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STRATUS CONSULTING
Protecting our Health from Professionals Climate
Change: a Training Course for
Public Health
Chapter 14: Global Change, Air Quality,
and Human Health
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STRATUS CONSULTING
Lecture Overview
Introduction to climate and air quality Characteristics and health effects of
major anthropogenic air pollutants Exposure-response relationships Global burden of disease due to air
pollution Has climate change affected air
pollution?– Observed trends– Integrated modeling
Co-benefits assessment
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STRATUS CONSULTING
Introduction
The mixtures of air pollutants produced by burning of fuels can:– Adversely affect human health– Promote climate change
In addition– Climate change can influence air pollution,
resulting in direct health effects– Climate change can affect other aspects
of air quality, including smoke from agricultural or wildfires, and aero-allergens like pollen and mold spores
STRATUS CONSULTING
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STRATUS CONSULTING
London: Mid-day in December 1952
UK Met Office, 2009
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STRATUS CONSULTING
London Killer Fog, December, 1952
DateUK Met Office, 2009
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STRATUS CONSULTING
PM2.5 Levels in Dhaka, Bangladesh
Clean Air Initiative, 2006
Standard
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STRATUS CONSULTING
Common Pollutants that are of Human Health Concern
Carbon monoxide (CO) Nitrogen dioxide (NO2) Lead (Pb) Sulfur dioxide (SO2)
Ozone (O3)
Particulate matter (PM2.5,PM10)
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STRATUS CONSULTING
Carbon Monoxide
Produced by incomplete combustion Inhibits the capacity of blood to
carry oxygen to organs and tissues. People with chronic heart disease
may experience chest pain when CO levels are high
At very high levels, CO impairs vision, manual dexterity and learning ability, and can be fatal
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STRATUS CONSULTING
Nitrogen Dioxide
Is produced from high-temperature combustion
Affects lung function in persons with asthma
Contributes to acid rain and secondary particle formation
Is a precursor of ground-level ozone
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STRATUS CONSULTING
Lead
Retards intellectual development of children
Lead in gasoline was historically the principal source
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STRATUS CONSULTING
Sulfur Dioxide
Emitted from combustion of sulfur-containing coal and oil, and from metal smelting operations
Reversible declines in lung function of people with asthma, and exacerbates respiratory symptoms in sensitive individuals
Also contributes to acid rain and to formation of PM2.5 through atmospheric reactions
Emissions reduced using scrubbers
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STRATUS CONSULTING
Ozone
Main pollutant responsible for photochemical smog, formed via reactions in the atmosphere from primary pollutants (NOx and VOCs) in the presence of sunlight
Higher temperatures favor ozone formation
Strong oxidant that damages cells lining the respiratory system, resulting in a variety of adverse health outcomes, including lung function decrease, asthma attacks, and premature death
Ozone is also a greenhouse gas
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STRATUS CONSULTING
Ground-level Ozone Formation
Queensland Government Environmental Protection Agency, 2006
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STRATUS CONSULTING
Particulate Matter (PM2.5, PM10)
Can be either primary or secondary; produced by combustion, atmospheric reactions, and mechanical processes
Wide range of physical/chemical properties
Wide range of human health impacts, including premature death
Higher temperatures may favor secondary formation
Some particle types contribute to climate warming; others to climate cooling
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STRATUS CONSULTING
Fine Particle Composition
Tennessee Valley Authority, 2009
Annual average fine particle data for 2001 from the Look Rock station of the Tennessee Valley Authority
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STRATUS CONSULTING
Health Effects of Air Pollution
Historical experience provides strong evidence for causal relationship between air pollution and premature death
Modern epidemiology studies have consistently found significant associations
Two primary epidemiologic study designs:– Time series studies of acute effects– Cohort or cross-section studies of chronic effects
Let’s look at the evidence for particle health effects…
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STRATUS CONSULTING
Air Pollution Epidemiology
Provides results relevant for policy makers
Assesses effects of real mix of pollutants on human health
Includes full range of susceptible populations
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STRATUS CONSULTING
Air Pollution Epidemiology (cont.)
But… Pollutants tend to co-vary, making it
hard to identify pollutant-specific effects
Demonstrates association between outcome and exposure, but not cause and effect
Confounding factors must be controlled Exposure assessment is “ecologic”
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STRATUS CONSULTING
Addresses short-term, acute effects of air pollution
Involves analysis of a series of daily observations of air pollution and health data
Widely used and economical approach, often utilizing readily-available data
Time Series Epidemiology
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STRATUS CONSULTING
Temporal studies avoid many of the confounding factors that can affect spatial studies
However, time-varying factors may confound the pollution associations …– Seasonal cycles, weather variables, day of
week
Time Series Epidemiology (cont.)
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STRATUS CONSULTING
Ozone and Acute Deaths
Bell et al., 2004
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STRATUS CONSULTING
Acute Mortality Responses to PM in US, Europe, and Asia
Exposure Risks
0.46 0.62 0.5
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
US (90 Cities)* Eur (21
Studies)*
Asia (6
Studies)
Perc
en
t In
crease
Exposure Response
0.46 0.62 0.5
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
US (90 Cities)* Eur (21
Studies)*
Asia (6
Studies)
Perc
en
t In
crease
Huizenga et al., 2005
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STRATUS CONSULTING
Prospective Cohort Studies
Address long-term, chronic effects Large populations in multiple cities
enrolled and then followed for many years to determine disease or mortality experience
Must control for “spatial” confounders, e.g., smoking, income, race, diet, occupation
Assessment of confounders at individual level is an advantage over cross-sectional, “ecologic” studies
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STRATUS CONSULTING
Long-term average concentrations of fine particle air pollution were associated with mortality rates, controlling for individual-level risk factors across six US cities
Results from Harvard Six Cities Study
Dockery et al., 1993
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STRATUS CONSULTING
Pope, C.A. et al., Journal of the American Medical Association: 287, 1132-1141, 2002
Source: Pope et al., 2002
American Cancer Society Study
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STRATUS CONSULTING
Objective: – To assess the relationship between long-
term exposure to fine particulate air pollution and all-cause, lung cancer, and cardiopulmonary mortality
Approach: – Vital status and cause of death data were
collected by the American Cancer Society through 1998 in 500,000 US adults from 50 urban areas for whom air pollution exposure data were available in 1980
American Cancer Society Cohort Study
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STRATUS CONSULTING
American Cancer Society Study Results
Pope et al., 2002
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STRATUS CONSULTING
American Cancer Study Conclusion
“Long-term exposure to combustion-related fine particle air pollution is an important environmental risk factor for cardiopulmonary and lung cancer mortality”
Pope et al., 2002
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STRATUS CONSULTING
WHO 2005 Air Quality Guidelines: Particulate Matter
PM2.5 PM10
10 μg/m3 annual mean25 μg/m3 24-hour mean
20 μg/m3 annual mean50 μg/m3 24-hour mean
World Health Organization, 2008d
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STRATUS CONSULTING
WHO 2005 Air Quality Guidelines: Ozone
World Health Organization, 2008d
Ozone (O3)
100 μg/m3 8-hour mean
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STRATUS CONSULTING
0
50
100
150
200
250
300
350
400
Ba
ng
ko
k
Be
ijin
g
Bu
sa
n
Co
lom
bo
Dh
aka
Ha
no
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Ho
Ch
i M
inh
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Ko
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an
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To
kyo
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gya
ka
rta
Average Ambient Air Quality Levels
(2000-2003)
SO2
NO2
SPM
PM10
SPM Limit = 60-90 µg/m3 (WHO, 1979)
3
PM10 Limit = 50 µg/m3 (USEPA, 1997)
SO2 Limit = 50 µg/m3 (WHO, 1999)
NO2 Limit = 40 µg/m3 (WHO, 1999)
Notes: Busan (2000-2002); Dhaka (2002-2003); Hanoi (2000-2002); Jakarta (2000-2001); Kathmandu (2003); Manila – PM10 (2002-2003); Mumbai (2000-2001); New Delhi (2000-2002); Osaka (2000-2001); Seoul (2000-2002), SPM (2000-2001); Surabaya (2001-2003) Tokyo (2000-2001)
Clean Air Initiative, 2004
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STRATUS CONSULTING
Health Impact Assessment
Step 1. Model future environmental conditions under various emissions and/or climate scenarios
Step 2. Gather existing knowledge regarding human health impacts given a change in environmental conditions (based on “exposure-response” equations)
Step 3. Estimate health impacts of modeled environmental changes
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STRATUS CONSULTING
Exposure-Response Calculations
Excess deaths attributed to PM is estimated by:
Where:– ∆y is the change in mortality incidence – y0 is the baseline mortality incidence, equal to
the baseline incidence rate times the potentially affected population
– β is the effect estimate – ΔPM is the change in PM2.5
STRATUS CONSULTING
yy0 e PM 1
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STRATUS CONSULTING
Global Burden of Disease – WHO 2004
Cohen et al., 2004
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STRATUS CONSULTINGCohen et al., 2004
Population Exposure to Particulate Matter
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STRATUS CONSULTINGCohen et al., 2004
Estimates of the Health Impact of Particulate Matter Exposure
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STRATUS CONSULTING
Can we assess potential future health impacts of air quality changes resulting from global climate change?
The Challenge for Air Pollution and Climate Change
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STRATUS CONSULTING
Effects of Climate Change on Tropospheric Ozone Formation
Formation reactions for ozone happen faster at high temperatures and with greater sunlight
Biogenic VOC emissions increase at higher temperatures
Regional air mass patterns over time and space may change, altering stagnation and clearance events
The mixing height of the lower atmosphere may change, affecting the dilution of pollution emitted at the surface
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STRATUS CONSULTING
The New York Climate and Health Project
Linking models for global and regional climate, land use and cover, and air quality…
To examine the potential public health impacts of ozone under alternative scenarios of climate change and regional land use in the 2020s, 2050s, and 2080s in the New York City (NYC) metropolitan region
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STRATUS CONSULTING
Develop exposure-response function for ozone using historical data from the NYC metropolitan area
Develop an integrated modeling system that includes modules for global climate, regional climate, and regional air quality
Examine alternative greenhouse gas growth scenarios
Combine scenarios to assess potential mortality risks in the NYC metro area in the 21st century
Approach
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STRATUS CONSULTING
Developing NYC Exposure-Response Functions for Temperature and Ozone
Model Outputs
Outcome:All internal-cause
daily deaths at county level
(JJA: 1990-1999)
POISSONRegression
Predictor:Daily ozone from
16 stations
PREDICTOR:Daily mean temp. from 16 stations
Day of Week
(Indicator Variable);
Spline of time
β coefficient estimates (Standard
Errors)
Input to risk assessment
Final Model:log (daily deaths)= DOW + spline(time) + b1(mean Tlag0)1-3 + b2(max O3 lag0-1)
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STRATUS CONSULTING
Integrated Modeling System Diagram
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STRATUS CONSULTING
Modeling Domains
Global climate (4 x 5)
Regional climate and ozone (36 km)
Health impacts
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STRATUS CONSULTING
Impact of Climate Change on Summertime Ozone Concentrations
∆2080s∆2050s
1990s ∆2020s
Hogrefe et al., 2004
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STRATUS CONSULTING
Simulated changes in 8-hour standard
exceedance days with climate
change
1990s — 2020s
Impact of Climate Change on Compliance with Ozone Standards
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STRATUS CONSULTINGKnowlton et al., 2004
Modeled Changes in: Mean 1-hr max O3 (ppb) O3-related deaths (%)
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STRATUS CONSULTING
Review
The mixtures of air pollutants produced by burning of fuels can– Adversely affect human health– Promote climate change
In addition– Climate change can influence air pollution,
resulting in direct health effects– Climate change can affect other aspects
of air quality, including smoke from agricultural or wild fires, and aero-allergens like pollen and mold spores
STRATUS CONSULTING
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STRATUS CONSULTING
Furthermore
There are other “air pollutants” besides the ones which come out of tail pipes and smoke stacks which have important impacts on human health, and for which climate change is causing changes…
STRATUS CONSULTING
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STRATUS CONSULTING
Forest Area Burned and Temperature Trends Canada 1920-1999: 5-year Means
Gillett et al., 2004
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STRATUS CONSULTING
Start Date of Birch Pollen Season in Brussels 1970-2006 Days after Jan 1 (5-year running means)
Emberlin et al., 2002
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STRATUS CONSULTING
Ragweed allergen
production increases as a
function of CO2
concentration
Singer et al., 2005
Impact of Increasing CO2 Concentrations on Ragweed Allergen Production
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STRATUS CONSULTING
IPCC, 2007b
Components of Radiative Forcing and Their Relative Impact
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STRATUS CONSULTING
Actions to Reduce Emissions from Fuel Combustion Will…
Improve public health via reductions in local and regional concentrations of PM, ozone, and other toxic air pollutants
Reduce human influence on global climate by reducing CO2 emissions
To the extent possible, these two “environmental health” goals should be addressed in an integrated, systematic way
STRATUS CONSULTING
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STRATUS CONSULTING
Conclusions: CO2 Stabilization Will Require Significant Changes
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STRATUS CONSULTING
Public Health practitioners will be called upon to assess the health co- benefits of mitigation activities, including equity aspects.
Conclusions (cont.): CO2 Stabilization Could Generate Health Co-benefits
IPCC, 2007c