EU takes Greece, Bulgaria to court over toxic air

Posted on December 4, 2020 by Respro® UK Ltd

The European Commission will take Bulgaria and Greece to the EU Court of Justice after both countries breached air pollution limits for years despite multiple warnings, the Commission said late on Thursday.

The two cases are the latest in a string of EU legal actions over poor air quality in countries including France, Italy and Romania, as Brussels seeks to clamp down on violations that threaten human health and the bloc’s pollution targets.

The Commission said it will refer Bulgaria to the EU’s top court for exceeding legal limits on particulate matter from 2015-2019 even after the court ordered the country’s government to address the issue in 2017.

Bulgaria could face financial penalties for flouting the earlier ruling. Bulgaria is one of the heaviest offenders in the European Union in terms of exceeding both annual and daily limits on particulate matter, the Commission said.

EU laws have required countries to limit particulate matter pollution since 2005. However, most of the bloc’s 27 members are set to miss targets this year to tackle dirty air.

The Commission also referred Greece to the court for exceeding particulate matter limits in the city of Thessaloniki for all but one year since 2005. “Efforts by the Greek authorities have to date been unsatisfactory and insufficient,” it said.

Air pollution is the biggest environmental health risk in Europe. Particulate matter contributed to around 379,000 premature deaths in 2018 in the EU, although this was 13% lower than in 2009, the European Environment Agency said in a recent report.

The Commission also referred Poland to the EU’s top court on Thursday for failing to protect forests and the wildlife that live there.

EU takes Greece, Bulgaria to court over toxic air | in-cyprus.com
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Air pollution where girl died in London ‘should have been treated as emergency’

Posted on December 1, 2020 by Respro® UK Ltd

Inquest into Ella Kissi-Debrah’s asthma death hears Lewisham council was slow to tackle issue

Illegal levels of air pollution in the area where a nine-year-old girl lived and died should have been treated as a public health emergency, an inquest heard.

Instead the London borough of Lewisham moved at a “glacial pace” to take steps to address toxic air from traffic where Ella Kissi-Debrah lived and went to primary school, the inquest in south London was told on Monday.

In a landmark legal case a coroner is being asked to rule that air pollution caused the death from an acute asthma attack of the primary school pupil in February 2013, a finding that would make legal history. It has never been identified as a cause of death before in the UK and this is thought to be the first case of its kind in the world.

Philip Barlow, an assistant coroner for inner south London, opened the hearing in which witnesses gave evidence via video link.

Barlow said the inquest would examine whether air pollution caused or contributed to Ella’s death, as well as how toxic air levels were monitored, the steps taken to reduce illegal levels of air pollution and what information was given to the public about reducing exposure.

He said it had already been decided that article 2 – the right to life – of the Human Rights Act, which scrutinises the role of public bodies in a person’s death, applied to the hearing.

As such, representatives from Lewisham council, the mayor of London and government will give evidence about their knowledge of the levels of toxic air around where Ella lived, the health impacts and what was being done to reduce the pollution.

The inquest was granted after years of campaigning by Ella’s mother, Rosamund Kissi-Debrah, when lawyers presented new evidence to the attorney general that directly linked Ella’s serious form of asthma and her death with the heavy traffic on London’s South Circular near her home. Her death coincided with one of the worst air pollution surges in her local area.

Giving evidence on Monday, David Edwards, the head of environmental health at Lewisham, accepted that levels of nitrogen dioxide (NO2) near the child’s home consistently exceeded the annual legal limit of 40µg/m3 between 2006 and 2010.

Asked by Barlow whether exposure to high levels of nitrogen oxides raised health concerns, he replied: “Yes, from my experience, yes it would.”

Representing the family, Richard Hermer QC asked: “For many years before Ella’s death Lewisham would have been aware that the levels of air pollution in the borough was placing the life and health of those who lived and worked there at risk?”

“Yes,” Edwards said.

The council official agreed the risk was particularly real to those suffering conditions such as asthma and was also increased for those who lived near high levels of traffic pollution.

Hermer said Ella’s home and school were in areas identified as of particular concern by the borough, both in terms of nitrogen oxide pollution and particulate matter.

“Taking what Lewisham would have known about what this meant in terms of deaths, what this meant about those at particular risk … this should have been treated as a public health emergency in the year before Ella’s death.”

Edwards replied: “Yes.”

But, Hermer said, it took the borough 10 years to draw up and adopt an action plan to try to tackle the problem. “That’s a glacial pace in the context of a public health emergency,” he said.

The borough was obliged when facing such a public health emergency to work to reduce air pollution levels and to inform those at risk.

Yet Ella’s mother, he said, in her evidence to be presented to the inquest, said she was never told about the risks of air pollution in relation to her daughter’s asthma.

“She is precisely the sort of person who should have been told about those risks, isn’t she?” Hermer asked.

“Yes,” Edwards replied.

Edwards told the hearing that ultimately the responsibility for tackling the levels of traffic using the South Circular through the borough lay with Transport for London and the national government.

“There are a number of people who have a greater impact than perhaps the local authority does,” said Edwards.

The hearing is due to last two weeks and will hear from government departments including Defra and the Department for Transport.

Ministers have repeatedly failed to bring air pollution from traffic within legal limits, for which they have been censured by judges several times.

In 2014 the first inquest into the child’s death made no mention of air pollution. The coroner ruled Ella had died of acute respiratory failure caused by severe asthma. This verdict was quashed in 2019 and a new inquest ordered after lawyers for the family presented evidence to theattorney general in 2018 from Prof Sir Stephen Holgate, one of the UK’s leading experts on air pollution.

The hearing continues.

Air pollution where girl died in London ‘should have been treated as emergency’ | Air pollution | The Guardian

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Potentially harmful aerosols concentrate in European urban centres

Posted on November 30, 2020 by Respro® UK Ltd

Atmospheric particles that increase levels of cellular oxidants when inhaled might be especially harmful. An analysis reveals which emissions should be limited to minimize the potential adverse health effects of such particles in Europe.

The inhalation of outdoor airborne particles can damage health and lead to premature death1,2. Writing in Nature, Daellenbach et al.3 report that certain components of atmospheric aerosols — those that have the potential to increase the oxidization of molecules in cells — might be responsible for most of the acute adverse effects of these particles in Europe. They also find that the distribution of these potentially harmful aerosols differs from that of the overall mass of aerosols, with hotspots in regions where the human population density is high. The overall mass concentration of particles is currently used as the key metric for assessing the risk of aerosols and to guide air-quality regulations. If the oxidation potential of aerosols is a stronger indicator of adverse effects, then the new results show that the evidence used at present to inform policymaking is deficient.

In many regions, the concentration of aerosol mass in the atmosphere has been monitored for decades. Correlations have thus been established1,2 between outdoor aerosol-mass levels and a diverse set of detrimental respiratory and cardiovascular diseases, along with a host of other conditions, such as diabetes and dementia.

However, the finding that a broad metric such as mass concentration is linked with these health effects is surprising, because aerosol particles are extremely complex. For example, they range continuously in diameter from tens of nanometres to tens of micrometres2,4. Particle size governs where particles are deposited in the respiratory system and whether they are transported to other organs, which in turn can influence the adverse effect produced2,4. Moreover, myriad chemical compounds can be found in aerosols, and the amount of each constituent varies continuously as particles grow and age4,5. Given the vast complexity of the particles we inhale, is there a better metric than mass concentration that could provide more-detailed insight into, and correlates more strongly with, the ill effects of aerosols on people?

One area of research has focused on a physiological mechanism known as oxidative stress to explain many of the varied adverse health outcomes of aerosols6,7. The idea is that particles carry oxidants into the lung and/or — probably a much worse effect — that specific components of the aerosol catalytically generate oxidants in cells when deposited in the lung or transported to other regions of the body. The oxidant load in cells is normally controlled, but if it becomes too high, the resulting damage to cellular components leads to oxidative stress and produces an overall inflammatory response.

Chemical assays have therefore been developed to analyse either the oxidants on particles or the aerosol components that generate oxidants in vivo, thereby allowing the oxidative potential (OP) — the capacity of particles to induce oxidative stress — to be measured. An ideal OP assay would comprehensively account for all the compounds that produce oxidative stress8 and their possible inter-actions with each other. Current assays arguably do not do this because they are sensitive to a few specific compounds.

To address this problem, Daellenbach et al. used three assays: one that quantifies the amount of oxidants on particles and two that assess the possible in vivo response. The authors loosely refer to all three as measures of aerosol OP, but agreement on more-precise terminology is needed in this field to clarify the source of oxidants (whether they were delivered by aerosols or formed in cells from aerosol components), and to aid consistency in the reporting of future results.

The authors collected about 90 samples of PM10 — particulate matter with a diameter of 10 micrometres or less — at each of 9 sites in Switzerland and Liechtenstein, and assessed the OP of the samples using the three assays. The authors then developed an air-quality model that predicted OP throughout Europe by extrapolating the data from the nine measurement sites, assuming that these locations were representative of all of Europe. They finally combined the model data with population-density data to calculate and compare human exposure to aerosol mass and OP. No comparisons were made to actual health data.

Daellenbach and co-workers found that OP was closely linked to human activities. The main sources of OP included organic aerosols produced indirectly from combustion, for example by residential wood burning, and metals from vehicle non-exhaust-pipe emissions (such as those produced by the use of brakes). This link to human activities resulted in the formation of OP hotspots at certain places with high population densities (Fig. 1).

By contrast, the overall mass distribution of PM10 was found to be more spatially uniform, because it was dominated by wind-blown mineral dust, organic aerosols derived indirectly from vegetation emissions, and sources of inorganic species, such as sulfate, nitrate and ammonium salts. An earlier study9 of aerosol-mass concentration also found that these salts contributed widely to aerosol mass and linked them to agricultural emissions (ammonium nitrate, for example, is a widely used fertilizer), thus suggesting that agricultural emissions should be a focus of efforts aimed at lowering premature mortality from aerosols over Europe. However, Daellenbach and colleagues show that these inorganic salts have low OP, and therefore are less concerning for human health. Clearly, any policy for protecting people from aerosols will be very different depending on which particle property — mass concentration or OP — is used to develop it.

It should be noted that evidence supporting the use of OP assays as indicators of health risks is mixed. The results of some toxicology tests of aerosol components do indeed correlate with OP determined by specific assays, and Daellenbach and colleagues show that this is the case for one of their assays. Several epidemiological studies have also shown that OP determined by some assays is more closely linked to specific adverse respiratory and cardio-vascular effects than is aerosol mass, but other studies do not10.

Moreover, it is difficult to compare studies that examine the effects of aerosol-mass concentration on human health with those that look at the effects of OP, because large data sets are needed for robust comparisons, and these are available only for mass-concentration studies. Instead, human exposure to OP is often predicted using computational models derived from a limited set of measurements, increasing the uncertainty of the results11,12. This is also an unavoidable limitation of Daellenbach and colleagues’ study.

Periodic reviews of the scientific bases for aerosol health effects by the World Health Organization1 and the US Environmental Protection Agency2 have so far found little evidence for replacing aerosol-mass concentration with metrics that focus more on the composition or source of the aerosols. But aerosol data founded on plausible biological mechanisms should be a better guide for future research addressing aerosol links to adverse health. Furthermore, as regulations and emissions driven by climate change alter the ambient aerosol composition in many regions, the usefulness of a mass-concentration metric might diminish. It is therefore prudent to explore other aerosol metrics, as Daellenbach et al. have done. Greater evaluation is now needed to help connect these metrics to human health data, to assess their utility.

Nature 587, 369-370 (2020)

Potentially harmful aerosols concentrate in European urban centres
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Europe’s air quality can still be deadly despite progress, EEA says

Posted on November 24, 2020 by Respro® UK Ltd

Many European citizens are exposed to harmful and sometimes illegal levels of pollution despite progress to improve air quality in recent years, the European Environment Agency said in a report on Monday.

Air pollution poses the biggest environmental health risk in the European Union, where in 2018 about 379,000 premature deaths were linked to exposure to particulate matter, 54,000 to nitrogen dioxide (NO2) and 19,000 to ground-level ozone.

The EEA report said EU air quality improved in the 10 years to 2018, when premature deaths associated with particulate matter and NO2 were respectively 13% and 54% lower than in 2009.

“In most cases, people are indeed living in air quality that is much improved, and that meets the standards of the EU,” said EEA Executive Director Hans Bruyninckx.

Still, most EU citizens in urban areas are exposed to levels of some pollutants that exceed stricter World Health Organization (WHO) guidelines.

For example, 74% of the EU’s urban population is exposed to particulate matter levels exceeding WHO standards, against 4% above EU limits.

The EEA said policies have helped improve air quality by cleaning up power plants and industry – which emit particulate matter and NO2. Policies such as low-emissions zones in cities had addressed road transport, the biggest source of NO2.

The agriculture sector, which emits ammonia from fertilisers and livestock manure, has been slower to cut pollution.

The EU has already launched legal action against 18 countries for breaching air quality laws and last month took France to court for flouting its rules for more than a decade.

The EEA analysis confirmed that Europe’s air pollution plummeted in April 2020, notably in Italy and Spain, as lockdowns to contain the COVID-19 pandemic curbed polluting economic activity and slashed transport use.

Europe’s air quality can still be deadly despite progress, EEA says | Reuters
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MRI Reveals Air Pollution Impact on Dementia Risk in Women

Posted on November 20, 2020 by Respro® UK Ltd

Older women exposed to higher levels of air pollution can experience a 24-percent increase in Alzheimer’s risk.

High levels of air pollution can put women in their 70s and 80s at a higher risk for developing a brain shrinkage that has been linked to Alzheimer’s disease, based on findings from their brain MRI scans.

In a study published in the Nov. 18 Neurology, investigators from the University of Southern California in Los Angeles outlined results that support putting more stringent policies in place to control air pollution levels and exposure.

“Our findings have important public health implications, because not only did we find brain shrinkage in women exposed to higher levels of air pollution, we also found it in women exposed to air pollution levels lower than those the [Environmental Protection Agency] considers safe,” said group lead Diana Younan, Ph.D., USC senior research associate and Alzheimer’s Association Research Associate in a statement released by the American Academy of Neurology. “While more research is needed, federal efforts to tighten air pollution exposure standards in the future may help reduce the risk of Alzheimer’s disease in our older populations.”

In this study, the team set out to investigate whether fine particle air pollution – microscopic particles of chemicals, smoke, dust, or other pollutants suspended in the air – can cause structural changes in the brain, leading eventually to dementia or Alzheimer’s. These particles are smaller than 2.5 micrometers – 30 times smaller than the width of a human hair, the team said.

For their investigation, funded by the National Institute on Aging, the team enrolled 712 women with an average age of 78 who did not have dementia when the study began. All women underwent an MRI brain scan at the beginning of the study, as well as five years later. And, they all provided information about their health histories, race/ethnicity, education, employment, alcohol use, smoking, and physical activity.

By using residential addresses, the team was able to determine the average air pollution exposure for each participant for the three years prior to the first MRI scan. They, then, divided the study population into four equal groups based on their exposure ranges and compared those values to the average yearly exposure of up to 12 µg/m3 that the Environmental Protection Agency considers to be safe. The study group with the lowest exposure averaged 7-to-10 micrograms of fine particle pollution per cubic meter of air (µg/m3), and the highest group averaged 13-to-19 µg/m3.

At the five-year mark, the team applied a machine learning tool designed to identify patterns of brain shrinkage that are specific to an increased Alzheimer’s disease risk to their MRI scans and gave patients a score between 0 and 1 based on how similar their brain scans were to Alzheimer’s disease patterns. Higher scores indicated a patient had experienced more brain changes in areas that were vulnerable to the disease.

According to their analysis, women’s scores increased from 0.28 at the beginning of the study to 0.44 after five years. They also determined that for each 3 µg/m3 increase in air pollution exposure, patients experienced a 0.03 change. This finding indicated a greater extent of brain shrinking over the five years that was equivalent to a 24-percent increased Alzheimer’s disease risk. That increase remained constant, Younan pointed out, even after the team adjusted for age, education, employment, cardiovascular disease, high blood pressure, physical activity, and any other factors that could affect brain shrinkage.

Overall, Younan said, this study adds to the knowledge base around the effects of air pollution on the brain.

“Our study found that women in their 70s and 80s who were exposed to the higher levels of air pollution had an increased risk of brain changes linked to Alzheimer’s disease over five years,” she said. “Our research suggests these toxins may disrupt brain structure or connections in the brain’s nerve cell network, contributing to the progression toward the disease.”

The study did have limitations, she said. Investigators only examined the brains of older women, and they only assessed regional fine particle pollution. They were also unable to assess participants’ air pollution exposure during middle-age and young adulthood. Consequently, additional research is needed.

MRI Reveals Air Pollution Impact on Dementia Risk in Women | Diagnostic Imaging
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NASA model reveals how much COVID-related pollution levels deviated from the norm

Posted on November 18, 2020 by Respro® UK Ltd

Since the COVID-19 pandemic began, space- and ground-based observations have shown that Earth’s atmosphere has seen significant reductions in some air pollutants. However, scientists wanted to know how much of that decline can be attributed to changes in human activity during pandemic-related shutdowns, versus how much would have occurred in a pandemic-free 2020.

Using computer models to generate a COVID-free 2020 for comparison, NASA researchers found that since February, pandemic restrictions have reduced global nitrogen dioxide concentrations by nearly 20%. The results were presented at the 2020 International Conference for High Performance Computing, Networking, Storage, and Analysis.

Nitrogen dioxide is an air pollutant that is primarily produced by the combustion of fossil fuels used by industry and transportation — both of which were significantly reduced during the height of the pandemic to prevent the novel coronavirus from spreading.

“We all knew the lockdowns were going to have an impact on air quality,” said lead author Christoph Keller with Universities Space Research Association (USRA) at NASA’s Goddard Space Flight Center in Greenbelt, Maryland. Keller works in Goddard’s Global Modeling and Assimilation Office (GMAO), which uses high-tech computer models to help track the chemistry of the ocean and the atmosphere, and forecast future climate scenarios. He says, “it was also soon clear that it was going to be difficult to quantify how much of that change is related to the lockdown measures, versus general seasonality or variability in pollution.”

No two years are exactly alike. Normal variations in weather and atmospheric circulation change the make-up and chemistry of Earth’s atmosphere. Comparing 2020 nitrogen dioxide concentrations with data from 2019 or 2018 alone would not account for year-to-year differences. But, because the NASA model projections account for these natural variations, scientists can use them to parse how much of the 2020 atmospheric composition change was caused by the COVID-19 containment measures.

Even with models, there was no predicting the sudden, drastic shifts in human behavior as the novel coronavirus — and the regulations attempting to control it — spread rapidly. Instead of trying to re-program their model with this unexpected event, Keller and his colleagues accounted for COVID-19 by having the model ignore the pandemic altogether.

The model simulation and machine learning analysis took place at the NASA Center for Climate Simulation. Its “business as usual” scenario showed an alternate reality version of 2020 — one that did not experience any unexpected changes in human behavior brought on by the pandemic.

From there it is simple subtraction. The difference between the model simulated values and the measured ground observations represents the change in emissions due to the pandemic response. The researchers received data from 46 countries — a total of 5,756 observation sites on the ground — relaying hourly atmospheric composition measurements in near-real time. On a city-level, 50 of the 61 analyzed cities show nitrogen dioxide reductions between 20-50%.

“In some ways I was surprised by how much it dropped,” said Keller. “Many countries have already done a very good job in lowering their nitrogen dioxide concentrations over the last decades due to clean air regulations, but what our results clearly show is that there is still asignificant human behavior-driven contribution.”

Wuhan, China was the first municipality reporting an outbreak of COVID-19. It was also the first to show reduced nitrogen dioxide emissions — 60% lower than simulated values expected. A 60% decrease in Milan and a 45% decrease in New York followed shortly, as their local restrictions went into effect.

“You could, at times, even see the decrease in nitrogen dioxide before the official policies went into place,” said co-author Emma Knowland with USRA at Goddard’s GMAO. “People were probably reducing their transit because the talk of the COVID-19 threat was already happening before we were actually told to shut down.” Once restrictions were eased, the decreases in nitrogen dioxide lessened, but remained below expected “business as usual” values.

Keller compared his estimates of the nitrogen dioxide decreases to reported economic numbers, namely, the gross domestic products, of the nations included in the study. According to Keller, they lined up shockingly well. “We would expect them to be somewhat related because nitrogen dioxide is so closely linked to economic activities, like people who travel and factories running,” he said. “It looks like our data captures this very well.”

The research is ongoing, and the GEOS model data used in this study are publicly available.

More information about GEOS can be found at: https://gmao.gsfc.nasa.gov/GEOS/

via NASA model reveals how much COVID-related pollution levels deviated from the norm — ScienceDaily
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Delhi AQI: This is how bad Delhi pollution was on Diwali night

Posted on November 16, 2020 by Respro® UK Ltd

With an hourly PM 2.5 concentration of 1,970 micrograms per cubic metre at 1am on the night after Diwali, the pollution readings at Vivek Vihar — a busy residential area in east Delhi — touched 33 times the safe standard, the highest in the national capital after the cracker ban across NCR was widely flouted.

The safe standard for PM 2.5 concentration is 60 micrograms per cubic metre. Mundka in west Delhi followed close behind with the hourly PM 2.5 concentration touching 1,853 micrograms per cubic metre, while Rohini in north Delhi, another bustling residential area, recorded an hourly PM 2.5 concentration of 1,798 micrograms per cubic metre, Delhi Pollution Control Committee (DPCC) data showed.

In contrast residential areas around Aurobindo Marg may have stuck more closely to the ban, with hourly readings touching a high of just 668 micrograms per cubic metre there. Similar low readings were recorded at Najafgarth (631 micrograms)., Dwarka Sector 8 (889 micrograms) and Pusa (758 micrograms), indicating some compliance in terms of the firecracker ban. All stations recorded PM2.5 readings over 10 times the safe standard on Diwali day, DPCC data shows.

Continue reading:
Delhi AQI: This is how bad Delhi pollution was on Diwali night | Delhi News – Times of India

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Exposure to air pollution during fetal period, early life linked with higher blood pressure

Posted on November 13, 2020 by Respro® UK Ltd

Exposure to an urban environment characterized by high levels of air pollution and noise in areas with a high building density during the fetal period and in early childhood may contribute to higher blood pressure. This was the conclusion of a study led by the Barcelona Institute for Global Health (ISGlobal) published in Environment International. ISGlobal is an institution supported by the “la Caixa” Foundation.

To study the impact of urban exposures on the cardiovascular health of children, the research team analyzed data from 4,279 children living in six European cities (Bradford in the United Kingdom, Poitiers and Nancy in France, Sabadell and Valencia in Spain, and Heraklion in Greece). All the children were participants in the European HELIX project.

The team assessed multiple aspects of the children’s environment: initially, during the prenatal period, the place of residence of the mothers during their pregnancy, and subsequently the homes of the children themselves. Factors studied included the built environment, natural spaces, traffic, air pollution, noise, climate and level of social and economic privation. Assessing the children’s blood pressure when they were between four and five years of age allowed them to study the long-term effect of the exposures analyzed.

Analysis of the results showed that exposure to higher levels of air pollution, particularly during the first two terms of pregnancy, was associated with higher blood pressure in childhood. Specifically, a 9.1 μg/m3 increase in NO2 was associated with a 0.9 mmHg increase in diastolic blood pressure. (A healthy diastolic blood pressure in children is around 50-80 mmHg) The limit value established by the World Health Organisation to protect the population from the damaging effects of NO2 is 40 μg/m3, a threshold exceeded on a regular basis in cities like Barcelona and Madrid.

Furthermore, other characteristics of the urban environment during childhood also appear to be important. High building density is associated with higher blood pressure and good urban transport connectivity is linked to lower blood pressure.

“It is possible that these associations reflect how people move around in the city and may indicate that greater connectivity promotes physical activity in the population.” Charline Warembourg, ISGlobal researcher, first author of the study

Exposure to noise also appears to be associated with higher blood pressure in children.

Based on their analysis of the results, the authors concluded that one in every five children lives in an urban environment characterised by levels of air pollution, noise, and building density that are associated with blood pressure values higher than those observed in children not exposed to these environmental factors.

The role of urbanization in cardiovascular disease

High blood pressure is one of the chief risk factors for cardiovascular disease, a condition which is currently the leading cause of death worldwide. “Numerous studies have shown that children with higher blood pressure are more likely to develop hypertension later in life,” says Martine Vrijheid, study leader and director of ISGlobal’s Childhood and Environment Programme. “The results of this study show how important it is to identify environmental exposures that contribute to hypertension in early life, from conception onwards.”

Given the increasing urbanization of the world’s population, the role that urban design and transport plays in health is a topic of growing concern. This study assessed, for the first time, the effects on the cardiovascular health of children of numerous exposures associated with the urban environment. “Our results show that, from conception onwards, the urban environment can affect blood pressure in preschool children” Warembourg points out. “This means that a commitment to urban design and transport planning designed to reduce damaging environmental exposures has the potential to reduce the risk of cardiovascular disease in adulthood”.

Exposure to air pollution during fetal period, early life linked with higher blood pressure
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