1. Towards Healthy Public Policy: Assessing & Mitigating Health Burden from Air Policy Analysis for Air Quality and Health Workshop at Metro Hall, Toronto – May 19, 2005 Monica Campbell Environmental Protection Office Toronto Public Health

2. People can spend a lot of time close to pollution sources

3. Presentation Overview  “ Healthy Public Policy”  Areas of activity  Integration of assessment tools  Policy questions of local significance

4. Healthy Public Policy n Fundamental concept in public health n Particularly relevant for environmental threats to health n Advocates for shifts in public policies that adversely impact health (eg. transportation, energy, urban form) n Need good assessment tools

5. Areas of Activity in Influencing Policies Related to Air Exposure assessment and health risk Risk communication Broad determinants of health (e.g. social aspects)

6. Exposure Assessment & Health Risk n Local point sources of community concern - St. John’s Crematorium (2000) - Lakeview coal-fired power plant (2000) n Ambient air pollution - Toronto Air-Pollution Burden of Illness study (2004)

7. St John’s Crematorium (Toronto) Method: Stack testing to establish emission rates of PM 10, heavy metals including mercury, dioxins & furans Ambient air monitoring before & after crematorium started operations Dispersion modeling Comparison of modeled and actual ambient levels Benchmarks: -Ambient air quality criteria (OMOE) -Toxicological criteria (RfD & RsD from US EPA)

8. St John’s Crematorium (Toronto) Results and Conclusions: n Crematorium actual and modelled emissions were very low and far below provincial standards n Worst-case concentrations were at most 1% of AAQC and 25% of health criteria n Background levels of PM 10 high and sometimes exceeded provincial standard but crematorium contribution very small

9. Lakeview Coal-Fired Power Plant Modelling study (2000) to estimate ambient concentrations of NOx and SO 2 with different operating conditions Lakeview (1997 base year operating at 19% capacity) found to contribute: < 0.3% of ambient annual NOx in GTA; < 9.2% of ambient annual SO 2 in GTA.

10. Annual Air Emissions from Lakeview Plant

11. Air Pollution Burden of Illness Study Why Do One? To estimate magnitude of health impact in cost-effective manner To provide health status information on which to base public health programs To communicate health risk To influence decision makers

12. What’s Involved in Conducting a BOI Study? Is a form of risk assessment Applies risk coefficients from existing epidemiological studies worldwide Uses community-specific data on daily pollution levels Uses community-specific data on adverse health outcomes such as hospitalizations and mortality (e.g. for respiratory and cardiac causes)

13. Calculating Burden of Illness H p (outcomes/yr) = H b x F p Where: H p =estimated air-pollution burden of illness H b =background rate of adverse health outcomes/year F p =fraction due to air pollution (F p =  H p /unit x P; where  H p /unit is the ‘risk coefficient’ per unit pollutant from published epidemiological studies, and P is the effective annual pollutant concentration)

14. Air Pollution Burden of Illness - Toronto 1,700 premature deaths/year 6,000 hospitalizations/year Would likely not have occurred when they did without exposure to air pollution Preventable Increases severity or frequency of common medical conditions and illnesses

16. Impact of 2000 BOI Study Gave rise to first Smog Summit in June 2000 Catalyzed creation of 20/20 The Way to Clean Air Initiated low-sulphur fuel purchases by City Gave rise to further research – Condition Critical: Fixing our Smog Alert Warning System Increased participation in policy discussions Facilitated NGOs in advocating for clean air

17. Risk Communication Studies that influence communication policies: Toronto Air Quality Index - Health Links Analysis Condition Critical: Fixing the Smog Warning System Evaluation of smog advice

18. The Air Quality Index (AQI) AQI ScaleCategory 0 - 15 16 - 31 32 - 49 50 - 99 100+ Very Good Good Moderate Poor Very Poor Smog Alert At AQI = 50, OMOE calls Air Quality Advisory Increasing severity of health effects

19. Mixed Messages  Toronto’s air quality is “good” or “very good” almost all the time  Triggers smog alerts only in the summer months  Toronto’s air pollution leads to 1,000 premature deaths and 5,500 hospitalizations each year  Air pollution affects health year round AQI Health Evidence (based on 2000 study)

20. Distribution in Health Outcomes by AQI Category (based on 2000 study)

22. Why the AQI Misrepresents Health Risk It did not include fine particulates (PM 10 /PM 2.5 ) It is based on out-of-date air quality standards It is based on a single “driver” pollutant, not the total mix of AQI pollutants

23. Days of “Poor” Air Quality in Toronto resulting from inclusion of PM 2.5 in the AQI

24. Evaluation of Smog Advice Personal exposure monitoring that compares ‘typical day’ exposures to PM <1, PM 2.5, VOCs and ozone levels among paired scenarios of individuals who did or did not follow smog alert advice Tries to understand how much total daily exposures can be reduced by shifting individual behaviours Collaboration among Chemical Engineering & Applied Chemistry at U of T, Health Canada, Environment Canada and Toronto Public Health

25. Incorporating Broad Determinants of Health: Social Aspects Air emissions and health status studies related to Ashbridges Bay Treatment Plant Health Impact Assessment – Designated bus route

26. Ashbridges Studies Air emissions study modelled 17 key pollutants under 4 scenarios, including with full incineration and no incineration at sewage treatment plant Health status study examined mortality, hospitalization and cancer rates in South Riverdale and Beaches community, in comparison to SES- matched communities

27. Ashbridges Studies Overall, the emissions profile improved over time as incinerator use was phased out and with projected improvements for odour control (including fugitive emissions) Both communities had higher mortality and hospitalization rates (overall) than their respective comparison communities South Riverdale has been burdened with more illness and pollution sources than other communities, although it is not possible to suggest a causal relationship

28. Ashbridges Studies Policy recommendation arising: That the OMOE considers the cumulative impact of emissions from any new or modified industrial facility on adjacent residential areas with elevated rates of illness or mortality prior to issuing a C of A ‘Cumulative’ currently means taking into account all emission sources from a facility

29. TPH Perspective on Cumulative Impact Total impact of all emission sources Impact of current ambient air pollution levels Impact of modelled new source contribution = + Cumulative impact is:

30. Environmental Justice Aspects Should consider integrating social dimensions such as environmental justice concepts when developing public policy Environmental justice concepts can lead to an examination of spatial distribution of pollution sources and correlations with community characteristics such as income levels, minority status or ethnicity. Can take into account that people of lower income are more likely to be exposed to air pollution and likely more susceptible to adverse effects from air pollution

31. Health Impact Assessment Methodology may be quantitative but typically includes a qualitative assessment of social aspects HIA results supported introduction of congestion charges (“toll roads) in London, England Toronto Public Health is completing a pilot HIA on the designated bus route planned to connect subway users to York University

32. Rapid Bus Route Pilot Health Impact Assessment Vehicle pollution Stress (commuting; driving) Equity issues (who benefits) Commute time Accident rates Outcomes Examined

33. Integration of Assessment Tools Policy Options Air Emissions Health Burden Ambient Levels

34. How to Deal with Different Health Outcomes? Premature mortality (acute) 177 Cardiovascular hospitalization 421 Respiratory hospitalizations 597 Adult chronic bronchitis 1,186 Emergency room visits 5,981 Bronchitis in children 11,997 Asthma symptom days 71,930 Pyramid of Health Effects Toronto Annual Estimates for Inhalable Particulates (PM 10 )

35. Some Policy Questions of Local Significance How does health burden shift if: Network of surface designated transit lanes introduced? Road congestion pricing is introduced? Bicycle network is created that reduces space for cars? Older vehicles are required to be retrofit or retired? Zoning is changed to reduce urban sprawl? Existing point sources are required to meet health-based air quality standards? Comprehensive energy conservation plan is implemented? Coal-fired power plants are replaced with natural gas?

36. For More Information Visit our Healthy People Healthy Environment home page at: www.toronto.ca/health/hphe