Direction de santé publique

Presented to: Healing the Planet: Creating a Peaceful

and Sustainable Future

September 26, 2009

Greenhouse Gases, Outdoor Air Pollution

and Public Health

Stéphane Perron, MD, MSc, FRCPC Direction de santé publique, Montréal

Professeur adjoint, DMSP, UdeMsperron@santepub-mtl.qc.ca

514-528-2400, poste 3291

Louis Jacques, MD, FRCPCDirection de santé publique, Montréal

Hôpital thoracique de Montréal, CISTE Professeur agrégé, DMSP, UdeM

ljacques@santepub-mtl.qc.ca514-528-2400, poste 3305

Presentation Outline

• Climate Change Quebec Emissions Health Impacts

• Oppressive Heat• Extreme Climate Events

• Outdoor Air Pollution Health Impacts Ragweed

• Public Health Approach

Climate Change

 

Climate Change Quebec Emissions

Source : MDDEP, 2008

Fig.1 – Distribution of GHG Emissions in Quebec, by Activity Sector

Source : MDDEP, 2008

Fig. 2 – Distribution of GHG Emissions in Quebec, 2006, by Gas Type

Source : MDDEP, 2008

Figure 4 – GHG Emissions in Quebec, by Activity Sector, from 1990 to 2006 (Mt, CO2 equivalent)

Climate Change

Health Impacts

Potential Impacts of Climate Change – International Perspective

Health ImpactsClimate-related mortalityInfectious diseasesAir quality / respiratory and cardiovacular diseases

Agricultural ImpactsAgricultural yieldsIrrigation needs

Forest ImpactsForest type changeSpecies migration

Water ImpactsDrinking water reservesWater qualityCompetition for the resource

Coastal Region ImpactsCoastal erosionCoastal floodingCost vs coastal community protection

Natural Spaces and SpeciesEcological zone changesNatural space distances

Climate Change Quebec Perspective

• Oppressive Heat Episodes

• Extreme Climate Events

Oppressive Heat

Daily Mortality and Average Temperatures in Major Cities – North America (solid lines)

and South America (dotted lines)

Daily Deaths vs Mean Temperature Paris, 2003 and 1999-2002

Montreal – June 1994 Heat Wave

Local Variation of Thermal and Vegetation Zones CSSS Cavendish

Oppressive Heat

Main Health Impacts of Oppressive Heat Episodes

• Direct Impacts: Muscular cramps Heat exhaustion Heatstroke mortality

• Indirect Impacts: Significant increase in death and

hospitalization rates among elderly, chronically-ill persons

Vulnerable Persons

• Hospitalized persons – 75 % of Quebec mortalities

• Children aged 0 to 4• Chronically-ill, elderly people (65 and over)

Cardiovascular, respiratory, stroke, kidney, neurological, diabetes

• Taking medication• Living alone downtown

Urban Heat Islands

• Mentally-ill persons

Health Impacts – Environmental Risk Factors

• Housing with no air conditioning

Sudden early summer heat wave with high humidity (acclimatization)

Lasting several days, with high nighttime temperatures (>25 oC)

Heat/pollen/smog/photochemical pollution interaction

Air Conditioned Residences

Montreal 20 %

Toronto 60 %

Prevention Strategies

Population Information and education on preventive

measures (hydration, air conditioning) Warning (monitoring) and alert (mobilization)

systems A call for vigilance

Health Establishments Develop techniques to reduce room heat loads Emergency action plans Early medical intervention

Action Strategies and Temperature

Normal Temperature• Preventive measure implementation

WarningTo 30 oC & Humidex 40 oC

• Information on preventive strategies• Public health warning

Alert To 30 oC & Humidex 40 oC

5 consecutive days & 5 consecutive nights• Emergency Action Plan

Protection Measures:Crisis Management

• Activate network emergency action plans• Operation Solidarity: search for persons at risk and

offer assistance• Make cooling-off locations available (municipal

shelters, shopping centres, etc.)• Take charge of people at risk, as required• Distribute water to the homeless• Manage overcrowded hospital emergency rooms

Extreme Climate Events

• 1998 ice storm • Carbon monoxide

poisoning epidemic• Will power outages

become more frequent?

Outdoor Air Pollution

Outdoor Air Pollutants

• Smog: chemical pollution which occurs mainly in urban areas, under certain weather conditions (hot day, low wind and temperature inversion)

• Ozone: occurs mainly when heat, NOx, VOCs and other pollutants react in the presence of UV

• Pollutants can be: Particulate matter: PM10, PM2.5, ultrafine

particles Gases : O3, NOx, SO2, CO, COV, …

Smog Day

Evolution of Pollutant Levels

• In the last few decades (~30 years), there has been a decrease in the average concentration of certain pollutants: SO2, CO, Pb and PM

• Somewhat stable levels: O3, NO2, COV, H2S

• Rising level: CO2

• Levels sometime exceed standards in some places and times (ex. : O3)

• Current standards are too weak to protect vulnerable persons.

Pollutant Sources

• Fixed: industry, housing, incinerators, …• Mobile: transportation • Linked to:

Motor vehicles (gasoline, diesel) Industrial activity Thermal power plants (coal, natural gas,…) Fossil fuel heating (wood, oil, natural gas, …) Waste incineration Fires …

WOOD HEATING Households With Wood Heating, Montreal Island

(DSP Montréal, 2001)

Health and Outdoor Air Pollution

Toxicity Mechanisms

• Inflammatory reaction • Autonomous nervous system

reaction• Increased blood viscosity and blood

clot formation• CO-generated Hypoxaemia (affects

persons with a heart failure condition)

• Possible causes: fine and ultra-fine particulate matter, NOx, ozone, etc.

1 540 par année, à Montréal

Health Impacts (Heart and Lung) Linked to Air Pollution

Leading Health Problems Linked to Air Pollution

• Increased mortality

• Heart disease

• Respiratory diseases, including COPD (Chronic Obstructive Pulmonary Disease), asthma, infections, allergic rhinitis

• Cancers, including lung and skin

Health Impacts

• Numerous epidemiological studies• Clearly demonstrated impacts for respirable

particle matter (particularly fines)• No known threshold• Long-term impacts more severe than short-

term impacts Important to reduce average exposure levels

• An increase in long-term cardio-respiratory mortality (6 %), including lung cancer (8 %), is linked to a 10µg/m3 increase in the average PM2.5 concentration

Main Health Impacts

• Short-term impacts: Worsening asthma Worsening cases of CVD (including death)

and COPD Increased risk of respiratory tract infections

• Long-term impacts: Lung development and respiratory functions

are affected Increased mortality (particularly from PM2.5):

from all causes, CVD, COPD and lung cancer

Most Vulnerable Persons

• Young children

• Elderly people

• The chronically-ill Heart and stroke Respiratory Diabetes

• People living near major thoroughfares

Ultrafine Particles

• Health impacts on people living near a major thoroughfare, with increased exposure to fine particles and Nox

53 % mortality increase for people aged 55 to 77, living 100 metres from a freeway. This rate increase is due to cardiorespiratory mortality (Hoek et al, 2002)

People 60 and over, living along busy highways, are 21% more likely to be hospitalized for respiratory problems (Smargiassi et al, Montreal, 2006)

Pregnant women living less than 200 meters from a freeway are 17% more likely to give birth to an underweight baby. (Généreux et al, Montreal, 2007)

Several other studies have documented the link between traffic intensity near the place of residence and myocardial infractions, respiratory problems and otitis.

What to do?

• Individual treatment

• Recommend measures to stop or reduce exposure: Measures controlled by patient or family Measures controlled by others

Public Health Actions• Alert System: Info-smog • Quantify health/social impacts• Awareness campaigns for the public and decision

makers • Promote emission reduction actions (transportation,

industry, wood heating), through:– Laws and regulations (revise emission standards…)– Tax incentives and disincentives– Public and active transport promotion policies– Policies to assist the purchase of greener vehicles

and equipment– Vehicle maintenance programs…

Preventive Medicine Practices

• Identify patients who are the most vulnerable to pollution events Elderly people, heart disease, heart failure,

asthma, chronic bronchitis, emphysema • Inform them of the personal measures that can

reduce health risks: Monitor smog warnings Reduce outdoor physical activity during smog

events, particularly during the most critical periods (late afternoon)

Avoid the most polluted places and other pollution sources (tobacco)

Action plan for Rx use

Ragweed

Allergic Rhinitis and Ragweed

• Affects > 10 % of the population 5th most-declared health problem in Quebec

• Ragwood might be responsible for most cases of allergic rhinitis

• Associated allergic manifestations: Rhinitis Conjonctivitis Asthma

• Upward trend: due to global warming?

Garneau M et al.

Figure 5.3 – Pollen concentration for 5 plants under study, Montreal and Quebec City, 1994 to 2002

Figure 5.1: Length of Pollinic Seasons for Ambrosia spp, Montreal, 1994-2002

Garneau, M. et al.

Fig. 4.1: Mean Medical Consultation Rate for Allergic Rhinitis, Montreal & Quebec City, 1994-2002

Garneau, M. et al.

Ragweed Infestation Index, Montreal Island, 2006Ragweed Infestation Index, Montreal Island, 2006

Allergic Symptom Prevalence in Children Aged 6 Months to 12 Years, by CLSC Territory – Montreal, 2006 Allergic Symptom Prevalence in Children Aged 6 Months to 12 Years, by CLSC Territory – Montreal, 2006

Interventions

• Clinical aspects: Recommend measures to reduce exposure for

allergic persons

• Public Health Actions: Discussions with municipalities and other

partners to implement a ragweed control programme

Public information Epidemiological monitoring

• Quebec Ragweed Roundtable website – Table québécoise de l’herbe à poux (TQHP)

The Clinician’s Role

• Identify health problems linked to environmental contamination

• Recommend measures to restore or protect the health of patients

• Inform people at risk of appropriate harm prevention and health promotion measures

• Inform other organizations having the potential to address harmful environments

• Refer people to other available resources, including public health officials and staff

• Know your community • Contribute to improving your community’s

environment

Health Promotion – Root Causes of Air Pollution and Other Health Impacts

Two examples:• Transport• Tree and Plant Cover

NOX

SO2

Fine andultrafine particles

GHGs

Transportation-Related Pollution

VOCs

SMOG

Increased Automobile Transport

Mortality, Heart and Respiratory

Diseases

Air Pollution

Reduced Active Mobility

(Walking, Cycling)

Obesity and Diabetes

Noise

Sleep Disruption, Hypertension

Urban Heat Islands

Reduced Plant and

Tree Cover, Paving and Asphalting

Excessive Mortality During

Heat WavesIncreased Traffic

Accidents

Increased Automobile Traffic

and Speed

Greenhouse Gas Increase

Global Warming

Source photo: Richard Joseph Jackson, Health and the Environment, http://www.lgc.org/freepub/land_use/presentations/2005.html.

Social Exclusion for Those Who Have no

Access to a Car

Neighbourhood /Functional Segregation

Car-Oriented Urban

Development

Plant and Tree Cover

Reduced Heat (80C)

Reduced Heat-Related

Health Problems

Reduced Ozone Pollution

Natural Ventilationr

Reduced Air Pollution

Decreased Run-off

Decreased Sewer Overload,

IncreasedNatural Filtration

Improved Water Quality

Less Phosphates, Heavy Metals,

Hydrocarbons and BacteriaIn Water

Public Access

Protection During

Oppressive Heat Periods

PhysicalActivity

Carbon Sinks

Reduced CO2

Improved Mental Health

Selected Environmental Health Information Sources

Information Sources and Documents…General

• Bulletin d’information en santé environnementale du Québec: http://www.inspq.qc.ca/cse/bise/index.htm

• Montreal DSP Website• Health Canada: www.hc-sc.gc.ca • US Environmental Protection Agency (US-

EPA): www.epa.gov/ • The Medical Journal of Australia: Protecting

the planet Series – MJA 2002, 177 (11/12): 590-

Information Sources and Documents…Chemical Substances

• Centre Anti-Poison (inspq.qc.ca) CAPQ: 1-800-463-5060

• Centre de toxicologie du Québec: 1-418-654-2254

• International Programme on Chemical Safety : www.inchem.org

• National Toxicology Program (NTP): http://ntp-server.niehs.nih.gov/

• Agency for Toxic Substances and Disease Registry (ATSDR), USA: www.atsdr.cdc.gov/hazdat.html

Information Sources and Documents…Guides, Criteria, Standards

• Air Quality Guidelines (WHO)www.who.int/peh/air/Airqualitygd.htm

• Health and Air Quality (Health Canada)www.hc-sc.gc.ca/hecs-sesc/qualite_air/index.htm

• Drinking Water Quality Recommendations (HC)www.hc-sc.gc.ca/ehp/dhm/catalogue/dpc_pubs/rqepdoc_appui/rqep.htm

Information Sources and Documents…Training and Education

• Supercourse. Epidemiology, the Internet and Global Health www.pitt.edu/~super1

• Environmental Health in Family Medicine www.ijc.org/boards/hptf/modules/content.html

• American College of Occupational and Environmental Medicine : www.acoem.org/

Information Sources and Documents…Climate Change

• Intergovernmental Panel on Climate Change (IPCC): http://www.ipcc.ch Climate change 2007 (4th report)

• Ouranos Consortium: http://www.ouranos.ca