Assessment of health benefits related to air quality improvement strategies in urban areas: An Impact Pathway Approach

Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal

OBJECTIVE

To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact.

RESULTS

Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution.

CONCLUSIONS

Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

Uncovering the overcapacity feature of China's industry and the environmental & health co-benefits from de-capacity

Overcapacity is regarded as an inevitable problem for rapid economic developing countries like China, which also causes serious adverse impacts on the environment and public health. However, few studies have quantified the overcapacity feature and corresponding co-benefit from de-capacity policy. To fill such research gaps, this study constructed a comprehensive assessment model by combining the Data Envelopment Analysis (DEA) model, the GAINS-China (Greenhouse gas - Air pollution Interactions and Synergies) model, and a meta-analysis and health impact assessment module, to measure the capacity utilization rate of 41 industrial sectors in 31 Chinese provinces and forecast the environmental and health co-benefits from de-capacity policy in 2050. Results showed that the capacity utilization rate of China's industry is 64.13% in 2018, which is much lower than the threshold value of 75%, indicating serious overcapacity in China's industry. Capacity utilization rates of light industries are higher (around 70%) than heavy industries (50%-60%), and the capacity utilization rate in East and South-Central China is higher (70%-96%) than West China (below 40%). Under a de-capacity scenario in 2050, China's CO₂ and PM_2.5 emissions are reduced by 1.05 billion tons (9.6%) and 57.8 kilotons (5.8%), respectively. This reduction in PM_2.5 emissions results in a substantial health co-benefit, reducing national premature mortality cases by approximately 792,100 (1.6%). Finally, it is recommended that de-capacity priority be given to industries with low capacity utilization rate, as well as regions with intensive heavy industry or high levels of greenhouse gas emissions, severe air pollution, and dense population.

Estimation of long-term and short-term health effects attributed to PM2.5 standard pollutants in the air of Ardabil (using Air Q + model)

Clean air is considered as a basic need for human health. However, air pollution is a significant threat to health in developed and developing countries. The aim of this study was to estimate the health effects attributed to PM_2.5 pollutants in the air of Ardabil in 2018 (using Air Q + model). Raw data related to particles were collected from the Department of Environment and processed in Excel software and converted into an input file of the Air Q + model, and in the final stage, by considering appropriate epidemiological parameters and combining these data with air quality data, it was possible to estimate the health effects of air pollution. The results showed that the average annual concentrations of PM_2.5 and PM₁₀ were 15.47 and 30.94 in the study year, respectively. The total number of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths on average during the study period were estimated to be 73, 11, 7, 15, and 14 deaths, respectively, which include 14.62, 15.78, 4.9, 12.43, and 11.6% of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths, respectively. In conditions of concentration above 5 µg/m³, attributed proportion, total number of attributed cases and number of attributed cases per 100,000 population (with moderate relative risk and confidence interval of 95%) for cardiovascular diseases have been estimated to be 0.95% 103 people and 42.19 people. Also, the attributed proportion, the total number of attributable cases, and the number of attributable cases per 100,000 population (with moderate relative risk and confidence of 95%) for the admission of respiratory diseases have been estimated at 97.1%, 68 persons and 3 persons, respectively. Our results suggest that particle exposure even at low concentrations is associated with an increased risk of overall mortality and specific cause mortality and hospital admissions for respiratory and cardiovascular diseases.

Is Population Density Associated with Non-Communicable Disease in Western Developed Countries? A Systematic Review

Over the last three decades, researchers have investigated population density and health outcomes at differing scale. There has not been a systematic review conducted in order to synthesise this evidence. Following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, we systematically reviewed quantitative evidence published since 1990 on population density and non-communicable disease (NCD) within Westernised countries. Fifty-four studies met the inclusion criteria and were evaluated utilising a quality assessment tool for ecological studies. High population density appears to be associated with higher mortality rates of a range of cancers, cardiovascular disease and COPD, and a higher incidence of a range of cancers, asthma and club foot. In contrast, diabetes incidence was found to be associated with low population density. High and low population density are therefore risk markers for a range of NCDs, indicating that there are unidentified factors and mechanisms underlying aetiology. On closer examination, our synthesis revealed important and complex relationships between population density, the built environment, the nature of greenspace and man-made exposures. In light of increasing rates of morbidity and mortality, future research is required to investigate these associations in order to establish causative agents for each NCD.

The Impact of Air Quality on Effective Labor Supply: Based on the Survey Data of Zhejiang Province in China

Labor is one of the most important factors of production and the basis for the development of social productivity. China’s aging population problem is serious, and the study of the labor supply is of great importance in order to achieve its second centenary goal regarding social development. In this study, four stage mixed sampling was used to conduct a questionnaire survey in the Zhejiang province of China, and 590 valid questionnaires were obtained. An ordered logit model and sample selection model were used to analyze the impact of air quality on the effective labor supply. The results show that the effective labor supply was significantly correlated with air quality. That is, the worse the air quality was, the lower the effective labor supply was, although this relationship was more explicit for people who worked indoors. When air quality impedes residents’ daily lives and even affects their health, it indirectly affects the effective supply of local labor. This paper indicates the causal relationship between economic development and the ecological environment and has enlightening significance for the realization of sustainable development.

Quantifying the impact of particle matter on mortality and hospitalizations in four Brazilian metropolitan areas

Air quality management involves investigating areas where pollutant concentrations are above guideline or standard values to minimize its effect on human health. Particulate matter (PM) is one of the most studied pollutants, and its relationship with health has been widely outlined. To guide the construction and improvement of air quality policies, the impact of PM on the four Brazilian southeast metropolitan areas was investigated. One-year long modeling of PM₁₀ and PM_2.5 was performed with the WRF-Chem model for 2015 to quantify daily and annual PM concentrations in 102 cities. Avoidable mortality due to diverse causes and morbidity due to respiratory and circular system diseases were estimated concerning WHO guidelines, which was adopted in Brazil as a final standard to be reached in the future; although there is no deadline set for its implementation yet. Results showed satisfactory representation of meteorology and ambient PM concentrations. An overestimation in PM concentrations for some monitoring stations was observed, mainly in São Paulo metropolitan area. Cities around capitals with high modelled annual PM_2.5 concentrations do not monitor this pollutant. The total avoidable deaths estimated for the region, related to PM_2.5, were 32,000 ± 5,300 due to all-cause mortality, between 16,000 ± 2,100 and 51,000 ± 3,000 due non-accidental causes, between 7,300 ± 1,300 and 16,700 ± 1,500 due to cardiovascular disease, between 4,750 ± 900 and 10,950 ± 870 due ischemic heart diseases and 1,220 ± 330 avoidable deaths due to lung cancer. Avoidable respiratory hospitalizations were greater for PM_2.5 among 'children' age group than for PM₁₀ (all age group) except in São Paulo metropolitan area. For circulatory system diseases, 9,840 ± 3,950 avoidable hospitalizations in the elderly related to a decrease in PM_2.5 concentrations were estimated. This study endorses that more restrictive air quality standards, human exposure, and health effects are essential factors to consider in urban air quality management.

Autonomous vehicles opportunities for cities air quality

The impacts of autonomous vehicles (AV) on safety, energy and atmospheric emissions have been recognised to be important issues, but an air quality impact assessment is missing. In this study, by using a numerical modelling approach, the impact of AV on the air quality of a medium-sized Portuguese urban area was evaluated. For that, the air pollutants nitrogen oxides (NOx) and carbon dioxide (CO₂) were considered and three scenarios were developed: i) a baseline scenario; ii) an autonomous scenario, assuming an AV market penetration rate of 30%; and iii) an electric autonomous scenario, taking into account that those 30% of AV are pure battery electric cars. A modelling system composed by a road traffic model, a road transport emission model and a Computational Fluid Dynamics air quality model was used. The autonomous scenario promoted an increase of both NOx (+1.8%) and CO₂ (+0.7%) emissions, while the electric autonomous scenario resulted in emission reductions of about 30% for both air pollutants. In terms of air quality, distinct patterns were found: i) the autonomous scenario promoted both increases and decreases of NOx concentrations; and ii) the electric autonomous scenario promoted a widespread reduction of NOx concentrations (with an average value of -4%). Overall the results showed that AV have the potential to improve urban air quality, but, further research is needed to enrich the findings of this work.

Estimating air pollution and health loss embodied in electricity transfers: An inter-provincial analysis in China

Electricity generation may create high levels of pollution, but its consumption is completely clean. Long-distance electricity transfers make the allocation of environmental externalities caused by electricity generation unfair at the regional level. This paper provides a generalized approach that can be used to evaluate air pollution and health loss embodied in electricity transfers. Impact pathway approach is combined with a network approach to evaluate embodied direct health loss and a sophisticated evaluation of air pollution diffusion is implemented to assess indirect environmental impacts between regions. Using China's inter-provincial power transmission as an example, this paper also reveals various air pollutant and health loss transfer patterns among the nation's provinces. The results emphasize the importance of characterizing the embodied environmental effects in electricity transfer through health losses rather than air pollution emissions. The inter-regional indirect impacts due to the diffusion of pollutants must be considered when examining the embodied health losses, which is even higher than the direct impact on the local. Several central regions in China, adjacent to the major electricity-export provinces, do not export a large amount of electricity, yet their health losses have increased significantly due to nationwide power transfers. The direct external health costs of electricity generation in China's major power-exporting provinces are relatively low. However, when indirect impacts are considered, external costs in the central and northern regions increase significantly. Therefore, the regional environmental benefits of shifting electricity generation to resource-rich remote areas are greatly reduced for many pairs of provinces.

Fuzzy inference system for modeling the environmental risk map of air pollutants in Taiwan

This study aimed to improve the uncertainty in spatial data of risk assessment through a Fuzzy inference system (FIS) as a way to conduct an environmental risk map of air pollution in Taiwan. In modeling, the feature inputs of FIS included the geographic coordinates and time, while the outputs are the pollutant concentrations. The outputs are supplements to the concentration contour on the map in comparison with Kriging interpolation. In our model, the FIS was designed using the official open data of air pollutants, including Pb and PM_2.5 that were collected from the monitoring stations in mid-southern Taiwan. The model involved data filtration and imputation in the preliminary scheme to extract the historical data for analysis. We used the data of Pb (2001-2013) and PM_2.5 (2006-2013) for the training process, and then used the data from 2014 to 2015 for validation. Our model was able to compute the smaller errors of inferred and measured values of Pb and PM_2.5 than the conventional method. The approach was applied to deduce the exposure of PM_2.5 distributed over the Taiwan Island in accordance with the governmental open data of seventy-three stations during 2006-2016 in order to produce our risk map. The designed model upon Fuzzy inference accesses potential risks of spatiotemporal exposures in the unmeasured locations with feasibility and adaptability for environmental management.

Application of multivariate statistical analysis using organic compounds: Source identification at a local scale (Napajedla, Czechia)

The study aimed to apply novel source classification tool for local scale air pollution assessment reducing the total number of organic compounds in the model. Samples of particulate matter (PM) were collected in the town of Napajedla (South-eastern Czech Republic) in 2016. The industrial sector of the town is represented by plastics processing and manufacturing, as well as by mechanical engineering. Analytical technique of pyrolysis chromatography with mass spectroscopy detection was employed to identify organic species in the PM₁₀ fraction. Two datasets (465 determined organic compounds and 50 selected organic markers) were used and compared by multivariate analysis - principal component analysis followed with hierarchical clustering on principal components incorporating compositional data approach. Three resulting clusters were observed in both cases. The cluster representing measurements near plastic processing and manufacturing plants was identical in both the analysed datasets with the same organic compounds that characterized resulting cluster Consequently, leading markers for plastic processing and manufacturing sources were suggested (bumetrizole, bis(tridecyl)phthalate, mono(2-ethylhexyl)phthalate). Other two clusters varied among the analysed datasets, however, dataset with selected markers showed more reliable outcomes. The results imply that concept of using only selected organic marker species with the compositional approach in multivariate statistical methods is sufficient and allows properly distinguishing the main air pollution sources between sampling locations even at a small urban scale.

The possibilities to identify combusted fuel based on an analysis of ash from local heating

Combustion of undesirable components with a high calorific value (waste: plastics, rubber, chipboard, plywood etc.) contribute to an increased emissions of PM particles. The possibility of identification of non-desirable fuels was verified by analysis of unburned carbon from bottom ash by means of pyrolysis-GC/MS. Compounds derived from thermal conversion of main wood components in the unburned carbon are formed by aldehydes, ketones, alkanes, alkenes, alkanoates, polycyclic aromatic hydrocarbons, compounds containing benzene, compounds containing phenol and nitrogen. Unburned carbon from plywood/chipboard contains compounds with nitrogen (heterocyclic and aliphatic) in increased concentrations (33-51 ng/mg) compared with unburned carbon from pure wood (7-12 ng/mg). The concentrations increased almost two times were proved for compounds containing phenols in unburned carbon from wood composite. Total amount of determined organic compounds is also almost two times higher than that contained in unburned carbon from wood. The indication of waste wood combustion from unburned carbon is possible using the ratio: phenol/(2-methylphenol+4-methylphenol).

Economic impacts from PM2.5 pollution-related health effects in China's road transport sector: A provincial-level analysis

Economic impact assessments of air pollution-related health effects from a sectoral perspective in China is still deficient. This study evaluates the PM_2.5 pollution-related health impacts of the road transport sector on China's economy at both national and provincial levels in 2030 under various air mitigation technologies scenarios. Health impacts are estimated using an integrated approach that combines the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model, a computable general equilibrium (CGE) model and a health model. Results show that at a national level, the road transport sector leads to 163.64 thousand deaths per year, increases the per capita risk of morbidity by 0.37% and accounts for 1.43 billion Yuan in health care expenditures. We estimate 442.90 billion Yuan of the value of statistical life loss and 2.09 h/capita of work time loss in 2015. Without additional control measures, air pollution related to the transport sector will cause 177.50 thousand deaths in 2030, a 0.40% per capita increase in the risk of morbidity, accounting for 4.12 billion Yuan in health care expenditures, 737.15 billion Yuan of statistical life loss and 2.23 h/capita of work time loss. Based on our model, implementing the most strict control strategy scenario would decrease mortality by 42.14%, morbidity risk by 42.14%, health care expenditures by 41.94%, statistical life loss by 26.22% and hours of work time loss by 42.65%, comparing with the no control measure scenario. In addition, PM_2.5 pollution from the road transport sector will cause 0.68% GDP loss in 2030. At a provincial level, GDP losses in 14 out of 30 provinces far exceed the national rate. Henan (1.20%), Sichuan (1.07%), Chongqing (0.99%), Hubei (0.94%), and Shandong (0.90%) would experience the highest GDP loss in 2030. Implementing control strategies to reduce PM_2.5 pollution in the road transport sector could bring positive benefits in half of the Chinese provinces especially in provinces that suffer greater health impacts from the road transport sector (such as Henan and Sichuan).

Health benefits of a reduction of PM10 and NO2 exposure after implementing a clean air plan in the Agglomeration Lausanne-Morges

Exposure to urban air pollution has been associated with adverse effects on cardio-vascular and respiratory health, both short and long term. Consequently, governments have applied policies to reduce air pollution. Quantitative health impact assessments of hypothetic changes in air pollution have been conducted at national and global level, but assessments of observed air pollution changes associated with specific clean air policies at a local or regional scale remain scarce. This study estimates health impacts attributable to a decrease in PM₁₀ and NO₂ exposure in the Agglomeration of Lausanne-Morges (ALM), Switzerland, between 2005 and 2015, corresponding to the implementation period of a supra-municipal plan of measures to reduce air pollution in different sectors such as transport, energy, and industry (called Plan OPair 05). The health impact assessment compares health effects attributed to air pollution exposure levels in 2015 (reference case) with those in 2005 (counterfactual scenario), using 2015 as baseline for all other input data. In the ALM, the modeled PM₁₀ exposure reduction of 3.3μg/m³ from 2005 to 2015 prevents 26 premature deaths (equivalent to around 290 years of life lost), 215 hospitalization days due to cardio-vascular and respiratory diseases as well as approximately 47,000 restricted activity days annually. Monetized health impacts of the reduction of PM₁₀ exposure are valued at approximately CHF 36 million annually. Immaterial costs, mainly related to the economic valuation of years of life lost, dominate the monetized health impacts (90% of total value), while savings at the workplace (net loss in production and reoccupation costs) amount to about CHF 1.9 million, and savings in health care costs to about CHF 0.5 million. The assessment is sensitive to the value assigned to immaterial costs and to uncertainties in the relative risk estimates, whereas variations in the baseline year (i.e. using 2005 data instead of 2015 data) affect results to a much lower degree. The alternative calculation based on NO₂ exposure, which dropped by 5.6μg/m³, suggests the prevention of 51 premature deaths (equivalent to around 550 years of life lost) overall impacts valued at CHF 49 million. All in all, the reduction in mortality due to the air quality improvements accounts for (depending on the considered pollutant) about 1% to 2% of total all-cause annual mortality in the ALM population or 4-8 times larger than the annual traffic fatalities in the ALM.