RHN workshop on environment and health (air pollution and active mobility) at the 11th European Public Health Conference


Air pollution is the biggest environmental risk to health, responsible each year for 7 million premature deaths globally and nearly 600 000 in the WHO European Region.

The workshop, “Better air for better health: a deep dive into air pollution in Europe and ways to tackle it”, jointly organized by the WHO Regions for Health Network (RHN), the WHO European Centre for Environment and Health, and the WHO Regional Office for Europe, provided an overview of WHO policies and tools pertinent to this area, and examples of best practice in assessing and improving environmental health conditions at the local and regional levels across the WHO European Region.

Hosted by the European Public Health Association (EUPHA) during the 11th EUPHA Conference in Ljubljana, Slovenia, on 30 November 2018, the workshop was moderated by Francesco Zambon, Coordinator, Investment for Health and Development in Healthy Settings, WHO European Office for Investment for Health, Venice, Italy.

WHO policies and tools to address air pollution and promote active mobility

In opening the workshop, Dorota Jarosinska, Programme Manager, Living and Working Environments, WHO European Centre for Environment and Health, explained that the relevance of ambient and household air pollution (AAP and HAP) to the global health agenda has increased over the last few years. Air pollution causes a significant burden on health and well-being, the environment and national economies in Europe.
According to 2016 estimates of global mortality attributable to air pollution, AAP and HAP accounted, respectively, for 4.2 million and 3.8 million premature deaths annually. The joint effect of AAP and HAP is responsible for 7 million premature deaths per year, mainly as a result of stroke, ischaemic heart disease and chronic and acute respiratory diseases, including asthma and lung cancer, and thus contributes to the overall burden of noncommunicable diseases.

In 2016, 91% of the world’s population was living in places where air-quality levels exceeded WHO limits.
In the WHO European Region alone, the economic cost of deaths and diseases resulting from air pollution amounted to US$ 1.6 trillion, equivalent to one tenth of the gross domestic product of the European Union in 2013. Air pollution disproportionally affects the least affluent parts of the Region and the most vulnerable populations, with dramatic societal and economic impacts. The overall compelling scientific evidence of the impacts of air pollution, including the significant burden of disease it causes, is a convincing argument for the need to take further action to reduce emissions and improve air quality. Scaling up and accelerating interventions to reduce air pollution in the energy, transport and other sectors is one way of helping to meet the United Nations Sustainable Development Goals for health (SDG3), energy (SDG7), and cities (SDG11), and contributing to climate change mitigation.

Quantifying the health risks of air pollution, using appropriate methods and tools, can support informed decision-making and progress monitoring towards better protecting human health through improved air quality. Dorota Jarosinska mentioned some of the WHO platforms, methods, and tools that facilitate assessment of the impact of air pollution on health and provide ways of tackling it:

  • the Transport, Health and Environment Pan-European Programme (THE PEP), a joint WHO Regional Office for Europe–United Nations Economic Commission for Europe platform to promote policy integration among the three sectors and action in selected priority areas;
  • the AirQ+ tool, a software tool for health-risk assessment that allows quantification of the health effects of exposure to air pollution, including estimates of reduction in life expectancy;
  • the Health Economic Assessment Tool (HEAT) for estimating reduced mortality as a result of regular walking or cycling.

AirQ+, HEAT, and several other tools are described in detail in the RHN webinar series, “Environment and health tools”.  Tools for calculating the benefits of sustainable transportation, or green space, including those for use in assessing the health benefits of carbon reductions, will become publicly available in the near future.

These tools, coupled with capacity-building efforts towards a multisectoral approach, can help the health sector demonstrate the health, climate and air-quality benefits that can be achieved by implementing emission-reduction policies and strategies. Strategic action requires a multisectoral approach and the promotion of change in cultural attitudes, behaviours and consumption patterns. Health-sector policies need to be complemented by policies on the production and consumption of energy, goods and services if progress towards more sustainable solutions is to be made.

Local and regional best practices in assessing and improving environmental health conditions

Ann Colles, Researcher, VITO (a Flemish research and technology organization in the area of cleantech and sustainable development), Flanders, Belgium, presented the Flemish community-based participatory approach to hot-spot biomonitoring. Human biomonitoring is a technique for measuring certain selected pollutants and their possible effects on human health through the use of biomarkers. Started in Flanders in 2002, the Flemish Centre of Expertise on Environment and Health is studying internal exposure to environmental pollution and related biological effects in newborns, adolescents and two groups of adults in the general population, and in adolescents living in areas with specific environmental pressure.

Funded and steered by the Flemish Government, the Centre brings together environmental health experts from the Flemish universities and two research institutes to work with a social scientific expert unit at the University of Antwerp. This unit focuses on risk communication, risk perception and aspects of knowledge production and interpretation, as well as cooperation between different scientific disciplines and other social and policy actors. The choice of a participatory approach to collecting data and setting priority action reflects Flanders’ commitment to promoting active involvement and equity, and to developing measures to decrease the social gap in exposure to environmental chemicals with a specific focus on vulnerable groups.

Peter Beznec, Director, Centre for Health and Development Murska Sobota, Pomurje Region, Slovenia, underlined how air pollution is affecting not only big cities, but rural areas and small towns as well. Since 2013–2014, the Pomurje Region has been developing a series of awareness-raising campaigns. These target local communities and educational institutions with the aim of reducing traffic and promoting sustainable mobility, such as the use of public transport, or walking/cycling to schools and kindergartens. Promoting an active road to school connects the entire community and enhances physical activity and social development in children. Actively involving the youngest segment of the population is key to changing behavioural patterns and influencing future generations.

The Traffic Snake Game (TSG) campaign, which originated in Flanders, Belgium, encourages school professionals, children and parents to walk or cycle to school and promotes the use of public transport and car sharing to increase mobile sustainability and encourage a less car-dependent lifestyle. In Slovenia, the campaign was first implemented in the Pomurje Region before being applied at the national level.
To tackle traffic-induced air pollution, the local authorities are preparing Sustainable Urban Mobility Plans. These provide needs assessments relevant to, and propose solutions for, each municipality in terms of investment in infrastructure and complementary soft measures for sustainable mobility.

Odile Mekel, President of EUPHA Section on Health Impact Assessment (HIA), North Rhine-Westphalia (NRW), Bochum, Germany, reported that air pollution is a very challenging topic in NRW where approximately 18 million people live.  At the national level, the media play an important role in raising and strengthening awareness of the estimated burden of disease attributable to traffic-related air pollution.  In addition, the health workforce is considered a paramount resource in intersectoral promotion and prevention activities (for example, producing and disseminating videos and infographic materials, among others, related to air pollution), reaching people also in local communities and rural areas.

Estimates of the burden of disease attributable to traffic-related air pollution show that high levels of pollution occur not only near isolated industrial facilities, but also throughout large parts of the traffic network and that comprehensive regional air-quality plans are needed to address them. Due to frequent exceedances of the limit values for particulate matter 10 and nitrogen dioxide, numerous air-quality and action plans need to be established. In NRW, restricting the admission of vehicles with higher exhaust emissions to certain zones is currently under discussion. Alternative transport policies will be needed, for example, to expand the range of local transport services and develop a comprehensive network of cycle and walking paths to promote active mobility among citizens.

Polina Zakharova, Director, and Anastasia Gorchakova, Analyst, Moscow State Environmental Protection Institution “Mosecomonitoring”, Moscow Metropolitan Area, Russia, reported traffic as the main source of air pollution in Moscow. Since 2010, much effort has been made to address this issue: new environmental policies have been established and several transport solutions adopted. Examples of these are: the purchase of eco-friendly buses, trolleybuses and trams; the creation of pedestrian spaces and cycling routes; increased restrictions on trucks and heavy vehicles, and the introduction of a city-bike rental system during the warmer months of the year.  In 2016, the launch of the Moscow Central Circle and Magistral surface transport system made transport more convenient and attracted new passengers. The growing popularity of the Moscow taxi service and car-sharing system has also helped reduce the number of private cars in the city, which has eased traffic and, in turn, improved the environment.

Thanks to these strategies, there has been a 25% decrease in traffic in Moscow since 2010, and emissions have been cut by 15%. Today, more than 62% of vehicles circulating in the city meet the Euro 4 emission standard, air quality is monitored throughout the city, and measurements are routinely taken for 26 different substances that pose the most serious health risks. In addition, modern air-pollution prediction models are used to develop relevant campaigns and action.