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Concerns for Health from Smog and Heat

Concerns for Health from Smog and Heat. Presentation to Smog Workshop for Ontario Medical Officers of Health Convened by Clean Air Partnership and Ontario Medical Association Dr. David McKeown February 2006. People can spend a lot of time close to pollution sources.

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Concerns for Health from Smog and Heat

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  1. Concerns for Health from Smog and Heat Presentation to Smog Workshop for Ontario Medical Officers of Health Convened by Clean Air Partnership and Ontario Medical Association Dr. David McKeown February 2006

  2. People can spend a lot of time close to pollution sources

  3. Health Effects of Air Pollution • More and longer lasting respiratory symptoms • Reduced lung function • More bronchitis and asthma attacks • More emergency room visits • More lung cancer and heart attacks • More hospitalizations & early deaths

  4. Burden of Illness Estimates – How Many People Are Affected? • Is a form of risk assessment • Applies risk coefficients from existing epidemiological studies worldwide • Uses community-specific data on daily pollution levels • Uses community-specific data on adverse health outcomes such as hospitalizations and mortality (e.g. for respiratory and cardiac causes)

  5. Air Pollution Burden of Illness – Toronto (2004) • 1,700 premature deaths/year • 6,000 hospitalizations/year • Would likely not have occurred when they did without exposure to air pollution • Preventable • Increases severity or frequency ofcommon medical conditions and illnesses • Created comprehensive agenda for provincial action to improve air quality

  6. Premature mortality (acute) 177 Cardiovascular hospitalization 421 Respiratory hospitalizations 597 Adult chronic bronchitis 1,186 Emergency room visits 5,981 Bronchitis in children 11,997 Asthma symptom days 71,930 Pyramid of Health EffectsToronto Annual Estimates for Inhalable Particulates (PM10)

  7. Air pollution makes asthma worse

  8. Comparison of Illness Estimates for Toronto from Air Pollution

  9. Air Quality Benefits Assessment Tool (AQBAT) • Computer simulation tool developed by Health Canada • Estimates human health benefits or impacts from changesin air quality • Pollutants – CO, NO2, O3, SO2, PM2.5, PM10 • Health Endpoints – Mortality (acute and chronic) – Acute respiratory symptom days – Chronic bronchitis – Cancer – Cardiac and respiration hospitalizations – Emergency room visits – Restricted activity days

  10. Smog and Heat Problems Compounded in Cities

  11. Urban Populations at Increased Risk • Vehicles and people are in close proximity • Canyon effect of buildings traps pollutants • Urban heat island effect • Roads contribute to heat retention in cities • Local emissions compound transboundary pollution • Elevated exposures during commuting (whether walking, cycling, waiting streetside for transit, or inside a vehicle in stagnant traffic)

  12. Climate Change is Happening • Green House gas (GHG) emissions increasing in Canada • Mean global temperature increased about 0.6C in last 100 years (1C in Canada) • Mean global temperatures expected to increase about 3 C this century • Kyoto Protocol - reduce GHG by 6% below 1990 levels by 2010 • Kyoto Protocol delays doubling CO2 levels by about 15 years

  13. Temperature Change Today Temperature Trend Today Source: Environment Canada

  14. Health Concerns with Extreme Heat • Death occurs when core body temperature rises 5 C • Seniors and infants at increased risk due to reduced capacity for temperature regulation • Contributory factors include high blood pressure, obesity, physical inactivity, medication use • about 10,000 Americans died due to oppressive heat in summer 1980 • about 11,000 Europeans died from heat in summer 2003

  15. Major Study Undertaken(Toronto Public Health, Environment Canada and Health Canada) • What are the combined effects of weather and air pollution? • What can we expect in the future? • How can we improve the heat warning system?

  16. Key Findings - Historical Analysis • Heat-related mortality significantly higher for seniors and those with cardiovascular illness than others • On those days with extreme heat, average daily mortality about twice as high as for comfortable days

  17. Key Findings - Historical Analysis • On average (for period 1954 - 2000), of the acute deaths each year in Toronto: • 120 were heat-related • 105 cold-related • 822 were air pollution-related • About 20% mortality associated with extreme temperature and 80% with air pollution

  18. Distribution in Mean Annual MortalityAttributable to Extreme Temperatures and Air Pollution

  19. Key Findings - Projections for Future • Based on average of five climate change scenarios and current air emissions remaining constant, the study projects: • heat-related mortality will double by 2050 and triple by 2080 • air-pollution related mortality will increase by 20% in 2050 and 25% in 2080, largely because of increased ozone levels from global warming • Global warming will make air pollution problems worse

  20. Public Warning Systems • Air Quality Index (AQI) - smog advisory issued by OMOE when AQI predicted to be 50 or greater (regional and persistent) • Heat Health Alert system- alerts issued by Toronto Public Health (other Canadian cities exploring similar system) • Extreme Heat Alert - greater than 90% chance of heat-related excess mortality • Heat Alert - greater than 65% chance of heat-related excess mortality

  21. Ontario Air Quality Index (AQI) AQI Scale Category 0 - 15 Very Good Good 16 - 31 Increasing severity of health effects 32 - 49 Moderate Smog Alert 50 - 99 Poor At AQI = 50, OMOE calls Air Quality Advisory 100+ Very Poor

  22. Smog Alert Days in Toronto In 2005, Toronto experienced 48 smog alert days

  23. Diurnal fluctuation in hourly pollutant levels (Toronto, 1997-2000)

  24. Diurnal fluctuation in hourly pollutant levels (Toronto, 1997-2000)

  25. Guidance Regarding Physical Activity and Air Pollution • Be physically active outdoors • Reduce intensity of outdoor activity at AQI levels that trigger symptoms or when AQI exceeds 50 • To reduce exposure, plan strenuous activity such as running or jogging before morning rush hour and in low traffic areas

  26. Proposed National Air Quality Health Index (AQHI)

  27. Heat Alert Days in Toronto In 2005, Toronto has experienced 26 heat alert days of which 18 were in the extreme heat category

  28. Fluctuations in Frequency of Hot Weather Days in Toronto (1954 to 2000)

  29. Conclusions • Air pollution continues to pose considerable health risk • Global warming makes air pollution and its impacts worse • Public health sector can catalyze and support reduction in emissions of air pollutants and greenhouse gases • Heat and smog alert warning systems help individuals take personal precautions

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