Section 6 Health Effects

Section 6 – Health Effects A Brief History of PM Section 6 – Health Effects

The Houses of Parliament, Stormy Sky Claude Monet, 1904 Section 6 – Health Effects

Air Pollution Disasters 1930 Meuse River Valley, Belgium A three-day episode of severe air pollution makes 6,000 ill and kills 63. 1948 Denora, PA Oct. 26 to 31: air pollution episode leaves 20 dead out of 14,000 persons. 1952 London, England Dec. 4 to 9: “Killer Fog” leaves three to four thousand people dead. Donora, PA at noon on Oct. 29, 1948 London buses are escorted by lantern at 10:30 in the morning. Section 6 – Health Effects

Section 6 – Health Effects Human Lung Air conducting Trachea Bronchi Bronchioles Gas exchange Respiratory bronchioles Alveoli Section 6 – Health Effects

Mouse lung exposed to Diesel Exhaust Normal mouse lung Exposed mouse lung Diesel Exhaust Particles (DEP) augment inflammation by increasing receptors for bacterial lipopolysaccharide. The effect is to make the lungs highly sensitive to the presence of normal levels of bacteria. This results in greatly heightened production of pro-inflammatory mediators from the cells. Section 6 – Health Effects

Mortality attributed to London Smog Schwartz, 1994 Section 6 – Health Effects

Outdoor Air Pollution Regulatory Categories Criteria Pollutants Present everywhere Ambient air quality standards Widely monitored Air toxics Long list (>180) Many carcinogens Less frequent ambient measurements Section 6 – Health Effects

Section 6 – Health Effects Criteria Pollutants Particulate matter PM10 (PM < 10 microns) PM2.5 (PM < 2.5 microns) (PM10-PM2.5 = coarse fraction) Nitrogen dioxide (NO2) Sulfur dioxide (SO2) Ozone (O3) Carbon monoxide Lead Section 6 – Health Effects

Section 6 – Health Effects

Disease and environmental factors Estimates of the burden of disease attributable to environmental factors vary depending on Type of disease Vulnerability Genetics Population group Socioeconomic aspects Large differences between people living in Industrialized/developing countries East/West of Europe and others Section 6 – Health Effects

Disease and environmental factors Major health impacts and their association with environmental factors Cancer: air pollution, mainly PM 2.5 and smaller, PAHs, metals (AS Cd Cr) Cardiovascular disease: air pollution (CO, O3, PM, Pb) Respiratory diseases: SO2, NO2, PM10 and PM 2.5, O3 Developmental disorders: Pb, Hg, Cd Nervous system disorders: Pb, PCBs, Methyl Hg, Mn Section 6 – Health Effects

Disease and environmental factors Air pollution is the environmental factor with the greatest health impact in Europe! Effect is expressed by number of deaths (mortality rates), and by DALYs: “Disability-Adjusted Life Years” An indicator of “burden of disease”, Gives an indication how disease can alter the ability of people to live a normal life compared with those with no disease. Expresses years of lost life. Effect also expressed as morbidity, such as increased frequency of chronic bronchitis, respiratory hospital admissions, restricted activity days. Section 6 – Health Effects

Disease and environmental factors WHO estimates for Europe (51 countries) Children age 0-4 years: 1.8 – 6.4 % of deaths from all causes due to outdoor air pollution Mild mental retardation due to lead exposure: 4.4 % of all DALYs In a selection of European cities each year: Air pollution responsible for 100 000 deaths and 725 000 years of lost life (DALYs) European Commission estimates in CAFÉ: 350 000 premature deaths in 2000 due to outdoor air pollution of PM2.5 alone = Average loss of life expectancy of 9 months for each European citizen Ozone causes 20 000 premature deaths annually Section 6 – Health Effects

Disease and environmental factors Heat waves cause excess deaths; however, large portion due to air pollution Heat wave in Europe summer 2003, in United Kingdom: 2045 excess deaths 4-13 August (compared with 1998-2002 average) Deaths due to air pollution: 225 – 593 due to ozone 207 due to PM10 Above represent 21 – 38 % of the excess deaths (John R. Stedman) Section 6 – Health Effects

Disease and environmental factors Strength of association between environmental factors and selected diseases, corresponding population impact and prevention possibilities (EEA and IPCC) Neurodevelopment (Pb): very likely 90-99 %, moderate, high Neurodevelopment (Hg): very likely 90-99 %, low, high Respiratory diseases (air pollution): very likely 90-99 %, high, moderate Asthma causation (air pollution): medium likelihood 33-66 %, high, moderate Many examples show that respiratory health and life quality improves with improved air quality. Section 6 – Health Effects

Section 6 – Health Effects Strength of association between environmental factors and selected diseases, corresponding population impact and prevention possibilities (EEA and IPCC) Neurodevelopment (Pb): very likely 90-99 %, moderate, high Neurodevelopment (Hg): very likely 90-99 %, low, high Respiratory diseases (air pollution): very likely 90-99 %, high, moderate Asthma causation (air pollution): medium likelihood 33-66 %, high, moderate Many examples show that respiratory health and life quality improves with improved air quality. Section 6 – Health Effects

many different sources PM is derived from many different sources Section 6 – Health Effects

Particulate Matter Sizes and Composition 10 um 1 um 0.1 um Anthropogenic: Sulfates Nitrates Ammonia Carbon Lead Organics Coarse Fine Natural: Soil Dust Seasalt Bioaerosols 2.5 um Ultra Fine PM10 can also be divided into several size fractions. Coarse particles are between 2.5 and 10 microns in diameter; fine particles in the 0.1 to 2.5 micron range; and particles less than 0.1 micron in diameter are referred to as ultrafine particles. [These are freshly emitted from combustion sources. They have almost no mass, but the absolute number of particles in this size category is very large. This represents a new and growing area of research.] Adverse health effects have been associated with all inhalable particles, PM10, as well as the PM2.5 and ultrafine sub-fractions of PM10. Section 6 – Health Effects

PM relative to hair cross section Hair cross section (60 mm) PM10 (10 mm) PM2.5 (2.5 mm) Human Hair Section 6 – Health Effects

Particles Affect the Lungs Respiratory system effects: Respiratory symptoms – irritation of airways, cough Decreased lung function Airway inflammation Asthma attacks, bronchitis Chronic bronchitis Section 6 – Health Effects

Public Health Risks Are Significant Particles are linked to: Premature death from heart and lung diseases Aggravation of heart and lung diseases, with increased: Hospital admissions Doctor and ER visits Medication use School and work absences Section 6 – Health Effects

Some Groups Are More at Risk People with heart or lung disease Greater deposition with chronic obstructive pulmonary disease (COPD) Older adults Greater prevalence of heart and lung disease Children More likely to be active Breathe more air per kg Bodies still developing Section 6 – Health Effects

Section 6 – Health Effects Nitrogen dioxide (NO2) Emissions from high temperature combustion processes: motor vehicle exhaust and stationary sources for power production Exposures indoors due to (unvented) gas appliances and infiltration of ambient NO2 (Complex atmospheric chemistry – can be transformed to HNO3 and nitrate particles) Section 6 – Health Effects

Nitrogen dioxide (NO2) effects Strong oxidant and respiratory irritant (forms nitrous and nitric acids in contact with water) NO2 irritates the nose, throat and lungs especially in people with asthma. Lowers resistance to respiratory infections such as influenza. Contributes to ozone formation (and thus to ozone effects indirectly). Section 6 – Health Effects

Section 6 – Health Effects Sulfur dioxide (SO2) Irritant gas resulting mainly from combustion of sulfur-containing fossil fuels (power plants, large industrial facilities, diesel vehicles) and metal smelting. (Is oxidized/hydrated to form sulfuric acid particles) Section 6 – Health Effects

Section 6 – Health Effects SO2 Effects Usually short-term concentration peaks SO2 reduces lung function: Constricts breathing passages, causing wheezing, shortness of breath and coughing, happens quickly. Lung function returns to normal about an hour after exposure ends. Causes above in healthy subjects and asthmatics; latter are substantially more sensitive Section 6 – Health Effects

Section 6 – Health Effects Ozone (O3) Ubiquitous exposure - formed by natural processes as well as human activities Principal constituent of photochemical smog – not emitted directly Highly reactive, but poorly soluble, allowing deep lung penetration Acute toxicity is related to dose = Concentration x Ventilation Rate x Time – increased risk from outdoor exertion Section 6 – Health Effects

Ozone Irritates Airways Symptoms: Cough Sore or scratchy throat Pain with deep breath, or chest pain Fatigue Rapid onset, but effect is greater 24 hours after exposure Similar symptoms for people with or without asthma Section 6 – Health Effects

Public Health Risks Are Significant Ozone is linked to: Aggravation of lung diseases, increased Hospital admissions Doctor and ER visits Medication use School and work absences Permanent lung changes Section 6 – Health Effects

Public Health Risks Are Significant Respiratory hospital admissions by daily maximum ozone level, lagged one day 114 112 110 108 106 104 102 Respiratory Admissions .01 .02 .03 .04 .05 .06 .07 .08 .09 .1 Ozone concentration (ppm) Section 6 – Health Effects (Burnett et al, 1994)

Some Groups Are More at Risk Children and adults who are active outdoors People with lung diseases, such as asthma People who are unusually sensitive to ozone Section 6 – Health Effects

Section 6 – Health Effects Air Quality Index Descriptors Cautionary Statement Good 0 – 50 No message Moderate 51 – 100 Unusually sensitive individuals Unhealthy for Sensitive Groups 101 - 150 Identifiable groups at risk - different groups for different pollutants Unhealthy 151 - 200 General public at risk; sensitive groups at greater risk Very Unhealthy 201 - 300 General public at greater risk; sensitive groups at greatest risk Section 6 – Health Effects

Section 6 – Health Effects Use AQI to Reduce Risk Dose = Concentration x Ventilation rate x Time Reduce concentration – schedule activities when pollution levels lower Reduce ventilation rate by taking it easier Reduce time spent in vigorous outdoor activities Pay attention to symptoms Section 6 – Health Effects

Health advisories make a difference Roper 2002 survey of 2000 people across the US: 52 % had heard of AQI “Code Orange” or “Code Red” air quality days Of those, 46 % have reduced exposure to air pollution UCLA – Neidell et al.: 4 to 7 % reduction in pediatric hospital admissions for asthma attributable to advisories Section 6 – Health Effects

Will It Matter if Air Pollution Decreases? The Dublin Experience Dublin’s air quality deteriorated in the 1980s after a switch from oil to cheaper bituminous coal for heating. In 1990 the Irish Government banned the use of bituminous coal within the city of Dublin, resulting in a reduction in PM concentrations. Change in age-standardized total, cause-specific, and age-specific mortality rates for Dublin County Borough for 72 months before and after ban of sale of coal in Dublin: decrease from 4.5 to 15.5 % depending on the specific group. Section 6 – Health Effects

The Utah Valley Steel mill closed due to a labor dispute 25 50 75 100 125 150 1985 1986 1987 1988 Steel Mill Closed PM (mg/m3) 20 40 60 80 Monthly Asthma Admissions Section 6 – Health Effects

Section 6 – Health Effects Example of Action Phasing out leaded gasoline Mental retardation due to lead exposure was estimated to be nearly 30 times higher in regions where leaded gasoline was still being used compared with regions where leaded gasoline had been completely phased out. Section 6 – Health Effects

Section 6 – Health Effects Information sources Talks by: Susan Lyon Stone, Michael Lipsett Robert Devlin, John R Stedman Guidelines on Biometeorology and Air Quality Forecasts, WMO, Public Weather Service Environment and Health, EEA Rep No 10/2005 Preventing disease through healthy environments, WHO, 2006 EPA (US), AIRNow: www.airnow.gov Section 6 – Health Effects

Need Chemical Weather Forecasting Section 6 – Health Effects