CHAPTER ONE

Introduction

Air pollution is a familiar environmental health hazard. We know what are looking at when
brown haze settles over a city, exhaust billows across a busy highway, or a plume rises from a
smokestack. Some air pollution is not seen, but its pungent smell alerts you (Parajuli, 2016).

When the National Ambient Air Quality Standards were established in 1970, air pollution was
regarded primarily as a threat to respiratory health. Over the next decades as air pollution
research advanced, public health concern broadened to include cardiovascular disease; diabetes
mellitus; obesity; and reproductive, neurological, and immune system disorders (Bull, 2003).

Air pollution exposure is associated with oxidative stress and inflammation in human cells,
which may lay a foundation for chronic diseases and cancer. In 2013, the International Agency
for Research on Cancer of the World Health Organization (WHO) classified air pollution as a
human carcinogen (Singh, et. al., 2013).

Air pollution is a mix of hazardous substances from both human-made and natural sources.
Vehicle emissions, fuel oils and natural gas to heat homes, by-products of manufacturing and
power generation, particularly coal-fueled power plants, and fumes from chemical production are
the primary sources of human-made air pollution. Nature releases hazardous substances into the
air, such as smoke from wildfires, which are often caused by people; ash and gases from volcanic
eruptions; and gases, like methane, which are emitted from decomposing organic matter in soils
(Marlon, et. al., 2019).

Traffic-Related Air Pollution (TRAP), from motor vehicle emissions, may be the most
recognizable form of air pollution. It contains most of the elements of human-made air pollution:
ground-level ozone, various forms of carbon, nitrogen oxides, sulfur oxides, volatile organic
compounds, polycyclic aromatic hydrocarbons, and fine particulate matter.

Ozone, an atmospheric gas, is often called smog when at ground level. It is created when
pollutants emitted by cars, power plants, industrial boilers, refineries, and other sources
chemically react in the presence of sunlight. Noxious gases, which include carbon dioxide,
carbon monoxide, nitrogen oxides (NOx), and sulfur oxides (SOx), are components of motor
vehicle emissions and byproducts of industrial processes (Spiegel, 2019).

Particulate matter (PM) is composed of chemicals such as sulfates, nitrates, carbon, or mineral

dusts. Vehicle and industrial emissions from fossil fuel combustion, cigarette smoke, and
burning organic matter, such as wildfires, all contain PM. A subset of PM, fine particulate matter
(PM 2.5) is 30 times thinner than a human hair. It can be inhaled deeply into lung tissue and
contribute to serious health problems. Particulate matter 2.5 accounts for most health effects due
to air pollution in the U.S. (Moores, 2009).

Volatile organic compounds (VOC) vaporize at or near room temperature—hence, the

designation volatile. They are called organic because they contain carbon. VOCs are given off by
paints, cleaning supplies, pesticides, some furnishings, and even craft materials like glue.
Gasoline and natural gas are major sources of VOCs, which are released during combustion
(Kan, 2011).

Polycyclic aromatic hydrocarbons (PAH) are organic compounds containing carbon and

hydrogen of more than 100 PAHs known to be widespread in the environment, fifteen 15 are
listed in the Report on Carcinogens. In addition to combustion, many industrial processes, such
as iron, steel, and rubber product manufacturing, as well as power generation, also produce
PAHs as a by-product. PAHs are also found in particulate matter Eze, et. al., (2014).
 CHAPTER TWO

2.0 LITERATURE REVIEW OF AIR POLLUTION

The World Health Organization (WHO) reports on six major air pollutants, namely particle
pollution, ground-level ozone, carbon monoxide, sulfur oxides, nitrogen oxides, and lead. Air
pollution can have a disastrous effect on all components of the environment, including
groundwater, soil, and air. Additionally, it poses a serious threat to living organisms. In this vein,
our interest is mainly to focus on these pollutants, as they are related to more extensive and
severe problems in human health and environmental impact. Acid rain, global warming, the
greenhouse effect, and climate changes have an important ecological impact on air pollution
(WHO, 2019).

Over its 50-plus year history, National Institute of Environmental Health Sciences (NIEHS) has
been a leader in air pollution research. In 1993, NIEHS researchers published the landmark Six
Cities Study, which established an association between fine particulate matter and mortality. The
institute continues to fund and conduct research into how air pollution affects health and the
population groups who are most affected (USGCRP, 2009).

This review is not a systematic review of all Hebrew Immigrant Aid Society (HIAs) on air
pollution. Criteria are large HIAs covering a large proportion of Europe (defined as more than
one country) with the aim of guiding international air pollution policies. The HIAs included here
have been chosen a priori by the APHEKOM group. In addition, we have added the Health risks
of air pollution in Europe (HRAPIE) project and the Tri-national study to fulfil abovementioned
criteria. We have included three WHO funded Global Burden of Disease Study (GBD) studies to
identify the methodological changes that have occurred over the years. The information
presented in this review is based on available technical reports and articles. We included the
following HIAs:

Improving knowledge and Communication for Decision Making on Air Pollution and Health in
Europe. 2) Air Pollution and Health: a European Information System (APHEIS) Clean Air For
Europe (CAFE) European Perspectives on Environmental Burden of Disease (hereafter referred
to as EBD) Global Burden of Disease due to outdoor air pollution for 2000 (hereafter referred to
as GBD2000) Global Burden of disease from urban outdoor air pollution for 2008 (hereafter
referred to as GBD 2008). Global Burden of disease from ambient air pollution for 2012
(hereafter referred to as GBD 2012) Tri-national study HRAPIE Part 2: Quantification of
Differences To quantify the reviewed differences, we have used an HIA online tool developed by
the APHEKOM project and freely available at http://si.easp.es/aphekom/ to conduct HIAs under
alternate assumptions.

This online tool provides guidelines and Excel spreadsheets and uses the general framework
recommended by WHO for performing an HIA. In this quantification exercise, we have based
our analyses on measured annual means of particulate matter with an aerodynamic diameter
smaller than 2.5 μm (PM2.5) in Stockholm, Budapest and Paris for the years 2004–2006. Thus,
this should not be interpreted as a complete HIA but rather as an exercise to quantify and show
how methodological differences affect the estimates. The cities were chosen based on their
representativeness of European air pollution levels with one city Stockholm, Sweden with
relatively low levels (mean levels of PM2.5 for 2004–2006 is 9 μg/m3 ); Paris, France with
higher levels (mean levels of PM2.5 for 2004– 2006 is 16 μg/m3 ); and Budapest, Hungary with
some of the highest levels of air pollutants (mean levels of PM2.5 for 2004–2006 is 34 μg/m3 )
(more details on levels in Table S1 in the Supplement).

Budapest was also chosen to help understand how missing PM2.5 measurements may influence
results when one uses particulate matter with an aerodynamic diameter smaller than 10 μm
(PM10) measurements as an approximation for the missing values of PM2.5 with differing
PM10/PM2.5 ratios. The three cities have also different age distributions and thus baseline
mortality and morbidity rates. As an example, the population in Stockholm was older compared
with the other two cities. We made the following methodological choices for our alternate HIA
calculations: a) We derived the exposure response-function from allcause mortality risk
estimates in the American Cancer Society Study by Pope et al. (hereafter referred to as ACS
study) that reported hazard ratios.
 CHAPTER THREE

3.0 IMPLICATION OF AIR POLLUTION

Air pollution and climate change are closely related. Climate is the other side of the same coin
that reduces the quality of our Earth (Gadi, et. al., 2012). Pollutants such as black carbon,
methane, tropospheric ozone, and aerosols affect the amount of incoming sunlight. As a result,
the temperature of the Earth is increasing, resulting in the melting of ice, icebergs, and glaciers.

In this vein, climatic changes will affect the incidence and prevalence of both residual and
imported infections in Europe. Climate and weather affect the duration, timing, and intensity of
outbreaks strongly and change the map of infectious diseases in the globe (Singh, et. al., 2013).
Mosquito-transmitted parasitic or viral diseases are extremely climate-sensitive, as warming
firstly shortens the pathogen incubation period and secondly shifts the geographic map of the
vector. Similarly, water-warming following climate changes leads to a high incidence of
waterborne infections. Recently, in Europe, eradicated diseases seem to be emerging due to the
migration of population, for example, cholera, poliomyelitis, tick-borne encephalitis, and malaria
(WHO, 2019).

The spread of epidemics is associated with natural climate disasters and storms, which seem to
occur more frequently nowadays (Maystre, 2019). Malnutrition and disequilibration of the
immune system are also associated with the emerging infections affecting public health (Parajuli,
2016).

The Chikungunya virus “took the airplane” from the Indian Ocean to Europe, as outbreaks of the
disease were registered in Italy (Gautam, 2012) as well as autochthonous cases in France. An
increase in cryptosporidiosis in the United Kingdom and in the Czech Republic seems to have
occurred following flooding (WHO, 2019).

As stated previously, aerosols compounds are tiny in size and considerably affect the climate.
They are able to dissipate sunlight (the albedo phenomenon) by dispersing a quarter of the sun's
rays back to space and have cooled the global temperature over the last 30 years (Spiegel, 2019).
3.1 Respiratory Disease Cause by Air Pollution

 Air pollution can affect lung development and is implicated in the development
of emphysema, asthma, and other respiratory diseases, such as chronic obstructive
pulmonary disease (COPD).
 PM and nitrogen oxide are linked to chronic bronchitis.

3.2 Cardiovascular Disease

 Fine particulate matter can impair blood vessel function and speed up calcification in

arteries.
 NIEHS researchers established links between short-term daily exposure by post-
menopausal women to nitrogen oxides and increased risk of hemorrhagic stroke.
 For a cross-section of older Americans, exposure to TRAP can result in lowered levels of
high-density lipoprotein, sometimes called good cholesterol, increasing their risk for
cardiovascular disease.
 According to a National Toxicology Program (NTP) report, TRAP exposure also
increases a pregnant woman’s risk for dangerous changes in blood pressure, known as
hypertensive disorders, which are a leading cause of pre-term birth, low birth weight, and
maternal and fetal illness and death (Parajuli, 2016).

3.3 Cancer

 A large study of more than 57,000 women found living near major roadways
may increase a woman’s risk for breast cancer.
 The NIEHS Sister Study found other airborne toxic substances, especially methylene
chloride, which is used in aerosol products and paint removers, are also associated
with increased risk of breast cancer.
 Occupational exposure to benzene, an industrial chemical and component of gasoline,
can cause leukemia and is associated with non-Hodgkin’s Lymphoma.
 A long-term study, 2000-2016, found an association between lung cancer incidence and
increased reliance on coal for energy generation (WHO, 2019).
3.4 Who does air pollution affect the most?

Air pollution affects everyone’s health, but certain groups may be harmed more.
Almost 9 out of 10 people who live in urban areas worldwide are affected by air pollution.

3.5 Children

The NIEHS-funded Children’s Health Study at the University of Southern California is one of

the largest studies of the long-term effects of air pollution on children’s respiratory health.
Among its findings:

 Higher air pollution levels increase short-term respiratory infections, which lead to more

school absences.
 Children who play several outdoor sports and live in high ozone communities are more
likely to develop asthma.
 Children living near busy roads are at increased risk for asthma.
 Children with asthma who were exposed to high levels of air pollutants were more likely
to develop bronchitis symptoms.
 Living in communities with higher pollution levels can cause lung damage (NEPIS, 2017).

 NIEHS-funded researchers from the University of California, Davis, Environmental

Health Sciences Center are conducting the Bio-Specimen and Fire Effects (B-SAFE)
Study. This ongoing project seeks to discover if and how recent wildfires and their smoke
affected pregnant women and their babies. Begun in 2017, study participants are pregnant
women who were living in Northern California when the 2018, 2019, or 2020 wildfires
occurred there.
 Breathing PM 2.5, even at relatively low levels, may alter the size of a child's developing
brain, which may ultimately increase the risk for cognitive and emotional problems later
in adolescence.
 Prenatal exposure to PAHs was associated with brain development effects, slower
processing speed, attention-deficit and hyperactivity disorder (ADHD) symptoms, and
other neurobehavioral problems in urban youth.
  In New York City, prenatal exposure to air pollution may play a role in
childhood ADHD-related behavior problems.
 Prenatal exposure to particulate matter was associated with low birth weight.
 Women exposed to high levels of fine particulate matter during pregnancy, particularly in
the third trimester, may have up to twice the risk of having a child with autism.
 Second and third trimester exposure to PM 2.5 might increase the chance of those
children having high blood pressure in early life.
 In California’s agricultural San Joaquin Valley, women who were exposed to high levels
of carbon monoxide, nitrogen oxide, or nitrogen dioxide during their first 8 weeks of
pregnancy were more likely to have a baby with neural tube defects.
 In Marietta, Ohio, home to a ferromanganese refinery, manganese concentrations in
blood and hair, a biomarker of air pollution exposure, were associated with lower child
IQ scores (Kassomenos, et. al., 2012).

3.6 Older adults

 Air pollution was linked to a greater chance of developing several neurological disorders,
including Parkinson's disease, Alzheimer's disease, and other dementias. Hospital
admissions data from 63 million older adults in the U.S., obtained over 17 years (2000-
2016), was analyzed along with estimated PM 2.5 concentrations by zip code to conduct
the study.
 In older adults, long-term exposure to TRAP may significantly hasten physical
disabilities. The risk is more pronounced among racial minorities and lower-income
people.
 PM 2.5 air pollution is also associated with accelerated memory problems and
Alzheimer’s-like brain declines, which was seen among women 65 years of age and
older.
 Nutrients may counter some harmful effects from air pollution. A 2020 study
found omega-3 fatty acids, obtained by eating certain fish, may protect against PM 2.5-
associated brain shrinkage in older women (Hou, et. al., 2010).
3.7 Rural dwellers

 An NIEHS-funded study found that concentrations of PM 2.5 in rural Washington State

were comparable to urban Seattle. In this study, as regional PM 2.5 increased, there
were increased asthma symptoms, such as limitation of activities, more wheezing, and
more nighttime waking, in rural children.
 In the rural U.S., large-scale animal feeding operations might compromise regional air
quality through emission of pollutants, such as ammonia gas. A study found acute lung
function problems in children with asthma in such areas (Dockery, 1993).

3.8 Different genes

Your genes play a role in respiratory health. NIEHS-funded research discovered that people
with specific gene variants, which made them more likely to have lung inflammation, had a
greater chance of suffering from asthma if they lived close to major roadways.

3.9 NIEHS and community involvement

Breathing dust from mine tailings, created by active and abandoned mining operations, affects
lung function. NIEHS grant recipients address such health hazards in disadvantaged
communities, such as Native American people in the West, through culturally relevant health
communication (Hashim, 2014).

NIEHS also helps residents of Imperial County, California track air pollution through a network
of 40 community-run monitors. In this county, long-term improvements in air quality were
associated with significant lung-function improvement in children.

Community-level tactics can help reduce exposure to TRAP:

 Using high-efficiency particulate air (HEPA) filtration.

 Building land-use buffers and vegetation barriers.
 Improving urban design with gardens, parks, and street-side trees.
 Creating active-travel options, such as bicycling and walking paths (Burroughs, 2017).
3.10 Why improving air quality matters

 Among children in Southern California, decreases in ambient nitrogen dioxide and PM

2.5 were associated with fewer cases of asthma.
 Bronchitis symptoms declined as pollution levels dropped in the Los Angeles region.
 When fossil-fuel power plants close, nearby air pollution is reduced. A study found
the incidence of preterm births went down within 5 kilometers of retired coal and oil-
powered plant locations.
 An NIEHS-funded study found that a mixture of several B vitamins may protect
DNA from changes attributable to PM 2.5 air pollution (Dherani, et. al., 2008).
 CHAPTER FOUR

CONCLUSION AND RECOMMENDATION

CONCLUSION

The health of the public, especially those who are the most vulnerable, such as children, the
elderly and the sick, is at risk from air pollution, but it is difficult to say the level of risk is. It is
possible that the problem has been over-stressed in relation to other challenges in the field of
public health.
 RECOMMENDATION

On an individual level, the risk to health from air pollution is very much smaller than that posed
by active cigarette smoking or accidents. It is also true that healthy individuals are rather unlikely
to be affected by exposure to the concentrations of outdoor air pollutants in many European
countries on most days of the year.
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