Title: Air Pollution and its Health Effects CART Presentation Nov 12th , 2004 David R. Pepper, M.D., M.S. with input from Kevin D. Hamilton RRT, John Telles MD, and Tom Cahill PhD
1Air Pollution andits Health EffectsCART
PresentationNov 12th , 2004David R. Pepper,
M.D., M.S. with input from Kevin D. Hamilton
RRT, John Telles MD, and Tom Cahill PhD
2Central Valley, is it
- The Lobster in the Pot ? or
3Its National News
- Business Week
- Not good for Business or other living things
- Now the worst air in the nation 4/14/04
4Can you see the air?
5Summer Fine Aerosols downwindYosemite NP
Visibility at 90th percentile
6Yosemite NP Visibility at 10th percentile
7How Bad is it?
- SMOG - Fresno 1 in the Nation
- We are 1 for 8 hour exceedances
- 1 in Particulate ppm exceedance days
- 3 for 1 hour exceedances (ozone)
- Asthma - Fresno 3 in the Nation
- 16 of our Children
8What about our schools?Reported by us to
CDC in 2000
9AEMPs Patients
10(No Transcript)
11SJV Costs - Asthma
- 300,000 (10) Asthmatics
- 1,200 pp/py
- Compliant
- 0.25 x 1,000 (chronic medications)
- Non-compliant
- 0.15 x 3 x 200 (unintended PCP visit)
- 0.15 x 1,000 (ER visits)
- 0.05 x 10,000 (Hospitalization)
- Total 360 Million for Asthma alone
- Plus Days missed (school and work)
12And.is Asthma the tip of the Iceberg?
- Asthma 5-7 Nation-wide
- 11 average Valley wide. (higher in pediatrics)
- Up to 30 in select populations
- The Future - - - ?????
- Emphysema, Cancer, Heart Disease
- Birth Defects, learning disorders
13Bad Effects - How?
- Acute
- O3 and PM trigger cytokine/histamines
- Inflammation and Vasospasm in arteries and
airways (Nose to Lung) - Asthma/Bronchitic Flares
- Sudden Cardiac Death
- Chronic
- Emphysema? Cancer? Heart Dz
- Air Pollution Kills 60,000 a year in US, 1,300 in
Valley
14What are the Sources?
- Business/Industry
- Energy
- Home
15Sources - Ag
16Sources Mobile
17Valleys - trap and magnify
18Pollution Transport Within and Between Air Basins
19AQI
- 100 Max accepable
- Who sets 100? (D. Jones, Evan Ship)
- What 100 are we using?
20What is in Dirty Air?
- Invisible
- VOC, NOX, ROG, SOX
- Ozone
- CO, Pb,
- Visible
- Smoke and Soot
- Particulates (PM)
21Ozones Effects
- 0.06 ppm rats cant clear asbestos fibers
- 0.08 ppm subjects tested in chamber 5 6 hrs
- - inflammatory mediators released
- - PFTs show ?lung function
- 0.15 ppm - shortening of cilia
- - necrosis of lung epithelium
cilia - 0.15 ppm - California Health Advisory
- 0.20 ppm - Stage I Smog Alert
22Ozone Trends - SJV
23(No Transcript)
24(No Transcript)
25Is Ozone the real culprit?
26Particulate Matter
- The real bad actor
- Ozone is old news
- C. Arden Pope PhD - Utah
- Pope Mosley MD New Mexico
27PM 2.5 CV Effects
- Vasoconstriction
- Perturbed autonomic nervous system
- Increase inflammatory cytokines
- Increase defibrillator discharges
- Progression of CAD
- Promotion of plaque rupture
- Increasing risk of acute MI (heart attack)
28(No Transcript)
29Smaller More concern
- Hair is 70 microns
- Particles 10 microns or less
- bypass bodys defenses and enter lung
- Coarse fraction (gt2.5-10 mm)
- deposits mostly in the airways,
- plus deep lung
- Fine fraction (lt2.5 mm)
- penetrates to deep lung
- crosses alveolar membrane
30Particulate Loadtpd
- Unpaved roads 24
- Tilling (farms) 17
- Paved Roads 13
- Wind/dust 11
- Ag burning 9
- Wildfires 2
31SJV PM-10 Exceedances
32(No Transcript)
33(No Transcript)
34Over 90 of Californians Still Breathe Unhealthy
Air at Times
Days Over State Ozone Standard
Days Over State PM10 Standard
Based on 2000 Monitoring Data
35Asthma
- Overlaps?
- Fresno gt16
- CHIS data
- ? Other factor
36California Pesticides
- Central Valley
- Specialty crops
- Perfect food
37(No Transcript)
38Solutions ?
- Modify our exposure (the way we live)
- Summer avoid mid-day outside
- Winter avoid early AM outside
- Filter the Air? (HEPA filters, Green Screen)
- Or.change.
39Atlantas Experiment
- 1996 summer Olympics 2 weeks
- Big increase in public transport x 2 wks
- Traffic congestion down 22
- Acute asthma visits down 42 in kids
- (Medicaid population)
- Friedman,M.S.,et.al.JAMA 285 897-905, 2001
40Solutions - change
- (Reduce) what we make (and use)
- Less burning (Fireplaces, Ag, etc)
- Mass Transit eg Trainsgt Light Railgt Buses gt
Carpools gt Cars gt SUVs - Drive less cars (and more bikes) or better mpg
cars (hybrids) - Alternative Fuels Natural Gas, Fuel Cell,
Hydrogen, Electric (avoid Diesel) - More dense population (avoid sprawl)
41Or Solutions Change
- EPA, APCD, Valley Air Quality rules
- Wood burning (eg gasgt stoves)
- Leaf Blowers and 2 stroke engines?
- Diesel Engines getting cleaner
- Farms and Dairies and Pesticides
- what are the best targets?
42Extreme solutions?
- 4/gallon for gas (indirect source fees)
- Air toll booths for those passing through
- Blended Bio-diesel, no Diesel, Gasahol
- Alternative Technology (LPG, Fuel Cells)
- Organic farming (and buying)
- Impound severe smokers (cars)
- Move ?
43Costs of Clean up?
- 1 cent a gallon tax
- How much for health insurance premiums? Per
person? For all of Chevron/Texaco? - How much is
- a life worth?
- your life worth?
- one year of your life?
44Why Clean Air ???Thank
you..drpepper_at_ucsfresno.edu
45(No Transcript)
46VMT - Our Car CultureOne gallon 12 lbs of Air
Pollution
47NOX Nitric Acid Forming Agents
48ROG (or VOC) what you smell
49(No Transcript)
50How do the components vary with particle size?
Coarse
Fine
Nitrates Sulfates Ammonia Carbon Metals Organics
Soil Salts Brake Dust Tire Rubber
0.1
10 mm
2.5
1
51- QUESTION The life span of people who live in
areas as polluted as the San Joaquin Valley is
reduced by - a.) 0 years
- b.) 1-2 years
- c.) 4-6 years
- d.) 8- 10 years
52- ANSWER b
- The life span of people who live in areas as
polluted as the San Joaquin Valley is reduced by - a.) 0 years
- b.) 1-2 years
- c.) 4-6 years
- d.) 8- 10 years