Image Credit: US Environmental Protection Agency

Air Pollution Health Effects and Medical Advocacy as Preventative Medicine

Rachel McIntosh-Kastrinsky, MSPHMAHA Manager

rachel@cleanaircarolina.org

Health Effects Pollutants and Sources AdvocacyOutdoor air pollution caused over 3 million premature deaths in 2010 and it is predicted the number will double by 2050 unless steps are taken to reduce air pollution (Caiazzo et al., 2013). In the United States, it is estimated that air pollution causes about 200,000 deaths per year (Lelieveld, et al., 2015).

The main air pollutants in North Carolina are ground level ozone, particulate matter and greenhouse gases or carbon emissions.

By using education and advocacy as preventive medicine, public health professionals can avert some of these premature deaths. Many public health professionals are aware of the impact air pollution has on asthma, but few are aware of the adverse effects air pollution can have on heart disease, children’s development, mental illness and others respiratory diseases. Even fewer patients and affected individuals are aware. By training public health professionals how to inform their patients and communities about these adverse effects, the sources of pollution and how to avoid exposure, many premature deaths can be avoided.

Air pollution affects the entire population. A study in Lancet found the odds ratio for air pollution triggering a heart attack is similar to other common triggers like physical exertion, alcohol and coffee (Nawrot et al., 2011).

In 2015, heart disease, chronic lower respiratory diseases and stroke accounted for nearly 30,000 deaths and are three of the top five leading causes of death in the North Carolina (North Carolina Department of Health and Human Services, 2017). The main causes of death linked to air pollution are heart disease, stroke, chronic obstructive pulmonary disease and lung disease.

Leading Causes of Death in North Carolina 2015

Rank Cause Number

1 Cancer 19,309

2 Heart disease 18,467

3 Chronic lower respiratory disease 5,221

4 Cerebrovascular disease 5,028

5 Alzheimer’s disease 3,803

North Carolina Heart Disease Mortality Rate 2011-2015

Age Adjusted Rates per 100,000 Population

112.4 – 148.3148.4 – 180.3180.4 – 219.9220.0 – 287.2

Cardiovascular disease is the leading cause of death in the United States and the second leading cause of death in North Carolina (Centers for Disease Control and Prevention, 2016). Above is a map of the North Carolina heart disease mortality rate from 2011-2015 by county.

Ground level ozone can harm our lungs and heart. It has been referred to as a “sunburn on the lungs” because it irritates the lung tissue. Ground level ozone is formed by a chemical reaction between sunlight and nitrogen oxides or NOx, and volatile organic compounds, or VOCs. These emissions come from coal combustion, vehicle exhaust, and industrial facilities. During the day as the temperature rises and traffic and industrial emissions build up, ozone levels grow.

The size of PM that we are most concerned about is PM2.5 (2.5 microns in diameter or smaller). The lungs cannot remove these invisible fine particles through the normal process of coughing. PM2.5 can reach deep in the lungs, causing inflammation, oxidative stress and imbalance of the autonomic nervous system. PM2.5 can reach the alveoli where it passes into the bloodstream. Studies have even shown it can cross the blood-brain barrier once reaching the bloodstream.

A more recent air pollution concern is what we call carbon pollution. Gasses such as carbon dioxide, methane and nitrous oxide, form a blanket around the Earth, trapping the sun’s heat. This phenomenon is called the greenhouse effect and is natural and necessary to support life on Earth. However, our excess emissions of greenhouse gases is making that heat-trapping blanket much too thick. This is disrupting our climate through major changes in temperature, precipitation and wind patterns.

Most carbon pollution is from the fossil fuels that we use for electricity and transportation, such as coal, natural gas and oil.

Gallup Poll: Public perception of honesty and integrity among various professions (2014)

Rank Professions % Very high or high

1 Nurses 80

2 Medical doctors 65

3 Pharmacists 65

4 Police Officers 48

5 Clergy 46

Public health professionals are in an excellent position to be effective advocates. According to a Gallup poll, they have the public’s trust (Riffkin, 2014). They also see first-hand the effects of air pollution on their patients. This gives them an authoritative voice in policy discussions. Working toward clean air policies makes their job as a provider more effective.

Medical Advocates for Healthy Air helps keep members informed and provides a platform for them to speak out.

Air Quality Index (AQI)

AQI Meaning

Good Air quality is considered satisfactory, and air pollution poses little to no concern.

Moderate There may be a moderate health concern for people who are unusually sensitive to air pollution. Consider limiting prolonged or heavy exertion outdoors.

Unhealthy for Sensitive Groups

Older adults, children, active people and those with heart or lung disease may experience health effects. Limit prolonged or heavy exertion outdoors.

Unhealthy Older adults, children, active people and those with heart or lung disease may experience more serious health effects Everyone may experience health effects. Limit prolonged or heavy exertion outdoors.

Very Unhealthy Everyone is likely to be affected. Avoid all outdoor exertion.

Join MAHA

Caiazzo, Fabio, Akshay Ashok, Ian A. Waitz, Steve H.L. Yim, and Steven R.H. Barrett. 2013. “Air Pollution and Early Deaths in the United States. Part I: Quantifying the Impact of Major Sectors in 2005.” Atmospheric Environment 79 (November). Pergamon: 198–208. doi:10.1016/J.ATMOSENV.2013.05.081.

Centers for Disease Control and Prevention. 2016. “FastStats - Leading Causes of Death.” https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.

References

Lelieveld, J, J S Evans, M Fnais, D Giannadaki, and A Pozzer. 2015. “The Contribution of Outdoor Air Pollution Sources to Premature Mortality on a Global Scale.” Nature 525 (7569). Nature Publishing Group, a division of Macmillan Publishers Limited. All Rights Reserved.: 367–71. http://dx.doi.org/10.1038/nature15371.

Nawrot, Tim S, Laura Perez, Nino Kunzli, Elke Munters, and Benoit Nemery. 2011. “Public Health Importance of Triggers of Myocardial Infarction: A Comparative Risk Assessment.” The Lancet 377 (9767). Elsevier: 732–40. doi:10.1016/S0140-6736(10)62296-9.

North Carolina Department of Health and Human Services. 2017. “NC SCHS: Interactive Health Data: Health Data Query System.” http://www.schs.state.nc.us/interactive/query/lcd/lcd.cfm.

Riffkin, Rebecca. 2014. “Americans Rate Nurses Highest on Honesty, Ethical Standards | Gallup.” Gallup. http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx.

MAHA helps identify and develop opportunities to facilitate your participation. You can be an effective advocate in only a few minutes a month.

• Talk to colleagues and family• Write letters to the editor and provide

interviews

• Visit elected officials and testify at public hearings

• Serve on boards and commissions

Public health professionals can help even more individuals by working with programs like Medical Advocates for Healthy Air to advocate for clean air policies.

www.cleanaircarolina.org/MAHA

Image Credit: US Environmental Protection Agency

Image Credit: US Environmental Protection Agency