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APHEISAir Pollution and Health: A European Information System
Bertil Forsberg, Sylvia Medina, Antoni Plasència, Ross Anderson, Lucia Artazcoz, Klea Katsouyanni,
Michal Krzyzanowski, Hans-Guido Mücke, Emile de Saegerand Joel Schwartz
On behalf of the APHEIS group
APHEIS is co-funded by the Pollution Related Diseases Programme of DG SANCOof the European Commission (contract No. SI2.131174 [99CVF2-604] -SI2.297300[2000CVG2-
607]-SI2.326507[2001CVG2-602]) and by the participating APHEIS institutions
APHEIS cities (26)
Steering Committee (Boston, USA)
(Tel-Aviv, Israel)
An epidemiological surveillance system
Aims to provide up-to-date and easy-to-use information on health impact assessment (HIA) of air pollution
For decision makers, environmental and health professionals, media and general public
Enables better-informed decisions about political, professional, personal issues
What is Apheis
How Apheis works
APHEIS coordination centre
Paris and Barcelona
Advisory groupsExposure assessmentEpidemiologyStatisticsPublic health Health impact assessment
Participating APHEIS Cities
Technical committeeExposure assessmentEpidemiologyStatisticsPublic HealthHealth Impact Assessment
City committeeNEHAPsLocal/national authoritiesMedical/environmental sciencesCitizens
Local/regional coordinator
Created five advisory groups: public health; health-impact assessment; epidemiology; exposure assessment; statistics
Drafted guidelines for designing and implementing the surveillance system, and for developing a standardised protocol for data collection and analysis for HIA
Review of capacities for HIA in institutions of participating cities
Actions, steps and resultsduring the first year
Implement or adapt organisational models designed during first year
Collect and analyse data for health-impact assessment
Prepare different health-impact scenarios
Prepare HIA report in standardised format (HIA in 26 cities)
Actions, steps and resultsduring the second year
1. Specify exposure
* PM10, BS
* Urban background stations
Five main steps in HIA
2. Define the appropriate health outcomes
* Acute effects
- Premature mortality excluding accidents and violent deaths
- Hospital admissions for respiratory diseases 65+ age group
- Hospital admissions for cardiac diseases all ages
* Chronic effects
- Mortality (all natural causes)
Five main steps in HIA
3. Specify the exposure-response functions
* Short-term exposure: APHEA2
Five main steps in HIA
Health indicator RR for 10 µg/m3 95%CI
Total mortality All ages
ICD9 <800 (Katsouyanni et al, 2001)
1.006 1.003 - 1.008
Respiratory hospital admissions 65 years +
ICD9 460-519 (Atkinson et al, 2001)
1. 001 1.00 - 1.009
Cardiac hospital admissions all ages
ICD9 410- 414.427.428 (Le Tertre et al, 2002)
1.011 1.004 - 1.018
3. Specify the exposure-response functions
* Long-term exposure: HIA in Austria, France and Switzerland based on two American cohort studies (Künzli et al, 2000).
Five main steps in HIA
Health indicator RR for 10 µg/m3 95%CI Total mortality
30 years + ICD9 <800
1.043 1.026-1.061
4. Derive population baseline frequency measures for health outcomes
5. Calculate number of attributable cases in target population (based on attributable proportion)
Five main steps in HIA
Demographic characteristics
* Nearly 39 million inhabitants in Western and Eastern Europe
* Proportion of people over 65 years: 15%, with highest proportion in Barcelona and lowest in London
Descriptive findings
Air pollution levels
* Black smoke measurements provided by 15 cities: Athens, Barcelona, Bilbao, Bordeaux, Celje, Cracow, Dublin, Le Havre, Lille, Ljubljana, London, Marseille, Paris, Rouen and Valencia
* PM10 measurements provided by 19 cities: Bordeaux, Bucharest, Budapest, Celje, Cracow, Gothenburg, Lille, Ljubljana, London, Lyon, Madrid, Marseille, Paris, Rome, Seville, Stockholm, Strasbourg, Tel Aviv and Toulouse
Descriptive findings
Annual mean levels and 10th and 90th percentiles of the distribution of PM10
Descriptive findings
0
10
20
30
40
50
60
70
80
90
100
Borde
aux
Bucha
rest
*
Budap
est
Celje
Craco
w
Gothe
nbur
gLil
le
Ljublj
ana
Lond
onLy
on
Mad
rid
Mar
seille
Paris
Rome
Seville
Stock
holm
Strasb
ourg
Tel A
viv
Toulo
use
µg/m3
2005
2010
Annual mean levels and 10th and 90th percentiles of the distribution of black smoke
Descriptive findings
0
20
40
60
80
100
120 µg/m3
Acute effects scenarios
* Reduction of PM10/BS levels to a 24-hour value of 50 µg/m3 (2005 and 2010 limit values for PM10) on all days exceeding this value
* Reduction of PM10/BS levels to a 24-hour value of 20 µg/m3 (to allow for cities with low levels of PM10/BS) on all days exceeding this value
* Reduction by 5 µg/m3 of all the 24-hour daily values of PM10/BS (to allow for cities with low levels of PM10/BS)
Health impact assessment findings
Chronic effects scenarios
* Reduction of the annual mean value of PM10 to a level of 40 µg/m3 (2005 limit values for PM10)
* Reduction of the annual mean value of PM10 to a level of 20 µg/m3 (2010 limit values for PM10)
* Reduction of the annual mean value of PM10 to a level of 10 µg/m3 (to allow for cities with low levels of PM10)
* Reduction by 5 µg/m3 of the annual mean value of PM10 (to allow for cities with low levels of PM10)
Health impact assessment findings
Potential benefits of reducing daily PM10 levels by 5 µg/m3 - Number of deaths per 100 000 inhabitants (95% confidence limits) attributable to the acute effects of PM10
HIA findings: PM10 acute-effects scenarios
0
1
2
3
4
5
6
7 Rate/100 000/year
Potential benefits of reducing annual mean values of PM10 by 5 µg/m3- Number of deaths per 100 000 inhabitants (95% confidence limits) attributable to the chronic effects of PM10
HIA findings: PM10 chronic-effects scenarios
0
5
10
15
20
25
30
35
40
45
50 Rate /100 000 / year
Standardised protocol for data collection and analysis
Conservative approach
* Did not consider newborn or infant mortality separately
* Did not consider many other health outcomes listed by WHO
* Did not consider independent effect of ozone
* Used range of reference levels in different scenarios
Interpretation of findings
Transferability of Exposure-Response (E-R) functions
* Short-term exposure: Question avoided by using E-R functions developed by APHEA 2
* Long-term exposure: Open question - used U.S. E-R functions
Interpretation of findings
Conclusions
* Our HIA provides a conservative but accurate and detailed picture of the impact of air pollution on health in 26 European cities, and shows that air pollution continues to threaten public health in Europe.
* Even very small and achievable reductions in air pollution levels have an impact on public health
* This impact justifies taking preventive measures even in cities with low levels of air pollution
Interpretation of findings
The Apheis second-year report also provides an individual picture for each of the 26 cities that describes:
* Local characteristics
* Air pollution sources
* Exposure data
* Health outcomes
* HIA
* Specific comments
City by city reports
To keep our HIA as accurate and up-to-date as possible:
* produce new exposure-response functions on short-term effects of AP
* calculate years of life lost or reduction in life expectancy, in addition to the attributable number of deaths based on long-term effects
Actions, steps and resultsduring the third year
To fulfill our mission of making our learnings available to the broadest possible audiences, and to evaluate the usefulness of our work on HIA among those who need to know:
* Explore and understand how best to meet the information needs of government decision and policy makers concerned with the impact of air pollution on public health
and
* Understand how to meet those needs in terms of content and form
Actions, steps and resultsduring the third year
Calculate costs to society of health effects of AP
Involve Apheis more closely in municipal, regional, national and European programmes (NEHAPS, AIRNET,CAFE, EUROHEIS).
Actions and steps to beundertaken in future years
The Apheis programme
* Multiyear, multiphase, proactive
* Answers key questions on air pollution and public health in Europe for a broad range of audiences
* Translates epidemiological findings into decision-making tool
* Bridges the gap between data and action
The broad view
The Apheis programme
* First broad-based European HIA of air pollution
* Consistent with other HIAs on air pollution worldwide
* Provides information on both local and European levels simultaneously with two main benefits:
- Local data can be used for local decision making (e.g. urban and transport planning; devising of steps to reduce air pollution)
- European authorities gain a global view on air pollution and public health
The broad view
The Apheis programme
* One more brick in the wall of evidence that air pollution continues to threaten public health
* Each phase builds on learnings of previous phase
* Needs ongoing commitment and funding by European Commission and EC member states
* For further information visit www.apheis.org
The broad view