Download Indoor Air Pollution

Research and services for healthy
megacities in the 21st Century
1|
Dr. Carlos Dora,
Coordinator, Public Health and Environment
World Health Organization
Public health and environment
This presentation
• Environmental causes for large burden of
Non Commnicable Diseases (NCDs)
• Urban policies that improve health and
prevent disease
• Air pollution a cause and an indicator
• Knowledge gaps – emerging questions
• Opportunities and synergies for
meteorology and health
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Public health and environment
Enormous burden of NCDs
2 in 3 deaths are from NCDs
Cardiovascular disease, mainly heart
disease, stroke
Cancer
Chronic respiratory diseases
Diabetes
Injuries
Costs: Trillions of U$ dollars
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Public health and environment
One third of urban populations live
in slums
4|
Public health and environment
Vulnerable (urban, older) populations
are growing rapidly
5|
Public health and environment
Extreme heat is associated with
increased mortality
6|
Public health and environment
For WHO as the Global Public Health
Organization the question are:
•What are the main diseases and their risk
factors?
•What are the route causes these risk factors?
•What are the best options to address them,
can we do about it?
•How do we best work with others to address
the above risks?
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Public health and environment
Environmental factors already cause over 25% of
global burden of disease
– world's least resilient populations most affected
Share of burden of disease
Diarrhoea
Respiratory infections
Malaria
Perinatal conditions
Communicable
Diseases
Childhood cluster
HIV/AIDS
Other unintentional injuries (excl. road traffic)
Cardiovascular diseases (IHD, CVD etc)
Chronic respiratory diseases (COPD, asthma etc)
Road traffic injuries
Noncommunicable
Diseases & Injuries
Cancers
Lead-caused MMR
0%
1%
2%
3%
4%
Environmental Fraction
Source: WHO Burden of Disease statistics
8|
Public health and environment
5%
6%
Total
7%
8%
9% 10%
Health in a 'Green Economy'
•
•
•
•
9|
Focus on policies to mitigate climate change proposed
by IPCC
Identify the health co-benefits &risks
Policies/investments most beneficial to health and equity
Constructive critique of IPCC proposed priorities for
action
Public health and environment
Health co-benefits from green and climate
friendly policies – Transport
Findings:
10 |
•
We are missing major health and mitigation co-benefit
from cycling/walking/transit & compact urban land use.
•
IPCC (and current transport investments) emphasize
improved vehicle fuels and engines; these may even
increase health risks from injuries, physical inactivity and
local air pollution (diesel)
Public health and environment
Health co-benefits from climate friendly
policies – Household Energy
Findings – IPCC (and Energy sector investments)
lack emphasis on household energy solutions
11 |
•
Cleaner biomass/biogas stoves can avert 2 million deaths annually from
childhood pneumonia, COPD and lung cancers, and reduce climatechanging Black Carbon emissions
•
Solar PV can replace kerosene for household electricity – averting
injuries, respiratory conditions and possibly TB
Public health and environment
Health co-benefits to health from green
and climate-friendly policies – Housing
IPCC overlooks slum housing /non technological options
12 |
•
More climate friendly housing, and better siting/planning can:
reduce deaths and illness from extreme heat/cold exposures &
urban heat island effect;
•
Improved natural ventilation and screening measures can protect
health from: vector borne and respiratory diseases/TB; asthmas
and allergies.
Public health and environment
Implications of Health in a Green Economy
1. Health co-benefits to be included in next set of IPCC
recommendations/priority setting
2. Increase chances of support from Climate Finance
3. Make health part of economic valuation climate strategies and
investments
4. Widen the use of health impact assessment (HIA) to identify
policies with best health performance
5. Facilitate that health is used as part of monitoring-reportingverification of sector policies and their health impacts
13 |
Public health and environment
Health in a green economy: 'Green' urban transport can reduce chronic disease, injuries and improve health equity
Transport reliant on private
vehicles increases congestion,
pollution, and physical inactivity.
Safe walking/cycling and rapid
transit networks can reduce injury,
cardiovascular disease & support
healthy physical activity.
Cycling to work reduced premature
mortality by 30% among commuter
groups in Shanghai & Copenhagen.
Rapid transit/NMT improves access
to schools, jobs & services for poor,
children, women, elderly & disabled,
improving equity.
14 |
Public health and environment
Evidence: Health outcomes directly linked to type of
urban infrastructure investment
Infrastructure for different travel modes (including presence and proximity of infrastructure)
More infrastructure
facilitating walking
(including general
assessments of
“walkability” of
neighbourhoods as
well as presence of
specific features, e.g.
pavements)
Increased walking, cycling or active
94,133,138,144,146,147,154,175,223–229
transport
Increased physical
104,154,155,160,176,184,223,228,230–239
activity
Reduced BMI or
111,118,119,165,224,234,238–240
obesity
234
Reduced air pollution-related effects
224
Improved reported health status
222,224
Reductions in specific health problems
47
Lower mortality / higher life expectancy
More infrastructure
facilitating cycling
Increased walking, cycling or active
94,136–139,141,144,171,175,241–243
transport
Increased physical
27,104,157,159,161,184,244
activity
Increased walking, cycling or active
44,133,140,146
transport
More infrastructure
facilitating public
transport use
15 |
Less walking, cycling or
active transport
Review of
studies on
infrastructure
investment,
physical
activity and
health –
89,94,150,152,179,245
103,140,157,159,182
Increased physical activity
113,117
Reduced BMI or obesity
246
Reduced air pollution-related effects
Less infrastructure
facilitating car travel
(including parking,
motorways)
179
Less active transport
Increased walking, cycling or active
245,247
transport
73
Reduced BMI or obesity
Public health and environment
WHO/Health in Green
Economy
(forthcoming)
Cost benefit analyses:
WHO tool for estimating health economic gains from cycling
Download the guidance document,
HEAT for cycling and user guide from
Public health and environment
16 | www.euro.who.int/transport/policy/20070503_1
2: Green housing and health
Little focus on energy-efficient heating, cooling and
natural ventilation can reduce strokes and
respiratory illness as well as TB and vector-borne
diseases;
Little focus on slums /poor housing - where needs are
greatest/benefits could be multiplied
Solar hot water heating - India
17 |
Public health and environment
Slum in Mexico City
Green energy and health
Light a billion lives - India
Solar hot water heating is an fast-growing, popular technology in
Turkey, China, South Africa, Middle East, etc.
China is mass marketing next-generation solar PV & passive. Below
passive solar "combi" hot water space heating raised night-time
winter temperatures from 6-8º C lows in village near Beijing
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Public health and environment
But these innovations lack global policy support
and financing for scale-up
Cape Town, South Africa's Kuyasa neighborhood slum upgrade: First
to be financed by UN Clean Development Mechanism (CDM). Solar
hot water systems, sewage and insulation (below) will help reduce
heat-related, respiratory and waterborne diseases.
BUT of 4500 CDM projects only 14 were for housing (2009)
CDM requirements remain too complex for most low-income
communities; don't consider "whole house" approaches; and don't
consider health.
19 |
Public health and environment
Making the link between health and sustainable
development.
Enabling health is considered in the planning and
implementation
20 |
Public health and environment
Air pollution a link for environment, health
and development
PM<10 – Coarse
PM <2.5 – Fine
PM<1 – Ultrafine
Medgadget .com
Particles smaller than 2.5 micrometers are able to penetrate through the lungs
and effect the body more systematically leading to cardiovascular disease and
can lead to adverse pregnancy outcomes.
21 |
Public health and environment
Burden of disease from Air Pollution
– higher than previous WHO estimates
• Outdoor air pollution → 3.3 million deaths/yr – large
proportion urban exposures
• Indoor air pollution → 3,5 million deaths/yr – mostly from
inefficient biomass/coal cookstoves
22 |
(Lim S et al, Lancet, 2012)
Public health and environment
Air Pollution is responsible for a very
large proportion of major NCDs
Indoor Air Pollution
~50% of all pneumonia deaths among children under 5
~30% of all COPD (Chronic obstructive pulmonary disease) deaths
~18% of disease & deaths from ischaemic heart disease
Outdoor Air pollution
~22 % of disease & deaths from ischaemic heart disease
~15 % of deaths from pneumonia in children under 5
~5% of COPD deaths – (from ambient ozone pollution)
Air pollution also is a factor in: Cancers, Asthma (ozone), Cataracts,
Adverse pregnancy outcomes, TB
23 |
(WHO,
2009/Lim,
Lancet, 2012)
Public
health
and environment
“Review of evidence on health aspects of air
pollution - REVIHAAP”, WHO 2013
selected conclusions on PM (A1)
Confirm and strengthen results form the 2005 WHO Guidelines on
Air Quality and Health.
–New studies on short- and long-term effects;
–Long-term exposures to PM2.5 are a cause of
cardiovascular mortality and morbidity;
–More insight on physiological effects and plausible
biological mechanisms linking short- and long-term PM2.5
exposure with mortality and morbidity;
–Studies linking long-term exposure to PM2.5 to several new
health outcomes (e.g. atherosclerosis, adverse birth
outcomes, childhood respiratory disease).
24 |
Public health and environment
LAQN Seminar, London, 21 June
2013
24
Meta-analysis of the association between long-term
exposure to PM2.5 and cardiovascular mortality
Study
Pub.
year
RR (95%CI)
%
per 10 µg/m3 weight
2002
2007
Hoek et al, EnvHealth 2013
25
2008
2011
2011
2011
2012
2013
2012
2011
25 |
Public health and environment
1.001.15
2.00
LAQN Seminar, London, 21 June
2013
Mortality and long-term exposure to PM2.5
Results of a cohort study in Rome
(1.3 million adults followed from
2001 to 2010)
Cesaroni et al. EHP 2013
PM2.5: 3-dimensional Eulerian model (1x1 km)
c= % increase in risk per 10
µg/m3
c=4%
AQG
26 |
c=6%
c=10
%
EU LV
Public health and environment
LAQN Seminar, London, 21 June 2013
26
% change
in artery wall
thickness
Carotid artery wall thickness (=risk of atherosclerosis)
and long-term PM2.5 exposure
AQG
Home outdoor PM2.5 (µg/m3)
EU LV
Heinz Nixdorf RECALL study, Ruhr region, Germany
27 |
Public health and environment
LAQN Seminar, London, 21 June
2013
27 2010
Bauer et al, JACC
Long term O3 exposure and risk of
death due to respiratory causes
ACS cohort of 448 thousand adults followed for 18 years
RR per 10 ppb = 1.040 (95% CI
1.010 - 1.067)
(2-pollutant model with O3 and
PM2.5)
28 |
Public health and environment
LAQN Seminar, London, 21 June
2013
28
Jerrett et al, NEJM 2009
Short-term exposure to ozone, mortality and hospital
admissions
European cities in the APHENA study
Per cent increase in deaths/admissions (95% CI)
per 10 µg/m3 increment in daily maximum
1-hour ozone concentrations
Single pollutant
Adjusted for PM10
Outcome
All-cause mortality a
0.18 (0.07–0.30)
0.21 (0.10–0.31)
Cardiovascular mortality: 75
years and older a
Cardiovascular mortality:
younger than 75 years a
0.22 (0.00–0.45)
0.21 (-0.01–0.43)
0.35 (0.12–0.58)
0.36 (0.10–0.62)
Respiratory mortality b
0.19 (-0.06–0.45)
0.21 (-0.08–0.50)
Cardiac admissions: older than
65 years a
-0.10 (-0.46–0.27)
0.64 (0.36–0.91)
Respiratory admissions: older
than 65 years b
0.19 (-0.28–0.67)
0.32 (0.05–0.60)
a lag
29 |
0-1 results; b lag 1 results
Public health and environment
LAQN Seminar, London, 21 June
2013
Katsouyanni et al 2009
29
REVIHAAP: Indoor, occupational and commuting
exposures vary more than exposure to OAP
•In the absence of tobacco smoke:
Commuting can increase exposures to PM, NO2, CO and
benzene, and is a major contributor to the exposure to UFP, BC
and metals (Fe, Ni and Cu in the underground);
Ambient air dominates population exposures to NO2 (no gas
appliances), PM2.5, BC, O3, CO and SO2 (also BaP, As, Cd, Ni and
Pb);
The high end of the individual exposures to PM10-2.5 and
naphthalene originate from indoor sources and commuting;
Solid fuel fired indoor fireplaces and stoves, where used in
suboptimal conditions, dominate the high end of the exposures to
PM2.5, BC, UFP, CO, benzene and BaP of the affected individuals.
30 |
Public health and environment
LAQN Seminar, London, 21 June
2013
30
Knwoledge gaps
1. Source contributions to Air Pollution-related diseases: %
of health burden from power generation, home energy & transport in
different cities and regions
2. Evidence on the effectiveness of interventions: Energyefficient homes, cookstoves, transport and power generation not only
reduce pollution/climate impacts, they generate multiple other health &
equity co-benefits
3. Improved global tracking of air pollution health impacts:
for better data on developing cities and rural as well as urban areas
31 |
Public health and environment
Knowledge Gap 1
Evidence about main sources of pollution
We need a stronger evidence base on sector air pollution contributions to:
•Identify AP health burden from transport, housing, power, etc.
•Build the case for preventive actions “upstream” in key sectors that pollute…
•The following slides present examples of some of the evidence we have… as
well as the types of questions we urgently need to explore.
32 |
Public health and environment
Unsustainable transport - an under-rated factor?
Urban case studies % of ambient PM2.5 from
vehicle exhaust and road dust*
Kolkata
24‐69% ‐ vehicle exhaust
4‐40% ‐ road dust
Delhi
19‐23% ‐ vehicle exhaust 4‐40% ‐ road dust
Mumbai
22‐28% ‐ vehicle exhaust 16‐38% ‐ road dust
Dhaka 45‐50% ‐ vehicle exhaust
Shanghai
12‐17% ‐ vehicle exhaust
2‐3% ‐ road dust
28‐24% ‐ vehicle exhaust
25‐50% ‐ primary traffic emissions only
Sao Paulo
European urban average
Beijing
13% ‐ vehicle exhaust
18.7% road dust (emissions inventory)
Source: (WHO, 2009) HELI Review of source apportionment data
* Note: Ranges indicate seasonal variations - higher concentrations in dry season
33 |
Public health and environment
2 million
deaths
annually are
from urban
air pollution.
What % of
these deaths
in major cities
are due to
transportpollution?
How does urban sprawl exacerbate air pollution?
Sprawl leads to
greater energy
consumption /per
capita and thus more
air pollution/GHGs.
But sprawl may
affect air pollution
exposures & health
differently in
urban/suburban
neighbourhoods, and
by region
Source. WHO, 2012/International Association of Public Transport , 2005
34 |
Public health and environment
How much does home coal/biomass burning add to
outdoor air pollution in poor cities?
% Regional Population Using Solid Fuels
WHO Air Quality Guideline Value
35 |
Public health and environment
Where are power plants a major urban AQ factor ?
Shanghai 2001 (PM2.5)
Autumn
Watered
Cyclone
Dust
Dust
3%
7%
Heavy Oil
6%
Marine
24%
Soils
0%
Power
Plants
28%
Vehicle
Exhaust
17%
•Road Dust
•2% •Coking •Smelter
•Cement
•2%
•6%
•5%
Spring
Marine
21%
Watered
Dust Cyclone
Dust
4%
8%
Heavy Oil
5%
Winter
•Marine
•28%
•Watered
•Dust •Cyclone
•4%
•Dust
•10%
•Heavy Oil
•4%
Soils
0%
Vehicle
Exhaust
16%
Road Dust
•Coking •Smelter •Cement
2%
•6%
•1%
•5%
Summer
Watered
Dust
3%
Cyclone
Dust
9%
Marine
31%
Heavy Oil
6%
Soils
1%
Power
Plants
23%
Vehicle
Exhaust
19%
Road Dust
3% Coking
1%
Smelter
8%
Cement
7%
Power
Plants
24%
Power
Plants
15%
Soils
2%
Vehicle
Exhaust Road Dust
Coking
12%
3%
2%
Smelter
9%
Cement
8%
Guttikunda - SAES, Shanghai, 2004
36 |
Public health and environment
Knowledge Gap 2
Effective interventions - multiple gains
WHO sees a need for evidence/guidance
to policy-makers
:
about policies that reduce air pollution and enhance other
aspects of health, e.g.
• Healthier homes
• Healthier transport
• Healthy cities
• Greater access to clean
energy for the poor
• More resilience in
emergencies (e.g. health
facilities)
37 |
Public health and environment
Energy-efficient homes reduce air pollution & other
housing risks such as...
Housing risks
•
•
•
•
•
•
•
38 |
Indoor/outdoor air pollution
Damp, mould & allergens
Poor indoor ventilation
Planning, transport access
Urban waste, sanitation & water
Heat Island
Storms/flooding
Public health and environment
Health impacts
•
•
•
•
•
•
•
Chronic/acute respiratory disease
Allergies, respiratory disease
Respiratory disease
Physical inactivity, NCDs, traffic injuries
Water and sanitation-borne disease
Strokes
Injuries/poverty
Innovative power generation not only reduces air
pollution, it improves….
•
Access to clean
energy/renewables for the poor
• Resilience in emergencies,
including for health facilities
• Grid efficiencies (e.g. through
CHP, distributed energy
generation reduce
pollution/unit of heat and power
• Healthy housing synergies from
design efficiencies+
renewables
39 |
Public health and environment
Solar lanterns,
India “Light a
Billion Lives”
Solar “suitcase” in
primary health
facility- Nigeria
Cogeneration of
Heat and Power
(CHP), New York
Presbyterian
Hospital
Sustainable transport not only reduces air pollution,
but also…
•
•
•
Increases physical activity
Reduces traffic injury
Frees urban road/parking for
green spaces
• Facilitates more equitable access
to mobility
• Eases movements of elderly,
children, disabled, women
• Promotes social cohesion in local
communities
40 |
Public health and environment
Evidence: health & carbon efficiencies linked to
sustainable urban modal split
Factor
Studies finding improved outcomes
Studies finding worse
outcomes
Use of different travel modes
More active transport
(walking, cycling)
88,185–197
Increased physical activity
35,109,118,148,188,199–205
Reduced BMI or obesity
23
More use of public
transport
Reduced air pollution-related effects
Improved quality of life or reported health
167,183,206
status
188,206
Reductions in specific health problems
Lower mortality / higher life
36,37,207
expectancy
Increased walking, cycling or active
208
transport
185,209,210
Increased physical activity
148,203,212
Reduced BMI or obesity
70,213
Reduced air pollution-related effects
Lower car use, car
ownership and traffic
volumes
Increased walking, cycling or active
94,129,132,134,141–143,149,150,152,178,179,214–
transport
217
160,181,191,218
Increased physical activity
73,109,148,164,218–221
Reduced BMI or obesity
166
Improved reported health status
222
Reductions in specific health problems
41 |
Public health and environment
Increased stress and
198
psychological distress
Increased road traffic
23
injury
Increased air pollution185
related effects
Increased risk of
211
tuberculosis
Review of
studies on
urban travel
mode,
physical
activity and
health –
WHO/Health in
Green Economy
(forthcoming)
Climate co-benefits: One-third of Global CO2
emissions from vehicles & home energy
Road transport & home energy also major sources of short-lived climate pollutants (e.g. black
carbon, other particulate matter) that damage health
42 |
Public health and environment
Climate impacts by Sector in 2020: Radiative
Forcing (Unger, 2010)
Household biomass/transport have greatest potential for short-term pollutant reductions
43 |
Public health and environment
Knowledge Gap 3
Improved global tracking of air pollution exposures and
health impacts
WHO sees a need for a coherent air quality & health platform:
•Air pollution monitoring is limited & fragmented
•New methods combining ground-level monitoring, satellite
tracking, remote sensing & chemical transport models can fill
gaps could improve estimates
•Need to link with interventions/sources of air pollution
to identify how policy change /trends in sector policies
affect air pollution and health
44 |
Public health and environment
Urban Air Quality Data (WHO)
1500 cities, but sparse coverage for Africa, Latin America, Middle East
– no coverage in rural areas
45 |
Public health and environment
Household air pollution data base (WHO)
• Data from over 900 household surveys
• Information on fuels and technologies used for cooking,
and now also for heating and lighting
• Base for estimates of IAP and related mortality
46 |
Public
health
(Lim
S etand
al,environment
Lancet, 2012)
Preventing disease – addressing their route causes in the environment and in development
47 |
Public health and environment
Health indicators for Post-2015
Sustainable Development
WHO related health to SD policies,
through the
•Wider use of HIA,
• Defining health-relevant indicators
for sustainable development goals
(EB 136/30)
•Convened consultation on health
indicators for Rio + 20
themes/disseminated through civil
society/government partners at the
conference
48 |
Public health and environment
Example 1: Urban Health indicators of Sustainable Development WHO/Hans Everts
• Healthy, efficient transport ↔ as measured by %
travel by transit/walking & cycling + mortality rates for
pedestrians/cyclists
• Deaths attributed to urban air pollution
• Slum housing with access to water/sanitation and
energy & improved climate resilience ↔ sustainable
urban development
49 |
Public health and environment
Example 2: Energy and Health indicators (SE4All initiative)
WHO/Hans Everts
• % of health care facilities with access to
clean/sustainable energy
• % of households with access to clean cookstoves
and/or clean fuels.
• Deaths and disease attributed to indoor and
outdoor air pollution (above WHO Air Quality
guidelines)
50 |
Public health and environment
Example3: Agriculture & Nutrition indicators of Sustainable Development WHO/Hans Everts
• % of childhood stunting ↔ unsustainable agro policies
& practices with undernutrition
• Obesity prevalence ↔ GHG-intensive fast & processed
foods
• % of total daily energy intake from saturated fats ↔
overconsumption of GHG-intensive red meat
51 |
Public health and environment
Where should we go next?
Global cooperation to identify:
1. Sector strategies and how they affect health : e.g. health
burden related to power generation, home energy &
transport in different cities and regions
2. Evidence on the effectiveness of interventions: Sector
interventions that reduce disease and climate change – e.g.
building energy efficiencies (e.g. cookstoves), sustainable
transport and innovative power generation/delivery
3. Improved global tracking of sector policies, risks to
health and health impacts, as they relate to
interventions: for better information on trends and how they
can be influenced by policy interventions.
52 |
Public health and environment