1. Indicatoren voor gezondheidsimpact van fijn stof en ozon: DALYs en externe kosten Jurgen Buekers & Rudi Torfs 05/04/2011

2. 28/06/20152 © 2010, VITO NV Introduction Integrated science assessment for paticulate matter (US EPA 2009) “a causal relationship exists between long-term exposures to PM2.5 and cardiovascular effects” “a causal relationship exists between long-term exposures to PM2.5 and mortality” Ozone and your health (US EPA 2009) “Ozone can irritate your respiratory system, reduce lung function, aggravate asthma, etc.”

3. 28/06/20153 © 2010, VITO NV » Environmental health problems incomparable » What is worse? » 2 adults with a cardiovascular disease dying prematurely during a smog episode » 10 children with asthma » 2 adults having some days problems with the lower respiratory tract Introduction

4. 28/06/20154 © 2010, VITO NV » DALYs » Combine information on the ‘quality’ and ‘quantity’ of life » Give an indication of the potential number of ‘healthy’ life years lost due to premature mortality or morbidity » DALY calculation = N x S x D » Number of people with environment-related morbidity or mortality » Severity factor (0=healthy; 1=death) » Duration of disease Disability Adjusted Life Years (DALYs)

5. 28/06/20155 © 2010, VITO NV Attributable cases (Number of people) Cases Concentration Observed Incidence Prevalence Observed concentration Relative risk  Epidemiological studies (e.g. Pope et al., 2002)

6. 28/06/20156 © 2010, VITO NV Attributable cases (Number of people) Cases Concentration Observed Incidence Prevalence Observed concentration Threshold Relative risk  Epidemiological studies (e.g. Pope et al., 2002) Basic frequency Attributable cases

7. 28/06/20157 © 2010, VITO NV Disability or Severity weights » Indication of the reduction in capacity due to the specific disease » Varying from 0 (healthy) to 1 (death) » Determined by experts (clinicians, researchers, etc.) » Overviews available (WHO, Australian burden of disease study) asthma Cardiovascular disease

8. 28/06/20158 © 2010, VITO NV Duration » Duration for morbidity: years of life lived with disability (YLD) » Duration for mortality: years of life lost (YLL)

9. 28/06/20159 © 2010, VITO NV DALYs De Hollander A.E.M. Assessing and evaluating the health impact of environmental exposures “Deaths, DALYs of Dollars?”. University of Utrecht. 2004.

10. 28/06/201510 © 2010, VITO NV Uncertainties » Framework of Knol Anne (2010) » Context uncertainty e.g. selected stressor, endpoint » Model structure uncertainty e.g. causal relationship » Parameter & input data uncertainty e.g. health statistics Knol, A., 2010. Health and the Environment: assessing the impacts, addressing the uncertainties, Thesis Utrecht University, the Netherlands.

11. 28/06/201511 © 2010, VITO NV DALYs in general » DALYs give an indication of the potential, relative order of magnitude of different (environmental) health problems, and can not be presented as absolute or completely representative numbers. » Smoking, genetic ability, food consumption etc. » Competing risks

12. 28/06/201512 © 2010, VITO NV Health outcomes Pollutant PM2.5PM10Ozone Effect Chronic Mortality after chronic exposure -- Accute Restricted activity days (RAD) Work loss days (WLD) Etc. Hospitalisations Use of bronchodilators Symptom days (problems with lower respiratory tract) Etc. Mortality Hospitalisation Use of bronchodilators Cough days Etc. Based on NEEDS 2007 (New Energy Externalities Development for Sustainability)

13. 28/06/201513 © 2010, VITO NV MIRA - Particulate matter (PM2.5 & PM10)

14. 28/06/201514 © 2010, VITO NV MIRA - Ozone

15. 28/06/201515 © 2010, VITO NV EBoDE-project » Quantification, comparison and ordering of different environmental stressors between EU countries » Goal is to develop a uniform method to calculate the health impact of these stressors (DALY calculation) between different countries » Create a platform for other countries » http://en.opasnet.org/w/Ebode http://en.opasnet.org/w/Ebode World Health Organisation Europe

16. 28/06/201516 © 2010, VITO NV EBODE-project DALYs/million averaged over 6 participating countries

17. 28/06/201517 © 2010, VITO NV EBODE project

18. 28/06/201518 © 2010, VITO NV EBoDE / BoD 6-12% of the standard WHO BOD is associated with the nine environmental stressors.

19. 28/06/201519 © 2010, VITO NV External Costs (euro) » Health effects expressed in term of external costs » Quantification is based on attributable cases (identical as calculated for DALYs) » Specific cost per case based on: -NEEDS (2007) -Reële milieugerelateerde gezondheidskosten in Vlaanderen (LNE, 2009 (Arcadis, MetroEconomia))

20. 28/06/201520 © 2010, VITO NV External Costs (euro) MIRA study PM (euro/inhabitant)Ozone (euro/inhabitant) REFEURVISREFEURVIS 2007597 (±258) 39 (±18) 2010535 (±243)520 (±220)499 (±217)42 (±20)44 (±20)43 (±18) 2015527 (±226)472 (±198)440 (±193)46 (±20)48 (±22)45 (±20) 2020501 (±208)409 (±184)347 (±150)47 (±22)53 (±24)43 (±20) 2025513 (±218)402 (±181)344 (±139)50 (±22)54 (±25)42 (±19) 2030521 (±223)410 (±173)332 (±145)53 (±24)56 (±25)39 (±17)

21. 28/06/201521 © 2010, VITO NV Summary » DALY as indicator for health impact PM and O 3 » Chronic exposure to PM2.5  largest health impact » Particulate matter: REF > EUR > VISI » EBoDE study: 9 stressors  largest health impact exposure to air PM » External costs

22. 28/06/201522 © 2010, VITO NV Thank you for the attention!