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Fresher - FoResight and Modelling for European HEalth Policy and Regulation Project 

Horizon 2020

  Horizon 2020


Densely populated urban areas in Europe are facing environmental public health challenges associated with air pollution, climate change, environmental noise, and the wider built environment. Despite improvements in air quality in Europe over recent decades, air pollutants, such as particulate matter (PM), nitrogen dioxide (NO2) and ground-level ozone (O3) still pose a significant threat to public health1. In addition, climate change is likely to aggravate certain public health risks, by increasing the frequency and severity of extreme weather events, such as heatwaves and floods. Road traffic noise has been linked to cardiovascular diseases, while the rapid urbanization has resulted in the growth of motor vehicles in many areas in the world, which is associated with morbidity and mortality from road traffic incidents.

WP3 focuses on identifying the main environmental risk factors and their interactions that affect public health and wellbeing in Europe. More specifically, the main objectives were to:
● Assess the health impacts of the main environmental risk factors (e.g. air pollution, environmental noise, climate change) and urban environmental determinants (e.g. housing, transport, walkability, urban green spaces) in European metropolitan areas; ● Provide a set of recommendations related to the analysis of the environmental health risk factors, in order to support stakeholders in decision making, particularly at city level. A number of descriptive metrics of environmental conditions (environmental indicators) were identified and analysed in relation with the associated public health impacts. The indicators included in the WP3 analysis are related to: air pollution (PM2.5, PM10, NO2, O3), traffic noise, high/low temperatures, urban green spaces, flooding events and road safety.

The environmental analysis enabled the determination of the health effects associated with the selected environmental conditions across and within the European metropolitan areas. By performing health impact assessment, the fraction of population deaths that is associated with the environmental factors (attributable mortality) was quantified. Key results are as follows:
● The highest mortality attributable to long-term exposure to PM2.5 was estimated for Athens and Brussels, where the median values across municipalities reached up to 18% and 16% respectively, whereas the highest mortality attributable to NO2 was estimated for London and Athens (10% and 9% respectively) in 2010; the range of attributable mortality estimates (e.g. 8-18% attributable deaths to PM2.5 in Athens) within the metropolitan areas indicates a significant intra-urban variability of air pollution health impacts;
● The mortality attributable to short-term exposure to O3 was significant in the southern European metropolitan areas (up to 32 attributable deaths per 100,000 inhabitants in Athens in 2012);
● The heat-related mortality was higher in Athens (6 attributable deaths per 100,000 inhabitants in 2006), while the cold-related mortality was higher in London (80 attributable deaths per 100,000 inhabitants in 2001);
● The positive impact of urban green space was more noticeable in Athens and Prague (preventable mortality: 20 and 33 per 100,000 inhabitants, respectively in 2012);
● The victims in road accidents decreased in 2011 compared to 2001/2002 in Barcelona and London; average estimates across municipalities dropped from 332 (2001) to 215 (2011) victims per 100,000 inhabitants in Barcelona and from 453 (2002) to 297 (2011) victims per 100,000 inhabitants in London.

The analysis performed within WP3 provided evidence of recent environmental public health impacts in European metropolitan areas, which can be used to inform the development of interventions to improve public health and reduce inequalities. The most important environmental indicators that need to be considered for policy making at city level are related to air pollution, urban green spaces and road safety. The significant variability of indicator values across and within the metropolitan areas suggests their contribution to the environmental health inequalities, in particular:

● Air pollutants (PM2.5 and NO2) were associated with high estimates of attributable mortality in most cities; the large variability of the estimates within the metropolitan areas indicates the need for considering interventions at local/municipal level;
● The evolution of the road safety indicators over time showed that road accidents have decreased in the last years of the assessment;
● The positive impact of urban green spaces on population health highlights the importance of developing green spaces for healthier environments.

1. EEA. Air Quality in Europe — 2013 Report. European Environment Agency Report No 9/2013; Luxembourg: Publications Office of the European Union; 2013.

PREPARED BY Christina Mitsakou 1, Sani Dimitroulopoulou 1, Clare Heaviside 1, Sotiris Vardoulakis 1
1 Public Health England (PHE)

The authors wish to acknowledge the EURO-HEALTHY WP3 partners for the provision of data: Sophia Rodopoulou, Evi Samoli and Klea Katsouyanni from National and Kapodistrian University of Athens, Claudia Costa and Paula Santana from University of Coimbra, Marc Mari Dell’Olmo  and Carme Borell from Agencia de Salut Publica de Barcelona, Michala Lustigova from Charles University Prague, Diana Corman from Karolinska Institutet, Nathalie Coue from CSI Piemonte, Mariska Bauwelinck and Patrick Deboosere from Vrije Universiteit Brussels, Conrad Franke from Beuth-Hochschule Fuer Technik Berlin. We would also like to thank Danielle Vienneau and Kees de Hoogh from Swiss TPH for the air pollution maps.

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