Presentation given by Prof. Doug Dockery at the 2015 Clean Air Conference, 28/09/15, Dublin

1. US Six Cities and Relevance
for Clean Air Policy in Ireland
Clean Air Conference 2015
September 28, 2015
Wood Quay Venue, Dublin
Douglas W. Dockery
Professor of Environmental Epidemiology
Harvard School of Public Health

2. Dublin Coal Ban
 On September 1, 1990, the
marketing, sale, and distribution of
bituminous coals was banned
within the city of Dublin (Air
Pollution Act, 1987).

3. 0
20
40
60
80
100
120
140
µg/m3
Dublin Black Smoke
Ban on Coal Sales
14.6 µg/m3
50.2 µg/m3

4. Bans on
Coal Sales
September 1, 1990
-Dublin
October 1, 1995
-Cork
October 1, 1998
-Limerick
-Dundalk
-Drogheda
-Wexford
-Arklow

5. 98th percentiles of Daily Black Smoke
Concentrations in Major Urban Areas
Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
DUBLIN CORK
1990 Ban 1995 Ban 1998 Ban

6. What are the effects of
repeated, long term
exposures to Fine Particles?

7. Satellite-Derived PM2.5:
2001–2006 Average
Von Donkelaar et al Envir Hlth Pers 2010;118:847

8. Six Cities Adult Mortality Study
 Random sample of
8411 adults in six
cities
 Dirty: Steubenville,
OH & St. Louis, MI
 Moderate: Watertown,
MA & Harriman, TN
 Clean: Topeka, KS &
Portage, WI
 Enrolled 1974-77
 14-16 years of
mortality follow-up
Dockery et al, NEJM 1993;329:1753

9. Follow-up

10. Six Cities Adult Mortality Study
 Random sample of
8411 adults in six
cities
 Dirty: Steubenville,
OH & St. Louis, MI
 Moderate: Watertown,
MA & Harriman, TN
 Clean: Topeka, KS &
Portage, WI
 Enrolled 1974-77
 14-16 years of
mortality follow-up
Dockery et al, NEJM 1993;329:1753

11. Six Cities Adult Mortality
0.7
0.8
0.9
1.0
1.1
1.2
1.3
1.4
0 10 20 30 40
PM2.5 (µg/m3
)
MortalityRiskRatio
Steubenville
Topeka
Watertown
Kingston
St. Louis
Portage
EPA NAAQS

12. Six Cities Mortality Follow-up
 1974 to 1989 follow-up
 Annual returned
postcards and
National Death Index
 1,364 deaths
 104,243 person
years
 PM2.5 measurements
1979-1986
 1990 to 1998 follow-up
 National Death Index
search
 1,368 deaths
 54,735 person
years
 PM2.5 estimated from
PM10 1990-1998
Laden et al, AJRCCM 2006;54:709

13. Six Cities Cohort Follow-up
Laden et al, AJRCCM 2006;54:709
0.7
0.8
0.9
1.0
1.1
1.2
1.3
1.4
0 5 10 15 20 25 30 35
PM2.5 (µg/m
3
)
MortalityRiskRatio
Steubenville
Topeka
Watertown
Kingston
St. Louis
Portage
Improved air quality
leads to reduced mortality

14. Can we see effect of air
pollution controls in US?

15. Age-adjusted death rates: United States, 1960-2005
600
800
1,000
1,200
1,400
Rateper100,000population
1970 1980 1990
Age-adjusted
1960
0
2000 2005

16. County life expectancies at birth for white males
and females;1997–2001
CJL Murray et al, Eight Americas: Investigating Mortality Disparities across Races, Counties, and
Race-Counties in the United States. PLoS Med. 2006 Sep;3(9):e260

17. Trends in the Levels of the Six Criteria Pollutants
Relative to U.S. National Standards: 1980 - 2006

18. 51 Metropolitan areas (dots); Study Counties (shaded gray)

19. Life Expectancy vs PM2.5
1978-82
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30 35
PM2.5 (µg/m3
)
LifeExpectancy
Steubenville
Topeka
Boston
EPA NAAQS
Pope, Ezzati, Dockery. NEJM 2009; 360:376

20. Life Expectancy vs PM2.5
1997-2001
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30 35
PM2.5 (µg/m
3
)
LifeExpectancy
Topeka
Boston
Steubenville
EPA NAAQS
Pope, Ezzati, Dockery. NEJM 2009; 360:376

21. Life Expectancy vs PM2.5
1980-2000
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30
PM2.5 (µg/m3
)
LifeExpectancy
Topeka
Pope, Ezzati, Dockery. NEJM 2009; 360:376

22. Life Expectancy vs PM2.5
1980-2000
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30
PM2.5 (µg/m
3
)
LifeExpectancy
Pope, Ezzati, Dockery (NEJM 2009)
EPA NAAQS
Health benefits below
current NAAQS
CAFE
Stage I
Limit
Value
CAFE
Stage II
Limit
Value

23. 71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30
LifeExpectancy
PM2.5 (µg/m3)
Coleraine St
PM2.5 9.7 µg/m3
↓
2012 Life Expectancy
80.9 year
1990 Life Expectancy
74.8 year
What would these results say about air
pollution in Ireland?
PM2.5 in 1990?

24. Black Smoke Before and After Bans
Goodman et al, JAWMA 2009

25. 71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30 35
LifeExpectancy
PM2.5 (µg/m3)
CORK
Black Smoke
Pre-Ban
32.4 µg/m3
↓
↑
Post-Ban
17.2 µg/m3
3.8 yr
Implications of US data for Cork?

26. 65
67
69
71
73
75
77
79
81
0 10 20 30 40 50
LifeExpectancy
PM2.5 (µg/m3)
1984-90
50.2 µg/m3
↑
1990-96
14.6 µg/m39.0 yr
Implications of US data for Dublin?

27. 0 2 4 6 8 10
Galway
Celbridge
Leixlip
Naas
Waterford
Limerick
Dundalk
Drogheda
Arklow
Cork
Dublin
2000Ban1998Ban
1995
Ban
1990
Ban
Estimated Extra Years Life Expectancy
Implications of US data?
Median 3.5 yrs

28. How big is 3.5 year increase in life
expectancy?
 68 year old nonsmoking male
 Additional life expectancy
15.5 years
 Additional 3.5 years
life expectancy
 19.0 years
+

29. How big is 3.5 year increase in life
expectancy in population of Ireland?
 Tobacco Smoking
 6.8 years reduced life expectancy for average smoker (Streppel
et al, Tob Cont 2007)
 31% Current Smoking in Ireland(2009) (Special Eurobarometer 332)
 6.8 yr among 31% of population
 2.1 yr longer life expectancy in population
 Diabetes
 7.8 years for men, 8.4 years for women (Fromer et al, Arch Int Med
2007)
 4.7% Diabetes Mielitus in Ireland (2005) (Institute of Public Health
in Ireland, 2006.)
 8 yr among 4.7% of population
 0.4 yr longer life expectancy in population
 Fine particle air pollution
 Median 3.5 years for reduction in Black Smoke due to ban
 100% of population affected
 3.5 yr longer life expectancy in population

30. Conclusions
 PM2.5 associated significant life
shortening (mortality)
 Improved air quality leads to
measurably improved public health
 Benefits at all levels of air pollution
 Even in clean communities
 Ireland likely has substantially longer
life expectancy due to ban on coal sales