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HEALTH COMMUNICATION & ADVOCACY - HLTH 634 A 15, 2018
IMPROVED AIR QUALITY: A
THREE-PRONGED
INTERVENTION APPROACH
Introduction
Global environmental health is an important factor in the quality of life of all humans. It
influences how long we may live and the health statuses we will endure while on this earth.
While environmental health pertains to preventing or controlling disease, injury, and disability
related to the interactions between people and their environment, it is influenced by several
factors including; exposure to hazardous substances in the air, water, soil, and food, natural and
technological disasters, climate change, occupational hazards and the built environment.1
Healthy People 2020 has selected 6 themes on which to focus in order to better global
environmental health. Outdoor air quality is listed as the first and to no coincidence, it is an area
in need of major improvement. Air pollution is a deadly presence society tends to overlook
because we cannot always see the damning effects. Poor air quality is linked to premature
death, cancer, and long-term damage to respiratory and cardiovascular systems.1 For these
reasons and more, decreasing air pollution is vital to human survival. It is an important step if a
healthy global environment is to be created.
But where exactly is the problem coming from? The sources of pollution vary from small
unit of cigarettes and natural sources such as volcanic activities to large volume of emission
from motor engines of automobiles and industrial activities.2 Interventions and changes are
being implemented worldwide and systematically to combat the rising sources that can cause
air pollution but a combination of interventions is what is needed. About 4.3 million people die
from household air pollution and 3.7 million from ambient air pollution.2 To have a drastic
impact on that death amount, an implementation of a combination of interventions among the
working class should be implemented.
The less gasoline we burn, the better we’re doing to reduce air pollution. This is the basis
for the combination of interventions needed to decrease air pollution and increase air quality to
bring about a healthier global environment. The individual intervention areas are,
transportation options, power provider options and local food options. The purpose of this
review is to describe the effects of air pollution on air quality and give the appropriate
justification for the aforementioned interventions. References included in this review support
the need for increased interventions to combat the issue and provide detailed context into the
issue and its potentially deadly effects. All references were selected based on up to date
relevance and credibility to the subject.
Body of Evidence
Over the last 10 years, there has been a substantial increase in findings that particulate
matter (PM) air pollution is not only exerting a greater impact on established health endpoints,
but is also associated with a broader number of disease outcomes.4 PM is largely produced in
correlation with increased motor vehicle exhaust. In highly trafficked regions, the emissions
from vehicles are quite substantial and they produce a higher negative effect on air quality.
The PM components from road traffic include engine emissions, comprising largely of EC
and OC, plus non-exhaust sources that are often characterized by elevated concentrations of
transition metals (brake wear [copper, antimony], tire abrasion [zinc], dust from road surfaces
[iron]).4 The largest single source is derived from diesel exhaust(DE). The transportation
intervention poses great aid as it will decrease the number of vehicles present on roads and
calls for more modes of transportation that emit none to minimal exhaust. Make good choices
about transportation. When you can, walk, ride a bike, or take public transportation. For driving,
choose cars that get better miles per gallon of gas or choose an electric car.3 By walking and
riding a bike or skateboard, we eliminate diesel exhaust completely. If this method was adopted
by the entire middle class, the decrease in emissions would drop drastically enough, perhaps
enough to produce air quality results in the near future. On top of those personal measures,
there are systematic changes that can be made that promote less air pollution. Impacts from
the current infrastructure can be reduced with barriers between busy corridors and residential
areas, traffic calming, optimized signalization, traffic circles versus stoplights and stop signs,
implementing disincentives to driving, giving preferences to other transportation modes, and
similar measures.5 Less polluting technologies that might be considered in future development
include greater reliance on public transportation and providing incentives for electric and hybrid
vehicles.5
Another method the working class can change in order to increase air quality s to
research their options for energy. Implementing solar or wind generated electricity, if
affordable, cam reduce emissions significantly. In order to reduce air pollutants, according to
the WHO with transitioning away from fossil fuel combustion (oil, coal) for large-scale energy
production, as well as diesel generators for small-scale production.6 Implementing this
systematic change will allow not only improve biological health, they will also reduce pollutants
and serve as a major factor for local economic development. These electric changes can also
increase promotion of healthy urban lifestyles, therefore driving quality of life for the working
class up. Increasing the use of low-emissions fuels and renewable combustion-free power
sources (like solar, wind or hydropower) and increasing reliance on the co-generation heat and
power and distributed energy generation (e.g. mini-grids and rooftop solar power generation)
make a healthier global environment achievable.6
Wind and solar power provide health, environmental, and climate benefits by displacing
conventional generators and therefore reducing emissions of carbon dioxide (CO2) and criteria
air pollutants, which include sulfur dioxide (SO2), nitrogen oxides (NOx), and fine particulate
matter (PM2.5).7 In order to assist in the implementation of these interventions, WHO provides
country-level technical support on best practices to both reduce air pollution and implement
mitigation strategies.6 Some of their tools that aid in the effectiveness and feasibility assessment
of interventions such as this include cost-benefit and cost-effectiveness analyses and health
impact assessments. Realizing these changes is more possible than the majority would like to
believe.
The third prong of the proposed intervention trio is local food options. This section runs
closely with the first prong as it decreases on emissions from exhaust due to transportation.
Purchasing food locally allows purchasers to buy food from within their own communities.
Conversely, when you shop at the grocery store, many of the food items you buy travel over
1500 miles to reach your plate and by cutting down on these miles, you are reducing the
environmental impact of your food.7 Food that is purchased locally leaves a smaller carbon
footprint as it does not involve plane or truck travel trips therefore cutting down on fossil fuel
burning and air pollution.
All references thus far have supported the notion that decreased air pollution resulting
in improved air quality is a necessity in order to decrease cases of cardiorespiratory diseases like
asthma exacerbation, asthma incidence, stroke, arrhythmia, heart failure etc. and death.
However, criticisms of these studies have included exposure misclassification and its resulting
bias towards the null, and residual confounding by both temporal and spatial factors including
time trends in exposure and health (e.g. hour of the day, weekday, season, long term time
trends), socioeconomic status and access to health care, smoking, other neighborhood factors,
exposures to other toxicants, and occupational exposure to pollution.9 There are many articles,
studies and reports citing transportation, power provider and local food choice changes as
catalysts for beneficial environmental changes. This study criticizes other for taking advantage of
previously conducted natural experiments and not digging deep enough to prove without a
doubt that the changes were in fact the sole causes of environmental betterment. The London
low emission zone, baseline study is cited below as an official example:
“Starting in early 2003, the mayor of London, England implemented a congestion
charging zone in central London, which charged drivers a small fee (~8 pounds in 2008) per day
to drive into the zone during working hours. As of 2008, congestion had improved with a 26%
reduction in the excess delay per kilometer, and a reduced traffic volume during the charging
hours, compared to before the charging scheme was implemented. Kelly et al (2011)
documented some difficulties in using primary care medical records for a health analysis, as
some primary care providers were concerned about losses in confidentiality due to geographic
patterns of NO2 and PM10 concentrations relative to residences of their patients in the dataset.
Therefore, they restricted analyses to NOx only in their pilot analyses. Kelly et al (2011) also did
not compare these traffic reductions or changes in cardiorespiratory outcomes (from 2003 to
2008) to another London area for the same time period. This would have provided further
evidence that the observed traffic changes, and thus estimated air pollution reductions, were a
result specifically of the congestion charging scheme.”9
This article is included because it adds definition to the subject. This article indicates that
the improvements sought out to justify transportation, energy and local food changes may in
fact not be completely reciprocal. With this information, it is only logical to factor in a forth
prong to the initial intervention. This prong will remain as an outside variable to be weighed and
identified once future studies are conducted and all areas are quantified and qualified
accordingly. For future natural experiments in this subject, will need to include suitable control
comparisons and less region based studies to provide more data detailed enough to prove cause
or effect on a disease response due to environmental and pollution stimulus.
Summary and Conclusion
Based on the review, the articles support the notion that a 4 pronged combination of
interventions incorporating the less gasoline we burn, the better we’re doing to reduce air
pollution theme is needed in order to propel air quality standards and increase global
environmental health. Moving forward, we need to pay more attention to traffic emissions
because they are a major source of ambient pollution. Ultimately, the most effective
intervention is primary prevention—the reduction in emissions of air pollutants. Active
commuting (eg, biking, walking) reduces air pollution (and greenhouse gas emissions) and
supports a more active lifestyle, which also has important health benefits.10 Based on the
research reviewed, despite a missing element that may not have been measured by current
survey and experiment methods, there is strong evidence documenting the benefits of
decreased emissions generated from the burning of fossil fuels, increased conversion to solar
and wind power as well as increased purchasing of local food sources. Progress has been made
to reduce unhealthy air emissions, but in 2008, approximately 127 million people lived in U.S.
counties that exceeded national air quality standards.1 The implemented intervention would
allow the working class to make a substantial depletion of adverse effects generated and would
bring the U.S. closer to meeting national air quality standards.
