BackgroundThere is a growing body of epidemiologic literature reporting associations between atmospheric pollutants and reproductive outcomes, particularly birth weight and gestational duration.ObjectivesThe objectives of our international workshop were to discuss the current evidence, to identify the strengths and weaknesses of published epidemiologic studies, and to suggest future directions for research.DiscussionParticipants identified promising exposure assessment tools, including exposure models with fine spatial and temporal resolution that take into account time–activity patterns. More knowledge on factors correlated with exposure to air pollution, such as other environmental pollutants with similar temporal variations, and assessment of nutritional factors possibly influencing birth outcomes would help evaluate importance of residual confounding. Participants proposed a list of points to report in future publications on this topic to facilitate research syntheses. Nested case–control studies analyzed using two-phase statistical techniques and development of cohorts with extensive information on pregnancy behaviors and biological samples are promising study designs. Issues related to the identification of critical exposure windows and potential biological mechanisms through which air pollutants may lead to intrauterine growth restriction and premature birth were reviewed.ConclusionsTo make progress, this research field needs input from toxicology, exposure assessment, and clinical research, especially to aid in the identification and exposure assessment of feto-toxic agents in ambient air, in the development of early markers of adverse reproductive outcomes, and of relevant biological pathways. In particular, additional research using animal models would help better delineate the biological mechanisms underpinning the associations reported in human studies.

ObjectiveQuantitative estimates of air pollution health impacts have become an increasingly critical input to policy decisions. The WHO project “Health risks of air pollution in Europe—HRAPIE” was implemented to provide the evidence-based concentration–response functions for quantifying air pollution health impacts to support the 2013 revision of the air quality policy for the European Union (EU).MethodsA group of experts convened by WHO Regional Office for Europe reviewed the accumulated primary research evidence together with some commissioned reviews and recommended concentration–response functions for air pollutant–health outcome pairs for which there was sufficient evidence for a causal association.ResultsThe concentration–response functions link several indicators of mortality and morbidity with short- and long-term exposure to particulate matter, ozone and nitrogen dioxide. The project also provides guidance on the use of these functions and associated baseline health information in the cost–benefit analysis.ConclusionsThe project results provide the scientific basis for formulating policy actions to improve air quality and thereby reduce the burden of disease associated with air pollution in Europe.Electronic supplementary materialThe online version of this article (doi:10.1007/s00038-015-0690-y) contains supplementary material, which is available to authorized users.

In addition to the number of attributable cases, our HIA has estimated the potential gain in life expectancy for long-term exposure to fine particles, contributing to a better quantification of the impact of AP on PH in Europe.

Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has never been more pressing. Conceptual models can facilitate this by providing theoretical frameworks and supporting stakeholder engagement process simplifications for inherently complex situations involving environment and human health and well-being. They can be tools to think with, to engage, to communicate and to help navigate in a sea of complexity. We believe models such as eDPSEEA can help frame many of the issues which have become the challenges of the new public health era and can provide the essential platforms necessary for progress.

37Purpose Fine particulate matter (PM 2.5 ) is considered to be one of the most important 38 environmental factors contributing to the global human disease burden. However, due to the 39 lack of broad consensus and harmonization in the life cycle assessment (LCA) community, 40 there is no clear guidance on how to consistently include health effects from PM 2.5 exposure 41 in LCA practice. As a consequence, different models are currently used to assess life cycle 42 impacts for PM 2.5 , sometimes leading to inconsistent results. In a global effort initiated by the 43 UNEP/SETAC Life Cycle Initiative, respiratory inorganics impacts expressed as health 44 effects from PM 2.5 exposure were selected as one of the initial impact categories to undergo 45 review with the goal of providing global guidance for implementation in life cycle impact 46 assessment (LCIA). The goal of this paper is to summarize the current knowledge and 47 practice for assessing health effects from PM 2.5 exposure and to provide recommendations for 48 their consistent integration into LCIA. 49Methods A task force on human health impacts was convened to build the framework for 50 consistently quantifying health effects from PM 2.5 exposure and for recommending PM 2.5 51 characterization factors. In an initial Guidance Workshop, existing literature was reviewed 52 and input from a broad range of internationally-recognized experts was obtained and 53 discussed. Workshop objectives were to identify the main scientific questions and challenges 54 for quantifying health effects from PM 2.5 exposure, and to provide initial guidance to the 55 impact quantification process. 56Results and recommendations A set of 10 recommendations was developed addressing: 57 (a) the general framework for assessing PM 2.5 -related health effects, (b) approaches and data 58 to estimate human exposure to PM 2.5 using intake fractions, and (c) approaches and data to 59 characterize exposure-response functions (ERF) for PM 2.5 and to quantify severity of the 60 diseases attributed to PM 2.5 exposure. Despite these advances, a number of complex issues, 61 such as those related to non-linearity of the ERF and the possible need to provide different 62 ERF's for use in different geographic regions, require further analysis. 63Conclusions and outlook Questions of how to refine and improve the overall framework 64 were analyzed. Data and models were proposed for harmonizing various elements of the 65 health impact pathways for PM 2.5 . Within the next two years, our goal is to build a global 66 guidance framework and to determine characterization factors that are more reliable for 67 incorporating the health effects from exposure to PM 2.5 into LCIA. Ideally, this will allow 68 quantification of the impacts of both indoor and outdoor exposure to PM 2.5 . 69