Fine particle air pollution is a public health emergency hiding in plain sight

Ambient air pollution is the largest environmental health problem in the United States and in the world more generally. Fine particulate matter smaller than 2.5 millionths of a meter, known as PM2.5, was the fifth-leading cause of death in the world in 2015, factoring in approximately 4.1 million global deaths annually. In the United States, PM2.5 contributed to about 88,000 deaths in 2015 – more than diabetes, influenza, kidney disease or suicide.

Current evidence suggests that PM2.5 alone causes more deaths and illnesses than all other environmental exposures combined. For that reason, one of us (Douglas Brugge) recently wrote a book to try to spread the word to the broader public.

Developed countries have made progress in reducing particulate air pollution in recent decades, but much remains to be done to further reduce this hazard. And the situation has gotten dramatically worse in many developing countries – most notably, China and India, which have industrialized faster and on vaster scales than ever seen before. According to the World Health Organization, more than 90 percent of the world’s children breathe air so polluted it threatens their health and development.

As environmental health specialists, we believe the problem of fine particulate air pollution deserves much more attention, including in the United States. New research is connecting PM2.5 exposure to an alarming array of health effects. At the same time, the Trump administration’s efforts to support the fossil fuel industry could increase these emissions when the goal should be further reducing them.

Where there’s smoke …

Particulate matter is produced mainly by burning things. In the United States, the majority of PM2.5 emissions come from industrial activities, motor vehicles, cooking and fuel combustion, often including wood. There is a similar suite of sources in developing countries, but often with more industrial production and more burning of solid fuels in homes.

Wildfires are also an important and growing source, and winds can transport wildfire emissions hundreds of miles from fire regions. In August 2018, environmental regulators in Michigan reported that fine particles from wildfires burning in California were impacting their state’s air quality.

Most deaths and many illnesses caused by particulate air pollution are cardiovascular – mainly heart attacks and strokes. Obviously, air pollution affects the lungs because it enters them as we breathe. But once PM enters the lungs, it causes an inflammatory response that sends signals throughout the body, much as a bacterial infection would. Additionally, the smallest particles and fragments of larger particles can leave the lungs and travel through the blood.

Emerging research continues to expand the boundaries of health impacts from PM2.5 exposure. To us, the most notable new concern is that it appears to affect brain development and has adverse cognitive impacts. The smallest particles can even travel directly from the nose into the brain via the olfactory nerve.

There is growing evidence that PM2.5, as well as even smaller particles called ultrafine particles, affect children’s central nervous systems. They also can accelerate the pace of cognitive decline in adults and increase the risk in susceptible adults of developing Alzheimer’s disease.

PM2.5 has received much of the research and policy attention in recent years, but other types of particles also raise concerns. Ultrafines are less studied than PM2.5 and are not yet considered in risk estimates or air pollution regulations. Coarse PM, which is larger and typically comes from physical processes like tire and brake wear, may also pose health risks.

Regulatory push and pull

The progress that developed countries have made in addressing air pollution, especially PM, demonstrates that regulation works. Before the U.S. Environmental Protection Agency was established in 1970, air quality in Los Angeles, New York and other major U.S. cities bore a striking resemblance to Beijing and Delhi today. Increasingly stringent air pollution regulations enacted since then have protected public health and undoubtedly saved millions of lives.

But it wasn’t easy. The first regulatory limits on PM2.5 were proposed in the 1990s, after two important studies showed that it had major health impacts. But industry pushback was fierce, and included accusations that the science behind the studies was flawed or even fraudulent. Ultimately federal regulations were enacted, and follow-up studies and reanalysis confirmed the original findings.

Now the Trump administration is working to reduce the role of science in shaping air pollution policy and reverse regulatory decisions by the Obama administration. One new appointee to the EPA’s Science Advisory Board, Robert Phalen, a professor of medicine at the University of California, Irvine, is known for asserting that modern air is actually too clean for optimal health, even though the empirical evidence does not support this argument.

On Oct. 11, 2018, EPA Administrator Andrew Wheeler disbanded a critical air pollution science advisory group that dealt specifically with PM regulation. Critics called this an effort to limit the role that current scientific evidence plays in establishing national air quality standards that will protect public health with an adequate margin of safety, as required under the Clean Air Act.

Opponents of regulating PM2.5 in the 1990s at least acknowledged that science had a role to play, although they tried to discredit studies that supported the case for regulation. The new approach seems to be to try to cut scientific evidence out of the process entirely.

No time for complacency

In late October 2018, the World Health Organization convened a special conference on global air pollution and health. The agency’s heightened interest appears to be motivated by risk estimates that show air pollution to be a concern of similar magnitude to more traditional public health targets, such as diet and physical activity.

Conferees endorsed a goal of reducing global deaths from air pollution by two-thirds by 2030. This is a highly aspirational target, but it may focus renewed attention on strategies such as reducing economic barriers that make it hard to deploy pollution control technologies in developing countries.

In any case, past and current research clearly show that now is not the time to move away from regulating air pollution that arises largely from burning fossil fuels, in the United States or abroad.

Doug Brugge, Professor of Public Health and Community Medicine, Tufts University and Kevin James Lane, Assistant Professor of Environmental Health, Boston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Domestic abuse and mental ill-health: twin shadow pandemics stalk the second wave

The coronavirus crisis has been stalked by two shadow pandemics – one of domestic abuse and one of mental health. Since the first outbreak of the virus, numerous reports have highlighted a marked increase in forms of domestic violence and abuse, especially intimate partner violence and domestic homicide. The pandemic has also been linked to rising rates of mental health issues around the world.

These two phenomena are intrinsically linked: research shows there is a strong association between mental ill-health and domestic abuse. This raises significant concerns as a second wave of the pandemic crashes upon us. Cities, regions and whole countries are going back into lockdown – a measure that has previously been reported to have increased rates of both domestic violence and mental health problems. This time around, we need to be better prepared to support victims and survivors.

Lockdowns exacerbate domestic abuse

UN Secretary General Antonio Guterres has described the rise in domestic violence in 2020 as a “horrifying global surge”. Evidence compiled by UN Women from the UK, the United States, France, Australia, Cyprus, Singapore, Argentina, Canada, Germany, and Spain shows a rise in demand for access to women’s refuges and other support services this year.

The UK charity Refuge reported a 700% increase in calls during a single day in April and by June calls had risen by 800% compared with pre-lockdown figures. The charity also reported a 300% increase in visits to its National Domestic Abuse Helpline website and a 950% rise in visits to their website.

Read more: Domestic violence shadow pandemic has not gone away after lockdown

It is likely that these statistics reflect a glimpse of the overall picture given the known difficulties of reporting abuse, which are now intensified for households where the perpetrator is more frequently or consistently at home due to COVID-19 measures. The incidence and prevalence of domestic violence does tend to increase during any stressful event or emergency, whether it is a natural disaster, or whether it is man-made.

The surge in domestic violence has not just been associated with instructions to stay home, but also linked to the economic and social stresses on households that have resulted from this pandemic. These include the growth in unemployment, uncertainty around furloughing and job security and the effects of social isolation.

The toll on mental health

The results of COVID-19 measures on mental ill-health have been widely covered with concerns that further mental health devastation is imminent as we face a second wave. Infection control measures such as social distancing and shielding lead to a higher risk of mental health problems such as anxiety, fear and sleep disturbances for general populations and can aggravate symptoms for people living with existing mental health conditions.

Research shows women who experience abuse from their partner are three times more likely to suffer depression, anxiety or severe conditions such as schizophrenia or bipolar disorder. Whether these are new or pre-existing problems, this impact is likely to be severe and long-lasting, resulting in more demands placed on already overburdened mental health systems.

The conditions associated with the pandemic have presented heightened risks and barriers to those who want to seek help. People’s means and opportunity to contact services may be restricted and access to support networks might be limited or wholly unreachable.

Those with existing mental health conditions might have limited access or difficulty accessing medication or therapy which, in turn, exacerbates mental ill-health. This can trigger self-harm, substance use or suicidal ideation. Every day in the UK, almost 30 women attempt suicide and every week three women take their own lives to escape domestic abuse.

Taking on two problems at once

As we are now at the onset of a second wave of the pandemic, it is likely we’ll see another surge in domestic abuse and its associated negative impacts on mental health. Obstacles to accessing support will continue and perhaps multiply during further lockdowns and services will remain frustrated by persistent underfunding and deficient resources in the face of greater demands.

Two already overburdened systems risk becoming even more frayed at the edges in the months to come. To respond to the severe, long-lasting impacts of domestic abuse and mental ill-health following COVID-19, governments should invest in evidence-based research and mainstream interventions that target the connections between the two phenomena. This includes screening for both domestic abuse and mental health problems by practitioners across both sectors, providing online interventions and safety planning. Governments should also encourage different services to work together, through more substantial funding and a policy response which recognises and responds to these overlapping issues.

COVID-19 will not be the last emergency we face with the potential to increase rates of domestic abuse and mental ill-health. We should use the lessons we have learned from this pandemic to prepare ourselves to better respond to other crises in future. These lessons can also help us understand the impact of emergencies on those experiencing domestic violence and mental-ill health at the same time.

If you are experiencing domestic violence or abuse, help is available from the following organisations and services:

Refuge – 0808 2000 237

If you need urgent help in the UK and are worried about being overheard, you can dial 999, then 55 to indicate that you cannot speak. The police will be able to assist you.

For mental health support you can call the Samaritans 24-hour helpline on 116 123 or go to their website.

Michaela Rogers, Senior Lecturer in Social Work, University of Sheffield and Parveen Azam Ali, Senior Lecturer, School of Nursing and Midwifery, University of Sheffield

This article is republished from The Conversation under a Creative Commons license. Read the original article.