Dr. Kenneth Sky:
Good morning,
I find it ironic that waking up to the news this morning first thing I heard was a smog alert.
Wouldn’t it be nice if someday there were no more smog alerts and no more unhealthy air. Also this morning, I heard a media report talking about Ontario’s air being cleaner. What we care about is what people breathe and which direction are we going in now.
The first misleading comfort given to the public is that people sometime talk about emissions, not what you are breathing ---- and talk about emissions can be misleading.
The second misleading comfort is that people talk about ancient history, what happened in the 1970’s and 80’s, and I think what the people of Ontario want to know is what they are breathing today and is the air they breathe getting better or worse.
A very brief history will help you understand why we are here today. In 1998, the OMA published a study called, "Health Effects of Ground Level Ozone, Acid Aerosols, and Particulate Matter". In this report we reinforced the fact that smog is a serious health hazard to the people of Ontario.
Last year we published our economic analysis of the dollar costs of those illnesses to our health care system and, more generally, to the taxpayers of Ontario. We reported that those costs are approximately one billion dollars annually.
We have devoted our efforts during these past three years to promoting a clean-up of Ontario's air. We have concentrated on monitoring the recommendations we made in 1998 which we believed and still believe would have a beneficial effect on Ontario's air. These recommendations can be found on page 30 of our Report, which is in your handout. They applied to not only the Ontario government but also, where appropriate, to the federal governments in Canada and the United States.
Three years later, I believe it is time to issue a report card. Unfortunately, I must report that when it comes to Ontario's air we are experiencing years of stagnation. The efforts we are undertaking are, to this point, insufficient to substantially protect the health of people who breathe Ontario's air. We believe that the health of Ontarians is threatened by the air they breathe.
Today, we are releasing a full report card on progress made on our 1998 recommendations. I also want to call for a change in the way we think about air pollution and the way we talk about it among ourselves. We must begin to understand and use words that describe the health impacts we all experience. We need to start referring to smog as a poison. In medicine poisons are chemicals that cause harm or death, which is what smog does. Together we must all take action. And by "we" I mean all levels of our community whether it be as governments, corporations, or individuals. Lets be clear about pollution and its effects on human health.
The two most important poisons in smog are ozone and particulate matter. Particulates are also described as acid water droplets or acid aerosols. These two toxic chemicals, ozone and particulate matter, are capable of damaging body tissues on contact. The tissues that are the most sensitive, due to their fragile nature, are those tissues which make up the linings of our lungs. Medical research repeatedly confirms these two poisons harm our lungs. They cause inflammation and swelling, which encroach upon our airways. This decreases our ability to move air in and out of our lungs. Medically, we call this "a decrease in lung function". This injury occurs in every individual, in each and every one of us. And on smoggy days we each lose a percentage of our lung function. Only those of us with healthy lungs have enough reserve capacity that we may not usually notice it, even though it is doing us harm.
Furthermore, people with chronic lung conditions such as asthma emphysema and chronic bronchitis, can become critically ill. For some time it has been known that smog also has an effect upon the conditions of the heart. We referred to this in our 1998 paper. And recently, further evidence has emphasized the importance of understanding the effect smog has in causing acute severe cardiac events like heart attacks. The health effects are now clearly understood and indisputable. And it is equally clear that the quality of the air we breathe must be improved.
But the quality is not improving. In fact, in our opinion, it’s getting worse.
I would now like to ask Dr. Boadway to describe what's happening to
Ontario's air.
Dr. Ted Boadway
As Dr. Sky said, the two most poisonous substances that make up smog are ozone and acid water droplets. Unfortunately the trend in neither of these toxins is encouraging. Levels of ozone are increasing in Ontario and levels of particulate matter are showing no improvement.
Lets first deal with Ozone. Over the past 10 years the average annual ozone level in Ontario has increased by 6%. However, when looking at the year-to-year changes, it's important to realize that levels vary over the course of the day and over the course of the year.
What you see in this graph is an average for 19 years increasing year over year. Of course, on hot, smoggy days ozone levels can reach levels 6 or 7 times higher than this. If the overall level is higher, it means that the peaks and the number of peaks will be greater also. Although at levels of 120 ppb all of us lose 10 and up to 20 per cent of our lung function, at every level between 0 and 120 a proportionate amount of lung function is lost. Indeed, the problem is that in the entirety of Canada average ozone levels are increasing as well. However, Ontario experiences the highest readings in Canada year after year.
It is also important to realize that both urban and rural areas are experiencing this increase. In fact, it comes as a shock to many people who live in rural Ontario, go to cottage country or send their kids to camp to learn that their ozone levels are often higher than those experienced in cities. And that their rate of increase of ozone levels each year over the last 18 years has been more rapid than that of cities. This occurs because the building blocks of ozone, which we will describe shortly, are given off by industrialized areas and places where there are many cars, and then effectively ‘cook’ in the atmosphere with sunlight to produce high ozone levels a few hours later, after they have drifted across the countryside.
So with ozone, the best understood and clearly one of the two most toxic poisons in smog, things are just getting worse rather than better. I would like to turn attention now to particulate matter and acid aerosols. As I have stated, these are poisonous because of the oxides of nitrogen and sulphur in them. Although the chemistry of these particles is very complex, the end result for our body on a smoggy day is that these particles deliver a dose of sulphuric and nitric acid directly to the membranes of our lungs. These are two of the strongest acids known to chemistry, and they are directly deposited onto some of the most fragile tissues of the body.
Unfortunately, over the last years particulate matter levels have shown no improvement. Particulate levels vary dramatically with geography. Vehicles are a large source of particles and therefore concentrations increase with population density. In this case, the city cores experience by far the worst particulate loads, but areas directly downwind can experience very high levels as well.
Sulphate levels are one method of measuring particulate matter because the sulphate gives rise to the sulphuric acid when in moisture in the atmosphere, especially on summer days. Sulphate levels have also shown little change in Ontario in the last years.
I would now like to turn attention to the building blocks of smog. The first two, NOx and VOCs, give rise to ozone in the presence of water and sunlight.
Early modest decreases in NOx at the beginning of the 90's have stagnated for the last 9 years or so. Furthermore, the amount of NOx being emitted by sources in Ontario has also failed to drop since the early 90's.
Early decreases in emission levels of VOCs over the last decade have leveled off in the last 5 years. Unfortunately, data on the actual levels of VOCs in the air are much more scant than for the other building blocks of smog and therefore our ability to use data other than amounts emitted is limited.
The last building block of smog to describe is sulphur dioxide. Sulphur dioxide, when emitted into the air, chemically reacts with oxygen and gives rise to sulphate - the source of acid in water droplets in the atmosphere. There have been dramatic decreases in sulphur dioxide levels since the 70s and decreases in concentrations in the air.
However, in the last 5 years these decreases have at least stalled and are probably slightly rising. Certainly emissions are increasing modestly and the concentration in the air we breathe is staying about the same.
A confounding factor needs to be considered in this explanation. It is apparent that in the last years the building blocks of smog have been about stable and yet the levels of ozone have been definitely increasing - how can this be? It appears that global warming is having an effect on smog formation. Temperature trends in Canada show a one degree average increase in the last 50 years. However, as has been widely reported, most of the warmest days of the last century have occurred in the last decade. It appears that the higher temperatures are having the effect of cooking the building blocks more effectively to create ozone. So one of the effects of climate change may be to increase smog.
Dr.Kenneth Sky
You have now seen why the Ontario Medical Association continues to be concerned about the direction our environment in Canada, and particularly Ontario, is heading.
The health of the people of Ontario continues to be threatened by the quality of the air we breathe. As physicians, we see people’s health seriously threatened by air pollution on a daily basis, in particular our elderly and our children. This is even more serious because we now know that pollution is harmful at lower levels then previously understood. And because clean air enhances the quality of life in Ontario we are making four additional recommendations for all levels of government and society to consider.
The OMA believes that the implementation of all our 1998 recommendations would result in an improvement in ozone and particulate matter levels in the air we breathe.
This, coupled with today’s four recommendations, will start to curtail the harmful effects of pollution on our patients.
Some of these recommendations are being accomplished, in other cases, action is underway, but much remains to be done. We urge governments to review our remaining recommendations and we invite them to work with the OMA to ensure that they are enforced rigorously. Relying on voluntary plans with no specific deadline and with no commitments from any polluter will not result in cleaner air.
Currently, most of Ontario’s air strategies are voluntary. Attached to your documents is a report card on our 1998 recommendations. Some are in the process of being accomplished
People are injured and made ill on days when no smog advisory is given and when the threshold has not been exceeded. We need to revise our notification process. Smog advisories should clearly articulate the health messages in a way that make sense to our patients. For example, smog advisories should target heart patients, who should know when pollution levels will harm their health and will aggravate their cardiac conditions.
Also, parents should be aware when pollution levels threaten the health of the fragile and vulnerable lungs of newborns and infants. Different smog levels affect patients in different ways.
Smog advisories should recognize this, so that patients are aware that they are at risk because of pollution.
We all have a need for, and an interest in, this information. The medical profession is committed to working with government to develop such information material.
We recommend that existing government websites should be expanded to include real time data and that every measure should be taken to ensure real time data are made available to the public.
In summary we recommend:
We recognize this is a challenge for government and industry but it is a challenge we must all face together for the sake of the health of our population. We want to work with all levels of government to ensure there is a balance between a healthy economy and a healthy population.
In conclusion, the Ontario Medical Association’s concerns for the harmful effects of smog continues. Smog is not just a summer issue, it harms us all year long. Low levels are injurious. The poisons we breathe are either staying stagnant or increasing. We are committed to follow this health problem and to continue to advocate for change and better information to the public.
And if you don’t believe our air is getting worse, I will leave you with this. There have been more smog advisories in Toronto to date so far this year than ever before at this time of year.
Thank-you