1. WHO work on air quality and health, focusing on the update of the global Air Quality Guidelines
Hanna Yang, Dorota Jarosinska, Roman Perez Velasco
WHO European Centre for Environment and Health
22nd EIONET Workshop on Air Quality Assessment and Management
Lisbon, Portugal, 3rd and 4th October, 2017

2. Presentation Outline WHO ECEH work on AQ
Existing WHO Air Quality Guidelines
Background for update of guidelines
WHO Guideline development process and scope of updated guidelines

3. WHO ECEH work on AQ

4. The WHO European Region
WHO European Centre for Environment and Health
53 Member States: pop. 4

5. WHO ECEH work on AQ and health
Reviewing the scientific evidence and providing guidance
: WHO Air Quality guideline
Developing tool to assess health risk attributable to air pollution
: Air Q+
Provide advice to the UNECE Convention on Long Range Transboundary Air Pollution
: leading the Joint Task Force on Health Aspects of Air Pollution

6. Existing WHO Air Quality Guidelines

7. WHO Air Quality Guidelines
Ambient air quality guidelines
AQG for Europe (1987)
AQG for Europe, 2nd Edition (2000)
AQG, Global Update 2005 (2006)
AQG global update (since 2016)
Indoor air quality guidelines
Dampness and mould (2009)
Selected chemical pollutants (2010)
Household fuel combustion (2014)

8. Air pollutants covered
INORGANIC
2000
Acrylonitrile*
Benzene
Butadiene
Carbon disulfide*
Carbon monoxide
1,2-Dichloroethane*
Dichloromethane
Formaldehyde
Polycyclic aromatic hydrocarbons
Polychlorinated biphenyls
Polychlorinated dibenzodioxins and dibenzofurans
Styrene
Tetrachloroethylene
Toluene
Trichloroethylene
Vinyl chloride
Arsenic
Asbestos*
Cadmium
Chromium
Fluoride
Hydrogen sulfide
Lead
Manganese
Mercury
Nickel
Platinum
Vanadium
Nitrogen dioxide
Ozone
Particulate matter
Sulfur dioxide
Radon
Environmental tobacco smoke
Man-made vitreous fibres
ORGANIC
CLASSICAL
INDOOR
* Not re-evaluated (1987 evaluation retained)
Acrylonitrile
Benzene
Carbon disulfide
1,2-Dichloroethane
Dichloromethane
Formaldehyde
Polynuclear aromatic hydrocarbons
Styrene
Tetrachloroethylene
Toluene
Trichloroethylene
Vinyl chloride
Arsenic
Asbestos
Cadmium
Carbon monoxide
Chromium
Hydrogen sulfide
Lead
Manganese
Mercury
Nickel
Nitrogen dioxide
Ozone
Radon
Sulfur dioxide and particulate matter
Vanadium
1987
ORGANIC
INORGANIC
2005
Particulate matter
Ozone
Nitrogen dioxide
Sulfur dioxide

9. WHO AQG Global Update (2005): Summary
Pollutant
Averaging time
AQG value
Particulate matter
PM2.5
PM10
1 year
24 hour (99th percentile)
10 µg/m3
25 µg/m3
20 µg/m3
50 µg/m3
Ozone, O3
8 hour, daily maximum
100 µg/m3
Nitrogen dioxide, NO2
1 hour
40 µg/m3
200 µg/m3
Sulfur dioxide, SO2
24 hour
10 minute
500 µg/m3
Levels recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution

10. WHO Air Quality Guidelines (AQG)
The most widely accepted set of public health recommendations, intended to assist policy-makers, health-care providers, and other relevant stakeholders to make informed decisions to protect public health from the adverse effects of air pollution
Based on a comprehensive and objective assessment of the available evidence
Intended for worldwide use, therefore recognize the heterogeneity of technological feasibility, economic development and other political and economical factors

11. WHO AQG addressed mainly to…
Decision/policy-makers and technical experts responsible for developing and implementing regulations and standards for environmental health, air pollution control, urban planning and others
Other stakeholders, including non-governmental organizations and advocacy groups - as a resource for risk communication, awareness rising or other purposes
Academics, health and environmental impact assessment practitioners and researchers in the field of air pollution – as updated evidence-based summaries of the relevant research findings in relation to the health effects of ambient air pollution

12. WHO AQG in setting national air quality standards
In 96 countries WHO AQG were the main resource to establish or revise national standards for PM10 and SO2 short-term (years ) (Vahlsing and Smith, 2011)

13. WHO AQG in the EU air quality legislation

14. World maps of national ambient air quality standards in relation to WHO air quality guideline values (WHO-AQG) for PM10
The PM10 WHO annual guideline value of 20 µg/m3 was adopted by only six authorities (Afghanistan, Cameroon, Fiji, Iceland, Iran and Switzerland), whereas most countries have set values between 40 and 50  µg/m3 up to 120  µg/m3
Source :

15. Background for update of AQ guidelines

16. Health impact of air pollution
Source: World Bank, 2016
6.5 million premature deaths worldwide in 2012, due to effects of ambient and household air pollution
600,000 premature deaths in WHO/ EURO each year
Economic cost of death and disease from air pollution amounts to USD 1.6 trillion in WHO/EURO alone
Source: WHO/EURO and OECD, 2015; WHO, 2016

17. New scientific evidence on health effects
Substantial body of new scientific evidence generated since WHO AQG 2005
WHO/EURO REVIHAAP report (2013)
IARC classification of air pollution as Group 1 carcinogen (2013)
More long term studies, including at lower level exposures
Additional information on shape of the exposure-response (i.e. IERs)
Studies on new health end-points
Recent national health risk assessments for ambient air pollutants
Emerging studies from China and other non-NA/EU areas
Accountability studies to evaluate effectiveness of air quality interventions

18. First WHA Resolution on Air Pollution and Health
Highlights the key role of health authorities in raising awareness about the potential to save lives and reduce health costs, if air pollution is addressed effectively
Identifies the need for strong cooperation between sectors and integration of health concerns into all national, regional and local air pollution-related policies
Urges Member States to develop air quality monitoring systems and health registries to improve surveillance for all illnesses related to air pollution
Urges Member States to strengthen international transfer of expertise, technologies and scientific data in the field of air pollution
Recognizes the role of WHO AQG, both for ambient and indoor air quality, in providing guidance and recommendations for clean air that protect human health

19. WHA Resolution and update of air quality guidelines
The WHA Resolution recognizes that :
…and requests the Director-General to significantly strengthen WHO’s capacities in the field of air pollution and health in order to provide:

20. WHO Guideline development process and scope of updated guidelines

21. The update of the WHO Global AQGs (2016 ~)
A global project coordinated by the WHO Regional Office’s European Centre for Environment and Health (ECEH), Bonn, with participation from all WHO regions and WHO headquarters
Funding and in-kind support provided by:
European Commission
Swiss Federal Office for the Environment
German Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety
United States Environmental Protection Agency
Government of the Republic of Korea

22. Proposed general objectives
To provide updated numerical concentration limits (i.e. guidelines) and, where possible, an indication of the shape of the concentration-response function for a number of ambient air pollutants, for relevant averaging times and in relation to critical health outcomes.
To provide a qualitative recommendation on the relation between exposure to desert dust and adverse health outcomes.

23. WHO guidelines
Represent the most widely accepted set of public health recommendations, intended to assist policy-makers, health-care providers, and other relevant stakeholders to make informed decisions for the protection of public health
Based on a comprehensive and objective assessment of the available
evidence
Generally intended for worldwide use, and therefore recognize the heterogeneity on technological feasibility, economic development and other political and economical factors
WHO adopted internationally recognized standards and methods to ensure that guidelines are free from biases and meet public health needs

24. Guideline development process - guideline groups and main steps
WHO Steering Group
Guideline Development Group and External Review Group
Systematic Review Teams
Management of Conflict of Interest
Formulations of the questions (PECOS/ PICO)
Evidence retrieval, assessment and synthesis
GRADE – Evidence profile
Systematic Review Process
From Evidence to Recommendations

25. Development of the new guidelines
Systematically review scientific evidence on:
Adverse health effects from exposure to PM2.5, PM10, NO2, SO2, O3 and CO for relevant averaging times and in relation to critical health outcomes
Adverse health impacts from desert and sand dust
Provide evidence-based recommendations
Concentration limits and, where possible, shape of the concentration-response function for each air pollutant/avg time/health outcome
Qualitative recommendation on the relationship between exposure to desert dust and adverse health outcomes

26. Systematic Review Teams
Long-term exposure to O3 and NO2 & all-cause and cause-specific mortality
Long-term exposure to PM & all-cause and cause-specific mortality
Short-term exposure to O3, NO2 and PM & all-cause and cause-specific mortality
Short-term exposure to O3, NO2 and SO2 & emergency department and hospital admissions due to asthma
Short-term exposure to CO and emergency department and hospital admissions due to ischaemic heart disease
Health impacts from desert and sand dust

27. Grading the evidence
Assessment of the overall quality of evidence for relationship between air pollutant, averaging time and health outcome(s):
Study limitations
Inconsistency of results
Indirectness of evidence
Imprecision
Publication bias
Magnitude of effect
Plausible confounding
Dose-response gradient
OVERALL QUALITY OF EVIDENCE:
High quality
Moderate quality
Low quality
Very low quality

28. Developing recommendations1
Quality of evidence (high / moderate / low / very low) 2
Balance of benefits and harms (when implementing the recommendation) 3
Values and preferences (of general population and/or specific groups) 4
Resource use (more or less resource-intensive to implement a recommendation)

29. From development to implementation
The guidelines provide a tool to:
Aid closing the gap between scientific evidence and practice/action
Lay foundations for developing limits and standards in national regulations
Derive the health burden from air pollution
Facilitate cost-effectiveness and cost-benefit analyses of various policies
Identify critical research gaps that will need to be filled in the future
Harmonise action plans for sustainable development within the regional and global frameworks

30. Progress of updating WHO global AQG
Ongoing project (started in 2016)
1st scoping meeting of Guideline development group meeting : Sep 2016
Selection of pollutants and health outcomes
Long-term and/or short-term exposure to PM (PM2.5, PM10), NO2, O3, SO2, CO
Health outcomes based on causality and severity of effects
Consideration of health impacts from natural sources (desert dust)
Guideline proposal approved by Guideline Review Committee: Jan 2017
Systematic reviews on long-term exposure to (PM, NO2 and O3) and short-term exposure to PM, NO2, O3, SO2, CO : May 2017 ~
2nd guideline development group meeting : 1416 March 2018

31. Thank you for your attention 31