P. Otorepec, M. GregoričIVZ RS

Use of rutinely collected air Use of rutinely collected air pollution and health data on pollution and health data on local level for simple evaluation local level for simple evaluation of health impact of health impact

Health - environment dataHealth - environment data

There is a large amount of health and env. data rutinely collected in most of EU countries. Most of data are used only for a limited purpose and very poorly used and almost never analysed together with different sets of data.

Our attempt was to combine two sets of data with simple analytical methods, that may serve regularly for assessment of local env. and health policies that lead to improvement of env. situation and health.

Ljubljana - local characteristicsLjubljana - local characteristics

Ljubljana metropolitan area has a population of roughly 270.000.

The number of people over 65 years is 40000 (14.8%). It has a climate that is transition between continental and

alpine, with prevailing weak local winds, influenced by urban heat island.

It is located in basin with regular temperature inversions. The meteorological conditions are extremely unfavourable

and dramatically contribute to build up of pollution. The average wind speed is below 1 m/s and average

yearly daily temperature is 10,9 C.

Demographic characteristics Demographic characteristics

City Year Population Population over

65 years

Land area Population density

Number Percent Km2 Inhabitants/Km2

Athens 1996 3 072 922 13 350 8 780

Barcelona 1999 1 505 581 20.7 99 15 196

Bilbao 1996 647 761 16.4 105 6 171

Bordeaux 1999 584 164 15.8 283 2 064

Bucharest 1999 2 028 000 13.0 238 8 521

Budapest 1999 1 775 587 17.5 524 3 389

Celje 1999? 50 121 14.0 230 218

Cracow 1999 738 150 13.4 327 2 258

Dublin 1998 510 139 13.1 113 4 488

Göteborg 2000 462 470 16.4 282 1 637

Le Havre 1999 254 585 15.1 199 1 279

Lille 1999 1 091 156 12.8 612 1 783

Ljubljana 1999? 284 763 14.8 902 316

London 1999 7 285 100 12.6 1 600 4 553

Lyon 1999 782 828 15.7 132 5 930

Madrid 1998 2 881 506 17.8 606 4 752

Marseille 1999 856 165 18.7 355 2 412

Paris 1999 6 164 418 13.8 762 8 090

Roma 1995 2 685 890 17.2 1 495 1 797

Rouen 1999 434 924 15.2 320 1 359

Sevilla 1996 697 485 13.5 141 4 947

Stockholm 1999 1 163 015 15.6 500 2 326

Strasbourg 1999 451 133 13.3 304 1 484

Tel Aviv 1996 1 139 700 14.2 171 6 665

Toulouse 1999 690 162 13.5 635 1 087

Valencia 1996 746 683 16.1 99.7 7 488

Sources of air pollution Sources of air pollution

In the city centre road traffic is the denominating source. In some residential areas coal burning and poor oil burning

is very important too. The central heating plant is using only coal. Local heating

plant and individual heating systems are still responsible for 30% of PM10 and BS emissions.

Transportation constitutes the main source of air pollution in Ljubljana: 70 % of the emissions of PM10. The most important vehicle category is diesel vehicles (city buses).

The maximal pollution level of PM10 in winter is 139 ug/m3,

and in summer 70 ug/m3. ug/m3.

Air pollution data Air pollution data

PM 10 24 hours average PM 10 yearly average Ozone (8 hours maximum of daily moving average

in summer) Ozone (8 hours maximum of daily moving average) Black smoke 24 hours average Sulphur dioxide 24 hours average, hourly rate NO2, NOx 24 hours average, hourly rate CO (8 hours maximum of daily moving average) Lead, cadmium - part of PM BTX - benzen, toluen, xylen (hourly values)

Health data Health data

Mortality data - excluding accidents and violent deaths (ICD9 800)

Respiratory Mortality data - (ICD9 460-519) Cardiovascular Mortality data - (ICD9 419-

414, 427, 428) Hospital admissions for respiratory diseases -

(ICD9 460-519) Hospital admissions for cardiac diseases -

(ICD9 419-414, 427, 428)

Particulate Matter – PM10Particulate Matter – PM10

Over the past decade many epidemiological studies have shown:

An association between exposure to small Short term increases in PM10 levels and increases in daily mortality and worsening symptoms of respiratory illnesses.

Studies have shown an increase in death due to respiratory diseases and worsening of symptoms in people with COPD and asthma.

Long term PM10 exposure caused increased incidence of respiratory disease.

Health Impact of PM 10 Health Impact of PM 10

Short term exposure; Acute effects on Respiratory Mortality (RR 1.012 / 10 ug/m3) Acute effects on Cardiovascular Mortality (RR 1.008 / 10

ug/m3) Acute effects of particles on Total Mortality - excluding

accidents and violent deaths (RR 1.0074 / 10 ug/m3), Hospital admissions Asthma attack Children (RR 1.051 / 10 ug/m3). Hospital admissions Asthma attacks Adults(RR 1.004 / 10 ug/m3). Long term exposure; Effects on Total Mortality (RR 1.1 / 10 ug/m3).

Method used Method used

Exposure data - we used regular data from air pollution monitoring network, to evaluate exposure throughout the city the levels were checked with mobile monitoring stations, and than existing results used for exposure assessment.

Health data - mortality and hospital admission data were used, only reliable health data.

Health effect - Exposure - Pollution - Health Effect Coefficient was used to calculate health effect of exposure. Ljubljana City specific Coefficient was obtained from analytical time series studies.

Exposure dataExposure data

The pollution indicators are monitored by Agency for Environment. The measurements from urban background stations that are geographically representative of the study area and not directly influenced by local sources of air pollution were selected: two stations for PM10. The values from the stations correlate very well with mobile stations, what means that exposure to PM10 is even throughout the city.

PM 10 Monitoring citesLocation Type

Figovec Urban backgroundAgency for Environment Urban background

Air pollution data :

daily mean levels (SD) of PM10 were 35.7 µg/m3

(19.5)

A.number of days where PM10 exceeded 20

µg/m3 were 287 days

B.number of days where PM10 exceeded 50

µg/m3 were 67 days.

Participating citiesParticipating cities

Apheis city

Annual mean levels of the distribution of Annual mean levels of the distribution of PM10, Required annual levels in EU in year PM10, Required annual levels in EU in year 2005 (40 ug/m3) and in year 2010 (20 ug/m3)2005 (40 ug/m3) and in year 2010 (20 ug/m3)

PM10 annual mean

0

20

40

60

80

100

120

140

160

180

Goteb

org

Stock

holm

Toulo

use

Lille

Borde

aux

Lond

on

Strasb

ourg

Lyon

Paris

Mar

seille

Budap

est

Bilbao

Ljublj

ana

Celje

Mad

rid

Sevilla

Rome

Tel A

viv

Bucha

rest

µg/m3

2005

2010

Number of days per year when PM10 Number of days per year when PM10 exceeded 24 - hour values of(50 ug/m3) exceeded 24 - hour values of(50 ug/m3) and (20 g/m3)and (20 g/m3)

Number of days where PM10 exceeded 20 and 50 µg/m3

0

50

100

150

200

250

300

350

400

Goteb

org

Stock

holm

Toulo

use

Lille

Borde

aux

Lond

on

Strasb

ourg

Lyon

Paris

Mar

seille

Budap

est

Bilbao

Ljublj

ana

Celje

Mad

rid

Sevilla

Rome

Tel A

viv

Bucha

rest

PM 10 over 20

PM10 over 50

µg/m3

Health indicators - LjubljanaHealth indicators - Ljubljana

National Institute of Public Health provides mortality data coded (ICD 10). For 1999 :

- daily mean for total mortality (ICD9<800) was 7,7 and SD:1,62

- standardised mortality rate using European population was 803,5 per 100 000 inhabitants.

Incidence rate of cardiac admissions - all ages was: 6,6/1000

Incidence rate of respiratory admissions all ages was: 9,5/1000

Incidence rates of respiratory admissions 65+ years was: 17/1000

Standardised mortality rates for all Standardised mortality rates for all cause of deathscause of deaths

standardised mortality rate

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

Toulo

use

Paris

Lyon

Borde

aux

Mar

seille

Rome

Strasb

ourg

Stock

holm

Le H

avre

Rouen

Lond

on

Goteb

org

Mad

rid

Bilbao Lil

le

Tel A

viv

Valen

cia

Sevilla

Craco

w

Athen

s

Ljublj

ana

Dublin

Celje

Barce

lona

Budap

est

Bucha

rest

Rate / 100 000 /year

Acute effect scenario - PM10Acute effect scenario - PM10

reduction of PM10 levels to a 24 hour value of 50 ug/m3 (2005, 2010 limit values for PM10) on all days exceeding this value

reduction of PM10 levels to a 24 hour value of 20 ug/m3 (to allow for cities with low levels of PM10) on all days exceeding this value

Benefits of reducing daily PM10 levels in the city of

Ljubljana to 20 µg/m3and to 50 µg/m3. Short-term

mortality (excess cases per 100 000 inhabitants) Number of days exceeding 20 µg/m3 - 287

Number of days exceeding 50 µg/m3 - 67

Excess cases per 100 000 Attributable casesShort-term mortality20 µg/m3 11.050 µg/m3 2,0

Potential benefits of reducing PM10 levels to Potential benefits of reducing PM10 levels to a 24-hour value of (20 ug/m3) on all days a 24-hour value of (20 ug/m3) on all days exceeding this value - Number of deaths per exceeding this value - Number of deaths per 100000 inhabitants attributable to acute 100000 inhabitants attributable to acute effects of PM10effects of PM10

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Borde

aux

Bucha

rest

Budap

est

Celje

Goteb

org

Lille

Ljublj

ana

Lond

onLy

on

Mad

rid

Mar

seille

Paris

Rome

Sevilla

Stock

holm

Strasb

ourg

Tel A

viv

Toulo

use

Rate / 100 000 /year

Chronic effect scenario - PM10Chronic effect scenario - PM10

reduction of the annual mean value of PM10 to a level of 10 ug/m3

reduction of the annual mean value of PM10 to a level of 20 ug/m3 (2010 limit values for PM10)

Table 3. Benefits of reducing PM10 annual mean

value to a level of 20 and 10 µg/m3. Long term

mortality (excess cases per 100 000 inhabitants)

Attributable cases

Excess cases per 100 000Long term mortality20 µg/m3 66,710 µg/m3 106,8

Potential benefits of reducing annual mean values Potential benefits of reducing annual mean values of PM10 to a level of 20 ug/m3 (2010 limit values of PM10 to a level of 20 ug/m3 (2010 limit values for PM10) - Number of deaths per 100000 for PM10) - Number of deaths per 100000 inhabitants attributable to acute and chronic inhabitants attributable to acute and chronic effects of PM10effects of PM10

-50.0

0.0

50.0

100.0

150.0

200.0

250.0

Borde

aux

Bucha

rest

Budap

est

Celje

Goteb

org

Lille

Ljublj

ana

Lond

onLy

on

Mad

rid

Mar

seille

Paris

Rome

Sevilla

Stock

holm

Strasb

ourg

Tel A

viv

Toulo

use

20 µg LT PM10

20 µg ST PM10

Rate / 100 000 /year

Table 2. Benefits of reducing daily PM10 levels to 20

µg/m3and to 50 µg/m3.

Hospital admissions (excess cases per 100000

inhabitants)Hospital admissions for cardiovascular diseases (all

ages)20 µg/m3 16,150 µg/m3 3,0Hospital admissions for respiratory diseases (+65)20 µg/m3 12,150 µg/m3 2,2

CommentsComments

Both urban background stations for PM10 were used to

estimate the exposure for Ljubljana in the study.

The levels of PM10 are of concern. The annual daily mean level

of PM10 is not decreasing and was 35,7 µg/m3 in 1999.

The main source of PM10 pollution is traffic. All public transport

is with diesel buses, diesel buses and trucks are very

common, and part of the vehicle fleet is not kept in a good

condition.

The centre of the city is missing traffic free zones and

pedestrian zones are scarce.

There are at least 40 deaths and almost 100 hospital admissions for

cardiovascular diseases and respiratory diseases per year, that can be

attributed only to exceed of EU level (20 µg/m3 that will be enforced in

2010). On a long run more than 300 lives per year could be spared,

providing that long term PM10 average annual value would not exceed 10

µg/m3.

City transport policy needs to recognise that it cannot only focus on the demand for roads but must make walking, cycling and public transport real and accessible choices. Public Health and Health Promotion is going to play a major role in developing these strategies and in their cross-sectoral implementation through Green Transport Plans, local Transport Plans and through improving access to public transport.

Health Impact Assessment - HIAHealth Impact Assessment - HIA

HIA can play a role in evaluating different policy scenarios for reducing air - pollution levels.

HIA provides number of health events attributable to air pollution in the target population.

WHO guidelines were used for assessing and using epidemiological evidence for environmental - health risk assessment and own HIA guidelines developed.