Health impact assessment of a reduction in ambient PM2.5 levels in Spain
Research Highlights
►This study reports the first nationwide estimate of the mortality impact of air pollution in Spain. ►A feasible reduction in PM2.5 levels would prevent 1720 all-cause deaths annually in Spain. ►Effective pollution control policies should be implemented to decrease PM2.5 emissions.
Introduction
There is a general scientific consensus as to the fact that air pollution is an important public health concern (Pope and Dockery, 2006, Curtis et al., 2006). Among the air pollutants, special mention should be made of particulate matter (PM), especially fine particles of less than 2.5 μm in diameter (PM2.5), since this seems to be associated with the most adverse health effects, including lung cancer and other types of cardiopulmonary mortality (Peters et al., 2001, Pope et al., 2002). In the USA, there has been a long tradition of studying the long-term health effects of PM2.5, thanks to the contribution made by various cohort studies (Dockery et al., 1993, Pope et al., 2002). In Europe, interest in this pollutant is growing, in view of the fact that PM2.5 levels have risen notably in recent decades, particularly in urban areas (Perez et al., 2009). This development, and the recent measurement of this pollutant in major European cities, have together led to a number of epidemiologic studies being undertaken (Brunekreef et al., 2009, Naess et al., 2007), the preliminary results of which are in line with those of USA studies. The findings of European cohort studies have added to the evidence that long-term exposure to PM2.5 is associated with increased mortality.
The knowledge generated by epidemiologic studies has led to the adoption of different air pollution control measures aimed at reducing harmful health effects. Nevertheless, most public health interventions or policy changes on this matter cannot be evaluated directly. In this context, health impact assessment (HIA) methodology (WHO, 2000) is a valuable tool, as it relies on available pollutant exposure-disease effect estimates and can be used to estimate the expected reduction in the burden of disease attributable to different air quality improvement scenarios (Krzyzanowski et al., 2002, Martuzzi et al., 2003, Nieuwenhuijsen et al., 2006). Up to now, HIA at the European level has enabled the health effects of reducing urban air pollution to be quantified, mostly by reducing cardiovascular or respiratory mortality and morbidity (Ballester et al., 2008, Boldo et al., 2006, Clancy et al., 2002, Medina et al., 2004).
In Spain, the Air Pollution Risk Assessment System (Sistema de Evaluación de Riesgos por Contaminación Atmosférica—SERCA) research project was set up to conduct a nationwide HIA of the previously mentioned problem, using a multidisciplinary approach combining researchers with expertise in detailed air pollution estimation and public health professionals. Accordingly, this will be the first project to furnish national estimates of the number of deaths that could be avoided in Spain if air pollution control measures were implemented.
The extensive use of HIA in the field of air pollution has induced some researchers to develop specific software tools to help estimate the health impact of changes in air quality. One of the best known of these tools is the Environmental Benefits Mapping and Analysis Program (BenMAP) (AAI, 2005), developed by the US Environmental Protection Agency (EPA) to perform customized HIA and benefit–cost analyses of air quality regulations (Davidson et al., 2007, Fann et al., 2009). This software integrates an HIA calculator and a geographic information system (GIS), and by way of global outputs, provides impact estimates (i.e., the number of avoidable cases in the study area) combined with the geographic distribution of the selected impact indicator for different scenarios simulating changes in air quality. This tool has, however, been rarely used outside the USA (Bae and Park, 2009, Tagaris et al., 2009).
This paper sought to perform a preliminary assessment of the number of total avoidable deaths attributable to a reduction in PM2.5 concentrations in Spain within the framework of the SERCA project. To achieve this, we compared a 2004 baseline scenario based on Spain's National Emissions Inventory (MMA (Ministry of Environment), 2006, EEA (European Environment Agency), 2006), against a 2011 control scenario with a theoretical reduction in PM2.5 exposure based on the implementation of planned air quality policies. The BenMAP (version 4.0.27) was used as the HIA calculating tool. We report the advantages and difficulties found in the customization of this software for use in a Spanish context.
Section snippets
Air pollution scenarios: 2004–2011
For HIA purposes, we defined a baseline scenario, which corresponded to the year 2004 and a control scenario, which would simulate pollution distribution in 2011 in a case where air quality control measures planned in 2004 were to prove successful.
The baseline scenario was drawn from Spain's National Emissions Inventory (for 2004). The control scenario (2011) was taken from the baseline scenario defined for Spain using Spain's Emission Projections methodology (Lumbreras et al., 2008), and
Results
According to our estimates, the proposed control scenario would imply a generalized improvement in annual mean PM2.5 concentration values (up to 4 μg/m3), though the average change in air quality (average annual PM2.5 concentration) nationwide from 2004 to 2011, as estimated by the CMAQ, would be moderated (0.7 μg/m3). Fig. 3 depicts the geographic variability of air pollution changes between control and baseline PM2.5 scenarios, clearly related to emission changes (Fig. 1). The highest reduction
Discussion
This study reports the first nationwide estimate of the mortality impact of changes in PM2.5 levels in Spain. Using CMAQ models for PM2.5 exposure assessment and the BenMAP as an HIA tool, we estimated that a feasible reduction in PM2.5 levels between 2004 and 2011 (based on national emission projections) would prevent approximately 1450 deaths annually in Spain in the 25 to 74 age groups (according to Laden et al., 2006) or 1720 deaths in the over-30 age group (according to Pope et al., 2002),
Conclusion
In conclusion, our study constitutes the first attempt to perform a national HIA of air pollution in Spain. The HIA findings showed the potential mortality-related benefits that could be expected if pollution control policies were successfully implemented. The magnitude of our results suggests that controlling fine particle pollution would result in thousands fewer avoidable deaths per year. Therefore, we strongly encourage policy makers to consider such harmful consequences by urgently
Acknowledgments
The CMAQ modeling system and the BenMAP software were made available by the US Environmental Protection Agency and are supported by the Community Modeling and Analysis System (CMAS) Center. The authors specially thank the contribution of Neal Fann (US EPA) for his assistance in customizing the BenMAP software.
This study was funded by the Spanish Ministry of the Environment and Rural and Marine Affairs (Ministerio de Medio Ambiente y Medio Rural y Marino) (058/PC08/3-18.1). Mortality data were
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2022, Environmental PollutionCitation Excerpt :Previous studies showed that premature deaths attributed to PM2.5 pollution increased with age (Mueller et al., 2021; Yang et al., 2020) and varied by sex (Hyun et al., 2021; Nayebare et al., 2019). Health impact assessment (HIA) is a useful tool to estimate the effects of air pollution exposure on a population (Boldo et al., 2011). Seposo et al. (2018) assessed the health impact of PM2.5 pollution among sex- and age-specific Japanese populations and found substantial differences in the impact on different age groups.