1. THE PEP Sub-regional workshop September 2013 Health effects of particulate matter: Policy implications for EECCA countries Marie-Eve Héroux Technical Officer, Air Quality & Noise European Centre for Environment and Health WHO Regional Office for Europe

2. THE PEP Sub-regional workshop September 2013 Presentation Outline Importance of air quality as a risk factor for health Burden of disease of air pollution WHO recommendations on air quality Risk management – what can be done? Implications for policy makers

3. THE PEP Sub-regional workshop September 2013 Premature mortality Hospital admissions Emergency room visits Visits to doctor Restricted activity/reduced performance Medication use Symptoms Impaired pulmonary function Sub clinical (subtle) effects Severity of health effect Proportion of population affected Air pollution health effets pyramid Source: American Thoracic Society, 2000

4. THE PEP Sub-regional workshop September 2013 Burden of disease from 20 leading causes in 2010 (% global DALYs) Lim et al. LANCET (2012) Ambient air pollution (PM 2.5 ): Globally: - 3.1 million deaths - ~ 3.0% of all DALYs In Western, Central and Eastern Europe: - 430,000 premature deaths; - over 7 million years of healthy life lost Ambient air pollution (PM 2.5 ): Globally: - 3.1 million deaths - ~ 3.0% of all DALYs In Western, Central and Eastern Europe: - 430,000 premature deaths; - over 7 million years of healthy life lost

5. THE PEP Sub-regional workshop September 2013 Years of life lost due to PM Lim S et al. Lancet 2012 Europe 5 0 10 million

6. THE PEP Sub-regional workshop September 2013 PM 2.5 annual exposure estimates for 2005 – GBD 2010 Project Brauer et al. EST (2012) The PM 2.5 estimates are generated from the grid cell average of SAT and TM5 and calibrated with a prediction model incorporating surface measurements

7. THE PEP Sub-regional workshop September 2013 Levels of and trends in PM in the WHO European Region (2010 data) = WHO guideline

8. THE PEP Sub-regional workshop September 2013 Gain in life expectancy (months) in 25 Aphekom cities for a decrease in PM 2.5 to WHO AQG (10 μg/m 3 ) (age 30+) Source: APHEKOM

9. THE PEP Sub-regional workshop September 2013 NCDs attributable to exposure to traffic-related air pollution Source: APHEKOM

10. THE PEP Sub-regional workshop September 2013 WHO Air Quality Guidelines Air quality guidelines – Global update (2005) Indoor air quality – dampness and mould (2009) Indoor air quality – selected pollutants (2010) Indoor air quality – household fuel combustion (planned: fall 2013)

11. THE PEP Sub-regional workshop September 2013 WHO AQG Summary (2005) PollutantAveraging timeAQG value Particulate matter PM 2.5 PM 10 1 year 24 hour (99 th percentile) 1 year 24 hour (99 th percentile) 10 µg/m 3 25 µg/m 3 20 µg/m 3 50 µg/m 3 Ozone, O 3 8 hour, daily maximum100 µg/m 3 Nitrogen dioxide, NO 2 1 year 1 hour 40 µg/m 3 200 µg/m 3 Sulfur dioxide, SO 2 24 hour 10 minute 20 µg/m 3 500 µg/m 3 Levels recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution

12. THE PEP Sub-regional workshop September 2013 IARC Monographs Next upcoming IARC monograph Ambient air pollution (WG meeting 8-15 October 2013)

13. THE PEP Sub-regional workshop September 2013 Risk management and air quality abatement Concerted action needed from public authorities, industries, and individuals at international/regional/sub regional/national/local levels –Regulatory measures: stricter AQ standards, emission limits,... –Structural changes: change in transport modes, land use planning, clean energy production,... –Behavioural changes: choice of cleaner transportation modes or household energy sources,... Co-benefits of integrating climate change and air pollution management strategies –Clean energy = low PM and other air pollutants, AND low greenhouse gas emissions

14. THE PEP Sub-regional workshop September 2013 Main directions for formulating policies and actions Evidence on health effects of air pollution increases Recent WHO evidence review “REVIHAAP” confirming conclusions of WHO AQG Global Update 2005 Cardiovascular morbidity and mortality particularly increased by PM exposure PM pollution is widespread and reduces life expectancy Important burden of disease from urban air pollution Implementation of actions to cut air pollution can result in measurable, significant health benefits and contribute to –Mitigation of GHG emission –Primary prevention of non-communicable diseases

15. THE PEP Sub-regional workshop September 2013 THANK YOU FOR YOUR ATTENTION!