Deep breath, deep dive: Air quality and your health

Transcript

Transcript

[Healthy Canadians logo with pulse sound]

[Music]

Megan Beahan : Welcome to Healthy Canadians your space for nuanced conversations and expert insights into the health topics that matter to us all. I'm your host Megan Beahen, and I’m joined today by Alex Newman, co-host and producer.

Alex Newman: Hey Megan, how are you doing?

Megan: Good thanks, how are you?

Alex: Pretty good. So, it may come as a surprise to some of us, but in order to live, we must breathe air. But seriously, I think it's something we don't put a lot of thought into is what's in the air we breathe. So, there's a lot of particulates, everything from like dust to whatever floating around, but it's just something we do every day, right.

Megan: That's right. And today we are talking about air quality and the impact it can have on our health. And today for a guest we have Angelos Anastasopolos. He's a senior scientist in the Healthy Environments and Consumer Safety Branch at Health Canada.

Alex: That’s great. Well, before we get started just a bit of housekeeping. So, although Health Canadians is produced by Health Canada and the Public Health Agency of Canada, what we discuss won’t always reflect the official positions and policies of the government of Canada, but that's okay. These are conversations not news releases.

Megan: Okay let's take a deep breath [audible breath] and talk about air quality.

[Music stops]

Megan: Angelos, welcome to Healthy Canadians.

Angelos Anastasopolos: Oh, thank you. Hi Megan.

Megan: Let's jump right in. I would love to hear what do you do at Health Canada?

Angelos: Oh my gosh. Okay. What do I do? I am an exposure scientist.

Megan: And what is that?

Angelos: Okay so stepping right back, basically, I do research and our group looks at air pollution and the effects on health. Now within that big umbrella, we, I myself, I’m an exposure scientist. What that is is a scientist that quantifies, qualifies, characterizes what you are exposed to when it comes to harmful things, such as air pollution in our case, in my case. And it literally means ... What are you breathing? What kind of air are you breathing? What's in that air? And what does that mean for your health, your health risk potentially?

Megan: Very, very cool.

Angelos: That’s the closest to a nutshell.

[Laughter]

Megan: Yeah, that that's a good nutshell, that's a great nutshell. I would love you to paint a little picture of, like, what does that look like during the day? Are you in like a lab? Are you measuring people? Watching people breathing?

Angelos: Yeah, so not myself, but we've done that in our group.  So, the group that I’m in is a research group, as I mentioned, and it's exposure science, so Air Pollution Exposure Science Section is the name of our group. And also you know our kind of cousin group looks at kind of health assessment analysis as well, so what are the health impacts of air pollution.

So, what does a typical day look like for most of us, or some of us, or the group of us? It's very collaborative, right. So, when we have field studies, and we do a lot of field studies, we're doing actually exactly what you said, Megan, right. We're actually, I think typical situation is we'll have, we'll set up a tripod in a home's backyard, because we want to say “okay. What is the air pollution like in this part of the city where this person lives?” Now it's not meant to be just that person. It's kind of an indication of their neighborhood, for example, in most cases, right. So, we might set up samplers in various studies in a lot of locations in backyards across the city, and that gives us an idea of how things are different from one part of the city to another.

In other cases, we've looked at personal exposure, so literally measuring the air that people are breathing. We had, you know way back a bit, but definitely an important founding study, is we worked with asthmatic children in one city in Canada. And we basically had little backpacks that the kids would carry with them all day long, and the backpack had a bunch of air pollution sampling equipment in it. And it was some of this equipment is kind of simple to understand. It's literally like a pump drawing air in, which is kind analogous to how you're breathing, but it pulls that air through a filter. So, that filter is then going to kind of capture whatever air pollutants, and specifically particulate matter - it could be Vapor phase pollutants as well - so you end up capturing a sample of the air that in this case the child was breathing.

And these children were uh volunteers, and you know, they were participating in the study because they also had asthma. We were very interested in that cohort that has asthma, because they have higher risk for effects. And so, we would kind of follow them through the day, or they would carry the backpack, and then they had a little diary and they would kind of write down “well, I'm I'm at school now” or “I'm at home now” and then “here's what's going on” like, you know, “my parents are cooking right now”, which might elevate the levels of pollution in the house. And the goal of that was just to see through a day, and day-to-day, what level of air pollution are they exposed to, how does that compare to what we consider kind of safe levels, or at least typical levels, and then to give some advice back on “ok, here's how you can reduce your exposure” to the parents and to the kids. So, that's kind of one example, but we do a lot of research.

We have people in our group that do epidemiology studies, so they're working with health data sets, like mortality data or hospitalization data, and then they're pairing it with exposure data sets, which is “okay, well, what air pollution levels did the people in this health database breathe, you know, at different points in time over let's say a 20-year span”. And so, that's another type of research that is within our group as well. And I work, not in our group but kind of adjacent to us, there's also toxicologists that we collaborate with. And they're focusing on figuring out - we know from associations and epi studies, and we'll get into this I think - that there's a lot of health impacts to air pollution exposure - but the toxicologists are really focusing on trying to figure out the mechanism, like “what is it exactly about those particles that are causing it?” And so, they're at a different level. They're working in a lab.

They're exposing lung tissue, for example, to air pollution, and then monitoring the effects. So, it's a range of stuff. And yeah, a lot of field work. I would say a lot of field work. And we like that part. We do like that part. It keeps us grounded.

Megan: I mean, that sounds like the interesting, um very interesting part. I love the picture you painted about the little back packs. 

Alex: I feel like, we’ve got to give some props to those kids too, cuz I'm just picturing, like, I'm picturing my toddler, who can't focus on anything for like more than 30 seconds. Like, to keep track of that and to carry it around all day, like, good for them, man. But uh too, it kind of paints a picture though too of how something so seemingly like innocuous, like, we just breathe all the time. Everyone does, right? But it kind of, when you look at the science, there's so many, like, there's so much nuance to it, and so many different aspects of what you're studying to, like, answer the question of “What is the quality of the air we breathe, and how is it affecting us, right? Like, it's amazing how complex it becomes.

Angelos: Yeah, it is complex. Yeah, the closer you look, the more there is to see is really what it comes down to.

Megan: And I'm curious about like how that all gets rolled up, and what that turns into, right. So, what do we do with that research? What do we do with that the backpack study? Like, what does that turn into?

Angelos: That's a good question. So, I guess most broadly, it turns into a couple things, maybe even three things. So, we try, because we're a research group, to publish our findings, which means we're publishing papers in peer-reviewed literature. And why? It's simply because science is like building on this you know big mountain of evidence. So, you kind of build on what's known before. The goal is to like find out something, share it, publish it, so other scientists can look at it and build on it. And sometimes, they'll find something that actually is like “oh, that's not quite right” or sometimes like “yeah, we also found that, and it also applies in this other country, or in this other demographic, or cohort”. And so, that's one goal is definitely to publish. Um, but the bigger reason for that is simply to share. And so, we also are sharing the results. So, in the case where I mentioned, for example, the little backpacks - and I know I really enjoyed that very much. We all did. We all like that type of field work with participants, because you're connecting with people that are interested and concerned, and instead of just ...

Alex: And affected too, right?

Angelos: And affected, right. And instead of the messaging being like - “Oh, you know, we're going to speak to people who might read this website”- you're now able to kind of have conversations with individuals that participated, that are interest, that, and they've got really good questions, and you can kind of give them the health advice, or the suggestions at least, that they can then take into account as they plan their day to reduce their exposures. So, it's definitely data sharing.

And part of that is also in other ways, like whether it's a webinar ,a seminar. It's like, when we collect data, when the Government of Canada collects data, because we're government scientists of course, we share it, because that's kind of the point. We're here to kind of find information out that can help Canadians. So, the goal is not to keep it, but to actually get it out there and to share it and make it available.

Alex: I bet you at least a few of those kids are going to become scientists too. What a cool experience as a kid to be exposed to that.

Angelos: Yeah, I know, yeah.

Megan: And we'll talk more later about what people can do with that information, as well. But I'd like to start with some basics a little bit. So, when we're talking about air pollution ... what do we mean by that? Like, what is included in that definition?

Angelos: Okay, so there's ... yeah, we could talk about this. We will talk about this a bit! [Laughter]. So, I had I had a few things, but like I wanted to kind of start - and maybe this is like a offbeat way to answer it - but I just wanted to start by saying kind of like good news. I'm a big believer ...

Megan: We love good news around here.

Angelos: We love good news, right! Exactly, right! And I think you know, when you're a health scientist or any kind of scientist, and especially a health scientist, you know you're trying to find out things that could improve people's health, which means you're looking at things that make people's health worse. So, it's good to sometimes step back and say the big picture. So, for air pollution, and speaking specifically to the Canadian context, I want to stress that Canada, comparatively to almost every place on the planet, has very, very good air quality. Even in our cities, our urban levels tend to be lower than cities, you know equivalent sized cities, in a lot of other countries.

Now, there's a lot of good reasons for that. It isn't only because, you know, we've done amazing things. It's also because Canada doesn't have a lot of population to begin with. Like our cities aren't ... we don't have these megalopolises, right. So, but that said, it's also other things. It is the fact that we have a certain amount of regulation. We have a certain kind of behaviors. Our industry is located a certain way. So, all of this means that, on the whole, I think we should not lose sight of that. That we do have good air quality. But, if it was, you know, there's, it's then important to say that there's no kind of perfectly safe level of some of the pollutants that we're going to talk about.

When we talk about particulate matter, for example, these really small particles that come from combustion, for example. It's not the only source, but it's kind of the one we often think of is when you have a fire, you're going to get soot. So, when you think about these little particles in soot, these little carbon particles like ash. When they're very, very small, you can imagine that when they're small enough they're respirable. You can breathe them in. They're small enough that they'll break in. And what's interesting there is we then classify these particles, particulate matter we call it “PM”, and we'll classify them by their size. Um and that's so ... we're going to get into the complexity here, if you don't mind.

Alex: No, no. It’s good.

Megan: Yeah, let’s get the details.

Angelos: So. we classify them by size. So, the sizes that we typically study, you'll hear for example PM10. So, PM10 is pm10 micron. So, that's like the size of a very small. It's definitely respirable, but they're still big enough that they'll tend to like settle out higher up in the lungs, let's say. So, oh yeah and I brought this. We might as well bring him out right now.

Megan: Let’s bring it out. 

Angelos: Okay. So guys, this is something I like recently kind of like was given, which I thought was kind of amazing.

Megan: And for listeners, he's holding up a very cute.

Angelos: Adorable.

Megan: I would say very cute ...

Angelos: I would even say adorable.

Megan: Adorable, pink um ..

Angelos: Lung.

Megan: Lung. It's a lung.

Angelos: It's a lung. It's absolutely a lung.

Alex: But unlike some lungs, he has eyes.

[Laughter]

Megan: Unlike most lungs, he does have eyeballs.

Angelos: Yea, yeah. He has eyeballs. That part is not true.

Megan: Pink is anatomically correct, I believe. But um ...

Angelos: But not the eyeballs. But nevertheless, so yeah so, this little lung - what I'm trying to ... I think it's kind of helpful to see here.

Megan: Yeah.

Angelos: It’s like, when you're breathing in through your mouth, through your nose, the larger particles are going to ... some of them are going to make it down even into the lungs, but the really fine particles are the ones we really, really worry about. And that's where a lot of our study is.

So, this is a size fraction that's called PM 2.5, 2.5 microns. Now, how small is that? It's like 20 to 30 times smaller than the thickness of a human hair. It's really, really small.

Megan: Okay.

Angelos: So, you can imagine when it's something that small, not only are you going to breathe it in, it's going to go down your trachea, it's going to go into your lungs. Of course, it's small enough. It just gets carried on the air, right.

Megan: Right.

Angelos: But it's going to make it into the lungs, and here I know like the you know the audio listeners can't see this, but you kind of have here like bronchial tubes coming down on the outside of Louis the lung here ... the inside. They would be on the inside in real life. Um so, they come down the bronchial tubes and they're really small size fraction, they're going to make it right to the end of the bronchial tubes, even to where we have like the little sacks that do air exchange with the bloodstream - the alveoli, right.

And so, these really fine particles are small enough that they're going to be able to cross over into the bloodstream. Now, I mention all this just to show that you go from breathing something in, and if it has a high concentration of PM, like these particles, then the finer particles could get all the way into the lungs. They could deposit in the lungs - that's already bad, because there's all kinds of health effects that could happen respiratory wise - but they could even cross over and then deposit anywhere in your body, because they get carried by your bloodstream, including like to your heart of course, including to your brain, so that's another important consideration.

And then the next step on complexity is ... Okay, so particles. We think of them as these little circles. So, they're not quite circles. They're literally an agglomeration of they could be various shapes. Um, but what matters is that they're not just carbon, right. We think of it as carbon because we're like “Oh,  it's soot. You burned something”, but it actually depends on what was combusted, or how they were produced. And so, they have all kinds of other compounds on them. So, they have including heavy metals. Some of which are toxic. They have organic compounds that are carcinogenic. One class is called PAHs (polycyclic aromatic hydrocarbons). It's a class of compounds that we know cause carcinogenesis. And so, these additional pollutants are on this pollutant that is respirable. And this is all in the air. And you don't want this deposited. And yet, we do breathe. We do have exposure.

And so, you imagine short exposures could lead to like some acute effects. You know, we've all been in situation where, you know, your eyes tear up, or you start, kind of, you get a bit of phlegm, or you're coughing a bit. But imagine people with asthma. They then get the constriction. They start to have trouble, kind of, breathing.

Alex: Yeah, it becomes serious quickly.

Angelos: They could have a full-on asthma attack, right. And then, over long periods of exposure, basically over our lifetime being exposed, then you could also have chronic effects. So, your health risk for all kinds of diseases, including cancer, for example, including even death from cardiac arrest. There's an increased risk even of that from long exposures to air pollution. So, there's definitely a lot of health impacts that come from the air pollution. Now, this is a long way of answering you.

Alex: Well, I think it's ... what was striking me when I was listening to you was that ... We did an episode not too long ago on environmental contaminants, and had a bit of a discussion around like microplastics, nanoplastics and things like that.

Angelos: Excellent yeah.

Alex: And it's like that's kind of in the public consciousness at the moment. Really like at a high level.

Megan: Yeah, what am I breathing? I was thinking the same thing when you were talking about it.

Alex: But what I mean too, it's like, I think we're maybe a little less aware of that - what's happening in our lungs too, right. Like, I mean, like, I was like - “wow”.

Megan: And going into the bloodstream, potentially.

Alex: Yeah, I was just thinking to myself - “this is a lot like the conversation we had on environmental contaminants too in terms of that, so it's interesting.

Angelos: And that's an emerging one, for sure. That's an emerging one. And microplastics are being studied by researchers, including exposure scientists, because yes, it's something that the awareness is really going up. It's like initially we were like “Oh, it's a water problem” and it sure is! But then, it's like “Oh, wait a minute. How did it get in the water? Oh, it floated through the air. Oh, so maybe it's breathed. Oh, but they're kind of big. Oh wait, some are small.”

Alex: Oh yeah, then the nano plastics.

Angelos: So, it's very it's very leading edge, but it's definitely something that a lot of of my colleagues are looking at, and we're also looking at within our group increasingly to consider microplastics.

But actually, if I can kind of like build off that, the other aspect to air pollution to think about - and I think this is this helps us a lot in the study, but I think it's relevant, is, um, it helps to think about the sources. Because, you know, we're talking kind of this broadly like, oh, you're breathing air, and it's like this invisible thing”. And that's kind of what initially made me interested in this field to begin with ... The fact that you've got something you can't see, but it has all kinds of real effects, and how do you make it so you can “quote, unquote” see it?

Megan: Yes.

Angelos: Well, you study it, right. You study it and you have kind of you know tools, including mathematical models, to try to understand it. And one of the things that we really focus on is we look at the different sources of air pollution. Because you could have –coming back to particles, for example - you could have particles from different sources. They're not going to be exactly the same. They're not going to have the same composition of metals, let's say, or organics. They're not going to be the same concentration. And so, it matters what the source is.

And when I say sources, we kind of, I think, we all kind of know, but I’ll mentioned it, that you could have like transportation sources. You have industry sources. You have sources, residential sources. So, a big one we spend a lot of time thinking about and studying are transportation sources, so transportation related air pollution. TRAP is the thing that my colleagues would have used as well, because that's kind of an easy way to kind of shorthand that.

So, we know that like car exhaust from combustion engines definitely produces particles. It produces is, you know, nitrogen oxides as well. In the past, it produced sulfur oxides when we had more sulfur in the fuel. But basically, it's producing air pollution, and it's interesting that the air pollution that is studied from those sources could have different health effects from some other. Like, you know, you think all these compounds are bad, but there's something about that mixture that comes out of one source versus another that seems to drive different health effects, or in some cases more health effects. And a lot of the health effects that we talk about for air pollution are definitely linked to transportation, like you know vehicle emissions. And we can kind of get into that, but definitely that's a source that we focus a lot on.

Megan: I want to talk more about vehicle pollution, because I feel like, one, that's interesting, but also that's where my mind goes first when I think about air quality. Because it is something that I can see, that I can smell, that if you live downtown you might have, you know, a lot of exposure to it, or more so than if you lived in a rural area. How big of a problem is, like, pollution from cars in Canada?

Angelos: It's, it's a problem for sure. And yes, it depends on where you live. But with road basically pollution that comes from from vehicles that are on roads, of course, the concentrations from those emissions kind of drop away as you move away, which makes sense. It kind of like diffuses, disperses, settles as you move further away. But further away is like, let's say, 500 metres, 300 metres, 500 metres. Usually, by that time levels from that particular source - there's still other air pollution in the air, of course. It’s not like now it's like a park - but the levels from, let's say, a busy road have dropped off usually when you're about half a kilometer away, right, or a couple of city blocks away.

Um. So, you're like “okay, that's good to know”. So, what does that really mean? It means that most people, whether they're commuting or even their homes are, or a lot of people happen to still be within that radius, um, and you have, of course, a network of roads. So, when you look at how many people are actually influenced by road pollution, it's probably about a third to even a half of the Canadian population is living, or working, or at very least commuting close to a busy roadway, and therefore being uh affected by pollution from vehicles. So, it's definitely pervasive, and we can think of the exceptions of, like you said, people who live in a rural setting, they would have less of this concern. But a lot a lot of Canadians still come into the city, and so, you may be exposed, if not most of the time, at least some of the time. 

And that is where you have a lot of concentrated emissions from the vehicles. You think about diesels. You think about gasoline and diesel vehicles, basically. And with diesel exhaust in particular - we talked a little bit about the sizes of particulate matter. So diesels are what we think of. I think a lot of people think about particulate matter when they see a diesel, because you'll sometimes see a puff coming out of like ...

Megan: Yeah, it’s like black smoke. You can see it.

Angelos: Right, like a garbage truck or a semi. You can actually see it. Like, it's like a release ...

[Laughter, inaudible verbal reactions]

Alex: Yeah. It looks like soot almost.

Angelos: Especially as it starts to, like, as it just starts to accelerate right off a light, um, you'll just see a puff or release, and definitely that's a release of particles.

Megan: Okay.

Angelos: So, and those are the ones that you can see. They're not all visible, of course.

Megan: Right.

Angelos: But, um, diesel exhaust particulate (DEP) has been studied quite a bit, because the combustion particles - they are that – um, are very, very small. They're even smaller than the size I mentioned of PM 2.5. They're like less than PM1, in fact. So, definitely respirable, and able to deposit, and then deposit systemically. So, very much concerned in that sense. And they do contain some of the things that we talk about. They definitely contain the carcinogenic organics that I mentioned, PAHs, and they also can contain metals that can be toxic. And so, diesel exhaust is almost like a subclass of vehicle exhaust that is studied very carefully. And there's very good reason why over time regulations are moving in to kind of, you know, reduce the emissions from them, and even replace some of these. We'll get, maybe a bit later, into talking about getting some of these vehicles just simply replaced with something that doesn't have exhaust emissions.

Megan: Why don't we talk about that right now? Let's talk about electronic vehicles, or zero emission vehicles. Like, as we move to that, obviously that's a big impact on our air quality, right?

Angelos: Yeah, yeah. It should be, yes. It should be. So actually, EVs ... again, we always talk about the good news story first. So like, the good news is, the good news is that it definitely has potential to improve air quality when it comes to road, on-road emissions - TRAP basically, Traffic-Related Air Pollution. Uh, and that's because ... It's funny. EVs are a fun thing to talk about.

Megan: Do you have an EV?

Angelos: Uh, I do not have an EV. I do not have an EV.

[Laughter]

Angelos: And that's a good question. That's a really good question, actually, because I'm a car guy.

Megan: Okay!

Alex: Oh, yeah.

Angelos: So, now that's not why ...

Megan: Let's talk about that.

Angelos: Yeah, that's not, that's not why I don't have an EV, but it shows how complex these issues are.

Megan: Right.

Angelos: So, so this is actually a good question. Okay let's talk about this a bit. So, because I had a chat with the Uber driver on the way here, for example, this morning. So, and we kind of talked about it. It was an Uber green, so it was like a hybrid vehicle in this case, and so we chatted a bit. And what we talked about was this that, um, EVs are easier when you have, when you live in the suburbs and you have a garage, and you can get a charging station at your house, and so on. This is going to change over time. Like, you know, this is what we've been promised. It's definitely, it's definitely happening. There's going to be more and more charging stations, public charging stations, and so this problem will eventually, we think, go away.

But in the current transition, it's kind of easier for some people than others. So speaking, you know, you made it personal. You asked about me. So, we, so my family, we live basically in the core of Downtown Ottawa. And so what does that mean? Like, that's  a decision, and in some cases, kind of a privilege as well that we live there, because we can commute actively. So, when I walk into the office, for example, or walk downtown, most of the time I would just be like ... I walk year-round to the office and my wife does the same thing to her office. We're able to do that. We have next to us like a park that, you know, we can jog in, for example. Or my wife. I don't jog, she does.

Megan: Thank you for that clarification

[Laughter]

Angelos: Um, but it makes the car thing a bit of a challenge. Because when you live downtown, and I don't know where you guys live, but having a house, having the garage, having the space ... not so easy.

Megan: Oh, for sure.

Angelos: Not so easy. And that means you're probably going to have a hard time having a charging station for an EV. And so, you kind of, you know, wait and see, and do things and kind of act in different ways to reduce your footprint. So in our case, I kind of hinted at it, it's actively commuting. Um, and enjoying those cars - because I am very much a car guy. I always have been - but enjoying them when you need them. Or when it's a real like it's just it's an outing with your buddies, and you're going for a rip, or you're going to go up to some, you know, like hilly roads, for example. So, but that's once in a while. That's not too often.

You try to avoid getting in the car and using it every single day, which because of where we live, we don't have to. Others have to. And in those cases, EVs are kind of a bit of a godsend. Because regardless of who ends up adopting EVs, and I think over time they're going to become you know a bigger portion of the fleet, what they're really good at is they have zero tailpipe emissions. So, everything we've talked about so far with respect to ... it doesn't apply.

But not everything. This is what I want to stress. So, there's no tailpipe emissions, because they're not burning a fossil fuel, right. So, that's fantastic. But the complexity comes in again, and that's kind of the theme, I think, of our chat here.

Megan: Yeah.

Angelos: Because even electric vehicles have to break, and yes they have regenerative braking, but they still have friction brakes, which means that they're shedding particles from the brake wearing, the steel of the rotor, and the organic and organometallic material of the pad. So, they're still releasing these particles, and they also have tire wear. So, that's something a lot of people don't think about. Until now with like microplastics, people are starting to kind of draw the connection, because tire wear is definitely a source. There's all kinds of things in tires. It's not just what we think of as rubber, but there's a lot of other like compounds in that rubber as well. And so, they definitely have tire wear and you could say “well, that's no different”, but we need to remember that EVS, at least for now, tend to be quite a bit heavier because of the batteries, right.

Megan: Okay.

Angelos: So, you know, this is all going to change. It’s an evolving space. But having said that caveat, I just wanted to say it so people don't say “oh, but you're overlooking this, that”. It's such like a charge topic. But let's step back to the good news. EVs totally eliminate in the use phase, like when they're being driven around, there are no tailpipe emissions, and that those tailpipe emissions are the bulk of the air pollutants that right now were concerned about, and are the reality. You've got diesel trucks, as I mentioned. You've got all these gasoline cars. And EVs are definitely going to improve the picture by slowly removing more and more of these older vehicles from the road. So, it's definitely, I think, a good new story coming, yeah.

Megan: I want to switch gears a little bit ...

Angelos: Good. I caught that.

[Laughter]

Megan: Could you just, like, laugh, a little.

Alex: Two drums in a cymbal fall off a cliff ...

[Laughter]

Angelos: Exactly. We need that.

Megan: And talk about climate change.

Angelos: Sure. Yeah.

Megan: And how does climate change factor into your research?

Angelos: Okay. So, climate change factors ... it's like adjacent because ... Maybe adjacent is not even the right word. Like, it's linked for sure. If you think about air pollution, you also are thinking about climate change. If you think about climate change, you're thinking about air pollution. So, what I mean by that is ... like again, stepping back, we know the consensus, you know, is very, very kind of backed up by all the data, that we know that it's air pollution, effectively, fossil fuel combustion in particular and other industrial combustion, that brought us to this accelerated climate change situation that we're finding ourselves in already. So, air pollution definitely is there, because that actually resulted in the climate change conditions that we are now kind of living through.

And then it's linked in another way too, which is as climate change gets worse, then there's more of an effect on air pollution. You could say “well, what do I mean by that?” Well, an obvious one, and I think a key one, is wildfires.

Megan: Right.

Alex: Oh, yeah.

Angelos: So right, we've lived through this here in Canada, last year in particular, and it's forecast you know that this year seems to have similar conditions from what the environment Canada folks are telling us, that uh we can probably anticipate similar conditions for wildfires this year. But thinking back to last year, we know that Wildfire smoke was a really big deal. Large plumes in a lot of parts of the country, and a lot of like transport of that wildfire smoke to cities that have a lot of people. So, all these kind of air pollution kind of related aspects, they do link to climate change. And it's kind of a feedback loop, unfortunately.

Alex: Yeah. Everything affects everything.

Angelos: So yeah, exactly. So, we do collaborate with the environment Canada scientists that do that lead on the climate change files, but they collaborate with us a lot because we of course are interested in the health aspect of what climate change is going to mean for Canadians. So yeah, it's a very topical thing.

Alex: Well, and it's very jarring too in in terms of the health aspects too. Because, I remember last summer. I mean, I've lived in Ottawa for most of my life, and I don't ever remember smoke like that being in the city. And I mean, I made the mistake of being a bit of a dumb dumb. I was doing some landscaping at the time, and I was like “oh, I'm just going to go ou and do like an hour's work. It'll be okay.” And like, I felt it afterwards. Like. it wasn't ... it was not a good idea, you know. And I'm an otherwise pretty healthy person. Uh, so I mean ... yeah.

Megan: It certainly makes you more mindful of the issue.

Alex: And well, I can only imagine with someone with COPD, or with Asthma, or something like that. Like, it would be very difficult.

Megan: Yeah, we've touched on this a little bit. Maybe you could talk a little bit about how, um, air quality issues or air pollution affects some people more than others?

Angelos: Okay. Yes, yes. So, I guess the the short of it here is that air pollution affects kind of all of us to some extent. And it starts like really early. So, even, you know, we have studies that have demonstrated that when children are in the womb there's an effect on the child, the developing child. And when children are born, It's associated. So, a mother being exposed to higher air pollution during pregnancy, could lead to greater risk during the pregnancy itself. There's low birth weights that can be associated as well, so there's some, there's some immediate effects on even at that early, early stage.

But then if we think about then the next stage, which is I think for a lot of people like that's what we think of, we think of young, you know, children basically. And air pollution definitely has health risks for children. And actually, talking about breathing in again, it's kind of easy to understand, because children for their body weight, for their size are breathing more air relative to their size than an adult does.

Alex: Oh.

Megan: Oh, cool.

Angelos: So, they're ... So, again tying it back to exposure, right, they are getting a higher, a disproportionate ...

Megan: They are higher exposed.

Angelos: Yes. If you had a child like in this room with us right now, they are going to have a disproportionate exposure, simply because they're going to be breathing more air relative to their size. Now, the other aspect to consider then is that children tend to like run around, which means ...

Megan: They do tend to do that.

Angelos: They do tend to do that

Alex: I have first-hand experience with this.

[Laughter]

Angelos: They run around. And so, what does that mean? That means, like, their heart rate is elevated, which means they're breathing, they're breathing faster, more often, so they're taking breaths more often. And again, if you think about exposure, that means that you're getting cumulatively more air exposure per, you know, length of time as soon as your heart rate goes up. So, it affects children in that way.

Then you go to like adults for example. We are affected of course during exercise. It kind of becomes, it's kind of a link there, because when we're exercising, we're running around, right. So, now we're the ones running around, and we're breathing more air, and now we are having a disproportionate exposure to whatever that air quality is. And in terms of, like, what the health effects are, we kind of touched on some of these, but it's a long, like, a long list of things, basically. But for sure, it's things that seem maybe a little bit obvious, for example respiratory disease. Asthma is a very big deal for a lot of Canadians, including a lot of children, and then it tends to kind of, some children are able to outgrow it, some children, it stays into adulthood. But when you have people with asthma, they're more sensitive to low air quality, because it will trigger that constricted breathing and that attack. You have, you mentioned, Alex, like Canadians that have COPD. That's, that's a big group of Canadians, and they have that challenge with air quality. But breathing air quality can, in children specifically, it's been linked to childhood leukemia, for example ... Something you wouldn't normally think of, but the link has been demonstrated.

So, we think also about cancers. Some of them are obvious. Lung cancer, lung cancer, I think, some people that maybe don't study this think “oh, lung cancer ... that's like a thing in the past”. Like, it is a very large amount of cancer that still occurs. It's like a dominant cause of cancer in Canada, and around the world, is still lung cancer. Which makes sense, because that's from all the air that we're breathing. That's a contributing factor. So lung cancer is a very big one, because as we mentioned, you're breathing carcinogens.

And there's ... and even if it's not cancer, you have general stress and inflammation of the lungs that happens from breathing in air. So, all these kind of effects are related to it and then even some things that are not so obvious. More recent research is showing that there's an effect on the brain. Exposure to air pollution has led to, like uh, has been linked to cognitive decline. There's a link potentially to dementia, the dementia group of diseases as well. So, it's kind of systemic in the possibilities of where the risk is.

And really it comes right down to, when we do health impact analysis, and that's something that we do within our broader division. We have these two sections that I mentioned, and the one section that I work with as well, and that my colleague who you interviewed recently, Mathieu, works in. We do health impact analysis, health impact assessment. And there you're looking at specific health end points, health outcomes of air pollution, and actually tallying them up, quantifying them across Canada by source, or even overall. And some of those outcomes are - and the one that we spend a lot of time talking about - is you have premature mortality. Because exposure to air pollution, and some of the compounds, like PM 2.5 and even NO2 and ozone, have been linked to premature mortality, whether it's respiratory related, whether it's cardiac related.

So, very real. Hospitalizations! Even if we don't go full dark, and we just back off and say “let's talk about illness”, well, when people are not feeling well, they're going to go to the hospital, whether it's an emergency room visit or see their health care provider. So there's a burden from a population health perspective to consider. That when we have poor air quality, and more and more people being exposed, you also are placing this burden on the healthcare system. So, it is a very ... it's a very important health stressor to think about. And I like it, because it isn't just all dark. Like there are certain things you can do, individually and societally, to kind of get us to cleaner air.

Megan: Let‘s get ... let’s get into that. 

Alex: Yeah, we need some positivity.

[Laughter]

Angelos: Okay. Like, I know. Because, I feel like we're getting really dark...

Megan: What can people do?

Angelos: I feel .. yeah ... I feel like we've been kind of spending a lot of time on that.

Alex: You know what, though. It's really good, though, because it gives perspective on it, I think. Because, like, it is so cascading, and you talked about like premature mortality, right. Like, it could be any one and all of those things put together that are influencing that, right. And even I was thinking when you were speaking, like moving away from the like critical illness side of things too, just having bad air quality means I can't get out and exercise.

Angelos: Exactly.

Megan: For sure.

Alex: You know what I mean? So, that has an impact on my health too, because I'm someone who's way too insecure to go to the gym ...

[Laughter]

Alex: Ah, but, um

Angelos: Oh, come on. No judging. No Judging.

Alex: I need be out my bike.

Angelos: Right. So, right.

[Laughter]

Alex: Sorry ... but it's true, right. I mean, it's kind of daunting to think about. So, tell us ... yeah, we need some good news.

Angelos: Yeah, well actually ... Okay, yes. You're, you're kind of on ... you guys are on the same wavelength. So, okay. So, what can we do? You're right. We need some sunshine here. So, there are certain things that we can do for sure. So, I kind of like, I like to think of it as three big things that individual basis, right. So, the first thing is get the data. So, what do I mean by that? I mean, like, get the air quality data, consult the data. Now, we have it ... we have it kind of amazing here in Canada, because we have the Air Quality Health Index, the AQHI.

And what does that mean? It means that you can look on your phone, right, or like jump on a website, and you can do it before you head out to do whatever you're going to do or to start your day. We do that usually ... we usually are like “okay, what's today like? Let me check the weather” and right there in the weather app, in most cases, depending on which app you're using, you'll see the AQHI reading. And what that will tell you is, it tells you what the air quality is, and that's what the AQI did before, but it puts it in the context of your health. And it's now speaking to specific like subgroups where it's like if you, for example, have asthma or you're in a more sensitive group, such as an elderly group, or you have other pre-existing conditions, then you maybe will want to change some of your behaviors to limit your exposure to outdoor air quality today. Or it'll say “it's fine”. Like, the air, the AQHI is very low. The air quality is good and the index is low, therefore go for it. So, that is the first thing I say is like get the data and then use the data.

And the second thing is tweak your habits. So like, what do I mean by tweak your habits? I mean, like, the things that you're doing. You mentioned, like, exercising or active communing, so let's talk about exercising, for example. Like, if the air quality that day or that hour when you're about to head out and go for a run or jump on your bike - for example in your case, Alex, it sounds like biking - and the AQHI is poor. So, what does that mean, like, if it's really bad? Maybe you should rethink it, and you should exercise indoors.

But let's say it's not like so bad. Well, there's still some consideration there. Choose your route, so that you're not right next to a busy road.

Alex: Sure.

Megan: Yeah, it’s an easy thing to do.

Angelos: Like, why jog ... like, I sometimes wonder when I see people jogging right next to a main road, and it's like ...

Megan: Do you want to yell at them out of the car - “Move to a park!”.

Angelos: No, move to a park, or like we mentioned about how as you move further away from the road the levels generally drop down, at least from that source, so get into, like you know, a tertiary road, like a smaller road. Get into the neighborhoods. Get into a park. Because that's where the air quality is going to be better. And that's just a tweak. Like you ... we want you know people to be fit. It's and, and actually ...

Megan: We want people to be outside.

Angelos: Exactly! So, the message is rarely like “don't exercise”. Usually, it's like ...Yes. You should be active. You should be. You should exercise, but tweak that good habit, so that it's, like, healthy each time you're doing it. And sometimes that tweak means doing it at a different time, or doing it indoors, or some, or at least like don't do it where you know there's busy car exhaust. Same with commuting, when people like walk to work. Like, choose your route. Don't walk the way you would drive, right. Because a) you don't have to. You're walking. That's kind of the joy of it. It's like, you don't have to go down, like you know, whatever the main route is to your office. So, choose the side streets. Go through a park, if it kind of makes sense, because that adds all kinds of additional benefits in addition to better air quality, right. So okay, so get the data, one, tweak your habits according to that data, right, and to your particular health situation and conditions, and, three, talk to your healthcare practitioner. So like, talking to the scientist we won't get you so far.

We’re kind of faking it here...

[Laughter]

Megan: It’s gotten us pretty far.

Alex: Yea, it’s a lot to dig into.

Angelos: But remember, like, this is where you know medical doctors, not just PHDs, but MDs, that's where their expertise lies. So, talk to your healthcare practitioner about ... because they're ... first of all, they have the knowledge more so on the health aspect of impacts of air quality. But also, they treat people as individuals, as patients. They might know the patient history. They have the broader picture. So, the messaging the Health Canada can give can only get you so far.

Your Healthcare practitioner is going to now individualize it to your specific case. So very important to get them involved, especially if you have these pre-existing conditions, or if it's you know an elderly parent, or an aging parent, is to have that conversation about where they live, are there differences in things they can do with their behaviors, and so on, because the healthcare practitioner these days, doctors they know a lot about environmental impacts on health, and they're usually, I find, more than happy to have those conversations and to advise.

And they're also, let's face it, this isn't all just behaviors ... there's medicines that are needed. An asthmatic, right, someone that's diagnosed, like clinically, with asthma, in most cases is going to have a rescue inhaler and possibly even another bronchial dilator for kind of daily use as well, depending on the patient, on the case. And so, where does that come from? That's the doctor that makes that diagnosis and that does that prescription, and it follows that patient through their kind of care and through their life. So, very important. That's kind of the third, the third kind of leg of the stool, is get your your healthcare practitioner involved. So, yeah.

Megan: We love a bulleted or number list here on Healthy Canadians.

Alex: It’s handy.

Megan: Those are some great tweaks.

Alex: That was a heck of a list.

Megan: And I think like a lot of those things most of us are doing intuitively anyway, right. Like you're thinking about putting on the fan when you're cooking, or opening up a window, or like intuitively most people would want to go walk in a green space or away from cars, right. But I think when you give all of that information that you gave, and the rationale behind it, it also helps to solidify why, like, being more mindful is also really important.

Angelos: That's a good word. Mindful. Yes.

Megan: To create those habits and stick to them.

Angelos: Yeah. Exactly. Yeah.

Alex: And I think that, like, really emphasizing the individual need is helpful and interesting too. Because one thing throughout our conversation that struck me is how everything ... like an interconnectedness, right. So, what's happening in your environment can be different and unique, and there's one element that is influencing the air quality in your house that might not be in your neighbor's house. So like, that's really important to understand that too. 

Angelos: And that's why we do the exposure science that that we do, which includes in some cases personal exposures. And we've talked a lot about individual behaviors, and I think that's really important, because ....

Megan: But let's talk about socio-economic factors.

Angelos: But there's more. There’s more. Exactly. So, because that I don't want it to make it sound like “oh, well then it's so easy”, right.  We'll just do these things and we're great.

Megan: We don't all have parks that are accessible to us. Yeah, so why don't you talk about that a little bit?

Angelos: So, in addition to those three things, which are really what can individuals do, this individuals can kind of do but it's more societal, community kind of level. We can change our built environment. We can have more green space, for example. We can have cars not polluting in the first case, so regulating their emissions, for example, or where they can drive and not having them close to people. So, this comes from bigger, bigger kind of grouped levels of decision making that goes beyond the individual. We've talked from a certain perspective about air quality. From a perspective of like being a homeowner in a city. That's not everyone's situation.

Megan: For sure.

Alex: Yeah.

Angelos: Even within a city let's, so even within that group of people who live in a city - homeowner or rent or doesn't matter, just someone living in a city - you have different parts of the city that have different levels of air quality. And so, where do you live in the city? That's going to influence. We've done a lot of studies that we call intra-urban studies. So, we kind of we did one in Calgary with my colleague who led that, and we had you know monitors in 125 locations across Calgary, and into the exurbs of Calgary so that we can do some contrast to the rural. And the goal there is to, kind of, is to quantify, like how much does it differ, your air pollution exposure, from one part of the city to another. What I'm getting at though is that where you live is dependent also on socioeconomic factors, right.

There's the body of research they're called social determinants of health, so we can control our health. There's like genetic determinants, of course, that's what we're born with. And then there's all these like behavioral and kind of activity-based that we've been talking about - you could do this, or you could you make certain choices. But there's these social determinants as well that, they're not really choices. And not again to be dark, but just to say that this is part of exposure science as well, because when we think about improving air quality, we should be thinking about everybody. And in fact, we should be prioritizing, and we tend to, groups and individuals and cohorts and parts of the country where you have these inequities.

So, it's a very important body of work to try to layer on. You look at how a city has different air pollution levels here to there, west to east, but then you put the layer of “okay, what are these additional socio-economic factors?” and suddenly you find, oh, okay, it seems like sometimes, for example, you have people with lower household income that are disproportionately exposed to higher air pollution. And that's not fair. That's a justice issue. And so, how do we change that? You can see that that's not up to the individual, because otherwise people would do it. It's societal. It's broader. And all this, kind of, additional complexity is part of it. So yeah, we have these you know three things we can all do, regardless of what group we're in, but we need to also be considering the societal and advocating for kind of change there and studying those inequities as well. Yeah, and we do.

Megan: Absolutely. Thank you. I think painting that big picture for everyone is super helpful. I think talking to you is very reassuring partly because you are so positive.

[Laughter]

Megan: As a human being. I don't know if people ever tell you that?

Angelos: No, no. I am. I am.

Megan: You have such, like, a positive outlook on all of this, and I love how you always bring up the positive on something that could sound scary to people, if you, you know, overthought it too much. Maybe you could talk a little bit before we close about what are you excited about at work? What are you getting jazzed about on a daily basis?

Angelos: Yeah. Oh, there's a couple of things. Okay, one thing is actually the people. So, when we have studies that are involving participants, or even if it's not participants on an individual basis. But for example, you know, I've led a few studies recently where we will go into a community - and it's a specific community that is of interest, of research interest, and personal interest as well, because they're near a transportation source.

Like for example, we had a study recently in Toronto, near a train yard. So this, and this is just an example. So, as an example, you think “okay, well, some people live near a train yard, some people don't. Is it different near the train yard? Okay. It seems like it might be. Let's better understand what that that means?” Because you've got diesel locomotives that are a very different source from we've been talking about: cars and diesel trucks, and so on.

Now imagine a diesel locomotive. It's in the yard. They tend to run all day and all night. They tend not to be, you know, they don't have like anti-idling, and in most cases for these large locomotives, they have to run. They're working all night long, and they're emitting pollutants, of course. And then, you also have the scraping of the rails, right. And then, you also have what we call co-exposures. You have noise. Noise is a stressor. Noise all the things that we talked about ... Not all of them, but a bunch of these health impacts that we've talked about, that have been associated with exposure to air pollution, some of those for sure are also associated with exposure to noise pollution.

And a lot of times what interest me is that noise and air - you sometimes are exposed at the same time when you're near traffic or you're, you know, if you live near a rail yard, or you're simply walking to work, or even in your car driving you've got the air pollution from the vehicles, but you also have the noise. And those co-stressors are really interesting to me, because some people ... you know, are they additives? Is it just, like okay, it's more, or is it even worse? Is it synergistic? Is it is it much, much more, because the two are experienced together by somebody. So, that area of research - getting into kind of combining the environmental media a little bit - is of kind of personal interest to me, and some of the collaborators I work with. And just doing these studies and getting ... I like sharing the results, right. So getting doing research in a community, but then having a workshop, or you know, a public seminar ...

Megan: To share the information?

Angelos: ... public meeting where we share the findings, right. We kind of ... this is what we published, or this is what we found, and talking to individuals who live there. And fielding their questions, which are amazing questions, because, like, people today ... like almost everything I said today is known by all kinds of people, and I don't mean just other scientists. I mean like it's amazing the people that are interested and motivated. All the information's out there. And people will often come with all kinds of very, very good information. And those ... that engagement though is what I really kind of value and enjoy. So yeah, that's kind of what keeps me kind of fired day to day.  And I like the mystery of it.

Like the last thing I guess like ... I always give long answers, because I'm Greek . We talk.

[Laughter]

Alex: No, it's okay.

Megan: They’re great answers. They’re great answers. 

Angelos: Let's just like say that we should have said it at the beginning. It's obvious with a name like you know Angelo and my last name. But in case it's not, I'm Greek Canadian. We talk.

Megan: No, they’re great stories.

Angelos: Right. Yeah. But the other aspect of what I get excited about is, you know, I work with a set of models called source apportionment models, which you know, all it really means is like you take, you try to separate out when you breathe air and you got all these pollutants in there. How do you know what caused it? Like, how much percent or amount is from cars, and how much is just here because it floated over from the United States? Because it's not that far south of us. And how much is there because of forest fires, right, that drifted over? And so on.

So, there's a way to like tease out - these sources tend to have different signatures - and so, that they call it forensics, environmental forensics, which sounds super exciting.

Alex: It sounds like environmental detective work.

[Laughter]

Megan: Yes. Exactly.

Angelos: It sounds super awesome, I know, I know. It sounds super awesome. It's like, the nitty-gritty of it is just like a lot of work, but it is still, when I step back, I still kind of feel really lucky that I get to work with this type of research and these types of models ,because it is cool. You're taking something invisible, and you're characterizing it, understanding it. You're basically starting to be able to see it. And I find that, kind of like, mystery, like you know, figuring out the mystery part of the science. I find that kind of motivating. So, but really it does come down I think to like finding stuff out, so that we can share it.

Megan: Thank you so much for sharing this information, but also for sharing your passion. Like, I know I feel more interested in air quality.

Alex: It's very obvious how passionate you are.

Megan: But that helps, you know. I think listeners will feel that, and you know, think about how they could be more mindful too about their habits. So, thank you so much for joining us, Angelos.

Angelos: Well, thank you very much for having me.

[Music]

Megan: Thanks for tuning in to Healthy Canadian. If you're watching on YouTube, click the like button, and subscribe to stay up-to-date on all future episodes. Find us wherever you get your podcast, and leave us a review if you like what you heard. For more information on health topics that matter to you visit Canada.ca/health

[Music]

Learn more

• Air pollution and air quality in Canada
• Wildfire smoke, air quality and your health: Overview
• Outdoor air pollution and health: Overview
• Traffic and air quality: Driving change through research
• Breathing easy in port cities: reducing the impact of marine shipping pollution
• Greater Toronto Hamilton Area Transportation Strategy for air quality
• Health impacts of traffic-related air pollution in Canada (PDF, 4.2 MB)
• Exposure to traffic-related air pollution in Canada: An assessment of population proximity to roadways (PDF, 2.2 MB)

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