1. Evaluating the Effectiveness of Interventions: Accountability Annemoon van Erp Senior Scientist, Health Effects Institute NERAM V Conference, October 16-18 2006

2. Why accountability? Air quality has improved substantially over the past decades Need to ensure that regulations are achieving the intended public health benefits Measuring indicators along entire chain from regulatory action  emissions  air quality  exposure  human health

3. Focusing the challenge on health: The Chain of Accountability Compliance, effectiveness Atmospheric transport, chemical transformation, and deposition Human time-activity in relation to indoor and outdoor air quality; Uptake, deposition, clearance, retention Susceptibility factors; mechanisms of damage and repair, health outcomes Regulatory action Emissions Ambient air quality Exposure/ dose Human health

4. Concept of accountability research Evaluating concurrent changes that affect exposure and health effects. This relates especially to regulations implemented over long time periods Participation of experts from broad range of disciplines History of HEI’s accountability program : –initiated in Strategic Plan for 2000–2005 –published accountability monograph in 2003 to discuss concepts and methods (HEI Communication 11) –issued four RFAs between 2002 and 2004 –HEI now has 6 ongoing studies, 1 study completed (report under review), and 1 under negotiation

5. HEI accountability studies Short-term interventions Traffic reduction –during Atlanta Olympic Games (Jennifer Peel) –congestion charging scheme in London (Frank Kelly) –low-emission zone in London (Frank Kelly) Replacing old wood stoves with less polluting stoves in Montana (Curtis Noonan) Coal ban in Irish cities (Douglas Dockery)

6. HEI accountability studies (2) Actions and events over longer term Changes in eastern Germany after the reunification, such as switching from brown coal to natural gas and increased use of diesel engines (Annette Peters) (completed and under review) Regulations requiring decreased SO 2 emissions from powers plants in eastern US (Richard Morgenstern)

7. Congestion charging scheme (London) PI: Frank Kelly, King’s College, London implemented in February 2003 to reduce traffic congestion in London’s inner city (charge £5, now £8) concomitant increase in public transportation show that traffic reduction  pollution reduction oxidative properties of PM collected on filters before and after implementation if pollution reduction evident, follow up with health study : (1) death & hospital admissions (2) respiratory and cardiovascular conditions in children and elderly obtained from primary care records

8. Low-emission zone (London) PI: Frank Kelly, King’s College London reduce pollution levels by excluding high emitters, starting in spring 2008 affects much larger area (greater London) prospective study: baseline assessment - pollution levels - collect filters for oxidative properties - access to primary care data improved monitoring network before start post-intervention study to be decided

9. Decreased SO 2 emissions from power plants (eastern US) PI: Richard Morgenstern, Resources for the Future reduction of SO 2 emissions from power plants under Title IV of the 1990 Clean Air Act Amendments source-by-source analysis to determine where and when reductions occurred source-receptor matrices to establish relationship between emissions reduction and improvement in air quality study on health effects to be finalized

10. Morgenstern: SO 2 emissions (cont’d) Data collection (1999-2005 time frame): SO 2 and NOx emissions from EPA’s National Emissions Inventory (point, area, and mobile sources) air quality and weather data from EPA’s Air Quality System (SO 2, SO 4, PM 10, PM 2.5 [speciated]) and NOAA’s National Climate Data Center health and demographic data from US Census and National Center for Health Statistics Source-by-source analysis: determine whether emissions reductions (SO 2, NOx, PM 2.5 ) are due to Title IV or other policies or changes in economic activity

11. Morgenstern: SO 2 emissions (cont’d) Statistical models linking emissions and air quality: econometric model with adjustment for wind direction between source and receptor weather-mediated source-receptor matrix based on a large-scale regional atmospheric model validate each model against observed data compare both models as to how they predict air quality (PM 10, PM 2.5, and SO 4 ) estimate what pollutant concentrations would have been in the absence of this policy; compare to observed concentrations

12. Morgenstern: SO 2 emissions (cont’d) Estimating health effects: focus on PM 10, PM 2.5, SO 4 reductions in 2005 attributed to reduced SO 2 emissions from power plants use concentration-response functions from existing epidemiologic studies focus on mortality and respiratory-related hospital admissions for the elderly, possibly other health outcomes estimate whether adverse health effects were avoided by the air quality improvement

13. What’s ahead: One study under negotiation : effects on mortality of reducing fuel sulfur content in Hong Kong HEI is preparing a Program Summary describing the accountability research program Work with CDC EPHT Branch, US EPA and States to apply newly developed environmental public health tracking methods to accountability Pursue new research and methods development on long-term and short-term impacts of domestic air quality actions on public health

14. Thank you! To find out more about HEI’s research program or to download the Accountability Monograph (HEI Communication 11) visit our website at www.healtheffects.orgwww.healtheffects.org