Civic Exchange 2009 The Air We Breathe Conference - Experts Symposium 9 January 2009
WHO Guidelines & How
presented by Ross Anderson (St George's, University of London)
http://air.dialogue.org.hk
Civic Exchange 2009 The Air We Breathe Conference - WHO Guidelines & How
1. WHO Guidelines & How
The Air We Breathe: a public
health dialogue
Hong Kong 10th January 2009
Ross Anderson
St George’s, University of London
2. Some questions
• What are the guidelines?
• How were they developed?
• Why have they been updated?
• What are their uses and limitations?
• Implications for policy in Hong Kong?
2
3. WHO AQG: Global update 2005
Pollutant Averaging time AQG value
Particulate matter
PM2.5 1 year 10 µg/m3
24 hour (99th percentile) 25 µg/m3
PM10 1 year 20 µg/m3
24 hour (99th percentile) 50 µg/m3
Ozone, O3 8 hour, daily maximum 100 µg/m3
Nitrogen dioxide, NO2 1 year 40 µg/m3
1 hour 200 µg/m3
Sulfur dioxide, SO2 24 hour 20 µg/m3
10 minute 500 µg/m3
4. WHO AQG: Global update 2005
Annual mean PM10 PM2.5 Basis for the selected level
level (µg/m3) (µg/m3)
Interim target-1 70 35 Levels associated with about
(IT-1) 15% higher long-term mortality
than at AQG
Interim target-2 50 25 Risk of premature mortality
(IT-2) decreased by approximately
6% compared to IT1
Interim target-3 30 15 Mortality risk reduced by
(IT-3) approximately 6% compared to
IT2 levels.
Air quality 20 10 Lowest levels at which total,
guideline CP and LCA mortality have
(AQG) been shown to increase (Pope
et al., 2002). The use of PM2.5
guideline is preferred.
7. Systematic evaluation of epidemiological
evidence. WHO guideline document
Recommendations
on Health Hazard Characterization:
1) Develop protocol for the review
2) Identify relevant studies
http://www.euro.who.int/document
3) Systematically assess the validity of each study /e68940.pdf
4) Conduct systematic overview of evidence from multiple
studies: the use of meta-analysis
5) Draw conclusions from epi evidence
- critical scientific thinking
- document the process of scientific reasoning
8. Updates of WHO guidelines
Year PM measure Guideline Notes
Annual mean
µg/m3
1970s SPM 60-90 Threshold
(Lowest observed level for health
effects ~ 150 + Safety factor of 2)
1987 Black Smoke 50 Threshold
(linked to SO2, also 50)
2000 PM10 Dose-response No threshold
2006 PM10 20 No threshold
2006 PM2.5 10 No threshold.
Hong Kong RSP 55 Threshold
1987
PM10 = RSP ~0.5 x 8
SPM; 2 x BS; 1.3 x PM2.5
9. Published time-series studies of air
pollution up to 2006 (Source: APED)
Cohort studies
Number of publications
70
60 WHO 1987 GL
50
40
30
20
10
0
00
03
91
97
82
85
88
94
73
76
79
20
20
19
19
19
19
19
19
19
19
19
Year of publication
All ETS Multi-city All Panels
July 06
9
10. Shifts in knowledge since the 1980s
• No threshold for health effects in the
ambient range
• Effects extend beyond the respiratory
system.
• Cardiovascular effects may be the most
important.
11. Long term exposure to PM and risk of mortality
in ACS cohort (~ 0.5 million people in a large
number of US cities followed for 16 years)
Adapted from
Pope et al 2002
11
12. Dose Response between Total Mortality and PM10
20
15
Percent Increase in Deaths
PM10 and daily
10
mortality: 22
5
European cities.
0
-5
0 50 100 150 200
Samoli et al 2005
PM10 (ìg/m3)
Ozone and daily
mortality: 21
European cities.
Gryparis et al 2004
14. Guidelines are not enforceable
standards/limit values
• Guidelines:
– Recommendation on protection of health or
environment from adverse effects of pollutants
• Standard:
– Concentration (exposure level) of the pollutant
determined by the regulatory authority as enforceable
– Instruments for implementation (monitoring and
reporting requirements, consequences of non-
compliance, …)
14
15. Threshold assumption is a critical
issue
Threshold: Implies safe level. Suited to
standards, limit values.
Non-threshold: Implies no safe level.
Suited to population exposure reduction.
17. Implementation of exposure reduction
concept for PM2.5 in the UK
(within the European framework)
Health based, and quantified by CBA
1. 15% reduction in average annual urban
background concentrations 2010 - 2020
2. Backstop objective (concentration cap) of 25
µg/m3 applicable to all areas. To provide
minimum protection.
17
The Air Quality Strategy for England, Scotland, Wales and N Ireland, 2008
18. Implications for Hong Kong
Q 1. Does the evidence underlying the GL
apply to Hong Kong?
Q 2. Should Hong Kong adopt these GL as
standards?
Q 3. If not, why not?
19. % increase in hospital admissions for
respiratory disease ages 65+ associated
with a 10 μg/m3 increase in pollutant
0.7
(Wong et al, 2002) 0.6
0.62
0.46 0.49
0.5
Percent Increase
1.8 0.4
1.6
HK London 0.3
0.2
1.4
0.1
1.2 0
US(90 Cities)* Eur(21 Cities)* Asia (4 Cities)
1
0.8
0.6 % increase in daily mortality
0.4 associated with 10µg/m3 PM10 (HEI 2004)
0.2
0
19
N O2 O3 PM SO2
20. Hong Kong and London
Some similarities
• Size and population
• Toxicity of pollution
• Large regional contribution to pollution
• Baseline health status
• Wealth, education and technical capacity
20
21. 0
50
100
150
200
250
Karachi
NewDehli
Katmandu
Dhaka
Kol Kata
Shanghai
Beijing
Gangzhou
HCMC
Asia
Mumbai
Colombo
Busan
IT1
Seoul
Manila
Bangkok
Taipei
HongKong
Tokyo
Lima
Arequipa
Medellin
Fortaleza
Santiago
Bogota
Hong Kong
Cochabamba
San Salvador
Guatemala city
Latin
IT2
Havana city
Mexico City
Quito
Rio de Janeiro
LaPaz
Sao Paulo
San Juan
Bello Horizonte
selected cities worldwide
Cairo
Vereenigen
Johannesburg
Africa
CapeTown
IT3
Prag
Torino
Bucharest
Barcelona
Milano
Roma
Krakow
Berlin
Erfurt
Oslo
Palermo
Sevilla
Annual average PM10 concentrations (µg/m3)
Bologna
Helsinki
Budapest
Florence
Hamburg
Europe
Vienna
Warsaw
Munich
AQG level
Amsterdam
Køln
Geneva
Basel
Zurich
Copenhagen
London
Athens
Leeds
Brussels
London
Stockholm
SanDiego
StLouis
LosAngeles
Annual average PM10 concentrations observed in
Knoxville
Houston
Pittsburg
Dallas
N.Amer
Memphis
Oklahoma
Washington
New York
Seattle
22. Hong Kong differs from London
• Sources:
– Local: e.g. more power generation and marine sources
– Greater regional component
• Not embedded in a regional strategy
• Objectives are not based on adequate protection of public
health
• It is not setting a challenging standard which is possible
based on best current knowledge and technology
• No effective legal framework to enforce compliance with
standards 22
23. Summary (1)
• The GL comprise recommendations for the
protection of health from adverse effects of
pollutants.
• They are a basis for the development of national
health-based standards.
• Updated evidence suggests that air pollutants
should now be considered as non-threshold
hazards.
• This means that reductions in exposure across
the whole population will bring the greatest
health benefits.
24. Summary (2)
• The effects of air pollution in Hong Kong
are likely to be similar to those in other
cities.
• National or Local strategies must take
individual circumstances into account, and
Hong Kong is no exception
• For local and regional strategies to work,
political will and appropriate enforcement
are required.