Indoor Radon: A Public Health Perspective
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1 Indoor Radon: A Public Health Perspective Dr Emilie van Deventer vandeventere@who.int Team Leader, Radiation Programme Department of Public Health, Environmental and Social Determinants ts of Health Ferid Shannoun Department of Public Health and Environment 1 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
2 World Health Organization Function: act as the UN directing and coordinating authority on international health work Objective: attainment by all peoples of the highest possible level of health Definition: "HEALTH is a state of COMPLETE physical, mental and social well-being and not merely the ABSENCE of disease or infirmity" (Constitution, 1948) 2 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
3 Ministries of Health (193 Member States) 6 regional offices 147 country offices IARC (Lyon) 3 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
4 Radiation and environmental health Natural existing exposures e.g. radon Chronic exposures from past accidents/conflicts Chernobyl, DU Emergency prep. & response (accidents, deliberate events) Planned exposures medical, occupational Non-Ionizing (EMF, UV) 4 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
5 Chronology of WHO Actions on radon. 1979: A WHO/EURO working group on indoor air quality first drew attention to the health effects from residential radon exposures 1988: IARC classified radon as a human carcinogen 1993: An international workshop on indoor radon, organized by WHO, considered for the first time a unified approach to control radon exposures and advised on communication of associated health risks 2005: WHO established the International Radon Project to identify effective strategies for reducing the health impact of radon and raise awareness about the consequences of radon exposures 5 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
6 WHO International Radon Project (IRP) Established in 2005: launch and first expert meeting in Geneva Scope: A global project, with key international and national partners Purpose: To reduce the population disease burden due to indoor radon Forum for international scientific and policy exchange: Several meetings with ~ 100 scientists and radon experts 6 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
7 WHO IRP Partners Albania Argentina Austria Belgium Brazil Bulgaria Canada China Czech Republic Finland France Georgia Germany Greece Hungary India Ireland Italy Japan Lithuania Luxembourg Norway Poland Romania Russian Federation Serbia Slovenia South Korea Spain Sweden Switzerland Turkey USA Ukraine United Kingdom 7 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
8 8 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
9 WHO Radon Survey (2007) Survey of WHO Member States (192) 36 countries provided detailed information Information collected on Guidelines Radon levels Measurement, mitigation and prevention Radon risks: communication and awareness-raising 9 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
10 WHO Handbook on Indoor Radon (2009) Introduction 1. Health Effects of Radon 2. Radon Measurements 3. Prevention and Mitigation 4. Cost-Effectiveness 5. Radon Risk Communication 6. National Radon Programmes env/ /en/ 10 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
11 Darby et al Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
12 Background The major recipient of the dose from inhalation of radon and its decay products is the lung 99% of the lung dose arises from radon progeny and not from the gas itself, as almost all of the gas that is inhaled is subsequently exhaled Only a small proportion of inhaled radon gas reaches the blood and other non-respiratory organs Doses to organs other than the respiratory tract are much lower (<100 times) 12 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
13 History of health effects Middle ages (15 th century) 1960: First epidemiological studies of miners 1988: Radon classified as human carcinogen by the WHO International Agency for Research on Cancer (IARC) 1994: Combined analysis of 11 miner studies (Lubin et al.) German uranium miners, 1950s 13 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
14 Residential radon studies In the 1980s and 1990s various epidemiological studies on lung cancer risk from residential radon were conducted in Europe, North America and China Cases-control study design Individual data on residential radon concentrations over the previous 5-35 years Individual data on smoking and other risk factors for lung cancer 14 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
15 Pooled indoor radon studies Large size, because the excess risk is expected to be small pooling of single studies Europe (Darby et al. 2005; 2006) 7,148 cases / 14,208 controls North America (Krewski et al. 2005, 2006) 3,662 cases / 4,966 controls China (Lubin et al. 2004) 1,050 cases / 1,995 controls 15 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
16 Risk of lung cancer by radon 3 Relative Risk (95% CI) 2,5 2 1,5 1 RR = 1 Excess Relative Risk ERR per 100 Bq/m 3 = 8.4 % 95% CI = 3% - 16% 0, Longterm average radon concentration in Bq/m 3 Relationship approximately linear without evidence for threshold [Darby et al. 2005] 16 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
17 Radon and smoking Radon is the second most important cause of lung cancer after smoking in many countries Radon is much more likely to cause lung cancer in people who smoke, or who have smoked in the past, than in lifelong non-smokers However, in many countries it is the primary cause of lung cancer among people who have never smoked 17 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
18 18 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
19 19 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
20 20 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
21 Radon causes lung cancer "Radon is a radioactive gas present in homes Radon is easy to measure "You can easily protect your family from radon 21 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
22 22 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
23 National radon programmes Organize a national radon programme Conduct radon surveys Identify and remediate homes with high radon concentrations Set national reference levels Implement building regulations and building codes Develop risk communication programmes 23 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
24 Some recent National Action Plans. 24 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
25 WHO-IRP Reference level A reference level of 100 Bq/m 3 is justified from a public health viewpoint based on the newest scientific evidence If this level cannot be implemented because of countryspecific factors, the reference level should not exceed 300 Bq/m 3 The decision to set a national reference level needs to take into account the prevailing economical and societal circumstances as well as various national factors such as: Distribution of radon Number of existing homes with high radon concentrations Prevalence of smoking 25 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
26 Since then 26 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
27 Radon in WHO documents Housing and health guidelines Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
28 International Basic Safety Standards (BSS Interim edition, 2011) Protection-and-Safety-of-Radiation-Sources-International-Basic- Safety-Standards-Interim-Edition-General-Safety-Requirements- Part-3 28 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
29 EC Directive 2013/59/EURATOM or the "European BSS" 29 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
30 In the pipeline. ICRP Publication 126 on " Radiological Protection against Radon Exposure" Just approved for publication IAEA Safety Guide on "Protection of the Public against Exposure Indoors due to Radon and Other Natural Sources of Radiation" co-published with WHO ICRP new conversion factors 30 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
31 Conclusion WHO aims to inform and raise public and political awareness about the risks of exposure to radon and to emphasize primary prevention National radon programs have an important role in reducing the burden of radon exposures Collaboration with national and international partners is key to better use resources and to avoid duplication Increased involvement of building professionals is essential, through better communication, training and education 31 Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
32 Welcome to Geneva 23-27June Latin American Symposium on Radon, 19 May 2014, Poços de Caldas, Brazil
33 Obrigada!!
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