Sports Utility Vehicles: A Public Health Model of Their Climate and Air Pollution Impacts in the United Kingdom.

The emission benefits of shifting towards battery electric vehicles have so far been hampered by a trend towards sports utility vehicles (SUVs). This study assesses the current and future emissions from SUVs and their potential impact on public health and climate targets. We modelled five scenarios of varying SUV sales and electrification rates, and projected associated carbon dioxide (CO2) and nitrogen oxide (NOx) emissions. Multiple linear regression was used to determine the relationship between vehicle characteristics and emissions. Cumulative CO2 emissions were valued using the social cost of carbon approach. Life table analyses were used to project and value life years saved from NOx emission reductions. Larger SUVs were disproportionately high emitters of CO2 and NOx. Replacing these with small SUVs achieved significant benefits, saving 702 MtCO2e by 2050 and 1.8 million life years from NO2 reductions. The largest benefits were achieved when combined with electrification, saving 1181 MtCO2e and gaining 3.7 million life years, with a societal value in the range of GBP 10-100s billion(s). Downsizing SUVs could be associated with major public health benefits from reduced CO2 and NOx emissions, in addition to the benefits of electrification. This could be achieved by demand-side mass-based vehicle taxation and supply-side changes to regulations, by tying emission limits to a vehicle's footprint rather than its mass.

Intervention of an Upgraded Ventilation System and Effects of the COVID-19 Lockdown on Air Quality at Birmingham New Street Railway Station.

High NO2 concentrations (long term average of 383 µg/m3 in 2016/2017) recorded at Birmingham New Street railway station have resulted in the upgrade of the bi-directional fan system to aid wind dispersion within the enclosed platform environment. This paper attempts to examine how successful this intervention has been in improving air quality for both passengers and workers within the station. New air pollution data in 2020 has enabled comparisons to the 2016/2017 monitoring campaign revealing a 23-42% decrease in measured NO2 concentrations. The new levels of NO2 are below the Occupational Health standards but still well above the EU Public Health Standards. This reduction, together with a substantial decrease (up to 81%) in measured Particulate Matter (PM) concentrations, can most likely be attributed to the new fan system effectiveness. Carbon Monoxide levels were well below Occupational and Public Health Standards at all times. The COVID-19 pandemic "initial lockdown" period has also allowed an insight into the resultant air quality at lower rail-traffic intensities, which produced a further reduction in air pollutants, to roughly half the pre-lockdown concentrations. This study shows the scope of improvement that can be achieved through an engineering solution implemented to improve the ventilation system of an enclosed railway station. Further reduction in air pollution would require additional approaches, such as the removal of diesel engine exhaust emissions via the adoption of electric or diesel-electric hybrid powered services.

Determination of the impact of rainfall on road accidents in Thailand.

The World Health Organization has highlighted that the number of deaths worldwide due to road accidents increases every year. It recommends that countries improve road safety for all people by providing sustainable and safe transport systems by 2030, efforts are especially required within Low Middle-Income Countries (LMICS). This study is the first to investigate the impact of rainfall on road accidents in Thailand. Thai emergency data were collected from the National Institute for Emergency Medicine (NIEM) between 2012 to 2018. A time-series design with generalized linear model (GLM) was applied to analyse the associations between road accidents and rainfall. The results are reported using relative risk (RR) at 95% confidence intervals compared with dry days. The effects of long-term trends, seasonality, day of the weeks, public holidays and other meteorological factors were controlled in the GLM. A meta-analysis was applied to summarise the estimate effect of rain groups stratified by the Northern and Southern provinces. Findings reported a significant increase in road accidents due to high rainfall levels both in the Southern and the Northern provinces. The pooled estimate risks in the Southern provinces have higher estimated risks than the Northern provinces. Both Northern and Southern provinces showed the rain group with 10-20 mm/day having the highest pooled estimated risk with RR = 1.052, (95% CI: 1.026-1.079) and RR = 1.062, (95% CI: 1.043-1.082), respectively, while surprisingly, heavy rain with more than 20 mm/day reported a reduction of risks. Road accidents can therefore be associated with rainfall. It is recommended that rainfall is factored into ambulance forecast models and warning systems, allowing for improvements in ambulance service efficiency. Policymakers need to integrate road safety policies that reduce road accidents in wet weather.

Impact of extreme temperatures on ambulance dispatches in London, UK.

BACKGROUND: Associations between extreme temperatures and health outcomes, such as mortality and morbidity, are often observed. However, relatively little research has investigated the role of extreme temperatures upon ambulance dispatches. METHODS: A time series analysis using London Ambulance Service (LAS) incident data (2010-2014), consisting of 5,252,375 dispatches was conducted. A generalized linear model (GLM) with a quasi-likelihood Poisson regression was applied to analyse the associations between ambulance dispatches and temperature. The 99th (22.8°C) and 1st (0.0°C) percentiles of temperature were defined as extreme high and low temperature. Fourteen categories of ambulance dispatches were investigated, grouped into 'respiratory' (asthma, dyspnoea, respiratory chest infection, respiratory arrest and chronic obstructive pulmonary disease), 'cardiovascular' (cardiac arrest, chest pain, cardiac chest pain RCI, cardiac arrhythmia and other cardiac problems) and 'other' non-cardiorespiratory (dizzy, alcohol related, vomiting and 'generally unwell') categories. The effects of long-term trends, seasonality, day of the week, public holidays and air pollution were controlled for in the GLM. The lag effect of temperature was also investigated. The threshold temperatures for each category were identified and a distributed lag non-linear model (DLNM) was reported using relative risk (RR) values at 95% confidence intervals. RESULTS: Many dispatch categories show significant associations with extreme temperature. Total calls from 999 dispatches and 'generally unwell' dispatch category show significant RRs at both low and high temperatures. Most respiratory categories (asthma, dyspnoea and RCI) have significant RRs at low temperatures represented by with estimated RRs ranging from 1.392 (95%CI: 1.161-1.699) for asthma to 2.075 (95%CI: 1.673-2.574) for RCI. The RRs for all other non-cardiorespiratory dispatches were often significant for high temperatures ranging from 1.280 (95% CI: 1.128-1.454) for 'generally unwell' to 1.985 (95%CI: 1.422-2.773) for alcohol-related. For the cardiovascular group, only chest pain dispatches reported a significant RR at high temperatures. CONCLUSIONS: Ambulance dispatches can be associated with extreme temperatures, dependent on the dispatch category. It is recommended that meteorological factors are factored into ambulance forecast models and warning systems, allowing for improvements in ambulance and general health service efficiency.

The impact of air pollutants on ambulance dispatches: A systematic review and meta-analysis of acute effects.

A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital data. Previously, no reviews focused solely on ambulance dispatch data. These data sets have excellent potential for environmental health research. For this review, publications up to April 2019 were identified using three main search categories covering: ambulance services including dispatches; air pollutants; and health outcomes. From 308 studies initially identified, 275 were excluded as they did not relate to ambulance service dispatches, did not report the air pollutant association, and/or did not study ambient air pollution. The main health outcomes in the remaining 33 studies were cardiac arrest (n = 14), cardiovascular (n = 11) and respiratory (n = 10) dispatches. Meta-analyses were performed to summarise pooled relative risk (RR) of pollutants: particulate matter less than 2.5 and 10 µm (PM2.5, PM10), the fraction between PM10 and PM2.5 (coarse) and suspended particulate matter (SPM) per 10 µg/m3 increase, carbon monoxide (CO) per 1 ppm increase and of sulphur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) per 10 ppb increment and ambulance dispatches. Statistically significant associations were found for ambulance dispatch data for all-respiratory and PM2.5 at 1.03 (95% CI:1.02-1.04) and at 1.10 (95% CI:1.00-1.21) for asthma and NO2 associations. For dispatches with subsequent paramedic assessment for cardiac arrest with PM2.5, CO and coarse dispatches at 1.05 (95% CI:1.03-1.08), 1.10 (95% CI:1.02-1.18) and 1.04 (95% CI:1.01-1.06) respectively. For dispatches with subsequent physician diagnosis for all-respiratory and PM2.5 at 1.02 (95% CI:1.01-1.03). In conclusion, air pollution was significantly associated with an increase in ambulance dispatch data, including those for cardiac arrest, all-respiratory, and asthma dispatches. Ambulance services should plan accordingly during pollution events. Furthermore, efforts to improve air quality should lead to decreases in ambulance dispatches.

Utility of Ambulance Data for Real-Time Syndromic Surveillance: A Pilot in the West Midlands Region, United Kingdom.

Introduction The Public Health England (PHE; United Kingdom) Real-Time Syndromic Surveillance Team (ReSST) currently operates four national syndromic surveillance systems, including an emergency department system. A system based on ambulance data might provide an additional measure of the "severe" end of the clinical disease spectrum. This report describes the findings and lessons learned from the development and preliminary assessment of a pilot syndromic surveillance system using ambulance data from the West Midlands (WM) region in England. Hypothesis/Problem Is an Ambulance Data Syndromic Surveillance System (ADSSS) feasible and of utility in enhancing the existing suite of PHE syndromic surveillance systems? METHODS: An ADSSS was designed, implemented, and a pilot conducted from September 1, 2015 through March 1, 2016. Surveillance cases were defined as calls to the West Midlands Ambulance Service (WMAS) regarding patients who were assigned any of 11 specified chief presenting complaints (CPCs) during the pilot period. The WMAS collected anonymized data on cases and transferred the dataset daily to ReSST, which contained anonymized information on patients' demographics, partial postcode of patients' location, and CPC. The 11 CPCs covered a broad range of syndromes. The dataset was analyzed descriptively each week to determine trends and key epidemiological characteristics of patients, and an automated statistical algorithm was employed daily to detect higher than expected number of calls. A preliminary assessment was undertaken to assess the feasibility, utility (including quality of key indicators), and timeliness of the system for syndromic surveillance purposes. Lessons learned and challenges were identified and recorded during the design and implementation of the system. RESULTS: The pilot ADSSS collected 207,331 records of individual ambulance calls (daily mean=1,133; range=923-1,350). The ADSSS was found to be timely in detecting seasonal changes in patterns of respiratory infections and increases in case numbers during seasonal events. CONCLUSIONS: Further validation is necessary; however, the findings from the assessment of the pilot ADSSS suggest that selected, but not all, ambulance indicators appear to have some utility for syndromic surveillance purposes in England. There are certain challenges that need to be addressed when designing and implementing similar systems. Todkill D , Loveridge P , Elliot AJ , Morbey RA , Edeghere O , Rayment-Bishop T , Rayment-Bishop C , Thornes JE , Smith G . Utility of ambulance data for real-time syndromic surveillance: a pilot in the West Midlands region, United Kingdom. Prehosp Disaster Med. 2017;32(6):667-672.

The Effects of Heat Advection on UK Weather and Climate Observations in the Vicinity of Small Urbanized Areas.

Weather and climate networks traditionally follow rigorous siting guidelines, with individual stations located away from frost hollows, trees or urban areas. However, the diverse nature of the UK landscape suggests that the feasibility of siting stations that are truly representative of regional climate and free from distorting local effects is increasingly difficult. Whilst the urban heat island is a well-studied phenomenon and usually accounted for, the effect of warm urban air advected downwind is rarely considered, particularly at rural stations adjacent to urban areas. Until recently, urban heat advection (UHA) was viewed as an urban boundary-layer process through the formation of an urban plume that rises above the surface as it is advected. However, these dynamic UHA effects are shown to also have an impact on surface observations. Results show a significant difference in temperatures anomalies ( p < 0.001 ) between observations taken downwind of urban and rural areas. For example, urban heat advection from small urbanized areas ( ∼ 1 km 2 ) under low cloud cover and wind speeds of 2-3 m s - 1 is found to increase mean nocturnal air temperatures by 0.6 ∘ C at a horizontal distance of 0.5 km. Fundamentally, these UHA results highlight the importance of careful interpretation of long-term temperature data taken near small urban areas.

Mortality and emergency hospitalizations associated with atmospheric particulate matter episodes across the UK in 2014.

Exposure to particulate air pollution is known to have negative impacts on human health. Long-term exposure to anthropogenic particulate matter is associated with the equivalent of around 29,000 deaths a year in the UK. However, short-lived air pollution episodes on the order of a few days are also associated with increased daily mortality and emergency hospital admissions for respiratory and cardiovascular conditions. The UK experienced widespread high levels of particulate air pollution in March-April 2014; observations of hourly mean PM2.5 concentrations reached up to 83µgm-3 at urban background sites. We performed an exposure and health impact assessment of the spring air pollution, focusing on two episodes with the highest concentrations of PM2.5 (12-14 March and 28 March-3 April 2014). Across these two episodes of elevated air pollution, totalling 10days, around 600 deaths were brought forward from short-term exposure to PM2.5, representing 3.9% of total all-cause (excluding external) mortality during these days. Using observed levels of PM2.5 from other years, we estimate that this is 2.0 to 2.7 times the mortality burden associated with typical urban background levels of PM2.5 at this time of year. Our results highlight the potential public health impacts and may aid planning for health care resources when such an episode is forecast.

Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis.

There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour.

Impact of climate change on the domestic indoor environment and associated health risks in the UK.

There is growing evidence that projected climate change has the potential to significantly affect public health. In the UK, much of this impact is likely to arise by amplifying existing risks related to heat exposure, flooding, and chemical and biological contamination in buildings. Identifying the health effects of climate change on the indoor environment, and risks and opportunities related to climate change adaptation and mitigation, can help protect public health. We explored a range of health risks in the domestic indoor environment related to climate change, as well as the potential health benefits and unintended harmful effects of climate change mitigation and adaptation policies in the UK housing sector. We reviewed relevant scientific literature, focusing on housing-related health effects in the UK likely to arise through either direct or indirect mechanisms of climate change or mitigation and adaptation measures in the built environment. We considered the following categories of effect: (i) indoor temperatures, (ii) indoor air quality, (iii) indoor allergens and infections, and (iv) flood damage and water contamination. Climate change may exacerbate health risks and inequalities across these categories and in a variety of ways, if adequate adaptation measures are not taken. Certain changes to the indoor environment can affect indoor air quality or promote the growth and propagation of pathogenic organisms. Measures aimed at reducing greenhouse gas emissions have the potential for ancillary public health benefits including reductions in health burdens related heat and cold, indoor exposure to air pollution derived from outdoor sources, and mould growth. However, increasing airtightness of dwellings in pursuit of energy efficiency could also have negative effects by increasing concentrations of pollutants (such as PM2.5, CO and radon) derived from indoor or ground sources, and biological contamination. These effects can largely be ameliorated by mechanical ventilation with heat recovery (MVHR) and air filtration, where such solution is feasible and when the system is properly installed, operated and maintained. Groups at high risk of these adverse health effects include the elderly (especially those living on their own), individuals with pre-existing illnesses, people living in overcrowded accommodation, and the socioeconomically deprived. A better understanding of how current and emerging building infrastructure design, construction, and materials may affect health in the context of climate change and mitigation and adaptation measures is needed in the UK and other high income countries. Long-term, energy efficient building design interventions, ensuring adequate ventilation, need to be promoted.

Ambulance call-outs and response times in Birmingham and the impact of extreme weather and climate change.

Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.

Including the urban heat island in spatial heat health risk assessment strategies: a case study for Birmingham, UK.

BACKGROUND: Heatwaves present a significant health risk and the hazard is likely to escalate with the increased future temperatures presently predicted by climate change models. The impact of heatwaves is often felt strongest in towns and cities where populations are concentrated and where the climate is often unintentionally modified to produce an urban heat island effect; where urban areas can be significantly warmer than surrounding rural areas. The purpose of this interdisciplinary study is to integrate remotely sensed urban heat island data alongside commercial social segmentation data via a spatial risk assessment methodology in order to highlight potential heat health risk areas and build the foundations for a climate change risk assessment. This paper uses the city of Birmingham, UK as a case study area. RESULTS: When looking at vulnerable sections of the population, the analysis identifies a concentration of "very high" risk areas within the city centre, and a number of pockets of "high risk" areas scattered throughout the conurbation. Further analysis looks at household level data which yields a complicated picture with a considerable range of vulnerabilities at a neighbourhood scale. CONCLUSIONS: The results illustrate that a concentration of "very high" risk people live within the urban heat island, and this should be taken into account by urban planners and city centre environmental managers when considering climate change adaptation strategies or heatwave alert schemes. The methodology has been designed to be transparent and to make use of powerful and readily available datasets so that it can be easily replicated in other urban areas.