2 ICAP Summary Report TABLE OF CONTENTS ACKNOWLEDGEMENTS... 1 INTRODUCTION... 1 DAMAGE ESTIMATES... 1 Health Effects... 1 Premature Death... 1 Hospital Admissions... 3 Emergency Room Visits... 4 Minor Illnesses... 5 Summary... 6 Economic Damages... 7 Lost Productivity... 7 Healthcare Costs... 7 Pain and Suffering... 7 Loss of Life... 8 Total Damages... 8 Regional Distribution of Damages... 8 REVISIONS TO ICAP... 8 Population Data... 8 Air Quality Data... 9 Base Incidence Rates... 9 Concentration-response Functions... 9 Economic Damage Coefficients ICAP Operation CONCLUDING COMMENTS Improved Damage Estimates Gaps and Uncertainties Enhanced Software Future Revisions REFERENCES LIST OF FIGURES Figure 1 Premature Deaths Broken Down By Age Group... 2 Figure 2 Hospital Admissions Broken Down By Illness Type... 3 Figure 3 - Hospital Admissions Broken Down By Age Group... 4 Figure 4 Emergency Room Visits Broken Down By Illness Type... 4 Figure 5 Minor Illnesses Broken Down By Illness Type... 5 Figure 6 Minor Illnesses Broken Down By Age Group... 6 LIST OF TABLES Table 1 Provincial Health Damage Summary for Three Example Years... 6 Table 2 Economic Damages for Three Example Years... 7
3 1 ICAP Summary Report Acknowledgements The Ontario Medical Association would like to thank the Laidlaw Foundation, Environment Canada, Health Canada and the Ontario Ministry of the Environment for their valuable contributions to this project. Without their assistance this work would not have been possible. Introduction In June 2000, the OMA presented the first version of our Illness Costs of Air Pollution software model and detailed findings on the health effects and economic costs of air pollution in Ontario. It was apparent that over time, a rapidly improving scientific understanding of smog s health effects would require the OMA to update this model. In 2000 the science would not support the information that we are now able to present. Due to our improved understanding, we have found that some of our previous estimates have been decreased, but the science now compels us to attribute more serious illness and premature deaths to smog. Included in the new OMA determinations of smog s toll are new health studies on the chronic effects of exposure, new air pollution and demographic data and extensive analysis of the principle studies on the health effects of air pollution. Improved as it is, there are still gaps in scientific understanding and thus further improvements to ICAP will be possible in the future. Of most concern to the OMA is the lack of credible studies on doctors office visits due to smog related illness. We have not included a value for this important and expensive impact, thus still underestimating smog s overall cost. Damage Estimates The updated version of ICAP has been used to generate revised estimates of provincial health and related economic damages associated with air pollution exposure. The following damage estimates relate primarily to the risks of exposure to fine particulate matter (i.e., PM 2.5 ) and ozone. Health Effects ICAP provides estimates of health effects according to four major health endpoints, namely, Premature Death Hospital Admissions Emergency Room Visits Minor Illnesses Damages for each of these major health endpoints may be further broken down by more specific illness categories, age groups and geographic locations. Following is a summary of the latest damage estimates for Ontario. Premature Death The revised version of ICAP includes concentration-response functions based on time-series and cohort epidemiological studies. Where available, the cohort-based relative risks, which show the long-term, cumulative impacts of air pollution, are preferred for policy analysis since they present a more complete picture of health risks associated with air pollution. Previous ICAP estimates of
4 2 ICAP Summary Report premature death were based on time-series studies, which only identified the immediate impacts of pollution. Figure 1 shows the expected number of premature deaths by age group over the next 20 years. The great majority of the premature deaths will be suffered by the elderly. It is our belief that children and infants with compromised health conditions are also at risk of premature death, but there is not sufficient scientific documentation for this age group, so the risk of these deaths has not been included in our calculations. The OMA s new cumulative estimate for smog-related premature mortality is 5,800 deaths annually. This is considerably greater than the 1,900 estimated in ICAP 2000 and there are a number of reasons for this. The 2000 estimate was based strictly on time-series studies and included risks for course smog particles (PM 10 ) only. We now have clear scientific evidence of premature deaths for a number of other pollutants (i.e., ozone (O 3 ) sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ) and carbon monoxide (CO)) and have included these time-series findings. The most significant change though is that we now have reliable cohort-based studies for PM 2.5 which show the premature deaths that result from the long-term effects of exposure. Although for the purposes of presentation we have added the short-term and long-term smog deaths together, they are quite different. The approximately 4,000 additional deaths for which smog is a factor are the result of a lifetime of exposure and the cumulative effects of smog on our bodies. Whereas short-term effects could be mitigated by eliminating the pollution exposure or providing medication to counteract a health response, a physician cannot cure someone whose tissue has accumulated the effects of smog over time. All that we can do then is try to manage the illness. Figure 1 Premature Deaths Broken Down By Age Group Similar to the 2000 premature death estimate, most of the deaths are related to respiratory and cardiovascular illnesses. The cohort-based studies found also an increased risk of death due to
5 3 ICAP Summary Report lung cancer. This finding relates not to an increased risk of contracting lung cancer (although this may be the case as well) but to an increased chance of premature death for those that do contract lung cancer from whatever cause. Hospital Admissions Comprehensive cohort-based epidemiological studies are available only for premature death. The risks for all other health endpoints are based on time-series studies. Likewise, all morbidity (illness) risks include only risks associated with exposure to particulate matter and ozone. Figure 2 shows the expected number of hospital admissions associated with respiratory and cardiovascular illnesses. Figure 2 Hospital Admissions Broken Down By Illness Type In ICAP 2005, the total hospital admissions associated with air pollution exposure is estimated at over 16,000. Most of these cases will be associated with cardiovascular illnesses. The increase in estimated hospital admissions compared to the ICAP 2000 estimate is associated with changes in the provincial population, improved and more comprehensive risk estimates and the inclusion of all cardiovascular and respiratory illness types that are treated at hospitals. The 2000 hospital admissions estimates were based only on six specific cardiovascular and respiratory illness types. Figure 3 shows the total hospital admissions broken down by age group. Most of the estimated hospital admissions are associated with two adult age categories. As with other illness risk estimates, the proportion of elderly cases is forecast to increase substantially as the baby boomers age and move into the oldest age class.
6 4 ICAP Summary Report Emergency Room Visits Less severe respiratory and cardiovascular illnesses are often treated by unscheduled emergency room visits. Figure 4 shows the expected number of emergency room visits associated with respiratory and cardiovascular illnesses. For the purposes of this determination, Emergency Room Visits that result in admission due to the more severe nature of the illness, have been factored out to avoid double counting. In 2005, the emergency room visits associated with air pollution exposure is estimated at almost 60,000 cases. As with hospital admissions, most of these cases will be associated with cardiovascular illnesses. Figure 3 - Hospital Admissions Broken Down By Age Group Figure 4 Emergency Room Visits Broken Down By Illness Type
7 5 ICAP Summary Report The increase in estimated emergency room visits is the result of additional risk estimates being added for fine particulate matter. The 2000 estimates were based primarily on ozone exposure. The distribution of these emergency room visits by age group is similar to that associated with hospital admissions. Likewise, the distribution is expected to be strongly skewed toward the elderly age group in the future. Minor Illnesses Minor illnesses are the least severe health endpoint associated with air pollution exposure but by far, the most common. Figure 5 shows the expected number of minor illnesses associated with exposure to particulate matter (i.e., PM 10 ) broken down by three general minor illness types. Figure 5 Minor Illnesses Broken Down By Illness Type Minor illness risk factors for exposure to fine particulate matter (i.e., PM 2.5 ) are not currently available. Likewise, there are a significant number of studies about respiratory clinical symptoms caused by ozone exposure but minor illness risk factors for ozone exposure have not been included in the revised version of ICAP due to the dearth of suitable epidemiological studies on minor illness risks. Finally, minor illness risks are included only for the youngest and oldest age groups, similar to the configuration of the 2000 version of ICAP. Undoubtedly, adults also suffer from minor illnesses associated with air pollution exposure but suitable risk factors are not currently available. For these reasons, the estimates of minor illness cases are likely underestimates. In 2005, a total of over 29 million minor illnesses are expected to be associated with air pollution exposure. Most of these cases will be minor restricted activity days and restricted activity days. As shown in Figure 6, these minor illnesses are associated only with the youngest and oldest age groups. Children under 18 account for the majority of the minor illness cases.
8 6 ICAP Summary Report Figure 6 Minor Illnesses Broken Down By Age Group Summary Table 1 provides a summary of estimated health cases associated with air pollution for four example years. These results show changes that occurred as the result of recent improvements to ICAP 2005, but also demonstrates the substantial increase in health damages that can be expected in Ontario over the next 20 years if air quality does not improve. For example, premature deaths are expected to climb from 5,800 in 2005 to 10,000 in Similar trends are evident with all of the other health endpoints included in ICAP. Table 1 Provincial Health Damage Summary for Four Example Years Example Years 2000* Premature Deaths 1,925 5,829 7,436 10,061 Hospital 9,807 16,807 20,067 24,587 Admissions Emergency Room 45,250 59,696 71,548 87,963 Visits Minor Illnesses 46,445,663 29,292,100 31,962,200 38,549,300 * Estimates from the original OMA ICAP model are included here for the purpose of comparison. Premature death estimates were significantly lower in 2000 because the previous model relied solely on time-series studies which only identified smog s immediate health effects. The science now makes it possible to estimate the health implications of long-term exposure and deaths due to smog-related chronic illness. Hospital admission estimates have increased as a result of changes to risk coefficients and more illnesses being included in the analysis. Emergency room visit estimates have increased because of new risk coefficients and the inclusion of more smog pollutants in our determination. Minor illness estimates have decreased as the result of changes to the risk coefficients, but were also significantly influenced by improved air pollution data and an increase in background level of air pollution.
9 7 ICAP Summary Report Economic Damages ICAP provides estimates of economic damages according to four major categories, namely, Lost productivity Healthcare costs Pain and suffering Loss of life Table 2 presents a summary of the economic damages for 2005, 2015 and 2026 in constant 2004 dollars. Following is a discussion of these revised economic damage estimates for Ontario. Table 2 Economic Damages for Three Example Years Example Years Lost Productivity $374,342,400 $402,883,900 $466,508,500 Healthcare Costs $506,612,700 $571,089,400 $701,988,500 Pain and Suffering $536,546,600 $593,149,400 $718,341,300 Loss of Life $6,391,700,000 $8,279,400,000 $11,027,400,000 Total $7,809,201,700 $9,846,522,700 $12,914,238,300 Lost Productivity Lost productivity includes the time lost due to treatment and recovery from air pollution-related illnesses. Lost productivity includes time lost by patients and caregivers. Lost time is valued at the going wage rate for the corresponding age of the person affected. In 2005, economic damages due to lost time from air pollution-associated illness are expected to be in the order of $374 million. This total is expected to increase to over $466 million by Healthcare Costs Healthcare costs include the costs of institutional care plus medication. In 2005, economic damages due to healthcare costs from air pollution-associated illness are expected to be in the order of $507 million. This total is expected to increase to nearly $702 million by Pain and Suffering Economic damages associated with pain and suffering relate to the amount that people are willing to pay to avoid illnesses causing pain and suffering. The original version of ICAP was based on a preliminary Canadian study of the willingness to pay of patients suffering from various types of symptoms. The results of that study have been refined and these refined pain and suffering estimates were used for these economic damages.
10 8 ICAP Summary Report In 2005, economic losses associated with pain and suffering from air pollution-related illness are expected to be in the order of $537 million. This total is expected to increase to more than $718 million by Loss of Life The value of premature death is estimated based on the willingness of people to pay to reduce this risk. The value of reducing the risk of premature death has been revised based on a recent Canadian study (Krupnick et al, 2002). The value varies with age. Overall, the default values in ICAP are considerably less than what have been used in other air pollution damage studies. In 2005, economic losses involving premature death associated with air pollution exposure are expected to be in the order of $6.4 billion. This total is expected to increase to over $11 billion by Total Damages Combining these four economic damage categories produces an estimate of the total provincial economic damages associated with exposure to air pollution. In 2005, overall economic losses associated with air pollution exposure are expected to be in the order of $7.8 billion. This total is expected to increase to over $12.9 billion by Regional Distribution of Damages The ICAP model has the capacity to produce quite detailed estimates of damages that can be broken down by various combinations of pollutants, locations, illness types and age groups. The OMA will soon release a summary of health and economic damages for various locations throughout the province. Further breakdowns can also be produced using the ICAP software, which the OMA will make available on its website. Revisions to ICAP ICAP relies on four principal information elements, namely, 1) the size and characteristics of the exposed population, 2) the type and concentration of air pollution to which the population is being exposed, 3) the expected health responses of the population to air pollution exposure, and 4) the economic consequences of adverse health effects caused by air pollution. All of these elements have been updated in the new version of ICAP. Population Data In Canada, a new population census is conducted every five years. The last census occurred in 2001, and so was not available for ICAP 2000, which relied on 1996 census data. These census statistics were obtained for each census division (CD) in Ontario and used to update the ICAP population data.
11 9 ICAP Summary Report Air Quality Data Comprehensive air quality monitoring data available for the most recent years (i.e., for 2000 to 2002) have been obtained. ICAP 2000 used air quality data from 1991 to The geographic interpolation of this data to census divisions was undertaken using a mathematical procedure known as kriging. The focus of ICAP relates to health damages associated with exposure to air pollutants arising from anthropogenic emissions. Some pollutants originate from natural causes (e.g., forest fires) and some originate from far outside our geographical region (e.g., global transport, stratospheric contributions, etc). For this reason, natural background concentrations are often deducted to obtain estimates of damages caused by human emissions of air pollutants. The estimates of background concentrations in this version of ICAP have been refined using data from the Ontario Ministry of the Environment. Base Incidence Rates Health damages associated with air pollution are dependent on: The size and health characteristics of the exposed population. The relative risk of exposure to a certain air pollutant at a certain concentration Base incidence rates (BIRs) for various illnesses in the population have been updated. Death and illness statistics were obtained from various sources for the Ontario population. Separate statistics were obtained where available for each of the three age groups in ICAP. Concentration-response Functions Several recent major reports were used to derive the new ICAP pollution concentration-health response functions (CRFs). The discovery of a mathematical problem with the S-Plus statistical software on which many epidemiologists had relied for their analyses necessitated an extensive re-investigation. The data was re-analysed and revised relative risk estimates were published (HEI, 2003). The results of this re-analysis have been incorporated in this new version of ICAP. Part of the reason for the urgent need to have the HEI re-analysis performed was the impending finalization of the U.S. Environmental Protection Agency (EPA) particulate matter criteria document. Once the HEI results were available, the criteria document was finalised and released to the public (US EPA, 2004). This document provides an exhaustive analysis covering studies from all parts of the world that relate to the epidemiological and clinical findings on the risk of exposure to particulate matter. This document and its interpretation by the US EPA were carefully considered in developing the particulate matter CRFs. A third major source of information was the Review of the California Ambient Air Quality Standard by the California Air Resources Board (CARB, 2005). This document is similar in scope and detail to the US EPA particulate matter criteria document. The ozone review document was a primary reference for the revised ozone concentration-response functions. All three documents are current and provide a strong technical basis on which to derive the ICAP concentration-response functions. Primary epidemiological studies were consulted as required.
12 10 ICAP Summary Report Another major development in the air pollution epidemiological literature has been the increasing attention being given to the results of relative risk estimates derived from long-term cohort studies. ICAP has been modified to include premature death concentration-response functions based on cohort studies. Economic Damage Coefficients The economic damage coefficients in ICAP have been adjusted to 2004 dollars. Some factors have been updated with readily available statistics (e.g., wage rates). Two major adjustments to the economic coefficients have been made, namely, the estimates of the losses associated with premature death and those relating to pain and suffering. These changes are in response to new studies published since the last version of ICAP was released. ICAP Operation Revisions have been made to the ICAP software to make it more user-friendly and transparent. Changes have been made to 1) the variables that the user can modify, 2) to the Monte Carlo simulation routine used for uncertainty analysis and 3) to the operation of the system when designing and reviewing the results of an ICAP run. Concluding Comments This summary report provides an overview of the revisions that have been made to ICAP and the effects of these revisions on provincial health and economic damage estimates. Following are some concluding comments arising from these results. Improved Damage Estimates These revised damage estimates represent a significant improvement over the previous damage estimates. Major improvements include: Updated population, air quality and base illness data. Refined and expanded concentration-response functions based on the latest scientific literature. Refined economic coefficients based on the latest health economics literature. Gaps and Uncertainties While the revised damage estimates are an improvement over the previous estimates, many gaps and uncertainties still remain. In most cases, these gaps tend to result in underestimates of the true damages. One such gap is the lack of a complete set of concentration-response functions for each of the air pollutants. As additional concentration-response functions are added, the damage estimates will improve further. In general, the variability of the damage estimates increases as the severity of the health endpoint decreases. This trend is due to several factors. First, the more severe health endpoints are more likely to result in accurate diagnoses and reporting. Second, the number of studies declines as the severity of the health endpoint declines. There are various reasons for this.
13 11 ICAP Summary Report Many of the ICAP default values include error ranges for the mean estimates. ICAP includes a Monte Carlo simulation routine designed to examine the effects of these error ranges on damages estimates. These uncertainty bounds are an important consideration when specific air quality improvement polices are being analysed. Enhanced Software A revised version of the ICAP software has been produced and is being released to the public, similar to what was done with the first version of ICAP. The new software has some significant improvements that make use of the model easier and more transparent. This new software should be used rather than the previous version of ICAP for analyzing the health consequences of air pollution. Future Revisions Undoubtedly, understanding of air pollution effects on human health will continue to expand in the future. The latest version of the ICAP software is a reasonable tool for analyzing and understanding the consequences of air pollution. However, users should recognize that ongoing refinements are essential. Given the increased user access to the ICAP default values, skilled and knowledgeable users will be better able to update their system as new information and understanding emerge. Nonetheless, refinements to the core software will likely continue to be required in the future. User feedback has been helpful in shaping the new version of ICAP and comments on the new version are welcomed. References California Air Resources Board (CARB), Review of the California Ambient Air Quality Standard For Ozone: Initial Statement of Reasons for Proposed Rulemaking, March 11, California Environmental Protection Agency, Air Resources Board and Office of Environmental Health and Hazard Assessment DSS Management Consultants Inc Refinements and Updating: Illness Costs of Air Pollution (ICAP). Report prepared for the Ontario Medical Association (OMA). Health Effects Institute (HEI) Revised Analyses of Time Series Study of Air Pollution and Health Special Report: Revised Analyses of the National Morbidity, Mortality and Air Pollution Study, Part II and Revised Analyses of Selected Time-Series Studies. Health Effects Institute, Cambridge, ME Krupnick A, Alberini A, Cropper M, Simon N, O Brien B, Goeree R and M Heintzelman Age, health, and the willingness to pay for mortality risk reductions: A contingent valuation survey of Ontario residents. J Risk Uncert 24: U.S. Environmental Protection Agency (US EPA) Air Quality Criteria for Particulate Matter. Office of Research and Development, National Center For Environmental Assessment, Research Triangle Park Office, Research Triangle Park, NC, EPA/600/P-99/002aF.
SOCO National Environment Protection (Ambient Air Quality) Measure Report of the Risk Assessment Taskforce 2 Appendix 6 Pb NO 2 Possible use of Health Risk Assessment in the Review of NEPM Pollutants Specified
AUTOCATALYSTS AND PLATINUM GROUP METALS (PGMs) PLATINUM GROUP METALS THE POWER TO IMPROVE LIVES LCA FACT SHEET LCA PRIMARY PRODUCTION FACT SHEET ENVIRONMENTAL PROFILE AUTOCATALYSTS FACT SHEET SECONDARY
Health Impacts of Air in India in India in India JN Pande Sitaram Bhartia Institute of Science and Research, New Delhi Well documented in developed countries using several epidemiological study designs.
FACT SHEET PROPOSED REVISIONS TO THE NATIONAL AMBIENT AIR QUALITY STANDARDS FOR SULFUR DIOXIDE SUMMARY OF ACTION o On November 16, 2009, EPA proposed to strengthen the National Ambient Air Quality Standard
AIR QUALITY AND URBAN HEALTH IMPACTS Waterloo Region A Preliminary Assessment Region of Waterloo Public Health, February 2008 AIR QUALITY AND URBAN HEALTH IMPACTS, WATERLOO REGION A Preliminary Assessment
Prediction of the distribution of the pollutants emitted by a waste incinerator in an urban area using numerical simulations Abstract In the last years, the problem of the control of the toxic emissions
www.defra.gov.uk Air Quality Appraisal Damage Cost Methodology Interdepartmental Group on Costs and Benefits, Air Quality Subject Group February 2011 Damage costs are one way of approximating the impacts
22 May 2014 Haze and Health Effects Image source: http://www.straitstimes.com 1. What is Haze? Haze is an aggregation in the atmosphere of very fine, widely dispersed, solid or liquid particles, or both,
The Public Health Management of Chemical Incidents Case Study Professor David Russell, The WHO Collaborating Centre for Chemical Incidents, Cardiff, Wales, UK Location http://www.wales-calling.com/wales-buttons-maps/wales-town-map.gif
What are the causes of air Pollution Pollutant Particulate Matter (PM-PM 10 and PM 2.5 ) Description and main UK sources Particulate Matter is generally categorised on the basis of the size of the particles
The Regulatory Impact Analysis (RIA) for the Mercury Air Toxics Standard (MATS) Kevin Culligan U.S. Environmental Protection Agency (EPA) Associate Division Director, Sector Policies and Programs Division
Impact of roadside pollution on public health Connie Li 1. Introduction With more than 7 million inhabitants, Hong Kong is one of the most urbanized and densely populated cities in the world. The metropolis
PUBLIC HEALTH ADVOCACY FOR SUSTAINABLE COMMUNITIES Bonnie Holmes-Gen Senior Director, Policy and Air Quality American Lung Association in California State of the Air 2012 Air Pollution Health Risks Premature
FOSSIL FUEL ENERGY IMPACTS ON HEALTH Helena Ribeiro Department of Environmental Health, Faculdade de Saúde Pública, Universidade de São Paulo, Brazil Keywords: Fossil Fuel, Combustion, Air Pollution, Respiratory
www.gov.uk/defra Valuing impacts on air quality: Updates in valuing changes in emissions of Oxides of Nitrogen (NO X ) and concentrations of Nitrogen Dioxide (NO 2 ) September 2015 Crown copyright 2015
Health effects of particulate matter and implications for policy in Europe Marie-Eve Héroux Technical Officer, Air Quality and Noise WHO European Centre for Environment and Health Bonn, Germany Presentation
The Evaluation of Cancer Control Interventions in Lung Cancer Using a Canadian Cancer Risk Management Model WK Evans, M Wolfson, WM Flanagan, J Shin, FF Liu JR Goffin, K Asakawa, N Mittmann, L Fairclough
COMMUNICATING AIR POLLUTION EXPOSURE: A NOVEL AIR POLLUTION INDEX SYSTEM BASED ON THE RELATIVE RISK OF MORTALITY ASSOCIATED WITH EXPOSURE TO THE COMMON URBAN AIR POLLUTANTS. Eugene K Cairncross 1 and Juanette
Updating BC Provincial Air Quality Objectives An Options Discussion Paper Prepared by: Robert B. Caton, PhD, RWDI West Inc. and David V. Bates, MD Prepared for: BC Ministry of Water, Land & Air Protection
2014 2015 Pre-Budget Consultation Submission to the Standing Committee on Finance Executive Summary and Recommendations August 6 th, 2014 Crohn s and Colitis Canada is pleased to provide input to the Standing
Invisible air pollution is the second biggest public health risk Barbican Association London: 26 April 2012 Simon Birkett, Founder and Director, Clean Air in London www.twitter.com/cleanairlondon http://delicious.com/cleanairlondon
NURSES AND ENVIRONMENTAL HEALTH CNA POSITION The environment is an important determinant of health and has a profound impact on why some people are healthy and others are not. 1 The Canadian Nurses Association
Jorine Campopiano US Environmental Protection Agency Region 9 Schools Environmental Health Coordinator May 27, 2014 Today we ll talk about The Flag Program The purpose of the program Background information
Impacts of air pollution on human health, ecosystems and cultural heritage Air pollution causes damage to human health, crops, ecosystems and cultural heritage The scientific data presented in this brochure
COMMUNITIES FOR A BETTER ENVIRONMENT Children s Exposure to Diesel Engine Exhaust: Important Facts For Consideration How Bad is Diesel Exhaust? Diesel exhaust is a sooty cocktail containing 40 different
Air Quality: Public Health Impacts and Local Actions This briefing is to inform public health professionals of the public health impacts of air pollution, the sources of air pollution and measures available
The Cost of Diabetes in The Cost of Diabetes in Saskatchewan The Saskatchewan Diabetes Cost Model 1 In 2009, the Canadian Diabetes Association commissioned a report, An Economic Tsunami: the Cost of Diabetes
Presentation to Conference on: The Costs of Air Pollution: A Forgotten Problem Università Bocconi, Milano 25 November 2014 Valuing life and health: the cost of air pollution by Dr. Rana Roy Introduction
NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential
Proposed PAHO Plan of Action for Cancer Prevention and Control 2008 2015 Prevent what is preventable, cure what is curable, provide palliative care for patients in need, and monitor and manage for results.
Estimated Public Health Impacts of Criteria Pollutant Air Emissions from the Salem Harbor and Brayton Point Power Plants Jonathan Levy 1 John D. Spengler 2 Harvard School of Public Health 665 Huntington
EPA Proposal for Control of Emissions from New Marine Compression- Ignition Engines at or Above 30 Liters Per Cylinder The U.S. Environmental Protection Agency (EPA) is proposing more stringent exhaust
Health Review and Response to James Bay Phase III Air Quality Monitoring Provided By: Richard Stanwick, M.D., M.Sc., FRCPC, FAAP Chief Medical Health Officer, Vancouver Island Health Authority With Consultation
Cost Benefit Analysis: Replacing Ontario s Coal-Fired Electricity Generation Prepared for Ontario Ministry of Energy Prepared by DSS Management Consultants Inc. RWDI Air Inc. April, 2005 I. EXECUTIVE SUMMARY
A. Occupations Health Care Job Information Sheet #12 Public Health A. Occupations 1) Epidemiologist 2) Health Promotion Worker 3) Public Health and Environmental Health Inspector 4) Asthma, COPD and Diabetes
WHO AIR QUALITY GUIDELINES GLOBAL UPDATE 2005 MEETING REPORT WHO air quality guidelines global update 2005 Report on a working group meeting, Bonn, Germany, 18--20 October 2005 WHOLIS number E87950 Original:
Overview It is unlikely that a new pandemic influenza strain will first emerge within Elgin County. The World Health Organization (WHO) uses a series of six phases, as outlined below, of pandemic alert
The Benefits and Costs of the Clean Air Act from 1990 to 2020 U.S. Environmental Protection Agency Office of Air and Radiation March 2011 S U M M A R Y R E P O R T Acknowledgements The study was led by
Dear Doctor, Thank you for having applied to a Pain Medicine Subspecialty Residency. At the present time, five Pain Medicine Residency programs have been accredited by the Royal College and this number
SPECIALTY CASE MANAGEMENT Our Specialty Case Management programs boost ROI and empower members to make informed decisions and work with their physicians to better manage their health. KEPRO is Effectively
SAVING LIVES AND REDUCING HEALTH CARE COSTS: HOW CLEAN AIR ACT RULES BENEFIT THE NATION A report from November 2011 Prepared by ABOUT THE GROUPS Trust for America s Health is a non-profit, non-partisan
Chapter 6: Incremental Benefits of Attaining Alternative Ozone Standards Relative to the Current 8-hour Standard (0.08 ppm) Synopsis Based on projected emissions and air quality modeling, in 2020, 28 counties
Impact Assessment of Dust, NOx and SO 2 By Pat Swords Content of the Presentation Historical Basis for Air Pollution Control Impacts of air pollutants on human health, etc. Impact Pathway Approach to assessing
Atmospheric Environment 40 (2006) 1706 1721 www.elsevier.com/locate/atmosenv Evaluating impacts of air pollution in China on public health: Implications for future air pollution and energy policies Xiaoping
Health Co-benefits of Carbon Standards for Existing Power Plants Part 2 of the Co-Benefits of Carbon Standards Study September 30, 2014 Joel Schwartz, Harvard School of Public Health, Harvard University;
Regulatory Impact Analysis (RIA) for the final Transport Rule Docket ID No. EPA-HQ-OAR-2009-0491 Regulatory Impact Analysis for the Federal Implementation Plans to Reduce Interstate Transport of Fine Particulate
Institute for Policy Integrity New York University School of Law Residual Risks The Unseen Costs of Using Dirty Oil in New York City Boilers Kevin R Cromar Jason A Schwartz Report No. 5 January 2010 Copyright
WILDFIRE RESTORATION OR DEVASTATION? PART I HEALTH HAZARDS There is a flip side to every coin. There are beneficial outcomes from wildfire. We are hearing a flood of commentaries from the environmental
POLLUTION: Is it causing cancer in my community? People are naturally concerned when family members, friends and neighbours get diagnosed with cancer. We want to understand why this is happening, and if
1.0 SUBJECT: Approval of Diesel Generators 2.0 OBJECTIVE: To outline the approval requirements for diesel generators within the province. 3.0 LEGISLATION: Applicable Legislation: Environmental Protection
METHODOLOGY FOR DEVELOPING AN AIR POLLUTION INDEX (API) FOR SOUTH AFRICA Eugene Cairncross 1 Juanette John 2, and Mark Zunckel 3 1 Peninsula Technikon, Box 1906, Bellville, 7535 2 CSIR-Environmentek, PO
All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefits
Why you and your Family Should Get the Flu Shot Why Get VaCCinated against influenza? Influenza (flu) is a virus that can lead to serious complications, hospitalization, or even death. Even healthy children
Delaware Public Service Commission 861 Silver Lake Boulevard Cannon Building, Suite 100 Dover, DE 19904 3 May 2007 Re: PSC Docket 07-20 Chairwoman McRae and Commissioners: The evaluation of both the Integrated
The cost of physical inactivity October 2008 The cost of physical inactivity to the Australian economy is estimated to be $13.8 billion. It is estimated that 16,178 Australians die prematurely each year
AUSTRALIAN TRUCKING ASSOCIATION Submission to: Title: Department of Infrastructure and Transport Review of Emissions Standards (Euro VI) for Heavy Discussion Paper Date: 12 December 2012 Minter Ellison
Nova Scotia s Air Quality Health Index (AQHI) Frequently Asked Questions Q: What is the Air Quality Health Index? A: The Air Quality Health Index or AQHI is a scale which provides information on outdoor
Indicator 9: Hospitalizations Significance i Pneumoconioses are lung diseases caused by dust exposure and nearly all are attributable to occupational exposures. Common types include silicosis, asbestosis,
Health Insurance Wellness Programs What s in it for you and how they affect your insurance premiums Introduction The Canadian approach to health care needs to change. Canadians generally have a reactive
Graduate Council Document 08-20b Approved by the Graduate Council November 20, 2008 PROPOSAL GRADUATE CERTIFICATE ADVANCED PRACTICE ONCOLOGY SCHOOL OF NURSING TO BE OFFERED AT PURDUE UNIVERSITY WEST LAFAYETTE
ECONOMIC EVALUATION OF HEALTH IMPACTS DUE TO ROAD TRAFFIC-RELATED AIR POLLUTION An impact assessment project of Austria, France and Switzerland by H. SOMMER, N. KÜNZLI, R. SEETHALER, O. CHANEL, M. HERRY,
www.gov.uk/defra Guide to UK Air Pollution Information Resources June 2014 Contents Introduction... 1 What public information is available?... 2 UK-AIR online... 2 Air Quality Websites for Scotland, Wales
Review of evidence on health aspects of air pollution REVIHAAP First results Review of evidence on health aspects of air pollution REVIHAAP Project First results This publication arises from the project
Working with Epidemiologists for Heart Disease & Stroke Prevention Program Development Betty C. Jung, RN MPH CHES Connecticut Department of Public Health firstname.lastname@example.org Albert Tsai, PhD, MPH
Frequently Asked Questions Regarding At Home and Inpatient Hospice Care Contents Page: Topic Overview Assistance in Consideration Process Locations in Which VNA Provides Hospice Care Determination of Type
Air Pollution in Ulaanbaatar: Public Health Impacts and Research Opportunities Ryan W. Allen, PhD Associate Professor Faculty of Health Sciences Simon Fraser University Burnaby, BC, Canada email@example.com
Children s Health and Nursing: A Summary of the Issues What s the issue? The foundation for healthy growth and development in later years is established to a large degree in the first six years of life.
Pollution Report Card Grading America s School Bus Fleets PATRICIA MONAHAN UNION OF CONCERNED SCIENTISTS February 2002 Pollution Report Card 1 Executive Summary Every day, parents watch the trusted yellow
Clean Air Council Via ELECTRONIC MAIL Environmental Quality Board Rachel Carson State Office Building.16 th Floor 400 Market Street Harrisburg, PA 17101-2301 Dear Chairperson Hanger: 2874 RECEIVED IRRC
1 EXECUTIVE BOARD EB136/CONF./9 Rev.1 136th session 29 January 2015 Agenda item 7.2 Health and the environment: addressing the health impact of air pollution Draft resolution proposed by the delegations
Cycle facts to arm and protect DEATHS AND INJURIES Time: 136 deaths in 2007 (Latest figures available) UK (129 in England) 2,458 serious injuries in 2007 in the UK source- National Office of Statistics
Air Quality Monitoring Study Shows Harmful Pollution Released in Air by Cigarette Smoking in Jamaica Key messages: 1. Exposure to secondhand smoke (SHS) from tobacco products is harmful to both smokers
January 12, 2016 VW 2-liter diesel car denial of recall, and Notice of Violation Frequently Asked Questions: What action is the California Air Resources Board (CARB) taking today? CARB took two actions
Chapter 4. Planning a cancer registry 0. M. Jensenl and S. Whelan2 Danish Cancer Registry, Danish Cancer Society, Rosenvaengets Hoveduej 35, PO Box 839, Copenhagen 21nternational Agency for Research on
THE COST OF DIABETES IN BRITISH COLUMBIA The British Columbia Diabetes Cost Model 1 In 2009, the Canadian Diabetes Association commissioned a report, An Economic Tsunami: the Cost of Diabetes in Canada,
Lung Cancer Consultant Outcomes Publication Introduction This report describes the outcomes of individual consultant thoracic and cardiothoracic surgeons who carry out surgery for lung cancer. It has been
PROTOCOL FOR THE INVESTIGATIVE APPROACH TO SERIOUS ANIMAL/HUMAN HEALTH PROBLEMS SPECIFIC PROCEDURE FOR DEALING WITH ANIMAL HEALTH PROBLEMS 1. Notification of Problem The primary responsibility for bringing
Assessment of Vulnerability to the Health Impacts of Climate Change in Middlesex-London Report Prepared for the Middlesex-London Health Unit Summary and Recommendations Summary and Recommendations Overview
Written Statement of Sarah Bucic, MSN, RN On behalf of the American Nurses Association and the Delaware Nurses Association The Clean Air Act and Public Health Before the Committee on Environment and Public