Wednesday 20 March 2013

Air Polution & Public Health


Nowadays, almost everyone drives a car to arrive at work. We also use electricity to power almost everything in our lives: fridges, computers, cell phones, and a whole lot more.
“But this electricity has to come from some place,” you may think, and indeed, the electricity you consume is most often generated through the stoking of fossil fuels such as oil, natural gas and coals. We also burn fossil fuels in factories to create other products. But oil, gas and coals aren’t the only source of energy we’ve got: nuclear power plants generate electricity through allowing radioactive materials to react with each other under tightly regulated conditions. Aside from these sources of energy, there are also several sources of energy which generate power which is considered ‘green’ and ‘clean’ – wind, solar and bio-fuel are amongst them.

But even though more ‘green’ sources of energy are becoming available, most of our electricity is still being generated by fossil fuel plants and nuclear reactors. Even then, air pollution is not solely caused by the burning of fuel. And while we know there are certain health risks involved, we often choose to turn a blind eye to them…


Health effects of the burning of fossil fuels
Burning any sort of fuel often generates by-products of combustion. CO2 and H2O are the most common products of combustion, along with heat, which is used to drive the electricity-generating turbines. Some unwanted by-products are carbon monoxide (CO), unburned hydrocarbons, metal particles, such as the highly toxic lead particulates, sulfur oxide gas (SO2 and SO3 being the most notable ones) and nitric oxide (NO). These by-products are considered air pollutants, as they are not supposed to be in the air we breathe, and can cause health effects. (Chiras)[2]

As we breathe in the pollutants, they most commonly affect our respiratory system.
The most commonly seen effects are:
* Irritation of the lungs
* Pneumonitis & bronchitis (inflammation of the lungs and bronchi, respectively)
* Shortness of breath
* Permanent damage to the lung tissue (emphysema)

The by-products previously mentioned can affect our health in different ways, depending on the duration of exposure and the pollutant itself.
In the following paragraphs, we’ll discuss the most common air pollutants and their effects on our health.


Carbon Monoxide Poisoning
One of the most notable examples is carbon monoxide poisoning, which frequently occurs in our own homes through incomplete combustion of fuels. Carbon monoxide cannot be noticed by your senses, as it is an odorless, colorless gas. Nevertheless, it is a potential killer: its symptoms are varied and its severity ranges from low to lethal.
The most common symptoms are headaches, weakness, dizziness, nausea, chest pain which may be somewhat similar to angina, vomiting, and altered mental states.
Symptoms of severe CO poisoning are cardiovascular stress, heart attacks, and altered mental state.
Carbon monoxide disrupts the body’s ability to deliver oxygen and utilize it. This is what causes the symptoms. (CDC)[1] Sources of CO are furnaces, water boilers which use fossil fuels, and transportation vehicles (cars, trucks, planes, and etcetera). (Chiras)[2]


Sulfur Oxide
The burning of fossil fuels and the smelting of mineral ores containing sulfur releases sulfur oxides into the air. Sulfur oxides (SOX) can cause inflammatory reactions in the airways and irritates the eyes as well. People with chronic conditions of the airways, such as bronchitis or asthma, may find that SOX aggravates their symptoms. (WHO) [3]
Chronic exposure to sulfur oxides may lead to permanent damage to the lungs (emphysema) and chronic bronchitis (inflammation of the bronchi). (Chiras)[2]

Nitrogen Oxide
During combustion of fossil fuels, nitrogen (N2) reacts with oxygen to form nitric oxide (NO). Nitric oxide in turn, can be converted to nitrogen oxides (NOX).[3]
Nitrogen oxides are irritants of the eyes, skin and airways.
Possible health effects are tachycardia, weak pulse, circulatory collapse, skin/ocular burns, coughs, shortness of breath, scarring of the lungs, pulmonary edema, bronchospasm, obstruction of the upper airways, hemorrhaging of the respiratory system, severe respiratory distress and failure, and death. (ATSDR)[4]


Particulate Matter
Fine particulates are contaminants which may be carried off by combustion gases. (Chiras)[2] Particulate matter consists of nitrates, sulfate, ammonia, sodium chloride and water. The particles are typically smaller than 10 mm in diameter, and as a general rule, the smallest particles are the most dangerous, as they can travel deeper into your lungs.
Current trends in research seem to point out that the particles emitted by vehicles, factories and power plants are the most hazardous to our health. (RIVM)[8]

It is generally assumed that people exposed to high levels of particulate matter have a shorter life expectancy (difference of several days up to several months). Those with pre-existing health conditions (cardiovascular disease, pulmonary disease) are considered highly vulnerable to the effects of particulate matter. (RIVM)[6][8]
There are certain theories of how particulates can cause health effects. One of them is that the particulates settle in the airways and cause local inflammation. This in turn, leads to difficulties breathing. Aside from this, they also cause permanent tissue damage through reactive oxygen-particles. This is why people with pre-existing pulmonary conditions are at risk.
Possible health effects are irritation of the lungs, chronic obstructive pulmonary disease (COPD) and cardiovascular disease, but some of those particulates are also carcinogenic: they may cause cancer. (WHO)[3]

According to the PBL, approximately 2300 to 3500 Dutch citizens die every year of acute health complications caused by particulate matter. The number of deaths caused by long-term health complications of chronic exposure to particulates is estimated to be at 12.000 to 24.000 a year. [7]

Ozone
Not to be mistaken for the ozone in the atmosphere, although their chemical formulas are exactly the same: O3.
The ozone we’re talking about is ground level ozone, or ‘bad’ ozone. It is the main component of smog. Although it is not emitted directly into the air, it is still an important pollutant. Ozone is created through chemical reaction of nitrogen oxides (NOX) with volatile organic compounds. This chemical reaction is speeded up by sunlight, which is why you’ll encounter smog more often during summertime. (WHO, US EPA) [3][9]

Risk groups are the elderly, those with pre-existing pulmonary conditions such as asthma, lung emphysema and bronchitis, children, and those with an active outdoor lifestyle. (US EPA, RIVM) [10][11]
Pre-existing pulmonary conditions may worsen due to ozone exposure, as it makes your airways hypersensitive to allergens (dust mite, pet hairs, fungi, pollen, etcetera). (RIVM, US EPA)[11][12]
Acute symptoms are irritation of the eyes and airways. Your throat may start to hurt. These symptoms typically last several minutes to hours after exposure to ozone. (US EPA) [12] Breathing in deeply may become painful as well, resulting in shallow, fast breathing, and decreased lung volume.
Congestion and inflammation of the lining of the lungs may also occur. Some studies hint at permanent damage to the lungs caused by exposure to ozone. (US EPA) [10][12]
Some studies also suggest that exposure to ozone may temporarily hamper your immune system, making it harder for your body to fight off infections. (US EPA) [12] It is also hinted that exposure to ozone might cause cardiovascular disease, although the process is not yet well understood, and requires further research. (US EPA) [13]
The increase in daily mortality caused by ozone is 0.3 to 0.4% per 10mg/m3 increase ozone exposure according to the WHO. [3]

Health effects of other air pollutants
While the previous paragraphs dealt with air pollutants emitted by the burning of fossil fuels, there are more pollutants. Covering all of them would require too much time however, and the coming paragraph will thus only deal with ozone-depleting substances, as they also adversely influence our health.

In the paragraph ‘Ozone’, a distinction was made between ground level ozone and stratospheric ozone. While ground level ozone is the dangerous sort of ozone, ozone occurring at high altitudes is actually beneficial to our health. It protects the earth from the sun’s harmful UV radiation. (US EPA)[14]

Before you go and hole yourself up in your house: you need a little UV radiation as well. There’s a delicate balance between too much/little and ‘just right’.
Too little UV radiation will cause skeletal malformation and vitamin D deficiency, whereas too much UV radiation will cause premature skin aging, skin and eye conditions, and cancer. (WHO)[15]
Here is where ozone-depleting substances (ODS) come in. ODSs damage the stratospheric ozone layer. Some ODSs are chlorofluorocarbons (CFCs), hydrochlorofluorocarbons (HCFCs) and halons. They were used in coolants, fire extinguishers, solvents and pesticides.
Most ODSs can remain intact in nature for years, and continue to have an effect on the ozone layer for a long time. Even though governments are regulating the use of ODSs, they will remain to have a profound effect on the ozone layer for many years to come.

Ultimately, this will mean that we have less protection against harmful UV radiation from the sun.
This will lead to an increase in cases of skin cancer, especially melanoma, which is the most fatal kind of skin cancer, cataracts, and impaired immune systems. (US EPA)[13]

Numbers from the UK state that 65.000 cases of skin cancer were reported in 1999 – the number of cases has more than doubled since the early 80s. (WHO, Cancer Research UK)[15]
Globally, about 66.000 deaths occur annually as the result of skin cancers. Globally, 12 to 15 million people become blind due to cataracts and it is estimated that about 20% of these cases were caused by too much UV radiation. (WHO)[15]
Of these cases, 650 people die in the Netherlands because of skin cancer, and 60.000 Dutch citizens are diagnosed with cataracts every year, although the number of cataract patients caused by overexposure to UV radiation is unknown. (RIVM)[16]

Health effects of using nuclear power
In the previous paragraphs, we already covered the health risks of using fossil fuels to generate electricity and to power our vehicles. Some people have come up with alternatives to using fossil fuels: nuclear power. The most important reason why people seem to support nuclear power is the fact that a nuclear power plant emits little to no air pollution.
It produces no sulfur dioxide and nitrogen dioxide. If the nuclear power plant continues to work as designed, it will release even fewer radioactive particles than a regular coal-fired power plant.[2]
Despite this, there are also drawbacks to using nuclear power. Nuclear power requires the use of radioactive elements to power the plant, and as many people know, radioactive elements generally aren’t very beneficial to your health. Tight regulations exist to make sure radioactive materials do not escape the plant, but, natural disasters and sabotaging does happen, as was demonstrated in Chernobyl and Fukushima.

Radiation Sickness
Also known as ‘Acute Radiation Syndrome’.
Radioactive materials produce
a-radiation, b-radiation, g-radiation, or a combination of them. It does not matter however, which type of radiation something produces. All forms of radiation have the potential to remove an electron, or multiple electrons from atoms in your body to create charged molecules, named ions. These ions then cause damage to other cells in your body.
Exposure to extremely high levels of radiation typically causes death within hours or days. If the victim does not die, the radiation causes radiation sickness, from which a person may or may not recover.
Its symptoms are nausea and vomiting, diarrhea, hair loss, fatigue, low amounts of thrombocytes (blood platelets required for clotting), hemorrhaging (result of low amount of thrombocytes), seizures, coma, damage to the skin which may present itself as a rash, and damage of the bone marrow. These symptoms may persist for several days, up to several months. (CDC)[5]
If the individual survives the initial sickness, he or she is at risk of developing cancer or leukemia at some point in his or her life. Cataracts, sterility and shorter life spans may also be expected.
Children, especially unborn children, are more sensitive to radiation. (Chiras) [2]

Our most immediate concern
If I were to be given the choice to deal with only one pollutant, I would probably choose to deal with particulate matter. This is because I think that particulate matter is the biggest threat to the health of Dutch citizens. Ground level ozone generally only occurs during summer months, and those who are at risk can choose to stay inside. Particulate matter however, is present at all times of the year.
The amount of deaths in the Netherlands due to health complications caused by particulate matter is significantly higher than the amount of pre-mature deaths caused by ground level ozone (1780 vs. 1340 in 2009).
In 2009, roughly 1% of all emergency hospitalizations for cardiovascular stress were caused by acute exposure to particulate matter, whereas merely 0.2% of all emergency hospitalizations for cardiovascular symptoms were caused by exposure to ozone. (CvdL)[17] 

Fig. 1: Amount of deaths in the Netherlands caused by particulates and ozone

Furthermore, the Organisation for Economic Co-operation & Development theorizes that in 2050, the amount of deaths caused by particulate matter will be over 4 times higher than the deaths caused by ozone, as is shown in the graph below.
Fig. 2: Amount of global premature deaths in 2010, 2030 and 2050[18]

The RIVM theorizes that while they are notable air pollutants, the amount of sulfur oxides and nitrogen oxides in the air is unlikely to cause significant damage to our health. [11]
None of the pollutants save particulates however, have been shown to cause cancer, which is why I believe that action should be taken to limit the emission of particulate matter, as cancer is a costly and life-debilitating disease.

In truth, all kinds of pollution should be dealt with, but particulate matter, followed by ozone, is the most likely killer, and therefore, requires our immediate attention.





[1] Centers for Disease Control and Prevention, Clinical Guidance for Carbon Monoxide(CO) Poisoning After A Disaster, September 19th, 2008
http://emergency.cdc.gov/disasters/co_guidance.asp
[2] Chiras, D.D., Environmental Science, 9th Edition, 2012
[3] World Health Organization, Air Quality and Health, September 2011,
http://www.who.int/mediacentre/factsheets/fs313/en/index.html
[4] Agency for Toxic Substances & Disease Registry, Medical Management Guidelines for Nitrogen Oxides, March 3rd, 2011
http://www.atsdr.cdc.gov/MMG/MMG.asp?id=394&tid=69
[5] Centers for Disease Control and Prevention, Acute Radiation Syndrome (ARS): A Fact Sheet for the Public, May 10th, 2006
http://www.bt.cdc.gov/radiation/ars.asp
[6] Rijksinstituut voor Volksgezondheid en Milieu, Fijn Stof, date unknown,
http://www.rivm.nl/Onderwerpen/Onderwerpen/F/Fijn_stof
[7] Planbureau voor de Leefomgeving, Veel gestelde vragen, date unknown,
http://www.pbl.nl/nl/dossiers/fijn-stof/veelgestelde_vragen/
[8] Rijksinstituut voor Volksgezondheid en Milieu, Dossier ‘Fijn Stof’, January 2013
[9] United States Environmental Protection Agency, Basic Information, November 1st, 2012,
http://www.epa.gov/glo/basic.html
[10] United States Environmental Protection Agency, Health Effects, November 1st, 2012,
http://www.epa.gov/glo/health.html
[11] Rijksinstituut voor Volksgezondheid en Milieu, Smog Gezondheidseffecten, date unknown,
http://www.rivm.nl/Onderwerpen/Onderwerpen/S/Smog/Gezondheidseffecten
[12] United States Environmental Protection Agency, Smog – Who Does It Hurt?, July 1999
[13] United States Environmental Protection Agency, Ozone and Your Health, date unknown
[14] United States Environmental Protection Agency, Ozone: Good Up High, Bad Nearby, date unknown
[15] World Health Organization, Health Effects of UV Radiation, date unknown
http://www.who.int/uv/health/en/
[16] Rijksinstituut voor Volksgezondheid en Milieu, UV ozonlaag en klimaat Effecten, date unknown
http://www.rivm.nl/Onderwerpen/Onderwerpen/U/UV_ozonlaag_en_klimaat/Effecten
[17] Compendium voor de Leefomgeving, Gezondheidseffecten van fijn stof en ozon, date unknown
http://www.compendiumvoordeleefomgeving.nl/indicatoren/nl0340-Gezondheidseffecten-van-fijn-stof-en-ozon.html?i=13-128
[18] Organisation for Economic Co-operation & Development, Environmental Outlook to 2050, 2012
http://www.oecd.org/env/indicators-modelling-outlooks/49928853.pdf

This post was written by a former student of VU University of Amsterdam (nowadays current student of the University of Amsterdam) for the subject 'Mens & Extern Milieu I'. I got myself 7 out of 10 points for this essay, a grade which I find remarkably low considering the fact that my professor only left 1 comment (I quote: "Source?") which dealt with a 154-word paragraph. Yes, I am pissed off beyond belief.
You have my permission to use the information provided in this essay for your own work. Do not copy it, unless you feel like getting a big fat insufficient due to plagiarism.

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