Mediterranean Health Interview Surveys Studies: long term exposure to air pollution and health surveillance

Reference: LIFE12 ENV/IT/000834 | Acronym: LIFE MED HISS



Knowledge of the long-term effects of air pollution on human health has been improving over the last ten years, mainly as a result of efforts to design and carry out large-scale epidemiological studies. However, long-term data remains unavailable for Mediterranean countries, which are different to continental and northern European areas. These countries experience higher air temperatures, have different particle composition and are subject to Saharan dust. In previous short-term effect studies in Europe, a clear north-south gradient was observed in mortality associated with particulate matter (PM-10), with Mediterranean cities more at risk than north European cities. Better knowledge of the long-term effects of air pollutants, including fine and coarse particles, is needed to contribute to environmental and health policy, to update and support EU legislation in this field, to plan mitigation actions and to implement effective, practical measures.


The LIFE MED-HISS project was a demonstration project involving partners in Spain, France, Italy and Slovenia. Its main objectives were to:

  • Update and develop EU environmental policy and legislation with improved data on the adverse health effects of air pollution (PM10, PM2.5, NO2 and O3);
  • Consolidate the knowledge base for the development, assessment, monitoring and evaluation of environmental policy and legislation, by setting up a European surveillance system of long-term effects of air pollution; and
  • Assess the feasibility of the adopted approach in other European countries.


    The LIFE MED-HISS project has consolidated the knowledge base for the development, assessment, monitoring and evaluation of environmental policy and legislation, by setting up a surveillance system of long-term air pollution effects, based on retrospective cohorts recruited using data of National Health Interview Surveys (NHIS) already available in the four countries (France, Italy, Slovenia and Spain). In particular, the project showed that when data allowing effective linkage between air pollution and mortality/hospitalisation is available, existing resources can be more easily used to obtain results that are comparable to those obtained in larger and more expensive cohort studies.

    A key result was the adoption of a low-cost approach which could be very useful for policy-makers in charge of public health surveillance. The project moreover developed tools and methods for the evaluation of the long-term effects of environmental exposure, and demonstrated the feasibility and reproducibility of the approach in other settings, locations and study periods.

    Specific results of the project include:

  • An evaluation of the long-term effects of PM10, PM2.5, and NO2 on mortality and hospitalisation, considering natural causes, cancer, cardiovascular and respiratory diseases and asthma. Extensive data on air pollutants and meteorological parameters was collected, and differences in the distribution of PM fractions across locations were found, also factoring in main meteorological patterns. Such data facilitates health effects estimates;
  • A database and a report describing the evaluation of the Health Impact Assessment of air pollution in four EU countries - Italy, France, Slovenia, and Spain – with the composition of particulate matter monitored in several locations; and
  • A protocol for statistical data analysis to examine effects on mortality and morbidity, consisting of a validated procedure describing the steps to be followed for cohort recruitment;
  • The method allows analyses to be carried out of the short-term health effects in multiple cities by pooling of country-specific results and exploring potential sources of heterogeneity across countries;
  • A database and a report providing estimates of the long-term effects of PM10, fine and coarse particles on mortality and morbidity for cardiovascular and respiratory diseases, and describing different exposure assessment experiences in the four European countries, with an assessment of inter-country variations; and
  • An evaluation of the feasibility of a simplified approach for air pollution exposure estimation, which could be used in future epidemiological studies.
  • T

    he project is relevant for local policy action, and direct contacts with a variety of local, national, and European stakeholders and NGOs were established in order to discuss the main results of the project and organise future common initiatives. As regards concrete policy implications, the project beneficiary was directly involved in drafting the Air Quality Regional Plan of Piedmont Region.

    Long-term impacts of the project included:

  • Implementation, updating and development of EU environmental policy and legislation on air quality: the project’s results offer clear indications for more adequate air quality legislation at EU level (including a robust scientific evidence of the long-term health effects of particles);
  • Integration of the environment into other policies: the results of the project confirmed that choices at environmental level have health consequences, and that environmental policy could have impact on various economic sectors, including the car industry – i.e. the design and production of low polluting vehicles – the production of heating systems using less fossil fuels and biomasses, and the control of emissions and targeted energy use in heavy industry; and
  • Global applicability and reproducibility of demonstrated technology: the same multi-disciplinary methodology as the one developed in MED-HISS could be used in the future by other projects/studies in the same area to evaluate the beneficial effects of new policies (if any), in other geographical areas to evaluate the effects of air pollution due to various sources, and in other contexts to evaluate the effects of other environmental exposures.
  • Additionally, specific activities were carried out to facilitate the transfer of the project’s methodology to other contexts (with protocols for data collection, statistical analysis, reports to stakeholders). Statistical analysis procedures were selected with the view to ensuring the maximum degree of transferability. The reliability and homogeneity of data collection and analysis procedures were reached by applying methods easily transferable to the scientific or technical departments of environmental/health agencies.

    Further information on the project can be found in the project's layman report and After-LIFE Communication Plan (see "Read more" section).


    Reference: LIFE12 ENV/IT/000834
    Acronym: LIFE MED HISS
    Start Date: 01/07/2013
    End Date: 30/09/2016
    Total Budget: 1,598,283 €
    EU Contribution: 790,788 €
    Project Location:


    Legal Status: PAT
    Address: VIA PIO VII 9, 10135, TURIN, Italia
    Contact Person: Ennio Cadum
    Tel: 39011196880760

    LIFE Project Map



    • Air pollutants
    • Human health protection
    • Risk assessment and monitoring


    • monitoring system
    • survey
    • air pollution
    • environmental impact assessment
    • environmental law
    • public health
    • human exposure to pollutants


    • Directive 2008/50/EC - Ambient air quality and cleaner air for Europe (21.05.2008)


    Name Type
    Centre de Recerca en Epidemiologia Ambiental (CREAL), Spain Participant
    Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Italy Participant
    Université Pierre et Marie Curie, France Participant
    ASL TO3, Italy Participant
    National Institute of Public Health, Slovenia Participant