Public Health, Air Quality, & EquityPublic Health, Air Quality, & EquityDr. Tony Iton, MD, JD, MPHDirector of Alameda County Public Health DepartmentPort of Oakland Maritime Air Quality Improvement PlanTask Force MeetingAugust, 14, 2007West OaklandWest OaklandHealth = HopeHOPEThe Toxic Burden Imposed onWest OaklandThe Toxic Burden Imposed onWest OaklandPacific Institute, WestOakland Diesel EmissionsInventory and Air Quality Monitoring StudyDiesel Particulate Matter EmissionsDiesel Particulate Matter EmissionsPacific Institute, WestOakland Diesel EmissionsInventory and Air Quality Monitoring StudyDiesel Particulate Matter EmissionsDiesel Particulate Matter EmissionsPort EmissionsPort EmissionsPort of Oakland 2005 Seaport Air Emissions InventoryCargo Handling Equipment (CHE)Freeways and RailwaysFreeways and RailwaysToxic ReleaseInventory SitesToxic ReleaseInventory Siteshttp://www.epa.gov/enviro/html/tris/tris_query.htmlLeaking Storage TanksContaminated SitesLeaking Storage TanksContaminated SitesAlameda CountyEnvironmental HealthDepartmentOther Health Effects of the PortOther Health Effects of the PortTraffic• Pedestrian, bicyclist and motoristinjuries and deaths• Increasing due to port expansionNoise• Caused by trucks, trains, cars, shipsand construction activities• Sleep disturbance, endocrinedisruptionThe Consequences of this ToxicBurdenThe Consequences of this ToxicBurdenTheoretical ConsequencesCARB, Quantification of HealthImpacts and Economic Valuation ofAir Pollution from Ports and Goods Movement in CaliforniaHealth Costs of Goods MovementHealth Costs of Goods MovementAnnual cost of air pollution from freight transport in California: $19.5 billion• 2400 premature deaths• 2000 hospital admissions—$67 million• 62,000 asthma and other lower respiratory symptoms—$1.1 million• 360,000 lost work days• 1.1 million lost school daysMore than half of this risk is from truck pollutionFor every dollar invested in mitigation,$3 to $8 in health costs can be avoidedWHO estimates that ambient air pollution isresponsible for 1.4% of all deaths inthe world (2002).Pollution and DiseasePollution and DiseaseRate ratio of United States most polluted cities compared to least polluted= 1.26 for mortality rate (Dockery et al, 1993)According to the California Air Resources Board (2004), attaining California PMstandards would annually prevent:• 6,500 premature deaths (3% of all deaths)• 4,000 hospital admissions for respiratory disease• 3,000 admissions for cardiovascular disease• 2,000 asthma-related ER visits• 400,000 cases of lower respiratory symptoms (such as cough) in children• 400,000 cases of upper respiratory symptoms (runny nose, itching eyes) inchildren• 8,000 cases of chronic bronchitis• 500,000 cases of respiratory illness (colds and flu)• 350,000 asthma attacksSamet and Krewski, 2007• Dock workers, truck drivers, and railroadworkers have elevated risk of lungcancer. (Garshick et al, 2004)• Areas near truck-congested freeways have elevated levels of CO, dieselconsituents, and ultrafine particles. (Zhu et al, 2002)• Residents living near ports have higher rates of oropharyngeal cancer andcertain types of lung cancer. (Mack, 2004)• Higher rates of cardiovascular disease and death (Jerrett et al, 2005) andreduced lung function (Gauderman et al, 2004) among those close to sourcesof traffic-related pollutants.Pollution and HealthPollution and HealthActual ConsequencesPastor et al, 2007Respiratory System DiseaseRespiratory System Disease• CO and NO2significantly positively correlated with respiratorysystem disease (Lee, 2007)• In France, doctor’s house calls for respiratory system diseasesincreased 3-6% with each increase of 10μg/m3in the mean levelsof PM2.5and PM10.Includes• Pneumonia and influenza• Chronic obstructive pulmonary disease• Bronchitis• Emphysema• AsthmaChronic Obstructive Pulmonary DiseaseChronic Obstructive Pulmonary Disease• Hospital admissions for COPD significantly related to most pollutants(PM10, NO2, CO, O3) on warm days (>=20C); related to SO2on colddays (Yang & Chen, 2007)• Ozone and PM10concentrations positively related to COPD hospitaladmissions (Medina-Ramón et al, 2006)AsthmaAsthma• New onset asthma related to high levels of PM2.5(>=13.7μm/m3) but notrelated to O3(Islam et al, 2007)• 111% increase in poorly controlled asthma in highest quintile of trafficdensity (Meng et al, 2007)• Increased diagnosed asthma and wheezing as traffic flow index increasedamong 6-to-7 year olds; adjusted forgender, family asthma history, andmother’s highest level of schooling (Carbajal-Arroyo et al, 2007)• High ozone concentrations related to emergency room visits (Tolbert et al,2000)Lung CancerLung Cancer• Lung cancer incidence and death both associated with high PM10(>=70μg/m3) in women (Hwang et al, 2007)• Lung cancer mortality increasedue to long-term exposure toPM2.5 (Pope et al, 2002; Krewski et al, 2005)Cardiovascular DiseaseCoronary heart disease, cerebrovascular disease, congestive heart failureCardiovascular DiseaseCoronary heart disease, cerebrovascular disease, congestive heart failure• CO and NO2related to ischemic heart disease emergency department visits(Szyszkowicz, 2007)• Increased susceptibility to adverse cardiovascular events associated withambient air pollution among persons with hypertension, diabetes, and COPD(Peel et al, 2006)• Long-term exposure to particulate matter has also been linked to increasedillness and death rates from cardiovascular disease, and that suddenincreases in air pollution may evencause more heart-related illnesses anddeaths than is seen from lung disease. (Pope, 2004)• Each increase of PM2.5of 10μg/m3associated with 24% greater risk of acardiovascular event and 76% greater risk of death (Miller et al, 2007)• 10μg/m3increase in PM10associated with increase in the rate of admissionfor CHF on the same day. (Wellenius et al, 2006)• In single-pollutant models, PM10, CO, NO2, SO2(but not O3) were positivelyand significantly associated with the rate of admission for CHF on the sameday. (Wellenius et al, 2005)• Vulnerable persons with chronic obstructive pulmonary disease and theelderly susceptible to NO2, PM2.5, PM10at lower levels than the generalpopulation. (Næss et al, 2006)Myocardial InfarctionMyocardial Infarction• After hospitalization with acuteMI, significant associations foundbetween PM10concentrations and hospitalization for congestive heartfailure, new hospitalizations for MI, and death (Zanobetti & Schwartz,2007)Life Expectancy—Oakland Flats and Hills (2000-2003)Life Expectancy—Oakland Flats and Hills (2000-2003)Alameda County505560657075808590951000% 10% 20% 30% 40% 50% 60%Poverty Rate

Life Expectancy (Years)Public Health’s RolePublic Health’s RoleBay Area Regional HealthInequities InitiativeMedical ModelSocio-Ecological HEALTH CARE ACCESSSOCIALINEQUALITIES• Class• Race/ethnicity• Gender• ImmigrationstatusINSTITUTIONALPOWER• Corporations &other businesses• Gov’t agencies• SchoolsNEIGHBORHOODCONDITIONS• Environment• Social• Physical• ResidentialsegregationRISK BEHAVIORS• Smoking• Nutrition• Physical activity• ViolenceDISEASE &INJURY• Infectious disease• Chronic disease• Injury (intentional& unintentional)MORTALITY• Infant mortality• Life expectancy

INDIVIDUAL HEALTH KNOWLEDGE GENETICSUPSTREAMSOCIAL FACTORSDOWNSTREAMHEALTH STATUSBay Area Regional HealthInequities InitiativeA Framework forHealth EquityGoal 1: Increase Quality and Years of Healthy Life• The first goal of Healthy People 2010 is to helpindividuals of all ages increase life expectancy 

# andimprove their quality of life.Goal 2: 

# EliminateHealth Disparities• The second goal of Healthy People 2010 is to eliminatehealth disparities among segments of the population,including differences that occur by gender, race orethnicity, education or income, disability, geographiclocation, or sexual orientation.Healthy People 2010Healthy People 2010Healthy People 2010 recognizes thatcommunities, states, and national organizationswill need to take a multidisciplinary approach toachieving 

# health equity—an approach thatinvolves improving health, education, housing,labor, justice, transportation, agriculture, and theenvironment.Healthy People 2010Healthy People 2010Health InequitiesHealth Inequities“Inequities refer to material, social, gender, racial,income, and other social and economicinequalities that are beyond the control ofindividuals and are therefore considered unfairand unjust.”-Health Canada, Population & Public Health BranchOur Simple GoalOur Simple GoalA healthy, economically vibrant sustainablecommunity in West Oakland• Good jobs• Housing• Education• Clean environmentInstitutional PowerInstitutional PowerWho has the power to change the conditions?• Maximize beneficial local economic impact of port• Minimize adverse environmental and social impactsof port• What is the port’s responsibility?Institutional PowerInstitutional PowerInstitutions play a powerful role in creating theconditions in neighborhoods.Bay Area Regional HealthInequities InitiativeMedical ModelSocio-Ecological HEALTH CARE ACCESSSOCIALINEQUALITIES• Class• Race/ethnicity• Gender• ImmigrationstatusINSTITUTIONALPOWER• Corporations &other businesses• Gov’t agencies• SchoolsNEIGHBORHOODCONDITIONS• Environment• Social• Physical• ResidentialsegregationRISK BEHAVIORS• Smoking• Nutrition• Physical activity• ViolenceDISEASE &INJURY• Infectious disease• Chronic disease• Injury (intentional& unintentional)MORTALITY• Infant mortality• Life expectancy

INDIVIDUAL HEALTH KNOWLEDGE GENETICSUPSTREAMSOCIAL FACTORSDOWNSTREAMHEALTH STATUSBay Area Regional HealthInequities InitiativeA Framework forHealth EquityCannot Have HealthyCommunities Withoutsocial, political, economic powerWhat is the Port’s responsibility?Questions?Questions?Port EmissionsPort EmissionsCARB Emission Reduction Plan for Ports and Goods Movement in CA, Appx B