1. Task Force on Health Recent results - Particulate matter Michal Krzyzanowski TFH Chair Head, Bonn Office European Centre for Environment and Health WHO Regional Office for Europe

2. TFH for 30 th Session of WGE 27-29 Sept 2011 Source: ENHIS PM10 levels in European Region of WHO

3. TFH for 30 th Session of WGE 27-29 Sept 2011 The overall evidence is consistent with a causal relationship between PM2.5 exposure and cardiovascular morbidity and mortality. This body of evidence has grown and been strengthened substantially since the first American Heart Association scientific statement was published in 2004. PM2.5 exposure is deemed a modifiable factor that contributes to cardiovascular morbidity and mortality. http://circ.ahajournals.org/content/121/21/2331 American Heart Association, Scientific Statement 2010: Evidence on causal link of CVD with fine particulate matter

4. TFH for 30 th Session of WGE 27-29 Sept 2011 Loss of life expectancy due to PM2.5 exposure in Europe – cause-of-death-specific vs. all cause estimates

5. TFH for 30 th Session of WGE 27-29 Sept 2011 Predicted average gain in life expectancy (months) for persons 30 years of age in 25 Aphekom cities for a decrease in average annual level of PM2.5 to 10 μg/m3

6. TFH for 30 th Session of WGE 27-29 Sept 2011 Associations between air pollution and the incidence of asthma and wheeze – meta-analysis of cohort studies Per 10 µg/m3 NO2Per 10 µg/m3 PM2.5 Anderson et al, Air Qual Atmos Health 2011 (NB: no association between asthma prevalence and AP)

7. TFH for 30 th Session of WGE 27-29 Sept 2011 Comparison of impacts of air pollution on exacerbations of diseases using two different HIA approaches in Aphekom

8. TFH for 30 th Session of WGE 27-29 Sept 2011 Reduction of PM exposure and increase of life expectancy in the US A decrease of 10 µg/m3 of PM2.5 associated with increase of life expectancy by 7.3 months between 1980 and 2000 Reduction in PM accounts for 15% of overall increase in life expectancy Pope AC et al, NEJM 2009

9. TFH for 30 th Session of WGE 27-29 Sept 2011 Benefits and costs of the Clean Air Act of the USA Source: US EPA 2011 http://www.epa.gov/oar/sect812/prospective2.html

10. TFH for 30 th Session of WGE 27-29 Sept 2011 European Study of Cohorts for Air Pollution Effects - ESCAPE EU FP7 project, 25 patners, coordinated by Univ Utrecht 30 cohorts, total 645,800 subjects followed over several years, ca. 37,000 deaths ESCAPE monitors PM2.5, PM10, NO2, NOx, BC, elemental composition of PM (TRANSPHORM) Exposure assessment based on land use regression models First results expected mid-2012

11. TFH for 30 th Session of WGE 27-29 Sept 2011 TFH review of health effects of black carbon (BC) – contents Metrics used to estimate BC exposure Effects of BC exposure observed in epidemiologic studies Evidence from toxicology including human clinical studies Conclusions http://live.unece.org/fileadmin/DAM/env/documents/2011/eb/wge/ece.eb.air.wg.1.2011.11.pdf

12. TFH for 30 th Session of WGE 27-29 Sept 2011 Single city, single pollutant estimates of risk of all cause mortality associated with PM10 and BC Janssen et al, EHP 2011

13. TFH for 30 th Session of WGE 27-29 Sept 2011 TFH review of health effects of black carbon (BC) –conclusions (1) Sufficient evidence on association of short-term (daily) variations in BC concentrations with short term changes in health and on associations of all cause and cardiopulmonary mortality with long-term average BC exposure. Suggestive evidence from short-term studies for BC being a better indicator of harmful particulate substances from combustion sources - especially traffic - than undifferentiated PM mass Insufficient evidence to allow of an evaluation of the qualitative differences between health effects of exposure to BC or to PM mass http://live.unece.org/fileadmin/DAM/env/documents/2011/eb/wge/ece.eb.air.wg.1.2011.11.pdf

14. TFH for 30 th Session of WGE 27-29 Sept 2011 TFH review of health effects of BC – conclusions (2) TFH agreed that the reduction of exposure to PM2.5 containing BC, and other combustion related PM material, for which BC is an indirect indicator, should lead to reduction of the health effects associated with PM. TFH recommended continuing the use of PM2.5 as the primary approach in quantifying the human exposure to PM and its health effects, and for predicting the benefits of exposure reduction measures. In evaluation of local actions aimed at reduction of population exposure to combustion particles (e.g. from motorized traffic) the use of BC as an additional indicator may be useful. http://live.unece.org/fileadmin/DAM/env/documents/2011/eb/wge/ece.eb.air.wg.1.2011.11.pdf