Air Quality and Human Health Impacts Overview

1. Module 10:Air quality

2. Key messages in Module 10 • The mixtures of air pollutants produced by burning of fuels & by wildfires, can adversely affect human health directly & indirectly • Elevated concentrations of particulate matter & ozone cause significant mortality • Climate variability can influence air quality, resulting in adverse health consequences • Includes affects on aero-allergens like pollen • Reducing the sources of air pollutions would prevent avoidable premature mortality

3. Module 10 outline 1 3 4 2 Benefits of air quality policies Health impacts of air pollution Introduction to air pollutants Exposures to air pollution

4. 1 Introduction to air pollutants & their characteristics

5. Air pollutants • Carbon monoxide (CO) • Nitrogen dioxide (NO2) • Lead (Pb) • Sulfur dioxide (SO2) • Particulate matter (PM2.5, PM10) • Ozone (O3) Strong evidence for causal relationship between air pollution & premature death • Time series studies of acute effects • Cohort or cross-section studies of chronic effects

6. Carbon monoxide • Produced by incomplete combustion • Inhibits the capacity of blood to carry oxygen to organs & tissues • People with chronic heart disease may experience chest pain when CO levels are high • At very high levels, CO impairs vision, manual dexterity & learning ability, & can be fatal

7. Nitrogen dioxide • Produced from high-temperature combustion • Affects lung function in persons with asthma • Contributes to acid rain & secondary particle formation • Is a precursor of ground-level ozone

8. Sulfur dioxide • Emitted from combustion of sulfur-containing coal & oil, & from metal smelting operations • Emissions reduced using scrubbers • Contributes to acid rain & to formation of PM2.5 through atmospheric reactions • Associated with reversible declines in lung function of people with asthma, & exacerbates respiratory symptoms in sensitive individuals

9. Particulate matter (PM2.5, PM10) • Can be primary or secondary • Produced by combustion, atmospheric reactions & mechanical processes • Associated with a wide range of human health impacts, including premature deaths • Higher temperatures may favor secondary formation • Some particle types contribute to climate warming, others to cooling

10. Ozone • Main pollutant responsible for photochemical smog • Formed via reactions in the atmosphere from primary pollutants (NOx & VOCs) in the presence of sunlight • Higher temperatures favor ozone formation • Ozone is also a greenhouse gas • Strong oxidant that damages cells lining the respiratory system, resulting in a variety of adverse health outcomes including lung function decrease, asthma attacks & premature death

11. Ground-level ozone formation Source: Queensland Government Environmental Protection Agency (2013)

12. 2 Exposure to air pollutants

13. What are the main sources of air pollution exposure in your country? What is being done to manage these sources?

14. Multiple sources of air pollutants

15. Forest fires

16. Forest fires & temperature trends Data from Canada 1920-1999: 5-year Means Source: Gillett et al. (2004)

17. Annual PM10 concentrations in Asian cities Source: Clean Air Initiative for Asian Cities (2010)

18. Average of annual average ambient air quality in 243 selected Asian cities Source: Clean Air Initiative for Asian Cities (2010)

19. % of population using solid fuels & annual mean air pollution levels Source: WHO (2012)

20. Pollen Change in pollination seasons & migration of birds & insects including bees & butterflies may affect the seasonality of allergy & asthma

21. Plants:Poison Ivy toxic oils Source: Climate Central

22. 3 Health impacts of PM & ozone

23. Source: AirBetter.org

24. Air pollution effects on the developing respiratory system Source: UCLA Institute of the Environment & Sustainability

25. Time series analyses • Analyzes a series of daily observations of air pollution & health to determine short-term, acute effects • Widely used & economical approach, often utilizing readily-available data • Temporal studies avoid many of the confounding factors that can affect spatial studies • Time-varying factors may confound the pollution associations • Seasonal cycles, weather variables, day of week

26. Prospective cohort studies • Address long-term, chronic effects • Large populations in multiple cities enrolled & followed for many years to determine morbidity or mortality experience • Must control for “spatial” confounders, e.g. smoking, income, race, diet, occupation • Assessment of confounders at individual level is an advantage over cross-sectional, ecologic studies

27. Review of evidence • Review of evidence on health aspects of air pollution – REVIHAAP project (WHO EURO) available at: http://euro.who.int/__data/assets/pdf_file/0004/193108/REVIHAAP-Final-technical-report-final-version.pdf?ua=1 • City level data available at: http://apps.who.int/gho/data/view.main.AMBIENTCITY2014?lang=en

28. Ambient air pollution attributable deaths in 2012, by WHO region Source: WHO

29. % childhood mortality due to air pollution Source: WHO (2012)

30. Climate change-induced changes in annual mean surface PM2.5 from 1981 - 2000 to 2081 - 2100 ug/m3 Source: Fang et al. (2013)

31. Climate change-induced changes in annual mean surface O3 from 1981-2000 to 2081-2100 (ppbv) Source: Fang et al. (2013)

32. Estimated change in premature mortality with changes in PM 2.5 & O3 PM2.5 O3 Additional annual premature mortalities per 1,000 km2 Additional annual premature mortalities per million population Future minus present Source: Fang et al. (2013)

33. Atmospheric brown cloud Increases in concentrations of PM 2.5 of 20 μg/m3 could lead to about 340,000 excess deaths per year in China & India Atmospheric brown haze is also altering regional weather, creating acid rain, & (perhaps) affecting forest & crop yields

34. 4 Benefits of air quality policies

35. WHO air quality guidelines • PM2.5 • 10 μg/m3 annual mean • 25 μg/m3 24-hour mean • PM10 • 20 μg/m3 annual mean • 50 μg/m3 24-hour mean • Ozone • 100 μg/m3 8-hour mean Source: WHO (2008)

36. WHO key facts on air pollution • Key sources of urban outdoor air pollution can be reduced by policies & investments supporting cleaner transport, energy-efficient housing, power generation, industry & better municipal waste management • Key rural & peri-urban air pollution sources can be reduced by decreasing outdoor emissions from household coal & biomass energy systems, agricultural waste incineration, forest fires & certain agro-forestry activities (e.g. charcoal production)

37. Co-benefits of avoided premature mortality from PM2.5 & O3 in 2030, 2050, & 2100 Deaths per year per 1,000km2 Deaths PM2.5 - cardiopulmonary disease plus lung cancer Ozone (O3) – respiratory disease Source: West et al. (2013)

38. What we covered in Module 10 1 3 4 2 Benefits of air quality policies Health impacts of air pollution Introduction to air pollutants Exposures to air pollution

39. Learning from Module 10 • The mixtures of air pollutants produced by burning of fuels & by wildfires, can adversely affect human health directly & indirectly • Elevated concentrations of articulate matter & ozone cause significant mortality • Climate variability can influence air quality, resulting in adverse health consequences • Includes affects on aero-allergens like pollen • Reducing the sources of air pollutions would prevent avoidable premature mortality

40. What action will you take in your work, given what you learnt in Module 10?

41. Coming up next… Module 16: Communicating climate change & health