Zafar Fatmi, Head Division of Environmental Health Sciences & Assistant Professor Dept.

of CHS, Aga Khan University

National Workshop on Cleaner Fuels and Vehicles

Islamabad, Pakistan 19th May, 2010

Synopsis
1.

2.
3.

4.

Major air pollutants of concerns for health. Fuel/vehicle emissions and its health effects. Air pollution in developed and developing megacities. First large scale health effects study on air pollution (PM) in Karachi preliminary results [one-year]

Burning MOUTH/LUNGS

Burning KITCHEN

Burning CITIES

NOTE: 60-90% similar chemicals. Difference in distance and concentration.

Environmental Burdens Premature Deaths

Source: WHO Global Burden of Disease

Environmental Risks

Global

Asian

Outdoor Air Indoor Air Tobacco Lead

799,000 1,619,000 5,400,000 234,000

487,000 1,025,000 3,700,000 88,000

Asian % of Global 61% 63% 69% 37%

Effects of Air Pollution

Human Health

Heritage

Respiratory, cardiovascular morbidity (illness) Mortality (death) Nitric/Sulfuric Acid erosion

Natural Resources

Agriculture

Acidification (lake and stream biology) Visibility

Ozone crop effects

Global warming and climate change

Increase in green house gases Increase temperature --- diseases like mosquito growth and related diseases

Major Vehicle/Fuel Emissions

Vehicle type (HTV, LTV), Age, Maintenance, Exhaust treatment, Wear of parts (tires and breaks), Type and Quality of Fuel, Engine lubricants

CO2 , CO Diesel Exhaust Particulate matter Lead Nitrogen Oxides (NOx) Hydrocarbons (HC) Secondary by-products (Ozone and PM)

Air Toxics (mobile source) Aldehydes Benzene Methanol Polycyclic aromatic hydrocarbons

Particulate Matter in Ambient Air

Coarse particles: TSP /PM10 /PM5

Include wind blown dust as well as bacteria, pollens and mold spores.

Fine particles (PM2.5): Tiny particles or droplets in the air mainly from combustion.

Sources: Motor vehicles and reaction of gases or droplets in the atmosphere.

PM2.5 Inhalation
Lungs Heart
Altered cardiac

autonomic function Increased dysrhythmic susceptibility Increased myocardial ischemia

Inflammation Oxidative stress Accelerated progression and exacerbation of COPD Increased respiratory symptoms Reduced lung function

Blood
Increased coagulability Peripheral thrombosis Altered rheology (flow) Reduced oxygen saturation

Systemic Inflammation Oxidative Stress

Proinflammatory mediators Leukocyte & platelet activation

Vasculature
Accelerated atherosclerosis Endothelial dysfunction Vasoconstriction and Hypertension

Brain
Increased cerebrovascular

ischemia

Multiple mechanistic pathways / complex interactions and interdependencies

Why lungs are exposed more?

Lungs have a greater exposure to the environment than any other part of the body including the skin. 6 liters per minute air inhaled Lungs surfaces area is equal to land area of a small house (80m2)

Health Effects Studies

Pollutant Potential health effects

TSP/PM10/2.5

Wheezing, asthma Respiratory infections COPD and exacerbation Excess mortality including CVD
Wheezing Respiratory infections and reduced lung functions Wheezing, asthma COPD, CVD Low birth weight Increase peri-natal deaths Lung cancer Cancer of mouth, pharynx, larynx Cataract

Nitrogen dioxide

Sulphur dioxide CO Benzopyrene Smoke

Lead in Blood and IQ decline among Children

[Lanphear BP et al., 2005]

Health Effects of Diesel

Advantages of diesel engines: higher fuel efficiency low CO and CO2 emissions Disadvantages: High emission of PM, NOx, and chemicals attached to PM (e.g. PAHs) Health effects: Acute effects (e.g. exacerbating asthma) Cancer

Diesel Effects on Childhood Illness

(Janssen NA, et al., 2003)

Reductions in Deaths after Sulphur Restriction

0 % Reduction in annual trend -5 -4 -3 -2 -1

-1.6% -2.4%

-4.2% -4.8%

-6

15-64

65+

15-64

65+

Cardiovascular

Respiratory

Megacities and Air Pollution

An estimated 20-30% of all respiratory diseases in Asian mega-cities such as Beijing Jakarta, Karachi, Kolkata and New Delhi arise due to air pollution.

Particulate Matter (PM10) (g/m3)

Source: World Development Indicator, 2008, Volume 8, 3.14

WHO guidelines = annual mean < 50 g/m3

Nitrogen Oxide (NO2) (g/m3)

Source: World Development Indicator, 2008, Volume 8, 3.14

Developed megacities Middle-income or developing megacities

WHO guidelines = annual mean <40 g/m3

Sulphur Oxide (SO2) (g/m3)

Source: World Development Indicator, 2008, Volume 8, 3.14

Developed megacities Middle-income or developing megacities

WHO guidelines = annual mean <50 g/m3

Association of PM2.5 with Cardiovascular and Respiratory Diseases in Karachi

Pakistan PI: Dr. Zafar Fatmi Co-inv.: Dr Ambreen Kazi
Division of Environmental Health Sciences, Department of Community Health Sciences, Aga Khan University, Pakistan. Dr Nadeem Rizvi, Jinnah Postgraduate Medical Center. Dr Sardar Alam Siddiqui, Karachi University.

US PI: Dr. David O Carpenter Co-inv.: Dr. Haider Khwaja & Dr Azhar Siddiqui Institute of Environment and Health, University at Albany, US.

Joint Project of Pakistan-US Science and Technology Cooperative program

Association of PM2.5 with Cardiovascular and Respiratory Diseases in Karachi

PM2.5 Tibet Center, Karachi

[WHO guideline (red line) = 24-hrs mean 25 g/m3] [Annual mean=15 g/m3]
300 250 200 300 250 200 150 100 50 0

150 100
50 0

30 Aug 14 Oct, 2008

300 250 200 150 100 50 0 300 250

24 Dec, 2008 08 Feb, 2009

200
150 100 50 0

18 Mar, 2009 03 May, 2009

29 Jun, 2009 15 Aug, 2009

PM2.5 Korangi, Karachi

[WHO guideline (red line) = 24-hrs mean 25 g/m3]
300 250 200 150 100 50 0 300 250 200 150 100 50 0 300 250 200 150 100 50 0

30 Aug 2008 14 Oct, 2008

300 250 200 150 100 50 0

24 Dec, 2008 08 Feb, 2009

18 Mar, 2009 03 May, 2009

29 Jun, 2009 15 Aug, 2009

PM 2.5 in Karachi
Minimum Maximum Annual mean [Annual mean=15 g/m3]

Tibet Centre

27

258

77.68

Korangi

29.6

278

99.28

Results

Results adjusted for time trends, meteorological factors, seasonal patterns Interpretation: For every 10 /m3 increase in PM2.5 leads to 16% more admissions (due cardiovascular diseases including myocardial infarction, cardiac failure, ischemic heart diseases), which needs medical attention.

DPSEEA Framework
Pressures (e.g. Production, consumption, waste release) Driving Forces (e.g. population growth, economic development, technology)

ACTION
Economic and Social Policies; Clean Technologies(Fuel)

Hazard Management
States (e.g. Natural hazards, resource availability, pollution levels ) Environmental Improvement; Pollution monitoring and control Education; Awareness raising Effects (e.g. well-being, morbidity, mortality) Treatment Rehabilitation

Exposures (e.g.External exposures, abnormal dose, target organ dose)

Health and environment cause-effect framework

(Ref: Kjellstriim T & Briggs D et al)

Thank You!
Zafar Fatmi Email: zafar.fatmi@aku.edu Website: http://www.aku.edu/CHS/ehs-index.shtml