Potential health cobenefits related to mitigation of air

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Potential health co-benefits related to mitigation of air pollution from wood burning: A systematic

Potential health co-benefits related to mitigation of air pollution from wood burning: A systematic review & health impact assessment case study in Athens, Greece JENNIFER BAILEY CLIMATE SCIENCE & POLICY SYMPOSIUM JUNE 9, 2017

Wood Burning & Climate Change GHG emissions contribution to climate change ◦ 47% of

Wood Burning & Climate Change GHG emissions contribution to climate change ◦ 47% of the increase in annual anthropogenic GHG emissions due to energy supply Wood as an energy source ◦ “carbon-neutral” as opposed to fossil fuels Burning wood produces: ◦ Smoke made up of gases (carbon monoxide, carbon dioxide) ◦ Particulate matter (PM) ◦ Black carbon Climate change mitigation policies targeting specific sources have environmental and health cobenefits

Wood Burning & Human Health impacts of PM: ◦ Mortality ◦ Aggravation of respiratory

Wood Burning & Human Health impacts of PM: ◦ Mortality ◦ Aggravation of respiratory and cardiovascular morbidity Ambient PM 2. 5 ranked 5 th as a mortality factor (2015) ◦ Exposure caused 4. 2 million deaths ◦ 7. 6% of total global deaths Other factors impacting air quality: ◦ Population growth ◦ Urban concentration ◦ Climate change Inequity in impacts of air pollution on vulnerable and exposed groups

Purpose Source-specific policies to address air quality, health, and indirectly climate change ◦ Multi-disciplinary

Purpose Source-specific policies to address air quality, health, and indirectly climate change ◦ Multi-disciplinary actors to maximize cost-effectiveness EU funded project: “the European network for observing our changing planet” ◦ Dedicated 1 strand: “Smart and Urban Solutions for air quality, disasters and city growth (SMURBS)” Background research for SMURBS project with a specific case study on Athens, Greece Athens Institute for Education & Research (ATINER) Public Health Conference: June 19 -22, 2017

Why Athens, Greece?

Why Athens, Greece?

Case Study: Athens, Greece Impact of the global financial crisis (2008): ◦ ◦ 23%

Case Study: Athens, Greece Impact of the global financial crisis (2008): ◦ ◦ 23% unemployment Negative GDP Austerity measures High price of oil and liquid fuels Urban pressure: ◦ 39% of total population of Greece lives in Athens ◦ Estimated 50, 000 migrants staying on the mainland ◦ Densely populated regions shown to have poor air quality Climate change impacts: ◦ Impede economic activity and negatively/disproportionately impact human health

Methods Using health impact assessment (HIA) methodology to quantify health benefits of reducing PM

Methods Using health impact assessment (HIA) methodology to quantify health benefits of reducing PM from wood burning Two different approaches: 1. Main analysis quantifying health benefits of policies instituted 2. Impact of intervention policies on vulnerable populations

Main Analysis (1) Intervention Reduced PM Exposure (2) Current PM Exposure (3) Exposure Difference

Main Analysis (1) Intervention Reduced PM Exposure (2) Current PM Exposure (3) Exposure Difference (4) Exposure Response Function (ERF) (5) Relative Risk (RR) Exposure Difference (6) Prevented health outcome

Main Analysis (1) Intervention Reduced PM Exposure (2) Current PM Exposure (3) Exposure Difference

Main Analysis (1) Intervention Reduced PM Exposure (2) Current PM Exposure (3) Exposure Difference (4) Exposure Response Function (ERF) (5) Relative Risk (RR) Exposure Difference (6) Prevented health outcome

Results: Systematic Literature Review successful intervention unsuccessful intervention

Results: Systematic Literature Review successful intervention unsuccessful intervention

Results: Meta-Analysis

Results: Meta-Analysis

Results: Main Analysis Pooled estimates from intervention studies (1) Intervention Reduced PM Exposure (2)

Results: Main Analysis Pooled estimates from intervention studies (1) Intervention Reduced PM Exposure (2) Current PM Exposure (3) Exposure Difference (4) Exposure Response Function (ERF) (5) Relative Risk (RR) Exposure Difference (a) Health outcome: average daily non -accidental mortality from Stafoggia et al. (2017) (6) Prevented health outcome: 0. 44 (95% CI: 0. 05 - 1. 47) From Stafoggia et al. (2017)

Secondary Analysis Hypothetical reduction from 0 -30% (1) Intervention Reduced PM Exposure (2) Current

Secondary Analysis Hypothetical reduction from 0 -30% (1) Intervention Reduced PM Exposure (2) Current PM Exposure (3) Exposure Difference (4) Exposure Response Function (ERF) (5) Relative Risk (RR) Exposure Difference (a) Health outcome: average daily non -accidental mortality from study within Athens, Greece (2017) (6) Prevented health outcome From Forastiere et al. (2007) Measurements in Athens, Greece (2015)

Results: Secondary Analysis

Results: Secondary Analysis

Discussion - Athens, Greece Wood burning contribution to total PM: ◦ PM 10: 1.

Discussion - Athens, Greece Wood burning contribution to total PM: ◦ PM 10: 1. 4 -7% ◦ PM 2. 5: 11% Current policy: ◦ Common ministerial recommendation to not burn wood on days with elevated PM Intervention in Athens ◦ Prevent 0. 44 daily deaths ◦ Low SES benefit 15 times as much as high SES groups Is an intervention policy economically viable? ◦ Return on investment for health intervention studies is 34 to 1 ◦ Christchurch, New Zealand : Net benefits = 750 million Euros

Conclusion Provides local-policy makers with information to put forth a no-regret policy that supports:

Conclusion Provides local-policy makers with information to put forth a no-regret policy that supports: 1. Human health benefits ◦ ◦ Prevent 0. 44 (95% CI: 0. 05 -1. 47) daily deaths Conservative estimate 2. Reduces social inequality ◦ The lower SES groups benefit 15 x as much as high SES in terms of prevented mortality 3. Cost-effectiveness ◦ Expected to be very cost-beneficial 4. Sustainable development ◦ ◦ Reducing pollutants that contribute to climate change Improve local air quality and environmental health

Tarik Benmarhnia, Ph. D | Committee Chair & Expert Advisor Evangelos Gerasopoulos, Ph. D

Tarik Benmarhnia, Ph. D | Committee Chair & Expert Advisor Evangelos Gerasopoulos, Ph. D | Expert Advisor Acknowledgements Ellie Farahani, Ph. D | Committee Member Lynn Russell, Ph. D | Committee Member CSP Cohort

QUESTIONS?

QUESTIONS?

References Intergovernmental Panel on Climate Change. (2015). Climate change 2014: synthesis report (R. K.

References Intergovernmental Panel on Climate Change. (2015). Climate change 2014: synthesis report (R. K. Pachauri & L. Mayer, Eds. ). Intergovernmental Panel on Climate Change. (2014). 2013: Anthropogenic and Natural Radiative Forcing. In Climate Change 2013: The Physical Science Basis: Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Kovats, R. , Valentini, L. , Bouwer, E. , Georgopoulou, E. , Jacob, D. , Martin, M. , . . . Soussana, J. (2014). 2014: Europe. In: Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part B: Regional Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (Tech. Rep. ). Intergovernmental Panel on Climate Change. Kassomenos, P. A. , Dimitriou, K. , & Paschalidou, A. K. (2013, August). Human health damage caused by particulate matter PM 10 and ozone in urban environments: the case of Athens, Greece. Cohen, A. J. , Brauer, M. , Burnett, R. , Anderson, H. R. , Frostad, J. , Estep, K. , . . . Forouzanfar, M. H. (2017, May). Estimates and 25 -year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. UNdata | country profile | Greece. (n. d. ). Hellenic Statistical Authority. (2016, December). Population and Social Conditions. Labour Force (Monthly Data). UNHCR. (2017 a, January). Greece Factsheet January 2017 (Tech. Rep. ). United Nations High Commissioner for Refugees. Chen, B. , & Kan, H. (2008, March). Air pollution and population health: a global challenge. Strand 1 - Smart cities and resilient societies. (2016).

References World Health Organization (Ed. ). (2006). Air quality guidelines: global update 2005: particulate

References World Health Organization (Ed. ). (2006). Air quality guidelines: global update 2005: particulate matter, ozone, nitrogen dioxide, and sulfur dioxide. Mueller, N. , Rojas-Rueda, D. , Basagaña, X. , Cirach, M. , Cole-Hunter, T. , Dadvand, P. , . . . Nieuwenhuijsen, M. (2016, June). Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities. Lunet, N. (Ed. ). (2012). Epidemiology - Current Perspectives on Research and Practice. Forastiere, F. , Stafoggia, M. , Tasco, C. , Picciotto, S. , Agabiti, N. , Cesaroni, G. , & Perucci, C. A. (2007, March). Socioeconomic status, particulate air pollution, and daily mortality: Differential exposure or differential susceptibility. Stafoggia, M. , Schneider, A. , Cyrys, J. , Samoli, E. , Andersen, Z. J. , Bedada, G. B. , . . . Forastiere, F. (2017, March). Association Between Short-term Exposure to Ultrafine Particles and Mortality in Eight European Urban Areas. Ministry of Environment & Energy. (2015). Data Measurements. Ifanti, A. A. , Argyriou, A. A. , Kalofonou, F. H. , & Kalofonos, H. P. (2013, November). Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care. PM Speciation and Source Apportionment (LIFE 11/ENV/ES/584 No. 4). (2016, December). Masters, R. , Anwar, E. , Collins, B. , Cookson, R. , Capewell, S. , 2017. Return on investment of public health interventions: a systematic review. Arthur Grimes, Time Denne, Philippa Howden-Chapman, Richard Arnold, Lucy Telfar-Barnard, Nicholas Preval, & Chris Young. (2012, June). Cost Benefit Analysis of the Warm Up New Zealand Programme (Final Report).

Pooled estimates from intervention studies (1) Intervention Reduced PM Exposure: 23% (95%CI: 19%, 27%)

Pooled estimates from intervention studies (1) Intervention Reduced PM Exposure: 23% (95%CI: 19%, 27%) (2) Current Exposure: PM 10: 36 (μg/m 3) (95%CI: 15, 57) (3) Exposure Difference: 8. 28 (μg/m 3) (95%CI: 2. 85, 15. 39) (4) Exposure Response Function (ERF): 0. 66% (95%CI: 0. 28, 1. 04) increase in mortality risk per 10 μg/m 3 increase in PM 10 (5) Relative Risk (RR) Exposure Difference: 0. 55% (95%CI: 0. 08, 1. 6) (a) Health outcome: average daily non-accidental mortality from study within Athens, Greece (2017) (6) Prevented average daily deaths: 0. 44 (95%CI: 0. 05, 1. 47) From study within Athens, Greece (2017)