Download Health Impacts

Direction de santé publique
Greenhouse Gases,
Outdoor Air Pollution
and Public Health
Presented to:
Healing the Planet: Creating a Peaceful
and Sustainable Future
September 26, 2009
Stéphane Perron, MD, MSc, FRCPC
Direction de santé publique, Montréal
Professeur adjoint, DMSP, UdeM
[email protected]
514-528-2400, poste 3291
Louis Jacques, MD, FRCPC
Direction de santé publique, Montréal
Hôpital thoracique de Montréal, CISTE
Professeur agrégé, DMSP, UdeM
[email protected]
514-528-2400, poste 3305
Presentation Outline
• Climate Change
Quebec Emissions
 Health Impacts

• Oppressive Heat
• Extreme Climate Events
• Outdoor Air Pollution
Health Impacts
 Ragweed

• Public Health Approach
Climate Change
Climate Change
Quebec Emissions
Fig.1 – Distribution of GHG Emissions in Quebec,
by Activity Sector
Source : MDDEP, 2008
Fig. 2 – Distribution of GHG Emissions in Quebec, 2006,
by Gas Type
Source : MDDEP, 2008
Figure 4 – GHG Emissions in Quebec, by Activity Sector,
from 1990 to 2006 (Mt, CO2 equivalent)
Source : MDDEP, 2008
Climate Change
Health Impacts
Potential Impacts of Climate
Change – International Perspective
Health Impacts
Climate-related mortality
Infectious diseases
Air quality / respiratory and
cardiovacular diseases
Agricultural Impacts
Agricultural yields
Irrigation needs
Forest Impacts
Forest type change
Species migration
Water Impacts
Drinking water reserves
Water quality
Competition for the resource
Coastal Region Impacts
Coastal erosion
Coastal flooding
Cost vs coastal community
protection
Natural Spaces and Species
Ecological zone changes
Natural space distances
Climate Change
Quebec Perspective
• Oppressive Heat Episodes
• Extreme Climate Events
Oppressive Heat
Daily Mortality and Average Temperatures
in Major Cities – North America (solid lines)
and South America (dotted lines)
Daily Deaths vs Mean Temperature
Paris, 2003 and 1999-2002
Montreal – June 1994 Heat Wave
Local Variation of Thermal and Vegetation Zones
CSSS Cavendish
Oppressive Heat
Main Health Impacts
of Oppressive Heat Episodes
• Direct Impacts:
 Muscular
cramps
 Heat exhaustion
 Heatstroke mortality
• Indirect Impacts:
 Significant
increase in death and
hospitalization rates among elderly,
chronically-ill persons
Vulnerable Persons
• Hospitalized persons – 75 % of Quebec
mortalities
• Children aged 0 to 4
• Chronically-ill, elderly people (65 and over)

Cardiovascular, respiratory, stroke, kidney,
neurological, diabetes
• Taking medication
• Living alone downtown

Urban Heat Islands
• Mentally-ill persons
Health Impacts –
Environmental Risk Factors
• Housing with no air conditioning
Air Conditioned
Residences
Montreal
20 %
Toronto
60 %



Sudden early summer heat wave with high
humidity (acclimatization)
Lasting several days, with high nighttime
temperatures (>25 oC)
Heat/pollen/smog/photochemical pollution
interaction
Prevention Strategies
Population



Information and education on preventive
measures (hydration, air conditioning)
Warning (monitoring) and alert (mobilization)
systems
A call for vigilance
Health Establishments



Develop techniques to reduce room heat loads
Emergency action plans
Early medical intervention
Action Strategies
and Temperature
Normal Temperature
• Preventive measure implementation
Warning
To 30 oC & Humidex 40 oC
•
Information on preventive strategies
• Public health warning
Alert
To 30 oC & Humidex 40 oC
5 consecutive days & 5 consecutive nights
• Emergency Action Plan
Protection Measures:
Crisis Management
• Activate network emergency action plans
• Operation Solidarity: search for persons at risk and
offer assistance
• Make cooling-off locations available (municipal
shelters, shopping centres, etc.)
• Take charge of people at risk, as required
• Distribute water to the homeless
• Manage overcrowded hospital emergency rooms
Extreme Climate Events
• 1998 ice storm
• Carbon monoxide
poisoning epidemic
• Will power outages
become more
frequent?
Outdoor Air Pollution
Outdoor Air Pollutants
• Smog: chemical pollution which occurs
mainly in urban areas, under certain weather
conditions (hot day, low wind and temperature
inversion)
• Ozone: occurs mainly when heat, NOx,
VOCs and other pollutants react in the
presence of UV
• Pollutants can be:
Particulate matter: PM10, PM2.5, ultrafine
particles
 Gases : O3, NOx, SO2, CO, COV, …

Smog Day
Evolution of Pollutant Levels
• In the last few decades (~30 years), there has
been a decrease in the average
concentration of certain pollutants: SO2, CO,
Pb and PM
• Somewhat stable levels: O3, NO2, COV, H2S
• Rising level: CO2
• Levels sometime exceed standards in some
places and times (ex. : O3)
• Current standards are too weak to protect
vulnerable persons.
Pollutant Sources
• Fixed: industry, housing, incinerators, …
• Mobile: transportation
• Linked to:
Motor vehicles (gasoline, diesel)
 Industrial activity
 Thermal power plants (coal, natural gas,…)
 Fossil fuel heating (wood, oil, natural gas, …)
 Waste incineration
 Fires
…

WOOD HEATING
Households With Wood Heating, Montreal Island
(DSP Montréal, 2001)
Health and Outdoor Air Pollution
Toxicity Mechanisms
• Inflammatory reaction
• Autonomous nervous system
reaction
• Increased blood viscosity and blood
clot formation
• CO-generated Hypoxaemia (affects
persons with a heart failure condition)
• Possible causes: fine and ultra-fine
particulate matter, NOx, ozone, etc.
Health Impacts (Heart and Lung)
Linked to Air Pollution
1 540 par année, à Montréal
Leading Health Problems
Linked to Air Pollution
• Increased mortality
• Heart disease
• Respiratory diseases, including COPD
(Chronic Obstructive Pulmonary
Disease), asthma, infections, allergic
rhinitis
• Cancers, including lung and skin
Health Impacts
• Numerous epidemiological studies
• Clearly demonstrated impacts for respirable
particle matter (particularly fines)
• No known threshold
• Long-term impacts more severe than shortterm impacts

Important to reduce average exposure levels
• An increase in long-term cardio-respiratory
mortality (6 %), including lung cancer (8 %), is
linked to a 10µg/m3 increase in the average
PM2.5 concentration
Main Health Impacts
• Short-term impacts:
Worsening asthma
 Worsening cases of CVD (including death)
and COPD
 Increased risk of respiratory tract infections

• Long-term impacts:
Lung development and respiratory functions
are affected
 Increased mortality (particularly from PM2.5):
from all causes, CVD, COPD and lung
cancer

Most Vulnerable Persons
• Young children
• Elderly people
• The chronically-ill

Heart and stroke

Respiratory

Diabetes
• People living near major thoroughfares
Ultrafine Particles
•
Health impacts on people living near a major thoroughfare,
with increased exposure to fine particles and Nox

53 % mortality increase for people aged 55 to 77, living 100
metres from a freeway. This rate increase is due to
cardiorespiratory mortality (Hoek et al, 2002)

People 60 and over, living along busy highways, are 21%
more likely to be hospitalized for respiratory problems
(Smargiassi et al, Montreal, 2006)

Pregnant women living less than 200 meters from a freeway
are 17% more likely to give birth to an underweight baby.
(Généreux et al, Montreal, 2007)

Several other studies have documented the link between
traffic intensity near the place of residence and myocardial
infractions, respiratory problems and otitis.
What to do?
• Individual treatment
• Recommend measures to stop or reduce
exposure:

Measures controlled by patient or family

Measures controlled by others
Public Health Actions
• Alert System: Info-smog
• Quantify health/social impacts
• Awareness campaigns for the public and decision
makers
• Promote emission reduction actions (transportation,
industry, wood heating), through:
–
–
–
–
Laws and regulations (revise emission standards…)
Tax incentives and disincentives
Public and active transport promotion policies
Policies to assist the purchase of greener vehicles
and equipment
– Vehicle maintenance programs…
Preventive Medicine Practices
• Identify patients who are the most vulnerable to
pollution events

Elderly people, heart disease, heart failure,
asthma, chronic bronchitis, emphysema
• Inform them of the personal measures that can
reduce health risks:




Monitor smog warnings
Reduce outdoor physical activity during smog
events, particularly during the most critical
periods (late afternoon)
Avoid the most polluted places and other
pollution sources (tobacco)
Action plan for Rx use
Ragweed
Allergic Rhinitis and Ragweed
• Affects > 10 % of the population

5th most-declared health problem in Quebec
• Ragwood might be responsible for most cases
of allergic rhinitis
• Associated allergic manifestations:
Rhinitis
 Conjonctivitis
 Asthma

• Upward trend: due to global warming?
Figure 5.3 – Pollen concentration for 5 plants under study,
Montreal and Quebec City, 1994 to 2002
Garneau M et al.
Figure 5.1: Length of Pollinic Seasons for Ambrosia spp, Montreal, 1994-2002
Garneau, M. et al.
Fig. 4.1: Mean Medical Consultation Rate for Allergic Rhinitis, Montreal & Quebec City, 1994-2002
Garneau, M. et al.
Ragweed Infestation Index, Montreal Island, 2006
Allergic Symptom Prevalence in Children Aged 6 Months
to 12 Years, by CLSC Territory – Montreal, 2006
Interventions
• Clinical aspects:

Recommend measures to reduce exposure for
allergic persons
• Public Health Actions:
Discussions with municipalities and other
partners to implement a ragweed control
programme
 Public information
 Epidemiological monitoring

• Quebec Ragweed Roundtable website – Table
québécoise de l’herbe à poux (TQHP)
The Clinician’s Role
• Identify health problems linked to environmental
contamination
• Recommend measures to restore or protect the
health of patients
• Inform people at risk of appropriate harm
prevention and health promotion measures
• Inform other organizations having the potential to
address harmful environments
• Refer people to other available resources, including
public health officials and staff
• Know your community
• Contribute to improving your community’s
environment
Health Promotion – Root Causes
of Air Pollution and Other Health Impacts
Two examples:
• Transport
• Tree and Plant Cover
Transportation-Related Pollution
GHGs
SMOG
NOX
SO2
Fine and
ultrafine particles
VOCs
Increased
Automobile
Transport
Air Pollution
Mortality, Heart and
Respiratory
Diseases
Increased
Automobile Traffic
and Speed
Car-Oriented
Urban
Development
Neighbourhood
/Functional Segregation
Social Exclusion for
Those Who Have no
Access to a Car
Increased Traffic
Accidents
Reduced
Plant and
Tree Cover,
Paving and
Asphalting
Urban Heat
Islands
Excessive
Mortality During
Heat Waves
Noise
Reduced Active
Mobility
(Walking,
Cycling)
Obesity and
Diabetes
Greenhouse Gas Increase
Sleep Disruption,
Hypertension
Global Warming
Source photo: Richard Joseph Jackson, Health and the Environment, http://www.lgc.org/freepub/land_use/presentations/2005.html.
Carbon Sinks
Decreased Run-off
Plant and Tree Cover
Reduced CO2
Reduced Heat
(80C)
Natural Ventilationr
Reduced
Ozone Pollution
Reduced
Heat-Related
Health Problems
Reduced
Air Pollution
Public Access
Protection
During
Oppressive
Heat Periods
Improved
Mental Health
Physical
Activity
Decreased
Sewer Overload,
Increased
Natural Filtration
Less Phosphates,
Heavy Metals,
Hydrocarbons and Bacteria
In Water
Improved
Water Quality
Selected Environmental Health
Information Sources
Information Sources and Documents…
General
• Bulletin d’information en santé
environnementale du Québec:
http://www.inspq.qc.ca/cse/bise/index.htm
• Montreal DSP Website
• Health Canada: www.hc-sc.gc.ca
• US Environmental Protection Agency (USEPA): www.epa.gov/
• The Medical Journal of Australia: Protecting
the planet Series – MJA 2002, 177 (11/12):
590-
Information Sources and Documents…
Chemical Substances
• Centre Anti-Poison (inspq.qc.ca) CAPQ: 1800-463-5060
• Centre de toxicologie du Québec:
1-418-654-2254
• International Programme on Chemical
Safety : www.inchem.org
• National Toxicology Program (NTP):
http://ntp-server.niehs.nih.gov/
• Agency for Toxic Substances and Disease
Registry (ATSDR), USA:
www.atsdr.cdc.gov/hazdat.html
Information Sources and Documents…
Guides, Criteria, Standards
• Air Quality Guidelines (WHO)
www.who.int/peh/air/Airqualitygd.htm
• Health and Air Quality (Health Canada)
www.hc-sc.gc.ca/hecs-sesc/qualite_air/index.htm
• Drinking Water Quality Recommendations (HC)
www.hc-sc.gc.ca/ehp/dhm/catalogue/
dpc_pubs/rqepdoc_appui/rqep.htm
Information Sources and Documents…
Training and Education
• Supercourse. Epidemiology, the Internet
and Global Health www.pitt.edu/~super1
• Environmental Health in Family Medicine
www.ijc.org/boards/hptf/modules/content.html
• American College of Occupational and
Environmental Medicine : www.acoem.org/
Information Sources and Documents…
Climate Change
• Intergovernmental Panel on Climate Change
(IPCC): http://www.ipcc.ch

Climate change 2007 (4th report)
• Ouranos Consortium: http://www.ouranos.ca