PROCEEDINGS of the
23rd International Congress on Acoustics
9 to 13 September 2019 in Aachen, Germany

Case study of an environmental noise and health assessment in theCity of Dusseldorf, Germany
Dirk SCHRECKENBERG1; Irene VAN KAMP2; Julia KUHLMANN1; Sarah BENZ1; Stephan
GROSSARTH1; Elisa VAN KEMPEN2; Mathias BASNER3; Alan Lex BROWN4; Charlotte CLARK5;
Danny HOUTHUIJS2; Oscar BREUGELMANS2; Annemarie VAN BEEK2; Brigit
JANSSEN-STELDER2123ZEUS GmbH, Germany

Netherlands National Institute for Public Health and the Environment (RIVM), The Netherlands

University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA,
4

Griffith School of Environment, Griffith University, Australia
5

ARUP, UK

ABSTRACTIn their recent Environmental Noise Guidelines (ENG) the World Health Organization (WHO) identified
several critical health outcomes of environmental noise, among them are cardiovascular diseases, annoyance,
effects on sleep, cognitive impairment, and hearing impairment/ tinnitus. Aiming at protecting the populationfrom adverse noise effects, the Environmental Noise Directive 2002/49/EC (END) is the main instrument
guiding the noise mapping and the development of noise action plans in EU Member States. END Annex III
describes methods of the assessment of health impacts (HIA) of noise in terms of the number of highly
annoyed and sleep disturbed persons in a given area. A new study commissioned by the European
Commission describes a HIA methodology for environmental noise, which considers the critical healthoutcomes as identified in the WHO ENG. In summary, two methods are described: the assessment of numberof people affected by different health outcomes and the environmental burden due to environmental noise interms of the calculation of disability-adjusted live years (DALY). We present a case study where both HIA
methods were applied to the City of Dusseldorf, Germany, in order to describe the status quo of the healthimpact as well as the health impact of simulated transportation noise interventions.
Keywords: Environmental noise, health impact assessment

1. INTRODUCTION
The EU Environmental Noise Directive 2002/49/EC (END; 1) is the main instrument guiding thenoise mapping and the development of noise action plans in EU Member States, aiming at protecting
the population from adverse noise effects.
As stated in END Annex III: 'Dose-effect relations should be used to assess the effect of noise on
populations.' According to the current version, the exposure-response relationship should concern therelation between (1) annoyance and Lden and (2) between sleep disturbance and L night , for road, rail andair traffic noise as well as for industrial noise.
The European Commission aims to revise Appendix III based on latest sci entific evidence of the
impact of environmental noise on health as provided by systematic reviews. These systematic reviews
were carried out within the frame of the Environmental Noise Guidelines (ENG) for the European
Region and were published by the World Health Organization (WHO) in 2018 (2). In the WHO ENG
several outcomes of environmental noise are identified. Health outcomes defined as critical are,annoyance, sleep disturbance, cardiovascular diseases, cognitive impairment, and hearing
impairment/tinnitus. Whereas the latter mainly refers to leisure noise, the other critical outcomes have
1

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schreckenberg@zeusgmbh.debeen mainly studied as impacts of transportation noise, i.e. aircraft, railway, and road traffic noise.
The European Commission has commissioned a new study to develop a health impact assessment(HIA) methodology for environmental noise which considers the critical health outcomes as identified
in the WHO ENG (3). The methodology is described in another contribution by Van Kamp et al. (4).
This contribution refers to the application of the HIA methodology to the City of Dusseldorf,
Germany, examining two key questions:(1)(2)

What is the status quo of the health impact of environmental noise (in the following
focused on transportation noise) in Dusseldorf?
What are the impacts of selected noise mitigation actions on health?

To address these questions, the following indices were used and calculated for transportation noise(road, railway, and aircraft traffic noise): 1) number of people affecte d by different health outcomes(NafP) and 2) the environmental burden due to environmental noise (disability-adjusted live years,
DALY) (Step 1, see section 2.3).
Concerning the former, the number of highly annoyed people, of highly sleep disturbed people aswell as the number of people with a coronary heart disease (CHD) per year and number of deaths due
to CHD – both attributable to noise – were calculated for the three transportation noise sources. For
aircraft noise, the number of children with reading impairment was assessed as well.
Except for children’s reading impairment, the above listed health outcomes were also used for the
DALYs. In addition, DALY calculations excluding high noise annoyance and high sleep disturbancewere compared to calculations including these two variables.

2. PROCEDURE, METHODS
2.1 Study area
The selected study area, Dusseldorf, Germany, has a total of 635,704 inhabitants, of which 537,631
are adults, i.e. are 18 years and older (85%). For this area, noise calculations have been made within
the frame of the 3 rd round of the noise mapping according to the EU directive for environmental noise(1). For one city district, Dusseldorf-Bilk, the Environment Agency of Dusseldorf (EAD) additionallycalculated the impact of three simulated source-specific noise abatement actions on changes in thenumber of exposed residents. These actions are:
1. Road traffic noise: Noise reducing road surfaces
2. Railway noise: Green tech rail profiles
3. Road traffic noise: Speed Limit 30 km/h (as compared to 50 km/h)
2.2 Data
The EAD provided population-exposure data for road, railway and aircraft traffic noise by linking
noise maps to residents’ addresses. L den and L night were used as acoustical measures. Both were divided
into 1 dB classes. Table 1 shows the dB ranges per noise source. It has to be noted that for aircraft noise,
the EAD could not provide noise exposure data below 45 dB, as the aircraft noise exposure estimations
are done by a different authority.
Table 1 – Ranges of acoustical measurements
Noise source

Lden

LnightRoad traffic<40 to 78 dB<40 to 69 dB

Railway traffic<40 to 90 dB<40 to 81 dB

Aircraft traffic

45 to 75 dB

45 to 66 dB

Demographic data such as age was derived from an official report (5) by the City of Dusseldorf(2016). Data regarding the mortality rate of CHD was taken from the WHO Mortality database forGermany (2015). Incidences for CHD were operationalized using hospital discharges. Here, data wasavailable from the European Hospital Morbidity Database of the WHO (2014). DALYs are calculated
by adding the years lived with a disease (YLD) and the years of life lost due to a disease (YLL). The
data used to calculate DALYs were extracted from the WHO Burden of Disease project (2016) (6). For

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this HIA example, it is assumed that the data are valid for Dusseldorf.
2.3 Methods
The HIA assessments (NafP, DALYs) are carried out in five steps:
Step 1: Choice of health outcomes (see introduction)
Step 2: Exposure assessment
Step 3: Choice of exposure-response functions
Step 4: Estimation of the NafP by transportation noise on the basis of step 1 to 3 and additionalsocial-spatial population data (number of residents in total, by age and gender)
Step 5: Estimation of DALYs due to transportation noise on the basis of step 1 to 4 and additional
data on health outcome-specific YLD and YLL.

3. RESULTS
3.1 HIA assessment process
In order to assess the status quo of the noise situation in Dusseldorf, noise data divided in 1-dBclasses ranging from 40 to 75 dB for L den and L night was used for road and railway traffic as well as forindustry and harbor noise. For aircraft noise, a range from 45 dB to 75 dB was used for Lden.
To calculate the change in noise exposure, both of the two simulated noise interventions concerning
road traffic noise (noise reducing road surfaces and speed limit 30km/h) were used. The calculatedchange in noise exposure regarding railway noise was assessed with one simulated intervention (green
tech rail profiles). The EAD then estimated the change in numbers of people exposed to traffic noisefor 1-dB classes (L den and L night ) (step 2).
Figures 1 and 2 show the distributions of people exposed to road and railway noise before and after
the implementation of the simulated noise mitigation actions in Dusseldorf-Bilk. It seems that the
proposed interventions do not strongly affect the percentage of noise exposed residents.

Figure 1 – Road traffic: Noise reducing road surfaces and speed limit reduction

Figure 2 – Railway: Green tech rail profiles

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3.2 HIA method 1 - NafPFor the HIA the following exposure functions are used (Step 3): For the percentage of highly
annoyed people (%HA), the generalized exposure response function (ERF) from the WHO review forenvironmental noise annoyance (7) was used. The number of highly sleep disturbed people (%HSD)
was assessed using the ERFs of the WHO review for the impact of environmental noise on sleep (8).
The ERF used to estimate the number of children with reading impairment due to aircraft noise canbe found in (3).
In order to calculate the incidence of CHD and the number of deaths related to CHD , both
attributable to noise, the so-called PAF (noise source-specific population attributed fraction) was used
(3, 4). Both PAFs were multiplied with the corresponding variable (i.e. hospital discharge rate and themortality rate for CHD) and the total number of residents in Dusseldorf. In both cases, this was done
for females and males separately
Table 2 shows the number of adult people annoyed and sleep disturbed by transportation noise andthe number of children with reading comprehension impaired by aircraft noise. Table 3 gives anexample of CHD incidence and mortality attributable to transportation noise for females and males,
respectively (Step 4).
Table 2 – Estimated number of highly noise annoyed and sleep disturbed adult people and children withreading impairment by aircraft noise in Dusseldorf
Health end point

Noise source

Number

Percent

Highly annoyedRoad

63,55811.82 %

(adults)

Rail

47,0898.76 %

Air

35,542

6.61 %

Highly sleep disturbed

Road

12,3442.30 %(adults)

Rail

16,5513.08 %

Air

569

0.11 %

Air

7,328

10.07 %

Nadults

537,631100.00 %Nchildren (7-17 years old)

72,742100.00 %Children with additional
reading impairment due
to aircraft noise

Table 3 – Estimated number of people with CHD attributable to transportation noise in Dusseldorf
Health end point

Noise source

Total estimated hospital discharges/ death in Dusseldorf
attributable to noise

CHD incidence

CHD mortality

Male

Female

Sum

Road

56

28

84

Rail

33

16

50

Air

2

1

3

Road

154

135

289

Rail

91

80

171

Air

5

5

10

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3.3

HIA method 2 - DALY

Additionally, the DALYs were calculated for CHD incidence and mortality for each noise source(Step 5). For comparison, the DALYs were also calculated including the variables high annoyance andhigh sleep disturbance. A disability weight of .01 was used for %HA and a disability weight of .0175
for %HSD. The number of DALYs regarding CHD due to noise is 621 (DALY I). When high sleep
disturbance and high annoyance are taken into account as well, this number increases to 2,760 (DALY
II). Table 4 gives an overview of the results.
Table 4 – DALYs for the current noise situation in Dusseldorf
Health end

Noise

Averagepoint

sourceestimated

PAF

Disability

Total YLD

Total YLL

weightAverage
DALYs

prevalence
High

Road

63558

0.01

636

0

636

annoyance

Rail

47089

0.01

471

0

471

Air

35542

0.01

355

0

355

High sleep

Road

12344

0.0175

284

0

284

disturbance

Rail

16551

0.0175

381

0

381

Air

569

0.0175

13

0

13

CHD

Road

0.0146982

14incidenceRail0.0087

982

9

Air

0.0005

982

1

CHD

Road

0.0182

20148

367

mortalityRail

0.0108

20148

218

Air

0.0006

20148

13

DALY I

621

DALY II

2760

Note. DALY = Disability-Adjusted Life Years, CHD = coronary heart diseases, PAF = average population
attributive fraction, YLD= Years of life lost due to disability, YLL= Years of Life lost due to premature death. DALY
I = DALYs calculation excludes DALYs due to noise annoyance and sleep disturbance, following GBD. DALY II =DALYs calculation includes DALYs due to noise annoyance and sleep disturbance.

3.4 HIA regarding the impact of noise mitigation actions
The second aim was to examine the effects of simulated interventions regarding road and railway
noise on NafPs and DALYs. Figure 3 depicts the study area Dusseldorf-Bilk and the locations of thethree interventions.
Table 5 presents the results regarding the health impact of the three simulated interventions (before
and after). As aircraft traffic noise is not affected by these interventions, it is not considered.
The two simulated interventions concerning road traffic noise would reduce the DALYs by 9.8%
(DALY I) and by 8.4% when high noise annoyance and high sleep disturbance are included (DALY II).
The number of highly annoyed people would decrease by 106 people ( -0.3%) and minus 26 people
would be highly sleep disturbed (-0.2%). Regarding CHD mortality, the number of deaths would be
reduced by one.
The simulated intervention affecting railway noise yields similar results. DALY I was found to
decrease by 9.1%.Adding annoyance and sleep disturbance to the calculation results in a decrease of
2.02 DALYs (7.8%). The number of CHD incidence and mortality would not be affec ted by theintervention.

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Figure 3 - Study area and delineation of the three noise reduction procedures
Table 5 – Overview of NafP (HIA method 1) and DALYs (HIA method 2) before and after interventions onroad traffic noise
Health end

Noise

Average

Average

DifferencepointsourceNafP

NafP

in NafP(before*)(after*)Average

Average

DALYs due DALYs due
to noise

to noise(before)(after)Averagedifferencein DALYs

Measure: Noise reducing road surfaces and speed limit 30 km/h
High

Road

annoyance
High sleep

Road

disturbance
CHD

Road

1490.21384.6-105.6(11.4%)(10.6%)(-0.8%)

289.4

263.1

-26.3

(2.2%)(2.0%)(-0.2%)

2,2

2.0

-0.2

14.90

13.85

(-7.1%)
6.66

6.05

0.38

0.34

-0.04
(-10.5%)

Road

7.7

6.9

-0.7

9.76

8.81

mortality
DALY I-0.60(-9.0%)

Incidence
CHD

-1.06

-0.95
(-9.7%)

--

--

--

10.15

9.16

-0.99
(-9.8%)DALY II

--

--

--

31.70

29.06

-2.65
(-8.4%)

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Table 6 – Overview of NafP (HIA method 1) and DALYs (HIA method 2) before and after an intervention on
tram (railway) noise
Health end

Noise

Average

Average

DifferencepointsourceNafP

NafP

in NafP(before*)(after*)Average

Average

DALYs due DALYs due
to noise

to noise(before)(after)Averagedifferencein DALYs

Measure: Green tech rail profiles
High

Tram

1056.8

991.9

-64.9

annoyance(rail)(8.1%)(7.6%)(-0.5%)High sleep

Tram

394.7

360.0

-34.7

disturbance(rail)(3.0%)(2.8%)(-0.2%)

CHD

Tram

1.4

1.3

-0.1

incidence(rail)

CHD

Tram

mortality(rail)DALY I

10.57

9.92

-0.65
(-6.2%)

9.08

8.28

-0.80
(-8.8%)

0.24

0.21

-0.02
(-8.3%)

4.8

4.3

-0.4

6.05

5.50

-0.55
(-9.1%)

--

--

--

6.29

5.72

-0.57
(-9.1%)DALY II

--

--

--

25.93

23.92

-2.02

(-7.8%)
Note. DALY = Disability-Adjusted Life Years, CHD = coronary heart diseases, PAF = average
population attributive fraction, YLD= Years of life lost due to disability, YLL= Years of Life lost due
to premature death. DALY I = DALYs calculation excludes DALYs due to noise annoyance and sleep
disturbance. DALY II = DALYs calculation includes DALYs due to noise annoyance and sleep
disturbance. *Before and after the interventions.

4. Conclusions
The described analyses show that different (additional) data sources, on which basis NafP and
DALYs are calculated, are needed. For example, specifically for DALYs, data was only available
nation-wide, but not at a city level (Dusseldorf). Due to the fact that in Germany different authorities
are responsible for noise mapping, depending on the noise source, and for gathering epidemiologicalas well as socio-spatial data these data may differ in their level of detail. The application of national
epidemiological data to a local level required assumptions to be made on the validity of thisapplication and may produce uncertainty in the assessments.
As there are no regional ERFs available for annoyance and sleep disturbance in Germany,
generalized ERFs were used in these analyses. This does not pose a problem when evaluating theimpact of interventions. However, since characteristics of the local population are not taken into
account in ERFs, estimating the number of highly annoyed or highly sleep disturbed people could be
problematic in terms of the validity of the assessments.
In addition, certain health outcomes take many years to develop and, therefore, short -term noisechanges, as assessed in this HIA, may not yield any effects.
Both HIA methods, but in particular the DALY calculations, are complex and need epidemiological
exercise.
Deciding on a noise intervention, i.e. targeting either road or railway noise, is a question of the HIA
method used. Using NafPs, the road traffic noise interventions would be more effective, as it results in
the highest decrease in affected (highly annoyed) people. On the other hand, the railway intervention
would reduce the percentage of highly sleep disturbed people and, thus, should be chosen when aiming
at improvements during the night.

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So far, the DALYs I only include CHD and are not recommended for evaluating noise action plans
as it provides little information for any preferences. In the near future, more robust ERFs should beavailable for other effects (e.g. stroke, diabetes), as more studies on the impacts of environmental
noise are being published. These effects could, then, be included in the DALYs I or II.
Overall, DALY II as well as NafP seem more appropriate to describe the status quo of the effects ofenvironmental noise on health at a (larger) city level. When it comes to evaluating and compari ng
different noise scenarios at a noise action plan level, DALY (either I or II) should be accompanied byanother HIA method.

ACKNOWLEDGEMENTS
This study was commissioned by the European Commission, DG Environment, Directorate A,
Policy, Coordination and Resources under Contract Number: 070203/SER/2017/771430/ENV.A.3
Title Contract: “Study on methodology to perform environmental noise and health assessment"
https://www.rivm.nl/publicaties/study-on-methodology-to-perform-environmental-noise-and-healtha
ssessment-a-guidance.

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