Estimated health impacts from maritime transport in the Mediterranean region and benefits from the use of cleaner fuels

Ship traffic emissions degrade air quality in coastal areas and contribute to climate impacts globally. The estimated health burden of exposure to shipping emissions in coastal areas may inform policy makers as they seek to reduce exposure and associated potential health impacts. This work estimates the PM2.5-attributable impacts in the form of premature mortality and cardiovascular and respiratory hospital admissions, from long-term exposure to shipping emissions. Health impact assessment (HIA) was performed in 8 Mediterranean coastal cities, using a baseline conditions from the literature and a policy case accounting for the MARPOL Annex VI rules requiring cleaner fuels in 2020. Input data were (a) shipping contributions to ambient PM2.5 concentrations based on receptor modelling studies found in the literature, (b) population and health incidence data from national statistical registries, and (c) geographically-relevant concentration-response functions from the literature. Long-term exposure to ship-sourced PM2.5 accounted for 430 (95% CI: 220–650) premature deaths per year, in the 8 cities, distributed between groups of cities: Barcelona and Athens, with >100 premature deaths/year, and Nicosia, Brindisi, Genoa, Venice, Msida and Melilla, with tens of premature deaths/year. The more stringent standards in 2020 would reduce the number of PM2.5-attributable premature deaths by 15% on average. HIA provided a comparative assessment of the health burden of shipping emissions across Mediterranean coastal cities, which may provide decision support for urban planning with a special focus on harbour areas, and in view of the reduction in sulphur content of marine fuels due to MARPOL Annex VI in 2020. © 2020 The AuthorsThe authors gratefully acknowledge the providers of health data and statistics: Nicosia (M. Athanasiadou, Health Monitoring Unit, Ministry of Health), Brindisi (M. Stafoggia, L. Bauleo, UOC Epidemiologia eziologica ed occupazionale, Dipartimento Epidemiologia del S.S.R. - ASL RME, Regione Lazio, Genoa-Venice (Istituto Superiore di sanità/Health Institute, http://old.iss.it/publ/ ), Misda (S. Distefano, Department for Policy in Health, Health Information and Research), Melilla ( https://pestadistico.inteligenciadegestion.mscbs.es/publicoSNS/Comun/ ), Athens (Hellenic Statistical Authority, http://www.statistics.gr/en/statistics/-/publication/SPO09/2014 ), and Barcelona (Servei Català de la Salut and the Registre de Mortalitat de Catalunya). The data provided by the Servei Català de la Salut and the Registre de Mortalitat de Catalunya, Servei de Gestió I Anàlisi de la Informació per a la Planificació Estratègica, Direcció General de Planificació en Salut, Departament de Salut were processed internally by CSIC. The authors also acknowledge fruitful technical discussions with Dr. A. Patton (Health Effects Institute, HEI). This work was partially funded by AGAUR (project 2017 SGR41 ) and by the Spanish Ministry of Science and Innovation (Project CEX2018-000794-S ). A. Karanasiou acknowledges support received through the Ramón y Cajal program (grant RYC-2014-16885 ) of the Spanish Ministry of Science, Innovation and Universities .Peer reviewe