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APHEIS Air Pollution and Health: A European Information System

Monitoring and assessment of health effects from air pollution Meeting 26 - 27.5.2005, JRC, EC, Ispra, Italy. APHEIS Air Pollution and Health: A European Information System Monitoring the impact of Air Pollution on Public Health in 26 European cities.

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APHEIS Air Pollution and Health: A European Information System

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  1. Monitoring and assessment of health effects from air pollution Meeting 26 - 27.5.2005, JRC, EC, Ispra, Italy APHEIS Air Pollution and Health: A European Information System Monitoring the impact of Air Pollution on Public Health in 26 European cities Sylvia Medina, National Institute of Public Health Surveillance, InVS, Saint Maurice, France Hans-Guido Mücke, Federal Environmental Agency, Berlin, Germany on behalf of the Apheis network

  2. What is Apheis ? • European public health surveillance systemto monitor the effects of air pollution (AP) on public health (PH) • Objective:translates epidemiological findings into decision-making tools and provide reliable, up-to-date and easy-to-use information on the effects of AP on PH • Target audiences: policy-makers, environment and health professionals, NGOs, the general public

  3. How Apheis meets the information needs of its key audiences (1) • Create a Europe-wide surveillance networkon the effects of AP on public health • Perform health-impact assessments (HIAs) on short- and long-term effects of AP over time • Deliver periodic reports on the impact of AP on PH at the city and European levels simultaneously • Develop communications tools for its different target audiences

  4. The Apheis Network

  5. The Apheis Network APHEIS Participating Centre APHEIS Coordination Centre Paris 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

  6. Actions, steps and results during thefirst 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

  7. Actions, steps and results during thesecond 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)

  8. * Our first HIA provided a conservative and detailed picture of the impact of air pollution on health in 26 European cities, and showed 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 -All other things being equal, reducing long-term exposure to PM10by just 5 µg/m3would have ‘prevented’ more than 5 000 premature deaths annually

  9. Actions, steps and results during thethird year • 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 of AP

  10. Actions, steps and results during thethird 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 in terms of content and form how best to meet the information needs of policy makers concerned with the impact of air pollution on public health • Develop tool templates/generic tools that centres can use Saklad Consultants for Apheis 3

  11. Five main steps in HIA 1. Specify exposure 2. Define the appropriate health outcomes 3. Specify the exposure-response functions 4. Derive population baseline frequency measures for health outcomes 5. Calculate number of attributable cases in target population

  12. 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

  13. Apheis 3 Short-term scenarios

  14. Apheis 3 Long-term scenarios

  15. Apheis 3 Health Impact Assessment Example of findings

  16. Annual mean levels and 5th and 95th percentiles of the distribution of PM10

  17. Reductions of PM2.5: 20 vs 15 µg/m3 • Our HIA revealed that reducing PM2.5 levelsto 15 µg/m3produces abenefitin terms of both total and cause-specific mortality that is over30% greaterthan for a reduction to 20 µg/m3 • However, because a significant health impact can be expectedeven below 15 µg/m3, we advise reducing air pollution to levels lower than 15 µg/m3: • All other things being equal, the HIA estimated that6 355premature deaths, including4 199cardiopulmonary deaths and743lung-cancer deaths, could be prevented annually if long-term exposure to PM2.5 levels were reducedby 3.5 µg/m3in each city

  18. Expected Gain in Life Expectancyat 30 years old if annual PM2.5 levels were reduced to 15 µg/m3

  19. Expected life expectancy for current PM2.5 levels and reduction to 15 µg/m3in Seville

  20. Expected gain in life expectancy if PM2.5 current annual mean levels (35 µg/m3)did not exceed15 µg/m3in Seville

  21. Uncertainties in the HIA process • Exposure measurements • Measurements methods (TEOM/Gravimetric) • Use of local/European correction factor • Number of stations and site selection • Quality assurance and control (QA/QC), and data quality (DQ) => Importance of the EURAQHEM project

  22. Uncertainties in the HIA process • Health Outcomes • Mortality data • Quality/Control Programme • Low percentage of missing data • Comparable data • Hospital admissions data • Completeness of registries-Quality/Control programmes • Problem of comparability of emergency vs total discharge diagnoses • Other morbidity data • Missing information

  23. Mortality Hospital admissions Emergencies Medical visits Restricted activity Medication Symptoms Infraclinical stage Number of persons

  24. Uncertainties in the HIA process • Transferability of Expo-Response Functions • Short-term HIA • European studies • Long-term HIA • US ACS study (Pope 2002) • Waiting for European cohort studies

  25. Learnings from Apheis • The APHEIS findings add one more brick in the wall of evidence that air pollution continues to threaten public health in Europe • Main source of air pollution in Apheis cities:Traffic • A bottom-up network very successful to help simultaneously local and European decision-making

  26. Learnings from Apheis • The Apheis programme fosters ongoing cross-fertilization between multiple disciplines and regions to: • create skilled, local teams • enrich know-how and the quality of its findings • and explore important HIA methodological issues • Using this approach, Apheis has established a good basis for comparing methods and findings between cities

  27. Learnings from Apheis • Today Apheis is a highly active network of environmental and health professionals in Europe: -Various local and national authorities have identified this network as able over time to provide sound scientific advice on health risks related to air pollution - Cities not involved in the Apheis programme have expressed a desire to join the Apheis network

  28. Who funds Apheis Co-funded by: * Pollution-Related Diseases Programme of Health and Consumer Protection DG (DG SANCO) of the European Commission, contract Nos.: • SI2.131174 [99CVF2-604] • SI2.297300 [2000CVG2-607] • SI2.326507 [2001CVG2-602] * Participating institutions in 12 European countries => JRC in Ispra 26-27 May 2005

  29. Special thanks to all the APHEIS group ! Athens:Antonis Analitis, Giota Touloumi, Klea Katsouyanni, Department of Hygiene and Epidemiology, University of Athens, Athens, Greece Barcelona:Lucía Artazcoz, Antoni Plasència, Agencia Municipal de Salut Pública (Municipal Institute of Public Health), Barcelona, Spain Bilbao:Koldo Cambra, Eva Alonso, Francisco Cirarda, Teresa Martínez, Departamento de Sanidad, Gobierno Vasco, Vitoria-Gasteiz, Spain Bucharest:Emilia Maria Niciu, Institutul de Sanatate Publica (Institute of Public Health), Bucharest, Romania Budapest:Anna Paldy, Janos Bobvos and Eszter Erdei, “Fodor József” Országos Közegészségügyi Központ Országos Környezetegészségugyi Intézet (“Jozsef Fodor” National Center for Public Health, National Institute of Env Health), Budapest, Hungary Cracow:Krystyna Szafraniec, Epidemiology and Preventive Medicine, Jagiellonian University, Cracow, Poland. Dublin:Pat Goodman and Luke Clancy, Saint James Hospital, Dublin, Ireland France, PSAS-9 project: Sylvie Cassadou (Toulouse), Pascal Fabre, Hélène Prouvost, Christophe Declerq (Lille), Daniel Eilstein (Strasbourg), Laurent Filleul (Bordeaux), Laurence Pascal (Marseille), Jean François Jusot (Lyon), Myriam D’Elf (Rouen, Le Havre), Agnès Lefranc, Benoit Chardon (Paris), and Alain Le Tertre, Institut de Veille Sanitaire, Saint-Maurice

  30. Special thanks to all the APHEIS group ! Ljubljana/Celje: Tina Gale, Peter Otorepec, Mateij Gregoric, Inštitut za Varovanje Zdravja (Institute of Public Health), Ljubljana, Republic of Slovenia London: Richard Atkinson and Ross Anderson, Saint George’s Hospital Medical School, London, UK Madrid: Mercedes Martínez (Dirección General de Salud Pública), Belén Zorrilla, Laura Lopez, Ana Gandarillas, Elena Boldo (Instituto de Salud Pública) Consejería de Sanidad, Laura Crespo (Dirección General de Calidad y Evaluación Ambiental) Consejería de Medio Ambiente, Comunidad de Madrid, Spain. Rome: Ursula Kirchmayer and Paola Michelozzi, ASL RM/E Azienda Sanitaria Locale Roma E (Local Health Authority Roma E), Rome, Italy Seville: Inmaculada Aguilera, Antonio Daponte, Escuela Andaluza de Salud Pública (Andalusian School of Public Health), Granada, Spain Stockholm/Gothenburg: Bertil Forsberg, Bo Segerstedt, Lars Modig, Umeå Universitet, Institutionen főr folkhalsa och klinisk medicin (Umeå University, Department of Public Health and Clinical Medicine), Umeå, Sweden Tel-Aviv: Ayana Goren, Sarah Hellmann, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, Israël Valencia: Ferrán Ballester, Carmen Iñíguez and José Luis Bosch (City Council), Escuela Valenciana de Estudios para la Salud (Valencian School of Studies for Health), Valencia, Spain

  31. Special thanks to all the APHEIS group ! Brussels:Catherine Bouland,Brussels Institute for the Management of The Environment (BIME) and Pierre Biot FPS Health, Food Chain Safety and Environment CAE, Belgium. Copenhagen: LisbethKnudsen, Institute of Public Health University of Copenhagen and Lis KEIDING National Board of Health, Denmark. Hamburg: Michael Schûmann, Arbeitsgruppe Epidemiologie, Institut für medizinische Biometrie und Epidemiologie (IMBE) and Hermann NEUS, Department for Science and Health (BWG) Germany. Lisbonne: Cristina Fraga Amaral, Filomena Araujo, Teresa Correia,General Health Directorate, Environmental Health Department, Portugal Prague: Ruzena Kubinova, Vladimíra Puklová,Environmental Health, National Institute of Public Health , Czech Republic. Rotterdam: Ingrid Walda, Municipal Health Service, Reind Van Doorn and Harma Boerema, Health Protection Agency, The Netherlands. Vienna: Manfred Neubergerand Hanns Moshammer,Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Austria

  32. Special thanks to all the APHEIS group ! • Steering Committee • Ross Anderson, Saint George’s Hospital Medical School, London, UK • Emile De Saeger, Nikolaos Stilianakis, Joint Research Centre, Institute for Environment and Sustainability, Joint Research Centre 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

  33. For further information please visit: www.apheis.net KNOWLEDGE ACTION APHEIS

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