Earth Observations to reduce major diseases caused by air pollution, water and sanitation and poor urban infrastructure Dr Carlos Dora Coordinator Department of Public Health and Environment Key messages for mini-campaign
This presentation: AP • Air Pollution causes important risk to health • Public health programmes have not focused on AP • WHA resolution calls for better data, evidence of effective interventions, communications and demand for solutions • Capacity building for health sector to estimate health benefits from policies in polluting sectors. Track health gains of policy change • SDG 3 and 7 – requires AP data • EO: need for higher resolution geographic temporal variation (cities, roads, agriculture burning, industry…) • To provide more precise estimates of AP over time, location, and help track impact of policy changes
Worldwide NCDs are the main cause of death 2 in 3 deaths are from NCDs • Cardiovascular disease, mainly heart disease, stroke • Cancer • Chronic respiratory diseases • Diabetes • Injuries Costs: Trillions of U$ dollars
Currently public health programmes to reduce NCDs consider only other major risk factors: • Tobacco • Physical inactivity • Diet (fat, sugar, fiber…) • Excess use of alcohol
New evidence over the last 10 years: AP is a major risk to NCDs Substantial new evidence showing that particles smaller than 2.5mm penetrate deepinto the lungs and effect the body more systematically leading to diseases like stroke, heart disease, in addition to the cancers,COPD and pneumonia/URLI. PM<10mm – Coarse PM<2.5mm – Fine PM<1mm – Ultrafine Medgadget .com
Lungs exposed to tobacco and to Indoor air pollution Pathology slides - Courtesy Prof. Saldiva, São Paulo, Brazil
“Review of evidence on health aspects of air pollution - REVIHAAP”, WHO 2013selected conclusions on PM (A1) Confirm and strengthen results form the 2005 WHO Guidelines on Air Quality and Health. • New studies on short- and long-term effects; • Long-term exposures to PM2.5 are a cause of cardiovascular mortality and morbidity; • More insight on physiological effects and plausible biological mechanisms linking short- and long-term PM2.5 exposure with mortality and morbidity; • Studies linking long-term exposure to PM2.5 to several new health outcomes (e.g. atherosclerosis, adverse birth outcomes, childhood respiratory disease). LAQN Seminar, London, 21 June 2013
Meta-analysis of the association between long-term exposure to PM2.5 and cardiovascular mortality Pub. year RR (95%CI) per 10 µg/m3 % weight Study 2002 2007 2008 2011 2011 2011 2012 Hoek et al, EnvHealth 2013 2013 2012 2011 1.15 1.00 2.00 LAQN Seminar, London, 21 June 2013
Mortality and long-term exposure to PM2.5 Results of a cohort study in Rome (1.3 million adults followed from 2001 to 2010) PM2.5: 3-dimensional Eulerian model (1x1 km) c= % increase in risk per 10 µg/m3 Cesaroni et al. EHP 2013 c=4% c=6% c=10% LAQN Seminar, London, 21 June 2013 AQG EU LV
Carotid artery wall thickness (=risk of atherosclerosis) and long-term PM2.5 exposure % change in artery wall thickness Home outdoor PM2.5 (µg/m3) Heinz Nixdorf RECALL study, Ruhr region, Germany EU LV AQG LAQN Seminar, London, 21 June 2013 Bauer et al, JACC 2010
Long term O3 exposure and risk of death due to respiratory causesACS cohort of 448 thousand adults followed for 18 years RR per 10 ppb = 1.040 (95% CI 1.010 - 1.067) (2-pollutant model with O3 and PM2.5) LAQN Seminar, London, 21 June 2013 Jerrett et al, NEJM 2009
Short-term exposure to ozone, mortality and hospital admissions European cities in the APHENA study a lag 0-1 results; b lag 1 results Katsouyanni et al 2009 LAQN Seminar, London, 21 June 2013
IARC 2012 finding: Diesel a carcinogen LONDON/GENEVA (Reuters) - The air we breathe is laced with cancer-causing substances and is being officially classified as carcinogenic to humans, the World Health Organization's cancer agency said on Thursday.
Ischemic and thrombotic effects of diluted diesel exhaust inhalation in men with coronary heart disease Myocardial ischemia during 15-minute exercise-induced stress and exposure to diesel exhaust or filtered air in 20 subjects Mills et al, NEJM 2007
More complete estimates of exposure to air pollution from Satellite Remote Sensing, air transport models and ground monitors
Estimating Burden of Disease and Death due to exposure to air pollution (and other risks to health)Burden of disease is estimated from: • Air pollution concentrations & human exposure • Evidence from epidemiology about the health impacts of air pollution • Diseases affected • Disease response to levels of AP (dose-response curves) • Baseline disease rates
Estimates of outdoor air pollution exposures used by WHO for BOD estimates Brings together existing data from: • Satellite remote sensing (sparsely covereed areas) • Urban ground monitoring stations – pollutant concentrations 3. Estimates of air pollution levels based on emissions from sectors (e.g. transport, industry, power production, etc.) Mathematical models - combining information from monitoring, from satellite remote sensing, chemical transport models to fill gaps and improve estimates
Deaths attributed to HAP + Outdoor Air Pollution ~ 7 million deaths globally in 2012 AP a main RF for around 1/5 of NCDs
3.7 million deaths were attributed to ambient air pollution exposure in 2012 Breakdown of by disease ~21 % of all deaths from ischaemic heart disease (IHD) ~23% of all deaths due to stroke ~13 % of all deaths to chronic obstructive pulmonary disease (COPD)
First World Health Assembly Resolution on Air Pollution and Health 7 million deaths a year due to household and ambient air pollution
The resolution: • key role health authorities in raising awareness about the potential to save lives and reduce health costs, if air pollution is addressed effectively. • Need for strong cooperation between different sectors and integration of health concerns into all national, regional and local air pollution-related policies. • It urges Member States to develop air quality monitoring systems and health registries to improve surveillance for all illnesses related to air pollution; • It urges Member States to strengthen international transfer of expertise, technologies and scientific data in the field of air pollution.
collaborate, as appropriate, with relevant international, regional and national stakeholders, to compile and analyse data on air quality, with particular emphasis on healthrelated aspects of air quality raise awareness of the public health risks of air pollution and the multiple benefits of Improved air quality, in particular in the context of the discussions on the post- 2015 development agenda to create, enhance and update, in cooperation with relevant United Nations agencies and programs a public information tool of WHO analysis, including policy and cost-efficiency aspects, of specific and available clean air technologies to address the prevention and control of air pollution, and its impacts on health; Asks the WHO advise and support tools to assist the health and other sectors at all levels of government, especially the local level and in urban areas, taking into account different sources of pollution in tackling air pollution and their health effects;
Recommendation 4: • Household combustion of kerosene is discouraged Rationale: • High levels of emissions of PM and other health-damaging emissions. • Epidemiologic studies suggest links to tuberculosis, cancer, respiratory disease, adverse birth outcomes, etc., but are not of adequate consistency/quality. • Kerosene use carries substantial risks of burns and poisoning.
Urban Air Quality Data (WHO)1600 cities, but sparse coverage for Africa, Latin America, Middle East – no coverage in rural areas
Found: discrepancy in satellite estimates for urban areas in developing countries Modelled data Ground monitors
Created: Global Platform on Air Quality and Health • To ensure best estimates of human exposure to air pollution will continue to be regularly available for Burden of Disease estimates, as well as to ensure accountability, transparency and wide access of these results worldwide. • Established in January 2014, • A wide collaboration with international agencies including UNECE, WMO, UNEP, JRC, IIASA, World Bank, space research agencies (e.g. NASA, JAXA), as well as national agencies and research institutions. • Yearly meetings to update on progress and results. • Task forces to provide improvements in methods and outputs from one year to the next. First year • improvements in data integration and statistical fusion, (using data from monitors, atmospheric transport models and satellite remote sensing). • First database of source apportionment studies (n=500)
Second year: • Data fusion: Global air quality data as a result of fusion from various data sources, report on progress and work ahead, • Emission sources information, including from emission inventories and source apportionment • Exposure-risk relationship: Integrated dose-response functions that relate levels of air pollution indoors and outdoors to a range of diseases, report on progress and work ahead. • Surface monitoring: key air pollution indicators to be monitored, minimum data sets for health purposes; systematic data collection and display; • Automated Data acquisition, portable monitors etc. quality of outputs form different sources, • Household air pollution: exposure assessment, progress in IAP data, availability of exposure data from Europe New task forces proposed: • Data fusion and synthesis – further improvements • Models for integrating Household and Ambient Air Polluton exposure estimates • Guidance on the collection of ground measurement data. • Guidance on source apportionment studies.
Recommendations for Satellite remote sensing • To strengthen satellite-derived PM2.5 estimates used by the Global Platform, the following steps are recommended: • Proceed towards higher spatial resolution of estimates (e.g. using satellites MODIS with 1-3 km resolution, MISR with 4 km, and eventually VIIRS with 750m resolution); • Use more accurate and precise retrievals (e.g. through MODIS Collection 6); • More fully incorporate active measurements (e.g. through CALIOP space-borne lidar); • Use measurements with higher temporal resolution to estimate annual mean more accurately (e.g. from geostationary satellites); • Endorse and foster the collocation of AOD and surface PM2.5 measurements (e.g. through SPARTAN project and other networks); • Develop related information on NO2 and other pollution species (e.g. using the TROPOMI instrument onboard the Sentinel-5 precursor satellite with 7km resolution after expected launch in 2015); • Build on expertise from space agencies to increase data continuity; • Consider modifications of the estimating procedures to account for urban increment; • Consider using ground-based and airborne measurements which offer valuable resources to calibrate and validate satellite data; • Consider exploring information on road networks to inform proximity to road. • Make formal statements to space agencies to encourage relevant measurements; • Nurture groups and communities that will inform the exposure dataset.
Establishment of a web-based resource providing access/ web linkage to: • Results from the platform – methods, tools, results • Tools for estimating health impacts from air pollution at local level • Exposure-response functions • Access to air quality databases: • WHO ambient air quality in cities, • WHO household air pollution database, • Joint ambient/ household air pollution (future) • Analysis of trends. • Burden of disease estimates. • Awareness raising and communication tools. • Collection of cost-effective interventions/ best practices to address air pollution and health.
A New Urban Health Project • Inform /support demand/ adoption of policy choices/behaviours that: • mitigate Air Pollution • mitigate Climate Pollutants (SLCPs, CO2) • maximize health benefits. • How? Equip/engage city actors in health, planning, development, government…, with: • Health knowledge – interventions with greatest health benefits. • Tools for health assessment and for M&E/scenarios. • Strengthened institutional and technical capacity. • Framework of collaboration, monitoring and evaluation. • Communication/awareness raising
Audiences • Part of the implementation of the WHA resolution 68.8 • International efforts on sustainable Energy, Transport, Energy, Waste Management, Land Use • Cities already organized to address air pollution, climate change, health (ICLEI, C40, Clean Air Asia, Healthy Cities…) • 5 to 7 pilot cities for in-depth work - model for other cities
Policies that fulfill multiple social objectivesFocus: main sources of air and climate pollutants • Health benefits from improving • Air pollution • Injuries, • Physical activity, • Noise, • Diets… • Air andClimate pollutant reductions • Transport • Waste burning • Home energy • Buildings • Land use plans • Industry
Health benefits from AP reduction Local/ short term health impacts Injuries, physical activity, noise, diet, Air pollution (PM) Transport, energy, land use policies / Combustion Climate change (SLCPs) Global/long term health impacts Climate change (CO2)
A significant fraction of NCDs is attributable to exposure to traffic-related air pollution Source: APHEKOM
'Healthy' urban transport can reduce chronic disease, injuries and improve health equity Better fuels and engines help, but private vehicle transport increases congestion, injuries, pollution, and physical inactivity. Rapid transit/NMT improves access to schools, jobs & services for poor, children, women, elderly & disabled, improving equity. It can reduce injury, cardiovascular disease & support healthy physical activity. Cycling to work reduced premature mortality by 30% among commuter groups in Shanghai & Copenhagen.
Effectiveness of interventions - BCA:WHO tool for estimating health economic gains from cycling HEAT for cycling and user guide from www.euro.who.int/transport/policy/20070503_1
Housing that is good for health « Improved insulation saved 0.26 months of life per person » (UK Warm Front Programme) Reduction of respiratory illness by 9% to 20% and increase of individual productivity between 0.48% and 11% with natural ventilation startegies Photo 1 (graphic, table, map, etc) zone « Reduced wheezing, days-off school, doctors' visits were reported by occupants of insulated homes « (NZ Insulation study)
Health co-benefits in housing Energy-efficient heating, cooling and natural ventilation can reduce strokes and respiratory illness as well as TB and vector-borne diseases; A focus on slums /sub-standard housing - where needs are greatest/benefits could be multiplied Solar hot water heating - India Slum in Mexico City
Indoor emissions • Outdoor indoor • Evidence base stronger than for other approaches • Implementation practicality – via design, production, standards, etc • Some options (clean fuels), are relatively independent of user behaviour.
Recap: AP • Air Pollution causes important risk to health • Public health programmes have not focused on AP • WHA resolution calls for better data, evidence of effective interventions, communications and demand for solutions • Capacity building for health sector to estimate health benefits from policies in polluting sectors. Track health gains of policy change • SDG 3 and 11– requires AP data • EO: need for higher resolution geographic temporal variation (cities, roads, agriculture burning, industry…) • To provide more precise estimates of AP over time, location, and help track impact of policy changes