The impacts and costs of air pollution
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1 The impacts and costs of air pollution Mike Holland APRIL meeting, April 13 th 2016
2 Previous RCP report on air pollution Commissioned 1959 Published 1970 Two concerns: Smoking Solid fuel use 2
3 Previous RCP report on air pollution Based on a different world Much coal burning Less traffic Little emission control Little health data to inform the work 3
4 The new report Produced by RCP and RCPH Written by Royal College members and invited experts Released February 2016 Available at: utputs/every-breath-we-take-lifelongimpact-air-pollution 4
5 New report headlines: Health burden Each year, 40,000 deaths in the UK from outdoor air pollution, valued at > 20 billion PM 2.5 NO 2 More linked to indoor air pollutants Radon: 2,300 Second hand smoke: 2,800 11,000 5
6 New report headlines: Range of impacts linked to air pollution Link to many diseases including: Cancer Diabetes Asthma Obesity Stroke Dementia Heart disease 6
7 New report headlines: AQ limits and public protection Neither the concentration limits set by government nor the World Health Organization s air quality guidelines are fully protective of health 7
8 Air quality guidelines and objectives WHO guidelines Based on evidence of pollution impacts Judgment of acceptable risk Objectives / limit values Recognise the guidelines, but take account of: economic efficiency practicability technical feasibility time-scales 8
9 New report headlines: Role of the medical profession When our patients are exposed to such a clear and avoidable cause of death, illness and disability, it is our duty as doctors to speak out. Medical profession is good at dealing with symptoms Barriers on acting on causal factors like air pollution 9
10 Development of disease during foetal development 10
11 Development of disease during the life course 11
12 Mechanistic links to illness Small changes in lung function linked to significant increase in illness 12
13 Mortality estimates for the UK (Chapter 6) Source, pollution year Pollutants Estimated equivalent attributable deaths COMEAP (2008) PM ,000 European Commission (2010) PM ,000 Global Burden of Disease (2010) O 3 1,400 PM O 3 31,000 PM ,400 O PM O 3 24,100 DEFRA (2008, 2013) PM 2.5 (= COMEAP) 29,000 NO 2 15,750 23,500 PM NO 2 44,750 52,500 RCP report (ca. 2013) PM NO 2 (+ O 3 ) 40,000 +/- 25% Note: Years shown are for pollution data, not year of publication 13
14 COMEAP results in more detail Highlights different ways of representing mortality impacts of air pollution Averages at ~12 years of lost life expectancy per equivalent attributable death 14
15 Interpretation of mortality estimates COMEAP considers the meaning of the estimate of the number of deaths, noting: Effects are principally from cardiovascular disease, which has multiple established and likely causes at the population level, and almost certainly has a complex mixture of factors affecting initiation and progression at the individual level. Estimates of deaths are a statistical construct, with air pollution playing some role in bringing forward the deaths of a larger number of people than the 29,000 COMEAP estimate. 15
16 GBD results in more detail 16
17 European Commission results for the UK (O 3 ) Effect Units Impact Mortality Deaths 1,400 Respiratory hospital admissions Cases 1,400 Cardiovascular hospital admissions Cases 2,700 Minor restricted activity days Days 6.6 million 17
18 European Commission results for the UK (PM 2.5 ) Effect Units Impact Mortality >30s (not additive with deaths) Life years lost 328,000 Mortality >30s (not additive with LYL) Deaths 30,000 Infant mortality Deaths 70 Chronic bronchitis in adults Cases 26,000 Bronchitis in children Cases 102,000 Respiratory hospital admissions Cases 12,000 Cardiovascular hospital admissions Cases 4,500 Restricted activity days Days 41 million Asthma symptom days (children) Days 1.2 million Lost working days Days 6.1 million Economic value of ~ 16 to 45 billion/year (excludes NO 2, upper bound adopts value of statistical life for mortality valuation) 18
19 Bronchitis and PM Differences in disease Adult bronchitis: long lasting disease, potentially severe effect, may be permanent (depending on definition of effect) Child bronchitis: temporary (2 weeks), recoverable Differences in adult bronchitis estimates for UK: EC estimate: 26,000 (incidence, new disease, value 850 million/year) New COMEAP estimate: 722,000 (prevalence, total burden) out of 4.5 million affected individuals in the UK (value?) Differences in use For EC, recommended for core analysis by WHO HRAPIE study For UK, recommended for sensitivity analysis by COMEAP COMEAP report on chronic bronchitis available at: 19
20 Selected recommendations for action Act now, think long term Educate professionals Protect the public when air pollution levels are high Tackle inequality, protecting those at most risk Lead by example in the NHS Major polluter! Collaborate with local authorities? 20
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