Health Impact Assessment Research Articles

New concentration-response functions for seven morbidity endpoints associated with short-term PM2.5 exposure and their implications for health impact assessment

BackgroundMorbidity burdens from ambient air pollution are associated with market and non-market costs and are therefore important for policymaking. The estimation of morbidity burdens is based on concentration–response functions (CRFs). Most existing CRFs for short-term exposures to PM2.5 assume a fixed risk estimate as a log-linear function over an extrapolated exposure range, based on evidence primarily from Europe and North America. ObjectivesWe revisit these CRFs by performing a systematic review for seven morbidity endpoints previously assessed by the World Health Organization, including data from all available regions. These endpoints include all cardiovascular hospital admission, all respiratory hospital admission, asthma hospital admission and emergency room visit, along with the outcomes that stem from morbidity, such as lost work days, respiratory restricted activity days, and child bronchitis symptom days. MethodsWe estimate CRFs for each endpoint, using both a log-linear model and a nonlinear model that includes additional parameters to better fit evidence from high-exposure regions. We quantify uncertainties associated with these CRFs through randomization and Monte Carlo simulations. ResultsThe CRFs in this study show reduced model uncertainty compared with previous CRFs in all endpoints. The nonlinear CRFs produce more than doubled global estimates on average, depending on the endpoint. Overall, we assess that our CRFs can be used to provide policy analysis of air pollution impacts at the global scale. It is however important to note that improvement of CRFs requires observations over a wide range of conditions, and current available literature is still limited. DiscussionThe higher estimates produced by the nonlinear CRFs indicates the possibility of a large underestimation in current assessments of the morbidity impacts attributable to air pollution. Further studies should be pursued to better constrain the CRFs studied here, and to better characterize the causal relationship between exposures to PM2.5 and morbidity outcomes.

Air Pollution and Health in Africa: The Burden Falls on Children

This study sought to examine the impact of air pollution on health in Africa. Air pollution is a major public health concern around the world. Exposure to air pollution has been linked to a slew of negative health consequences, ranging from subclinical effects, physiological changes in pulmonary functions and the cardiovascular system, to clinical symptoms, outpatient and emergency-room visits, hospital admissions, and finally to premature death. Health impact assessments indicate that sub-Saharan Africa suffers a high burden of disease and premature deaths, attributable to environmental pollution in the world. The health and economic repercussions of rapid pollution increases could jeopardize African efforts to enhance economic development, establish human capital, and achieve the Sustainable Development Goals (SDGs). Despite all these, literature on pollution and health is still scanty in the case of Africa. This study was quantitative in nature, and it used a difference GMM approach to estimate its model. The GMM results showed that children are negatively affected by pollution. Children under the age of five are especially at risk, and the effects are believed to be most severe in developing countries, where exposure to high levels of ambient air pollution throughout childhood is thought to lower total life expectancy by an average of 4–5 years. Based on the findings of this study, it is recommended that African countries must not overlook the pollution problem. They must promote and use low carbon technologies and services. In the absence of active intervention, pollution will soon raise morbidity and death.

Health benefits of Open Streets programmes in Latin America: a quantitative health impact assessment

To improve physical activity in Latin American cities, several interventions have been promoted, such as Open Streets programmes. Our study aims to quantify the health and economic effects of Open Streets-related physical activity in 15 Latin American cities. We used a quantitative health impact assessment approach to estimate annual premature deaths and disease incidence (ischaemic heart disease, ischaemic stroke, type 2 diabetes, colon cancer, breast cancer, and dementia) avoided, the disability-adjusted life-years (DALYs) gained, and the cost saving (from reduced premature mortality) related to increased physical activity from Open Streets programmes in 15 Latin American cities. Input data were obtained from scientific publications, reports, and open street city surveys spanning 2017 to 2019. Physical activity data were converted to metabolic equivalent of the task. Exposure-response relationship functions were applied to estimate relative risk and population-attributable fraction, enabling the assessment of premature deaths and disease incidence. The percentage of male users of the Open Streets programmes ranged from 55% (27 500 of 50 000 in Guatemala) to 75% (2250 of 3000 in El Alto, Bolivia), and female users ranged from 25% (750; El Alto) to 45% (22 500; Guatemala). We estimated that the current Open Streets programmes in the 15 Latin American cities studied could prevent 363 (95% CI 271-494) annual premature deaths due to increased physical activity, with an annual economic impact of US$194·1 million (144·9 million-263·9 million) saved and an annual reduction of 1036·7 DALYs (346·7-1778·3). If one Open Streets event is added per week in each of those cities, the potential benefit could increase to 496 (370 to 677) premature deaths prevented each year. Open Streets programmes in Latin America can provide health and economic benefits related to increased physical activity and can be used as a health promotion and disease prevention tool. EU's Horizon 2020 research and innovation programme.

영국 지방 도시계획에서의 건강영향평가 통합과 시사점

The purpose of this study was to review the health impact assessment system in local planning in England and to make recommendations for the integration of health impact assessment in Korea. Health impact assessment is a combination of procedures, methods, and tools to identify the potential health impacts of a policy, plan, program, or project and the distribution of these impacts across different sub-populations. Local planning covers various health determinants of health and therefore, can be a useful vehicle to incorporate health in local planning. In England, the National Planning Policy Framework and Health and Social Care Act set the stage for health impact assessment at the national level in the planning and the public health, respectively. According to these national legal frameworks, both planning and public health sectors provide guidance for health impact assessment for local practitioners. The discussion section provides specific recommendations for each of planning and public health sectors in order to integrate health impact assessment into local planning.

보건복지분야 도시건강 관련 연구의 동향

This paper discusses the trend of research on urban health in the disciplines of health and welfare by reviewing publications on urban health. Publications were searched using city and health related keywords in Korean Health and Welfare Institute’s open access repository. Research on urban health mainly discussed social issues, including family, housing, homelessness, socio-economic and physical environments in urban and rural areas. Local governments’ health and welfare policy budgets were also commonly addressed in studying the wellbeing of the residents in disadvantaged urban areas.
 Research on health impact assessments were found to address the broader social and environmental determinants of health in cities. As the findings illustrate, urban health research needs to continuously address those environmental and social determinants of urban health with a focus on transforming policy and governance through community empowerment.

Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessment

Ambient air pollution is a major risk to health and wellbeing in European cities. We aimed to estimate spatial and sector-specific contributions of emissions to ambient air pollution and evaluate the effects of source-specific reductions in pollutants on mortality in European cities to support targeted source-specific actions to address air pollution and promote population health. We conducted a health impact assessment of data from 2015 for 857 European cities to estimate source contributions to annual PM2·5 and NO2 concentrations using the Screening for High Emission Reduction Potentials for Air quality tool. We evaluated contributions from transport, industry, energy, residential, agriculture, shipping, and aviation, other, natural, and external sources. For each city and sector, three spatial levels were considered: contributions from the same city, the rest of the country, and transboundary. Mortality effects were estimated for adult populations (ie, ≥20 years) following standard comparative risk assessment methods to calculate the annual mortality preventable on spatial and sector-specific reductions in PM2·5 and NO2. We observed strong variability in spatial and sectoral contributions among European cities. For PM2·5, the main contributors to mortality were the residential (mean contribution of 22·7% [SD 10·2]) and agricultural (18·0% [7·7]) sectors, followed by industry (13·8% [6·0]), transport (13·5% [5·8]), energy (10·0% [6·4]), and shipping (5·5% [5·7]). For NO2, the main contributor to mortality was transport (48·5% [SD 15·2]), with additional contributions from industry (15·0% [10·8]), energy (14·7% [12·9]), residential (10·3% [5·0]), and shipping (9·7% [12·7]). The mean city contribution to its own air pollution mortality was 13·5% (SD 9·9) for PM2·5 and 34·4% (19·6) for NO2, and contribution increased among cities of largest area (22·3% [12·2] for PM2·5 and 52·2% [19·4] for NO2) and among European capitals (29·9% [12·5] for PM2·5 and 62·7% [14·7] for NO2). We estimated source-specific air pollution health effects at the city level. Our results show strong variability, emphasising the need for local policies and coordinated actions that consider city-level specificities in source contributions. Spanish Ministry of Science and Innovation, State Research Agency, Generalitat de Catalunya, Centro de Investigación Biomédica en red Epidemiología y Salud Pública, and Urban Burden of Disease Estimation for Policy Making 2023-2026 Horizon Europe project.

Promoting health and wellbeing at health precincts: a rapid review of four built environment audit tools for assessing health precincts

Abstract In Australia, ‘health precincts’ are increasingly touted as the new innovation hub. They perform important health care functions, and often incorporate vital research and innovation roles. As such, they do not only assist patients in recovery but also promote health and wellbeing to safeguard their patients, visitors and workers. Although their functions in disease care are unquestionable, less is known about whether and how health precincts promote health and wellbeing. Over the past decade, several audit tools have been developed to assess the degrees of, first, sustainability and, more recently, health promotion of individual buildings. No comparable audit tools, however, exist that can account for the role of health promotion of multi-building and multi-functional spaces like health precincts. This paper reports on a rapid review on the suitability of four existing built environment audit tools—the Health Facility Audit Tool, health impact assessments, the WELL Building Standard checklist, and the Built Environment Assessment Tool—for assessing the promotion of health in health precincts. Twenty-six papers published in English between 2010 and 2022 were included in this rapid review, many (n = 15) of which were critical assessment of one of the four tools. Our findings show a lack of application of such tools at the precinct scale, with many instead focusing on the city or metropolitan scale (n = 7) or individual office buildings (n = 5). For each audit tool, we report on the benefits and drawbacks highlighted. We conclude with suggestions on how these audit tools may be adapted for application at health precincts.

Future impacts of O3 on respiratory hospital admission in the UK from current emissions policies

Exposure to ambient ozone (O3) O3 is associated with impacts on human health. O3 is a secondary pollutant whose concentrations are determined inter alia by emissions of precursors such as oxides of nitrogen (NOx) and volatile organic compounds (VOCs), and thus future health burdens depend on policies relating to climate and air quality. While emission controls are expected to reduce levels of PM2.5 and NO2 and their associated mortality burdens, for secondary pollutants like O3 the picture is less clear. Detailed assessments are necessary to provide quantitative estimates of future impacts to support decision-makers. We simulate future O3 across the UK using a high spatial resolution atmospheric chemistry model with current UK and European policy projections for 2030, 2040 and 2050, and use UK regional population-weighting and latest recommendations on health impact assessment to quantify respiratory emergency hospital admissions associated with short-term effects of O3. We estimate 60,488 admissions in 2018, increasing by 4.2%, 4.5% and 4.6% by 2030, 2040 and 2050 respectively (assuming a fixed population). Including future population growth, estimated emergency respiratory hospital admissions are 8.3%, 10.3% and 11.7% higher by 2030, 2040 and 2050 respectively. Increasing O3 concentrations in future are driven by reduced nitric oxide (NO) in urban areas due to reduced emissions, with increases in O3 mainly occurring in areas with lowest O3 concentrations currently. Meteorology influences episodes of O3 on a day-to-day basis, although a sensitivity study indicates that annual totals of hospital admissions are only slightly impacted by meteorological year. While reducing emissions results in overall benefits to population health (through reduced mortality due to long-term exposure to PM2.5 and NO2), due to the complex chemistry, as NO emissions reduce there are associated local increases in O3 close to population centres that may increase harms to health.

Impact of native-plants policy scenarios on premature mortality in Denver: A quantitative health impact assessment

BackgroundCities often use non-native plants such as turf grass to expand green space. Native plants, however, may require less water and maintenance and have co-benefits for local biodiversity, including pollinators. Previous studies estimating mortality averted by adding green space have not considered the provision of native plants as part of the greening policies. AimWe aim to estimate premature deaths that would be prevented by the implementation of native-plants policy scenarios in the City of Denver, Colorado, USA. MethodsAfter conducting interviews with local expert stakeholders, we designed four native-plants policy scenarios: (1) greening 30% of all city census-block groups to the greenness level of native plants, (2) adding 200-foot native-plants buffers around riparian areas, (3) constructing large water retention ponds landscaped with native plants, and (4) greening parking lots. We defined the normalized difference vegetation index (NDVI) corresponding to native plants by measuring the NDVI at locations with known native or highly diverse vegetation. Using a quantitative health-impact assessment approach, we estimated premature mortality averted under each scenario, comparing alternative NDVI with the baseline value. ResultsIn the most ambitious scenario, we estimated that 88 (95% uncertainty interval (UI): 20, 128) annual premature deaths would be prevented by greening 30% of the area of census block groups with native plants. We estimated that greening 30% of parking-lot surface with native plants would prevent 14 annual deaths (95% UI: 7, 18), adding the native buffers around riparian areas would prevent 13 annual deaths (95% UI: 2, 20), and adding the proposed stormwater retention ponds would prevent no annual deaths (95% UI: 0, 1). ConclusionUsing native plants to increase green spaces has the potential to prevent premature deaths in the City of Denver, but results were sensitive to the definition of native plants and the policy scenario.

Long-term health and economic impacts of air pollution in Greater Geneva

Introduction: We estimated the health and economic impacts of chronic exposure to air pollution for the Swiss part of the Greater Geneva area from 2016 to 2018. Materials and methods: We extracted from fine-scale modelled concentration maps for two pollutant indicators, particulate matter PM2.5 and nitrogen dioxide. Then, we performed a quantitative health impact assessment of the health burden attributable to anthropogenic-origin air pollution, and estimated the benefits of compliance with the federal Ordinance on Air Pollution Control (OAPC) limit values. Finally, we computed the economic impacts of these health effects. Results: Exposure to fine particles of anthropogenic origin was responsible for 7.5% of annual mortality (280 deaths or 5,900 life years lost), for 14 lung cancers and for 68 strokes annually in the Canton of Geneva. Compliance with the OAPC limit value of 10 µg/m3 as an annual average would reduce annual mortality by 1.5% (62 deaths avoided or 1,300 life years gained). Exposure to anthropogenic-origin NO2 was associated with 5.3% of annual deaths (approximately 200 deaths per year). The estimated total negative economic impacts of anthropogenic-origin fine particles were at least CHF2017 1.3 billion per year, whereas compliance with the OAPC limit values would result in annual economic benefits of at least CHF2017 290 million. Conclusion: We confirmed that air quality remains a health issue on which stakeholder mobilisation is vital. Action plans should tackle emissions from freight and personal mobility, heating, industry and agriculture, while seeking to improve knowledge on health risks from air pollution exposure.

‘A recipe for cultural disaster!’– a case study of Woolworths Group’s proposal to build an alcohol megastore in Darwin, Northern Territory

BackgroundThe health and wellbeing impacts of commercial activity on Indigenous populations is an emerging field of research. The alcohol industry is a key driver of health and social harms within Australia. In 2016 Woolworths, the largest food and beverage retailer in Australia, proposed to build a Dan Murphy’s alcohol megastore in Darwin, near three ‘dry’ Aboriginal communities. This study examines the tactics used by Woolworths to advance the Dan Murphy’s proposal and understand how civil society action can overcome powerful commercial interests to protect Aboriginal and Torres Strait Islander health and wellbeing.MethodsData from 11 interviews with Aboriginal and non-Aboriginal informants were combined with data extracted from media articles and government, non-government and industry documents. Thematic analysis was informed by an adapted corporate health impact assessment framework.ResultsWoolworths employed several strategies including lobbying, political pressure, litigation, and divisive public rhetoric, while ignoring the evidence suggesting the store would increase alcohol-related harm. The advocacy campaign against the proposal highlighted the importance of Aboriginal and non-Aboriginal groups working together to counter commercial interests and the need to champion Aboriginal leadership. Advocacy strategies included elevating the voices of community Elders in the media and corporate activism via Woolworths’ investors.ConclusionsThe strategies used by the coalition of Aboriginal and non-Aboriginal groups may be useful in future advocacy campaigns to safeguard Aboriginal and Torres Strait Islander health and wellbeing from commercial interests.

Defining indicators for the scoping stage of health impact assessment to evaluate tobacco control policy in the city of Beijing

IntroductionBeijing initiated the nation’s most comprehensive tobacco control program that adheres to the WHO Framework Convention on Tobacco Control. This study aimed to identify a set of indicators for the scoping of an Health Impact Assessment (HIA) to assess this policy.MethodsThis study used a modified Delphi process. It proposed a tobacco control health impact framework based on the Driving forces- Pressure- State- Exposure- Effect- Action model and the Determinants of Health Theory. After a review of current surveillance system and literature, a working group of 13 experts with multidisciplinary background was established to formulate indicator evaluation criteria and conduct indicator scoring. Each indicator was scored by experts according to four evaluation criteria chosen. Indicators that obtained a total score above 80% and with standard error less than 5 were selected as the final set of indicators. Kendall’s coefficient of concordance was calculated.ResultsTwenty-three out of 36 indicators were selected. Smoking prevalence, mortality rate, hospital admission rate, tobacco consumption and hospital admission fees of smoking related diseases achieved more than 90% of total scores and ranked as the top five. Kendall’s concordance coefficient was 0.218 for all indicators. For all model composition, Kendall’s concordance coefficients were statistically significant.ConclusionThis study identified a set of twenty-three indicators for scoping of HIA of a comprehensive tobacco control policy in Beijing based on a tobacco control health impact conceptual framework. The set of indicators achieved high scores and statistically significant consistency and has great potential to promote the evaluation of tobacco control policy in a global city. Further study might use the set of indicators for HIA on tobacco control policy to analyze empirical data.

A Case Analysis of the Equity-Focused Health Impact Assessment on Reducing Health Inequality in Canberra

In relation to COVID-19, people in policy settings are exposed to a number of health inequalities that are interconnected with many complex determinants. However, few Equity-Focused Health Impact Assessment (EfHIA) studies have been highlighted as relevant to the ongoing pandemic. The EfHIA is regarded as a mechanism for identifying multidimensional causes of health inequality and presents an opportunity to improve interventions in the development of policies or programmes. This research uses an EfHIA Community Funding Programme (CFP) conducted in Canberra to evaluate the performance of EfHIA, evaluating its process and influences on reducing health inequality, with the main findings being that this assessment performs well in relation to health promotion. This study provides a systematic literature review of the theoretical and practical literature, with the evidence reviewed suggesting that it is essential to adopt effective EfHIA strategies and tools to address root issues of health inequality in relation to policy. In this regard, this research considers the extent to which positive changes can be attributed to strategies of the EfHIA across. Finally, in pursuit of effectiveness and equity, the twin-track approach of health promotion and health equality should be utilised in making decisions, the EfHIA having been implemented over a short period with only few resources in most cases. More theoretical research and empirical studies are therefore required to contribute to the use of EfHIA tools so as to reduce health inequality in the future.

Health Impact Assessment of Short-Term Exposure to Particulate Matter (PM10) in Northern Thailand.

In northern Thailand, in recent decades, particulate pollution from the burning of biomass has become a serious issue with toxicological implications for human health, especially during the winter months of January to April. The purpose of this study was to explore short-term exposure to particulate matter (PM10) in northern Thailand. The high PM10 concentration in 2012 was used as a case study. We used the EPA's Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) for the health impact assessment, along with ground-based measurement data. The annual average observed PM10 concentration was in the range of 43-61 μg/m3, with a maximum observed PM10 concentration of 300 μg/m3 in March. We then assessed the impacts of PM10 exposure in northern Thailand. When the PM10 concentration was reduced to 120 μg/m3, the undesirable effects on respiratory mortality decreased by 5%-11%. When the concentration of PM10 was reduced to 45 μg/m3, the deleterious effects on respiratory mortality decreased by 11-30%. In conclusion, adherence to the WHO-AQG, particularly for PM10 (45 μg/m3), tends to result in considerable reductions in respiratory disease mortality in northern Thailand.

The Health Economic Assessment Tool (HEAT) for walking and cycling - experiences from 10 years of application of a health impact assessment tool in policy and practice.

In recent years, walking and cycling have moved into the focus as promising approaches to achieve public health, sustainable transport, climate goals and better urban resilience. However, they are only realistic transport and activity options for a large proportion of the population when they are safe, inclusive and convenient. One way to increase their recognition in transport policy is the inclusion of health impacts of walking and cycling into transport economic appraisals. The Health Economic Assessment Tool (HEAT) for walking and cycling calculates: if x people walk or cycle a distance of y on most days, what is the economic value of impacts on premature mortality, taking into account effects of physical activity, air pollution and road fatalities, as well as effects on carbon emissions. Different data sources were collated to examine how the HEAT in more than 10 years of existence, and to identify lessons learned and challenges. Since its launch in 2009, the HEAT has gained wide recognition as a user friendly, yet robust, evidence-based tool usable by academics, policymakers, and practitioners. Originally designed for use in Europe, it has since been expanded for global use. Challenges for a wider uptake of health-impact assessment (HIA) tools including active transport such as HEAT are the promotion and dissemination to local practitioners and policy makers also outside European and English-speaking regions and in low- and middle-income contexts, further increasing usability, and more generally the advancement of systematic data collection and impact quantification related to walking and cycling.

Fuzzy Decision Algorithm for Health Impact Assessment in a 5G Environment

The widespread use of mobile phones and other wireless communication devices raises concerns about radiation’s impact on humans. A new algorithm for making decisions for the assessment of the biological impact of non-ionizing radiation is presented in this paper. The algorithm was developed according to ICNIRP (the International Commission on Non-Ionizing Radiation Protection) guidelines using fuzzy logic. Appropriate membership function choices and optimized fuzzy rule selections are crucial for fuzzy modeling. Fuzzy logic is widely applied for multiparameter process modeling using linguistic forms and mathematical expressions. A comprehensive analysis of 4G and 5G network parameters was carried out including electrical and magnetic field strengths, frequency ranges, power densities, and exposure times. The proposed hands-on fuzzy decision-making algorithm can be used for fast, easy, and reliable non-ionizing radiation risk assessment for the following social groups: residents, on-site workers, and professional users.

Health Determinants, Applications, and Methods: A Systematic Literature Review on the Relationships Between the Urban Transport of People and Health

This study seeks to contextualize the literature related to the urban transport of people and health. The methodology consisted of a systematic literature review, considering papers published between 2016 and 2021. Some 438 articles were selected for the initial analysis. It was observed that the most recurrent themes were analyses on transportation accessibility and health, and the impacts of active transportation and the built environment on health. Some 173 articles on travel behavior impacts were thoroughly analyzed. The most commonly evaluated health determinants were level of physical activity and obesity. Some studies applied standard questionnaires for health self-assessments. The analyses showed that mental/psychological well-being can have multiple dimensions. Most studies evaluated health determinants using statistical tools, specifically regression models and structural equation models. Health impact assessment was also applied recurrently in the analyzed articles. This study presents theoretical and practical implications, contributing to the state-of-the-art by theoretically deepening understandings of the relationships between transport and health. We also highlighted health aspects, methods, and data collection instruments that could be used in future studies. A better understanding of these relationships can also aid in developing public transportation strategies and policies that help move people and promote social-economic development, while also positively affecting individual physical and mental well-being.

Health Impact Assessment to Promote Urban Health: A Trans-Disciplinary Case Study in Strasbourg, France

Health Impact Assessment (HIA), an inherently trans-disciplinary approach, is used to help evaluate and improve projects or programmes in sectors such as transportation, where new infrastructure is likely to have effects on health. This article describes the screening, scoping, appraisal, and recommendation steps of an HIA on a new 24 km highway around the conurbation of Strasbourg, France. Methods included a literature review and quantitative estimates of the health effects of air pollution and noise. Although planned, interviews and focus groups proved impossible due to political and administrative difficulties. In replacement, answers to a related public inquiry were submitted to a secondary, thematic analysis. The new infrastructure is likely to create or help maintain some jobs in the short term and might accelerate certain journeys, but it does not seem able to improve local mobility and air quality issues. It crystallises the dissatisfaction of a part of the local population and raises the question of the transparency of the design and validation processes of major infrastructure projects. Despite an unfavourable political context, the HIA approach described in this article was able to overcome methodological difficulties and obstacles thanks to creative research methods and trans-disciplinarity to finally yield relevant information and suggestions for urban health promotion.

22 Development of an Integrated Exposure Pathway Model for Health Impact Assessment of Traffic Ultrafine Particles (H2020 Ultrhas-Project)

Abstract Recently, the causal associations between traffic emissions and health effects were strengthened by the systematic reviews by the Health Effects Institute (HEI#23, 2022). According to EuroStat data Europeans spend 87-97% of their time indoors in homes, workplaces, schools and nurseries. Breathing volumes are dominated by the time spent indoors (16 m³ indoors and 1.4 m³ outdoors), even though breathing rates in outdoor environments are higher. This demonstrates the importance of taking into account time activity as well as infiltration to indoor spaces when estimating intake of particles. The ULTRHAS project aims to link in vitro toxicological evidence for particulate matter to health impact assessments to look specifically into this. An integrated exposure pathway model will consider for different microenvironments, and physical activity patterns to quantify the particle intake in selected gender and age groups. Relative to the commonly applied approach using residential address and corresponding outdoor pollution levels we specifically add handling of (i) infiltration into indoor spaces and (ii) variability in breathing volumes based on physical activities. The model will provide inhalation volumes for selected target populations, to be applied in the intake-DALY estimation of burden of disease parameters in the following phases of the project.

The contribution of the exposome to the burden of cardiovascular disease.

Large epidemiological and health impact assessment studies at the global scale, such as the Global Burden of Disease project, indicate that chronic non-communicable diseases, such as atherosclerosis and diabetes mellitus, caused almost two-thirds of the annual global deaths in 2020. By 2030, 77% of all deaths are expected to be caused by non-communicable diseases. Although this increase is mainly due to the ageing of the general population in Western societies, other reasons include the increasing effects of soil, water, air and noise pollution on health, together with the effects of other environmental risk factors such as climate change, unhealthy city designs (including lack of green spaces), unhealthy lifestyle habits and psychosocial stress. The exposome concept was established in 2005 as a new strategy to study the effect of the environment on health. The exposome describes the harmful biochemical and metabolic changes that occur in our body owing to the totality of different environmental exposures throughout the life course, which ultimately lead to adverse health effects and premature deaths. In this Review, we describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. We discuss selected exposome studies and highlight the relevance of the exposome concept for future health research as well as preventive medicine. Wealso discuss the challenges and limitations of exposome studies.