Air Pollution and Health in Developing Asia - China Specific Impacts from the Global Burden of Disease
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Air Pollution and Health in Developing Asia China Specific Impacts from the Global Burden of Disease A dialogue on air science and policies in China and Hong Kong Robert O’Keefe Vice President, Health Effects Institute Chair Clean Air Asia Hong Kong
Public Health Impact can be a major driver of decisions • It demonstrates that air pollution is an important factor affecting people, nations • Provides health-based rationale for air quality and source standards worldwide • Provides the health basis for assessing costs & benefits • Standards, in turn, drive technology decisions with air and climate implications • Cleaner vehicles & alternate transport • Less coal-fired electricity, efficiency, alternate fuels
Most Chinese Cities Substantially Exceed WHO, Chinese Air Quality Guidelines 160 2009 Annual Mean PM10 Levels in Chinese Cities 140 China Standard: 100µg/m3 120 Annual Mean PM10 Levels (µg/m3 ) 100 80 60 WHO Guideline: 20 µg/m3 40 20 0 Source: WHO 2011
Estim ated population-w eighted am bient air pollution levels - PM 2.5 -increased w orldw ide and in China 1990- 2010 50% increase in 1990 → 2010: population-weighted 10% increase in global population-weighted PM2.5 PM2.5
The Global Burden of Disease (GBD) • A systematic scientific effort to quantify the magnitude of health loss from disease and injuries in 187 countries around the world from 1990 to 2010 • E.g. cardiovascular disease, respiratory disease, HIV-AIDS, cancer road traffic injuries and • Risks associated with conditions linked with those diseases • E.g. smoking, diet, high blood pressure, air pollution, overweight • Measured as “Disability Adjusted Life Years (DALYs) and Mortality” • Last completed with WHO for Year 2000 • Newest version, funded by Gates Foundation, was published in December, 2012 • HEI leadership for outdoor air pollution analysis
Particulate Matter (PM) • High levels of PM (> 500 µg/m3) known to cause premature death • e.g. London 1952 • Thousands of studies in US, Europe, elsewhere have found association of PM with mortality at much lower levels (
Chinese PM10 Evidence from the PAPA Multi-City, Coordinated Studies HEI Research Report 154, November 2010 •Conducted in partnership with principal investigators Dr. Kan Haidong (Fudan),; Dr. CM Wong (University of Hong Kong), among others •Consistent small increase in risk with daily increase in PM10 •Communication 13, available at www.healtheffects.org/publications Excess risk (%) of mortality for a 10mg/m3 increase in average concentration of pollutants (lag 0-1 days)
Asia in a Global Context (PM10 and Daily Mortality) The effects of pollution are more similar than different … …and global science can be broadly relevant
Asia in a Global Context: Recent China results on long term effects of air pollution are consistent with the results of the Global Burden of Disease GBD risk functions China results: Cao et al. 2011
The GBD 2010 Results for Air Pollution
Previous Global Burden of Disease in 2000 Mortality attributable to leading risk factors High blood pressure Tobacco High cholesterol Underweight Unsafe sex Low fruit and vegetable intake Overweight and obesity Physical inactivity Alcohol Unsafe water, sanitation, and hygiene High-mortality developing Indoor smoke from solid fuels Iron deficiency Lower-mortality developing Urban air pollution Developed Zinc deficiency Vitamin A deficiency Outdoor Air Pollution Contaminated health care injections Occupational airborne particulates ranked 13th Occupational risk factors for injury Lead exposure Illicit drugs 0 1000 2000 3000 4000 5000 6000 7000 8000 Ezzati et al. 2002; WHO 2002 Mortality in thousands (Total 55.86 million)
2010: Ambient PM2.5 now among the leading global risks for mortality and lost years of healthy life (Lim et al 2012, and http://viz.healthmetricsandevaluation.org/gbd-compare/) Contributes to 3.2 million premature deaths worldwide
Dramatic Demographic Shifts: People Living Much Longer Worldwide But increased susceptibility to “diseases of aging” (heart disease, stroke, COPD, lower respiratory infection, lung Cancer…diseases most associated with air pollution East Asia South Asia
New, More Extensive Global Estimates Based on Measurements, Remote Sensing (Brauer, et al, 2011) Combined estimates from satellites (AOD), chemical transport models and ground-level measurements -Highest regional averages in East /South Asia -Many breathe concentrations much higher than regional average -89% population in areas exceeding WHO PM
Top 20 Mortality Risk Factors in China for 2010 Ambient PM2.5 is 4th leading factor (Lim et al 2012, and http://viz.healthmetricsandevaluation.org/gbd-compare/) Ambient PM2.5 contributed to estimated 1,2 million premature deaths in 2010
Public Health Impact of Air Pollution is well-documented and substantial • GBD 2010 documents that air pollution is a very important factor affecting global public health • High levels of outdoor air pollution are responsible for over 3.2 million premature deaths annually and 76 million years of healthy life years lost around the world • Developing Asia, including India and China bears over 2/3 of the world wide global health burden in this key area • 60 years of western health studies and an increasing base of high quality Asian health studies provide confidence in this assessment • Health, economic and ecological reasons to take action • Actions typically highly cost effective
Thank You! Robert O’Keefe rokeefe@healtheffects.org
Positive Steps in China, to Reduce Air Pollution …by government that can benefit air pollution and climate Significant new national monitoring program for PM2.5 and O3 underway o China-Wide by 2016 o Real time transparent reporting will maintain public focus 2012 --Recent pollution limits for PM and Ozone o Standards are comparable to WHO interim targets (IT); Grade II PM2.5, PM10 and O3 2013 National Action Plan; -Bans new coal plants around Beijing, Shanghai, key regions -Begin shift from coal to gas, renewables, nuclear (2017 reduction to 65% total coal in energy consumption) …though recent projections show increases in coal mining, due to growth in overall energy use -Target 10% reduction in urban fine particle pollution by 2017, additional reductions in 3 major regions -2013 State Council Clean Fuels Roadmap for China: fuel quality (10 PPM Sulfur), aggressive scrappage, other transport measures Much more work needed….compliance and follow through critical …As are the recommendations of RAQM
Air Quality, PM, and Cancer • New review of all air pollution and cancer • Follows reviews of many components: PAHs, benzene, butadiene, diesel • Called Air Pollution, and PM, known human carcinogens (Group 1) based on: • US (ACS) and Europe (ESCAPE) long term cohorts that found associations with lung cancer • According to GBD, approximately 220,000 lung cancer deaths attributable to air pollution worldwide 22
K ey Features of the GBD AQ im pact estim ates for China (Yang GH et al. The Lancet 2013) • Includes the entire population both urban and rural • Prior studies had only estimated urban • Estimates PM2.5 exposure using satellites, air quality models, and data from >100 Chinese monitors • Risk estimates based on systematic review and synthesis of all latest epidemiologic studies • These are consistent with the results of newest Chinese studies • Methods and results published in peer-reviewed journals - all data are publically available
Estimated 2010 levels of PM2.5 in China
Household solid fuel emissions also contribute to Ambient Air Pollution • Global: Household emissions contribute ~15% (4 µg/m3) of ambient PM2.5 • China: Household emissions contribute ~ 15% (7 µg/m3) of PM2.5 • India: Household emissions contribute ~25-30% (10µg/m3) of PM2.5 •The fifth leading risk factor for mortality in China in 2010 ~ 1 million premature deaths
IARC Meeting on Diesel June 5 – 12, 2012 • Noted substantial (>98%) improvements in new technology diesel in US, Europe • Based review on animal and human exposures to old (and much older) diesel • Concluded that: • Animal studies provided sufficient evidence of link between diesel and cancer • Human studies (with DEMS added) provided sufficient evidence of link • Mechanistic studies provided strong evidence of plausible mechanisms by which diesel could cause cancer in humans Classified diesel exhaust as a “known” human carcinogen
Summary • The Public health impact of air pollution key to informing, driving policy • GBD, the new global standard for credible health impact assessment, finds the greatest burden in developing Asia, with over 630,000 premature deaths and 74 million health years of life lost 2010 • Vehicles are not the only source of concern for air pollution, but high urban exposures and proximity to roadways of dense populations in India’s cities makes it a special concern • Emissions from older diesel engines, with significant PM impacts, and new IARC designation as Known Human Carcinogen is an important source to reduce • HEI ACES continues to document that new technology diesel, with low sulfur fuel and particle filters yields dramatic emission reductions and negligible health effects, is an important way forward
In China: Health Concerns Driving New PM2.5 and Ozone Air Quality Standards (2012 - 2016), New Transparency Extreme pollution episodes result in citizen unrest, international embarrassment, expat flight, Chinese official press GBD coverage: Air pollution sped death of 1.2 million in China Global Together, drive flurry of Times action by|Chinese 2013-4-2 0:53:0 Government Recent directions •2012 --New pollution limit and monitoring requirements for PM and Ozone o Standards are comparable to WHO interim targets (IT); Grade II PM2.5, PM10 and O3 Significant new monitoring phased in over next four years o National monitoring program for PM2.5 and O3 underway o China-Wide by 2016 o Real time transparent reporting will maintain public focus An increasingly affluent middle-class can afford to care about pollution
Am bient Air Pollution Ex pert Group H Ross Anderson (Co-Chair) SGHM S U London Markus Amann I I ASA/ Vienna Michelle Bell Yale University Michael Brauer U British Colum bia Bert Brunekreef U Utrecht Richard Burnett Health Canada Aaron Cohen (Co-Chair) Health Effects I nstitute Frank Dentener EC-JR C Majid Ezzati Harvard University Bryan Hubbell USEPA Kan Haidong Fudan University Michal Krzyzanowski W HO/ Euro-Bonn Francine Laden Harvard University Stephanie London NI EHS Randall Martin Dalhousie University Sumi Mehta UN Fnd Clean Stoves Program Bart Ostro California EPA Kiran Dev Pandey W orld Bank Arden Pope Brigham Young U Beate Ritz UCLA Isabelle Romieu I AR C Amir Sapkota U M aryland Kirk Smith UC Berkeley George Thurston New York University Rita van Dingenen EC –JR C Aaron van Donkelaar Dalhousie University
Asia PM 2.5 Source Apportionment: Vehicles ~20% - 35% Source: Chowdhury, HEI
Coal consumption key contributor to regional background
Household and Ambient Air Pollution: India and China face a double burden • Household air pollution (HAP) was: • the second leading risk factors for mortality in India in 2010: ~1 million • The fifth leading risk factor for mortality in China in 2010: ~ 1 million • HAP contributes to ambient PM2.5 and so is responsible for some proportion of the burden of disease attributed to ambient PM2.5 • Reducing household air pollution is necessary in some settings in order to improve outdoor air quality
1,234,000 Deaths Attributable to Ambient PM2.5 by Cause in China in 2010
India: Many Cities Substantially Exceed WHO and Indian Air Quality Guidelines India Standard: 60µg/m3
Indian Results: PM10 Evidence from Chennai PAPA study Approximately 0.3% -0.6% increase in mortality per 10 µg/m3 PM10 Similar Results in Delhi as Well… Fig. 23: A comparison of the estimated RR’s for PM10 obtained from the core zonal model, alternative models and sensitivity analysis. Dr. Kalpana Balakrishnan and colleagues HEI 2011
Short-term exposure: CAPES CAP ES cities CAP ES研究的城市
The Health Effects Institute Trusted Science Cleaner Air Better Health • An independent non-profit institute providing trusted science on the health effects of air pollution for 30 years • Balanced Core Support • US EPA and Industry (Worldwide Motor Vehicle) • Partnerships • Also WHO, ADB, Clean Air Asia, major universities and medical institutions, EU, US DOE, industries, foundations, others • Independent Board and Expert Science Committees • Oversee and intensively peer review all science • International experts India, China, many others) • Hundreds of policy-relevant studies and scientific reviews, reanalysis conducted around the world, with strong Asia focus • Understanding local impacts in a global context to inform policy
GBD 2010: China (and others) have seen health progress 1990 to 2010: Much lower death from infectious disease (tuberculosis, diarrhea, early childhood illness) Yang GH et al.
Top 20 Mortality Risk Factors in India for 2010 Ambient PM2.5 is 5th leading mortality risk factor Ambient PM2.5 caused an estimated 627,000 deaths ̴ 6% of all deaths in 2010
Extensive Press on China Global Burden of Disease Including detailed coverage in China official press - China’s toxic smog battle worse than first feared -Air Pollution Linked to 1.2 Million Premature Deaths in - China's ChinaAir Pollution Linked To Millions Of Early Deaths -City Air Makes Us Sick, Chinese Tell Doctor - Air Pollution Killing Children and Elderly in China -‘Airpocalypse’ in China: Air Pollution Kills Over a Million
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