A presentation made at the 2015 NC BREATHE Conference by Jason West, PhD of University of North Carolina - Chapel Hill. Sponsored by Clean Air Carolina and partners, the 2015 NC BREATHE Conference was held on March 27, 2015 in Raleigh, NC to bring together air quality researchers, medical and public health professionals, and policymakers to share the latest research on the health impacts of air pollution, the positive health outcomes related to clean air policy-making, and the resulting economic benefits.

1. Air Pollution: What are the health risks
at current levels in the U.S?
Junfeng (Jim) Zhang
Professor of Global and Environmental Health

3. NOx SIP call
RVP phased in
The NAAQS - getting better all the time
Bachmann 2007;57:652-97

4. Fine-Particulate Air Pollution and Life Expectancy in
the United States. Arden Pope, III, Ph.D., Majid Ezzati, Ph.D.,
and Douglas W. Dockery, Sc.D N Engl J Med 2009;360:376-86
Reductions in air pollution accounted for up
to 5 months or 15% of total increased life
expectancy (2.7 years) since 1970 Clean Air
Act.
4

5. What are risks at current levels?
• For mortality:
– Short-term increases in mortality
– Longer-term increases in mortality
• For morbidity:
– Diverse adverse respiratory effects
– Adverse cardiovascular effects
– Other effects: reproductive, etc

7. -2.00 -1.00 0.00 1.00 2.00 3.00 4.00
% change
Chicago
Minneapolis
Colorado Springs
New Haven
St. Paul
Overall
Tacoma
Spokane
Seattle
Tucson
p < 0.05
Schwartz
1999
Schwartz
1997
% Change in daily emergency admissions for
cardiovascular disease associated with a 10
µg/m3 increase in daily PM10 concentration

8. Air Pollution and Reproductive
Effects
0
20
40
60
80
100
120
140
160
180
RecordCount
Publication Year *partial year data
PubMed search string: ("air pollution"[MeSH Terms] OR ("air"[All Fields] AND "pollution"[All Fields]) OR "air pollution"[All Fields]) AND
("reproduction"[MeSH Terms] OR "reproduction"[All Fields] OR "reproductive"[All Fields])
*

12. SCIENTIFIC AND POLICY CHALLENGES

13. The Narrowing Range of Exposure
PM level
NAAQS 1971
Risk
NAAQS 1987
NAAQS 1997
NAAQS 2006
Policy-Related
Background
National Ambient Air Quality Standards
http://www.epa.gov/ttn/naaqs/standards/pm/s_pm_index.html

14. What is the Form of the Concentration-Response
Relationship?
Concentration
Risk
Sublinear
Supra-linear
Linear, Threshold
Linear, No-threshold
Policy Implication: For the same amount of risk reduction, different
amount of concentration reduction is needed under different shapes of
concentration-response curves.

15. Air Pollution & Health
J. Jason West
Dept. of Environmental Sciences & Engineering
Univ. of North Carolina, Chapel Hill

16. How do we understand air pollution?
WRF
Met model
SMOKE
Emission
processor
CMAQ
Air quality
model
Burden of
disease
model
Recommendations for
future measurements
Emissions
inventories
Met
measurements
AQ, satellite
measurements
Emissions Concentrations Health
Effects
Exposure

17. 17
Global mortality burden – ACCMIP
ensemble
Ozone-related mortality PM2.5-related mortality(*)
470,000 (95% CI: 140,000 - 900,000) 2.1 million (95% CI: 1.3 - 3.0 million)
(*) PM2.5 calculated as a sum of species (dark blue)
PM2.5 as reported by 4 models (dark green)
Light-colored bars - low-concentration threshold (5.8 µg m-3)
Silva et al. ERL 2013

18. 18
Global Burden: PM2.5-related mortality
CPD+LC mortality , deaths yr-1 (1000
km2)-1,
multi-model mean in each grid cell , 6 models
Global and regional mortality per year
Regions
Total
deaths
Deaths
per
million
people
(*)
North America 43,000 152
Europe 154,000 448
Former Soviet
Union
128,000 793
Middle East 88,700 371
India 397,000 715
East Asia 1,049,000 1,191
Southeast Asia 158,000 564
South America 16,800 92
Africa 77,500 327
Australia 1,250 78
Global 2,110,000 665
1
(*) Exposed population (age 30 and
older)
Silva et al. (2013)

19. Brauer et al., 2012
Combining multiple data streams:
measurements, model, satellite

20. Global burden of disease of outdoor air pollution
Lim et al., 2012
3.2 million deaths per year
(95% CI:2.8 – 3.6 million)
WHO GBD 2010

21. Some uncertainties
• Sources – understanding difficult sources
like fires, windblown dust, residential
sources.
• Chemical mechanisms – improve complex
processes like SOA formation, PM size-
composition.
• Observations – lack of observations in rural
regions, new opportunities with satellites.

22. US Policy-relevant analyses
Analysis of
individual sector
contributions to
US air pollution
mortality.
Fann et al., EST, 2013

23. Co-benefits of global GHG mitigation
for air quality and health
Avoided air pollution-related deaths
from global GHG reductions:
2030: 0.5 ± 0.2 million yr-1
2050: 1.3 ± 0.5
2100: 2.2 ± 0.8
2030
Monetized health co-benefits
(blue & red) vs. cost of GHG
reduction (green):
West et al., NCC, 2013

24. Better relating atmospheric science and health impacts
• Communities need to work together more!
– Use models and satellites to estimate
exposure for epidemiologic studies.
– Better measure key pollutants of interest
(ultrafine PM, chemical components of PM,
metals).
– Estimate air pollution by source for
epidemiologic studies.
– Better relate “ambient concentration” with
personal exposure to drive health studies.

25. Goal for Today’s Discussion
Identify 3-5 recommendations and
opportunities to improve scientific
understanding of air pollution and its health
effects.
• Foci – a city, NC, USA, global
• Aspects of science – understanding sources,
atmospheric processes, mechanisms of health
impacts, epidemiology.
• Links with other problems – climate change,
mobility, energy, economics, related health
effects.

26. Science & Health Recommendations
• Communication of science to public & policy
– what is the nugget?
– Make it personal
– Citizen science, ozone gardens, daily air pollution communication
– Overcoming scientific demoralism
– How to visualize air quality & health effects?
– Training scientists to communicate. Use communication professionals.
• Analysis inspired by policy
– Importance of different sectors, sources
– Agriculture is underappreciated & undercontrolled in NC
• Improving health effects studies
– Take advantage of key health data (NC DETECT)
– Relation of air pollution with precursors of disease (anxiety, pain, mood, obesity)
– Susceptible populations
– Analysis of Mixtures, pollutant properties
– Citizen science
– Effects of bioaccumulation, understand toxicity.
• Atmospheric scientists and health scientists working together better
– Better methods to work across scales.
– Provide info on sources.
• Plan for interventions to prevent health effects
– Diet & exercise as mitigating factor.
– Working with susceptible populations