Global and Local Impact of Air Pollution on Health

Junfeng (Jim) ZhangProfessor of Global and Environmental Health

Global Health Challenges Duke University, October 17, 2013

Air Pollution throughout History• The earliest form of anthropogenic airborne

emission is wood smoke.• Humans have required sources of warmth and

cooking fuel for millennia.• Coal smoke contributed greatly to air pollution

problems in the early days of the industrial revolution.

• The “excessive” use of fossil fuels in the modern life causes urban air pollution around the globe and contributes dominantly to the increases in green house gases.

Open-fire biomass cooking is common in developing country villages.

Today, exposure indoors to coal and biomass smoke affects more than 65% of the Chinese population, and about half of the world’s population

Smith et al 2000, Zhang et al 2000

Smoke (point) vs. Smog (area)•Biomass smoke

•Coal smoke

•Tobacco smoke

• etc

June 2006, Ba Da Ling, Beijing

Smog – Regional air pollution

QuestionThe word “smog” was first used to describe Los Angeles air.

True or False?

False•“Smog” was first used to describe the “smoky fog” in London in the early 1900s.

•However, the word has been associated with Los Angeles since the 1940s.

The London Smog*

* Smog = Smoke + Fog

Daytime in London, December 1952

Source: National ArchivesParticle levels – 3,000 mg/m3

4000 extra deaths in the week

Donora, Pennsylvania, 1948

Sulfurous (London) Smog vs. Photochemical (Los Angeles ) Smog

Photochemical smog:

HC + NOx + UV = Smog (O3 + PM + aldehydes, + etc)

Modern Air Pollution Control Regulations

In U.K, 1956 - Clean Air Act:Introduced Smoke control Areas, controlled chimney heights. Prohibited emission of dark smoke from chimneys, with some exceptions.

In U.S. Clean Air Act of 1970, establishment of EPA and ….

Question

MORE

True or False?

vehicle miles driven,cars, trucks, ships, planes, trains,people, homes, power used,…

…but LA air is getting cleaner!

True!

Annual Average PM2.5 (ug/m3)

0

5

10

15

20

25

30

35

40

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

Upland

Mira Loma

Riverside

Long Beach

Anaheim

Glendora

Santa Barbara

True

Annual Average NO2 (ppb)

0

5

10

15

20

25

30

35

40

45

50

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

Upland

Mira Loma

Riverside

Long Beach

Anaheim

Glendora

San Dimas

Santa Barbara

Somewhat true10 A.M. to 6 P.M. Annual Average O3 (ppb)

0

10

20

30

40

50

60

70

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

Upland

Mira Loma

Riverside

Long Beach

Anaheim

Glendora

San Dimas

Santa Barbara

Harvard Six Cities Studies

WatertownPortage

St. Louis

Topeka

Kingston

Steubenville

1990 – 1998(black letter)

S

H

1974 – 1989 (red letter)

L

WTP

Laden F, et al. Reduction in fine particulate air pollution and mortality: Extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med. 2006 173(6):667-72

Decreasing mortality rate ratios & decreasing pollution

21

S: SteubenvilleH: KingstonL: St. LuisW: WatertownT: TopekaP: Portage

Fine-Particulate Air Pollution and Life Expectancy in the United States. Arden Pope, III, Ph.D., Majid Ezzati, Ph.D., and Douglas W. Dockery, Sc.D N Engl J Med 2009;360:376-86

Reductions in air pollution accounted for up to 15% of increased life expectancy since 1970 Clean Air Act (2.7 years)

22

Outdoor Air Pollution and health in the Developing

Countries of Asia: A Comprehensive Review

Heath Effects Institutewww. healtheffects.org

June 2006

Air pollution levels in many Chinese cities far exceed health based air quality standards

5-yr Average PM10, SO2 and NO2

Standards from WHO air quality guideline, 2005 Global Update (WHO 2006): PM10 annual average, 20 μg/m3; SO2 24-hr average, 20 μg/m3; and NO2 annual average, 40 μg/m3

(2000-2004) 5-yr average PM10, SO2 and NO2 concentrations in selected Asian cities

Urban populations

Urban populations in the world and various regions of Asia, including future projections(Data compiled from United Nations Economic and Social Affairs 2006)

(Data compiled from International Energy Agency 2007)

Total Primary Energy Consumption in Asia, 1990-2005

The energy use index is a unitless measure of total primary energy consumption for which the value in 1990 is equal to 100

Values for All Asia are Weighted averages of the regions

(Data compiled from International Energy Agency 2007)

Fuel Consumption in Transportation in Asia, 1990-2005

The energy use index is a unitless measure of total primary energy consumption for which the value in 1990 is equal to 100. Jet fuel is excluded.

Values for All Asia are Weighted averages of the regions

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

157.8169.9

189.9212.4

229.6258.3

287.6312.8

350.4

401.9

480.9498.3

520.0

Vehicle inventory of Beijing (unit: 104)

(data source: http://www.bjjtgl.gov.cn/publish/portal0/tab118/)

January PM2.5 concentrations measured at US Embassy in Beijing

Fashionably masked women on Saturday outside an amusement park in Beijing. The WHO has standards that judge an air-quality score above 500 to be more than 20 times the level of PM in the air deemed safe. By Edward WongPublished: January 12, 2013

On Scale of 0 to 500, Beijing’s Air Quality Tops ‘Crazy Bad’ at 755!!

Global ambient PM2.5

Population-weighted geometric mean concentrations (µg/m3)Global 20North America 10East Asia 34

van Donkelaar A et al. 2010. Global Estimates of Ambient Fine Particulate Matter Concentrations from Satellite-based Aerosol Optical Depth: Development and Application. Environ Health Perspect :-. doi:10.1289/ehp.0901623

33

Death (in millions) Attributable to Selected Risk Factors, Worldwide (GDB 2012)

6,297,287.00

3,478,773.003,223,540.00 3,183,940.00

674,038.00481,429.00

Predominantly in LDCs, 65% in Asia alone

Zhang, et al. 2010. The Lancet. 375 (1111).

Table: Traditional, modern, and emerging environmental risk factors in China

Major Health Effects Populations at risk or affected

Traditional

Indoor air pollution from solid fuel combustion

Chronic obstructive pulmonary disease, acute lower respiratory infection, lung cancer, possibly low birthweight8

Almost all rural residents (~740 million); about 35% of urban residents (~200 million); estimated 420,000 premature death yearly8

Modern

Outdoor air pollution

Cardiorespiratory mortalities and morbidities (acute respiratory infections and symptoms, lung cancer, possibly adverse birth outcomes)9,10

Almost all urban residents (~580 million); rural residents living near industrial facilities and cities; an estimated 470,000 premature deaths in 200012-15

Disability-Adjusted Life-Years (DALY, in millions) Attributable to Selected Risk Factors, Worldwide

Tobacco sm

oking (in

cluding se

cond-han

d smok

e)

household ai

r pollu

tion fr

om solid

pollutio

n

ambien

t part

iculat

e matt

er pollu

tion

physical

inactivity

or lo

w level

of acti

vity

occupa

tional

risk fa

ctors

for injurie

s

lead ex

posure

156,838

108,084

76,163 69,318

23,44413,936

The Beijing HEART Study

Health Effects of Air Pollution Reduction Trial

July 13, 2001

• International Olympic Committee awarded

Beijing to host 2008 Summer Olympics

• Beijing promised to make air quality during

the Olympics comparable to air quality in

previous host cities.

http://www.technotraits.com/2008/08/21-amazing-facts-about-beijing-olympics-2008/

• The total cost of Beijing Olympics is around 43 billion USD with 1.8 billion of construction, ~ 9 billion for air quality improvements.

Before full-scale control

Full-scale control Post full-scale controlFinished before June 30)

Relocating heavy industrial polluters, etc. Capital Steel factory and other factories, near Beijing; install desulfurization facilities in factories around Beijing

Implementing low fugitive emission facilities at more than 1000 gas stations

March 1, 2008 - permanently Introduce new vehicular

emission standard, equivalent to Euro 4

June 23 - September 19 50% of government cars

were not allowed to run Diesel and heavy duty

vehicles not allowed to run in Beijing

Only those vehicles meeting emission standard equivalent to Euro 2 were allowed to enter Beijing

July 20- Sept. 19, 2008The odd/even plate number

rule for traffic control Stricter control on vehicles

entering Beijing Reduce or stop production

at certain factories surrounding Beijing

Aug. 8 – 23 and Sept. 7 – 19, 2008

Extra 20% of governmental cars were not allowed to run

Stop outdoor construction activities

Temporarily close some gas station

Increase bus fleet and transit frequency

After September 20

Lifting of regulation adopted from 20 July.

Control approximately 20% of private cars based on the last digit of plate number, to be continued until April 10, 2013

The Beijing HEART Study

Pathways and BiomarkersPulmonary (Inflammation & ROS) FeNOEBC: pH, Nitrite, MDA

Air pollutantsPM2.5, EC, OCSO2, SO4, NO2, CO

Hemostasis sCD62p, sCD40L, VWF

Autonomic function SBP, DBP, Heart rate, rMSSD, SDNN, LF,HF, LF/HF, VLF, total power

Systemic (Inflammation& ROS) Fibrinogen, RBC, WBC 8OHDG, MDA

6/2/

2008

10/3

0/20

08

7/7/

2008

8/4/

2008

8/29

/200

8

9/30

/200

8

6/10

/200

8

6/23

/200

8

8/15

/200

8

10/6

/200

8

10/1

7/20

08

7/20

/200

8

9/20

/200

8

Pre-Olympics During-Olympics Post-Olympics

V-1 V-2 V-3 V-4 V-5 V-6

Continuous pollutants measurement period

Filter-based PM2.5 collection period

Clinic visits 1 to 6 (V-1, V-2, V-3, V-4, V-5 and V-6)

David Q. Rich, ScD., Howard M. Kipen, MD, MPH., Wei Huang, ScD., Guangfa Wang, MD., Yuedan Wang, PhD., Ping Zhu, MD., Pamela Ohman-Strickland, PhD., Min Hu, PhD., Claire philipp, MD., Scott R. Diehl, PhD., Shou-En Lu, PhD., Jian Tong, MS., Jicheng Gong, PhD.,

Duncan Thomas, PhD. and Junfeng Zhang, PhDFemale (N=62) Male (N=63)

Mean±SD Range Mean±SD RangeAge (years) 24±1 (22,29) 24±2 (19,33)Height (m) 1.62±0.05 (1.52,1.72) 1.71±0.06 (1.58,1.83)Weight (kg) 53.7±7.2 (40.0,75.0) 66.3±10.7 (51.5,101.0)BMI (kg/m2) 20.6±2.4 (16.2,29.3) 22.5±2.9 (17.8,31.9)Systolic BP† (mmHg) 105±8 (90,125) 116±10 (95,138)

Diastolic BP (mmHg) 68±6 (60,85) 74±7 (60,88)

Relative Changes in Pollutant Concentrations from Pre-Olympic Period

Relative Changes in Inflammatory and Hemostasis Biomarker Levels from the Pre-

Olympic Period

Funding Agencies

NIEHS: 1 R01 ES015864

Health Effects Institute: 4760-RPFA05-3

China Natural Science Foundation: 20637020

Beijing Environmental Protection Bureau

Acknowledgement Study participants

Lab and field technicians, nurses, graduate students

The OfficialFresh Air

Can Of the Beijing

Olympic Games 2008’“100% pure” from the Bird Nest

Crying while

breathing

2008Beijing Olympi

c

A formula for tackling air pollution problems in China:

Legislations + Technology = Clean Air

Based on the lessons learned from the developed world:

Thank You

Retrieved from http://www.arb.ca.gov/research/apr/apr.htm

Spare Slides

The London smog disaster of 1952. Death rate with concentrations of smoke

Day

(Data compiled from World Bank 2008)

PM10 in Urban areas in Asia, 1990-2005

Trends in urban ambient PM10 concentrations in urban areas in Asia

Data are estimates from GMAPs, values for All Asia are Weighted averages of the regions

Brook et al, Circulation 109:2655-2671, 2004

TIMING

Susceptibility

“In 2010, household air pollution from solid fuels and outdoor air pollution was responsible for 3.5 and 3.3 million premature deaths

respectively, worldwide.”

- GBD Project findings, The Lancet (2012), 380: 2224-2260