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      From Good Intentions to Proven Interventions: Effectiveness of Actions to Reduce the Health Impacts of Air Pollution

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          Abstract

          Background

          Associations between air pollution and a multitude of health effects are now well established. Given ubiquitous exposure to some level of air pollution, the attributable health burden can be high, particularly for susceptible populations.

          Objectives

          An international multidisciplinary workshop was convened to discuss evidence of the effectiveness of actions to reduce health impacts of air pollution at both the community and individual level. The overall aim was to summarize current knowledge regarding air pollution exposure and health impacts leading to public health recommendations.

          Discussion

          During the workshop, experts reviewed the biological mechanisms of action of air pollution in the initiation and progression of disease, as well as the state of the science regarding community and individual-level interventions. The workshop highlighted strategies to reduce individual baseline risk of conditions associated with increased susceptibility to the effects of air pollution and the need to better understand the role of exposure duration in disease progression, reversal, and adaptation.

          Conclusion

          We have identified two promising and largely unexplored strategies to address and mitigate air pollution–related health impacts: reducing individual baseline risk of cardiovascular disease and incorporating air pollution–related health impacts into land-use decisions.

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          Most cited references76

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          Fine-particulate air pollution and life expectancy in the United States.

          Exposure to fine-particulate air pollution has been associated with increased morbidity and mortality, suggesting that sustained reductions in pollution exposure should result in improved life expectancy. This study directly evaluated the changes in life expectancy associated with differential changes in fine particulate air pollution that occurred in the United States during the 1980s and 1990s. We compiled data on life expectancy, socioeconomic status, and demographic characteristics for 211 county units in the 51 U.S. metropolitan areas with matching data on fine-particulate air pollution for the late 1970s and early 1980s and the late 1990s and early 2000s. Regression models were used to estimate the association between reductions in pollution and changes in life expectancy, with adjustment for changes in socioeconomic and demographic variables and in proxy indicators for the prevalence of cigarette smoking. A decrease of 10 microg per cubic meter in the concentration of fine particulate matter was associated with an estimated increase in mean (+/-SE) life expectancy of 0.61+/-0.20 year (P=0.004). The estimated effect of reduced exposure to pollution on life expectancy was not highly sensitive to adjustment for changes in socioeconomic, demographic, or proxy variables for the prevalence of smoking or to the restriction of observations to relatively large counties. Reductions in air pollution accounted for as much as 15% of the overall increase in life expectancy in the study areas. A reduction in exposure to ambient fine-particulate air pollution contributed to significant and measurable improvements in life expectancy in the United States. 2009 Massachusetts Medical Society
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            Woodsmoke health effects: a review.

            The sentiment that woodsmoke, being a natural substance, must be benign to humans is still sometimes heard. It is now well established, however, that wood-burning stoves and fireplaces as well as wildland and agricultural fires emit significant quantities of known health-damaging pollutants, including several carcinogenic compounds. Two of the principal gaseous pollutants in woodsmoke, CO and NOx, add to the atmospheric levels of these regulated gases emitted by other combustion sources. Health impacts of exposures to these gases and some of the other woodsmoke constituents (e.g., benzene) are well characterized in thousands of publications. As these gases are indistinguishable no matter where they come from, there is no urgent need to examine their particular health implications in woodsmoke. With this as the backdrop, this review approaches the issue of why woodsmoke may be a special case requiring separate health evaluation through two questions. The first question we address is whether woodsmoke should be regulated and/or managed separately, even though some of its separate constituents are already regulated in many jurisdictions. The second question we address is whether woodsmoke particles pose different levels of risk than other ambient particles of similar size. To address these two key questions, we examine several topics: the chemical and physical nature of woodsmoke; the exposures and epidemiology of smoke from wildland fires and agricultural burning, and related controlled human laboratory exposures to biomass smoke; the epidemiology of outdoor and indoor woodsmoke exposures from residential woodburning in developed countries; and the toxicology of woodsmoke, based on animal exposures and laboratory tests. In addition, a short summary of the exposures and health effects of biomass smoke in developing countries is provided as an additional line of evidence. In the concluding section, we return to the two key issues above to summarize (1) what is currently known about the health effects of inhaled woodsmoke at exposure levels experienced in developed countries, and (2) whether there exists sufficient reason to believe that woodsmoke particles are sufficiently different to warrant separate treatment from other regulated particles. In addition, we provide recommendations for additional woodsmoke research.
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              Health effects of fine particulate air pollution: lines that connect.

              Efforts to understand and mitigate thehealth effects of particulate matter (PM) air pollutionhave a rich and interesting history. This review focuseson six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There hasbeen substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidiity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonaryhealth. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.
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                Author and article information

                Journal
                Environ Health Perspect
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                January 2011
                20 August 2010
                : 119
                : 1
                : 29-36
                Affiliations
                [1 ] School of Human Kinetics, University of British Columbia, Vancouver, British Columbia, Canada
                [2 ] British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
                [3 ] Swiss Tropical and Public Health Institute, Basel, Switzerland
                [4 ] University of Basel, Basel, Switzerland
                [5 ] International Agency for Research on Cancer, Lyon, France
                [6 ] Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
                [7 ] Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                [8 ] Providence Heart and Lung Institute, St. Paul’s Hospital, Vancouver, British Columbia, Canada
                [9 ] Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
                [10 ] School of Environmental Health and
                [11 ] Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                [12 ] Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
                [13 ] Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
                [14 ] Center for Environmental Health Sciences, University of Montana, Missoula, Montana, USA
                [15 ] Département de Santé Environnementale et Santé au Travail, Université de Montréal, Montréal, Quebec, Canada
                [16 ] Institut National de Santé Publique du Québec, Montréal, Quebec, Canada
                [17 ] Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
                [18 ] London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
                Author notes
                Address correspondence to M. Brauer, School of Environmental Health, The University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver, BC Canada, V6T 1Z3. Telephone: (604) 822-9585. Fax: (604) 822-9588. E-mail: brauer@ 123456interchange.ubc.ca

                The authors declare they have no actual or potential competing financial interests.

                Article
                ehp-119-29
                10.1289/ehp.1002246
                3018496
                20729178
                c691082a-c121-4bbb-acd3-e8cb49f8c07e
                This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI.
                History
                : 2 April 2010
                : 20 August 2010
                Categories
                Review

                Public health
                respiratory,urban planning,exposure,air pollution,antioxidant,intervention,cardiovascular,public health

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