Quantification of Heaith Impacts of Air Poiiution Reduction in Kensington & Cheisea and Westminster
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Quantification of heaith impacts of air poiiution reduction in Kensington & Cheisea and Westminster Dr Jennifer Susan Mindell Thesis for Doctorate of Phiiosophy (PhD) imperiai Coliege of Science, Technology and Medicine, University of London ProQuest Number: U643768 All rights reserved INFORMATION TO ALL U SE R S The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest U643768 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 To David, Judith and William Abstract Health Impact Assessment (HIA) is an assessment of the health effects, positive or negative, of a project, programme or policy. However, the quality of the evidence base currently available for HIA may limit the soundness and completeness of the conclusions, and consequently the capacity to achieve health gain. I developed a four-stage framework of the information required to quantify health impacts: evidence for causality, magnitude of response, baseline event rate, and change in exposure. The UK National Air Quality Strategy requires local authorities to achieve targets for seven outdoor air pollutants. I conducted systematic literature reviews and evaluated the epidemiological evidence relating ambient particulates and nitrogen dioxide (the pollutants relevant to central London) to various health outcomes. For those assessed as being causal, I considered the shape and magnitude of the relationship. Using local authority air pollution data, I modelled three ways in which pollution could fall to achieve the UK objectives. I wrote spreadsheets to estimate the effects on premature deaths and hospital admissions of reducing pollution to the objectives, combining the exposure-response coefficients with baseline mortality or hospital episode statistics data and modelled falls in pollution. I then performed these calculations for Kensington & Chelsea and Westminster. Air quality management using technical fixes will accomplish only these health gains; traffic reduction would have a broader range of health impacts. I reviewed the availability of evidence for other ways in which transport affects health, particularly community severance and physical activity. Policies that achieve air quality targets by reducing traffic are likely to have substantially greater health benefits than those that rely on technical fixes, but this is unquantifiable at present. I also compared my approach with the rapid literature review in general usage in HIA, and have identified specific gaps in the evidence and research needs. I declare that the work in this thesis is my own, except where I have stated in the text that it is based on work conducted jointly with my supervisor (chapter one, section 1.2.2). Dr Jennifer Mindell Certified by PliD supervisor ' 7 Dr Michael Joffe Contents Page no. List of tables in thesis ............................................................................................................................... 6 List of figures ............................................................................................................................................ 8 Raw data and technical material on CD-ROM ....................................................................................9 List of abbreviations ............................................................................................................................... 10 Acknowledgments ...................................................................................................................................11 Section one: Introduction __________ 12 Chapter one: Health Impact Assessment ......................................................................................12 Chapter two: Air quality management .......................................................................................... 46 Section two: Health effects of reducing air pollution _ _ _ _ 65 Chapter three: Literature review method and exam ple ........................................................... 6 6 Chapter four: The health effects of particulates ....................................................................... 8 8 Chapter five: The health effects of nitrogen d io x id e .........................................................125 Chapter six: The health effects of reducing air pollution in Westminster and Kensington & Chelsea to UK air quality objectives ......................................................................................152 Section three: _____________ 192 Chapter seven: Physical activity ...................................................................................................195 Chapter eight: Community severance ........................................................................................219 Chapter nine: Discussion and conclusions ................................................................................240 References 264 List of tables in thesis Page Table 1.1 Features of various approaches to HIA 1994-1995 21 Table 1.2 Features of various approaches to HIA by 1997 24 Table 1.3 Features of various approaches to HIA since 1998 26 Table 1.4 Summary of reviews of HIA 30 Table 1.5 Examples of determinants of determinants 41 Table 2.1 Sources and health effects of UK National Air Quality Strategy pollutants 47 Table 2.2 Projected population of Westminster and Kensington & Chelsea, 2000 49 Table 2.3 Pollution in Westminster and Kensington & Chelsea 51 Table 2.4 Air pollution standards for nitrogen dioxide and particulates 56 Table 2.5 Emissions of PMio in London, compared with the UK, 1990 61 Table 3.1 Effects of PMio on heart disease deaths 75 Table 3.2 Effects of PMio on ischaemic heart disease admissions 77 Table 3.3 Effects of PMio on admissions for specific causes of heart disease 79 Table 4.1 Estimates used of percentage change in mortality for the effect of an acute 97 change of Ipg/m^ PMio Table 4.2 Estimates used of percentage change in emergency healthcare for the 98 effect of an acute change of Ip-g/m^ PMio Table 4.3 Reviews, meta-analyses and pooled analyses of the acute effects of 107 particulates on health Table 4.4 Conclusions of reviews, meta-analyses and pooled analyses on the acute 112 effects on the acute effects of particulates on total mortality Table 4.5 Conclusions of reviews, meta-analyses and pooled analyses on the acute 113 effects of particulates on hospital admissions Table 4.6 Conclusions of reviews of acute effects of particles on respiratory 114 symptoms Table 4.7 Summary of acute effects of particles on lung function 115 Table 4.8 Summary of evidence for causal associations between particulates and 122 acute health effects, according to evidence published by December 2000 Table 4.9 Summary of evidence for causal associations between particulates and 124 chronic health effects, according to evidence published by December 2000 Table 5.1 Estimates used of percentage change in outcome for the effect of a change 133 of Ippb in 24hr-NÛ2 Table 5.2 Estimates used of percentage change in outcome for the effect of a change 134 of Ippb in max Ihr-NOz Table 5.3 Reviews & meta-analyses of the effects of NO 2 on health 136 Table 5.4 Fixed- and random-effects model meta-analysis of effects of NO 2 on lower 141 respiratory tract symptoms in children Table 5.5 Random-effects model meta-analysis of effects of NO 2 on respiratory 141 illness in children Page Table 5.6 Summary of evidence for causal associations between NOzand acute health 149 effects, according to evidence published by December 2000 Table 5,7 Summary of evidence for causal associations between NO 2 and chronic 151 health effects, according to evidence published by December 2000 Table 6.1 Audit trail for duplicate records in Hospital Episode Statistics (HES) 155 databases Table 6.2 UK National Air Quality Strategy objectives used in this study 157 Table 6.3 Effects on premature deaths delayed by reducing PMio in Westminster 166 from 1996-1998 levels Table 6.4 Effects on emergency admissions and consultations by reducing annual 167 mean PMio in Westminster from 1996-1998 levels Table 6.5 Effects on emergency admissions and consultations by reducing 168 24hr-PMio in Westminster from 1996-1998 levels Table 6 . 6 Effects on deaths brought forward of reducing RBKC PMio from 1996- 170 1998 background levels Table 6.7 Effects on emergency admissions and consultations by reducing RBKC 171 PMio from 1996-1998 background levels Table 6 . 8 Effects on deaths brought forward of reducing Westminster 24hr-N02 172 from 1996-1998 levels to objectives Table 6.9 Effects on deaths brought forward of reducing Westminster maximum 172 lhr-N 0 2 from 1996 - 1998 levels to UK objectives Table 6.10 Effects on emergency hospital admissions and consultations of reducing 173 Westminster 24hr-N02 from 1996-1998 levels to UK objectives Table 6.11 Effects on admissions brought forward of reducing Westminster daily 174 maximum lhr-NÛ 2 from 1996-1998 levels to UK objectives Table 7.1 Availability of information for quantifying some of the effects on health of 194 transport Table 7.2 The variance-weighted geometric