Mindell, Jennifer Susan; (2002) Quantification of health impacts of air pollution reduction in Kensington & Chelsea and Westminster. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Health Impact Assessment (HIA) is an assessment of the health effects, positive or negative, of a project, programme or policy. However, the quality of the evidence base currently available for HIA may limit the soundness and completeness of the conclusions, and consequently the capacity to achieve health gain. I developed a four-stage framework of the information required to quantify health impacts: evidence for causality, magnitude of response, baseline event rate, and change in exposure. The UK National Air Quality Strategy requires local authorities to achieve targets for seven outdoor air pollutants. I conducted systematic literature reviews and evaluated the epidemiological evidence relating ambient particulates and nitrogen dioxide (the pollutants relevant to central London) to various health outcomes. For those assessed as being causal, I considered the shape and magnitude of the relationship. Using local authority air pollution data, I modelled three ways in which pollution could fall to achieve the UK objectives. I wrote spreadsheets to estimate the effects on premature deaths and hospital admissions of reducing pollution to the objectives, combining the exposure-response coefficients with baseline mortality or hospital episode statistics data and modelled falls in pollution. I then performed these calculations for Kensington & Chelsea and Westminster. Air quality management using technical fixes will accomplish only these health gains; traffic reduction would have a broader range of health impacts. I reviewed the availability of evidence for other ways in which transport affects health, particularly community severance and physical activity. Policies that achieve air quality targets by reducing traffic are likely to have substantially greater health benefits than those that rely on technical fixes, but this is unquantifiable at present. I also compared my approach with the rapid literature review in general usage in HIA, and have identified specific gaps in the evidence and research needs.

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