Research during the past 10–20 years confirms thatoutdoor air pollution contributes to morbidity andmortality.1,2 Whereas some effects may be related toshort-term exposure,3 others have to be consideredcontributions of long-term exposure.4,5 Although themechanisms are not fully explained, epidemiologicalevidence suggests that outdoor air pollution is acontributing cause of morbidity and mortality.6 State-ofthe-art epidemiological research has found consistentand coherent associations between air pollution andvarious outcomes (eg, respiratory symptoms, reducedlung function, chronic bronchitis, and mortality).6Relative risks related to air pollution, however, arerather small. For example, for an average adult, the riskof dying may increase on any given day by less than 1% ifthe concentration of inhalable (<10 m diameter)particulate matter (PM10) increases by 10 g/m3.3 Giventhe finite resources available to protect health, there is aneed to weight different risks and to allocate preventiveresources to get the maximum benefit. We present athree-country interdisciplinary assessment of the impactrelated to air polution on morbidity and mortality. Theproject has been initiated by WHO Europe as a casestudy in the framework of the transport environment andhealth session of the WHO Ministerial Conference onEnvironment and Health, held in London, UK, in 1999.7National agencies from Austria, France, andSwitzerland assessed the external public-health costs oftotal air pollution and of traffic-related air pollution. Thefocus on traffic-related air pollution and on economicvaluation is based on the argument that traffic createscosts which are not covered by the polluters (themotorists). Such costs cause economic problems,because they are not included in the market price, whichleads to a wasting of scarce and important resources(eg, clean air, silence, and clean water). To stop thiswastage, the real price should be put on clean air. Withthe present study, an important part of the externaltraffic-related costs, namely the negative impacts oftraffic-related air pollution on human health wereassessed in terms of attributable number of cases. Thequantification of the related external costs aresummarised in an Organisation for Economic Cooperationand Development (OECD) report. The fullproject reports are available from WHO(www.who.dk/london99/transport04.htm, accessed Aug17, 2000).8–10
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