Using air quality monitoring data for public health action health impact assessment studies
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Using air quality monitoring data for public health action: Health Impact Assessment Studies. Marco Martuzzi World Health Organisation, Regional Office for Europe European Centre for Environment and Health, Rome Division. Rationale.

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Using air quality monitoring data for public health action health impact assessment studies

Using air quality monitoring data for public health action:Health Impact Assessment Studies

Marco Martuzzi

World Health Organisation, Regional Office for Europe

European Centre for Environment and Health, Rome Division


Rationale
Rationale

  • Clinical and epidemiological evidence on health effects of outdoor air pollution is abundant

  • Risks have been identified, and dose-response relationships have been characterised for several pollutants and health endpoints

  • Compared to other risk factors risks are small

  • Exposure is ubiquitous, majority of people exposed

  • Need to assess overall public health relevance of air pollution

  • Air quality monitoring data increasingly available


Assessing the impact
Assessing the impact

  • Policy makers under growing pressure

  • Underlying cost-benefit type question, “what would we gain if we could reduce concentrations to X?”

  • Recent research has addressed this issue

  • Metrics for health impact: attributable risks (risk assessment studies), years of life lost (YLL), and economic evaluations

  • Air pollution impact studies have been published, e.g., France-Switzerland-Austria (Kuenzli 2000); UK (Hurley 2000), Italy (submitted), US, …


Methods for air pollution hia
Methods for air pollution HIA

  • Use PM as a summary indicator of all pollutants (cannot evaluate separate roles); recent studies include ozone

  • Risk functions for selected outcomes

  • Exposure estimates, usually average concentrations for large population

  • Observed rates or prevalence

  • “Prudent” estimates, i.e., identify part of the health effects effectively attributable to AP


8 italian cities
8 Italian Cities

  • PM10 data from monitoring stations

  • Mortality, morbidity, hospital admission

  • Average concentration 52.6 g/m3

  • Estimate rates or prevalences predicted at lower concentrations

  • Compare with observed rates

  • Reference PM10 levels: 20, 30, 40 g/m3

  • “Conservative” risk coefficients, e.g. for long term mortality: 1.026 / 10 g/m3 (95% CI 1.009 – 1.043)


Methods
Methods

E=A*B*C*P

A = Attributable proportion [(RR-1)/RR]

B = occurrence of health endpoint

C = change in concentration (from reference value)

P = exposed population


Mortality
Mortality

  • Long term effects (from cohort studies), age 30+, excluding accidental causes: Austria 5,600; France 31,700; Switzerland 3,300

  • PM10 reference level: 7.5 g/m3

  • Dose response coefficient for mortality: 1.04 / g/m3

  • But who dies? When? (Important especially for economic evaluation)

  • UK study: estimate YLL


Health impact studies
Health Impact studies

  • “First generation” studies

  • Rough approximations involved, generally thought to be “conservative”

  • Work is needed, two levels:

    • Methods for risk assessment of air pollution

    • Interpretation and use of results in public health and risk management


Methods for ap risk assessment
Methods for AP risk assessment

  • Validity of average concentrations (consistent with epidemiological studies)

  • Extrapolation across populations

  • Naïve estimates of uncertainty

  • Different pollutants (ozone probably needs separate treatment)

  • Better dose-response models

  • More health endpoints, esp. short- vs. long-term effects


Interpretation
Interpretation

  • Attributable vs preventable

  • Susceptible subgroups (the elderly being a group of special interest)

  • Consider realistic scenarios of reduction of concentrations

  • Risk assessment vs HIA assessment (e.g., of transport policies)


Conclusions
Conclusions

  • HIA studies useful to fill the knowledge gap between laboratory, clinical, epidemiological evidence and public health policy

  • Make public health action on AP more compelling

  • Need to improve methodology and evaluate implications more thoroughly (possibly better communication)

  • Quality and completeness of AP data has been improving

  • Still need: higher spatial resolution, partitioning of sources

  • HIA transport: Noise, accidents, cycling and walking, psychosocial effects


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