The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City.

Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and São Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration-response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children's medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly 21 to 165 billion Dollars (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration-response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies.

[1]  Kazuhiko Ito,et al.  Daily PM10/mortality associations: an investigations of at-risk subpopulations. , 1996, Journal of exposure analysis and environmental epidemiology.

[2]  J. Bongaarts,et al.  Global Environment Outlook , 1998 .

[3]  P. Saldiva,et al.  Air pollution and child mortality: a time-series study in São Paulo, Brazil. , 2001, Environmental health perspectives.

[4]  D. Davis Short-term improvements in public health from global-climate policies on fossil-fuel combustion: an interim report , 1997, The Lancet.

[5]  Joel Schwartz,et al.  Short-term Effects of Ambient Oxidant Exposure on Mortality: A Combined Analysis within the APHEA Project , 1997 .

[6]  J. Schwartz,et al.  Air Pollution and Hospital Admissions for Cardiovascular Disease in Tucson , 1997, Epidemiology.

[7]  B. Brunekreef,et al.  Air pollution and health , 2002, The Lancet.

[8]  D. Mannino,et al.  Air Pollution and Heart Rate Variability Among the Elderly in Mexico City , 2003, Epidemiology.

[9]  A P Verhoeff,et al.  Air Pollution and Daily Mortality in Amsterdam , 1996, Epidemiology.

[10]  R. Burnett,et al.  Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. , 2002, JAMA.

[11]  N. Gouveia,et al.  Association between ambient air pollution and birth weight in São Paulo, Brazil , 2003, Journal of epidemiology and community health.

[12]  D. Loomis,et al.  Mortality and ambient fine particles in southwest Mexico City, 1993-1995. , 1998, Environmental health perspectives.

[13]  Xander Olsthoorn,et al.  Improving air quality in metropolitan Mexico City: an economic valuation , 2002 .

[14]  M. Mazari-Hiriart,et al.  Are megacities viable? A cautionary tale from Mexico City. , 1996, Environment.

[15]  G. Carmichael,et al.  Quantifying the human health benefits of curbing air pollution in Shanghai. , 2004, Journal of environmental management.

[16]  Michal Krzyzanowski,et al.  Health Effects of Transport-related Air Pollution , 2005 .

[17]  G M Böhm,et al.  Association between air pollution and mortality due to respiratory diseases in children in São Paulo, Brazil: a preliminary report. , 1994, Environmental research.

[18]  D V Bates,et al.  Air pollution and health. , 1988, The American review of respiratory disease.

[19]  M Blettner,et al.  Traditional reviews, meta-analyses and pooled analyses in epidemiology. , 1999, International journal of epidemiology.

[20]  G. Thurston,et al.  Climate change. Hidden health benefits of greenhouse gas mitigation. , 2001, Science.

[21]  B. Oftedal,et al.  Lung cancer and air pollution: a 27 year follow up of 16 209 Norwegian men , 2003, Thorax.

[22]  Bryan J. Hubbell,et al.  Health-Related Benefits of Attaining the 8-Hr Ozone Standard , 2004, Environmental health perspectives.

[23]  Dana Loomis,et al.  Airborne Coarse Particles and Mortality , 2000 .

[24]  I. Romieu,et al.  Fine Particulate Matter and Wheezing Illnesses in the First Year of Life , 2004, Epidemiology.

[25]  D Krewski,et al.  Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases. , 1995, American journal of epidemiology.

[26]  R. O'Ryan,et al.  Urban Air Quality and Human Health in Latin America and the Caribbean , 2005 .

[27]  M. Bell,et al.  International expert workshop on the analysis of the economic and public health impacts of air pollution: workshop summary. , 2002, Environmental health perspectives.

[28]  R. Etzel,et al.  Effects of urban air pollutants on emergency visits for childhood asthma in Mexico City. , 1995, American journal of epidemiology.

[29]  G. Thurston,et al.  Hidden Health Benefits of Greenhouse Gas Mitigation , 2001, Science.

[30]  J. Miranda,et al.  Absolute principal component analysis of atmospheric aerosols in Mexico city , 2000 .

[31]  J. Vonk,et al.  Short term effects of air pollution on emergency hospital admissions for respiratory disease: results of the APHEA project in two major cities in The Netherlands, 1977-89. , 1996, Journal of epidemiology and community health.

[32]  R. D. Morris,et al.  Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures. , 1998, Environmental health perspectives.

[33]  M. Green Air pollution and health , 1995 .

[34]  M. Andrade,et al.  Air pollution and pediatric respiratory hospital admissions in São Paulo, Brazil , 1999 .

[35]  D. Botter,et al.  A longitudinal study of mortality and air pollution for São Paulo, Brazil , 2002, Journal of Exposure Analysis and Environmental Epidemiology.

[36]  A. Cohen,et al.  Outdoor air pollution and lung cancer. , 2000, Environmental health perspectives.

[37]  J. Schwartz,et al.  Short-term effects of ambient oxidant exposure on mortality: a combined analysis within the APHEA project. Air Pollution and Health: a European Approach. , 1997, American journal of epidemiology.

[38]  Francesca Dominici,et al.  National maps of the effects of particulate matter on mortality: exploring geographical variation. , 2002, Environmental health perspectives.

[39]  M. Molina,et al.  Megacities and Atmospheric Pollution , 2004, Journal of the Air & Waste Management Association.

[40]  Kazuhiko Ito,et al.  A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers. , 1992, Journal of exposure analysis and environmental epidemiology.

[41]  I. Romieu,et al.  Association between levels of fine particulate and emergency visits for pneumonia and other respiratory illnesses among children in Santiago, Chile. , 1999, Journal of the Air and Waste Management Association.

[42]  Israel Laguna,et al.  Co-control of urban air pollutants and greenhouse gases in Mexico City. , 2004, Environmental science & technology.

[43]  D. O’Connor,et al.  Climate Policy without Tears CGE-Based Ancillary Benefits Estimates for Chile , 1999 .

[44]  P. Artaxo,et al.  Wintertime and summertime São Paulo aerosol source apportionment study , 2001 .

[45]  Judith C Chow,et al.  Chemical composition of PM2.5 and PM10 in Mexico City during winter 1997. , 2002, The Science of the total environment.

[46]  M. Hernández-Ávila,et al.  Efecto de la contaminación ambiental sobre las consultas por infecciones respiratorias en niños de la Ciudad de México , 1997 .

[47]  J. Schwartz,et al.  Effects of ambient particulate matter and ozone on daily mortality in Rotterdam, The Netherlands. , 1997, Archives of environmental health.

[48]  Ian J. Bateman,et al.  Economic Valuation With Stated Preference Techniques , 2002 .

[49]  Paulo Hilário do Nascimento Saldiva,et al.  Air Pollution and Emergency Room Visits Due to Chronic Lower Respiratory Diseases in the Elderly: An Ecological Time-Series Study in São Paulo, Brazil , 2002, Journal of occupational and environmental medicine.

[50]  D. Strachan,et al.  Air pollution and daily mortality in London: 1987-92 , 1996, BMJ.

[51]  T. Lefèvre,et al.  Assessing Health Benefits of Controlling Air Pollution from Power Generation: The Case of a Lignite-Fired Power Plant in Thailand , 2001, Environmental management.

[52]  J. Samet Particulate air pollution and mortality: the Philadelphia story. , 1995 .

[53]  Guy Garrod,et al.  Economic Valuation of the Environment: Methods and Case Studies , 1999 .

[54]  D. Dockery,et al.  Health effects of air pollution exposure on children and adolescents in São Paulo, Brazil * † , 2001, Pediatric pulmonology.

[55]  S L Zeger,et al.  Air pollution and mortality in Philadelphia, 1974-1988. , 1997, American journal of epidemiology.

[56]  M. Lebowitz,et al.  Air pollution and hospital admissions for cardiovascular disease. , 1998, Epidemiology.

[57]  G. Thurston,et al.  Assessing the health benefits of urban air pollution reductions associated with climate change mitigation (2000-2020): Santiago, São Paulo, México City, and New York City. , 2001, Environmental health perspectives.

[58]  K. Berhane,et al.  Air pollution and daily hospital admissions in metropolitan Los Angeles. , 2000, Environmental health perspectives.

[59]  J. Schwartz,et al.  Short term effects of urban air pollution on respiratory health in Milan, Italy, 1980-89. , 1996, Journal of epidemiology and community health.

[60]  J. Goldsmith,et al.  AIR POLLUTION AND DAILY MORTALITY , 1961, The American journal of the medical sciences.

[61]  B. Ostro,et al.  Air pollution and morbidity revisited: A specification test , 1987 .

[62]  M. O'Neill,et al.  Ozone, area social conditions, and mortality in Mexico City. , 2004, Environmental research.

[63]  R. Burnett,et al.  The effect of the urban ambient air pollution mix on daily mortality rates in 11 Canadian cities. , 1998, Canadian journal of public health = Revue canadienne de sante publique.

[64]  A S Whittemore,et al.  Asthma and air pollution in the Los Angeles area. , 1980, American journal of public health.

[65]  M Lippmann,et al.  Respiratory hospital admissions and summertime haze air pollution in Toronto, Ontario: consideration of the role of acid aerosols. , 1994, Environmental research.

[66]  L. Lave,et al.  Effect of the Fine Fraction of Particulate Matter versus the Coarse Mass and Other Pollutants on Daily Mortality in Santiago, Chile , 2000, Journal of the Air & Waste Management Association.

[67]  J. Schwartz,et al.  Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. , 1996, Journal of epidemiology and community health.

[68]  Bernd Hansjürgens,et al.  Economic valuation through cost-benefit analysis--possibilities and limitations. , 2004, Toxicology.

[69]  C. D. Alonso,et al.  São Paulo aerosol characterization study. , 1997, Journal of the Air & Waste Management Association.

[70]  D. Dockery,et al.  Air pollution and mortality in elderly people: a time-series study in Sao Paulo, Brazil. , 1995, Archives of environmental health.

[71]  M. Grand,et al.  Impacts of greenhouse and local gases mitigation options on air pollution in the Buenos Aires Metropolitan Area: Valuation of human health effects , 2002 .

[72]  S I Bangdiwala,et al.  Ozone, suspended particulates, and daily mortality in Mexico City. , 1997, American journal of epidemiology.

[73]  D. Strachan,et al.  Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints. , 1999, The European respiratory journal.

[74]  D. Strachan,et al.  Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987-88 and 1991-92. , 1996, Journal of epidemiology and community health.

[75]  E Ortiz,et al.  Basic statistics of PM2.5 and PM10 in the atmosphere of Mexico City. , 2002, The Science of the total environment.

[76]  A. Monzón,et al.  Valuation of social and health effects of transport-related air pollution in Madrid (Spain). , 2004, The Science of the total environment.

[77]  L. Cifuentes,et al.  MORTALITY RISK REDUCTIONS AT PRESENT AND AT AN ADVANCED AGE : PRELIMINARY RESULTS FROM A CONTINGENT VALUATION STUDY IN CHILE , 2000 .

[78]  C. Sánchez-Carrillo,et al.  Surveillance of Acute Health Effects of Air Pollution in Mexico City , 2003, Epidemiology.

[79]  Jonathan I Levy,et al.  Issues and Uncertainties in Estimating the Health Benefits of Air Pollution Control , 2003, Journal of toxicology and environmental health. Part A.

[80]  A. Cohen,et al.  Lung cancer and air pollution. , 1995, Environmental health perspectives.

[81]  Luiz Alberto Amador Pereira,et al.  Association between air pollution and ischemic cardiovascular emergency room visits. , 2003, Environmental research.

[82]  G M Böhm,et al.  Air pollution and respiratory illness of children in São Paulo, Brazil. , 1999, Paediatric and perinatal epidemiology.

[83]  J. Chow,et al.  Analysis of PM2.5and PM10 in the Atmosphere of Mexico City during 2000-2002 , 2004, Journal of the Air & Waste Management Association.

[84]  R. Burnett,et al.  Effects of air pollution on emergency room visits for respiratory illnesses in Montreal, Quebec. , 1997, American journal of respiratory and critical care medicine.

[85]  B. Ostro,et al.  Air pollution and mortality: results from a study of Santiago, Chile. , 1996, Journal of exposure analysis and environmental epidemiology.

[86]  D. Abbey,et al.  Chronic respiratory symptoms associated with estimated long-term ambient concentrations of fine particulates less than 2.5 microns in aerodynamic diameter (PM2.5) and other air pollutants. , 1995, Journal of exposure analysis and environmental epidemiology.

[87]  A. Braga,et al.  Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil , 2003, Journal of epidemiology and community health.

[88]  F. Dominici,et al.  Seasonal analyses of air pollution and mortality in 100 US cities. , 2005, American journal of epidemiology.

[89]  Nelson Gouveia,et al.  Time series analysis of air pollution and mortality: effects by cause, age and socioeconomic status , 2000, Journal of epidemiology and community health.

[90]  N Künzli,et al.  Assessment of deaths attributable to air pollution: should we use risk estimates based on time series or on cohort studies? , 2001, American journal of epidemiology.

[91]  Rakesh Kumar,et al.  Economic Valuation of Health Impacts of Air Pollution in Mumbai , 2002, Environmental monitoring and assessment.

[92]  R. D. Morris,et al.  Air pollution and hospital admissions for cardiovascular disease in Detroit, Michigan. , 1995, American journal of epidemiology.

[93]  J D Spengler,et al.  Effects of inhalable particles on respiratory health of children. , 1989, The American review of respiratory disease.

[94]  J Schwartz,et al.  Particulate air pollution and chronic respiratory disease. , 1993, Environmental research.

[95]  D. Loomis,et al.  Air pollution and infant mortality in Mexico City. , 1999, Epidemiology.

[96]  P. Saldiva,et al.  Urban Air Pollution Risks to Children: A Global Environmental Health Indicator , 1999 .

[97]  J. Sarnat,et al.  Analysis of PM10, PM2.5, and PM2.5–10Concentrations in Santiago, Chile, from 1989 to 2001 , 2005, Journal of the Air & Waste Management Association.

[98]  B. Ostro,et al.  Air pollution and health effects: A study of medical visits among children in Santiago, Chile. , 1999, Environmental health perspectives.

[99]  I. Romieu,et al.  Air pollution and school absenteeism among children in Mexico City. , 1992, American journal of epidemiology.

[100]  Tony Fletcher,et al.  Respiratory diseases in children and outdoor air pollution in São Paulo, Brazil: a time series analysis , 2000, Occupational and environmental medicine.

[101]  P. Artaxo,et al.  Aerosol composition and source apportionment in Santiago de Chile , 1999 .

[102]  E. Luebeck,et al.  A critical review of the evidence on particulate air pollution and mortality. , 1996, Epidemiology.

[103]  A. Le Tertre,et al.  Short term respiratory health effects of ambient air pollution: results of the APHEA project in Paris. , 1996, Journal of epidemiology and community health.