Towards Healthy Public Policy: Assessing

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Towards Healthy Public PolicyAssessing
Mitigating Health Burden from Air

• Policy Analysis for Air Quality and Health
• Workshop at Metro Hall, Toronto May 19, 2005
• Monica Campbell
• Environmental Protection Office
• Toronto Public Health

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People can spend a lot of time close to pollution
sources
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Presentation Overview

• Healthy Public Policy
• Areas of activity
• Integration of assessment tools
• Policy questions of local significance

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Healthy Public Policy

• Fundamental concept in public health
• Particularly relevant for environmental threats
  to health
• Advocates for shifts in public policies that
  adversely impact health (eg. transportation,
  energy, urban form)
• Need good assessment tools

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Areas of Activity in Influencing Policies Related
to Air

• Exposure assessment and health risk
• Risk communication
• Broad determinants of health (e.g. social aspects)

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Exposure Assessment Health Risk

• Local point sources of community concern
• - St. Johns Crematorium (2000)
• - Lakeview coal-fired power plant (2000)
• Ambient air pollution
• - Toronto Air-Pollution Burden of Illness
• study (2004)

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St Johns Crematorium (Toronto)

• Method
• Stack testing to establish emission rates of
  PM10, heavy metals including mercury, dioxins
  furans
• Ambient air monitoring before after crematorium
  started operations
• Dispersion modeling
• Comparison of modeled and actual ambient levels
• Benchmarks
• - Ambient air quality criteria (OMOE)
• - Toxicological criteria (RfD RsD from US EPA)

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St Johns Crematorium (Toronto)

• Results and Conclusions
• Crematorium actual and modelled emissions were
  very low and far below provincial standards
• Worst-case concentrations were at most 1 of AAQC
  and 25 of health criteria
• Background levels of PM10 high and sometimes
  exceeded provincial standard but crematorium
  contribution very small

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Lakeview Coal-Fired Power Plant

• Modelling study (2000) to estimate ambient
  concentrations of NOx and SO2 with different
  operating conditions
• Lakeview (1997 base year operating at 19
  capacity) found to contribute
• lt 0.3 of ambient annual NOx in GTA
• lt 9.2 of ambient annual SO2 in GTA.

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Annual Air Emissions from Lakeview Plant
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Air Pollution Burden of Illness Study

• Why Do One?
• To estimate magnitude of health impact in
  cost-effective manner
• To provide health status information on which to
  base public health programs
• To communicate health risk
• To influence decision makers

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Whats Involved in Conducting a BOI Study?

• Is a form of risk assessment
• Applies risk coefficients from existing
  epidemiological studies worldwide
• Uses community-specific data on daily pollution
  levels
• Uses community-specific data on adverse health
  outcomes such as hospitalizations and mortality
  (e.g. for respiratory and cardiac causes)

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Calculating Burden of Illness

• Hp(outcomes/yr) Hb x Fp
• Where
• Hp estimated air-pollution burden of illness
• Hb background rate of adverse health
  outcomes/year
• Fp fraction due to air pollution
• (Fp? Hp/unit x P where ? Hp/unit is the risk
  coefficient per unit pollutant from published
  epidemiological studies, and P is the effective
  annual pollutant concentration)

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Air Pollution Burden of Illness - Toronto

• 1,700 premature deaths/year
• 6,000 hospitalizations/year
• Would likely not have occurred when they did
  without exposure to air pollution
• Preventable
• Increases severity or frequency of common medical
  conditions and illnesses

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Impact of 2000 BOI Study

• Gave rise to first Smog Summit in June 2000
• Catalyzed creation of 20/20 The Way to Clean Air
• Initiated low-sulphur fuel purchases by City
• Gave rise to further research Condition
  Critical Fixing our Smog Alert Warning System
• Increased participation in policy discussions
• Facilitated NGOs in advocating for clean air

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Risk Communication

• Studies that influence communication
• policies
• Toronto Air Quality Index - Health Links Analysis
• Condition Critical Fixing the Smog Warning
  System
• Evaluation of smog advice

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The Air Quality Index (AQI)
AQI Scale
Category
0 - 15
Very Good
Good
16 - 31
Increasing severity of health effects
32 - 49
Moderate
Smog Alert
50 - 99
Poor
At AQI 50, OMOE calls Air Quality Advisory
100
Very Poor
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Mixed Messages
Health Evidence (based on 2000 study)

• Torontos air quality is good or very good
  almost all the time
• Triggers smog alerts only in the summer months

• Torontos air pollution leads to 1,000 premature
  deaths and 5,500 hospitalizations each year
• Air pollution affects health year round

AQI
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Distribution in Health Outcomes by AQI Category
(based on 2000 study)
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Why the AQI MisrepresentsHealth Risk

• It did not include fine particulates (PM10/PM2.5)
• It is based on out-of-date air quality standards
• It is based on a single driver pollutant, not
  the total mix of AQI pollutants

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Days of Poor Air Quality in Toronto resulting
from inclusion of PM2.5 in the AQI
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Evaluation of Smog Advice

• Personal exposure monitoring that compares
  typical day exposures to PMlt1, PM2.5, VOCs and
  ozone levels among paired scenarios of
  individuals who did or did not follow smog alert
  advice
• Tries to understand how much total daily
  exposures can be reduced by shifting individual
  behaviours
• Collaboration among Chemical Engineering
  Applied Chemistry at U of T, Health Canada,
  Environment Canada and Toronto Public Health

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Incorporating Broad Determinants of Health
Social Aspects

• Air emissions and health status studies related
  to Ashbridges Bay Treatment Plant
• Health Impact Assessment Designated bus route

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Ashbridges Studies

• Air emissions study modelled 17 key pollutants
  under 4 scenarios, including with full
  incineration and no incineration at sewage
  treatment plant
• Health status study examined mortality,
  hospitalization and cancer rates in South
  Riverdale and Beaches community, in comparison to
  SES- matched communities

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Ashbridges Studies

• Overall, the emissions profile improved over time
  as incinerator use was phased out and with
  projected improvements for odour control
  (including fugitive emissions)
• Both communities had higher mortality and
  hospitalization rates (overall) than their
  respective comparison communities
• South Riverdale has been burdened with more
  illness and pollution sources than other
  communities, although it is not possible to
  suggest a causal relationship

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Ashbridges Studies

• Policy recommendation arising
• That the OMOE considers the cumulative impact of
  emissions from any new or modified industrial
  facility on adjacent residential areas with
  elevated rates of illness or mortality prior to
  issuing a C of A
• Cumulative currently means taking into account
  all emission sources from a facility

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TPH Perspective on Cumulative Impact
Cumulative impact is
Total impact of all emission sources
Impact of current ambient air pollution levels
Impact of modelled new source contribution


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Environmental Justice Aspects

• Should consider integrating social dimensions
  such as environmental justice concepts when
  developing public policy
• Environmental justice concepts can lead to an
  examination of spatial distribution of pollution
  sources and correlations with community
  characteristics such as income levels, minority
  status or ethnicity.
• Can take into account that people of lower income
  are more likely to be exposed to air pollution
  and likely more susceptible to adverse effects
  from air pollution

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Health Impact Assessment

• Methodology may be quantitative but typically
  includes a qualitative assessment of social
  aspects
• HIA results supported introduction of congestion
  charges (toll roads) in London, England
• Toronto Public Health is completing a pilot HIA
  on the designated bus route planned to connect
  subway users to York University

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Rapid Bus Route Pilot Health Impact Assessment
Outcomes Examined

• Vehicle pollution
• Stress (commuting driving)
• Equity issues (who benefits)
• Commute time
• Accident rates

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Integration of Assessment Tools
Air Emissions
Policy Options
Health Burden
Ambient Levels
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How to Deal with Different Health Outcomes?
Pyramid of Health Effects Toronto Annual
Estimates for Inhalable Particulates (PM10)
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Some Policy Questions of Local Significance

• How does health burden shift if
• Network of surface designated transit lanes
  introduced?
• Road congestion pricing is introduced?
• Bicycle network is created that reduces space for
  cars?
• Older vehicles are required to be retrofit or
  retired?
• Zoning is changed to reduce urban sprawl?
• Existing point sources are required to meet
  health-based air quality standards?
• Comprehensive energy conservation plan is
  implemented?
• Coal-fired power plants are replaced with natural
  gas?

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For More Information
Visit our Healthy People Healthy Environment home
page at www.toronto.ca/health/hphe