Air Pollution Impacts on Cardiopulmonary Disease in Beijing: An integrated study of Exposure Science, Toxicogenomics and Environmental Epidemiology

This proposal aims to do a comprehensive evaluation of air pollution health impacts on cardiopulmonary health through integration of exposure, epidemiology, and toxicology/toxicogenomic studies. We will do detailed assessments of people's exposure to air pollution, estimating exposures for long- and short-term epidemiological analyses, and linking these to epidemiological analyses of long term health impacts based on a cohort study, short-term effects (i.e. biomarkers, blood pressure, heart rhythm, peak flow) based on a panel study, and early life effects based on a birth cohort. Additionally, we test the effect of reducing exposure to fine particles, but not gases, by designing an intervention study where volunteers will wear a face mask and examining the exposure-response relationship for the same short-term effects we evaluate in the panel study. The short-term physiological measurements we conduct in the epidemiological studies will provide insight into the mechanisms by which air pollutions affects cardiopulmonary health. To complement the human based studies into mechanisms of action, our project will also conduct extensive in vivo analyses of mechanistic effects, and early life toxicogenomics/metabonomics. Finally, we will provide practical advice to stakeholders based on our study findings, by assessing the potential value of selected strategies for control of exposure to outdoor health protection in a health risk assessment.

Who will benefit and how?
The immediate beneficiaries will be the environmental and health regulatory agencies in China, (e.g., the State Environment and Health Working Group, the Ministry of Environmental Protection, and the National Health and Family Planning Commission) and Beijing in particular (e.g., Beijing Municipal Environmental Protection Bureau), responsible for mitigation of adverse air quality in China. The citizens of China will gain immediate health and well-being benefit from mitigation actions implemented as a result of findings from this project in association with findings form the other projects within this directed research programme. Health workers and other academics will benefit from the new information we generate on adverse effects on the cardiopulmonary system caused by air pollution generally and by specific pollutants and sources.

How will they benefit?
The proposed research will provide better understanding of the role of specific pollutants and sources, their mechanisms of action, and the likely effectiveness of interventions to reduce personal exposures. Our research is geared not only towards advancement of scientific knowledge about how high levels of air pollution from sources in Beijing impact cardiopulmonary health on a mechanistic level, but also on determining the impact of interventions on health through experimental design and modelling. In particular, we focus on examining the health effects of air pollution on susceptible populations with cardiovascular and reversible airway disease and the efficacy of measures that can be taken by citizens to reduce their exposure. Additionally, through the understanding that we will gain about where people are most exposed and the source types that contribute to their total personal exposure, we will provide information that can be used to more effectively target interventions - on a regional, local, residential, and individual level.
Regulatory agencies will benefit from this information so that they can design pollution, exposure, and health reduction strategies in a more cost-effective manner, and citizens, especially those with existing cardiovascular and respiratory disease, will benefit from the recommendations of personal-level strategies that we will investigate. Our project will provide information that can be considered by Theme 4 in developing practical policy solutions to reduce air pollution exposures.
Health workers will benefit from the new information we generate through the laboratory models and population studies; new understanding of the inter-relationships between exposure biomarkers, effect biomarkers and susceptibility biomarkers in the population, under conditions of Chinese mega-cities with identification of potentially susceptible subgroups with cardiopulmonary disease; improved understanding of the mechanisms of action or cardiopulmonary toxicity; and knowledge on how a relatively simple intervention to reduce personal exposure may improve short-term health effects, from which benefits of longer-term personal exposure reduction can also be inferred.

Dissemination
We will work with the other Theme 3 project on health effects and with the atmospheric pollution themes (1 and 2) and Theme 4 (Solutions) on developing workshops and stakeholder consultations to disseminate our information to regulatory authorities, non-governmental organisations, and other relevant stakeholders. These will be led by our Chinese partners. In addition, to the standard academic channels of dissemination through journal articles and conferences, we will develop information materials that can be distributed to patients on the health impacts of air pollution and means that they can take to reduce their exposures. These materials will be made available through hospitals and doctors.