1. WHO European Centre for Environment and Health Recent WHO Findings on Health Risks Introduction Introduction Projects Projects Key findings Key findings Follow-up Follow-up Jürgen Schneider Project Manger WHO ECEH, Bonn, Germany TASK FORCE INTEGRATED ASSESSMENT MODELLING (Twenty-eight session, Haarlem, 7-9 May 2003 )

2. WHO European Centre for Environment and Health WHO Air Quality and Health Methodology of health impact assessment (participation in AIRNET & APHEIS) Systematic Review of Health Aspects of Air Quality in Europe (focus on ‘priority pollutants’ PM and ozone, NO 2 ) Update of WHO Air Quality Guidelines Health impacts of transport-related air pollution Health risks of POPs from LRTAP AQ strategies for NIS Capacity building in air quality monitoring and assessment (NIS & ALB)

3. WHO European Centre for Environment and Health WHO Project Systematic Review of Health Aspects of Air Quality in Europe (2002-2004) Purpose: To provide the EC DG Environment (& CAFE) with a systematic, periodic, scientifically independent review of the health aspects of air quality in Europe. Scientific Advisory Committee (SAC) Guides the overall review WHO Working Group (SAC + invited experts) Up-date the scientific evidence on health aspects of air pollution, agree on answers

4. WHO European Centre for Environment and Health Systematic Review Health aspects of PM, NO 2 and ozone Focused on twelve questions received from the CAFE Steering Group Used state-of-the-art knowledge on epidemiology and toxicology Short answers, supported by more extensive justifiactions Extensively reviewed Presented to stakeholders in Brussels Now available on web: http://www.euro.who.int/document/e79097.pdf

5. WHO European Centre for Environment and Health 1) Is there new scientific evidence to justify reconsideration of the current WHO Guidelines for the pollutant? Particulate matter: Yes Association of PM exposure with health effects have been strengthened Fine PM (measured as PM2.5) strongly associated with mortality and other endpoints PM10 is still considered to be a relevant metrics BS should be re-evaluated Ozone: Yes Evidence from epidemiological studies on effects of short-term exposure to ozone (mortality and morbidity) Evidence of long-term effects on lung function Nitrogen dioxide: No Very limited new evidence on potential mechanisms of NO 2 effects Reiteration of important role of NO 2 as indicator for traffic related air pollution and precursor of both ozone and secondary PM Systematic Review

6. WHO European Centre for Environment and Health 2 ) Which effects can be expected of long-term exposure? PM Long-term exposure may lead to a marked reduction in life expectancy. Increases in lower respiratory symptoms and reduced lung function in children, COPD and reduced lung function in adults Ozone Reduced lung functions in children NO 2 Some evidence for decreased lung function and increase of risk of respiratory syndroms Systematic Review

7. WHO European Centre for Environment and Health 3) Is there a threshold below which no effects on health are expected to occur in all people? For all three pollutants: No The population distribution of susceptibility may be such that effects are expected at very low levels Thresholds differ depending on endpoint selected Increasingly sensitive epidemiological study designs have identified adverse effects of air pollution at increasingly lower levels  Replacing the threshold concept with a more complete concept using exposure risk functions should be considered Systematic Review

8. WHO European Centre for Environment and Health 4) Are the effects dependent on the subject’s characteristics? PM Elderly and those with pre-existing disease are at higher risk Socially disadvantaged and poorly educated are at higher risk for mortality Ozone Mortality and hospital admissions increase with age Effects on asthmatic children might be greater Larger effects in children which spend more time outdoor Nitrogen dioxide Systematic Review

9. WHO European Centre for Environment and Health 6) Is the considered pollutant per se responsible for effects on health? PM: Yes – even though no single causative agent can be identified Ozone: Yes Nitrogen dioxide: A clear answer can not be given Systematic Review

10. WHO European Centre for Environment and Health 7) For PM: which of the physical and chemical characteristics of particulate air pollution are responsible for health effects? Fine PM is more hazardous than larger particles Metal content Organic components such as PAH Endotoxins Extremely small particles (< 100 nm) Systematic Review

11. WHO European Centre for Environment and Health 10) Which are the critical sources of the pollutant? Motor vehicle emissions Other combustion processes Wind-blown dust of crustal origin: less critical Systematic Review

12. WHO European Centre for Environment and Health 12) What averaging period is most relevant from the point of view of protecting human health? Particulate matter: Short-term (24 hours) and long-term (annual) guidelines are recommended Ozone: Short-term: 8-hour average is appropriate Long-term: associations are not clear enough to allow specific recommendation Nitrogen dioxide: Both, short-term (1 h) and long-term are warranted Systematic Review

13. WHO European Centre for Environment and Health Follow-up: Meta-analysis to derive concentration-response functions for Particualte matter Mortality (cause-specific) Hospital admissions (cause-specific) Ozone Mortality (cause-specific) Hospital admissions (cause-specific) Symtom exacerbation in astmatics Nitrogen dioxide The working group did not recommend the use of regression coefficients for NO 2 from regression models to assess the effect of NO 2 by itself. Systematic Review

14. WHO European Centre for Environment and Health Second round of questions by CAFE Steering Group Relevance of peak exposure? Uncertainties Specific populations at risk? Why should we keep the annual AQG for NO 2 ? Other polluants relevant? Systematic Review

15. WHO European Centre for Environment and Health WHO AQG published in 2000, but work finalised in 1996 Systematic review recommended an update for PM and ozone Update a world-wide activity Process initiated; request for funding Finalise until end of 2004 Update WHO AQG

16. WHO European Centre for Environment and Health Joint UN/ECE WHO Task Force on Health 6. Meeting 22-23 May in Bonn Approaches to risk assessment Modelling and assessment of health impacts of particulate matter and ozone from long range transboundary air pollution Relevance of secondary inorganic aerosols for PM-related health effects Is the AOT60 approach still appropriate? Possible approaches to include effects on morbidity into IAM

17. WHO European Centre for Environment and Health CAFE WG on PM PM is a priority pollutant of CAFE -> WG on PM Revision of Position Paper on PM Attainability of current LV (stage I and II) Guidance on targets for CAFE/IAM, based on advice from WHO, but also other considerations like attainability, cost-effectivness, etc. Draft version of the revised position paper will be discussed at a stakeholder conference in October 2003

18. WHO European Centre for Environment and Health Health impacts of transport-related air pollution Objective The objective of the WHO workshop is to provide a systematic literature review on transport-related health hazards. Time schedule  15 th July, submission of papers  1 st September, the draft monograph for external review  Mid October 2003 - WHO WG Workshop in WHO Bonn Office End 2003 - finalizing the monograph Contents 1.Factors Determining Emissions in the European Regions 2.Contribution of Traffic to Ambient Air Pollution Levels in the European Region 3.Human Exposure to Transport Related Air Pollution and Dose 4.Epidemiological Studies on Transport Related Health Effects 5.Toxicological Studies on Transport-Related Health Effects 6.Assessment of Health Hazards of Transport-Related Air Pollution

19. WHO European Centre for Environment and Health TASK FORCE INTEGRATED ASSESSMENT MODELLING (Twenty-eight session, Haarlem, 7-9 May 2003 )