Health benefits of a reduction of PM10 and NO2 exposure after implementing a clean air plan in the Agglomeration Lausanne-Morges

Exposure to urban air pollution has been associated with adverse effects on cardio-vascular and respiratory health, both short and long term. Consequently, governments have applied policies to reduce air pollution. Quantitative health impact assessments of hypothetic changes in air pollution have been conducted at national and global level, but assessments of observed air pollution changes associated with specific clean air policies at a local or regional scale remain scarce. This study estimates health impacts attributable to a decrease in PM10 and NO2 exposure in the Agglomeration of Lausanne-Morges (ALM), Switzerland, between 2005 and 2015, corresponding to the implementation period of a supra-municipal plan of measures to reduce air pollution in different sectors such as transport, energy, and industry (called Plan OPair 05). The health impact assessment compares health effects attributed to air pollution exposure levels in 2015 (reference case) with those in 2005 (counterfactual scenario), using 2015 as baseline for all other input data. In the ALM, the modeled PM10 exposure reduction of 3.3μg/m(3) from 2005 to 2015 prevents 26 premature deaths (equivalent to around 290 years of life lost), 215 hospitalization days due to cardio-vascular and respiratory diseases as well as approximately 47,000 restricted activity days annually. Monetized health impacts of the reduction of PM10 exposure are valued at approximately CHF 36 million annually. Immaterial costs, mainly related to the economic valuation of years of life lost, dominate the monetized health impacts (90% of total value), while savings at the workplace (net loss in production and reoccupation costs) amount to about CHF 1.9 million, and savings in health care costs to about CHF 0.5 million. The assessment is sensitive to the value assigned to immaterial costs and to uncertainties in the relative risk estimates, whereas variations in the baseline year (i.e. using 2005 data instead of 2015 data) affect results to a much lower degree. The alternative calculation based on NO2 exposure, which dropped by 5.6μg/m(3), suggests the prevention of 51 premature deaths (equivalent to around 550 years of life lost) overall impacts valued at CHF 49 million. All in all, the reduction in mortality due to the air quality improvements accounts for (depending on the considered pollutant) about 1% to 2% of total all-cause annual mortality in the ALM population or 4-8 times larger than the annual traffic fatalities in the ALM.