# Presentation: 457274

## Air Quality and Public HealthThird Energy Analysis ForumJune 11, 2003

- Aaron J Cohen
- Health Effects Institute

## Slide 2

## Air Quality and Public Health

**What are the health effects of outdoor air pollution from fuel combustion?**
**What is the current attributable burden of disease?**
**What can we expect if we improve air quality in the world’s cities (e.g. by reducing reliance on fossil fuels)?**
**What are major research needs?**

## Mortality

**Mortality**

**Restricted activity**

**Sub-clinical pathological**
**physiological changes**

**Exposed but not affected**

**Hospital admission**

**Emergency room visit**

**Primary care visit**

**Self care**

**No care**

**Symptoms**

**UTILIZATION OF**
** ****HEALTH SERVICES**

**DISEASE AND ILLNESS**
**(acute or chronic)**

## Combustion-Source Air Pollution: complex mixture-varied effects

**Different components appear to have different effects**
**Carbon Monoxide - circulatory system, heart**
**Ozone - respiratory system, lung**
**Lead - nervous system, brain**
**PM - lung, potential effects on heart**
**Diesel, Air Toxics - cancer, respiratory effects**
**CO****2**** and Carbon Particles  - climate change**
**There are potential effects of the Mixture**

## Daily Mortality Relative Risk from Short-term Exposure to Inhalable  Particles (PM10)(Dominici et al. 2003)

**Notes:**
Adjusting for time varying confounding factors is more important than model specification. This pictures shows the robustness of the NMMAPS national average estimate to the degree of adjustment for confounding factors and model specification 

## World-wide Estimates of Percent Increase in Daily Mortality (Cohen AJ, Anderson HR, Ostro B  et al. 2003 In Press)

## Estimated Effect of Long-term Exposure to Fine Particles (PM2.5)

**The Harvard Six-Cities Study (Dockery et al 1993) and ACS Study (Pope et al 2002) find associations of longer-term average PM exposure and mortality **
**Larger relative effects than the time-series studies of daily mortality: ~6.0 % / 10 micrograms PM****2.5**
**No developing-country cohort studies**

## Estimated Burden (95% CIs) of Urban Air Pollution Worldwide(Cohen AJ, Anderson HR, Ostro B.  2003 In Press)

## Environmental Burdens: Premature Deaths(WHO World Health Report 2002)

## Measuring impacts of improvements in air quality (1)

**Indirect: modelled using existing risk coefficients**
**US EPA’s 812 retrospective and prospective studies of the US CAA**
**GBD/CRA**
**Various reports on the ancillary benefits of GHG reductions (e.g., Working Group on Public Health and Fossil Fuel Combustion 1997; ****Cifuentes L, Borja-Aburto VH, Gouveia N 2001)**

## Effects of a 10% reduction in air pollution in four large cities (Cifuentes L, Borja-Aburto VH, Gouveia N 2001)

## Measuring impacts of improvements in air quality (2)

**Direct: estimated from studies of the actual policy interventions **
**Banning sale of coal in Dublin (Clancy et al 2002)**
**Reducing sulfur in fuel in Hong Kong (Hedley et al 2002)**

## Reductions in Cardiovascular Mortality in Dublin Post-1990 Ban on Coal Sales(Clancy et al. 2002)

## Summary (1)

**Air pollution from combustion of fossil fuels has significant health effects**
**Potential for significant health benefits from reducing reliance on fossil fuels**
**Additional research needed to reduce uncertainty in estimating attributable and avoidable burden of disease**
**Comprehensive and consistent air quality measurements in developing regions**
**Coordinated epidemiologic studies in developing regions with the largest estimated attributable burdens e.g., HEI’s PAPA project**
**Direct evaluation of policies designed to improve air quality**

## Summary (2)

**Additional research needed to reduce uncertainty in estimating attributable and avoidable burden of disease**
**Health effects of outdoor air pollution from specific sources**
**Health effects of potential new technologies (SCET)**

## Thank You!

**acohen@healtheffects.org**
- _[www.healtheffects.org](http://www.healtheffects.org/)_
**www.airimpacts.org**

## Environmental Burdens: DALYs(WHO World Health Report 2002)

## Global distribution of mortality attributable to 20 leading selected risk factors(Ezzati et al 2002)

## Global distribution of mortality attributable to 20 leading selected risk factors(Ezzati et al 2002)

**Global distribution of mortality attributable to 20 leading selected risk factors****(Ezzati et al 2002)**

## REDUCTIONS IN DEATHS AFTER SULPHUR RESTRICTION

- -6

- -5

- -4

- -3

- -2

- -1

- 0

- 15-64

- 65+

- 15-64

- 65+

- 15-64

- 65+

**REDUCTIONS IN DEATHS AFTER SULPHUR RESTRICTION**

- All causes

- Cardiovascular

- Respiratory

- % Reduction in annual trend

- -1.8%

- -2.8%

- -1.6%

- -2.4%

- -4.8%

- -4.2%

## Health Effects of Trans-boundary Air Pollution from Bio-Mass Burning: Indonesian Forest Fires

## How to extrapolate the ACS concentration-response function?(Cohen AJ, Anderson HR, Ostro B. 2003 In Press)