1. Hong Kong is a beautiful city Sunday 1 August 2004 Photo: Edward Stokes; Hong Kong Conservation Photography Foundation However, sometimes less so… Tuesday 4 January 2005 Photo: Edward Stokes; Hong Kong Conservation Photography Foundation AIR POLLUTION IN HONG KONG and the PEARL RIVER DELTA AJ Hedley 1, SM McGhee 1, W Barron 2, PYK Chau 1, J Chau 1, TQ Thach 1, TW Wong 3, C Loh 4, CM Wong 1 1 University of Hong Kong 2 University of Science and Technology 3 Chinese University of Hong Kong 4 Civic Exchange

2. Department of Community Medicine, School of Public Health, University of Hong Kong

3. BAD AIR, BAD PRESS

4. Department of Community Medicine, School of Public Health, University of Hong Kong (microgram per cubic meter) Pollution (RSP) 0 20 40 60 80 100 Vancouver 2004 (13) Shanghai, Guangzhou 2004 (99) London 2005 (30) Paris 2003 (21) New York 2003 (22) Los Angeles 2003 (44) Hong Kong 2004 (62) Hong Kong AQO WHO AQG Hong Kong roadside 2004 (80) HONG KONG IS WORSE THAN MOST CITIES

5. Department of Community Medicine, School of Public Health, University of Hong Kong Monthly concentration of PM 10 in year 2001-05 Time Concentration (  g/m 3 ) Roadside General Source: Environmental Protection Department/ Department of Community Medicine HKU Proposed WHO PM 10 (annual) = 20 Hong Kong PM 10 AQO (annual) = 55

6. Department of Community Medicine, School of Public Health, University of Hong Kong BeforeAfter On July 1 st 1990 the Environmental Protection Department restricted the sulphur content of fuel to 0.5% by weight The Hong Kong air quality intervention 1990 Kwai Tsing

7. Department of Community Medicine, School of Public Health, University of Hong Kong AIR POLLUTANT CONCENTRATIONS 1988 - 95 IN HONG KONG HALF YEARLY MEAN LEVELS

8. Department of Community Medicine, School of Public Health, University of Hong Kong Effect of conversion to low sulfur fuel (0.5%) on transition metals Nickel (Ni) Vanadium (V)  before =9.48;  after =2.87; p =0.000  before =24.73;  after =3.95; p =0.000

9. Department of Community Medicine, School of Public Health, University of Hong Kong Reductions in cardiopulmonary deaths after sulfur restriction 1990 All causesCardiovascularRespiratory % Reduction in annual trend -6 -5 -4 -3 -2 0 15-6465+15-6465+15-6465+ -1.8% -2.8% -1.6% -2.4% -4.8% -4.2%

10. Department of Community Medicine, School of Public Health, University of Hong Kong Monthly Trends of SO 2, Ni, V in Year 2001-04 Concentration (SO 2 : mg/m 3 ; V/Ni: ng/m 3 ) Month Data source: HKEPD; Plotting: Chau/Hedley 2006 p=0.001 p=0.129 p=0.048 SO 2 Ni V

11. Department of Community Medicine, School of Public Health, University of Hong Kong Hazy days Number per year Year Source: Hong Kong Observatory Hong Kong: Annual decline in visibility

12. Department of Community Medicine, School of Public Health, University of Hong Kong An analysis directed to Government Legislators, media and public Understanding the connection between visibility, air pollution and health costs in pursuit of accountability, environmental justice and health protection

13. Department of Community Medicine, School of Public Health, University of Hong Kong Visibility and pollutants in Hong Kong Tsim Sha Tsui to Victoria Harbour Average pollutant levels across Hong Kong Sunday 1 August 2004 Tuesday 4 Jan 2005 MICROGRAM PER CUBIC METER Source of data: Environmental Protection Department

14. Department of Community Medicine, School of Public Health, University of Hong Kong Hourly visibility on the days the photographs were taken Source of data: Hong Kong Observatory 12.8

15. Department of Community Medicine, School of Public Health, University of Hong Kong Four levels of air quality: General and roadside * Based on general monitoring stations except the background monitoring station at Tap Mun Chau LevelDefinition*RSPNO 2 SO 2 1 Poor The mean of the concentrations on Poor visibility days 12910764 14516366 2 Better The mean of the concentrations on Better visibility days 253522 456023 3 Good The mean of the minimum concentrations on Better visibility days 16208 23369 4 Average The annual Average of all actual daily concentrations in 2004 616225 8010123

16. Department of Community Medicine, School of Public Health, University of Hong Kong Potential improvements in air quality in Hong Kong 0 20 40 60 80 100 (microgram per cubic meter) Pollution Hong Kong 2004 (62) Good Better Average average to better average to good Poor % of days at these levels in Hong Kong 2% 8% 44% 43% 2%

17. Department of Community Medicine, School of Public Health, University of Hong Kong Doctor visits, hospital admissions and deaths: Excess risks and avoidable events From time series, excess risks of: * family doctor visits * hospital admissions for cardiopulmonary disease * all causes mortality For each pollutant (P) we estimated the impact (I), as avoidable events for each health outcome, from air quality improvement as N I *ER P *L P = I P Avoidable events and I P * C I = Avoidable costs

18. Department of Community Medicine, School of Public Health, University of Hong Kong UNIT COSTS IN ESTIMATION OF AVOIDABLE COSTS From gazetted public sector and surveys costs of: * in-patient and ambulatory care * travel costs * productivity loss From surveys, willingness-to-pay to avoid: * symptoms (cough) day * hospital admission * death

19. Department of Community Medicine, School of Public Health, University of Hong Kong Estimation of health impact and costs: Single or multiple pollutants? In Shanghai, Wuhan and Hong Kong the largest mortality excess risks are for NO 2 and SO 2, robust in 2-pollutant models The Hong Kong sulfur restriction led to reduction in mortality of 1% per 10µg/m 3 SO 2 in the absence of change in RSP, NO 2 and O 3 In Hong Kong the largest effect on hospital admissions for cardiopulmonary disease is associated with NO 2 ; in London with RSP

20. Department of Community Medicine, School of Public Health, University of Hong Kong SO 2 NO 2 RSP (84%) (41%) Correlation between pollutants Correlation between NO 2 and RSP Partial correlation between NO 2 and SO 2 adjusted by RSP Partial correlation between RSP and SO 2 adjusted by NO 2 (1-[0.768] 2 ) = 0.41 NO 2 (1-[0.067] 2 – [0.39] 2 ) = 0.84 SO 2

21. Department of Community Medicine, School of Public Health, University of Hong Kong Estimating the total contribution of pollutants to the burden of health effects and costs Main estimate: T = RSP + 0.41 NO 2 + 0.84 SO 2 + O 3 Sensitivity analysis: “At least impact”-highest single pollutant effect for each outcome RSP + O 3 (WHO 2003) SO 2 intervention effect (mortality)

22. Department of Community Medicine, School of Public Health, University of Hong Kong Poor Avoidable events: Deaths 0 20 40 60 80 100 (microgram per cubic meter) Pollution Hong Kong 2004 Good Better Average 1,300

23. Department of Community Medicine, School of Public Health, University of Hong Kong Poor 0 20 40 60 80 100 (microgram per cubic meter) Pollution Hong Kong 2004 Good Better Average 60,000 Avoidable events: Hospital bed days

24. Department of Community Medicine, School of Public Health, University of Hong Kong Poor 0 20 40 60 80 100 (microgram per cubic meter) Pollution Hong Kong 2004 Good Better Average 6,700,000 Avoidable events: Doctor visits

25. Department of Community Medicine, School of Public Health, University of Hong Kong Annual $ Value of air quality improvement US$ M Total: US$2250MTotal: US$246M Direct health costs & productivity loss avoided Intangible costs for pain & suffering + US$ M

26. Department of Community Medicine, School of Public Health, University of Hong Kong Results of sensitivity analysis on annual avoidable mortality and costs if pollution levels reduce from Average to Good levels Sensitivity analysis No. of avoidable deaths Direct cost US$ M Productivity loss US$ M Intangible cost US$ M General stations1,335189572,250 Single pollutant with the largest effect* for each outcome 860103351442 RSP + O 3 34813623926 SO 2 only600--- Roadside pollutant levels1,505198632,435 * Mortality NO 2 ; Admissions NO 2 ; Family doctor visits RSP

27. Department of Community Medicine, School of Public Health, University of Hong Kong THE HKSAR GOVERNMENT RESPONSE “The costs are indirect” “Other cities have worse levels of pollution” “More evidence is needed on health effects” People need to understand that “clearer skies may cost consumers more”

28. Department of Community Medicine, School of Public Health, University of Hong Kong

29. Canada guideline (24hr) = 25 NZ guideline (annual) = 20 Non-roadside Reach HK AQO = Year 1996 Reach Canada guideline = Year 2026 Reach NZ guideline = After year 2031 Roadside Reach HK AQO = Year 2008 Reach Canadian guideline = Year 2015 Reach NZ guideline = Year 2016 RSP: Projected trends in Hong Kong

30. Department of Community Medicine, School of Public Health, University of Hong Kong THE NEED for EFFECTIVE MULTI-SECTORAL STRATEGIES Local and regional sources Near term technical solutions Mid term technical priorities Long term structural solutions *Cleaner fuels*Urban design *Euro IV & V*Manufacturing *Flue gas sulpurization*Power sector *Rail rather than roads*Transport

31. Department of Community Medicine, School of Public Health, University of Hong Kong

32. Hong Kong: 1987 Air Quality Objectives 0 20 40 60 80 100 Hong Kong AQO 1987 WHO AQG 2006 PM 2.5 PM 10 /SO 2 NO 2 Hong Kong (2004) Average Pollutant Levels RSP/NO 2 (General) RSP (Roadside) NO 2 (Roadside) 150150 1010 SO 2 NO 2 PM 10 HK WHO

33. Department of Community Medicine, School of Public Health, University of Hong Kong Reduction in Bronchial Hyper-Reactivity

34. Department of Community Medicine, School of Public Health, University of Hong Kong Non-roadside Reach Euro guideline = Year 2017 HK Air Quality Objective (annual) = 80 Euro guideline = 40 Roadside Reach HK AQO = Year 2010 Reach Euro guideline = After year 2030 Nitrogen Dioxide

35. Department of Community Medicine, School of Public Health, University of Hong Kong Visibility and pollutants in Hong Kong Ap Lei Chau to Aberdeen Harbour Average pollutant levels across Hong Kong Friday 23 July 2004 Thursday 16 September 2004 MICROGRAM PER CUBIC METER Source of data: Environmental Protection Department