1. World Health Organization
5 September, 2018
Breathless World
Annette Prüss-Ustün
Air Pollution Symposium, November 2017, Istanbul

2. Overview of the presentation
World Health Organization
Overview of the presentation
5 September, 2018
Air pollution and health
WHO’s role
What can be done ?

3. Air pollution and health

4. Air pollution 6,5 million deaths per year.
Sense of urgency – political issue, demand for action.
Traditionally thought of as an environmental issue,
has become an urgent public health crisis.
Traditionally little involvement of the health sector. 2

5. World Health Organization
5 September, 2018
Outrage
Kathmandu, Winter 2016/2017

6. Air pollution and health
PM<10mm – Coarse
PM<2.5mm – Fine
PM<1mm – Ultrafine
Heart Disease
Stroke
Adverse Pregnancy Outcomes
Chronic obstructive pulmonary disease
Cognitive development
Childhood pneumonia
Tuberculosis
Lung cancer
Diabetes
Cataract
The relationship between PM & health is size dependent. The aerodynamic diameter of PM plays an important role in the human toxicity as this can impact the level or degree of entry into the body.
Larger or coarse fraction particles of PM, with aerodynamic diameter greater than 2.5 micrometers and less than 10 micrometers such as dust, pollen are restricted to the thoracic cavity and are unable to penetrate the smaller airway systems.
PM 2.5 and smaller or the fine fraction have more severe impacts on health due to its greater ability to deposit on smaller airways & aveoli in the lungs. Ambient studies outdoors have shown that days with higher concentrations of PM 2.5, show a larger percentage of black carbon than those days with high concentrations of coarse fractions.
Evidence relating specifically to ultrafine particles is still limited but considering its small size, its ability to penetrate different tissues and organs suggest a greater ability to effect the body systematically.
Image on the left helps show where the in the respiratory tract that particles can deposit. Often particles smaller than 2.5 are able to penetrate deep into the lungs and effect the body more systematically leading to cardiovascular disease and adverse pregnancy outcomes.
However please note that size alone does not determine the health effects as considerations of chemical composition, concentration and/or surface area are also important to consider.
The smaller-diameter particulates have the most health impacts as they enter into the body’s orifices, particularly lungs, most easily. Among those, PM10 with aerodynamic diameter less than 10greater than 2.5 micrometers and micrometers such as dust, pollen can penetrate the thoracic cavity. PM 2.5 and smaller penetrate the smaller airway systems and thus have more severe impacts on health due to its greater ability to deposit on smaller airways & aveoli in the lungs. Ambient studies outdoors have shown that days with higher concentrations of PM 2.5, show a larger percentage of black carbon than those days with high concentrations of coarse fractions.
Image on the left helps show where the in the respiratory tract that particles can deposit. Often particles smaller than 2.5 are able to penetrate through the lungs and effect the body more systematically leading to cardiovascular disease and can lead to adverse pregnancy outcomes.

7. Mortality from air pollution
Ambient air pollution (AAP)
3.0 million deaths/yr
Household air pollution (HAP)
4.3 million deaths/yr
According to WHO GBD figures for 2012, released in 2014 and 2016, Ambient Air Pollution is estimated to be responsible for 3.0 million premature deaths a year and Household air
pollution for 4,3 million deaths in 2012, making of HAP is world’s largest environmental-health risk
AAP: Ambient air pollution: global assessment of exposure and burden of disease, WHO Geneva, 2016.
HAP: WHO Global Health Observatory,
Mongolia Air Pollution Forum

8. World Health Organization
Joint Effects: Disease Burden from Household AP + Ambient AP (AAP), 2012
5 September, 2018
In some areas, a significant fraction of ambient air pollution (AAP) is caused by household fuel combustion
WHO estimates that around 6.5 million premature deaths are caused by the joint effects of HAP and AAP annually

9. SDG 3.9.1 Mortality rate from air pollution

10. Number of deaths per year attributable to selected risks, World
Sources: WHO 2012, Global Health Observatory; IHME 2016,

11. SDG 11.6.2 Exposure to particulate matter PM2.5
Ambient air pollution
SDG Exposure to particulate matter PM2.5
92% of world population breathe an air above the WHO Air Quality Guidelines

12. WHO guideline values (annual mean) PM2.5: 10 μg/m3 PM10: 20 μg/m3

13. Household air pollution SDG 7. 1
Household air pollution SDG Use of clean fuels and technologies for cooking, 2014
In 2014, over 3 billion people primarily used polluting fuels for cooking

14. SDG 3.9.1 Mortality from joint effect of air pollution, 2012
6.5 millions deaths – 1 in 9 deaths

15. WHO’s response

16. World Health Assembly Resolution A68
World Health Assembly Resolution A68.8 An enhanced global response to the adverse health effects of air pollution
Highlights the key role of health authorities in raising awareness about the potential to save lives and reduce health costs, if air pollution is addressed effectively.
Identifies the need for strong cooperation between different sectors and integration of health concerns into all national, regional and local air pollution-related policies.
Urges Member States to develop air quality monitoring systems and health registries to improve surveillance for all illnesses related to air pollution;
Urges Member States to strengthen international transfer of expertise, technologies and scientific data in the field of air pollution.

17. WHO Global Platform on Air Quality and Health
World Health Organization
WHO Global Platform on Air Quality and Health
5 September, 2018
Established in January 2014, last meeting March
Main purpose: Strengthening countries capacity to address air pollution and related health risks through enhanced estimates of air pollution exposure.
Availability of information about exposure of population to air pollution is the key for:
risk assessment
communication
development and implementation of effective policies.
A the March meeting, the objectives were to :
Review progress and emerging issues
Identify gaps and opportunities
Propose next steps
Respond to questions by countries and scientists
Shaddick G. et al (2016), 'Data Integration Model for Air Quality: A Hierarchical Approach to the Global Estimation of Exposures to Ambient Air Pollution', Journal of the Royal Statistical Society (Series C).

18. What can WHO do about it? Gathering data, evidence & raising awareness
Global databases on outdoor air pollution in cities, household energy use, and household air pollution measurements
Global Platform on Air Quality and Health: combining satellite imagery, chemical transport models & ground-level monitoring
Normative work & support to countries
World Health Assembly Resolution & road map (2015 and 2016)
WHO Air quality guidelines
Reviewing & synthesizing the evidence on the effectiveness of technological & policy interventions for both acute & chronic exposure and health outcomes
ISO Standards for cookstoves
Connecting air pollution to sustainable development & climate
UN Secretary General’s Sustainable Energy for All initiative (SE4All)
Inter-Agency and Expert Group on Sustainable Development (IAEG)
Climate & Clean Air Coalition (CCAC)
Outdoor air pollution (OAP) has typically been considered a problem for cities, and monitoring (if available) is typically limited to urban areas.
New methods have been developed to monitor outdoor air quality in both urban and rural areas globally using varying sources of information including satellite imagery, chemical transport models and ground-level monitoring
WHO has been collaborating with various experts in the field to plan a more comprehensive and robust global monitoring system for outdoor air quality using these new methods
WHO plans to coordinate a meeting with stakeholders and experts to review these new methods and develop an action plan for their use by WHO for routine monitoring of outdoor air quality and its associated health impacts
In 2011, WHO launched its Outdoor Air Pollution database—housing air quality data from over 1100 cities worldwide
Database serves as an important tool for countries and municipalities to monitor and track air quality and its impacts in cities
WHO is in the process of updating this database with more recent estimates and when possible data from new cities not currently represented in the database
Countries are becoming more and more aware of the health impacts of poor air quality and are seeking support and guidance on effective interventions to improve health and air quality
There is a paucity in the evidence looking at the effectiveness of interventions
WHO is looking for technical support to systematically review the evidence base on the effectiveness of outdoor air quality interventions at improving health
Increasing our knowledge about the effectiveness of interventions can help drive evidence-based policy across sectors to improve health & air quality

19. World Health Organization
5 September, 2018
WHO Global Platform on Air Quality and Health: Task groups requiring expert inputs
8 Task Groups:
Improvement in Exposure assessment:
Assessment of Health Impacts
Desert and sand dust
Low Cost Air Quality Monitoring
Response to air pollution episodes
Citizens’ science
Communication

20. BreatheLife campaign - breathelife2030.org
Aim
To mobilize cities and individuals to protect our health and our planet from the effects of air pollution
Citywide commitments towards WHO Air Quality Guidelines, and solutions
Actions for individuals
Health sector leadership

21. World Health Organization
5 September, 2018
A global campaign to protect our health and climate by improving air quality
For Cities : 35 cities have joined, commitments towards AQG & solutions
London, Washington DC, Santiago, Manchester, Aburrà Valley, Jalisco State, Mongolia
For the General public : information on risks, air quality levels, actions
For the Health professionals: information on risks for patients, actions
Campaign was framed under the Climate and Clean Air Coalition (CCAC), WHO, UNEP , which also used their regional offices and initiatives (e.g. WHO healthy cities) and launched in October 2016 at UN HABITAT III conference
Involved city and governments officials that were interested to joining the network  of cities (it started with a few now there are 35 after one year, and more have shown interest in joining) to demonstrate support for air quality solutions, leadership and engagement. Cities like London, Washington DC, Manchester, Santiago and several other cities in LA, and a country: Mongolia, commit to improve air quality in line with the WHO AQ Guidelines for particulate matter air pollution.
Cities networks and NGOs such as ICLEI (Local Governments for Sustainability), C40, Clean Air Asia, Clean Air Initiative, Global Alliance on clean cookstoves, etc are part of the campaign, enables more visibility and reaching out more people
BreatheLife2030.org website contains information on health impacts of AP and solutions, videos, infographics, data, and it is interactive so that people, cities, health workers can sign up and join the campaign, and use the available material and tools. Social media engagement important to inform and drive the conversation; Twitter, Facebook, so far 21 mill views are registered
Synergies between different stakeholders (climate, air pollution, health), joint resources, and wide outreach were key to success                              
Launched Oct 2016 at UN HABITAT III Conference breathelife2030.org

22. A global campaign to protect our health
and climate by improving air quality

24. Solutions CITY WIDE SOLUTIONS ACTIONS FOR INDIVIDUALS
Transport
Waste management
Household air & pollution
Food & agriculture
Energy supply
Industry
ACTIONS FOR INDIVIDUALS
Reduce your contribution
Minimize exposure
HEALTH SECTOR LEADERSHIP
Education & advocacy
Sustainable facilities
Service delivery

25. World Health Organization
Urban Health Initiative -
Create demand for actions that prevent air pollution-related diseases
5 September, 2018

26. Moving ahead with urban transformation
2) Health & economic
tools
1) Policies mapped
3) Scenarios tested
4) Health Leadership
5) Communications
6) Urban leaders act

27. What role for health actors ?

28. Health Sector Role Convey the health burden
Provide leadership in health matters related to air pollution.
Convene different sectors to address public health issues.
Support improved standards.
Conduct health-based assessments.
Protect those at risk.
Advocate for monitoring.
The health sector has a duty to:
Protect children, who do not have a voice
Use existing PH knowledge to inform decisions
Help ensure best use of resources – invest where the benefits are greater
Help reduce health inequity through public policies
Health matters to all sectors and to the economy

29. Thank you WHO resources Air pollution Ambient air pollution
Ambient air pollution
Breathelife campain
AirQ+ on the web
health-risk-assessment-of-air-pollution
Mongolia Air Pollution Forum