Prof Nino Künzli MD PhD Deputy Director Swiss Tropical and Public Health Institute Basel Dean of the Swiss School of Public Health SSPH Professor ID: 784891
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Slide1
1
Präsentationstitel
Transport, Air Pollution and Health in Europe Prof. Nino Künzli, MD, PhDDeputy-Director Swiss Tropical and Public Health Institute BaselDean of the Swiss School of Public Health (SSPH+) Professor of Public Health, University Basel, SwitzerlandPrepared for 13th SessionTransport, Health and Environment Pan-European Programme (THE PEP) 2015 Symposium Reducing transport-related emissions for a better environment and human healthWHO Regional Office for Europe and Economic Commission for EuropeGeneva November 17th, 2015 - 15-18h Policy Briefing – 15:30-16:00
Department of Epidemiology & Public Health
Swiss
TPH
is
an
associated
Institute
of
University
of
Basel
Slide2Content
Health
effects: up-dates & trendsEmission trendsConcentrations & exposureHealth and economic impactTransport & noiseCommunication issues2
Slide3Scientific Advisory
Committee
: Hugh Ross Anderson, Bert Brunekreef, Aaron Cohen, Klea Katsouyanni, Dan Krewski, Wolfgang Kreyling, Nino Künzli, Xavier QuerolLINK: http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/air-quality/activities/health-aspects-of-air-pollution-and-review-of-eu-policies-the-revihaap-and-hrapie-projects
PDF: http://www.euro.who.int/__data/assets/pdf_file/0004/193108/REVIHAAP-Final-technical-report-final-version.pdf?ua=1 2013
Slide4Health
Effects of
air pollutionAcute EffectsDaily mortalityRespiratory & cardiovascular problemsHospital AdmissionsEmergency room visitsPrimary care visitsAdditional medication / self medicationDays of restricted activitiesWork & school absenteismPhysiologic changes (e.g. lung function)
Long-term effectsChronic diseasesLife expectancyChronic obstructive lung diseaseAsthmaLung cancer
Faster
aging
&
loss
of
lung
function
Atherosclerosis
cardiovascular diseasesMore to come…Diabetes Neurodevelopment, cognitive functionPre-term birthLow birth weight
4
Slide5Relevant
trends in science and
evidenceLarger studies, better power, detection of sensitive subgroups, evaluation of thresholdsBetter understanding of mechanismsInsights into pollutant- , source-, subject- and life period-specific effects (e.g. pregnancy)New health outcomes of interest: diabetes, metabolic syndrom, neurodevelopment, cognitive function etc.5A few examples
Slide6ESCAPE study areas in
EUROPE
PM+NOx
NOx only
Larger
studies
….
Slide77
%
change in deathAll subjects: (N=322’159;19 cohorts) 7% (2 to 13%)Distribution of home outdoor PM2.5 among participants of 19 European cohort studies and effect of a 5µg/m³ increase in home outdoor PM2.5 on mortality
(ESCAPE Study – Beelen et al, Lancet 2013)Larger studies….
Slide88
Only
subjects <20µg/m³ (N=304’759; 17
studies): 7% (1 to 13%)
%
change
in
death
All
subjects
:
(N=322’159;19
studies
)
7%
(2
to
13%)
No thresholds of «no effect»
Slide9Traffic
density (per 5’000 vehilces per
day) is associated with the prevalence of hypertension in 12 ESCAPE cohortsFuks et al, EHP, Sept 2014Source related effect (traffic) Prevalence of hypertension increased 2%
per 5’000 vehicles passing in front of the home (per day)
Slide10Living
close to
busy roads increases exposure to ultrafine particles (UFP), soot, black smoke (BS), elemental carbon (EC)These toxic constituencies affect health too, for example: Carcinogenic ( lung cancer)Death ( shorter life expectancy)Morbidity (cardio-respiratory)NeurodevelopmentIf traffic pollution management
plans reduce «black smoke» concentration by 10µg/m³ Life expectancy increases ~3-4
months
Jannsen
et al,
Env
Health
Perspect
,
Dec
2011
10
Slide1111
Environmental International, 2015
novel health outcomesPrevalence
of DIABETES is associated with home outdoor air quality (PM10) in the Swiss SAPALDIA study (and in other studies too)Eze et al, Env Internat 2015
Slide12Air Pollution
and Neuropsychological Development: A
Review of the Latest EvidenceSuades-González,et al, Endocrinology, 2015“Sufficient evidence” for detrimental effects of pre- or postnatal exposure toPolycyclic aromatic hydrocarbons intelligence quotient (IQ)PM2.5 autism spectrum disorder12novel health outcomes
Slide13pollutant
specific effects: diesel sootBUT: there is no «magic bullet»!ALL ARE HEALTH RELEVANT: soot, ultrafine particles
, coarse particles, PM2.5, PM10, NOx, Ozone, SO2 etc……
Slide14low
normal
increased obese Body-mass-indexAttenuation of
lung function loss per 10 ug/m3 improvement in fine particles
benefit
Obese
did
not
profit
from
beneficial
effect
of
better
air
quality
on
attenuation
of
lung
function
loss
(Schikowski et al, Swiss SAPALDIA Study, 2014)
susceptibility
factors
Slide15Content
Health
effects: up-dates & trendsEmission trendsConcentrations & exposureHealth and economic impactTransport & noiseCommunication issues15
Slide1616
Combustion
–
the
prime
cause
of
ambient
air
pollution
(
and
climate
change
…) in Europe
Slide17NOx
emission trends in Europe
(EU-28) from various sources17Fuel household/institutionalin 1’000 tons / yrTransport
Slide18Fine
particle
emission trends in Europe (EU-28) from various sources18Fuel household/institutionalin 1’000 tons / yrTransport
Slide1919
Trends in
black carbon emissions from surface transportation (teragrams per
yr) (World Bank Report. 2014)
Slide2020
Trends in
vehicle activity (World Bank Report. 2014)
Slide21Content
Health
effects: up-dates & trendsEmission trendsConcentrations & exposureHealth and economic impactTransport & noiseCommunication issues21
Slide22EU
annual
mean limit valueWHO annual mean limit valueThe lack of attainment situation in the EU-28 as compared to science-based WHO annual mean limit values
Slide2391-93%
of
EU citizens live where home outdoor PM2.5 levels are higher than recommended by WHO to protect health (i.e. > 10 µg/m³)
Slide24Large
percentage of EU citizens
live close to busy roads (> 10’000 vehicles per day)Perez at al (APHEKOM Team) – Eur Respir J 2013
City
Population
(Million in habitants)
% population within 75m
(average 29%)
% population within 150m
(average 52%)
Granada
0.24
14%
28%
Ljubljana
0.27
23%
47%
Bilbao
0.31
29%
59%
Sevilla
0.7
20%
38%
Valencia
0.74
44%
71%
Brussels
1.03
37%
64%
Stockholm
1.3
14%
30%
Barcelona
1.53
56%
77%
Vienna
1.66
36%
62%
Rome
2.81
22%
43%
Slide25High income (or education) is not necessarily associated with better air quality home outdoors !
Associations vary across European cities and possibly even within cities
BUT: poverty correlates with poorer health and nutrition status, which may increase susceptibility to air pollutionDoes socio-economic status determine exposure?
Slide26Content
Health
effects: up-dates & trendsEmission trendsConcentrations & exposureHealth and economic impactTransport & noiseCommunication issues26
Slide27Premature
mortality attributable
to ambient air pollution (PM2.5 & Ozone) in EuropeLelieveld et al, Nature 2015 2010 381’000 death 2050 530’000 deathLargest source : traffic (30-40%) (assuming carbonecous PM toxicity to be 5x higher; else ~20%)27
Slide2828
Primary
source of air pollution attributable mortality (Lelieveld et al, Nature 2015)biomassresidential comb.agricultureTRANSPORT
Slide2929
Percent
of diseases attributed to traffic-related air pollution in 10 EU cities (6 countries) with 1.89 mio children and 1.85 mio. adults >65 yrsAttributable to near-road pollution: Asthma cases in children 14%Coronary heart diseases 28%Attributable to urban air pollution (including
from traffic)Episodes with asthma symptoms 15%Asthma hospitalisations 15%Non-fatal myocardial infarctions 31%Hospital admission for infarctions 29%Hospital admission for stroke 27%
Perez at al (APHEKOM Team) –
Eur
Respir
J 2013; Chanel et al,
Eur
J
Health
Economics, 2015 in press
...
translates
into
costs of
370 million Euro /
yr
Slide30Economic
impact of
air pollution in 48 member states of European Region(OECD report 2015)Morbidity and premature mortality costs: 1.575 tril. US$/yr>1% of Gross Domestic Product (in 44 out of 48 countries)Road transport fraction: ~50% of totalBenefits of Commission proposal B7 to costs 42 : 130
Slide31Content
Health
effects: up-dates & trendsEmission trendsConcentrations & exposureHealth and economic impactTransport & noiseCommunication issues31
Slide3232
Shared
biologic mechanisms of action !NoiseAir pollution
Blood pressureCardiac functionSerum cholesterolTriglyceridesFree faty acids
Fibrinogen
Acute
Pulmonary
reflexes
Chronic
:
Pulmonary
inflam
. /
Oxidative
stressAutonomic Nervous SystemSystemic inflammationAtherosclerosisMyocardial Infarction, Stroke
Thrombosis
Serum Glucose
Stress response
Modified
after
Henry, 1992;
Devlin
and Wayne, US
EPA
Indirect pathway
Conscious
Cortical perception
Emotional stress
Direct
pathway
Unconscious
Physiological
stress
Autonomic
nervous
system
Endocrine
system
Deregulation
Adrenaline
, NA
Fatty
acids
Glycogenolysis
Glucocorticoids
(cortisol)
Slide33Health
effects of
traffic noiseSleep deprivationCardiovascular health (blood pressure)Cognitive functionOther chronic ailments related to psycho stress and sleep disordersHigh expenditures to cope with noise
Slide34Pollutant
Transport costs
Air pollution health costs *1,756Noise & health * & annoyance costs1,799CO2 (climate change)1,959External costs of transport, Switzerland 2010in millions of Swiss Francs (per yr)Vienneau et al, 2015* medical treatment costs, net lost output, replacement recruitment costs, intangible costs
Slide35Content
Health
effects: up-dates & trendsEmission trendsConcentrations & exposureHealth and economic impactTransport & noiseCommunication issues35
Slide36Transport
and health…
... is also an “urban planning” issue(transportation infrastructure...)
Slide37Progress
expected: Policy roadmap for Light Duty
and Heavy Duty Diesel Engines PM emission standardsLight Duty Heavy Dutyon track: pro-active EU emission control
Slide38EU –
absence of
science based ambient air quality standardsEU «air quality standards» accept large health burdenEU misleads public in communicating that «only 10-14% of the population» live in unhealthy air (i.e. rest is «in compliance» with EU standards)BUT: 91-93% of EU population live at levels above science-based limit values proposed by WHO
WHO Guide-lineIran
Swiss
stan
-dards
State of
Cali-fornia
U.S.A.
Fede-ral
E.U.
PM
2.5
annual
mean
10
µg/m
3
10
µg/m
3
(10 µg/m
3
)
Proposed
by
Federal
Commis-sion
12
µg/m
3
12
µg/m
3
25
µg/m
3
Interest-
based
rules
Science
based
standards
For
a Table
with
National
standards
:
see
Künzli et al, IJPH Editorial Aug 2015
and
Swiss TPH web
site
-
http
://ludok.swisstph.ch
/
Not
at
all on
track
:
EU
air
quality
standards
Slide39VW
Scandal in context
In Europe not (primarily) an «air pollution health» but an ethical and legal scandal (industry grossly misleading authorities and the publicReminder for high relevance of strong regulations of emissions coupled with independent emission control strategies, science-based ambient air quality standards, and monitoring to protect public healthHealth damage caused by inadequate air quality standard setting of EU Commission is MUCH LARGER than what (health damage) of VW scandal
can ever be!39
Slide40not
on
track:global science-based policies
Slide41NO
x
emissions, traffic and gross domestic product development in Switzerland, 1990 - 2010 1990 2010
70‘000 tons NOx / yr
10‘000
tons
NOx
/
yr
NO
x
emissions
from
traffic41
Vehicle
Kilometers
driven
/
year
GDP in 1990:
30‘000
Mio
$
Gross
Domestic
Product
(GDP)
in 2010:
70‘000
Mio
$
…
it
works
!
Slide42CONCLUSION
Transport related
pollutants and noise affect HEALTH and the climateClean air policies DO WORK - air pollution is NOT the «price to pay» for economic progressAir pollution and noise cause a large economic health burdenEU air quality standards ignore science: >90% of EU inhabitants live in places not complying with WHO air quality recommendations WHO Guideline values are NOT NEGOTIABLE and must be globalizedStrong emission standards, control, and monitoring crucial
Slide4343
Thank
you for your attention Nino.Kuenzli@unibas.chDeputy
Director Swiss Tropical and Public Health Institute Basel andDean Swiss School of Public Health SSPH+ (Universities of Basel, Bern, Geneva, Lausanne, Lugano, Luzern, Neuchâtel, Zürich)