Pandemic management requires exposure science.

COVID-19 was first detected in Wuhan, China, on 8.12.2019, and WHO announced it a pandemic on 11.3.2020. No vaccines or medical cures against COVID-19 were available in the first corona year. Instead, different combinations of generic non-pharmaceutical interventions - to slow down the spread of infections via exposure restrictions to 'flatten the curve' so that it would not overburden the health care systems, or to suppress the virus to extinction - were applied with varying levels of strictness, duration and success in the Pacific and North Atlantic regions. Due to an old misconception, almost all public health authorities dismissed the possibility that the virus would be transmitted via air. Opportunities to reduce the inhalation exposure - such as wearing effective FFP2/N95 respirators, improving ventilation and indoor air cleaning - were missed, and instead, hands were washed and surfaces disinfected. The fact that aerosols were acknowledged as the main route of COVID-19 transmission in 2021 opened avenues for more efficient and socially less disruptive exposure and risk reduction policies that are discussed and evaluated here, demonstrating that indoor air and exposure sciences are crucial for successful management of pandemics. To effectively apply environmental and personal exposure mitigation measures, exposure science needs to target the human-to-human exposure pathways of the virus.

Corrigendum to "City scale climate change policies: Do they matter for wellbeing?" [Prev. Med. Rep. 6 (2017) 265-270].

[This corrects the article DOI: 10.1016/j.pmedr.2017.03.019.].

Advancements in Life Cycle Human Exposure and Toxicity Characterization.

BACKGROUND: The Life Cycle Initiative, hosted at the United Nations Environment Programme, selected human toxicity impacts from exposure to chemical substances as an impact category that requires global guidance to overcome current assessment challenges. The initiative leadership established the Human Toxicity Task Force to develop guidance on assessing human exposure and toxicity impacts. Based on input gathered at three workshops addressing the main current scientific challenges and questions, the task force built a roadmap for advancing human toxicity characterization, primarily for use in life cycle impact assessment (LCIA). OBJECTIVES: The present paper aims at reporting on the outcomes of the task force workshops along with interpretation of how these outcomes will impact the practice and reliability of toxicity characterization. The task force thereby focuses on two major issues that emerged from the workshops, namely considering near-field exposures and improving dose­response modeling. DISCUSSION: The task force recommended approaches to improve the assessment of human exposure, including capturing missing exposure settings and human receptor pathways by coupling additional fate and exposure processes in consumer and occupational environments (near field) with existing processes in outdoor environments (far field). To quantify overall aggregate exposure, the task force suggested that environments be coupled using a consistent set of quantified chemical mass fractions transferred among environmental compartments. With respect to dose­response, the task force was concerned about the way LCIA currently characterizes human toxicity effects, and discussed several potential solutions. A specific concern is the use of a (linear) dose­response extrapolation to zero. Another concern addresses the challenge of identifying a metric for human toxicity impacts that is aligned with the spatiotemporal resolution of present LCIA methodology, yet is adequate to indicate health impact potential. CONCLUSIONS: Further research efforts are required based on our proposed set of recommendations for improving the characterization of human exposure and toxicity impacts in LCIA and other comparative assessment frameworks. https://doi.org/10.1289/EHP3871.

Characterizing Aggregated Exposure to Primary Particulate Matter: Recommended Intake Fractions for Indoor and Outdoor Sources.

Exposure to fine particulate matter (PM2.5) from indoor and outdoor sources is a leading environmental contributor to global disease burden. In response, we established under the auspices of the UNEP/SETAC Life Cycle Initiative a coupled indoor-outdoor emission-to-exposure framework to provide a set of consistent primary PM2.5 aggregated exposure factors. We followed a matrix-based mass balance approach for quantifying exposure from indoor and ground-level urban and rural outdoor sources using an effective indoor-outdoor population intake fraction and a system of archetypes to represent different levels of spatial detail. Emission-to-exposure archetypes range from global indoor and outdoor averages, via archetypal urban and indoor settings, to 3646 real-world cities in 16 parametrized subcontinental regions. Population intake fractions from urban and rural outdoor sources are lowest in Northern regions and Oceania and highest in Southeast Asia with population-weighted means across 3646 cities and 16 subcontinental regions of, respectively, 39 ppm (95% confidence interval: 4.3-160 ppm) and 2 ppm (95% confidence interval: 0.2-6.3 ppm). Intake fractions from residential and occupational indoor sources range from 470 ppm to 62 000 ppm, mainly as a function of air exchange rate and occupancy. Indoor exposure typically contributes 80-90% to overall exposure from outdoor sources. Our framework facilitates improvements in air pollution reduction strategies and life cycle impact assessments.

City scale climate change policies: Do they matter for wellbeing?

Climate change mitigation policies aim to reduce climate change through reducing greenhouse gas (GHG) emissions whereas adaption policies seek to enable humans to live in a world with increasingly variable and more extreme climatic conditions. It is increasingly realised that enacting such policies will have unintended implications for public health, but there has been less focus on their implications for wellbeing. Wellbeing can be defined as a positive mental state which is influenced by living conditions. As part of URGENCHE, an EU funded project to identify health and wellbeing outcomes of city greenhouse gas emission reduction policies, a survey designed to measure these living conditions and levels of wellbeing in Kuopio, Finland was collected in December 2013. Kuopio was the northmost among seven cities in Europe and China studied. Generalised estimating equation modelling was used to determine which living conditions were associated with subjective wellbeing (measured through the WHO-5 Scale). Local greenspace and spending time in nature were associated with higher levels of wellbeing whereas cold housing and poor quality indoor air were associated with lower levels of wellbeing. Thus adaption policies to increase greenspace might, in addition to reducing heat island effects, have the co-benefit of increasing wellbeing and improving housing insulation.

Spatial and temporal trends in the mortality burden of air pollution in China: 2004-2012.

While recent assessments have quantified the burden of air pollution at the national scale in China, air quality managers would benefit from assessments that disaggregate health impacts over regions and over time. We took advantage of a new 10×10km satellite-based PM2.5 dataset to analyze spatial and temporal trends of air pollution health impacts in China, from 2004 to 2012. Results showed that national PM2.5 related deaths from stroke, ischemic heart disease and lung cancer increased from approximately 800,000 cases in 2004 to over 1.2 million cases in 2012. The health burden exhibited strong spatial variations, with high attributable deaths concentrated in regions including the Beijing-Tianjin Metropolitan Region, Yangtze River Delta, Pearl River Delta, Sichuan Basin, Shandong, Wuhan Metropolitan Region, Changsha-Zhuzhou-Xiangtan, Henan, and Anhui, which have heavy air pollution, high population density, or both. Increasing trends were found in most provinces, but with varied growth rates. While there was some evidence for improving air quality in recent years, this was offset somewhat by the countervailing influences of in-migration together with population growth. We recommend that priority areas for future national air pollution control policies be adjusted to better reflect the spatial hotspots of health burdens. Satellite-based exposure and health impact assessments can be a useful tool for tracking progress on both air quality and population health burden reductions.

Public health impacts of city policies to reduce climate change: findings from the URGENCHE EU-China project.

BACKGROUND: Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments. METHODS: Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response functions. Additionally there were literature reviews, three longitudinal observational studies and two cross sectional surveys. RESULTS: There are four key findings. Firstly introduction of electric cars may confer some small health benefits but it would be unwise for a city to invest in electric vehicles unless their power generation fuel mix generates fewer emissions than petrol and diesel. Second, adopting policies to reduce private car use may have benefits for carbon dioxide reduction and positive health impacts through reduced noise and increased physical activity. Third, the benefits of carbon dioxide reduction from increasing housing efficiency are likely to be minor and co-benefits for health and wellbeing are dependent on good air exchange. Fourthly, although heating dwellings by in-home biomass burning may reduce carbon dioxide emissions, consequences for health and wellbeing were negative with the technology in use in the cities studied. CONCLUSIONS: The climate-change reduction policies reduced CO2 emissions (the most common greenhouse gas) from cities but impact on global emissions of CO2 would be more limited due to some displacement of emissions. The health and wellbeing impacts varied and were often limited reflecting existing relatively high quality of life and environmental standards in most of the participating cities; the greatest potential for future health benefit occurs in less developed or developing countries.

Building-related health impacts in European and Chinese cities: a scalable assessment method.

BACKGROUND: Public health is often affected by societal decisions that are not primarily about health. Climate change mitigation requires intensive actions to minimise greenhouse gas emissions in the future. Many of these actions take place in cities due to their traffic, buildings, and energy consumption. Active climate mitigation policies will also, aside of their long term global impacts, have short term local impacts, both positive and negative, on public health. Our main objective was to develop a generic open impact model to estimate health impacts of emissions due to heat and power consumption of buildings. In addition, the model should be usable for policy comparisons by non-health experts on city level with city-specific data, it should give guidance on the particular climate mitigation questions but at the same time increase understanding on the related health impacts and the model should follow the building stock in time, make comparisons between scenarios, propagate uncertainties, and scale to different levels of detail. We tested The functionalities of the model in two case cities, namely Kuopio and Basel. We estimated the health and climate impacts of two actual policies planned or implemented in the cities. The assessed policies were replacement of peat with wood chips in co-generation of district heat and power, and improved energy efficiency of buildings achieved by renovations. RESULTS: Health impacts were not large in the two cities, but also clear differences in implementation and predictability between the two tested policies were seen. Renovation policies can improve the energy efficiency of buildings and reduce greenhouse gas emissions significantly, but this requires systematic policy sustained for decades. In contrast, fuel changes in large district heating facilities may have rapid and large impacts on emissions. However, the life cycle impacts of different fuels is somewhat an open question. CONCLUSIONS: In conclusion, we were able to develop a practical model for city-level assessments promoting evidence-based policy in general and health aspects in particular. Although all data and code is freely available, implementation of the current model version in a new city requires some modelling skills.

Environmental burden of disease in Europe: assessing nine risk factors in six countries.

BACKGROUND: Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. OBJECTIVES: The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). METHODS: Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. RESULTS: About 3-7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 µm; PM2.5) is the leading risk factor associated with 6,000-10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600-1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. CONCLUSIONS: With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability.

Application of the maximum cumulative ratio (MCR) as a screening tool for the evaluation of mixtures in residential indoor air.

The maximum cumulative ratio (MCR) method allows the categorisation of mixtures according to whether the mixture is of concern for toxicity and if so whether this is driven by one substance or multiple substances. The aim of the present study was to explore, by application of the MCR approach, whether health risks due to indoor air pollution are dominated by one substance or are due to concurrent exposure to various substances. Analysis was undertaken on monitoring data of four European indoor studies (giving five datasets), involving 1800 records of indoor air or personal exposure. Application of the MCR methodology requires knowledge of the concentrations of chemicals in a mixture together with health-based reference values for those chemicals. For this evaluation, single substance health-based reference values (RVs) were selected through a structured review process. The MCR analysis found high variability in the proportion of samples of concern for mixture toxicity. The fraction of samples in these groups of concern varied from 2% (Flemish schools) to 77% (EXPOLIS, Basel, indoor), the variation being due not only to the variation in indoor air contaminant levels across the studies but also to other factors such as differences in number and type of substances monitored, analytical performance, and choice of RVs. However, in 4 out of the 5 datasets, a considerable proportion of cases were found where a chemical-by-chemical approach failed to identify the need for the investigation of combined risk assessment. Although the MCR methodology applied in the current study provides no consideration of commonality of endpoints, it provides a tool for discrimination between those mixtures requiring further combined risk assessment and those for which a single-substance assessment is sufficient.

Driver and passenger exposure to aerosol particles in buses and trams in Helsinki, Finland.

This study investigates commuter and driver exposure to aerosol particles in buses and trams in Helsinki, Finland. Particle number and PM(2.5) concentrations were determined in the cabin and the driver's compartment. In addition, the <2.5 microm black carbon concentration was measured in the driver's compartment and PM(2.5) was collected for elemental analysis in the cabin. The measurements were repeated on two generations of buses and trams including two measurement days in each vehicle type. Fine particle number and mass concentrations in the driver's compartments were only slightly increased compared to Helsinki background air. Daily average ratios of number and mass to the background varied in range 0.8-4.3 and 1.0-2.9, respectively, both being the highest in the older bus type. However, the drivers were exposed to elevated levels of black carbon, which some studies have addressed to be strongly correlated with adverse health effects. The daily average ratio of black carbon to the background varied between 2.4 and 11.4. Additionally, the black carbon concentration had spatial variation. The drivers were exposed to higher peak concentrations of black carbon in downtown area. Particle concentrations were smaller in the driver's compartment than in the cabin. The newer technology in the newer model of the tram and bus seemed to decrease driver exposure to aerosol particles.

Population exposure to fine particles and estimated excess mortality in Finland from an East European wildfire episode.

Long-range transported particulate matter (PM) air pollution episodes associated with wildfires in the Eastern Europe are relatively common in Southern and Southeastern Finland. In severe cases such as in August-September 2002, the reduced visibility and smell of the smoke, and symptoms such as irritation of eyes and airways experienced by the population raise the issue into the headlines. Because PM air pollution, in general, has been identified as a major health risk, and the exposures are of repeating nature, the issue warrants a risk assessment to estimate the magnitude of the problem. The current work uses the available air quality data in Finland to estimate population exposures caused by one of the worst episodes experienced in this decade. This episode originated from wildfires in Russia, Belarus, Ukraine, and the Baltic countries. The populations of 11 Southern Finnish provinces were exposed between 26 August and 8 September 2002, for 2 weeks to an additional population-weighted average PM(2.5) level of 15.7 microg/m(3). Assuming similar effect on mortality for these particles as observed in epidemiological time series studies on urban particles (0.5%-2% increase in mortality per 10 microg/m(3), central estimate 1%), this exposure level would be associated with 9-34 cases (17 cases central estimate) of additional mortality. Epidemiological evidence specific to particles from biomass combustion is scarce, affecting also the reliability of the current risk assessment. Do the wildfire aerosols exhibit the same level of toxicity as the urban particles? To shed light on this question, it is interesting to look at the exposure data in relationship to the observed daily mortality in Finland, even though the limited duration of the episode allows only for a weak statistical power. The percentage increases observed (0.8%-2.1% per 10 microg/m(3) of fine PM) are in line with the more general estimates for urban PM and those used in the current risk assessment.

Parameter and model uncertainty in a life-table model for fine particles (PM2.5): a statistical modeling study.

BACKGROUND: The estimation of health impacts involves often uncertain input variables and assumptions which have to be incorporated into the model structure. These uncertainties may have significant effects on the results obtained with model, and, thus, on decision making. Fine particles (PM2.5) are believed to cause major health impacts, and, consequently, uncertainties in their health impact assessment have clear relevance to policy-making. We studied the effects of various uncertain input variables by building a life-table model for fine particles. METHODS: Life-expectancy of the Helsinki metropolitan area population and the change in life-expectancy due to fine particle exposures were predicted using a life-table model. A number of parameter and model uncertainties were estimated. Sensitivity analysis for input variables was performed by calculating rank-order correlations between input and output variables. The studied model uncertainties were (i) plausibility of mortality outcomes and (ii) lag, and parameter uncertainties (iii) exposure-response coefficients for different mortality outcomes, and (iv) exposure estimates for different age groups. The monetary value of the years-of-life-lost and the relative importance of the uncertainties related to monetary valuation were predicted to compare the relative importance of the monetary valuation on the health effect uncertainties. RESULTS: The magnitude of the health effects costs depended mostly on discount rate, exposure-response coefficient, and plausibility of the cardiopulmonary mortality. Other mortality outcomes (lung cancer, other non-accidental and infant mortality) and lag had only minor impact on the output. The results highlight the importance of the uncertainties associated with cardiopulmonary mortality in the fine particle impact assessment when compared with other uncertainties. CONCLUSION: When estimating life-expectancy, the estimates used for cardiopulmonary exposure-response coefficient, discount rate, and plausibility require careful assessment, while complicated lag estimates can be omitted without this having any major effect on the results.

Issues in consumer exposure modeling: towards harmonization on a global scale.

Understanding where and how chemicals are used throughout their life cycle is becoming increasingly important. In 2003, within the context of REACH and GPSD legislation, the European Commission started developing a European and global infrastructure of exposure methods and tools. The infrastructure aims (1) to link modeling tools and exposure-related data and scenarios in a single framework so that harmonized exposure assessment procedures can be developed for consumer products in the EU and (2) to make this framework flexible enough to allow global application. A number of issues are raised by a global infrastructure of consumer exposure modeling that answers to multi-legislative mandates. These include transparency, consistency, usability, and defensibility of the models, including the relevant degree of complexity for priority setting versus assessment. As part of the initiative to set up a harmonized global infrastructure on consumer exposure assessment, these issues were presented, discussed, and further developed in a series of European Commission-sponsored workshops organized in October 2004 and June 2005 as part of the "Harmonization of Consumer Exposure Models on a Global Scale" project. The project focused on development, harmonization, and validation of consumer exposure modeling approaches. The workshops included experts from the EU, USA, Japan, and Canada. The conclusions and recommendations made on the basis of this work are described. To help achieve harmonization of approaches, the European Commission's Joint Research Centre is proposing a framework (1) to compare information on elements of chemical risk assessment to understand exposure regulations in different countries, (2) to save time and expense by sharing information and models, and (3) to promote credible science through better communication among organizations and by peer review of assessments and assessment procedures.

Risk management measures for chemicals in consumer products: documentation, assessment, and communication across the supply chain.

This paper analyzes the way risk management measures (RMMs) for consumer products have been used to date in authority and industry risk assessments. A working concept for consumer product RMMs is developed, aimed at controlling, limiting or avoiding exposures, and helping to insure the safe use (or handling) of a substance as part of a consumer product. Particular focus is placed on new requirements introduced by REACH (registration, evaluation, and authorization of chemicals). A RMMs categorization approach is also developed, dividing consumer product RMMs into those that are product integrated and those that are communicated to consumers. For each of these categories, RMMs for normal use, accidental use or misuse need to be distinguished. The level of detail for documenting, assessing and communicating RMMs across supply chains can vary, depending on the type of the assessment (tiered approach). Information on RMMs was collected from published sources to demonstrate that a taxonomical approach using standard descriptors for RMMs libraries is needed for effective information exchange across supply chains.

Source apportionment of population representative samples of PM(2.5) in three European cities using structural equation modelling.

Apportionment of urban particulate matter (PM) to sources is central for air quality management and efficient reduction of the substantial public health risks associated with fine particles (PM(2.5)). Traffic is an important source combustion particles, but also a significant source of resuspended particles that chemically resemble Earth's crust and that are not affected by development of cleaner motor technologies. A substantial fraction of urban ambient PM originates from long-range transport outside the immediate urban environment including secondary particles formed from gaseous emissions of mainly sulphur, nitrogen oxides and ammonia. Most source apportionment studies are based on small number of fixed monitoring sites and capture well population exposures to regional and long-range transported particles. However, concentrations from local sources are very unevenly distributed and the results from such studies are therefore poorly representative of the actual exposures. The current study uses PM(2.5) data observed at population based random sampled residential locations in Athens, Basle and Helsinki with 17 elemental constituents, selected VOCs (xylenes, trimethylbenzenes, nonane and benzene) and light absorbance (black smoke). The major sources identified across the three cities included crustal, salt, long-range transported inorganic and traffic sources. Traffic was associated separately with source categories with crustal (especially Athens and Helsinki) and long-range transported chemical composition (all cities). Remarkably high fractions of the variability of elemental (R(2)>0.6 except for Ca in Basle 0.38) and chemical concentrations (R(2)>0.5 except benzene in Basle 0.22 and nonane in Athens 0.39) are explained by the source factors of an SEM model. The RAINS model that is currently used as the main tool in developing European air quality management policies seems to capture the local urban fraction (the city delta term) quite well, but underestimates crustal particle levels in the three cities of the current study. Utilizing structural equation modelling parallel with traditional principal component analysis (PCA) provides an objective method to determine the number of factors to be retained in a model and allows for formal hypotheses testing.

Current state of the science: health effects and indoor environmental quality.

Our understanding of the relationship between human health and the indoor environment continues to evolve. Previous research on health and indoor environments has tended to concentrate on discrete pollutant sources and exposures and on specific disease processes. Recently, efforts have been made to characterize more fully the complex interactions between the health of occupants and the interior spaces they inhabit. In this article we review recent advances in source characterization, exposure assessment, health effects associated with indoor exposures, and intervention research related to indoor environments. Advances in source characterization include a better understanding of how chemicals are transported and processed within spaces and the role that other factors such as lighting and building design may play in determining health. Efforts are under way to improve our ability to measure exposures, but this remains a challenge, particularly for biological agents. Researchers are also examining the effects of multiple exposures as well as the effects of exposures on vulnerable populations such as children and the elderly. In addition, a number of investigators are also studying the effects of modifying building design, materials, and operations on occupant health. Identification of research priorities should include input from building designers, operators, and the public health community.