1. Health Benefits of Improving Air
Quality
Clean Air – the Continuing Public Health Challenge
Dublin Institute of Technology
June 27, 2012
Douglas W. Dockery
Professor of Environmental Epidemiology
Harvard School of Public Health

2. Reform Environmental
Regulation
 As president, Mitt Romney will
eliminate the regulations
promulgated in pursuit of the Obama
administration’s costly and ineffective
anti-carbon agenda.
 Romney will also press Congress to
reform our environmental laws to
ensure that they allow for a proper
assessment of their costs.
http://www.mittromney.com/issues/regulation

3. Benefits and Costs of Federal Regulations in US
 Largest estimated benefits
of ALL Federal Regulations
attributable to the
reduction in public
exposure to a single air
Other
pollutant: fine particulate
matter.
 Clean Air Fine Particulate
Implementation
Mortality
 Benefits ($ Millions/year)
 $19,00 to $167,000
 Costs ($ Millions/year)
 $ 7,000

4. What is Fine Particulate Air
Pollution?
 Anything collected on a filter
 Solid particles or liquid droplets
 Not gases
BS - Black Smoke
PM - Mass

5. Size Matters

6. Wiley Interdisciplinary Reviews

7. What is evidence for effects
of fine combustion particles
(BS and PM2.5) on mortality?

8. Experience in Dublin
 Oil crisis in 1970’s
led to programs to
encourage use of
solid fuels,
primarily coal
Dundalk
 1980’s - switch
from oil to coal
 Dominant source
of air pollution in
Dublin was smoke
from domestic Wexford
fires

9. • Deterioration in air quality after switch to coal
(Flanagan, 1986)
• During winters of 1980’s, Dublin experienced number of
severe air pollution episodes.

10. Dublin Borough
800 40
Black Smoke (ug/m3)
Black 35
600
Smoke
30
Deaths
400
25
200
20
0 15
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
January 1982

11. Dublin Borough
800 40
Black Smoke (ug/m3)
Black 35
600
Smoke
30
Deaths
Deaths
400
25
200
20
0 15
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
January 1982

12. Dublin County Burrough
January 1982
40
35
Deaths
30
25
20
15
10
0 200 400 600 800
3 Day Mean Black Smoke (ug/m3)

13. Dublin 1980-1990
17
16
15
Deaths per Day
14
13
12
11
10 Mean of 20 consecutive points
9
0 100 200 300 400
3 Day Mean Black Smoke (ug/m3)

14. Cardiovascular Deaths: Dublin 1980-1990
9
8
Deaths per Day
7
6
5
Mean of 20 consecutive points
4
0 100 200 300 400
3 Day Mean Black Smoke (ug/m3)

15. Respiratory Deaths: Dublin 1980-1990
4
Deaths per Day
3
2
Mean of 20 consecutive points
1
0 100 200 300 400
3 Day Mean Black Smoke (ug/m3)

16. Other Deaths: Dublin 1980-1990
Non-Cardiovascular, Non-Respiratory
6
Deaths per Day
5
4
Mean of 20 consecutive points
3
0 100 200 300 400
3 Day Mean Black Smoke (ug/m3)

17. Can we see effect of air
pollution controls in Dublin?

18. Dublin Coal Ban
 On September 1, 1990, the
marketing, sale, and distribution of
bituminous coals was banned
within the city of Dublin (Air
Pollution Act, 1987).

19. Dublin Black Smoke
140 Ban on Coal Sales
120
100
80 -36 g/m3
g/m3
60
(-71%)
40
20
0

20. Dublin Total Mortality
Ban on Coal Sales
12
Deaths per 1000 Pyr
7% drop in Total Mortality
10
8
6

21. Dublin Cardiovascular
6 Ban on Coal Sales
Deaths per 1000 Pyr
5
4
3 13% drop in
Cardiovascular Mortality
2

22. Dublin Respiratory Deaths
3
Ban on Coal Sales
Deaths per 1000 Pyr
2
1
16% drop in
Respiratory Mortality
0

23. Summary
 Air pollution is associated with acute
increases in deaths at levels seen in
Ireland in the 1980’s
 Effects on respiratory and
cardiovascular system
 Reductions in air pollution in Dublin
have produced measurable
improvements in health

24. Dublin 1990-1996
Cardio-Respiratory Deaths
11
10
Deaths per Day
9
8
7
Mean of 20 consecutive points
6
0 10 20 30 40 50
3 Day Mean Black Smoke (ug/m3)

25. Dublin 1980-1990
17
16
15
Deaths per Day
14
13
12
11
10 Mean of 20 consecutive points
9
0 100 200 300 400
3 Day Mean Black Smoke (ug/m3)

26. Dublin 1990-1996
Cardio-Respiratory Deaths
11
10
Deaths per Day
9
8
7
Mean of 20 consecutive points
6
0 100 200 300 400
3 Day Mean Black Smoke (ug/m3)

27. Bans on
Coal Sales
September 1, 1990
-Dublin
October 1, 1995
-Cork
October 1, 1998
-Limerick
-Dundalk
-Drogheda
-Wexford
-Arklow

28. 98th percentiles of Daily Black Smoke
Concentrations in Major Urban Areas
DUBLIN CORK
1990 Ban 1995 Ban 1998 Ban
Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality

29. What are the effects of
repeated, long term
exposures to Fine Particles?

30. Satellite-Derived PM2.5:
2001–2006 Average
Von Donkelaar et al Envir Hlth Pers 2010;118:847

31. Six Cities Adult Mortality Study
 8111 adults in 6 cities
 Dirty: Steubenville &
St. Louis
 Moderate: Watertown &
Kinston/Harriman
 Clean: Topeka &
Portage
 Enrolled starting in 1974
 14-16 years of mortality
follow-up
 Effect of 10 g/m3 PM2.5
 +13% (95% CI 4%
to 23%) increase in
mortality rate
Dockery et al, NEJM 1993;329:1753

32. Six Cities Adult Mortality
1.4
EPA NAAQS
1.3 Steubenville
Kingston
Mortality Risk Ratio
1.2
St. Louis
1.1 Topeka
Watertown
1.0 Portage
0.9
0.8
0.7
0 10 20 30 40
PM 2.5 ( g/m3)

33. Six Cities Mortality Follow-up
 1974 to 1989 follow-up  1990 to 1998 follow-up
 Annual returned  National Death Index
postcards and search
National Death Index
 1,368 deaths
 1,364 deaths
 54,735 person
 104,243 person years
years
 PM2.5 measurements  PM2.5 estimated from
1979-1986 PM10 1990-1998
Laden et al, AJRCCM 2006;54:709

34. Six Cities Cohort Follow-up
1.4
1.3
Steubenville
Mortality Risk Ratio
1.2 Kingston
1.1 Topeka
1.0
Portage
0.9
St. Louis
Watertown Improved air quality
0.8 leads to reduced mortality
0.7
0 5 10 15 20 25 30 35
PM 2.5 (g/m3)
Laden et al, AJRCCM 2006;54:709

35. Can we see effect of air
pollution controls in US?

36. Age-adjusted death rates: United States, 1960-2005
1,400
Rate per 100,000 population
1,200
Age-adjusted
1,000
800
600
0
1960 1970 1980 1990 2000 2005

37. Trends in the Levels of the Six Criteria Pollutants
Relative to U.S. National Standards: 1980 - 2006

38. Estimated PM10

39. County life expectancies at birth for white males
and females;1997–2001
CJL Murray et al, Eight Americas: Investigating Mortality Disparities across Races, Counties, and
Race-Counties in the United States. PLoS Med. 2006 Sep;3(9):e260

40. Cigarette Smoking – United States
SOURCES: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey

41. Fine Particulate Air Pollution and
US County Life Expectancies
Pope, Ezzati, Dockery (NEJM 2009)
 Standardized life expectancy for each US
County by year
 51 U.S. metropolitan areas (217 counties)
 PM2.5 data for ~1980 and ~2000
 Estimated association between reductions
PM2.5 and change in life expectancy,
controlling for
 changes in socio-economic indicators
 changes in demographic variables
 proxy indicators of cigarette smoking (COPD and
Lung Cancer mortality).

42. 51 Metropolitan areas (dots); Study Counties (shaded gray)

43. Life Expectancy vs PM2.5
1978-82
81
80
EPA NAAQS
79
78
Life Expectancy
77 Boston
76
75
Topeka
74
73
72 Steubenville
71
5 10 15 20 25 30 35
PM2.5 (g/m3)
Pope, Ezzati, Dockery. NEJM 2009; 360:376

44. Life Expectancy vs PM2.5
1997-2001
EPA NAAQS
81
Boston
80
79
78
Life Expectancy
Steubenville
77
76
75
74
Topeka
73
72
71
5 10 15 20 25 30 35
PM 2.5 ( g/m3)
Pope, Ezzati, Dockery. NEJM 2009; 360:376

45. Life Expectancy vs PM2.5
1980-2000
81
80
79
78
Life Expectancy
77
76
Topeka
75
74
73
72
71
5 10 15 20 25 30
3
PM2.5 (g/m )
Pope, Ezzati, Dockery. NEJM 2009; 360:376

46. Life Expectancy vs PM2.5
1980-2000
81
0.61 ± 0.20 yr per
80 10g/m3 PM2.5
79
78
Life Expectancy
77
76
75
74
73
72
71
5 10 15 20 25 30
3
PM 2.5 (g/m )
Pope, Ezzati, Dockery (NEJM 2009)

47. Life Expectancy vs PM2.5
1980-2000
81
80
79
78
Life Expectancy
77
76
75
74
73
2000 Boston 1980
72 3
11.3 g/m 3
18.1 g/m
71
5 10 15 20 25 30
PM 2.5 ( g/m ) 3
Pope, Ezzati, Dockery (NEJM 2009)

48. PM2.5 obligations set out in
CAFE Directive 2008/50/EC
Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality

49. Life Expectancy vs PM2.5
1980-2000
81
EPA NAAQS CAFE CAFE
80 Stage II Stage I
Limit Limit
79 Value Value
78
Life Expectancy
77
76
75
74
73
72 Health benefits below
current NAAQS
71
5 10 15 20 25 30
PM 2.5 ( g/m )
3
Pope, Ezzati, Dockery (NEJM 2009)

50. Summary statistics for PM2.5
concentrations in 2010
DUBLIN CORK ENNIS
Annual mean limit value 25 μg/m3.
Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality

51. Life Expectancy vs PM2.5
1980-2000
Pope, Ezzati, Dockery (NEJM 2009)

52. Life Expectancy vs PM2.5
1980-2000
Pope, Ezzati, Dockery (NEJM 2009)

53. Life Expectancy vs PM2.5
1980-2000
Pope, Ezzati, Dockery (NEJM 2009)

54. Life Expectancy vs PM2.5
1980-2000
Pope, Ezzati, Dockery (NEJM 2009)

55. How big is 0.5 year increase in life
expectancy?
 65 year old nonsmoking male
 Additional life expectancy
17.5 years
 Additional 0.5
years life
expectancy
 18.0 years

56. How big is 0.5 year increase in life
expectancy in population of Ireland?
 Tobacco Smoking
 6.8 years reduced life expectancy for average smoker (Streppel
et al, Tob Cont 2007)
 31% Current Smoking in Ireland(2009) (Special Eurobarometer 332)
 6.8 yr among 31% of population
 2.1 yr longer life expectancy in population
 Diabetes
 7.8 years for men, 8.4 years for women (Fromer et al, Arch Int Med
2007)
 4.7% Diabetes Mielitus in Ireland (2005) (Institute of Public Health
in Ireland, 2006.)
 8 yr among 4.7% of population
 0.4 yr longer life expectancy in population
 Fine particle air pollution
 0.5 years for 2 g/m3 reduction in PM2.5
 100% of population affected
 0.5 yr longer life expectancy in population

57. Conclusions
 PM2.5 associated significant health
effects
 Life shortening (mortality)
 Improved air quality leads to
measurably improved public health
 Benefits at all levels of air pollution
 Even in clean communities

59. Current U.S. Values for Health Effects
 Premature death $5.5 million
 Chronic bronchitis $340,000
 Heart attacks $66,000 - $140,000
 Hospital admissions $6,000 - $18,000
 ER visits $300
 Respiratory symptoms $15 - $60
 Asthma attacks $40
 Work loss days $100
 School absences $75

60. Counties with PM2.5 Monitoring
2000 and 2007
Pop Density
(Ppl/mi2)
Correia, Pope, Ezzati, Dockery, Dominici

61. Life Expectancy vs PM2.5
2000 (545 Counties)
84
EPA NAAQS
82
80
Life Expectancy
78
Mean
76 76.7 years
74
72
70 Mean
13.2 g/m3
68
0 5 10 15 20 25
3
PM2.5 (g/m )
Correia, Pope, Ezzati, Dockery, Dominici

62. Life Expectancy vs PM2.5
2007 (545 Counties)
84
EPA NAAQS
82
80
Life Expectancy
78 Mean
77.5 years
76
74
72
70 Mean
11.6 g/m3
68
0 5 10 15 20 25
3
PM2.5 (g/m )
Correia, Pope, Ezzati, Dockery, Dominici

63. Life Expectancy vs PM2.5
2000- 2007 (545 Counties)
84
EPA NAAQS
82
80
Life Expectancy
78
76
74
72
70
68
0 5 10 15 20 25
3
PM2.5 (g/m )
Correia, Pope, Ezzati, Dockery, Dominici

64. Life Expectancy vs PM2.5
2000 - 2007 (545 Counties)
84 EPA NAAQS
0.35 ± 0.16 yr per
82 10g/m3 PM2.5
80
Life Expectancy
78
76
74
72
70
68
0 5 10 15 20 25
3
PM2.5 (g/m )
Correia, Pope, Ezzati, Dockery, Dominici

65. Summary statistics for black smoke
concentration April 2009-March 2010
DUBLIN
Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality