WHO review of evidence on health aspects of air pollution for the revision of the EU air policies WHO review of evidence on health aspects of air pollution for the revision of the EU air policies Marie-Eve Heroux, Michal Krzyzanowski and Hans-Guido Mücke* * WHO Collaborating Centre for Air Quality Management and Air Pollution Control at the Federal Environment Agency, Berlin/Germany 18 th EINOET workshop, 24/25 October 2013 in Dublin

Review of evidence on health aspects of air pollution / REVIHAAP and HRAPIE Review of evidence on health aspects of air pollution / REVIHAAP and HRAPIE WHO/EC funded both projects REVIHAAP and HRAPIE From Sept 2011 to Spring 2013 Development of answers to 26 key policy questions on: Particulate matter PM 2.5 and PM 10 (7 questions) Ground-level ozone (4 questions) Other air pollutants (NO 2, SO 2, metals, PAHs) and their mixtures (10 questions) General questions 18 th EINOET workshop, 24/25 October 2013 in Dublin

Review of evidence on health aspects of air pollution / REVIHAAP and HRAPIE Review of evidence on health aspects of air pollution / REVIHAAP and HRAPIE -> General questions Impact on revision of EU policies and/or need to revise WHO AQG Emerging issues on health risks from air pollution Evidence of health benefits from reduction of air pollution Evidence of threshold for PM, O 3, and NO 2 Identification/development of concentration-response functions (CRFs) to be included in cost-benefit analysis 18 th EINOET workshop, 24/25 October 2013 in Dublin

1. WHO-EU project „Review of Evidence on Health Aspects of Air Pollution – REVIHAAP“ ( ) 1. WHO-EU project „Review of Evidence on Health Aspects of Air Pollution – REVIHAAP“ ( ) - WHO project jointly financed by WHO and EC, managed by WHO/ECEH, Bonn office (Marie-Eve Heroux) - Evidence review in response to 24 key policy questions from the EC, predominantly concerning NO 2, O 3 and PM - Timing: 20 months, Sept 2011 – April Steering Advisory Committee (8 experts, multiple TCs) - Review of evidence and drafting the answers: 29 experts - External review: 30 experts - Two expert meetings (Aug 2012 & Jan 2013) - Full rationales published in June Followed by a sister project: “Health risks of air pollution in Europe – HRAPIE” - health risk assessment, emerging issues 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.1 REVIHAAP: selected conclusions on PM health effects 1/2 1.1 REVIHAAP: selected conclusions on PM health effects 1/2 New studies on short- and long-term effects Long-term exposures to PM 2.5 are a cause of cardiovascular mortality and morbidity 8 th CAPPA conference, 12 September 2013 in Sibenik/Croatia

1.1 REVIHAAP: selected conclusions on PM health effects 2/2 1.1 REVIHAAP: selected conclusions on PM health effects 2/2 Both short term (such as 24h averages) and long term (annual mean) exposure to PM 2.5 affects health (A5) More insight on physiological effects and plausible biological mechanisms linking short- and long-term PM 2.5 exposure with mortality and morbidity Studies linking long-term exposure to PM 2.5 to several new health outcomes (e.g. atherosclerosis, adverse birth outcomes, childhood respiratory disease). 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.2 REVIHAAP: selected conclusions on ozone (B1) 1.2 REVIHAAP: selected conclusions on ozone (B1) New evidence for an effect of long-term exposure to ozone on: respiratory (and cardiorespiratory) mortality (ACS study); mortality among persons with potentially predisposing conditions (COPD, diabetes, congestive heart failure, and myocardial infarction); asthma incidence, asthma severity, hospital care for asthma and lung function growth. 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.2 REVIHAAP: selected conclusions on ozone, cont. 1.2 REVIHAAP: selected conclusions on ozone, cont. Adverse effects of exposure to daily ozone concentrations (maximum daily 1-hr or 8-hr mean) on: all-cause, cardiovascular and respiratory mortality; respiratory and cardiovascular hospital admissions. The evidence for a threshold for short-term exposure is not consistent, but where a threshold is observed, it is likely to lie below 45 ppb (90 µg/m 3 ) (max 1-hr). (B2) 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.3 REVIHAAP: selected conclusions on NO 2 (C2-3,D1) 1.3 REVIHAAP: selected conclusions on NO 2 (C2-3,D1) New studies document associations between day-to-day variations in NO 2 and variations in mortality, hospital admissions, and respiratory symptoms; New studies showing associations between long-term exposure to NO 2 and mortality and morbidity; Both short- and long-term studies have found these adverse associations at concentrations that were at or below the current EU LV (= WHO AQG); 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.3 REVIHAAP: selected conclusions on NO 2 (C2-3,D1) 1.3 REVIHAAP: selected conclusions on NO 2 (C2-3,D1) The associations between NO 2 and short-term health effects in many studies remain after adjustment for other pollutants (including PM 10, PM 2.5, black smoke). … it is reasonable to infer that NO 2 has some direct effects. No evidence to suggest changing the averaging time for the short-term EU limit value (1-hour) (D1) 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.4 REVIHAAP: selected conclusions on total exposure 1.4 REVIHAAP: selected conclusions on total exposure Elevated health risks associated with living in close proximity to roads is unlikely to be explained by PM 2.5 mass. (C1) In the absence of tobacco smoke: Ambient air, indoor sources and commuting are all important for population exposures to NO 2 (where gas appliances are frequent), benzene and naphthalene; The high end of the individual exposures to PM and naphthalene originate from indoor sources and commuting; Solid fuel fired indoor fireplaces and stoves, where used in suboptimal conditions, dominate the high end of the exposures to PM 2.5, BC, UFP, CO, benzene and BaP of the affected individuals. 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.5 REVIHAAP: critical data gaps (A7/C9) – selected conclusions on health effects studies 1.5 REVIHAAP: critical data gaps (A7/C9) – selected conclusions on health effects studies More epidemiological studies to update E-R functions based on meta- analyses for integrated risk assessment; The coordinated application of atmospheric science, epidemiological, controlled human exposure and toxicological studies to advance understanding of the: sources responsible for the most harmful emissions, physical–chemical composition of the pollution, biological mechanisms that lead to adverse effects on health; 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.5 REVIHAAP: critical data gaps (A7/C9) – selected conclusions on health effects studies, cont. 1.5 REVIHAAP: critical data gaps (A7/C9) – selected conclusions on health effects studies, cont. Air pollution should be considered to be one complex mix, and conditions under which this mix has the largest effect on human health need to be identified; Advances in atmospheric modelling, in conjunction with validation studies that use targeted monitoring campaigns, will provide a more efficient way forward in research on health effects, rather than relying on increasing the number of components measured by routine monitoring networks. 18 th EINOET workshop, 24/25 October 2013 in Dublin

1.6 REVIHAAP: Main conclusions 1.6 REVIHAAP: Main conclusions Considerable amount of new scientific information on health effects of PM, O 3 and NO 2 observed at levels commonly present in Europe, has been published in the recent years. It: supports the scientific conclusions of the WHO Air Quality Guidelines updated in 2005; indicates that the effects can occur at air pollution concentrations lower than those serving to establish the 2005 Guidelines; provides scientific arguments for the decisive actions to improve air quality and reduce the burden of disease associated with air pollution in Europe. 18 th EINOET workshop, 24/25 October 2013 in Dublin

2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2.1Aim of the project - to assess the views of stakeholders and experts to identify emerging issues on health risks from AP, either related to specific source categories (e.g. transport, biomass combustion, metal industry, refineries, power production), specific gaseous pollutants or specific components of PM (e.g. size-range like nano-PM and UFP, raw earth metals, BC) 18 th EINOET workshop, 24/25 October 2013 in Dublin

2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2.2Methods - development of an electronic survey tool by WHO-ECEH (M-E Heroux, G Chan) and Dublin Institute for Technology/DIT (S Henschel and P Goodman); pilot tested - disseminated by WHO-ECEH spring 2013 (May/June) - 15 questions for app. 15 minutes: 11 per indentified risk; 4 on demographic aspects - survey responses were analysed collectively for trends - WHO report is under preparation; to be published in th EINOET workshop, 24/25 October 2013 in Dublin

2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2.3Main findings questionnaires returned - Emerging risks identified (i) may only recently be identified or (ii) may have existed for a long time, but only recently their significance or importance is coming to the fore - the top 6 emission sources categories (out of total of 16 categories) posing an emerging health threat: road transport: 40.7%; space heating: 15%; shipping: 8.8%; energy production: 6.2%, metal industries: 6.2%; agriculture: 5.3% 18 th EINOET workshop, 24/25 October 2013 in Dublin

2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2.4Other key observations - strong signal for ‘metal’ components for a number of source categories - strong signal for ‘smaller’ PM, esp. PM2.5 and UFP - concern for the increase in prevalence of certain sources, and growth in exposed population - cardiovascular, respiratory, cancer and neurobehavioral effects have been identified as key AP health impacts 18 th EINOET workshop, 24/25 October 2013 in Dublin

2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2.5Conclusion - limited response rate due that the electronic survey could be accessed four weeks only - length of questionnaire was probably to long, and discouraged respondents - 15 questions for app. 15 minutes: 11 per indentified risk; 4 on demographic aspects - survey responses were analysed collectively for trends - WHO report is under preparation; to be published in th EINOET workshop, 24/25 October 2013 in Dublin

2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2. EU-WHO project „Health Risks of Air Pollution in Europe – HRAPIE“ (2013) 2.6 Further HRAPIE tasks - Reply the EC question: “What concentration-response functions for key pollutants should be included in cost-benefit analysis supporting the revision of EU air quality policy?” - Follow recommendations of the HRAPIE project concerning CRFs for the pollutant-health outcome pairs. 18 th EINOET workshop, 24/25 October 2013 in Dublin