STEP Conference 2014 – Cleaner Air, Healthier Places

Developing evidence-based messages on

air pollution and health

18th November 2014

Dr. Colin N. Ramsay Consultant Epidemiologist Health Protection Scotland

Presentation Aims

To outline the rationale for the Scottish Government /

SEPA / SUAQ Programme project on Air Pollution and

Health Impacts (APHIP)

• Air Pollution and Health in Scotland – the issues behind the

project.

• Why do we need this particular project – the questions the

project aims to address.

• How do we plan to address the questions.

• What do we hope to achieve – the intended outcomes.

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Air Pollution Today – Global Phenomenon

Nasa satellite image reveals the extent of

China's air pollution

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Air Pollution in Scotland / Glasgow

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• Death risk increased even with low exposure.

• The greatest health threat was from long-term exposure to fine-particle air pollution with a

diameter of less than 2.5 micrometers (PM2.5).

• It was found that for every increase of 5 µg/m3 in annual exposure to PM2.5, the risk of

dying from natural causes increases by 7%.

"Our findings show that long-term exposure to fine particulate air pollution is associated with

natural-cause mortality, even at concentration ranges well below the present European annual

mean limit value.”

Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22

European cohorts within the multicentre ESCAPE project

Background

Few studies on long-term exposure to air pollution and mortality have been reported from Europe.

Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to

investigate the association between natural-cause mortality and long-term exposure to several air pollutants.

Project Title:

Air Pollution and Health Impacts Project (APHIP)

Project Aim: • To develop an evidence-based set of key messages on air

pollution and health impacts focused on encouraging people

to adopt healthier and less polluting transport options.

Funding: • By Scottish Government Environment Directorate and SEPA

– Scottish Environment on the web (SEWEB) project via

Scottish Urban Air Quality Steering Group

as part of Research Programme.

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The Issue

- Air Pollution and Health Impacts in Scotland

Current consensus of views on air pollution and health

• Air pollution is not good for human health.

• Multiple sources of air pollution; natural and man made

(anthropogenic).

• Anthropogenic air pollution should be controllable, ideally

preventable.

• Transport (road traffic) sourced pollution (particulates, NOx,

ozone) is a major contributor to anthropogenic air pollution and

health impacts.

• Changing the pattern of road transport use could reduce air

pollution, especially in urban areas.

• People need to be “encouraged” to change their travel habits

and choice of transport: need “key messages”. 8

The Questions (1)

If we want to persuade people to change their behaviour,

we have to have a sound evidence-base.

- Are we sure the current consensus view is correct?

• What are the current trends in road transport use in Scotland?

• How bad is (traffic related) air pollution in Scotland?

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10 Figure 1: Vehicles licensed - See more at: http://www.transportscotland.gov.uk/statistics/j285663-03.htm#sthash.zD0SiI6j.dpuf

Figure 1: Vehicles licensed Figure 2: New registrations of vehicles

Figure 3: Traffic (vehicle kilometres) Figure 4: Reported road casualties

Current Trends in Road Transport Use in Scotland (Transport Scotland)

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Overview of travel in Scotland

2007-08 2012-13 Change

Car Traffic (m/veh km) on all

roads 34,545 33,777 -2%

Pedal Cycles (m/veh km) on

all roads 240 310 29%

ScotRail Passengers (millions) 74.5 83.3 12%

Bus Passengers (millions) 488 423 -13%

Air Passengers (millions) 25,132 22,207 -12%

Ferry Passengers (millions) 10.7 9.7 -9%

Source: STS 2013

Transport Scotland Statistics

Trends in PM2.5 in Scotland (de-seasonalised)

2007 - 2013

12 HPS Air Quality (PM2.5 particulate air pollution) and Mortality in Scotland - Briefing Document: http://www.hps.scot.nhs.uk/enviro/spotlightdetail.aspx?id=629

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Trends in NO2 in Scotland

“Air pollution: the mass killer that keeps on killing”

Sunday Herald New Era magazine, 19 May 2013

“By far the highest pollution was found on the

Glasgow subway”

Maps based on monitoring for nitrogen dioxide,

analysed by Friends of the Earth Scotland.

The Questions (2)

Assuming the evidence supports the consensus view

How do we create “Cleaner Air, Healthier Places”?

- What questions is this project trying to answer?

• What are the health impacts of anthropogenic (traffic related) air

pollution generally and in Scotland particularly?

• How do we effectively encourage people to change their travel

habits and choice of transport?

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COMEAP – Mortality Effects on Long Term Exposure

to Particulate Air Pollution in the UK (2010) • Review of evidence of health impacts / mortality burden associated with

man made (anthropogenic) particulate air pollution (based on 2008 UK air

pollutant data).

• Effect of anthropogenic particulate pollutant was equivalent to 29,000

deaths in UK at typical ages; equivalent to loss of 340,000 life years

(allowing for variation in age at time of death).

• Measures are averages / aggregates across the population.

– not known how effects distributed among individuals.

• “As everyone dies eventually, no lives are ever saved by reducing

environmental exposures – deaths are delayed resulting in increased life

expectancy”.

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Estimates of Mortality Associated with Fine Particulate

Air Pollution by Local Authority, in Scotland

Area Population

Age 25+

Deaths

Age 25+

Mean

Anthropogenic

PM2.5 (μg m-3)

Attributable

Fraction

(%)

(1)

Attributable

Deaths

Age 25+

(2)

Associated

Life Years Lost

(3)

UK 42788600 557828 9.4 5.3 28969 306835

England 35878000 458743 9.9 5.6 25002 264749

Scotland 3660533 53800 6.8 3.9 2094 22474

Wales 2075433 31041 7.5 4.3 1320 13549

Northern Ireland 1174633 14243 6.6 3.8 553 6063

Footnotes Table

1.Attributable fraction: the proportion of deaths estimated as due to long-term exposure to anthropogenic particulate air pollution. 2.Attributable deaths: long-term exposure to anthropogenic particulate air pollution is estimated to have an effect on mortality risks equivalent to the number of attributable deaths. Air pollution is likely to contribute a small amount to the deaths of a larger number of exposed individuals rather than being solely responsible for the number of deaths equivalent to the calculated figure of attributable deaths. 3.Associated life-years lost: the years of life lost to the population due to increased mortality risk attributable to long-term exposure to particulate air pollution.

Table 1: Baseline population, modelled population-weighted mean concentrations (µg m-³) and estimated effects on annual mortality in

2010 of anthropogenic PM2.5 air pollution.

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Estimates of Mortality Associated with Fine Particulate

Air Pollution by Local Authority, in Scotland (cont:)

Scotland Council

Area

Population

Age 25+

Deaths

Age 25+

Mean

Anthropogenic

PM2.5 (μg m-3)

Attributable

Fraction

(%)

(1)

Attributable

Deaths

Age 25+

(2)

Associated

Life Years Lost

(3)

Aberdeen City 150600 2049 7.4 4.2 86 936

Aberdeenshire 172300 2198 5.6 3.2 70 749

Dumfries &

Galloway 109067 1790 5.8 3.3 60 597

Dundee City 97900 1677 7.3 4.1 69 774

Edinburgh,

City of 339533 4169 8.6 4.9 205 2269

Eilean Siar 19400 349 4.2 2.4 8 85

Fife 253733 3770 6.8 3.9 146 1569

Glasgow, City

of 408333 6508 8.3 4.7 306 3333

Highland 160167 2296 4.3 2.5 57 641

Table 2: Baseline population, modelled population-weighted mean concentrations (µg m‾³) and estimated effects on annual mortality

in 2010 of anthropogenic PM2.5 air pollution.

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APHEKOM

The Research Approach

How do we plan to address the research questions?

• Adopt “Good Place Better Health” (GPBH) model (Scottish

Government).

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“Historically we have focused on

creating environments free from

significant hazards. Whilst this

continues to be important we now

recognise an additional need to

create positive physical environments

which nurture health and wellbeing.”

Good Places, Better Health

Implementation Plan 2008

Good Places Better Health Method - Project

Three components:

• A review of published evidence on health impacts of air pollution.

• A review of published evidence on strategies and methods of

changing people’s behaviour on transport choices.

• A review of key factors and influences that create the current

patterns of air pollution and determine people’s choice of

transport:

- using modified DPSEEA conceptual model to frame and map

issues

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Research Evidence on Air Pollution and Health Impacts Journal publications 2012 / 2013:

• Occupational and Environmental Medicine: 85 papers

• Lancet: 102 papers

• Epidemiology: 138 papers

• Research findings sometimes inconsistent / contradictory.

• Study locations / populations are heterogeneous, hence may not be

representative of experience in UK / Scotland.

• Reliance on systematic reviews of evidence to determine the most robust

estimates of health effects.

• Reliance on expert groups (e.g. COMEAP) and consensus statements

for conclusions on impacts of air pollution, for use in policy

formulation and to guide public health action.

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EU / WHO Initiatives

Review of Evidence on Health Aspects of Air Pollution

(REVIHAAP) (2013)

Provides additional support for effects of PM10 and PM2.5 on short and long

term exposures on mortality and morbidity.

• Long term exposure to PM2.5 is a cause of cardiovascular morbidity and

mortality.

• Evidence of association between PM2.5 and atherosclerosis, adverse

birth outcomes, childhood respiratory disease (asthma).

• Emerging evidence of association between long term PM2.5 exposure

and neurodevelopmental / cognitive function (dementia) and chronic

metabolic conditions e.g. diabetes.

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Review of

Evidence on

Efforts to

Change

People’s

Transport

Choices

POLICY

and

ACTION

Modified DPSEEA Process

Upstream factors

Downstream factors

Good Places Better Health Methodology

Modifiers

mDPEESA Conceptual Model – Upstream Factors

Drivers Pressures Environmental State

Driver - Transport policy to date: • Geared to efficient movement of people and goods;

• Bur recognition that transport systems have significant impacts

on quality of life and health.

Driver - Transport in future: • Should be aimed at protecting and promoting good health

minimising CO2 production as well as providing effective means

of moving people and goods.

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• N.B. The law of unintended consequences e.g. use of diesel engines in cars; CO2 but NOx

• Hence S.Gov. Low Emission Strategy (LES).

mDPSEEA Modelling

Final Stage: Identify Actions

Low Emission Strategy Upstream

Interventions Downstream

Interventions

By-products:

• Review of evidence on air pollution and health impacts with key

messages based on best evidence.

• Review of evidence on influencing and modifying behaviour

linked to reducing air pollution associated with transport use, with

key messages on what works in practice, in behaviour

modification.

• mDPSEEA map of relationships between upstream and

downstream factors that influence the current environmental

state of road traffic related air pollution.

Main Output:

• Formulate key messages aimed at the public, policy makers (and

potentially politicians) based on research evidence-base and

mDPSEEA map. 27

Intended Project Outputs and Outcomes