Health Effects Of Transport-related Air Pollution
The World HealthOrganization (WHO) is aspecialized agencyof the United Nationscreated in 1948 with theprimary responsibility forinternational health mattersand public health. The WHORegional Office for Europeis one of six regional officesthroughout the world, eachwith its own programmegeared to the particularhealth conditions of thecountries it serves.While transport is a vital part of modern life, policymakers in the WHO European Region face the difficultchallenge of both reducing the related risks to healthand the environment and meeting countries’ requirements for effective transport systems. Diseases relatedto the air pollution caused by road transport affect tensof thousands of people in the Region each year. Policiesfor more effective action need to be based on a betterunderstanding of the determinants of exposure and therole of various pollutants in harming health.Member sBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech andsNorwayPolandPortugalRepublic of MoldovaRomaniaRussian FederationSan MarinoSerbia and jikistanThe former YugoslavRepublic of MacedoniaTurkeyTurkmenistanUkraineUnited KingdomUzbekistanThis book helps to meet this need. It provides a systematic review of the literature and a comprehensiveevaluation of the health hazards of transport-relatedair pollution. The review addresses: factors determiningemissions, the contribution of traffic to pollution levels,human exposure and the results of epidemiologicaland toxicological studies to identify and measure thehealth effects.This book is designed for two main audiences: policymakers and experts in transport-related air pollutionand public health. Accordingly, it offers both summaryinformation for the former and full discussion, primarilyfor the latter. A separate summary for policy-makers isalso available. For both groups, this book identifies thekey facts emerging from the accumulated evidence, anduses them to suggest both topics for further researchand well-justified short-term action to protect health.It can help both groups play their part in making andimplementing transport policies in the European Regionthat maximize the benefits to health.ISBN 92-890-1373-6World Health OrganizationRegional Office for EuropeScherfigsvej 8, DK-2100 Copenhagen Ø, DenmarkTel.: 45 39 17 17 17. Fax: 45 39 17 18 18. E-mail: postmaster@euro.who.intWeb site: www.euro.who.intHealth effects of transport-related air pollutionThe WHO RegionalOffice for Europe
The World Health Organization was established in 1948 as the specialized agencyof the United Nations responsible for directing and coordinating authority forinternational health matters and public health. One of WHO’s constitutionalfunctions is to provide objective and reliable information and advice in the fieldof human health. It fulfils this responsibility in part through its publicationsprogrammes, seeking to help countries make policies that benefit public healthand address their most pressing public health concerns.The WHO Regional Office for Europe is one of six regional offices throughoutthe world, each with its own programme geared to the particular health problemsof the countries it serves. The European Region embraces some 870 million people living in an area stretching from the Arctic Ocean in the north and the Mediterranean Sea in the south and from the Atlantic Ocean in the west to the PacificOcean in the east. The European programme of WHO supports all countries inthe Region in developing and sustaining their own health policies, systems andprogrammes; preventing and overcoming threats to health; preparing for futurehealth challenges; and advocating and implementing public health activities.To ensure the widest possible availability of authoritative information andguidance on health matters, WHO secures broad international distribution ofits publications and encourages their translation and adaptation. By helpingto promote and protect health and prevent and control disease, WHO’s bookscontribute to achieving the Organization’s principal objective – the attainmentby all people of the highest possible level of health.
Health effectsof transport-relatedair pollutionEdited by:Michal Krzyzanowski,Birgit Kuna-Dibbert and Jürgen Schneider
WHO Library Cataloguing in Publication DataHealth effects of transport-related air pollution /edited by MichalKrzyzanowski [et al.]1.Air pollution 2.Air pollutants 3.Vehicle emissions – adverse effects4.Environmental exposure 5.Health policy 6.Policy making 7.EuropeI.Krzyzanowski, Michal II.Kuna-Dibbert, Birgit III.Schneider, JürgenISBN 92 890 1373 7(NLM Classification : WA 754)ISBN 92-890-1373-7Address requests about publications of the WHO Regional Office to: by e-mail publicationrequests@euro.who.int (for copies of publications)permissions@euro.who.int (for permission to reproduce them)pubrights@euro.who.int (for permission to translate them) by postPublicationsWHO Regional Office for EuropeScherfigsvej 8DK-2100 Copenhagen Ø, Denmark World Health Organization 2005All rights reserved. The Regional Office for Europe of the World Health Organizationwelcomes requests for permission to reproduce or translate its publications, in part orin full.The designations employed and the presentation of the material in this publicationdo not imply the expression of any opinion whatsoever on the part of the World HealthOrganization concerning the legal status of any country, territory, city or area or of itsauthorities, or concerning the delimitation of its frontiers or boundaries. Where thedesignation “country or area” appears in the headings of tables, it covers countries,territories, cities, or areas. Dotted lines on maps represent approximate border linesfor which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does notimply that they are endorsed or recommended by the World Health Organization inpreference to others of a similar nature that are not mentioned. Errors and omissionsexcepted, the names of proprietary products are distinguished by initial capitalletters.The World Health Organization does not warrant that the information containedin this publication is complete and correct and shall not be liable for any damagesincurred as a result of its use. The views expressed by authors or editors do not necessarilyrepresent the decisions or the stated policy of the World Health Organization.Printed in DenmarkCover design: Sven Lund
ContentsContributors .vAcknowledgements.viiiAbbreviations .ixForeword .xiExecutive summary.xiiiFactors determining emissions.xiiiContribution of traffic to pollution levels .xiiiHuman exposure . xivStudies on health effects . xvIntroduction . 1How to read this report and how it was written . 4References . 41. Factors determining emissions in the WHO European Region –Alois Krasenbrink, Giorgio Martini, Urban Wass, Edward Jobson,Jens Borken, Reinhard Kuehne, Leonidas Ntziachristos, Zissis Samarasand Menno Keuken. 7Key points . 7Introduction . 8Transport patterns . 9Road transport . 17Transportation technologies . 29Fuels and additives . 37References . 462. Contribution of traffic to levels of ambient air pollution in Europe –Menno Keuken, Eric Sanderson, Roel van Aalst, Jens Borkenand Jürgen Schneider . 53Key points . 53Introduction . 54Traffic emissions of nitrogen oxides, carbon monoxide and VOCsin Europe . 55Contribution of traffic emissions to ozone and nitrogen oxides . 58iii
Composition of primary traffic-related PM emissions . 59Improving air quality by decreasing traffic emissions . 61Contribution of traffic emissions to urban air quality . 63Contribution of traffic to PM in urban areas . 67Concentrations of ozone and nitrogen dioxide in urban areasand streets . 74Effect of traffic management on urban air quality . 76Conclusions and the action needed . 78References . 803. Human exposure to transport-related air pollution –Eric Sanderson, David Briggs, Matti Jantunen, Bertil Forsberg,Magnus Svartengren, Radim Šrám John Gulliver and Nicole Janssen. 85Key points . 85Introduction . 86Methods of assessing exposure . 87Exposures in urban versus rural regions . 90Exposure of people living near busy traffic routes . 93Assessment of traffic exposure in a variety of microenvironments . 108Conclusions . 113References . 1144. Studies on health effects of transport-related air pollution –Joachim Heinrich, Per E. Schwarze, Nikolaos Stilianakis, Isabelle Momas,Sylvia Medina, Annike I. Totlandsdal, Leendert von Bree,Birgit Kuna-Dibbert and Michal Krzyzanowski . 125Key points . 125Introduction . 126Mortality . 128Respiratory morbidity . 131Cardiovascular morbidity . 147Cancer . 150Pregnancy outcomes and male fertility . 155Intervention studies . 157Discussion . 161References . 1655. Health risk assessment of transport-related air pollution –Birgit Kuna-Dibbert and Michal Krzyzanowski . 185Identified health effects. 185Needs for further research . 186Justified action . 188References . 189iv
ContributorsAuthorsJens BorkenInstitute of Transport Research, German Aerospace Center (DLR), Berlin,GermanyDavid BriggsEnvironment and Health Sciences, Imperial College, London, UnitedKingdomBertil ForsbergDepartment of Public Health and Clinical Medicine, Umeå University,SwedenJohn GulliverSchool of Medicine, Imperial College, London, United KingdomJoachim HeinrichInstitute of Epidemiology, GSF National Research Centre for Environmentand Health, Neuherberg, GermanyNicole JanssenInstitute for Risk Assessment Sciences (IRAS), Utrecht University,NetherlandsMatti JantunenNational Public Health Institute (KTL), Kuopio, FinlandEdward JobsonEnergy Conversion and Physics, Volvo Technology Corporation,Gothenburg, SwedenMenno KeukenNetherlands Organisation for Applied Scientific Research (TNO),Apeldoorn, NetherlandsAlois KrasenbrinkJoint Research Centre, European Commission, Ispra, ItalyMichal KrzyzanowskiWHO European Centre for Environment and Health, Bonn, WHORegional Office for Europev
Birgit Kuna-DibbertWHO European Centre for Environment and Health, Bonn, WHORegional Office for EuropeGiorgio MartiniJoint Research Centre, European Commission, Ispra, ItalySylvia MedinaInstitut de Veille Sanitaire (InVS), Saint-Maurice, FranceIsabelle MomasService “Santé Publique et Environnement”, Université René Descartes,Paris, FranceLeonidas NtziachristosLaboratory of Applied Thermodynamics, Aristotle University, Salonica,GreeceZissis SamarasLaboratory of Applied Thermodynamics, Aristotle University, Salonica,GreeceEric SandersonInstitute for Risk Assessment Sciences (IRAS), Utrecht University,NetherlandsJürgen SchneiderWHO European Centre for Environment and Health, Bonn, WHORegional Office for EuropePer E. SchwarzeNorwegian Institute of Public Health, Oslo, NorwayRadim J. ŠrámInstitute of Experimental Medicine, Academy of Sciences of the CzechRepublic, Prague, Czech RepublicNikolaos StilianakisJoint Research Centre, European Commission, Ispra, ItalyMagnus SvartengrenDepartment of Public Health Sciences, Division of OccupationalMedicine, Karolinska Institute, Stockholm, SwedenRoel van AalstEuropean Environment Agency, Copenhagen, DenmarkUrban WassEnvironment & Chemistry, Volvo Technology Corporation, Gothenburg,Swedenvi
Other contributors and reviewersLucy Bayer-OglesbyInstitut für Sozial- und Präventivmedizin, Universität Basel, SwitzerlandAnnelie BehndigDepartment of Respiratory Medicine and Allergy, Umeå UniversityHospital, SwedenAnders BlombergDepartment of Respiratory Medicine and Allergy, Umeå UniversityHospital, SwedenKenneth DonaldsonELEGI/Colt Laboratories, MRC Centre for Inflammation Research,University of Edinburgh Medical School, United KingdomPaul FischerNational Institute of Public Health and the Environment (RIVM),Bilthoven, NetherlandsRagnberth HelledayDepartment of Respiratory Medicine and Allergy, Umeå UniversityHospital, SwedenReinhart KühneInstitute of Transport Research, German Aerospace Center (DLR), Berlin,GermanyMarco MartuzziWHO European Centre for Environment and Health, Rome, WHORegional Office for EuropeEmilia M. NiciuInstitute of Public Health, Bucharest, RomaniaFrancesca RacioppiWHO European Centre for Environment and Health, Rome, WHORegional Office for EuropeThomas SandstrømDepartment of Respiratory Medicine and Allergy, Umeå UniversityHospital, SwedenVicki StoneSchool of Life Sciences, Napier University, Edinburgh, United KingdomPeter StraehlSwiss Agency for the Environment, Forests and Landscapes, Berne,Switzerlandvii
Håkan TörnqvistDepartment of Public Health and Clinical Medicine, Umeå University,SwedenAnnike I. TotlandsdalNational Institute of Public Health and the Environment (RIVM),Bilthoven, NetherlandsLeendert van BreeNational Institute of Public Health and the Environment (RIVM),Bilthoven, NetherlandsPaulo VineisDepartment of Biomedical Sciences and Human Oncology, TurinUniversity, ItalyDenis Zmirou-NavierAgence française de sécurité sanitaire environnementale, Maison Alfort,FranceAcknowledgementsThe work on this book was supported by grants obtained by WHO from theFederal Ministry for the Environment, Nature Conservation and Nuclear Safetyof Germany and the Agency for the Environment, Forests and Landscapes ofSwtizerland. For this support, and for the contributions of all the authors andreviewers, we are very grateful.Michal Krzyzanowski, Birgit Kuna-Dibbertand Jürgen Schneiderviii
AbbreviationsOrganizations, other entities and E PEPTRAPCAUNECEAllgemeiner Deutscher Automobil ClubThematic Network on Air Pollution and HealthAir Pollution and Health: a European Approach 2Clean Air for Europeproject on concerted actions on non-technical measuresand their impact on air quality and emissionsEuropean Committee for StandardizationEuropean CommissionEuropean Environment Agencyeastern Europe, the Caucasus and central AsiaEuropean Free Trade AssociationEuropean Programme on Emissions, Fuels and EnginesTechnologiesEuropean Unionstudy of air pollution exposure distributions of adulturban populations in EuropeInternational Agency for Research on CancerInternational Study of Asthma and Allergies in Childhoodproject on a healthier environment through the abatementof vehicle emissions and noiseNational Morbidity, Mortality, and Air Pollution Studystudy of acute pollution effects on asthmatic childrenSmall Area Variations in Air Quality and Health studyTransport, Health and Environment Pan-EuropeanProgrammeproject on transport-related air pollution onchildhood asthmaUnited Nations Economic Commission for EuropeTechnical �-deoxyguanosineix
8-dihydro-2’-deoxyguanosineconcentrated ambient particlesconfidence intervalcombustion and other particulate matterdiesel exhaust particlesdeoxyribonucleic acidelectrocardiogramforced mid-expiratory flowgeographical information systemsgross domestic productgranulocyte-macrophage colony stimulating factorgross national productintercellular adhesion molecule 1interferon gammaimmunoglobulininterleukinleukocyte function-associated antigen 1monocyte chemoattractant protein 1monocrotalineodds ratioOperational Street Pollution Modelovalbuminpolycyclic aromatic hydrocarbonspassenger-kilometresparticulate matterparts per millionribonucleic acidreactive oxygen speciesrelative riskstandardized incidence ratiostandardized mortality ratiosurfactant proteinstandardized reference materialT-helpertonne-kilometrestumour necrosis factor alphavascular cell adhesion molecule 1volatile organic compoundsx
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