Health Benefits of Improving Air            QualityClean Air – the Continuing Public Health Challenge            Dublin In...
Reform EnvironmentalRegulation As president, Mitt Romney will  eliminate the regulations  promulgated in pursuit of the O...
Benefits and Costs of Federal Regulations in US                         Largest estimated benefits                       ...
What is Fine Particulate AirPollution? Anything collected on a filter   Solid particles or liquid droplets   Not gases ...
Size Matters
Wiley Interdisciplinary Reviews
What is evidence for effectsof fine combustion particles(BS and PM2.5) on mortality?
Experience in Dublin Oil crisis in 1970’s  led to programs to  encourage use of  solid fuels,  primarily coal            ...
• Deterioration in air quality after switch to coal   (Flanagan, 1986)• During winters of 1980’s, Dublin experienced numbe...
Dublin Borough                      800                                                         40Black Smoke (ug/m3)     ...
Dublin Borough                      800                                                         40Black Smoke (ug/m3)     ...
Dublin County BurroughJanuary 1982         40         35Deaths         30         25         20         15         10     ...
Dublin 1980-1990                 17                 16                 15Deaths per Day                 14                ...
Cardiovascular Deaths: Dublin 1980-1990                 9                 8Deaths per Day                 7               ...
Respiratory Deaths: Dublin 1980-1990                 4Deaths per Day                 3                 2                  ...
Other Deaths: Dublin 1980-1990                         Non-Cardiovascular, Non-Respiratory                 6Deaths per Day...
Can we see effect of airpollution controls in Dublin?
Dublin Coal Ban On September 1, 1990, the  marketing, sale, and distribution of  bituminous coals was banned  within the ...
Dublin Black Smoke        140                   Ban on Coal Sales        120        100         80                        ...
Dublin Total Mortality                                      Ban on Coal Sales                      12Deaths per 1000 Pyr  ...
Dublin Cardiovascular                      6               Ban on Coal SalesDeaths per 1000 Pyr                      5    ...
Dublin Respiratory Deaths                      3                                         Ban on Coal SalesDeaths per 1000 ...
Summary Air pollution is associated with acute  increases in deaths at levels seen in  Ireland in the 1980’s Effects on ...
Dublin 1990-1996                          Cardio-Respiratory Deaths                 11                 10Deaths per Day   ...
Dublin 1980-1990                 17                 16                 15Deaths per Day                 14                ...
Dublin 1990-1996                          Cardio-Respiratory Deaths                 11                 10Deaths per Day   ...
Bans onCoal SalesSeptember 1, 1990-DublinOctober 1, 1995-CorkOctober 1, 1998-Limerick-Dundalk-Drogheda-Wexford-Arklow
98th percentiles of Daily Black SmokeConcentrations in Major Urban Areas                  DUBLIN      CORK       1990 Ban ...
What are the effects ofrepeated, long termexposures to Fine Particles?
Satellite-Derived PM2.5:2001–2006 Average                 Von Donkelaar et al Envir Hlth Pers 2010;118:847
Six Cities Adult Mortality Study 8111 adults in 6 cities      Dirty: Steubenville &       St. Louis      Moderate: Wate...
Six Cities Adult Mortality                               1.4                                                     EPA NAAQS...
Six Cities Mortality Follow-up 1974 to 1989 follow-up           1990 to 1998 follow-up   Annual returned               ...
Six Cities Cohort Follow-up                                     1.4                                     1.3               ...
Can we see effect of airpollution controls in US?
Age-adjusted death rates: United States, 1960-2005                              1,400Rate per 100,000 population          ...
Trends in the Levels of the Six Criteria PollutantsRelative to U.S. National Standards: 1980 - 2006
Estimated PM10
County life expectancies at birth for white malesand females;1997–2001        CJL Murray et al, Eight Americas: Investigat...
Cigarette Smoking – United StatesSOURCES: Centers for Disease Control and Prevention, National Center for Health Statistic...
Fine Particulate Air Pollution andUS County Life ExpectanciesPope, Ezzati, Dockery (NEJM 2009) Standardized life expectan...
51 Metropolitan areas (dots); Study Counties (shaded gray)
Life Expectancy vs PM2.51978-82                  81                  80                                      EPA NAAQS    ...
Life Expectancy vs PM2.51997-2001                                           EPA NAAQS                  81                 ...
Life Expectancy vs PM2.51980-2000                  81                  80                  79                  78Life Expe...
Life Expectancy vs PM2.51980-2000                  81                                                                     ...
Life Expectancy vs PM2.51980-2000                  81                  80                  79                  78Life Expe...
PM2.5 obligations set out inCAFE Directive 2008/50/EC                Air Quality in Ireland 2010; Key Indicators of Ambien...
Life Expectancy vs PM2.51980-2000                  81                                                        EPA NAAQS    ...
Summary statistics for PM2.5concentrations in 2010                   DUBLIN                              CORK             ...
Life Expectancy vs PM2.51980-2000                           Pope, Ezzati, Dockery (NEJM 2009)
Life Expectancy vs PM2.51980-2000                           Pope, Ezzati, Dockery (NEJM 2009)
Life Expectancy vs PM2.51980-2000                           Pope, Ezzati, Dockery (NEJM 2009)
Life Expectancy vs PM2.51980-2000                           Pope, Ezzati, Dockery (NEJM 2009)
How big is 0.5 year increase in lifeexpectancy? 65 year old nonsmoking male   Additional life expectancy     17.5 years ...
How big is 0.5 year increase in lifeexpectancy in population of Ireland?   Tobacco Smoking     6.8 years reduced life ex...
Conclusions PM2.5 associated significant health  effects   Life shortening (mortality) Improved air quality leads to  m...
Current U.S. Values for Health Effects   Premature death        $5.5 million   Chronic bronchitis     $340,000   Heart ...
Counties with PM2.5 Monitoring                     2000 and 2007Pop Density (Ppl/mi2)                                Corre...
Life Expectancy vs PM2.52000 (545 Counties)                  84                                                           ...
Life Expectancy vs PM2.52007 (545 Counties)                  84                                                           ...
Life Expectancy vs PM2.52000- 2007 (545 Counties)                  84                                                EPA N...
Life Expectancy vs PM2.52000 - 2007 (545 Counties)                  84                            EPA NAAQS               ...
Summary statistics for black smokeconcentration April 2009-March 2010          DUBLIN            Air Quality in Ireland 20...
Clean Air – the Continuing Public Health Challenge. Health Benefits of Improving Air Quality - Douglas Dockery
Clean Air – the Continuing Public Health Challenge. Health Benefits of Improving Air Quality - Douglas Dockery
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Clean Air – the Continuing Public Health Challenge. Health Benefits of Improving Air Quality - Douglas Dockery

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Clean Air – the Continuing Public Health Challenge. Health Benefits of Improving Air Quality - Douglas Dockery

  1. 1. Health Benefits of Improving Air QualityClean Air – the Continuing Public Health Challenge Dublin Institute of Technology June 27, 2012 Douglas W. Dockery Professor of Environmental Epidemiology Harvard School of Public Health
  2. 2. Reform EnvironmentalRegulation As president, Mitt Romney will eliminate the regulations promulgated in pursuit of the Obama administration’s costly and ineffective anti-carbon agenda. Romney will also press Congress to reform our environmental laws to ensure that they allow for a proper assessment of their costs. http://www.mittromney.com/issues/regulation
  3. 3. Benefits and Costs of Federal Regulations in US  Largest estimated benefits of ALL Federal Regulations attributable to the reduction in public exposure to a single air Other pollutant: fine particulate matter.  Clean Air Fine Particulate Implementation Mortality  Benefits ($ Millions/year)  $19,00 to $167,000  Costs ($ Millions/year)  $ 7,000
  4. 4. What is Fine Particulate AirPollution? Anything collected on a filter  Solid particles or liquid droplets  Not gases BS - Black Smoke PM - Mass
  5. 5. Size Matters
  6. 6. Wiley Interdisciplinary Reviews
  7. 7. What is evidence for effectsof fine combustion particles(BS and PM2.5) on mortality?
  8. 8. Experience in Dublin Oil crisis in 1970’s led to programs to encourage use of solid fuels, primarily coal Dundalk 1980’s - switch from oil to coal Dominant source of air pollution in Dublin was smoke from domestic Wexford fires
  9. 9. • Deterioration in air quality after switch to coal (Flanagan, 1986)• During winters of 1980’s, Dublin experienced number of severe air pollution episodes.
  10. 10. Dublin Borough 800 40Black Smoke (ug/m3) Black 35 600 Smoke 30 Deaths 400 25 200 20 0 15 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 January 1982
  11. 11. Dublin Borough 800 40Black Smoke (ug/m3) Black 35 600 Smoke 30 Deaths Deaths 400 25 200 20 0 15 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 January 1982
  12. 12. Dublin County BurroughJanuary 1982 40 35Deaths 30 25 20 15 10 0 200 400 600 800 3 Day Mean Black Smoke (ug/m3)
  13. 13. Dublin 1980-1990 17 16 15Deaths per Day 14 13 12 11 10 Mean of 20 consecutive points 9 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  14. 14. Cardiovascular Deaths: Dublin 1980-1990 9 8Deaths per Day 7 6 5 Mean of 20 consecutive points 4 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  15. 15. Respiratory Deaths: Dublin 1980-1990 4Deaths per Day 3 2 Mean of 20 consecutive points 1 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  16. 16. Other Deaths: Dublin 1980-1990 Non-Cardiovascular, Non-Respiratory 6Deaths per Day 5 4 Mean of 20 consecutive points 3 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  17. 17. Can we see effect of airpollution controls in Dublin?
  18. 18. Dublin Coal Ban On September 1, 1990, the marketing, sale, and distribution of bituminous coals was banned within the city of Dublin (Air Pollution Act, 1987).
  19. 19. Dublin Black Smoke 140 Ban on Coal Sales 120 100 80 -36 g/m3g/m3 60 (-71%) 40 20 0
  20. 20. Dublin Total Mortality Ban on Coal Sales 12Deaths per 1000 Pyr 7% drop in Total Mortality 10 8 6
  21. 21. Dublin Cardiovascular 6 Ban on Coal SalesDeaths per 1000 Pyr 5 4 3 13% drop in Cardiovascular Mortality 2
  22. 22. Dublin Respiratory Deaths 3 Ban on Coal SalesDeaths per 1000 Pyr 2 1 16% drop in Respiratory Mortality 0
  23. 23. Summary Air pollution is associated with acute increases in deaths at levels seen in Ireland in the 1980’s Effects on respiratory and cardiovascular system Reductions in air pollution in Dublin have produced measurable improvements in health
  24. 24. Dublin 1990-1996 Cardio-Respiratory Deaths 11 10Deaths per Day 9 8 7 Mean of 20 consecutive points 6 0 10 20 30 40 50 3 Day Mean Black Smoke (ug/m3)
  25. 25. Dublin 1980-1990 17 16 15Deaths per Day 14 13 12 11 10 Mean of 20 consecutive points 9 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  26. 26. Dublin 1990-1996 Cardio-Respiratory Deaths 11 10Deaths per Day 9 8 7 Mean of 20 consecutive points 6 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  27. 27. Bans onCoal SalesSeptember 1, 1990-DublinOctober 1, 1995-CorkOctober 1, 1998-Limerick-Dundalk-Drogheda-Wexford-Arklow
  28. 28. 98th percentiles of Daily Black SmokeConcentrations in Major Urban Areas DUBLIN CORK 1990 Ban 1995 Ban 1998 Ban Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
  29. 29. What are the effects ofrepeated, long termexposures to Fine Particles?
  30. 30. Satellite-Derived PM2.5:2001–2006 Average Von Donkelaar et al Envir Hlth Pers 2010;118:847
  31. 31. Six Cities Adult Mortality Study 8111 adults in 6 cities  Dirty: Steubenville & St. Louis  Moderate: Watertown & Kinston/Harriman  Clean: Topeka & Portage Enrolled starting in 1974 14-16 years of mortality follow-up Effect of 10 g/m3 PM2.5  +13% (95% CI 4% to 23%) increase in mortality rate Dockery et al, NEJM 1993;329:1753
  32. 32. Six Cities Adult Mortality 1.4 EPA NAAQS 1.3 Steubenville Kingston Mortality Risk Ratio 1.2 St. Louis 1.1 Topeka Watertown 1.0 Portage 0.9 0.8 0.7 0 10 20 30 40 PM 2.5 ( g/m3)
  33. 33. Six Cities Mortality Follow-up 1974 to 1989 follow-up  1990 to 1998 follow-up  Annual returned  National Death Index postcards and search National Death Index  1,368 deaths  1,364 deaths  54,735 person  104,243 person years years  PM2.5 measurements  PM2.5 estimated from 1979-1986 PM10 1990-1998Laden et al, AJRCCM 2006;54:709
  34. 34. Six Cities Cohort Follow-up 1.4 1.3 Steubenville Mortality Risk Ratio 1.2 Kingston 1.1 Topeka 1.0 Portage 0.9 St. Louis Watertown Improved air quality 0.8 leads to reduced mortality 0.7 0 5 10 15 20 25 30 35 PM 2.5 (g/m3)Laden et al, AJRCCM 2006;54:709
  35. 35. Can we see effect of airpollution controls in US?
  36. 36. Age-adjusted death rates: United States, 1960-2005 1,400Rate per 100,000 population 1,200 Age-adjusted 1,000 800 600 0 1960 1970 1980 1990 2000 2005
  37. 37. Trends in the Levels of the Six Criteria PollutantsRelative to U.S. National Standards: 1980 - 2006
  38. 38. Estimated PM10
  39. 39. County life expectancies at birth for white malesand females;1997–2001 CJL Murray et al, Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med. 2006 Sep;3(9):e260
  40. 40. Cigarette Smoking – United StatesSOURCES: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey
  41. 41. Fine Particulate Air Pollution andUS County Life ExpectanciesPope, Ezzati, Dockery (NEJM 2009) Standardized life expectancy for each US County by year 51 U.S. metropolitan areas (217 counties)  PM2.5 data for ~1980 and ~2000 Estimated association between reductions PM2.5 and change in life expectancy, controlling for  changes in socio-economic indicators  changes in demographic variables  proxy indicators of cigarette smoking (COPD and Lung Cancer mortality).
  42. 42. 51 Metropolitan areas (dots); Study Counties (shaded gray)
  43. 43. Life Expectancy vs PM2.51978-82 81 80 EPA NAAQS 79 78Life Expectancy 77 Boston 76 75 Topeka 74 73 72 Steubenville 71 5 10 15 20 25 30 35 PM2.5 (g/m3) Pope, Ezzati, Dockery. NEJM 2009; 360:376
  44. 44. Life Expectancy vs PM2.51997-2001 EPA NAAQS 81 Boston 80 79 78Life Expectancy Steubenville 77 76 75 74 Topeka 73 72 71 5 10 15 20 25 30 35 PM 2.5 ( g/m3) Pope, Ezzati, Dockery. NEJM 2009; 360:376
  45. 45. Life Expectancy vs PM2.51980-2000 81 80 79 78Life Expectancy 77 76 Topeka 75 74 73 72 71 5 10 15 20 25 30 3 PM2.5 (g/m ) Pope, Ezzati, Dockery. NEJM 2009; 360:376
  46. 46. Life Expectancy vs PM2.51980-2000 81 0.61 ± 0.20 yr per 80 10g/m3 PM2.5 79 78Life Expectancy 77 76 75 74 73 72 71 5 10 15 20 25 30 3 PM 2.5 (g/m ) Pope, Ezzati, Dockery (NEJM 2009)
  47. 47. Life Expectancy vs PM2.51980-2000 81 80 79 78Life Expectancy 77 76 75 74 73 2000 Boston 1980 72 3 11.3 g/m 3 18.1 g/m 71 5 10 15 20 25 30 PM 2.5 ( g/m ) 3 Pope, Ezzati, Dockery (NEJM 2009)
  48. 48. PM2.5 obligations set out inCAFE Directive 2008/50/EC Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
  49. 49. Life Expectancy vs PM2.51980-2000 81 EPA NAAQS CAFE CAFE 80 Stage II Stage I Limit Limit 79 Value Value 78Life Expectancy 77 76 75 74 73 72 Health benefits below current NAAQS 71 5 10 15 20 25 30 PM 2.5 ( g/m ) 3 Pope, Ezzati, Dockery (NEJM 2009)
  50. 50. Summary statistics for PM2.5concentrations in 2010 DUBLIN CORK ENNIS Annual mean limit value 25 μg/m3. Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
  51. 51. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  52. 52. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  53. 53. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  54. 54. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  55. 55. How big is 0.5 year increase in lifeexpectancy? 65 year old nonsmoking male  Additional life expectancy 17.5 years  Additional 0.5 years life expectancy  18.0 years
  56. 56. How big is 0.5 year increase in lifeexpectancy in population of Ireland? Tobacco Smoking  6.8 years reduced life expectancy for average smoker (Streppel et al, Tob Cont 2007)  31% Current Smoking in Ireland(2009) (Special Eurobarometer 332)  6.8 yr among 31% of population  2.1 yr longer life expectancy in population Diabetes  7.8 years for men, 8.4 years for women (Fromer et al, Arch Int Med 2007)  4.7% Diabetes Mielitus in Ireland (2005) (Institute of Public Health in Ireland, 2006.)  8 yr among 4.7% of population  0.4 yr longer life expectancy in population Fine particle air pollution  0.5 years for 2 g/m3 reduction in PM2.5  100% of population affected  0.5 yr longer life expectancy in population
  57. 57. Conclusions PM2.5 associated significant health effects  Life shortening (mortality) Improved air quality leads to measurably improved public health Benefits at all levels of air pollution  Even in clean communities
  58. 58. Current U.S. Values for Health Effects Premature death $5.5 million Chronic bronchitis $340,000 Heart attacks $66,000 - $140,000 Hospital admissions $6,000 - $18,000 ER visits $300 Respiratory symptoms $15 - $60 Asthma attacks $40 Work loss days $100 School absences $75
  59. 59. Counties with PM2.5 Monitoring 2000 and 2007Pop Density (Ppl/mi2) Correia, Pope, Ezzati, Dockery, Dominici
  60. 60. Life Expectancy vs PM2.52000 (545 Counties) 84 EPA NAAQS 82 80Life Expectancy 78 Mean 76 76.7 years 74 72 70 Mean 13.2 g/m3 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  61. 61. Life Expectancy vs PM2.52007 (545 Counties) 84 EPA NAAQS 82 80Life Expectancy 78 Mean 77.5 years 76 74 72 70 Mean 11.6 g/m3 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  62. 62. Life Expectancy vs PM2.52000- 2007 (545 Counties) 84 EPA NAAQS 82 80Life Expectancy 78 76 74 72 70 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  63. 63. Life Expectancy vs PM2.52000 - 2007 (545 Counties) 84 EPA NAAQS 0.35 ± 0.16 yr per 82 10g/m3 PM2.5 80Life Expectancy 78 76 74 72 70 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  64. 64. Summary statistics for black smokeconcentration April 2009-March 2010 DUBLIN Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality

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