This document summarizes a presentation about a project called the Air Pollution and Health Impacts Project (APHIP). The project aims to develop evidence-based messages to encourage healthier transportation choices and reduce air pollution. It will review evidence on health effects of air pollution and strategies for changing transportation behavior. The research approach involves assessing published evidence on air pollution health impacts and behavioral change strategies using a conceptual model to identify factors influencing transportation choices and air pollution levels. The presentation outlines the rationale, questions, and intended outcomes of the APHIP project.

1. STEP Conference 2014 – Cleaner Air, Healthier Places Developing evidence-based messages on air pollution and health 18th November 2014 Dr. Colin N. Ramsay Consultant Epidemiologist Health Protection Scotland

2. Presentation Aims To outline the rationale for the Scottish Government / SEPA / SUAQ Programme project on Air Pollution and Health Impacts (APHIP)
•Air Pollution and Health in Scotland – the issues behind the project.
•Why do we need this particular project – the questions the project aims to address.
•How do we plan to address the questions.
•What do we hope to achieve – the intended outcomes.
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Air Pollution Today – Global Phenomenon
Nasa satellite image reveals the extent of China's air pollution

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Air Pollution in Scotland / Glasgow

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•Death risk increased even with low exposure.
•The greatest health threat was from long-term exposure to fine-particle air pollution with a diameter of less than 2.5 micrometers (PM2.5).
•It was found that for every increase of 5 μg/m3 in annual exposure to PM2.5, the risk of dying from natural causes increases by 7%. "Our findings show that long-term exposure to fine particulate air pollution is associated with natural-cause mortality, even at concentration ranges well below the present European annual mean limit value.”
Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants.

7. Project Title: Air Pollution and Health Impacts Project (APHIP) Project Aim:
•To develop an evidence-based set of key messages on air pollution and health impacts focused on encouraging people to adopt healthier and less polluting transport options. Funding:
•By Scottish Government Environment Directorate and SEPA – Scottish Environment on the web (SEWEB) project via Scottish Urban Air Quality Steering Group as part of Research Programme.
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8. The Issue - Air Pollution and Health Impacts in Scotland Current consensus of views on air pollution and health
•Air pollution is not good for human health.
•Multiple sources of air pollution; natural and man made (anthropogenic).
•Anthropogenic air pollution should be controllable, ideally preventable.
•Transport (road traffic) sourced pollution (particulates, NOx, ozone) is a major contributor to anthropogenic air pollution and health impacts.
•Changing the pattern of road transport use could reduce air pollution, especially in urban areas.
•People need to be “encouraged” to change their travel habits and choice of transport: need “key messages”.
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9. The Questions (1) If we want to persuade people to change their behaviour, we have to have a sound evidence-base. - Are we sure the current consensus view is correct?
•What are the current trends in road transport use in Scotland?
•How bad is (traffic related) air pollution in Scotland?
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Figure 1: Vehicles licensed - See more at: http://www.transportscotland.gov.uk/statistics/j285663-03.htm#sthash.zD0SiI6j.dpuf
Figure 1: Vehicles licensed
Figure 2: New registrations of vehicles
Figure 3: Traffic (vehicle kilometres)
Figure 4: Reported road casualties
Current Trends in Road Transport Use in Scotland (Transport Scotland)

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Overview of travel in Scotland
2007-08
2012-13
Change
Car Traffic (m/veh km) on all roads
34,545
33,777
-2%
Pedal Cycles (m/veh km) on all roads
240
310
29%
ScotRail Passengers (millions)
74.5
83.3
12%
Bus Passengers (millions)
488
423
-13%
Air Passengers (millions)
25,132
22,207
-12%
Ferry Passengers (millions)
10.7
9.7
-9%
Source: STS 2013
Transport Scotland Statistics

12. Trends in PM2.5 in Scotland (de-seasonalised) 2007 - 2013
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HPS Air Quality (PM2.5 particulate air pollution) and Mortality in Scotland - Briefing Document: http://www.hps.scot.nhs.uk/enviro/spotlightdetail.aspx?id=629

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Trends in NO2 in Scotland “Air pollution: the mass killer that keeps on killing” Sunday Herald New Era magazine, 19 May 2013
“By far the highest pollution was found on the Glasgow subway”
Maps based on monitoring for nitrogen dioxide, analysed by Friends of the Earth Scotland.

14. The Questions (2) Assuming the evidence supports the consensus view How do we create “Cleaner Air, Healthier Places”? - What questions is this project trying to answer?
•What are the health impacts of anthropogenic (traffic related) air pollution generally and in Scotland particularly?
•How do we effectively encourage people to change their travel habits and choice of transport?
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15. COMEAP – Mortality Effects on Long Term Exposure to Particulate Air Pollution in the UK (2010)
•Review of evidence of health impacts / mortality burden associated with man made (anthropogenic) particulate air pollution (based on 2008 UK air pollutant data).
•Effect of anthropogenic particulate pollutant was equivalent to 29,000 deaths in UK at typical ages; equivalent to loss of 340,000 life years (allowing for variation in age at time of death).
•Measures are averages / aggregates across the population.
–not known how effects distributed among individuals.
•“As everyone dies eventually, no lives are ever saved by reducing environmental exposures – deaths are delayed resulting in increased life expectancy”.
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16. Estimates of Mortality Associated with Fine Particulate Air Pollution by Local Authority, in Scotland
Area
Population
Age 25+
Deaths
Age 25+
Mean
Anthropogenic
PM2.5 (μg m-3)
Attributable
Fraction
(%)
(1)
Attributable
Deaths
Age 25+
(2)
Associated
Life Years Lost
(3)
UK
42788600
557828
9.4
5.3
28969
306835
England
35878000
458743
9.9
5.6
25002
264749
Scotland
3660533
53800
6.8
3.9
2094
22474
Wales
2075433
31041
7.5
4.3
1320
13549
Northern
Ireland
1174633
14243
6.6
3.8
553
6063
Footnotes Table
1.Attributable fraction: the proportion of deaths estimated as due to long-term exposure to anthropogenic particulate air pollution.
2.Attributable deaths: long-term exposure to anthropogenic particulate air pollution is estimated to have an effect on mortality risks equivalent to the number of attributable deaths. Air pollution is likely to contribute a small amount to the deaths of a larger number of exposed individuals rather than being solely responsible for the number of deaths equivalent to the calculated figure of attributable deaths.
3.Associated life-years lost: the years of life lost to the population due to increased mortality risk attributable to long-term exposure to particulate air pollution.
Table 1: Baseline population, modelled population-weighted mean concentrations (μg m-³) and estimated effects on annual mortality in 2010 of anthropogenic PM2.5 air pollution.
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Estimates of Mortality Associated with Fine Particulate Air Pollution by Local Authority, in Scotland (cont:)
Scotland Council Area
Population
Age 25+
Deaths
Age 25+
Mean
Anthropogenic
PM2.5 (μg m-3)
Attributable
Fraction
(%)
(1)
Attributable
Deaths
Age 25+
(2)
Associated
Life Years Lost
(3)
Aberdeen City
150600
2049
7.4
4.2
86
936
Aberdeenshire
172300
2198
5.6
3.2
70
749
Dumfries & Galloway
109067
1790
5.8
3.3
60
597
Dundee City
97900
1677
7.3
4.1
69
774
Edinburgh, City of
339533
4169
8.6
4.9
205
2269
Eilean Siar
19400
349
4.2
2.4
8
85
Fife
253733
3770
6.8
3.9
146
1569
Glasgow, City of
408333
6508
8.3
4.7
306
3333
Highland
160167
2296
4.3
2.5
57
641
Table 2: Baseline population, modelled population-weighted mean concentrations (μg m‾³) and estimated effects on annual mortality in 2010 of anthropogenic PM2.5 air pollution.

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APHEKOM

19. The Research Approach How do we plan to address the research questions?
•Adopt “Good Place Better Health” (GPBH) model (Scottish Government).
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“Historically we have focused on creating environments free from significant hazards. Whilst this continues to be important we now recognise an additional need to create positive physical environments which nurture health and wellbeing.”
Good Places, Better Health Implementation Plan 2008

20. Good Places Better Health Method - Project Three components:
•A review of published evidence on health impacts of air pollution.
•A review of published evidence on strategies and methods of changing people’s behaviour on transport choices.
•A review of key factors and influences that create the current patterns of air pollution and determine people’s choice of transport: - using modified DPSEEA conceptual model to frame and map issues
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21. Research Evidence on Air Pollution and Health Impacts Journal publications 2012 / 2013:
• Occupational and Environmental Medicine: 85 papers
• Lancet: 102 papers
• Epidemiology: 138 papers
•Research findings sometimes inconsistent / contradictory.
•Study locations / populations are heterogeneous, hence may not be representative of experience in UK / Scotland.
•Reliance on systematic reviews of evidence to determine the most robust estimates of health effects.
•Reliance on expert groups (e.g. COMEAP) and consensus statements for conclusions on impacts of air pollution, for use in policy formulation and to guide public health action.
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22. EU / WHO Initiatives Review of Evidence on Health Aspects of Air Pollution (REVIHAAP) (2013) Provides additional support for effects of PM10 and PM2.5 on short and long term exposures on mortality and morbidity.
•Long term exposure to PM2.5 is a cause of cardiovascular morbidity and mortality.
•Evidence of association between PM2.5 and atherosclerosis, adverse birth outcomes, childhood respiratory disease (asthma).
•Emerging evidence of association between long term PM2.5 exposure and neurodevelopmental / cognitive function (dementia) and chronic metabolic conditions e.g. diabetes.
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23. Review of Evidence on Efforts to Change People’s Transport Choices

24. POLICY and ACTION
Modified DPSEEA Process
Upstream factors
Downstream factors
Good Places Better Health Methodology
Modifiers

25. mDPEESA Conceptual Model – Upstream Factors Drivers Pressures Environmental State Driver - Transport policy to date:
•Geared to efficient movement of people and goods;
•Bur recognition that transport systems have significant impacts on quality of life and health. Driver - Transport in future:
•Should be aimed at protecting and promoting good health minimising CO2 production as well as providing effective means of moving people and goods.
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•N.B. The law of unintended consequences e.g. use of diesel engines in cars; CO2 but NOx
•Hence S.Gov. Low Emission Strategy (LES).

26. mDPSEEA Modelling Final Stage: Identify Actions
Low Emission Strategy
Upstream Interventions
Downstream Interventions

27. By-products:
•Review of evidence on air pollution and health impacts with key messages based on best evidence.
•Review of evidence on influencing and modifying behaviour linked to reducing air pollution associated with transport use, with key messages on what works in practice, in behaviour modification.
•mDPSEEA map of relationships between upstream and downstream factors that influence the current environmental state of road traffic related air pollution. Main Output:
•Formulate key messages aimed at the public, policy makers (and potentially politicians) based on research evidence-base and mDPSEEA map.
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Intended Project Outputs and Outcomes