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WHO European Centre for Environment and Health WHO European Centre for Environment and Health WHO European Centre for Environment and Health WHO European Centre for Environment and Health WHO Air Quality Guidelines for Europe Michal Krzyzanowski WHO ECEH Bonn Office http://www.euro.who.int/air NERAM Colloquium IV

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WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

WHO Air Quality Guidelinesfor Europe

Michal KrzyzanowskiWHO ECEH Bonn Office

http://www.euro.who.int/air

NERAM Colloquium IV

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

European Union Clean Air Policy

Objective: to reduce air pollution to a level where it does not impose a significant risk to human health and the environment as a whole

NERAM Colloquium IV

Policies related to AQ in European Region of WHOPolicies related to AQ in European Region of WHO

Environmental Strategy for countries of Eastern Europe, Caucasus and Central Asia (EECCA)

Objective: The reduction of risk to health through reduction of urban air pollutionKey action: The optimisation of standards, accounting for health impacts (based on WHO criteria)

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

WHO Role•To provide science-based advice to achieve the objective of clean air policy; •Act as science – policy interface

NERAM Colloquium IV

WHO AQ programme 2002-5• „Systematic review of health aspects of air quality in Europe“

• Global update of WHO Air Quality Guidelines

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

WHO Systematic Review of Health Aspects of Air Quality in Europe, 2001-2004

Scientific Advisory CommitteeRoss Anderson, Tom Bellander, Joseph Brain, Bert Brunekreef, Erik Dybing,

Stephen Holgate, Klea Katsouyanni, Robert Maynard, Jon Samet and Bernd Seifert

WHO Experts / ReviewersU. Ackermann-Liebrich, B. Armstrong, R. Atkinson, JG. Ayres, A. Bernard, M. Bobak,

P. Borm, R. Burnett, F. Cassee, A. Chatterjee, A. Chauhan, D. Coggon, A..Cohen, D. Dockery, K..Donaldson, M. Everard, T. Fletcher, F. Forastiere, B. Forsberg,

M. Frampton, J. Gamble, L. Gephart, RM. Harrison, J. Heinrich, U. Heinrich, F. Hurley, D. Jarvis, SL. Johnston, FJ Kelly, J. Kielhorn, K. Konstantinou, P. Koutrakis, N. Künzli,

J. Lambrozo, D. Laxen, B. Leaderer, M. Lippmann, F. Martinez, L. Martson, J. Mauderly, B. Miller, H. Muhle, M. Neuberger, B. Ostro, J. Peacock, J. Pekkanen, A. Peters, J. Peters,

O. Raaschou-Nielsen, R. Rapp, N. Ribas-Fito, RJ. Richards, I. Romieu, RO. Salonen, T. Sandstrom, R. Schlesinger, P. Schwarze, RJ. Sram, J. Stedman, J. Sunyer, I. Tager,

L. van Bree, P. van den Hazel, J. Vandenberg, D. Walters, H. Walton, U. Wass, S. Weiland, E. Wichmann, G. Winneke

NERAM Colloquium IV

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

««Systematic Review of health aspects of air quality in Systematic Review of health aspects of air quality in EuropeEurope»», 2002/4 , 2002/4 –– Summary ReportSummary Report

http://www.euro.who.int/document/E83080.pdf

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Systematic Review: selected resultsSystematic Review: selected resultsPM

Which of the physical and chemical characteristics of particulate air pollution are responsible for health effects?

- Fine PM is more hazardous than larger particles

- Metal content

- Organic components such as PAH

- Endotoxins

- Extremely small particles (< 100 nm)

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Ozone

Is there a threshold below which no effects on health are expected to occur?

Epidemiology: no evidence for threshold from short-term studies; confidence in the existence of associations of O3 with health decreases as concentrations decrease

Chamber studies: may show thresholds in the studied group but this is not sufficient to indicate a threshold of effects for ALL people

Systematic Review: selected results Systematic Review: selected results

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

NO2

What is the basis for maintaining the WHO NO2annual specific guideline value of 40 µg/m3?

Toxicology: adverse effects of long-term exposure to NO2 at higher concentrations.

Epidemiology: adverse health effects associated with NO2 at the annual average concentration ca. 40 µg/m3 … WHO annual specific guideline value of 40 µg/m3 should be retained or lowered.

Systematic Review: selected results Systematic Review: selected results

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

The effects of air pollution on The effects of air pollution on children's health and developmentchildren's health and development

Conclusions on causal associations:

PM and respiratory deaths in post-neonatal periodAmbient air poll & lung function development (pre & post natal)PM and O3 exposure and asthma aggravationPb and neurobehavioural development

Several suggestions for causal associations in available data

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Is there a threshold below which no effects on healthare expected to occur in all people?

For PM, O3 and NO2: No

⇒ Replace the threshold concept with exposure-risk functions

Systematic Review

resp

onse

exposure

WHO European Centre for Environment and Health

Sources: Pope et al, JAMA 2002; Circulation 2004

Long term exposure to PM and risk of mortalityin ACS cohort

TFH 2003: “..apply the relative risk for all cause mortality… in the extended American Cancer Society (ACS) cohort study Pope et al. (2002).”

1.08 – 1.151.12All CVD & diabetes0.86 – 0.920.92Dis. of respir.syst.

1.04 – 1.231.14Lung cancer

0.95 – 1.061.01All other causes

1.03 – 1.161.09Cardiopulmonary

1.02 – 1.111.06All causes

95% CIRR per 10 ug/m3 PM2.5*)Cause of mortality

*)Average PM2.5 estimate

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Loss in average statistical life expectancy due to identified anthropogenic PM2.5

(months)

2000 2010 2020Average of calculations for 1997, 1999, 2000 & 2003 meteorologies

Source: IIASA

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

0

10

20

30

40

50

60

70

80

daily

max

8-h

r mea

n

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Premature mortality attributable to daily max. 8 hour means ozone > 35 ppb (SOMO35)

Applied relative risk factor: 1.003 / 10 µg/m3 increase in daily max 8 h mean

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Premature mortality attributable to daily max. 8 hour means ozone > 35 ppb (SOMO35)

(cases/year)

0

1000

2000

3000

4000

5000Au

stria

Belg

ium

Den

mar

k

Finl

and

Fran

ce

Ger

man

y

Gre

ece

Irela

nd

Italy

Luxe

mbo

urg

Net

herla

nds

Por

tuga

l

Spa

in

Sw

eden UK

Cze

ch R

ep.

Est

onia

Hun

gary

Latv

ia

Lith

uani

a

Pol

and

Slo

vaki

a

Slo

veni

a

2000 2010 2020

Source: IIASA

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

WHO AQG WHO AQG –– Global UpdateGlobal Update

• Ross H Anderson, UK• Bert Brunekreef, Netherlands• Binheng Chen, China• Aaron Cohen, USA• Robert L Maynard, UK• Isabelle Romieu, Mexico• Supat Wangwongwatana, Thailand• Kirk Smith, USA

NERAM Colloquium IV

Steering Group:

WHO European Centre for Environment and HealthWHO European Centre for Environment and Health

WHO AQG WHO AQG –– Global UpdateGlobal UpdatePlanning Meeting: London, 11 January 2005

Pollutants to be considered in 2005: PM, O3, NO2, SO2

Structure:Policy oriented Executive SummaryPart 1: Application of Guidelines in AQ policy and managementPart 2: Hazard assessment of PM, O3, NO2, SO2Part 3: Derivation of Guidelines

Draft ready for external review: Summer 2005WHO WG Meeting: week 17-21 October 2005

NERAM Colloquium IV

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Thank youThank you

http://www.euro.who.int/air

[email protected]

NERAM Colloquium IV

WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health

Products of the Products of the ««Systematic Review of health aspects Systematic Review of health aspects of air quality in Europeof air quality in Europe»», 2002/4, 2002/4

Health aspects of air pollution with particulate matter, ozone and nitrogen dioxide http://www.euro.who.int/document/e79097.pdf

Meta-analysis of time-series studies and panel studies of particulate matter (PM) and ozone (O3) http://www.euro.who.int/document/e82792.pdf

Health aspects of air pollution – answers to follow-up questions from CAFE http://www.euro.who.int/document/E82790.pdf

The effects of air pollution on children's health and development: a review of the evidence http://www.euro.who.int/document/EEHC/execsum.pdf(full report: 2005)

Health aspects of air pollution http://www.euro.who.int/document/E83080.pdf