Marko Tainio

Polish Academy of Sciences

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James Woodcock

University of Cambridge

Jouni T. Tuomisto

Finnish Institute for Health and Welfare

Audrey de Nazelle

Imperial College London

Thiago Hérick de Sá

World Health Organization

Niko Karvosenoja

Finnish Environment Institute

Anna Goodman

London School of Hygiene & Tropical Medicine

Jaakko Kukkonen

Finnish Meteorological Institute

Zbigniew Nahorski

Polish Academy of Sciences

Kaarle Kupiainen

Ministry of the Environment

Ari Karppinen

Finnish Meteorological Institute

Cooperative Institutions

University of Cambridge

MRC Epidemiology Unit

Barcelona Institute for Global Health

Finnish Institute for Health and Welfare

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Pompeu Fabra University

Medical Research Council

Finnish Environment Institute

University of Eastern Finland

Center for Research in Environmental Epidemiology

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Uncertainty in health risks due to anthropogenic primary fine particulate matter from different source types in Finland

WOS (2010)

Marko Tainio Jouni T. Tuomisto Juha Pekkanen Niko Karvosenoja Kaarle Kupiainen

Abstract The emission-exposure and exposure-response (toxicity) relationships are different for different emission source categories of anthropogenic primary fine particulate matter (PM 2.5 ). These variations have a potentially crucial importance in the integrated assessment, when determining cost-effective abatement strategies. We studied the importance of these variations by conducting a sensitivity analysis for an integrated assessment model. The model was developed to estimate the adverse health effects to the Finnish population attributable to primary PM 2.5 emissions from the whole of Europe. The primary PM 2.5 emissions in the whole of Europe and in more detail in Finland were evaluated using the inventory of the European Monitoring and Evaluation Programme (EMEP) and the Finnish Regional Emission Scenario model (FRES), respectively. The emission-exposure relationships for different primary PM 2.5 emission source categories in Finland have been previously evaluated and these values incorporated as intake fractions into the integrated assessment model. The primary PM 2.5 exposure-response functions and toxicity differences for the pollution originating from different source categories were estimated in an expert elicitation study performed by six European experts on air pollution health effects. The primary PM 2.5 emissions from Finnish and other European sources were estimated for the population of Finland in 2000 to be responsible for 209 (mean, 95% confidence interval 6–739) and 357 (mean, 95% CI 8–1482) premature deaths, respectively. The inclusion of emission-exposure and toxicity variation into the model increased the predicted relative importance of traffic related primary PM 2.5 emissions and correspondingly, decreased the predicted relative importance of other emission source categories. We conclude that the variations of emission-exposure relationship and toxicity between various source categories had significant impacts for the assessment on premature deaths caused by primary PM 2.5 .

Exposure Assessment

Primary (astronomy)

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Health co-benefits in mortality avoidance from implementation of the mass rapid transit (MRT) system in Kuala Lumpur, Malaysia

Reviews on Environmental Health (2016)

Soo Chen Kwan Marko Tainio James Woodcock Jamal Hisham Hashim

The mass rapid transit (MRT) is the largest transport infrastructure project under the national key economic area (NKEA) in Malaysia. As urban rail is anticipated to be the future spine of public transport network in the Greater Kuala Lumpur city, it is important to mainstream climate change mitigation and public health benefits in the local transport development. This study quantifies the health co-benefits in terms of mortality among the urbanites when the first line of the 150 km MRT system in Kuala Lumpur commences by 2017.Using comparative health risk assessment, we estimated the potential health co-benefits from the establishment of the MRT system. We estimated the reduced CO2 emissions and air pollution (PM2.5) exposure reduction among the general population from the reduced use of motorized vehicles. Mortality avoided from traffic incidents involving motorcycles and passenger cars, and from increased physical activity from walking while using the MRT system was also estimated.A total of 363,130 tonnes of CO2 emissions could be reduced annually from the modal shift from cars and motorcycles to the MRT system. Atmospheric PM2.5 concentration could be reduced 0.61 μg/m3 annually (2%). This could avoid a total of 12 deaths, mostly from cardio-respiratory diseases among the city residents. For traffic injuries, 37 deaths could be avoided annually from motorcycle and passenger cars accidents especially among the younger age categories (aged 15-30). One additional death was attributed to pedestrian walking. The additional daily physical activity to access the MRT system could avoid 21 deaths among its riders. Most of the mortality avoided comes from cardiovascular diseases. Overall, a total of 70 deaths could be avoided annually among both the general population and the MRT users in the city.The implementation of the MRT system in Greater Kuala Lumpur could bring substantial health co-benefits to both the general population and the MRT users mainly from the avoidance of mortality from traffic injuries.

10.1515/reveh-2015-0038

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Citations (15)

The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

BMJ (2011)

David Rojas‐Rueda Audrey de Nazelle Marko Tainio Mark Nieuwenhuijsen

Introduction: Obesity is a major risk factor for developing sleep apnea syndrome. CPAP is its treatment. Moreover, the use of CPAP may decrease perioperative complications in patients who have to undergo bariatric surgery. - Objective: To study the prevalence of OSAS in morbidly obese subjects. - Methods: We studied all patients who were referred to our unit of sleep disorders with an obesity diagnosis, using the following inclusion criteria: BMI higher than 40, acceptance of polygraphy. All patients answered a clinical questionnaire in order to assess: symptoms of sleep apnea and cardiometabolic comorbidity. Additionally, they all went through a polygraphic or polysomnographic study. The diagnosis of OSA was established with the presence of an AHI higher than 5 and the severity rating was made according to the SEPAR criteria. - Results: In three years we have studied 292 subjects with the stablished criteria, 115 men, 176 women, average age 47.1 +/-14. Average BMI 46.7. SAHS diagnosis was established in 243 cases (83.5% prevalence) of which 54 (22.2%) had mild OSA, 62 (25.5%) moderate OSA, and 127 (52.2%) severe OSA. In patients with OSA, the Epworth test average result was 7.43 +/-4.5 and in terms of comorbidity, 106 patiens had hipertension, 43.6%, 89 had dyslipidemia (36.6%) and 60 had diabetes (24.6%), 11 had had ischemic events (4.7%) and 5 had cerebrovascular disease (2%). - Conclusions: Individuals with morbid obesity have a very high prevalence of OSA in the absence of significant hypersomnolence. The need to treat these patients makes us recommend the routinary performance of polygraphic studies, even in paucisymptomatic patients.

Health Impact Assessment

Cycling

Health Benefits

10.1136/bmj.d4521

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Citations (658)

A guide to Value of Information methods for prioritising research in health impact modelling

arXiv (Cornell University) (2019)

Rob Johnson James Woodcock Audrey de Nazelle Thiago Hérick de Sá Rahul Goel

Health impact simulation models are used to predict how a proposed intervention or scenario will affect public health outcomes, based on available data and knowledge of the process. The outputs of these models are uncertain due to uncertainty in the structure and inputs to the model. In order to assess the extent of uncertainty in the outcome we must quantify all potentially relevant uncertainties. Then to reduce uncertainty we should obtain and analyse new data, but it may be unclear which parts of the model would benefit from such extra research. This paper presents methods for uncertainty quantification and research prioritisation in health impact models based on Value of Information (VoI) analysis. Specifically, we 1. discuss statistical methods for quantifying uncertainty in this type of model, given the typical kinds of data that are available, which are often weaker than the ideal data that are desired; 2. show how the expected value of partial perfect information (EVPPI) can be calculated to compare how uncertainty in each model parameter influences uncertainty in the output; 3. show how research time can be prioritised efficiently, in the light of which components contribute most to outcome uncertainty. The same methods can be used whether the purpose of the model is to estimate quantities of interest to a policy maker, or to explicitly decide between policies. We demonstrate how these methods might be used in a model of the impact of air pollution on health outcomes.

Value of information

Sensitivity Analysis

Uncertainty Quantification

Value (mathematics)

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A comparison of the health and environmental impacts of increasing urban density against increasing propensity to walk and cycle in Nashville, USA

Cities & Health (2019)

Sohail Ahmad Anna Goodman Felix Creutzig James Woodcock Marko Tainio

The transportation sector accounts for approximately 23% of the total energy-related carbon dioxide (CO2) emissions worldwide and 33% in the USA. At the same time, physical inactivity contributes to adverse health through non-communicable diseases. If policies can increase active transport (walking and cycling) and reduce car use, they could benefit human health and environmental health but the relative impact of different approaches has been under researched. This study estimated change in all-cause mortality and CO2 emissions in greater Nashville, Tennessee (USA) for two scenarios: (a) the propensity to walk and cycle a trip of a given distance increases directly to the same levels as seen in England, and (b) walking and cycling trips increase and travel distance decrease indirectly as a result of a more compact urban form. If the propensity to walk and cycle in Nashville were equal with England, about 339 deaths and about 36 ktCO2e (1%) of transportation-related CO2 emissions could be avoided per year. The compact urban form scenario could avoid 170 deaths and 370 ktCO2e (10%) of transportation-related CO2 emissions. In Nashville, both increasing the propensity to use active transport and more compact urban form would have notable public health gains, but a more compact form would have a much bigger effect on emissions.

Cycling

Kilometer

10.1080/23748834.2019.1659667

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Citations (6)

Impact of airborne particulate matter on human health: an assessment framework to estimate exposure and adverse health effects in Poland

Archiwum Ochrony Środowiska (2010)

Marko Tainio Jaakko Kukkonen Zbigniew Nahorski

Fine particulate matter (PM 2.5 ) air pollution is one of the main environmental health problems in developed countries. According to modeling estimates the PM 2.5 concentrations in Poland are among the highest in Europe. In this article we focus on exposure assessment and estimation of adverse health effects due to PM2.5 air pollution. This article consists of two parts. In the first part, we discuss the main methods used to estimate emission-exposure relationships and adverse health effects due to PM 2.5 air pollution. In the second part, we present an assessment framework for Poland. We illustrate this framework by estimating the premature deaths and change in life expectancy in Poland caused by anthropogenic, primary PM 2.5 emissions from different Eu- ropean countries, and, in proportion, the premature deaths in different European countries caused by primary PM2.5 emissions from Poland. The PM2.5 emissions were evaluated using the inventory of the European Moni- toring and Evaluation Programme (EMEP). The emission-exposure relationships were based on the previously published study and the exposure-response functions for PM 2.5 air pollution were estimated in expert elicitation study performed for six European experts on air pollution health effects. Based on the assessment, the anthro- pogenic primary PM2.5 from the whole of Europe is estimated to cause several thousands of premature deaths in Poland, annually. These premature deaths are both due to PM2.5 emissions from Poland and transportation of PM 2.5 from other European countries, both of these in almost equal parts. The framework presented in this article will be developed in the near future to a full scale integrated assessment, that takes into account both gaseous and PM air pollution.

Exposure Assessment

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TRANSPORTATION, AIR POLLUTION AND PHYSICAL ACTIVITIES (TAPAS): GENERAL DESCRIPTION OF THE 6-CITY ACTIVE TRAVEL POLICY INTEGRATED HEALTH RISK ASSESSMENT PROGAM

ISEE Conference Abstracts (2011)

Audrey de Nazelle Zorana Jovanovic Andersen Ari Rabl Hana Brůhová Foltýnová Martina S. Ragettli

Background: Active travel policies can address some of the greatest global public health challenges - physical inactivity and urban air pollution - while generating multiple co-benefits. Risks may also arise for some who shift to active travel and increase air pollution inhalation and traffic hazard exposure. TAPAS aims at assessing health impacts of such policies in an integrated framework in 6 case-study cities: Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. Methods: TAPAS operates at the interface of policy and scientific research. Program steps include: 1) development of a conceptual framework linking active travel policies to health, 2) expert international workshop assessing conceptual framework and state-of-the art knowledge on relevant exposure-response functions; 3) criteria development for identifying policies of interest in case-study cities; 4) local stakeholder involvement to confront potential choice of policies with local needs and interest; 5) identification of commonalities across case study policies for comparable assessments; 6) identification of local data sources for model inputs; 7) quantitative model development. Also, TAPAS case-study city partners develop specific research projects to provide new knowledge filling research gaps in the current framework. Results: Steps 1-2 have been reported (de Nazelle et al. 2011). Candidate policies were classified in terms of a) known or quantifiable effectiveness, b) local and international interest, and transferability to other cities; c) time and scale of implementation. TAPAS partners identified policies of greatest interest (see accompanying posters), from which the most common themes were selected for preliminary assessments: Bike - lane network; Bike parking; inter-modality; traffic-calming; pricing (parking/congestion); bike sharing systems. A preliminary quantitative model was built and will be populated with local data. Conclusion: TAPAS is viewed as a useful framework by stakeholders. It will provide an evidence-base for designing policies that encourage a shift to active transportation providing physical activity and other health benefits and mitigate risks.

Health Impact Assessment

Traffic calming

Identification

Conceptual framework

10.1289/isee.2011.01670

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TRANSPORTION, AIR POLLUTION AND PHYSICAL ACTIVITIES (TAPAS), A 6-CITY INTEGRATED HEALTH RISK ASSESSMENT PROGRAM OF ACTIVE TRAVEL POLICIES: THE WARSAW CASE STUDY

ISEE Conference Abstracts (2011)

Marko Tainio Piotr Holnicki Katarzyna Juda-Rezler Artur Badyda Magdalena Reizer

Background and Aims: Within the TAPAS research program, quantitative assessments are developed for six case study cities in Europe, linking determinants of active travel to potential co-benefits and co-risks of modal shifts from motorized to non-motorized modes of travel. We describe here the Warsaw case study. Methods: The collection of required data is made as collaboration between different research institutions and city authorities. In addition to already existing data, data from measurements and from the questionnaires will be collected in this and in connected projects. The stakeholder will be contacted in the near future to discuss the data, available policy options and the use of the results. The assessing of uncertainties in the TAPAS model will be special focus. Results: Warsaw, capital city of Poland, has officially 1.7 million inhabitants. The total population of the city is unknown and it is possibly much larger than official one. During the week days and weekends only 0.9% and 1.7% of the trips, respectively, are made with bicycles. Approximately 20% of the trips are made by foot. Large different between walking and bicycling activity is likely to be due to infrastructural issues. The climate in Warsaw is typical central-European climate with daily mean temperature of 8.2°C and annual Precipitation of 495 mm. Thus, the climate is good for both walking and for cycling most of the year. However, Warsaw bike lane network is fragmented and safe bicycle parking places are rare. Both of these will decrease the usability of bicycles inside the city. Therefore the relevant policies we are considering for assessment include 1) the development of the bike lane network; 2) bicycle parking; 3) bicycle renting system. Conclusions: Warsaw is an interesting case for studying a city where the use of bicycles is low but on the same time bicycle infrastructure is under construction.

Capital city

10.1289/isee.2011.01262

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The carbon savings and health co-benefits from the introduction of mass rapid transit system in Greater Kuala Lumpur, Malaysia

Journal of Transport & Health (2017)

Soo Chen Kwan Marko Tainio James Woodcock Rosnah Sutan Jamal Hisham Hashim

Transportation is a convenient way to incorporate an active lifestyle, in addition to reducing environmental pollution. This study estimates the changes in carbon dioxide (CO2) emissions and the health co-benefits from two new mass rapid transit (MRT) lines in Greater Kuala Lumpur, Malaysia. Changes in CO2 and air pollutant emissions were estimated from motor vehicle activity based on the travel information collected from a survey. Health effects were estimated using a comparative health risk assessment method. Exposure to air pollution was modelled based on the reduction in ambient PM2.5 concentration. Traffic injury was estimated using a constant risk per distance for each transport mode. Physical activity was modelled based on the amount of walking to or from the stations. Health outcomes were calculated as changes in premature deaths and disability adjusted life years (DALYs). The two MRT lines would reduce 337,800 t of CO2 equivalent per year from private transportation. However, the use of motor vehicle in the station access-egress would offset 28% of the total carbon savings. The ambient PM2.5 concentration would be reduced by 0.12 µg/m3, preventing 5 deaths and 104 DALYs per year. Reduced traffic injuries would prevent 88 deaths and 6300 DALYs per year, while increased walking would prevent 90 deaths and 3200 DALYs per year. Sensitivity analysis revealed that travel distance, modal shift and station access-egress distance could considerably change CO2 emission reduction, while relative risks of physical activity could significantly affect attributable burden of diseases. The two MRT lines would reduce 6% of CO2 equivalent emission from private motor vehicles in Greater Kuala Lumpur and bring important health co-benefits to the population. However, strategic planning around the MRT stations for access and egress is necessary to achieve maximal benefits.

Mode of transport

10.1016/j.jth.2017.06.006

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Citations (51)

A Probabilistic Characterization of the Relationship between Fine Particulate Matter and Mortality: Elicitation of European Experts

Environmental Science & Technology (2007)

Roger Cooke Andrew Wilson Jouni T. Tuomisto Oswaldo Morales‐Nápoles Marko Tainio

In support of an assessment of the mortality impacts of the Kuwait Oil Fires we interviewed six European experts in epidemiology and toxicology using formal procedures for elicitation of expert judgment. While the primary focus of the elicitations was to characterize the public health impacts of the fires, the experts provided quantitative estimates of the mortality impacts of hypothetical changes in the levels of ambient fine particulate matter (PM2.5) in both the United States and Europe. Uncertainty was assessed by asking each expert to provide the 5th, 25th, 50th, 75th, and 90th percentiles of their subjective cumulative probability density function for each quantity of interest. The results suggest that many regulatory risk assessments underestimate the impacts of PM2.5 mortality; confirm that only a small fraction of the mortality impact occurs within the first few months after exposure; and indicate that it may be important to better address the differential toxicities of particles from various source classes. By providing quantitative estimates of the uncertainty in current estimates of PM2.5 mortality risks, the study facilitates structured analysis of the value of further research on PM2.5 and its impacts.

Expert elicitation

Exposure Assessment

10.1021/es0714078

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Citations (116)