353025201510
0.9
1.0
1.1
1.2
1.3
• Portage, W• Topeka, KS
• Waterown, MA(Boston)
• Harriman, TN(Knoxville)• St. Louis, MO
• Stebenville, OH
Long-term mortality. 6 cities, Dockery 1993
The six cities study: PM2.5 –MORTALITY (Dockery , NEJM 1993)
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
% o
f P
M2
.5M
on
ito
rs
Annual Mean PM2.5 (μg/m3)
Change in Distribution of Annual Mean PM2.5 2000 to 2015
Series1 Series2 Series3
78% of monitors below 12 µg/m3 in 2010
37% of monitors below 12 µg/m3 in 2000
94% of monitors below 12 µg/m3 in 2015
2000 2010 2015
CHANGE in PM2.5 DISTRIBUTION LOS ANGELES
Why air pollution
▪ Gases (NO2)
▪ Particles (PM2.5, UFP)
▪ Organic comp.
▪ Soot particles
▪ Metals…
.
.
Bronchial epithelium
10µm 1 µm 0.1µm
Courtesy: K. Donaldson & A. Peters
▪ Insulin Resistance
▪ Type 2 diabetes
▪ Type 1 diabetes
▪Bone metabolism ▪Skin Aging
▪Stroke
▪Neurological development
▪Mental Health
▪Neurodegenerative diseases
▪Cardiovascular Disease Mortality
▪Cardiovascular Disease Morbidity
▪Myocardial Infarction
▪Arrhythmia
▪Congestive Heart Failure
▪Changes in Heart Rate Variability
▪ST-Segment Depression
▪Premature Birth
▪Decreased Birth Weight
▪Decreased foetal growth
▪ In uterine growth retardation
▪Decreased sperm quality
▪Preclampsia
▪High blood pressure
▪Endothelial dysfunction
▪ Increased blood coagulation
▪Systemic inflammation
▪Deep Venous Thrombosis
▪Respiratory Disease Mortality
▪Respiratory Disease Morbidity
▪ Lung Cancer
▪Pneumonia
▪Upper and lower respiratory symptoms
▪Airway inflammation
▪Decreased lung function
▪Decreased lung growth
Joint ERS / ATS statement(ERJ 2017)
Air pollution affects multiple organs
immediately and has long-term consequences:
the FOURTH CAUSE of DEATH
Cohen A. Lancet 2017
ELEMENTAL CARBONINDOOR-OUTDOORBREATHE PROJECT
y = 0,7558x + 0,1409R² = 0,8442
y = 0,9083x + 0,0471R² = 0,8374
0
1
2
3
4
5
6
0 1 2 3 4 5 6
IN
OUT
Cold Season Warm Season
Rivas I, 20140
2000
4000
6000
8000
10000
12000
14000
16000
18000
27/01 28/01 29/01 30/01 31/01 01/02 02/02 03/02 04/02
BC [n
g/m
3 ]
SC-8
Brain function development and imaging in 2750 school children by low
(—) and high (- -) traffic pollution
Adjusted for sex, maternal education, residential neighbourhood socio-economic
status and school pair; school and subject as nested random effects.
Sunyer et al. Plos Medicine 2015 Pujol et al. Neuroimage 2016
a time series from 24h of personal measurements of BC from a child participant
personal measurements in a small subsample (N=51)
Què fem?
Tenim la diagnosi ben feta: ciutats amb l’aire contaminat
Originat sobretot pel tràfic
Un problema de salut prioritari
Ara toca trobar solucions: -. La bicicleta (elèctrica) és el vehicle urbà
-. Compartir
-. Vehicle a motor (mercaderies, ...) elèctric
-. Reduir espai tràfic: corredors verds, carrils bici
GREEN SPACE AND BRAIN DEVELOPMENT AND IMAGING
Dadvand et al 2015
PNASN=2,593 children, 7-10 yrs
Efectes secundaris del vehicle a motor URBÀ
• Contaminació aire
• Soroll
• Manca exercici físic
• Ocupació de l’espai (verd)
• Dificulta la interacció social
DensityMixed land
use/diversityDistanceDesign
DestinationaccessibiltyConnectivity
Transportinfrastructure
WalkabilityBikeability
Green space
Indoor/outdoor
WalkingCycling
CarPublic
transport
Air pollutionNoise
TemperatureUV Radiation
Cardiovascular and Respiratory
diseaseMental healthNeurodevelop
ment/cognitivefunction
Cancer
Acute/chronic
Prematuremortality
Urban design Behaviour Pathways Morbidity Mortality
Policies
Context: socio-economic, genetic, nutrition
StressSocial contacts
Physicalactivity
Nieuwenhuijsen 2016
Mueller et al 2017
PREMATURE DEATHS
PREVENTED
• 15,801 premature deaths prevented
annually in 167 European cities if the
mode share of cycling went up to 24.7%
Mueller et al 2017
EXPOSURE PATTERNS IN CITIES
Air
pollution
Temperatur
e
Green
space
Noise
DEATHS DUE TO POOR URBAN AND
TRANSPORT PLANNING
BARCELONA1154
659599
376
116
0
200
400
600
800
1000
1200
1400
Physical activity(95% CI: 858,1577)
Air pollution (95% CI: 386,834)
Noise(95% CI: 0,1009)
Heat(95% CI: 324,442)
Green spaces(95% CI: 0,236)
Mueller et al 2017Traffic injury deaths 30
2904 premature deaths (95% CI: 1568, 4098) (→ almost 20% of mortality)
Mueller et al 2017
52,001 DALYs (95% CI: 42,866–61,136)
Què fem?
La mobilitat no es pot deslligar de la planificació urbana:
• Substituir el cotxe com a vehicle de mobilitat a la ciutat té importants beneficis sobre la salut: reducció soroll, contaminació, calor.
• Augmentar el transport actiu té un gran impacte en salut per l’augment de l’exercici físic.
• Crear un espai urbà verd i amigable afavoreix el transport actiu.
Intervenció
• Model de ciutat: Cars free cities??
• Vehicle urbà: – Bicicleta (elèctrica)– Transport interurbà actiu
• Transport mercaderies ‘net’ • Compartir el transport
– Més i millor transport públic– ‘net’
• Reduir vehicles privats– Corredors verds– Carrils bici– Zones peatonals– Aparcament
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