Two Decades of Air Pollution Health Risk Assessment: Insights From the Use of WHO's AirQ and AirQ+ Tools.

Objectives: We evaluated studies that used the World Health Organization's (WHO) AirQ and AirQ+ tools for air pollution (AP) health risk assessment (HRA) and provided best practice suggestions for future assessments. Methods: We performed a comprehensive review of studies using WHO's AirQ and AirQ+ tools, searching several databases for relevant articles, reports, and theses from inception to Dec 31, 2022. Results: We identified 286 studies that met our criteria. The studies were conducted in 69 countries, with most (57%) in Iran, followed by Italy and India (∼8% each). We found that many studies inadequately report air pollution exposure data, its quality, and validity. The decisions concerning the analysed population size, health outcomes of interest, baseline incidence, concentration-response functions, relative risk values, and counterfactual values are often not justified, sufficiently. Many studies lack an uncertainty assessment. Conclusion: Our review found a number of common shortcomings in the published assessments. We suggest better practices and urge future studies to focus on the quality of input data, its reporting, and associated uncertainties.

Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation.

BACKGROUND: Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems. METHODS: This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP. RESULTS: We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation. CONCLUSIONS: NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

WHO air quality database: relevance, history and future developments.

Air pollution is the second most important risk factor for noncommunicable diseases, but air quality monitoring is lacking in many low- and middle-income countries. The World Health Organization (WHO) recently released its 2022 updated air quality database status report. This report contains data from about 6743 human settlements, a sixfold increase from 1102 settlements in its first publication in 2011, which shows that air pollution is increasingly recognized as a health priority at global and national levels. However, progress varies across the world. More than 90% of the settlements in the database are in high- and middle-income countries and areas mainly in China, Europe, India and North America. The database is crucial for increasing awareness of air pollution, and for calculating global exposures and the corresponding burden of disease attributable to air pollution. This article describes the progress made and challenges in collecting air quality data. The database uses official data sources which can be difficult to access and assess, because air quality monitoring is done by different government bodies or uses varying monitoring methods. These air quality data can be used by the health sector to engage in discussions on monitoring air quality to protect public health, and facilitate multisectoral engagement of United Nations agencies to support countries to conform with the 2021 WHO air quality guidelines. Although air pollution levels in most countries are higher than those recommended in the guidelines, any action policy-makers take to reduce air pollution will help reduce the burden of air pollution on health.

Bien que la pollution de l'air représente le deuxième facteur de risque le plus important pour les maladies non transmissibles, de nombreux pays à revenu faible et intermédiaire ne mènent aucun contrôle de la qualité de l'air. L'Organisation mondiale de la Santé (OMS) a récemment publié l'édition 2022 du rapport de situation relatif à sa base de données sur la qualité de l'air. Ce rapport renferme des informations sur près de 6743 établissements humains, un chiffre six fois supérieur aux 1102 établissements humains figurant dans la première publication de 2011, ce qui montre que la pollution de l'air est davantage reconnue comme une priorité en matière de santé, tant à l'échelle nationale qu'internationale. Pourtant, les avancées ne sont pas les mêmes partout dans le monde. Plus de 90% des établissements mentionnés dans la base de données se trouvent dans des pays à revenu faible et intermédiaire, ainsi que dans des régions principalement situées en Chine, en Europe, en Inde et en Amérique du Nord. Cette base de données est essentielle pour mieux sensibiliser à la pollution de l'air, mais aussi pour calculer l'exposition mondiale et l'impact des maladies qui lui sont attribuables. Le présent article décrit les progrès réalisés et les défis qui subsistent dans la collecte d'informations liées à la qualité de l'air. La base de données utilise des sources officielles, qui peuvent être difficiles d'accès et compliquées à évaluer car le contrôle de la qualité de l'air est effectué par plusieurs organismes gouvernementaux ou emploie des méthodes différentes. Les informations ainsi récoltées peuvent être exploitées par le secteur de la santé pour entamer des discussions sur le contrôle de la qualité de l'air. Objectif: préserver la santé publique et favoriser la mobilisation multisectorielle d'agences des Nations Unies pour aider les pays à se conformer aux lignes directrices de l'OMS relatives à la qualité de l'air, qui datent de 2021. Même si, dans la plupart des pays, les niveaux de pollution de l'air dépassent les recommandations formulées dans ces lignes directrices, toute action entreprise par les responsables politiques pour les faire baisser contribuera à réduire l'impact qu'exerce cette pollution sur la santé.

La contaminación del aire es el segundo factor de riesgo más importante de las enfermedades no transmisibles, pero en muchos países de ingresos bajos y medios no se vigila la calidad del aire. La Organización Mundial de la Salud (OMS) publicó hace poco su informe actualizado de 2022 sobre el estado de la base de datos de calidad del aire. Este informe contiene datos de unos 6743 asentamientos humanos, es decir, seis veces más que los 1102 asentamientos de su primera publicación en 2011, lo que demuestra que la contaminación del aire se reconoce cada vez más como una prioridad sanitaria a nivel mundial y nacional. Sin embargo, los progresos varían en todo el mundo. Más del 90% de los asentamientos de la base de datos se encuentran en países y regiones de ingresos altos y medios, principalmente en China, Europa, India y Norteamérica. La base de datos es esencial para aumentar la concienciación sobre la contaminación del aire y para calcular las exposiciones globales y la correspondiente carga de morbilidad atribuible a la contaminación del aire. Este artículo describe los progresos realizados y los desafíos que plantea la recopilación de datos sobre la calidad del aire. La base de datos utiliza fuentes de datos oficiales a las que puede resultar difícil acceder y evaluar porque el control de la calidad del aire lo realizan diferentes organismos gubernamentales o utilizan métodos de control que varían. El sector sanitario puede utilizar estos datos sobre la calidad del aire para participar en debates sobre la vigilancia de la calidad del aire con el fin de proteger la salud pública y facilitar el compromiso multisectorial de los organismos de las Naciones Unidas para ayudar a los países a cumplir las directrices de la OMS 2021 sobre la calidad del aire. Aunque los niveles de contaminación del aire en la mayoría de los países son superiores a los recomendados en las directrices, cualquier medida que adopten los responsables de formular políticas para reducir la contaminación del aire contribuirá a reducir la carga de la contaminación del aire sobre la salud.

Socio-demographic and neighbourhood factors influencing urban green space use and development at home: A population-based survey in Accra, Ghana.

In Sub-Saharan Africa and other developing regions, there has been very little systematic attempt to document the uses and perceived health benefits of urban green spaces in cities and the factors influencing usage. We therefore sought to establish the availability, accessibility and use of urban green spaces, and the perceived health benefits in an African population. We also ascertained the factors influencing use and development of green spaces at home. A population-based survey was conducted in Accra, the capital city of Ghana, spanning 11 Municipal and 3 Sub-Metropolitan areas. Multivariable binary logistic regression adjusting for potential confounders was used to establish the association between green space use and development at home, and socio-demographic, neighbourhood and health factors. Odds ratios and their corresponding 95% confidence intervals were estimated from the models. Several socio-demographic (gender, age, marital status, occupation, ethnicity, religion) and district-level (population density, income level, neighbourhood greenness) factors were associated with use of green spaces and development of green spaces at home in Accra. Residents who were worried about depletion of green spaces in their community were more likely to develop green spaces at home. In neighbourhoods with moderate and high level of greenness, residents were less likely to develop green spaces at home. Five-percent and 47% of green space users in Accra reported witnessing an improvement in their physical and mental health, respectively, from use of green spaces. The study findings can inform policy action for promoting use and development of green spaces in African cities and for mitigating depletion and degradation of the limited urban greenery.

Between Policy and Risk Communication: Coverage of Air Pollution in Ghanaian Newspapers.

Mass media plays an increasingly persuasive role in orienting political decisions, shaping social agendas, influencing individuals' actions, and interpreting scientific evidence for the public. With growing scientific understanding of the health, social and environmental consequences of air pollution, there is an urgent need to understand how media coverage frames these links, particularly in Low- and Middle-Income Countries. This paper examines how the Ghanaian print and electronic media houses are covering air pollution issues given increased efforts at reducing air pollution within the country. The main goal of this work is to track the progress of policies to reduce air pollution. We used a qualitative content analysis of selected newspapers (both traditional and online) between the periods 2016 and 2021 and we found that articles on air pollution have been increasing, with more reportage on impact and policy issues compared to causes of air pollution. A focus group with six members of the media confirmed an interest in covering health and environmental issues, particularly coverage of specific diseases and human-interest pieces. This increasing attention is likely associated with intensifying local, national, and international action to improve air quality in Ghana, and growing awareness of the health impacts of air pollution.

Green CURIOCITY: a study protocol for a European birth cohort study analysing childhood heat-related health impacts and protective effects of urban natural environments.

INTRODUCTION: The European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as exposure to urban natural environments, is unknown. Green CURe In Outdoor CITY spaces (Green CURIOCITY) will analyse how heat exposure during pregnancy affects birth outcomes and how long-term heat exposure may influence children's neurodevelopment. We will also investigate if adverse effects can be mitigated by urban natural environments. A final goal is to visualise intraurban patterns of heat vulnerability and assist planning towards healthier cities. METHODS AND ANALYSIS: We will use existing data from the Human Early-Life Exposure cohort, which includes information on birth outcomes and neurodevelopment from six European birth cohorts. The cohort is linked to data on prenatal heat exposure and impact on birth outcomes will be analysed with logistic regression models, adjusting for air pollution and noise and sociobehavioural covariates. Similarly, impact of cumulative and immediate heat exposure on neurodevelopmental outcomes at age 5 will be assessed. For both analyses, the potentially moderating impact of natural environments will be quantified. For visualisation, Geographical information systems data will be combined to develop vulnerability maps, demonstrating urban 'hot spots' where the risk of negative impacts of heat is aggravated due to sociodemographic and land use patterns. Finally, geospatial and meteorological data will be used for informing GreenUr, an existing software prototype developed by the WHO Regional Office for Europe to quantify health impacts and augment policy tools for urban green space planning. ETHICS AND DISSEMINATION: The protocol was approved by the Comité Ético de Investigación Clínica Parc de Salut MAR, Spain. Findings will be published in peer-reviewed journals and presented at policy events. Through stakeholder engagement, the results will also reach user groups and practitioners.

Particulate matter pollution at traffic hotspots of Accra, Ghana: levels, exposure experiences of street traders, and associated respiratory and cardiovascular symptoms.

BACKGROUND: There are limited studies on the health effects of street trading in spite of common knowledge that individuals engaged in the trade are exposed to high levels of traffic-related air pollution per their mode of operation, and also the fact that the venture is a dominant occupation in cities of Sub-Saharan Africa (SSA) and other developing regions. OBJECTIVE: We characterized particulate matter (PM) pollution levels at traffic hotspots of Accra, Ghana during the dry and wet seasons, and assessed exposure experiences of street traders. METHODS: A cross-sectional study was conducted among 236 street traders operating along six selected traffic routes of Accra and a comparison group of 186 office workers. PurpleAir PA-II monitors were used to measure PM levels at the selected traffic routes. We estimated annual PM2.5 exposure of street traders using assigned seasonal PM2.5 levels, and information collected in a structured questionnaire on their activity patterns. Outcomes investigated were self-reported respiratory and cardiovascular symptoms. RESULTS: PM levels at Accra traffic hotspots were high in both seasons. 1 ug/m3 increase in PM2.5 exposure increased respiratory, cardiovascular, and overall symptoms by a factor of 0.00027 (95% CI: 0.00012, 0.00041), 0.00022 (95% CI: 0.00007, 0.00036), and 0.00048 (95% CI: 0.00023, 0.00073), respectively. Compared to office workers, high PM2.5 exposure among street traders was associated with increased odds of coughing, catarrh (postnasal drip), sneezing, rapid heart beating, irregular heartbeat, sharp chest pains, fainting spells, headaches, and dizziness. Low and medium PM2.5 exposure was associated with increased odds of dermatitis, rapid heart beating, and irregular heartbeat, and sharp chest pains, respectively. CONCLUSIONS: We found consistent evidence that PM2.5 exposure among street traders increases the occurrence of respiratory and cardiovascular symptoms. We also provide indicative measurements of PM levels at traffic hotspots of a rapidly growing SSA city with heavy vehicular traffic and yet, limited air quality monitoring capacity.

How can vegetation protect us from air pollution? A critical review on green spaces' mitigation abilities for air-borne particles from a public health perspective - with implications for urban planning.

Air pollution causes the largest death toll among environmental risks globally, but interventions to purify ambient air remain inadequate. Vegetation and green spaces have shown reductive effects on air-borne pollutants concentrations, especially of particulate matter (PM). Guidance on green space utilisation for air quality control remains scarce, however, as does its application in practise. To strengthen the foundation for research and interventions, we undertook a critical review of the state of science from a public health perspective. We used inter-disciplinary search strategies for published reviews on green spaces and air pollution in key scientific databases. Using the PRISMA checklist, we systematically identified reviews with quantitative analyses. For each of the presented PM mitigation mechanisms, we conducted additional searches focused on the most recent articles published between 2016 and early 2021. The included reviews differentiate three mitigation mechanisms of green spaces for PM: deposition, dispersion and modification. The most studied mechanism is deposition, particularly measures of mass and settling velocity of PM on plant leaves. We consolidate how green space setups differ by scale and context in their potentials to reduce peak exposures, stationary (point) or mobile (line) pollution sources, and the potentially most harmful PM components. The assessed findings suggest diverse optimisation options for green space interventions, particularly concerning plant selection, spatial setup, ventilation and maintenance - all alongside the consideration of supplementary vegetation effects like on temperature or water. Green spaces' reductive effects on air-borne PM concentrations are considerable, multi-mechanistic and varied by scale, context and vegetation characteristics. Such effect-modifying factors must be considered when rethinking public space design, as accelerated by the COVID-19 pandemic. Weak linkages amid involved disciplines motivate the development of a research framework to strengthen health-oriented guidance. We conclude on an urgent need for an integrated and risk-based approach to PM mitigation through green space interventions.

Short-term health effects from outdoor exposure to biomass burning emissions: A review.

Biomass burning (BB) including forest, bush, prescribed fires, agricultural fires, residential wood combustion, and power generation has long been known to affect climate, air quality and human health. With this work we supply a systematic review on the health effects of BB emissions in the framework of the WHO activities on air pollution. We performed a literature search of online databases (PubMed, ISI, and Scopus) from year 1980 up to 2020. A total of 81 papers were considered as relevant for mortality and morbidity effects. High risk of bias was related with poor estimation of BB exposure and lack of adjustment for important confounders. PM10 and PM2.5 concentrations originating from BB were associated with all-cause mortality: the meta-analytical estimate was equal to 1.31% (95% CI 0.71, 1.71) and 1.92% (95% CI -1.19, 5.03) increased mortality per each 10 µg m-3 increase of PM10 and PM2.5, respectively. Regarding cardiovascular mortality 8 studies reported quantitative estimates. For smoky days and for each 10 µg m-3 increase in PM2.5 concentrations, the risk of cardiovascular mortality increased by 4.45% (95% CI 0.96, 7.95) and by 3.30% (95% CI -1.97, 8.57), respectively. Fourteen studies evaluated whether respiratory morbidity was adversely related to PM2.5 (9 studies) or PM10 (5 studies) originating from BB. All found positive associations. The pooled effect estimates were 4.10% (95% CI 2.86, 5.34) and 4.83% (95% CI 0.06, 9.60) increased risk of total respiratory admissions/emergency visits, per 10 µg m-3 increases in PM2.5 and PM10, respectively. Regarding cardiovascular morbidity, sixteen studies evaluated whether this was adversely related to PM2.5 (10 studies) or PM10 (6 studies) originating from BB. They found both positive and negative results, with summary estimates equal to 3.68% (95% CI -1.73, 9.09) and 0.93% (95% CI -0.18, 2.05) increased risk of total cardiovascular admissions/emergency visits, per 10 µg m-3 increases in PM2.5 and PM10, respectively. To conclude, a significant number of studies indicate that BB exposure is associated with all-cause and cardiovascular mortality and respiratory morbidity.

Urban Municipal Solid Waste management: Modeling air pollution scenarios and health impacts in the case of Accra, Ghana.

Despite the clear link between air pollution and health, research to investigate the relationship between municipal solid waste management and air pollution and health has not been prioritized. Such research may generate scientific information that would help reduce population exposure to air pollutants. This paper examines the case study of Accra in Ghana, a city dealing with serious waste management problems. The paper proposes a methodology to estimate the impact of waste management on urban air pollution and health. The analysis is described in the following four steps: (1) collecting data on the waste sector; (2) modeling the emissions arising from waste management; (3) transforming emissions to concentration values and (4) estimating the burdens on health. The assessment has been conducted using the CCAC SWEET tool and WHO AirQ+. The method presented can be used in different locations, depending on data availability, when analyzing the impact of and potential changes to waste sector policies. The results of this health impact assessment indicate that, based on the emissions of PM2.5 from the waste sector in Accra, a change from the business-as-usual to more sustainable options would reduce air pollutants emissions and avert 120 premature deaths in 2030. Levels of air pollution in Accra are significant and interventions to reduce PM2.5 exposure should be promoted. The detailed analysis of the current situation provides suggestions for waste management policies in terms of impacts on health and ideas to reconsider the waste policies in Accra.

Population awareness and attitudes toward waste-related health risks in Accra, Ghana.

Despite significant knowledge about the potential health hazards of waste, there are few studies in African cities that investigate awareness of health issues related to waste management, although such research is needed to lower population exposure. This paper examines the case study of Accra in Ghana, a city dealing with serious health and pollution problems. Three focus groups and 157 households in Accra were surveyed on household waste disposal and awareness of waste-related health hazards. Surveyed households had limited knowledge of waste-related health hazards in their neighbourhoods. Although the households reported diseases that could be associated with environmental factors linked to waste management, 87% of all surveyed households did not think that someone in their household could have fallen ill of a disease that can be related to waste. In middle- and high-income neighbourhoods, waste burning increases substantially when waste is not collected.

Quantifying the Public Health Benefits of Reducing Air Pollution: Critically Assessing the Features and Capabilities of WHO's AirQ+ and U.S. EPA's Environmental Benefits Mapping and Analysis Program - Community Edition (BenMAP - CE).

Scientific evidence spanning experimental and epidemiologic studies has shown that air pollution exposures can lead to a range of health effects. Quantitative approaches that allow for the estimation of the adverse health impacts attributed to air pollution enable researchers and policy analysts to convey the public health impact of poor air quality. Multiple tools are currently available to conduct such analyses, which includes software packages designed by the World Health Organization (WHO): AirQ+, and the U.S. Environmental Protection Agency (U.S. EPA): Environmental Benefits Mapping and Analysis Program - Community Edition (BenMAP - CE), to quantify the number and economic value of air pollution-attributable premature deaths and illnesses. WHO's AirQ+ and U.S. EPA's BenMAP - CE are among the most popular tools to quantify these effects as reflected by the hundreds of peer-reviewed publications and technical reports over the past two decades that have employed these tools spanning many countries and multiple continents. Within this paper we conduct an analysis using common input parameters to compare AirQ+ and BenMAP - CE and show that the two software packages well align in the calculation of health impacts. Additionally, we detail the research questions best addressed by each tool.

Green spaces and mortality: a systematic review and meta-analysis of cohort studies.

BACKGROUND: Green spaces have been proposed to be a health determinant, improving health and wellbeing through different mechanisms. We aimed to systematically review the epidemiological evidence from longitudinal studies that have investigated green spaces and their association with all-cause mortality. We aimed to evaluate this evidence with a meta-analysis, to determine exposure-response functions for future quantitative health impact assessments. METHODS: We did a systematic review and meta-analysis of cohort studies on green spaces and all-cause mortality. We searched for studies published and indexed in MEDLINE before Aug 20, 2019, which we complemented with an additional search of cited literature. We included studies if their design was longitudinal; the exposure of interest was measured green space; the endpoint of interest was all-cause mortality; they provided a risk estimate (ie, a hazard ratio [HR]) and the corresponding 95% CI for the association between green space exposure and all-cause mortality; and they used normalised difference vegetation index (NDVI) as their green space exposure definition. Two investigators (DR-R and DP-L) independently screened the full-text articles for inclusion. We used a random-effects model to obtain pooled HRs. This study is registered with PROSPERO, CRD42018090315. FINDINGS: We identified 9298 studies in MEDLINE and 13 studies that were reported in the literature but not indexed in MEDLINE, of which 9234 (99%) studies were excluded after screening the titles and abstracts and 68 (88%) of 77 remaining studies were excluded after assessment of the full texts. We included nine (12%) studies in our quantitative evaluation, which comprised 8 324 652 individuals from seven countries. Seven (78%) of the nine studies found a significant inverse relationship between an increase in surrounding greenness per 0·1 NDVI in a buffer zone of 500 m or less and the risk of all-cause mortality, but two studies found no association. The pooled HR for all-cause mortality per increment of 0·1 NDVI within a buffer of 500 m or less of a participant's residence was 0·96 (95% CI 0·94-0·97; I2, 95%). INTERPRETATION: We found evidence of an inverse association between surrounding greenness and all-cause mortality. Interventions to increase and manage green spaces should therefore be considered as a strategic public health intervention. FUNDING: World Health Organization.