1. Health Costs due to Road Traffic-Related Air Pollution
An impact assessment project of Austria, France and Switzerland
Rita K. Seethaler
The Urban Transport Institute
Australia

2. Targets
A common methodological framework
Comparable empirical results

3. The main partners Austria: France: Switzerland:
Federal Ministry of Environment, Youth and Family Affairs
Federal Environment Agency
France:
Agency for Enivronment and Energy Management ADEME
Switzerland:
Federal Department for Environment, Transport, Energy and Communications

4. Three disciplines co-operate...
Air Pollution:
Exposure assessment of the residential population (particulate matter PM10, traffic share)
Epidemiology:
Exposure-Response relationship for selected health outcomes (air pollution attributable cases)
Economy:
Evaluation of monetary health costs (willingness-to-pay)

5. Structure of the study

6. PM10 Population Exposure: General Methodological Framework
Main Steps
acquisition and analysis of data on the ambient concentration of particulate matter
annual mean PM10 mapping using empirical dispersion models or statistical methods
estimation of the road traffic related PM10 fraction
calculation of population exposure by superposition of the PM10 map on the population distribution map

7. Differences in PM10 Modelling
Differences in Measurement Methods of Ambient Concentration of Particulate Matter (state of art 1999)
Austria network of Total Suspended Particulate (TSP) measured by beta attenuation and TEOM. NOx emission inventory available.
France until recently used the Black Smoke (BS) method exclusively, some sites are now equipped with PM10 samplers (TEOM sampler) No emission inventory for PM10 available.
Switzerland changed the national monitoring network from TSP to PM10 measurements by gravimetric filter samplers.
PM10 emission inventory available.

8. Population Exposure to Total PM10
Frequency distribution of PM10 population exposure

9. Population Exposure to PM10 without traffic-related share
Frequency distribution of PM10 population exposure

10. Population weighted annual PM10 averages
Interpretation with regard to the considerable variability of road traffic PM10
Higher relative contribution of road traffic to total PM10 in city centers
Typical values are 40-60% in cities and <30% in rural areas (Swiss model)

11. Public Health Impact Assessment of Air Pollution: Calculation of attributable number of cases

12. Health outcomes included in the assessment.
Health outcome
Age
Total mortality
Adults,
30 years of age
Respiratory hospital admissions
All ages
Cardiovascular hospital admissions
All ages
Chronic bronchitis incidence
Adults,
25 years of age
Acute Bronchitis
Children, < 15 years of age
Restricted activity days
Adults,
30 years of age
Asthmatics: asthma attacks
Children, < 15 years of age
Adults,
15 years of age

13. Definitions and sources (references)
Definitions and sources (references)
Health outcome
Definition
Sources (References)
Long-term mortality (adults  30 years)
death rate, excluding violent death / accidents
aged and >30 years, respectively
Dockery DW et al, 1993
Pope CA et al, 1995
Respiratory Hospital Admissions
(all ages)
ICD , all ages
ICD9 466, , 493, , , all ages
ICD , , all ages
Spix C et al, 1998
Wordley J et al, 1997
Prescott GJ et al, 1998
Cardiovascular Hospital Admissions (all ages)
ICD , all ages
ICD , all ages
ICD , , , all ages
Poloniecki JD et al, 1997
Medina S et al, 1997
Chronic Bronchitis Incidence (adults  25 years)
symptoms of cough and/or sputum production on most days, for at least three months per year, and for 2 years or more, age >=25 years
Abbey DE et al, 1993
Bronchitis episodes (children <15 years)
bronchitis in the last 12 months (parents or guardian’s answer), ages 10-12, and 6-15 years, respectively
Dockery DW et al, 1989
Dockery DW et al, 1996
Braun-Fahrländer C et al,1997
Restricted Activity Days (adults  20 years)
any days where a respondent was forced to alter normal activity, due to respiratory disease ICD , , , , 519, and 783, age years
Ostro B et al, 1990 
Asthma attacks (children < 15 years)
lower respiratory symptoms, age 6-12 years
asthma, age 7-15 years
lower respiratory symptoms, age 7-13 years
Roemer W et al, 1993
Segala C et al, 1998
Gielen MH et al, 1997
Asthma attacks (adults  15 years)
wheeze, age years
shortness of breath, age years
wheeze, age years
Dusseldorp A et al, 1995
Hiltermann TJN et al, 1998
Neukirch F et al,1998

14. Calculation example of the additional cases per 10 g/m3 PM10 and 1 million inhabitants
e.g. in Switzerland:
= ‘ x
fixed
baseline increment
expected baseline
frequency at
exposure of 7.5 g/m3
Relative risk
for an increase of
10 g/m3
D = P x (RR-1)

15. Short term and long term effects of air pollution
The effects of air pollution have two dimensions in time:
First, for some people, the level of pollution on a given day or week may trigger morbidity or death. These are acute effects, well established in many highly qualified time series studies in Europe and abroad. These short term effects may move the event of death from a considerable number of people forwards.
There is, however, a further aspect of air pollution, ultimately leading to earlier death: recurrent cumulative exposure may enhance morbidity, including e.g., chronic bronchitis. People with these diseases (to which air pollution contributed) have impaired health and shorter life expectancy, thus, they may die earlier, although the EVENT of death may not always be closely related to the daily level of pollution.
This overall effect of air pollution on life-expectancy is captured by the cohort studies whereas the short-term studies capture only one part of the overall problem. (Dr. Nino Kuenzli et al.)

16. Air pollution and mortality: long-term frailty and terminal trigger
Death triggered
By air pollution
Not by air pollution
Frailty level A B
Due to air pollution C D
Not due to air poll.

17. (susceptibility for death)
Contribution of Air Pollution CASE A : long-term + terminal trigger of death
Frailty
(susceptibility for death)
SMOG EPISODE
Death
Cumulative exposure
Chronic Bronchitis
Time
Birth
Age at death

18. Quantitative results: Health effects attributable to road traffic-related air pollution
In Total (Austria, France and Switzerland)
300,000 cases of acute bronchitis in children
25,000 cases of chronic bronchitis in adults
25,000 hospital admissions
162,000 asthma attacks in children
295,000 asthma attacks in adults
16 Million days with restricted activity in adults
21,000 cases of premature mortality (long-term)

19. Comparison: fatal road accidents and air pollution related mortality
20000
18000
1970 Road accidents
16000
14000
1996 Road accidents
12000
absolute number of cases
10000
1996 air pollution rel.
premature deaths
8000
6000
4000
2000
Austria
France
Switzerland

20. Years of life lost due to road accidents or air pollution related mortality (1996)
50000
100000
150000
200000
250000
300000
350000
Austria
France
Switzerland
number of Life years lost
From Road accidents
(ø 40 years lost)
from Air pollution related mortality
(ø 10 years lost)

21. Overview of the costs of morbidity
Costs of illness
Costs of averting-
behaviour
Treatment costs
Loss of production
Avertive expenditures
collectively borne
collectively borne
collectively borne
Intangible Costs
Treatment costs
Loss of production
Avertive expenditures
Disutility
associated with
indvidually borne
individually borne
individually borne
morbidity individually borne
Market Prices available
Market Prices not available
Private Costs (= individual WTP)
Social Costs
(individually and collectively borne)

22. The value of a prevented fatality based on willingness-to-pay
Example:
Policy measure for risk reduction from
4 cases per 10,000 inhabitants to
3 cases per 10,000 inhabitants.
Risk reduction: 1 case per 10,000 Inhabitants =
Individual willingness-to-pay for a risk reduction of
1 case in 10,000 inhabitants = 100 EURO.
Value of a prevented fatality: 100 EUR/ = 1 Million EURO

23. Willingness-to-pay cost factors used for the monetary assessment of mortality
Tri-lateral study (A,F,CH); 1.4 adjusted down
Jones-Lee M. (1998); Fatal road accidents
1.2 Mio EUR
2.6 Mio EUR
3.1 Mio EUR
Source
Department of Health (UK)
Instiute of Environm. Studies, Norway (1997)
ZEW, Centre for Europ. Econ. Research (1998)
ISI Frauenhofer Institute (1998)
WTP-value
ExternE (1995)
0.9 Mio EUR
1.4 Mio EUR

24. Willingness-to-pay cost factors used for the monetary assessment of morbidity
Health outcome
Respiratory hospital adm.
Cardio-vascular hosp.adm.
Chronic Bronchitis (adults)
Acute Bronchitis (children)
Restricted activity days
Asthma attacks
Source
ExternE (1995)
Chestnut L.G. (1995)
Maddison D. (1997)
WTP (EUR)
7,870/adm.
209,000/case
131/case
94/day
31/attack

25. Health costs due to air pollution
Health costs due to air pollution
Austria
8.1
France
58.3
Switzer-land
7.1
All three countries
73.4
Total (mill. Euro)
6 700
38 900
4 200
49 700
Attributable to road traffic (mill. Euro
2 900
21 600
2 200
26 700
Inhabitants
(mill.)

26. Traffic-related Monetary Health Costs
Austria, France and Switzerland
Total health WTP-costs: 27 billion EUR p.a.
= 1.7% of GDP
(Partial assessment: 3.5 billion EUR p.a.)
Per capita WTP-costs: 360 EUR p.a.
Predominant part: 70% of costs for premature mortality
Morbidity WTP-costs: 7 billion EUR p.a.
75% for chronic bronchitis, 22% RAD

27. The “At least approach”
Lowest assessed level of 7.5 g/m3 for health effects
Not all PM10 related health effects are considered
(infant mortality, respiratory symptom days)
The effect estimate reflects the air pollution mix of an
urban environment. Specific independent effects of
single pollutants are not considered.
Seasonally limited air pollution related health effects
are not considered (e.g. ozone exposure in summer)
Willingness-to-pay value of fatal road accidents of
1.4 Mio EUR is reduced of 61% according to higher
age of air pollution related victims.
This WTP value is lower than values used in other
European studies (e.g. ExternE: Mio. EUR)

28. Outlook – research needs
Data improvement for the assessment of exposure and transport-related share
Effects of ozone, effects of other pollutants additive to PM10 effects
Age distribution at time of death
Simultaneous effects of noise and air pollution
Monetary valuation of health impacts: Elements included in WTP
Situational effects on WTP, age effects on WTP, other effects
Appropriate measure of uncertainty