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    WMOs Global Atmosphere Watch

    SymposiumAir Quality & Health

    18 March 2013, Geneva, Switzerland

    PUBLIC HEALTH AND ENVIRONMENT

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    WMOs Global Atmosphere Watch Symposium:Air Qual ity & h eal th

    Heather Adair-Rohani

    Technical Officer

    Interventions for a Healthy Environment Unit

    Dept. of Public Health & Environment

    WHO HQ

    WHO's Public Health and Environment Department s role is

    to promote a healthier environment, intensify primary

    prevention and influence public policies in all sectors so as to

    address the root causes of environmental threats to health.

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    WMOs Global Atmosphere Watch Symposium:Air Qual ity & h eal th

    Presentation Overview:

    Health Impacts of Air Pollution

    Exposure & Disease Burden

    Moving forward: Better estimating exposure

    Moving forward: WHO Activities for healthy air

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    Health Impacts: A ir Pol lutantsProduc ts of incomplete combus t ion

    Outdoor Air Pollution CO2 emissions are not a direct problem for health---rather it is a mixtureof pollutants that are released during the incomplete combustion of carbon-

    based fuels that have direct impacts on health.

    The products of incomplete combustion (PICS) include but are not limited

    to things like particulate matter, ozone, methane, poly-aromatichydrocarbons, carbon monoxide, etc

    The single most studied and one of the most important health-damaging

    pollutant is particulate matter (PM).

    PAH COCH4 NMVOCs

    NOxSOx

    CH2O

    CO2

    PM

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    Health Impacts: A ir Pol lutantsParticu late Matter

    Outdoor Air PollutionPM in urban and non-urban environments

    which can be formed primarily or secondarily, is

    a complex mixture of chemical components that

    have diverse chemical & physical characteristics

    that can impact health such as size, part icl e

    core chemistry, metals, bio genic or ig in etc.

    The toxicity of PM may potentially arise from

    the particles presence on biological tissues, to

    the actions of chemical constituents, includingabsorded components or a combination of these

    factors.

    Exposure to PM is associated with bronch ia l

    ir r i tat ion , inf lammation , inc reased react iv i ty,

    redu ced mu coci l iary clearance, geno toxi c

    event s (i.e. carcinogen ic)and reduced

    macrophage respo nse.

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    Health Impacts: Growing Evidence-baseSpecific health outcomes

    1. Outdoor Air Pollution

    Outcome Strength of

    Evidence

    Child ALRI, Lung

    cancer, COPD, LBW,

    Cataract

    Strong

    TB, Cancer of UADT Moderate

    Ca cervix, adult

    ALRI, asthma,

    O/Media

    Moderate

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    Exposure:How b ig is the prob lem?

    Pollution Outdoor air pollution

    Household air pollution

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    Exposure: Who & how much?Outdoor A i r Pol lu t ion (OAP)

    oInefficient foss i l fuel combust ionfrom the industry,

    and t ranspor tsectors along with biomass burn ing

    are some of the largest contributors to OAP.

    oThe greatest health impacts from exposure to

    outdoor air pollution are seen more in middle- to high-

    income countries.

    oExposure to OAP in urban areas was responsible forto 1 million premature deaths & accounted for0.5% of

    the total disease burden in 2004.

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    Exposure: Who & how much?Outdoor A i r Pol lu t ion (OAP)

    oA recent Lancet study, estimates that in 2010, 3.3

    m i l lion d eathsand 3.1% of the global disease burden

    from were attributed to OAP in both urban & rural

    areas

    0.5 million of these deaths or16%can be attributed

    to the outdoor air pollution from household air

    pollution leaking outdoors.

    o A large part of the variations in OAP disease

    estimates are due to urban/rural coverage, different

    underlying disease burden estimates & greater number

    of disease outcomes (e.g. CVD) accounted for in OAP

    recent estimates

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    Exposure: WHO & how much?Househo ld A ir Pol lut ion (HAP)

    1. Outdoor Air PollutionoAround 2.7 billion people, mostly in developing

    countries, rely on the traditional use of solid fuels (i.e.

    wood, dung, coal, crop waste) to meet their cooking,

    needs.

    o In 2004, WHO estimates nearly two million deaths

    were attributed to household air pollution from the use

    of open fires and simple stoves for cookingaccounting

    for2.7%of the global disease burden

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    Exposure: WHO & how much?Househo ld A ir Pol lut ion (HAP)

    1. Outdoor Air Pollutiono The 2012 Lancetstudy shows an increase in disease

    burden to HAP---3.5 m il l iondeaths and 4.5% of the

    total disease burden attributed to HAP

    oSimilar to OAP, a greater number of diseaseoutcomes accounted in new deaths and disease

    estimates including cardiovascular disease, lung

    cancer from biomass use, and cataract.

    o These estimates only account from the deaths and

    disease from pr imary cook ing fuel ---mortality &

    morbidity estimates are likely to be higher if secondary

    fuel use, and other end uses (heating, lighting) were

    accounted for in exposure estimates.

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    Moving Forward: Growing Evidence-base for healthIntegrated Concentration-response function

    1. Outdoor Air Pollution

    Kirk R. Smith, Jennifer L. Peel

    Environ Health Perspect. 2010 December;118(12): 16431645. Published online 2010

    August 20.

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    Moving Forward: Growing Evidence-base for healthIntegrated Concentration-response function

    1. Outdoor Air Pollution

    Kirk R. Smith, Jenn ifer L. Peel

    Environ Health Perspect. 2010 December;

    118(12): 16431645. Published online 2010August 20.

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    Moving forward: Estimating OAP ExposureSatell i te-based estimates pro vid e a truly global pic ture o f the

    burden of dis ease due to ou tdoo r air pol lut ion

    Outdoor Air Pollution

    Unger, 2010

    Brauer M, Ammann M, Burnett R et al. GBD 2010 Outdoor AirPollution Expert Group 2011 Submitted under review

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    Moving forward: Estimating OAP ExposureSatell i te-based estimates pro vid e a truly global pic ture o f the

    burden of dis ease due to ou tdoo r air pol lut ion

    Outdoor Air Pollution

    Unger, 2010

    2005 population-weightedregional estimated average PM2.5

    Distributions of selected regional2005 estimated PM2.5 by urban andrural areas

    Brauer M, Ammann M, Burnett R et al. GBD 2010 Outdoor Air

    Pollution Expert Group 2011 Submitted

    under review

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    16

    Crouse D, Burnett RD et al. Risk of Mortality in Relation to Long-term Exposure to Low Concentrations of Fine Particulate

    Matter: A Canadian National-level Cohort Study. Submitted 2011

    Canadian Census Cohort (1991 2001)

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    Moving Forwarding: Estimating OAP ExposureSatell i te-based estimates of Moscow smoke event

    Before Fires During Fires

    van Donkelaar et al., in prepFrom: A van Donkelaar et al.Atmospheric Environment 2011

    MODIS-based (IQR)

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    Moving Forwarding: Estimating OAP ExposureSatell i te-based estimates and HAP

    Before Fires During Fires

    van Donkelaar et al., in prep

    Source: S Guttikunda. Urban Air Pollution Analysis for Ulaanbaatar. Worldbank report 2007

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    Moving Forwarding: Guidance for Healthy AirWHO Act iv i ties for pol icy-makers & impl ementat ion

    Before Fires During Fires

    van Donkelaar et al., in prep

    Indoor Air QualityWHO Air Quality Guidelines for household fuel combustion

    Expansion of WHO Global Household Energy Database

    Outdoor Air Quality

    Update & expansion of WHOs Outdoor Air Pollution database Update of WHO Air Quality Guidelines, Global update 2005

    Support to countries for air quality monitoring and intervention

    implementatione.g. Sustainable Energy for All Global Tracking

    Framework, UN Energy

    Raising awareness forhealth co-benefits of climate change

    adaptation & mitigation strategiesHealth in the Green Economy

    Series, WMO/WHO Climate & Health Atlas, Clean Air Coalition for

    Short-Lived Pollutants

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    Before Fires During Fires

    van Donkelaar et al in prep

    Thank you and any questions?