Search

An international colloquium, “Strategies for Clean Air and Health,” was organized by the Network of Environmental Risk Assessment and Management (NERAM) and the AIRNET European Network on Air Pollution and Health to identify directions for air quality policy development and research priorities to improve public health. A conference statement was prepared to provide guidance from the perspective of an international group of scientists, regulators, industries, and interest groups on a path forward to improve the interface between science and clean air policy strategies to protect public health. The statement represents the main findings of two breakout group discussion sessions, supported by perspectives of keynote speakers from North America and Europe on science–policy integration and views of the delegates expressed in plenary discussions. NERAM undertook a carefully considered process to try to ensure that the statement would accurately reflect the conference discussions, including documentation of supporting comments from the proceedings and inviting delegates' comments on two draft versions of the statement. [ABSTRACT FROM AUTHOR]

Assessment of potential human health risks associated with environmental and other agents requires careful evaluation of all available and relevant evidence for the agent of interest, including both data-rich and data-poor agents. With the advent of new approach methodologies in toxicological risk assessment, guidance on integrating evidence from mul-tiple evidence streams is needed to ensure that all available data is given due consideration in both qualitative and quantitative risk assessment. The present report summarizes the discussions among academic, government, and private sector participants from North America and Europe in an international workshop convened to explore the development of an evidence-based risk assessment framework, taking into account all available evidence in an appropriate manner in order to arrive at the best possible characterization of potential human health risks and associated uncertainty. Although consensus among workshop participants was not a specific goal, there was general agreement on the key consider-ations involved in evidence-based risk assessment incorporating 21st century science into human health risk assessment. These considerations have been embodied into an overarching prototype framework for evidence integration that will be explored in more depth in a follow-up meeting.

The European Union's REACH Regulation requires determination of potential health and environmental effects of chemicals in commerce. The present case study examines the application of REACH guidance for health hazard assessments of three high production volume (HPV) aluminium (Al) substances: metallic aluminium, aluminium oxide, and aluminium hydroxide. Among the potential adverse health consequences of aluminium exposure, neurotoxicity is one of the most sensitive targets of Al toxicity and the most critical endpoint. This case study illustrates integration of data from multiple lines of evidence into REACH weight of evidence evaluations. This case study then explains how those results support regulatory decisions on classification and labelling. Challenges in the REACH appraisal of Al compounds include speciation, solubility and bioavailability, application of assessment factors, read-across rationale and differences with existing regulatory standards. Lessons learned from the present case study relate to identification and evaluation of toxicologic and epidemiologic data; assessing data relevance and reliability; development of derived no-effect levels (DNELs); addressing data gaps and preparation of chemical safety reports., (Copyright © 2020. Published by Elsevier B.V.)

New European legislation known as REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) was introduced in 2007 to increase the speed at which the health and/or environmental risks of industrial chemicals were being assessed and managed (REACH (EC) No 1907/2006). REACH consolidated earlier chemicals-control statutes and placed the burden of assessing, and identifying the means to manage risks on industry. This paper details the REACH process for controlling and managing hazardous chemicals and challenges encountered in applying the provisions of REACH and the guidance documents available from European Chemical Agency. Special attention is paid to challenges in evaluating potential health risks of metals such as aluminum and aluminum compounds. Lessons learned from over a decade of experience with REACH legislation are also noted., (Copyright © 2020. Published by Elsevier B.V.)

Objective: Quantitative estimates of air pollution health impacts have become an increasingly critical input to policy decisions. The WHO project "Health risks of air pollution in Europe--HRAPIE" was implemented to provide the evidence-based concentration-response functions for quantifying air pollution health impacts to support the 2013 revision of the air quality policy for the European Union (EU)., Methods: A group of experts convened by WHO Regional Office for Europe reviewed the accumulated primary research evidence together with some commissioned reviews and recommended concentration-response functions for air pollutant-health outcome pairs for which there was sufficient evidence for a causal association., Results: The concentration-response functions link several indicators of mortality and morbidity with short- and long-term exposure to particulate matter, ozone and nitrogen dioxide. The project also provides guidance on the use of these functions and associated baseline health information in the cost-benefit analysis., Conclusions: The project results provide the scientific basis for formulating policy actions to improve air quality and thereby reduce the burden of disease associated with air pollution in Europe.

Introduction: This report provides the methodology and findings from the project: Air Pollution and Health: a European and North American Approach (APHENA). The principal purpose of the project was to provide an understanding of the degree of consistency among findings of multicity time-series studies on the effects of air pollution on mortality and hospitalization in several North American and European cities. The project included parallel and combined analyses of existing data. The investigators sought to understand how methodological differences might contribute to variation in effect estimates from different studies, to characterize the extent of heterogeneity in effect estimates, and to evaluate determinants of heterogeneity. The APHENA project was based on data collected by three groups of investigators for three earlier studies: (1) Air Pollution and Health: A European Approach (APHEA), which comprised two multicity projects in Europe. (Phase 1 [APHEA1] involving 15 cities, and Phase 2 [APHEA2] involving 32 cities); (2) the National Morbidity, Mortality, and Air Pollution Study (NMMAPS), conducted in the 90 largest U.S. cities; and (3) multicity research on the health effects of air pollution in 12 Canadian cities., Methods: The project involved the initial development of analytic approaches for first-stage and second-stage analyses of the time-series data and the subsequent application of the resulting methods to the time-series data. With regard to the first-stage analysis, the various investigative groups had used conceptually similar approaches to the key issues of controlling for temporal confounding and temperature; however, specific methods differed. Consequently, the investigators needed to establish a standard protocol, but one that would be linked to prior approaches. Based on exploratory analyses and simulation studies, a first-stage analysis protocol was developed that used generalized linear models (GLM) with either penalized splines (PS) or natural splines (NS) to adjust for seasonality, with 3, 8, or 12 degrees of freedom (df) per year and also the number of degrees of freedom chosen by minimizing the partial autocorrelation function (PACF) of the model's residuals. For hospitalization data, the approach for model specification followed that used for mortality, accounting for seasonal patterns, but also, for weekend and vacation effects, and for epidemics of respiratory disease. The data were also analyzed to detect potential thresholds in the concentration-response relationships. The second-stage analysis used pooling approaches and assessed potential effect modification by sociodemographic characteristics and indicators of the pollution mixture across study regions. Specific quality control exercises were also undertaken. Risks were estimated for two pollutants: particulate matter - 10 pm in aerodynamic diameter (PM10) and ozone (O3)., Results: The first-stage analysis yielded estimates that were relatively robust to the underlying smoothing approach and to the number of degrees of freedom. The first-stage APHENA results generally replicated the previous independent analyses performed by the three groups of investigators. PM10 effects on mortality risk estimates from the APHEA2 and NMMAPS databases were quite close, while estimates from the Canadian studies were substantially higher. For hospitalization, results were more variable without discernable patterns of variation among the three data sets. PM10 effect-modification patterns, explored only for cities with daily pollution data (i.e., 22 in Europe and 15 in the U.S.), were not entirely consistent across centers. Thus, the levels of pollutants modified the effects differently in Europe than in the United States. Climatic variables were important only in Europe. In both Europe and the United States, a higher proportion of older persons in the study population was associated with increased PM10 risk estimates, as was a higher rate of unemployment - the sole indicator of socioeconomic status uniformly available across the data sets. APHENA study results on the effects of O3 on mortality were less comprehensive than for PM10 because the studies from the three regions varied in whether they analyzed data for the full year or only for the summer months. The effects tended to be larger for summer in Europe and the United States. In the United States they were lower when controlled for PM10. The estimated effect of O3 varied by degrees of freedom and across the three geographic regions. The effects of O3 on mortality were larger in Canada, and there was little consistent indication of effect modification in any location., Conclusions: APHENA has shown that mortality findings obtained with the new standardized analysis were generally comparable to those obtained in the earlier studies, and that they were relatively robust to the data analysis method used. For PM10, the effect-modification patterns observed were not entirely consistent between Europe and the United States. For O3, there was no indication of strong effect modification in any of the three data sets.

Expert opinion from Canada, the United States and European Union countries was solicited to examine the regulatory and non-regulatory approaches used to protect children's environmental health. Thirty-five experts were interviewed by telephone from June 2004 to March 2005 using an open-ended survey questionnaire. Experts were asked to name legislative and non-legislative tools used to protect children's environmental health in their jurisdiction as well as the effectiveness of approaches taken, barriers, facilitators, methods of evaluation, and recommendations for improving children's health protection. A number of common themes were revealed by experts in different countries as well as novel approaches that could be used to improve children's environmental health. Determining what types of governance and non-governance instruments are most effective based on experience from other jurisdictions, allows for the determination of common, effective, policy choice from shared children's health environmental risks. It also provides a broad classification of different approaches that have been used for children's environmental health. Three main areas suggested for strengthening children's environmental health protection included: research and surveillance, institutional organization, and regulatory capacity.

The public is increasingly concerned about risks associated with food. Food-borne diseases can easily mobilize public concerns and create strong emotional, behavioral, and political reactions with significant negative economic and psychosocial outcomes. This was observed in various countries globally experiencing the presence of prion disease bovine spongiform encephalopathy (BSE). This study highlights case-study material from various countries for key psychosocial impacts such as the public's worry and fear vis-a-vis beef consumption and the loss of confidence and trust in authorities stemming from the occurrence and management of the BSE crisis. These psychosocial impacts and resultant public behavioral responses are presented at a number of levels including individual, family, community, and societal for several European countries, with special emphasis on the UK case study. Given failures to identify the scope of individual concern about prion diseases, and to address these concerns in decision-making processes and risk communication strategies, there remains a need for further systematic research and psychosocial monitoring of the ripple effects of BSE.

Background: THE APHENA (AIR POLLUTION AND HEALTH: A Combined European and North American Approach) study is a collaborative analysis of multicity time-series data on the effect of air pollution on population health, bringing together data from the European APHEA (Air Pollution and Health: A European Approach) and U.S. NMMAPS (National Morbidity, Mortality and Air Pollution Study) projects, along with Canadian data., Objectives: The main objective of APHENA was to assess the coherence of the findings of the multicity studies carried out in Europe and North America, when analyzed with a common protocol, and to explore sources of possible heterogeneity. We present APHENA results on the effects of particulate matter (PM) < or = 10 microm in aerodynamic diameter (PM(10)) on the daily number of deaths for all ages and for those < 75 and > or = 75 years of age. We explored the impact of potential environmental and socioeconomic factors that may modify this association., Methods: In the first stage of a two-stage analysis, we used Poisson regression models, with natural and penalized splines, to adjust for seasonality, with various degrees of freedom. In the second stage, we used meta-regression approaches to combine time-series results across cites and to assess effect modification by selected ecologic covariates., Results: Air pollution risk estimates were relatively robust to different modeling approaches. Risk estimates from Europe and United States were similar, but those from Canada were substantially higher. The combined effect of PM(10) on all-cause mortality across all ages for cities with daily air pollution data ranged from 0.2% to 0.6% for a 10-microg/m(3) increase in ambient PM(10) concentration. Effect modification by other pollutants and climatic variables differed in Europe and the United States. In both of these regions, a higher proportion of older people and higher unemployment were associated with increased air pollution risk., Conclusions: Estimates of the increased mortality associated with PM air pollution based on the APHENA study were generally comparable with results of previous reports. Overall, risk estimates were similar in Europe and in the United States but higher in Canada. However, PM(10) effect modification patterns were somewhat different in Europe and the United States.

This article provides (1) a synthesis of the literature on the linkages between air pollution and human health, (2) an overview of quality management approaches in Canada, the United States, and the European Union (EU), and (3) future directions for air quality research. Numerous studies examining short-term effects of air pollution show significant associations between ambient levels of particulate matter (PM) and other air pollutants and increases in premature mortality and hospitalizations for cardiovascular and respiratory illnesses. Several well-designed epidemiological studies confirmed the adverse long-term effects of PM on both mortality and morbidity. Epidemiological studies also document significant associations between ozone (O3), sulfur (SO2), and nitrogen oxides (NO(x)) and adverse health outcomes; however, the effects of gaseous pollutants are less well documented. Subpopulations that are more susceptible to air pollution include children, the elderly, those with cardiorespiratory disease, and socioeconomically deprived individuals. Canada-wide standards for ambient air concentrations of PM2.5 and O3 were set in 2000, providing air quality targets to be achieved by 2010. In the United States, the Clean Air Act provides the framework for the establishment and review of National Ambient Air Quality Standards for criteria air pollutants and the establishment of emissions standards for hazardous air pollutants. The 1996 European Union's enactment of the Framework Directive for Air Quality established the process for setting Europe-wide limit values for a series of pollutants. The Clean Air for Europe program was established by the European Union to review existing limit values, emission ceilings, and abatement protocols, as set out in the current legislation. These initiatives serve as the legislative framework for air quality management in North America and Europe.

The Chernobyl accident, which occurred April 26, 1986, resulted in a large release of radionuclides, which were deposited over a very wide area, particularly in Europe. Although an increased risk of thyroid cancer in exposed children has been clearly demonstrated in the most contaminated regions, the impact of the accident on the risk of other cancers as well as elsewhere in Europe is less clear. The objective of the present study was to evaluate the human cancer burden in Europe as a whole from radioactive fallout from the accident. Average country- and region-specific whole-body and thyroid doses from Chernobyl were estimated using new dosimetric models and radiological data. Numbers of cancer cases and deaths possibly attributable to radiation from Chernobyl were estimated, applying state-of-the-art risk models derived from studies of other irradiated populations. Simultaneously, trends in cancer incidence and mortality were examined over time and by dose level. The risk projections suggest that by now Chernobyl may have caused about 1,000 cases of thyroid cancer and 4,000 cases of other cancers in Europe, representing about 0.01% of all incident cancers since the accident. Models predict that by 2065 about 16,000 (95% UI 3,400-72,000) cases of thyroid cancer and 25,000 (95% UI 11,000-59,000) cases of other cancers may be expected due to radiation from the accident, whereas several hundred million cancer cases are expected from other causes. Although these estimates are subject to considerable uncertainty, they provide an indication of the order of magnitude of the possible impact of the Chernobyl accident. It is unlikely that the cancer burden from the largest radiological accident to date could be detected by monitoring national cancer statistics. Indeed, results of analyses of time trends in cancer incidence and mortality in Europe do not, at present, indicate any increase in cancer rates -- other than of thyroid cancer in the most contaminated regions -- that can be clearly attributed to radiation from the Chernobyl accident.