1. Health Effects of Air Pollution: A Summary of Recent Findings
Francesco Forastiere
Carpi, 27 October 2017

2. Science 307:1857-1861, News Focus, March 2005

3. Osservazioni satellitari
Environ Health Perspect 118:847–855 (2010).

4. Satellite-derived map of PM2. 5 averaged over 2001-2006
Satellite-derived map of PM2.5 averaged over Credit: Dalhousie University, Aaron van Donkelaar

5. Stafoggia et al, Env Int, 2016 Air pollution maps, Italy, 2006-2012
Maps of PM10 in Italy at high resolution using satellite data (1 Km grid)
Stafoggia et al, Env Int, 2016

6. From proxies to fixed monitors to sensors, satellites and data fusion

7. (target or limit value)
WHO AQG Summary (2005)
Pollutant
Averaging time
AQG value
EU standard
(target or limit value)
Particulate matter
PM2.5
PM10
1 year
24 hour (99th percentile)
10 µg/m3
25 µg/m3
20 µg/m3
50 µg/m3 --
40 µg/m3
50 µg/m3***
Ozone, O3
8 hour, daily maximum
100 µg/m3
120 µg/m3***
Nitrogen dioxide, NO2
1 hour
200 µg/m3
200 µg/m3***
Sulfur dioxide, SO2
24 hour
10 minute
500 µg/m3
125 µg/m3***
350 µg/m3*** (1 hr)
WHO levels are recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution
***Permitted exceedances each year

8. THE EFFECTS OF AIR POLLUTION ON HEALTH ARE OFTEN CONVENIENTLY CLASSIFIED:
In short-term and long-term effects
although there is probably a continuum of effects in the time scale, which are not yet fully understood.

9. Acute effects Temporal differences Chronic effects Spatial differences
Roma PM10 ed NO2

10. Short-term health effects

11. Deaths from London Smog, December 1952

12. Samet et al, NEJM,
2000; 343 (24):1742
% change per 10μg/m3

13. APHEA RESULTS
Percentage increase in the daily number of deaths associated with 10 ug/m3 increase in PM10 measurements for each city.
Katsouyanni, 2001

14. MED-PARTICLES: the cities

15. Effects of PM2.5 and PM2.5-10 on mortality,
EHP 2013

16. Long-term health effects

17. Long-term exposure and mortality
POPE ET AL, JAMA 2002

19. Cause of mortality RR (95% CI) All cause 1.06 (1.02 – 1.11)
Adjusted mortality relative risks (RR) associated with 10μg/m3 change in PM2.5* (Pope et al, 2002)
Cause of
mortality RR (95% CI)
All cause (1.02 – 1.11)
Lung cancer (1.04 – 1.23)
Cardiopulmonary 1.09 (1.03 – 1.16)
All other cause (0.95 – 1.06)
*Adjusted for age, sex, race, smoking, education, marital status, body mass, alcohol consumption, occupational exposure, diet.

20. European Studies

21. Air pollution in the Rome Longitudinal Study
EHP 2013
Average exposure at baseline:
43.6 μg/m3 NO2
23.0 μg/m3 PM2.5

22. The air pollution maps in Rome

23. Air pollution and mortality in the Rome Longitudinal Study
EHP 2013
10 ug/m3 NO2
10 ug/m3 PM2.5
Cases HR
95%CI
Non accidental mortality
144,441
1.03
1.02
1.04
1.05
Cardiovascular mortality
60,318
1.06
1.08
IHD mortality
22,562
1.10
1.13
Respiratory mortality
8,825
1.00
0.97

24. EHP 2013 EU Limit Value EU Limit Value
Using these maps, they established that NO2 was related to all-cause and cardiovascular mortality, and that this relationship was also clear at levels well below the EU Limit Value of 40 microgram/m3. Even more important, this relationship was found to be independent of the relationship between PM2.5 and mortality in this study.
EHP 2013

25. ESCAPE study areas in
EUROPE
PM+NOx
NOx only

26. The ESCAPE project

27. The ESCAPE project

28. The ESCAPE project PM10 (10 ug/m3) PM2.5 (5 ug/m3)
PM10
(10 ug/m3)
PM2.5
(5 ug/m3)
Non accidental mortality
1.04 (1.00–1.09)
1.07 (1.02–1.13)
CV mortality
1.02 (0.92–1.14) 
0,99 (0.91–1.08)
Incidence of acute coronary events
1.12 ( )
1.13 ( )
Incidence of stroke
1.02 ( )
1.19 ( )
Lung cancer incidence
1.22 (1.03–1.45)
1.18 (0.96–1.46)

29. Recent statements and publications on air pollution

30. IARC Monographs
There are other sources of particles for which the evidence base is strong.
Here I am showing you a recent re-evaluation for household use of solid fuels, and in that monograph you can find the evidence for the combustion of coal – it is also categorized as Group 1.
And obviously, another source of particles with very important health consequences is tobacco smoke, both for the smoker as well as for non-smokers from exposure to environmental tobacco smoke.

31. 68th World Health Assembly
May 26, 2015

32. Health effects of particulate air pollution
Insulin Resistance
Type 2 diabetes
Type 1 diabetes
Bone metabolism
Skin Aging
Stroke
Neurological development
Mental Health
Neurodegenerative diseases
Cardiovascular Disease Mortality
Cardiovascular Disease Morbidity
Myocardial Infarction
Arrhythmia
Congestive Heart Failure
Changes in Heart Rate Variability
ST-Segment Depression
Premature Birth
Decreased Birth Weight
Decreased foetal growth
In uterine growth retardation
Decreased sperm quality
Preclampsia
High blood pressure
Endothelial dysfunction
Increased blood coagulation
Systemic inflammation
Deep Venous Thrombosis
Respiratory Disease Mortality
Respiratory Disease Morbidity
Lung Cancer
Pneumonia
Upper and lower respiratory symptoms
Airway inflammation
Decreased lung function
Decreased lung growth
Joint ERS / ATS statement (ERJ, 2016)

34. The Lancet, May 2017
4.2 million deaths attributable
to PM2.5 in 2015

35. Deaths attributable to ambient particulate matter pollution in 2015
Figure 5
Deaths attributable to ambient particulate matter pollution in 2015
Deaths attributable to ambient particulate matter pollution in 2015
ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Island. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.
The Lancet DOI: ( /S (17) )
Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

36. October 2017
“Targets and timetables are essential, and governments at all levels need to establish short-term and long-term targets for pollution control and to support the agencies and regulations needed to attain these goals. Legally mandated regulation is an essential tool, and both the polluter-pays principle and an end to subsidies and tax breaks for polluting industries need to be integral components of pollution control programmes”.