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The impacts and
costs of air
pollution
Mike Holland
APRIL meeting,
April 13th 2016
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Previous RCP report on air pollution
• Commissioned 1959
• Published 1970
• Two concerns:
– Smoking
– Solid fuel use
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Previous RCP report on air pollution
• Based on a different world
– Much coal burning
– Less traffic
– Little emission control
– Little health data to inform the work
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The new report
• Produced by RCP and
RCPH
• Written by Royal College
members and invited experts
• Released February 2016
• Available at: https://www.rcplondon.ac.uk/projects/o
utputs/every-breath-we-take-lifelong-
impact-air-pollution
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New report headlines:
Health burden
• Each year, 40,000 deaths in the UK from
outdoor air pollution, valued at >£20 billion
– PM2.5
– NO2
• More linked to indoor air pollutants
– Radon: 2,300
– Second hand smoke: 2,800 – 11,000
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New report headlines:
Range of impacts linked to air pollution
• Link to many diseases including:
– Cancer
– Asthma
– Stroke
– Heart disease
– Diabetes
– Obesity
– Dementia
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New report headlines:
AQ limits and public protection
• Neither the
concentration
limits set by
government nor
the World Health
Organization’s
air quality
guidelines are
fully protective of
health
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Air quality guidelines and objectives
• WHO guidelines
– Based on evidence of pollution impacts
– Judgment of “acceptable” risk
• Objectives / limit values
– Recognise the guidelines, but take account of:• economic efficiency
• practicability
• technical feasibility
• time-scales
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New report headlines:
Role of the medical profession
• “When our patients are exposed to such a
clear and avoidable cause of death, illness
and disability, it is our duty as doctors to
speak out.”
– Medical profession is good at dealing with
symptoms
– Barriers on acting on causal factors
like air pollution
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Development of disease during foetal
development
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Development of disease during the life
course
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Mechanistic links to illness
• Small changes in lung function linked to
significant increase in illness
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Mortality estimates for the UK
(Chapter 6)
Source, pollution year Pollutants Estimated equivalent
attributable deaths
COMEAP (2008) PM2.5 29,000
European Commission (2010) PM2.5 30,000
O3 1,400
PM2.5 + O3 31,000
Global Burden of Disease
(2010)
PM2.5 23,400
O3 770
PM2.5 + O3 24,100
DEFRA (2008, 2013) PM2.5 (= COMEAP) 29,000
NO2 15,750 – 23,500
PM2.5 + NO2 44,750 – 52,500
RCP report (ca. 2013) PM2.5 + NO2 (+ O3) 40,000 +/- 25%
Note: Years shown are for pollution data, not year of publication
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COMEAP results in more detail
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Highlights different ways of representing mortality impacts of air pollution
Averages at ~12 years of lost life expectancy per equivalent attributable death
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Interpretation of mortality estimates
• COMEAP considers the meaning of the estimate
of the number of deaths, noting:
– Effects are principally from cardiovascular disease,
which has multiple established and likely causes at
the population level, and almost certainly has a
complex mixture of factors affecting initiation and
progression at the individual level.
• Estimates of deaths are a statistical construct,
with air pollution playing some role in bringing
forward the deaths of a larger number of people
than the 29,000 COMEAP estimate.15
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GBD results in more detail
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European Commission results for the UK
(O3)
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Effect Units Impact
Mortality Deaths 1,400
Respiratory hospital admissions Cases 1,400
Cardiovascular hospital admissions Cases 2,700
Minor restricted activity days Days 6.6 million
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European Commission results for the UK
(PM2.5)
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Effect Units Impact
Mortality >30s (not additive with deaths) Life years lost 328,000
Mortality >30s (not additive with LYL) Deaths 30,000
Infant mortality Deaths 70
Chronic bronchitis in adults Cases 26,000
Bronchitis in children Cases 102,000
Respiratory hospital admissions Cases 12,000
Cardiovascular hospital admissions Cases 4,500
Restricted activity days Days 41 million
Asthma symptom days (children) Days 1.2 million
Lost working days Days 6.1 million
Economic value of ~£16 to 45 billion/year (excludes NO2, upper bound adopts
value of statistical life for mortality valuation)
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Bronchitis and PM
• Differences in disease
– Adult bronchitis: long lasting disease, potentially severe effect, may be
permanent (depending on definition of effect)
– Child bronchitis: temporary (2 weeks), recoverable
• Differences in adult bronchitis estimates for UK:
– EC estimate: 26,000 (incidence, new disease, value £850 million/year)
– New COMEAP estimate: 722,000 (prevalence, total burden) out of
4.5 million affected individuals in the UK (value?)
• Differences in use
– For EC, recommended for core analysis by WHO HRAPIE study
– For UK, recommended for sensitivity analysis by COMEAP
COMEAP report on chronic bronchitis available at: https://www.gov.uk/government/publications/comeap-long-term-exposure-to-air-pollution-and-chronic-bronchitis 19
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Selected recommendations for action
• Act now, think long term
• Educate professionals
• Protect the public when air pollution levels
are high
• Tackle inequality, protecting those
at most risk
• Lead by example in the NHS
– Major polluter!
– Collaborate with local authorities? 20