Integrating Health on Air Quality Assessment—Review Report on Health Risks of Two Major European Outdoor Air Pollutants: PM and NO₂

Abstract

Quantifying the impact of air pollution on the public's health has become an increasingly critical component in policy discussion. Recent data indicate that more than 70% of the world population lives in cities. Several studies reported that current levels of air pollutants in urban areas are associated with adverse health risks, namely, cardiovascular diseases and lung cancer. IARC recently classified outdoor air pollution and related particulate matter (PM) as carcinogenic to humans. Despite the air quality improvements observed over the last few years, there is still continued widespread exceedance within Europe, particularly regarding PM and nitrogen oxides (NOx). The European Air Quality Directive 2008/50/EC requires Member States to design appropriate air quality plans for zones where air quality does not comply with established limit values. However, in most cases, air quality is only quantified using a combination of monitored and modeled data and no health impact assessment is carried out. An integrated approach combining the effects of several emission abatement measures on air quality, impacts on human health, and associated implementation costs enables an effective cost-benefit analysis and an added value to the decision-making process. Hence, this review describes the basic steps and tools for integrating health into air quality assessment (health indicators, exposure-response functions). In addition, consideration is given to two major outdoor pollutants: PM and NO2. A summary of the health metrics used to assess the health impact of PM and NO2 and recent epidemiologic data are also described.

Metrics in Urban Health: Current Developments and Future Prospects

“…Mortality is the most studied health end point associated with air pollution (32). One reason is the widespread availability of mortality data for large populations, and another reason is its simple interpretation (18). Although earlier research focused on linking air pollution to respiratory health (47,60), the focus has shifted more recently to its impacts on cardiovascular health (10,73,113).…”

“…In particular, measures of the concentration of particulate matter (PM) of different sizes such as PM 2.5 and PM 10 (particles with diameters less than or equal to 2.5 µm and 10 µm) were most commonly used to determine health effects (7,8,18,44,53,75,92,113). Other common pollutants include nitric oxides and sulfur dioxide (89,90).…”

Economic evaluation of air pollution impacts on human health: an overview of applied methodologies

“…With this purpose, Miranda et al [7] based their research on European air quality plans, reviewed the assessment capabilities and modelling tools to evaluate the effects of emission abatement strategies improving air quality. The health impacts arising from air pollution can be estimated using as support the work by Costa et al [8] that describes how health can be integrated in air quality assessment through exposure and dose-response functions. Thereby, emphasis will be given to the following components: physical impacts considering different health indicators, and external costs to remediate the occurred damages or prevent productivity losses and pain/suffering.…”

“…According to numerous studies, certain vulnerable groups within population (e.g. elderly people, children, and those with underlying diseases) have shown a greater risk of being affected by air pollutants [8,11,16].…”

“…Nevertheless it is important to consider also the cumulative exposure over time (long-term exposure) resulting in chronic effects [8]. Short-term exposure studies usually explore time-series of hourly and daily changes in air pollution, and daily death counts or cause-specific hospitalizations [14].…”