Transcript Health Costs due to Road Traffic

Health Costs due to
Road Traffic-Related Air Pollution
An impact assessment project of
Austria, France and Switzerland
Rita K. Seethaler
The Urban Transport Institute
Australia
Targets
 A common methodological framework
 Comparable empirical results
The main partners
 Austria:
Federal Ministry of Environment, Youth and Family
Affairs
Federal Environment Agency
 France:
Agency for Enivronment and Energy Management
ADEME
 Switzerland:
Federal Department for Environment, Transport, Energy
and Communications
Three disciplines co-operate...
 Air Pollution:
Exposure assessment of the residential
population (particulate matter PM10, traffic share)
 Epidemiology:
Exposure-Response relationship for selected
health outcomes (air pollution attributable cases)
 Economy:
Evaluation of monetary health costs (willingnessto-pay)
Structure of the study
Air pollution map
with traffic
Air pollution map
without traffic
Population map
Exposure of the
population
Number of
cases
PM
in
10
20
30
40
50
60
10
concentration
3
µg/m
Exposure-response relationship
between air pollution and the
number of mortality and
morbidity cases
Number of
cases
PM
10
20
30
40
50
60

Number of mortality
and morbidity cases
Difference:
Number of mortality
and morbidity cases
due to road transport
Health costs per case
External health costs due to
road-traffic related air pollution
concentration
in µg/m
10
3
PM10 Population Exposure:
General Methodological Framework
Main Steps
 acquisition and analysis of data on the ambient
concentration of particulate matter
 annual mean PM10 mapping using empirical dispersion
models or statistical methods
 estimation of the road traffic related PM10 fraction
 calculation of population exposure by superposition of
the PM10 map on the population distribution map
Differences in PM10 Modelling
Differences in Measurement Methods of Ambient
Concentration of Particulate Matter (state of art 1999)
Austria
network of Total Suspended Particulate (TSP) measured by beta
attenuation and TEOM. NOx emission inventory available.
France
until recently used the Black Smoke (BS) method exclusively, some
sites are now equipped with PM10 samplers (TEOM sampler).
No emission inventory for PM10 available.
Switzerland
changed the national monitoring network from TSP to PM10
measurements by gravimetric filter samplers.
PM10 emission inventory available.
Population Exposure to Total PM10
PM10 Population exposure (total PM10)
60%
Population (%)
50%
40%
Austria
30%
France
Switzerland
20%
10%
0%
0 - 10
10 - 20
20 - 30
30 - 40
40 - 50
> 50
PM10 concentration (µg/m³)
Frequency distribution of PM10 population exposure
Population Exposure to PM10 without
traffic-related share
Population (%)
PM10 population exposure (without traffic share)
100
90
80
70
60
50
40
30
20
10
0
Austria
France
Switzerland
0-10
10-20
20-30
30-40
40-50
>50
PM10 concentration (μg/m3 )
Frequency distribution of PM10 population exposure
Population weighted annual PM10 averages
PM10 concentration in g/m3 (annual mean)
Austria
France
Switzerland
Total PM10
26.0
23.5
21.4
PM10 without fraction
attributable to road traffic
18.0
14.6
14.0
PM10 due to road traffic
8.0
8.9
7.4
 Interpretation with regard to the considerable variability of road
traffic PM10
 Higher relative contribution of road traffic to total PM10 in city
centers
 Typical values are 40-60% in cities and <30% in rural areas (Swiss
model)
Public Health Impact Assessment of Air Pollution:
Calculation of attributable number of cases
Number
of cases
costs
attributable number
of cases
without
Air Pollution (PM10)
with
Health outcomes included
in the assessment
.
Health outcome
Age
Total mortality
Adults,  30 years of age
Respiratory hospital admissions
All ages
Cardiovascular hospital admissions
All ages
Chronic bronchitis incidence
Adults, 
Acute Bronchitis
Children, < 15 years of age
Restricted activity days
Adults,  30 years of age
Asthmatics: asthma attacks
Children, < 15 years of age
25 years of age
Adults,  15 years of age
Definitions and sources (references)
Health outcome
Definition
Sources (References)
Long-term mortality
(adults  30 years)
death rate, excluding violent death / accidents
aged 25-75 and >30 years, respectively
Dockery DW et al, 1993
Pope CA et al, 1995
Respiratory Hospital
Admissions
(all ages)
ICD9 460-519, all ages
ICD9 466, 480-487, 493, 490-492, 494-496, all ages
ICD9 480-487, 490-496, all ages
Spix C et al, 1998
Wordley J et al, 1997
Prescott GJ et al, 1998
Cardiovascular Hospital
Admissions (all ages)
Chronic Bronchitis
Incidence (adults  25
years)
ICD9 410-436, all ages
ICD9 390-459, all ages
ICD9 390-459, all ages
ICD9 410-414, 426-429, 434-440, all ages
symptoms of cough and/or sputum production on most
days, for at least three months per year, and for 2 years or
more, age >=25 years
Wordley J et al, 1997
Poloniecki JD et al, 1997
Medina S et al, 1997
Prescott GJ et al, 1998
Abbey DE et al, 1993
Bronchitis episodes
(children <15 years)
bronchitis in the last 12 months (parents or guardian’s
answer), ages 10-12, 8-12 and 6-15 years, respectively
Dockery DW et al, 1989
Dockery DW et al, 1996
Braun-Fahrländer C et al,1997
Restricted Activity Days
(adults  20 years)
any days where a respondent was forced to alter normal
activity, due to respiratory disease ICD9 460-466, 470-474,
480-486, 510-516, 519, and 783, age 18-65 years
Ostro B et al, 1990
Asthma attacks (children
< 15 years)
lower respiratory symptoms, age 6-12 years
asthma, age 7-15 years
lower respiratory symptoms, age 7-13 years
Roemer W et al, 1993
Segala C et al, 1998
Gielen MH et al, 1997
Asthma attacks (adults 
15 years)
wheeze, age 18-80 years
shortness of breath, age 18-55 years
wheeze, age 16-70 years
Dusseldorp A et al, 1995
Hiltermann TJN et al, 1998
Neukirch F et al,1998
Calculation example of the additional cases per
10 g/m3 PM10 and 1 million inhabitants
e.g. in Switzerland:
337
=
fixed
baseline increment
7‘794
x
expected baseline
frequency at
exposure of 7.5 g/m3
D10
=
P0
x
0.043
Relative risk
for an increase of
10 g/m3
(RR-1)
Short term and long term effects of air pollution
The effects of air pollution have two dimensions in time:
First, for some people, the level of pollution on a given day or week may trigger
morbidity or death. These are acute effects, well established in many highly
qualified time series studies in Europe and abroad. These short term effects
may move the event of death from a considerable number of people forwards.
There is, however, a further aspect of air pollution, ultimately leading to earlier
death: recurrent cumulative exposure may enhance morbidity, including e.g.,
chronic bronchitis. People with these diseases (to which air pollution
contributed) have impaired health and shorter life expectancy, thus, they may
die earlier, although the EVENT of death may not always be closely related to
the daily level of pollution.
This overall effect of air pollution on life-expectancy is captured by the cohort
studies whereas the short-term studies capture only one part of the overall
problem. (Dr. Nino Kuenzli et al.)
Air pollution and mortality:
long-term frailty and terminal trigger
Death triggered
Frailty level
By air pollution Not by air pollution
Due to air pollution
A
B
Not due to air poll.
C
D
Contribution of Air Pollution
CASE A : long-term + terminal trigger of death
Frailty
SMOG EPISODE
(susceptibility for
death)
Death
Cumulative exposure
Chronic Bronchitis
Time
Birth
Age at death
Quantitative results: Health effects
attributable to road traffic-related air pollution
In Total (Austria, France and Switzerland)







300,000
25,000
25,000
162,000
295,000
16 Million
21,000
cases of acute bronchitis in children
cases of chronic bronchitis in adults
hospital admissions
asthma attacks in children
asthma attacks in adults
days with restricted activity in adults
cases of premature mortality (long-term)
absolute number of cases
Comparison: fatal road accidents and
air pollution related mortality
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
1970 Road accidents
1996 Road accidents
1996 air pollution rel.
premature deaths
Austria
France
Switzerland
number of Life years lost
Years of life lost due to road accidents or air
pollution related mortality (1996)
350000
300000
250000
200000
150000
100000
50000
0
Austria
From Road accidents
(ø 40 years lost)
France
Switzerland
from Air pollution related mortality
(ø 10 years lost)
Overview of the costs of morbidity
Costs of illness
Costs of avertingbehaviour
Treatment costs Loss of production
collectively borne collectively borne
Avertive expenditures
collectively borne
Treatment costs Loss of production
indvidually borne individually borne
Avertive expenditures
individually borne
Market Prices available
Intangible Costs
Disutility associated with
morbidity individually borne
Market Prices not available
Private Costs (= individual WTP)
Social Costs(individually and collectively borne)
The value of a prevented fatality based
on willingness-to-pay
Example:
Policy measure for risk reduction from
 4 cases per 10,000 inhabitants to
 3 cases per 10,000 inhabitants.
Risk reduction: 1 case per 10,000 Inhabitants = 0.0001
Individual willingness-to-pay for a risk reduction of
1 case in 10,000 inhabitants = 100 EURO.
Value of a prevented fatality: 100 EUR/0.0001 = 1 Million
EURO
Willingness-to-pay cost factors used for the
monetary assessment of mortality
WTP-value
Source
0.9 Mio EUR
Tri-lateral study (A,F,CH); 1.4 adjusted down
1.4 Mio EUR
Jones-Lee M. (1998); Fatal road accidents
1.2 Mio EUR
Department of Health (UK)
2.6 Mio EUR
ExternE (1995)
3.1 Mio EUR
Instiute of Environm. Studies, Norway (1997)
ZEW, Centre for Europ. Econ. Research (1998)
ISI Frauenhofer Institute (1998)
Willingness-to-pay cost factors used for
the monetary assessment of morbidity
Health outcome
Respiratory hospital adm.
WTP (EUR) Source
7,870/adm.
ExternE (1995)
Cardio-vascular hosp.adm. 7,870/adm.
ExternE (1995)
Chronic Bronchitis (adults) 209,000/case
Chestnut L.G. (1995)
Acute Bronchitis (children) 131/case
Maddison D. (1997)
Restricted activity days
94/day
Maddison D. (1997)
Asthma attacks
31/attack
Maddison D. (1997)
Health costs due to air pollution
Inhabitants
(mill.)
Total (mill.
Euro)
Attributable
to road
traffic (mill.
Euro
Austria
France
Switzerland
All three
countries
8.1
58.3
7.1
73.4
6 700
38 900
4 200
49 700
2 900
21 600
2 200
26 700
Traffic-related
Monetary Health Costs
Austria, France and Switzerland
 Total health WTP-costs: 27 billion EUR p.a.
 = 1.7% of GDP
 (Partial assessment: 3.5 billion EUR p.a.)
 Per capita WTP-costs: 360 EUR p.a.
 Predominant part: 70% of costs for premature
mortality
 Morbidity WTP-costs: 7 billion EUR p.a.
 75% for chronic bronchitis, 22% RAD
The “At least approach”
•
•
•
•
•
•
Lowest assessed level of 7.5 g/m3 for health effects
Not all PM10 related health effects are considered
(infant mortality, respiratory symptom days)
The effect estimate reflects the air pollution mix of an
urban environment. Specific independent effects of
single pollutants are not considered.
Seasonally limited air pollution related health effects
are not considered (e.g. ozone exposure in summer)
Willingness-to-pay value of fatal road accidents of
1.4 Mio EUR is reduced of 61% according to higher
age of air pollution related victims.
This WTP value is lower than values used in other
European studies (e.g. ExternE: 2.1-3.0 Mio. EUR)
Outlook – research needs
 Data improvement for the assessment of exposure and
transport-related share
 Effects of ozone, effects of other pollutants additive to
PM10 effects
 Age distribution at time of death
 Simultaneous effects of noise and air pollution
 Monetary valuation of health impacts: Elements included
in WTP
 Situational effects on WTP, age effects on WTP, other
effects
 Appropriate measure of uncertainty