Meeting of the Eionet National Reference Centres for Noise Copenhagen, 7 th - 8 th October 2010

1. Meeting of the Eionet National Reference Centres for NoiseCopenhagen, 7th - 8th October 2010 Good Practice Guide –Noise And Health For Action Planning Wolfgang Babisch European Environment AgencyExpert Panel on Noise (EPoN) European Environment Information and Observation Network

2. Expert Panel on Noise (EPoN)

3. European Environmental Agency (EEA)Expert Panel on Noise (EPoN)Priority Tasks • Working group that aims to support the European Environmental Agency and the European Commission with the implementation and development of an effective noise policy for Europe. • Assist with the development of the European Noise Database and specifically advise on the linkages between population exposure and potential health effects. • Assist EEA and the DG ENV with the drafting of guidelines on the preparation of noise action plans including cost benefit analyses.

4. EU Noise PolicyCALM Network Coordination of European Research for Advanced Transport Noise Mitigation, funded by the 6th Framework Programme of the European Community “Avoid harmful effects of noise exposure from all sources and preserve quiet areas.” Community Research Strategy Plan Source: CALM (2004)

5. Environmental Noise Directive (END)Directive 2002/49/EG • Environmental Noise Directive (END) (2002/49/EC 2002) • "…assessment and management of environmental noise action plans to reduce harmful effects of noise exposure." Annex III: “... dose-effect curves should be used to assess the effects of noise on populations.” Source: CALM (2004)

6. Hazard identification Exposure assessment Exposure-response relationship Risk characterization Attributable risk concept END Research Risk management Regulatory options Quantitative Risk AssessmentHeath Impact Assessment

7. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END

8. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END

9. Sound  Noise • Noise is normally defined as "unwanted sound". • Noise is "audible sound that causes disturbance, impairment or health damage".

10. Sound  Noise • Noise is normally defined as "unwanted sound". • Noise is audible sound that causes disturbance, impairment or health damage. • The terms "noise" and "sound" are often synonymously used when the purely acoustical dimension is meant (e. g. noise level, noise indicator, noise regulation, noise limit, noise standard, noise action plan, aircraft noise, road traffic noise, occupational noise).

11. Sound  Noise • Noise is normally defined as "unwanted sound". • Noise is audible sound that causes disturbance, impairment or health damage. • The terms "noise" and "sound" are often synonymously used when the purely acoustical dimension is meant (e. g. noise level, noise indicator, noise regulation, noise limit, noise standard, noise action plan, aircraft noise, road traffic noise, occupational noise). • The link between exposure and outcome is given by reasonably well-established exposure-response curves which are derived from research into noise effects.

12. Noise Indicators(Note: Noise levels refer to the outside façade of buildings if not otherwise specified)

13. WHO Health Definition(Physical, mental and social wellbeing) WHO Health Definition(Physical, mental and social wellbeing)Quality Of Life and Ill-health Social science Epidemiology

14. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END

15. Health Endpoints 1) Lden and Lnight are defined as outside exposure levels. 2) Level above which effects start to occur or start to rise above background

16. Mortality Disease(insomnia, cardiovascular) Risk factors(blood pressure, cholesterol,blood clotting, glucose) Severity Stress Indicators(autonomous response, stress hormones) Feelings of discomfort (disturbance, annoyance, sleep disturbance) Number of people affected Severity vs. Number Of People      Source. WHO (1972) - modified

17. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END

18. Health Endpoints Annoyance Noise annoyance is a term used in generalfor all negative feelings such as disturbance, dissatisfaction, displeasure, irritation and nuisance.

19. ICBEN ScaleISO 15666 1)"Thinking about the last 12 months or so, when you are here at home, how much does noise from (...source...) bother, disturb, or annoy you?" Extremely – Very – Moderately – Slightly – Not at all 2) "Next is a zero to ten option scale for how much (...source...) noise bothers, disturbs or annoys you when you are here at home. If you are not at all annoyed choose zero, if you are extremely annoyed choose ten, if you are somewhat in between choose a number between zero and ten." "Thinking about the last 12 months or so, what number from zero to ten best shows how much you are bothered, disturbed, or annoyed by (...source...) noise?" 0 – 1 – 2 – 3 – 4 – 5 – 6 – 7 – 8 – 9 – 10 Not at all Extremely Severely annoyed

20. ICBEN ScaleCut-off Points 1) "Highly annoyed": 72% of the scale length 2) "Annoyed": 50% of the scale length 3) "Little annoyed": 18% of the scale length 4) Continuous scale

21. Annoyance "Highly Annoyed" WHO Community Noise Guidelines (1999): "Serious annoyance" 80 Aircraft 70 Road 60 Railway 50 Percent highly annoyed (HA) [%] 40 25%-CriterionCommon rule 30 20 10 0 35 40 45 50 55 60 65 70 75 80 Noise level (Lden, 24h) [dBA] Source: Miedema and Oudshoorn (2001), European Commission Working Group on Dose-Effect Relations (2002)

22. Annoyance Due To Aircraft NoiseHas Increased In The More Recent Years "Little annoyed" "Annoyed" "Highly annoyed" Newer studies Newer studies Newer studies Older studies Older studies Older studies %LA, %A, %HA for aircraft noise. Lower curves (blue) pre 1990 dataset, high curves post-1990 dataset. Source: TNO (2009)

23. Comparisons Of Sound Sources

24. Health Endpoints Sleep disturbance

25. Reported Sleep Disturbance "Highly Sleep Disturbed" WHO Night Noise Guidelines for Europe (2009): "Night noise guideline" (NOAEL) WHO Community Noise Guidelines (1999): "Sleep disturbance" 35 Aircraft 30 Road 25 Railway 20 Percent highly sleep disturbed (HSD) [%] 15 10 5 0 35 40 45 50 55 60 65 70 75 80 Noise level (Lnight) [dBA] Source: Miedema and Oudshoorn (2001), European Commission Working Group on Health and Socio-Economic Aspects (2004)

26. EEG Awakenings (Polysomnographic) Single Aircraft Flyover – "DLR Laboratory Study" Noise induced awakening 33 dB (Changes to wake or to sleep-stage S1 within 90 seconds) Probability of sleep stage changes to awake Spontaneous awakening Maximum Sound Pressure Level LAS,max [dB] Source: Basner et al., 2006

27. Sleep Disturbance (Polysomnographic)Aircraft Noise Simulation – "DLR Field Study" Steep Increase of Adverse Effects Lnight, outside (aircraft) 365 EEG awakenings per year Figure 1: The average number of additionally aircraft noise induced awakenings per night. Altogether, 10 million 8-hour nights with 1 to 200 (1, 2, 3,…, 200) noise events randomly drawn from the DLR field study 20 were simulated. The lines represent (from below to above) 2.5, 25, 50, 75, and 97.5 percentiles. In an 8 h undisturbed night of a healthy sleeper, on average 24 spontaneous EEG awakenings (as defined by Rechtschaffen and Kales1) can be observed (equalling 8,760 spontaneous awakenings per year). Source: Basner and Griefahn, 2008

28. Sleep Disturbance – Other Sleep IndicatorsAircraft Noise

29. Sleep Disturbance – Other Sleep IndicatorsRoad Traffic Noise

30. Health Endpoints Cardiovascular Effects

31. Noise Stress • What are the long-term effects of chronic noise exposure? Dysregulation, disturbed homeostasis, physiologic and metabolic imbalance!

32. Simplified Noise Reaction Model Noise Exposure (Sound Level) Direct pathway Indirect pathway Disturbance of activities, sleep communication Hearing loss Annoy-ance Cognitive and emotional response Stress Indicators Physiological stress reactions (homeostasis) Autonomic nervous system (sympathetic nerve) Endocrine system (pituitary gland, adrenal gland) Risk Factors Blood pressure Blood lipids Blood viscosity Cardiac output Blood glucose Blood clotting factors Manifest Disorders Cardiovascular Diseases Hypertension Arteriosclerosis Ischaemic heart diseases Sound exposure Disturbance ofintended activities Stress indicators Biologicalrisk factors Cardiovasculardiseases Source: Babisch (2002)

33. Evidence • Biological model • Laboratory experiments on humans(acute effects, high and moderate noise levels) • Animal experiments(long-term effects, high noise levels) • Occupational noise studies(long-term effects on humans, high noise levels) • Environmental noise studies(long-term effects on humans, moderate noise levels)

34. Sleep And Health Sleepquality Nightnoise Health WHO; URL: http://www.euro.who.int/Noise

35. WHO Expert Groups on NoiseWHO European Centre for Environment and Health, Bonn 2002 - 2010 • Noise and Health Indicators • Housing and Health • Aircraft Noise and Health • Practical Guidance for Risk Assessment of Environmental Noise • Night Noise Guidelines For Europe (2009) • Environmental Noise Burden of Disease (2010) http://www.euro.who.int/Noise

36. Exposure-Response Curve: HypertensionMeta-Analysis: Aircraft Noise Exposure-response function: OR per 10 dB(A) = 1.13, 95% CI = 1.00-1.28, range Ldn= 50-70 dB(A) pooled(5 studies) Heterogeneity: p = 0.002 Source: Babisch und van Kamp, 2008

37. Exposure-Response Curve: Ischaemic Heart DiseaseMeta-Analysis: Road Traffic Noise Exposure-response function: OR per 10 dB(A) = 1.17, 95% CI = 0.87-1.57, range LAeq16h = 55-75 dB(A) OR = 1.629657 – 0.000613*(Lday,16h)2 + 0.000007357*(Lday16h)3, R2 = 0.96 Myocardial infarction Heterogeneity: p = 0.943 Analytical studies(CC, CO) Source: Babisch (2006, 2008)

38. Health Endpoints Cognitive Impairment

39. Reading Comprehension"Ranch Study" Aircraft noise associated with deficits in reading comprehension and recognition memory 2844 children Source: Stansfeld et al., 2005

40. Hypothetical Exposure-Response Curve- Cognitively Affected - Staffan Hygge Assuming that 100% of the noise exposed are cognitively affected at a very high noise level, e.g. 95 Ldn, and that none are affected at a safely low level, e.g. 50 Ldn, a straight line (linear accumulation) connecting these two points, as in the Figure below can be used as basis for approximation. Since for theoretical reasons based on an (assumed) underlying normal distribution, the true curve should have the same sigmoidal function form as the two curves in the figure. Source: Hygge, 2009 (presentation in Helsinki)

41. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END

42. Attributable FractionFormula Population attributable risk Impact fraction AF = {(Pi * RRi) - 1} /  (Pi * RRi) where: Pi = Proportion of the population in exposure category iRRi = relative risk at exposure category i compared to the reference level

43. Attributable Fraction: Myocardial Infarction / IHDExample: Germany, Adults Moyocardial Infarction (MI) Caused By Traffic Noise Reference year 1999 Attributable fraction: 2.9% Germany 1999: MI: 133,115 cases IHD: 849,557 cases Due to road traffic noise: 3,900 MI cases/year 24,700 IHD cases/year MI = Myocardial infarctionIHD = Ischaemic heart diseases * Probabilistic model

44. DALYsDisability Adjusted Life Years • Idea: One figure to aggregate different levels of severityQuantification unit, priority setting, DALYs as a public health currency • DALY = YLL + YLDThe sum of years of potential life lost due to prematuremortality and the years of productive life lost due to disabilityYLL = ND (number of deaths) x DW (disability weight) x LD (standard life expectancy at age of death in years)YLD = NI (number of incident cases) x DW (disability weight) x LI (average duration of disability in years) • Severity weight factors (disability weights)Dependent on cultural weighing systems, expert rating

45. Disability WeightsDALYs Disability weights that have been used • Mortality = 1.000 • Non-fatal acute myocardial infarction = 0.406 (WHO) • Ischaemic heart disease = 0.350 (de Hollander, 1999) • High blood pressure = 0.352 (Mathers, 1999) • Primary insomnia = 0.100 (WHO, 2007) • Sleep disturbance = 0.020 (Knol, 2005);0.055 (Müller-Wenk, 2005) • Annoyance = 0.010 (Stassen, 2008);0.033 (Müller-Wenk, 2005) • Cognitive impairment = 0.006 (Hygge, 2009)

46. DALY Examples

47. Environmental Burden Of DiseaseThe Netherlands Source: de Hollander, 2004

48. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END

49. Economic Valuation • Common procedures for assessment of benefits • Contingent valuation (willingness to pay)Benefit of 25 € per household per decibel per year above noise levels of Lden= 50-55 dB. • (Example tyre noise study: quieter tyres could produce benefits to the public of about 48 and 123 billion €) • Hedonic pricingData from real estate market; lower value of properties exposed to higher noise levels. Best estimate: House prices loose 0.5% (range: 0.2% - 1.5%) of their value per decibel over Lden= 50-55 dB. Sources: Navrud (2002); The European Commission Working Group on Health and Socio-Economic Aspects (2003)

50. Good Practice GuideNoise And Health For Action Planning Scope of the document • Definitions • Present current knowledge about the health effects of noise (which health endpoints?) • Practical validated tools to calculate health impacts of noise (exposure-response relationships) • Risk assessment • Cost-benefit analyses • Quality targets • Implications for END