Current focus

The group is currently finalising the collection of health information. This is a very important part of the project's work yet it has proved problematic, as medical information is subject to restricted access, it has been a very long road to collect the full range of information required.However, a path has now been secured to this information, and the group is currently selecting the data most relevant for their work. This represents an important step forward,
and now the group is at the stage of sorting medical information to put into the system for diagnostic purposes.

Areas of study

The group's studies on jellyfish have been closed following feedback from EU inspectors. While a sophisticated methodology has been developed and used for these studies, and a great deal of interesting information has been gathered, the experts in Brussels have decided that work with jellyfish is less relevant than initially hoped in terms of the interface between health and environment.While this is of course a disappointment, the group's work with jellyfish has brought significant advances, particularly in terms of developing an effective research methodology. This will bring significant benefits to the group's studies on other areas of air and coastal water quality, including the characterisation of water quality and analysis of the environmental cocktail in the water that leads to certain events.

Project Overview

Introduction

This pilot is focused on ensuring interoperability between health services and environmental monitoring teams on the French Riviera, a very populated area of South East France.

Research will be done in collaboration with Nice's hospital and, more precisely, with the Heath and Environment platform of the Centre Hospitalier, Universitaire of Nice.

The pilot region

The Provence Alpes Côte d'Azur (PACA) area is located in the South East of France and Alpes Maritimes is a county of this region.

The PACA region as a whole has a population of about five million people, which makes up eight per cent of the total population of France.

The Alpes Maritimes county covers 4300 km², and has a population of just over one million people, 95 per cent of whom live close to the sea.

The PACA region is very well known for leisure and many people retire there. In the Alpes Maritimes area, for example, the percentage of people over 60 years old is up to 60 per cent. These two aspects are relevant to this study in that:

Tourism and the region's environmental heritage (Alpes, French Riviera, Natural Park) are suffering from pollution, largely from Marseilles and Milano.

The air quality (which is bad especially in summer), together with the health vulnerability of seniors and children in the area, mean there are serious sanitary concerns.

The Relation between air quality and health

Much has been written about the close association between exposure to pollutants and ill-health, increased hospital admissions and increased daily mortality due to cardiovascular and respiratory causes.

European legislators have responded to this situation with dedicated directives such as the Air Quality Framework Directive 96/62/EC of 27 September 1996 with its daughter directives and the Clean Air for Europe (CAFE) programme. Moreover, the ENHIS project, coordinated by WHO/Europe and co-sponsored by the European Commission, aims at implementing an Environment and Health Information System in Europe. The goal of this system is to generate and analyse environmental health information to support relevant policies in Europe.

The development of an adequate tool for observation to understand the impacts of pollution levels on public health is of utmost importance. Dissemination of and discussion about an information set, related to health and the environment, for both patients and citizens, will be established.

The main objectives are to establish correlations between air pollution, exposure to air pollution and the reaction of people to this aggression. We can then validate a risk index and build a prediction model of this sanitary index.

Figure Example of risk map for the asthma in the Alpes Maritimes area (green: weak risk up to red: high risk)

This index will allow us to map risk areas for any given pathology (see figure) and to map targeted and general population.

An Aggregate Risk Index (ARI), based on the Relative Risk (RR) values, will be developed for various pollutants (PM10, SO2, NO2, O3) and health outcomes (total mortality, mortality for cardiovascular and respiratory causes, morbidity for respiratory, asthma and chronic obstructive pulmonary diseases) for the Alpes-Maritimes County.

This index will take into account the possible adverse effects associated with the coexistence of all the pollutants and environmental parameters. RR factors will be used to calculate sub-index values for each pollutant. To account for the reality of ubiquitous simultaneous exposure to a mixture of the common air pollutants, the final ARI will be the sum of the normalised values of the individual indices for each pollutant.

It is very useful for the authorities, the health care community as well as citizens to have daily easy information on the levels of air pollution and the proper measures to be taken for the protection of human health: alert, risk maps, near-real-time messages and forecast tools.

Interview with application pilot responsible Pierre Sicard

Patrick Truss spoke to Pierre Sicard, Chloé Vincent and Antoine Mangin about their work on air and coastal water quality on the French Riviera

Patrick Truss: What types of data do you use in your work?

Pierre Sicard: For the air quality pilot, we are developing an aggregated risk index per pathology, age range and sex. This brings together data from various databases, including air quality, meteorology and health data.

Health data are extracted from the Primary Health Insurance database and from feedback of the citizens. Meteorological data are extracted from the MM5 model. Air quality data are available from the AIRES platform: an emission-dispersion modelling platform for operational production of temporal and spatial distribution of primary and secondary pollutants.

This index will take into account the possible adverse effects associated with the coexistence of all pollutants (chemical and biological) and environmental parameters. This index is based on the relative risk associated with short-term exposure to common air pollutants: particulate matter, sulphur dioxide, ozone, nitrogen dioxide. To account for the reality of the multiple exposures impacts of chemical, biological and\or physical agents, the final index will be the sum of the normalised values of the individual relative risk values for the main environmental contaminants. The second step will consist in the construction of a prediction model of this sanitary index from the given agents and meteorological data.

PT: How will you integrate and use this data to generate predictions about air and water quality?

Chloé Vincent: We have used our measurements to study the correlation between air or water quality and the evolution of people's health. We have setup a formula for the risk index in air quality and a probability of occurrence for water quality based on environmental parameters such as pollutant concentration. Each of these formulas is a predictive model making the link between the environmental cocktail and health. As we know the environmental factors from operational daily modelling, we can make predictions for either air quality impact on health or jellyfish probability of occurrence.
The methodology used for air quality and coastal water quality is very similar and both aim at an operational warning system for populations but the two thematics are different. There is no interaction between the two sources of information.

PT: How will you present this information? Who are the main end-users?

Antoine Mangin: Our information will be presented via the internet, through dedicated web-pages, and also a concerted information-push towards our main end-users, primarily healthcare professionals.
A small group of healthcare professionals are already involved; by the end of the project this will be extended to a larger group, but during the project it will be limited. Healthcare professionals rely on us to develop, in collaboration with them, the right indicators, but once that is done their main expectation is that we will provide them with the right kind of indicators for their work.

PT: What are the main parameters of water quality?

AM: There are two kinds of parameters of water quality: physical parameters, such as temperature, salinity and current speed. Then you have biological parameters, such as the concentration of chlorophyll for instance, or the concentration of bacteria.

PT: Does the fact that coastal waters are tidal mean they are relatively healthy?

AM: It is true that the agitation of the water plays an important role in determining its quality, but in the Mediterranean the tide is very low, around 15-20 centimetres. No real water circulation is induced by the tide; in some cases this is compensated for by the waves playing a bigger role in agitating the water, but in the French Riviera we don't have a lot of waves. So in some areas of the Riviera waters are relatively stagnant, and in other parts less so. That's why biological and physical parameters are equally important in determining the quality of water.

PT: Is that a general principle, or is it just with reference to the French Riviera?

AM: The conditions outlined above are common across much of the warm Mediterranean. However, in the English Channel or the Bay of Biscay the tide level is much more important, and as such the balance between physical and biological parameters is not the same.
Therefore we will have to adapt our indicators to other seas. However, the principle is always the same; if you have a large tide then you have large currents and a kind of washing effect.

PT: Does water quality typically fluctuate quite a lot over the course of a year?

AM: There is high tourist pressure on the French Riviera, in Summer the number of people living in Nice is at least double of that in Winter. The more tourists there are then the more waste is released into the sea, that is the first aspect .
The second issue is that in Summer solar conditions cause a warming of the upper surface of the water, so it is stratified, and all the contaminants are locked into the upper layer of the water. In Winter there is no problem with water quality but there are very few tourists. In Summer there is a lot of tourist pressure at a time when the risk of poor water quality is higher.

PT: If pollutants are locked into the top layer of the water does that mean they have an impact on air quality as well?

AM: This is a major research topic, as currently we don't know exactly how pollution is exchanged between air and the sea. In coastal, urban areas it is quite probable that there will be high concentrations of ozone just above the sea, but at the moment we cannot say that the sea contaminates the air and vice-versa.

PT: How important is water quality in the French Riviera to the local tourist industry?

AM: Of course water quality is important to attracting tourists, but it is important to note here that we are speaking about air quality and water quality, this doesn't mean that we are talking about air pollution and water pollution. The fact that we are studying the quality of water does not imply that the water is polluted,  quality means that we want to quantify and qualify what is in the water as a biological experiment. I can say there is no real water pollution in the French Riviera because it is very controlled. We are bound by EU regulations on water quality, so the water is clean. Nevertheless, there are some elements in the water that may or may not trigger algae blooms or jellyfish occurrences, this is what we mean by water quality. We are characterising what is in the water; we are looking at what kind of environmental cocktail will favour the jellyfish population, or lead to an algae bloom, or encourage cyanobacteria development. The quality of this water could be good, but due to its temperature, salinity or chlorophyll levels it may even if it meets EU water quality standards lead to these events.

PT: Will you also look at the evolution of water quality?

AM: The idea is to use something relatively stable as an observation system, because we may have some opportunities for observation. Here we use satellite observations, so this work will continue in future, there will be sustained observations of water quality.

PT: This would help you develop a comparative framework for how the water has changed?

AM: Yes, we will be able to look at the evolution of water quality over the last decade and look at how it might develop in future, we would then use that to develop forecasts.
We measure what we are able to measure, for example temperature and chlorophyll levels. Based on these components we say ok, there is a risk or not of jellyfish occurrence, or of an algae bloom. We provide daily risk indexes.