The pall of smog that hovers over our cities is becoming more suffocating and lethal in the suburbs, where in the less green neighborhoods with a high density of traffic and inhabitants over 65, the death rates attributable to nitrogen dioxide and fine particles reach up to 50-60% more than the average for central areas. The mix of smog and worse lifestyles, more common in the more peripheral neighbourhoods, is under accusation.
On this topic and on the many studies that highlight the increasingly clear link between smog and tumors, cardiovascular diseases, asthma, depression and alteration of development in children even in the fetal phase, epidemiologists, pulmonologists, experts in the evaluation and management of quality of life will discuss air, representatives of organizations involved in reducing the impact of smog, including representatives of the World Health Organization. With a population of almost 1.4 million inhabitants, Milan is the second metropolitan city in Italy, historically plagued by the problem of smog both for the numerous emission sources that it shares with the Po Valley (industrial, residential, traffic and intensive farming) which, added to the stagnation of high pressure and the particular orographic conditions, do not favor the dispersion of atmospheric pollutants.
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The long-term effects
To evaluate the long-term health effects on the population, the Milan Health Protection Agency (ATS-MI) conducted a study which estimated the average concentration levels of pollutants (NO2, PM10 and PM2.5) for the year 2019 with an unprecedented spatial resolution of 25 square meters. The data were then cross-referenced with the georeferenced health and demographic information already used for population studies in ATS-MI.
“The results, recently published in Epidemiologia&Prevenzione, the magazine of the Italian Epidemiology Association, allow us to define a real map of pollution and its effects, neighborhood by neighborhood and reveal, for the first time, that nitrogen dioxide and fine particles have death rates per 100,000 inhabitants which can reach up to 60% higher in some areas of the Milanese suburbs compared to the city centre”, he declares Sergio Hararico-president of the congress, of the Division of Respiratory Diseases and Division of Internal Medicine of the San Giuseppe MultiMedica IRCSS Hospital and the University of Milan.
“The case of Milan could be similar to what happens in other large Italian cities in peripheral areas which have high levels of air pollution due to the high number of inhabitants, roads with intense vehicular traffic such as ring roads and little greenery with stagnation of air – adds Harari -. The combination of smog and disadvantaged socio-economic conditions which overlap with peripheral areas, inducing worse lifestyles such as more smoking and sedentary lifestyles, produces a multiplicative effect of mortality from pollution in the areas furthest from the center. The fact of being more fragile and being exposed to pollutants therefore translates into greater damage”.
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Deaths from PM2.5
The over 1,600 deaths per year from all causes attributable to PM2.5 and the over 1,300 deaths per year attributable to nitrogen dioxide in Milan are in fact not distributed in the same way across the territory. “Pollution has greater effects especially in the peripheral neighborhoods crossed by very busy roads, densely populated and where there is a greater quantity of people over 65 years of age, therefore more fragile in the face of the effects of smog. Also other elements relating to socio-economic characteristics of the population can help explain why pollution hits harder in the suburbs than in the center. However, the rate of deaths is decidedly higher in some areas than in others, less urbanized and greener”, he explains Francesco Forastiere, co-president of the congress, of the National Research Council (CNR-IFT) and of the environmental research group of Imperial College London.
It is the suburbs that suffer the most. “As regards exposure to nitrogen dioxide, responsible for 10% of deaths from natural causes (130.3 per 100 thousand inhabitants), the highest death rates were recorded in peripheral neighborhoods such as Quarto Oggiaro with 158 deaths per 100,000 inhabitants and in Gallaratese with 170 per 100,000 inhabitants, compared to values around 100 in the city centre”, underlines Pier Mannuccio Mannucci, co-president of the congress, of the IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation and of the Hemophilia and Thrombosis Center Angelo Bianchi Bonomi of Milan. “As regards PM2.5, responsible for 13% of deaths from natural causes (160 out of 100 thousand inhabitants) and 18% of deaths from lung cancer, the heaviest consequences occur in peripheral areas such as Mecenate, Lorenteggio and Black Bands where death rates exceed 200 per 100,000 inhabitants, while in the center the death rates are around 130 per 100,000 inhabitants”, adds Mannucci.
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Finally, as regards PM10, to which 4% of deaths from natural causes are attributed (50 per 100 thousand inhabitants), those who pay the highest price are, for example, the areas of Niguarda, Bande Nere and Gallaratese to the west and Buenos Aires downtown. “Chronic exposure to smog is harmful to health in global terms, with repercussions not only on the respiratory system, but also on the cardiovascular system and an increase in heart attacks and strokes. Pollution can also have negative consequences on a brain, causing cognitive delays in childhood and impacting the development of neurodegenerative diseases, such as Parkinson’s”, the experts point out.
Possible solutions
The ZTL – What “saves” the central areas are instead the limited traffic zones, which play a very important role in reducing pollutants and deleterious effects on health, as demonstrated by a review published in the journal Lancet Public Health by Imperial College London. The review reviewed 16 studies conducted on ZTLs in Germany, Japan and the United Kingdom, which demonstrated a clear reduction in problems affecting the cardiovascular system, with fewer cases of hypertension, hospitalizations, deaths from heart attacks and strokes. In particular, a German study on hospital data from 69 cities with restricted traffic zones found a 2-3% drop in heart problems and a 7-12% drop in strokes, with benefits (especially for the elderly) that led to a saving of 4 .4 billion euros for healthcare. Several studies have also highlighted beneficial effects for the respiratory system, although the data seems less consistent.
The London model – “The special London Ztl deserves a separate chapter, which at the RespiraMi conference will be treated from a scientific point of view with a discussion between scientists and also between the mayor of Milan Giuseppe Sala and Poppy Lyle, responsible for air pollution in Greater London Authority. Last summer, the British capital decided to extend the ban on the circulation of the most polluting vehicles to the entire metropolitan area (stirring quite a bit of controversy). Transit in the so-called ULEZ (Ultra Low Emission Zone) is allowed only to Euro 4 vehicles if petrol or Euro 6 if diesel. Anyone who does not own a car in line with these standards can use it by paying a toll”, comments Harari.
The initiative of London Mayor Sadiq Khan was praised by Maria Neira, director of the WHO Department of Public Health and Environment, who in an interview in the British Medical Journal defined the London ULEZ as an “example for all mayors of the world“.
The other European models – Like London, there are many European cities that are experimenting with new urban models to reduce smog, noise and the “heat island” effect, as reported by a study published in Environment International. The review starts from the city of Barcelona, which by virtue of its grid road network has developed a model of superblocks, i.e. large blocks whose perimeter can be crossed by cars, while the area inside is returned to residents, pedestrians and cyclists. According to an estimate by the Institute for Global Health at Pompeu Fabra University, this model implemented across the entire city could avoid almost 700 deaths per year, especially thanks to the reduction of smog.
In Paris you experience “the city of 15 minutes”, where work, school, shopping, entertainment, culture, leisure and other activities can be reached in 15 minutes on foot or by bicycle from home. Evaluations of the health effects have not yet been carried out, but significant physical and mental benefits are expected due to the increase in physical activity (due to greater walking and cycling) and the greater presence of green spaces. A reduction in motorized traffic could also lead to a reduction in air pollution, noise and CO2 emissions.
Finally, car-free cities and neighborhoods are making their way, which only allow the circulation of public transport, pedestrians and cyclists. Hamburg, which plans to eliminate cars by 2034, is inspired by this model.
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The new EU directive – The change could accelerate with the new European directive on air quality on which an agreement was reached a few days ago in Brussels following the interinstitutional negotiation bringing together representatives of the European Parliament, the Council of the European Union and the European Commission. The document brought European standards closer to the World Health Organization guidelines by drastically reducing the maximum levels of annual concentrations of PM2.5 (from 25 to 10 mg/m3) and nitrogen dioxide (from 40 to 20 mg/m3). m3) that each state will have to respect by 2030 to achieve an environment free of harmful pollution by 2050, in accordance with the European Green Deal and the Zero Pollution Action Plan.
More severe limits are also foreseen for sulfur dioxide, ozone, heavy metals such as arsenic, lead or nickel. “However, exemptions have been provided for areas where compliance with the new limits is more difficult, including the Po Valley, but the consequences for health could be very serious: a study recently published in the International Journal of Public Health estimates that the postponement of 10 years of compliance with the new air quality limits could cause almost 330,000 premature deaths in Europe, a third of which in our country”, concludes Harari.
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