public health and environment 1 |1 | earth observations to reduce major diseases caused by air...

Public health and environment 1 |

Earth Observations to reduce major diseases caused by air pollution,

water and sanitation and poor urban infrastructure

Dr Carlos DoraCoordinator

Department of Public Health and Environment

Key messages for mini-campaign


This presentation: AP

• Air Pollution causes important risk to health

• Public health programmes have not focused on AP

• WHA resolution calls for better data, evidence of effective interventions, communications and demand for solutions

• Capacity building for health sector to estimate health benefits from policies in polluting sectors. Track health gains of policy change

• SDG 3 and 7 – requires AP data

• EO: need for higher resolution geographic temporal variation (cities, roads, agriculture burning, industry…)

• To provide more precise estimates of AP over time, location, and help track impact of policy changes


2 in 3 deaths are from NCDs

Cardiovascular disease, mainly heart disease, strokeCancerChronic respiratory diseasesDiabetesInjuries

Worldwide NCDs are the main cause of death

Costs: Trillions of U$ dollars


Currently public health programmes to reduce NCDs consider only other major risk factors:

• Tobacco

• Physical inactivity

• Diet (fat, sugar, fiber…)

• Excess use of alcohol


PM<10m – Coarse

PM<2.5m – Fine

PM<1m – Ultrafine

Medgadget .com

New evidence over the last 10 years: AP is a major risk to NCDs

Substantial new evidence showing that particles smaller than 2.5m penetrate deep into the lungs and effect the body more systematically leading to diseases like stroke, heart disease, in addition to the cancers, COPD and pneumonia/URLI.


Lungs exposed to tobacco and to Indoor air pollution

Pathology slides - Courtesy Prof. Saldiva, São Paulo, Brazil


“Review of evidence on health aspects of air pollution -

REVIHAAP”, WHO 2013 selected conclusions on PM (A1)

Confirm and strengthen results form the 2005 WHO Guidelines on Air Quality and Health.

–New studies on short- and long-term effects;

–Long-term exposures to PM2.5 are a cause of cardiovascular mortality and morbidity;

–More insight on physiological effects and plausible biological mechanisms linking short- and long-term PM2.5 exposure with mortality and morbidity;

–Studies linking long-term exposure to PM2.5 to several new health outcomes (e.g. atherosclerosis, adverse birth outcomes, childhood respiratory disease).

LAQN Seminar, London, 21 June 2013

7


Meta-analysis of the association between long-term exposure to PM2.5 and cardiovascular mortality

1.00 2.001.15

Study % weight

RR (95%CI)per 10 µg/m3

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2002

2011

2011

2011

2012

2013

2012

2011

2007

2008

Pub. year


Mortality and long-term exposure to PM2.5

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c= % increase in risk per 10 µg/m3

c=10%

c=6%c=4%

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9

Results of a cohort study in Rome (1.3 million adults followed from 2001 to 2010)

PM2.5: 3-dimensional Eulerian model (1x1 km)



Carotid artery wall thickness (=risk of atherosclerosis) and long-term PM2.5 exposure

AQG EU LV

Bauer et al, JACC 2010

% c

hang

ein

art

ery

wal

l th

ickn

ess

Home outdoor PM2.5 (µg/m3)

10

Heinz Nixdorf RECALL study, Ruhr region, GermanyLAQN Seminar, London, 21 June

2013


Long term O3 exposure and risk of death due to respiratory causes

ACS cohort of 448 thousand adults followed for 18 years


11Jerrett et al, NEJM 2009

RR per 10 ppb = 1.040 (95% CI 1.010 - 1.067)(2-pollutant model with O3 and PM2.5)


Short-term exposure to ozone, mortality and hospital admissions

European cities in the APHENA study

Outcome

Per cent increase in deaths/admissions (95% CI) per 10 µg/m3 increment in daily maximum

1-hour ozone concentrationsSingle pollutant Adjusted for PM10

All-cause mortality a 0.18 (0.07–0.30) 0.21 (0.10–0.31) Cardiovascular mortality: 75 years and older a

0.22 (0.00–0.45) 0.21 (-0.01–0.43)

Cardiovascular mortality: younger than 75 years a

0.35 (0.12–0.58) 0.36 (0.10–0.62)

Respiratory mortality b 0.19 (-0.06–0.45) 0.21 (-0.08–0.50) Cardiac admissions: older than 65 years a

-0.10 (-0.46–0.27) 0.64 (0.36–0.91)

Respiratory admissions: older than 65 years b

0.19 (-0.28–0.67) 0.32 (0.05–0.60)


12

a lag 0-1 results; b lag 1 results Katsouyanni et al 2009


IARC 2012 finding: Diesel a carcinogen

LONDON/GENEVA (Reuters) - The air we breathe is laced with cancer-causing substances and is being officially classified as carcinogenic to humans, the World Health Organization's cancer agency said on Thursday.


Ischemic and thrombotic effects of diluted diesel exhaust inhalation in men with coronary heart

diseaseMyocardial ischemia during 15-minute exercise-induced stress and exposure to diesel exhaust or filtered air in 20 subjects

Mill

s et

al,

NE

JM 2

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14


More complete estimates of exposure to air pollution from Satellite Remote Sensing, air transport models and ground monitors


Estimating Burden of Disease and Death due to exposure to air pollution (and other

risks to health)

Burden of disease is estimated from:1. Air pollution concentrations & human exposure

2. Evidence from epidemiology about the health impacts of air pollution

1. Diseases affected

2. Disease response to levels of AP (dose-response curves)

3. Baseline disease rates


Estimates of outdoor air pollution exposures

used by WHO for BOD estimates

Brings together existing data from:

1. Satellite remote sensing (sparsely covereed areas)

2.Urban ground monitoring stations – pollutant concentrations

3. Estimates of air pollution levels based on emissions from sectors (e.g. transport, industry, power production, etc.)

Mathematical models - combining information from monitoring, from satellite remote sensing, chemical transport models to fill gaps and improve estimates


Deaths attributed to HAP + Outdoor Air Pollution

~ 7 million deaths globally in 2012AP a main RF for around 1/5 of NCDs


3.7 million deaths were attributed to ambient air pollution exposure in 2012

Breakdown of by disease

~21 % of all deaths from ischaemic heart disease (IHD)

~23% of all deaths due to stroke

~13 % of all deaths to chronic obstructive pulmonary disease (COPD)


First World Health Assembly Resolution on Air Pollution and Health

7 million deaths a year due to household and ambient air pollution


The resolution:

• key role health authorities in raising awareness about the potential to save lives and reduce health costs, if air pollution is addressed effectively.

• Need for strong cooperation between different sectors and integration of health concerns into all national, regional and local air pollution-related policies.

• It urges Member States to develop air quality monitoring systems and health registries to improve surveillance for all illnesses related to air pollution;

• It urges Member States to strengthen international transfer of expertise, technologies and scientific data in the field of air pollution.


collaborate, as appropriate, with relevant international, regional and national stakeholders, to compile and analyse data on air

quality, with particular emphasis on healthrelated aspects of air quality

to create, enhance and update, in cooperation with relevant United Nations agencies and programs a public information tool of WHO analysis, including policy and cost-efficiency aspects, of specific and available clean air technologies to address the prevention and control of air pollution, and its impacts on health;

advise and support tools to assist the health and other sectors at all levels of government, especially the local level and in urban areas, taking into account different sources of pollution in tackling air pollution and their health effects;

raise awareness of the public health risks of air pollution and the multiple benefits of Improved air quality, in particular in the context of the discussions on the post- 2015 development agenda

Asks the WHO


SDG 11: cities

Target indicator11.7 Annual mean levels of fine particulate matter (i.e.

PM2.5) air pollution in cities (population weighted)

Goal 11 Make cities and human settlements inclusive,

safe, resilient and sustainable.

Target 11.7 By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality, municipal and other waste management.


SDG 7: EnergyGoal 7 Ensure access to affordable, reliable, sustainable, and

modern energy for all

Target 7.1 By 2030, ensure universal access to affordable, reliable and modern energy services

Target Indicator

7.1 7.1.1 Percentage of population with electricity access

7.1.2 Percentage of population with primary reliance on clean fuels and technologies at the household level*


Recommendation 4:– Household combustion of kerosene is

discouraged

Rationale:

– High levels of emissions of PM and other health-damaging emissions.

– Epidemiologic studies suggest links to tuberculosis, cancer, respiratory disease, adverse birth outcomes, etc., but are not of adequate consistency/quality.

– Kerosene use carries substantial risks of burns and poisoning.

Rationale:

– High levels of emissions of PM and other health-damaging emissions.

– Epidemiologic studies suggest links to tuberculosis, cancer, respiratory disease, adverse birth outcomes, etc., but are not of adequate consistency/quality.

– Kerosene use carries substantial risks of burns and poisoning.


SDG 3: HealthGoal 3 Ensure healthy lives and promote well-being for all

at all ages

Target 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution from contamination.

Target Proposed Indicator

3.9 3.9.1. Mean levels of exposure to air pollution (population weighted) OR deaths and diseases due to air pollution


Urban Air Quality Data (WHO)1600 cities, but sparse coverage for Africa, Latin America, Middle East

– no coverage in rural areas


Satellite Remote Sensing


Modelled data Ground monitors

Found: discrepancy in satellite estimates for urban areas in developing countries


Created: Global Platform on Air Quality and Health

• To ensure best estimates of human exposure to air pollution will continue to be regularly available for Burden of Disease estimates, as well as to ensure accountability, transparency and wide access of these results worldwide.

• Established in January 2014,

• A wide collaboration with international agencies including UNECE, WMO, UNEP, JRC, IIASA, World Bank, space research agencies (e.g. NASA, JAXA), as well as national agencies and research institutions.

• Yearly meetings to update on progress and results.

• Task forces to provide improvements in methods and outputs from one year to the next.

First year – improvements in data integration and statistical fusion, (using data from monitors,

atmospheric transport models and satellite remote sensing).

– First database of source apportionment studies (n=500)


Second year:• Data fusion: Global air quality data as a result of fusion from various data sources, report on

progress and work ahead, • Emission sources information, including from emission inventories and source

apportionment • Exposure-risk relationship: Integrated dose-response functions that relate levels of air

pollution indoors and outdoors to a range of diseases, report on progress and work ahead.• Surface monitoring: key air pollution indicators to be monitored, minimum data sets for

health purposes; systematic data collection and display;• Automated Data acquisition, portable monitors etc. quality of outputs form different sources,• Household air pollution: exposure assessment, progress in IAP data, availability of exposure

data from Europe

New task forces proposed:• Data fusion and synthesis – further improvements• Models for integrating Household and Ambient Air Polluton exposure estimates • Guidance on the collection of ground measurement data.• Guidance on source apportionment studies.


Recommendations for Satellite remote sensing

•To strengthen satellite-derived PM2.5 estimates used by the Global Platform, the following steps are recommended:

•Proceed towards higher spatial resolution of estimates (e.g. using satellites MODIS with 1-3 km resolution, MISR with 4 km, and eventually VIIRS with 750m resolution);•Use more accurate and precise retrievals (e.g. through MODIS Collection 6);•More fully incorporate active measurements (e.g. through CALIOP space-borne lidar);•Use measurements with higher temporal resolution to estimate annual mean more accurately (e.g. from geostationary satellites);•Endorse and foster the collocation of AOD and surface PM2.5 measurements (e.g. through SPARTAN project and other networks); •Develop related information on NO2 and other pollution species (e.g. using the TROPOMI instrument onboard the Sentinel-5 precursor satellite with 7km resolution after expected launch in 2015);•Build on expertise from space agencies to increase data continuity;•Consider modifications of the estimating procedures to account for urban increment; •Consider using ground-based and airborne measurements which offer valuable resources to calibrate and validate satellite data;•Consider exploring information on road networks to inform proximity to road.•Make formal statements to space agencies to encourage relevant measurements;•Nurture groups and communities that will inform the exposure dataset.


Establishment of a web-based resource providing access/ web linkage to:


Causes of air and climate pollutants urban infrastructure


A New Urban Health Project Inform /support demand/ adoption of policy

choices/behaviours that:• mitigate Air Pollution • mitigate Climate Pollutants (SLCPs, CO2)• maximize health benefits.

How? Equip/engage city actors in health, planning, development, government…, with:• Health knowledge – interventions with greatest health benefits.• Tools for health assessment and for M&E/scenarios.• Strengthened institutional and technical capacity.• Framework of collaboration, monitoring and evaluation.• Communication/awareness raising


Audiences• Part of the implementation of the WHA resolution

68.8• International efforts on sustainable Energy,

Transport, Energy, Waste Management, Land Use• Cities already organized to address air pollution,

climate change, health (ICLEI, C40, Clean Air Asia, Healthy Cities…)

• 5 to 7 pilot cities for in-depth work - model for other cities


Policies that fulfill multiple social objectivesFocus: main sources of air and climate pollutants

• Transport

• Waste burning

• Home energy

• Buildings

• Land use plans

• Industry

1. Health benefits from improving• Air pollution• Injuries, • Physical activity,• Noise,• Diets…

2. Air andClimate pollutant reductions


Health benefits from AP reduction

Air pollution (PM)

Climate change (CO2)

Local/short term health impacts

Global/long term health impacts

Climate change (SLCPs)

Injuries, physical activity, noise, diet,


A significant fraction of NCDs is attributable to exposure to traffic-related air pollution

Source: APHEKOM


•

Better fuels and engines help, but private vehicle transport increases congestion, injuries, pollution, and physical inactivity.

Rapid transit/NMT improves access to schools, jobs & services for poor, children, women, elderly & disabled, improving equity. It can reduce injury, cardiovascular disease & support healthy physical activity.

Cycling to work reduced premature mortality by 30% among commuter groups in Shanghai & Copenhagen.

'Healthy' urban transport can reduce chronic disease, injuries and improve health equity


Effectiveness of interventions - BCA:WHO tool for estimating health economic

gains from cycling

HEAT for cycling and user guide from www.euro.who.int/transport/policy/20070503_1


« Improved insulation saved 0.26 months of life per person » (UK Warm Front Programme)

Housing that is good for health

Reduction of respiratory illness by 9% to 20% and increase of individual productivity between 0.48% and 11% with natural ventilation startegies

« Reduced wheezing, days-off school, doctors' visits were reported by occupants of insulated homes « (NZ Insulation study)

Photo 1(graphic, table, map, etc) zone


Health co-benefits in housing

Energy-efficient heating, cooling and natural ventilation can reduce strokes and respiratory illness as well as TB and vector-borne diseases;

A focus on slums /sub-standard housing - where needs are greatest/benefits could be multiplied

Solar hot water heating - IndiaSlum in Mexico City


Indoor emissions

• Outdoor indoor• Evidence base stronger

than for other approaches• Implementation practicality

– via design, production, standards, etc

• Some options (clean fuels), are relatively independent of user behaviour.


Recap: AP

• Air Pollution causes important risk to health

• Public health programmes have not focused on AP

• WHA resolution calls for better data, evidence of effective interventions, communications and demand for solutions

• Capacity building for health sector to estimate health benefits from policies in polluting sectors. Track health gains of policy change

• SDG 3 and 11– requires AP data

• EO: need for higher resolution geographic temporal variation (cities, roads, agriculture burning, industry…)

• To provide more precise estimates of AP over time, location, and help track impact of policy changes


Water and santitation


Purposes of Global Monitoring

Global advocacy: monitoring for action

Measuring progress for the global community

Informing global investments

Informing investments at country

Supporting regional and country benchmarking and reporting

Focus on national governments and citizens


Transition in the development sector

MDGs(born out of Millennium Declaration: buy in of 189 Member States)

Focused on human development 8 goals, 21 targets, 60 indicators Countries did primary evaluations and submitted results to an overview committee

Post2015 development agenda (post Rio+20 SDGs, SDSN, WHO-World Bank UHC, HFA2 etc.)

growing consensus on sustainable development ensuring economic, social and environmental sustainability, and good governance)Goes beyond human development OWG: 17 goals, 169 targets, more than 1000 indicators


Lessons from MDG monitoring High focus on development: silent on sustainability etc.

Piggy backing on household surveys

Cost effective

Limits indicators and timely reporting

Admin data: quality improved in the last decade?

Earth observations:

Data available for cost effective monitoring

Billions in EO: developed countries contribution to monitoring?


Task Team Contributors• International: WHO, GEO, WMO, UNU-FLORES, WCRP

(GEWEX), WMO-CHY, CIESIN, World Bank, UN Global Pulse

• Countries: Australia (CSIRO), Bangladesh, China, Colombia, Japan (MEXT), Germany, Pakistan, USA (USEPA, USGS, NSF, USACE, US GEO),

• Space Agencies: ESA, JAXA, NASA, NOAA

• Academia and institutes: Chouaib Doukkali University (Morocco), U of Tokyo, Chinese Academy of Sciences, U of Bonn, Vrije Universiteit Amsterdam, University of Twente, CUNY, U of Texas, GMU, Delatres, Fraunhofer Institute of Optronics, WRI

• Two members from SG IEAG on data revolution for SD


• Achieve universal access to safe drinking water, sanitation and hygiene

• Improve by (x%) the sustainable use and development of water resources in all countries

• All countries strengthen equitable, participatory and accountable water governance

• Reduce untreated wastewater by X%, nutrient pollution by Y% and increase wastewater reuse by Z%

• Reduce mortality by (x%) and economic loss by (y%) from natural and human-induced water-related disasters

UN proposal to OWG


OWG draft to UN General Assembly• 6.1 by 2030, achieve universal and equitable access to safe and affordable drinking water for all

• 6.2 by 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

• 6.3 by 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater, and increasing recycling and safe reuse by x% globally

• 6.4 by 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity, and substantially reduce the number of people suffering from water scarcity

• 6.5 by 2030 implement integrated water resources management at all levels, including through transboundary cooperation as appropriate

• 6.6 by 2020 protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes

• 6.a by 2030, expand international cooperation and capacity-building support to developing countries in water and sanitation related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies

• 6.b support and strengthen the participation of local communities for improving water and sanitation management

Public health and environment 57 |57

EO in next generation development monitoring


Earth Observations for knowledge and action• Earth observations include:

1) Satellite data (global, periodic)

2) In-situ measurements (local, frequent)

• Observations on the cusp:

1) Data Assimilation System outputs

2) Model outputs

3) Citizen observations (Big data)

Courtesy: NASA

Courtesy: Environment Canada

In-situ point measurements may not always be representative of an area


The EOTT reviewed all of the WWQM and WRM indicators and assessed how EO could be used to assess the UN Water recommended indicators. The results are documented in the EOTT indicators report.

Following the availability of TT reports a few members of EODI TT reviewed the additional suggested indicators and makes the following assessment and proposed further contributions of EOTT.

EODI works to date:


EO: need to integrate with socio-economic data

Potential EO Data applications

%dom ww

treated

%indus ww

treated

%municipal ww reused

%indus ww

reused

WQ (N, Ph)

EO Population Density X X X X

Infrastructure data-maps X

Precipitation X X

Water Cycle Data X X

Distributed Hydrologic model

X X

Water Use X X X

On sustainability: to reconsider maximum use of available data, rather than trying to force fit EO into the current paradigm


EO and WRM

Indicator/data type

Withdraw/

availability

%basins with

alloc frmwk

Storage capacity/%avaul

able

Change in

ecosystem

Red list,

living planet index

Water stress

Domestic use per

capita

EO Population Density

X X X X X X

Infrastructure data-maps

X X X X X X

Precipitation X X X X X

Water cycle data X X

Water storage X X X X X X X

Ground water X X X

Distributed Hydrologic model

X X X X X X X

Water Use X X X X X


Assessment of TT reports• Lack of cross fertilization between the TTs

• EO largely not considered, like WQ, IWRM etc.

• Doesn't consider the capacity of national statistical systems, lack links with UN Statistical Division

• Lack of innovation and transformative thinking

• Too many suggestions for questionnaire approach

• AQUASTAT, GEMSSTAT, are they 'fit for purpose'?• General rule of indicators: from data, from use of tools…stats paper!


Target 6.3: waste water indicators

EOTT recommended indicator: A consolidated indicator of waste water production, treatment and reuse/recyclingRationale: AQUASTAT and natural Environment agencies have reliable statistics for some countries but are limited. Global Estimates validated by AQUASTAT greatest promiseEO support for the indicator:

Population densities derived from Landsat data can be combined with census data to estimate waste water generation potential, Releases and their impacts.

1)

High resolution satellite images could document the location of treatment facilities.

2)


Target 6.3: water quality indicators

EOTT recommended indicator: The UN Water indicator related to Nitrogen and Phosphorus pollution in large lakes, water bodies and coastal zones.Rationale: The WQ TT report indicators seemed complex and focused on point data. While improving GEMSTAT data is desirable, an indicator that provides information for every country is most desirable. EO support for the indicator:

. http://earthobservatory.nasa.gov/IOTD/view.php?id=84125

LANDSAT and MODIS data provide global data on phytoplankton blooms and sedimentation

Hydrologic models can estimate the movement and changes of concentrations of pollutants (incl. N and Ph) in rivers


Target 6.4: water-use efficiency and scarcity indicators

EOTT recommended indicator: indicator suggested by TT: Water Use Efficiency Index and its variation in time and by sector.Rationale: Water Use Efficiency is the critical indicator for the target because it is foundational to the other objectives.EO support: EO can provide comprehensive information on water availability including precipitation & can be used to estimate consumption of water through irrigation & others

Irrigation estimated from ET in Arizona

Operational satellite based average

precipitation product from

NOAA


Target 6.5: IWRM indicators

EODI recommended indicator: Number of tools and data sets available to support IWRM.Rationale: Implementation of IWRM is very difficult and needs to be enabled by the support of agencies and countries with this vision.EO support for the indicator:

The availability and sharing of satellite information is not restricted by national boundaries or national data policies.Other basin-scale EO data relate to:-Changes in water availability-Water stress-Storage capacity or CC impacts

Basins Countries Lack of data sharing across borders


Target 6.6: ecosystems indicators

EOTT recommended indicator: Natural Water Capital IndexRationale: More relevant to water issues than some others in this TT report. It also ties to some of the overall issues of Natural Capital and ecosystem services that the UN may consider.EO support for the Indicator:

Groundwater variability From NASA: variability in lake levels

EO can provide water storage in groundwater and surface stores (lakes) and measures of wetland and ecosystem extent


Evaluation of EO applicability


Application of remote-sensed technologies to main health risks from climate change

Risk maps of suitability for vector-borne disease transmission

Satellite based weather warnings connected to operational health services

City-level risk maps of urban heat island effect

Qualitative assessment of the health impacts of climate change in the late 21st century (IPCC, 2014)


Use of remote-sensed technologies to enhance key functions of health resilience to climate risks

WHO Operational framework on health resilience to climate change. Inner circle is the standard "building blocks" of health systems. Outer sections represent the key functions that should be strengthened to enhance health resilience to climate change.

Remote-sensed risk maps to inform V&A assessments

Remote-sensing as an input to health early earning systems

Remote-sensing highlighted as an emerging technology to enhance health resilience

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