HEALTH RISKS OF OZONE FROM LONG-RANGE TRANSBOUNDARY AIRPOLLUTION TRANSBOUNDARY LONG-RANGE FROM RISKSOFOZONE HEALTH Ozone is a highly oxidative compound formed in the lower atmosphere from gases (originating to a large extent from anthropogenic sources) by photochemistry driven by solar radiation. Owing to its highly reactive chemical properties, ozone is harmful to vegetation, materials and human health. In the troposphere, ozone is also an effi cient greenhouse gas. This report summarizes the results of a multidisciplinary analysis aiming to assess the eff ects of ozone on health. The analysis indicates that ozone pollution aff ects the health of most of the populations of Europe, leading to a wide range of health problems. The eff ects include some 21 000 premature deaths annually in 25 European Union countries on and after days with high ozone levels. Current policies are insuffi cient to signifi cantly reduce ozone levels in Europe and their impact in the next decade. World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18 E-mail: [email protected] Web site: www.euro.who.int Health risks of ozone from long-range transboundary air pollution Abstract Ozone is a highly oxidative compound formed in the lower atmosphere from gases (originating to a large extent from anthropogenic sources) by photochem- istry driven by solar radiation. Owing to its highly reactive chemical properties, ozone is harmful to vegetation, materials and human health. In the troposphere, ozone is also an efficient greenhouse gas. This report summarizes the results of a multidisciplinary analysis aiming to assess the effects of ozone on health. The analysis indicates that ozone pollution affects the health of most of the popula- tions of Europe, leading to a wide range of health problems. The effects include some 21 000 premature deaths annually in 25 European Union countries on and after days with high ozone levels. Current policies are insufficient to significantly reduce ozone levels in Europe and their impact in the next decade. Keywords AIR POLLUTANTS, ENVIRONMENTAL - adverse effects OZONE RISK ASSESSMENT ENVIRONMENTAL EXPOSURE ENVIRONMENTAL MONITORING ISBN 978 92 890 42895 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permis- sion to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2008 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps repre- sent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recom- mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Cover photos: ©Paul Hampton | Dreamstime.com − © Godfer | Dreamstime.com (children playing ball) Edited by: Frank Theakston. Book design: Sven Lund Health risks of ozone from long-range transboundary air pollution Markus Amann, Dick Derwent, Bertil Forsberg, Otto Hänninen, Fintan Hurley, Michal Krzyzanowski, Frank de Leeuw, Sally J. Liu, Corinne Mandin, Jürgen Schneider, Per Schwarze, David Simpson Acknowledgements This report was prepared by the Joint WHO/Convention Task Force on the Health Aspects of Air Pollution according to Memoranda of Understanding be- tween the United Nations Economic Commission for Europe (UNECE) and the WHO Regional Office for Europe (ECE/ENHS/EOA/2004/001 and ECE/ENHS/ EOA/2008/001). WHO thanks the Swiss Federal Office for the Environment for its financial support of the work of the Task Force. Additional contributions from Anne-Gunn Hjellbrekke of the Norwegian Institute for Air research (NILU) are gratefully acknowledged. Convention on Long-range Transboundary Air Pollution Contents Abbreviations vii Executive summary ix 1. Introduction 1 Structure of the report 2 2. Hazard assessment of ozone 3 Ozone toxicokinetics 3 Acute responses 5 Chronic effects in humans 11 Thresholds 15 Susceptible groups 17 Health implications 18 3. Sources of ozone precursors 21 Ozone formation and atmospheric transport 21 Sources of ozone precursor emissions 23 Projections of future emissions of ozone precursors 24 Interactions of ozone precursor emissions with other 30 environmental problems 4. Ozone levels 31 Monitoring results 31 Observed ozone trends 39 Modelling techniques and validation 47 Ozone and climate change 50 5. Population exposure projections 53 Exposure versus ambient measurements 54 Population exposure modelling 56 6. Risk estimates 59 Effects of ozone on mortality 60 Estimation of impacts on morbidity 65 Health effects and cost–benefit analysis 71 Transferability between populations 72 Evidence on reversibility of the health impacts 73 7. Conclusions 75 Ozone air pollution is a significant health hazard in Europe 75 Health effects of long-range transboundary ozone are most likely 75 proportional to the contribution of long-range sources to ozone exposure levels Current policies lead to only a small reduction in risk 76 Key uncertainties, research needs and policy implications 76 References 79 Annex 1. List of Working Group members and reviewers 95 ABBREVIATIONS vii Abbreviations Organizations and programmes ACS American Cancer Society AHSMOG Adventist Health and Smog (study) AirBase European air quality database (http://air-climate.eionet. europa.eu/databases/airbase/) CAFE Clean Air for Europe Programme of the European Commission (http://europa.eu/scadplus/leg/en/lvb/ l28026.htm) CAFE CBA CAFE Cost–Benefit Analysis project (http://www.cafe-cba.org)COMEAP Committee on the Medical Effects of Air Pollution COMEAP Committee on the Medical Effects of Air Pollution ECHRS European Community Respiratory Health Survey EEA European Environment Agency (www.eea.europa.eu) EMEP Cooperative Programme for Monitoring and Evaluation of the Long-range Transmission of Air Pollutants in Europe (www.emep.int) EU European Union EU15 European Union with 15 Member States as it existed between 1995 and 2004 EU25 European Union with 25 Member States as it existed between 2004 and 2007 GAINS Greenhouse gas – Air pollution INteractions and Synergies IPCC Intergovernmental Panel on Climate Change ISAAC International Study of Asthma and Allergies in Childhood MSC-W EMEP Meteorological Synthesizing Centre – West, hosted by the Norwegian Meteorological Institute RAINS Regional Air Pollution Information and Simulation model of IIASA viii HEALTH RISKS OF OZONE FROM LONG-RANGE TRANSBOUNDARY AIR POLLUTION UNECE United Nations Economic Commission for Europe (www.unece.org) IIASA International Institute for Applied Systems Analysis, Vienna (http://www.iiasa.ac.at/) OECD Organisation for Economic Co-operation and Development Technical terms AOT40/AOT60 accumulated ozone above the level of 40/60 ppb, a measure of cumulative annual ozone concentrations used as indicator of vegetation (health) hazards CI confidence interval (a measure of statistical uncertainty in numerical estimates) CIMT carotil intima-media thickness CLE current legislation (concerning emission of pollutants to the atmosphere) COPD chronic obstructive pulmonary disease DALY disability-adjusted life-year (a measure of health burden) ELF epithelial lining fluid FEF25–75 forced expiratory flow between 25% and 75% FVC FEF75 forced expiratory flow at 75% FVC FEV1 forced expiratory volume in 1 second (measure of respiratory function) F gases fluorinated greenhouse gases (hydrofluorocarbons, perfluorocarbons and sulfur hexafluoride) FVC forced vital capacity (measure of respiratory function) HIS United States Health Interview Study HRV heart rate variability ABBREVIATIONS ix ICD-9 International Statistical Classification of Diseases and Related Health Problems, ninth revision LRS lower respiratory symptoms LRTAP long-range transboundary air pollution MTFR maximum technologically feasible reduction (concerning emission of pollutants to the atmosphere) NOx nitrogen oxides NOy reactive nitrogen oxide OH hydroxyl radical OFIS ozone fine structure model PAN peroxyacetyl nitrate PM particulate matter ppb/ppm parts per billion/parts per