Applying policy and health effects of air pollution in South Korea: focus on ambient air quality standards

Jongsik Ha 환경독성보건학회 2014 환경독성보건학회지 Vol.29 No.-

Objectives : South Korea’s air quality standards are insufficient in terms of establishing a procedure for their management. The current system lacks a proper decision-making process and prior evidence is not considered. The purpose of this study is to propose a measure for establishing atmospheric environmental standards in South Korea that will take into consideration the health of its residents. Methods : In this paper, the National Ambient Air Quality Standards (NAAQS) of the US was examined in order to suggest ways, which consider health effects, to establish air quality standards in South Korea. Up-to-date research on the health effects of air pollution was then reviewed, and tools were proposed to utilize the key results. This was done in an effort to ensure the reliability of the standards with regard to public health. Results : This study showed that scientific research on the health effects of air pollution and the methodology used in the research have contributed significantly to establishing air quality standards. However, as the standards are legally binding, the procedure should take into account the effects on other sectors. Realistically speaking, it is impossible to establish standards that protect an entire population from air pollution. Instead, it is necessary to find a balance between what should be done and what can be done. Conclusions : Therefore, establishing air quality standards should be done as part of an evidence-based policy that identifies the health effects of air pollution and takes into consideration political, economic, and social contexts.

Utilization of health insurance data in an environmental epidemiology

Ha, Jongsik,Cho, Seongkyung,Shin, Yongseung The Korean Society of Environmental Toxicology 2015 환경독성보건학회지 Vol.30 No.-

Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future.

Utilization of health insurance data in an environmental epidemiology

Jongsik Ha,Seongkyung Cho,Yongseung Shin 환경독성보건학회 2015 환경독성보건학회지 Vol.30 No.-

Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future.

Effect of Previous-Winter Mortality on the Association between Summer Temperature and Mortality in South Korea

Ha, Jongsik,Kim, Ho,Hajat, Shakoor National Institute of Environmental Health Science 2011 Environmental health perspectives Vol.119 No.4

<P><B>Background</B></P><P>It has recently been postulated that low mortality levels in the previous winter may increase the proportion of vulnerable individuals in the pool of people at risk of heat-related death during the summer months.</P><P><B>Objectives</B></P><P>We explored the sensitivity of heat-related mortality in summer (June–August) to mortality in the previous winter (December–February) in Seoul, Daegu, and Incheon in South Korea, from 1992 through 2007, excluding the summer of 1994.</P><P><B>Methods</B></P><P>Poisson regression models adapted for time-series data were used to estimate associations between a 1°C increase in average summer temperature (on the same day and the previous day) above thresholds specific for city, age, and cause of death, and daily mortality counts. Effects were estimated separately for summers preceded by winters with low and high mortality, with adjustment for secular trends.</P><P><B>Results</B></P><P>Temperatures above city-specific thresholds were associated with increased mortality in all three cities. Associations were stronger in summers preceded by winters with low versus high mortality levels for all nonaccidental deaths and, to a lesser extent, among persons ≥ 65 years of age. Effect modification by previous-winter mortality was not evident when we restricted deaths to cardiovascular disease outcomes in Seoul.</P><P><B>Conclusions</B></P><P>Our results suggest that low winter all-cause mortality leads to higher mortality during the next summer. Evidence of a relation between increased summer heat-related mortality and previous wintertime deaths has the potential to inform public health efforts to mitigate effects of hot weather.</P>

Applying policy and health effects of air pollution in South Korea: focus on ambient air quality standards

Ha, Jongsik The Korean Society of Environmental Toxicology 2014 환경독성보건학회지 Vol.29 No.-

Objectives South Korea's air quality standards are insufficient in terms of establishing a procedure for their management. The current system lacks a proper decision-making process and prior evidence is not considered. The purpose of this study is to propose a measure for establishing atmospheric environmental standards in South Korea that will take into consideration the health of its residents. Methods In this paper, the National Ambient Air Quality Standards (NAAQS) of the US was examined in order to suggest ways, which consider health effects, to establish air quality standards in South Korea. Up-to-date research on the health effects of air pollution was then reviewed, and tools were proposed to utilize the key results. This was done in an effort to ensure the reliability of the standards with regard to public health. Results This study showed that scientific research on the health effects of air pollution and the methodology used in the research have contributed significantly to establishing air quality standards. However, as the standards are legally binding, the procedure should take into account the effects on other sectors. Realistically speaking, it is impossible to establish standards that protect an entire population from air pollution. Instead, it is necessary to find a balance between what should be done and what can be done. Conclusions Therefore, establishing air quality standards should be done as part of an evidence-based policy that identifies the health effects of air pollution and takes into consideration political, economic, and social contexts.

한국의 건강 분야 기후변화적응 연구동향 분석

하종식(Ha, Jongsik) 한국기후변화학회 2014 한국기후변화학회지 Vol.5 No.2

환경영향평가서 위생·공중보건 항목의 위해성 평가 개선 연구

하종식 ( Jongsik Ha ),김경호,김유미,양경,최영웅,양태경 한국환경정책평가연구원 2017 기본연구보고서 Vol.2017 No.-

우리나라의 건강영향평가는 「환경보건법」 제13조에 따라 환경영향평가 대상 사업 중 특정 사업에 대해 개발로 인한 건강영향평가 및 저감방안을 마련하는 형태로 진행되고 있다. 특히 개발사업으로 인한 대기질(악취), 수질, 소음·진동의 영향 및 이로 인한 건강 악영향을 개별로 평가하고 있으며, 이를 근거로 개별 저감방안을 마련하고 있다. 하지만 현행 건강영향평가는 개발사업 주변의 주거 및 활동 인구분포를 감안한 위해성 평가 및 이를 고려한 저감방안 마련 그리고 수용체 중심에서 다양한 매체의 영향을 통합한 영향평가에 한계가 있다. 이에 본 연구의 목적은 환경영향평가서 내 위생·공중보건 항목 평가·작성 시 수용체중심의 매체 통합적 위해성 평가를 위한 방법론적 개선 방안을 제안하는 것이다. 방법론적 개선 방안은 수용체 중심의 매체 통합적 위해성 평가에 대한 개념 및 세부 방법론 정립, 시범적 적용 그리고 이를 바탕으로 현행 위생·공중보건 항목의 작성 매뉴얼 개선(안)을 제안하는 것으로 추진하였다. 본 보고서의 장별 주요 내용은 다음과 같다. 제2장은 환경영향평가와 건강영향평가, 건강영향평가로서의 위생·공중보건 항목의 작성, 위해성 평가에 대한 일반적인 개념 및 그간 위생·공중보건 항목 평가·작성에서의 위해성 평가와 관련한 개선 요구사항, 그리고 이를 바탕으로 향후 개선이 시급히 요구되는 사항에 대해서 정리하였다. 제3장은 수용체 중심의 위해성 평가, 매체 통합적 위해성 평가와 관련한 개념을 문헌 조사하고 이를 바탕으로 본 연구에서의 개념 및 적용 수준을 제시하였다. 이를 근거로 본 연구에서는 실제 적용을 위한 수용체 분포 분석 방법론, 수용체 노출정도를 고려한 위해도 개념 및 기준, 그리고 누적 위해성 평가 수행 가능 검토 및 향후 방향을 제시하였다. 제4장은 수용체 중심의 위해성 평가와 관련한 수용체 분포 분석 및 이를 적용한 위해성 평가의 시범적 분석결과를 제시하였다. 또한 이를 활용한 현행 위생·공중보건 항목의 작성 매뉴얼 개선(안)을 제시하였다. 본 연구는 현행 국내 건강영향평가 수행 시에 활용되는 위해성 평가의 방법론적 개선방안을 제시했다는 데 그 의미가 있다. 이번 연구에서는 개발사업으로 인해 발생하는 유해물질의 확산에 중심을 둔 위해성 평가에서 주변의 수용체 분포 특성을 고려한 위해성 평가로 개선·적용하는 방안을 제시하였으며, 지금까지 매체별로 진행된 건강영향평가에서 수용체 중심의 매체 통합적 위해성 평가로의 시도 및 향후 방향을 제시하였다. 후속 연구로는 환경영향평가서 내 위생·공중보건 항목 평가·작성과 관련한 도구 개발, 이번 연구에서 다룬 톨루엔 및 소음·진동 누적노출로 인한 건강영향 실증연구와 현행 위생·공중보건 항목의 평가 대상 물질에 대한 누적노출과 관련한 건강영향 문헌조사 및 적용방안을 제언하였다. Health Impact Assessment(HIA) in South Korea is conducted as a process for assessing and reducing the health impacts of the project under the 「Environmental Health Act」 Article 13. Individual mitigation plan is being prepared based on evaluation of the adverse effects of air quality (odor), water quality, and noise and vibration caused by development projects. However, current HIA has limitations on the risk assessment and reduction plan considering the distribution of residential and active population around development projects, and also has limitation on the integrated impact assessment combining various health hazards on receptor. The purpose of this study is to suggest methodological improvement measures for the risk assessment in the evaluation of the hygiene and public health items within the receptor-centered environmental impact assessment. The methodological improvement measures include establishing the conceptual and detailed methodology for the receptor-centered risk assessment, applying pilot project, and proposing an improvement reporting manual for the current hygiene and public health items. The main contents of this study are as follows. Chapter 2 describes the environmental impact assessment and evaluation of health impacts as HIA, the general concept of risk assessment, and the improvement requirements related to risk assessment in HIA. The chapter also examines the urgent requirements for future improvement. Chapter 3 presents the concept and application level based on the literature review of the concepts related to the risk assessment of the receptor-centered risk and the integrated risk assessment. Based on these results, this study suggests a methodology of receptors distribution for the actual application, the concept and criteria of risk considering the receptor exposure level, the possibility of performing the cumulative risk assessment and the future direction. Chapter 4 presents the results of the analysis on the receptor distribution related to the receptor-centered risk assessment and the results of the applied pilot risk assessment. Moreover, it suggests the improvement reporting manual for the current HIA. This study is significant in that it suggests an improved methodology for the risk assessment which is currently utilized in the domestic HIA. In this study, an improved and application measure for the risk assessment focusing on the diffusion of harmful substances which are generated by development projects is suggested, considering the distribution characteristics of the surrounding receptors. The study also suggests the future direction of the integrated risk assessment. As a follow-up study, development of the tools related to HIA and researched on the health impacts of the cumulative exposure is suggested.

기후 · 대기 환경정책에 활용하기 위한 건강 위해성 평가 개선 연구 농도반응함수의 국내 표준안을 중심으로

하종식 ( Jongsik Ha ),최영웅,송지윤,정옥진,양태경 한국환경정책평가연구원 2016 기본연구보고서 Vol.2016 No.-

기후변화와 대기오염으로 인한 건강 피해를 정량화하기 위한 건강 위해성 평가는 보다 효율적이고 효과적인 정책을 수립하는 데 있어 필수적인 방법론이다. 이미 건강 위해성 평가는 해외 선진국들에서 기후·대기 환경정책 수립 시에 적극 활용되고 있으며, 국내에서도 『2차 수도권 대기환경관리 기본계획(2015-2024)』 등을 수립하는 데 참조되고 있다. 하지만 건강 위해성이 기후·대기 환경정책 수립에 있어 근거로 활용됨에도 불구하고, 국내의 경우에 이를 위한 평가표준안은 부재한 실정이다. 특히 건강 위해성 평가에 필수 요소인 농도반응함수의 국내 평가표준안 부재는 평가결과에 대한 국민 혼란을 가중시킬 수 있을 뿐만 아니라 관련한 기후·대기 환경정책 필요성에 대한 근거마저도 위협한다. 본 연구의 목적은 기후·대기 노출로 인한 건강 위해성 정도를 합리적인 수준에서 산출하는 건강 위해성 평가의 농도반응함수 국내 표준안을 마련하고, 이를 시범적용해 보는 것이다. 농도반응함수 표준안 마련은 해외 선진국에서의 평가 방법 및 국내 연구 현황을 고려하여 국내 활용성 개선을 소기의 목표로 하였으며, 이에 건강 위해성 평가 개념 및 기후·대기 환경정책 적용 현황 조사, 건강 위해성 평가 방법론 분석, 그리고 농도반응함수 국내 표준안 개발과 시범적용이라는 3가지 사항을 중심으로 연구를 추진하였다. 본 보고서의 장별 주요 내용은 아래와 같다. 보고서 2장에서는 건강 위해성 평가의 개념과 본 연구에서의 범위, 기후·대기 환경정책에서의 활용, 그리고 이를 통한 평가 방법론에 있어 활용상의 문제점 개선 사항 등 시사점을 다루었다. 3장에서는 건강 위해성 평가 방법론에 대한 세부적인 내용으로서 관련 통계모형, 모수, 그리고 방법론의 불확실성을 조사하여 서술하였다. 특히 역학연구에서 건강 위해성 평가의 핵심 요소 중 하나로 볼 수 있는 건강영향함수 및 CR함수를 추정하기 위한 4가지 통계모형들의 이론적 배경 및 논리적 구조를 기술하였으며, 이를 기반으로 건강영향평가 결과물의 의미 등을 정리·서술하였다. 건강 위해성 평가의 불확실성 평가에서는 방법론 차원의 불확실성과 과거 연구 수행상의 불확실성을 조사·정리하여 본 연구에서 제안할 농도반응함수의 표준안 개발 방향에 참조하였다. 4장에서는 농도반응함수의 국내 표준안 개발을 위한 체계적 문헌 고찰과 농도반응함수의 주요 특성을 분석하였으며, 연구의 주요 결과로 국내 표준안을 제시하였다. 문헌조사의 총 대상 기간은 1980년부터 2015년까지로 설정하였고, 체계적 문헌고찰을 통해 총 102건의 학술논문 데이터베이스(DB)를 구축하였으며, 정형화된 논문 선택 과정에 따라 최종 표준안에 활용된 36건의 논문을 선정하였다. 이 과정에서 농도반응함수의 주요 특성을 대기오염물질별, 노출특성별, 그리고 건강영향별 항목으로 구분하여 DB를 구축하였으며, 가능한 범위 내에서 농도반응함수에 대한 메타분석을 실시하였다. 분석 결과를 기반으로 국내 표준안 제시를 위한 국내 농도반응함수를 통합 및 선정하였고, 이에 대한 정책적 활용 방안을 제시함과 더불어 시범분석을 실시하였다. 이번 연구는 건강 위해성 평가의 국내 농도반응함수 표준안 제안과 정책적 활용방안 사항만으로도 그 의미가 있다. 덧붙여 이번 연구를 수행하면서 국내 과거 건강 위해성 평가 연구 보고서를 비교·정리하였으며, 국내 역학연구를 정리하였다. 이를 근거로 건강 위해성 평가를 기후·대기 환경과 관련한 세부적인 정책도구로 활용함에 있어 추가 연구 및 대기오염 관련 국내 역학연구의 방향에 대해 제언하였다. Health Risk Assessment (HRA) is an important tool for measuring the impacts of air pollution which can be useful in designing environmental policies related to climate and atmosphere. In some countries, HRA is already being used widely as an important reference in formulating climate and air policies. Likewise, over the past few years, the South Korean Ministry of Environment has been utilizing HRA in some cases for similar purposes. However, as of now, no nationally defined standard assessment form for HRA exists. More importantly, the absence of standard concentration response functions (CRFs) form naturally leads to incoherence in the assessment results, which in turn could cause confusion amongst policy-makers. The purpose of this study is to tabulate and test a national standard CRFs form, which could be used in HRAs, and would allow researchers and policy-makers to make reasonable estimations on the health risks of exposure to pollution related to climate and atmosphere. This study, with the aim of improving the applicability of existing national CRFs, suggests a standard CRFs form to be used in HRAs, and as a process to derive the final outcome, is divided into three core sections: i) research on HRA concepts, and real world applications on environmental policies concerning climate and atmosphere; ii) analysis of various HRA methodologies and; iii) tabulating and testing the national standard form. In the second part, the paper discusses the concept of HRA, its application in the real world and implications, scope of study, methodologies and inherent problems associated with the field of study, and possibilities for improvement. The third part of the paper discusses in detail the statistical models, parameters, and uncertainties pertaining to methodologies. To be specific, the paper summarizes theories and logics behind 4 statistical models, used to derive CRFs and Health Impact Functions (HIFs), both of which are important aspects of HRAs in epidemiological studies. Information about the methodological and empirical uncertainties was collected and taken into account during the preparation of a standard CRFs form. In the fourth part, the paper suggests a national standard form for selecting CRFs to be used in HRAs for decision-making or other similar purposes. After a thorough and systematic literature review, characteristics of the selected empirical results were carefully analysed and categorized. The empirical results adopted in the study range between the years 1980-2015 and a total of 102 results were selected to be used as a database. Following a standardized screening process, we chose 36 empirical results to be used in the final standard form. This process included categorizing the database results according to the characteristics of pollutants, exposure, and health impacts, and meta-analysis of the base CRFs within possible boundaries. The CRFs included in the final standard form were then ranked according to their applicability in policy design or assessment, and was tested using pre-existing data on pollutant concentrations and exposures. This study is important in that it suggests a standardized national CRFs form with possibilities for application in policy-making. It examines various epidemiological studies in South Korea and comparatively reviews past HRAs. Based on these results, the paper concludes by suggesting further area of study with respect to using HRA as a policy tool for designing and implementing environmental policies concerning climate and atmosphere.

하절기 기온상승으로 인한 사망의 기여부담 변화

하종식(Jongsik Ha) 한국환경보건학회 2012 한국환경보건학회지 Vol.38 No.6

Objectives: Due to global warming resulting from climate change, there has been increasing interest in the relationship between temperature and mortality. These temperature-related deaths depend on diverse conditions related to a given place and person, as well as on time. This study examined changes in the impact of high temperatures on death in summer, using the effect and burden of elevated temperatures on deaths in Seoul and Daegu. Methods: A Poisson regression model was used to estimate short-term temperature effects on mortality. Temperature-related risks were divided into three time periods of equal length (1996-2000, 2001-2005, and 2006-2010). In addition, in order to compare the impact of high temperatures on deaths, this study calculated the proportion of attributable deaths to population, which simultaneously considers the threshold and the slope above the threshold. Results: The effect and burden of high temperatures on deaths is high in Daegu. However, the impact (i.e. the effect and burden) of elevated summer temperatures on deaths has declined over the past 15 years. Sensitivity analyses using alternative thresholds show the robustness of these findings. Conclusion: This study suggests that the attributable burden of high temperatures on deaths to be more plausible than relative risk or threshold for comparing the health impact of high temperatures across populations. Moreover, these results contain important implications for the development or the adjustment of present and future strategies and policies for controlling the temperature-related health burden on populations.

건강영향평가 분야에서의 위해소통을 위한 리스크 테이블 제작 연구

하종식 ( Jongsik Ha ),이영수 ( Youngsoo Lee ),강유진 ( Eugene Kang ) 한국환경정책평가연구원 2016 한국환경정책평가연구원 기초연구보고서 Vol.2016 No.-

건강영향평가는 「환경보건법」 제13조에 따라 환경영향평가제도 틀 내에서 위생·공중보건 항목의 영향평가로 수행되고 있다. 국내 건강영향평가는 개발사업이나 중요한 개발 프로그램의 시행에서 발생할 수 있는 영향을 특정 인구집단의 건강에 한정하여 평가하고, 관련 개발사업이나 프로그램의 조정 또는 대책을 마련토록 하는 수단으로 정의할 수 있다. 이러한 과정에서 건강영향평가 결과에 대한 지역주민과의 위해소통은 환경영향평가를 통해 개발사업의 긍정적 영향의 최대화 및 부정적 영향의 최소화라는 목적을 위한 지역주민의 의견수렴 과정에서 핵심적인 고려사항이 될 수 있다. 하지만 건강영향평가의 위해소통과 관련한 소통목적, 소통대상, 소통경로 등은 비교적 구체적으로 정의되는 반면에 건강영향평가와 관련한 위해정보는 구체화되지 못한 상황이다. 이에 본 연구는 현행 건강영향평가 위해정보로서 Risk Table을 제작하고, 적절한 의미 해석 및 시범적용 등을 통하여 활용방안을 제시하는 것이 목적이다. 먼저 위해소통 개념 및 건강영향평가에서의 위해소통 현황을 조사·정리하였다. 이후 건강영향평가에서 적용 가능한 위해정보로서 Risk Table을 제작하고자, 건강영향평가에서의 정량적 평가방법론 및 국내외 Risk Table 사례를 바탕으로 비교 가능성, 불확실성 등의 한계를 고려한 제작원칙을 마련 하였다. 최종적으로 본 연구에서 Risk Table은 건강영향평가의 정량적 평가에 대한 비교 척도로서 10^-7부터 10^-3까지 17개 리스크 요인들로 구성되도록 하였으며, 인포그래픽스를 통해 일반인에게 친숙도가 높고 이해가 쉽도록 하였다. 제언으로서 본 연구는 제안한 Risk Table이 건강영향평가 위해소통의 유용한 도구로 활용될 수 있도록, Risk Table 자체의 향후 개선방향과 Risk Table을 활용하는 건강영향평가 위해소통 절차의 개선방향을 제시하였다. In South Korea, under article 13 of the Environmental Health Act, Health Impact Assessment (HIA) is being carried out to examine the category of hygiene and public health within the framework of the environmental impact assessment. Thus, HIA can be defined as a means to modify development projects or programs by measuring the negative health impacts that these programs may impose on certain groups of population. Risk Communication (RC) of the assessment results with the local community and the public is an essential part of HIA that seeks to maximize positive impacts and minimize negative impacts of development projects. The aim, subject, and method of RC are relatively well-defined within the context of HIA. However, as it stands, guidelines regarding risk information is quite insufficient and discrete. This study aims to develop a Risk Table, which provides risk information in the current HIA of South Korea, analyze its implications, and suggest its application in, for instance, pilot tests. The paper begins with information about the most recent concepts of RC and its usage in HIA. In the next part, principles to be adopted for the preparation of the Risk Table are defined by considering quantitative methodologies of HIA and by reviewing national and international case studies on producing Risk Tables. The final outcome of the study consists of a Risk Table with 17 selected risk factors within the risk boundary of 10^-7 and 10^-3. The Risk Table is expected to be used as a relative index for quantitative assessments in HIA, and is presented as infographics to allow better RC with the public. The study concludes by suggesting possible ways to improve the risk table itself, and also the application of the Risk Table as a means for RC in HIA.