Myriam Tobollik

Transport-related measures to mitigate climate change in Basel, Switzerland: A health-effectiveness comparison study

BACKGROUND Local strategies to reduce green-house gases (GHG) imply changes of non-climatic exposure patterns. OBJECTIVE To assess the health impacts of locally relevant transport-related climate change policies in Basel, Switzerland. METHODS We modelled change in mortality and morbidity for the year 2020 based on several locally relevant transport scenarios including all decided transport policies up to 2020, additional realistic and hypothesized traffic reductions, as well as ambitious diffusion levels of electric cars. The scenarios were compared to the reference condition in 2010 assumed as status quo. The changes in non-climatic population exposure included ambient air pollution, physical activity, and noise. As secondary outcome, changes in Disability-Adjusted Life Years (DALYs) were put into perspective with predicted changes of CO2 emissions and fuel consumption. RESULTS Under the scenario that assumed a strict particle emissions standard in diesel cars and all planned transport measures, 3% of premature deaths could be prevented from projected PM2.5 exposure reduction. A traffic reduction scenario assuming more active trips provided only minor added health benefits for any of the changes in exposure considered. A hypothetical strong support to electric vehicles diffusion would have the largest health effectiveness given that the energy production in Basel comes from renewable sources. CONCLUSION The planned local transport related GHG emission reduction policies in Basel are sensible for mitigating climate change and improving public health. In this context, the most effective policy remains increasing zero-emission vehicles.

Health impact assessment of transport policies in Rotterdam: Decrease of total traffic and increase of electric car use

BACKGROUND Green house gas (GHG) mitigation policies can be evaluated by showing their co-benefits to health. METHOD Health Impact Assessment (HIA) was used to quantify co-benefits of GHG mitigation policies in Rotterdam. The effects of two separate interventions (10% reduction of private vehicle kilometers and a share of 50% electric-powered private vehicle kilometers) on particulate matter (PM2.5), elemental carbon (EC) and noise (engine noise and tyre noise) were assessed using Years of Life Lost (YLL) and Years Lived with Disability (YLD). The baseline was 2010 and the end of the assessment 2020. RESULTS The intervention aimed at reducing traffic is associated with a decreased exposure to noise resulting in a reduction of 21 (confidence interval (CI): 11-129) YLDs due to annoyance and 35 (CI: 20-51) YLDs due to sleep disturbance for the population per year. The effects of 50% electric-powered car use are slightly higher with a reduction of 26 (CI: 13-116) and 41 (CI: 24-60) YLDs, respectively. The two interventions have marginal effects on air pollution, because already implemented traffic policies will reduce PM2.5 and EC by around 40% and 60% respectively, from 2010 to 2020. DISCUSSION The evaluation of planned interventions, related to climate change policies, targeting only the transport sector can result in small co-benefits for health, if the analysis is limited to air pollution and noise. This urges to expand the analysis by including other impacts, e.g. physical activity and well-being, as a necessary step to better understanding consequences of interventions and carefully orienting resources useful to build knowledge to improve public health.

Development of a quantitative methodology to assess the impacts of urban transport interventions and related noise on well-being

Well-being impact assessments of urban interventions are a difficult challenge, as there is no agreed methodology and scarce evidence on the relationship between environmental conditions and well-being. The European Union (EU) project “Urban Reduction of Greenhouse Gas Emissions in China and Europe” (URGENCHE) explored a methodological approach to assess traffic noise-related well-being impacts of transport interventions in three European cities (Basel, Rotterdam and Thessaloniki) linking modeled traffic noise reduction effects with survey data indicating noise-well-being associations. Local noise models showed a reduction of high traffic noise levels in all cities as a result of different urban interventions. Survey data indicated that perception of high noise levels was associated with lower probability of well-being. Connecting the local noise exposure profiles with the noise-well-being associations suggests that the urban transport interventions may have a marginal but positive effect on population well-being. This paper also provides insight into the methodological challenges of well-being assessments and highlights the range of limitations arising from the current lack of reliable evidence on environmental conditions and well-being. Due to these limitations, the results should be interpreted with caution.

Burden of Outdoor Air Pollution in Kerala, India—A First Health Risk Assessment at State Level.

Ambient air pollution causes a considerable disease burden, particularly in South Asia. The objective of the study is to test the feasibility of applying the environmental burden of disease method at state level in India and to quantify a first set of disease burden estimates due to ambient air pollution in Kerala. Particulate Matter (PM) was used as an indicator for ambient air pollution. The disease burden was quantified in Years of Life Lost (YLL) for the population (30 + years) living in urban areas of Kerala. Scenario analyses were performed to account for uncertainties in the input parameters. 6108 (confidence interval (95% CI): 4150–7791) of 81,636 total natural deaths can be attributed to PM, resulting in 96,359 (95% CI: 65,479–122,917) YLLs due to premature mortality (base case scenario, average for 2008–2011). Depending on the underlying assumptions the results vary between 69,582 and 377,195 YLLs. Around half of the total burden is related to cardiovascular deaths. Scenario analyses show that a decrease of 10% in PM concentrations would save 15,904 (95% CI: 11,090–19,806) life years. The results can be used to raise awareness about air quality standards at a local level and to support decision-making processes aiming at cleaner and healthier environments.

Das Konzept der umweltbedingten Krankheitslast

GOAL OF THE STUDY Environmental risk factors are of great importance for public health with a considerable but often unused potential for prevention. However, knowledge about the complex associations between the environment and health effects is limited for some risk factors. A concept, which is using the existing evidence on associations between the impact of environmental factors and health effects, is the environmental burden of disease (EBD) concept. The aim of this article is to present the quantification method of the EBD concept and to discuss the advantages and its points of criticism. METHODS The EBD concept combines morbidity and mortality data in a single measure (Disability-Adjusted Life Year, DALY) to enable a comparative description of the burden of disease. Life years are used as measurement unit. The environmental share of the total DALYs is quantified by using the attributable fraction. RESULTS Despite its increasing application especially in the international context, the method is still criticized, because by summarizing the complex construct of health in one single measurement unit, much important information about quality of life is lost. A further criticism refers to partly arbitrarily set social value choices. Additionally, missing or insufficient data can limit the quality and validity of EBD estimations. CONCLUSION A scientific discourse is needed to decide to what extent the EBD approach can and should be used in Germany.

Proceedings of the International Workshop ‘From Global Burden of Disease Studies to National Burden of Disease Surveillance'

Table of contentsI1 Introduction and aims of the workshop Christa Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich PlassS1 History, concept, and current results of GBD for GermanyTom Achoki, Katherine Leach-Kemon, Peter Speyer, William E. Heisel, Emmanuela Gakidou, Theo VosS2 Methodology of the GBD 2013 Study–Mortality, Morbidity, Risk-FactorsMohammad Hossein ForouzanfarS3 National burden of disease surveillance examples of good practice: the case of Public Health EnglandJürgen C. SchmidtS4 Critical aspects of the burden of disease methodology and country-specific challengesClaudia E. SteinS5 Non-communicable disease surveillance in Germany – public health and data challengesChrista Scheidt-Nave, Elena von der Lippe, Benjamin Barnes, Markus Busch, Nina Buttmann-Schweiger, Judith Fuchs, Christin Heidemann, Klaus Kraywinkel, Enno Nowossadeck, Thomas ZieseS6 Different approaches in estimating the burden of communicable diseases using the examples of the healthcare associated infections and influenzaUdo Buchholz, Matthias an der Heiden, Tim Eckmanns, Sebastian HallerS7 Behavioral and environmental attributable risk estimationMohammad Hossein ForouzanfarS8 Environmental Burden of Disease (EBD) in Germany – past achievements and future perspectivesDietrich Plass, Myriam Tobollik, Dagmar Kallweit, Dirk WintermeyerC1 Conclusions of the workshopChrista Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich Plass

The feasibility of estimating the total environmental burden of disease due to cadmium: experiences of the VegAS project

Abstract Background Cadmium is associated with several human health effects. Exposure via ambient background air is far less significant than through the food chain. The question is whether current concentrations of cadmium in the air still pose a health threat in terms of attributable cases of lung cancer in Germany. The German VegAS project (long title: Distribution-based analysis of the health effect of environmental stressors) quantified the environmental burden of disease (EBD) of cadmium in ambient air. Methods A comprehensive review of the literature until early 2012 was done to identify cadmium-induced health outcomes and exposure–response functions. Evidence was checked using predefined criteria. National data sources for health and exposure information were consulted to estimate disability-adjusted life-years (DALYs) lost due to cadmium. The range of uncertainty by variation of uncertain parameters was described in detail. Findings DALYs of lung cancer due to inhalation of cadmium in ambient background air in Germany (0·2131 ng/m 3 ) were quantifiable and estimated at 7 DALYs lost (0·0087 DALYs per 100 000 population). Uncertainty analysis using various unit risk estimates yielded a maximum of 348 DALYs. Interpretation By quantifying the EBD of airborne cadmium and lung cancer, only a very small part of the total EBD due to cadmium is quantified. Still, looking only at this small fraction of possible EBD due to cadmium, up to 348 DALYs (range maximum) could be prevented if this toxic substance was reduced to zero. Evidence supports an association between exposure to cadmium and kidney damage; bone disease; and lung, kidney, and prostate cancer. However, incompatibility of data affecting all dimensions of exposure and the EBD model undercut most quantification for supporting a scientifically validated environmental health policy. Funding The VegAS project was funded by the Federal Ministry of Environment, Nature Conservation, and Nuclear Safety in context of the Environment Research Plan 2009. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.

P I – 1–9 Health effects of ultrafine particles – a systematic literature review

Background/aim Evidence from toxicological studies suggests that Ultrafine Particles (UFP) can be inhaled deeply into the lungs and can infiltrate the blood stream. Therefore, UFPs might be more harmful for human health than larger particles. Since the last systematic review, new epidemiological studies were published. Thus, we aimed for an updated review of studies evaluating the health effects of UFPs. Methods We systematically searched in MEDLINE and the LUDOK database applying two search strategies identifying relevant epidemiological studies published after the HEI-review from 2013 until May 2017. We considered quantitative health effects of environmentally related UFPs (with at least one of the following measurements: UFP particle mass <100 nm, Quasi-UFP particle mass <250 nm, particle number concentration <100 nm, Nucleation mode, Accumulation-mode, Aitken-mode and/or surface area concentration). Studies investigating effects of industrially generated nanoparticles or particles emitted in workplace settings, as well as toxicological and controlled exposure studies were excluded. No limitations were set concerning the health endpoints. Only German and English articles were included. Results We identified 80 epidemiological studies for our review, including 29 panel, 13 time-series, 9 crossover, 8 cross-sectional, 7 cohort, 6 case-crossover, 4 scripted exposure, and 2 case-control studies. Two studies were not classified according to our categories. Most studies (73) had a short-term study design. The analyses are ongoing and the results will be presented at the conference. Conclusion The variety and number of studies identified through our literature review poses the need to systematically reassess the health effects of UFPs. Consequently, there is also the need to assess the study quality to further appraise the harmful effects of UFPs.

OP IX – 4 Quantification of environmental burden of disease related to nitrogen dioxide exposure in germany

Background/aim Epidemiological studies have shown associations of nitrogen dioxide (NO2) with numerous health outcomes. EU-wide air quality limit values for NO2 are in place but regularly exceeded at measuring stations near roads in Germany. Therefore, a health risk assessment for the NO2-exposure of the German population was conducted. Methods For 2007 up to 2014, maps of the annual spatial 1*1 km2 distribution of a population-weighted NO2 concentration indicator were calculated based on assimilated modelling data of background NO2 within a 7*8 km2 grid and population density within a 250*250 m2 grid. For three model regions a small scale assessment of the NO2 exposure was achieved by considering concentrations in the higher resolved urban background as well as close to highly polluted street sections. A systematic literature search of epidemiological studies was performed to ascertain the current evidence on long-term health effects of NO2 and to identify exposure-response-functions transferrable to Germany. The Environmental Burden of Disease-concept was applied to quantify the NO2-associated health risks for relevant outcomes. Results The yearly mean of background NO2 slightly decreased from 13 μg/m3 (range: 4.3 to 37.3 μg/m3) in 2007 to 11.8 μg/m3 (3.4 to 32.7 μg/m3) in 2014. Using a counterfactual value of 10 µg/m3, 5966 (95%-confidence interval: 2031 to 9,893) premature deaths and 49,726 (16,929 to 82,456) Years of Live Lost (YLL) due to cardiovascular mortality attributable to NO2 long-term exposure were estimated for the year 2014. Between 2007 and 2014 an overall slightly decreasing trend was observed for attributable premature deaths. The higher resolution of NO2-concentration for the three model regions led to a substantial increase in the estimated number of premature deaths due to cardiovascular disease by 40% to 165%. Conclusion The present estimates are based on NO2 concentrations reflecting background exposure and thus underestimate the burden of disease. A better accuracy of the NO2 exposure estimation accounting for the higher concentrations in urban areas close to traffic improves the burden of disease quantification and may enhance the distinction of health effects related to fine and ultrafine particles.

Erratum to: BURDEN 2020—Burden of disease in Germany at the national and regional level

Erratum to:Bundesgesundheitsbl (2018) https://doi.org/10.1007/s00103-018-2793-0 The original publication of this article contained an error in the list of the authors, in which the contributing author Christian Schmidt was missing. The full list of authors has now been updated. The original article …