1. 1 1 Healthy Air Matters: Health Effects of Air Pollution Janice Nolen Assistant Vice President, National Policy American Lung Association Janice.Nolen@Lung.org

2. 2 Air Pollution in the Past 1972 Birmingham 1966 New York City

3. 3 Air Pollution in the Past “Separated here by only a narrow strip of water, the Four Corners Power Plan and a Navajo sheep herder represent two worlds.” Four Corners Power Plant, May 1972

4. 4 November 3, 2010 at 11 AM from Clean Air Fairbanks October 20, 2010 at 1:30 PM Fairbanks, AK, haze from particulate matter 2010 Air Pollution in the Present

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6. 6 Why tell people about air quality? Someone in every family faces higher risk from air pollution

7. 7 Children, teens have growing lungs, spend more time outdoors, inhale more air per pound. Children, teens face higher risk

8. 8 Aging brings a gradual decline in the body’s systems that makes us more vulnerable. Older adults face higher risk

9. 9 Chronic diseases increase risk from air pollution Having asthma or other lung diseases, cardiovascular disease or diabetes puts you at higher risk.

10. 10 Even healthy adults can face increased risk. Working or exercising outdoors increases exposure, especially near highways.

11. 11 People with low incomes face increased risk. Poorer people often live closer to sources of pollution, may have higher incidence of disease, and less access to care.

12. 12 How does air pollution hurt us?

13. 13 Cause or Worsen Asthma Dust mites & cockroaches Mold & dampness Animal dander Tobacco smoke Traffic Pollution Nitrogen oxides Sulfur dioxide Ozone Particulate Matter Pollen Formaldehyde Domestic birds Fragrances Wood burning

14. 14 Cause Cancer Radon (lung) Particulate matter (lung) Tobacco smoke (lung and others) Asbestos (lung cancer, mesothelioma) Formaldehyde Benzene and other VOCs Dioxins and Furans Arsenic (lung)

15. 15 Cause or Worsen Lung Disease Nitrogen oxides (risk of infection) Ozone and Particulate Matter (COPD) Tobacco Smoke Bacteria & viruses (pneumonia, influenza, colds, Legionella) Acid Gases

16. 16 Worsen Cardiovascular Disease Tobacco Smoke Particulate matter Wood burning Ozone

17. 17 Harms or may harm central nervous system Carbon monoxide Pesticides Lead (learning impairment) Mercury Ozone Particulate Matter

18. 18 Harms reproduction or development Mercury Particulate Matter Carbon monoxide Ozone PAHs

19. 19 Kills people Carbon monoxide Particulate Matter Ozone Tobacco Smoke

20. 20 Our 16 th Annual Report Puts air pollution into everyday language Gives public local information Focuses attention on ozone and particle pollution

21. 21 In 2011-2013, we found: Lower annual PM 2.5 levels 13 of the most polluted cities had lowest ever Many more episodes of high PM 2.5 24-hour Some cities had highest averages we’d seen Ozone mixed Some better, some worse

22. 22 Reasons for improvement—Clean Air Act The Clean Air Act tools at work: New emissions control equipment on coal-fired power plants Converting fleets of diesel trucks, buses, trains, barges, tractors and heavy equipment to low-emissions vehicles Clean Air Act

23. 23 Warmer temperatures with climate change Drought, wildfires, grassfires, dust Warmer 2012 led to more ozone Ozone still better than 16 years ago We’ve cleaned up a lot of raw ingredients for ozone Heat Reason for more particles and ozone?

24. 24 The News In 2011-2013, more than 4 people in 10 live in counties with an F for ozone

25. 25 Premature death Coughing and wheezing Asthma attacks Worsening of COPD Cardiovascular harm May harm central nervous system May increase risk of low birth weight –US EPA, Integrated Science Assessment for Ozone and Related Photochemical Oxidants, 2013 Health effects of ozone oxygen

26. 26 EPA Staff recommended range EPA proposed range Health and Medical Community supports 60 ppb CASAC preferred range Options on the table EPA taking comment on 60 ppb

27. 27 New findings show current standard needs to be stronger Multiple chamber studies show ozone down to 60 ppb harms healthy adults. Adams (2002), Adams (2006), Brown et al (2008) and Kim et al (2011) Gold standard of testing—only ozone, only healthy adults, for 6.6 hours Solid evidence that concentrations >60 ppb risks many healthy adults, and most critically, susceptible populations

28. 28 New findings show current standard needs to be stronger Epidemiological studies provide real-world evidence for the need for 60 ppb 6 multi-city studies in the US and Canada Looked at premature death and hospital/ ED admissions Increased risk shows up in most cities that would have met a standard of 65 or 70 ppb. Bell et al., 2006; Cakmak et al., 2006b; Dales et al., 2006; Katsouyanni et al., 2009, Mar and Koenig, 2009; Stieb et al, 2009

29. 29 Nationwide Benefits of Attaining Standard in 2025 Throughout the United States (except California) Measure 60 ppb65 ppb70 ppb Premature Deaths Avoided in 20257,9004,3001,440 Asthma Attacks Avoided in Children in 20251,800,000960,000320,000 Respiratory Hospital Admissions Avoided in 20252,9001,500510 Asthma Emergency Department Visits Avoided in 20254,1002,3001,400 Missed School Days Avoided in 20251,900,0001,000,000330,000

30. 30 The more we look beyond the lungs, the more risks we’re finding. Here are a few.

31. 31 Uncovering newer risks from ozone Ozone exposure likely causes cardiovascular harm Human chamber studies suggest ozone causes heart rate variability. Animal studies show evidence of harm in blood biomarkers. EPA ISA, 2013

32. 32 Uncovering newer risks from ozone Evidence suggests that ozone exposure harms the central nervous system. Studies in rats find similar impacts to the kinds shown in Alzheimer’s and Parkinson’s disease. Human studies lacking here. -EPA ISA 2013

33. 33 Uncovering newer risks from ozone Stronger evidence of harm from long term exposure (30 days or longer)

34. 34 Uncovering newer risks from ozone Long-term exposure to ozone is likely to cause respiratory harm. Hospital admissions, ED visits Asthma attacks New onset asthma for people with specific genetic variants EPA ISA 2013

35. 35 Uncovering newer risks from ozone Evidence suggests that long term ozone exposure affects -EPA ISA 2013 Cardiovascular harm Reproduction and Development

36. 36 Uncovering newer risks from ozone Evidence suggests that long-term exposure to ozone causes: Central nervous system harm Premature death

37. 37 Push the White House to adopt stronger ozone standards and a strong Clean Power Plan. Outdoor air Our Advocacy

38. 38 Our Advocacy Bring Healthy Air Home Reducing indoor air pollution, including radon and smokefree multifamily housing

39. 39 Healthy Air is Core to our mission and vision Mission To save lives by improving lung health and preventing lung disease Vision A world free of lung disease

40. 40 Why do we fight for healthy air? Millions of reasons

41. 41 Our Credo We will breathe easier when the air in every American community is clean and healthy. We will breathe easier when people are free from the addictive grip of tobacco and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces and workplaces is clear of secondhand smoke. We will breathe easier when children no longer battle airborne poisons or fear an asthma attack. Until then, we are fighting for air.