom
Sylvia Medina, France
Lidia Morawska, Australia
Antonio Mutti, Italy
Tim Nawrot, Belgium
Juha Pekkanen, Finland
Mary Ross, United States
Jürgen Schneider, Austria
Joel Schwartz, United States
Frances Silverman, Canada
Jordi Sunyer, Spain
Observers
Markus Amann, IIASA
Arlean Rhode, CONCAWE
Wolfgang Schoepp, IIASA
André Zuber, European Commission
WHO Secretariat (ECEH Bonn)
Marie-Eve Héroux
Michal Krzyzanowski (up to 08.2012)
Svetlana Cincurak
Kelvin Fong
Elizabet Paunovic
Helena Shkarubo
LAQN Seminar, London, 21 June 2013 26
http://www.euro.who.int/__data/assets/pdf_file/0020/182432/e96762-final.pdf