APHEIS. Health impact assessment of air pollution and communication strategy. Third year report

This report sought to analyse the impact of air pollution on public health in 26 cities in 12 European countries as part of the ongoing work of the Apheis programme. This Apheis-3 phase added further evidence to the finding in Apheis-2 that air pollution continues to pose a significant threat to public health in urban environments in Europe. In particular, concerning the ability of Apheis cities across Europe to meet future standards designed to reduce the impact of air pollution on health, Apheis-3 determined that, while most of the 26 cities studied met the annual mean cut-off of 40 Œg/m3 set as the limit value for PM10 to be reached by all member states of the European Union by 2005, 21 cities still exceeded the 2010 limit value of 20 Œg/m3. Nonetheless, nine cities nearly met the latter value. Concerning the impact of exposure to PM10 in the very short, short and long terms, in the 23 Apheis cities that measured PM10, totalling almost 36 million inhabitants, if all other things were equal and exposure to outdoor concentrations of raw PM10 were reduced to 20 Œg/m3 in each city, 2 580 premature deaths, including 1 741 cardiovascular and 429 respiratory deaths, could be prevented annually if the impact is only estimated over a very short term of 2 days. The short-term impact, cumulated over 40 days, would be more than twice as great, totalling 5 240 premature deaths prevented annually, including 3 458 cardiovascular and 1 348 respiratory deaths. And the long-term impact2 over several years would be even higher, totalling 21 828 premature deaths prevented annually. Apheis-3 also contributed the following significant findings: For both total and cause-specific mortality, the benefit of reducing converted PM2.5 levels to 15 Œg/m3 is more than 30% greater than for a reduction to 20 Œg/m3. Moreover, even at 15 Œg/m3 a significant health impact can be expected. In specific, the Apheis-3 HIA estimated that 11 375 "premature" deaths, including 8 053 cardiopulmonary deaths and 1 296 lung-cancer deaths, could be prevented annually if long-term exposure to the annual mean of converted PM2.5 levels were reduced to 20 Œg/m3 in each city; and that 16 926 premature deaths, including 11 612 cardiopulmonary deaths and 1 901 lung-cancer deaths, could be prevented annually if long-term exposure to converted PM2.5 were reduced to 15 Œg/m3. In terms of life expectancy, if all other things were equal and the annual mean of PM2.5 converted from PM10 did not exceed 15 Œg/m3 the potential gain in life expectancy of a 30-year-old person would average between 2 and 13 months, due to the reduction in total mortality. Black smoke is often considered a good proxy for traffic-related air pollution. In the 16 cities that measured BS, which total over 24 million inhabitants, if all other things were equal and BS levels were reduced to a 24-hour value of 20 Œg/m3, 1 296 total "premature" deaths including 405 cardiovascular deaths and 109 respiratory deaths, could be prevented annually. In the Apheis cities, particulate pollution contributed in a non-negligible manner to the total burden of mortality as follows: - All other things being equal, when only considering very short-term exposure, the proportion of all-causes mortality attributable to a reduction to 20 Œg/m3 in raw PM10 levels would be 0.9% of the total burden of mortality in the cities measuring PM10. This proportion would be greater, 1.8%, for a cumulative short-term exposure up to 40 days. Effects of long-term reduction in corrected PM10 levels would account for 7.2% of the burden of mortality. - For black smoke, only very short-term exposure (raw levels) was considered. All other things being equal, the proportion of all-causes mortality attributable to a reduction to 20 Œg/m3 in BS levels would be 0.7% of the total burden of mortality. - For long-term exposure to PM2.5 converted from corrected PM10, all other things being equal the proportion of all-causes mortality attributable to a reduction to 20 Œg/m3 in converted PM2.5 levels would be 4% of the total burden of mortality. In order to provide a conservative overall picture of the impact of urban air pollution on public health in Europe, like its predecessor Apheis-2 the Apheis-3 phase used a limited number of air pollutants and health outcomes for its HIAs. Apheis-3 also established a good basis for comparing methods and findings between cities, and explored important HIA methodological issues. Our findings add further support to WHO's view that "it is reasonable to assume that a reduction of air pollution will lead to considerable health benefits." And, at least for particulate pollution, our findings support WHO's already strong recommendation for "further policy action to reduce levels of air pollutants including PM, NO2 and ozone"(WHO 2004). (R.A.)