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WHO Air Quality Guidelines WHO Air Quality Guidelines WHO Air Quality Guidelines WHO Air Quality Guidelines Emerging Issues Emerging Issues
Carlos DoraCarlos Dora
World Health OrganizationWorld Health Organization
GenevaGeneva
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This presentationThis presentation
��The WHO ambient air quality The WHO ambient air quality guidelinesguidelines
��AQG use in policy makingAQG use in policy making
��Emerging issues in air quality and Emerging issues in air quality and ��Emerging issues in air quality and Emerging issues in air quality and healthhealth
–– Evidence on the impact of interventionsEvidence on the impact of interventions
–– CoCo--benefits benefits –– linking climate change and local air linking climate change and local air pollutionpollution
–– Indoor air quality Indoor air quality -- development of WHO development of WHO guidelines guidelines
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WHO AQG TeamWHO AQG Team
http://www.euro.who.int/air
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Air Quality Guidelines: Air Quality Guidelines: contents part contents part 1 1
N. Janssen (The Netherlands), S. Mehta (US) Human exposure to air pollution3
B. Sivertsen (Norway) Air pollution levels2
R. Harrison (UK) Sources of air pollution1
Part 1. Application of AQG for policy development and risk reduction
AuthorsTitleChapter
K. Balakrishnan (India), NG Bruce (UK) Indoor air quality: special issues in risk assessment and management
9
A. Fernandez (Mexico), M. Zuk (Mexico) Applications of guidelines in policy formulation
8
B. Ostro (US) Health impact assessment7
P. Kinney (US), MS O’Neill (US) Environmental equity6
M. Utell (US), M. Frampton (US) Determinants of susceptibility5
N. Gouveia (Brazil), M. Maisonet (PAHO/Chile) Health effects of air pollution4
N. Janssen (The Netherlands), S. Mehta (US) Human exposure to air pollution3
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Air Quality Guidelines: Air Quality Guidelines: contents part contents part 22
P. Saldiva (Brazil), N. Künzli (US / Switzerland) Ozone11
J. Samet (US), M. Brauer (Canada) R.Schlesinger (US)
Particulate matter10
Part 2. Risk assessment of selected pollutants
AuthorsTitleChapter
M. Lippmann (US), K. Ito (US) Sulfur dioxide13
F. Forastiere (Italy), A. Peters (Germany) F. Kelly (UK), ST Holgate (UK)
Nitrogen dioxide12
Scientific Advisory Group:RH Anderson (UK), B. Brunekreef (The Netherlands), B. Chen (China), A. Cohen (USA) R. Maynard (UK), I. Romieu (Mexico), KR. Smith (USA), S. Wangwongwatana (Thailand)
WHO coordination: Michal Krzyzanowski
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Air Pollution and Health
All Deaths
Cardio-respiratory
Hospital admissions
Asthma e bronchitis casesSeverity
Visits to emergency rooms
Medical consultations
Reduction in physical capacity
Use of medicaments
Symptoms
Changes in lung function
Sub-clinical effects
Proportion of the population
affected
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Long term exposure and Long term exposure and healthhealth
Pope et al, 2002
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Short term exposures and Short term exposures and healthhealth
0.46
0.62
0.49
0.4
0.5
0.6
0.7
Percent Increase in Mortality per 10 ug/m3 PM10
0.61
* Estimates Using Pre-GAM Results (without revision)
0
0.1
0.2
0.3
0.4
US(90
Cities)*
Eur(21
Cities)*
Asia (4
Cities)
PAHO (3
Cities)
Curtesy: A. Cohen /HEI
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Ozone health effectsOzone health effects
��Respiratory effectsRespiratory effects
�� Cardiovascular Cardiovascular effectseffects
�� Immune effectsImmune effects�� Immune effectsImmune effects
�� Susceptible Susceptible subgroups :subgroups :–– AsthmaticsAsthmatics
–– ChildrenChildren
–– The elderlyThe elderly
–– Those with certain Those with certain underlying diseasesunderlying diseases
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Systematic review of the Systematic review of the evidenceevidence
SummaryFull text
Oct Oct –– Nov Nov 20042004: : Steering Group Steering Group established; established;
Jan Jan -- Sept Sept 20052005: : review of the review of the evidence (ca evidence (ca 80 80 experts involved);experts involved);
http://www.who.int/phe/air/aqg2006execsum.pdf
experts involved);experts involved);
1818--20 20 October October 20052005: : WG meeting, BonnWG meeting, Bonn(report published Feb (report published Feb 20062006););
5 5 October October 2006 2006 ––formal announcement formal announcement of AQGof AQG
WHO editing/printing WHO editing/printing
April April 2007 2007 publicationpublication
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WHO AQG for particulate matterWHO AQG for particulate matter
Risk of premature mortality decreased by approximately 6% compared to IT1
2550Interim target-2 (IT-2)
Levels associated with about 15% higher long-term mortality than at AQG
3570Interim target-1 (IT-1)
Basis for the selected levelPM2.5(µg/m3)
PM10 (µg/m3) Annual mean level
Lowest levels at which total, CP and LCA mortality have been shown to increase (Pope et al., 2002). The use of PM2.5guideline is preferred.
1020Air quality guideline (AQG)
Mortality risk reduced by approximately 6% compared to IT2 levels.
1530Interim target-3 (IT-3)
AQG 2000: no guideline value
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• There is considerable toxicological evidence of potential detrimental effects of UF particles on human health,
• The existing body of epidemiological evidence is insufficient to reach a conclusion on the exposure–
WHO AQG: Global update: WHO AQG: Global update: The role of ultrafine particlesThe role of ultrafine particles
insufficient to reach a conclusion on the exposure–response relationship of UF particles.
No recommendations can be provided as to guideline concentrations of UF particles at this point in time.
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Significant health effects, substantial proportion of vulnerable population affected.
240 µg/m3High level
Effects at the selected ozone levelDaily
maximum 8-hour mean
WHO AQG: Global update: WHO AQG: Global update: Ozone: daily maximum Ozone: daily maximum 88--h meanh mean
This concentration will provide adequate protection of public health, though some health effects may occur below this level.
100 µg/m3Air quality guideline (AQG)
Important health effects, an intermediate target for populations with ozone concentrations above this level. Does not provide adequate protection of public health.
160 µg/m3
Interim target-1 (IT-1)
AQG 2000: 120 µg/m3
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The guideline values remain unchanged at the
following levels:
40 µg/m3 for annual mean;
WHO AQG: Global update: WHO AQG: Global update: Nitrogen dioxideNitrogen dioxide
200 µg/m3 for 1-hour mean.
Rationale:• Experimental data: NO2 toxic above 200 µg/m3 • Epi studies: NO2 – marker of mixture of combustion related pollution• Precursor of ozone and PM2.5
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-50 µg/m3
Intermediate goal based on controlling either (1) motor vehicle (2) industrial emissions and/or (3)
Interim target-2 (IT-2)
-125 µg/m3Interim target-1 (IT-1) (2000 AQG level)
10-minute average SO224-hour average SO2
WHO AQG: Global update: Sulfur dioxideWHO AQG: Global update: Sulfur dioxide
500 µg/m320 µg/m3Air quality guidelines (AQG)
(2) industrial emissions and/or (3) power production; feasible goal to be achieved leading to significant health improvements that would justify further improvements
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Summary of WHO AQGSummary of WHO AQG
10 µg/m3
25 µg/m3
20 µg/m3
50 µg/m3
1 year24 hour (99th percentile)
1 year24 hour (99th percentile)
Particulate matterPM2.5
PM10
AQG valueAveraging timePollutant
20 µg/m3
500 µg/m324 hour10 minute
Sulfur dioxide, SO2
40 µg/m3
200 µg/m31 year1 hour
Nitrogen dioxide, NO2
100 µg/m38 hour, daily maximumOzone, O3
50 µg/m324 hour (99th percentile)
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Using the Guidelines in Using the Guidelines in establishing policy establishing policy
�� Norms and standardsNorms and standards
�� TargetsTargets
�� Quantification of expected benefits from Quantification of expected benefits from achieving the targets (lives, disability, achieving the targets (lives, disability, achieving the targets (lives, disability, achieving the targets (lives, disability, economic)economic)
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Reduce the exposure Reduce the exposure to cut the health effect to cut the health effect
Effect
Exposure
AQG IT-2 IT-1
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PMPM10 10 ITIT--11: challenge to : challenge to somesome cities in Asiacities in Asia
80
100
120
140
160
co
nce
ntr
atio
ns in
µg
/m3
0
20
40
60
Ban
gkok
Bei
jing
Chi
ang
Mai
Col
ombo
Dha
kaH
o C
hi M
inh
Hon
g Ko
ngK
athm
andu
Kol
kata
Mum
bai
New
Del
hiSh
angh
aiS
inga
pore
Sur
abay
a
Xi'a
nco
nce
ntr
atio
ns in
µg
/m
WHO 2005 PM10 Interim Target – 1 = 70 µg/m3
Source: CAI-Asia
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PMPM10 10 ITIT--22: challenge to : challenge to mostmost cities in Asiacities in Asia
80
100
120
140
160
co
nce
ntr
atio
ns in
µg
/m3
0
20
40
60
Ban
gkok
Beijin
gC
hian
g M
aiC
olom
bo
Dha
kaH
o C
hi M
inh
Hon
g Ko
ngK
athm
andu
Kol
kata
Mum
bai
New
Del
hiSh
angh
aiS
inga
pore
Sur
abay
a
Xi'a
n
co
nce
ntr
atio
ns in
µg
/m
WHO 2005 PM10 Interim Target – 2 = 50 µg/m3
Source: CAI-Asia
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PMPM10 10 ITIT--33: challenge to : challenge to allall cities in Asiacities in Asia
WHO 2005 PM10 Interim Target – 3 = 30 µg/m3
Source: CAI-Asia
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PMPM10 10 AQG: the future for AQG: the future for all cities in Asiaall cities in Asia
WHO WHO 2005 2005 PMPM10 10 AQG = AQG = 2020 µg/mµg/m33
Source: CAI-Asia
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Climate change: • Immediate and long term threats to health
• Health systems will need to adapt
• Mitigation measures will be developed
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City populations more vulnerable to Climate Change Health Impacts
1. Heatwaves: urban heat islands, interaction with air pollution
Deaths During 2003 Summer Heatwave.
Paris Funeral Services (2003)
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A deadly combination: Temperature, PM10 and Mortality
Stafoggia et al, AJE in press
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Air pollution emissions in the Air pollution emissions in the EUEU--2727
80%
100%
120%
Re
lative t
o 2
00
0
80%
100%
120%
Rela
tive
to
20
00
SO2
NOx
PM
0%
20%
40%
60%
2000 2005 2010 2015 2020R
ela
tive t
o 2
00
00%
20%
40%
60%
2000 2005 2010 2015 2020
Rela
tive
to
20
00
-40% SO2
-15% NOx
-12% PM
PRIMES energy scenariowith climate measures
(-20% CO2 in 2020)
Business-as-usualnational energy projections(+3% CO2 in 2020)
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Wildfires
Thanks to Bert Brunekreef
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Probability of exceeding ozone Probability of exceeding ozone concentrations with increasing concentrations with increasing
temperaturestemperatures
Denmann, Brasseur et al, IPCC
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Massive Scale Urbanization Massive Scale Urbanization ––new buildingsnew buildings
China:
• Double proportion of people in urban areas 1980-2005areas 1980-2005
• 1,6% Increase a year
• An extra 280 million people in cities by 2025 (baseline = 2000)
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Emerging issues in air Emerging issues in air quality and healthquality and health
––Evidence on the impact of interventions Evidence on the impact of interventions to reduce air pollutionto reduce air pollution
CoCo--benefits benefits –– linking climate change and linking climate change and ––CoCo--benefits benefits –– linking climate change and linking climate change and local air pollutionlocal air pollution
––Indoor air quality Indoor air quality -- development of WHO development of WHO guidelines guidelines
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Combustion quality
Allergens
Naphthalene
Household ventilationVentilation
Benzene
Stove ventingDampness and mouldFormaldehyde
Indoor combustion Biological agents Pollutants
Development of WHO Guidelines for Indoor Air QualityDevelopment of WHO Guidelines for Indoor Air QualityWG Meeting, Bonn, 23WG Meeting, Bonn, 23--24 October 200624 October 2006
PAH², especially BaP³
Halogenated compounds
Particulate matter¹
Radon (Rn)
- from pets
Carbon monoxide (CO)
Fuels - from house dust mitesNitrogen dioxide (NO2)
Allergens
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Summary of the health risk evaluation (selected items)
- Sufficient epidemiologic evidence from studies conducted in different countries in
different climatic conditions showing that occupants of damp or mouldy buildings,
both homes and public buildings, are at increased risk of experiencing respiratory
symptoms, respiratory infections, and exacerbations of asthma.
- Some evidence suggests an increased risk of developing allergic rhinitis and
asthma.
WHO Guidelines for Indoor AQ: Dampness and MouldWHO Guidelines for Indoor AQ: Dampness and MouldWG Meeting, Bonn, WG Meeting, Bonn, 1717--18 18 October October 20072007
- remediation of dampness problems leads to reduction in adverse health
outcomes.
- Clinical evidence shows that exposures to moulds and other dampness-related
microbial agents increase the risk of rare conditions, such as hypersensitivity
pneumonitis/allergic alveolitis, chronic rhinosinusitis and the allergic fungal
sinusitis.
- Toxicological evidence both in vivo and vitro support these findings by showing
diverse inflammatory and toxic responses after exposure to specific micro-
organisms isolated from damp buildings, including their spores, metabolites and
components.
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Persistent dampness and microbial growth on interior surfaces and in building structures should be avoided (or minimized) as they may lead to adverse health effects.
• Indicators of dampness and microbial growth include presence of condensation on surfaces or in structures, visible mould, perceived mould odour, and a history of water damage, leakage or water penetration. Thorough inspection and – if needed – appropriate measurements may be used for confirmation of indoor problems related to moisture and microbial growth.
• Currently, the relationship between dampness, microbial exposure and health effects cannot be
WHO Guidelines for Indoor AQ: Dampness and MouldWHO Guidelines for Indoor AQ: Dampness and MouldWG Meeting, Bonn, WG Meeting, Bonn, 1717--18 18 October October 20072007
• Currently, the relationship between dampness, microbial exposure and health effects cannot be precisely quantified, and therefore no quantitative health based guideline values or thresholds can be recommended for acceptable levels of specific micro-organism contamination. Instead it is recommended that dampness and mould-related problems should be prevented. When they do occur, they should be remediated because of the increased risk of adverse microbial and chemical exposures.
• Well-designed, constructed, and maintained building envelopes are critical to the prevention and control of excess moisture and microbial growth by avoiding thermal bridges and preventing intrusion by liquid or vapour phase water.
• Management of moisture requires proper control of temperatures and ventilation to avoid high humidity, condensation on surfaces, and excess moisture in materials. Ventilation should be distributed effectively in spaces and stagnant air zones should be avoided.
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OpportunitiesOpportunities
�� International leadership and collaboration International leadership and collaboration with WHO and others on indoor air quality, with WHO and others on indoor air quality, building energy efficiency and healthbuilding energy efficiency and health
�� Within a broad view of health aspects of Within a broad view of health aspects of buildings (air, injuries, noise, other)buildings (air, injuries, noise, other) buildings (air, injuries, noise, other)buildings (air, injuries, noise, other)
�� To contribute to direct health impacts and to To contribute to direct health impacts and to climate change mitigation knowledge/ climate change mitigation knowledge/ strategies strategies
�� A clear focus on documenting the health A clear focus on documenting the health impacts of internventions impacts of internventions