Health effects of transport-related air pollution Edited by: Michal Krzyzanowski, Birgit Kuna-Dibbert and Jürgen Schneider

WHO Library Cataloguing in Publication Data Health effects of transport-related air pollution /edited by Michal Krzyzanowski … [et al.] 1.Air pollution 2.Air pollutants 3.Vehicle emissions – adverse effects 4.Environmental exposure 5.Health policy 6.Policy making 7.Europe I.Krzyzanowski, Michal II.Kuna-Dibbert, Birgit III.Schneider, Jürgen ISBN 92 890 1373 7

(NLM Classification : WA 754) ISBN 92-890-1373-7

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Contents Contributors ................................................................................................v Acknowledgements....................................................................................viii Abbreviations ..............................................................................................ix Foreword ......................................................................................................xi Executive summary....................................................................................xiii Factors determining emissions.........................................................xiii Contribution of traffic to pollution levels ........................................xiii Human exposure ............................................................................. xiv Studies on health effects ................................................................... xv Introduction ................................................................................................ 1 How to read this report and how it was written ................................... 4 References ......................................................................................... 4 1. Factors determining emissions in the WHO European Region – Alois Krasenbrink, Giorgio Martini, Urban Wass, Edward Jobson, Jens Borken, Reinhard Kuehne, Leonidas Ntziachristos, Zissis Samaras and Menno Keuken............................................................................. 7 Key points ......................................................................................... 7 Introduction ..................................................................................... 8 Transport patterns ............................................................................. 9 Road transport ................................................................................ 17 Transportation technologies ............................................................ 29 Fuels and additives .......................................................................... 37 References ....................................................................................... 46 2. Contribution of traffic to levels of ambient air pollution in Europe – Menno Keuken, Eric Sanderson, Roel van Aalst, Jens Borken and Jürgen Schneider ........................................................................ 53 Key points ....................................................................................... 53 Introduction ................................................................................... 54 Traffic emissions of nitrogen oxides, carbon monoxide and VOCs in Europe ................................................................................... 55 Contribution of traffic emissions to ozone and nitrogen oxides ......... 58 iii

Composition of primary traffic-related PM emissions ...................... 59 Improving air quality by decreasing traffic emissions ........................ 61 Contribution of traffic emissions to urban air quality ....................... 63 Contribution of traffic to PM in urban areas .................................... 67 Concentrations of ozone and nitrogen dioxide in urban areas and streets ................................................................................... 74 Effect of traffic management on urban air quality ............................. 76 Conclusions and the action needed .................................................. 78 References ....................................................................................... 80 3. Human exposure to transport-related air pollution – Eric Sanderson, David Briggs, Matti Jantunen, Bertil Forsberg, Magnus Svartengren, Radim Šrám John Gulliver and Nicole Janssen..... 85 Key points ....................................................................................... 85 Introduction ................................................................................... 86 Methods of assessing exposure ......................................................... 87 Exposures in urban versus rural regions ............................................ 90 Exposure of people living near busy traffic routes .............................. 93 Assessment of traffic exposure in a variety of microenvironments ... 108 Conclusions .................................................................................. 113 References ..................................................................................... 114 4. Studies on health effects of transport-related air pollution – Joachim Heinrich, Per E. Schwarze, Nikolaos Stilianakis, Isabelle Momas, Sylvia Medina, Annike I. Totlandsdal, Leendert von Bree, Birgit Kuna-Dibbert and Michal Krzyzanowski ................................ 125 Key points ..................................................................................... 125 Introduction ................................................................................. 126 Mortality ...................................................................................... 128 Respiratory morbidity ................................................................... 131 Cardiovascular morbidity .............................................................. 147 Cancer .......................................................................................... 150 Pregnancy outcomes and male fertility ........................................... 155 Intervention studies ....................................................................... 157 Discussion .................................................................................... 161 References ..................................................................................... 165 5. Health risk assessment of transport-related air pollution – Birgit Kuna-Dibbert and Michal Krzyzanowski ................................ 185 Identified health effects.................................................................. 185 Needs for further research .............................................................. 186 Justified action .............................................................................. 188 References ..................................................................................... 189 iv

Contributors Authors Jens Borken Institute of Transport Research, German Aerospace Center (DLR), Berlin, Germany David Briggs Environment and Health Sciences, Imperial College, London, United Kingdom Bertil Forsberg Department of Public Health and Clinical Medicine, Umeå University, Sweden John Gulliver School of Medicine, Imperial College, London, United Kingdom Joachim Heinrich Institute of Epidemiology, GSF National Research Centre for Environment and Health, Neuherberg, Germany Nicole Janssen Institute for Risk Assessment Sciences (IRAS), Utrecht University, Netherlands Matti Jantunen National Public Health Institute (KTL), Kuopio, Finland Edward Jobson Energy Conversion and Physics, Volvo Technology Corporation, Gothenburg, Sweden Menno Keuken Netherlands Organisation for Applied Scientific Research (TNO), Apeldoorn, Netherlands Alois Krasenbrink Joint Research Centre, European Commission, Ispra, Italy Michal Krzyzanowski WHO European Centre for Environment and Health, Bonn, WHO Regional Office for Europe v

Birgit Kuna-Dibbert WHO European Centre for Environment and Health, Bonn, WHO Regional Office for Europe Giorgio Martini Joint Research Centre, European Commission, Ispra, Italy Sylvia Medina Institut de Veille Sanitaire (InVS), Saint-Maurice, France Isabelle Momas Service “Santé Publique et Environnement”, Université René Descartes, Paris, France Leonidas Ntziachristos Laboratory of Applied Thermodynamics, Aristotle University, Salonica, Greece Zissis Samaras Laboratory of Applied Thermodynamics, Aristotle University, Salonica, Greece Eric Sanderson Institute for Risk Assessment Sciences (IRAS), Utrecht University, Netherlands Jürgen Schneider WHO European Centre for Environment and Health, Bonn, WHO Regional Office for Europe Per E. Schwarze Norwegian Institute of Public Health, Oslo, Norway Radim J. Šrám Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, Czech Republic Nikolaos Stilianakis Joint Research Centre, European Commission, Ispra, Italy Magnus Svartengren Department of Public Health Sciences, Division of Occupational Medicine, Karolinska Institute, Stockholm, Sweden Roel van Aalst European Environment Agency, Copenhagen, Denmark Urban Wass Environment & Chemistry, Volvo Technology Corporation, Gothenburg, Sweden vi

Other contributors and reviewers Lucy Bayer-Oglesby Institut für Sozial- und Präventivmedizin, Universität Basel, Switzerland Annelie Behndig Department of Respiratory Medicine and Allergy, Umeå University Hospital, Sweden Anders Blomberg Department of Respiratory Medicine and Allergy, Umeå University Hospital, Sweden Kenneth Donaldson ELEGI/Colt Laboratories, MRC Centre for Inflammation Research, University of Edinburgh Medical School, United Kingdom Paul Fischer National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands Ragnberth Helleday Department of Respiratory Medicine and Allergy, Umeå University Hospital, Sweden Reinhart Kühne Institute of Transport Research, German Aerospace Center (DLR), Berlin, Germany Marco Martuzzi WHO European Centre for Environment and Health, Rome, WHO Regional Office for Europe Emilia M. Niciu Institute of Public Health, Bucharest, Romania Francesca Racioppi WHO European Centre for Environment and Health, Rome, WHO Regional Office for Europe Thomas Sandstrøm Department of Respiratory Medicine and Allergy, Umeå University Hospital, Sweden Vicki Stone School of Life Sciences, Napier University, Edinburgh, United Kingdom Peter Straehl Swiss Agency for the Environment, Forests and Landscapes, Berne, Switzerland vii

Håkan Törnqvist Department of Public Health and Clinical Medicine, Umeå University, Sweden Annike I. Totlandsdal National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands Leendert van Bree National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands Paulo Vineis Department of Biomedical Sciences and Human Oncology, Turin University, Italy Denis Zmirou-Navier Agence française de sécurité sanitaire environnementale, Maison Alfort, France

Acknowledgements The work on this book was supported by grants obtained by WHO from the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety of Germany and the Agency for the Environment, Forests and Landscapes of Swtizerland. For this support, and for the contributions of all the authors and reviewers, we are very grateful. Michal Krzyzanowski, Birgit Kuna-Dibbert and Jürgen Schneider

viii

Abbreviations Organizations, other entities and studies ADAC AIRNET APHEA2 CAFE CANTIQUE CEN EC EEA EECCA EFTA EPEFE EU EXPOLIS IARC ISAAC HEAVEN NMMAPS PEACE SAVIAH THE PEP TRAPCA UNECE

Allgemeiner Deutscher Automobil Club Thematic Network on Air Pollution and Health Air Pollution and Health: a European Approach 2 Clean Air for Europe project on concerted actions on non-technical measures and their impact on air quality and emissions European Committee for Standardization European Commission European Environment Agency eastern Europe, the Caucasus and central Asia European Free Trade Association European Programme on Emissions, Fuels and Engines Technologies European Union study of air pollution exposure distributions of adult urban populations in Europe International Agency for Research on Cancer International Study of Asthma and Allergies in Childhood project on a healthier environment through the abatement of vehicle emissions and noise National Morbidity, Mortality, and Air Pollution Study study of acute pollution effects on asthmatic children Small Area Variations in Air Quality and Health study Transport, Health and Environment Pan-European Programme project on transport-related air pollution on childhood asthma United Nations Economic Commission for Europe

Technical terms 1-OH-pyrene 8-OHdG

1-hydroxypyrene 8-hydroxy-2’-deoxyguanosine ix

8-oxodG CAPs CI CoPM DEPs DNA ECG FEF25–75% GIS GDP GM-CSF GNP ICAM-1 IFN-γ Ig IL LFA-1 MCP-1 MCT OR OSPM OVA PAHs pkm PM ppm RNA ROS RR SIR SMR SP SRM Th tkm TNF-α VCAM-1 VOCs

8-oxo7,8-dihydro-2’-deoxyguanosine concentrated ambient particles confidence interval combustion and other particulate matter diesel exhaust particles deoxyribonucleic acid electrocardiogram forced mid-expiratory flow geographical information systems gross domestic product granulocyte-macrophage colony stimulating factor gross national product intercellular adhesion molecule 1 interferon gamma immunoglobulin interleukin leukocyte function-associated antigen 1 monocyte chemoattractant protein 1 monocrotaline odds ratio Operational Street Pollution Model ovalbumin polycyclic aromatic hydrocarbons passenger-kilometres particulate matter parts per million ribonucleic acid reactive oxygen species relative risk standardized incidence ratio standardized mortality ratio surfactant protein standardized reference material T-helper tonne-kilometres tumour necrosis factor alpha vascular cell adhesion molecule 1 volatile organic compounds

x