1. Section 6 Health Effects

2. Section 6 – Health Effects
A Brief History of PM
Section 6 – Health Effects

3. The Houses of Parliament, Stormy Sky
Claude Monet, 1904
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4. Air Pollution Disasters
1930 Meuse River Valley, Belgium
A three-day episode of severe air pollution makes 6,000 ill and kills 63.
1948 Denora, PA
Oct. 26 to 31: air pollution episode leaves 20 dead out of 14,000 persons.
1952 London, England
Dec. 4 to 9: “Killer Fog” leaves three to four thousand people dead.
Donora, PA at noon on
Oct. 29, 1948
London buses are escorted by lantern at 10:30 in the morning.
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5. Section 6 – Health Effects
Human Lung
Air conducting
Trachea
Bronchi
Bronchioles
Gas exchange
Respiratory
bronchioles
Alveoli
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6. Mouse lung exposed to Diesel Exhaust
Normal mouse lung
Exposed mouse lung
Diesel Exhaust Particles (DEP) augment inflammation by increasing receptors for bacterial lipopolysaccharide. The effect is to make the lungs highly sensitive to the presence of normal levels of bacteria. This results in greatly heightened production of pro-inflammatory mediators from the cells.
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7. Mortality attributed to London Smog
Schwartz, 1994
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8. Outdoor Air Pollution Regulatory Categories
Criteria Pollutants
Present everywhere
Ambient air quality standards
Widely monitored
Air toxics
Long list (>180)
Many carcinogens
Less frequent ambient measurements
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9. Section 6 – Health Effects
Criteria Pollutants
Particulate matter
PM10 (PM < 10 microns)
PM2.5 (PM < 2.5 microns)
(PM10-PM2.5 = coarse fraction)
Nitrogen dioxide (NO2)
Sulfur dioxide (SO2)
Ozone (O3)
Carbon monoxide
Lead
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10. Section 6 – Health Effects

11. Disease and environmental factors
Estimates of the burden of disease attributable to environmental factors vary depending on
Type of disease
Vulnerability
Genetics
Population group
Socioeconomic aspects
Large differences between people living in
Industrialized/developing countries
East/West of Europe
and others
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12. Disease and environmental factors
Major health impacts and their association with environmental factors
Cancer: air pollution, mainly PM 2.5 and smaller, PAHs, metals (AS Cd Cr)
Cardiovascular disease: air pollution (CO, O3, PM, Pb)
Respiratory diseases: SO2, NO2, PM10 and PM 2.5, O3
Developmental disorders: Pb, Hg, Cd
Nervous system disorders: Pb, PCBs, Methyl Hg, Mn
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13. Disease and environmental factors
Air pollution is the environmental factor with the greatest health impact in Europe!
Effect is expressed by number of deaths (mortality rates), and by DALYs:
“Disability-Adjusted Life Years”
An indicator of “burden of disease”,
Gives an indication how disease can alter the ability of people to live a normal life compared with those with no disease. Expresses years of lost life.
Effect also expressed as morbidity, such as increased frequency of chronic bronchitis, respiratory hospital admissions, restricted activity days.
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14. Disease and environmental factors
WHO estimates for Europe (51 countries)
Children age 0-4 years: 1.8 – 6.4 % of deaths from all causes due to outdoor air pollution
Mild mental retardation due to lead exposure: 4.4 % of all DALYs
In a selection of European cities each year:
Air pollution responsible for deaths and
years of lost life (DALYs)
European Commission estimates in CAFÉ:
premature deaths in 2000 due to outdoor air pollution of PM2.5 alone =
Average loss of life expectancy of 9 months for each European citizen
Ozone causes premature deaths annually
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15. Disease and environmental factors
Heat waves cause excess deaths; however, large portion due to air pollution
Heat wave in Europe summer 2003, in United Kingdom:
2045 excess deaths 4-13 August (compared with average)
Deaths due to air pollution:
225 – 593 due to ozone
207 due to PM10
Above represent 21 – 38 % of the excess deaths
(John R. Stedman)
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16. Disease and environmental factors
Strength of association between environmental factors and selected diseases, corresponding population impact and prevention possibilities (EEA and IPCC)
Neurodevelopment (Pb): very likely %, moderate, high
Neurodevelopment (Hg): very likely %, low, high
Respiratory diseases (air pollution): very likely %, high, moderate
Asthma causation (air pollution): medium likelihood %, high, moderate
Many examples show that respiratory health and life quality improves with improved air quality.
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17. Section 6 – Health Effects
Strength of association between environmental factors and selected diseases, corresponding population impact and prevention possibilities (EEA and IPCC)
Neurodevelopment (Pb): very likely %, moderate, high
Neurodevelopment (Hg): very likely %, low, high
Respiratory diseases (air pollution): very likely %, high, moderate
Asthma causation (air pollution): medium likelihood %, high, moderate
Many examples show that respiratory health and life quality
improves with improved air quality.
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18. many different sources
PM is derived from
many different sources
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19. Particulate Matter Sizes and Composition
10 um
1 um
0.1 um
Anthropogenic:
Sulfates
Nitrates
Ammonia
Carbon
Lead
Organics
Coarse
Fine
Natural:
Soil
Dust
Seasalt
Bioaerosols
2.5 um
Ultra Fine
PM10 can also be divided into several size fractions.
Coarse particles are between 2.5 and 10 microns in diameter;
fine particles in the 0.1 to 2.5 micron range; and
particles less than 0.1 micron in diameter are referred to as ultrafine particles.
[These are freshly emitted from combustion sources. They have almost no mass, but the absolute number of particles in this size category is very large. This represents a new and growing area of research.]
Adverse health effects have been associated with all inhalable particles, PM10, as well as the PM2.5 and ultrafine sub-fractions of PM10.
Section 6 – Health Effects

20. PM relative to hair cross section
Hair cross section (60 mm)
PM10
(10 mm)
PM2.5
(2.5 mm)
Human Hair
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21. Particles Affect the Lungs
Respiratory system effects:
Respiratory symptoms – irritation of airways, cough
Decreased lung function
Airway inflammation
Asthma attacks, bronchitis
Chronic bronchitis
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22. Public Health Risks Are Significant
Particles are linked to:
Premature death from heart and lung diseases
Aggravation of heart and lung diseases, with increased:
Hospital admissions
Doctor and ER visits
Medication use
School and work absences
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23. Some Groups Are More at Risk
People with heart or lung disease
Greater deposition with chronic obstructive pulmonary disease (COPD)
Older adults
Greater prevalence of heart and lung disease
Children
More likely to be active
Breathe more air per kg
Bodies still developing
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24. Section 6 – Health Effects
Nitrogen dioxide (NO2)
Emissions from high temperature combustion processes: motor vehicle exhaust and stationary sources for power production
Exposures indoors due to (unvented) gas appliances and infiltration of ambient NO2
(Complex atmospheric chemistry – can be transformed to HNO3 and nitrate particles)
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25. Nitrogen dioxide (NO2) effects
Strong oxidant and respiratory irritant (forms nitrous and nitric acids in contact with water)
NO2 irritates the nose, throat and lungs especially in people with asthma.
Lowers resistance to respiratory infections such as influenza.
Contributes to ozone formation (and thus to ozone effects indirectly).
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26. Section 6 – Health Effects
Sulfur dioxide (SO2)
Irritant gas resulting mainly from combustion of sulfur-containing fossil fuels (power plants, large industrial facilities, diesel vehicles) and metal smelting.
(Is oxidized/hydrated to form sulfuric acid particles)
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SO2 Effects
Usually short-term concentration peaks
SO2 reduces lung function:
Constricts breathing passages, causing wheezing, shortness of breath and coughing, happens quickly.
Lung function returns to normal about an hour after exposure ends.
Causes above in healthy subjects and asthmatics; latter are substantially more sensitive
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28. Section 6 – Health Effects
Ozone (O3)
Ubiquitous exposure - formed by natural processes as well as human activities
Principal constituent of photochemical smog – not emitted directly
Highly reactive, but poorly soluble, allowing deep lung penetration
Acute toxicity is related to dose = Concentration x Ventilation Rate x Time – increased risk from outdoor exertion
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29. Ozone Irritates Airways
Symptoms:
Cough
Sore or scratchy throat
Pain with deep breath, or chest pain
Fatigue
Rapid onset, but effect is greater 24 hours after exposure
Similar symptoms for people with or without asthma
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30. Public Health Risks Are Significant
Ozone is linked to:
Aggravation of lung diseases, increased
Hospital admissions
Doctor and ER visits
Medication use
School and work absences
Permanent lung changes
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31. Public Health Risks Are Significant
Respiratory hospital admissions by daily maximum ozone level, lagged one day
114
112
110
108
106
104
102
Respiratory Admissions
Ozone concentration (ppm)
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(Burnett et al, 1994)

32. Some Groups Are More at Risk
Children and adults who are active outdoors
People with lung diseases, such as asthma
People who are unusually sensitive to ozone
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33. Section 6 – Health Effects
Air Quality Index
Descriptors
Cautionary Statement
Good – 50
No message
Moderate 51 – 100
Unusually sensitive individuals
Unhealthy for Sensitive Groups
Identifiable groups at risk - different groups for different pollutants
Unhealthy
General public at risk; sensitive groups at greater risk
Very Unhealthy
General public at greater risk; sensitive groups at greatest risk
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34. Section 6 – Health Effects
Use AQI to Reduce Risk
Dose = Concentration x Ventilation rate x Time
Reduce concentration – schedule activities when pollution levels lower
Reduce ventilation rate by taking it easier
Reduce time spent in vigorous outdoor activities
Pay attention to symptoms
Section 6 – Health Effects

35. Health advisories make a difference
Roper 2002 survey of 2000 people across the US:
52 % had heard of AQI “Code Orange” or “Code Red” air quality days
Of those, 46 % have reduced exposure to air pollution
UCLA – Neidell et al.:
4 to 7 % reduction in pediatric hospital admissions for asthma attributable to advisories
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36. Will It Matter if Air Pollution Decreases?
The Dublin Experience
Dublin’s air quality deteriorated in the 1980s after a switch from oil to cheaper bituminous coal for heating.
In 1990 the Irish Government banned the use of bituminous coal within the city of Dublin, resulting in a reduction in PM concentrations.
Change in age-standardized total, cause-specific, and age-specific mortality rates for Dublin County Borough for 72 months before and after ban of sale of coal in Dublin: decrease from 4.5 to 15.5 % depending on the specific group.
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37. The Utah Valley Steel mill closed due to a labor dispute25 50 75
100
125
150
1985
1986
1987
1988
Steel Mill
Closed
PM (mg/m3) 20 40 60 80
Monthly Asthma Admissions
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38. Section 6 – Health Effects
Example of Action
Phasing out leaded gasoline
Mental retardation due to lead exposure was estimated to be nearly 30 times higher in regions where leaded gasoline was still being used compared with regions where leaded gasoline had been completely phased out.
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39. Section 6 – Health Effects
Information sources
Talks by:
Susan Lyon Stone, Michael Lipsett
Robert Devlin, John R Stedman
Guidelines on Biometeorology and Air Quality Forecasts, WMO, Public Weather Service
Environment and Health, EEA Rep No 10/2005
Preventing disease through healthy environments, WHO, 2006
EPA (US), AIRNow:
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40. Need Chemical Weather Forecasting
Section 6 – Health Effects