Air Pollution and Health in Developing Asia - China Specific Impacts from the Global Burden of Disease
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Air Pollution and Health in Developing Asia
China Specific Impacts from the Global Burden of
Disease
A dialogue on air science and policies in China and Hong Kong
Robert O’Keefe
Vice President, Health Effects Institute
Chair Clean Air Asia
Hong Kong
Public Health Impact can be a major
driver of decisions
• It demonstrates that air pollution is an important
factor affecting people, nations
• Provides health-based rationale for air quality and
source standards worldwide
• Provides the health basis for assessing costs & benefits
• Standards, in turn, drive technology decisions with air
and climate implications
• Cleaner vehicles & alternate transport
• Less coal-fired electricity, efficiency, alternate fuels
Most Chinese Cities Substantially Exceed WHO,
Chinese Air Quality Guidelines
160
2009 Annual Mean PM10 Levels in Chinese Cities
140
China Standard: 100µg/m3
120
Annual Mean PM10 Levels (µg/m3 )
100
80
60
WHO Guideline: 20 µg/m3
40
20
0
Source: WHO 2011
Estim ated population-w eighted am bient air pollution
levels - PM 2.5 -increased w orldw ide and in China 1990-
2010
50% increase in
1990 → 2010: population-weighted
10% increase in global
population-weighted PM2.5
PM2.5
The Global Burden of Disease (GBD)
• A systematic scientific effort to quantify the magnitude of health
loss from disease and injuries in 187 countries around the world
from 1990 to 2010
• E.g. cardiovascular disease, respiratory disease, HIV-AIDS, cancer road
traffic injuries and
• Risks associated with conditions linked with those diseases
• E.g. smoking, diet, high blood pressure, air pollution, overweight
• Measured as “Disability Adjusted Life Years (DALYs) and Mortality”
• Last completed with WHO for Year 2000
• Newest version, funded by Gates Foundation, was published in
December, 2012
• HEI leadership for outdoor air pollution analysis
Published in
Special Triple
Issue of The
Lancet
December 2012
GBD 2010 Team
488 authors from 303 institutions in 50 countries.
7
The Evidence: What are the GBD estimates based on?
Particulate Matter (PM) • High levels of PM (> 500 µg/m3) known to cause premature death • e.g. London 1952 • Thousands of studies in US, Europe, elsewhere have found association of PM with mortality at much lower levels (
Chinese PM10 Evidence from the
PAPA Multi-City, Coordinated Studies
HEI Research Report 154, November 2010
•Conducted in partnership with principal
investigators Dr. Kan Haidong (Fudan),;
Dr. CM Wong (University of Hong
Kong), among others
•Consistent small increase in risk with
daily increase in PM10
•Communication 13, available at
www.healtheffects.org/publications
Excess risk (%) of mortality for a 10mg/m3 increase in
average concentration of pollutants (lag 0-1 days)Asia in a Global Context
(PM10 and Daily Mortality)
The effects of pollution are more similar than different …
…and global science can be broadly relevantAsia in a Global Context:
Recent China results on long term effects of air pollution are
consistent with the results of the Global Burden of Disease
GBD risk
functions
China results:
Cao et al.
2011The GBD 2010 Results for Air Pollution
Previous Global Burden of Disease in
2000
Mortality attributable to leading risk factors
High blood pressure
Tobacco
High cholesterol
Underweight
Unsafe sex
Low fruit and vegetable intake
Overweight and obesity
Physical inactivity
Alcohol
Unsafe water, sanitation, and hygiene
High-mortality developing
Indoor smoke from solid fuels
Iron deficiency
Lower-mortality developing
Urban air pollution Developed
Zinc deficiency
Vitamin A deficiency
Outdoor Air Pollution
Contaminated health care injections
Occupational airborne particulates
ranked 13th
Occupational risk factors for injury
Lead exposure
Illicit drugs
0 1000 2000 3000 4000 5000 6000 7000 8000
Ezzati et al. 2002; WHO 2002 Mortality in thousands (Total 55.86 million)2010: Ambient PM2.5 now among the leading global risks
for mortality and lost years of healthy life
(Lim et al 2012, and http://viz.healthmetricsandevaluation.org/gbd-compare/)
Contributes
to 3.2 million
premature
deaths
worldwideDramatic Demographic Shifts: People Living Much
Longer Worldwide
But increased susceptibility to “diseases of aging”
(heart disease, stroke, COPD, lower respiratory
infection, lung Cancer…diseases most associated
with air pollution
East Asia
South AsiaNew, More Extensive Global Estimates Based on
Measurements, Remote Sensing
(Brauer, et al, 2011)
Combined estimates from satellites (AOD), chemical
transport models and ground-level measurements
-Highest regional averages in East /South
Asia
-Many breathe concentrations much higher
than regional average
-89% population in areas exceeding WHO PMTop 20 Mortality Risk Factors in China for 2010
Ambient PM2.5 is 4th leading factor
(Lim et al 2012, and http://viz.healthmetricsandevaluation.org/gbd-compare/)
Ambient PM2.5
contributed to
estimated 1,2
million
premature
deaths in 2010Public Health Impact of Air Pollution
is well-documented and substantial
• GBD 2010 documents that air pollution is a very important factor
affecting global public health
• High levels of outdoor air pollution are responsible for over 3.2
million premature deaths annually and 76 million years of healthy
life years lost around the world
• Developing Asia, including India and China bears over 2/3 of the
world wide global health burden in this key area
• 60 years of western health studies and an increasing base of high
quality Asian health studies provide confidence in this assessment
• Health, economic and ecological reasons to take action
• Actions typically highly cost effectiveThank You! Robert O’Keefe rokeefe@healtheffects.org
Positive Steps in China, to Reduce Air Pollution
…by government that can benefit air pollution and climate
Significant new national monitoring program for PM2.5 and O3 underway
o China-Wide by 2016
o Real time transparent reporting will maintain public focus
2012 --Recent pollution limits for PM and Ozone
o Standards are comparable to WHO interim targets (IT); Grade II PM2.5, PM10
and O3
2013 National Action Plan;
-Bans new coal plants around Beijing, Shanghai, key regions
-Begin shift from coal to gas, renewables, nuclear (2017 reduction to 65% total
coal in energy consumption) …though recent projections show increases in
coal mining, due to growth in overall energy use
-Target 10% reduction in urban fine particle pollution by 2017, additional
reductions in 3 major regions
-2013 State Council Clean Fuels Roadmap for China: fuel quality (10 PPM
Sulfur), aggressive scrappage, other transport measures
Much more work needed….compliance and follow through
critical …As are the recommendations of RAQMAir Quality, PM, and Cancer
• New review of all air pollution
and cancer
• Follows reviews of many
components: PAHs, benzene,
butadiene, diesel
• Called Air Pollution, and PM,
known human carcinogens
(Group 1) based on:
• US (ACS) and Europe
(ESCAPE) long term cohorts
that found associations with
lung cancer
• According to GBD,
approximately 220,000 lung
cancer deaths attributable to air
pollution worldwide
22K ey Features of the GBD AQ im pact estim ates for China
(Yang GH et al. The Lancet 2013)
• Includes the entire population
both urban and rural
• Prior studies had only estimated
urban
• Estimates PM2.5 exposure
using satellites, air quality
models, and data from >100
Chinese monitors
• Risk estimates based on
systematic review and
synthesis of all latest
epidemiologic studies
• These are consistent with the
results of newest Chinese studies
• Methods and results published
in peer-reviewed journals - all
data are publically availableEstimated 2010 levels of PM2.5 in China
Household solid fuel emissions also contribute
to Ambient Air Pollution
• Global: Household emissions contribute ~15% (4 µg/m3) of ambient PM2.5
• China: Household emissions contribute ~ 15% (7 µg/m3) of PM2.5
• India: Household emissions contribute ~25-30% (10µg/m3) of PM2.5
•The fifth leading risk factor for mortality in China in 2010
~ 1 million premature deathsIARC Meeting on Diesel
June 5 – 12, 2012
• Noted substantial (>98%) improvements in new technology diesel in US, Europe
• Based review on animal and human exposures to old (and much older) diesel
• Concluded that:
• Animal studies provided sufficient evidence of link between diesel and cancer
• Human studies (with DEMS added) provided sufficient evidence of link
• Mechanistic studies provided strong evidence of plausible mechanisms by
which diesel could cause cancer in humans
Classified diesel exhaust
as a “known” human
carcinogenSummary • The Public health impact of air pollution key to informing, driving policy • GBD, the new global standard for credible health impact assessment, finds the greatest burden in developing Asia, with over 630,000 premature deaths and 74 million health years of life lost 2010 • Vehicles are not the only source of concern for air pollution, but high urban exposures and proximity to roadways of dense populations in India’s cities makes it a special concern • Emissions from older diesel engines, with significant PM impacts, and new IARC designation as Known Human Carcinogen is an important source to reduce • HEI ACES continues to document that new technology diesel, with low sulfur fuel and particle filters yields dramatic emission reductions and negligible health effects, is an important way forward
In China: Health Concerns Driving New PM2.5 and Ozone
Air Quality Standards (2012 - 2016), New Transparency
Extreme pollution episodes result in citizen unrest, international
embarrassment, expat flight, Chinese official press GBD coverage:
Air pollution sped death of 1.2 million in
China
Global
Together, drive flurry of Times
action by|Chinese
2013-4-2 0:53:0
Government
Recent directions
•2012 --New pollution limit and monitoring requirements for PM and Ozone
o Standards are comparable to WHO interim targets (IT); Grade II PM2.5, PM10 and
O3
Significant new monitoring phased in over next four years
o National monitoring program for PM2.5 and O3 underway
o China-Wide by 2016
o Real time transparent reporting will maintain public focus
An increasingly affluent middle-class can afford to care about pollutionAm bient Air Pollution Ex pert Group H Ross Anderson (Co-Chair) SGHM S U London Markus Amann I I ASA/ Vienna Michelle Bell Yale University Michael Brauer U British Colum bia Bert Brunekreef U Utrecht Richard Burnett Health Canada Aaron Cohen (Co-Chair) Health Effects I nstitute Frank Dentener EC-JR C Majid Ezzati Harvard University Bryan Hubbell USEPA Kan Haidong Fudan University Michal Krzyzanowski W HO/ Euro-Bonn Francine Laden Harvard University Stephanie London NI EHS Randall Martin Dalhousie University Sumi Mehta UN Fnd Clean Stoves Program Bart Ostro California EPA Kiran Dev Pandey W orld Bank Arden Pope Brigham Young U Beate Ritz UCLA Isabelle Romieu I AR C Amir Sapkota U M aryland Kirk Smith UC Berkeley George Thurston New York University Rita van Dingenen EC –JR C Aaron van Donkelaar Dalhousie University
Asia PM 2.5 Source Apportionment: Vehicles ~20% - 35%
Source: Chowdhury, HEICoal consumption key contributor to regional background
Household and Ambient Air Pollution:
India and China face a double burden
• Household air pollution (HAP) was:
• the second leading risk factors for mortality in India in 2010: ~1 million
• The fifth leading risk factor for mortality in China in 2010: ~ 1 million
• HAP contributes to ambient PM2.5 and so is responsible for
some proportion of the burden of disease attributed to ambient
PM2.5
• Reducing household air pollution is necessary in some settings
in order to improve outdoor air quality1,234,000 Deaths Attributable to Ambient PM2.5
by Cause in China in 2010India: Many Cities Substantially Exceed WHO and
Indian Air Quality Guidelines
India Standard: 60µg/m3Indian Results:
PM10 Evidence from Chennai PAPA study
Approximately 0.3% -0.6% increase in mortality per 10 µg/m3 PM10
Similar Results in Delhi as Well…
Fig. 23: A comparison of the estimated RR’s for PM10 obtained from the core
zonal model, alternative models and sensitivity analysis.
Dr. Kalpana Balakrishnan
and colleagues HEI 2011Short-term exposure: CAPES
CAP ES cities
CAP ES研究的城市The Health Effects Institute
Trusted Science Cleaner Air Better Health
• An independent non-profit institute providing trusted science on the
health effects of air pollution for 30 years
• Balanced Core Support
• US EPA and Industry (Worldwide Motor Vehicle)
• Partnerships
• Also WHO, ADB, Clean Air Asia, major universities and medical institutions,
EU, US DOE, industries, foundations, others
• Independent Board and Expert Science Committees
• Oversee and intensively peer review all science
• International experts India, China, many others)
• Hundreds of policy-relevant studies and scientific reviews, reanalysis
conducted around the world, with strong Asia focus
• Understanding local impacts in a global context to inform policyGBD 2010: China (and others) have seen health progress
1990 to 2010: Much lower death from infectious disease
(tuberculosis, diarrhea, early childhood illness)
Yang GH et al.Top 20 Mortality Risk Factors in India for 2010
Ambient PM2.5 is 5th leading mortality risk factor
Ambient PM2.5
caused an
estimated
627,000
deaths
̴ 6% of all
deaths in 2010Extensive Press on China Global Burden of Disease
Including detailed coverage in China official
press - China’s toxic smog battle
worse than first feared
-Air Pollution Linked to 1.2
Million Premature Deaths in
- China's
ChinaAir Pollution Linked
To Millions Of Early Deaths
-City Air Makes Us Sick,
Chinese Tell Doctor
- Air Pollution Killing
Children and Elderly in China
-‘Airpocalypse’ in China: Air
Pollution Kills Over a MillionYou can also read
