Air Science Policy: The U.S. Perspective on

Addressing Future Air Quality Challenges

C. Arden Pope III

Mary Lou Fulton Professor of Economics

Presented at:

Air Science Policy Forum

Dublin, Ireland

April 15, 2013

Early “Killer smog” episodes demonstrated that air pollution at extreme

levels can contribute to respiratory and cardiovascular disease and death

Dec. 5-9, 1952: London--1000’s of excess deaths

Dec. 1-5, 1930: Meuse Valley, Belgium

60 deaths (10x expected)

Oct. 27-31, 1948: Donora, PA

20 deaths, ½ the town’s population fell ill

Respiratory and cardiovascular

disease and death

The killer episodes spurred air pollution policies in the U.S.

Killer Smog (and related research)

Public Policy Results 1955-1967: Air pollution control

acts

1967, 1970: Clean Air Act,

Major Amendments, National

Environmental Policy Act

1977 & 1990: Major

Amendments to Clean Air Act

1980’s: Elimination of

extreme “Killer Smog”

episodes & Improved air

quality

1930: Meuse Valley, Belgium

1948: Donora, PA

1952: London, England

By the 1980’s, many thought the air pollution problem

had been solved…

…but by the early 1990’s, several studies suggested

that even moderate levels of air pollution could

contribute to significant health effects.

Utah Valley, 1980s

• Winter inversions trap local pollution

• Natural test chamber

• Local Steel mill contributed ~50% PM2.5

• Shut down July 1986-August 1987

• Natural Experiment

Large difference in air quality

when inversions trap air pollution in valley

Utah Valley: Clean day

Utah Valley: Dirty day

(PM10 = 220 mg/m3)

mg

/m3/N

um

be

rs o

f A

dm

issio

ns

0

50

100

150

200

250

300

PM10 concentrations Children's respiratory hospital admissions

Mean PM10

levels forMonthsIncluded

Mean HighPM

10

levels forMonthsIncluded

PneumoniaandPleurisy

Bronchitisand Asthma

Total

Children's Respiratory Hospital AdmissionsFall and Winter Months, Utah Valley

Sources: Pope. Am J Pub Health.1989; Pope. Arch Environ Health. 1991

When the steel mill was open, total children’s hospital

admissions for respiratory conditions approx. doubled. m

g/m

3/N

um

bers

of A

dm

issio

ns

0

50

100

150

200

250

300

PM10 concentrations Children's respiratory hospital admissions

Mean PM10

levels forMonthsIncluded

Mean HighPM

10

levels forMonthsIncluded

PneumoniaandPleurisy

Bronchitisand Asthma

Total

Children's Respiratory Hospital AdmissionsFall and Winter Months, Utah Valley

Sources: Pope. Am J Pub Health.1989; Pope. Arch Environ Health. 1991

Mill

Open

Mill

Closed

% incre

ase in m

ort

alit

y

0

1

2

3

Estimates frommeta analysis

Estimates from Multicity studies

29 c

itie

s(L

evy e

t a

l. 2

00

0)

GA

M-b

ase

d s

tud

ies

(Stie

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l. 2

00

2,

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3)

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ad

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nd

ers

on

et

al. 2

00

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6 U

.S.

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lem

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n 2

00

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rg 2

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MA

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. citie

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uro

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rench

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n G

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lica

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g/m

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0

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g/m

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0

20

g/m

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0

20

g/m

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M1

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20

g/m

3 P

M1

0

10

g/m

3 P

M2.5

20

g/m

3 P

M1

0

10

g/m

3 P

M2.5

10

g/m

3 P

M2.5

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 B

S

40

g/m

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SP

20

g/m

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PM

Re

vie

w o

f A

sia

n L

it.-

-8 s

tudie

s(H

EI

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po

rt,

Ta

ble

TS

2)

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

Estimates frommeta analysisfrom Asian Lit

PA

PA

Stu

die

s--

4 s

tudie

s(H

EI

Re

po

rt,

Ta

ble

TS

2)

Asia

n L

it.

inco

rpora

tin

g P

AP

A s

tud

ies

(HE

I R

epo

rt,

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ble

TS

2)

18 L

atin

Am

. stu

die

s

(PA

HO

20

05)

20

g/m

3 P

M1

0

10 mg/m3 PM2.5 or 20 mg/m3 PM10 → 0.4% to 1.5%

increase in relative risk of mortality—Small but

remarkably consistent across meta-analyses and multi-city studies.

Daily time-series studies ***of over 200 cities***

• Case-crossover study of acute ischemic coronary

events (heart attacks and unstable angina) in 12,865

cardiac patients on Utah’s Wasatch Front

• Patients underwent coronary angiography

• Results showed associations between air pollution and

cardiovascular disease

2006;114:2443-48

Evidence mounted suggesting that air pollution has significant

impacts on cardiovascular health.

%

-10.00

-5.00

0.00

5.00

10.00

15.00

20.00

Figure 2. Percent increase in risk (and 95% CI) of acute coronary events associated with

10 mg/m3 of PM

2.5, stratified by various characteristics.

All

acute

coro

nary

Subsequent M

I

Unsta

ble

Angin

a

Age<

65

Age>

=65

Male

Fem

ale

Sm

okin

g

Non S

mokin

g

BM

I<30

BM

I>=

30 C

HF

,yes

CH

F,n

o

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ert

ensio

n,y

es

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ert

ensio

n,n

o

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erlip

idem

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es

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es

Dia

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ily h

isto

ry,y

es

Fam

ily h

isto

ry,n

o

# ofDiseasedVessels

# of Risk Factors

01

2

3

0

1

2

3

4+

Index M

I

Just a few days of PM exposure significantly increased

risk for heart attacks and ischemic heart disease.

Short-term changes in air pollution exposure

are associated with:

• Daily death counts (respiratory and cardiovascular)

• Hospitalizations

• Lung function

• Symptoms of respiratory illness

• School absences

• Ischemic heart disease

• Etc.

Longer-term air pollution exposure has

been linked to even substantially larger

health effects.

Median PM2.5

for aprox. 1980

8 10 12 14 16 18 20 22 24 26 28 30 32 34

Ad

juste

d M

ort

alit

y f

or

19

80

(D

ea

ths/Y

r/1

00

,00

0)

600

650

700

750

800

850

900

950

1000

Mean sulfate for aprox. 1980

4 6 8 10 12 14 16 18 20 22 24

Ad

juste

d M

ort

alit

y

for

19

80

(D

ea

ths/Y

r/1

00

,00

0)

600

650

700

750

800

850

900

950

1000

Mean PM2.5

for aprox. 1980

8 10 12 14 16 18 20 22 24 26 28 30 32 34

600

650

700

750

800

850

900

950

1000

Mean TSP for aprox. 1980

15 30 45 60 75 90 105 120 135 150 165

600

650

700

750

800

850

900

950

1000

Figure 1. Age-, sex-, and race-adjusted population-based mortality rates in U.S. cities for 1980 plotted over various indices of particulate air pollution.

Age-, sex-, and race- adjusted population-

based mortality rates in U.S. cities for 1980

plotted over various indices of particulate

air pollution (From Pope 2000).

Methods:

• 14-16 year prospective follow-up of 8,111 adults living in six U.S. cities.

• Monitoring of TSP PM10, PM2.5, SO4, H+, SO2, NO2, O3 .

• Data analyzed using survival analysis, including Cox Proportional Hazards Models.

• Controlled for individual differences in: age, sex, smoking, BMI, education, occupational exposure.

An Association Between Air Pollution and

Mortality in Six U.S. Cities

Dockery DW, Pope CA III, Xu X, Spengler JD,

Ware JH, Fay ME, Ferris BG Jr, Speizer FE. 1993

In 1993, the Harvard “Six-Cities” study was published.

It followed > 8,000 adults for 14-16 years to observe

associations between air pollution and risk of death.

Adjusted relative risk of dying were

almost linearly associated with air pollution.

http://jama.ama-assn.org/

Increased levels of fine PM increased risk of death.

Air pollution is most strongly associated with deaths from

ischemic heart disease, dysrhythmias, heart failure, cardiac

arrest and related heart disease.

RR

(95%

CI)

0.65

0.70

0.75

0.80

0.85

0.90

0.95

1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

1.40

All

Ca

rdio

va

scu

lar

plu

s D

iab

ete

s

Isch

em

ic h

ea

rtd

ise

ase

Dysrh

yth

mia

s,H

ea

rtfa

ilure

, C

ard

iac a

rre

st

Hyp

ert

en

siv

ed

ise

ase

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er

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ero

scle

rosis

,a

ort

ic a

ne

ury

sm

s

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reb

ro-

va

scu

lar

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er

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rdio

-va

scu

lar

Dia

be

tes

Re

sp

ira

tory

Dis

ea

se

s

CO

PD

an

da

llie

d c

on

ditio

ns

Pn

eu

mo

nia

,In

flu

en

za

All

oth

er

resp

ira

tory

Figure 1. Adjusted relative risk ratios for cardiovascular and respiratory mortality associated with

a 10 mg/m3 change in PM

2.5 for 1979-1983, 1999-2000, and the average of the two periods.

(Relative size of the dots correspond to the relative number of deaths for each cause.)

2004;109:71-77.

John Godleski

Risk ratios for

death

associated

with a 10 µg/m3

change in PM2.5

Dot sizes

indicate the

number of

deaths for each

cause.

The Six-Cities and ACS studies have undergone

extensive peer review and analyses. Their results

are reproducible and remarkably robust.

Legal uncertainty largely

resolved with 2001

unanimous ruling by the

U.S. Supreme Court.

Pe

rce

nt

inc

rea

se

in

mo

rta

lily

ris

k (

95

% C

I)

-10

0

10

20

30

40

50

60

70

80

90

100

110

120180

190

All Cause CPD CVD IHD

U.S. Medicare Cohort studies:

•Eftim et al. Epidemiology 2008

•Zegar et al. EHP 2008

Cohorts of Medicare participants cities of the 6-cities and ACS study, plus all U.S.

U.S. Medicare Cohort Studies

Modern air pollution science has resulted in new and tighter

standards in the U.S. for air pollution—especially PM2.5

Contemporary

Science

Public Policy Results 1997: New PM2.5 standards

(24-hr 65 µg/m3,

annual 15 µg/m3)

2006: PM2.5 24-hr standard

revised (35 µg/m3)

2012: PM2.5 annual standard

revised (12 µg/m3)

1990 - 2013: Continued

general improvements in

air quality

1989+ Time-series studies

1993+ Prospective cohort

mortality studies

1997+ 100’s of other

including tox.,

clinical, etc.

So, an obvious question—

Has reducing air pollution resulted in

substantial and measurable

improvements in human health?

- Matching PM2.5 data for

1979-1983 and 1999-2000 in

51 Metro Areas

- Life Expectancy data for

1978-1982 and 1997-2001 in

211 counties in 51 Metro areas

- Evaluate changes in Life

Expectancy with changes in

PM2.5 for the 2-decade period

of approximately 1980-2000.

Fine-Particulate Air Pollution and Life

Expectancy in the United States

C. Arden Pope, III, Ph.D., Majid Ezzati, Ph.D., and Douglas W.

Dockery, Sc.D.

January 22, 2009

Do cities with bigger improvements in air quality have bigger

improvements in health, measured by life expectancy?

Reduction in PM2.5

, 1980-2000

0 2 4 6 8 10 12 14

Ch

an

ge

in

LE

, 1

98

0s -

19

90

s

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

22

47

49

45

4

10

17

19

46

48

6

43

50

24 21

36

8

34

20

7

25

1

11

12

14 44

51

27

3

28

30

32

13

18 26

9

29

23

37

38

40

15

33

5

2

35 31

16 39

41

42

Reduction in PM2.5

, 1980-2000

0 2 4 6 8 10 12 14

Re

sid

ua

l ch

an

ge

s in

LE

co

ntr

olli

ng f

or

co

va

ria

tes

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

1.5

2.0

2.5

22

47 49

45

4

10 17

19

46

48

6 43 50

24

21

36

8

34

20 7

25

1

11

12

14

44

51

27 3 28

30

32 13

18

26

9

29

23

37

38

40

15

33

5

2

35

31

16

39

41 42

A

B

YES. On average, the greater the reduction in air

pollution, the greater the increase in life expectancy.

Francesca Dominici

Brook, Rajagopalan, Pope, et al. 2011

AHA Scientific Statement, PM and CVD

Ambient Concentrations ( g/m3)

$

CT

CM

Marginal HealthCosts of Pollution

Ambient Concentrations ( g/m3)

$

Marginal Costof Abatement

Marginal Health Costof Pollution

CT C* C

M

In Six-Cities study, adjusted relative risk of dying were

almost linearly associated with air pollution.

In ACS study, adjusted relative risk of dying were

almost linearly associated with air pollution.

Ambient Concentrations ( g/m3)

$

Marginal Costof Abatement

Marginal Health Costof Pollution

C*

0 60 120 180 240 300

Ad

jus

ted

Re

lati

ve

Ris

k

1.0

1.5

2.0

2.5

<3cigs/day

estimated daily dose of PM2.5

, mg

23+cigs/day

8-12cigs/day

13-17cigs/day

18-22cigs/day

4-7cigs/day

Pope, Burnett, Krewski, et al. 2009.

Figure 1. Adjusted relative

risks (and 95% CIs) of IHD

(light gray), CVD (dark

gray), and CPD (black)

mortality plotted over

estimated daily dose of

PM2.5 from different

increments of current

cigarette smoking.

Diamonds represent

comparable mortality risk

estimates for PM2.5 from air

pollution. Stars represent

comparable pooled relative

risk estimates associated

with SHS exposure from

the 2006 Surgeon

General’s report and from

the INTERHEART study.

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Pollution Abatement

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Finally,

This stylized approach ignores various uncertainties and

complications including:

Interactive multi-pollutants,

Issues of environmental justice,

How do efforts to reduce traditional air pollutants

complement or diverge from efforts to address climate

change and is there a reasonable way to integrate these

efforts.

Thank you.