Implementation Update of the Canadian Air Quality Health Index

1. Implementation Update of the Canadian Air Quality Health Index Dave Henderson (MSC/Environment Canada) & Christina Daly (AHED/Health Canada) US EPA Air Now Conference Risk Communications San Diego,CA March 7, 2011

2. Presentation • Fundamentals • Risk and the AQHI • Update: What’s new since April 2008 • implementation continues … continuous improvement begins • Risk communications case studies

3. AQHI - Air Now History • February 2005 - San Francisco • Revisiting Canadian Air Quality Indices: A Health Risk Based Approach • February 2007 - Orlando • Testing and Evaluating the Air Quality Health Index • April 2008 – Portland • Air Quality Health Index: Fundamentals and Future

4. Risk Communications • Risk is the potential that a chosen action or activity (including the choice of inaction) will lead to a loss (an undesirable outcome). The notion implies that a choice having an influence on the outcome exists (or existed). Wikipedia, 2011 • defined as "any exchange of information concerning the existence, nature, form, severity or acceptability of health or environmental risks”. Decision-making Framework for Identifying, Assessing and Managing Health Risks (Health Canada, 2000) • “Risks cannot be managed without communication because, as research shows, communication is the most powerful influence on people's risk decision-making and behaviour” A Framework for Strategic Risk Communications Within the Context of Health Canada and the PHAC's Integrated Risk Management (Health Canada, 2006)

5. Does such a risk exist? • Yes … significant and numerous studies on the impact of air pollution on society indicate risk but particularly those seen to be sensitive populations.

6. But what about perception • Those who promote and regulate health and safety need to understand how people think about and respond to risk. Without such understanding, well-intentioned policies may be ineffective “ Slovic, Paul (1987) Perception of Risk, Science Volume 236

7. Perception is Everything • Air Quality Scope • Hazards • Susceptibility • Pollutant Levels and Drivers • Risk Avoidance Behaviour Options • Information on Air Quality • Flexibility (in Behaviour) • Options • Health Outcomes Expected

8. Why Choose Risk? • Units of measure are meaningless to public • Health science and stakeholder concerns did not support the use of thresholds • Health advice is not tied to legislation or regulations • Simplified multi pollutant communications • Weighted short-term health risk of the pollutant mixture • Research shows public confusion linking pollutants to health advice • Positive experience with the UV index

9. Vulnerability Exposure risk dependent on : the degree of exposure Where people spend their time Level of activity (breathing rate) individual characteristics Age Health status (respiratory, cardiovascular disease)

10. Presentation • Illustrates level of health risk with colour &number scale of 1-10+ • Labels the level of HEALTH risk as “low”, “moderate”, “high” or “very high” • Active living prompts • Forecasts local air quality for the current and next day • Provides health messaging for both general & at-risk populations on how to minimize that risk

11. Reducing Exposure Risk

12. What is new since Portland • National Implementation • National transition from pilots to replacement of AQIs • National program of support • AQHI available in 9 of 10 provinces (stay tuned for the summer) • 49 locations (with more to come) • 6 provinces have retired their provincial AQIs and one other province will retire its AQI in 2011 • Partnership of Provincial environment and health departments and agencies, Non Government Organizations and the communications industry continues • Full integration into Environment Canada’s weather dissemination systems

13. Monitoring and Data • Partnership with provinces • Increasing priority with the National Air Pollution Surveillance (NAPS) network • Feeder for Air Now • Assessments in progress • monitoring required for AQHI forecasts • Representativeness of national monitoring network

14. Dissemination • National web portal airhealth.ca /coteairsante.ca • Enhanced relationship with the Weather Network • AQHI available twice-hourly in most markets • Integration into suite of media products • AQHI forecast information to be added to national automated telephone answering network (summer) • Third-party widgets and mobile phone apps

15. Forecasting • All 7 Storm Prediction Centres issuing AQHI forecasts • Part of their responsibility on the weather forecast desk • New modelling support for AQHI forecasting • GEM MACH 15 • New statistical models being developed • New forecast production tools • Forecasts based on understanding of behavior of pollutants • Improved integration into weather dissemination stream

16. Evaluation • Successful evaluations and audits of the program • Commissioner for Environment and Sustainable Development • Clean Air Agenda • 2010 Health Canada funded public opinion research • Ongoing performance management • Significant reliance on third parties for outcomes

18. Outreach • Health Canada • Certified on-line AQHI course for health practitioners • Memorandums of Agreement with other levels of government to support implementation • Outreach tools targeted at specific audiences • Environment Canada • Grants and Contributions Funding (31 agreements) 1.1M CDN over the last 4 year • Creative outreach to support local implementations and environmental improvement goals of the AQHI

19. Framework for Continuous Improvement Environment Canada Health and Air Quality Services Management Board Joint AQHI Secretariat AQHI Implementation Committee Outreach Working Group Advisories Working Group Evaluation Working Group Health Affects Working Group Health Messages Working Group

20. Focus on Continuous Improvement • Science supporting AQHI formulation • New data and new health endpoints • Comprehensive research plan to address science issues • Health Messaging • Follow-up of 2010 Workshop • Expansion of service to small communities • Enhancing consistency of data delivery • Dedicated delivery “pipes” from provinces to CMC • Investigating the operational feasibility of satellite derived pollution concentrations

21. Reducing the Risk … Examples • Using AQHI funding EC and HC have supported initiatives at reducing health risk using: • innovative delivery of outreach material • innovative integration with environmental objectives • innovative dissemination technologies

22. Clean Air Champions: Delivery Air Aware=Educate on Issues + Protect Health (AQHI) + Lifestyle Choices I. School – Curriculum Connected Program • Grade 9 - up to post secondary • Curriculum resources and activities • Promote more active lifestyles II. Community & Sport & Recreation – • Coaches/Admin & Active Youth • Air Quality and Lung Health • ‘Emergency Preparedness’ using AQHI Tool III. Vancouver 2010 Olympic Games • First ever NGO allowed in Olympic Athletes’ Villages • PSA/AQHI with significant reach across Canada

23. Clean Air Partnerships: Integration • Cooperation with Toronto Public Health • “20/20 Way to Clean Air” • AQHI integrated into promotional material on personal actions to reduce energy use and climate change • Focus on multicultural populations • AQHI translated into 13 different languages • Innovative delivery of programs through a cadre of non-governmental agencies

24. New Dissemination Technologies • Emerging dissemination technologies used to push AQHI information for at risk groups • Telephone Notification • IVR pilot (Windsor) and Quebec pilot • Enhanced message recall and retention • Significant behaviour modification to reduce risk • Smart Phone Pilot • Push-AQHI and Pull-personal health information • Asthma Management Plan support • Preliminary results show improvement in Quality of Life scores

25. Summary • Understanding risk perception has underpinned the development of the AQHI • National AQHI implementation is ongoing • Continuous improvement the emerging area of focus • Many examples have shown the value of partnerships, integration and use of new dissemination technologies to reduce risk

26. Thank-you Contact Information: Dave Henderson – Environment Dave.Henderson@ec.gc.ca Christina Daly - Health Christina.Daly@hc-sc.gc.ca 613-954-4505