WHO European Centre for Environment and Health Overview of health impacts of particulate matter in Europe Michal Krzyzanowski WHO ECEH Bonn Office Joint WHO / Convention Task Force on Health Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Expert Group on PM, 1 st Meeting, May 2005 Assessment of health impacts of PM: References Health aspects of air pollution with particulate matter, ozone and nitrogen dioxide. Report on a WHO Working Group, Bonn, Germany January Health aspects of air pollution – answers to follow up questions from CAFÉ. Report on a WHO Working Group, Bonn, Germany January 2004 WHO 2004 (E82790) Meta-analysis of time series studies and panel studies of particulate matter (PM) and ozone (O3). WHO 2004 (E82792) Health aspects of air pollution: Results from the WHO project “Systematic review of health aspects of air pollution in Europe”, WHO 2004 (E83080)

WHO European Centre for Environment and Health Expert Group on PM, 1 st Meeting, May 2005 Assessment of health impacts of PM: References Technical Reports from TFH Meetings: 6 th TFH Meeting: Modelling and assessment of health impact of particulate matter and ozone. EB.AIR/WG.1/2004/11 7 th TFH Meeting: Modelling and assessment of health impact of particulate matter and ozone. EB.AIR/WG.1/2004/11 United Nations Economic Commission for Europe, Geneve.

WHO European Centre for Environment and Health Source: WHO 2004 Expert Group on PM, 1 st Meeting, May 2005 Relative risks (RR) for mortality related to 10 µg/m3 increase in daily PM concentration – results of meta-analysis all cause respiratory cardiovascular all cause respiratory cardiovascular all cause respiratory cardiovascular all cause respiratory cardiovascular PM10BSOzonePM2.5 European studies American studies RR

WHO European Centre for Environment and Health Source: WHO 2004 Relative risk for all-cause mortality and a 10 µg/m 3 increase in daily PM10 in Europe Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Expert Group on PM, 1 st Meeting, May 2005 Excess relative risk from US cohort studies StudyPM MetricExcess RR*) (%)95% CI Six CityPM Six City newPM ACSPM ACS NewPM ACS NewPM – 2.2 ACS NewPM10/ ACS NewPM10/15 SSI – 4.1 ACS extendedPM – 7.5 ACS extendedPM – 9.9 ACS extendedPM2.5 Avg AHSMOGPM10/ – 9.2 AHSMOGPM – 21 VAPM *) per 10 µg/m3 PM2.5 and 20 µg/m3 PM10/15Source: US EPA 2003

WHO European Centre for Environment and Health Source: Pope et al, JAMA 2002 Long term exposure to PM and risk of mortality in ACS cohort (ca. 0.5 million people followed for 16 years) Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health The effects of air pollution on children's health and development Conclusions on causal associations:  PM and respiratory deaths in post-neonatal period  Ambient air poll & lung function development (pre & post natal)  PM and O3 exposure and asthma aggravation  Pb and neurobehavioural development Several suggestions for causal associations Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Q3) Is there a threshold below which no effects on health of PM are expected to occur in all people? Answer: Epidemiological studies on large populations have been unable to identify a threshold concentration below which ambient PM has no effect on health. It is likely that within any large human population, there is such a wide range of susceptibility that some subjects are at risk even at the lowest end of concentration range. Comments: Thresholds differ depending on endpoint selected Increasingly sensitive epidemiological study designs have identified adverse effects of air pollution at increasingly lower levels Systematic Review Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Systematic Review Q7: Which of the physical and chemical characteristics of particulate air pollution are responsible for health effects? - Fine PM is more hazardous than larger particles - Metal content - Organic components such as PAH - Endotoxins - Extremely small particles (< 100 nm) Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Physical and chemical characteristics of PM in relation to health effects Comments: - Role of size vs. chemical composition – difficult to be separated - Even not toxic particles may be carriers of toxic chemicals or act as catalysers of reactions on the surface - Different PM components affect different systems Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Physical and chemical characteristics of PM in relation to health effects (7 th TFH meeting, following 2 nd Round of Systematic Review): Conclusion para. 24: only the anthropogenic contribution to PM2.5 mass should be assessed; for this anthropogenic contribution, no no-effect level was assumed due to the absence of compelling toxicological data about different PM components acting in the complex ambient PM mixture, it was not possible to precisely quantify the relative importance of the main PM components for effects on human health at this stage. Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Loss of life expectancy Due to PM2.5 from anthropogenic sources Loss of Life expectancy in months Source:EMEP & IIASA Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Estimates of health impacts of anthropogenic PM in EU Source: CAFE 2005

WHO European Centre for Environment and Health Determinants of health damage by air pollution Health effect Health effect = unit risk x baseline health x PM concentration x size of exposed population PM level = C PM level = ½ C Population = PPopulation = 2 PHealtheffectsEQUAL

WHO European Centre for Environment and Health Conclusions  The body of evidence on health effects of PM has strenghtened consideralbly in the past few years.  Initial insight to the possible mechanisms from toxi studies.  The evidence is sufficient to recommend further policy actions on local, regional and international levels to reduce PM exposure.  Further research needed to resolve several detailed questions and increase European data base. Expert Group on PM, 1 st Meeting, May 2005

WHO European Centre for Environment and Health Thank you Expert Group on PM, 1 st Meeting, May 2005