Air Pollution and the Inland Port

Thousands of studies have established that air pollution is a broad-based health hazard, provoking a long list of diseases very similar in type and scope to those related to smoking cigarettes, including shortened life expectancy, and premature death.   Furthermore, there is no safe level of pollution.  The more pollution, the greater the adverse health outcomes, although the relationship between air pollution and mortality is hyperbolic as demonstrated by the graph below.1  It shows that there is no safe level of pollution, and that per unit of exposure, and the relationship between premature death and air pollution is even stronger at low doses.

From any baseline, any increase in air pollution will have public health consequences.  But increases from a baseline of low levels of air pollution actually have greater public health danger than the same increases from more polluted baselines.

While what has been revealed about the inland port is still vague, it has become increasingly clear that there is no scenario under which a port would not be a significant new source of air pollution for the Salt Lake Valley and other areas of the Wasatch Front.  Even if some of the port located loading machinery (switchers) is electrified, a robust, “successful” port would increase pollution from three types of mobile sources carrying various commodities--diesel powered trucks, train locomotives, and air cargo. 

There are two common denominators for most of the health consequences of air pollution.  The first is the provocation of an inflammatory response that affects the lungs and the vascular system and, downstream, all major organs including the placenta of a pregnant mother.  Both  of the high volume pollutants, ozone and particulate pollution, precipitate inflammation.  This is the presumed biological reason why air pollution exposure accelerates the aging process.  More specifically, premature death is triggered through multiple mechanisms--heart disease (heart attacks, abnormal heart rhythms, impaired heart mechanics and aggravation of heart failure), strokes, lung disease (pneumonia, asthma, respiratory failure), and cancer.  A landmark study published this year showed that extremely small increases in ozone over ten years were associated with emphysematous loss of lung tissue and function equivalent to nearly three decades of a full pack a day smoking habit.

The second common denominator is the literal invasion of human tissue by pollution particles themselves which is both another source of inflammation, as well as a means by which attached toxic chemicals gain access to the intracellular matrix.  Particle invasion of nearly all critical organs has now been documented, prompting researchers to state that pollution is “potentially affecting every organ in the body,” which allows a pathway to “cause, complicate, or exacerbate” many diseases and poor health outcomes.2

Air pollution’s effect on the lungs is intuitive for the public, probably because it is the primary source of overt pollution related symptoms.  Both particulate pollution and ozone have been shown repeatedly to increase the risk and severity of virtually every type of lung disease, from mild reactive airway disease to fatal pulmonary fibrosis, from infancy to the geriatric population.  Indeed, air pollution significantly increases the incidence of infant mortality primarily by increasing the rate of serious respiratory diseases.  

Air pollution is toxic to the brain throughout the entire age spectrum, from the brain development stage of intrauterine life to the elderly.  It permanently impairs early brain development, including altering brain architecture and reducing the size of specific brain structures like the corpus callosum, hippocampus, and left hemispheric white matter. The clinical result is reduced memory, cognitive function and learning ability acutely and chronically from school children to the elderly.  Air pollution is responsible for about 20% of the growing epidemic of Alzheimer’s dementia.  It is also highly associated with every type of mental illness--depression, behavioral and attention deficit disorders, and even schizophrenia, and hospitalization for mental illness. It is even associated with increased rates of violence, crime, unethical behavior, and decreased stock market returns by stock traders.

Air pollution damages epigenetic function and impairs fetal development, causing birth defects, miscarriages, still births and higher rates of infant deaths.  Furthermore, air pollution provokes just about every other type of pregnancy/fetal development complication that can translate into life long impacts on adult health--low birth weight, premature birth, pre-eclampsia, premature rupture of membranes, placenta previa and accreta, and uterine inflammation.   

The World Health Organization has declared air pollution the most important environmental cause of cancer, especially for increasing the risk of lung and bladder cancer.  However, just about every other type of cancer has been shown to occur at increased rates among populations exposed to more air pollution.    Other studies show that cancer survival is also decreased among patients exposed to more air pollution.

The wide range of human morbidity from air pollution includes increased risk of multiple types of infections, liver and kidney diseases, inflammatory bowel disease, poor cholesterol profile, auto-immune disorders, metabolic diseases like hypothyroidism, juvenile and type II diabetes, osteoporosis, and arthritis.

Perhaps the greatest impact of air pollution on public health is the damage it can do to chromosomal function which can be passed on to future generations.  At least three generations can be harmed even when only one generation is exposed. Even modest levels of air pollution can impair the chromosomes of germ cells of future parents, negatively affecting the health of future generations from exposures long before conception.  Air pollution also reduces fertility rates by causing damage to sperm, eggs, even decreasing success rates of in vitro fertilization. 

While port related pollution will extend throughout the Wasatch Front, there is also little doubt that the NorthWest Quadrant will become a new pollution hotspot.  Nearby neighborhoods will bear the brunt of the health consequences from the port and could be characterized as  
“sacrifice zones.”   

Other inland ports in other cities have been burdened by the pollution from hundreds to thousands of new semi trucks, and dozens of additional fully loaded trains every day.  At the Port of Los Angeles, locomotive diesel engines operating within the port were responsible for as much pollution as 480,000 cars,3,4 (about half the cars registered in Utah) and were found to increase the risk of cancer for nearby residents.5    

A recent, highly cited study indicates that long term exposure to even low levels of diesel exhaust raises the risk of dying from lung cancer about 50% for residents who live near industrial operations, and about 300% for the workers.7,8 

In response to these studies, Joseph Fraumeni Jr., Director of the National Cancer Institute's Division of Cancer Epidemiology and Genetics, stated, “The findings suggest that the risks may extend to other workers exposed to diesel exhaust and to people living in urban areas where diesel exhaust levels are elevated.”

Increased large truck traffic will add to existing congestion on Salt Lake Valley freeways, which will further increase traffic emissions of pollutants and greenhouse gases from non-port vehicles on the freeway network.9

A recent study of the Los Angeles airport has also shown that emissions from aviation traffic  are much larger than previously estimated, doubling particulate pollution downwind as far out as ten miles, and increasing levels four to five times above baseline, as far out as 5-6 miles.  The study estimated that the city’s airport was responsible for as half as much pollution as all the vehicles on the city’s freeway network.6  This lends evidence to the expectation that air cargo related to an inland port will also be a significant new source of pollution.  

Details of all the medical consequences of air pollution and their scientific basis are far beyond the scope of this summary.  However, attached as an appendix is a summary of the information from nearly 1,350 studies. 

1.  Peters, A. Air Quality and Cardiovascular Health: Smoke and Pollution Matter. Circulation. 2009: 120:924-927

2.  Schraufnagel D, et al.  Air Pollution and Noncommunicable Diseases.  Chest.  February 2019Volume 155, Issue 2, Pages 409–416

3.  Port of Los Angeles, Final Draft: Port-Wide Baseline Air Emissions Inventory: Executive Summary; June 2004.
 
4.  48 US DOT Federal Highway Association, State Motor Vehicle Registrations 2004. Available at: http://www.fhwa.dot.gov/ policy/ohim/hs04/htm/mv1.htm

5.  California Air Resources Board, “Diesel Particulate Matter Exposure Assessment Study for the Ports of Los Angeles and Long Beach,” Final Report; April 2006.

6.  Hudda N, et al.  Emissions from an International Airport Increase Particle Number Concentrations 4-fold at 10 km Downwind.  Environ. Sci. Technol., 2014, 48 (12), pp 6628–6635.  DOI: 10.1021/es5001566

7.  Silverman DT, Samanic CM, Lubin JH, et al. The diesel exhaust in miners study: a nested case- control study of lung cancer and diesel exhaust. J Natl Cancer Inst. March 2, 2012. doi:10.1093/jnci/ djs034.

8.  Attfield MD, Schlieff PL, Lubin JH, et al. The diesel exhaust in miners study: a cohort mortality study with emphasis on lung cancer. J Natl Cancer Inst. March 2, 2012. doi:10.1093/jnci/djs035.

9.  Zhang K,  Batterman S, Dion F.  Vehicle emissions in congestion: Comparison of work zone, rush hour and free-flow conditions.  Atmospheric Environment 45 (2011) 1929e1939

Appendix
The Health Consequences of Air Pollution 
prepared by Utah Physicians for a Healthy Environment 

Updated Dec. 29, 2019

Pollution and the Cardiovascular System

*The signature physiologic consequence of air pollution is the same as cigarette smoke: a low grade arterial inflammation, arteriolar narrowing, and vascular prothrombotic changes.   Chemical markers of these changes are found even in young healthy adults.  As with cigarette smoke the effect can be almost immediate and chronic exposure to even low concentrations of pollution are associated with an acceleration of atherosclerosis and significant arteriolar narrowing and stiffness. Breathing more ozone in childhood increases arterial wall thickness in young adults. 
*Simultaneously high concentrations of multiple pollutants have a synergistic effect on hospitalizations for cardiac disease. 
*Air pollution causes average blood pressure to increase within minutes. All organs are affected. Blood pressure rises are found in even in children and from prenatal exposure.
*Air pollution can alter electrical signaling within the heart, starting as early as infancy. Rates of arrhythmias, heart attacks and strokes increase with air pollution and are the primary cause for increased community mortality rates. Those rates increase within hours after exposure and stay elevated for as long as 30 days after the exposure has ended. 
*In patients who suffer from heart failure, air pollution reduces cardiac function.  Even in patients without known heart disease, air pollution increases the size of heart chambers, indicative of impaired function, a precursor of heart failure.
*Particulate pollution concentrations typical of the Wasatch Front increase mortality rates about 10% according to the formula recommended by the American Heart Association published in May, 2010.  Ozone causes further increase in mortality, although less than particle matter.  That means between 1,000 and 2,000 Utahns die prematurely every year due to our air pollution.   Approximately 210,000 premature deaths occur annually in the US from combustion emissions.   The average pollution related premature death represents about ten years of lost life.
*Particulate pollution from coal and diesel combustion are likely much more potent in triggering heart and vascular disease than most other sources.
*Mortality plotted against air pollution concentrations shows no safe threshold, even at low levels, well below EPA national ambient air quality standards (NAAQS). Furthermore this curve is not linear. The steepest part of the curve is at low doses, i.e. small air pollution reductions have even greater public health benefit when the concentrations are already low.   Even at what are considered ‘background’ levels of particulate pollution there are increased risks for cardiopulmonary mortality compared to clean, filtered air.  Nearly all the mortality caused by air pollution occurs in cities and towns that meet the EPA’s national air quality standards.
*Air pollution impairs exercise capability, even in the very fittest of individuals. Even in young, healthy adults air pollution increases biomarkers of inflammation and thrombosis and increases blood pressure and heart rate.   Air pollution offsets the cardiorespiratory benefits of exe
*Air pollution shortens life expectancy and accelerates the aging process. The residents of the average American city lose 1-3 years of life expectancy, in Northern China residents lose 5.5 years. 
*The increase in mortality risk persists for decades after exposure.
*There are very likely genetic differences in human susceptibility to the arterial inflammation provoked by air pollution.  Furthermore, the progression of inflammation and cardiovascular changes are more pronounced in those who are already at higher risk. 
*Inhaled nanoparticles preferentially lodge in the lining of blood vessels where inflammation and atherosclerosis already exist, and they can remain there for months, and perhaps much longer.  Particle pollution also lodges in heart tissue, in astonishing amounts--billions of particles per gram of heart tissue.
*Air pollution alters the blood lipid profile, decreasing HDL levels.  
*Black Americans suffer greater cardiovascular impacts from air pollution than caucasians. 
*Radioactive isotopes attached to particulate pollution carry additional cardiovascular risks.          
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Pollution and the Brain

* The systemic inflammation caused by air pollution also affects the brain 
* Air pollution components, including toxic, metallic nanoparticles, reach the brain and can penetrate deeply into the parenchyma. 
* Many of the compounds adsorbed to particulate matter are neurotoxic. 
*  Air pollution causes CNS oxidative stress, neuroinflammation, neuronal damage, neuronal loss, loss of brain mass in key areas that control memory, cortical stress measured by EEG, enhancement of Alzheimer type-abnormal filamentous proteins (beta amyloid and phosphorylated tau), BBB and microglial (immune system) changes, and cerebrovascular damage. Many of these changes can be found in infants, children and young adults.
* Air pollution exposure is associated with almost the full range of clinical neurologic disorders throughout the age spectrum, including lower intelligence, diminished motor function, attention deficit and behavioral problems, decreased cognition and accelerated dementia in adults, delinquent behavior in adolescents, higher rates of violent crime, higher rates of strokes, ALS, relapses in multiple sclerosis, autism, impaired olfactory sense, Parkinson's, and other neurodegenerative diseases, depression, anxiety, substance abuse, schizophrenia and suicide.  Air pollution is even associated with decreased stock market returns by reducing mood and trading activity of stock traders.
* Acute air pollution exposure on the way to school affects students’ attention span during the ensuing school day.
* Prenatal exposure to air pollution is particularly harmful to brain development, even causing loss of white matter involving the left hemisphere, corpus callous and hippocampus, which results in impaired memory, cognition and behavioral disorders in childhood.  

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Pollution and Chromosomal Function/Fetal Development/Fertility 

*Babies are essentially born pre-polluted by the air breathed by the mother during pregnancy. Particulate matter and the chemicals attached to them can cross the placenta and interfere with fetal development 
* Pregnant women exposed to more air pollution give birth to babies with significantly more chromosomal aberrations including shorter telomeres and epigenetic changes which can be passed on to multiple subsequent generations. 
* Exposure even to brief episodes of pollution at critical stages in the development of the human embryo can cause a person to experience an increased likelihood of multiple chronic diseases including those of the heart, lungs, immune system and brain and even obesity, diabetes, cancer and shortened life expectancy. 
* Air pollution breathed by a pregnant mother causes epigenetic changes in the womb, which is associated with higher rates of lung and heart disease in animals and humans in childhood as an adult.
* Pollution impairs virtually every component of human reproduction—causing sperm DNA damage, increase in the rates of male infertility,  decreases fertilization, menstruation, and increases miscarriages and other adverse reproductive outcomes. 
* Children living near petrochemical industries are exposed to high PAH levels, contributing to DNA damage. Industrial pollution is even more genotoxic than traffic pollution.
*Regarding birth weights and poor neurologic outcomes, males are generally more affected by prenatal air pollution than females. 
*Even preconception pollution exposure of the mother increases the risk of congenital malformations ###########################################################################

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Current Opinion in Pediatrics: April 2009 - Volume 21 - Issue 2 - p 243-251 doi: 10.1097/MOP.0b013e32832925cc Therapeutics and toxicology: Edited by Robert O. Wright Epigenetics and environmental chemicals Baccarelli, Andrea; Bollati, Valentina 
http://www.newsweek.com/2010/10/30/how-your-experiences-change-your-sperm-and- 
eggs.html 

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Pollution and the Lung 

* Air pollution permanently inhibits lung growth in children.  In fact prenatal exposure can reduce fetal lung development, impairing lung function in childhood and permanently reducing the number of alveoli (air sacs) in the lungs.
* Brief exposure to ozone and particulate matter reduce lung function even in young healthy adults and the reduction can last for a week after the pollution exposure is over. 
* Air pollution causes lung cancer. 
* Long term ozone exposure causes an increase in overall mortality in addition to that from particulate matter. Most of the mortality is respiratory. 
*Long term exposure to even small increases in ozone cause as much emphysematous destruction of lung tissue and function as 29 years of cigarette smoking a pack a day
* Air pollution causes, complicates, or exacerbates virtually all pulmonary diseases, from mild reactive airways disease to fatal pulmonary fibrosis.
* Air pollution is associated with increased rates of serious lower respiratory infections, and hospitalization and death from most respiratory diseases from neonates to the elderly. 
* The correlation between the above health outcomes and ozone are still found at concentrations between one half and one third the current EPA NAAQS. 
*Air pollution causes DNA damage and cell death to lung cells.
                      
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Pollution and Birth Outcomes 

*Air pollution causes morphologic changes in the placenta, narrowing blood vessels, and inhibiting blood transfer to the fetus.   Pollution nanoparticles can be found embedded in the placenta itself.
*Pregnant women exposed to more air pollution have multiple clinical adverse pregnancy outcomes including: higher blood pressure, higher rates of pre-eclampsia, intrauterine growth retardation, miscarriages, still births, higher rates of gestational diabetes, premature birth, premature rupture of membranes (PROM), low birth weight syndrome, neonates with smaller head circumference, and heart and spinal cord birth defects.
*Intrauterine inflammation, a significant risk factor for premature birth, is increased with air pollution exposure during pregnancy and even prior to conception.
*Hourly increases in air pollution at the beginning of labor is associated with higher rates of premature birth.
*Both acute and chronic ozone exposure is related to increased rates of still births,  even exposure just in the several days prior to delivery.
*Folate supplements can offset the negative impact of air pollution on the success of assisted reproduction.
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Air Pollution and Cancer

     *Air pollution is associated with higher rates of breast, lung, prostate, cervical, brain, nasal, pharyngeal, liver, pancreatic and stomach cancer, and childhood leukemia. Pre-natal pollution exposure is associated with increased rates of multiple childhood cancers. 
*World health experts now believe that nearly 30% of lung cancer is due to air pollution
*Air pollution is associated with decreased survival in patients will all types of cancer, especially breast cancer.
*The World Health Organization has declared air pollution the most important environmental cause of cancer, more important that second hand cigarette smoke. The WHO placed it in the same category as asbestos and ionizing radiation            
 
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Air Pollution and Metabolic Disorders

* More exposure to air pollution, even short term, decreases insulin sensitivity, glucose tolerance, increases rates of Type I and Type II diabetes, and promotes obesity and metabolic syndrome.
*Prenatal exposure has a particularly strong association with childhood obesity. 
*Lipid metabolism is impaired, good cholesterol (HDL) is decreased, and bad cholesterol (LDL) is increased with more air pollution.
*Air pollution impairs thyroid function in pregnant mothers, thyroid development in the fetus.  and thyroid function newborns.  Impaired thyroid function is a likely mechanism for air pollution causing low birth weight and can impair fetal brain development
*Diesel exhaust impairs liver function

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71.  Kim JS, et al.  Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study.  Environ Int. 2019 Oct 14;133(Pt A):105180. doi: 10.1016/j.envint.2019.105180. [Epub ahead of print]
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73.  Yu Y, et al.  Air pollution, noise exposure, and metabolic syndrome - A cohort study in elderly Mexican-Americans in Sacramento area.  Environ Int. 2019 Nov 25;134:105269. doi: 10.1016/j.envint.2019.105269. [Epub ahead of print]

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Miscellaneous Health Consequences
 
* Immune suppression, inflammatory bowel disease, bacterial and viral infections, lupus, juvenile arthritis, sleep apnea, and obesity are elevated in populations exposed to more air pollution. 
*Air pollution can induce liver toxicity, accelerate liver inflammation and steastosis. 
*Air pollution causes systemic oxidative stress, triggers the inflammatory chemical cascade, endothelial cell death, cytotoxicity, macrophage infiltration, and increases lipid deposition. Particulate matter penetrates intracellular structures. 
*Air pollution accelerates the aging process.
*Air pollution increases infant mortality and SIDS. 
* Wood smoke is uniquely toxic, the most toxic type of air pollution that most people are ever exposed to. 
*Air pollution decreases kidney function. 
*Osteoporosis is associated with air pollution.
*Pollution exposure in utero or in infancy increases the likelihood of osteoarthritis and rheumatoid arthritis decades later in adulthood.
*Lead exposure (common in urban air pollution) is associated with significant increased adult mortality primarily related to cardiovascular disease.
         
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