On March 2, in Paris, the European Aphekom project, coordinated by the French Institute for public health surveillance (InVS), presented the results of a three-year study on air pollution and its impact on health, conducted by 60 researchers in 25 cities across Europe. Sorry for the sceptics, but the data are once again worrying, with the important new information that health impact is now associated with a monetary impact.

It is thus clear that if the 25 European cities involved in the study (from Barcelona to Athens, from Bucharest to Rome, from London to Stockholm), brought dust concentrations (PM10 and PM 2.5) down to the safety threshold recommended by the World Health Organisation (respectively 20 µg/m³ and 10 µg/m³), 19,000 lives (including 15,000 from cardiovascular diseases) and 31.5 billion euro could be saved. Every year.

From this standpoint, research takes on a clear political significance, as it not only shows the damage, but it also provides guidelines on how to mend it. Investing, even massively in environmental mitigation measures (especially on mobility, industrial emissions and heating systems) would cost nothing. The lives saved and the diseases avoided as a result of reduced pollution would in fact lower health care costs and increase productivity. In short, more health but also more GDP. Who knows, may be if this alarming pollution situation is presented this way, it may sound better to the ears of decision-makers.

Among the 25 cities listed in the study, Rome (which is not among the most polluted Italian cities) ranks among the top ones, with particles concentration of 39 µg/m³ of PM10 and 21 µg/m³ of PM 2.5 .To be sure, these are almost compliant with current legislation, but well above the WHO recommended thresholds, which are equal to half the current mandatory limits (respectively 20 e 10 µg/m³).The average of the maximum value of the moving average for eight hours in the concentration of ozone (O3) is instead 73 µg/3, therefore within the WHO guidelines (100 µg/m³). Obviously if such a calculation were applied to a more polluted city like Milan, it would result in even higher figures.

The health impact assessments (HIA) conducted in Rome by the Department of Epidemiology of the Lazio Region (Forastiere et al.) used two scenarios to assess the benefits of the reduction in PM₁₀, ozone and PM_2.5: a reduction of 5 µg/m³ and a reduction to the levels of the WHO guidelines. PM₁₀ and ozone were used to assess the effect of a short-term exposure to air pollution while PM2.5 was used to assess the long-term effects of exposure.

If Rome complied with the WHO guidelines, it would avoid 1,278 deaths from chronic diseases. If a similar decrease were also implemented on PM10, Rome would also avoid 227 deaths from diseases in the short term and a thousand hospitalizations per year. All in all, 2.2 billion euro per year would be saved. Nearly one billion if the reduction were only 5µg/m³ .

The table summarizes the key findings for the suspended particulate matter for Rome:

Key findings
	Short-term effects		Long-term effects
	PM10		PM2.5
	reduction of 5µg/m3	reduction to 20 µg/m3 (WHO guidelines)	reduction of 5µg/m3	reduction to 10 µg/m3 (WHO guidelines)
Mortality
Years of life gained by persons aged 30			0.4	1.0
Annual number of deaths from avoidable cardiovascular causes			471	997
Annual number of deaths from avoidable natural causes	61	227	594	1278
Economic gain (million €)	5.3	19.7	983.1	2115.1
Hospitalizations for respiratory diseases
Annual number of avoidable cases	158	579
Economic gain (million €)	0.6	2.3
Hospitalizations for heart diseases
Annual number of avoidable cases	118	434
Economic gain (million €)	0.5	1.7

A reduction of 5 µg/m³ in the average ozone concentration, instead, would avoid 32 deaths, 31 hospitalizations of elderly people for heart diseases and 5 hospitalizations in the population aged 15-64 for respiratory diseases.

To calculate the economic impact of pollution (which in any case is an underestimate, because it refers only to health damages), the researchers took as a reference the "value" of life (average over all ages) established by consensus among European health economists with the method of "willingness to pay": € 1.6 million for each person, which multiplied by epidemiological estimates result precisely in the 30 billion euro that could be saved in the 25 cities examined.

Some cities, such as London, Dublin and Stockholm, in fact, are already complying with WHO standards. Others, such as Bucharest, Budapest, Barcelona, Athens and Rome are more polluted and would therefore have much to gain from radical air quality improvement projects. The gain can even be quantified as additional months of life expectancy on average for persons thirty years of age: a sizable 22 months in Bucharest, 12 in Rome and not even one in Stockholm, where most of the job has already been done.

#LLL# Picture 1

Among the other findings of the Aphekom study it emerges that in Rome, 23% of residents live at less than 75 meters from a busy road. The results of the study show that 11% of cases of asthma exacerbation in children, 18% of acute problems in the elderly suffering from Chronic Obstructive Pulmonary Disease, and 23% of acute problems in elderly patients with coronary heart diseases can be attributed to heavy pollution in the area of residence.

"These important results highlight the health and monetary benefits arising from implementing a policy on air pollution," noted the Italian researchers. "This policy should aim at the benefits that could result from regulating pollution near busy roads".

Italia Nostra: a national anti pollution policy is needed
The website of the Aphekom study