Conditions for a Meaningful Health Impact Assessment for Local Stakeholders: the Example of the Arve Valley in France
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atmosphere Article Conditions for a Meaningful Health Impact Assessment for Local Stakeholders: The Example of the Arve Valley in France Mathilde Pascal *, Jean-Marc Yvon, Magali Corso, Myriam Blanchard, Perrine De Crouy-Chanel and Sylvia Medina Santé publique France, 12 rue du Val d’Osne, 94 415 Saint Maurice, France; [email protected] (J.-M.Y.); [email protected] (M.C.); [email protected] (M.B.); [email protected] (P.D.C.-C.); [email protected] (S.M.) * Correspondence: [email protected] Received: 11 May 2020; Accepted: 27 May 2020; Published: 29 May 2020 Abstract: This article illustrates how a health impact assessment (HIA) can be used to promote a collaborative discussion among stakeholders as part of a local action plan aimed at improving air quality. We performed a HIA of the mortality impacts of long-term exposure to fine particles PM2.5 in the Arve Valley in France. This narrow valley can experience high levels of pollution mostly during winter. However, local stakeholders expressed strong, contradictory opinions on the associated health impacts. Our HIA helped overcome existing silos and shifted the overriding question from “Is it true that air pollution kills people?” to “What can we do to improve air quality?” HIAs have proven to be an excellent decision-support tool in many contexts. In addition, they should continue to be useful provided that their scope, specific objectives, choices, calculation assumptions, and limitations are thoroughly explained to all stakeholders and made easily accessible. Keywords: health impact assessment; mortality; fine particles; stakeholders involvement 1. Introduction Chronic exposure to outdoor air pollution, and especially to fine particles, has been proven to favor the development of various diseases [1–6], leading to premature mortality [7–9]. Despite extensive scientific literature on the topic, disbelief of the reality of these health impacts by stakeholders may impair actions to improve air quality. Victims of air pollution are not directly identifiable, as long-term exposure to air pollutants is a risk factor for a wide range of chronic diseases (e.g., cardiovascular, respiratory, renal diseases, cancer, ::: ), while short-term exposure exacerbates the symptoms of an equally wide range of health pre-existing conditions. In addition, for fine particles (PM10 and PM2.5), the European (EU) air quality regulatory values are less strict than the World Health Organization’s (WHO) recommended guideline values. For instance, in France, according to the EU regulation, PM2.5 annual mean concentration should not exceed 25 µg/m3 (20 µg/m3 in 2020), while the WHO guideline value is 10 µg/m3. Epidemiological studies document health impacts even below this value [9]. Finally, policies tackling air pollution directly question people’s lifestyles and habits (e.g., use of cars vs. alternative transport modes, use of woodstoves ::: ), and can therefore have a low public acceptance. All of these factors contribute to debates on air pollution impacts and solutions. The health impact assessment (HIA) approach was developed to help decision-makers understand the public health burden of the environmental or social determinants of health. It has been largely used to assess the health impacts of air pollution, and evaluate the potential benefits of planned or implemented actions [10]. Here, we illustrate how an HIA helped to bring all stakeholders Atmosphere 2020, 11, 566; doi:10.3390/atmos11060566 www.mdpi.com/journal/atmosphere Atmosphere 2019, 10, x FOR PEER REVIEW 3 of 13 of governmental institutions on biomass burning, and the low perception of its contribution to air pollution by the population has resulted in extensive debate. In this context, the French public health agency was requested by the local health authorities to document the health impacts of air pollution in the area. However, developing an epidemiological Atmospherestudy did2020 not, 11seem, 566 justified in that context. The scientific knowledge was sufficient to conclude2 that of 14 air pollution levels in the Arve Valley presented a risk for the population. It would not add any new (localevidence, politicians, while methodological industrials, non-governmental issues, costs, and long organizations delays were::: expected) together before in obtaining a common results. goal, Thethe developmentrisk would have of a been local airto further quality defer policy the in aimpl Frenchementation valley, inof aactions context by of the high local debate authorities, around givenair pollution. the local controversy on the health impacts of air pollution AThe HIA Arve was Valley seen isas located a better in choice, the French as it Alps,gives inan the opportunity vicinity of to the structure Mont Blanc the country.existing Theknowledge bottom onof theair pollution, valley gathers combining more literature-based than 150,000 inhabitants, evidence with with local a high data. population It can be performed density (Figurerapidly,1 ).it Theis transparent, western part easily of the reproducible, valley concentrates and can abe broad used rangeto promote of industrial a collaborative activities practical in a small discussion territory. Theamong slopes stakeholders. of the valley A quantitative are dedicated HIA to agriculture,demonstrates and the toward magnitude the east of the to tourism.expectedThe health Mont impacts. Blanc Outputscountry isof an HIAs iconic hopefully and popular lead natural to the environment discussion famouson appropriate for outdoor interventions/solutions activities. In this area to of the valley,identified natural problem. spaces It (i.e.,helps places overcome without existing human silos constructions) and shifts the can overriding represent qu upestion to 97% from of the “Is surface it true thatof the air municipalities. pollution kills people?” to “What can we do to improve air quality?” Figure 1. Population density in the Arve Valley (inhabitants per square km, 2012 census). Figure 1. Population density in the Arve Valley (inhabitants per square km, 2012 census). The valley is also the entry point of the tunnel under Mont Blanc that connects France to Italy and is used daily by about 5000 trucks [11]. The valley is surrounded by mountain chains, and segmented by a series of bottlenecks that perturb air circulation. This topography, with the high density of air pollution emission sources (industries, traffic, and woodstoves during winter) in a small area, and the frequency of cold temperature inversions common in the valley during winter, results in an exceedance of air quality target or limit values for several pollutants. PM10 concentrations show a strong seasonal pattern with high concentrations 3 in winter, frequently exceeding 50 µg/m . Since the beginning of PM10 measurements in 1999, the daily limit value (80 µg/m3) is exceeded several times each year, with a maximum concentration of 188 µg/m3 measured in 2009. The residential sector, mainly wood heating, is the main source of fine particulate matter emissions (70% of emissions for PM2.5) during winter [11,12]. The target value for benzo-a-pyrene (1 ng/m3 on annual mean) is also exceeded at the air quality monitoring station, located in the narrowest part of the valley, again with a strong seasonal pattern. 3 High NO2 annual concentrations (around 40µg/m per year) are observed at the vicinity of the main traffic road, which connects the western and eastern parts of the valley. Annual concentrations Atmosphere 2020, 11, 566 3 of 14 at urban stations range between 20 and 30 µg/m3 per year. The Arve Valley is one of the 24 areas in France for which the European Court of Justice has stated that the annual limit value for NO2 has been systematically and persistently exceeded since 2010, and that actions implemented to solve the situation have been insufficient [13]. Finally, during summer, ozone formation is favored by sunshine and altitude. Figure2 illustrates the trends in annual mean concentrations of NO 2, PM10, and PM2.5 measured Atmospherein the valley 2019, between 10, x FOR 2008PEER REVIEW and 2019. Fixed measurements of PM2.5 started in 2016. 4 of 13 Figure 2. Annual trends in NO2, PM10, and PM2.5 measured in the valley between 2008 and 2019 (data Figure 2. Annual trends in NO2, PM10, and PM2.5 measured in the valley between 2008 and 2019 (data source: Atmo Auvergne Rhône Alpes). source: Atmo Auvergne Rhône Alpes). During winter, the population can perceive air pollution, as the visibility is modified. A qualitative 2.study Methods on the perception of air pollution in the valley found that 40% of the participants perceived a poor air quality,We performed and 65% a degradationquantitative ofHIA, the following air quality the through general time. principles A majority stated of theby the study WHO participants and the guidelineslinked poor developed air quality by with the French health public issues health [14,15]. ag Concernsency. The wereobjectives especially were to exacerbated quantify the by public three 3 healthepisodes burden during of wintersair pollution 2011, 2013,in the and area 2016, to support when PMdecision-making.10 concentrations exceeded 50 µg/m for more thanThe 15 consecutive conceptual days. framework In recent of years,the HIA several was (1) non-governmental to define a study associations period and have area, been based created on the to availabilityclaim for a betterof data; air (2) quality. to choose In