Air Pollution and Health.pptx in public health

Awareness in public health safety

1. Air Pollution and Health DR MAHADIE BK

2. Presentation outline Definition of Key Terms Introduction Epidemiology Public Health Significance Types of Air Pollution Sources of air pollution Key air pollutants and their effects

3. Definitions of key terms Health: Is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Air Pollution: is contamination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere (WHO).

4. Introduction Clean air is fundamental for health Oxygen which is a component of air is vital for life in living organisms. Any alteration in the quality of air negatively affects health, yet 99% of the world’s population lives in places where air quality levels are below WHO limits. Today, air pollution is one of the biggest environmental threats to human health, alongside climate change and an important determinant of health (WHO,2021)

5. Numerous epidemiological studies have found an association between air pollution and a wide range of adverse health effects in the general population, ranging from subtle subclinical effects to premature death

6. Epidemiology of Air Pollution WHO data shows that almost all of the global population (99%) breathe air that exceeds WHO guideline limits and contains high levels of pollutants, with low- and middle-income countries suffering from the highest exposures. Around 2.4 billion people are exposed to dangerous levels of household air pollution, while using polluting open fires or simple stoves for cooking fueled by kerosene, biomass (wood, animal dung and crop waste) and coal. Some groups – for example older adults, children, pregnant women and people with an underlying disease , such as asthma – may be more at risk, and may develop more severe health effects more quickly when exposed to air pollution In addition, certain groups may be exposed to higher levels of outdoor air pollution, e.g. people living near busy traffic routes or those in specific occupational or socioeconomic groups

7. Factors affecting vulnerability to air pollution People are more vulnerable to having adverse health reactions to air pollution in the following situations; Particularly high concentrations of particulate matter; Close proximity to activities generating high levels of pollution e.g. heavy traffic on roads, uncontrol construction or demolition sites, use of biomass for domestic energy.

8. Cont…. Additional factors include; Age of person exposed; children, especially under-five, and older people are particularly vulnerable. Health status of person exposed: people with pre-existing diseases such asthma and other respiratory diseases, cardiovascular diseases, are at greater risk of health effects. Pregnant women; evidence has shown that pregnancy increases vulnerability to the effects of particulate matter exposure with potential effects to the unborn child such as low and pre-term birth weight.

9. Cont… Low socioeconomic status; persons with low socio-economic status with a pre-existing disease, poor nutritional status and poor housing conditions, including where household combustion of solid fuels takes place for cooking, heating or lighting. People living on street and in poor housing are particularly vulnerable Occupational exposures; construction workers, traffic police, road sweepers, and those working outdoors and in highly polluted settings. Smoking of tobacco products and exposure to second-hand smoke

10. Air Pollution in Uganda In accordance with the WHO’s guidelines, the air quality in Uganda is considered unsafe with the most recent data indicating the country’s annual mean concentration of PM2.5 is 46 µg/m3 which exceeds the recommended maximum of 5 µg/m3 (WHO, 2021) The burden of disease (mortality & morbidity) attributable to air pollution in the country has been on the rise in recent years, with Kampala having the second worst air in Africa, according to the AirVisual’s 2018 World Air Quality Report. 43% of deaths from stroke and ischaemic heart disease are caused by air pollution (WHO, 2021)

11. Uganda-Kampala Capital City

12. Public Health Significance of Air Pollution

13. Public Health Significance of Air Pollution Air pollution is the leading environmental risk factor globally. WHO estimates show that around 7 million deaths, mainly from NCDSs, are attributable to the joint effects of ambient and household air pollution (WHO,2018). Similar global assessments of ambient air pollution alone suggest between 4 million and 9 million deaths annually and hundreds of millions of lost years of healthy life, with the greatest attributable disease burden seen in low-and-middle-income counties.

14. Public Health Significance of Air Pollution The burden of disease attributable to air pollution is now estimated to be competing with other major global health risks such as unhealthy diet and tobacco smoking, and was in the top five out of 87 risk factors in the global assessment (GBD 2019 Risk Factors Collaborators, 2020)

15. Types of Air Pollution Air Pollution can be classified into two broad types: Indoor Air pollution Outdoor (ambient) Air Pollution Indoor AP: degradation of indoor air quality by harmful chemicals and other materials. It can be up to 10 times worse than outdoor AP because contained areas enable pollutants to build up more than open spaces. Household AP was responsible for an estimated 3.2 million deaths per year in 2020, including over 237,000 deaths of children under the age of 5. Household AP accounted for the loss of an estimated 86 million healthy life years in 2019, with the largest burden falling on women living in low- and middle-income countries.  Almost half of all deaths due to lower respiratory infection among children under 5 years of age are caused by inhaling particulate matter (soot) from household air pollution.

16. Types of Air Pollution Outdoor (ambient) AP: air pollution in the outdoor environment, that is, in outdoor air, but which can enter or be present in indoor environments. Ambient (outdoor) air pollution is estimated to have caused 4.2 million premature deaths worldwide in 2019. Some 89% of those premature deaths occurred in low- and middle-income countries, and the greatest number in the WHO South-East Asia and Western Pacific Regions.

17. AP can also be classified based on origin: Primary air pollutants: these are emitted directly from a particular source such as PM2.5 and PM10 (dust), NO2, CO, SO2 Secondary air pollutants: these are as a result of chemical reactions such as Ozone, smog, chlorofluorocarbons AND based on: Resources: Natural resources e.g. forest fires, volcanic activity, vegetative decay etc. and made-made resources e.g. industrial activities, transportation, power plants States of Matter: Gaseous pollutants, which exist in a gaseous state at standard temperatures and pressures, such as Nitrogen dioxide and carbon dioxide. Particulate pollutants which as suspended in air, are produced through human activities like manufacturing and natural sources like volcanic eruptions

18. Six Criteria Pollutants Particulate matter (PM2.5 and PM10) Carbon monoxide (CO) Ozone (O3) Nitrogen dioxide (NO2) Sulfur dioxide (SO2) Lead Beyond the 6 criteria pollutants, there are also other pollutants such biological microorganisms (bacteria etc.), pollen grains, ash, soot, etc.

19. Common Sources of Pollution Natural sources: Volcanic eruptions Forest fires Storms Decay of organic matter Man-made sources: Household Combustion devices Automobile emissions Industrial facilities Agriculture/ waste incineration Industries

20. Particulate Matter (PM2.5 & PM10) Particulate Matter also called particle pollution, is the term for a mixture of solid particles and liquid droplets found in the air. Particulate Matter includes: PM10: Inhalable particles, with diameters that are generally 10 micrometers and smaller. PM2.5: fine inhalable particles, with diameters that are generally 2.5 micrometers and smaller. (The average human hair is about 70 micrometers in diameter-making it 30 times larger than the largest fine particle)

21. PM cont… These particles come in many sizes and shapes and can be made up of hundreds of different chemicals. Some are emitted directly from a source, such as construction sites , unpaved roads , mining operations, fields, Smokestacks or fires . Most particles form in the atmosphere as a result of complex reactions of chemicals such as sulfur dioxide and nitrogen oxides, which are pollutants emitted from power plants, industries and automobiles.

22. Main Health Impacts of PM The health impacts of particulate matter depend on the level of exposure (frequently expressed in ug/m3) and the duration of exposure (which can be either short term e.g. 8 or 24 hours or long term e.g. annual ). Individual sensitivity to the health impacts of particulate matter can vary. Short term exposure to particulate matter (or PM) is likely to cause acute health reactions such as irritation to the eyes , nose , and throat , coughing , wheezing and increased frequency of acute respiratory infections, deep in your lungs .

23. Cont… More prolonged and continued exposure to either high or lower levels of air pollution can also lead to an increased risk of respiratory infections , exacerbation of asthma , bronchitis or serious chronic effects including reduced lung function , ischaemic heart disease , stroke , lung cancer and premature death. Such symptoms are a particular concern in rural and peri-urban settings where use of wood, agricultural waste and animal dung is used for cooking, heating and lighting and exposure levels can be high and prolonged over long periods of time

24. Sulphur dioxide (S0 2 ) Sulfur dioxide (SO 2 ) is a gaseous air pollutant composed of sulfur and oxygen. SO2 forms when sulfur-containing fuel such as coal, petroleum oil, or diesel is burned. Sulfur dioxide gas can also change chemically into sulfate particles in the atmosphere, a major part of fine particle pollution, which can blow hundreds of miles away. Produced when coal and fuel oil are burned Natural Sources : geological emissions, volcanic eruptions, biological decay of organic matter that contains sulphur and ocean water, reduction of sulphates Man-made sources: combustion of fossil fuels (distillate oils, residual oils and natural gas; metal ores that produce Sulphur dioxide during refining, roasting of metal sulphides e.g. ZnS and Cu 2 S

25. Health effects of Sulphur dioxide Sulfur dioxide causes a range of harmful effects on the lungs: Wheezing, shortness of breath and chest tightness and other problems, especially during exercise or physical activity. Rapid breathing during exercise helps SO 2  reach the lower respiratory tract, as does breathing through the mouth. Long-term exposure at high levels increases respiratory symptoms and reduces the ability of the lungs to function. Short exposures to peak levels of SO 2  in the air can make it difficult for people with asthma to breathe when they are active outdoors. Increased risk of hospital admissions or emergency room visits, especially among children, older adults and people with asthma.

26. Carbon monoxide (CO) Carbon monoxide is a colorless, non-irritating, odorless, and tasteless gas. It is found in both outdoor and indoor air. Carbon monoxide is made when carbon in fuel is not burned completely. It is produced from both human-made and natural made sources. The most important human-made source of CO is automobiles. Inside homes, improperly adjusted gas appliances, furnaces, wood burning stoves, and fireplaces are a potential source of carbon monoxide. CO is released from wood burning/volcanoes/forest fires

27. Health effects of Carbon monoxide CO is harmful because it binds to hemoglobin in the blood, reducing the ability of blood to carry oxygen interfering with oxygen delivery to the body’s organs. The most common effects of CO exposure are; Fatigue Head aches Confusion Dizziness due to inadequate oxygen delivery to the brain For people with cardiovascular disease, short-term CO exposure can further reduce their body’s already compromised ability to respond to the increased oxygen demands of exercise, exertion, or stress. Unborn babies whose mothers experience high levels of CO exposure during pregnancy are at risk of adverse development effects.

28. Ozone (O 3 ) Ozone at ground level – not to be confused with the ozone layer in the upper atmosphere – is one of the major constituents of photochemical smog and it is formed through the chemical reaction between oxides of nitrogen and volatile organic compounds in the presence of sunlight. Due to the photochemical nature, the highest levels of ozone are seen during periods of sunny weather. Breathing in ground level ozone can trigger a variety of health problems including: chest pain, coughing, throat irritation, and congestion. It can worsen bronchitis, emphysema, and asthma . It can also reduce lung function and inflame the lining of the lungs . Repeated exposure may permanently scar lung tissue .

29. Nitrogen dioxide (NO 2 )   Nitrogen dioxide (NO2)  is a chemical compound that belongs to a group of highly reactive gases called  nitrogen oxides (NOx) . They are the major pollutants of the earth’s atmosphere.  Nitrogen dioxide is easily recognized. It can be recognized by its reddish-brown color and its characteristic pungent odor. This smell can be found in streets polluted by traffic. It can emerge from natural sources and human activities. From natural sources Lightning Volcanic activity Forest fires Human activities Outdoor,  anthropogenic NO2 emissions  come mainly from internal combustion engines (largely diesel) and power plants, but also from heating or electricity generation. But beware, even if NO2 is mainly an  outdoor air pollutant , it can pose a threat to  indoor air quality  as well. Smoking, gas stoves or chimney fires, or oil stoves for example, can generate significant levels of NO2 in enclosed spaces, and must be adequately ventilated to prevent the gases from building up.

30. Health effects of NO2 Exposure to nitrogen dioxide (NO2) is associated with a number of adverse effects on the  respiratory system . NOx reacts with ammonia, moisture and other compounds to form small particles. Because of their very small size, these particles can penetrate deep into the respiratory tract. Short-term exposure  to nitrogen dioxide (NO2) has been shown to have a linear association with an  increased risk of death , both cardiovascular and respiratory, according to a recent  study published in BMJ. . Prolonged exposure to high levels of NO2  may contribute to the development of asthma, increase the risk of respiratory infections and chronic lung disease (coughing, wheezing, difficulty breathing, reduced sense of smell…). People with asthma, as well as children and the elderly, are generally at greater risk of health effects from NO2.

31. Lead Lead is a naturally occurring metal that can cause negative health effects. People can become exposed to lead through occupational and environmental sources. This mainly results from: inhalation of lead particles generated by burning materials containing lead, for example during smelting, recycling, stripping leaded paint and plastic cables containing lead and using leaded aviation fuel; and ingestion of lead-contaminated dust, water (from leaded pipes) and food (from lead-glazed or lead-soldered containers) and from hand-to-mouth behavior. Children younger than 6 years are more likely to be exposed due to their hand-to-mouth behavior. Many children ingest lead dust by putting objects such as toys and dirt in their mouths. Lead exposure can have serious consequences for the health of children where at high levels of exposure to lead the brain and CNS can be severely damaged causing coma, convulsions and even death. Children who survive severe lead poisoning may be left with permanent intellectual disability and behavioral disorders.

32. Health effects of Lead At lower levels of exposure that cause no obvious symptoms, lead is now known to produce a spectrum of injury across multiple body systems. In particular, lead can affect children’s brain development, resulting in reduced IQ, behavioral changes such as reduced attention span and increased antisocial behavior, and reduced educational attainment. Lead exposure also causes anemia, hypertension, renal impairment, immunotoxicity and toxicity to the reproductive organs. The neurological and behavioral effects of lead are believed to be irreversible. Lead also causes long-term harm in adults, including increased risk of high blood pressure, cardiovascular problems and kidney damage. Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight. The World Health Organization’s 2021 update of the  Public health impact of chemicals: knowns and unknowns  estimates that nearly half of the 2 million lives lost to known chemicals exposure in 2019 were due to  exposure to lead. Lead exposure is estimated to account for 21.7 million years lost to disability and death (disability-adjusted life years, or DALYs) worldwide due to long-term effects on health, including 30% of the global burden of idiopathic intellectual disability, 4.6% of the global burden of cardiovascular disease and 3% of the global burden of chronic kidney diseases.

33. WHO Air Quality Guideline levels (AQG)

34. References https://www.epa.gov/pm-pollution/particulate-matter-pm-basics#PM https://www.epa.gov/pm-pollution/health-and-environmental-effects-particulate-matter-pm https://dicf.unepgrid.ch/uganda/pollution#:~:text=In%20accordance%20with%20the%20WHO's,%C2%B5g%2Fm3%20%5B2%5D . https://cdn.who.int/media/docs/default-source/country-profiles/environmental-health/environmental-health-uga-2022.pdf?sfvrsn=ee16d996_4&download=true https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health