Restrictions on tobacco smoke and the Asbestos scandal have put indoor air quality under the spotlight in the recent past, resulting in tough policies to stop damage to human health. While tobacco continues to be the biggest health culprit, nowadays attention is also turning to "chemical cocktails," toxic fumes from heating and cooking, and damp and mould caused by poor ventilation.
Milestones
- 2001: European Commission launches Clean Air for Europe (CAFE) programme, setting out a broad range of policy measures to reduce air pollution.
- 2004: European Commission adopts Environment and Health Action Plan (2004-2010). Action 12 of the plan focuses specifically on indoor air quality.
- 2005: European Commission adopts 'Thematic Strategy' on air pollution, focusing on outdoor air.
- May 2007: EU adopts Euro 5 emissions standards for cars. The directive makes particulate filters compulsory on all new vehicles in order to reduce emissions of particulate matter (see EurActiv LinksDossier).
- April 2008: EU adopts Air Quality Directive. The directive sets pollution limits for fine dust particles and broadens clean air laws to new sectors such as agriculture, transport and small industrial plants (see EurActiv LinksDossier).
- March 2010: European health ministers at the WHO adopt Parma declaration on environment and health. The declaration ranks air quality outdoors and indoors as the third priority action for protecting children's health in Europe.
- Dec. 2011: Planned completion of INTERA project, which seeks to improve understanding of human exposure to air pollutants at home.
- Early 2012: Commission to present proposals for a new environment action programme to follow up on the 6th Environment Action Plan, including health-related aspects.
- Autumn 2012: Sinphonie project to make recommendations on indoor air quality and health impacts in schools.
- End Jan. 2013: HealthVent project to hand over health-based ventilation guidelines for Europe, taking energy-efficiency into account.
Policy Summary
Europeans spend 80% of their time on average indoors, whether at home, school or work or on public transport.
But while outdoor air pollution has attracted much attention from policymakers, the quality of indoor air has so far remained largely below their radar screens.
A recent EU-funded research project called Airmex – European Indoor Air Monitoring and Exposure Assessment – found that levels of many harmful air pollutants are in fact greater indoors than outdoors.
An EU strategy on air pollution outdoors has resulted in a directive on ambient air quality, adopted in 2008, which set EU-wide limits on fine particle emissions for the first time ever. The strategy also led to the adoption of stricter emission standards for cars and vans, known as Euro 5 and Euro 6.
According to the European Commission, 370,000 people in Europe die prematurely every year from diseases linked to air pollution – 350,000 of them due to atmospheric microparticles or dust of a diameter of less than 2.5 micrometres known as Particulate Matter (PM2.5), which originates from transport (cars, ships and planes), agriculture and small industrial plants.
In a mid-term review of its Environment and Health Action Plan 2004-2010, the Commission mentioned tobacco control measures among the main achievements of addressing indoor air quality at EU level. Others included an opinion on air fresheners delivered by the Scientific Committee on Health and Environmental Risks (SCHER).
The EU executive said it now wanted to take the fight against air pollution to the next level by tackling indoor air quality. In a statement annexed to the 2008 air quality directive, the Commission announced it would consider measures to reduce emissions from domestic boilers and water heaters, as well as those emitted by the solvent content of paints, varnishes and vehicle-refinishing products.
However, current EU rules are patchy, and cover areas as diverse as the 2007 REACH regulation on chemicals, the Construction Products Directive (CPD) or a 2000 directive relating to limit values for benzene and carbon monoxide in ambient air.
Moreover, Brussels seems to have lost appetite for big environmental initiatives. In response to queries from EurActiv, a Commission spokesperson said indoor air quality was not a legal competence of the European Union and that responsibility fell mainly on the member states.
In its mid-term review of the Environment and Health Action Plan, the EU executive said future actions on indoor air quality "will focus on information to the public and professionals, exchange of best practices at national and local level and on coordination of ongoing policies linked to indoor air quality".
According to public health groups and environmentalists, this amounts to no less than a promise for inaction.
Issues
Taking stock
In 2010 the Belgian EU Presidency took stock of current legislation on air quality across Europe and made recommendations for further action at European level.
France is developing indicators to monitor indoor air quality and boasts a compulsory labelling system for building materials, while Germany is currently evaluating such products, the Belgian Presidency noted. Scandinavian countries, meanwhile, have opted for voluntary product labelling.
Belgium now wants all these initiatives pulled together into a standardised EU framework.
Taking stock
In 2010 the Belgian EU Presidency took stock of current legislation on air quality across Europe and made recommendations for further action at European level.
France is developing indicators to monitor indoor air quality and boasts a compulsory labelling system for building materials, while Germany is currently evaluating such products, the Belgian Presidency noted. Scandinavian countries, meanwhile, have opted for voluntary product labelling.
Belgium now wants all these initiatives pulled together into a standardised EU framework.
"For a long time, all the focus has been on the quality of outdoor air," said the Belgian minister in charge of the environment, Paul Magnette, pointing out that Europeans spend an average of 80% of their time indoors.
Moreover, the quality of indoor air is further reduced by better insulation in buildings and the use of certain products that are irritants or allergens, he said, calling on the European Commission to launch a public consultation (Green Paper) to explore policy options to address the issue.
For Belgium, one of the priorities is to reduce pollutant emissions at source – in building materials, household products, soft furnishings, floor coverings, etc.
To achieve this, he said the EU needs to set criteria for defining what constitutes "good" indoor air and draw up a list of priority substances.
Multiple sources of indoor air pollution
Although these objectives are laudable, tackling indoor air quality might be easier said than done as the sources of pollution are multiple.
The French Indoor Air Quality Observatory and the US Environmental Protection Agency (EPA) have drawn up the following list of pollution sources:
- From outdoors: Pollution caused by car exhausts, energy burning, volatile organic components, etc. (see EurActiv LinksDossier on the EU's clean air strategy).
- From buildings and furniture: Such as construction products, decoration or furniture that contains glue (formaldehyde) or other volatile components.
- From heating: Mainly carbon monoxide emissions from gas-powered heaters and water boilers.
- From plant and animal allergens: For example from cats, dogs and dust mites.
- From human activity: Such as tobacco smoke, cooking-related fume exhausts and cleaning products.
- From dampness and mould: Growth on wood, paper, carpet, foods and insulation can cause asthma and other respiratory illnesses (see EPA guide for clinicians).
An EU-funded research project called Airmex (European Indoor Air Monitoring and Exposure Assessment) found that levels of many harmful air pollutants are greater indoors than outdoors.
The research, published in February 2010, found that levels of the chemical compound benzene – a known carcinogen – were worryingly high, indicating higher exposure than what is normally expected according to annual EU limit values for ambient air quality.
The study also suggested that sensitivity to indoor air pollutants depends on other factors unique to the individual, such as gender, stress and genetic background.
Tackling multiple exposure: A new paradigm
Dimitrios Kotzias of the European Commission's in-house scientific body, the Joint Research Centre, says it is currently difficult to evaluate the impact of chemicals on indoor air quality and human health.
The difficulty lies in isolating exposure to one or a mixture of chemicals, as well as the concentration levels and the duration of the exposure, he says. "Exposure to single compounds does not reflect real health risks," Kotzias stresses, adding that future focus "should be on exposure to chemical mixtures" – what he describes as the "cocktail effect".
Kotzias also underlines the need to explore the effects of "chronic low dose exposure" to air contaminants at concentrations typically found in indoor environments. Studies, he argues, should target vulnerable sections of the population like "elderly people, children and people with lower socio-economic status".
"A new paradigm is needed to assess how a lifetime of exposure to environmental factors affects the risk of developing chronic diseases," Kotzias claims, advocating a "multi-pollutant approach" and the establishment of a "human exposure fingerprint" involving personal exposure assessments over a longer period of time.
He also suggests focusing on substances that are yet to be considered, such as surfactants, pesticides, the chemical composition of particles found in air and "reactive oxygen species" known as "radicals".
An EU-funded research project, called INTERA (Integrated Exposure for Risk Assessment in Indoor Environments), is seeking to improve understanding of human exposure to air pollutants in residential settings. The project, which is partly funded by European chemical industry group Cefic, is aiming to define methodologies for predicting indoor exposure to chemical contaminants.
Formaldehyde, benzene top list of high-priority chemicals
Despite reservations over the complexity of evaluating risks, Kotzias says the Commission has identified three categories of priority chemicals that are relevant to indoor air quality:
- High priority: Formaldehyde, nitrogen dioxide, carbon monoxide, benzene and naphthalene. The World Health Organisation (WHO) adds trichloro-tetrachloro ethylene and PAHs (benzo-a-pyrene) to this list as well as radon gas from soil, which can enter households through cracks in the foundations, or via tobacco smoke.
- Second priority: Acetaldehyde, styrene, toluene and xylenes.
- Additional substances of interest: Ammonia, delta-Limonene, alpha-Pinene.
Formaldehyde – linked to cancer – as well as benzene – linked to leukemia and neurological diseases – currently appears to be the substance of greatest concern (see complete list of indoor air pollutants and their effects on health from the French Indoor Air Quality Observatory).
An EU-funded research project, called Airmex, investigated indoor air quality in public buildings and kindergartens in a number of European cities. It found that personal exposure concentrations to harmful pollutants – especially formaldehyde and benzene – are for the most part above healthy limits.
Formaldehyde is widely used in the wood products industry, which uses formaldehyde-based resins to manufacture boards or plywood used in furniture or flooring.
The EU's Construction Products Directive, which dates back to 1988, is currently being reviewed and its scope could be extended to include furniture products that use formaldehyde.
The health risks of formaldehyde exposure were recently illustrated in the US. In the wake of Hurricanes Katrina and Rita, in 2006 the Federal Emergency Management Agency (FEMA) provided trailers and mobile homes for people left homeless by the disasters. But after moving in, some started complaining of breathing difficulties, nosebleeds and persistent headaches. It was later discovered that formaldehyde-based resins were used in the production of these homes, with indoor concentration levels higher than commonly found.
However, for many manufacturing sectors, formaldehyde is irreplaceable. "Because of its unique and versatile nature, formaldehyde cannot easily be replaced in many consumer and industrial products," said the American Chemical Industry Council, an industry group.
Another priority pollutant is benzene, a petroleum product and a known carcinogen used in the manufacturing of rubbers, lubricants, drugs, synthetic detergents, pesticides, solvents and petrol.
Although highly regulated, benzene exposure is rife in the US, causing an estimated 10,000 deaths per year, according to Benzene.org, a pressure group.
Indoor air generally contains higher levels of benzene than outdoor air, notes the World Health Organisation (WHO). This is because Benzene often enter houses from outdoor sources such as heavy traffic, petrol stations or industrial gases. But there are also indoor sources from products that contain it such as glues, paints, furniture wax, and detergents. A major source of benzene exposure is tobacco smoke.
According to the WHO, reducing exposure to benzene will require "reducing or eliminating human activities that release benzene, such as smoking tobacco, using solvents for hobbies or cleaning, or using building materials that off-gas benzene".
In the US, benzene's use as a solvent was banned more than 20 years ago. Workers in industries using benzene are advised to wear specific clothing and eye protection in order to limit exposure. These include chemical workers, painters and those in petrol stations or the paper and pulp industry (full list here).
Healthy homes and workplaces: Ventilation is key
Ensuring that homes – but also factories and offices – are properly ventilated is seen as key to tackling health risks linked to indoor air pollution.
In factories, the European Agency for Safety and Health at Work says 19% of EU workers report being exposed to toxic vapour for a quarter or more of their working time. If the risks are not properly managed, the agency says they can be harmful to workers' health, with effects ranging from mild eye and skin irritations to asthma. In extreme cases, prolonged exposure may also lead to cancer.
Employers are obliged by law to protect their workers from dangerous substances and to train them on how to handle them safely, the agency points out.
In office spaces, ventilation is often provided by air conditioning or filtering systems. Concentrations of ambient air pollutants are lower in air-conditioned rooms such as modern offices and public indoor spaces, according to the European Respiratory Society (ERS), an organisation bringing together medical practitioners, scientists and researchers on respiratory diseases.
Energy savings drive undermining indoor air quality
On the other hand, air conditioning uses a lot of energy, which creates other problems. Indeed, the drive to slash energy consumption in homes and offices has had a negative impact on indoor air quality.
New building techniques have reduced the volume of air exchanged through walls, windows and doors, causing moisture and contaminants to build up. Sick Building Syndrome is now a common expression used to describe diverse conditions linked to poor indoor air quality, such as headaches, fatigue or eye and nasal irritations.
The European Federation of Allergy and Airways Diseases Patients' Associations (EFA) warns that better insulation prevents proper ventilation of homes and offices. "The positive developments regarding climate change and energy efficiency risk becoming an obstacle and even cancel progress in IAQ," says the EFA's Susanna Palkonen.
"We are about to seal our homes and workplaces," she warns.
"That's the whole problem with indoor air quality: you have competing and sometimes contradicting targets," sums up Loredana Ghinea from the European Chemical Industry Council (Cefic).
The importance of ventilation is mentioned in the Energy Performance of Buildings Directive (EPBD). But the directive does not establish binding energy-efficiency standards for ventilation and a section on health aspects has not been implemented, says Palkonen.
The European Respiratory Society (ERS) says a contentious issue is whether patients with respiratory diseases should invest in indoor air filter systems. While the possible benefits should not be dismissed, it says such solutions must be weighed against costs, energy consumption and other factors.
"Ventilation is one of the IAQ management options," agrees Cefic's Ghinea. "However, we need to ensure that European health-based ventilation guidelines are developed. Furthermore, we have to pay careful attention to the proper installation, maintenance and use of the ventilation systems so that we don't do even more damage."
One EU-funded project, HealthVent, is working on EU-wide ventilation guidelines to safeguard people from poor air quality in places like schools, nurseries and offices, while ensuring that energy is utilised efficiently.
"This is great," said the EFA's Susanna Palkonen, speaking of HealthVent. But she warns that such initiatives "will not directly translate into policy unless there is high level support" from politicians.
The HealthVent project is due to present its results at the end of January 2013.
Positions
The European Commission appears to be reluctant at this stage to set standards for indoor air quality, saying the responsibility falls mainly on the member states.
"It is important to mention first that indoor air quality is not a legal competence of the European Union and legislation and regulation addressing it is the responsibility of the member states," said Aikaterini Apostola, a spokesperson for EU Commissioner John Dalli, responsible for health and consumer policy.
Meanwhile, outdoor air pollution is already tackled by EU legislation, which falls under the responsibility of the Commission's environment directorate, Apostola said. "The Commission uses the Air Quality Directive that applies to outdoor air quality as a reference for setting non-binding indoor air quality guidelines for indoor compounds of outdoor origin," she explained.
Apostola did not confirm claims by the Belgian EU Presidency about the upcoming launch of a public consultation (Green Paper) on indoor air quality, saying: "Following the EU Environment & Health Action Plan that ran from 2004 to 2010, the next step is to assess what has been done."
Indoor air quality was flagged as a key issue by the World Health Organisation (WHO), which published guidelines on dampness and mould as well as on chemicals in indoor environments. In 2004, health ministers from the WHO European region signed up to the Parma declaration which established an Action plan on Children's environment and health in Europe (CEHAPE).
The plan highlighted the need to provide children with healthy indoor environments in kindergartens, schools and public recreational settings. European countries pledged to make these environments tobacco-smoke free by 2015.
Genon Jensen, executive director of the Health and Environment Alliance (HEAL), a non-profit group, says that the WHO guidelines should be taken up in a new EU framework on indoor air quality.
"The World Health Organisation recommends targets on indoor air quality at which the health risks are significantly reduced. Together with important EU-funded research findings, they provide a scientific basis for legally enforceable standards in Europe as part of a Green Paper on indoor air quality. With such a move, the European Commission would open up significant opportunities for improvements in public health," she said.
HEAL is especially concerned with the impacts of indoor air pollution on children's health and recalls that all EU countries as well as the European Commission signed up to the 2004 Parma declaration.
"A Green Paper on indoor air quality could draw on the latest scientific findings and on the WHO's recommendations for legally enforceable standards in Europe. Public enthusiasm for using EU environmental policy to improve public health is growing all the time," said Anne Stauffer, policy manager at HEAL.
The European Federation of Allergy and Airways Diseases Patients' Associations (EFA), says it is essential that the EU takes a comprehensive view on indoor air quality. "It's a classic example of health in all policies," says the EFA's executive officer Susanna Palkonen, stressing that indoor air is a cross-cutting issue involving many policy areas such as health, environment and research.
More importantly, indoor air quality is not limited to people with pulmonary diseases, the EFA stresses. "It concerns everyone who needs to breathe," Palkonen told EurActiv. "The previous Environment and Health Action Plan took IAQ up and important projects were supported by the EU and the DG SANCO's Expert Group on Indoor Air Quality was born. But this can only go so far unless we have political priority," Palkonen said.
In terms of priorities, Pelkonen said the EFA would put labelling schemes for construction products and ventilation first. But she added that "this needs a strategic view on IAQ". Second-hand smoke is another "huge issue" for EFA, she said, supporting calls for a total ban on smoking in the workplace.
"IAQ is complex but it's not rocket science," she said.
The European Respiratory Society (ERS), an organisation representing medical practitioners, scientists and researchers on respiratory diseases, says the most prevalent problem for indoor air quality is still environmental tobacco smoke, and other indoor sources – fireplaces, kerosene heaters and consumer products – that influence indoor air quality more than outdoor air pollutants.
The ERS says the problem is particularly acute in developing countries, where smoke from cooking and energy burning in open fires or stoves exacerbates indoor air pollution. "Every year, indoor air pollution is responsible for the death of 1.6 million people – that's one death every 20 seconds," the ERS underlines.
In Europe, it calls for all workplaces to have good quality indoor air environments, particularly schools. According to the ERS, "the simplest and most effective measure to reduce indoor air pollution would be to implement comprehensive smoking bans in work and public places, especially for schools, kindergarten and day care centres". Other measures, it says, "range from better building codes and guidelines for ventilation and moisture control, control of pollution sources, product policy and labelling systems (building and consumer products)."
Christian Schaible, chemicals policy officer at the European Environment Bureau (EEB), an NGO, says: "There are no official limits for indoor contamination, so harmful chemicals cocktails are left to build up to alarming levels. The Commission needs to start taking indoor air quality seriously."
In particular, Schaible describes contaminated dust as "a serious concern". "A German study recently found that many kindergartens and crèches are contaminated with high levels of harmful plasticisers. These plasticisers, known as phthalates, have been shown to change hormone levels and cause birth defects at high doses."
Phtalate manufacturers beg to disagree, saying flexible PVC articles including flooring, wall coverings and furniture are safe for use in all environments, including nursery schools.
The European Council for Plasticisers and Intermediates (ECPI), an industry group, claims that it is not accurate to refer to “offgassing” of phthalates. "Phthalate plasticisers are tightly bound within PVC, even in abraded particles that may be collected in the form of dust. […] Household dust does not correlate to exposure levels for phthalates, neither is this an indicator of indoor air quality". The EPCI concludes that calls to ban all phthalates are "not based on scientific facts and should be rejected."
Loredana Ghinea from the European Chemical Industry Council (Cefic) says the top priority in tackling indoor air pollution is tobacco smoke. "Tobacco smoke is, when present, so dominant that the larger part of the IAQ problem in these homes would be solved by eliminating this source," she told EurActiv.
Pollution from outdoor air and exhausts from cooking come second and third. "There is a consensus that a whole two-thirds of the burden of disease generally associated with IAQ is caused by exposure to fine particulate matters originating mostly from outdoor air and indoor combustion of solid fuels for cooking and heating, if present," Ghinea says.
"The next significant exposures are building dampness, bioaerosols from outdoor air, radon, carbon monoxide from indoor combustion sources and the volatile organic compounds coming from consumer or construction products."
But Ghinea refutes suggestions that chemicals manufacturers wanted to avoid responsibility. "Given that we are facing millions of different complex indoor environments, I think that we have to look at the influencing factors in parallel through an integrated strategy. This means that we also address chemical factors according to their respective potential health impact attribution."
However, Ghinea warns policymakers that action needs to be "proportionate to the respective factors" at play. Regarding formaldehyde specifically, she stresses that the substance was not only man-made but also occurred from natural sources such as rotten fruit, cigarette butts or even beer. "Formaldehyde is one of the identified priority chemical factors to have an impact on health. The only solution is to deal with it and help to identify what the best management options are," she says.
Camfil-Farr, a Swedish company that produces air filters and clean air solutions, says the drive to insulate houses and offices since the 1970s has led to a buildup of contaminants and moisture inside buildings, causing health concerns.
"Indoor Air Quality (IAQ) should be a public health concern. For example, vulnerable individuals who live near roads, where air pollution from traffic is a serious health risk, should fight for their right to breathe cleaner air," the company says. "Doctors could be their vocal allies in this struggle. We need to pay attention to the importance of healthy IAQ. Camfil Farr's vision is clear: clean air should be considered a human right."
The company believes indoor air quality regulations at European level would improve public health. But in the absence of such rules, it says existing ventilation standards can be revamped to improve health while saving energy. "In the absence of general norms for indoor air quality levels, ventilation standards are attracting increasing attention from policymakers to accommodate health concerns and to maximise energy savings potential," Camfil says.
It warned the Commission not to overlook health issues when designing energy savings policies. "Energy policies are designed by DG Energy policy officers and experts that do not take into account the need for healthy indoor environment, focusing on the primary target of energy conservation. Too simplified concepts will definitely compromise indoor air quality and Europeans’ health."