Accountability studies of air pollution and health effects: lessons learned and recommendations for future natural experiment opportunities

Abstract

To address limitations of observational epidemiology studies of air pollution and health effects, including residual confounding by temporal and spatial factors, several studies have taken advantage of ‘natural experiments’, where an environmental policy or air quality intervention has resulted in reductions in ambient air pollution concentrations. Researchers have examined whether the population impacted by these air quality improvements, also experienced improvements in various health indices (e.g. reduced morbidity/mortality). In this paper, I review key accountability studies done previously and new studies done over the past several years in Beijing, Atlanta, London, Ireland, and other locations, describing study design and analysis strengths and limitations of each. As new ‘natural experiment’ opportunities arise, several lessons learned from these studies should be applied when planning a new accountability study. Comparison of health outcomes during the intervention to both before and after the intervention in the population of interest, as well as use of a control population to assess whether any temporal changes in the population of interest were also seen in populations not impacted by air quality improvements, should aid in minimizing residual confounding by these long term time trends. Use of either detailed health records for a population, or prospectively collected data on relevant mechanistic biomarkers coupled with such morbidity/mortality data may provide a more thorough assessment of if the intervention beneficially impacted the health of the community, and if so by what mechanism(s). Further, prospective measurement of a large suite of air pollutants may allow a more thorough understanding of what pollutant source(s) is/are responsible for any health benefit observed. The importance of using multiple statistical analysis methods in each paper and the difference in how the timing of the air pollution/outcome association may impact which of these design features is most important is also discussed. Based on these and other lessons learned, researchers may provide a more epidemiologically rigorous evaluation of cause-specific health impacts of an air quality intervention or action.

Environmental degradation and inclusive human development in sub‐Saharan Africa

“…Socio‐economic externalities can be observed from the perspective of income, health and education. In summary, if the negative net effect of environmental degradation on inclusive development is driven by all components of the inequality adjustment human development index (education, health and income), then the findings are consistent with studies which have established that environmental degradation is negative on income (Zivin & Neidell, ), long life and health (Boogaard et al, ; Rich, ), and education (Clark et al, ; Currie et al, ; Sunyer et al, ).…”

“…Such environmental degradation negatively affects human well‐being and promotes exclusive development, both at national and human levels. These theoretical insights are consistent with this study, because as has been seen in the previous paragraphs, environmental degradation affects all dimensions of the inequality‐adjusted human development index used in this study, notably: education (Clark et al, ; Currie et al, ; Sunyer et al, ), health and life expectancy (Boogaard et al, ; Rich, ) and income (Zivin & Neidell, ).…”

“…Moreover, such atmospheric pollution can also affect the ability of pupils to study effectively in class (Clark et al, ; Sunyer et al, ). Second, from a logical standpoint, environmental degradation or pollution also has a direct effect on the health and life expectancy of citizens (Boogaard, van Erp, Walker, & Shaikh, ; Rich, ). Third, intuitively, environmental degradation can influence a family's income by affecting the ability of workers in a household to search for work and/or work effectively even when work is found (Zivin & Neidell, ).…”

The role of globalization in modulating the effect of environmental degradation on inclusive human development

“…Moreover, studying at home and at school can be considerably constrained by serious atmospheric pollution (Clark, Crombie, Head, van Kamp, van Kempen & Stansfeld, 2012;Sunyer et al, 2015). Third, it follows from the previous narratives that environmental pollution naturally affects healthy living and consequently, the life expectancy of the population (Rich, 2017;Boogaard, van Erp, Walker & Shaikh, 2017).…”

Life cycle assessment of concrete production with a focus on air pollutants and the desired risk parameters using genetic algorithm

“…Each of the pollutants creates a unique risk toward health at the workplace, the extent of which can be extracted from Eq. 1 [29]. In this part, the medium risk rate (RR = 3) and the lesser values (RR ≤ 3) are considered as the ideal situation, and the ultimate goal of determining M includes the extent of exposure in micrograms per cubic meter (W), average working hours in a week, and D, average time of each exposure (hourly) in desirable conditions.…”