Bedeutung der Gesetzgebung zur Luftreinhaltung in der Prävention umweltbedingter Erkrankungen

Die Luftverschmutzung beispielsweise durch Feinstaub (PM, particulate matter), Stickoxide oder Ozon ist schädlich für die Gesundheit. Bestehende Lungenkrankheiten können sich durch kurzfristig erhöhte Luftbelastung verschlimmern. Langfristige Luftbelastung trägt insbesondere zur Entstehung von kardiorespiratorischen Erkrankungen bei. In Deutschland starben im Jahr 2019 53.000 Menschen vorzeitig aufgrund der Feinstaubbelastung. Die Luftreinhaltung ist eine politische Aufgabe mit großem gesundheitlichem Potenzial. Sie hat in den letzten Jahren wesentlich zur Verbesserung der Luftqualität und damit der Gesundheit beigetragen. In Anbetracht der neuen stringenteren Luftqualitätsleitlinien der Weltgesundheitsorganisation (WHO) sind die Behörden und Politiker nun weltweit mit der Frage der Anpassung der Luftreinhalteziele konfrontiert. In Europa prägt die EU-Direktive die Luftreinhalteziele der Mitgliedstaaten. Die Festlegung der Richtwerte obliegt dem EU-Parlament und dem Rat der EU. Das Nichterreichen der gesetzten Ziele ist mit Strafen verbunden. Deshalb besteht die Gefahr, dass erreichbare und weniger ambitionierte Ziele gesetzt werden. Bereits heute liegen die EU-Richtwerte wesentlich höher als jene in den USA oder der Schweiz. Während „nur“ 11 % der Bevölkerung in der EU einer Belastung über dem EU-Grenzwert für Feinstaub PM10 im Jahr 2020 ausgesetzt waren, sind bei Anwendungen der neuen WHO-Leitlinie 71 % der Bevölkerung übermäßigen und gesundheitsgefährdenden Feinstaubwerten ausgesetzt. Zur wichtigsten und erfolgreichsten Maßnahme der Luftreinhaltung zählt die Reduktion der Luftschadstoffe an der Quelle: die Emissionsbegrenzung. Trotz der Energiekrise dürfen Ziele bezüglich Luftreinhaltung und Klimaschutz nicht aus den Augen verloren werden. Wichtig ist, dass der Gesundheitsschutz nicht dem Einzelnen überlassen werden kann. Gesundheitsfachleute haben in der Beratung empfindlicher Patienten im Umgang mit kurzfristig erhöhter Luftschadstoffbelastung eine wichtige klinische Funktion, aber darüber hinaus ist ihre beratende Rolle in der Politik sehr bedeutsam.

Ambient Air Quality Standards and Policies in Eastern Mediterranean Countries: A Review

Objectives: National ambient air quality standards (NAAQS) are critical tools for controlling air pollution and protecting public health. We designed this study to 1) gather the NAAQS for six classical air pollutants: PM_2.5, PM₁₀, O₃, NO₂, SO₂, and CO in the Eastern Mediterranean Region (EMR) countries, 2) compare those with the updated World Health Organizations Air Quality Guidelines (WHO AQGs 2021), 3) estimate the potential health benefits of achieving annual PM_2.5 NAAQS and WHO AQGs per country, and 4) gather the information on air quality policies and action plans in the EMR countries. Methods: To gather information on the NAAQS, we searched several bibliographic databases, hand-searched the relevant papers and reports, and analysed unpublished data on NAAQS in the EMR countries reported from these countries to the WHO/Regional office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE). To estimate the potential health benefits of reaching the NAAQS and AQG levels for PM_2.5, we used the average of ambient PM_2.5 exposures in the 22 EMR countries in 2019 from the Global Burden of Disease (GBD) dataset and AirQ+ software. Results: Almost all of the EMR countries have national ambient air quality standards for the critical air pollutants except Djibouti, Somalia, and Yemen. However, the current standards for PM_2.5 are up to 10 times higher than the current health-based WHO AQGs. The standards for other considered pollutants exceed AQGs as well. We estimated that the reduction of annual mean PM_2.5 exposure level to the AQG level (5 μg m^-3) would be associated with a decrease of all natural-cause mortality in adults (age 30+) by 16.9%-42.1% in various EMR countries. All countries would even benefit from the achievement of the Interim Target-2 (25 μg m^-3) for annual mean PM_2.5: it would reduce all-cause mortality by 3%-37.5%. Less than half of the countries in the Region reported having policies relevant to air quality management, in particular addressing pollution related to sand and desert storms (SDS) such as enhancing the implementation of sustainable land management practices, taking measures to prevent and control the main factors of SDS, and developing early warning systems as tools to combat SDS. Few countries conduct studies on the health effects of air pollution or on a contribution of SDS to pollution levels. Information from air quality monitoring is available for 13 out of the 22 EMR countries. Conclusion: Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs and enhanced air quality monitoring are essential elements for reduction of air pollution and its health effects in the EMR.

A Scoping Review on Air Quality Monitoring, Policy and Health in West African Cities

Ambient air pollution is a global health threat that causes severe mortality and morbidity from respiratory, cardiovascular, and other diseases. Its impact is especially concerning in cities; as the urban population increases, especially in low- and middle-income countries, large populations risk suffering from these health effects. The Economic Community of West African States (ECOWAS) comprises 15 West African countries, in which many cities are currently experiencing fast growth and industrialization. However, government-led initiatives in air quality monitoring are scarce in ECOWAS countries, which makes it difficult to effectively control and regulate air quality and subsequent health issues. A scoping study was performed following the Arksey and O’Malley methodological framework in order to assess the precise status of air quality monitoring, related policy, and legislation in this region. Scientific databases and gray literature searches were conducted, and the results were contrasted through expert consultations. It was found that only two ECOWAS countries monitor air quality, and most countries have insufficient legislation in place. Public health surveillance data in relation to air quality data is largely unavailable. In order to address this, improved air quality surveillance, stricter and better-enforced regulations, regional cooperation, and further research are strongly suggested for ECOWAS.

Prolonged Life Expectancy for Those Dying of Stroke by Achieving the Daily PM2.5 Targets

This time-series study collects data on stroke-related mortality, years of life lost (YLL), air pollution, and meteorological conditions in 96 Chinese cities from 2013 to 2016 and proposes a three-stage strategy to generate the national and regional estimations of avoidable YLL, gains in life expectancy and stroke-related population attributable fraction by postulating that the daily fine particulate matter (PM2.5) has been kept under certain standards. A total of 1 318 911 stroke deaths are analyzed. Each 10 µg m-3 increment in PM2.5 at lag03 is associated with a city-mean increase of 0.31 (95% CI: 0.19, 0.44) years of life lost from stroke. A number of 914.11 (95% CI: 538.28, 1288.94) years of city-mean life lost from stoke could be avoided by attaining the WHO's Air Quality Guidelines (AQG) (25 µg m-3). Moreover, by applying the AQG standard, 0.11 (0.08, 0.15) years of life lost might be prevented for each death, and about 0.91% (95% CI: 0.62%, 1.19%) of the total years of life lost from stroke might be explained by the daily excess PM2.5 exposure. This study indicates that stroke patients can have a longer life expectancy if stricter PM2.5 standards are put in place, especially ischemic stroke patients.

Air Pollution and Health: The Need for a Medical Reading of Environmental Monitoring Data

Air pollution is a recent public health issue. In 2006, the World Health Organization (WHO) published updated air quality guidelines for a number of air pollutants (including PM10 and PM2.5), which recommended for particulate matter annual average concentration levels at half or less the limit values set by European legislation. In the European Union, around 80% of the European urban population is exposed to air pollution above the levels recommended by the WHO guidelines. Only in 2015 the WHO addressed for the first time the topic of the health impacts of air pollution in its general assembly, which adopted a resolution clearly defining air pollution as the world’s largest single environmental health risk factor. Nowadays, the WHO considers air pollution as a major public health threat, causing a 7% increase in overall mortality for each increase of 10 μg/m³ in annual average of PM2.5. This result has been achieved thanks to the outstanding efforts of the director of the WHO’s Environment and Public Health Department, Dr. Maria Neira, who has devoted her full commitment to highlighting the consequences that air pollution has on people’s health. More recently, at European level, the Air Quality Directive has been subject to a fitness check, published in 2019; the European Green Deal has since announced its aim to align EU air quality standards more closely with the WHO recommendations. Every year, the European Environment Agency (EEA) publishes its “Air Quality in Europe” Report to assess the figures on air pollution across Europe and related health impacts. However, environmental data provided by official regional or national agencies—used by decision makers to adopt preventive measures such as limitations on urban traffic or domestic heating—refer to legal thresholds established by the law (usually on the basis of values set at European level, at least for the EU). These legal thresholds, however, are not adequate to fully protect population against all impacts from air pollution as recommended by WHO and scientific evidence. Therefore, we point out the need for a medical reading of environmental monitoring data that should be performed both at national and regional or local level by health authorities, to foster population health protection against air pollution and guarantee the application of the precautionary principle. A stronger cooperation between environmental agencies and health authorities is needed to address the new challenges to human and planetary health arising from air pollution and climate change. Health authorities should integrate their medical staff with new professionals and researchers with adequate training in environmental sciences to foster population health protection against air pollution. For this purposes, multi-disciplinary research units or teams should be established by local health authorities on environmental health topics, working together with medical staff and environmental agencies for a mutual integration of competencies.

Ozone Pollution: A Major Health Hazard Worldwide

Oxides of nitrogen (NO_x) and volatile organic compounds (VOCs) released into the atmosphere can react in the presence of solar irradiation, leading to ozone formation in the troposphere. Historically, before clean air regulations were implemented to control NO_x and VOCs, ozone concentrations were high enough to exert acute effects such as eye and nose irritation, respiratory disease emergencies, and lung function impairment. At or above current regulatory standards, day-to-day variations in ozone concentrations have been positively associated with asthma incidence and daily non-accidental mortality rate. Emerging evidence has shown that both short-term and long-term exposures to ozone, at concentrations below the current regulatory standards, were associated with increased mortality due to respiratory and cardiovascular diseases. The pathophysiology to support the epidemiologic associations between mortality and morbidity and ozone centers at the chemical and toxicological property of ozone as a strong oxidant, being able to induce oxidative damages to cells and the lining fluids of the airways, and immune-inflammatory responses within and beyond the lung. These new findings add substantially to the existing challenges in controlling ozone pollution. For example, in the United States in 2016, 90% of non-compliance to the national ambient air quality standards was due to ozone whereas only 10% was due to particulate matter and other regulated pollutants. Climate change, through creating atmospheric conditions favoring ozone formation, has been and will continue to increase ozone concentrations in many parts of world. Worldwide, ozone is responsible for several hundreds of thousands of premature deaths and tens of millions of asthma-related emergency room visits annually. To combat ozone pollution globally, more aggressive reductions in fossil fuel consumption are needed to cut NO_x and VOCs as well as greenhouse gas emissions. Meanwhile, preventive and therapeutic strategies are needed to alleviate the detrimental effects of ozone especially in more susceptible individuals. Interventional trials in humans are needed to evaluate the efficacy of antioxidants and ozone-scavenging compounds that have shown promising results in animal studies.

A century of the Archives of Environmental & Occupational Health

With this issue, the Archives of Environmental & Occupational Health celebrates 100 years of continuous publication since its foundation as the Journal of Industrial Hygiene in 1919. During its first century, the Archives established an extraordinary legacy in the development of no less than three fields of research and practice: (1) occupational medicine, (2) industrial hygiene, and (3) air pollution studies and regulation. Its contribution to American environmental protection standards in air quality was particularly important, as the journal served as a major outlet for crucial air pollution research during the early years of the new United States Environmental Protection Agency. Its pages also chart the development of occupational health as an independent field, as well as the later emergence of modern environmental health as a related co-discipline. As the Archives moves into its second century of continuous publication, the journal will continue shaping the fields of environmental and occupational health; building on the solid foundation of evidence-based research from which humankind continues to benefit.

Comparison of motorcycle taxi driver's respiratory health using an air quality standard for carbon monoxide in ambient air: a pilot survey in Benin

Introduction

Ambient air quality standards are not designed to protect people occupationally exposed to outdoor air pollution on a routine basis. This study aimed to assess the effect of exceeding the US ambient air quality standard for carbon monoxide (CO) on motorcycle taxi drivers respiratory health.

Methods

A cross-sectional study of 85 current motorcycle taxi drivers with at least 5 years of job tenure in Cotonou (Benin) was conducted. Personal CO was measured with a portable CO data logger for 8 hours per day during working hours. A questionnaire on respiratory symptoms was administered to participants and spirometry was performed. Participants were divided into two groups, those with exposure to CO >9 ppm and ≤9 ppm, according to the US Environmental Protection Agency (EPA) National Ambient Air Quality Standard which is an 8-hour average of 9ppm. 8 and 10 ppm were also used an exposure limit. Analysis was done using these two groups.

Results

Socio-demographic characteristics were well balanced between the two study groups. The drivers with a CO exposure of more than 9ppm had non-significantly more respiratory symptoms (OR=1.67; 95%CI:0.26,10.74), lower FVC and FEV1 compared to the less exposed group but they have a significant lower PEF (-10%, p=0.02). When we used an exposure limit of 8 or 10 ppm the results were not statistically different.

Conclusion

Drivers with a CO exposure >9 ppm tend to have more respiratory problems. More research is needed to reinforce this result in order to improve air quality standards to protect workers occupationally exposed to outdoor air pollution.

The use of a new passive sampler for ozone and nitrogen oxides monitoring in ecological effects research

A simple, cost-effective diffusive sampler is described that is suitable for measuring parts per billion (ppb) levels of ozone and nitrogen oxides. The diffusive sampler makes use of nitrite for ozone determination whereas for nitrogen oxides and nitrogen dioxide an active carbon tissue impregnated with sodium carbonate is used. Nitrate and nitrite, the formation of which is proportional to the pollutant concentration and sampling duration, are the two species analysed, respectively. Diffusion tubes have the advantage of being a low- cost, convenient way of mapping spatial distributions and investigating long-term trends of ozone and nitrogen oxides. The method is extremely useful for assessing long-term concentrations such as the annual mean for nitrogen oxides, as required by the Daughter Directive 1999/30/EC. Field tests to validate the method have been carried out at an urban background location with co-located passive samplers and continuous measurements of O3 and NOx. An application in ecological effects monitoring for ozone is also presented.