Elsevier

Science of The Total Environment

Volume 449, 1 April 2013, Pages 390-400
Science of The Total Environment

Assessing the public health impacts of urban air pollution in 25 European cities: Results of the Aphekom project

https://doi.org/10.1016/j.scitotenv.2013.01.077Get rights and content

Abstract

Introduction

The Aphekom project aimed to provide new, clear, and meaningful information on the health effects of air pollution in Europe. Among others, it assessed the health and monetary benefits of reducing short and long-term exposure to particulate matter (PM) and ozone in 25 European cities.

Method

Health impact assessments were performed using routine health and air quality data, and a common methodology. Two scenarios were considered: a decrease of the air pollutant levels by a fixed amount and a decrease to the World Health Organization (WHO) air quality guidelines. Results were economically valued by using a willingness to pay approach for mortality and a cost of illness approach for morbidity.

Results

In the 25 cities, the largest health burden was attributable to the impacts of chronic exposure to PM2.5. Complying with the WHO guideline of 10 μg/m3 in annual mean would add up to 22 months of life expectancy at age 30, depending on the city, corresponding to a total of 19,000 deaths delayed. The associated monetary gain would total some €31 billion annually, including savings on health expenditures, absenteeism and intangible costs such as well-being, life expectancy and quality of life.

Conclusion

European citizens are still exposed to concentrations exceeding the WHO recommendations. Aphekom provided robust estimates confirming that reducing urban air pollution would result in significant health and monetary gains in Europe. This work is particularly relevant now when the current EU legislation is being revised for an update in 2013.

Highlights

► Aphekom performed health impact assessments of urban air pollution in Europe. ► Improving air quality would result in significant health and monetary gains. ► PM2.5 annual mean to 10 μg/m3 could add more than 6 months of life expectancy at age 30 in half of the cities. ► The associated costs would reach 30 billion Euros annually.

Introduction

Urban air quality represents a major public health burden and is a long-standing concern to European citizens. Despite a major decrease in the pollutant levels in Europe since the 1950s and the implementation of the first European Commission Directive on Ambient Air Quality in 1980, regularly updated since then, important disparities in exposure to air pollution between and within European countries still remain.

Air pollution is associated with a range of diseases, symptoms and infraclinic conditions that impair the health and quality of life in European cities. In the recent years, several epidemiological studies have reported associations between an increase in daily levels of ozone (O3) and particulate matter (PM), and an increase in the following days, of the mortality and hospital admissions predominantly related to respiratory and cardiovascular diseases. These short-term effects have been extensively documented in multicentre time-series studies (Anderson et al., 2004, Atkinson et al., 2005, Ballester et al., 2006, Bell et al., 2004, Bell et al., 2005, Biggeri et al., 2005, Dominici et al., 2005, Faustini et al., 2011, Garrett and Casimiro, 2011, Gryparis et al., 2004, Ito et al., 2005, Le Tertre et al., 2002, Saez et al., 2002, Stafoggia et al., 2009), producing robust estimates for Europe and North America. Chronic exposure to fine particles (PM2.5) has also been associated with an increase in long-term mortality, and with an increased risk of developing lung cancer and cardio-pulmonary diseases (myocardial infarction, chronic obstructive pulmonary disease, asthma) (Brook et al., 2010, Jerrett et al., 2005, Krewski et al., 2009, Pope et al., 2002, Pope et al., 2004). There is less conclusive evidence on the effect of chronic exposure to ozone, although Jerrett et al. linked long-term respiratory mortality with exposure to ozone during summer (Jerrett et al., 2009a). The relation between exposure to ozone, particulate matter and specific health outcomes is supported by the consistency of epidemiological findings across different cities, periods and study designs; the coherence of the observed effects; the indication of an increased risk at higher exposure levels; and the biological plausibility strengthened by clinical and toxicological studies. In particular, several results are in favour of a causal relationship between chronic exposure to PM2.5 and cardiovascular morbidity and mortality (Brook et al., 2010, Chen et al., 2008, Pope and Dockery, 2006).So far, threshold levels for no observable health effects have not been identified (World Health Organisation, 2005).

However, current European air quality standards for PM and ozone are still above the World Health Organization Air Quality Guidelines (WHO-AQG) that aim to protect public health. In Europe, annual mean PM10 should not exceed 40 μg/m3 (limit value set in 2005), and Member States are requested to reduce exposure to PM2.5 in urban areas below 20 μg/m3 by 2015 (legally binding value). The WHO-AQG for PM, chosen as the lowest levels at which total, cardiopulmonary and lung cancer mortality have been shown to significantly increase in response to long-term exposure to PM are set as an annual mean of 20 μg/m3 for PM10 and 10 μg/m3 for PM2.5. For ozone, the EU air quality directive still refers to the previous WHO-AQG of 120 μg/m3 (8-hour mean) (Air Quality Directive, 2008/50/EC). This value should not be exceeded more than 25 days per calendar year. The updated WHO-AQG, chosen as the concentration associated with a 1–2% increase in daily mortality, correspond to 100 μg/m3 for the maximum daily 8-hour O3 mean (World Health Organisation, 2005).

Several health impact assessments (HIA) have already reported the major public health burden of PM and ozone in Europe (Ballester et al., 2008, Boldo et al., 2006, Kunzli et al., 2000, Watkiss et al., 2005, World Health Organisation, 2010). In this paper, we present new HIA for 25 European cities, using recent data and new epidemiological knowledge on the impacts of PM and ozone on mortality and hospitalizations.

Since stakeholders drafting policies to reduce air pollution must take into account many considerations, such as economic and social constraints, political orientations and urban planning, the paper also presents an economic valuation of the estimated health gains from reducing air pollution levels in European cities, and an analysis of the overall uncertainties.

These analyses were part of the European project Aphekom, whose objective was to improve knowledge and to develop tools to better assess and communicate the health benefits from an improvement in urban air quality in Europe.

Section snippets

Study period and study areas

The HIA were performed in the 25 European cities from 12 countries participating in the Aphekom project (Fig. 1). A common study period, 2004–2006, was chosen based on data availability. In each city, a study area was defined according to a common protocol and with the advice of local experts in order to ensure that average pollutant levels measured at fixed monitors could be considered good proxies of the average population exposure.

Choice of health endpoints of the HIA

Health endpoints were chosen based on available concentration

Characteristics of the centres

The population of cities studied varied from 236,982 inhabitants in Granada to 7,484,900 inhabitants in London (median: 955,702), totalling nearly 39 million inhabitants in the 25 cities, of which 21% (5,849,709 inhabitants) were older than 65 years of age. The standardized mortality rate for all-causes mortality in the population 30 years old varied from 634 per 100,000 in Rome to 1572 per 100,000 in Bucharest (median 975 per 100,000), with a notably larger share of cardiovascular mortality in

Summary of main findings

In the 25 cities, population is still exposed to air pollutant levels higher than those recommended by the WHO to protect public health. The largest health burden was attributable to the impacts of chronic exposure to PM2.5. Complying with the WHO guideline of 10 μg/m3 in annual mean would add up to 22 months of life expectancy at age 30, depending on the city, corresponding to 19,000 postponed deaths each year. The associated monetary gain would total some €31 billion annually, including savings

Competing interest

None.

Acknowledgements

The huge amount of work behind the Aphekom project is the fruit of the generous and constructive input from all the members of the Aphekom network. We wish to give our special thanks and appreciation to all of them. We also thank M. Stempfelet for her help in producing Fig. 1.

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  • Cited by (0)

    Funding: The Aphekom project has been co-funded by the European Commission's Programme on community Action in the Field of Public Health (2003–2008) under Grant Agreement No. 2007105, and by the many national and local institutions that have dedicated resources to the fulfilment of this project.

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