The Apheis programme

 

 

Latest Apheis Health Impact Assessment in 26 cities adds new evidence that air pollution continues to threaten public health in Europe. The report also provides key insight on information needs of policy makers and how to reach them effectively and efficiently.

 

Apheis (Air Pollution and Health: A European Information System) released the latest findings in its ongoing assessment of the impact of particulate air pollution on health in 26 cities in 12 European countries.  The new evidence provided by the third phase of the Apheis programme confirmed the finding of Apheis-2 that air pollution continues to pose a significant threat to public health in urban environments in Europe.

 

Another key part of Apheis-3 investigated how to reach individuals who make and influence policy on air pollution and health in Europe; and how to deliver Apheis' findings to them effectively and efficiently.  This work produced a model that shows who the key players are in the policy-making process; how information flows between them; what types of information scientific and policy users active in the process each require; and what are the best forms in which to deliver this content to them to ensure maximum understanding and usage of the information Apheis produces.

 

This twin focus on both providing the latest scientific findings and developing a strategy for communicating them aims to fulfill Apheis' mission of meeting the information needs of individuals and organizations concerned with the impact of air pollution on health in Europe, and in particular the needs of individuals who influence and set policy in this area on the European, national, regional and local levels.

 

Created in 1999, the Apheis programme (www.apheis.net) is co-funded by the EC's Directorate General of Health and Consumer Protection and by Apheis' partners.  The Apheis programme is coordinated by Institut de Veille Sanitaire (InVS) in Saint-Maurice, France and by Agencia Municipal de Salut Pública de Barcelona (AMSPB) in Spain.

 

 

New data sources and calculations, and refreshed data show continuing health threat

 

To broaden and deepen the previous assessment in Apheis-2 of the impact of air pollution on health, the Apheis-3 phase included new sources of data on air pollution and health in its analysis.  In particular, in this new HIA (health impact assessment) Apheis-3 added data for PM_2.5 (particles less than 2.5 micrometers in size) to the existing black smoke and PM₁₀ measurements; and Apheis-3 investigated cause-specific mortality (cardiovascular, lung-cancer and respiratory deaths) as well as total mortality.  In addition to calculating attributable number of deaths at a given point in time, Apheis-3 also calculated the potential gain in life expectancy in order to provide a dynamic picture of the effects of air pollution on health over subjects' lifetimes.

 

In terms of findings, Apheis-3 revealed that reducing converted [1] PM_2.5 levels to 15 µg/m³ produces a benefit in terms of both total and cause-specific mortality that is over 30% greater than for a reduction to 20 µg/m³. 

 

In specific, the Apheis-3 HIA estimated that 11 375 "premature" deaths, including 8 053 cardiopulmonary deaths and 1 296 lung-cancer deaths, could be prevented annually if long-term exposure to the annual mean of converted PM_2.5 levels were reduced to 20 µg/m³ in each city; and that 16 926 premature deaths, including 11 612 cardiopulmonary deaths and 1 901 lung-cancer deaths, could be prevented annually if long-term exposure to converted PM_2.5 were reduced to 15 µg/m³.

 

In terms of life expectancy, if all other things were equal and the annual mean of converted PM_2.5 did not exceed 15 µg/m³, the potential gain in life expectancy of a

30-year-old person would average between 2 and 13 months, due to the reduction in total mortality.

 

These findings on the benefits of reducing PM_2.5 to 20 and 15 µg/m³ are particularly relevant at a time when discussions are taking place to set limit values for PM_2.5 as part of the CAFE legislation process at the European Commission.

 

In specific, for public-health reasons our HIA recommends 15 µg/m³ as the limit value for PM_2.5.  However, because a significant health impact can be expected even at 15 µg/m³, we advise reducing air pollution to levels even lower than 15 µg/m³.

 

Concerning the impact of exposure to PM₁₀ in the very short, short and long terms, in the 23 Apheis cities that measured PM₁₀, totalling almost 36 million inhabitants, if all other things were equal and exposure to outdoor concentrations of raw PM₁₀ [2] were reduced to 20 µg/m³ in each city, 2 580 premature deaths, including 1 741 cardiovascular and 429 respiratory deaths, could be prevented annually if the impact is only estimated over a very short term of 2 days.  The short-term impact, cumulated over 40 days, would be more than twice as great, totalling 5 240 premature deaths prevented annually, including 3 458 cardiovascular and 1 348 respiratory deaths.  And the long-term impact over several years would be even higher, totalling 21 828 premature deaths prevented annually.

 

Concerning the ability of Apheis cities across Europe to meet future standards designed to reduce the impact of air pollution on health, Apheis-3 determined that, while most of the 26 cities studied met the annual mean cut-off of 40 µg/m³ set as the limit value for PM₁₀ to be reached by all member states of the European Union by 2005, 21 cities still exceeded the 2010 limit value of 20 µg/m³.  Nonetheless, nine cities nearly met the latter value.

 

As for black smoke, often considered a good proxy for traffic-related air pollution, in the 16 Apheis cities that measured BS, totalling over 24 million inhabitants, if all other things were equal and BS levels were reduced to a 24-hour value of 20 µg/m³, 1 296 total premature deaths, including 405 cardiovascular deaths and 109 respiratory deaths, could be prevented annually.

 

 

Model for communicating Apheis' findings better to policy makers

 

As a reminder, the Apheis programme seeks to meet the information needs of individuals and organizations concerned with the impact of air pollution on health in Europe; and in particular the needs of those individuals who influence and set policy in this area on the European, national, regional and local levels.

Like many providers of scientific information, however, Apheis doubted the ability of scientific reports alone to meet the needs of this key audience.

 

Because the Apheis programme wanted to go beyond just ensuring that its findings are scientifically valid and up-to-date, Apheis-3 sought to develop an actionable strategy to communicate Apheis' findings to this key audience based on learning its needs directly from its members.

 

Our communications research identified each of the many types of key players in the long, complex chain that leads from the scientists to whom we distribute our reports directly, and who use them, to the policy makers whose actions ultimately have the greatest effect on public health, but who only receive our reports indirectly and use them rarely, if at all.

 

Our research showed that:

 

• Policy advisors and makers, who comprise both scientific and policy users, each have different problems to solve, different ways of processing information, different levels of scientific knowledge and different cultures, meaning each group has different information needs

• These policy advisors and makers are generally unlikely to use the scientific reports we develop as is, contrary to scientists.

Based on this evidence, we concluded that Apheis needs to act proactively to:

 

• Apply the above learnings to the way it shapes and delivers its information and messages to both scientific and policy users

• Develop a range of communications tools that goes beyond our comprehensive scientific reports to include summary reports, brochures, presentations and Q&As whose focus, content and form are tailored to the separate information needs of scientific and policy users

• Ensure that the information needed by policy advisors and makers actually reaches them.

 

Taking these steps will greatly enhance the way Apheis communicates with the key audiences that set policy on air pollution in Europe, and will thus help Apheis contribute better to improving public health.

 

 

 

About the Apheis network of environment and health professionals

 

To fulfill its mission, the Apheis programme has assembled a network of environment and health professionals in 26 European cities and created an epidemiological surveillance system that generates information on an ongoing basis and produces reports at periodic intervals.

 

The 26 cities, located in 12 European countries, include Athens, Barcelona, Bilbao, Bordeaux, Bucharest, Budapest, Celje, Cracow, Dublin, Gothenburg, Le Havre, Lille, Ljubljana, London, Lyon, Madrid, Marseille, Paris, Rome, Rouen, Seville, Stockholm, Strasbourg, Tel Aviv, Toulouse and Valencia.

 

The Apheis programme fosters ongoing cross-fertilization between multiple disciplines and regions to create skilled, local teams; enrich know-how and the quality of its findings; and explore important HIA methodological issues.

  Using this approach, Apheis has established a good basis for comparing methods and findings between cities.  This unique combination provides both local officials with standardized local data, analysis and knowledge for local decision making, and

European officials with standardized local data analyzed to provide a global view for European policy making.

 

 

Future steps

 

Apheis will implement its communications strategy when funds are allocated to developing the different communications tools recommended for each of its target audiences.

 

While continuing the development of HIAs of outdoor air pollution, Apheis will join the ENHIS project (Environment and Health Information System) of the WHO-European Centre for Environmental Health (ECEH) co-sponsored by the European Commission and ENHIS's partners.

 

In this new project, Apheis will coordinate health impact assessment issues; and it will test and adapt, in new cities and for new environmental risk factors, the methodology developed by Apheis.  The ultimate goal of this new phase of Apheis' work is to provide a global picture of the environmental burden of disease in Europe.

 

 

References

 

2.     Reinhard Kaiser, Isabelle Romieu, Sylvia Medina, Joel Schwartz, Michal Krzyzanowski, Nino Kunzli. Air Pollution Attributable Postneonatal Infant Mortality in U.S. Metropolitan areas: A Risk Assessment Study. Environmental Health: A Global Access Science Source 2004;3:4.

 

3.     Medina S, Plasencia A, Ballester F, Mücke HG, Schwartz J.  on behalf of the Apheis group. Apheis: Public Health Impact of PM10 in 19 European Cities. J Epidemiol Community Health. 2004. J Epidemiol Community Health 2004;58;831-836

 

4.     Medina S., Plasència A., Artazcoz L. Quénel P., Katsouyanni K., Mücke H.-G., De Saeger E., Krzyzanowsky M., Schwartz J. and the contributing members of the APHEIS group. APHEIS Health Impact Assessment of Air Pollution in 26 European Cities. Second year report, 2000-2001. Institut de Veille Sanitaire, Saint-Maurice, September 2002; 225 pages.

 

5.     Medina S., Plasència A., Artazcoz L. Quénel P., Katsouyanni K., Mücke HG., De Saeger E., Krzyzanowsky M., Schwartz J. and the contributing members of the APHEIS group. APHEIS Monitoring the Effects of Air Pollution on Public Health in Europe. Scientific report, 1999-2000. Institut de Veille Sanitaire, Saint-Maurice, March 2001; 136 pages.

 

6.     Evaluation and use of epidemiological evidence for Environmental Health Risk Assessment. WHO Regional Office for Europe, Copenhagen 2000 (EUR/00/5020369)

 

7.     Quantification of health effects of exposure to air pollution. WHO, Regional Office for Europe, Copenhagen 2001, (E74256)

 

8.     Katsouyanni K, Touloumi G, Samoli E, Gryparis A, Le Tertre A, Monopolis Y, Rossi G, Zmirou D, Ballester F, Boumghar A, Anderson HR, Wojtyniak B, Paldy A, Braunstein R, Pekkanen J, Schindler C, Schwartz J. Confounding and effect modification in the short-term effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 project. Epidemiology. 2001 Sep.12(5):521-31.

 

9.     Atkinson RW, Anderson HR, Sunyer J, Ayres J, Baccini M, Vonk JM, Boumghar A, Forastiere F, Forsberg B, Touloumi G, Schwartz J, Katsouyanni K. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. Am J Respir Crit Care Med. 2001 Nov 15; 164(10 Pt 1): 1860-6.

 

10.     Le Tertre A,  Medina S, Samoli E, Forsberg B, Michelozzi P, Boumghar A, Vonk JM, Bellini A, Atkinson R, Ayres JG, Sunyer J, Schwartz J, Katsouyanni K.  Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities. J Epidemiol Community Health. 2002 Oct;56(10):773-9.

 

11.  Künzli N, Kaiser R, Medina S et al. Public-health impact of outdoor and traffic-related air pollution: a European assessment. The Lancet 2000; 356:795-801

 

12.  Pope CA, Burnett RT, Thun MJ, et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002;287:1132-1141.