1. Health impact
of outdoor air
pollutants-
“Some Cases”
Presented
By:
Surendra Bam

2. Outline
• London 2012 Olympics: Could Air Quality Affect Athlete
Performance?
• Air Pollution: Urgent cause for concern in India.
• Health Impact of Outdoor Air Pollution in China: Current
Knowledge and Future Research Needs.
• Health Effects of Outdoor Air Pollution in Developing
Countries of Asia: A Literature Review
• Air quality and health (WHO Media centre)
• Air Quality Index (AQI), USEPA
• References

3. London 2012 Olympics: Could Air
Quality Affect Athlete Performance?
United
Kingdom
Figure 1: Map of Europe
showing the exceedances
of the annual limit value
for NO2 in 2009. Graphic
reproduced from
European Environment
Agency (2011).
Source: www.decodedscience.com

4. • Air pollution has been linked with adverse
health effects in London since the 1952 smog
event.
• The effect of air pollution on athletes has
been a concern since the 1984 Los Angeles
Olympics, when British Steve Ovett collapsed
following the 800m final with respiratory
problems. He cited air pollution as a major
contributing factor to his episode of exercise-
induced asthma.

5. How Could Athletes be Affected at the
Olympic Games?
• Potential health problems resulting from exposure to air
pollutants during exercise include cardiovascular complaints,
decreased performance, asthma, decreased lung function,
and pulmonary hypertension. Athletes are especially
susceptible to health effects from air pollution for four main
reasons:
a) During exercise an increased volume of air is inhaled in
comparison to periods of rest.
b) In response to this exertion, more air is inhaled through the
mouth than when at rest. The mouth lacks the filter systems
of the nose which remove pollution before it can reach the
lungs.
c) The increased air flow during exercise means that pollutants
travel deeper into the lung.
d)The fraction of particulate matter that is deposited during
exercise (i.e. during increased tidal volume) is higher than
during periods of rest (i.e. lower tidal volume).

6. • The most common chronic medical condition among athletes
is asthma (or airway hyper-responsiveness), with about 8% of
athletes affected.
• The effect is greatest for outdoor endurance athletes – in a
number of cases, athletes who did not suffer from asthma in
their childhood went on to develop asthma following years of
athletic training.
• A recent study which investigated marathon times and the
link with air pollution has shown that women have a greater
vulnerability to this issue.

7. Air Pollution: Urgent cause for
concern in India
(Source: www. healthindia.com)
• This year an Environment Performance Index (EPI) report placed India at the
bottom of the 132 countries assessed. Air in some Indian cities has particulate
matter (PM) levels 5 times above safety limits.

8. • Acute respiratory infections account for 13%
deaths in hospitalized children in India.
• Recently WHO declared a direct link between
diesel exhaust and cancer – raising further
alarm bells regarding India’s growing public
health concerns.
• In India, PM10 levels are the biggest cause of
health concern. In 2007, nearly 52% (63) cities
were at critical PM10 levels (≥1.5 times limit).

9. Health Impact of Outdoor Air Pollution in
China: Current Knowledge and Future Research
Needs
(Source: Environ Health Perspect. May, 2009)
• Currently, inhalable particles; PM10, SO2, and
nitrogen dioxide (NO2) are the criteria pollutants
of concern in China.
• Outdoor air pollution has become a major
concern for public health. The World Bank
(2007) estimated that the total health cost
associated with outdoor air pollution in urban
areas of China in 2003 was between 157 and 520
billion Chinese yuan, accounting for 1.2–3.3% of
China’s gross domestic product.

10. • A recent multicity time-series analysis in Hong Kong,
Shanghai, and Wuhan provided further evidence of
short-term risks (Wong et al. 2008), with significant
health effects detected at air pollution levels below
minimum air quality standards in China.
• Several prospective cohort studies in North America
and Europe have estimated effects of long-term
exposure to air pollution on mortality (Pope and
Dockery 2006), but it is not clear whether the findings
from developed countries apply to China, given
differences in the levels and characteristics of air
pollution, and in sociodemographic characteristics.

11. Health Effects of Outdoor Air
Pollution in Developing Countries of
Asia: A Literature Review
• Systematic identification of 140
peer-reviewed Asian studies 1980-
2003
• Special focus on studies of daily
changes in air pollution and health
• Conduct first ever “Asian meta
analysis” quantifying risks, finding
initial similarities with West
• Identify knowledge gaps to guide
future research
• Active communication to policy
makers

12. Many Health Effects Studied
12
10
Number of Studies
TSP
8 PM10
PM2.5
6 SO2
NO2
4 CO
O3
2
0
All-Cause Respiratory Cardiovascular Respiratory Cardiovascular
Mortality Mortality Mortality Hospital Hospital
Admissions Admissions
Outcome Diagnosis

13. Daily Mortality: Initial Results:
Asian Risk Estimates Similar to West

14. Air quality and health
WHO Media centre (September 2011)
• The WHO Air quality guidelines represent the most
widely agreed and up-to-date assessment of health
effects of air pollution, recommending targets for air
quality at which the health risks are significantly
reduced. The Guidelines indicate that by reducing
particulate matter (PM10) pollution from 70 to 20
µg/mᵌ , we can cut air quality related deaths by around
15%.
• Urban outdoor air pollution is estimated to cause 1.3
million deaths worldwide per year. Those living in
middle-income countries disproportionately
experience this burden.

15. WHO Air quality guidelines (AQGs), 2005
Outdoor Air pollutants WHO Guideline values
PM2.5 10 μg/m3 annual mean
25 μg/m3 24-hour mean
PM10 20 μg/m3 annual mean
50 μg/m3 24-hour mean
O3 100 μg/m3 8-hour mean
NO2 40 μg/m3 annual mean
200 μg/m3 1-hour mean
(SO2) 20 μg/m3 24-hour mean
500 μg/m3 10-minute mean

16. • The Air Quality Index (AQI) is an index for reporting daily air
quality. It tells you how clean or polluted your air is, and
what associated health effects might be a concern for you.
• The AQI is calculated for four major air pollutants regulated
by the Clean Air Act: ground level ozone, particle pollution,
carbon monoxide, and sulfur dioxide.

17. How Does the AQI Work?
• Think of the AQI as a yardstick that runs from
0 to 500. The higher the AQI value, the greater
the level of air pollution and the greater the
health Impact.
• An AQI value of 100 generally corresponds to
the national air quality standard for the
pollutant, which is the level EPA has set to
protect public health.

18. • AQI is divided into six levels of health concern:
Meaning
Air quality is considered satisfactory,
and air pollution poses little or no risk
Air quality is acceptable; however, for
some pollutants there may be a
moderate health concern for a very
small number of people who are
unusually sensitive to air pollution.
Members of sensitive groups may
experience health effects. The general
public is not likely to be affected.
Everyone may begin to experience
health effects; members of sensitive
groups may experience more serious
health effects.
Health warnings of emergency
conditions. The entire population is
more likely to be affected.
Health alert: everyone may experience
more serious health effects

19. Source: www.airnow.gov.

20. • Each day, monitors record concentrations of the major
pollutants at more than a thousand locations across the
country.
• These raw measurements are converted into a separate
AQI value for each pollutant standard formulas
developed by EPA.
• Many cities also provide reporting and forecasts for the
next day’s AQI.
• These forecasts help local residents protect their health
by alerting them to plan their strenuous outdoor
activities for a time when air quality is better.

21. References
• Environ Health Perspect. 2009 May
• www.airnow.gov.
• WHO Media centre (Updated September
2011)
• WHO Air quality guidelines (AQGs), 2005
• www.decodedscience.com
• www. healthindia.com