Mediterranean Health Interview Surveys Studies: long term exposure to air pollution and health surveillance (MEDHISS)

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Summary of the project

Air pollution is the number one environmental factor contributing to premature mortality and it importantly affects quality of life, given its contribution to the onset and worsening of cardiovascular and respiratory diseases. The European Commission is engaged from many years in evaluating air pollution real impact on the human health and promoting effective measures to its reduction. Many studies have demonstrated an association between short-term exposure to air pollution and the occurrence of acute health events. However, less is known about the health effects of being chronically exposed to high air pollution levels, which is the current situation for a large part of the population in the Mediterranean area. A better knowledge of the long-term health effects of air pollutants is mandatory in order to guide the European policy dealing with environment and health (Environment and Health Action Plan). The problems targeted by the MED HISS project are to estimate long-term health effects of air pollution in four Mediterranean countries (France, Italy, Slovenia and Spain), providing new evidence to support EU legislation and implementing an epidemiological cheaper surveillance system to monitor these effects over time. The project started on first of July 2013 in order to give the first results before the end of the project (June 2016). The proposed low-cost approach, suitable for surveillance, is based on linking resources like air pollution prediction models, mortality and hospital admissions registries and National Health Interview Surveys, already available and mandatory in all European countries. In particular, the surveys contain representative samples of the general population, covering both urban and rural areas. Each individual is linkable to mortality and hospital admissions information.

A measure of exposure is assigned through the national deterministic dispersion models (in France-CHIMERE, in Italy-MINNI, in Slovenia-ARSO and in Spain-CALIOPE) integrated with monitoring stations information. The recent scientific literature is confirming that long-term air pollution (specially particulate matter) exposure has effects on mortality for cardiovascular and respiratory diseases, and for lung cancer too, in European population. Nevertheless these studies were mainly focused on few big cities or on particular subpopulation (susceptible groups). MED HISS wants to settle an inexpensive way to monitor health effects of air pollution over time, covering the whole national territories and all European population. In most cases the studies are referred to health data at an individual level (behavior habits, socio-economic status etc.) or to aggregated health data (e.g. measurement of characteristics to municipality level). Where the follow-up of population participating in Health Surveys would not be possible the robustness of alternative approaches will be tested. These analyses are possible thanks to a partnership which includes well-experienced epidemiological institutions together with experts in the field of environmental epidemiology and air quality monitoring and modeling. Arpa Piemonte (Italy) is the coordinator of the project. It can be important for the EU to know the trend of health risks associated to air pollution over time. MED HISS surveillance system can be sustained for long periods of time and will allow to explore trends over different decades. Some challenges ahead of the implementation of this system include the adoption of restrictive privacy policies that prevent the access to individual health information. The aim of MED HISS is to demonstrate the feasibility of this kind of approach in France, Italy, Slovenia and Spain, in order to make it available in all European countries.