The Lancet, Volume 377, Issue 9769, Page 875, 12 March 2011>doi:10.1016/S0140-6736(11)60330-9
A breath of fresh air please
Source: The Lancet
That air pollution is hazardous to human health is well known. WHO estimates that, worldwide, at least 2 million people every year die prematurely due to the health effects caused by a lack of clean air. In the USA alone, 3 million tons of toxic chemicals are released into the environment each year. And 30% of medical costs in the USA are estimated to be related to air pollution. Three newly released reports underscore the importance of having an effective air-pollution policy for the benefit of health. On March 2, the US Environmental Protection Agency (EPA) released its second prospective report entitled The Benefits and Costs of the Clear Air Act from 1990 to 2020. The document quantifies the number of health-related events preventable as a result of the Act. The 1990 Clear Air Act, a US federal law intended to reduce airborne fine particles and ground-level ozone pollution has, according to EPA, in 2010 alone prevented 160 000 cases of early death, 130 000 heart attacks, 1·7 million asthma attacks, and 13 million lost working days. The numbers estimated for the year 2020 are even more dramatic: not only will the existing regulations create a saving of around US$2 trillion in health costs, but will also save 230 000 lives, and prevent 200 000 heart attacks, 2·4 million asthma attacks, and 17 million lost working days. This EPA report convincingly shows that the health benefits greatly exceed the costs of implementing clean-air protection.
Also on March 2, the Aphekom project, sponsored by the European Commission and coordinated by the French Institute of Public Health Surveillance, released data from a 3-year research study that looked at air pollution in 25 cities in 12 European Union (EU) countries, where a total of 39 million habitants currently reside. Of all the cities studied, Stockholm was the only one found to be below WHO’s recommended level of fine particulate pollution of 10 ?/m3. At the other end of the pollution scale are Bucharest, Budapest, and Barcelona (38·2, 33·7, and 27 ?/m3, respectively). The report notes that curbing pollution to WHO standards of fine particulate pollution throughout Europe could save 19 000 lives per year, add almost 2 years to local life expectancy for people aged 30 years and older, and save €31·5 billion in health costs and work absenteeism. In a subset of ten European cities studied, the report also points out, living near a busy road could be responsible for 15% of childhood asthma cases and a higher percentage of other common chronic diseases in adults 65 years and older.
On Feb 24, The Lancet published online a meta-analysis of 36 studies led by Tim Nawrot from Hasselt University, Diepenbeek, Belgium, which showed that air pollution is also an important trigger for heart attacks. On an individual level, the effect of air pollution is small (5%). But at the population level, Nawrot and colleagues’ work suggests that, considering the magnitude of the risk and the high prevalence of exposure in the population, air pollution is an important factor in initiating heart attacks, and of a similar magnitude to other well accepted heart attack triggers such as physical exertion, alcohol, and coffee.
WHO should revisit its 6-year-old 2005 Air Quality Guidelines. It should put more focus on low-income and middle-income countries, where air pollution regulations are commonly lacking and health effects on the local populations widely ignored. For example, Indian cities have up to ten to 20 times higher levels of air pollutants than do cities in the USA and Europe. And the air quality of China’s cities are among the worst in the world, as was shown by the recent work by Zhang and colleagues, published inThe Lancet last March.
Regulatory efforts to curb air pollution on a local, domestic, and global scale need to be rigorously implemented, enforced, and enhanced. Governments, as public servants, have the duty and responsibility to protect the health of their citizens. In the USA, the EPA’s proposed budget cuts for the years 2011 and 2012 should be reversed. These cuts will jeopardise the US Government’s ability to protect its citizens from a multitude of health problems and premature deaths caused by the lack of clean air. Meanwhile, in Europe, various member states of the EU have already exceeded the mandated particle value limits, and thus the scheduled revision of present regulations in 2013 is a welcome act. At the same time, vulnerable individuals who live near roads where air pollution from traffic is a serious health risk should fight for their right to breathe cleaner air. Doctors should be their vocal allies in this struggle.