Making the case: Health impact assessment and the health economics of Low Emission Zones (Leeds and Bradford)

Transcription

1 Making the case: Health impact assessment and the health economics of Low Emission Zones (Leeds and Bradford) Duncan Cooper (Wakefield Council) James Lomas (York University) Sally Jones (Bradford Council) Richard Crowther, Richard Dixon (Leeds Council) Mike Gent (Public Health England) 1

2 550 deaths per year in Leeds/Bradford attributable to PM2.5 Morbidity? Other pollutants? Presentation title - edit in Header and Footer 2

3 Background Low Emission Zone Feasibility Study (2011 DEFRA grant) Aim: Costs and benefits of measures to improve air quality 1. Health Impact Assessment (Bradford/Leeds Las, PHE) 2. Health Economic Analysis (York University) Health impact assessment: Identify areas in Leeds and Bradford that would benefit from reductions in road pollution Identify the specific health benefits 3

4 Analytical model of emissions and health impact Presentation title - edit in Header and Footer 4

5 Source apportionment work Localised fleet profile (ANPR) + SATURN traffic modelling (2011, 2016, 2021) + PITHEM emissions calculation tool + Exhaust emissions / vehicle type / road network 5

6 Scenarios modelled (emissions levels by 2016 and 2020) Scenario 1: Euro 4 Buses and HGVs are upgraded to Euro 6 Scenario 2: Euro 5 Buses are upgraded to Euro 6 Scenario 3: Year 2000 petrol to diesel split is achieved Scenario 4: 10% reduction in car and small vehicle journeys 6

7 Baseline emissions - social deprivation Deprived inner city areas & areas adjacent to major roads experienced highest baseline emission levels (PM2.5 and NO 2) & poorest air quality Low: 0-10 ug/m3 annual average, Medium: ug/m3, Higher: >20 ug/m3 7

8 Future emissions - social deprivation Assuming all Euro 5 buses are upgraded to Euro 6 by 2021 (Scenario 2) Largest projected reductions in NOx in the most deprived areas Low impact: 0-10ug/m3 annual average, Medium impact: 10-15ug/m3, High impact: >15ug/m3 8

9 Health effects of PM 2.5 and NOx (quantifiable?) Effects Deaths from all causes (COMEAP, 2010) Quantification coefficient (relative risks) 1.06 increase (95% CI ) per 10 µg/m3 increase in PM2.5 Cardiovascular and respiratory deaths (COMEAP, 2009) 1.09 increase (95% CI ) per 10 µg/m3 increase in PM2.5 Coronary events (Cesaroni, BMJ, 2014) 10 site cohort study 1.19 increase (95% CI ) per 5ug/m3 increase in PM2.5 (if exposure below 15ug/m3) Low birth weight (<2500g) (Pederson, Lancet, 2013) 14 cohort studies 1.18 increase (95% CI ) per 5 ug/m3 increase in PM2.5 Childhood asthma (Takenoue, Paediatrics Int, 2012) Asthma development (0-18yrs): ( ) for 10 p.p.b increase in NO2 (18.8 mg/m3) 9

10 Methodology for estimating health impact [Health impact] = [baseline disease rate] X [PM2.5 reduction / 10mg/u3] x [Risk coefficient] For each Lower Super Output area For each health outcome 10

11 Leeds & Bradford estimated annual reduction in: All mortality Cardiopulmonary mortality Pre term babies Low birth weight babies Presentation title - edit in Header and Footer 11

12 Estimated reduction in the number of children and young people (0-18yrs) developing asthma 12

13 Scenario 2: Euro 5 to Euro 6 bus upgrades by 2021 Presentation title - edit in Header and Footer 13

14 Evaluating interventions that improve health through improvements in air quality: an illustration with the West Yorkshire Low Emission Zone Feasibility Study James Lomas (CHE CLAHRC Y&H) 1 st December 2015

15 Applying pharmaco-economic principles to air pollution Allows transparent and accountable decision-making Benefits to using a consistent and coherent set of principles in analysis Can compare across wide-range of competing demands and interventions (across LA priorities and wider) Illustrated using Leeds/Bradford low emission strategy Using QALY framework Costs to NHS/PSS CLAHRC Yorkshire and Humber

16 How much are they worth? Health outcome QALY loss Additional resource use Combined loss All-cause death ,000 Coronary event ,000 50,000 Childhood asthma 0.9 3,000 21,000 Term, low birth weight birth - 2,000 2,000 Pre term birth ,000 50,000 CLAHRC Yorkshire and Humber

17 A sample scenario pre EURO 4 buses and HGVs were upgraded to EURO 6 by 2016 (n.b. could implement multiple scenarios) 2012 baseline reductions in emissions from within Leeds and Bradford ORRs: tonnes of PM 2.5 per annum tonnes of NO x per annum NPV cost of implementation: 6,300,000 (Ricardo AEA, 2014) CLAHRC Yorkshire and Humber

18 A sample scenario s health benefits Health event Pollutant Number averted per year (ORR) Total value, nearest 10k (combining resource use and monetary valuation of QALYs) All-cause mortality death PM (3, 18) 1,680,000 Coronary events (Bradford PM (0, 9) 250,000 only) Term, low birth weight birth Term, low birth weight birth PM (3, 12) 20,000 NO 2 10 (0, 20) 20,000 Pre term birth PM (2.0, 2.3) 110,000 Total annual effect n/a 2,080,000 Cases of childhood asthma NO 2 157* (39, 264) 3,300,000* CLAHRC Yorkshire and Humber

19 A toolkit for implementation and dissemination Excel based toolkit Either input reduction in emissions and population under consideration Or estimated health impacts Toolkit generates alternative valuations of estimated health impacts based on assumptions around strength of evidence CLAHRC Yorkshire and Humber

20 Implications Further work: impact of spikes v average pollutant concentrations and health Caveats [personal exposure, emission models, other health impacts] Improvements in health occur via integrated policies spanning: air quality (cleaner and less emissions) active travel (walking, cycling, public transport, community transport) community safety strategies such as traffic calming increased creation and use of urban green space Successful Dept Transport bid to upgrade Bradford buses, input to OLEV bid West Yorkshire Single Transport Plan health and sustainability are cross cutting themes Local evidence does make a difference: Dept Transport / OLEV funding [Manningham upgrades] 20