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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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The Assessment Toolbox?

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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

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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

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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.