Environment

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Environment health what we know what we can
know evidence from international research
Paul Wilkinson London School of Hygiene
Tropical Medicine Environment health
conference, Jerusalem 2 June 2008
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OUTLINE

• CONTEXT
• TRADITIONAL POLLUTANTS
• AREAS FOR PRECAUTION
• GLOBAL CHANGES
• INTERVENTIONS
• PRIORITIES

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• Outdoor air pollutants
• Lead
• Occupational hazards
• Water quality
• Urban noise

• Atmospheric carbon dioxide
• Persistent Organic Pollutants
• Ozone-depleting gases
• Urban non-biodegradable waste

• Household sanitation
• Aflatoxin in food
• Indoor air pollution

Exposure or environmental damage
200
2,000
20,000
Societal economic growth GNP/person over time
(in notional US dollars)
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5 December 1952
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Deaths, London AC, 1-15 December 1952
10
500
Deaths
8
400
6
300
Deaths
Smoke, County Hall, mg.m-3
4
200
Black smoke
2
100
0
0
30 Nov 52
05 Dec 52
10 Dec 52
15 Dec 52

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• Reduction, especially in industrial and domestic
  combustion sources, with substantial decline in
  particle (mass) concentration SO2
• Change from classical to photo-chemical smog
  (transport sources)
• Emergence of new toxicological and
  epidemiological evidence, incl. - time-series -
  semi-ecological cohorts
• Identified risks at the (lower) ambient
  concentrations in modern cities
• Evidence strongest for respirable particles
  (lt10µm), but also for SO2, ozone, NO2, CO

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Summary estimates for relative risks for
mortality and different air pollutants
Source WHO

• Limitations of time-series evidence
• harvesting
• not relevant to disease induction

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AN ASSOCIATION BETWEEN AIR POLLUTION AND
MORTALITY IN SIX U.S. CITIES Dockery D, et al.
N Engl J Med 1993 3291753-9
Dockery D et al. N Engl J Med 19933291753-1759
Estimated Adjusted Mortality-Rate Ratios and
Pollution Levels in the Six Cities
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Ischaemic and Thrombotic Effects of Dilute
Diesel-Exhaust Inhalation in Men with Coronary
Heart Disease Mills, NL et al. NEJM 2007
357(11)1075-82.
ST-segment evidence of myocardial ischemia during
15-Minute intervals of exercise-induced stress
and exposure to diesel exhaust or filtered air in
the 20 subjects.
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Estimated PM10 Concentration in World Cities (pop
gt100,000)
PM10 (µg/m3) . 5-14 . 15-29 . 30-59 .
60-99 . 100-254
Source Cohen AJ et al. 2004
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Risk of congenital anomalies near hazardous-waste
landfill sites in Europe the EUROHAZCON study.
H Dolk, M Vrijheid, B Armstrong, L Abramsky, F
Bianchi, E Garne, V Nelen, E Robert, J E S Scott,
D Stone, R Tenconi. Lancet 1998 352 42327
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SOME CURRENT QUESTIONS FOR ISRAEL

• Non-Hodgkins lymphoma
• Trichloroethene emissions from soil
• Wastewater re-use heavy metals
• -gt health impact studies vs epidemiological
  enquiry

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Warnings and precautions(after Grandjean and
Landrigan, 2006)
Unexplained but seemingly widespread rise in
testicular cancer Cancer cells have been
demonstrated in fetal tissue
Decreased sperm quality may be a partial cause of
low fertility in Europe
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Exposure to PCBs correlates with less efficient
response to routine childhood immunizations
Source Heilmann et al., 2006
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ANNUAL CARBON BUDGET(Giga-tonnes carbon)
10 GtEmissions to the atmosphere
4.5 GtAccumulates in the atmosphere
5.5 GtAbsorbed by ocean and land ecosystems

• Decreasing trend
• Slows with atmosphere-ocean equilibration
• Probable CC feedbacks - warming and drying -
  slower ocean circulations

• Based on Friedlingstein, P. A steep road to
  climate stabilization. Nature 2008 451297-8

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Paleo-climate CO2 record, Vostock ice cores,
Antarctica
550
10
500
450
5
400
0
350
CO2 concentrations, ppmv
Temperature (degrees Celsius) relative to today
300
250
-5
200
150
-10
-400
-350
-300
-250
-200
-150
-100
-50
0

Thousands of years relative to present
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CLIMATE CHANGE HEALTH
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AUGUST 2003
Temperature distribution across Europe on 10
August 2003 at 1500hrs British Summer Time
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MORTALITY IN PARIS, 1999-2002 v 2003
peak 13 Aug
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Water critical regions Medium water stress today
future increase in stress plus HDIgt0.8 A2
scenario, ECHAM4, 2020s
From Alcamo and Heinrichs, 2002. In Dialogue on
Water and Climate, 2003.
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VECTOR-BORNE DISEASE
Parasite
Mosquito
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NET CHANGE IN POPULATION AT RISK BY 2050
Rogers D and Randolph S. The global spread of
malaria in a future, warmer world. 2000 Science
2891763-1765.
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If we could be absolutely sure that nothing more
drastic than linear changes in the climate
could occur, it would be reassuring. The small
chance of something really catastrophic is more
worrying than the greater chance of less extreme
events Catastrophic change could negate
decades of economic and social advance Rees, M.
Astronomer Royal of the UK
The one process now going on that will take
millions of years to correct is the loss of
genetic and species diversity by the destruction
of natural habitats. This is the folly our
descendants are least likely to forgive us.
Edward O Wilson Pellegrino University Research
Professor in Entomology, Harvard University
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INTERVENTIONS SOME COMMON PATHWAYS

• TRANSPORT
• ENERGY ENERGY EFFICIENCY
• BUILT ENVIRONMENT
• AGRICULTURE
• WATER RESOURCES

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Trends in mode of transport used by children,
England
2.0
Car occupant
1.5
Ratio of miles travelled
1.0
Walking
0.5
Cycling
Source National Travel Surveys
1985
2000
1990
1995
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ACTIVE TRANSPORT HEALTH
Climate change
Road injuries
Chronic disease
Physical inactivity
Vehicle transport
Overweight/obesity
Mental well-being
Environmentalpollution
Noise/QoL
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ACTIVE TRANSPORT GAINS

• For an average car driving women 35-44 years
• 15 g fat tissue per day
• 5.6 kg fat tissue per year
• Decrease
• 2040 in risk of premature mortality
• 25 in breast cancer risk
• gt20 all cancer risk
• gt30 diabetes mellitus

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LONDON CONGESTION CHARGE Health effects of change
in air pollution
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AIR POLLUTION SOURCES IN LONDON SOUTH-NORTH
TRANSECT
URBAN AIR POLLUTION
local (mainly transport) emissions sources
urban area sources (within London)
long-range transport
Sources of pollution transect of central London
(modelled)
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THE COSTBENEFIT EQUATIONS

• Economic costs
• Effects of active transport physical activity,
  obesity related health consequences
• Air pollution
• Mitigation of climate change
• Road injuries
• Noise
• Quality of urban environment

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SUGGESTED PRIORITIES

• Policies to address major environment health
  needs(climate change/energy, air pollution,
  transport) strategic directions
• (2) Health impact analysis/option
  appraisal overviews specific concerns
• (3) Studies that capitalize on unique research
  opportunities pre-natal early life, army
  recruitment data
• (4) Epidemiological studies of selected major
  local public health concerns

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CONTACT DETAILS
Paul Wilkinson Public Environmental Health
Research Unit London School of Hygiene Tropical
Medicine Keppel Street London WC1E
7HT paul.wilkinson_at_lshtm.ac.uk Tel 44 (0)20
7927 2444