Air Quality Regulation

Jonathan M. Samet, MD, MS

Distinguished Professor and Flora L. Thornton Chair
University of Southern California Keck School of Medicine
Director, USC Institute for Global Health
 Air Pollution
Disasters of the 20th
Century

“The Fog Disaster in the Meuse Valley, 1930 … led to the

first scientific proof of the potential for atmospheric
pollution to cause deaths and disease, and it clearly
identified the most likely causes. Sixty deaths that were
attributed to the fog occurred on Dec 4 and 5.” — Nemery
et al. (2001). Lancet.

“Beginning on October 26, 1948, sparse air movement contributed to a

temperature inversion in the atmosphere over western Pennsylvania, Ohio, and
areas of neighboring states. A fog laden with particulates and other industrial
contaminants saturated the air of Donora, a small industrial town on the banks
of the Monongahela River, some 30 miles south of Pittsburgh. Visibility was so
poor that even locals lost their sense of direction. An estimated 5000 to 7000
persons in a town of 14000 residents became ill, some 400 required
hospitalization, and 20 died before rain dispersed the killing smog on October
30 and 31, 1948.” — Helfand et al. (2001). AJPH.
2
“This is why the London Disaster of 1952 should be commemorated; the
many efforts to limit ambient air pollution that have occurred in the past
50 years are the proper memorial to those who were its unheralded
victims.” — David V. Bates
Environmental Health Perspectives • Vol. 110 | No. 12 | December 2002

3
Burden of disease attributable to 20 leading risk factors in 2010, expressed as a percentage of global DALYs, both sexes

4
Evidence to Policy

5
Evidence-Based Epidemiology Toxicology
Environmental
Decision Making Hazard Identification

Yes No

How much risk?

Epidemiology QRA Toxicology

Decisions
Regulation
6
The Yin and Yang of Evidence and Uncertainty

n  Evidence n  Uncertainty

u  What we know
u  Determine causation and risk
u  Basis for action
u  Developed with synthesis/
integration
u  What we do not know
u  Basis for more research
u  Delay action
u  Uncertainties will always persist

7
The Evidence Act Not Act
Scale
Evidence

Politics
Costs
Activists
Advocates

Uncertainty

8
Air Quality Regulation in the United States and Evidence-Driven
Improvements in Air Quality

9
L.A.’s Storied Past: The Birthplace of Smog

July 26, 1943: L.A. Gets First Big Smog

Source: L.A. Smogtown blog. Retrieved from www.lasmogtown.com 10

November 5, 1966

November 5, 1966
New York Times archives
11
12
What Are Risks at Current Levels?

n  For mortality

u  Short-term increases in mortality
u  Longer-term increases in mortality

n  For morbidity

u  Diverse adverse respiratory effects
u  Adverse cardiovascular effects
u  Other effects: reproductive
u  Susceptible populations

13
The Clean Air Act: 42 U.S.C. §7401 et seq. (1970)

n  Comprehensive federal law that regulates air emissions from stationary and mobile
sources

n  Authorizes EPA to establish National Ambient Air Quality Standards (NAAQS)

n  Calls for states and EPA to solve multiple air pollution problems through programs
based on the latest science and technology information

Source: Environmental Protection Agency. Retrieved from http://www.epa.gov/air/caa/ 14

Clean Air Act Section 109

n  Section 109 (42 U.S.C. 7409) directs the Administrator to propose and promulgate
“primary” and “secondary” NAAQS for pollutants identified under section 108. Section
109(b)(1) defines a primary standard as one “the attainment and maintenance of
which in the judgment of the Administrator, based on such criteria and allowing
an adequate margin of safety, is requisite to protect the public health.”

15
16
National Ambient Air Quality Standards (NAAQS)

Primary/ 
Pollutant Averaging time Level Form
secondary
8-hour 9 ppm
Carbon monoxide primary Not to be exceeded more than once per year
1-hour 35 ppm
primary and  Rolling 3-month
Lead 0.15 µg/m3  Not to be exceeded
secondary average
primary 1-hour 100 ppb 98th percentile, averaged over 3 years
Nitrogen dioxide primary and
Annual 53 ppb Annual mean
secondary
primary and  Annual fourth-highest daily maximum 8-hour
Ozone 8-hour 0.075 ppm
secondary concentration, averaged over 3 years
primary Annual 12 µg/m3 Annual mean, averaged over 3 years
secondary Annual 15 µg/m3 Annual mean, averaged over 3 years
Particle PM2.5
primary and 
pollution 24-hour 35 µg/m3 98th percentile, averaged over 3 years
secondary
primary and Not to be exceeded more than once per year on
PM10 24-hour 150 µg/m3
secondary average over 3 years
99th percentile of 1-hour daily maximum
Sulfur dioxide primary 1-hour 75 ppb
concentrations, averaged over 3 years
secondary 3-hour 0.5 ppm Not to be exceeded more than once per year
Source: EPA. National Ambient Air Quality Standards. Links to information on specific pollutants can be found at http://www.epa.gov/air/criteria.html 17
The Clean Air
Act Success
Story

Cumulative benefits 1970–90

•  $6 to $50 trillion
Cumulative costs
•  $520 billion

18
Samet. (2011, July 21). N Engl
Med, 365, 3, 198–201.
19
Current Scientific Challenges

20
The Narrowing
Range of
Exposure

Source: National Ambient Air Quality Standards. Retrieved from

http://www.epa.gov/ttn/naaqs/standards/pm/s_pm_index.html
21
What Is the Form of the Relationship?

22
http://ehp.niehs.nih.gov/1307049/

23
Burnett et al. (2014). EHP.
24
Concentration-
Response

25
Global Air Pollution

26
Fine Particles in the Air: NASA Satellite Data

Source: NASA. Retrieved from http://www.nasa.gov/topics/earth/features/health-sapping.html 27

Deaths Attributable to Ambient PM2.5 by Cause in the US, India, and China
in 2010

Source: Aaron Cohen, Health Effects Institute, Co-Chair of GBD 2010 Ambient Air Pollution Expert Group. 28
29
 WHO Air Quality
Guidelines

Source: WHO. (2005). WHO Air Quality Guidelines

for Particulate Matter, Ozone, Nitrogen Dioxide and
Sulfur Dioxide. Global Update 2005. Summary of
Risk Assessment. 30
Delhi

Credit: Jonathan M. Samet.

31
Air Quality Guidelines: PM10

Annual 24-hour

Source: WHO. (2006). Air quality guidelines. Global update 2005. 32

We Don’t Want the London Fog of 1952 to Happen Again

33