Impactes de la contaminació local en la salud pública

Jordi Sunyer

Gas Natural 2016

Air pollution is increasing

Most of the population lives in

polluted areas

Air pollution (PM10, μg/m3) by

cities (WHO 2011)

• Ahvas (Iran) 327

• Ulam Bator (Mongolia) 279

• Quetta (Pakistan) 263

• Kampur (India) 244

• Gabarone (Botswana) 240

• Barcelona 38

• Stockholm 18

Ischemic heart disease and

PM2.5, globally (World bank 2016)

NO2

results

Cyrys, Atm Env

2012

EU Limit Value

Ambient Aerosols

Gases and primary particles

Organic compounds

Soot particles

Metals

Secondary particles

Crustal material

Biological material

……

Brook et al. 2004

Ambient particulate matter (PM)

is defined by its size

. .

Bronchial epithelium

10µm 1 µm 0.1µm

Courtesy: K. Donaldson & A. Peters

Size matters for the

translocation

Alveolar

macrophage

Zimmermann

Karg

Cyrys

Behrendt/Allessandrini

Schulz

Peters

Wolff

Schramm

Maier

AndraeWittmaack

Zimmermann

Karg

Cyrys

Behrendt/Allessandrini

Schulz

Peters

Wolff

Schramm

Maier

AndraeWittmaack

1 µm 10 µm

35 30 25 20 15 10

0.9

1.0

1.1

1.2

1.3

• Portage, W • Topeka, KS

• Waterown, MA (Boston)

• Harriman, TN (Knoxville) • St. Louis, MO

• Stebenville, OH

Long-term mortality. 6 cities, Dockery 1993

The six cities study:

PM2.5 –MORTALITY (Dockery , NEJM 1993)

WHO

AQG

EU

Limit

Value

US EPA

Standard

ACS cohort: Guidelines for PM2.5

Pope et al 2002

Insulin Resistance

Type 2 diabetes

Type 1 diabetes

Bone metabolism Skin Aging

Stroke

Neurological development

Mental Health

Neurodegenerative diseases

Cardiovascular Disease Mortality

Cardiovascular Disease Morbidity

Myocardial Infarction

Arrhythmia

Congestive Heart Failure

Changes in Heart Rate Variability

ST-Segment Depression

Premature Birth

Decreased Birth Weight

Decreased foetal growth

In uterine growth retardation

Decreased sperm quality

Preclampsia

High blood pressure

Endothelial dysfunction

Increased blood coagulation

Systemic inflammation

Deep Venous Thrombosis

Respiratory Disease Mortality

Respiratory Disease Morbidity

Lung Cancer

Pneumonia

Upper and lower respiratory symptoms

Airway inflammation

Decreased lung function

Decreased lung growth

Joint ERS / ATS statement (in press)

Air pollution affects multiple organs

immediately and has long-term

consequences

Particulate air pollution causes 3.5 million deaths

WHO 2014

Health Effects of Fine Particles: Lines that Connect (Pope et Dockery 2006)

Mechanisms by which exposure to PM

damages our health

Brook RD 2010.

Long-term Exposure to Fine Particles

and Coronary Artery Calcification

Progression

Kaufmann et al. Lancet 2016

Developing fetus is susceptible to environmental insults

Reproductive and developmental

effects of pre-natal air pollution

- Effects on fetus

Fetal growth

Length of gestation

Congenital anomalies

Stillbirth

Neurodevelopment

Lung function

- Effects on mother

Pregnancy-induced hypertensive disorders

Gestational diabetes

The BREATHE project: BRain dEvelopment and Air polluTion ultrafine particles in scHool childrEn

Pujol

Neuroimage

2016

Economical impact by region, 2013 (World bank 2016)

Interventions: % of days above standards in Los

Angeles (US)

1976 1990 2002

75%

50%

25%

Interventions ‘cars free cities’

• Reduce vehicles in the cities

– green corridors

– Cycling lines

• More and better public transport

• Cleaner transport

Co-benefices of healthy cities

1. Reduce air pollution.

2. Pacify the environment (noise), increase

social contact and physical exercise.

3. Increase greenness and reduce local

temperature.

4. Reduce global warming.

Conclusion

•Air pollution is increasing

•Most of the population lives in polluted areas •Air pollution affects multiple organs immediately and has long-term consequences •There is time for interventions: new urban planning for healthy cities

MOLTES GRÀCIES

jordi.sunyer@isglobal.org

Some figures PM air pollution (WHO 2014, World bank 2016)

- Fourth cause of death,

- First environmental risk

- Causes around 5 million deaths (3 million PM AP)

- One out of 10 deaths (6% of deaths PM AP)

- 5.5 trillion $ (3 PM AP)

- 4.8% losses in GDP in Europe

- Reduction of PM in US has been followed of

health improvements, including an increase of life

expectancy

http://www.who.int/phe/health_topic

s/outdoorair/databases/en/ Globally, 7 million deaths were attributable

to the joint effects of household and

ambient air pollution in 2012. The Western

Pacific and South East Asian regions bear

most of the burden with 2.8 and 2.3 million

deaths, respectively. Almost 680’000

deaths occur in Africa, about 400’000 in

editerranean region, 287’000 in Europe

and 131’000 in the Americas.

Fine and ultrafine particles and

ischemic heart disease mortality 100,000 California

teachers aged 30-80

years in 1995

Exposure estimation for

4km grids based on

emission inventories

Follow-up for mortality for

2001-2007

1085 ischemic heart

disease deaths

PM2.5 UFP

Re

lative

Ris

k p

er

IQR

0,8

1,0

1,2

1,4

1,6 Single

Two-pollutant

Ostro et al. EHP 2015

Obesity in children from 5 Euro areas

BIB EDEN KANC MOBA RHEA SAB Total

Obese 4,76 1,46 7,92 0,69 10,05 8,43 5,64

Overweight 9,96 13,66 12,87 7,9 19,6 21,2 14,71

Normal 85,28 84,88 79,21 91,41 70,35 70,36 79,65

0%

20%

40%

60%

80%

100%

WHO Obesity %

Normal Overweight Obese

BIB EDEN KANC MOBA RHEA SAB Total

WtH>0.5 10,87 7,32 20,79 3,09 27,27 24,82 16,07

Normal 89,13 92,68 79,21 96,91 72,73 75,18 83,93

50%

60%

70%

80%

90%

100%

Waist-to-Height ratio >0.5

Normal WtH>0.5