AIR POLLUTION AND WEATHER-RELATED HEALTH IMPACTS: METHODOLOGICAL STUDY BASED ON SPATIO-TEMPORALLY DISAGGREGATED MULTI-POLLUTANT MODELS

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

There is a large and convincing body of epidemiological evidence linking short term exposure to outdoor air pollutants to adverse health effects. However, most of this evidence is derived from studies that have linked single pollutants to health in urban environments. There is increasing recognition that greater protection against the adverse health effects of air pollution could be achieved by focusing research and policy not on individual pollutants, but by a multi-pollutant approach. Furthermore, the spatial variation in pollutant concentrations and their health impacts, especially in rural areas and areas outside the larger cities where much of the UK population reside, are not-well established. Socio-economic impacts (and related issues of environmental justice) and other geographically-determined factors, including housing characteristics (indoor pollution), are also potential modifiers of exposure to outdoor air pollution. The increasing complexity of the scientific inquiry is matched by the difficulties of formulating, proving and implementing appropriate regulatory policy. This proposal builds upon an existing collaboration between researchers in the environmental and health disciplines, with the addition of investigators and practitioners from the policy and social science fields. Our proposal aims to provide new epidemiological evidence on the health impacts of exposure to multiple pollutants; to examine the implications of such evidence for regulation and control of air quality; and to assess how uncertainties in evidence affect its translation into actionable evidence-based policies and the evaluation of their costs and benefits. There are several unique innovations in our study: 1) the development of long series of high resolution (5 km) datasets for daily concentrations of a range of pollutants and weather data, linked to geo-referenced health data including daily mortality, hospital admissions and data on heart attacks; 2) an examination of the contribution of the indoor environment as a modifier of exposure to outdoor pollutants to provide an integrated assessment of the risks to health of short term exposure to air pollution; 3) an integrated assessment of the health effects of various near-term future air quality and climate policies in 2030 as well as selected emissions reduction policies for the UK; 4) the development of a 'decision analysis' tool that includes assessment of uncertainties and can be used to infer the likely outcomes of these various policy choices.

Publications

10 25 50
 
Title Invisible heat: 'Deep above' by Adam Chodzko 
Description Through our research on climate change and health, I supported an artwork initiative curated by Alice Sharp with initial funding from the Wellcome Trust, to develop artworks relating to climate change. One of the outputs of this initiative was a film by Adam Chodzko about psychology and climate change called 'Deep Above'. It premiered at the Watershed, Bristol, November 2015 alongside a series of debates and workshops. 
Type Of Art Artwork 
Year Produced 2015 
Impact The film has been taken on tour around the UK with screenings accompanied by debates with panels of artists, academics and scientists. These debates have focused on questions such as "The role of art and artists in considering climate change?" and "Can psychology help us to accept and act on the scientific evidence on climate change? The impact is impossible to quantify but it has helped raise debate about scientific evidence among new audiences. 
URL http://invisibledust.com/project/adam-chodzko-deep-above/
 
Description The key findings of relevance to public policy may be summarized follows:

Air pollution exposure and impacts
• Analyses of the sources of pollution show that, for particles of maximum aerodynamic diameter less than 2.5 microns (PM2.5) - those which are thought to carry the main risk for health - emissions from power generation and transport sectors are both major contributors, as is combustion in the non-industrial sector. But the largest contribution to PM2.5 air pollution across the UK overall (based on spatial average) is from the agriculture sector (relating to use of fertilizers, land management etc). Action in all these sectors is therefore important for control of particle pollution.
• Although agriculture is the largest contributor to PM2.5 concentrations spatially, it is less important a source of primary particles (i.e. those directly released into the atmosphere by wind, combustion processes, or human activities) as opposed to secondary particles derived from the oxidation of primary gases such as sulphur and nitrogen oxides into sulfuric acid and nitric acid.
• The importance of the transport sector is accentuated by the proximity of populations to emissions from this sector especially in urban areas, and they are also important for nitrogen oxides (NOx), comprising nitric oxide and nitrogen dioxide. There is emerging evidence that nitrogen dioxide may carry risks for health that are independent of those attributable to particle components of air pollution. Although the evidence does not allow precise quantification of this NO2-related health risk, it gives greater importance to action to control emissions from motor vehicles, especially diesel cars and lorries.
• Reduction of air pollutant emissions from industrial, non-industrial, transport and agriculture sources appear likely to increase atmospheric concentrations of ozone (O3), largely as a result of the reduced 'titration effect' of nitrogen dioxide (the atmospheric chemical reactions that breakdown O3). In consequence, emissions control policies over coming years are likely to exacerbate the exposure of human populations to ozone, rather than to reduce it.
• Climate change alone is likely to have only modest impacts on atmospheric pollution unless accompanied by changes in emission sources (a small effect on PM2.5, some modest local increases in NOx which may titrate more ozone, mixed effects on coarse particle fractions), but models suggest the potential for substantial increases in temperatures, especially during summer months in southern Britain: some models indicate mean July temperatures that increase by as much as 6 or 7 degrees Celsius under high emissions trajectories - which would represent a substantial hazard for public health.

Exposure patterns with socio-economic deprivation
• Most pollutants show a gradient of higher exposure with increasing socio-economic deprivation across the UK, although the variations based on 5x5 km grid average pollution levels are relatively modest (mainly a few percent difference between the least and most deprived deciles of the population). NOx, total PM2.5, primary PM2.5, and elemental carbon (EC) and organic carbon (OC) all show clear increases in concentration with greater SE-deprivation, with the greatest increases in PM2.5, primary PM2.5 and NO2 concentrations occurring from the middle of the deprivation distribution to the most deprived deciles. Ozone shows an inverse relationship with socio-economic deprivation.
• Modelling the effect of the sectoral emission sources suggests that control policies will have little effect on the socio-economic gradient in exposure patterns, and in many cases are likely to lead to a small increase in the gradient even though overall air pollution burdens would be reduced including for the most deprived populations.
• Populations in the most deprived decile of the population are estimated to have 4% greater years of life lost due to PM2.5 exposure than the least deprived group experienced. This effect is likely to be exacerbated by the higher underlying disease rates in the more socio-economically disadvantaged groups, which, in consequence carry an appreciably larger air pollution disease burden in absolute terms than less deprived groups.

Health risks
• Analyses of data from the AWESOME project on the health effects of short term exposure to particle pollution and its components suggest generally weak (and generally statistically insignificant) relationships with health outcomes. They do not add appreciably to the existing evidence base. They do however provide some mixed evidence for the adverse effects of nitrogen dioxide in relation to the risk of admission to hospital with heart attacks or other acute myocardial ischaemia.
• Analyses do confirm clear evidence for temperature related risks, however. An important new finding based on linkage of housing characteristics to epidemiological data is that vulnerability to heat risk appears to depend on the characteristics of the home in which you live. People who live in dwellings that are predicted to be more likely to overheat (have relatively high indoor temperatures during hot weather) carry an appreciably greater risk of mortality attributable to heat, especially during more extreme heat. This suggests potential for adaptations to dwellings to reduce heat exposure and associated risks to health.
• Further modelling work suggests that dwelling characteristics are appreciably more important that the urban heat island effect in determining population vulnerability to heat.

Housing as a determinant of exposure to outdoor air pollution
• Our research provided evidence that built form and building envelope characteristics of dwellings (the exposed external surface area, the internal volume, the permeability of the building fabric etc) appreciably alter the infiltration of outdoor pollution into the indoor environment. In London, older detached and semidetached dwellings had the highest indoor/outdoor pollutant ratios, modern purpose-built flats the lowest.
• Because of such differences in the ingress of outdoor pollution into the home, the dwelling form has a potentially important influence on human exposure to particle and other outdoor air pollutants, with differences of around 50% between the least and most 'leaky' dwellings.
• Such differences suggest that interventions aimed at altering the ventilation characteristics of dwellings may offer important opportunities for protecting against air pollution. However, care is need to balance the effects of protection against outdoor pollution with impacts on exposure from sources of exposure inside the home, which would increase with increased air tightness.
Exploitation Route The findings above have relevance to pollution control policies in many sectors of the economy (energy, housing, transport, agriculture etc) and suggest potentially important foci for action, including housing design and adaptations. These are relevant to government and multiple other sectors. The evidence on temperature-related risks emphasize the importance of addressing vulnerability under climate change and provide specific evidence for action in relation to housing.
Sectors Agriculture, Food and Drink,Communities and Social Services/Policy,Construction,Education,Energy,Environment,Healthcare,Government, Democracy and Justice,Manufacturing, including Industrial Biotechology,Transport

 
Description The results of the AWESOME project, both with respect to air pollution and climate impacts, have been discussed with policy makers at various levels, including the UK government, the GLA (informing aspects of the London Plan) and internationally. Research carried out for the AWESOME project also made a substantial contribution to the development of the Health Impacts of Domestic Energy Efficiency Measures (HIDEEM) tool for the UK Department of Energy and Climate Change (DECC). This included the construction of micro-environmental stock models to quantify indoor environmental conditions and calculate the monetary value of the health impact associated with energy efficiency changes in the housing stock.
First Year Of Impact 2013
Sector Construction,Energy,Environment,Government, Democracy and Justice
Impact Types Policy & public services

 
Description Air pollution, pollen, asthma and hay fever and their interactive effect on cognitive development
Amount £110,000 (GBP)
Funding ID R8/H12/83/NE/P010660/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 01/2017 
End 12/2017
 
Description Air pollution, pollen, asthma and hayfever and their interactive effect on cognitive development: environment & health data linkage feasibility study
Amount £109,851 (GBP)
Funding ID NE/P010660/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 11/2016 
End 10/2017
 
Description Atmospheric Pollution and Human Health in a Developing Megacity. Air pollution impacts on cardiopulmonary disease in Beijing: an integrated study of exposure science, toxicogenetics, and environmental epidemiology
Amount £390,973 (GBP)
Funding ID NE/N007182/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 01/2016 
End 12/2019
 
Description Climate Resilience of Care Settings
Amount £251,957 (GBP)
Funding ID NE/S016767/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 02/2019 
End 01/2020
 
Description Health Protection Research Unit on Environmental Change and Health (Kovats et al)
Amount £2,000,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2014 
End 03/2019
 
Description Health and economic impacts of urban heat islands and greenspace
Amount £499,962 (GBP)
Funding ID 216035/Z/19/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2020 
End 03/2023
 
Description Our Planet, Our Health
Amount £149,988 (GBP)
Funding ID 205207 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 12/2016 
End 11/2017
 
Description Our Planet, Our Health
Amount £5,130,000 (GBP)
Funding ID Complex Urban Systems for Sustainability and Health 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 02/2018 
End 01/2022
 
Description Warmth & Wellbeing pilot
Amount € 119,792 (EUR)
Organisation Irish Department of Communications, Marine and Natural Resources 
Start 04/2016 
End 03/2020
 
Description Wellcome Trust Sustaining Health: Optmization of health and sustainability goals for low income housing (Optihouse)
Amount £269,041 (GBP)
Funding ID 106895/Z/15/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2015 
End 03/2018
 
Description Wellcome Trust Sustaining Health: Sustainable Healthy Urban Environments (SHUE)
Amount £261,037 (GBP)
Funding ID 103908 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2014 
End 04/2017
 
Title Methods for quantifying temperature-health relationships 
Description Contribution to the advancement of methods for quantifying temperature-health impact relationships 
Type Of Material Model of mechanisms or symptoms - mammalian in vivo 
Year Produced 2013 
Provided To Others? Yes  
Impact Contribution to the scientific methods deployed for characterizing heat and cold-related impacts 
 
Title Model of the health impact of housing characteristics and health 
Description A model of the relationship between dwelling characteristics/adaptations, the indoor environment and health. Initiated by research funded by Department of Energy and Climate Change, but substantially developed, extended and applied through subsequent projects. Main application is to examine the potential impact of energy efficiency and similar interventions on human exposures. Based on combination of building physics and health impact models. 
Type Of Material Computer model/algorithm 
Provided To Others? No  
Impact Has been used by the Department of Energy and Climate Change in analysis of policy options relating to the health impact associated with energy efficiency changes in the housing stock. Has also been integrated with the National Household Model (NHM) run by the Centre for Sustainable Energy. Results from the model have helped to characterize the importance of housing characteristics as a modifier of exposure to outdoor pollutants, and as modifiers of vulnerability to outdoor temperature during periods of heat and cold. 
 
Description 2015 Annual UK Review Meeting on Outdoor and Indoor Air Pollution Research 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Annual meeting (jointly sponsored by NERC) to discuss air pollution research attended by researchers, officials from government departments, local authority representatives and others. Also included open meeting on Health Impact Assessment for air pollution. Sparked discussion about the implications of key messages.
Year(s) Of Engagement Activity 2015
 
Description Commons Select Committee Hearing on DEFRA role in tackling air quality 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This was a Hearing of the Environment, Food and Rural Affairs Select Committee, considering the role of DEFRA's strategy in tackling air pollution. I was one of three academic researchers who made presentations (mainly about our recent research but also on the field more generally tailored to current debates) and answered questions from Committee members, as well as providing written evidence. Not possible to interpret whether there has been discernible impact on policy positions.
Year(s) Of Engagement Activity 2015
URL http://www.parliament.uk/business/committees/committees-a-z/commons-select/environment-food-and-rura...
 
Description Conference presentation: Healthy cities conference (Manchester) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation stimulated discussion and questions on urban development needs and implications for health.

Interest from various audience with research and policy interest in learning more about project.
Year(s) Of Engagement Activity 2014
 
Description IPCC International Expert Meeting on Human Settlement and Infrastructure 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Expert group considering issues relating to climate change vulnerability and responses related to human settlements as part of the Intergovernmental Panel on Climate Change consultation process. Kolkata, March 22-24, 2011

This was an evidence gathering symposium for IPCC reports
Year(s) Of Engagement Activity 2011
 
Description International seminar & training on sustainable urban development and healthy cities 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This was an international seminar on sustainable and healthy cities, held in Beijing, 10 November 2017. Co-organized by the National Development and Reform Commission (NDRC) and National Patriotic Health Campaign Office of China, the World Health Organization(WHO) and China Center for Urban Development(CCUD), with support from Institute for China Sustainable Urbanization, Tsinghua University. Over a hundred participants joined the seminar including members of the China International Cities Development Alliance(CICAD), city mayors, representatives of the local development and reform commissions(DRCs), representatives of international organizations, well-known experts and scholars at home and abroad, and entrepreneurs, and discussed over healthy city and sustainable development planning. Debated issues relating to air pollution, climate change and other environment and health issues, and implications for public policy.
Year(s) Of Engagement Activity 2017
URL http://www.urban-eu-china.eu/en/event/2017-international-seminar-on-sustainable-and-healthy-cities-h...
 
Description Media interview, CNN Asia 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This was a ten minute breakfast news interview at CNN Asia on the dual challenges of air pollution and climate change ahead of the Heads of States meeting of the Association of South East Asian (ASEAN) countries. The impact is difficult to judge, but it was intended as a contribution to public debate about key areas of public policy relating to environment and health.
Year(s) Of Engagement Activity 2015
 
Description Open meeting: Select Committee of the Senate of the Philippines 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was an open hearing/debate at the Senate of the Philippines (the Philippines parliament) on Balancing Energy, Health and the Climate Challenge. It was attended by a wide array of contributors, including senators, members of the public, NGOs, industry representatives and others to discuss key policy challenges relating to air pollution, climate change and other environmental health impacts in energy, transport, agriculture and other policy areas. My participation was sponsored by the Foreign and Commonwealth Office, and I spoke about evidence from our UK research alongside Chairpersons of Senate Committees on Energy, Climate Change, Health and Demography, as well as representatives of the Climate Change Commission, the Environmental Management Bureau, The World Health Organization, local campaigners of Health Care Without Harm-Asia, the UK Ambassador and others. It prompted a vigorous debate about policy development in the Philippines and Asia more generally, with particular focus on the run up to the UN Framework Convention on Climate Change meeting in Paris, in November 2015.
Year(s) Of Engagement Activity 2015
 
Description Parliamentary Office for Science and Technology briefing 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This was a 90 minute briefing session hosted by the Parliamentary Office for Science and Technology, at Portcullis House. The event ("Air Quality - an integrated understanding of health risks ") was chaired by Baroness Manningham-Buller, and took the form of a working breakfast where MPs and Peers were able to discuss science and policy issues relating to new knowledge on the interconnections and pathways between air pollutants and stressors, exposure routes and health effects in humans. I was one of several researchers given opportunity to speak for five minutes before answering questions, alongside DEFRA, PHE and third sector representatives. As follow-up, I was asked to attend a subsequent Select Committee hearing.
Year(s) Of Engagement Activity 2015
 
Description Pint of Science public engagement 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Pint of Science evening event held at 'The Astronomer', 17 May 2017, on climate change and health (and the health consequences of CC mitigation) designed to stimulate debate with the public. Attended by around 40 people to discuss what our own and more general science tells us about the needed responses to climate change and the associated implications for health, including 'co-benefits'.
Year(s) Of Engagement Activity 2017
 
Description Policy-maker briefing, Jakarta, Indonesia 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This was a "Road-to-Paris public coffee morning", organized jointly by the UK Embassy and local officials to discuss matters relating to health aspects of climate change and air pollution ahead of the COP21 conference, and including a lunch meeting with the Indonesian President's Special Envoy for Climate Change. I gave the 'keynote talk' about research evidence. It is impossible to judge what weight it carried in the development of government strategy, but there was wide recognition of the the potential benefits for health of more sustainable development strategies in various areas of government policy. Audience was interested in hearing new evidence about potential health gains. That does not necessarily equate with any shift in policy positions, but it probably reinforced the UK's efforts.
Year(s) Of Engagement Activity 2015
 
Description Presentation to LWEC-sponsored event: the AWESOME project 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Meeting was mainly aimed at information exchange among current reseasrchers with projects relevant to the EEHI and Living with Envrioinmental Change initiatives. There was discussion among the group about methods and emergent findings.

There was interest from various workshop participants in learning more about the project and the potential implications of its findings especially for health policy.
Year(s) Of Engagement Activity 2014
 
Description Public lecture, Manila College of Public Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Open lecture at the University of the Philippines Manila College of Public Health attended by university staff and students, Philippine Society of Sanitary Engineers, British Embassy staff, representatives of Health Care Without Harm and others. Engendered vigorous discussion (air pollution, energy, development).
Year(s) Of Engagement Activity 2015
 
Description Scientific conference presentation: associations between air pollutants and socio-economic status in England 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Presentation provoked considerable discussion with other researchers and policy groups.

There was interest in exchanging findings and methods from other research groups, and requests from NGO groups in being kept informed about the work of the project and its results.
Year(s) Of Engagement Activity 2014
URL http://depts.washington.edu/uwconf/isee2014/
 
Description Scientific conference presentation: modelling the modifying effect of homes on population exposure to outdoor pollution 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Sparked discussion on the importance of taking account of the modifying influence of housing for exposure to temperature and air pollution, and the relevance of such factors to policy interventions.

Interest from other researchers in learning more about the methods. Discussion with policy makers about relevance to policy development.
Year(s) Of Engagement Activity 2014
URL http://depts.washington.edu/uwconf/isee2014/