Feb. 17, 2013.  Salt Lake Tribune Op Ed.  Solving our inversion pollution.


Air quality on the Wasatch front is a Public Health Crisis: How to Protect Your Health by Howie Garber M.D / Utah Physicians for a Healthy Environment(UPHE)

During winter inversions, the air quality along the Wasatch front including Ogden, Salt Lake City, Orem-Provo , and Logan ranks among the top 25 worst cities in the U.S. This air quality poses a significant threat to our health. Estimates are that current air pollution levels shortens our lives by two years. Compare this to smoking a pack of cigarettes a day, which shortens one’s life by 8 years.

Air pollution is composed of small particles, (PM-2.5), coarse particles (Pm-10), Ozone, oxides of nitrogen and sulfur and toxic metals such as mercury and lead. Fine particle pollution or PM2.5 describes particulate matter that is 2.5 microns in diameter and smaller – 1/30th the diameter of a human hair. These Pm 2.5 particles are small enough to pass deep into the lungs. Much of our Pm2.5 pollution comes from trucks, buses, automobiles, refineries and coal fired power plants. Particulate air pollution is worst during winter temperature inversions. The EPA has set a 24hour standard for pm2.5 at 35 micrograms per cubic meter. The annual EPA standard is 15 micrograms per cubic meter. During typical days of winter air pollution along the Wasatch front, the Pm2.5 can reach 30-80mcg/m3. Concentrations of Pm2.5, Pm 10, Ozone, and Carbon Monoxide are monitored hourly at sites in Salt lake, Ogden, Provo, Park City, St George and Logan. The public can monitor these levels at http://www.airquality.utah.gov/slc-currentconditions.html and at http://www.airnow.gov/. Salt Lake, Ogden and Provo are non attainment areas for PM-10. Salt Lake County is very close to violating EPA standards for ozone and pm-2.5 and is expected to be designated non attainment.
Health studies have shown a significant association between exposure to fine particles and premature death from heart or lung disease. Fine particles have been linked to effects such as: cardiac arrhythmias; heart attacks; pneumonia, asthma attacks; lung cancer and bronchitis. These effects result in increased hospital admissions, emergency room visits, and absences from school or work.

A recent study in Utah conducted over 8 years showed that days with PM2.5 increases of 10ug/m3 resulted in an increase in heart attacks of 4.5%. The results were linear so that on a smoggy day with a level of Pm2.5 of 60 would have a 25% increase in heart attacks. With regard to long term PM2.5 exposure, a recent national study of 65,000 women conducted over 4 years found that a 10ug/m3 rise in chronic PM2.5 exposure resulted in a 24%increase in the risk of cardiovascular events, a 76% increase in the risk of death from heart disease, and a 35% increase in the risk from stroke. Particulate air pollution has been shown to accelerate atherosclerosis and inflammation throughout the body. Another effect of particulate exposure is to decrease heart rate variability which may contribute to heart attacks and strokes.

Current estimates are that along the Wasatch front, 1000 to 2,000 people die each year from the direct effects of air pollution. It is important to note that no level of ozone or particulate air pollution is safe and the limits that the EPA sets are constrained by politics, the demands of industry, and our needs to drive, and burn fossil fuels.

Seniors and children, those with preexisting heart and lung disease, previous stroke, heart attack, or diabetes are considered more susceptible to air pollution. While it is easy to identify these susceptibilities, as many as 20% of people who have heart attacks have no identifiable risk factors. Before exercising outdoors one should check levels of ozone and particulates. During winter inversions or at other times of high particulate pollution it is best to exercise in the mountains or inside( health club or walking at a shopping mall). The recommendation of UPHE is that susceptible individuals and those with multiple cardiac risk factors should limit prolonged outdoor activity when Pm2.5 is between 20-35. When Pm2.5 is Over 35, there should be no prolonged outdoor exertion by anyone. It is important to note that the Utah Dept of Air Quality (DAQ)issues its first warning(Advisory A) at PM2.5 levels between 35 and 55 and states that at these levels , “those with respiratory or heart disease, the elderly and children should reduce prolonged or heavy exertion outdoors.” Above PM 2.5 levels above 55, “everyone should reduce prolonged or heavy exertion”. UPHE doesn’t feel like DAQ recommendations are adequately protective of people’s health. This type of information can never be obtained from medical trials. It is not ethical or appropriate to exercise people with coronary disease on bad air days and see if some have heart attacks.

Given the known associated morbidity and mortality of air pollution, significant benefit would result if Utah physicians were aware of daily pollution levels and forecasts and could advise patients with known risk factors. When particulate and ozone levels are high, asthmatics and those with chronic bronchitis should check their peak flows more often. For many patients decreases in peak flow or symptoms of sinusitis, allergies, or pneumonia may correlate with levels of air pollution. It is important for physicians and patients to know that air pollution may have exacerbated or even caused their illness, heart attack, or stroke. We would like patients and physicians to share their experiences with us.

Given the fact that autos are the greatest source of particulates, all of us are a major part of the problem. “We have met the enemy and it is us.” There needs to be more individual and community effort to limit driving, and use mass transit on bad air days. Warming up your car contributes to pollution. Similarly idling outside schools, airports, and other places is neglectful of public health. Buying cars with fuel efficiency and keeping them well tuned will also help. On bad air days, working at home, car pooling, not driving or driving at 50-55 mph and avoiding rapid acceleration all would help.

The political climate in Utah has never been more favorable for improving our air quality. Ralph Becker, recently elected Mayor of Salt Lake City and Salt Lake County Mayor Peter Caroon have superb environmental records. Governor Jon Huntsman has stated that air quality is a priority. More funding is needed to retrofit trucks and school buses with less polluting exhaust systems. Our public health emergency requires a community response. Our roads can use more bicycle paths. UPHE advocates expansion of our mass transit system and free mass transit on bad air days. Higher parking fees on polluted days would discourage auto use. All the available scientific evidence show that EPA standards are not stringent enough to protect our health. UPHE advocates stricter air quality standards in Utah and a moratorium on coal fired power plants. Utah Physicians for a Healthy Environment, Utah Moms for Clean Air, and the Utah Clean Air Alliance are all newly formed organizations to make the Wasatch front a healthier environment.
UPHE is looking for more health professionals to become involved in solving our air pollution problem. We are asking physicians and health professionals to join who might have the interest in developing expertise with one environmental problem. We will need help giving presentations and meeting with community officials. To get people to use mass transit, bicycles, and use their automobiles less, we need to convince people to change their behavior. We consider breathing clean air to be a basic human right; however it will only be achieved by demanding this of our elected officials and by changing our lifestyle.

Children are especially susceptible to air pollution and it has been shown that living close to freeways adversely affects lung development in children. Recent statistics from the Utah Dept of Health shows that in North Salt Lake and Woods cross-16.2% of children less than 17 years old have asthma. This is in contrast to the normal prevalence of 5%. Common sense would seem to point to the nearby oil refineries and I-15. Studies have shown an association between air pollution and increased premature births, low birth weight, and infant mortality.

Ozone is a major contributor to summertime smog. Forest fires hundreds of miles away from the Wasatch and ozone from Southern California can contribute to our problems in Utah. Oil refineries also produce precursors of ozone. Record temperatures in Utah last summer resulted in many days of unhealthy ozone levels along the Wasatch front communities. Elevated Ozone contributes to premature death, asthma attacks, respiratory inflammation, and infection. A 2004 study looked at ground level ozone in 95 cities. Changes in ground level ozone were significantly associated with an increase in death in many U.S. cities. The increase in death occurred at ozone levels below the EPA clean air standards. The EPA’s maximum for ground level ozone is 80 part per billion. The researchers calculated that a 10ppb reduction in daily ozone could save 4,000 lives throughout the 95 cities included in the study. During the 1996 Atlanta Olympics reducing traffic and ozone by increasing mass transit resulted in 44% fewer ER visits for asthma attacks.

Before exercising outdoors one should check levels of ozone and particulates. Exposure to ozone can be minimized in the summer by exercising in early morning before ozone has had a chance to rise. When ozone levels are greater than 50 ppb, strenuous outside exercise is not recommended.

There is very limited data on the relationship between outdoor and indoor air. Studies at several Utah schools have shown that staying indoors is protective when particulates outside are high. With limited data it was interesting to note that on days with low particulate air pollution, the air quality is often better outside than inside. Susceptible individuals or those with several coronary risk factors can protect themselves from ozone or particulate air pollution with HEPA filters. Using personal monitors, pm2.5 is higher is higher on a person than indoors or outdoors. (check health effects institute for info on air filters and personal monitors.
Relationship between indoor and outdoor air is complex- depends on if it’s a tight new house or an older drafty one. Also depends on if smokers or fireplace in house.


Written on December 17th, 2011

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Utah Physicians for Healthy Environment