Swiss Re Ag · SIX:SREN
Swiss Re — Investor Presentation (October 2014)
44 slides from Swiss Re's investor presentation, Oct 15, 2014
Slide 1: Health Risk – Air Pollution
Health Risk – Air Pollution Health Risk Factors in Rapidly Changing Economies Swiss Re Centre for Global Dialogue October 15, 2014 Douglas W. Dockery Loeb Professor of Environmental Epidemiology Chair, Department of Environmental Health Harvard School of Public Health 1
Slide 2: ‘Airpocalypse’ Hits Harbin, Closing Schools
‘Airpocalypse’ Hits Harbin, Closing Schools October 21, 2013 School was canceled, traffic was nearly paralyzed and the airport was shut down in the northeast Chinese city of Harbin on Monday as off-the-charts pollution dropped visibility to less than 10 meters in parts of the provincial capital. A d
Slide 3: Choking smog returned to blanket Beijing and surrounding areas
Choking smog returned to blanket Beijing and surrounding areas yesterday, four days after a dangerous smog alert was lifted. Meteorologists said pollution levels were likely to remain high until after the National Day "golden week" ends tomorrow - and the traffic crush as people returned from holida
Slide 4: WHO Ambient air pollution in cities database 2014
World Health Organization Public health, environmental and social determinants of health (PHE) Ambient (outdoor) air pollution in cities database 2014 The database contains results of ambient (outdoor) air pollution monitoring from almost 1600 cities in 91 countries. Air quality is represented by an
Slide 5: Delhi pollution comparable to Beijing
India's state air monitoring centre has admitted that pollution in Delhi is comparable to that of Beijing, but disputed a World Health Organisation (WHO) finding that the Indian capital had the dirtiest atmosphere in the world. A study of 1,600 cities across 91 countries released on Wednesday by the
Slide 6: What is Fine Particulate Air Pollution (PM2.5)?
What is Fine Particulate Air Pollution (PM2.5)? Anything collected on a filter Solid particles or liquid droplets Not gases
Slide 7: Global Satellite-Derived PM2.5: 2001–2006 Average
Global Satellite-Derived PM2.5: 2001–2006 Average 7 Von Donkelaar et al Envir Hlth Pers 2010;118:847
Slide 8: WHO Tabulation of PM2.5: 2012 Means by Country
WHO Tabulation of PM2.5 2012 Means by Country India China Mexico Brazil Switzerland United Kingdom United States 0 10 20 30 40 50 60 Annual Mean PM2.5 (mg/m3) http://www.who.int/phe/health_topics/outdoorair/databases/cities/en/
Slide 9: WHO Tabulation of PM2.5: 2012 Means – Cities
WHO Tabulation of PM2.5 2012 Means – Cities Delhi Beijing Rio de Janeiro Mexico City Zurich 0 25 50 75 100 125 150 Annual Mean PM2.5 (mg/m3) http://www.who.int/phe/health_topics/outdoorair/databases/cities/en/
Slide 10: Beijing still struggling to deal with traffic congestion
Beijing still struggling to deal with traffic congestion. South China Morning Post Nov 10, 2013 10
Slide 11: Coal and cars combine to increase pollution in North
Coal and cars combine to increase pollution in North By Wang Qian 2010-12-08 11
Slide 12: Household Air Pollution - a Major Avoidable Risk Factor for Cardiorespiratory Disease
Household Air Pollution - a Major Avoidable Risk Factor for Cardiorespiratory Disease An Ethiopian An Indian woman woman trying to ignite dried preparing to dung in a brick stove cook over a three-stone fire in a wooden outbuilding A Peruvian mother holding A Malawian woman a young child cooking ove
Slide 13: Cooking with Solid Fuels
Cooking with Solid Fuels Biomass and Coal 13
Slide 14: Comparative Risk Assessment
Comparative Risk Assessment Global Burden of Disease Study 2010 14
Slide 15: Burden of disease attributable to leading risk factors in 2010
Burden of disease attributable to 20 leading risk factors in 2010 3.5 million deaths, 108 Million DALY 3.2 million deaths, 76 Million DALY 15 The Lancet, 2012; 380(9859): 2224 - 2260
Slide 16: Burden of Disease: India, China, Brazil, and Mexico
Burden of Disease: India, China, Brazil, and Mexico 16
Slide 17: Courtesy of Mike Brauer
PM2.5 (ug/m3) \ j ]o-1 5-10 RR 20-40 RM 20+ , ~ # ] 1-2 J) 10-15 I 40-60 Estimated (PM10)f9 : re curt § Mike B " PA $ *’ Courtesy of Mike Brauer 2-5 | 15-20 J co-80 @ Measured ¥ - ¥ y
Slide 18: Burden of disease attributable to risk factors: China
Burden of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of China DALYs China http://www.healthmetricsandevaluation.org/gbd/country-profiles 18
Slide 19: Courtesy of Mike Brauer
& PM2.5 al ’ o-1 5-10 JM 20-40 j 20+ : y 1-2 [)) 10-15 I 40-60 Estimated (PM10) ne = Courtesy of Mike Brauer 2-5 [I] 15-20 NM) 60-20 @ Measured mers :
Slide 20: Burden of disease attributable to risk factors: India
Burden of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of India DALYs India http://www.healthmetricsandevaluation.org/gbd/country-profiles 20
Slide 21: Courtesy of Mike Brauer
21 Courtesy of Mike Brauer
Slide 22: Burden of disease attributable to risk factors: Mexico
Burden of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of Mexico DALYs Mexico http://www.healthmetricsandevaluation.org/gbd/country-profiles 22
Slide 23: Courtesy of Mike Brauer
Courtesy of Mike Brauer 2-8 [I 15-20 MM coco @ Measured
Slide 24: Burden of disease attributable to risk factors: Brazil
Burden of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of Brazil DALYs Brazil http://www.healthmetricsandevaluation.org/gbd/country-profiles 24
Slide 25: How do they estimate these numbers?
How do they estimate these numbers? Dose – Response Exposure Population statistics 25
Slide 26: Six Cities Adult Mortality Study
Six Cities Adult Mortality Study 8111 adults in 6 cities Dirty: Steubenville & St. Louis Moderate: Watertown & Kinston/Harriman Clean: Topeka & Portage Enrolled starting in 1974 14-16 years of mortality follow-up Dockery et al, NEJM 1993;329:1753
Slide 27: Follow-up
Follow-up HARVARD LUNG STUDY IS THE LABEL BELOW CORRECT? CYES BNO ‘IF NO, PLEASE MAKE CORRECTIONS. Home phone # Has the person named below died? wo a Yosp Date of Death es ieee <a 7 §- . i Lake Hitis FR - L = This card was completed by: a named above O Spouse Ci Other Relative orFriend ©) Other Hand
Slide 28: Follow-up
Follow-up Rue secs + a IF NO, PLEASE MAKE CORRECTIONS. ~ HARVARDLUNGSTUDY RES !5 IS THELABEL BELOW GORRECT? [YES [NO ——— —— sai wate TART ge it yes, specify Has the person named below died? [JNo 3Yes Date of Death > City/State of Death [ - 9042-5 Or a ” STEUBENVILLE® CH 43952 This card was completec
Slide 29: Mortality Risk Ratio
Delhi (153 ug/m3) Six Cities Adult Mortality Beijing (56 ug/m3) 1.4 EPA NAAQS 1.3 Steubenville Kingston Mortality Risk Ratio 1.2 Zurich St. Louis (14 ug/m3) 1.1 Topeka Watertown 1.0 Portage 0.9 0.8 0.7 0 10 20 30 40 PM 2.5 (mg/m3)
Slide 30: Comprehensive Dose-Response
Comprehensive Dose-Response 30 Pope et al, Circulation. 2009;120:941-948
Slide 31: Comprehensive Dose-Response
Comprehensive Dose-Response 31 Pope et al, Circulation. 2009;120:941-948
Slide 32: Comprehensive Dose-Response
Comprehensive Dose-Response 32 Pope et al, Circulation. 2009;120:941-948
Slide 33: What does this mean for the individual?
What does this mean for the individual? What is effect of life expectancy? 33
Slide 34: Survival curves 18-100 years and estimated life expectancy
Survival curves 18-100 years and estimated life expectancy (LE) for alternative excess risk assumptions Survival Life Curve Expectancy Never Smoker Never-Smoker 80.6 LE years 80.6 years Moderate Smoker LE yr 7.8 72.8 yearsLE reduced Living Polluted City LEyr 3.1 77.5 years reduced LE 34
Slide 35: Years Reduced Life Expectancy
Estimated Years reduced life expectancy - exposures to cigarette smoke and fine particle air pollution 14 Personal Smoking Second Hand Fine Particle Years Reduced Life Expectancy 12 Smoking Air Pollution 10 8 6 4 2 0 35
Slide 36: WHO Tabulation of PM2.5: 2012 Means – Cities
WHO Tabulation of PM2.5 2012 Means – Cities Delhi Beijing Rio de Janeiro Mexico City Zurich 0 25 50 75 100 125 150 Annual Mean PM2.5 (mg/m3) http://www.who.int/phe/health_topics/outdoorair/databases/cities/en/
Slide 37: Years Reduced Life Expectancy - Lifetime Exposure
Years Reduced Life Expectancy - Lifetime Exposure 9 Cigarette Smoking Fine Particle Air Pollution* 8 Years Reduced Life 7 Expectancy 6 5 4 3 2 1 0 * Compared to Zurich 37
Slide 38: Incremental Risk
Incremental Risk Estimate of effect of each year of exposure Effect of potential changes in exposures or behaviors. Comparative risk for a worker or student who temporarily moves to such an environment. Consider 50-year old non-smoker who spends one year in mild, moderate, and high PM2.5 air
Slide 39: Estimated days of reduced life expectancy per year of exposure
Estimated days of reduced life expectancy 1 year exposures to cigarette smoke and fine particle air pollution 50 years of age 80 Cigarette Smoking Fine Particle Air Pollution* 70 Days Reduced Life 60 Expectancy 50 40 30 20 10 0 * Compared to 15 ug/m3 39
Slide 40: Estimated days of reduced life expectancy per year of exposure
Estimated days of reduced life expectancy 1 year exposures to cigarette smoke and fine particle air pollution 50 years of age 80 70 Cigarette Smoking Fine Particle Air Pollution* Days Reduced Life 60 Expectancy 50 40 30 20 10 0 * Compared to Zurich 40
Slide 41: Effect of Age of living in Delhi?
Effect of Age of living in Delhi? Baseline risk goes up with age Impact of each year of exposure to high pollution increases with age 35 yrs – 29 days reduced LE 50 yrs – 67 days reduced LE 65 yrs – 116 days reduced LE 41
Slide 42: What does this mean for the individual?
What does this mean for the individual? Not suggesting that their life is measurably shortened. Rather these estimates reflect the increase probability of death in each year. How would they die? Acute events such as myocardial infarction, stroke, asthma attack, or traffic accident. Assume
Slide 43: Summary
Summary Each year of living in highly polluted city (e.g. Delhi) reduces expected average life expectancy by 30 to 120 days compared to living in cleaner city (e.g. Zurich) Comparable to effects of being moderate smoker Over a lifetime, this amounts to up about 7 years lost life expectancy 43
Slide 44: Basic Copyright Notice & Disclaimer
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