2. R E 1 Monitoring environmental health around Schiphol airport Carla van Wiechen, Danny Houthuijs, Siem Heisterkamp, Erik Lebret

3. EUROHEIS 30-31 March 2003 | Carla van Wiechen 2 F GB D B NL

4. EUROHEIS 30-31 March 2003 | Carla van Wiechen 3 Health Impact Assessment Schiphol (HIAS) Monitoring programme 2002 - 2006 Aims to keep the finger on the pulse to assess changes in environmental quality and environmentally related health effects to support the decision making process on the development of air traffic

5. EUROHEIS 30-31 March 2003 | Carla van Wiechen 4 HIAS - Monitoring Combination of various study designs cross-sectional questionnaire survey (2002) –reference data panel study (2002 - 2005) –in areas with expected changes in aircraft noise small area level analyses with routine data –follow-up spatial pattern of disease

6. EUROHEIS 30-31 March 2003 | Carla van Wiechen 5 HIAS - small area health statistics Health data hospital admissions –cardiovascular diseases –respiratory diseases medication use –cardiovascular –respiratory –sleeping pills / sedatives Environment Advisory Committee Schiphol –number of complainants about aircraft noise

7. EUROHEIS 30-31 March 2003 | Carla van Wiechen 6 HIAS - small area health statistics Population data per postcode area, by 5-year age and sex –yearly updated (national statistical office) Health determinants at postcode level socio-economic indicators –% high and low income –average value of housing stock % non-Western immigrants smoking –estimation of % smokers

8. EUROHEIS 30-31 March 2003 | Carla van Wiechen 7 HIAS - small area health statistics Geographical data spatial link via postcode area 55 km 2 490 postcodes total population: 2,890,000 postcode average: 5,900 inhabitants [10 - 21,000]

9. EUROHEIS 30-31 March 2003 | Carla van Wiechen 8 HIAS - small area health statistics Environmental exposure data air traffic noise L den (day, evening, night) 50 dB(A) 58 dB(A)

10. EUROHEIS 30-31 March 2003 | Carla van Wiechen 9 HIAS - small area health statistics Environmental exposure data L night (23:00-7:00) 49 dB(A)

11. EUROHEIS 30-31 March 2003 | Carla van Wiechen 10

12. EUROHEIS 30-31 March 2003 | Carla van Wiechen 11 dB(A)

13. EUROHEIS 30-31 March 2003 | Carla van Wiechen 12 variance: between postcodes high (30) within postcodes low (1) between years lowest (0.5) Average values of L den per postcode

14. EUROHEIS 30-31 March 2003 | Carla van Wiechen 13 HIAS - small area health statistics Statistical method –Bayesian disease mapping –spatiotemporal modelling –Markov chain Monte Carlo simulation methods (MCMC) –compare competing models: exchangeable conditional autoregressive (CAR) –use of Expected Predicted Deviance (EPD)

15. EUROHEIS 30-31 March 2003 | Carla van Wiechen 14 Complainants aircraft noise –Standard Ratio –year 2000 –model: exchangeable –interaction of time and site

16. EUROHEIS 30-31 March 2003 | Carla van Wiechen 15 100

17. EUROHEIS 30-31 March 2003 | Carla van Wiechen 16 HIAS - small area health statistics Resuming ingredients to get started further development of aggregated health determinants search for solutions to constraints further exploration of exposure co-variables Thank you for your attention!

18. EUROHEIS 30-31 March 2003 | Carla van Wiechen 17 HIAS - Monitoring Environmental exposure data Expected changes between years 2000 and 2005 (L den ) noise decrease noise increase

19. EUROHEIS 30-31 March 2003 | Carla van Wiechen 18 HIAS - Monitoring Environmental exposure data Road traffic L day (7:00-23:00) 49 dB(A)

20. EUROHEIS 30-31 March 2003 | Carla van Wiechen 19 Health Impact Assessment Schiphol (HIAS) Phase I1991-1993 Health studies in relation to environmental pollution, as part of Environmental Impact Assessment Phase II1995-2002 Fill up gaps in knowledge Ecological studies: health registries Epidemiological field studies on e.g.: - annoyance, self-reported health, perceived risks - sleep disturbance - respiratory complaints in children - performance of children (RANCH)