Public Health, Air Quality, & Eq

Public Health, Air Quality, & Eq

Dr. Tony Iton, MD, JD, MPH

Director of Alameda County Public Health Department

Port of Oakland Maritime Air Quality Improvement Plan

Task Force Meeting 

August, 14, 2007
West Oakland West Oakland 

Health = Hope
HOPE
The Toxic Burden Imposed 

West Oakland

The Toxic Burden Imposed 

West Oakland
Pacific Institute, West Oakland 

Inventory and Air Quality 

Diesel Particulate Matter Emissions Diesel Particulate Matter Emissions
Pacific Institute, West Oakland 

Inventory and Air Quality 

Diesel Particulate Matter Emissions Diesel Particulate Matter Emissions
Port Emissions Port Emissions

Port of Oakland 2005 Seaport Air Em

Cargo Handling Equipment (CHE)
Freeways and Railways Freeways and Railways
Toxic Release 

Inventory Sites

Toxic Release Inventory Sites

http://wwhtml/tris/
Leaking Storage Tanks

Contaminated Sites

Leaking Storage TanksContaminated Sites

Envi
Other Health Effects of the Port Other Health Effects of the Port

Traffic• Pedestrian, bicyclist and motorist

injuries and deaths

• Increasing due to port expansionNoise• Caused by trucks, trains, cars, ships

and construction activities

• Sleep disturbance, endocrine

disruption
The Consequences of this To

Burden

The Consequences of this To

Burden
Theoretical Consequence
CARB, Quantification of Health Impacts and Econo

Air Pollution from Ports and Goods Movem

Health Costs of Goods Movement Health Costs of Goods Movement

Annual cost of air pollution from freight transport in California: $1• 2400 premature deaths• 2000 hospital admissions—$67 million• 62,000 asthma and other lower respiratory symptoms—$1.1 m• 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 ca
WHO estimates that ambient air pollution is responsible for 1.4% 

the world (2002).

Pollution and Disease Pollution and Disease

Rate ratio of United States most polluted cities compared to least = 1.26 for mortality rate (Dockery et al, 1993)According to the California Air Resources Board (2004), attaining 

standards 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) i• 400,000 cases of upper respiratory symptoms (runny nose, itch

children

• 8,000 cases of chronic bronchitis• 500,000 cases of respiratory illness (colds and flu)• 350,000 asthma attacks 
Samet a
• Dock workers, truck drivers, and railroad workers have elevated 

cancer. (Garshick et al, 2004)

• Areas near truck-congested freeways have elevated levels of CO

consituents, and ultrafine particles. (Zhu et al, 2002)

• Residents living near ports have higher rates of oropharyngeal c

certain types of lung cancer. (Mack, 2004)

• Higher rates of cardiovascular disease and death (Jerrett et al, 

reduced lung function (Gauderman et al, 2004) among those clof traffic-related pollutants.

Pollution and Health Pollution and Health
Actual Consequences


P
Respiratory System Disease Respiratory System Disease

• CO and NO

2 significantly positively correlated with respirato

system disease (Lee, 2007)

• In France, doctor’s house calls for respiratory system diseas

increased 3-6% with each increase of 10μg/m

3 in the mean 

of PM2.5 and PM10.

Includes• Pneumonia and influenza• Chronic obstructive pulmonary disease

• Bronchitis• Emphysema• Asthma

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease

• Hospital admissions for COPD significantly related to most pol

(PM10, NO

2, CO, O

3) on warm days (>=20C); related to SO

2 o

days (Yang & Chen, 2007)

• Ozone and PM10 concentrations positively related to COPD hos

admissions (Medina-Ramón et al, 2006)

Asthma Asthma

• New onset asthma related to high levels of PM2.5 (>=13.7μm/m3) 

related to O3 (Islam et al, 2007)

• 111% increase in poorly controlled asthma in highest quintile of t

density (Meng et al, 2007)

• Increased diagnosed asthma and wheezing as traffic flow index in

among 6-to-7 year olds; adjusted for gender, family asthma histomother’s highest level of schooling (Carbajal-Arroyo et al, 2007)

• High ozone concentrations related to emergency room visits (Tolb

2000)



Lung Cancer Lung Cancer

• Lung cancer incidence and death both associated with high P

(>=70μg/m3) in women (Hwang et al, 2007)

• Lung cancer mortality increase due to long-term exposure to 

PM2.5 (Pope et al, 2002; Krewski et al, 2005)

Cardiovascular Disease

Coronary heart disease, cerebrovascular disease, congestive heart 

Cardiovascular DiseaseCoronary heart disease, cerebrovascular disease, congestive heart f

• CO and NO

2 related to ischemic heart disease emergency departm

(Szyszkowicz, 2007)

• Increased susceptibility to adverse cardiovascular events associate

ambient air pollution among persons with hypertension, diabetes, (Peel et al, 2006)

• Long-term exposure to particulate matter has also been linked to 

illness and death rates from cardiovascular disease, and that suddincreases in air pollution may even cause more heart-related illnesdeaths than is seen from lung disease. (Pope, 2004)

• Each increase of PM2.5 of 10μg/m

3 associated with 24% greater ri

cardiovascular event and 76% greater risk of death (Miller et al, 2

• 10μg/m

3 increase in PM10 associated with increase in the rate of a

for CHF on the same day. (Wellenius et al, 2006)

• In single-pollutant models, PM10, CO, NO

2, SO

2 (but not O

3) were 

and significantly associated with the rate of admission for CHF on day. (Wellenius et al, 2005)

• Vulnerable persons with chronic obstructive pulmonary disease an

elderly susceptible to NO

2, PM2.5, PM10 at lower levels than the ge

population. (Næss et al, 2006)

Myocardial Infarction Myocardial Infarction

• After hospitalization with acute MI, significant associations f

between PM10 concentrations and hospitalization for conges

failure, new hospitalizations for MI, and death (Zanobetti & 2007)

Life Expectancy—

Oakland Flats and Hills (2000-2003)

Life Expectancy—Oakland Flats and Hills (2000-2003)

Alameda County

50556065707580859095

100

0% 10% 20% 30% 40% 5

Poverty Rate

Life Expectancy (Years)
Public Health’s Role Public Health’s Role
Bay Area Regional Health In

Socio-Ecological Medical 

HEALTH

CARE 

ACCESS

SOCIALINEQUALITIES• Class• Race/ethnicity• Gender• Immigration 

status

INSTITUTIONALPOWER• Corporations & 

other businesses

• Gov’t agencies• Schools

NEIGHBORHOODCONDITIONS• Environment

• Social• Physical

• Residential 

segregation

RISK BEHAVIORS• Smoking• Nutrition• Physical activity• Violence

DISEASE &INJURY• Infectious disease• Chronic disease• Injury (intentional 

& unintentional)

INDIVIDUAL

HEALTH

KNOWLEDGE

GENETICS UPSTREAM

SOCIAL FACTORS

Bay Area Regional Health In

A Framework for

Health Equity
Goal 1: Increase Quality and Years of Health

• The first goal of Healthy People 2010 is to help 

individuals of all ages increase life expectancy aimprove their quality of life.

Goal 2: Eliminate Health Disparities

• The second goal of Healthy People 2010 is to el

health disparities among segments of the populaincluding differences that occur by gender, race ethnicity, education or income, disability, geogralocation, or sexual orientation.

Healthy People 2010 Healthy People 2010
Healthy People 2010 recognizes that 

communities, states, and national organizatwill need to take a multidisciplinary approacachieving health equity—an approach that 

involves improving health, education, housilabor, justice, transportation, agriculture, anenvironment.

Healthy People 2010 Healthy People 2010
Health Inequities Health Inequities

“Inequities refer to material, social, gender

income, and other social and economic inequalities that are beyond the control of individuals and are therefore considered uand unjust.”

- Health Canada, Population & Public Health Branch
Our Simple Goal Our Simple Goal

A healthy, economically vibrant sustainable community in West Oakland

• Good jobs• Housing• Education• Clean environment
Institutional Power Institutional Power

Who has the power to change the conditions?

• Maximize beneficial local economic impact of • Minimize adverse environmental and social im

of port

• What is the port’s responsibility?
Institutional Power Institutional Power

Institutions play a powerful role in creating the 

conditions in neighborhoods.

Bay Area Regional Health In

Socio-Ecological Medical 

HEALTH

CARE 

ACCESS

SOCIALINEQUALITIES• Class• Race/ethnicity• Gender• Immigration 

status

INSTITUTIONALPOWER• Corporations & 

other businesses

• Gov’t agencies• Schools

NEIGHBORHOODCONDITIONS• Environment

• Social• Physical

• Residential 

segregation

RISK BEHAVIORS• Smoking• Nutrition• Physical activity• Violence

DISEASE &INJURY• Infectious disease• Chronic disease• Injury (intentional 

& unintentional)

INDIVIDUAL

HEALTH

KNOWLEDGE

GENETICS UPSTREAM

SOCIAL FACTORS

Bay Area Regional Health In

A Framework for

Health Equity
Cannot Have Healthy 

Communities Without

social, political, economic p

What is the Port’s responsib

Questions? Questions?
Port Emissions Port Emissions

CARB Emission Reduction Plan for Ports and Goods Moveme