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Quantifying the health impacts of outdoor air pollution: useful estimations for public health action
  1. Sylvia Medina1,
  2. Ferran Ballester2,3,4,
  3. Olivier Chanel5,
  4. Christophe Declercq1,
  5. Mathilde Pascal1
  1. 1Département Santé Environnement, Institut de Veille Sanitaire, Saint Maurice, France
  2. 2University of Valencia, Valencia, Spain
  3. 3Department of Environment and Health, Centre for Public Health Research (CSISP)/FISABIO, Valencia, Spain
  4. 4CIBER Epidemiología y Salud Pública (CIBERESP), Valencia, Spain
  5. 5Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS and IDEP, Marseille, France
  1. Correspondence to Dr Sylvia Medina, Département Santé Environnement, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice cedex, France; s.medina{at}

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According to WHO,1 health impact assessment (HIA) is A combination of procedures, methods and tools used to evaluate the potential health effects of a policy, programme or project. Using qualitative, quantitative and participatory techniques, HIA aims to produce recommendations that will help decision makers and other stakeholders make choices about alternatives and improvements to prevent disease/injury, and to actively promote health.

The typical procedural steps in HIA include screening, scoping, assessment of health effects, recommending alternatives and mitigations, reporting and monitoring.2 Each step helps predict or foresee potential effects of policy decisions on a population's health. In specific, quantitative risk assessment, an essential component of HIA, provides estimations of the potential health risks or impacts associated with a variety of hazards.3–6

Since the beginning of HIA development, environmental risk factors have been one of the targeted groups of health determinants—besides the social ones. In this commentary, we would like to discuss some methodological aspects and potential uses of the quantitative estimation of the health impact of outdoor air pollution.

In recent years, this hazard has been one of the environmental factors most frequently quantified using HIA because the toxicological and epidemiological evidence supports a strong causal relationship between exposure and health effects.7 Since the individual risk from air pollution is relatively low while the whole population is exposed, HIA provides a clearer view of its impact on public health.8

The classical HIA method, derived from the WHO-HIA general method,9 quantifies the impact on health of short-term and long-term exposures to air pollution using four successive steps: (1) selecting concentration-response functions (ie, relative risks, (RRs)) from epidemiological studies; (2) estimating the distribution of exposure levels in the population studied; (3) collecting data on the prevalence or incidence of selected health indicators and, finally, (4) calculating …

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  • Contributors SM and FB wrote the first draft of the manuscript; all authors enriched it and contributed equally to the writing of the manuscript.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.