18.1 Houtrookvrij - Andersen What science tells us 2023 05_4

Life after WHO 2021 AQG – What does science tell us? Zorana Jovanovic Andersen, Chair of the European Respiratory Society (ERS) Environment and Health Committee; Professor in Environmental Epidemiology, Department of Public Health, University of Copenhagen, Denmark 24th May, 2023 we inhale 10,000 liters of air/day

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 • WHO 2005 AQG (Hoek et al. 2013): 6.2%* • WHO 2021 AQG (Chen & Hoek 2020): 8.0% 1. ELAPSE (after WHO 2021 AQG): 11.8% 2. Stronger effects at low levels? • https://www.ersnet.org/wp-content/uploads/2022/04/Statement-HIA-by-ERS_ISEE_final-002.pdf • https://journals.lww.com/environepidem/Fulltext/2022/10000/Benefits_of_future_clean_air_policies_in_Europe_.5.aspx*interpretation: 6.2 % increase in mortality risk for each 10 µg/m3 increase in PM2,5 Global EU 2019 : 307,000 deaths attributed to PM 2.5 2020: 412,000 deaths attributed to PM 2.5 238,000 deaths > 5 µg/m 3 PM 2.5 EEA 3. Air pollution and climate change – inseparable issues

Health burden of air pollution COVID-19 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…. Air Pollution and Lung (Erik) • Long-term (years, lifetime) exposure to air pollution can lead to impaired lung function and development of new lung disease in healthy individuals and increased risk of dying from those diseases: 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: wheezing, cough, shortness of breath, need for medication, ER visits, hospitalizations, and death Ella Kissi-Debrah - 9 year old girl suffered fatal asthma attack triggered by air pollution, London, February 2013 GBD - Mortality specific- causes, ‘fraction attributable’ to air pollution https://www.stateof globalair.org/ 16% asthma cases in children due to air pollution* *Khreis H, et al.. Environ. Int.

2017 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, *International Agency for Research on Cancer (IARC) ‘Air Pollution and Cancer’ 2013 GBD - ‘fraction attributable’ to air pollution https://www.stateofglobalair.org/ 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) Early life Adulthood Old age

Everyone is exposed – some are more vulnerable • Children • Pregnant women • Elderly • Chronic diseases patients • Poor (environmental inequality) Brussels, Belgium Sofia, Bulgaria

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