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Your Environment. Your Health.

Health impact metrics for air pollution management strategies

Environmental Health Economic Analysis Annotated Bibliography


Review, Research article Cost-benefit analysis (CBA)
Martenies SE, Wilkins D, and Batterman SA
Environ Int
Authors performed a literature review of health impact assessment (HIA) metrics pertaining to air quality management, developed evaluative criteria for selecting and using the metrics, and illustrated the metrics in a Michigan-based case study where PM2.5 concentrations were reduced from 10 to 8 μg/m3 in an urban area. Results from the case study showed that the total monetized health benefit of the 2 μg/m3 change in Wayne County, Michigan exceeded $1.9 billion annually, and the greatest number of avoided cases occurred for low severity morbidity outcomes such as, asthma exacerbations and minor restricted activity days. The authors concluded that quantitative metrics describing the direction, magnitude, and severity of expected health impacts can help inform decision makers and elevate health concerns to the level of other political and economic drivers into evaluations of projects, programs, and policies. They also made several recommendations for selecting metrics that are appropriate for air quality applications: metrics should be comprehensive, identify the number of people affected for each morbidity and mortality outcome, clearly communicate both direct and indirect impacts, use local data, incorporate outcomes of high public health importance, and represent spatial and temporal dimensions of impacts.
Not available

Health Outcomes

  • Mortality (premature and infant mortality)
  • respiratory outcomes (asthma exacerbations, pneumonia, COPD)
  • cardiovascular outcomes (ischemic heart disease, stroke)
  • cancer outcomes (lung, trachea, and bronchus cancers)

Environmental Agents

List of Environmental Agents:

  • Air pollutants (particulate matter (PM 2.5/fine))

Source of Environmental Agents:

  • Industrial, commercial, area, and mobile emission sources

Economic Evaluation / Methods and Source


  • Cost-benefit analysis (CBA)

Cost Measured:

  • Predicted number of cases of mortalities and morbidities attributable to changes in PM2.5 levels
  • disability-adjusted life years (DALYs)
  • years of life lost (YLL)
  • years living with disability (YLD)

Potential Cost Measures:

  • Impacts related to other pollutants
  • impacts of PM2.5 on outcomes such as cancer and adverse birth outcomes
  • impacts of short-term exposure to PM2.5 on mortality outcomes
  • time lost to avoidance behaviors (e.g., not participating in recreational activities)

Benefits Measures:

  • Avoided cases of premature mortality, all-cause deaths, and cause-specific deaths (COPD, lung, trachea, and bronchus cancers, ischemic heart disease, and stroke)
  • avoided cases of asthma exacerbations
  • avoided cases of minor restricted activity days
  • avoided work loss days
  • avoided asthma emergency department visits
  • avoided hospitalizations for outcomes related to cardiovascular, pneumonia, COPD, and asthma
  • avoided cases of non-fatal myocardial infarction
  • avoided DALYs, YLL, and YLD
  • emissions-based reductions (i.e., monetized benefits per ton of PM2.5 emitted per year)

Potential Benefits:

  • Co-benefits related to other pollutants
  • co-benefits of pollution control policies (e.g., transportation policies)


  • Detroit, Michigan, and surrounding county (Wayne County)

Models Used:

  • Population Attributable Fraction (PAF) method
  • Health impact function (HIF) method

Methods Used:

  • Authors evaluated quantitative metrics used in health impact assessments (HIAs) and similar analyses that are relevant to air quality management at the urban and potentially regional scales. The authors — 1) performed a review of literature published between 2011 and 2015 to identify HIA metrics used for both project and policy applications; 2) evaluated and selected HIA quantitative metrics based on explicit criteria; and 3) demonstrated the formulation, use, strengths, and limitations of the selected metrics in a Michigan-based case study that focuses on PM2.5 concentrations being lowered from 10 to 8 μg/m3.

Sources Used:

  • Population dynamics and air pollution: the impact of demographics on health impact assessment of air pollution (Flachs et al., 2013); Interpreting health statistics for policymaking: the story behind the headlines (Walker et al., 2007); National ambient air quality standards for particulate matter (US EPA, 2013a); Characterizing the PM2.5-related health benefits of emission reductions for 17 industrial, area and mobile emission sectors across the U.S. (Fann et al., 2012a); Estimating the national public health burden associated with exposure to ambient PM2.5 and ozone (Fann et al., 2012b); An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure (Burnett et al., 2014); A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010 (Lim et al., 2012); National emissions inventory (US EPA, 2012b); Analysis and apportionment of organic carbon and fine particulate matter sources at multiple sites in the Midwestern United States (Buzcu-Guven et al., 2007); Sources of fine urban particulate matter in Detroit, MI (Gildemeister et al., 2007); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Martenies SE, Wilkins D, and Batterman SA. 2015. Health impact metrics for air pollution management strategies. Environ Int.
  • Pubmed
  • DOI

NIEHS Funding:

  • R01ES022616, P30ES017885

Other Funding: (Not available)

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