Transcript Title 1

WORKING FOR A HEALTHY FUTURE
Air Pollution Evidence and Policy in
Europe: the CAFE Experience
Environmental Inequalities # 4, Newcastle, 16-17 Jan 07
Fintan Hurley (IOM): [email protected]
With thanks to the CAFE CBA team:
Mike Holland (EMRC), Steve Pye (AEA Technology);
Paul Watkiss; Alistair Hunt (University of Bath);
and to Bert Brunekreef (IRAS, Utrecht) for some slides…
INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK
www.iom-world.org
CAFE: Clean Air for Europe
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Clean Air For Europe programme
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Commission’s objectives included:
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Health protection, expressed especially as reductions in mortality from air
pollution
Protection of ecosystems
Extensive work programme managed by DG Environment.
Strongly based in evidence, including detailed evaluations for CAFE by
expert groups convened by the World Health Organisation (WHO).
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Umbrella programme of the European Commission on control of ambient
air pollution
Led by EC DG Environment
Mostly qualitative, not quantitative
See http://ec.europa.eu/environment/air/cafe/index.htm
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HIA and CBA within CAFE
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Health Impact Assessment (HIA):
• A combination of procedures, methods and tools
• by which a policy, programme or project may be judged
• as to its potential effects on the health of a population,
• and the distribution of those effects within the population'.
WHO/ECHP, 1999, Gothenburg Consensus Paper
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CAFE included a full HIA and cost-benefit analysis (CBA)
of policies – ‘baseline’ and new policies
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Described in full at: http://cafecba.aeat.com/html/reports.htm
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Components of air pollution HIA
Population
at risk:
overall;
subgroups
Pollution:
sources;
emissions
pathways
Incremental
pollution +
background
Valuations
Background data:
morbidity rates
C-R functions:
Risks as % change
Per unit pollutant
Impacts
Benefits of improved air quality
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Inequalities and air pollution HIA
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Differences in air pollution
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Differences in relative risks, per unit exposure (µg/m3)
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expressed as % change in risk of adverse health effect
Differences in background rates of mortality or morbidity
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The nature of the air pollution mixture
Associated concentrations of individual pollutants (i.e. PM, O3, NO2
etc.), as measured at fixed-point monitoring stations
Personal exposures, for a given background concentration
the same % change implies a different absolute level of impact, if
background rates differ
Differences in monetary valuation of health effects
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Willingness To Pay depends on income
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Differences included in CAFE HIA methods
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Differences in air pollution (PM, O3)
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Differences in relative risks + background rates
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Modelled differences by location
50km x 50km grid – crude
Personal exposures ignored - % change based on background
concentrations
By age-group (e.g. 0-14; 15-64; 65+)
(By gender)
By health status (e.g. exacerbations of asthma)
By country or region (e.g. rates of asthma)
Differences in monetary valuation of health effects
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‘Standard’ values used throughout EU-25
Some higher values for children
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Health Effects Quantified in CAFE CBA
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Chronic exposure:
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Mortality (PM) – the dominant effect
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Development of bronchitis (PM)
Acute exposure (daily variations)
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Mortality (O3)
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Hospital admissions
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Respiratory (PM, O3); Cardiovascular (PM)
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Days of Restricted Activity; Days off Work (PM, O3)
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Days with symptoms (PM, O3)
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In people with chronic lung disease (asthma, COPD)
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In the general population
No threshold for PM from human activity; cut-point of 35ppb for O3
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HIA/ CBA Process in CAFE (1)
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CBA Team selected in open competition
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Preferred team was long-established – ExternE, through the 1990s.
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CAFE CBA methods consistent with WHO recommendations
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Led by AEA Technology (Paul Watkiss);
IOM led on HIA methods
WHO for CAFE, including meta-analyses
WHO in Task Force on Health of UNECE Convention on Long-Range
Trans-boundary Air Pollution
But in many instances we needed to go beyond WHO
recommendations, especially for morbidity
Uncertainty assessed qualitatively and quantitatively (Monte Carlo
methods, subjective distributional assumptions)
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HIA/ CBA Process in CAFE (2)
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Several stakeholder consultation days
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Comments on draft methodology
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Strong industry representation; detailed comments
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Most member states generally passive;
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Detailed UNICE comments + formal response (32 pages…)
Yes UK comments
Comments from other DGs, especially DG Enterprise
Formal external review of draft methodology
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High-level US HIA/ CBA team (HIA: Bart Ostro)
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Mortality, Morbidity and Valuation
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Mortality expressed as
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(i) changes in life expectancy and (ii) ‘attributable deaths’;
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CAFE CBA team strongly preferred (i); peer reviewers and
Commission wanted (ii) also
Monetary valuation and Mortality
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Value of a life year (VOLY): €50k - €120k
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Value of statistical life, of a prevented fatality (VSL/VPF): €1-2M.
Morbidity
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Mix of medical costs, lost productivity and willingness to pay (WTP)
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Results – general comments
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Results presented for physical effects and in
monetary terms
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Key question: How do benefits of reducing air
pollution compare with costs?
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Focus was on EU-wide results
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Limited disaggregation:
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By age – main impacts are in older people
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By country
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Results – physical impacts
End Point Name
CLE 2020
Ozone effects
Acute Mortality (thousand premature deaths)
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Respiratory Hospital Admissions (thousands)
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Minor Restricted Activity Days (thousands)
42,000
Respiratory medication use (thousand days, children)
13,000
Respiratory medication use (thousand days, adults)
8,200
Cough and LRS (thousand days children)
65,000
PM effects
Chronic Mortality1) – thousand years of life lost (YOLLs)
2,500
1)
Chronic Mortality – thousand deaths
270
Infant Mortality (0-1yr) – thousand deaths
0.35
Chronic Bronchitis (thousand cases, adults)
128
Respiratory Hospital Admissions (thousands)
42
Cardiac Hospital Admissions (thousands)
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Restricted Activity Days (thousands)
220,000
Respiratory medication use (thousand days, children)
2,000
Respiratory medication use (thousand days, adults)
21,000
Lower Respiratory Symptom days (thousands, children)
89,000
Lower Respiratory Symptom days (thousands, adults)
210,000
A
B
C
MTFR
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39,000
12,000
7,500
60,000
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38,000
12,000
7,300
59,000
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18
37,000
12,000
7,200
58,000
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36,000
11,000
7,000
56,000
2,000
220
0.28
103
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180,000
1,600
17,000
71,000
170,000
1,900
210
0.27
97
32
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170,000
1,500
16,000
67,000
160,000
1,800
200
0.26
94
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160,000
1,500
15,000
65,000
150,000
1,700
190
0.25
90
30
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160,000
1,400
15,000
62,000
150,000
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Number of Premature Deaths from PM
2000 and 2020 in the baseline
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IIASA estimates of loss of life expectancy in
(i) 2000 and (ii) 2020 – CAFE Baseline
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CBA Results in Monetary Terms
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Key question: How do benefits of reducing air pollution
compare with costs?
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Results presented for four policy scenarios, in increasing
degree of severity
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A, B, C, MTFR – Maximum Technically Feasible Reduction
Four benefits estimates given
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Using deaths (higher) or life-years (lower)
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Using mean (higher) or median (lower) values from monetary
valuation studies
http://europa.eu.int/comm/environment/air/cafe/pdf/ia_repo
rt_en050921_final.pdf (Commission staff paper, Table 33)
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General Results: Benefit-Cost Ratio
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Both costs and benefits increase as PM is reduced
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Benefits much greater than costs at the point where the
Commission decided to target its reduction policies (i.e.
20% reduction in PM2.5); i.e. benefit-cost ratio >1.
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Benefit-cost ratio varies by country – only just >1 in Ireland
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There is a strong economic case for even stronger
reductions i.e. Europe-wide, the benefit-cost ratio of further
reductions is also >1
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Results – Billion Euro/yr
EU25 Annualised Benefits
Low estimate
High estimate
EU25 Annualised Costs
Total
Benefit to Cost Ratio
Low estimate
High estimate
A
B
C
MTFR
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120
46
147
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160
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182
5.9
10.7
14.9
39.7
6.3
4.3
3.4
1.4
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4.6
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Benefit: Cost Ratio
Benefit / Cost Ratio varies by Country
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2
0
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EU25 Results – Marginal Benefit/Costs
From
CLE to A
From A
to B
From B
to C
From C
to MTFR
EU incremental annualised benefits (health and crops)
Total with Mortality – VOLY - low (median)
38
8.3
4.1
6.9
Total with Mortality – VSL – high (mean)
120
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EU-25 annualised costs in Billion€/year – incremental changes to each scenario
Total
5.9
4.8
4.2
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Total with Mortality – VOLY – low (median)
6.3
1.7
1.0
0.3
Total with Mortality – VSL – high (mean)
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5.6
3.2
0.9
Benefit to cost ratio
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Commission’s proposals for ambient PM
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Focus on PM2.5 rather than PM10
20% reduction in PM2.5, by the year
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A ‘cap’ of 25 µg/m3 PM2.5
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Target, i.e. not legally binding
Roughly equivalent to 40 µg/m3 PM10
Legally binding
Changes to ‘anthropological PM10’
Inequalities
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Proposals would reduce inequalities in health protection
But imply corresponding inequalities in costs of compliance…
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Comments on policy and what shaped it (1)
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Move to PM2.5 + focus on annual average progressive but
major problem: 20% reduction not legally binding
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Cost benefit analysis extremely useful in assessing
potential policies and so as input to the policy decision
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Must be scientific and evidence based - independent inputs
Peer review and consultation is essential
But final policy not decided by the CBA – further reductions
warranted
Different groups initially sceptical (NGO and industry) but used
analysis to support their arguments opportunistically
Reducing inequalities not a primary driver of the policy
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Comments on policy and what shaped it (2)
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Commission’s policy proposals (PM Directive) considered by many
scientists as not stringent enough, and indeed a step backwards
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Letter, early 2006; Further statement, September 2006
Apparently DG Environment willing to do more; but very strong lobby
against further reductions:
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Various DGs (Enterprise, Transport, Agriculture, +, apparently, Commission
President?) – ‘competitiveness’ rather than health
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Industry
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Various Member States
Focus moved to European Parliament and Council of Ministers
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Media reporting
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Popular press articles aimed at policy makers
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Wholesale attempts to discredit the science in nonscientific media
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‘Manufacturing uncertainty’
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Attacks on individual scientists
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Thanks to Bert Brunekreef, IRAS, Utrecht, for next 2 slides
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February 2006
‘The PM Panic machine is a textbook example of how to
make politics from science’
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European Parliament and Council of Ministers
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Parliament (September 2006)
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Council of Ministers (October 2006)
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MEPs adopted a co-decision report (1st reading)
571 for, 43 against, 18 abstentions
More ambitious targets, greater flexibility…’
e.g. Target of 20 (not 25) µg/m3 PM2.5 by 2010; Binding by 2015
More flexibility implies more scope for ‘special cases’; Implies
greater health inequalities?
More flexibility…..
But rejects Parliament’s call for stricter limits….
The story continues….
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THANK YOU!
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