World Health Organization 5 September, 2018 Breathless World Annette Prüss-Ustün Air Pollution Symposium, 18-19 November 2017, Istanbul

Overview of the presentation World Health Organization Overview of the presentation 5 September, 2018 Air pollution and health WHO’s role What can be done ?

Air pollution and health

Air pollution 6,5 million deaths per year. Sense of urgency – political issue, demand for action. Traditionally thought of as an environmental issue, has become an urgent public health crisis. Traditionally little involvement of the health sector. 2

World Health Organization 5 September, 2018 Outrage Kathmandu, Winter 2016/2017

Air pollution and health PM<10mm – Coarse PM<2.5mm – Fine PM<1mm – Ultrafine Heart Disease Stroke Adverse Pregnancy Outcomes Chronic obstructive pulmonary disease Cognitive development Childhood pneumonia Tuberculosis Lung cancer Diabetes Cataract The relationship between PM & health is size dependent. The aerodynamic diameter of PM plays an important role in the human toxicity as this can impact the level or degree of entry into the body. Larger or coarse fraction particles of PM, with aerodynamic diameter greater than 2.5 micrometers and less than 10 micrometers such as dust, pollen are restricted to the thoracic cavity and are unable to penetrate the smaller airway systems. PM 2.5 and smaller or the fine fraction have more severe impacts on health due to its greater ability to deposit on smaller airways & aveoli in the lungs. Ambient studies outdoors have shown that days with higher concentrations of PM 2.5, show a larger percentage of black carbon than those days with high concentrations of coarse fractions. Evidence relating specifically to ultrafine particles is still limited but considering its small size, its ability to penetrate different tissues and organs suggest a greater ability to effect the body systematically. Image on the left helps show where the in the respiratory tract that particles can deposit. Often particles smaller than 2.5 are able to penetrate deep into the lungs and effect the body more systematically leading to cardiovascular disease and adverse pregnancy outcomes. However please note that size alone does not determine the health effects as considerations of chemical composition, concentration and/or surface area are also important to consider. The smaller-diameter particulates have the most health impacts as they enter into the body’s orifices, particularly lungs, most easily. Among those, PM10 with aerodynamic diameter less than 10greater than 2.5 micrometers and micrometers such as dust, pollen can penetrate the thoracic cavity. PM 2.5 and smaller penetrate the smaller airway systems and thus have more severe impacts on health due to its greater ability to deposit on smaller airways & aveoli in the lungs. Ambient studies outdoors have shown that days with higher concentrations of PM 2.5, show a larger percentage of black carbon than those days with high concentrations of coarse fractions. Image on the left helps show where the in the respiratory tract that particles can deposit. Often particles smaller than 2.5 are able to penetrate through the lungs and effect the body more systematically leading to cardiovascular disease and can lead to adverse pregnancy outcomes.

Mortality from air pollution Ambient air pollution (AAP) 3.0 million deaths/yr Household air pollution (HAP) 4.3 million deaths/yr According to WHO GBD figures for 2012, released in 2014 and 2016, Ambient Air Pollution is estimated to be responsible for 3.0 million premature deaths a year and Household air pollution for 4,3 million deaths in 2012, making of HAP is world’s largest environmental-health risk AAP: Ambient air pollution: global assessment of exposure and burden of disease, WHO Geneva, 2016. HAP: WHO Global Health Observatory, http://apps.who.int/gho/data/node.main.133?lang=en Mongolia Air Pollution Forum

World Health Organization Joint Effects: Disease Burden from Household AP + Ambient AP (AAP), 2012 5 September, 2018 In some areas, a significant fraction of ambient air pollution (AAP) is caused by household fuel combustion WHO estimates that around 6.5 million premature deaths are caused by the joint effects of HAP and AAP annually

SDG 3.9.1 Mortality rate from air pollution

Number of deaths per year attributable to selected risks, World Sources: WHO 2012, Global Health Observatory; IHME 2016, http://ghdx.healthdata.org/gbd-results-tool

SDG 11.6.2 Exposure to particulate matter PM2.5 Ambient air pollution SDG 11.6.2 Exposure to particulate matter PM2.5 92% of world population breathe an air above the WHO Air Quality Guidelines http://maps.who.int/airpollution/

WHO guideline values (annual mean) PM2.5: 10 μg/m3 PM10: 20 μg/m3 http://maps.who.int/airpollution/

Household air pollution SDG 7. 1 Household air pollution SDG 7.1.2 Use of clean fuels and technologies for cooking, 2014 In 2014, over 3 billion people primarily used polluting fuels for cooking

SDG 3.9.1 Mortality from joint effect of air pollution, 2012 6.5 millions deaths – 1 in 9 deaths

WHO’s response

World Health Assembly Resolution A68 World Health Assembly Resolution A68.8 An enhanced global response to the adverse health effects of air pollution Highlights the key role of health authorities in raising awareness about the potential to save lives and reduce health costs, if air pollution is addressed effectively. Identifies the need for strong cooperation between different sectors and integration of health concerns into all national, regional and local air pollution-related policies. Urges Member States to develop air quality monitoring systems and health registries to improve surveillance for all illnesses related to air pollution; Urges Member States to strengthen international transfer of expertise, technologies and scientific data in the field of air pollution.

WHO Global Platform on Air Quality and Health World Health Organization WHO Global Platform on Air Quality and Health 5 September, 2018 Established in January 2014, last meeting March 2017. Main purpose: Strengthening countries capacity to address air pollution and related health risks through enhanced estimates of air pollution exposure. Availability of information about exposure of population to air pollution is the key for: risk assessment communication development and implementation of effective policies. A the March meeting, the objectives were to : Review progress and emerging issues Identify gaps and opportunities Propose next steps Respond to questions by countries and scientists Shaddick G. et al (2016), 'Data Integration Model for Air Quality: A Hierarchical Approach to the Global Estimation of Exposures to Ambient Air Pollution', Journal of the Royal Statistical Society (Series C).

What can WHO do about it? Gathering data, evidence & raising awareness Global databases on outdoor air pollution in cities, household energy use, and household air pollution measurements Global Platform on Air Quality and Health: combining satellite imagery, chemical transport models & ground-level monitoring Normative work & support to countries World Health Assembly Resolution & road map (2015 and 2016) WHO Air quality guidelines Reviewing & synthesizing the evidence on the effectiveness of technological & policy interventions for both acute & chronic exposure and health outcomes ISO Standards for cookstoves Connecting air pollution to sustainable development & climate UN Secretary General’s Sustainable Energy for All initiative (SE4All) Inter-Agency and Expert Group on Sustainable Development (IAEG) Climate & Clean Air Coalition (CCAC) Outdoor air pollution (OAP) has typically been considered a problem for cities, and monitoring (if available) is typically limited to urban areas. New methods have been developed to monitor outdoor air quality in both urban and rural areas globally using varying sources of information including satellite imagery, chemical transport models and ground-level monitoring WHO has been collaborating with various experts in the field to plan a more comprehensive and robust global monitoring system for outdoor air quality using these new methods WHO plans to coordinate a meeting with stakeholders and experts to review these new methods and develop an action plan for their use by WHO for routine monitoring of outdoor air quality and its associated health impacts In 2011, WHO launched its Outdoor Air Pollution database—housing air quality data from over 1100 cities worldwide Database serves as an important tool for countries and municipalities to monitor and track air quality and its impacts in cities WHO is in the process of updating this database with more recent estimates and when possible data from new cities not currently represented in the database Countries are becoming more and more aware of the health impacts of poor air quality and are seeking support and guidance on effective interventions to improve health and air quality There is a paucity in the evidence looking at the effectiveness of interventions WHO is looking for technical support to systematically review the evidence base on the effectiveness of outdoor air quality interventions at improving health Increasing our knowledge about the effectiveness of interventions can help drive evidence-based policy across sectors to improve health & air quality

World Health Organization 5 September, 2018 WHO Global Platform on Air Quality and Health: Task groups requiring expert inputs 8 Task Groups: Improvement in Exposure assessment: Assessment of Health Impacts Desert and sand dust Low Cost Air Quality Monitoring Response to air pollution episodes Citizens’ science Communication

BreatheLife campaign - breathelife2030.org Aim To mobilize cities and individuals to protect our health and our planet from the effects of air pollution Citywide commitments towards WHO Air Quality Guidelines, and solutions Actions for individuals Health sector leadership

World Health Organization 5 September, 2018 A global campaign to protect our health and climate by improving air quality For Cities : 35 cities have joined, commitments towards AQG & solutions London, Washington DC, Santiago, Manchester, Aburrà Valley, Jalisco State, Mongolia For the General public : information on risks, air quality levels, actions For the Health professionals: information on risks for patients, actions Campaign was framed under the Climate and Clean Air Coalition (CCAC), WHO, UNEP , which also used their regional offices and initiatives (e.g. WHO healthy cities) and launched in October 2016 at UN HABITAT III conference Involved city and governments officials that were interested to joining the network  of cities (it started with a few now there are 35 after one year, and more have shown interest in joining) to demonstrate support for air quality solutions, leadership and engagement. Cities like London, Washington DC, Manchester, Santiago and several other cities in LA, and a country: Mongolia, commit to improve air quality in line with the WHO AQ Guidelines for particulate matter air pollution. Cities networks and NGOs such as ICLEI (Local Governments for Sustainability), C40, Clean Air Asia, Clean Air Initiative, Global Alliance on clean cookstoves, etc are part of the campaign, enables more visibility and reaching out more people BreatheLife2030.org website contains information on health impacts of AP and solutions, videos, infographics, data, and it is interactive so that people, cities, health workers can sign up and join the campaign, and use the available material and tools. Social media engagement important to inform and drive the conversation; Twitter, Facebook, so far 21 mill views are registered Synergies between different stakeholders (climate, air pollution, health), joint resources, and wide outreach were key to success                               Launched Oct 2016 at UN HABITAT III Conference breathelife2030.org

A global campaign to protect our health and climate by improving air quality

http://breathelife2030.org/

Solutions CITY WIDE SOLUTIONS ACTIONS FOR INDIVIDUALS Transport Waste management Household air & pollution Food & agriculture Energy supply Industry ACTIONS FOR INDIVIDUALS Reduce your contribution Minimize exposure HEALTH SECTOR LEADERSHIP Education & advocacy Sustainable facilities Service delivery

World Health Organization Urban Health Initiative - Create demand for actions that prevent air pollution-related diseases 5 September, 2018

Moving ahead with urban transformation 2) Health & economic tools 1) Policies mapped 3) Scenarios tested 4) Health Leadership 5) Communications 6) Urban leaders act

What role for health actors ?

Health Sector Role Convey the health burden Provide leadership in health matters related to air pollution. Convene different sectors to address public health issues. Support improved standards. Conduct health-based assessments. Protect those at risk. Advocate for monitoring. The health sector has a duty to: Protect children, who do not have a voice Use existing PH knowledge to inform decisions Help ensure best use of resources – invest where the benefits are greater Help reduce health inequity through public policies Health matters to all sectors and to the economy

Thank you WHO resources Air pollution Ambient air pollution www.who.int/topics/air_pollution/en/ Ambient air pollution http://www.who.int/phe/health_topics/outdoorair/en/ Breathelife campain http://breathelife2030.org/ AirQ+ on the web http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/activities/airq-software-tool-for- health-risk-assessment-of-air-pollution Mongolia Air Pollution Forum