Health Effects of Air Pollution Research and Regulation

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Health Effects of Air Pollution Research and
Regulation
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Social Support Networks
Income and Social Status
Education
Employment and Working Conditions
Culture
Physical Environments
Determinants of Health
Gender
Biology and Genetics
Social Environments
Personal Health Practices and Coping Skills
Health Services and Social Services
Healthy Child Development
World Health Organization
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Central London during the killer smog, December
1952. At this point, visibility is less than 30
feet. During the height of the smog, people could
not see their own hands or feet, and buses had to
be led by policemen walking with flares. Credit
'When Smoke Ran Like Water', by Devra Davis,
Perseus Books
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Effect of Pollution Episode on Mortality
(London, England)
500
2500
Deaths
450
2000
400
1500
PM10
PM10 (?g/m3)
Total Deaths Per Day
350
1000
300
500
250
200
0
0
2
4
6
8
10
December, 1962
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Toronto on a Smoggy Day. Credit Jeff Brook,
Environment Canada.
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Effect of Pollution Episode
(Toronto, Canada)
41.0
40
40.5
36
40.0
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Deaths
Total Deaths Per Day
39.5
PM2.5 (?g/m3)
28
39.0
24
PM 2.5
38.5
20
38.0
16
-2
0
2
4
6
8
Time Relative to Episode Day
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Health Canadas Air Health Mandate

• Canadian Environmental Protection Act (CEPA)
• Major statutory instrument
• Co-responsibility of Ministers of Health of
  Environment
• Provides for the assessment of environmental
  health risks
• Development of regulations and environmental
  targets (e.g. AQOs, emission limits)
• Federal Health Advisor
• Ambient indoor air quality (i.e. CWS, IAQ
  guidelines)
• Canadian Environmental Assessment Act

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Health Canadas Air Health Priorities

• Canada-wide Standards
• Particulate matter (PM)
• Ozone
• Transboundary Air
• Canada-US Air Quality Agreement
• Border Air Quality Strategy (BAQS)
• Methylcyclopentadienyl manganese tricarbonyl
  (MMT)
• Ethanol

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Health Canadas Air Health Activities (1)

• Research on ambient air pollutants
• Epidemiologic research (acute and chronic)
• - morbidity and mortality time series studies
• - panel studies
• - case-control and longitudinal
• Human Clinical Chamber Studies
• Toxicological Studies
• Population Exposure Studies
• Air Health Impact Quantification

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Measurement of Physiological Responses to
Concentrated Ambient Particles Gaseous
Pollutants
Gage Occupational Environmental Health Unit
Gage Occupational Environmental Health Unit
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Health Effects Consensus Findings (Independent
Expert Panel)Reducing sulphur to 30 ppm improves
the health of Canadians
Number of CasesExtrapolated for All of
Canada2001 to 2020

2,100
Mortality
Hospital Admissions
2,400
6,800
Emergency Room Visits
new cases of chronic bronchitis
7,600
new cases of bronchitis in children
93,000
1.6 million
restricted activity days
3.3 million
asthma symptom days
acute respiratory symptomse.g. new cases of
croup, pneumonia
11 million
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Health Canadas Air Health Activities (2)

• Risk Assessment - Standards/guidelines/regulations
  
• Canada-wide Standards,
• National Ambient Air Quality Objectives and
  Guidelines
• Canadian Environmental Protection Act
• Risk Communication
• Publications www.hc-sc.gc.ca/air
• Fact sheets eg. CV/R Disease,Seniors
• National health based Air Quality Index (AQI)

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Saint John
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Health Effects of Exposure to Ambient Air
Pollution
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Health Effects of Air Pollution

• Short term effects
• More people die and are admitted to hospital for
  heart and lung problems on days with elevated
  levels of air pollution.
• These effects are the tip of the iceberg
  relative to other, milder effects.
• Effects found at levels previously thought to be
  safe.
• Effects observed using widely varying study
  designs large scale population studies to
  controlled laboratory studies in humans/ animals.

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ADVANCEMENT MECHANISM
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26 European cities or regions
13 Canadian cities
Shenyang
38 U.S. cities/ regions
Beijing

7 Korean cities

Mexico City
Bangkok

Brisbane
Sao Paulo


Sydney
Santiago


Melbourne

Christchurch

Location of Studies of Air Pollution and Mortality
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ACUTE MORTALITY, MULTI-POLLUTANTS GAM VS.
NON-GAM

ns
Increase per mean concentration
ns
PM2.5
PM2.5-10
NS Not significantly associated with mortality
(Meta-analysis Stieb et al. 2002)
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Health Effects of Air Pollution

• Long term effects
• People do not live as long in cities with high
  air pollution.
• Air pollution may contribute to the development
  of lung cancer and chronic lung disease, but more
  research is required.
• Evidence is emerging of reproductive effects,
  including low birth weight and premature birth.
• Chronic effects of exposure have the greatest
  potential for population health impacts.

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Effects of chronic exposurelung function in
children
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Adjusted Relative Risk of term LBW for maternal
exposures to O3, PM10 and SO2 in Nova Scotia 1988
- 2000

• 
  
  
  
  
  1st Trimester 2nd Trimester 3rd
  Trimester
• O3
• lt 25th percentile (referent)
• 25 - 50th percentile 1.18 (0.89, 1.55) 0.92
  (0.69, 1.22) 0.72 (0.48, 1.08)
• 51 - 75th percentile 1.06 (0.80, 1.41) 1.07
  (0.81, 1.41) 0.73 (0.50, 1.08)
• gt 75th percentile 1.04 (0.76, 1.44) 0.99 (0.72,
  1.37) 0.93 (0.61, 1.44)
• Continuous 0.99 (0.98, 1.02) 1.01 (0.99,
  1.03) 1.00 (0.97, 1.03)
• PM10
• lt 25th percentile (referent)
• 25 - 50th percentile 1.26 (0.95, 1.67) 1.01
  (0.76, 1.34) 0.98 (0.74, 1.28)
• 51 - 75th percentile 1.25 (0.95, 1.65) 1.15
  (0.88, 1.51) 1.15 (0.89, 1.50)
• gt 75th percentile 1.34 (1.03, 1.75) 1.08 (0.83,
  1.41) 1.05 (0.80, 1.36)
• Continuous 1.02 (1.00, 1.04) 1.00 (0.99,
  1.02) 1.00 (0.98, 1.02)
• SO2
• lt 25th percentile (referent)
• 25 - 50th percentile 0.93 (0.69, 1.24) 1.13
  (0.86, 1.48) 1.02 (0.79, 1.34)
• 51 - 75th percentile 1.19 (0.89, 1.60) 1.11
  (0.83, 1.49) 0.86 (0.63, 1.18)

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Vehicle traffic, land-use, and intra-urban
variability of ambient nitrogen dioxide in
Toronto, Canada
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Truck Traffic and Lung function in Children
Brunekreef, Epidemiology 1997 8 298-303
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Tip of the Iceberg
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Canadian Research Priorities

• To what extent does long term exposure to air
  pollution contribute to chronic disease?
• Can we identify a safe level if we try harder?
• What is the contribution of individual air
  pollutants versus the mixture?
• What are the health effects of coarse PM?
• Evidence is accumulating with regards to the
  health effects of traffic, but other sources of
  air pollution have not examined to the same
  extent.
• More research is required into the relationships
  between socioeconomics and air pollution health
  effects.
• How can we make physiological sense out of the
  effects seen in epidemiological studies?
• What are the climate change/weather linkages?

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Evidence-based Regulatory Initiatives

• The Government's Clean Air Strategy (2000)
• Canada-wide Standards for PM and Ozone (2000)
• Ozone Annex to the 1991 Canada/U.S. Air Quality
  Agreement (2000)
• Federal Agenda on Cleaner Vehicles, Engines and
  Fuels (2001)
• Addition of particulate matter (2001), ozone and
  its precursors and PM precursors to the CEPA List
  of Toxic Substances (2003)
• Border Air Quality Strategy (2003)

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Recommendations/Considerations for Air Health
Projects for Rio De Janeiro (Medium- term)

• Risk communication increase public awareness to
  facilitate personal and collective risk
  management decision making.
• Engagement of health professionals.
• Development of a linked health, environmental and
  socioeconomic data inventory.
• Management structure (collaborative partnerships)
  for air-health initiatives.
• Time series morbidity/mortality studies
  respiratory, cardiovascular and lung cancer
  (PM2.5 gaseous pollutants)
• Panel studies eg. children, elderly, asthmatics.
• Ethanol health/exposure assessment
• Health impact quantification studies
• Air Health Indicator

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Traffic-related Air Pollution

• Lung function
• Spirometric measures FVC, FEV1, PEF
• Respiratory symptoms
• Wheezing, cough, bronchitis, shortness of breath
• Physician-diagnosed asthma
• No generally accepted criteria for diagnosis of
  asthma in infants
• Hospitalization for respiratory causes
• Mortality
• All causes, cardiopulmonary causes, respiratory
  causes, lung cancer

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LBW in the NE United States (Maisonet et al.,
2001)
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Effects of Sulphur in Gasoline on Health
Reduced emissions result in better air quality,
and this in turn leads to improved health for
Canadians