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APHEIS 2

APHEIS 2. Air Pollution and Health: A European Information System A Health Impact Assessment of Air Pollution In 26 European Cities Emilia Maria Niciu 1 , Anna Paldy 2 , Eszter Erdei 2 , Michal Krzyzanowski 3 Sylvia Medina 4 , Antonio Placencia 5 , on behalf of the Apheis network

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APHEIS 2

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  1. APHEIS 2 Air Pollution and Health: A European Information System A Health Impact Assessment of Air Pollution In 26 European Cities Emilia Maria Niciu1, Anna Paldy2, Eszter Erdei2, Michal Krzyzanowski3 Sylvia Medina4, Antonio Placencia5, on behalf of the Apheis network 1- Institutul de Sanatate Publica (Institute of Public Health), Bucharest, Romania 2- Jozsef Fodor National Center for Public Health, National Institute of Environmental Health), Budapest, Hungary 3- WHO European Centre for Environment and Health, Bonn Office, Germany 4- Institut de Veille Sanitaire, Saint-Maurice, France 5- Institut Municipal de Salut Pública (Municipal Institute of Public Health), Barcelona, Spain ISEE CEE Chapter ,Balaton, Hungary, 4-6 October 2003

  2. Who funds Apheis Co-funded by: * Pollution-Related Diseases Programme of Health and Consumer Protection DG of the European Commission, contract Nos.: • SI2.131174 [99CVF2-604] • SI2.297300 [2000CVG2-607] • SI2.326507 [2001CVG2-602] * Participating institutions in 12 European countries

  3. What methods did we use Network * Network of environmental and public-health professionals * 16 centres totalling 26 cities in 12 European countries * Each centre part of a city, regional or national institution active in the field of environmental health

  4. What methods did we use Network

  5. What methods did we use Network Health outcomes monitoring (local/national institutes of public health, EUROSTAT, WHO) Exposure assessment Quantitative relationships of exposure and health-effect estimates (local networks, European Env. Agency; WHO collaborating  centre for air quality control, Berlin; European Reference Laboratory Air Pollution, Ispra)  (APHEIS)  Health impact assessment (cases, population, attributable risks) (APHEIS, WHO-ECEH)  Dissemination of information for defined target audiences (APHEIS)    E&H professionals Decision makers Citizens  Air quality management/Public-health actions  Evaluation (European Commission)

  6. What methods did we use Network Participating APHEIS Cities APHEIS coordination centre Paris and Barcelona Local/regional coordinator Technical committee Exposure assessment Epidemiology Statistics Public Health Health Impact Assessment Advisory groups Exposure assessment Epidemiology Statistics Public health Health impact assessment City committee NEHAPs Local/national authorities Medical/environmental sciences Citizens

  7. Actions, steps and results during the first year • Created five advisory groups: public health; health-impact assessment; epidemiology; exposure assessment; statistics • Drafted guidelines for designing and implementing the surveillance system, and for developing a standardised protocol for data collection and analysis for HIA • Review of capacities for HIA in institutions of participating cities

  8. Actions, steps and results during the second year • Implement or adapt organisational models designed during first year • Collect and analyse data for health-impact assessment • Prepare different health-impact scenarios • Prepare HIA report in standardised format (HIA in 26 cities)

  9. Five main steps in HIA 1. Specify exposure * PM10, BS * Urban background stations

  10. Five main steps in HIA 2. Define the appropriate health outcomes * Acute effects - Premature mortality excluding accidents and violent deaths - Hospital admissions for respiratory diseases 65+ age group - Hospital admissions for cardiac diseases all ages * Chronic effects   - Premature mortality

  11. Five main steps in HIA 3. Specify the exposure-response functions * Short-term exposure: APHEA2

  12. Five main steps in HIA 3. Specify the exposure-response functions * Long-term exposure: HIA in Austria, France and Switzerland based on two American cohort studies(Künzli et al, 2000). 3 Health indicator RR for 10 µg/m 95%CI Total mortality 30 years + 1.043 1.026 - 1.061 ICD9 <800

  13. Five main steps in HIA 4. Derive population baseline frequency measures for health outcomes 5. Calculate number of attributable cases in target population

  14. HIA modelKünzli, Kaiser, Medina et al, Lancet 2000; 356: 795 - 801 Incidence/ prevalence E-R function Scenarios Attributable cases Observed level: annual mean PM10 Reference level PM10

  15. Descriptive findings Demographic characteristics * Nearly 39 million inhabitants in Western and Eastern Europe ( 34 mil. in 21WE cities 5 mil. in 5 CEE cities) * Proportion of people over 65 years: 15%, with highest proportion in Barcelona and lowest in London

  16. Descriptive findings Air pollution levels * PM10 - measurements provided by 19 cities: Bordeaux, Bucharest,Budapest, Celje, Cracow, Gothenburg, Lille, Ljubljana, London, Lyon, Madrid, Marseille, Paris, Rome, Seville, Stockholm, Strasbourg, Tel Aviv and Toulouse * Black Smoke - measurements provided by 15 cities: Athens, Barcelona, Bilbao, Bordeaux, Celje, Cracow, Dublin, Le Havre, Lille, Ljubljana, London, Marseille, Paris, Rouen and Valencia

  17. µg/m3 100 90 80 70 60 50 40 2005 30 20 10 2010 0 Lille Lyon Paris Celje Seville London Madrid Rome Tel Aviv Cracow Ljubljana Budapest Marseille Toulouse Bordeaux Stockholm Strasbourg Bucharest * Gothenburg Descriptive findings Distribution of annual mean levels (10th and 90th percentiles) of PM10

  18. 120 µg/m3 100 80 60 40 20 0 Lille Paris Dublin Bilbao Ljubljana Athens Celje London Rouen Cracow Marseille Valencia Bordeaux Le Havre Barcelona Descriptive findings Distribution of annual mean levels (10th and 90th percentiles) of Black Smoke

  19. 1200 Rate / 100 000 /year 1000 800 600 400 200 0 Lille Lyon Paris Bilbao Dublin Celje London Athens Rome Rouen Seville Madrid Cracow Ljubljana Tel Aviv Toulouse Bordeaux Marseille Valencia Bucharest Budapest Le Havre Stockholm Strasbourg Barcelona Gothenburg Descriptive findings Health indicators :Standardised mortality rates for all causes of deaths in the 26 cities

  20. Rate / 100 000 /year incidence rate of cardiac admissions all ages 4000 incidence rate of respiratory admissions over 65 years of age 3500 3000 2500 2000 1500 1000 500 0 Lille Lyon Paris Bilbao Celje London Madrid Seville Rome Rouen Tel Aviv Ljubljana Marseille Toulouse Valencia Bordeaux Strasbourg Bucharest Le Havre Stockholm Barcelona Gothenburg Descriptive findings Health indicators: Incidence rates for hospital admissions in 22 cities ( 8 with emergency admissions, 14 with general admissions)

  21. Health impact assessment findings Acute effects scenarios * Reduction of PM10/BS levels to a 24-hour value of 50 µg/m3 (2005 and 2010 limit values for PM10) on all days exceeding this value * Reduction of PM10/BS levels to a 24-hour value of 20 µg/m3 (to allow for cities with low levels of PM10/BS) on all days exceeding this value * Reduction by 5 µg/m3 of all the 24-hour daily values of PM10/BS (to allow for cities with low levels of PM10/BS)

  22. Health impact assessment findings Chronic effects scenarios * Reduction of the annual mean value of PM10 to a level of 40 µg/m3 (2005 limit values for PM10) of 20 µg/m3 (2010 limit values for PM10) of 10 µg/m3 (to allow for cities with low levels of PM10) * Reduction by 5 µg/m3 of the annual mean value of PM10 (to allow for cities with low levels of PM10)

  23. Rate/100 000/year 7 6 5 4 3 2 1 0 Gothenburg Strasbourg Ljubljana Stockholm London Bordeaux Bucharest Budapest Marseille Toulouse Lille Lyon Tel Aviv Seville Madrid Cracow Paris Celje Rome HIA findings: PM10 acute-effects scenarios Potential benefits of reducing daily PM10 levels by 5 µg/m3 - Number of deaths per 100 000 inhabitants attributable to the acute effects of PM10 (95% C.I.)

  24. 6 Rate /100 000 /year 5 4 3 2 1 Ljubljana Bordeaux 0 Barcelona London Marseille Le Havre Athens Dublin Valencia Cracow Rouen Bilbao Lille Celje Paris HIA findings: Black Smoke acute-effects scenarios Potential benefits of reducing daily black smoke levels by 5 µg/m3- Number of deaths per 100 000 inhabitants attributable to the acute effects of black smoke (95%C.I.)

  25. 50 Rate /100 000 / year 45 40 35 30 25 20 15 10 5 0 Gothenburg Stockholm Strasbourg Ljubljana London Budapest Lille Bucharest Lyon Tel Aviv Bordeaux Marseille Seville Toulouse Madrid Paris Cracow Celje Rome HIA findings: PM10 chronic-effects scenarios Potential benefits of reducing annual mean values of PM10 by 5 µg/m3- Number of deaths per 100 000 inhabitants attributable to the chronic effects of PM10 (95% C.I.)

  26. HIA findings: PM10 in CEE cities CEE CITIES • out of a total of 32 mil in 19 cities • HIA for long term exposure on total mortality found that 5 547 (3 368 - 7 744) premature death could be prevented annually if PM10 concentrations were reduced by 5 µg/m3

  27. Interpretation of findings Standardised protocol for data collection and analysis Conservative approach : * Did not consider newborn or infant mortality separately * Did not consider many other health outcomes listed by WHO * Did not consider independent effect of ozone * Used range of reference levels in different scenarios

  28. Interpretation of findings Transferability of Exposure-Response (E-R) functions: * Short-term exposure: Question avoided by using E-R functions developed by APHEA 2 * Long-term exposure: Open question - used U.S. E-R functions

  29. Interpretation of findings Conclusions * Our HIA provides a conservative but accurate and detailed picture of the impact of air pollution on health in 26 European cities, and shows that air pollution continues to threaten public health in Europe. * Even very small and achievable reductions in air pollution levels have an impact on public health * This impact justifies taking preventive measures even in cities with low levels of air pollution

  30. Apheis 2002-2003

  31. Actions, steps and results during the third year (2002-03) • To keep our HIA as accurate and up-to-date as possible: - Produce new exposure-response functions on short-term effects of AP - Calculate years of life lost or reduction in life expectancy, in addition to the attributable number of deaths based on long-term effects

  32. Actions, steps and results during the third year • To fulfill our mission of making our learnings available to the broadest possible audiences, and to evaluate the usefulness of our work on HIA among those who need to know: - Explore and understand how best to meet the information needs of policy makers concerned with the impact of air pollution on public health and - Understand how to meet those needs in terms of content and form

  33. The broad view • Apheis is a multiyear, multiphaseproactivepublic-health programme • Each phase builds on learnings of previous phase • First broad-based European HIA of air pollution on both the city and European levels simultaneously • Consistent with other HIAs on air pollution worldwide • Translates epidemiological findings into decision-making tool • One more brick in the wall of evidence that air pollution continues to threaten public health

  34. The future

  35. Epheis Environmental Pollution and Health: A European Information System

  36. Background • Call for proposalsDGSANCO 2003-2008 • ENHIS Environment and Health Information System (WHO- ECEH Bonn) • Six modules: • Identification of relevant policies/corresponding needs • Development of Indicators • Methods for data retrieval/processing • Creation of NCC, networking • Integrate HIA (Epheis) • Database development and maintenance • Coordination WHO-Bonn • Steering Committee • Length first year :1 Feb 2004-30 Jan 2005

  37. Objective • Comparative risk assessment (CRA) of different environmental risk factors in Europe • Selected environmental risk factors • Method based on HIA and CRA

  38. For further information please visit: www.apheis.org

  39. Who are our partners 1. University of Athens, Athens, Greece 2. Institut Municipal de Salut Pública (Municipal Institute of Public Health), Barcelona, Spain 3. Departamento de Sanidad, Gobierno Vasco, Vitoria-Gasteiz, Spain 4. Institutul de Sanatate Publica (Institute of Public Health), Bucharest, Romania 5. Jozsef Fodor National Center for Public Health, National Institute of Environmental Health), Budapest, Hungary 6. National Institute of Hygiene, Warsaw, Poland 7. Saint James Hospital, Dublin, Ireland 8. Institut de Veille Sanitaire, Saint-Maurice, France 9. Inštitut za Varovanje Zdravja RS, (Institute of Public Health), Ljubljana, Republic of Slovenia

  40. Who are our partners 10. Saint George’s Hospital Medical School, London, UK 11. Dirección General de Salud Pública, Consejeria de Sanidad, Comunidad de Madrid (Department of Public Health, Regional Ministry of Health, Madrid Regional Government), Madrid, Spain 12. ASL RM/E Local Health Authority Roma E, Rome, Italy 13. Escuela Andaluza de Salud Pública (Andalusia School of Public Health), Granada, Spain 14. Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden 15. Tel Aviv University, Tel Aviv, Israel 16. Escuela Valenciana de Estudios para la Salud (Valencia School of Health Studies), Valencia, Spain

  41. Who are our partners Steering Committee Ross Anderson, Saint George’s Hospital Medical School, London, UK Emile De Saeger, Joint Research Centre, Institute for Environment and Sustainability, Ispra, Italy Klea Katsouyanni, Department of Hygiene and Epidemiology, University of Athens, Athens, Greece Michal Krzyzanowski, WHO European Centre for Environment and Health, Bonn Office, Germany Hans-Guido Mücke, Umweltbundesamt - Federal Environmental Agency, WHO Collaborating Centre, Berlin, Germany Joel Schwartz, Harvard School of Public Health, Boston, USA Roel Van Aalst, European Environmental Agency, Copenhagen, Denmark

  42. Who are our partners Coordinators • Sylvia Medina, Institut de Veille Sanitaire (Institute of Public Health), Saint-Maurice, France • Antoni Plasència, Institut Municipal de Salut Pública (Municipal Institute of Public Health), Barcelona, Spain Programme Assistant • Claire Sourceau, Institut de Veille Sanitaire, Saint-Maurice, France

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