Maximizing health benefits and minimizing inequality: incorporating local-scale data in the design and evaluation of air quality policies.

The U.S. Environmental Protection Agency undertook a case study in the Detroit metropolitan area to test the viability of a new multipollutant risk-based (MP/RB) approach to air quality management, informed by spatially resolved air quality, population, and baseline health data. The case study demonstrated that the MP/RB approach approximately doubled the human health benefits achieved by the traditional approach while increasing cost less than 20%--moving closer to the objective of Executive Order 12866 to maximize net benefits. Less well understood is how the distribution of health benefits from the MP/RB and traditional strategies affect the existing inequalities in air-pollution-related risks in Detroit. In this article, we identify Detroit populations that may be both most susceptible to air pollution health impacts (based on local-scale baseline health data) and most vulnerable to air pollution (based on fine-scale PM(2.5) air quality modeling and socioeconomic characteristics). Using these susceptible/vulnerable subpopulation profiles, we assess the relative impacts of each control strategy on risk inequality, applying the Atkinson Index (AI) to quantify health risk inequality at baseline and with either risk management approach. We find that the MP/RB approach delivers greater air quality improvements among these subpopulations while also generating substantial benefits among lower-risk populations. Applying the AI, we confirm that the MP/RB strategy yields less PM(2.5) mortality and asthma hospitalization risk inequality than the traditional approach. We demonstrate the value of this approach to policymakers as they develop cost-effective air quality management plans that maximize risk reduction while minimizing health inequality.