1.3 The improved practice In contrast to the dramatic revision of reported premature deaths,it can be the numbers reported before and after concluded that there has been a modest the GBD-2010 Study -from 1.3 million increase only with reference to global premature deaths reported for 2008,to mortality from AAP since 2005. 3.7 million reported for 2012-the actual change in estimated premature deaths As reported by the OECD(OECD,2014) over time is relatively modest. and as shown in Table 1.2,mortality decreased in the 34 countries of the As shown in Table 1.2,in the period OECD by about 20 000 premature deaths from 2005 to 2010 the estimated global (≈4%)，although this was offset by an mortality from AAP-defined here as the increase in premature deaths in China, sum of APMP and AOP-increased by an India and the rest of the world.In the absolute figure of approximately 135 000: same period,the 53 Member States of the that is,by about 4%. WHO European Region,taken together, also recorded a reduction in premature Inclusion of AOP values,which is deaths of about 68 000 (=12%)-that necessary given the available data,limits is to say,a greater reduction and rate of comparability with other estimates based reduction than that recorded for the 34 on PM alone.However,since AOP makes OECD countries,taken together. up less than 5%of the 3.376 million Table 1.2.Change in estimated premature deaths from AAP, 2005-2010 Deaths from ambient 2005 2010 Change from PM+AOP 2005to2010 (%) Global total 3240129 3375977 +4.2 OECD-34 497958 478104 -4.0 WHO European Region 577221 509100 -11.8 Source:IHME (2014). These data are consistent with the premature deaths from 2005 to 2010(see evidence presented by the OECD(OECD, OECD,2014).The evidence presented 2014),which shows that most of the here shows that the results from the non- OECD's European member countries OECD part of the WHO European Region achieved a reduction in premature deaths do not alter the basic pattern found for over this period-to a greater or lesser OECD member countries in Europe. extent-while most of its non-European member countries did not:the United Itisimportant to note that the improvement States of America achieved a reduction, observed in the WHO European Region but the remaining non-European follows in the wake of regulatory countries -Canada,Mexico and Chile intervention across the relevant sectors in the Americas,Japan and the Republic within the European Union (EU),which of Korea in Asia,as well as Australia and also influences the rest of the Region. New Zealand -suffered an increase in For the EU,the European Environment 6
6 Table 1.2. Change in estimated premature deaths from AAP, 2005–2010 Deaths from ambient PM + AOP 2005 2010 Change from 2005 to 2010 (%) Global total 3 240 129 3 375 977 +4.2 OECD-34 497 958 478 104 –4.0 WHO European Region 577 221 509 100 –11.8 Source: IHME (2014). 1.3 The improved practice In contrast to the dramatic revision of the numbers reported before and after the GBD-2010 Study – from 1.3 million premature deaths reported for 2008, to 3.7 million reported for 2012 – the actual change in estimated premature deaths over time is relatively modest. As shown in Table 1.2, in the period from 2005 to 2010 the estimated global mortality from AAP – defined here as the sum of APMP and AOP – increased by an absolute figure of approximately 135 000; that is, by about 4%. Inclusion of AOP values, which is necessary given the available data, limits comparability with other estimates based on PM alone. However, since AOP makes up less than 5% of the 3.376 million reported premature deaths, it can be concluded that there has been a modest increase only with reference to global mortality from AAP since 2005. As reported by the OECD (OECD, 2014) and as shown in Table 1.2, mortality decreased in the 34 countries of the OECD by about 20 000 premature deaths (≈ 4%), although this was offset by an increase in premature deaths in China, India and the rest of the world. In the same period, the 53 Member States of the WHO European Region, taken together, also recorded a reduction in premature deaths of about 68 000 (≈ 12%) – that is to say, a greater reduction and rate of reduction than that recorded for the 34 OECD countries, taken together. These data are consistent with the evidence presented by the OECD (OECD, 2014), which shows that most of the OECD’s European member countries achieved a reduction in premature deaths over this period – to a greater or lesser extent – while most of its non-European member countries did not: the United States of America achieved a reduction, but the remaining non-European countries – Canada, Mexico and Chile in the Americas, Japan and the Republic of Korea in Asia, as well as Australia and New Zealand – suffered an increase in premature deaths from 2005 to 2010 (see OECD, 2014). The evidence presented here shows that the results from the nonOECD part of the WHO European Region do not alter the basic pattern found for OECD member countries in Europe. It is important to note that the improvement observed in the WHO European Region follows in the wake of regulatory intervention across the relevant sectors within the European Union (EU), which also influences the rest of the Region. For the EU, the European Environment
Agency (EEA)recorded an overall in ambient concentrations of pollutants improvement in the trend of pollutant and human exposure (see,for example. emissions for the period from 2002 to EEA,2013a and OECD,2014).The EEA 2011 (EEA,2013a),with reductions in (2013b)reported that in 2011,33%of emissions of primary PM(14%for PM,o the urban population was exposed to and 16%for PM,and in emissions of PM,levels above the EU limit,and 88% its main precursors,including by 27%for to PMo levels above the tighter WHO nitrogen oxides(NO).NO,emissions are air quality guidelines (AQG)limit.The also a precursor for ozone and the 27% OECD also argued (OECD,2014)that reduction in NOy emissions was matched the problem has been compounded by by similar reductions in other ozone increasing market penetration of diesel precursor gas emissions.Moreover,and (see also Carslaw et al.,2011;EEA, mainly owing to progressively tighter 2012;Moore Newey,2012;Carslaw emission limits for Euro 4 vehicles in Rhys-Tyler,2013).In contrast to petrol 2005 and Euro 5 vehicles in 2009,2 the vehicles,diesel vehicles are reported reduction in emissions achieved in the to have not shown significant reduction critical transport sector-by 24%for PMo in NO,emissions since the mid-1990s by 27%for PM2s and by 31%for NOx- (Carslaw Rhys-Tyler,2013).However, exceeded the reduction in emissions partly as a consequence of policy and tax overall for the period in question.3 regulations designed to combat climate change,the recent past has witnessed Notwithstanding the improvements,the a continuing shift from petrol to diesel problem that the above-mentioned EU vehicles (EEA,2012). regulatory intervention was designed to address remains very serious.In At any rate,the yearly premature death particular,owing to the improvements toll from AAP of more than half a million in monitoring and modelling technology, people in the WHO European Region is it is now clear that the relatively rapid a remarkably high number,setting the decline in pollutant emissions at source context in which any improving trend has been followed by a slower decline should be evaluated. 1.4 APMP and HAP in the WHO European Region The evidence presented in Table 1.2 is high-income countries.Where such data relevant to the global and regional levels are available,predominantly in the low- for ambient PM.The evidence presented and middle-incomes countries of the in Table 1.3 is by country and reports Region,they reveal a sufficiently serious mortality due to ambient PM and HAP problem to merit discussion in this report. from solid fuels,comparing the years 2005and2010. Table 1.3 shows the sum of mortality data for ambient PM and HAP from solid Data for PM by country are available for all fuels,for the years 2005 and 2010.This Member States of the European Region is a simple sum,rather than an estimate (with the exception only of Monaco and of joint effects;it should therefore be San Marino).Data by country for HAP interpreted with caution. from solid fuels are not available for 24 2 These European emission standards define the acceptable limits for exhaust emissions of new vehicles sold in EU Member States.They are defined in a series of EU directives staging the progressive introduction of increasingly stringent standards(Euro 4 was introduced in January 2005,followed in September 2009 by Euro 5)and concentrated on cleaning up emissions from petrol and diesel cars,especially reducing PM and oxides of nitrogen(NO). 3 As noted above,a roughly similar pattern is observable in the United States:see,inter alia,the evidence presented in Amann,Klimont Wagner(2013),American Lung Association(2013),and United States EPA(EPA,2013)
7 Agency (EEA) recorded an overall improvement in the trend of pollutant emissions for the period from 2002 to 2011 (EEA, 2013a), with reductions in emissions of primary PM (14% for PM10, and 16% for PM2.5) and in emissions of its main precursors, including by 27% for nitrogen oxides (NOX). NOX emissions are also a precursor for ozone and the 27% reduction in NOX emissions was matched by similar reductions in other ozone precursor gas emissions. Moreover, and mainly owing to progressively tighter emission limits for Euro 4 vehicles in 2005 and Euro 5 vehicles in 2009,2 the reduction in emissions achieved in the critical transport sector – by 24% for PM10, by 27% for PM2.5 and by 31% for NOX – exceeded the reduction in emissions overall for the period in question.3 Notwithstanding the improvements, the problem that the above-mentioned EU regulatory intervention was designed to address remains very serious. In particular, owing to the improvements in monitoring and modelling technology, it is now clear that the relatively rapid decline in pollutant emissions at source has been followed by a slower decline 2 These European emission standards define the acceptable limits for exhaust emissions of new vehicles sold in EU Member States. They are defined in a series of EU directives staging the progressive introduction of increasingly stringent standards (Euro 4 was introduced in January 2005, followed in September 2009 by Euro 5) and concentrated on cleaning up emissions from petrol and diesel cars, especially reducing PM and oxides of nitrogen (NOx ). 3 As noted above, a roughly similar pattern is observable in the United States: see, inter alia, the evidence presented in Amann, Klimont & Wagner (2013), American Lung Association (2013), and United States EPA (EPA, 2013). in ambient concentrations of pollutants and human exposure (see, for example, EEA, 2013a and OECD, 2014). The EEA (2013b) reported that in 2011, 33% of the urban population was exposed to PM10 levels above the EU limit, and 88% to PM10 levels above the tighter WHO air quality guidelines (AQG) limit. The OECD also argued (OECD, 2014) that the problem has been compounded by increasing market penetration of diesel (see also Carslaw et al., 2011; EEA, 2012; Moore & Newey, 2012; Carslaw & Rhys-Tyler, 2013). In contrast to petrol vehicles, diesel vehicles are reported to have not shown significant reduction in NOX emissions since the mid-1990s (Carslaw & Rhys-Tyler, 2013). However, partly as a consequence of policy and tax regulations designed to combat climate change, the recent past has witnessed a continuing shift from petrol to diesel vehicles (EEA, 2012). At any rate, the yearly premature death toll from AAP of more than half a million people in the WHO European Region is a remarkably high number, setting the context in which any improving trend should be evaluated. 1.4 APMP and HAP in the WHO European Region The evidence presented in Table 1.2 is relevant to the global and regional levels for ambient PM. The evidence presented in Table 1.3 is by country and reports mortality due to ambient PM and HAP from solid fuels, comparing the years 2005 and 2010. Data for PM by country are available for all Member States of the European Region (with the exception only of Monaco and San Marino). Data by country for HAP from solid fuels are not available for 24 high-income countries. Where such data are available, predominantly in the lowand middle-incomes countries of the Region, they reveal a sufficiently serious problem to merit discussion in this report. Table 1.3 shows the sum of mortality data for ambient PM and HAP from solid fuels, for the years 2005 and 2010. This is a simple sum, rather than an estimate of joint effects; it should therefore be interpreted with caution
Table 1.3.Premature deaths from air pollution (APMP,HAP,and APMP+HAP)per country in the WHO European Region,2005 and 2010 APMP HAP APMP+HAP 2005 2010 2005 2010 2005 2010 Albania 1643 1512 2740 2620 4382 4132 Andorra 29 31 29 31 Armenia 2590 2607 2914 1847 5504 4454 Austria 3642 3122 3642 3122 Azerbaijan 5146 5131 3834 1819 8980 6950 Belarus 8400 8236 3257 1659 11657 9895 Belgium 6169 5663 - - 6169 5663 Bosnia and 2171 2016 4824 4775 6995 6791 Herzegovina Bulgaria 11269 9492 10106 8652 21375 18145 Croatia 3692 3057 1930 1316 5622 4373 Cyprus 323 299 323 299 Czech Republic 8731 7028 1306 575 10037 7603 Denmark 1833 1818 1833 1818 Estonia 189 351 815 537 1004 888 Finland 386 450 - 386 450 France 17916 16892 17916 16892 Georgia 2971 3282 7130 7547 10101 10829 Germany 50051 41582 、 50051 41582 Greece 8797 8068 8797 8068 Hungary 11497 9189 10114 8453 21612 17642 Iceland 18 22 18 22 Ireland 482 671 482 671 Israel 2552 2452 2552 2452 Italy 34511 32447 34511 32447 Kazakhstan 11461 10064 9361 5763 20822 15827 Kyrgyzstan 3380 2858 5152 4491 8532 7349 Latvia 398 1145 1163 655 1561 1801 Lithuania 1405 1771 1657 1036 3063 2806 Luxembourg 179 145 179 145 Malta 231 228 一 231 228 Montenegro 480 391 512 439 992 830 Netherlands 7828 6553 7828 6553 Norway 353 186 353 186 Poland 29301 24729 27004 23816 56304 48544 Portugal 3453 3683 3453 3683 Republic of Moldova 4306 3225 2641 1877 6947 5103 Romania 26214 21674 19266 15558 45480 37233 Russian Federation 98035 94558 37796 24894 135831 119452 Serbia 9310 7081 11731 9368 21041 16449 8
8 APMP HAP APMP + HAP 2005 2010 2005 2010 2005 2010 Albania 1 643 1 512 2 740 2 620 4 382 4 132 Andorra 29 31 – – 29 31 Armenia 2 590 2 607 2 914 1 847 5 504 4 454 Austria 3 642 3 122 – – 3 642 3 122 Azerbaijan 5 146 5 131 3 834 1 819 8 980 6 950 Belarus 8 400 8 236 3 257 1 659 11 657 9 895 Belgium 6 169 5 663 – – 6 169 5 663 Bosnia and Herzegovina 2 171 2 016 4 824 4 775 6 995 6 791 Bulgaria 11 269 9 492 10 106 8 652 21 375 18 145 Croatia 3 692 3 057 1 930 1 316 5 622 4 373 Cyprus 323 299 – – 323 299 Czech Republic 8 731 7 028 1 306 575 10 037 7 603 Denmark 1 833 1 818 – – 1 833 1 818 Estonia 189 351 815 537 1 004 888 Finland 386 450 – – 386 450 France 17 916 16 892 – – 17 916 16 892 Georgia 2 971 3 282 7 130 7 547 10 101 10 829 Germany 50 051 41 582 – – 50 051 41 582 Greece 8 797 8 068 – – 8 797 8 068 Hungary 11 497 9 189 10 114 8 453 21 612 17 642 Iceland 18 22 – – 18 22 Ireland 482 671 – – 482 671 Israel 2 552 2 452 – – 2 552 2 452 Italy 34 511 32 447 – – 34 511 32 447 Kazakhstan 11 461 10 064 9 361 5 763 20 822 15 827 Kyrgyzstan 3 380 2 858 5 152 4 491 8 532 7 349 Latvia 398 1 145 1 163 655 1 561 1 801 Lithuania 1 405 1 771 1 657 1 036 3 063 2 806 Luxembourg 179 145 – – 179 145 Malta 231 228 – – 231 228 Montenegro 480 391 512 439 992 830 Netherlands 7 828 6 553 – – 7 828 6 553 Norway 353 186 – – 353 186 Poland 29 301 24 729 27 004 23 816 56 304 48 544 Portugal 3 453 3 683 – – 3 453 3 683 Republic of Moldova 4 306 3 225 2 641 1 877 6 947 5 103 Romania 26 214 21 674 19 266 15 558 45 480 37 233 Russian Federation 98 035 94 558 37 796 24 894 135 831 119 452 Serbia 9 310 7 081 11 731 9 368 21 041 16 449 Table 1.3. Premature deaths from air pollution (APMP, HAP, and APMP + HAP) per country in the WHO European Region, 2005 and 2010
©Emilio M.Dotto Table 1.3.(continued) APMP HAP APMP+HAP 2005 2010 2005 2010 2005 2010 Slovakia 4512 3777 810 389 5322 4166 Slovenia 1011 876 387 237 1398 1113 Spain 15123 14042 15123 14042 Sweden 1003 1040 1003 1040 Switzerland 2978 2656 2978 2656 Tajikistan 2763 2760 5160 4441 7923 7200 The former Yugoslav Republic of Macedonia 1822 1662 2212 2112 4033 3774 Turkey 27175 28126 9498 6647 36674 34772 Turkmenistan 4918 4930 363 166 5282 5096 Ukraine 76443 52868 25522 13592 101965 66460 United Kingdom 27546 23373 一 27546 23373 Uzbekistan 18637 18722 11368 8951 30005 27672 Total (of available data) 565271 498538 220575 164231 785846 662769 Note.Monaco and San Marino are excluded owing to lack of data Source:data extracted from IHME(2014). As already noted,the WHO European In relative terms,HAP from solid fuels Region,taken as a whole,achieved constitutes both a lesser and a declining about a 12%reduction in premature share of the overall mortality from air deaths from ambient PM from 2005 to pollution in the WHO European Region. 2010.The 29 countries for which data In 2010,this share was about 25%, on HAP from solid fuels are available while globally,that share exceeded 50% achieved an overall reduction of about WHO,2014b). 25%.Nonetheless,the premature death toll (sum)as recorded in 2010 remains In addition to the number of premature remarkably high (at about 663 000 in a deaths,the impact of air pollution on single year). health can be captured by several other 9
9 APMP HAP APMP + HAP 2005 2010 2005 2010 2005 2010 Note. Monaco and San Marino are excluded owing to lack of data. Source: data extracted from IHME (2014). Slovakia 4 512 3 777 810 389 5 322 4 166 Slovenia 1 011 876 387 237 1 398 1 113 Spain 15 123 14 042 – – 15 123 14 042 Sweden 1 003 1 040 – – 1 003 1 040 Switzerland 2 978 2 656 – – 2 978 2 656 Tajikistan 2 763 2 760 5 160 4 441 7 923 7 200 The former Yugoslav Republic of Macedonia 1 822 1 662 2 212 2 112 4 033 3 774 Turkey 27 175 28 126 9 498 6 647 36 674 34 772 Turkmenistan 4 918 4 930 363 166 5 282 5 096 Ukraine 76 443 52 868 25 522 13 592 101 965 66 460 United Kingdom 27 546 23 373 – – 27 546 23 373 Uzbekistan 18 637 18 722 11 368 8 951 30 005 27 672 Total (of available data) 565 271 498 538 220 575 164 231 785 846 662 769 Table 1.3. (continued) As already noted, the WHO European Region, taken as a whole, achieved about a 12% reduction in premature deaths from ambient PM from 2005 to 2010. The 29 countries for which data on HAP from solid fuels are available achieved an overall reduction of about 25%. Nonetheless, the premature death toll (sum) as recorded in 2010 remains remarkably high (at about 663 000 in a single year). In relative terms, HAP from solid fuels constitutes both a lesser and a declining share of the overall mortality from air pollution in the WHO European Region. In 2010, this share was about 25%, while globally, that share exceeded 50% (WHO, 2014b). In addition to the number of premature deaths, the impact of air pollution on health can be captured by several other © Emilio M. Dotto
indicators,of which the most commonly of different diseases on the population; used are: DALYs lost -the sum of YLLs and years of life lost (YLLs),sometimes YLDs,often referred to as BOD. called life-years lost (LYLs)-namely, the number of years by which a life is Table 1.4 presents country-specific shortened by a premature death; estimates of DALYs lost as a result of air YLDs-a measure of the relative impact pollution in 2005 and 2010. Table 1.4.DALYs lost as a result of air pollution (APMP,HAP,and APMP+HAP)per country in the WHO European Region,2005 and 2010 APMP HAP APMP+HAP 2005 2010 2005 2010 2005 2010 Albania 34136 29858 63024 56095 97161 85953 Andorra 453 469 453 469 Armenia 51671 49141 62803 37897 114474 87039 Austria 55032 45883 55032 45883 Azerbaijan 142085 130019 139650 60198 281735 190217 Belarus 169257 157970 69237 33923 238494 191893 Belgium 101014 89698 101014 89698 Bosnia and Herzegovina 41438 36245 92684 86147 134122 122392 Bulgaria 205548 164432 193302 156958 398850 321390 Croatia 62703 49122 34670 22403 97373 71525 Cyprus 5962 5513 5962 5513 Czech Republic 145150 112463 23631 10045 168781 122508 Denmark 28483 27876 、 28483 27876 Estonia 3263 5492 14634 8909 17897 14401 Finland 6600 7326 6600 7326 France 290973 266018 290973 266018 Georgia 62113 66084 156091 156878 218204 222962 Germany 774268 632545 774268 632545 Greece 130321 117569 130321 117569 Hungary 209322 159555 194088 154739 403410 314294 Iceland 286 325 286 325 Ireland 8347 11451 8347 11451 Israel 42109 39563 42109 39563 Italy 482927 436848 482927 436848 Kazakhstan 281429 244457 256429 159122 537858 403579 Kyrgyzstan 87449 74414 162712 146609 250161 221023 Latvia 7398 19339 21910 11579 29308 30918 Lithuania 25394 29974 31403 18716 56796 48689 Luxembourg 3058 2389 3058 2389 Malta 3817 3606 3817 3606 10
10 APMP HAP APMP + HAP 2005 2010 2005 2010 2005 2010 Albania 34 136 29 858 63 024 56 095 97 161 85 953 Andorra 453 469 – – 453 469 Armenia 51 671 49 141 62 803 37 897 114 474 87 039 Austria 55 032 45 883 – – 55 032 45 883 Azerbaijan 142 085 130 019 139 650 60 198 281 735 190 217 Belarus 169 257 157 970 69 237 33 923 238 494 191 893 Belgium 101 014 89 698 – – 101 014 89 698 Bosnia and Herzegovina 41 438 36 245 92 684 86 147 134 122 122 392 Bulgaria 205 548 164 432 193 302 156 958 398 850 321 390 Croatia 62 703 49 122 34 670 22 403 97 373 71 525 Cyprus 5 962 5 513 – – 5 962 5 513 Czech Republic 145 150 112 463 23 631 10 045 168 781 122 508 Denmark 28 483 27 876 – – 28 483 27 876 Estonia 3 263 5 492 14 634 8 909 17 897 14 401 Finland 6 600 7 326 – – 6 600 7 326 France 290 973 266 018 – – 290 973 266 018 Georgia 62 113 66 084 156 091 156 878 218 204 222 962 Germany 774 268 632 545 – – 774 268 632 545 Greece 130 321 117 569 – – 130 321 117 569 Hungary 209 322 159 555 194 088 154 739 403 410 314 294 Iceland 286 325 – – 286 325 Ireland 8 347 11 451 – – 8 347 11 451 Israel 42 109 39 563 – – 42 109 39 563 Italy 482 927 436 848 – – 482 927 436 848 Kazakhstan 281 429 244 457 256 429 159 122 537 858 403 579 Kyrgyzstan 87 449 74 414 162 712 146 609 250 161 221 023 Latvia 7 398 19 339 21 910 11 579 29 308 30 918 Lithuania 25 394 29 974 31 403 18 716 56 796 48 689 Luxembourg 3 058 2 389 – – 3 058 2 389 Malta 3 817 3 606 – – 3 817 3 606 Table 1.4. DALYs lost as a result of air pollution (APMP, HAP, and APMP + HAP) per country in the WHO European Region, 2005 and 2010 indicators, of which the most commonly used are: • years of life lost (YLLs), sometimes called life-years lost (LYLs) – namely, the number of years by which a life is shortened by a premature death; • YLDs – a measure of the relative impact of different diseases on the population; • DALYs lost – the sum of YLLs and YLDs, often referred to as BOD. Table 1.4 presents country-specific estimates of DALYs lost as a result of air pollution in 2005 and 2010