Title: Towards Healthy Public Policy: Assessing
1Towards 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
2People can spend a lot of time close to pollution
sources
3Presentation Overview
- Healthy Public Policy
- Areas of activity
- Integration of assessment tools
- Policy questions of local significance
4Healthy 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
5Areas of Activity in Influencing Policies Related
to Air
- Exposure assessment and health risk
- Risk communication
- Broad determinants of health (e.g. social aspects)
6Exposure 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)
7St 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)
-
8St 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
9Lakeview 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.
10Annual Air Emissions from Lakeview Plant
11Air 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
12Whats 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)
13Calculating 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)
14Air 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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16Impact 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
17Risk Communication
- Studies that influence communication
- policies
- Toronto Air Quality Index - Health Links Analysis
- Condition Critical Fixing the Smog Warning
System - Evaluation of smog advice
18The 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
19Mixed 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
20Distribution in Health Outcomes by AQI Category
(based on 2000 study)
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22Why 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
23Days of Poor Air Quality in Toronto resulting
from inclusion of PM2.5 in the AQI
24Evaluation 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
25Incorporating Broad Determinants of Health
Social Aspects
- Air emissions and health status studies related
to Ashbridges Bay Treatment Plant - Health Impact Assessment Designated bus route
26Ashbridges 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
27Ashbridges 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
28Ashbridges 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
29TPH 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
30Environmental 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
31Health 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
32Rapid Bus Route Pilot Health Impact Assessment
Outcomes Examined
- Vehicle pollution
- Stress (commuting driving)
- Equity issues (who benefits)
- Commute time
- Accident rates
33Integration of Assessment Tools
Air Emissions
Policy Options
Health Burden
Ambient Levels
34How to Deal with Different Health Outcomes?
Pyramid of Health Effects Toronto Annual
Estimates for Inhalable Particulates (PM10)
35Some 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?
36For More Information
Visit our Healthy People Healthy Environment home
page at www.toronto.ca/health/hphe