Outdoor Air and Health: An integrated Atlas to support decision-making and research

Project Rationale

Scientific evidence regarding the impact of air pollution on human health is continuously growing and air quality control is now widely recognized as a key factor in protecting public health.

In Italy, several areas are critical in terms of air pollution and it has repeatedly been subject to infringement procedures by the European Commission due to exceedances of air pollutant limits in certain parts of the country.

However, governance tools and mechanisms that can inform decision-making processes are currently lacking. These should provide organized access to up-to-date, high-quality data on exposure to air pollutants in relation to potential health outcomes, as well as on the impact of mitigation interventions.

Objectives

The project “Outdoor Air and Health: An Integrated Atlas to Support Decision-Making and Research” aims to fill this information gap by providing each Italian region with the capacity to perform a dynamic assessment of the health impacts of air pollution, with the goal of supporting evidence-based decision-making processes.

The project is structured around six specific objectives:

1. Establishment of a steering committee for the interpretation and use of data and results;

2. Development of an integrated Atlas of data and evidence on air pollutants and health outcomes;

3. Research and development activities to enhance air quality monitoring;

4. Impact assessments to quantify the health effects of air pollution;

5. Enrichment of longitudinal studies by the Italian National Institute of Statistics (Istat) based on population censuses and sample surveys;

6. Implementation of participatory initiatives and development of a common language and shared metrics among technical experts and stakeholders.

The project’s core activity, defined under Objective 2, is the development of a national atlas that will systematically compile and analyze evidence on the associations between air quality and health outcomes.

Through Objectives 3 and 4, the project also seeks to promote and systematize monitoring activities focusing on non-conventional pollutants, health outcomes for which the association with air quality is not yet fully established, and interactions between environmental exposures and factors related to clinical frailty and social vulnerability.

In this context, Objective 5 aims to provide a more powerful analytical framework for health impact assessment than those currently available. Specifically, it seeks to combine follow-up data from individuals included in the General Population Census or interviewed in Istat health surveys with estimates of environmental exposure. This integrated approach will enable the evaluation of the long-term effects of air pollution on mortality and morbidity while accounting for socioeconomic conditions, lifestyles, self-perceived health status, chronic diseases, and healthcare utilization.

The project outputs must not only be scientifically robust, accurate, and regularly updated, but also accessible and useful to stakeholders and decision-makers. To this end, Objective 1 includes the establishment of a governance framework to support the generation, processing, interpretation, and dissemination of information.

This objective, as well as the project, is further supported by Objective 6, which aims to foster a common language among stakeholders, increase awareness of the mechanisms linking air pollution and health, and support the training of professionals involved in both the development and dissemination of the atlas.

Duration and Funding

The project “Outdoor Air and Health: An Integrated Atlas to Support Decision-Making and Research” (code PREV-A-2022-12376981) is a four-year project running from January 2023 to 31 December 2026. It falls within Investment Line 1.4 of the “Health, Environment, Biodiversity and Climate” Project under the National Complementary Investment Plan (PNC-E.1) linked to Italy’s National Recovery and Resilience Plan (PNRR) and has received total funding of €2.1 million.

Regions and Institutions Involved

The lead region and project coordinator is Emilia-Romagna Region (Northern Italy). The project also involves three other Regions in Northern Italy (Veneto, Lombardy, and Piedmont), one Region in Central Italy (Lazio), and two regions in Southern Italy (Apulia and Sicily). Across these territories, several operational units contribute to the project, representing expertise in the fields of health, environment, and research, including Local Health Authorities, Regional Environmental Protection Agencies (ARPAs), universities, the Italian National Research Council (CNR). The Institute for Environmental Protection and Research (ISPRA), Istat, and CEA (Center for Environmental Ethics) are also involved in the project.

The initiative also benefits from the specific expertise of ARPA Marche in the fields of environment and health and, with the contribution of ARPA Molise, promotes further investigation of a specific environmental issue affecting that Region.

Contents of the Volume

The volume includes a user guide to the Atlas and five peer-reviewed scientific articles. The guide presents the contents available in the web-based Atlas, together with examples of maps and detailed descriptions of all available query functions.

The five articles describe the process through which the Atlas content, methodological approaches, and communication strategies were developed.

As a preliminary activity, a review of public websites providing interactive maps and infographics on the health impacts of air pollution was conducted. The results of this review are presented in the article “Outdoor Air and Health Atlas” project: Explorative web review and quality assessment of web open data Atlases of air pollution effects on health.

The second and third articles describe the participatory and co-creation process that informed the development of the Atlas content. Concerning technical spects, the article The co-creation process of the “Outdoor Air and Health Atlas” project: A tool to support decisions and research presents the results of the Delphi process used to define the Atlas contents. The process undertaken to identify users’ information needs is described in the article The co-creative process of the “Outdoor Air and Health Atlas” project: stakeholder and user involvement in the definition of information and communication needs, which reports the findings of focus groups and stakeholder interviews.

The article Methods of the “Outdoor Air and Health Atlas”: a national integrated system to assess the health impact of air pollution in Italy outlines the methodological framework adopted to quantify the health effects of air pollution within the Atlas.

Finally, the article Case studies for the utility and validity test of the “Outdoor Air and Health Atlas” project: definition of the conceptual framework describes the development of a conceptual framework and its application to nine case studies conducted across six Italian regions to evaluate the validity and practical utility of the Atlas.