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Development of the WHO Environmental Noise Guidelines for the European Region: An Introduction

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Abstract

Following the Parma Declaration on Environment and Health adopted at the Fifth Ministerial Conference (2010), the Ministers and representatives of Member States in the WHO European Region requested the World Health Organization (WHO) to develop updated guidelines on environmental noise, and called upon all stakeholders to reduce children's exposure to noise, including that from personal electronic devices. The WHO Environmental Noise Guidelines for the European Region will provide evidence-based policy guidance to Member States on protecting human health from noise originating from transportation (road traffic, railway and aircraft), wind turbine noise, and leisure noise in settings where people spend the majority of their time. Compared to previous WHO guidelines on noise, the most significant developments include: consideration of new evidence associating environmental noise exposure with health outcomes, such as annoyance, cardiovascular effects, obesity and metabolic effects (such as diabetes), cognitive impairment, sleep disturbance, hearing impairment and tinnitus, adverse birth outcomes, quality of life, mental health, and wellbeing; inclusion of new noise sources to reflect the current noise environment; and the use of a standardized framework (grading of recommendations, assessment, development, and evaluations: GRADE) to assess evidence and develop recommendations. The recommendations in the guidelines are underpinned by systematic reviews of evidence on several health outcomes related to environmental noise as well as evidence on interventions to reduce noise exposure and/or health outcomes. The overall body of evidence is published in this Special Issue.
International Journal of
Environmental Research
and Public Health
Project Report
Development of the WHO Environmental Noise
Guidelines for the European Region: An Introduction
Dorota Jarosi ´nska 1, *ID , Marie-Ève Héroux 1, Poonum Wilkhu 1, James Creswick 1,
Jos Verbeek 2ID , Jördis Wothge 1and Elizabet Paunovi´c 1
1World Health Organization (WHO) Regional Office for Europe, European Centre for Environment
and Health, Platz der Vereinten Nationen 1, 53113 Bonn, Germany; herouxm@who.int (M.-È.H.);
wilkhup@who.int (P.W.); creswickj@who.int (J.C.); wothgej@who.int (J.W.); paunovice@who.int (E.P.)
2Finnish Institute of Occupational Health, Cochrane Work, Neulaniementie 4, 70701 Kuopio, Finland;
Jos.Verbeek@ttl.fi
*Correspondence: jarosinskad@who.int
Received: 12 April 2018; Accepted: 18 April 2018; Published: 20 April 2018
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Abstract:
Following the Parma Declaration on Environment and Health adopted at the Fifth
Ministerial Conference (2010), the Ministers and representatives of Member States in the WHO
European Region requested the World Health Organization (WHO) to develop updated guidelines
on environmental noise, and called upon all stakeholders to reduce children’s exposure to noise,
including that from personal electronic devices. The WHO Environmental Noise Guidelines for the
European Region will provide evidence-based policy guidance to Member States on protecting human
health from noise originating from transportation (road traffic, railway and aircraft), wind turbine
noise, and leisure noise in settings where people spend the majority of their time. Compared to
previous WHO guidelines on noise, the most significant developments include: consideration of
new evidence associating environmental noise exposure with health outcomes, such as annoyance,
cardiovascular effects, obesity and metabolic effects (such as diabetes), cognitive impairment,
sleep disturbance, hearing impairment and tinnitus, adverse birth outcomes, quality of life,
mental health, and wellbeing; inclusion of new noise sources to reflect the current noise environment;
and the use of a standardized framework (grading of recommendations, assessment, development,
and evaluations: GRADE) to assess evidence and develop recommendations. The recommendations
in the guidelines are underpinned by systematic reviews of evidence on several health outcomes
related to environmental noise as well as evidence on interventions to reduce noise exposure and/or
health outcomes. The overall body of evidence is published in this Special Issue.
Keywords:
noise; WHO environmental noise guidelines; noise abatement; Environmental Noise
Directive; health; wellbeing
1. Introduction
Normal sounds become noise when they are unwanted or harmful. Exposure to environmental
noise is associated with an increased risk of negative physiological and psychological health outcomes.
Although noise is a product of many human activities, widespread exposure to noise from transport
(road traffic, railway, and aircraft) is of major concern, affecting the health and wellbeing of many
people in Europe. To this effect, environmental noise features among the top environmental hazards to
physical and mental health and wellbeing in Europe [1,2].
Int. J. Environ. Res. Public Health 2018,15, 813; doi:10.3390/ijerph15040813 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2018,15, 813 2 of 7
2. Policy Context
The World Health Organization Regional Office for Europe comprises fifty-three Member States
covering a vast geographical region from the Atlantic to the Pacific oceans. The European Environment
and Health Process and its Ministerial Conferences guide the regional efforts to address the main
environmental challenges to human health. The Parma Declaration on Environment and Health,
adopted by the Member States of the WHO European Region at the Fifth Ministerial Conference
in 2010, made implicit the need to reduce exposure to noise, and called upon the WHO to develop
suitable guidelines [3].
At the European Union scale, the Environmental Noise Directive (END) 2002/49/EC offers a
common approach to avoiding and preventing exposure to environmental noise, thereby reducing its
harmful effects, as well as preserving quiet areas [
4
]. In implementing this directive, the European
Commission is supported by the European Environment Agency (EEA), which gathers the noise
exposure data and maintains the Noise Observation and Information Service for Europe (NOISE) [5].
The END (2002/49/EC) is a primary legislative tool for achieving one of the priority objectives
of the Seventh Environment Action Programme, of “significantly reducing noise pollution in the EU
by 2020 and thereby moving closer to World Health Organization (WHO) recommended levels” [
6
].
The directive sets out methods for collecting data on noise levels. These END outputs, then, provide a
basis for developing measures to reduce noise levels at source.
3. Data on Noise Exposure Levels
The current state of knowledge on noise sources and population exposure in Europe is largely
based on data submitted by the member countries of the European Union (EU) on a five-year cycle
to the EEA [
4
,
7
]. The EEA database covers noise sources specified in the END (such as major roads,
major railways, major airports, and urban agglomerations) and number of people exposed to each of
the noise sources inside and outside urban areas. Noise levels (L) are calculated and represented in 5-dB
interval bands at L
den
55 dB (an average of day, evening, and night) and at night (
Lnight)50 dB
.
These long-term average noise exposure indicators are reasonable and common predictors of adverse
health effects in a population. However, other noise indicators might be useful to reflect special
noise situations. In the case of noisy but short-lived events, like shooting noise or noise emitted by
trains, Lmax is often used; for example, Lmax is an indicator of the maximum sound pressure reached
during a defined measurement period. Used for setting noise limits, it is also considered in studies to
determine certain health effects (e.g., awakening reactions) [8,9].
New scientific evidence, as also illustrated by the systematic reviews published in this Special
Issue, shows that health and wellbeing can be affected at lower noise levels than specified by the
END [
10
]; however, as reporting for these lower levels is not required under the END, there is a paucity
of data on numbers of the population exposed below 55 dB. Analyses of the available noise exposure
data show consistently that the dominant source of noise in Europe is road traffic; the second one is
noise from railways, followed closely by aircraft noise. An extension of the mapping of noise exposure
to the levels below 55 dB would expand the knowledge base and facilitate the evaluation of progress
in preventing adverse health effects.
Despite substantial progress over the last fifteen years in data mapping and development of noise
action plans, there is room for further improvement. For example, in 2013, only 44% of the expected
data was delivered in the latest reporting round under the END [
11
]. In particular, noise exposure data
from the eastern part of the Region is lacking, and inconsistencies in quality and quantity of reported
data make the discernment of noise exposure patterns difficult.
The data related to noise sources and exposure information as prescribed by the END,
combined with the data on industrial activity, urban areas, land use, and areas protected for the
benefit of nature reported by countries to the EEA, were the basis of a first spatial assessment of areas
in Europe potentially unaffected by noise pollution caused by human activity [
11
]. Protection of such
Int. J. Environ. Res. Public Health 2018,15, 813 3 of 7
areas, largely undisturbed by noise from traffic, industry, or recreational activities is vitally important
also from the perspective of human health protection.
4. Burden of Disease in Europe
Noise exposure is associated with a number of adverse health outcomes. Auditory effects of
noise include hearing impairment and tinnitus, whilst nonauditory effects refer to cardiovascular
and metabolic effects; adverse birth outcomes; poor quality of life, mental health, and wellbeing;
annoyance; cognitive impairment; and poor sleep. Sleep disturbance and annoyance, mostly related to
road traffic noise, are the most prevalent effects from noise.
The WHO Global Burden of Disease (GBD) measures the burden of disease using the
disability-adjusted life-year (DALY) [2], which combines years of life lost due to premature mortality
and years of life lost due to time lived in states of less than full health. The DALYs lost due to
noise-induced health outcomes in the western part of Europe were estimated to be equivalent to:
903,000 years for sleep disturbance, 654,000 years for annoyance, 61,000 years for ischaemic heart
disease, 45,000 years for cognitive impairment of children, and 22,000 years for tinnitus [
2
]. The burden
of disease could not be calculated for the eastern and central part of the WHO European Region due to
a lack of reported noise exposure data.
5. Why the Urgency?
With projections of rapid urban growth in Europe (80% of the citizens are expected to be living in
or near a city by 2020) [
12
] and increased demand for road, rail, and air transport [
13
], a simultaneous
increase in noise exposure and the associated adverse health effects can be anticipated. Hence, it is
pertinent to continue positioning noise mitigation as a cross-cutting theme on the agenda of urban
development and transport policies.
Available reported data on long-term average exposure show that 65% of Europeans living in
major urban areas are exposed to daytime noise levels greater than 55 dB, and more than 20% to
night-time noise levels greater than 50 dB, at which adverse health effects occur frequently [
5
].
As shown by the Eurostat surveys, noise from neighbours (defined as noise from, e.g.., neighbouring
apartments, staircases, or water pipes) and streets (described as noise linked to traffic, business,
factories, agricultural activities, clubs, and yard) is also perceived to be a source of annoyance.
An estimated 18% of citizens of the 28 member countries of the European Union reported being
exposed to noise from neighbours or the streets in their living areas in 2016, a decrease from 24% in
2005 [
14
,
15
]. As data on noise created by neighbours is not collected through the noise-exposure
mapping process (END 2002/49/EC), such a noise has not been considered in the development of the
WHO Environmental Noise Guidelines.
Furthermore, reliance on wind energy has increased in the last years in Europe, with wind farms
being an important component of Europe’s shift towards a greener, renewable energy supply. However,
the noise from increased installations of wind turbines have resulted in higher public annoyance in the
EU [16].
Finally, concerns on the increasing exposure to noise in leisure settings are growing along with
operation of personal music devices at unsafe volumes. WHO estimated that young people worldwide
could be at risk of hearing loss due to these unsafe listening practices [
17
]. In the EU, a conservative
estimate of users of devices such as personal music players and mobile phones with music functions
lies in the range of 50–100 million people [
18
]. Noting the possible effects of wind turbines and personal
devices on health, scientific literature pertaining to these noise sources have been considered in the
development of the Noise Guidelines.
6. The WHO Guidelines
In 1999 and 2009, WHO published guidelines to protect human health, specifically from
community noise and night noise exposure [
18
,
19
]. Over the years, there have been a number of
Int. J. Environ. Res. Public Health 2018,15, 813 4 of 7
key developments and a substantial increase in the number and quality of studies on environmental
noise exposure and health outcomes, with newly found associations with annoyance; cardiovascular
effects; obesity and metabolic effects (such as diabetes); cognitive impairment; sleep disturbance;
hearing impairment and tinnitus; adverse birth outcomes; and quality of life, mental health,
and wellbeing. Another development is that whilst earlier studies focused mainly on road traffic
and aircraft noise [
11
], newer studies also include noise from other sources such as railways and
wind turbines.
In light of this new evidence, the WHO Environmental Noise Guidelines for the European
Region are being developed in accordance with the “WHO Handbook for Guideline Development”,
which sets out a clear framework to ensure rigorous adherence to the systematic use of evidence as the
basis for developing public health recommendations [
20
]. Systematic reviews of scientific literature
guided by specific key questions using the PICO or PECCOS (population, intervention/exposure,
control, confounder, outcome, and study design) structure form the basis of the recommendations in
the guidelines.
The two main questions that frame the guideline recommendations are:
1.
In the general population exposed to environmental noise, what is the exposure–response
relationship between exposure to environmental noise (reported as various indicators) and
the proportion of persons with a validated measure of health outcome, when adjusted
for confounders?
2.
In the general population exposed to environmental noise, are interventions effective in reducing
exposure to and/or health outcomes from environmental noise?
The development of the guidelines involves the collaboration of many groups, including the
WHO steering group, the Guideline Development Group (GDG), the External Review Group (ERG)
and the Systematic Review Team (SRT). The exact roles and composition of these groups, set out in the
WHO Handbook for Guideline Development, are briefly summarized here [20]:
-
The prime responsibility of the GDG lies in the development of evidence-based recommendations,
based on the outcomes of the systematic reviews of evidence as well as careful
consideration of other factors (such as values and preferences, balance of benefits and harms,
and resource implications).
-
The SRT is comprised of leading experts in the field of environmental noise and health, and their
role is to review all relevant literature in the context of the guidelines.
- The ERG is composed of thematic experts as well as stakeholders representing individuals who
are likely to be affected by the recommendations and interested parties. They are asked to
participate at different stages to comment on clarity and implications for implementation.
Declaration of interests for each member of these groups are collected and managed to prevent
bias from conflicts of interest. More information on the types of interests that need to be declared can
be found in the handbook.
Seven systematic reviews of evidence were commissioned by WHO to assess the relationship
between environmental noise and the following health outcomes: (1) annoyance; (2) cardiovascular and
metabolic effects; (3) cognitive impairment; (4) effects on sleep; (5) hearing impairment and tinnitus;
(6) adverse birth outcomes; and (7) quality of life, mental health, and wellbeing. An eighth systematic
review was commissioned to assess the effectiveness of environmental noise interventions in reducing
exposure and associated impacts on health. The reviews separately assess the environmental noise
coming from the following sources, for each relevant health outcome: road traffic, railway, aircraft,
wind turbines, and leisure. In the context of the WHO environmental noise guidelines, leisure noise
was defined as outdoor and indoor exposure during leisure activities (such as discotheques, cafes,
festivals, concerts, or personal music devices). Due to the individualized retrieval of evidence for
each of the systematic reviews, the timeframes of the included literature varied; an indication of the
Int. J. Environ. Res. Public Health 2018,15, 813 5 of 7
temporal coverage of the studies included can be found in specific systematic reviews. A detailed
description of the methodology used to conduct the systematic evidence reviews, including individual
protocols, has been prepared as part of the guidelines development process and will be published on
the WHO Regional Office for Europe website.
The key objectives of the systematic evidence reviews were to assess the strength of the association
between exposure to environmental noise and incidence or prevalence of adverse health effects,
and where possible, to quantify the risk of these health effects with an incremental increase in noise
exposure. A detailed description of the methodology used to conduct the systematic evidence reviews
can be found in the systematic reviews published in this Special Issue.
WHO has adopted the grading of recommendations, assessment, development, and evaluations
(GRADE) approach [
20
] in order to assess the quality of evidence and develop and report
recommendations in the form of guidelines. GRADE is widely acknowledged as an effective method
of rating the quality of the evidence and linking evidence to clinical recommendations because this
approach facilitates judgments about the certainty in the observed effect estimates and the strength
of the recommendations. The limitations to the application of the original GRADE in environmental
health have been discussed in the literature [
21
]. Specifically in the context of the environmental noise
guidelines, the GRADE approach was adapted to the observational studies, which are usually the
only source of research evidence in this area. The main adaptations made to the GRADE approach for
environmental noise are also discussed in the systematic reviews. The upcoming guidelines focus on
the WHO European Region and provide policy guidance to its Member States that is compatible with
the noise indicators commonly used in the END, namely Lden and Lnight.
7. Looking Ahead
The evidence summarized and presented in the systematic evidence reviews is the basis for the
development of recommendations in the WHO Environmental Noise Guidelines for the European
Region. Aimed at decision-makers and technical experts, the new guidelines offer not only scientific,
evidence-based rationale for identifying levels, at which environmental noise is related to a significant
health impact, but also recommendations for actions to reduce exposure. For all who are involved in
health and environmental impact assessment, such as policy makers, advocacy bodies, and researchers,
these guidelines make recommendations on noise levels above which we are confident that there
are health impacts for some noise sources and provide guidance for quantifying these impacts.
Moreover, the guidelines highlight critical data and research gaps to be addressed in future studies.
Although developed for the WHO European Region, the guidelines provide a general framework for
use by a global audience.
8. Conclusions
As policy-makers begin to address rapid urbanization and sustainable economic development,
the evidence systematically reviewed as part of the WHO Environmental Noise Guidelines for the
European Region offers a useful reference for establishing the links between noise pollution and
public health, especially taking into account effects on large populations in urban environments.
Governments and communities are encouraged to use the opportunity to champion a multidisciplinary
approach to help mainstream noise mitigation in their sustainable development processes.
Acknowledgments:
The World Health Organization Regional Office for Europe acknowledges funding from the
Swiss Federal Office for the Environment and the German Federal Ministry for Environment, Nature Conservation
and Nuclear Safety. Marie-Ève Héroux was a WHO Technical Officer on air quality and noise until
March 2017
.
The Regional Office thanks all contributors to the WHO Steering Group, Guidelines Development Group,
Systematic Review Team, and External Review Group for their invaluable contributions in the guideline
development process. All rights in the work, including ownership of the original work and copyright thereof, is
vested in WHO. The WHO Regional Office for Europe has granted the Publisher permission for the reproduction
of this article.
Int. J. Environ. Res. Public Health 2018,15, 813 6 of 7
Author Contributions:
Dorota Jarosi´nska coordinated the guideline development process; Marie-Ève Héroux
was a responsible technical officer (until March 2017); James Creswick was in charge of communication aspects;
Poonum Wilkhu and Jördis Wothge were WHO consultants; Jos Verbeek was a methodologist. Elizabet Paunovi´c
supervised the overall process of the guideline development. Dorota Jarosi´nska, Marie-Ève Héroux,
James Creswick and Poonum Wilkhu drafted the manuscript; Jos Verbeek and Jördis Wothge contributed to its
specific sections. All authors read, commented on and approved the final manuscript.
Conflicts of Interest: The authors declare no conflict of interest.
Disclaimer:
The authors alone are responsible for the views expressed in this publication and they do not
necessarily represent the decisions or policies of the World Health Organization.
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2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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While ambitious carbon reduction policies are needed to avoid dangerous levels of climate change, the costs of these policies can be balanced by wide ranging health benefits for local communities. Cities, responsible for ~70% of the world's greenhouse gas (GHG) emissions and home to a growing majority of the world's population, offer enormous opportunities for both climate action and health improvement. We aim to review the current state of knowledge on key pathways leading from carbon mitigation to human health benefits, and to evaluate our current ability to quantify health benefits for cities around the world. For example, because GHGs and air pollutants are both released during fuel combustion, reducing fuel burning can reduce both GHGs and air pollutants, leading to direct health benefits. Air quality improvements may be particularly important for city-scale climate action planning because the benefits occur locally and relatively immediately, compared with the global and long-term (typically, decades to centuries) benefits for the climate system. In addition to improved air quality, actions that promote active transport in cities via improved cycling and pedestrian infrastructure can reap large cardiovascular health benefits via increased physical activity. Exposure to green space has been associated with beneficial health outcomes in a growing number of epidemiological studies and meta-analyses conducted around the world. Finally, noise is an underappreciated environmental risk factor in cities which can be addressed through actions to reduce motor vehicle traffic and other noise sources. All of these environmental health pathways are supported by well-conducted epidemiological studies in multiple locales, providing quantitative exposure–response data that can be used as inputs to health impact assessments (HIAs). However, most epidemiologic evidence derives from studies in high-income countries. It is unclear to what extent such evidence is directly transferable for policies in low- and middle-income countries (LMICs). This gap calls for a future focus on building the evidence based in LMIC cities. Finally, the literature suggests that policies are likely to be most effective when they are developed by multidisciplinary teams that include policy makers, researchers, and representatives from affected communities.
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The acoustic environment of residential areas is critical to the health of the residents. To reveal the impact of the acoustic environment on people’s mental health and create a satisfactory acoustic setting, this study took a typical old residential area in Harbin as an example, conducted a field measurement and questionnaire survey on it, and took typical acoustic sources as the research object for human body index measurement. The relationship between heart rate (HR), skin conductivity level (SCL), physiological indicators, semantic differences (SD), and psychological indicators was studied. The sound distribution in the old community was obtained, determining that gender, age, and education level are significant factors producing different sound source evaluations. Music can alleviate residents’ psychological depression, while traffic sounds and residents’ psychological state can affect the satisfaction evaluation of the sound environment. There is a significant correlation between the physiological and psychological changes produced by different sounds. Pleasant sounds increase a person’s HR and decrease skin conductivity. The subjects’ HR increased 3.24 times per minute on average, and SCL decreased 1.65 times per minute on average in relation to hearing various sound sources. The SD evaluation showed that lively, pleasant, and attractive birdsongs and music produced the greatest HR and SCL changes, and that the sound barrier works best when placed 8 m and 18 m from the road.
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Achieving sustainable urban development requires a reorientation in the planning, management, and design of cities based on the use of cross-cutting solutions that can systematically address urban problems. The implementation of Nature-based Solutions (NBS) such as green walls in cities contributes to reducing the effects of a systemic issue: climate change. This field of research is constantly evolving, and there is a growing need for systematic analysis to understand the current scenario, identify gaps, and accelerate new lines of research. This review aims to demonstrate the impact of green walls on urban comfort by providing a systematic review of the state of the art in the field of temperature reduction and acoustic absorption, identifying the factors that influence urban comfort through the use of vegetation, and highlighting research gaps that can be further explored. The most relevant results have shown that the temperature reduction is mainly influenced by the shading capacity of the selected vegetation type, the evapotranspiration process of the plants, and the presence of substrate. Also, the acoustic absorption capacity is influenced to a greater extent by the system's configuration, the substrate's characteristics, and the vegetation's density. In both cases, the environmental conditions in which they are found can vary the impact to a greater or lesser extent. The results of this research are relevant for the implementation of green walls as a climate change mitigation tool in cities and the development of new research approaches.
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This study aims to suggest representative spectra of heavy-weight impact sounds and subject responses. In 2004, the Korean government implemented mandatory criteria that require a minimum concrete slab thickness of 210 mm for box-frame reinforced concrete apartment houses. Spectra representative of 140 households was derived through unsupervised cluster analysis of heavy-weight impact sounds made by rubber balls and tires. As a result, the frequency spectra and single-number quantities measured from apartments constructed before the standard was applied (110–180 mm) and those of apartments built after the introduction of the standard (210 mm) were found to be different. Based on the impact sounds created by a rubber ball and a tire, a sound pressure level in the 63–125 Hz band (Spectrum 1) was dominant for apartment houses with a floor slab of 210 mm. In apartment houses with a slab thickness of 110–180 mm, a sound pressure level in the 125–500 Hz band was relatively high (Spectrum 2 and 3). A total of 108 subjects with normal hearing were asked to express their level of annoyance relative to the sounds created by the rubber ball and tire. Spectrum 1 for the rubber ball showed a lower percentage of highly annoyed (%HA) than Spectrum 2 and 3 less than 60 dB (LiA,Fmax). In Spectrum 1, the tire elicited a higher %HA compared with Spectrum 2 and 3 above 50 dB (LiA,Fmax). Five categories of heavy-weight impact sounds with different spectra are suggested based on the annoyance responses of subjects.
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Background: Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. Objectives: The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). Methods: Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. Results: About 3-7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 μm; PM2.5) is the leading risk factor associated with 6,000-10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600-1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. Conclusions: With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability.
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There is high demand in environmental health for adoption of a structured process that evaluates and integrates evidence while making decisions and recommendations transparent. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework holds promise to address this demand. For over a decade, GRADE has been applied successfully to areas of clinical medicine, public health, and health policy, but experience with GRADE in environmental and occupational health is just beginning. Environmental and occupational health questions focus on understanding whether an exposure is a potential health hazard or risk, assessing the exposure to understand the extent and magnitude of risk, and exploring interventions to mitigate exposure or risk. Although GRADE offers many advantages, including its flexibility and methodological rigor, there are features of the different sources of evidence used in environmental and occupational health that will require further consideration to assess the need for method refinement. An issue that requires particular attention is the evaluation and integration of evidence from human, animal, in vitro, and in silico (computer modeling) studies when determining whether an environmental factor represents a potential health hazard or risk. Assessment of the hazard of exposures can produce analyses for use in the GRADE evidence-to-decision (EtD) framework to inform risk-management decisions about removing harmful exposures or mitigating risks. The EtD framework allows for grading the strength of the recommendations based on judgments of the certainty in the evidence (also known as quality of the evidence), as well as other factors that inform recommendations such as social values and preferences, resource implications, and benefits. GRADE represents an untapped opportunity for environmental and occupational health to make evidence-based recommendations in a systematic and transparent manner. The objectives of this article are to provide an overview of GRADE, discuss GRADE's applicability to environmental health, and identify priority areas for method assessment and development.
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The health effects of community noise are considered to be a more and more important public health issue. In many cities of the world, high levels of noise prevail in the vicinity of busy streets and airports and in indoor environments. The guidelines for noise exposure prevention published by the WHO in 1980 have been updated and revised in 1992-1995, and finalised in 1999. Health-based guidelines have to be applied within a framework of noise management. Key issues of noise management include abatement options, models for forecasting and assessment of effectiveness of source control action, standards setting process for existing and future sources, noise assessment, and testing compliance with noise standards. All these issues are addressed in the new WHO Guidelines for Community Noise, which were published recently.
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Traffic noise is interfering during day- and nighttime causing distress and adverse physiological reactions in large parts of the population. Railway noise proved less annoying than aircraft noise in surveys which were the bases for a so called 5 dB railway bonus regarding noise protection in many European countries. The present field study investigated railway noise-induced awakenings during sleep, nighttime annoyance and the impact on performance the following day. Comparing these results with those from a field study on aircraft noise allowed for a ranking of traffic modes concerning physiological and psychological reactions. 33 participants (mean age 36.2 years ± 10.3 (SD); 22 females) living alongside railway tracks around Cologne/Bonn (Germany) were polysomnographically investigated. These data were pooled with data from a field study on aircraft noise (61 subjects) directly comparing the effects of railway and aircraft noise in one random subject effects logistic regression model. Annoyance was rated in the morning evaluating the previous night. Probability of sleep stage changes to wake/S1 from railway noise increased significantly from 6.5% at 35 dB(A) to 20.5% at 80 dB(A) LAFmax. Rise time of noise events had a significant impact on awakening probability. Nocturnal railway noise led to significantly higher awakening probabilities than aircraft noise, partly explained by the different rise times, whereas the order was inversed for annoyance. Freight train noise compared to passenger train noise proved to have the most impact on awakening probability. Nocturnal railway noise had no effect on psychomotor vigilance. Nocturnal freight train noise exposure in Germany was associated with increased awakening probabilities exceeding those for aircraft noise and contrasting the findings of many annoyance surveys and annoyance ratings of our study. During nighttime a bonus for railway noise seems not appropriate.
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The Institute of Aerospace Medicine at the German Aerospace Center (DLR) investigated the influence of nocturnal aircraft noise on sleep in polysomnographic laboratory and field studies between 1999 and 2004. The results of the field studies were used by the Regional Council of Leipzig (Germany) for the establishment of a noise protection plan in the official approval process for the expansion of Leipzig/Halle airport. Methods and results of the DLR field study are described in detail. Special attention is given to the dose-response relationship between the maximum sound pressure level of an aircraft noise event and the probability to wake up, which was used to establish noise protection zones directly related to the effects of noise on sleep. These protection zones differ qualitatively and quantitatively from zones that are solely based on acoustical criteria. The noise protection plan for Leipzig/Halle airport is presented and substantiated: (1) on average, there should be less than one additional awakening induced by aircraft noise, (2) awakenings recalled in the morning should be avoided as much as possible, and (3) aircraft noise should interfere as little as possible with the process of falling asleep again. Issues concerned with the representativeness of the study sample are discussed.
Updated Assessment; European Topic Centre on Air Pollution and Climate Change Mitigation
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Blanes, N.; Fons, J.; Houthuijs, D.; Swart, W.; de la Maza, M.S.; Ramos, M.J.; Castell, N.; van Kempen, E. Noise in Europe 2017: Updated Assessment; European Topic Centre on Air Pollution and Climate Change Mitigation (ETC/ACM): Bilthoven, The Netherlands, 2017.
Noise from Neighbours or from the Street-EU-SILC Survey
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Eurostat. Noise from Neighbours or from the Street-EU-SILC Survey. Available online: http://ec.europa. eu/eurostat/en/web/products-datasets/-/ILC_MDDW01 (accessed on 8 January 2018).
Quality of Life: Facts and Views
  • Eurostat
Eurostat. Quality of Life: Facts and Views, 2015 ed.; Publications Office of the European Union: Luxembourg, 2015; ISBN 978-92-79-43616-1.