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The Health Effects of AirPollution

Robert M. OKeefe, Vice President

Health Effects Institute

National Workshop on Improvement of

Urban Air Quality of Pakistan

Lahore

December 2004

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Assessing the Health Effects of Air

Pollution

Health Effects Institute

Air Pollution and Health Effects

Public Health And Air Pollution in Asia

Program PAPA The existing Asia science literature

New Asian studies

Conclusions

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The Health Effects Institute

Founded in 1980 to provide impartial, high-quality scienceon health effects of vehicle and other emissions

Joint and Equal Core Funding from

Government (U.S. EPA)

Industry (28 Worldwide Vehicle Manufacturers) Today many partners worldwide: ADB, WHO, EU

California ARB (CARB), Oil, other Industries

Independent Expert Science Committees oversee and

peer review all research Over 225 studies - Americas, Asia, Europe - ozone,

carbon monoxide, particulate matter, diesel exhaust,

benzene, butadiene, methanol, others

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Air Pollution and Health:

What we know about the effects

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Air Pollution has Many Effects

Health Respiratory, cardiovascular morbidity

Mortality

Heritage

Nitric Sulfuric Acid erosion Natural Resources

Acidification (lake and stream biology)

Mercury deposition (fish tissue)

Visibility

Agriculture Ozone crop effects (~40% reduction in rice, soy yield in Pakistancity)

*(Wahid 2003 Veranasi)

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Many Sources of Air Pollution in

Asia

Combustion Open burning

Brick Kilns

Vehicles

Trash burning

Factories

Power generation

Cooking in slums

Non-Combustion Agricultural

cultivation

Street sweeping

Windblown sand Unpaved roads

Paved roads(asbestos, rubberetc)

Construction

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Vehicle Emissions and Exposure

Must consider all effects of the system:

different vehicle types -

2 and 3 wheelers cars

trucks and buses

vehicle plus fuels (and fuel components)

tailpipe emissions plusevaporativeemissions

maintenance of system

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Major Vehicle/Fuel Emissions

Carbon Monoxide

Diesel Exhaust

Particulate Matter (PM)

Lead

Nitrogen Oxides (NOx)

and Hydrocarbons (HC)

Precursors to Ozone

and PM

Nitrogen Dioxide

Air Toxics

Aldehydes

formaldehyde

acetaldehyde others

Benzene

1,3-butadiene

Methanol Polycyclic organic

matter (e.g. PAHs)

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Health Effects

Different Pollutants have Different Effects Carbon Monoxide - circulatory system, heart

Ozone - respiratory system, lung

Lead - nervous system, brain PM - lung, potential effects on heart

Diesel, Air Toxics - cancer, respiratory

effects

There are potential effects of the Mixture

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Health Effects

Some populations more sensitive than others Children

Elderly

people with heart and lung disease Asthma is growing

150 million asthmatics worldwide

Increasing in most countries (2% to 5% per year)

Asthmatics much more sensitive to air pollution

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Particulate Matter (PM)

Health Effects

High levels of PM (e.g. 500 /m3) known tocause premature death

e.g. London 1952

Recent studies in US, Europe, Asia, South

America have found association of PM with

death at much lower levels (< 50ugm3)

no evidence of a threshold (safe level) Progress made to identify a plausible

biological mechanism for these effects;

results not yet definitive

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PM - The Epidemiology Studies

A Number of Epidemiology Studies

Europe Studies Harvard 6 Cities Study

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PM Health Effects - India, ThailandSource: Chhabra 2001, Pande 2001, Vichit-Vadakan, 2001

05

10

15

20

25

30

35

40

4550

%I

ncreaseinEffects

Emergency

Visits(Pande)

Chronic

Effects

(Chhabra)

Bangkok

Asthma

COAD

Cardiac

Cough

Phlegm

Lung Function

Adult Resp.

Child Resp.

Nurse Resp.

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Ozone Health Effects

Known to cause inflammation in respiratory tract

Effects have been demonstrated for short term, longterm effects are less certain

some people appear to develop tolerance

Reduces ability to breathe (lung function) for somepeople

Increases hospitalization for asthma, other lungdiseases

New US study finds Ozone mortality effects*(Domenchi et. al 2004)

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Ozone Health Effects

Figure 1. Individual Response to

Ozone Exposure (after Kulle, et al,

Am. Rev.)

-5

0

5

10

15

20

25

30

0.1 0.15 0.2 0.25

Ozone Concentration (ppm)

%R

eduction

inFEV1

Some humans have been shown to have reduced lungfunction (measured as FEV1) after exposure to ozone

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Diesel Health Effects Diesel Engines have substantial advantages:

higher fuel efficiency

lower CO and CO2 emissions

However, they also emit high levels of :

particulate matter, NOx, and chemicals attached

to the particles (e.g. PAHs)

Two major types of health effects : acute effects (e.g. exacerbating asthma)

cancer effects

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Diesel Effects on Childhood Illness(Brunekreef, et al Study in 24 Dutch schools)

1

1.2

1.4

1.6

1.8

2

2.2

Increased Symptoms comparing High Truck Traffic

>10,000) to Low Truck Traffic

asthma

hayfever

phlegm

HD allergy

pet allergy

wheeze last year

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Assessing Diesel Cancer Risk

In general, some 30 studies of effects onworkers have provided best data

Consistent small (20-40%) increase in

lung cancer associated with exposure Some questions about each study

Leading International Agencies (WHO,

IARC, US NIEHS, US EPA) haveconcluded diesel is a probable human

carcinogen

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Sulfur Dioxide

Emitted from fossil fuel combustion especially from coal burning facilities, high sulfur fuels

Can impair breathing in asthmatic children

and adults

Has been associated, along with PM, with increased aggravation of heart and lung disease

premature mortality

Recent study in Hong Kong (Lancet 2002)

has found: substantial reductions in SO2 emissions can result in

measurable improvements in mortality and illness

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1988 1989 1990 1991 1992 1993 1994 1995

0

20

40

60

80

NO2

SO2

O3

PM10

Microgramspercubicmetre

Year

AIR POLLUTANT CONCENTRATIONS 1988 - 95 IN HONG KONG

HALF YEARLY MEAN LEVELS

Fuel restriction on sulphur

50% reduction in SO2

after the intervention

No change in

other pollutants

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-6

-5

-4

-3

-2

-1

0

15-64 65+ 15-64 65+ 15-64 65+

REDUCTIONS IN DEATHS AFTER SULPHUR RESTRICTION

All causes Cardiovascular Respiratory

%R

eductionin

annualtrend

-1.8%

-2.8%

-1.6%

-2.4%

-4.8%

-4.2%

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Air Toxics Health Effects

Benzene

a known human

carcinogen

studies in U.S. andChinese workers have

shown link between

exposure and

increased leukemia

Metals

Range of effects,

heart, reproductive,

cancers

1,3 Butadiene

a probable or

known human

carcinogen studies in laboratory

animals and US and

Czech workers have

shown effects

Aldehydes, PAHs

Cancers, Irritants

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Air Pollution and Health in Asia:The Public health and Air Pollution Program

(PAPA)

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The Problem: Air Pollution in Asia:High Levels in Many Cities (2000-2001)

Source: Benchmarking Report on Air Quality in Asian cities Stage 2, 2004 (forthcoming)

SPM Limit = 90 g/m3 (WHO, 1979)

0

50

100

150

200

250

300

350

400

concentrationin

g/m

3

SO2 NO2 SPM PM10

PM10Limit = 50 g/m3 (USEPA, 1997)

SO2Limit = 50 g/m3 (WHO, 1999)

NO2Limit = 40 g/m3 (WHO, 1999)

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Lancet

October,

2002

E i l B d

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Environmental Burdens

Premature Deathssource: WHO Global Burdon of Disease

EEnnvviirroonnmmeennttaallRRiisskkss

GGlloobbaallEEssttiimmaattee

AAssiiaannEEssttiimmaattee((SSEEAARR++WWPPRR))

AAssiiaaaassaappeerrcceennttooffGGlloobbaall

UUnnssaaffeeWWaatteerr 11,,773300,,000000 773300,,000000 4422%%

UUrrbbaannOOuuttddoooorrAAiirr

779999,,000000 448877,,000000 6611%%

IInnddoooorrAAiirr 11,,661199,,000000 11,,002255,,000000 6633%%

LLeeaadd 223344,,000000 8888,,000000 3377%%

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The Challenge: Expanding current science

base to inform Asian air regulatory decisions

Air pollution poses clear health effects

Western research is relevant to Asian populations,

however extrapolation poses challenges

Population characteristics Pollution sources and mixes

Are observed risks similar?, greater?, smaller?

A clear need for representative air pollution & healthstudies of local Asian populations

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PAPA Program Partnership with CAI-ASIA to understand the health effects of air

pollution in Asia, now and in the future

Active effort underway:

Published Scienti f ic Reviewand Meta Analysisof what is knowntoday about health effects in Asian cities

Conducting ser ies of epidemio logical stud iesin representative

Asian cities Understand local impact

Combine to provide Asia-wide understanding

Publish a Comprehensive Assessmentof the state of air pollutionand health across Asian cities

Bui ld capaci tyof local scientists

Overal l Goal: Quality science to inform key Asian regulatory & policy

decisions

Health Effects of Outdoor Air Pollution

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Health Effects of Outdoor Air Pollution

in Developing Countries of Asia: A

Literature Review Systematic identification of 140

peer-reviewed Asian studies1980-2003

Special focus on studies of daily

changes in air pollution andhealth

Conduct first ever Asian metaanalysis quantifying risks,finding initial similarities with

West

Identify knowledge gaps toguide future research

Active communication to policy

makers

St di f Ai P ll ti d H lth i A i 1980 2003

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Studies of Air Pollution and Health in Asia 19802003

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Many Health Effects Studied

0

2

4

6

8

10

12

All-Cause

Mortality

Respiratory

Mortality

Cardiovascular

Mortality

Respiratory

Hospital

Admissions

Cardiovascular

Hospital

Admissions

Outcome Diagnosis

NumberofStud

ies

TSP

PM10

PM2.5

SO2

NO2

CO

O3

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Daily Mortality: Initial Results:

Asian Risk Estimates Similar to West

0.460.62 0.49

0

0.10.2

0.3

0.4

0.5

0.6

0.7

Percent

Increase

US(90 Cities)* Eur(21 Cities)* Asia (4 Cities)

Percent Increase in Mortality per 10 micrograms of

Exposure

* Estimates Using Pre-GAM Results (without revision)

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PAPA:Looking Ahead

A Special Challenge: Understanding the interactionamong air pol lut ion , poverty, and heal th In Asia high levels of air pollution, dense population,

extensive poverty are prevalent

Some initial evidence (mostly from West) that the poor

face worse effects from air pollution Could be due to:

Different exposures (roadside, indoor, occupational)

Poorer SES\health status (nutrition, medical care) leading tohigher susceptibility

Other factors Potential Public health implications could be significant

New study under design in Ho Chi Minh City tounderstand poverty effects

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Conclusions Air Pollution from many sources, including vehicles,

fuels have been shown to have effects on mortality,morbidity

Problem will grow with economic expansion

WHO estimates place air pollution mortality in hundreds

of thousands across South Asia, Eastern Mediterraneanregion (including Pakistan)

While studies are extrapolated from developed world,initial PAPA Review and analysis tend to confirm resultsin Asian populations, though many limitations exist

The PAPA program is building a better base of Asianhealth and air pollution science New studies across Asia, with capacity building as a priority

Role of poverty in air pollution to be assessed

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Conclusions

Better air monitoring needed over long term To determine current status, monitor ongoing

progress and assess health, communicate to

public However, Pakistan urban conditions alsowarrant near term action Visible emissions wide-spread

Dense population level, clear exposure

Acute effects commonplace

Provided basis of action in many countries (UK,HK, others) beforecomprehensive monitoring

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Thank You!

Bob OKeeferokeefe @healtheffects.org

www.healtheffects.org