and PM - Umweltbundesamt

11.11.2013
Evidence on health effects
in support of the review of
the EU air quality policies:
the WHO REVIHAAP and
HRAPIE Projects
Marie-Eve Héroux
Technical Officer, Air Quality & Noise
European Centre for Environment and Health
WHO Regional Office for Europe
Outline
• WHO work on air quality
• Context for REVIHAAP and HRAPIE projects
• REVIHAAP/HRAPIE Process
• Main findings
• Implications for WHO guidelines and EU air
policy
• Conclusions
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WHO core functions – summary
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Providing leadership on matters critical to health and
engaging in partnerships where joint actions are needed
Articulating ethical and evidence-based policy positions
Setting normative guidance
Shaping the research agenda, and stimulating the
generation, translation and dissemination of valuable
knowledge
Providing technical support, catalyzing change and
developing sustainable institutional capacity
Monitoring the health situation and assessing the trends
Based on: http://www.who.int/governance/eb/constitution/en/
WHO Air Quality Guidelines
• Air quality guidelines
– Global update (2005)
• Indoor air quality
– Dampness and mould (2009)
– Selected pollutants (2010)
– Household fuel combustion (planned:
2013)
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WHO AQG Summary (2005)
Pollutant
Particulate matter
PM2.5
Averaging time
AQG value
EU standard
(target or limit value)
1 year
24 hour (99th percentile)
10 µg/m3
25 µg/m3
25 µg/m3
--
1 year
24 hour (99th percentile)
20 µg/m3
50 µg/m3
40 µg/m3
50 µg/m3***
Ozone, O3
8 hour, daily maximum
100 µg/m3
120 µg/m3***
Nitrogen dioxide, NO2
1 year
1 hour
40 µg/m3
200 µg/m3
40 µg/m3
200 µg/m3***
Sulfur dioxide, SO2
24 hour
10 minute
20 µg/m3
500 µg/m3
125 µg/m3***
350 µg/m3*** (1 hr)
PM10
Levels recommended to be achieved everywhere in order to
significantly reduce the adverse health effects of pollution
***Permitted exceedances each year
IARC Monographs
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PM10 levels have remained overall
stable and above WHO guidelines...
WHO
Guideline
=
20 µg/m3
PM10 levels in European Region of WHO
Source: Airbase/EEA
Context for REVIHAAP & HRAPIE work
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About REVIHAAP & HRAPIE
• Objective: provide the European Commission and its
stakeholders with scientific evidence-based advice on
health aspects of air pollution
• Work in support of the review of EU air quality legislation
due in 2013
• Address health considerations only
• Jointly financed WHO and EC, coordinated by
WHO/Europe
• Final report for REVIHAAP now available on WHO
website
• Project HRAPIE completed Sept 2013 – report available
soon
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REVIHAAP & HRAPIE Process
REVIHAAP: Evidence review in response to 24 key policy questions from the EC
– Review of evidence and drafting the answers: 29 authors
– External review: 30 experts
HRAPIE: response to 2 questions
– Survey of experts on emerging issues
– Recommendations for health impact assessment
• Scientific Advisory Committee (8 experts, 3 meetings, multiple TCs)
• Two expert meetings (Aug 2012 & Jan 2013)
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REVIHAAP and HRAPIE
Scientific Advisory Committee (SAC)
• Hugh Ross Anderson, United Kingdom
• Bert Brunekreef, The Netherlands
• Aaron Cohen, United States
• Klea Katsouyanni, Greece
• Daniel Krewski, Canada
• Wolfgang G. Kreyling, Germany
• Nino Künzli, Switzerland
• Xavier Querol, Spain
REVIHAAP contributors
Authors of answers and rationales
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Richard Atkinson, United Kingdom
Lars Barregård, Sweden
Tom Bellander, Sweden
Rick Burnett, Canada
Flemming Cassee, The Netherlands
E. de Oliveira Fernandes, Portugal
Francesco Forastiere, Italy
Bertil Forsberg, Sweden
Susann Henschel, Ireland
Gerard Hoek, The Netherlands
Stephen T Holgate, United Kingdom
Nicole Janssen, The Netherlands
Matti Jantunen, Finland
Frank Kelly, United Kingdom
Timo Lanki, Finland
Inga Mills, United Kingdom
Ian Mudway, United Kingdom
Mark Nieuwenhuijsen, Spain
Bart Ostro, United States
Annette Peters, Germany
David Phillips, United Kingdom
C. Arden Pope III, United States
Regula Rapp, Switzerland
Gerd Sällsten, Sweden
Evi Samoli, Greece
Peter Straehl, Switzerland
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Annemoon van Erp, United States
Heather Walton, United Kingdom
Martin Williams, United Kingdom
External revievers
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Joseph Antó, Spain
Alena Bartonova, Norway
Vanessa Beaulac, Canada
Michael Brauer, Canada
Hyunok Choi, United States
Bruce Fowler, United States
Sandro Fuzzi, Italy
Krystal Godri, Canada
Patrick Goodman, Ireland
Dan Greenbaum, United States
Jonathan Grigg, United Kingdom
Otto Hänninen, Finland
Roy Harrison, United Kingdom
Peter Hoet, Belgium
Barbara Hoffmann, Germany
Phil Hopke, United States
Fintan Hurley, United Kingdom
Barry Jessiman, Canada
Haidong Kan, China
Thomas Kuhlbusch, Germany
Morton Lippmann, United States
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Robert Maynard, United Kingdom
Sylvia Medina, France
Lidia Morawska, Australia
Antonio Mutti, Italy
Tim Nawrot, Belgium
Juha Pekkanen, Finland
Mary Ross, United States
Jürgen Schneider, Austria
Joel Schwartz, United States
Frances Silverman, Canada
Jordi Sunyer, Spain
Observers
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Markus Amann, IIASA
Arlean Rhode, CONCAWE
Wolfgang Schoepp, IIASA
André Zuber, European Commission
WHO Secretariat (ECEH Bonn)
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Marie-Eve Héroux
Michal Krzyzanowski (up to 08.2012)
Svetlana Cincurak
Kelvin Fong
Elizabet Paunovic
Helena Shkarubo
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REVIHAAP format –
Questions, answers and rationales
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Answer
– Couple paragraphs, short, clear, concise
– Directed at policy makers; prerequisite for usefulness in the policy process
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Rationale
– Few pages, but more complex questions require longer text
– Comprehensive, evidenced-based
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List of references and methodology
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Use of recent major reviews plus
systematic review of more recent pubs
26 Key policy-relevant questions for the EU
• Covers regulated air pollutants at EU level:
PM, ozone, NO2, SO2, metals (As, Cd, Hg, Pb, Ni), PAHs
• New findings regarding health effects
• Concentration-response functions and thresholds
• Air pollution constituents and sources
• Integration of evidence and policy implications
• WHO air quality guidelines
• EU policies
• Critical data gaps
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REVIHAAP Main Findings
Evidence on health effects of PM
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Evidence on health effects of PM
• The scientific conclusions of the 2005 WHO Guidelines about the evidence
for a causal link between PM2.5 and adverse health outcomes in humans
have been confirmed and strengthened and, thus, clearly remain valid
• New studies on short- and long-term effects
• Studies linking long-term exposure to PM2.5 to several new health
outcomes (e.g. atherosclerosis, adverse birth outcomes, childhood
respiratory disease, neurodevelopment and cognitive function,
diabetes)
• Associations between long-term exposure to PM2.5 and mortality at
levels below the current annual WHO AQ
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Organs of the human body affected by
particulate air pollution
Modified after Peters et al. JOEM 2011
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Long-term exposure to low PM2.5 and mortality
Canadian cohort study (2.1 million adults, 1991-2001; annual
average: 8.7 µg/m3)
Crouse et al. EHP 2012
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Meta-analysis of the association between long-term
exposure to PM2.5 and cardiovascular mortality
Study
RR (95%CI) %
per 10 µg/m3 weight
Pub. year
2002
2007
2008
2011
2011
2011
2012
2013
2012
2011
1.00 1.15
2.00
Hoek et al, Env Health 2013
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Mortality and long-term exposure to PM2.5
Results of a cohort study in Rome (1.3 million adults followed from 2001 to
2010)
PM2.5: 3-dimensional Eulerian model (1x1 km)
c= % increase in risk per 10 µg/m3
c=4
%
AQG
c=6
%
c=10
%
EU LV
Cesaroni et al. EHP 2013
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Evidence on exposure times
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Evidence on exposure times
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Mortality and morbidity effects of long-term exposure greater than those
of short-term
– Most evidence for PM2.5, some for PM10
– Hardly any long-term studies on coarse and ultrafine particles
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Strong evidence of daily (24-hour average) exposures to PM associated
with both mortality and morbidity
– Immediately and in subsequent days
– Repeated (multiple days) exposures may result in larger health
effects than the effects of single days
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Evidence on peak exposures
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Toxicological and clinical studies show that peak exposures (< few
hours) lead to immediate physiological changes (supported by
epidemiological studies)
EEG brain
Blood pressure
Heart function
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Evidence on exposure times (continued)
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Both short-term (such as 24-hour average) and long-term (annual means)
exposure to PM2.5 affect health
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May not affect same populations
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Not all biological mechanisms relevant for both acute and long-term
effects
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Short-term monitoring relevant for public health action in periods of
high PM
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Effects due to exacerbations and progression of underlying diseases
Maintaining independent short-term and long-term limit values for ambient
PM10 in addition to PM2.5 to protect against the health effects of both fine
and coarse particles is well supported
Evidence on thresholds and
linearity
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Latest evidence on thresholds and linearity
for PM2.5 – short-term exposure
• Substantial evidence on associations observed down to very
low levels of PM2.5
• No observed threshold below which no one would be
affected
• No deviations from linearity for ambient levels of PM2.5
observed in Europe
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Latest evidence on thresholds and linearity
for PM2.5 – long-term exposure
• Few data at low PM2.5 levels
• No evidence of a threshold in the observed PM2.5 range
• Recent studies reporting effects on mortality at concentrations
below an annual average of 10 µg/m3
• Suggestions of a steeper exposure-response relation at lower
PM2.5 levels
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Conclusions on thresholds and linearity
for PM2.5
In the absence of a threshold and in light of linear or supra-linear
risk functions, public health benefits will result from any
reduction of PM2.5 concentrations whether or not the current
levels are above or below the limit values.
Source: Pope et al. 2011
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Evidence on fractions and
components other than PM2.5 and
PM10
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Three important components or metrics
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PM mass (PM2.5, PM10) comprises fractions with varying types and
degrees of toxicity
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Substantial exposure and health research findings
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Not sufficient evidence to differentiate constituents that are more closely
related to specific health outcomes
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The following may provide valuable metrics for the effects of mixtures of
pollutants from a variety of sources:
1.
Black carbon
2.
Secondary inorganic aerosols
3.
Secondary organic aerosols
Black carbon
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Black carbon (light absorption methods) vs.
Elemental/organic carbon (thermo-optical
methods)
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Recent evidence linking BC with
cardiovascular health effects and premature
mortality
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Both short term (24 hours) and long term
(annual)
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BC associations remain robust when
together with PM2.5
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Black carbon (continued)
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May operate as universal carrier of
chemicals of various toxicity
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Always associated with other substances
from combustion of carbon-containing
fuels, such as organic compounds
Additional air quality metric for evaluating
health risks of primary combustion from
traffic, including organic particles, not taken
into account with PM2.5 mass
Size: Coarse particles
• Associated in epidemiological studies with
– adverse respiratory and also cardiovascular health effects
– premature mortality
• Data from clinical studies are scarce
• Toxicological studies report that coarse particles can be
equally toxic compared to PM2.5 on a mass basis
• Difference in risk between coarse and fine PM can at least
partially be explained by differences in intake and different
biological mechanisms
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Size: Ultrafine (<0.1 µm) particles
• Limited evidence on short-term
exposures and cardiorespiratory health
as well as the central nervous system
• Hardly any data on chronic exposure
• Clinical and toxicological studies have
shown that ultrafine particles in part
act through mechanisms not shared
with larger particles that dominate
mass-based metrics such as PM2.5 or
PM10
Evidence on PM sources
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Source types
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Road traffic
– carbonaceous material (most evidence)
– traffic-generated dust, including road, brake
and tyre wear
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Coal combustion (sulfate)
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Shipping (oil combustion, sulfate)
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Power generation (oil and coal combustion)
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Metal industry (e.g. nickel)
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Biomass combustion (e.g. wood combustion,
wildfires)
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Desert dust episodes
Evidence of health risks from proximity to roads
• Elevated health risks associated with living in close proximity to roads
is unlikely to be explained by PM2.5 mass.
• Current evidence does not allow discernment of the pollutants or
pollutant combinations that are related to different health outcomes,
although association with tail pipe primary PM is increasingly
identified.
• Toxicological research indicates that non-exhaust pollutants could be
responsible for some of the observed health effects.
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Ozone and NO2
Evidence on health effects of ozone
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New evidence for an effect of long-term exposure to ozone on:
• mortality, especially among persons with potentially predisposing conditions
• asthma (incidence, severity, hospital care), lung function growth
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Adverse effects of exposure to daily ozone concentrations (max daily 1-hr or 8-hr
mean):
• all-cause, cardiovascular and respiratory mortality
• respiratory and cardiovascular hospital admissions,
• after adjustment for the effects of particles (PM10)
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The evidence for a threshold for short-term exposure not consistent, but likely to lie
below 45 ppb (90 µg/m3) (max 1-hr)
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Evidence on health effects of NO2
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New studies on associations between day-to-day variations in NO2 and variations
in mortality, hospital admissions, and respiratory symptoms.
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New studies on associations between long-term exposure to NO2 and mortality
and morbidity.
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Both short- and long-term studies found these adverse associations at
concentrations at or below the current EU LV (= WHO AQG).
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Associations (short-term NO2) remain after adjustment for other pollutants
(including PM10, PM2.5, black smoke).
– … it is reasonable to infer that NO2 has some direct effects.
– No health evidence to suggest changing the averaging time for the
short-term EU limit value (1-hour).
Implications for WHO guidelines
• REVIHAAP recommends revision of 2005 WHO guidelines
• PM:
• Need to revise guidelines for PM2.5 and PM10 (24-hr and
annual)
• Additional guideline to capture effects of road vehicle PM
emissions, building on black carbon evidence
• Evidence on others, such as UF and organic carbon, too
scarce for guideline development
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Implications for WHO guidelines
• Ozone:
• Additional guideline for long-term (months to
years) average ozone to be considered
• NO2:
• Short-term and long-term effects to be considered
during guideline revision
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HRAPIE
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HRAPIE questions
• Is there evidence of new emerging issues on risks to
health from air pollution, either related to
– specific source categories (e.g. transport, biomass combustion, metals
industry, refineries, power production),
– specific gaseous pollutants or
– specific components of particulate matter (e.g. size-range like nanoparticles and ultra-fines, rare-earth metals, black carbon (EC/OC))?
• What concentration-response functions for key pollutants
should be included in cost-benefit analysis supporting the
revision of EU air quality policy?
HRAPIE survey on emerging issues
• Assess views of
stakeholders and experts by
on-line electronic survey tool
in May/June 2013
• Total of 100 respondents
• Emerging risks identified
(i) recently or
(ii) may have existed for a
long time, but only recently
their significance is coming
to the fore
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HRAPIE survey on emerging
issues (continued)
• Strong signal for ‘metal’ components for a number of source
categories, and for ‘smaller’ PM, esp. PM2.5 and UFP
• Concern for the increase in prevalence of certain sources,
and growth in exposed population
• Experts feel that many well-known issues still require
attention
• Consistent with REVIHAAP evidence review
• Report on WHO website available soon
HRAPIE recommendations for CBA
• Cost-benefit analysis (CBA) of the selected policy
scenario: estimation of all health benefits supported by
evidence to compare with costs of emission reduction under
the scenario
• Pollutants considered: PM2.5, PM10, O3, NO2
– All pollutant-outcome pairs have sufficient evidence for causality
of effects as assessed by REVIHAAP
– Classification depending on uncertainty of available data and
precision of estimates enabling reliable quantification of effects
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HRAPIE recommendations: contents
REVIHAAP and HRAPIE Main conclusions
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Considerable amount of new scientific information on health effects of PM,
ozone and NO2 has been published in the recent years
– Evidence has strengthened
– Effects observed at levels commonly present in Europe
– Supports the scientific conclusions of the WHO Air Quality Guidelines,
last updated in 2005
– Indicates that the effects can occur at air pollution concentrations lower
than those serving to establish the 2005 Guidelines
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Provides scientific arguments for the decisive actions to improve air quality
and reduce the burden of disease associated with air pollution in Europe.
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THANK YOU FOR YOUR
ATTENTION!
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