First Annual National Health And Climate Change Science And Policy Research Consensus Conference - How Will Climate Change Affect Priorities For Your Health Science And Policy Research?

Health Issue Topic: Air pollution-related health effects

Summary of discussions

Dr. Barbara MacKinnon, of the New Brunswick Lung Association, presented the report of the air-pollution health effects group. After reviewing the research questions identified during the breakout session, MacKinnon noted that a number of climate-related health concerns and research needs are interrelated. The research sub-topics developed in the group represent only some of the possible research gaps. The starting points include identifying what characterizes health as it relates to climate change and air pollution. In this context, the determinants of health also need to be re-characterized. Of utmost importance in dealing with air pollution in relation to climate change is the need for comprehensive information on the health implications of measures to mitigate greenhouse gas emissions. For instance, sealing up houses to increase their energy efficiency without knowing the effects on indoor air quality may have unanticipated effects on human health. The health effects of recommended mitigation measures should therefore be examined from an overall co-benefits and health perspective.

The consequences of increased temperature on the nature and frequency of smog events and their impact on health requires more study. For some air contaminants such as pollens and spores, much more needs to be known about the impact of climate change and the impact on population health.

The group endorsed initiatives for longitudinal population health studies. Only by that means can the impact of climate change be determined objectively and the value of mitigation strategies assessed.

The research should be gap-driven and new techniques may be required to better assess exposure and health risks. The areas of research must be broad to determine direct and indirect health risks. These issues cannot be taken lightly, and work to address them must start now. Health effects from air pollution or climate change should be examined not only from a disease aspect, but also from a "quality of life" perspective. One should therefore ask: "What are the direct and indirect impacts of air pollution on our lives ?"

Regarding the location of C-CIARN's central office, the group commented that, although Health Canada's current organizational role is a positive one, C-CIARN should be kept at arm's length from government agencies.

Air pollution and related health effects

Knowledge
Strengths

• There is a wealth of knowledge, not only in Canada but throughout the world, on air pollution, including ozone and particulate matter.
• The level of knowledge integration is high in Canada.
• Senior politicians have begun to focus on long-term initiatives.

Limitations

• Knowledge and research are available to fill the gaps, but there is no clearinghouse to make information more widely available.
• There is not enough effort to distinguish between the effects of outdoor and indoor air pollution.
• Studies tend to cover large areas, where the effects of localized pollution may vary.
• There is no clear identification of the health effects that come directly from climate change.
• Better knowledge is needed on the indirect effects of sunlight and temperature on pollution.
• Funding is limited and uncertain, while long-term research projects are needed, and should be encouraged and supported.
• There have only been limited efforts to make people understand and agree that air pollution and climate change are related.
• Public education and outreach will be required, to avoid panic and encourage citizens to reduce the use of materials that are causing air pollution.
• There are insufficient links between researchers dealing with air pollution and climate change
• Air pollution and climate change must be examined as a whole, in order to identify sensitivities and vulnerabilities related to health.

Data Sources
Strengths

• There is an abundance of useful data on air pollution.
• International sources are prepared to share the results of air pollution studies.

Limitations

• Data are not specific enough, and there is little guidance on their usefulness.
• There is a need for a better knowledge of the correlations between air temperature and air pollution.
• More emphasis is needed on mortality as an indicator, quality of life parameters, and individual exposure data.
• There are concerns about the quality of data collected by private and non-governmental organizations.

Methods
Strengths

• A commendable willingness to collaborate has brought Environment Canada and Health Canada closer together.

Limitations

• Current scientific methodologies have inadequate predictive power.
• Funding is insufficient.
• Collaboration between ministries is inadequate.
• There have been no individual studies on health-related effects, as opposed to studies in the field of ecological epidemiology.
• Federal and provincial governments and educational institutions must work more closely together.
• The relative importance of health effects must be weighed, in order to determine resource allocations.

Capacity
Strengths

• Information can be disseminated through partnerships.
• Co-operative efforts include cross-border collaborations.
• Policy-makers and scientists are communicating more effectively.
• High-quality researchers are in place in government agencies and universities.

Limitations

• There is no central facility to maintain and coordinate data.
• There are not enough personnel to fill gaps at the research and managerial levels.
• Inadequacies have been identified in medical studies that examine the direct health effects of air pollution.

C-CIARN and the Climate Change and Health Office

• Both Health Canada and Environment Canada have responsibilities with respect to air pollution, and an interest in the Climate Change Impact and Adaptation Research Network, C-CIARN . Environment Canada is taking a lead role in relation to the regional C-CIARN nodes. Health Canada may be the appropriate central organization to manage the C-CIARN health node, but the effectiveness of that node may be compromised if it is situated within the Department.
• A public education, outreach and climate change 'hub' is in place in each province. It has been suggested that Health Canada should have a more active role in the entire outreach and education structure.
• Provinces have an impact on the C-CIARN nodes (or hubs) and can make good use of them. The health node could fulfill its role best when it is not considered to be under the command and control of Health Canada, although it can provide organization or funding. However, the node needs buy-in from provincial and territorial ministries of health. Therefore the C-CIARN health node should be independe nt from Health Canada.
• The agenda for the C-CIARN nodes may already be set, but it is recommended that regional sub-sector nodes be independent. This will provide a better stakeholder mix.
• Network hubs provide a facilitation role and can draw people together. There is a need to ensure that nodes are tied into the climate change hub.
• The International Centre for Air Quality and Human Health, a foundation representing a coalition of New England and Eastern Canadian Lung Associations, was mentioned as a forum for integrating the PEO and Research efforts of the Hubs and C-CIARN on issues relating specifically to air quality and health.

The group agreed that a C-CIARN health node or hub would function more effectively as a clearinghouse if there were a distance established between it and Health Canada , although the latter could be a sponsoring agency.

• To keep participants informed and engaged from this point on, the Climate Change and Health office should: produce regular newsletters to establish and increase the lines of communication; establish a clearinghouse; coordinate with researchers; build a research library; identify knowledge gaps; and hold annual workshops for knowledge exchange.
• There should be a degree of distance between the C-CIARN health node and Health Canada.

Strategic Questions

The research agenda should address the following strategic questions (associated research subtopics are in parentheses):

• Identify and measure air components (emissions research), (exposure)
• Determine toxicity (exposure), (determinants of health), (impact of climate change onair pollution - synergistic/cascade effects)
• Identify sources of components (emissions research)
• Assess human exposure (exposure)
• Establish links to health effects and create country-wide criteria (determinants of health), (impact of climate change on air pollution - synergistic/cascade effects)
• Identify the percentage of health impacts stemming from indoor rather than outdoor airquality (exposure), (determinants of health), (effects of mitigation), (impact ofclimate change on air pollution - synergistic/cascade effects)
• Determine health effects that are mitigating (e.g. bio-fuel such as methanol and bio-diesel) (effects of mitigation)
• Establish an interaction (correlation) between indoor and outdoor air quality anddetermine the best method of improving indoor air quality (exposure), (impact ofclimate change on air pollution - synergistic/cascade effects)
• Conduct cost/benefit health analysis and intervention in relation to older housing inurban, poor or Aboriginal communities (determinants of health), (effects of mitigation)
• Construct a methodology to determine changes in distribution of air pollution, allergensand particles (meteorological aspects), (determinants of health), (impact of climatechange on air pollution - synergistic/cascade effects)
• Develop methodologies to quantify exposure and effects (exposure), (determinants ofhealth), (methodology)
• Identify an appropriate methodology for risk analysis (determinants of health), (effectsof mitigation), (methodology)
• Establish "quality of life" as a standard when examining air pollution and climate change(determinants of health), (impact of climate change on air pollution - synergistic/cascade effects)
• Identify the benefits of climate change related to warmer winters (meteorologicalaspects), (determinants of health), (impact of climate change on air pollution -synergistic/cascade effects)
• Construct a methodology to track air transportation mechanisms (exposure),(meteorological aspects), (methodology)
• Assess the indirect effects and consequences of climate change and air pollution onwater, food and ecosystem (exposure), (determinants of health)
• Identify the effects of climate change on long-range transport of persistent organicpollutants (exposure), (meteorological aspects), (impact of climate change on airpollution-synergistic/ cascade effects)
• Determine the impact of climate change on wild fires and the subsequent health effects (exposure) (meteorological aspects), (determinants of health), (impact of climate change on air pollution - synergistic/cascade effects)

The following are the essential conditions for addressing all research questions:

• Partnership and collaboration;
• Gap analysis (basic and up-front);
• A country-wide approach (including all regions);
• Linkages to existing research;
• Establishment of baselines (ensuring consistency and using existing studies);
• Long-term monitoring of changes in conditions;
• A long-term commitment;
• Appropriate standardization;
• Longitudinal studies;
• An interdisciplinary approach.

Research Tasks, Outputs/Deliverables, Uses, Disciplines and Prerequisites

Emissions Research

• Research tasks: track changes in emissions quality and quantity.
• Outputs/deliverables: health effects; exposure; baseline for reduction strategies; emissions factors.

Exposure

• Research tasks: create measures for air pollutants, allergens and other sources of exposure; conduct outdoor and indoor measurements, as well as personal exposure and meter studies; develop indicators; develop new exposure models.
• Outputs/deliverables: risk estimates; models of exposure; toxicological information already known; database development.

Meteorological Aspects

• Research tasks: develop specific climate models for regions and cities, incorporating air pollution measures; apply meteorological models to assess and measure long-range transport of air pollutants; create measurements; improve data-gathering techniques.
• Outputs/deliverables: climate models that predict the amount and distribution of pollutants; a representative database.

Determinants of Health

• Research tasks: refine and develop robust indicators of health and well-being; coordinate with other national indicators; establish the direct and indirect links with pollutants;determine sensitive geographic and demographic population groups; identify effects of co-exposures and synergistic effects; conduct longitudinal studies.
• Outputs/deliverables: robust and reliable health and well being indicators; accurate and reliable risk estimates; a pilot project with the Canadian Lung Association; parameters to measure the effectiveness of mitigation.

Effects of Mitigation

• Research tasks: commission longitudinal studies; identify the effects of energy conservation on indoor air quality; conduct assessments to determine the health impacts of all options developed under the National Climate Change Process (NCCP).
• Outputs/deliverables: parameters to assess effectiveness of mitigation; a report outlining health costs and benefits.

Impact of Climate Change on Air Pollution - Synergistic and Cascade Effects

• Research tasks: establish linkages between climate change and air quality, and air quality and health; conduct laboratory studies; develop models to investigate synergistic and cascade effects.
• Outputs/deliverables: improved and reliable data to enhance understanding of the relationship between climate change, pollution, health and well-being; simulations of synergistic and cascade effects.

Methodology

• Research tasks: improve, evaluate and validate methods of assessing risk; create multi-model assessments.
• Outputs/deliverables: appropriat e selection of methods to achieve desired results; probability of increases in the mortality rate.

Points common to all research sub-topics ("Commonalities") Uses:

• Research should be needs- and gap-driven, and should provide forewarning to health professionals, to governmental and non-governmental health organizations, and should feed into a clearinghouse for public use, and into a broad range of other information mechanisms and initiatives.
• Research should support and inform pollutant mitigation policy choices and measures as well as related legislative reforms, and it should be used to prioritize health risk management measures.

Methods:

• Comprehensive multi-disciplinary approaches linking to existing knowledge and capacities should be preferred.
• Longitudinal studies need to be done to assess long-term implications of how Climate Change and variability may influence air pollutants and their health effects.
• Research should be done in regional, national, or international partnerships.

Critical Paths / Priorities

A Critical Path Analysis was not carried out. Instead, the tasks were ranked in terms of priorities.

The top priorities are:

• to determine knowledge gaps,
• to review the health benefits and costs of Climate Change mitigation options set out in the national action plans,
• to establish baselines for monitoring future changes and trends in air pollutants and their direct and indirect health effects, and
• to use standardized research methods.

The next priorities are:

• to initiate longitudinal health effects studies and
• studies of the interactive effects of air pollutants under the environmental conditions expected under Climate Change.

Health Issue Topic: Air Pollution and Health

Research Sub-Topic	Emissions/ Contaminant Research	Exposure Research
Strategic Question	What are the sources of the emissions/ contaminants (such as pollen or dust)? What are the contaminants and their concentrations?	What is the relationship between contaminant concentration and individual exposure?
Tasks	Track changes in contaminant quality and quantity, using the National Pollutant Release Inventory (NPRI) and other data bases.	Measure personal exposure to indoor and outdoor air contaminants. Develop exposure models and health risk estimates.
Products	Baseline and trend data; maps, graphs, revised priority contaminant lists	Databases of air contaminant exposure. Exposure models.
Uses / Linkages	Assessing pollutant emission/other contaminant production trends and reduction strategies. Exposure and health effects studies at local, regional, national levels.	Exposure and health risk estimates for individuals.
Order On Critical Path	1/ considerable information exists	1

Research Sub-Topic	Determinants of Health
Strategic Question	What are the health benefits of climate change? What is the toxicity of different levels of single pollutants and combined pollutants? What are their health effects? What percentage of health impacts stem from indoor vs outdoor exposure?
Tasks	Define and apply indicators of health and well-being which are responsive to climate change. Establish direct and indirect toxicity and health effects of single and mixed air pollutants at a range of concentrations. Determine sensitive population groups. Do longitudinal health effects studies following pilot projects with Canadian Lung Association (CLA) and other partners.
Products	Reliable indicators of the effects of climate change. Toxicity and health risk estimates for air pollutants. Parameters to measure effectiveness of pollutant emission mitigation.
Uses / Linkages	Estimates of health benefits of climate change. Improved health risk assessment and risk management of air pollutants.
Order On Critical Path	2/ a range of information exists

Research Sub-Topic	Effects of Mitigation	Metereological Aspects
Strategic Question	What are the health benefits and health risks of mitigation efforts (e.g. energy efficiency measures affecting indoor air quality)? What are the best benefit/cost mechanisms to improve indoor air quality?	How will Climate Change affect air transportation patterns and levels of toxic pollutants and biologic agents? How will higher temperatures and UV radiation levels affect air chemistry and airborne biologic agents?
Tasks	Study effects of mitigation measures (e.g. to improve energy efficiency) on indoor air quality and human health by longitudinal studies. Determine health impacts of all options under the national action plan on Climate Change.	Develop models to assess effects of Climate Change on chemical and biologic air pollutant mixtures, levels, and transportation. Take measurements using improved data gathering techniques.
Products	Comprehensive health cost-benefit estimates of national climate change mitigation measures.	Databases. Coupled climate, UV radiation, and air pollution models.
Uses / Linkages	Truly cost effective mitigation measures. Supporting data for outreach and information initiatives to promote truly beneficial mitigation measures.	Better knowledge of amounts and distribution of chemical and biologic air pollutants for improved health risk assessment and management.
Order On Critical Path	3	3/4

Research Sub-Topic	Synergistic/ Cascade Effects	Methodology
Strategic Question	What are the effects of air pollution modified by Climate Change on water and food supplies and ecosystems? What are the effects of Climate Change on transport of POPs? How will Climate Change influence wild fires and their health effects?	Are the criteria and indicators for assessing air pollution effects on health and "quality of life" good enough? How can methods for health risk analysis be improved?
Tasks	Study linkages of Climate Change to air, water, and food quality and their health implications. Conduct laboratory and field studies. Develop models that relate synergistic and cascade effects of air pollutants.	Improve, evaluate and validate methods of assessing health risks of air pollutants. Create and use multi-model assessment methods.
Products	Better air pollutant data bases and models. Simulations of how Climate Change may affect air pollutants and their health impacts, including those resulting from wild fires.	Improved and validated investigative and modeling methods.
Uses / Linkages	Improved knowledge of interactions between Climate Change and air pollutants and their effects on ecosystem and human health. Better air pollutant health risk assessment and management.	Better health risk and health impact assessment methods for direct and indirect effects of air pollutants. "Quality of Life" assessments.
Order On Critical Path	5	1 and ongoing