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| Folie 2 Workshop on Review and Assessment of European Air Pollution Policies

| Folie 3 European Air Pollution Policies Assessment of health effects in an air pollution strategy Jürgen Schneider Umweltbundesamt GmbH Project Manager Air Quality and Health at WHO ( )

| Folie 4 Introduction Key new findings on the effect of air pollution on health (focussing on PM) Consequences for air pollution policy Conclusions European Air Pollution Policies

| Folie 5 European Air Pollution Policies Which effects?

| Folie 6 European Air Pollution Policies Associations with mortality have been demonstrated for many different locations with different methods and different scales

| Folie 7 European Air Pollution Policies Associations with mortality have been demonstrated for many different locations with different methods and different scales

| Folie 8 European Air Pollution Policies

| Folie 9 European Air Pollution Policies Intervention studies: Coal ban in Dublin (Clancy et al., 2002) Utah valley Atlanta Olympics Hong Kong S emissions German re-unification

| Folie 10 European Air Pollution Policies New methods

| Folie 11 European Air Pollution Policies Possible mechanisms

| Folie 12 European Air Pollution Policies PM exposure is asscoiated with : Arrythmia (Peters et al., 2000) Influence on heart rate variability (Pope et al., 1999; Holguin et al., 2003,....) Acute arterial vasoconstriction (Brook at el., 2002) Increase of plasma viscosity (Peters et al., 1997) Increase of C-reactive protein (Peters et al., 2001) Myocardial infarction (Peters et al., 2001; D’Ippoliti et al., 2003)

| Folie 13 European Air Pollution Policies Some key findings of the systematic review on PM: Links between AP and several effetcs have been strengthened PM affects CV system Effects at very low levels (previously considered safe) Crucial components in tox studies: OC, UFP, HM Crucial sources: prim. Combustion sources LT effects outweigh ST effects Small scale differences in air quality might result in different risks at least for some of the health outcomes

| Folie 14 European Air Pollution Policies How to quantify the impacts?

| Folie 15 European Air Pollution Policies Annual health loss in DALYs

| Folie 16 European Air Pollution Policies Which indicator? The Task Force on Health recommended  to use PM2.5 as indicator for PM related mortality  Apply the factor of the Pope et al. (2002) study for IAM And noted that:  different PM2.5 components may not be equally hazardous. but concluded:  it is not possible to quantify the relative importance of the main PM components for effects on human health at this stage.

| Folie 17 European Air Pollution Policies response exposure.. concentration – response relationships for different health endpoints provide more useful information for designing effective strategies to reduce adverse effects on human health.

| Folie 18 Reduce hot spot exposure only? European Air Pollution Policies

| Folie 19 One limit value for the whole of Europe? European Air Pollution Policies

| Folie 20 Peaks or long-term? European Air Pollution Policies

| Folie 21 Conclusions Air pollution still affects your health! Reduction of exposure of the overall population is crucial! For PM: Chronic effect on mortality seem to outweigh acute effects – but its not the only effect Those exposed at hot spots seem to have a higher risk Additional insights will support to further refine strategies (PM monit, health,..) Air quality and health

| Folie 22 Open questions How to combine different tools effectively (maximum benefit)? How to combine the different scales effectively? How to chose the ambition level? How to balance the risk? Air quality and health