Health impact of outdoor air pollutantsSome Cases

Presented By: Surendra Bam

Outline
London 2012 Olympics: Could Air Quality Affect Athlete Performance?

Air Pollution: Urgent cause for concern in India.

Health Impact of Outdoor Air Pollution in China: Current Knowledge and Future Research Needs.

Health Effects of Outdoor Air Pollution in Developing Countries of Asia: A Literature Review
Air quality and health (WHO Media centre) Air Quality Index (AQI), USEPA References

London 2012 Olympics: Could Air Quality Affect Athlete Performance?

United Kingdom

Figure 1: Map of Europe showing the exceedances of the annual limit value for NO2 in 2009. Graphic reproduced from European Environment Agency (2011).

Source: www.decodedscience.com

 Air pollution has been linked with adverse health effects in London since the 1952 smog event. The effect of air pollution on athletes has been a concern since the 1984 Los Angeles Olympics, when British Steve Ovett collapsed following the 800m final with respiratory problems. He cited air pollution as a major contributing factor to his episode of exerciseinduced asthma.

How Could Athletes be Affected at the Olympic Games?

Potential health problems resulting from exposure to air pollutants during exercise include cardiovascular complaints, decreased performance, asthma, decreased lung function, and pulmonary hypertension. Athletes are especially susceptible to health effects from air pollution for four main reasons: a) During exercise an increased volume of air is inhaled in comparison to periods of rest. b) In response to this exertion, more air is inhaled through the mouth than when at rest. The mouth lacks the filter systems of the nose which remove pollution before it can reach the lungs. c) The increased air flow during exercise means that pollutants travel deeper into the lung. d)The fraction of particulate matter that is deposited during exercise (i.e. during increased tidal volume) is higher than during periods of rest (i.e. lower tidal volume).

 The most common chronic medical condition among athletes is asthma (or airway hyper-responsiveness), with about 8% of athletes affected. The effect is greatest for outdoor endurance athletes in a number of cases, athletes who did not suffer from asthma in their childhood went on to develop asthma following years of athletic training.
A recent study which investigated marathon times and the link with air pollution has shown that women have a greater vulnerability to this issue.

Air Pollution: Urgent cause for concern in India

(Source: www. healthindia.com) This year an Environment Performance Index (EPI) report placed India at the bottom of the 132 countries assessed. Air in some Indian cities has particulate matter (PM) levels 5 times above safety limits.

 Acute respiratory infections account for 13% deaths in hospitalized children in India. Recently WHO declared a direct link between diesel exhaust and cancer raising further alarm bells regarding Indias growing public health concerns. In India, PM10 levels are the biggest cause of health concern. In 2007, nearly 52% (63) cities were at critical PM10 levels (1.5 times limit).

Health Impact of Outdoor Air Pollution in China: Current Knowledge and Future Research Needs
(Source: Environ Health Perspect. May, 2009)

Currently, inhalable particles; PM10, SO2, and nitrogen dioxide (NO2) are the criteria pollutants of concern in China. Outdoor air pollution has become a major concern for public health. The World Bank (2007) estimated that the total health cost associated with outdoor air pollution in urban areas of China in 2003 was between 157 and 520 billion Chinese yuan, accounting for 1.23.3% of Chinas gross domestic product.

 A recent multicity time-series analysis in Hong Kong, Shanghai, and Wuhan provided further evidence of short-term risks (Wong et al. 2008), with significant health effects detected at air pollution levels below minimum air quality standards in China.
Several prospective cohort studies in North America and Europe have estimated effects of long-term exposure to air pollution on mortality (Pope and Dockery 2006), but it is not clear whether the findings from developed countries apply to China, given differences in the levels and characteristics of air pollution, and in sociodemographic characteristics.

Health Effects of Outdoor Air Pollution in Developing Countries of Asia: A Literature Review
Systematic identification of 140 peer-reviewed Asian studies 19802003 Special focus on studies of daily changes in air pollution and health

Conduct first ever Asian meta analysis quantifying risks, finding initial similarities with West
Identify knowledge gaps to guide future research Active communication to policy makers

Many Health Effects Studied

12 10

Number of Studies

8 6 4 2 0
All-Cause Mortality Respiratory Mortality Cardiovascular Mortality Respiratory Hospital Admissions Cardiovascular Hospital Admissions

TSP PM10 PM2.5 SO2 NO2 CO O3

Outcome Diagnosis

Daily Mortality: Initial Results: Asian Risk Estimates Similar to West

Air quality and health

WHO Media centre (September 2011)
The WHO Air quality guidelines represent the most widely agreed and up-to-date assessment of health effects of air pollution, recommending targets for air quality at which the health risks are significantly reduced. The Guidelines indicate that by reducing particulate matter (PM10) pollution from 70 to 20 g/m , we can cut air quality related deaths by around 15%. Urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year. Those living in middle-income countries disproportionately experience this burden.

WHO Air quality guidelines (AQGs), 2005

Outdoor Air pollutants PM2.5 WHO Guideline values 10 g/m3 annual mean 25 g/m3 24-hour mean 20 g/m3 annual mean 50 g/m3 24-hour mean 100 g/m3 8-hour mean 40 g/m3 annual mean 200 g/m3 1-hour mean

PM10

O3 NO2

(SO2)

20 g/m3 24-hour mean 500 g/m3 10-minute mean

 The

Air Quality Index (AQI) is an index for reporting daily air quality. It tells you how clean or polluted your air is, and what associated health effects might be a concern for you. The AQI is calculated for four major air pollutants regulated by the Clean Air Act: ground level ozone, particle pollution, carbon monoxide, and sulfur dioxide.

How Does the AQI Work?

Think of the AQI as a yardstick that runs from 0 to 500. The higher the AQI value, the greater the level of air pollution and the greater the health Impact. An AQI value of 100 generally corresponds to the national air quality standard for the pollutant, which is the level EPA has set to protect public health.

 AQI is divided into six levels of health concern:

Meaning
Air quality is considered satisfactory, and air pollution poses little or no risk Air quality is acceptable; however, for some pollutants there may be a moderate health concern for a very small number of people who are unusually sensitive to air pollution. Members of sensitive groups may experience health effects. The general public is not likely to be affected.

Everyone may begin to experience health effects; members of sensitive groups may experience more serious health effects. Health warnings of emergency conditions. The entire population is more likely to be affected. Health alert: everyone may experience more serious health effects

Source: www.airnow.gov.

 Each day, monitors record concentrations of the major pollutants at more than a thousand locations across the country. These raw measurements are converted into a separate AQI value for each pollutant standard formulas developed by EPA. Many cities also provide reporting and forecasts for the next days AQI. These forecasts help local residents protect their health by alerting them to plan their strenuous outdoor activities for a time when air quality is better.

References
Environ Health Perspect. 2009 May www.airnow.gov. WHO Media centre (Updated September 2011) WHO Air quality guidelines (AQGs), 2005 www.decodedscience.com www. healthindia.com