ATS Statement on Health Effects of Air Pollution

Author: Monica Preboth
Date: Oct 1, 2000

The Assembly on Environmental and Occupational Health of the American Thoracic Society (ATS) has updated its 1985 official statement on what constitutes an adverse health effect of air pollution. ATS has revised the statement because new scientific findings have raised questions as to the boundary between adverse and nonadverse health effects of air pollution. The revised statement appears in the February 2000 issue of the American Journal of Respiratory and Critical Care Medicine.

The new statement is intended to provide guidance to policy makers and others who interpret the scientific evidence on the health effects of air pollution for the purpose of risk management. The statement proposes principles to be used when weighing evidence and setting boundaries between adverse and nonadverse health effects.

In preparing the statement, the ATS committee identified the following general considerations for interpreting evidence on the health effects of air pollution: population health versus individual risk, ethics and equity, economic costs, susceptibility and heterogeneity of perspectives.

Based on the dimensions of adverse effects, the ATS committee makes the following recommendations:

Biomarkers. Biomarkers were examined as indicators of exposure, effect or susceptibility. Few of the many biomarkers have been sufficiently validated to allow them to be used to determine adverse effects that warrant preventive measures.

Quality of Life. Decreased health-related quality of life caused by pollution should be accepted as an adverse health effect.

Physiologic Impact. Reversible loss of lung function in combination with the presence of symptoms should be considered adverse; any detectable level of permanent lung function loss attributable to air pollution exposure should be considered adverse.

Symptoms. Air pollution-related symptoms associated with diminished quality of life or with a change in clinical status should be considered adverse.

Clinical Outcomes. Detectable effects of air pollution on clinical measures should be considered adverse.

Mortality. Any effect on mortality should be considered adverse. Consideration should be given to the extent of life-shortening that underlies the association.

Population Health Versus Individual Risk. Assuming that the relationship between the risk factor and the disease is causal, a shift in the risk factor distribution, and hence the risk profile of the exposed population, should be considered adverse, even in the absence of the immediate occurrence of frank illness.

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