Table 3.
Summary of health impact assessments and comments on health equity according to the type of the strategies.
| Strategy Type | Major Air Pollutants | Reference | Pollution Control Outcome or Targeted Level | Health Outcome * | Was Health Equity Assessed? If Not, Comment on Health Equity |
|---|---|---|---|---|---|
| General regulations on air quality control in Europe | PM2.5, PM10 | Mindell, J. and Joffe, M., 2004 [39] | PM10 concentration with 35 permitted exceedances in 2004 and with 7 exceedances for 2009 for 24 h limit of 50 μg/m3; PM10 annual mean of 20 μg/m3 | Avoided 2–39 deaths per 100,000 if complying 2009 24 h PM10 target; 3.7–9.3 delayed death if complying UK 2009 annual PM10 target in Westminster | Yes, reducing air pollution would decrease inequities because exposure would be reduced most in deprived areas and because those who would benefit most were those with worse health, the very young and older people |
| Ballester, F. et al., 2008 [41] | Annual PM2.5 dropped to 25 μg/m3, 20 μg/m3, 15 μg/m3, and 10 μg/m3, respectively | Annual all-cause premature deaths avoided up to 114 (Cracow) per 100,000 if annual PM2.5 dropped to 10 μg/m3; Averagely 3% of the total mortality burden among 30 years and older can be reduced | No. Comment: Cracow, Athens and Rome had the most pollution, and benefited the most; London, Dublin and Stockholm had less pollution, and benefited less |
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| Perez, L. et al., 2009 [42] | Annual mean ambient air PM10 concentration dropped from 50 μg/m3 to 20 μg/m3 (WHO) and to 40 μg/m3 (EU) | With WHO target, monetized health benefit was 6400 million Euros per year (1600 euro per capita) from mortality and morbidity | No. Comment: with targeted standards. No sign of effect on health equity |
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| Boldo, E. et al., 2011 [45] | An average annual reduction of 0.7 μg/m3 in PM2.5 concentration | Annually, 6 per 100,000 population of all-cause deaths avoided for over 30-years group and 5 per 100,000 population avoided for the 25–74 years age group | No. Comment: major absolute health benefits were in Spain’s most densely populated cities, such as Madrid, Barcelona, Seville, and relative benefits were the highest in Andalusia and Mediterranean areas |
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| Energy related strategies | SO2, NOx, TSP, Black smoke | Aunan, K. et al., 1998 [35] | SO2 concentration dropped by 5.7%, TSP dropped by 9.3%, NOx dropped by 10.1%, nmVOC (non-methane volatile organic compounds) dropped by 10%, and other greenhouse gases dropped | The program reduced air pollution attributed annual excess death by 9% for the whole population, reduced air pollution attributed annual excess infant death (0–1 year) by 11.4%, reduced annual acute respiratory symptom-days for children and adults by 11.2% and 9.8%, and reduced 25 annual lung cancer cases. The monetized health benefit was 1563 million US dollar | No. Comment: for 65+, infant, and those with pre-existing health conditions, the exceeded cases or exposure days were largely decreased, thus benefited more |
| Clancy, L. et al., 2002 [36] | Mean Black smoke concentration dropped by 70% and SO2 concentration dropped by 33.8% | Adjusted mortality rate decreased by 5.7% for total non-trauma, 10.3% for cardiovascular, 15.5% for respiratory, 7.9% for less than 60 years group, 6.2% for 60–74 years group and 4.5% for over than 75 years group | No. Comment: the Ban greatly decreased mortality, particularly for cardiovascular disease group |
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| Chanel, O. et al., 2014 [33] | Gradual decline in SO2 concentration | Postponed annual 2212 premature deaths for 20 cities after 2000 comparing with pre 1993; Annual monetized health benefit from mortality was 191.6 million Euro | No. Comment: the lowest number of postponed deaths attributable to the regulation was obtained in Bilbao and the highest in Athens |
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| Traffic emission control related interventions | NOx, PM | Burr, M.L. et al., 2003 [37] | PM10 concentration decreased by 23% (8.0 μg /m3) in the congested streets and by 29% (3.4 μg /m3) in the uncongested; PM2.5 decreased by 23.5% in congested streets and 26.6% in uncongested streets | Clear improvement around the congested streets for rhinitis symptoms, but no clear differences for low respiratory symptoms | No. Comment: the people living along the intervention area benefited more since the intervention covered specific congested area |
| Hutchinson, E.J. et al., 2004 [38] | NO2 concentration dropped by around 20%, PM10 dropped by around 10%, O3 increased slightly, VOCs dropped by around 30%, and CO dropped by more than 70% | Net health benefit of 510 million Pound to 1998, and 2157 million Pound to 2005 with the combined concentration change of NO2, PM10 and O3 | No. Comment: the city people benefit mostly, the rural areas are unlikely to have large health benefit. |
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| Tonne, C. et al., 2008 [40] | NO2 and PM10 concentrations dropped moderately | Total 183 YLG per 100,000 for NO2 reduction and 63 YLG for PM10 reduction per 10 years in CCS area | Yes, more deprived areas had higher air pollution concentration, and these areas also experienced greater air pollution reductions and mortality benefits compared to less deprived areas | ||
| Johansson, C. et al., 2009 [43] | NOx emission dropped by up to 12%, and PM10 dropped by up to 7% | Annually 20.6 YLG per 100,000 people for NOx reduction | No. Comment: the people in the city center (inside the charge cordon) will have the largest reduction in exposure |
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| Cesaroni, G. et al., 2011 [46] | NO2 and PM10 concentrations decreased by up to 23% and 10% by the policy | 921 YLG per 100,000 along busy road for NO2 reduction, average 686 YLG per 100,000 from NO2, and 116 YLG per 100,000 for PM10 within 150 m of the High traffic Road with the intervention during 15 years | Yes, because wealthy people lived in city center in Rome. High socio-economic population gained most of the health benefit, thus it increased the SEP inequity | ||
| Cyrys, J. et al., 2014 [47] | PM10 concentration dropped by up to 10%, and diesel particle dropped by 58% | Annually 144 avoided death per million due to diesel particle decrease | No. Comment: the people living in the zone might benefit more, or people who suffered more from traffic air pollutants benefited more |
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| Greenhouse-gas emission reduction strategies | PM2.5, O3 | Woodcock, J. et al., 2009 [44] | PM2.5 concentration decreased by up to 9.7% | PM2.5 concentration reduction avoided 33 related premature deaths and 319 DALYs per million population | No. Comment: no sign of effect on health equity |
| Schucht, S. et al., 2015 [48] | For population weighted annual average PM2.5 concentration, with mere air quality policies, 75% decrease from 2005 to 2050, with extra 68% reduction if combining climate policies; For SOMO35 (ozone concentrations accumulated dose over a threshold of 35 ppb), 1% increase without climate policies, and 86% decrease with climate policies | Adjusted by the EU population change, for chronic PM2.5 mortality, air quality control policies would reduce YLL attributable to PM2.5 from 4.6 million to 1 million from 2005 to 2050, with further 300,000 reduction if combining with climate policy. For ozone, premature deaths from acute exposure to ozone would increase from 31,000 to 48,000 from 2005 to 2050, while they would decrease to 7000 with climate mitigation policies at a global level. The monetized health damage would reduce from 3% of the EU GDP in 2005 to 0.4% in 2050 merely with air quality control policies, and to 0.1% if combining with climate policies. | No. Comment: the climate strategies in general decrease the air pollutants (PM2.5 and ozone). No sign of effect on health equity |
* Several studies modelled the health outcomes under different scenarios, but here we only include the one with the largest health benefit.