2009 Nov 28 – Response to Air Quality Objectives Review Public Consultation

Date: 28 November 2009
Dr. TAM Cheuk Yin, President, Hong Kong Thoracic Society
Dr. Maureen ML WONG President, American College of Chest Physicians (HK & Macau Chapter)

We are a group of doctors and health care professionals specializing in respiratory medicine. On behalf of our 2 local respiratory societies (Hong Kong Thoracic Society & American College of Chest Physicians, Hong Kong & Macau Chapter), we would like to express our view on the captioned as followed, when we champion lung health for all in our city:

Our beliefs

• We take the liberty to thanks Hong Kong Government in taking the visionary lead to review air quality in Hong Kong and appreciate its effort to seek consultation over this highly important matter.
• Instead of expenses, we firmly believe measures to improve air quality should be viewed positively as “INVESTMENT” with rewards, which ultimately can be transcribed into health and quality of life of our citizens in tangible or intangible ways.
• To achieve a better Air Quality Hong Kong, the government should boldly convince and exhort its nexus of stakeholders the importance of lung health when they review and formulate any policy, in particular those not in-the-know.

• Our professional arguments
• Numerous overseas and local studies have convincingly shown that air pollution is associated with excessive respiratory and cardiovascular morbidity as well as mortality.
• Rise in concentrations of ambient air pollutants were observed to have an increased risk of hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (COPD)¹ and asthma², and visits to general practitioner for respiratory diseases in Hong Kong.³
• Large scale studies in Europe e.g. Air Pollution on Health: a European Approach [APHEA] ² study and USA e.g. Morbidity, Mortality, and Air Pollution [NMMAP] had also shown that air pollutants were associated with admissions for asthma, COPD and pneumonia.^4-6
• Not only hospitalizations, respiratory mortality was also observed to be associated with increased levels of air pollutants.⁷
• Alarmingly, evidence exists supporting air pollution has an adverse effect on lung development in the young.⁸
• In numerical terms, a recent HK study has found that air quality improvement from the annual average to the lowest pollutant levels of better visibility days, comparable to the World Health Organization air quality guidelines, would avoid 1335 deaths, 60,587 hospital bed days, and 6.7 million doctor visits for respiratory complaints each year.⁹

• Granted that respiratory disease was the most common cause of mortality and hospitalization in Hong Kong in 2005¹⁰, improvement of air quality is crucial to decrease the burden of respiratory disease to the society, not to mention economic loss.

Our proposals

• Earnestly, we call on the reduction of emission of pollutants and support the direction of control measures as stipulated in Chapter 6 of the Consultation Paper.
• As direct exposure imposed not only long term effect on health but also immediate risk, we support the establishment of LOW EMISSION ZONE (LEZ) in those highly populated as well as busy commercial area.
• We agree with the proposal to bring up the AQO of Hong Kong of the 3 major air pollutants, viz. NO2, CO and Pb (as mentioned in the Section 5.2) to the ultimate WHO AQGs, and we expect the government to outline a clearer timeframe when achieving these goals.
• That said, we also need to adopt the ultimate WHO AQGs of the other 4 pollutants, viz. SO2, RSP(PM10), RSP(PM2.5) and O3, given their well known deleterious effect on lung health.¹¹
• Population health is vital to the healthy (struggling?) survival of HK as a vibrant city, the government should make every attempt at intervals, to review and report the progress it has made on its own policy development and efforts of regional and international collaboration when it delivers its promise to protect and provide a “Better Air Quality Hong Kong”.

Yours sincerely,
Dr. TAM Cheuk Yin, President, Hong Kong Thoracic Society
Dr. Maureen ML WONG President, American College of Chest Physicians (HK & Macau Chapter)

References:

1. Ko FW, Tam W, Wong TW, et al. Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong. Thorax 2007; 62:780-785
2. Ko FW, Tam W, Wong TW, et al. Effects of air pollution on asthma hospitalization rates in different age groups in Hong Kong. Clin Exp Allergy 2007; 37:1312-1319
3. Wong TW, Tam W, Tak Sun Yu I, et al. Association between air pollution and general practitioner visits for respiratory diseases in Hong Kong. Thorax 2006; 61:585-591
4. Dominici F, Peng RD, Bell ML, et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. Jama 2006; 295:1127-1134
5. Medina-Ramon M, Zanobetti A, Schwartz J. The effect of ozone and PM10 on hospital admissions for pneumonia and chronic obstructive pulmonary disease: a national multicity study. Am J Epidemiol 2006; 163:579-588
6. Atkinson RW, Anderson HR, Sunyer J, et al. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. Am J Respir Crit Care Med 2001; 164:1860-1866
7. Samet JM, Dominici F, Curriero FC, et al. Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994. N Engl J Med 2000; 343:1742-1749
8. Gauderman WJ, Avol E, Gilliland F, et al. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med 2004; 351:1057-1067
9. Hedley AJ, McGhee SM, Barron B, et al. Air pollution: costs and paths to a solution in Hong Kong–understanding the connections among visibility, air pollution, and health costs in pursuit of accountability, environmental justice, and health protection. J Toxicol Environ Health A 2008; 71:544-554
10. Chan-Yeung M, Lai CH, Chan KS, et al. CHAN,The burden of lung disease in Hong Kong: A report from the Hong Kong Thoracic Society Respirology (2008) 13 (Suppl. 4), S133–S165
11. WHO Air quality Guidelinesfor particulate matter, ozone, nitrogen dioxide and sulpher dioxide. Global update 2005. Summary of risk assessment. http://www.who.int/phe/health_topics/outdoorair_aqg/en/index.html

Briefings on Air Quality Objectives (AQO) review Consultation (2009 Aug 28) here