Vรถrรถsmarty et al. Nature 467, 555-561 (29 September 2010)
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Environmental Health, Energy, and Transportation: Bringing Health to the Fuel Mixture Sponsored by The Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine Nov 29-30, 2007 National Academy of Sciences 2100 Constitution Ave, NW Washington, D.C
Goal: This workshop will address the potential environmental and public health consequences of transport fuel production and use. It will focus on the unintended consequences of previous changes to fuel mixtures, and examine possibilities for new fuel sources and mixtures. The workshop will explore the costs and benefits of potential fuel mixtures for the United States, with an emphasis on health, sustainability, environmental and public health consequences. www.iom.edu/ehsrt
Ciência
Economia Política
Economia
Ciência
Política
Política Ciência
Economia
The Lancet, Volume 360, Issue 9341, 19 October 2002, Pages 1184-1185
The Lancet, Volume 360, Issue 9341, 19 October 2002, Pages 1184-1185
São Paulo – 28 µg/m3 ug/m3
%
Fator 1
2.43
8.58 Solo
Fator 2
7.01
24.72 Óleo
Fator 3
3.87
13.66 Leve
Fator 4
10.90
38.45 Pesado
1,14
relative risk of death
1,12 1,1 1,08 1,06 1,04 1,02 1 0,98 20
40
60
80 PM10 categories
100
120
140
relative risk for desfibrillator discharge
1,45 1,4 1,35 1,3 1,25 1,2 1,15 1,1 1,05 1 0-5.2
5.3-79
7.9-11.5 PM 2.5 (ug/m3)
11.6-17
17.5-74-8
Lancet. 2011 Feb 26;377(9767):732-40
Fine Particulate (PM2.5)Air Pollution de Miranda et al, Air Qual Atmos Health 2011
WHO Air Quality Guideline 10 µg/m3 20 µg/m3 28 µg/m3 16 µg/m3
Magnitude of Impacts
Health Impacts: “ Pyramid of Effects”
Thousands
Death Death
Tens of Thousands
ER visits, visits, ER Hospital Hospital admissions, admissions, Heart Heart attacks attacks Doctor visits, visits, School Doctor School absences, Lost Lost work absences, workdays days
Millions
Severity of Effects
Respiratory symptoms, Medication Respiratory symptoms, use, Asthma attacksattacks Medication use, Asthma Lung functiondecrements, decrements, Inflammation, Lung function Inflammation, Cardiac effects effects Cardiac
Proportion of Population Affected
40
Estimated benefits of 10% reduction in S達o Paulo air pollutants between 2000 and 2020 Bell, Davis, Gouveia, Borja-Aburto, Cifuentes, Envir Res 2006; 100:431 Health endpoint Mortality Adult Infant (<1 year) Medical visits Children's medical visits (3 to 15 years) Hospital admissions (cardiovascular) Hospital admissions (respiratory) Children's hospital admissions Emergency room visits (respiratory) Bronchitis and asthma Asthma attacks Acute bronchitis Chronic bronchitis Activity effects Restricted activity days (18 to 65 years) Work loss days
Events avoided 113,165 735 138,572 1,449 10,945 5,563 102,331 817,064 38,384 11,603 6,852,601 2,376,710
Air Pollution Health Effects Studies: S達o Paulo CHILDREN
Mortality
Mortality
ADULT
Saldiva et al, 1994 Pereira et al, 1998 Conceic達o et al., 2001 Hospital Lin Admissions et al, 2004 Braga et al., 2001 Saldiva et al., 1994 Gouveia and Fletcher, 2000 Farhat et al 2005
Saldiva et al., 1995; Death Gouveia & Fletcher, 2000b; Botter et al., 2002; Hospital Admissions ER visits, Martins et al., 2004 Freitas et al 2004 Hospital Elderly (Martins et al., 2006) admissions, MI Emergency (Cendon etl al,Room 2006) Visits Heart attacks Elderly (Martins et al., 2002) Ischemic Heart (Lin et al., 2003) Emergency Room Visits Doctor visits, School Lin et al., 1999 Arrhythmias (Santos et al, 2008) absences, Lost work days CVD (Pereira Fihlo et al, 2008) Martins et al, 2002 COPD (Akinaga et al 2009)
Resp Symptoms Sih 1997
Low Birth Weight Gouveia et al., 2004
Respiratory symptoms, Medication use, Asthma attacks
Lung function decrements, Inflammation, Cardiac effects
IVF/ET Perin et al, 2010
Histopathology
Souza et al, 1998 Guimar達es et al, 2000 de Oliveira, 2006 Experimental Saldiva et al, 1992; Lemos et al, 1994; Pereira et al, 1995; Reym達o et al, 1997; Novaes et al, 2010 Cury et al, 2000; Soares et al, 2003; Veras et al, 2008; Veras et al, 2009; Damaceno-Rodrigues et al, 2009; 42 Matsumoto e tal, 2010; Yoshizaki et al, 2010; Zanchi et al, 2010; Riva et al, 2011
Six Cities Adult Mortality Study Dockery et al, NEJM 1993: 329:1753 •
8411 adults in 6 cities – – –
• •
Dirty: Steubenville & St. Louis Moderate: Watertown & Kinston/Harriman Clean: Topeka & Portage
Enrolled starting in 1974 14-16 years of mortality follow-up
Six Cities Adult Mortality 1,4
EPA NAAQS
Steubenville
Mortality Risk Ratio
1,3
Kingston
1,2
St. Louis 1,1
Topeka
Watertown
Portage
1,0 0,9 0,8 0,7 0
10
20
30 3
PM 2.5 (Âľg/m )
40
American Cancer Society Study • Existing prospective cohort – sample of entire US population – 1,200,000 adults
• Detailed personal characteristics • Matched by metropolitan area to 1980 PM2.5 data (50 monitors; 295,223 subjects) • Effect of 10 µg/m3 PM2.5 – +7% (95% CI 4% to 10%) increase in mortality
Pope et al, Am J Respir Crit Care Med. 1995;151:669
1980
Adjusted Mortality for 1980 (Deaths/Yr/100,000)
Age-, sex-, and race- adjusted mortality rates in U.S. cities for 1980 fine particulate (PM2.5) air pollution WHO US EPA Guideline Standard
1000 950 900 850 800 750 700
Sao Paulo 28 Âľg/m3
650
â&#x2020;&#x201C; 600
PM2.5 8
10
12
14
16
18
20
22
24
26
28
30
32
34
Pope et al, 2000
Six Cities Mortality Follow-up •
1974 to 1989 follow-up – Annual returned postcards and National Death Index – 1,364 deaths •
–
•
1990 to 1998 follow-up –
National Death Index search
–
1,368 deaths •
54,735 person years
104,243 person years
PM2.5 measurements 1979-1986
Laden et al, AJRCCM 2006;54:709
–
PM2.5 estimated from PM10 1990-1998
Six Cities Cohort Follow-up 1,4
Mortality Risk Ratio
1,3 1,2
Steubenville
Kingston Topeka
1,1 1,0
Portage St. Louis
0,9
Watertown
Improved air quality leads to reduced mortality
0,8 0,7 0
5
10
15
20
PM 2.5 (Âľg/m3)
Laden et al, AJRCCM 2006;54:709
25
30
35
Life Expectancy vs PM2.5 1978-82 81 80
EPA NAAQS 79
Life Expectancy
78
Slope -1.2 yr/10 µg/m3
77
Boston
76 75
Topeka 74 73 72
Steubenville
71
5
10
15
20 PM 2.5 (µg/m3)
25
30
35
Pope, Ezzati, Dockery (NEJM 2009)
Life Expectancy vs PM2.5 1997-2001 Boston
81
EPA NAAQS
80 79
Life Expectancy
78 77 76
Slope -2.1 yr/10 µg/m3
75 74
Topeka
Steubenville
73 72 71
5
10
15
20
25
30
35
PM 2.5 (µg/m3)
Pope, Ezzati, Dockery (NEJM 2009)
Life Expectancy vs PM2.5 1980-2000 81 80
Life Expectancy
79 78 77 76
Topeka
75 74 73 72 71
5
10
15
3
20
25
PM2.5 (Âľg/m )
Pope, Ezzati, Dockery (NEJM 2009)
30
Life Expectancy vs PM2.5 1980-2000 81 80
Life Expectancy
79 78 77 76 75 74 73 72 71
5
10
15
20
25
30
3
PM 2.5 (Âľg/m ) Pope, Ezzati, Dockery (NEJM 2009)
Life Expectancy vs PM2.5 1980-2000 81 San Jose, CA
80
Life Expectancy
79
San Diego, CA
Los Angeles, CA
78 77 76 75 74 73
↑ São Paulo
72
28.1 µg/m3
71
5
10
15
20 3
PM2.5 (µg/m )
25
30
Life Expectancy vs PM2.5 1980-2000 81 San Jose, CA
80
Life Expectancy
79
San Diego, CA
Los Angeles, CA
78 77 76 75 3.5 yr 74 73 72
↑ Curitiba
↑ São Paulo
14.4 µg/m
28.1 µg/m3
3
71
5
10
15
20 3
PM2.5 (µg/m )
25
30
Statement on the health co-benefits of policies to tackle climate change •The improvement of health both locally and globally shouldbe one of the main criteria motivating climate changemitigation measures. The potential health co-benefits andharms should be considered when making choices about mitigation policies. •The health co-benefits of climate change mitigation should be given greater prominence in international negotiations, for example through dedicated sessions on this topic. •Health Ministers and ministries should actively engage in promoting mitigation strategies that result in health cobenefits in their own country and should make the case for such strategies to their national climate change negotiators in advance of international meetings. •Health policymakers, scientists, health professionals and industry should reach beyond national and disciplinary boundaries to collaborate with each other to study, develop and implement climate change mitigation measures that also benefit health. •The health community must provide leadership by reducing the emissions from health systems.