Post on 05-Oct-2020
12/01/20071
Integrated Assessment of Health Risks of Environmental Stressors in Europe
The INTARESE Project
A 5-year Integrated Project
Funded under the Sixth Framework Programme of the European Union
Prof. David BriggsSmall Area Health Statistics Unit (SAHSU)
Imperial College London
12/01/20072
The INTARESE Project
The aim:To develop, test and apply a methodology for integrated assessment of health risks from environmental stressors, in order to support policy in the EU
Deliverables:Conceptual framework for assessmentGeneric methods and toolsTesting and demonstration of integrated assessmentsOperational toolbox (assessment system)User network and training
The partnership:33 partner institutions from 14 countriesUniversities, national ministries/government agencies, industry7 sub-projects, 24 work packages
12/01/20073
Rationale
1. Modern environmental health problems are complexMultiple hazards, pathways and primary/secondary effects Combined and cumulative exposuresLow relative risks but potentially large public health effectsNesting of local and global problemsEntanglement of acute and chronic effectsVariations in susceptibility and adaptability of population
2. Traditional methods of risk assessment are inadequate
Assessments must cross traditional boundaries of policy, science and expertise Assessments must show links within environment-health system and opportunities to interveneAssessments must be comprehensive and consistent but adaptable to local circumstance
12/01/20074
Principles
1. Implies capability to integrate assessment of risksSource to ultimate impactDifferent environmental hazards, pathways and mediaDifferent health effects and population groupsDifferent policy areas and responsibilitiesDifferent spatial and temporal scale
2. Knowledge and data are imperfect Make best possible use of available data and knowledgeRecognise and report uncertaintiesUsers must be willing to face up to complexity and uncertainty (precautionary approaches)
3. Perceptions of, and responses to, risk depend on the perspectiveof the observer
Issue framing is crucial – how we define a problem defines the assessmentStakeholders must be involved if they are to trust outcomes of assessment
12/01/20075
Who Needs Integrated Assessment and Why?
1. Key usersEU policy-makersInternational agencies (e.g. WHO, UNEP, World Bank) Voluntary organisations (e.g. FoE)National governmental agencies, environment/health ministriesIndustry (e.g. oil, chemicals, insurance)Researchers and risk assessors (e.g. epidemiology, toxicology, environmental science, risk management)
2. ApplicationsEnvironmental burden of disease assessmentPriority settingPerformance analysis (policy, technology etc)Scenario analysis (policy, technology etc)Liability assessmentRisk managementPublic information and participation
12/01/20076
Some Working Definitions
1. Integrated assessment
The assessment and reporting of collective (health) risks and impacts across different hazards, exposure pathways, spatial areas or scales, time periods and/or policy areas, in a consistent and comparable manner
2. Health risks
Probability and distribution across the population of possible adverse health effects arising from exposures to environmental stressors
3. Health impacts
The potential public health burden and associated social consequences, in terms of morbidity, mortality and monetary or other costs
4. Environmental stressor
Any environmental source, agent or process that has the potential adversely to affect human health
12/01/20077
The integrating principle
Source activityxRelease coefficientxDilution ratexContact ratexIntake ratexDose-response functionxPopulationxValue
Environmental circumstances
Time activitySetting
Time activityPhysiology
SusceptibilityTiming/durationMixtures
DistributionTime activityHeterogeneity
Value systems
TechnologyPractice
Emissions
Concentration
Exposure
Dose
Risk
Health impact
Cost
12/01/20078
SettingsIndoor
AmbientOccupational
etc
EjectionCorrosion/ corrasionDischargeLeakageDumping
ExposuresInhalation
Dermal contactIngestion
Sub-clinicalMorbidityMortality
AgeGender
Pre-existing health
LifestyleHealthcare
EXTERNALITIES
Absorbed
Target organ
Effective
TransportDiffusion
Mass transfer
TransformationSorting
DepositionChemical reactions
Abrasion
AirWater
SoilEtc
Media
Releases
SourcesExposure
Population
Distribution
Time-activity
DALYs/ QALYsCosts/ Benefits
Perceptionsetc
EquityGoals
AversionsEntitlements
Dose ImpactsHealth effects
Vulnerability
Values
HazardConcentration
LoadMagnitude
etcActivities
Natural(rocks, soil,
atmospheric, extra-terrestrial)
Anthropogenic(extraction, processing, distribution,
storage)
AgentsGasesSolids
Chemicals/ solutesEnergy
Components
Influences
The Full Chain Framework
12/01/20079
An Example of the Full Chain Framework: Road Traffic
Road traffic
(volume, feet mix,
speed etc)
Noise emissions
Kinetic energy
Pedestrians
Cyclists
Vehicle occupants
NOx
Particles
Benzene
Respiratory illness
Cancer
Cardio-vascular illness
Physical injuries
Sleep disturbance
Economic costs
Mortality
Morbidity
Social costs
Quality of life
O3
Road accidents
Indoor
Ambient
In-vehicle
Indoor
Ambient
Atmospheric emissions
Sound levels
Indoor
Ambient
Indoor
Ambient
In-vehicle
Concentrations
Exposures
Exposures
Annoyance
Time activity patterns Population sensitivity
Values and priorities
12/01/200710
An Example of the Full Chain Framework: Noise
AircraftIndoor
Annoyance
Sleep disturbance
Cardio-vascular illness
Industry
Road traffic
Occupational
Domestic activities
Hearing damage
Noise emissions
Economic costs
Mortality
Morbidity
Social costs
Quality of life
Ambient
Noise levels
Domestic
Ambient
Exposures
Time activity patterns
Population sensitivity
Health effects
Values and priorities
12/01/200711
Assessment Methodology
1. Source-exposureSource activity + Release + Dispersion/decay + Exposure + IntakeExposure modellingSource attribution
2. Exposure-health effectDose-response functions, toxicologySystematic review)Expert elicitation
3. Risk characterisationExposure – health effect – secondary impacts (e.g. costs)Indicator specification Risk communication
4. Uncertainty analysisConceptualisation – measurement – modelling – reporting - interpretationError propagationUncertainty reporting
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Monitoring and Surveillance
Integrated risk assessment depends on the availability of reliable and consistent data throughout the source-impact chain
1. Monitoring and modellingEnvironmental - personal, in-situ, satelliteBiomonitoring – biomarkers of exposure, susceptibility and effectHealth surveillance – baseline rates, verification
2. Adequacy assessmentRelevance and sensitivity – links to healthQuality – accuracy, representativeness, coverage, resolutionInter-operability – consistency, comparability, connectivityAccessibility – access facilities, costs, confidentiality
3. EnhancementGood practice guidanceLinkage and inter-conversionGap-fillingNew technologies
12/01/200713
Policy Assessments: Rationale and Themes
1. RationaleTest and enhance assessment methodologyDemonstrate assessmentsFirst approximations for policy issuesSelected to represent different types of issue from different perspectives
2. Policy themesRoad transportHousingAgricultureDrinking waterHousehold hazardous chemicalsSolid wasteClimate
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Policy Assessments: Agriculture
Farming system- Farm type- Location- Area
Cropping system- Crop type- Area
Livestock density- Livestock type- Numbers
Pesticide usage- Pesticide type- Spraying rate- Soil injection rate - Timing
Livestock wastes- Production- Slurry spreading rate- Soil injection rate
Soil type- Soil depth- Soil texture- Infiltration capacity- Organic matter content- pH
Meteorology- Temperature- Rainfall- Wind speed- Wind direction
Atmospheric concentration- Pesticides- Endotoxins- Allergens
Groundwater concentration- Pesticides- Organic compounds
Surface water concentration- Pesticides- Organic compounds
Geology/hydrology- Rock type- Aquifer depth- Slope angle- Runoff rate
Inhalation- Pesticides- Endotoxins- Allergens
Ingestion- Pesticides- Organic compounds
Dermal contact- Pesticides- Organic compounds
Population- Age stratified
number- Location- Employment- Time-activity
Sources
Releases
Media Exposure
Dose
Health Effects
Pesticides- Stillbirths- Congenital anomalies- Poisoning- Neurological and
developmental disorders- Cancers
Livestock waste- Zoonotic infection
Aerosols- Asthma- Allergic rhinitus- Wheeze- Hay fever
Mortality rateMorbidity rateDALYs
Impacts
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Policy Assessments: Housing
Energy efficiency
NutritionLower fuel use & cost
Increased disposable
income
Increased temperature
Alteredventilation
Indoor air quality
Mould growth
Cardio-respiratory
illness
Winter morbidity/mortality
Psycho-social well-being
Reduced emissions
Local and global environmental
impacts
Use of spaceSocial interactionSense of control
VENTILATION
WARMTH
ENERGY USE
Thermal comfortEnergy efficiency
NutritionLower fuel use & cost
Increased disposable
income
Increased temperature
Alteredventilation
Indoor air quality
Mould growth
Cardio-respiratory
illness
Winter morbidity/mortality
Psycho-social well-being
Reduced emissions
Local and global environmental
impacts
Use of spaceSocial interactionSense of control
VENTILATION
WARMTH
ENERGY USE
Thermal comfort
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Policy Assessments: Drinking Water
Exposure routes
GroundSurfaceRe-usedWater
e.g. As, Ca, Mg, U, Br
Sourcewater
AgricultureIndustry
PharmaceuticalsHouseholds
e.g. nitrates, EDCs, pathogens, pesticides
Watertreatment
Waterdistribution
Drinkingwater
Food
Disease:Cancer
ReproductiveInfectious
Taste/odour
Watershortage
Regulation
Climatechange
Populationgrowth includingmigration and mass tourism
PersonalBehaviour
e.g. showering,ingestion etc.
Water treatmentmethod
DBPs
Agingmaterial
Contaminatione.g. PAHs, Pb,
pathogens
Wastewater
Other disease factors e.g. age, socio-economic
status, genetics etc.
Exposure routes
GroundSurfaceRe-usedWater
e.g. As, Ca, Mg, U, Br
Sourcewater
AgricultureIndustry
PharmaceuticalsHouseholds
e.g. nitrates, EDCs, pathogens, pesticides
Watertreatment
Waterdistribution
Drinkingwater
Food
Disease:Cancer
ReproductiveInfectious
Taste/odour
Watershortage
Regulation
Climatechange
Populationgrowth includingmigration and mass tourism
PersonalBehaviour
e.g. showering,ingestion etc.
Water treatmentmethod
DBPs
Agingmaterial
Contaminatione.g. PAHs, Pb,
pathogens
Wastewater
Other disease factors e.g. age, socio-economic
status, genetics etc.
12/01/200717
The Assessment Toolbox: Purpose
To provide a means of doing integrated risk assessment long after the INTARESE project has been completed:
a guidance system for integrated risk assessmentaccess to generic information and knowledgeexamples and case studies of integrated risk assessmenta set of tools for integrated risk assessmenta platform for risk communication and stakeholder participation
12/01/200718
The Assessment Toolbox: Description
1. Components and functionalityManual/tutorial for integrated risk assessmentDescriptions/results of previous studiesCore data (population, baseline health data etc) Exposures (population distributions/profiles, hazard maps etc) Dose-response functionsLinks to external data and modelsFramework builder (for issue framing)Indicator calculator (DALYs, attributable risks, intake fractions etc)Display system (maps, graphs, tables etc)
2. Operational designWeb-based or stand-aloneMenu driven
12/01/200719
The Assessment Toolbox?
12/01/200720
The Assessment Toolbox?
information
charts/graphs
maps
methods
data
PM10Netherlands
OPTIONS
Output
overview health perception policy costs/benefits
Input
editview helphomeexposure
PM10 – Health – Maps
health
maps
More info More info
information
charts/graphs
maps
methods
data
PM10Netherlands
OPTIONS
information
charts/graphs
maps
methods
data
PM10Netherlands
OPTIONS
Output
overview health perception policy costs/benefits
Input
editview helphomeexposure
Output
overview health perception policy costs/benefitsperception policy costs/benefits
Input
editview helphome
Input
editview helphomeexposure
PM10 – Health – Maps
health
maps
More info More info
12/01/200721
Challenges and Issues
1. The limits of scienceDose-response functionsLinkage of epidemiological and toxicological dataCombined exposuresQuantifying uncertainty in a complex worldEarly warning and emerging issues
2. The limits of monitoringSampling density and coverage (e.g. personal monitoring, biomarkers)Specificity versus generality (e.g. biomarkers)Spatial and temporal resolution (e.g. health data, environmental surveys)Consistency of practice (e.g. personal monitoring, exposure modelling)
3. The limits of risk communication and useIndicators: the ‘cart before the horse’Understanding of uncertainty: precaution or prevarication Evidence-based policy: from evidence to action
12/01/200722
For More Information
Visit the INTARESE website
www.intarese.org
And if you would like to be involved as a user
Contact s.udondem@imperial.ac.uk
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.