title: Lean diesel technology and human health: a case study in six Brazilian metropolitan regions.
abstract: OBJECTIVE
  Due to their toxicity, diesel emissions have been submitted to progressively more restrictive regulations in developed countries. However, in Brazil, the implementation of the Cleaner Diesel Technologies policy (Euro IV standards for vehicles produced in 2009 and low-sulfur diesel with 50 ppm of sulfur) was postponed until 2012 without a comprehensive analysis of the effect of this delay on public health parameters. We aimed to evaluate the impact of the delay in implementing the Cleaner Diesel Technologies policy on health indicators and monetary health costs in Brazil.
  
  
  METHODS
  The primary estimator of exposure to air pollution was the concentration of ambient fine particulate matter (particles with aerodynamic diameters <2.5 μm, [PM2.5]). This parameter was measured daily in six Brazilian metropolitan areas during 2007-2008. We calculated 1) the projected reduction in the PM2.5 that would have been achieved if the Euro IV standards had been implemented in 2009 and 2) the expected reduction after implementation in 2012. The difference between these two time curves was transformed into health outcomes using previous dose-response curves. The economic valuation was performed based on the DALY (disability-adjusted life years) method.
  
  
  RESULTS
  The delay in implementing the Cleaner Diesel Technologies policy will result in an estimated excess of 13,984 deaths up to 2040. Health expenditures are projected to be increased by nearly US$ 11.5 billion for the same period.
  
  
  CONCLUSIONS
  The present results indicate that a significant health burden will occur because of the postponement in implementing the Cleaner Diesel Technologies policy. These results also reinforce the concept that health effects must be considered when revising fuel and emission policies.
authors: Laboratório de Poluição Atmosférica Experimental, Departmento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. pauloafonso@lim05.fm.usp.br
authors: Paulo Afonso de
authors: PA
authors: André
authors: Mariana Matera
authors: MM
authors: Veras
authors: Simone Georges El Khouri
authors: SG
authors: Miraglia
authors: Paulo Hilário Nascimento
authors: PH
authors: Saldiva
mesh_terms: D000328:Adult; D017677:Age Distribution; D000393:Air Pollutants / Q000592:standards / Q000633:toxicity*; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002675:Child, Preschool; D058735:Environmental Policy / Q000191:economics; D005260:Female; D005742:Gasoline / Q000633:toxicity*; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000633:toxicity; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D011634:Public Health; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D001335:Vehicle Emissions / Q000633:toxicity*
chemical_list: D000393:Air Pollutants; D005742:Gasoline; D052638:Particulate Matter; D001335:Vehicle Emissions