Review of evidence on health aspects of air pollution ...

1 Review of evidence on health aspects of air pollution REVIHAAP project Technical report This publication arises from the project REVIHAAP and has received funding from the European Union. The WHO European Centre for Environment and health , Bonn, WHO Regional Office for Europe, coordinated the development of this publication. ABSTRACT This document presents answers to 24 questions relevant to reviewing European policies on air pollution and to addressing health aspects of these policies. The answers were developed by a large group of scientists engaged in the WHO project Review of evidence on health aspects of air pollution REVIHAAP.

2 The experts reviewed and discussed the newly accumulated scientific evidence on the adverse effects on health of air pollution , formulating science-based answers to the 24 questions. Extensive rationales for the answers, including the list of key references, are provided. The Review concludes that a considerable amount of new scientific information on the adverse effects on health of particulate matter, ozone and nitrogen dioxide, observed at levels commonly present in Europe, has been published in recent years.

3 This new evidence supports the scientific conclusions of the WHO air quality guidelines, last updated in 2005, and indicates that the effects in some cases occur at air pollution concentrations lower than those serving to establish these guidelines. It also provides scientific arguments for taking decisive actions to improve air quality and reduce the burden of disease associated with air pollution in Europe. This publication arises from the project REVIHAAP and has been co-funded by the European Union.

4 Keywords AIR POLLUTANTS AIR pollution ADVERSE EFFECTS ENVIRONMENT AND PUBLIC health evidence BASED PRACTICE GUIDELINES health POLICY Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen , Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( ). World health Organization 2013 All rights reserved. The Regional Office for Europe of the World health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full.

5 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World health Organization in preference to others of a similar nature that are not mentioned.

6 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World health Organization be liable for damages arising from its use.

7 The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World health Organization. The views expressed herein can in no way be taken to reflect the official opinion of the European Union. REVIHAAP project : Technical report Page iv CONTENTS Acknowledgements .. v Abbreviations .. vi Introduction .. 1 A. health effects of PM .. 6 Question A1 .. 6 Question A2 .. 10 Question A3 .. 32 Question A4 .. 35 Question A5 .. 38 Question A6 .. 41 B. health effects of ozone.

8 47 Question B1 .. 47 Question B2 .. 59 Question B3 .. 62 Question B4 .. 64 C. Proximity to roads, NO2, other air pollutants and their mixtures .. 67 Question C1 .. 67 Question C2 .. 73 Question C3 .. 113 Question C4 .. 117 Question C5 .. 127 Question C6 .. 137 Question C7 .. 142 Question C8 .. 155 Questions A7 & C9 .. 165 Question C10 .. 175 D. General questions .. 182 Question D1 .. 182 Question D2 .. 197 Question D4 .. 208 References .. 215 List of invited experts participating in REVIHAAP .. 300 REVIHAAP project : Technical report Page v Acknowledgements This publication was developed by the WHO Regional Office for Europe as part of the Review of evidence on health aspects of air pollution REVIHAAP project .

9 This project has been co-funded by the European Union under Contribution Agreement No. 07-0307/2011/604850/SUB/C3. REVIHAAP project : Technical report Page vi Abbreviations Organizations, other entities and studies AHSMOG Loma Linda University Adventist health and Smog study AIRS Aerometric Information Retrieval System APED Air pollution Epidemiology Database APHEA Air pollution and health : a European Approach APHEIS Air pollution and health : a European Information System project APHENA Air pollution and health .

10 A European and North American approach study ATS American Thoracic Society ATSDR Agency for Toxic Substances and Disease Registry of the United States Department of health and Human Services BENMAP Environmental Benefits Mapping and Analysis program CAFE Clean Air for Europe Programme CLRTAP Convention on Long-range Transboundary Air pollution COMEAP the United Kingdom's Committee on the Medical Effects of Air Pollutants CPS-II American Cancer Society Cancer Prevention Study II EC European Commission EEA European Environment Agency EFSA European Food Safety Authority EGEA French Epidemiological study on Genetics and Environment of Asthma EPA United States Environmental Protection Agency EPAQS United Kingdom Expert Panel on Air Quality Standards EU European Union FAO Food and Agriculture Organization of the United Nations HEIMTSA health and Environment Integrated Methodology and Toolbox for Scenario Assessment project HRAPIE health Risks of Air pollution in Europe IARC International Agency for Research on