1. Updating the science on health assessment
Michal Krzyzanowski
WHO European Centre for Environment and Health
Bonn Office

2. WHO AQG: Global update 2005: Summary of updated AQG values
Pollutant
Averaging time
AQG value
Particulate matter
PM2.5
PM10
1 year
24 hour (99th percentile)
10 µg/m3
25 µg/m3
20 µg/m3
50 µg/m3
Ozone, O3
8 hour, daily maximum
100 µg/m3
Nitrogen dioxide, NO2
1 hour
40 µg/m3
200 µg/m3
Sulfur dioxide, SO2
24 hour
10 minute
500 µg/m3
AQG levels recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution

3. Percent increase in the daily number of deaths per 10 µg/m3 of PM10 (lag 1): APHENA study
Samoli et al, EHP 2008

4. RR for deaths for all causes per 10 µg/m3 annual mean PM2.5

5. Health impacts of fine PM – update analysis of ACS cohort
Hazard rates for PM2.5 by cause-of-death (with adjustment for ecologic covariates). 18 years follow up of 360,000 participants of ACS cohort
Krewski et al, HEI 140, May 2009

6. Risks for coronary artery calcification
Risks for coronary artery calcification*) and exposure to traffic-related air pollution
4,494 participants (age years) of the German Heinz Nixdorf Recall Study
Hoffmann B et al, Circulation 2007
*) CAC assessed by non-contrast enhanced electron-beam computed tomography

7. Ischemic and thrombotic effects of dilute diesel exhaust inhalation in men with coronary heart disease
Myocardial inchemia during 15-minute intervals of exercise-induced stress and exposure to diesel exhaust or filtered air in the 20 subjects
Mills et al, NEJM 2007

8. Respiratory effects of exposure to diesel traffic: randomized study of 60 adults with asthma in London
Mean % changes during and after 2 h walk on Oxford street and Hyde Park
McCreanor et al, NEJM 2007

9. Reduction of PM exposure and increase of life expectancy in the US
Reduction in PM accounts for 15% of overall increase in life expectancy
Pope AC et al, NEJM 2009
A decrease of 10 µg/m3 of PM2.5 associated with increase of life expectancy by 7.3 months between 1980 and 2000

10. Potential reduction in YLL for two scenarios for PM2
Potential reduction in YLL for two scenarios for PM2.5 reduction: LV compliance and AEI-reduction target
Source: F. De Leeuw, J. Horalek, ETC/ACC, 2009

11. Effects of long term O3 exposure
Risk of death due to respiratory causes. Results of analysis of ACS cohort of 448,000 adults followed for up to 18 years
RR per 10 ppb = (95% CI )
(2-pollutant model with O3 and PM2.5)
Jerrett et al, NEJM 2009

12. Effects of long term O3 exposure
Risk of asthma hospital admissions in children and mean O3 in
Lin et al, EHP 2008

13. Associations between air pollution and the incidence of asthma and wheeze – meta-analysis of cohort studies
Per 10 µg/m3 NO2
Per 10 µg/m3 PM2.5
Anderson et al, Air Qual Atmos Health 2011

14. TFH review of health effects of BC – preliminary conclusions
Sufficient evidence on association of short-term (daily) variations in BC concentrations with short term changes in health and on associations of all cause and cardiopulmonary mortality with long-term average BC exposure.
Suggestive evidence for BC being a better indicator of harmful particulate substances from combustion sources - especially traffic - than undifferentiated PM mass
Insufficient evidence to allow of an evaluation of the qualitative differences between health effects of exposure to BC or to PM mass

15. TFH review of health effects of BC – preliminary conclusions
TFH agreed that the reduction of exposure to PM2.5 containing BC, and other combustion related PM material, for which BC is an indirect indicator, should lead to reduction of the health effects associated with PM.
TFH recommended continuing the use of PM2.5 as the primary approach in quantifying the human exposure to PM and its health effects, and for predicting the benefits of exposure reduction measures.
In evaluation of local actions aimed at reduction of population exposure to combustion particles (e.g. from motorized traffic) the use of BC as an additional indicator may be useful

16. European Study of Cohorts for Air Pollution Effects – ESCAPE http://www.escapeproject.eu/
EU FP7 project, 25 patners, coordinated by Univ Utrecht
30 cohorts, total 645,800 subjects followed over several years, ca. 37,000 deaths
ESCAPE monitors PM2.5, PM10, NO2, NOx, BC, elemental composition of PM (TRANSPHORM)
Exposure assessment based on land use regression models
First results expected mid-2012

17. Conclusions
Scientific evidence on health effects of air pollution increases confirming conclusions of WHO AQG Global Update 2006
Cardiovascular disease affected by PM exposure
Uncertain long term effects of O3 exposure
New studies (incl. ESCAPE) expected to respond to (some of the) outstanding questions