The health and environmental issues of increased road traffic and climate change


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Dr George Crisp, WA Chair, Doctors for the Environment Australia (DEA) delivered this presentation at the 2012 WA Transport Infrastructure Summit in Perth. For more information on the upcoming event, please visit

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The health and environmental issues of increased road traffic and climate change

  1. 1. Health and Environmental Impactsof Increased Road Traffic andClimate ChangeDr. George Crisp
  2. 2. Doctors for the Environment, Australia (DEA) is a voluntary, doctor’sorganisation, formed in 2001, with members in all States and Territories. Theaim of the organisation is to inform and educate the public, the medicalprofession and policy makers about the relationships between health and theenvironment. Our priority issue at the present time is the health effects ofclimate change. DEA is a member of the International Society of Doctors forthe Environment.Scientific committee:Prof. Stephen Boyden AMProf. Peter Doherty ACProf. Bob Douglas AOProf. Frank Fenner ACProf. Michael Kidd AMProf. Steve Leeder AOProf. Ian Lowe AOProf. Tony Mc MichaelProf. Peter NewmanSir Gustav Nossal ACProf. Hugh PossinghamProf. Lawrie Powell ACProf. Fiona Stanley ACNorman SwanProf. David Yencken AO
  3. 3. What is Air Pollution ?Air Pollution: consists of introducedchemicals, biological or particulate matterinto the atmosphere that cause harm oradversely effect human health or other livingorganisms or damage the natural or builtenvironment.
  4. 4. Ambient Air pollution estimated to causeover 800,000 deaths each year worldwideSource: WHO, 2006
  5. 5. Historical perspective
  6. 6. Air Pollutants• Primary• Particulate Matter ( PM10, PM2.5, PM1 )• NOx• SO2• CO• Pb• Air toxics ( VOCs , PAH, Heavy metals )• Secondary• Ozone ( photochemical smog )• Particulates (gaseous pollutants forming aerosols)
  7. 7. Air Pollutants and health Long Term effects - greatly outweigh acuteeffects Range of disease – eg cardiovascular disease Particulate pollution - >80% of effects No threshold – no safe lower limit / vulnerablegroups
  8. 8. Particle depositionPM <1PM 2.5PM 10
  9. 9. Health Effects of ParticulatesRespiratory: Asthma / COPD, Pneumonia, Lung CancerCardiovascular: Coronary Heart Disease, Arrhythmias.Strokes.Paediatric: SIDS, infant mortality, lung development andinfections.Obstetric: Preterm labour, Low birth weight.Endocrinology: Diabetes ?.Psychiatric: Depression ?, Suicide ?
  10. 10. Mortality – long term exposureFor every 10 µg/m³ increase in fine particulate (PM₂.₅)exposure, there was an associate increased risk of:– 6% All cause mortality1 ( > 10% )– 12% Cardiopulmonary mortality2– 76% Cardiovascular mortality in WHI study3– 14% Lung cancer mortality41 Chen, Goldberg. Effects of outdoor pollution on chronic illness. McGill J Med 20092 American Cancer Study. (Pope et al. JAMA, 287:1132-1141. 2002);3 Long-term exposure to air pollution cardiovascular disease in women. N Engl J Med 20074 Pope et al. Circulation, 109:71 -77 2004
  11. 11. Living near Major Roads Proximity to roads -  Exposure 50% increased allergy risk1 Asthma – < 50m  56% increase– causes 15% of childhood asthma cases 2 Lung Cancer, Cardiovascular Disease3, Strokes4 .. Inside cars !!Source:1 Heinrich American Journal Resp Med and Critical Care – 20082 EU Aphekom Project3 US Health Effects Institute - 20104 Ambient Air Pollution Progression of Atherosclerosis in Adults. Kunzli- 2010
  12. 12. Diesel Promoted on reduced GHG emissions Sulphur > 20x the particulate emissions of petrol engine Ultrafine particles (PM1) < 1 µm ( Nanoparticles)A diesel 4WD car → > $1000 /yr in health costs
  13. 13. Conclusion:
  14. 14. ProgessProblems
  15. 15. PClimate Change in Australia• Rise in land temperatures• More hot days – associated risk of bushfires• More variable rainfall• More extreme weather with storms, floods anddroughts21
  16. 16. CC-Related Health Impacts in AustraliaAlready apparent (events amplified by climate change):Uptrend in annual no. of heat-days: deaths, hospitalisationsIncrease in no./severity bushfires: injury, death, resp. hazard, mental healthLikely, current:Contribution to rise in microbial food-poisoning (diarrhoeal diseases)Increased mental health impacts in (warmer, drier) parts of rural AustraliaPredicted health impacts, future:Extreme weather events: injuries, deaths, inf. disease outbreaks, depressionWater shortages: local food yields, rural wellbeing, hygieneMosquito-borne infectious diseases: Ross River, dengue fever, chikungunya,Japanese encephalitis (?), malaria (??)Heat-stressed livestock: zoonotic risksOutdoor workers: physiological threshold, behaviour, productivity. earningsStressed/displaced groups – tensions, conflicts, mental health, etc.-- Rural communities/families-- Remote indigenous communities-- Regional ‘climate refugees’
  17. 17.  Health impacts and risks are not merely‘collateral damage’ – they are our strongestsignal that CC is serious
  18. 18. Links: Climate Change and Air QualitySynergy between high temp.s and adverse effects of pollutants: Ozone SO2 PMBushfires increase.• VOCs• PMOzone formation – photochemical reactionOzone is a powerful tropospheric greenhouse gas.
  19. 19. Cost and benefitsCAFE (Europe)20% emissions reduction = €13- 52 Billion ( by 2020 )30% = €20 -76 billion+ 105,000 reduction in life years lost+ 2,800 less hospital admissionsCOMEAP ( UK 2009 ): 29,000 deaths / yr0.4 -3.5 % GDP ( UK 2012 )Reducing PM2.5 by 1μg/m3 adds 20 days to life expectancy
  20. 20. Costs: Australia AUS ~ 2.3 % of all deaths1 ( ~ 3000 /yr ) NSW: $ 4.7 billion, 640 -1400 d/yr in 2003 (GSMR2005)Motor Vehicle related air pollution: $30.4 billion, of which $17.2 b – PM10 (Beer 2002), $2.7 billion, 700- 2000 deaths (BTRE 2005 )Source: 1NSW Dept of
  21. 21. Key messages– Air Pollution and Climate Change aremajor public health problems.– Air Pollution is likely to worsen withClimate change.– The human health costs are colossal– Other health co-benefits of action : roadtrauma, physical activity, social …– Effective policy should capture full costs.
  22. 22. Thank you
  23. 23.  MVA – A$ 17.8 billion, >1,400 deaths pa. Globally 1.2 million. 50 million injuries. Inactivity: A$ 13.8 billion, 13,000 deaths pa. Obesity / overweight: A$21 billion
  24. 24. PWe’re releasing 350million years ofstored CO2 VERY quickly150 years 100 years 50 years NOWFirst OilWell4142 cars,10 milesconcreteroad in US240,000,000 homePCs650,000,000 cars4,800,000,000passenger flights4,000,000,000 bulbspa EU+USA alone(that’s 126 a second)Firstcommercialjet ticketFirst homePCDomesticlight bulb37
  25. 25. Health Impacts of Climate Change“ Climate Change is the biggest globalhealth threat of the 21st Century ”Lancet, 2009
  26. 26. Climate Science 101 The accumulation of greenhouse gases in the atmosphereeffectively increases the trapping of heat from the sun, hence arise in the Earth’s surface temperature. Greenhouse gases include CO2, water vapour, methane andnitrous oxide The increase in temperature is proportional to theconcentration of greenhouse gases in the atmosphere CO2 concentration has increased from: Pre-industrial- 280ppm 1958- 316ppm 2012- 400ppm Average global temperature rise so far 0.76 deg C
  27. 27. Global Carbon Emissions:
  28. 28. The Earth is Warming
  29. 29. Overview: Ambient Air Pollution Health impacts of: Local / regional Air Pollution Climate Change Costs of pollution Co-Benefits of Emissions reduction
  31. 31. Sea Level Rise
  32. 32. P46
  33. 33. CO2 increase over timeIPCC 1990
  34. 34. Source: McMichael 2012
  35. 35. Climate Change: Health Impact PathwaysPhysicalsystems(river flows, soilmoisture, ocean temp)Biologicalcycles, innature … &Ecologicallinks/functionEconomicimpacts: infrastructure,farm and factory production,GDP growth, jobsHuman Health:• Injuries/deaths• Thermal stressIndirecthealthimpacts –ecologicallymediatedIndirecthealthimpacts– sociallymediatedDirect impacts(extreme weatherevents, heatwaves,air pollutants, etc.)• Infectious diseases• Under-nutrition• Mental stresses• Other disordersClimateChangeImpacts
  36. 36. Outline of Central ArgumentPopulation Health is At Risk... and that’s a Profound ‘Alarm Bell’ Human-driven climate change (CC) is happening Physical, biological, social systems are being affected… and that affects food yields, water flows, infectious agents,physical safety, social stability Those impacts then affect human health/survival* Health risks are not mere ‘collateral damage’ – they are ourstrongest signal that CC is serious So: mitigate CC urgently; and, meanwhile, adapt wisely* Many examples are now emerging worldwide: Trends in heatwaveimpacts, increases in weather disasters, extensions of some infectiousdiseases, apparent regional impacts on food yields (e.g. Africa),coastal/island communities’ anxieties and displacement (mental health)
  37. 37. Health effects of climate change Extreme events and consequences Changing patterns of disease Water and food insecurity Vulnerable shelter and human settlements Economic Population migration and conflict These effects are both direct and indirect
  38. 38. Extreme climate events Floods Related infectious diseases ie. cholera, dengue, malaria,leptospirosis increased after hurricane in Nicuragua in 1998 Reduction in water quality and sanitation Loss of property, farmlands, direct loss of life Psychological trauma Cyclones and hurricanes Direct loss of life, property, farmlands Reduction in water quality and sanitation Psychological trauma Bushfires Direct loss of life, property, farmlands Psychological trauma Heatwaves
  39. 39. Source: Nature, 17 Feb 2011
  40. 40. Max daily temp, 2008-09Dec 1 Feb 1Date2008/092007/0845 oCExtreme Heat-Wave, Jan/Feb 2009:Total Emergency Cases, by Ambulance, in Melbourne,Australia, during Dec-Feb, 2007-2009Modified from: Vic. Dept Human Services, 2009
  41. 41. Current impacts at 0.76 deg riseCurrent impacts at 0.76 deg rise Victoria: Hottest day ever recorded 7th Feb. 2009 Driest start to year for 150years 2009 Fire danger rating for Victoria on 7th Feb. 2009ranged between 120-190 (previous record wasBlack Saturday in 1939 of 100) where100=catastrophic rating 374 deaths from heat stress in first week of Feb.David Karoly. 16/2/09January 2009 heatwave in Victoria report-Chief Health Officer, Victoria.
  42. 42. Statistical distribution ofsummer temps: 2003(N. Switzerland). Consequences:- - Deaths (EU) : 70,000(Lancet 2009) - Agriculture -$12.3B - Wildfires 1.2 m acres - Nuclear powershutdowns - Hydro reduced - Apline glacial 10%loss
  43. 43. Climate and Air Pollution Airborne pollution - Photochemical smog Urban heat island Bushfires Maladaptive response Aeroallergens - Temperature / humidity Early spring - Longer season Changing flora
  44. 44. Changing patterns of diseaseVector borne diseaseincreases withtemperaturetemperature is  vectorreproduction; parasitedevelopment and bitefrequencyincrease in malaria, tick-borne encephalitis anddengue feverPathogen multiplication /survivalIntermediate / host species– health, range,population.Mosquito abundance increasesby a factor of 10 for every 0.1deg C increase in temperature
  45. 45. NCEPH/CSIRO/BoM/UnivOtago, 2003DENGUE FEVER: Estimated geographic region suitable* fortransmission: Climate scenarios, 20502050 risk region: Medium GHGemissions scenarioDarwinKatherineCairnsMackayRockhamptonTownsvillePort HedlandBroome........Carnarvon.DarwinKatherineCairnsMackayRockhamptonTownsvillePort HedlandBroome..Brisbane.......Current risk region, fordengue transmission DarwinKatherineCairnsMackayRockhamptonTownsvillePort HedlandBroome........Carnarvon. 2050 risk region: HighGHGemissions scenarioBrisbaneBrisbane* Global statistical model (Hales),applied to Australia: Function ofrainfall and water vapour pressure.
  46. 46. UK DH 2007
  47. 47. Water and food insecurityFood shortage - Famine:Climate change is likely to compound existing foodinsecurityFood emergencies have increased from 15/yearin 80’s to >30/year : UN World Food ProgramCorn and soybean yields in USA reduced by 17%for every 1 deg C temp riseDrought:1/6 world population live in glacial fed watercatchments which are vulnerable to climatechangeincreased water temp and reduced water flow leadto reduced water qualityLancet, 2009
  48. 48. 2 degree temperature riseUp to 20% of species may become extinct3 degree temperature riseUp to 1/3 of species may become extinctSource: IPCC 2007Climate Change – Threatto Biodiversity
  49. 49. • provides us with food• regulates pests anddiseases• modifies local climate,• detoxifies air and water• protects us from floods,avalanches and tsunamis• degrades waste, recyclesnutrients,• source of current andfuture drugs.• fulfills spiritual andaesthetic needsLoss of biodiversity is a serious and unquantifiedthreat to human life !Biodiversity and Health
  50. 50. Urban Heat Island effect
  51. 51. Particulate Matter Defined by particle Size Composition Both parameters are related to the source anddetermine their potential for harm. Cause >80% of air pollution health impacts.
  52. 52. For every 10 μg/m³ increase in PM₁₀:~ 1.2 asthma consultations / 1000 children~ 0.5 asthma consultations / 1000 adults~ 4% increase in ED admissions (Brisbane2006)> 1/3 of asthma attacks in USA result of airpollutionAsthma
  53. 53. List of priority hazardous air pollutants (Commonwealth SOE 2001)Air pollutantScoreHealth effectsBenzene 9 Carcinogenic, causes anaemia1,3-Butadiene 8 CarcinogenPolycyclic aromatichydrocarbons (PAH)8 Carcinogen, environmentally persistentArsenic and compounds 8 Carcinogen, environmentally persistentChromium and compounds 8Carcinogen, affects respiratory system, inhalation can damage nose, throat, lungs, stomach and intestines,environmentally persistent. May lead to asthma, other allergic reactions, stomach upsets, ulcers, convulsions and kidneydamageNickel and compounds 8 Carcinogen, can affect the respiratory system, environmentally persistentCadmium andcompoundsA 7Carcinogen linked to prostate and kidney cancer in humans and also to lung and testicular cancer in animals. Smoke fromburning cadmium or cadmium oxide can, in severe cases, affect respiratory system, environmentally persistentDioxins and furans 7 Carcinogen, skin disease, environmentally persistent and bioaccumulatesMercury 7 Can cause reproductive problems, environmentally persistent, bioaccumulatesDichloromethane 5Probable carcinogen, moderately persistent in the environment. High concentrations may cause unconsciousness anddeath. Exposure may irritate lungs, cause pulmonary oedema and irregularheartbeat. Long-term exposures at high level may damage the liver and brainFormaldehyde 5 Carcinogen, irritates the skin, eye and respiratory system, and can exacerbate asthmaStyrene 5 Possible carcinogen1,4-Dichlorobenzene 3 Probable carcinogen, moderately persistent in the environmentTetrachloroethylene 3 Probable carcinogenManganese compounds 3 Can affect brain function, moderately persistent in the environmentA higher score indicates a more seriousconcern.Source: EPAV (1999c).
  54. 54. Emission Reduction Benefits - USABenefits of Clean Act 1990 – ( US EPA 2011 ),By 2010: … 160,000 early deaths, ( 230 infants )1.7 million asthma attacks,130,000 heart attacks ( non fatal )13 million lost working days.By 2020: ….. prevent ~ 230,000 early deaths / yearSaving ~ $ 2 trillion / yearReturn on investment ( mid range ) …. 30 : 1
  55. 55. Air pollution - Costs- EU 167,000 d/yr (CAFE study)- UK 180001 - 29,0002 d/yr, (~ 60% Traffic1)Health costs ~ 0.4 – 3.5% GDP1- AUS ~ 2.3 % of all deaths3 ( ~ 3000 /yr )$30.4 billion, of which $17.2 b – PM10 ( Beer 2002 ),$2.7 billion (in 2000), 700 - 2000 deaths ( BTRE 2005 )- NSW: $ 4.7 billion, 640 -1400 d/yr in 2003 (GSMR 2005)Source: 1 Yim et al, Pub Health Impacts of Combustion Emissions UK 20122 COMEAP 2009 3 NSW Dept of
  56. 56. Total Annual Economic Costs of Motor Traffic Air Pollution (AUD$m)(Bureau of Transport and Regional Economics 2003)Capital Cities Mortality MorbidityBase case Lower Upper Base case Lower UpperSydney 713 441 990 785 782 788Melbourne 448 276 621 466 465 468Brisbane 197 122 273 223 222 223Adelaide 113 70 156 109 109 110Perth 104 64 144 110 110 111Hobart 8 5 11 7 7 7Darwin 5 3 7 10 10 10Canberra 8 5 12 0 0 0All capital cities 1596 986 2214 1712 1705 1718
  57. 57. Transport, Energy and HealthSource: Energy and Transport. Woodcock et al.Lancet. Sept 2007
  58. 58. Why is Air Pollution an issue?– Affects large numbers of people.– Exposure is Involuntary.– Air pollution is likely to worsen with Climatechange.– Also affects the health of flora and fauna.– The human health costs are colossal– …. a largely uncosted Externality.– Other health co-benefits of action : road trauma,physical activity, Urban Heat Island.
  59. 59. Health Effects PyramidSource: AIRNET – EU Network on Air Pollution and Health WG4 ( 2004 )
  60. 60. Key Messages Adverse health effects from climate change, air pollution,MVAs, physical inactivity, energy insecurity andenvironmental degradation, are all linked by theircommon antecedent fossil fuel energy use in transport Full costs of pollution and co-benefits of action are notyet being recognised or factored in to decision making,and planning. Policies that encourage transition to a low carbon energytransportation system could have significant publichealth, as well as economic benefitsBased on “Energy and Transport” Woodcock et alLancet 2007
  61. 61. Conclusions Adverse health effects from climate change, air pollution,MVAs, physical inactivity, energy insecurity andenvironmental degradation, are all linked by theircommon antecedent fossil fuel energy use in transport. Effective policy should incorporate and understand thesynergies between climate change and air pollution andresulting health impacts. As it can have significant,immediate and cumulative public health, as well aseconomic benefits.Ref: “Energy and Transport” Woodcock et al Lancet 2007,“NSW Pub Health Bulletin” Dennekamp, Carey 2010