240321 SHV Brief Gemeenten en NVG Adviescommissie bijlage 2 - Andersen What science tells us

we inhale 10,000 liters of air/day

Life after WHO 2021 AQG – What does science tell us? Zorana Jovanovic Andersen, Chair of the European Respiratory Society (ERS) 24th May, 2023 Environment and Health Committee; Professor in Environmental Epidemiology, Department of Public Health, University of Copenhagen, Denmark

WHO 2021 AQG – main messages and beyond

1. Everyone is exposed – no lower threshold

1. Everyone in Europe is exposed to harmful levels of air pollution (97.5% European population) 2. No lower threshold below which air pollution is safe

Source: file:///C:/Users/vlq961/Downloads/ETC%20HE%20report%202022-3_status_eionet_mix_2021_2022-03-31_FINAL-2.pdf

2. Air pollution burden is huge, increasing & underestimated EEA • WHO 2005 AQG (Hoek et al. 2013): 6.2%* 2019: 307,000 deaths attributed to PM2.5 Global • WHO 2021 AQG (Chen & Hoek 2020): 8.0% 2020: 412,000 deaths attributed to PM2.5 1. ELAPSE (after WHO 2021 AQG): 11.8% 238,000 deaths > 5 µg/m3 PM2.5

EU 2. Stronger effects at low levels?

• https://www.ersnet.org/wp-content/uploads/2022/04/Statement-HIA-by-ERS_ISEE_final-002.pdf *interpretation: 6.2 % increase in mortality risk for each 10 µg/m3 increase in PM 2,5 • https://journals.lww.com/environepidem/Fulltext/2022/10000/Benefits_of_future_clean_air_policies_in_Europe_.5.aspx

3. Air pollution and climate change – inseparable issues

Health burden of air pollution Premature deaths + millions of new cases of disease, symptoms, worsened quality of life, doctor visits, ER visits, hospital admissions, sick days (school & work), medication use….

COVID-19

Air Pollution and Lung (Erik) GBD - Mortality • Long-term (years, lifetime) exposure to air specific- pollution can lead to impaired lung function causes, and development of new lung disease in ‘fraction attributable’ healthy individuals and increased risk of dying to air pollution from those diseases: https://www.stateof globalair.org/

asthma, COPD, pneumonia, COVID-19, lung cancer • Short-term (hours, days) exposure to air pollution can exacerbate existing lung disease in lung patients and trigger: 16% asthma cases in wheezing, cough, shortness of breath, need for children due to medication, ER visits, hospitalizations, and death air pollution* *Khreis H, et al.. Environ. Int. 2017

Ella Kissi-Debrah - 9 year old girl suffered fatal asthma attack triggered by air pollution, London, February 2013

Air pollution and cardio-metabolic health (Petter)

GBD - Mortality specific-causes, ‘fraction attributable’ to air pollution https://www.stateofglobalair.org/

Air pollution and cancer (Michelle)

• Cancer causes 1 in 4 deaths in the EU (1.3 million cancer deaths in 2020) • Air pollution is carcinogenic,* causes lung cancer and possibly other (breast, liver, blood, stomach, colon) cancers • BECA - the EU Green Deal is a key tool to limit people’s exposure to (air) pollution and prevent cancer, GBD - ‘fraction attributable’ to air pollution https://www.stateofglobalair.org/ *International Agency for Research on Cancer (IARC) ‘Air Pollution and Cancer’ 2013

Emerging issues: air pollution and the brain (Barbara)

• Impaired neurocognitive development in children (learning difficulties, loss of IQ, ADHD, autism) • Accelerated cognitive decline (dementia) elderly • Mental health (suicide, depression, anxiety)

Adulthood Old age Early life

Everyone is exposed – some are more vulnerable Brussels, Belgium

• Children • Pregnant women • Elderly Sofia, Bulgaria

• Chronic diseases patients • Poor (environmental inequality)

Conclusion

New AAQD, fully aligned with WHO 2021 AQG, is a major public and planetary health opportunity, that would: 1. prevent a substantial number of new cases of major NCDs 2. make EU citizens more resilient to seasonal influenza epidemics and COVID-19-like new pandemics 3. improve life of lung, heart, and other chronic disease patients 4. Indirect benefit for health - help mitigate unprecedented climate change impact on our health and our planet

Clean air as a basic civil right - no one should get sick or die from breathing

Thank You zorana.andersen@sund.ku.dk @zoranajova

Rosamund Adoo Kissi Debrah:'We need to ensure parents know the impact air pollution has on their children'

https://www.youtube.com/watch?v=V673obDHCVc