by M LI · 2018 · Cited by 2 — The cost of air pollution consequences on the economy In the second section, the consequences of air pollution on health are FINAL.pdf
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Dr Mark LiChief Medical Of˜cer of SCOR Global Life, Beijing Mark Li, who joined SCOR in 2011, is responsible for underwriting, claims and medical issues for the Life & Health division in Beijing. He has more than 15 years of experience in the Life & Health insu -rance industry and is a Fellow of the Life Management Institute. As a practicing doctor, he worked for 14 years at the Internal Medicine department of a Teaching Hospital. Léo MallatGroup Senior Risk Manager, SCOR Léo Mallat joined SCOR™s Risk Division in 2014. Previously Advisor to the Chairman and Head of Public Affairs, he is now in charge of developing the Group Recovery Plan. Trained in biology, ac -tuarial science and public health law, he began his career as a researcher (CNRS, INSERM, Veolia Environment) and has also represented the French Government on a health and environment wor -king group at the WHO. Health impacts of air pollutionMark LI and Léo MALLAT July 2018
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CONTENTS I. Air pollution: components and dynamics p.5 1.The different categories of air pollutants p.5 2. Dynamics and trends of air pollution p.8 II. Health effects of pollution p.12 1. Short-term or long-term exposure p.12 2. Respiratory diseases p.16 3. Cardiovascular diseases p.17 4. Stroke p.17 5. Cancer p.18 6. Other health effects p.19 7. Reversibility of air pollution effects p.21 III. Air pollution and the (re)insurance industry p.22 1.The cost of air pollution consequences on the economy p.22 2. A growing challenge for life (re)insurers p.23 3. Possible consequences for (re)insurance demand p.25 Conclusion p.26 Appendix p.27Bibliography p.33
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Air, water and food, in this order, are the core metabolic requirements for human life. A reduction in either the quality or quantity of any of these essential resources constitutes a major threat to human health. Due to the globalization of industrial production and energy needs, and to an increasing number of acute air pollution episodes in many cities worldwide, air pollution has become a growing concern over the past decade, with mounting evidence of its dramatic health impacts. Air pollution is today considered as the world™s most serious environmental health risk by the World Health Organisation (WHO). Numerous studies have consistently shown its deleterious effect on human health. It is estimated that polluted air was responsible for over 6 million deaths worldwide in 2016 1, twice as many as AIDS, tuberculosis and malaria combined. Ambient particulate matter, nitrogen dioxides and other pollutants have been associated with increased prevalence of a number of respiratory and cardiovascular diseases 2, cancers and even appear to be correlated with neurodevelopmental disorders in children and neurodegenerative diseases in adult. Data on air quality indicators is becoming increasingly available and the science underlying the related health impact is also evolving rapidly 3.As a global reinsurer with signi˜cant exposure to mortality risks, SCOR is monitoring the consequences of emerging risks that might have an impact on human life, such as air pollution, endocrine disruptors and anti-microbial resistance, to name a few. The (re)insurance industry has recognized that air pollution should be considered as an important emerging risk 4.This paper presents the issue of air pollution and discusses the latest ˜ndings of fundamental research with regard to its consequences on human health. It is organized as follows: in the ˜rst section, the nature and dynamics of air pollution are described. In the second section, the consequences of air pollution on health are documented. In the last section, the consequences of air pollution on the (re)insurance industry are discussed. Abstract1Global Burden of Disease Study, 2016 [1] 2Beelen et al., 2014 [2], Carey et al., 2013 [3], Cesaroni et al., 2013 [4], Turner et al., 2017 [5], Garcia et al., 2016 [6], Gakidou Emmanuela et al., 2017 [7] 3.Beelen et al., 2008 [8]4.Risk Radar, CRO Forum https://www.thecroforum.org/wpcontent/uploads/2018/05/CRO-ERI_Emerging-Risk-RadarTrends_Apr2018_ FINAL.pdf
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5 Amount of the loss divided by the value of the insured property 6See paragraph c. Ozone.7WHO, 2013 [10]8One millionth of a metre. 9WHO, 2018 [9]10Deng, X., Rui, W., Zhang, F. et al., 2013 [11] 11 WHO, 2013 [10]12Hendriks et al., [12]By contrast, secondary pollutants are formed in the atmosphere as a result of a chemical reaction between gaseous precursors such as sulphur dioxide, oxides of nitrogen, ammonia and non-methane volatile organic compounds. They include the following elements: Oxides of nitrogen 5, Ozone6. a. Particulate matter (PM)PM, or coarse particles7, consist of invisible solid and liquid particles with diameters of either less than 10˚m8 (PM10), or 2,5˚m (PM2.5). They affect more people than any other pollutant9, and can penetrate into the respiratory tract. PM 2.5, being even smaller, can reach the deepest areas of the breathing apparatus, such as the pulmonary alveoli 10.They include ultra˜ne particles having a diameter of less than 0.1µm. The chemical compounds of PM include sulfates, nitrates, ammonium and other inorganic ions such as sodium, potassium, calcium or magnesium, metals such as cadmium, copper, nickel and zinc and biological components such as allergens or microbes 11.PM can be generated by industry, transport and agriculture, and due to their light weight, can also be carried on air currents from one country to another. As an example, two-thirds of the PM 10 recorded in the Netherlands is estimated to have originated in foreign countries 12.10 mm 100 µm 100 nm 10 µm 10 nm 1 millionth of a meter 1 billionth of a meter 1 thousandth of a meter ants hairs PM10 2.5 µm PM2.5 cells bacteria viruses DNA1 mm 1 µm 1 nm COARSE PARTICLES FINE PARTICLES PM0.1 ULTRAFINE PARTICLES Figure 1: Schematic overview of the relative size of PM 10, PM2.5 and ultra˜ne particles. 06 Health impacts of air pollution – SCOR Paper #42 – July 2018
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The WHO 2005 Air Quality Guidelines (see Appendice, page 30) recommend maintaining PM concentrations below the following levels: ł PM2.5: 10 µg.m-3 annual mean; 25 µg.m-3 24-hour mean; ł PM10: 20 µg.m-3 annual mean; 50 µg.m-3 24-hour mean. According to the WHO, in 2016, 91% of the world population was living in places where the air quality guidelines levels were not met. b. Nitric oxides (NOx)Nitric oxides include nitric oxide (NO) and nitrogen dioxide (NO 2), the result of the oxidation of nitric oxide by ozone. Nitrogen dioxide is a by-product of combustion reactions, and typically appears during the burning of fossil fuels in power plants. In cities, where it contributes to the formation of smog events 13, most of the nitrogen dioxide comes from motor vehicle exhaust. Nitric oxide is an important molecule in human cells, but has a limited toxicity in the concentrations at which it is found in the atmosphere. However, exposure to nitrogen dioxide can decrease lung function and increase the risk of respiratory symptoms 14. c. Ammonia (NH3)Ammonia is the most abundant alkaline gas in the atmosphere and the most commonly produced chemical. It is a precursor for the nitrogen reaction chain and is produced naturally from decomposition of organic matter, including plants, animals and wastes. The largest source of NH 3 emissions is agriculture, with both animal husbandry and the use of fertilizers.Being lighter than air, this gas usually rises and does not typically lead to immediate impact on health. At high concentrations however, or in moist areas, ammonia leads to throat and respiratory tract irritation. d. OzoneOzone is known as the high altitude shield of the Earth, where it protects the atmosphere against the harmful ultraviolet radiation emitted by the sun. However, at lower altitudes ozone is a secondary pollutant resulting from a reaction between nitric oxides and organic volatile compounds (as hydrocarbons present in petrol). This photochemical process can only occur under the radiation of the sun, which explains the summer-seasonality of ozone pollution events. Ozone peaks have documented consequences on lungs15 and the respiratory tract 16.07 Health impacts of air pollution – SCOR Paper #42 – July 201813 Wang et al., 2016 [13] 14WHO, 2003 [14]15WHO, 2003 [14]16Anderson, H.R. et al., 2003 [15]
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e. Sulphur dioxideSulphur dioxide (SO2) is a corrosive gas produced by the consumption of fuel containing sulphur, such as coal and oil. It can also be discharged in the atmosphere through natural processes, such as organic decomposition or volcanic eruptions. Sulphur dioxide irritates the skin and mucous membranes (eyes, nose, throat and lungs), and can affect the respiratory system. Sulphur dioxide reacts with water in the air to form sulphuric acid, an important component of the phenomenon of acid rain. 2. Dynamics and trends of air pollution Air pollution is considered an emerging risk, and its dynamics depend on a broad range of factors. A WHO global comparative analysis of air pollution17 concludedthat ambient air pollution increased by 8% between 2008 and 2013. In the absence of more stringent policies, or disruptive technological changes, increasing economic activity and energy demand will lead to a signi˜cant increase in global emissions of air pollutants in the coming decades. This is because air pollution mirrors the underlying baseline assumptions of economic growth, but at a slower pace. The OECD has developed projections of emissions of pollutants over time based on environmental-economic models (ENV Linkage models) where some pollutants, in particular nitrous oxides, are expected to almost double by 2060. The ˜gure below summarises the projected trends in emissions of the most common pollutants, in particular black carbon (a component of ˜ne particulate matter Œ PM2.5), carbon monoxide, nitric oxides (NOx) and sulphur dioxide (SO2).Figure 2: Emission projections over time indexed with respect to 2010 1817WHO, 2016 [18]18 OECD, 2016 [16]08 Health impacts of air pollution – SCOR Paper #42 – July 2018
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Finally, there are geographical discrepancies in both levels and trends of air pollution, due to the uneven level of development and population concentration around the globe. The concentration of pollutants, and in particular of PM, are already above the levels recommended by the WHO Air quality guidelines in a number of regions, such as in South and East Asia. Several studies have demonstrated that air pollution negatively correlates with the level of income of countries, as Europe, the Americas and the Western Paci˜c Region face low levels of pollution, while urban air pollution averages in the Eastern Mediterranean and South East Asia can exceed WHO limits by up to 5-10 times20.Pollution in ancient Rome.Economic activities have always been associated with the discharge of pollutants into the atmosphere. Residents of ancient Rome were already concerned about air pollution, calling the city™s smoke cloud grave caelum (fiheavy heavenfl) and infamis aer (fiinfamous airfl)19. Philosopher and statesman Seneca even wrote, in A.D. 61 fiNo sooner had I left behind the oppressive atmosphere of the city and that reek of smoking cookers which pour out, along with clouds of ashes, all the poisonous fumes they™ve accumulated in their interiors whenever they™re started up, than I noticed the change in my conditionfl.The analysis of ancient Greenland ice provides evidence for the presence of lead in the air at the time of the Roman Empire, due to a process of silver extraction, making it the oldest report of international atmospheric pollution. 09 Health impacts of air pollution – SCOR Paper #42 – July 201819Frontinus, De Aquis Urbis Romae, 1st Century AC. [17] 20Beelen et al., 2008 [8]
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