Global and Local Impact of Air Pollution on Health
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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
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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.
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Open-fire biomass cooking is common in developing country villages.
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Today, exposure indoors to coal and biomass smoke affects more than 65% of the Chinese population, and about half of the world’s population
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Smith et al 2000, Zhang et al 2000
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Smoke (point) vs. Smog (area)•Biomass smoke
•Coal smoke
•Tobacco smoke
• etc
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June 2006, Ba Da Ling, Beijing
Smog – Regional air pollution
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QuestionThe word “smog” was first used to describe Los Angeles air.
True or False?
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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.
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The London Smog*
* Smog = Smoke + Fog
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Daytime in London, December 1952
Source: National ArchivesParticle levels – 3,000 mg/m3
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4000 extra deaths in the week
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Donora, Pennsylvania, 1948
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Sulfurous (London) Smog vs. Photochemical (Los Angeles ) Smog
Photochemical smog:
HC + NOx + UV = Smog (O3 + PM + aldehydes, + etc)
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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 ….
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Question
MORE
True or False?
vehicle miles driven,cars, trucks, ships, planes, trains,people, homes, power used,…
…but LA air is getting cleaner!
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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
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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
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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
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Harvard Six Cities Studies
WatertownPortage
St. Louis
Topeka
Kingston
Steubenville
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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
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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
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Outdoor Air Pollution and health in the Developing
Countries of Asia: A Comprehensive Review
Heath Effects Institutewww. healtheffects.org
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June 2006
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Air pollution levels in many Chinese cities far exceed health based air quality standards
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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
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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)
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(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
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(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
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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/)
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January PM2.5 concentrations measured at US Embassy in Beijing
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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!!
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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
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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
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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
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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
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The Beijing HEART Study
Health Effects of Air Pollution Reduction Trial
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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.
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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.
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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
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The Beijing HEART Study
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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
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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)
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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)
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Relative Changes in Pollutant Concentrations from Pre-Olympic Period
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Relative Changes in Inflammatory and Hemostasis Biomarker Levels from the Pre-
Olympic Period
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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
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The OfficialFresh Air
Can Of the Beijing
Olympic Games 2008’“100% pure” from the Bird Nest
Crying while
breathing
2008Beijing Olympi
c
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A formula for tackling air pollution problems in China:
Legislations + Technology = Clean Air
Based on the lessons learned from the developed world:
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Thank You
Retrieved from http://www.arb.ca.gov/research/apr/apr.htm
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Spare Slides
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The London smog disaster of 1952. Death rate with concentrations of smoke
Day
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(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
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Brook et al, Circulation 109:2655-2671, 2004
TIMING
Susceptibility
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“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