Towards WHO Guidelines on Environmental Noise Joerdis Wothge Consultant on Noise, Living and Working Environments World Health Organization, European Centre for Environment and Health Evidence of health effects of noise European Commission - 9th Noise Expert Group Meeting 30th November 2017, Brussels, Belgium

Overview

Overview 1 Introduction 2 Guideline Development Process 3 Differences to prior Guidelines 4 Current status Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease

Overview 1 Introduction 2 Guideline Development Process 3 Differences to prior Guidelines 4 Current status Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease

Overview 1 Introduction 2 Guideline Development Process 3 Differences to prior Guidelines 4 Current status Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease

Overview 1 Introduction 2 Guideline Development Process 3 Differences to prior Guidelines 4 Current status Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease

Overview 1 Introduction 2 Guideline Development Process 3 Differences to prior Guidelines 4 Current status 5 Target Audience

Burden of disease At least 100 million people in the EU are affected by road traffic noise above the assessment threshold specified in the END (55dB) Over 83 million Europeans are exposed to harmful levels of noise from night-time road traffic (above 50 dB) At least one million healthy years of life are lost due to road traffic noise in Western Europe Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease

Burden of disease At least 100 million people in the EU are affected by road traffic noise above the assessment threshold specified in the END (55dB Lden) Over 83 million Europeans are exposed to harmful levels of noise from night-time road traffic (above 50 dB) At least one million healthy years of life are lost due to road traffic noise in Western Europe Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease Source: WHO/JRC, 2011; EEA, 2017

Burden of disease At least 100 million people in the EU are affected by road traffic noise above the assessment threshold specified in the END (55dB Lden) Over 83 million Europeans are exposed to harmful levels of noise from night-time road traffic (above 50 dB Lnight) At least one million healthy years of life are lost due to road traffic noise in Western Europe Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease Source: WHO/JRC, 2011; EEA, 2017

Burden of disease At least 100 million people in the EU are affected by road traffic noise above the assessment threshold specified in the END (55dB Lden) Over 83 million Europeans are exposed to harmful levels of noise from night-time road traffic (above 50 dB Lnight) At least 1.6 million healthy years of life are lost due to road traffic noise in Western Europe Sleep disturbance and annoyance related to road traffic noise contribute most to the burden of disease Source: WHO/JRC, 2011; EEA, 2017

WHO noise guidelines Represent the most widely accepted set of public health recommendations, intended to assist policy-makers, health-care providers, and other relevant stakeholders to make informed decisions for the protection of public health Based on a comprehensive and objective assessment of the available evidence Generally intended for worldwide use, and therefore recognize the heterogeneity on technological feasibility, economic development and other political and economical factors WHO adopted internationally recognized standards and methods to ensure that guidelines are free from biases and meet public health needs 2009

WHO noise guidelines 2009

WHO noise guidelines

WHO environmental noise guidelines for the European Region WHO noise guidelines WHO environmental noise guidelines for the European Region

Guideline Development Process

Development of new guidelines Systematically review scientific evidence on: Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Critical health outcomes Health outcomes included in the reviews Critical health outcomes

Critical health outcomes Important health outcomes Health outcomes included in the reviews Critical health outcomes Important health outcomes

Critical health outcomes Important health outcomes Health outcomes included in the reviews Cardiovascular Disease Annoyance Sleep disturbance Cognitive Impairment Hearing Impairment & Tinnitus Critical health outcomes Important health outcomes

Critical health outcomes Important health outcomes Health outcomes included in the reviews Cardiovascular Disease Annoyance Sleep disturbance Cognitive Impairment Hearing Impairment & Tinnitus Diabetes & metabolic diseases Adverse birth outcomes Quality of life, well-being Critical health outcomes Important health outcomes

Noise sources considered Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute First three have been most commonly reported on. Wind turbine and Leisure noise are new features.

Noise sources considered Road traffic Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute First three have been most commonly reported on. Wind turbine and Leisure noise are new features.

Noise sources considered Railway Road traffic Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute First three have been most commonly reported on. Wind turbine and Leisure noise are new features.

Noise sources considered Railway Road traffic Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute First three have been most commonly reported on. Wind turbine and Leisure noise are new features. Aircraft

Noise sources considered Railway Wind turbines Road traffic Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute First three have been most commonly reported on. Wind turbine and Leisure noise are new features. Aircraft

Noise sources considered Railway Wind turbines Road traffic Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute Leisure First three have been most commonly reported on. Wind turbine and Leisure noise are new features. Aircraft

Noise sources considered Railway Wind turbines Road traffic Sources: Umweltbundesamt, BASt, dpa/Bernd von Jutrczenka, dpaheute Leisure First three have been most commonly reported on. Wind turbine and Leisure noise are new features. Aircraft

Guideline Development Process – Initial Process Overview See next slide for processes in between initial approval for development and final approval by GRC Start End

Guideline Development Process – Initial Process Overview Decision to produce Environmental Noise Guidelines Initial approval by GRC Initial approval for development Final approval by GRC Relevant internal approvals ADG, LLP Proofread, Publish, Dissemination See next slide for processes in between initial approval for development and final approval by GRC Start End

Guideline Development Process – Initial Process Overview Decision to produce Environmental Noise Guidelines Initial approval by GRC Initial approval for development Final approval by GRC Relevant internal approvals ADG, LLP Proofread, Publish, Dissemination See next slide for processes in between initial approval for development and final approval by GRC Start End

Guideline Development Process – Initial Process Overview Decision to produce Environmental Noise Guidelines Initial approval by GRC Initial approval for development Final approval by GRC Relevant internal approvals ADG, LLP Proofread, Publish, Dissemination Guideline process can take up to 3 to 4 years See next slide for processes in between initial approval for development and final approval by GRC Start End

Guideline Development Process - guideline groups and main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Guideline Groups

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Guideline Groups Main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Guideline Groups Main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Management of Conflict of Interest Guideline Groups Main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Management of Conflict of Interest Systematic Review Process Guideline Groups Main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Management of Conflict of Interest Systematic Review Process Guideline Groups Main steps

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Systematic Reviews Cardiovascular diseases Effects of sleep Cognitive impairment Hearing impairment and tinnitus Diabetes and metabolic effects Adverse birth outcomes Quality of life, mental health and wellbeing Interventions Systematic reviews to be published in June

Grading the evidence

Grading the evidence Assessment of the overall quality of evidence by Systematic Review Teams:

Grading the evidence Assessment of the overall quality of evidence by Systematic Review Teams: Study limitations Inconsistency of results Indirectness of evidence Imprecision Publication bias Magnitude of effect Plausible confounding Dose-response gradient

Grading the evidence OVERALL QUALITY OF EVIDENCE Assessment of the overall quality of evidence by Systematic Review Teams: Study limitations Inconsistency of results Indirectness of evidence Imprecision Publication bias Magnitude of effect Plausible confounding Dose-response gradient OVERALL QUALITY OF EVIDENCE

Grading the evidence OVERALL QUALITY OF EVIDENCE High quality Assessment of the overall quality of evidence by Systematic Review Teams: Study limitations Inconsistency of results Indirectness of evidence Imprecision Publication bias Magnitude of effect Plausible confounding Dose-response gradient OVERALL QUALITY OF EVIDENCE High quality Moderate quality Low quality Very low quality

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Management of Conflict of Interest Systematic Review Process Guideline Groups Main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Management of Conflict of Interest Systematic Review Process From Evidence to Recommendations Guideline Groups Main steps

Guideline Development Process - guideline groups and main steps WHO steering group Guideline Development Group External review group Systematic Review Teams Management of Conflict of Interest Systematic Review Process From Evidence to Recommendations Guideline Groups Main steps

Developing recommendations ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Factors to be considered Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Factors to be considered Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Factors to be considered Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Factors to be considered Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Factors to be considered Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Types of Recommendations Factors to be considered Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Types of Recommendations Factors to be considered Strong recommendation Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Developing recommendations Types of Recommendations Factors to be considered Strong recommendation Conditional recommendation Quality of Evidence Balance of Benefits and harms Values and Preferences Resource Use ‘strong’: the guideline is based on the confidence that the desirable effects of adherence to the recommendation outweigh the undesirable consequences. The quality of the evidence combined with certainty about the values, preferences, benefits and feasibility inform this recommendation, which should be implemented in most circumstances; or ‘conditional’: there was less certainty about the combined quality of evidence, values and preferences of individuals and populations affected, benefits and feasibility of this recommendation meaning there may be circumstances or settings in which it will not apply.

Differences to Prior Guidelines

Existing Guidelines

Fundamental differences Differences between the guidelines at a glance.

Fundamental differences 1 New, strictly evidence-based methodology Including meta-analysis and systematic reviews Internationally recognized standards to ensure guidelines are of high methodological quality 2 Modified style of recommendations Exact exposure values for every considered health outcome Guideline values defined separately for each noise source in 5 dB(A) steps Differences between the guidelines at a glance.

Fundamental differences 1 New, strictly evidence-based methodology Including meta-analysis and systematic reviews Internationally recognized standards to ensure guidelines are of high methodological quality 2 Modified style of recommendations Exact exposure values for every considered health outcome Guideline values defined separately for each noise source in 5 dB(A) steps Differences between the guidelines at a glance.

Fundamental differences 1 New, strictly evidence-based methodology Including meta-analysis and systematic reviews Internationally recognized standards to ensure guidelines are of high methodological quality 2 Modified style of recommendations Exact exposure values for every considered health outcome Guideline values defined separately for each noise source in 5 dB(A) steps Differences between the guidelines at a glance.

Fundamental differences 1 New, strictly evidence-based methodology Including meta-analysis and systematic reviews Internationally recognized standards to ensure guidelines are of high methodological quality 2 Modified style of recommendations Exact exposure values for every considered health outcome Guideline values defined separately for each noise source in 5 dB(A) steps Differences between the guidelines at a glance.

Fundamental differences 1 New, strictly evidence-based methodology Including meta-analysis and systematic reviews Internationally recognized standards to ensure guidelines are of high methodological quality 2 Modified style of recommendations Exact exposure values for every considered health outcome Guideline values defined separately for each noise source in 5 dB(A) steps Differences between the guidelines at a glance.

Fundamental differences 1 New, strictly evidence-based methodology Including meta-analysis and systematic reviews Internationally recognized standards to ensure guidelines are of high methodological quality 2 Modified style of recommendations Exact exposure values for every considered health outcome Guideline values defined separately for each noise source in 5 dB(A) steps Differences between the guidelines at a glance.

Fundamental differences 3 Expansion of noise sources Including transportation noise, wind turbine and leisure noise 4 Expansion of number of health outcomes Adverse birth outcomes, diabetes, obesity, stroke, etc. Incidence, prevalence and mortality considered separately where possible 5 Inclusion of effects of intervention measures mitigating noise exposure Differences between the guidelines at a glance.

Fundamental differences 3 Expansion of noise sources Including transportation noise, wind turbine and leisure noise 4 Expansion of number of health outcomes Adverse birth outcomes, diabetes, obesity, stroke, etc. Incidence, prevalence and mortality considered separately where possible 5 Inclusion of effects of intervention measures mitigating noise exposure Differences between the guidelines at a glance.

Fundamental differences 3 Expansion of noise sources Including transportation noise, wind turbine and leisure noise 4 Expansion of number of health outcomes Adverse birth outcomes, diabetes, obesity, stroke, etc. Incidence, prevalence and mortality considered separately where possible 5 Inclusion of effects of intervention measures mitigating noise exposure Differences between the guidelines at a glance.

Fundamental differences 3 Expansion of noise sources Including transportation noise, wind turbine and leisure noise 4 Expansion of number of health outcomes Adverse birth outcomes, diabetes, obesity, stroke, etc. Incidence, prevalence and mortality considered separately where possible 5 Inclusion of effects of intervention measures mitigating noise exposure Differences between the guidelines at a glance.

Fundamental differences 3 Expansion of noise sources Including transportation noise, wind turbine and leisure noise 4 Expansion of number of health outcomes Adverse birth outcomes, diabetes, obesity, stroke, etc. Incidence, prevalence and mortality considered separately where possible 5 Inclusion of effects of intervention measures mitigating noise exposure Differences between the guidelines at a glance.

Fundamental differences 3 Expansion of noise sources Including transportation noise, wind turbine and leisure noise 4 Expansion of number of health outcomes Adverse birth outcomes, diabetes, obesity, stroke, etc. Incidence, prevalence and mortality considered separately where possible 5 Inclusion of effects of intervention measures mitigating noise exposure Differences between the guidelines at a glance.

Current Status

Development of new guidelines Systematically review scientific evidence Health effects of environmental noise Effectiveness of interventions to reduce exposure and improve health Provide evidence-based recommendations Exposure—response relationships Effectiveness of interventions

Systematic Reviews Evidence: Most health evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise: more annoyance and sleep disturbance than other types of noise  Substantial benefit expected from markedly reducing noise  Separate recommendations for road, rail and aircraft noise (Lden, Lnight)

Systematic Reviews Evidence: Most health evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise: more annoyance and sleep disturbance than other types of noise  Substantial benefit expected from markedly reducing noise  Separate recommendations for road, rail and aircraft noise (Lden, Lnight)

Systematic Reviews Evidence: Most health evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise: more annoyance and sleep disturbance than other types of noise  Substantial benefit expected from markedly reducing noise  Separate recommendations for road, rail and aircraft noise (Lden, Lnight)

Systematic Reviews Evidence: Most health evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise: more annoyance and sleep disturbance than other types of noise  Substantial benefit expected from markedly reducing noise  Separate recommendations for road, rail and aircraft noise (Lden, Lnight)

Transportation noise Most health evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise is % HA / % HSD than other types of transportation noise Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial benefit expected from markedly reducing noise

Transportation noise Evidence: Most health evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise is % HA / % HSD than other types of transportation noise Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial benefit expected from markedly reducing noise

Transportation noise Evidence: Most evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise is % HA / % HSD than other types of transportation noise Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial benefit expected from markedly reducing noise

Transportation noise Evidence: Most evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise more % HA / % HSD than other types of transportation noise Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial benefit expected from markedly reducing noise

Transportation noise Evidence: Most evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise more % HA / % HSD than other types of transportation noise Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial benefit expected from markedly reducing noise

Transportation noise Evidence: Most evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise more % HA / % HSD than other types of transportation noise  Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial health benefits expected from markedly reducing noise

Transportation noise Evidence: Most evidence on road traffic noise, followed by aircraft noise, little on railway noise Aircraft noise more % HA / % HSD than other types of transportation noise  Individual recommendations for road, rail and aircraft noise for Lden, Lnight  Substantial health benefits expected from markedly reducing noise

Leisure noise Evidence: Very low quality evidence coming directly from studies relating leisure noise exposure to health outcomes Difficulty in properly assessing exposure and development of hearing impairment / tinnitus Strong supportive evidence from occupational noise field  Concern about young population being exposed  Benefit from reducing exposure  Some low cost measures available

Leisure noise Evidence: Very low quality evidence coming directly from studies relating leisure noise exposure to health outcomes Difficulty in properly assessing exposure and development of hearing impairment / tinnitus Strong supportive evidence from occupational noise field  Concern about young population being exposed  Benefit from reducing exposure

Leisure noise Evidence: Very low quality evidence coming directly from studies relating leisure noise exposure to health outcomes Difficulty in properly assessing exposure and development of hearing impairment / tinnitus Strong supportive evidence from occupational noise field  Concern about young population being exposed  Benefit from reducing exposure

Leisure noise Evidence: Very low quality evidence coming directly from studies relating leisure noise exposure to health outcomes Difficulty in properly assessing exposure and development of hearing impairment / tinnitus Strong supportive evidence from occupational noise field  Concern about young population being exposed  Benefit from reducing exposure  Some

Leisure noise Evidence: Very low quality evidence coming directly from studies relating leisure noise exposure to health outcomes Difficulty in properly assessing exposure and development of hearing impairment / tinnitus Strong supportive evidence from occupational noise field  Concern about young population being exposed  Benefit from reducing exposure

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure assessment is an issue Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure assessment is an issue Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure assessment is an issue Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure is difficult to assess Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure is difficult to assess Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure is difficult to assess Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Wind turbine noise Evidence: Very low quality evidence on health outcomes, partly different for annoyance Noise exposure is difficult to assess Hard to dissociate noise impacts from other considerations such as visual aspects, infrasound, amplitude modulation, etc. Aware of new studies currently taking place that may add on to this body of evidence  Concern from population living in vicinity to wind turbines

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Noise interventions Evidence: Most evidence for road traffic, and less for aircraft Little/no evidence for rail, wind and leisure noise Most studied health outcomes: annoyance / sleep disturbance Implementation of interventions: Effectiveness of implementation is context specific Resources needed for implementation highly variable Importance of community involvement General recommendation: health should be encouraged to be considered in noise abatement measures and policy Sources: betonform.com, Goettinger Tageblatt / Hinzmann

Target audience Geographical region: WHO European Region But: Recommendations may also be applied to countries outside WHO European Region

Target audience Technical experts, decision-makers (local, national, international level) Health impact assessment, environmental impact assessment practitioners and researchers Authorities and non-governmental organizations engaged in risk communication and general awareness raising Geographical region: WHO European Region But: Recommendations may also be applied to countries outside WHO European Region

Target audience Technical experts, decision-makers (local, national, international level) Health impact assessment, environmental impact assessment practitioners and researchers Authorities and non-governmental organizations engaged in risk communication and general awareness raising Geographical region: WHO European Region But: Recommendations may also be applied to countries outside WHO European Region

Target audience Technical experts, decision-makers (local, national, international level) Health impact assessment, environmental impact assessment practitioners and researchers Authorities and non-governmental organizations engaged in risk communication and general awareness raising Geographical region: WHO European Region But: Recommendations may also be applied to countries outside WHO European Region

Target audience Technical experts, decision-makers (local, national, international level) Health impact assessment, environmental impact assessment practitioners and researchers Authorities and non-governmental organizations engaged in risk communication and general awareness raising Geographical region: WHO European Region But: Recommendations may also be applied to countries outside WHO European Region

Target audience Technical experts, decision-makers (local, national, international level) Health impact assessment, environmental impact assessment practitioners and researchers Authorities and non-governmental organizations engaged in risk communication and general awareness raising Geographical region: WHO European Region But: Recommendations may also be applied to countries outside WHO European Region

Thank you for your attention The END Thank you for your attention http://www.euro.who.int/en/health-topics/environment-and-health 130