recent developments in air quality and health - summary of conclusions from who project revihaap -...

Recent developments in

Air quality and health –

Summary of conclusions from

WHO project REVIHAAP

Marie-Eve Héroux

Technical Officer, Air Quality & Noise

European Centre for Environment and Health

WHO Regional Office for Europe

Air Science Policy Event

15 April 2013, Dublin

Presentation outline

• WHO projects REVIHAAP and HRAPIE

• Context, process, progress, timeline

• Results from evidence review

• Main conclusions from REVIHAAP



Context for REVIHAAP and HRAPIE work



Review of evidence on health aspects of

air pollution for guidance of EU policy

OBJECTIVE:

To provide the European Commission and its

stakeholders with scientific evidence- based advice on

health aspects of air pollution in support of the

comprehensive review of air quality legislation due in

2013.

*While some of the questions directly address policies, the

recommendations from the projects are based solely on scientific

conclusions on health aspects of air pollution, and do not consider

other issues which are relevant for policy formulation.



WHO projects

- Jointly financed WHO/EC

- Coordinated by WHO-ECEH

- Provide answers to 26 key questions posed by the EC

REVIHAAP

(24 questions)

Review of evidence review on

health aspects of

air pollution

Oct 2011 – April 2013

(18 months)

HRAPIE (2 questions, building on

REVIHAAP work)

Identification of

concentration-response

functions for key pollutants

and health outcomes

Survey on newly

emerging issues on risks to

health from air

pollution

Sept 2012 – Sept 2013

(12 months)



REVIHAAP: Process and progress

Scientific Advisory Committee

• 8 experts

• Offer guidance and oversight of project

• SAC meetings December 2011 & June 2012

Review of evidence and development of answers

• 29 experts authors

• Across various relevant disciplines

• Represent wide range of countries and institutions

• Work together in small groups

• 32 experts external reviewers

• Comment on completeness, validity and clarity

• WHO Expert meetings August 2012 & January 2013

Publications:

• REVIHAAP First results published January 2013

• Full technical report available April 2013



REVIHAAP Key questions

• PM, ozone, NO2, SO2, metals (As, Cd, Hg, Pb, Ni), PAHs

• New findings regarding health effects

• Concentration-response functions and thresholds

• Air pollution constituents and sources

• Integration of evidence and policy implications

• WHO air quality guidelines

• EU policies

• Critical data gaps



Evidence on health effects of PM (1/2)

• The scientific conclusions of the 2005 WHO Guidelines about the

evidence for a causal link between PM2.5 and adverse health

outcomes in humans have been confirmed and strengthened and,

thus, clearly remain valid

• New studies on short- and long-term effects

• Studies linking long-term exposure to PM2.5 to several new

health outcomes (e.g. atherosclerosis, adverse birth outcomes,

childhood respiratory disease, neurodevelopment and cognitive

function, diabetes)

• Associations between long-term exposure to PM2.5 and mortality

at levels below the current annual WHO AQG

• Effects of long-term exposure greater than those of short-term



Evidence on health effects of PM (2/2)

• Both short-term (such as 24-hour average) and long-term (annual

means) exposure to PM2.5 affect health

• Maintaining independent short-term and long-term limit values for

ambient PM10 in addition to PM2.5 to protect against the health

effects of both fine and coarse particles is well supported

• In the absence of a threshold and in light of linear or supra-linear

risk functions, public health benefits will result from any reduction of

PM2.5 concentrations, whether or not the current levels are above or

below the limit values



Evidence on PM sources, fractions and

components • Three important components – black carbon, secondary

organic aerosols, and secondary inorganic aerosols – for which

there is substantial exposure and health research finding

associations and effects

– may provide valuable metrics for the effects of mixtures of

pollutants from a variety of sources

• Short-term exposures to coarse particles (including crustal

material) are associated with adverse respiratory and

cardiovascular health effects, including premature mortality

• Increasing, though as yet limited, epidemiological evidence on

the association between short-term exposures to ultrafine

(<0.1 µm) particles and cardio-respiratory health, as well as the

central nervous system



Evidence on health effects of ozone

• New evidence for an effect of long-term exposure to ozone on:

– mortality, especially among persons with potentially predisposing

conditions (COPD, diabetes, congestive heart failure, and

myocardial infarction)

• asthma incidence, asthma severity, hospital care for asthma and

lung function growth

• Adverse effects of exposure to daily ozone concentrations (maximum

daily 1-hr or 8-hr mean) on:

• all-cause, cardiovascular and respiratory mortality

• respiratory and cardiovascular hospital admissions, after

adjustment for the effects of particles (PM10)

• The evidence for a threshold for short-term exposure not consistent,

but likely to lie below 45 ppb (90 µg/m3) (max 1-hr)



Evidence on health effects of NO2

• New studies document associations between day-to-day variations in

NO2 and variations in mortality, hospital admissions, and respiratory

symptoms.

• New studies showing associations between long-term exposure to

NO2 and mortality and morbidity.

• Both short- and long-term studies found these adverse associations

at concentrations at or below the current EU LV (= WHO AQG).

• The associations between NO2 and short-term health effects in many

studies remain after adjustment for other pollutants (including PM10,

PM2.5, black smoke).

• … it is reasonable to infer that NO2 has some direct effects.

• No health evidence to suggest changing the averaging time for

the short-term EU limit value (1-hour).



Evidence of health risks from proximity to

roads

• Elevated health risks associated with living in close proximity to

roads is unlikely to be explained by PM2.5 mass.

• Current evidence does not allow discernment of the pollutants

or pollutant combinations that are related to different health

outcomes, although association with tail pipe primary PM is

increasingly identified.

• Toxicological research indicates that non-exhaust pollutants

could be responsible for some of the observed health effects.



REVIHAAP Main conclusions

• Considerable amount of new scientific information on health effects

of PM, ozone and NO2 has been published in the recent years

– Evidence has strengthened

– Effects observed at levels commonly present in Europe

– Supports the scientific conclusions of the WHO Air Quality

Guidelines, last updated in 2005

– Indicates that the effects can occur at air pollution

concentrations lower than those serving to establish the 2005

Guidelines

• Provides scientific arguments for the decisive actions to improve air

quality and reduce the burden of disease associated with air

pollution in Europe.

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