Transportation Research Part D 40 (2015) 155–165

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Transportation Research Part D

journal homepage: www.elsevier.com/locate/trd

Health externalities of ship air pollution at port – Piraeus port

case study
Stefanos D. Chatzinikolaou ⇑, Stylianos D. Oikonomou, Nikolaos P. Ventikos
Laboratory for Maritime Transport, School of Naval Architecture and Marine Engineering, National Technical University of Athens, Greece

a r t i c l e i n f o a b s t r a c t

Article history: This paper is employing the well-known methodology of impact pathway approach to
Available online 25 September 2015 assess the external costs in human health from ship air pollution at port areas. The passen-
ger port of Piraeus, Greece is the scenery of the study. Piraeus port is in the vicinity of the
Keywords: greater Athens metropolitan area where almost half of the country’s population lives.
Ship air emissions at port Hence, this port is the central hub of the Greek coastal passenger ship system which con-
Health external cost nects the islands of the Aegean Sea with land and is characterized by heavy ship traffic. The
case study presented in this paper assesses the annual external cost in human health from
air emissions produced by all passenger ships and cruise ships calling the port of Piraeus.
Health cost from ships at port has been estimated at both local (Athens metropolitan area)
and regional level (entire territory of Greece). Results show that higher costs occur at the
local level. The dominant pollutants creating this cost are particulate matter (PM2.5, and
PM10). Overall, the results indicate that the health impact of Piraeus’s passenger port emis-
sions is not negligible; however the cost of PM10 is considerably lower than the corre-
sponded cost deriving from the land based industries of the Athens regional area for
which comparison has been available.
Ó 2015 Elsevier Ltd. All rights reserved.

Introduction and literature review

Air pollution has become a major threat to human health and the environment. The World Health Organisation (WHO)
considers the exposure to air pollution as the world’s largest single environmental health risk, causing 1 in 8 of total global
deaths, or 7 million deaths in year 2012 (WHO, 2014).
Maritime transport activities are contributors to air pollution problems especially with respect to air emissions resulting
from the combustion process of marine engines. Hence, since the large portion of international ship traffic occurs not far
from the coastline (Endresen et al., 2003) air pollution from ships can also have impacts on human health. There is evidence
showing that particulate matter (PM) emissions from shipping are responsible for approximately 60,000 premature deaths
annually (Corbett et al., 2007), most of them occurring near populated coastlines in East Asia, South Asia, and Europe. In
response, the International Maritime Organisation (IMO) has recently adopted specific regulations for reducing air pollution
in specific areas around the world (the so-called Emission Control Areas, ECA). European counties have also put in force
specific measures for the reduction of ship air pollution in harbor areas.
Air pollution constitutes one of the most significant environmental problems for Athens, the capital city of Greece, with
its 4 million inhabitants and over 9000 industrial installations (Mirasgedis et al., 2008). Piraeus port is one important instal-
lation in the Athens area, since it constitutes the largest port infrastructure of Greece with multiple functions (bulk cargo,

⇑ Corresponding author.

http://dx.doi.org/10.1016/j.trd.2015.08.010
1361-9209/Ó 2015 Elsevier Ltd. All rights reserved.
156 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165

container, passenger and cruise terminals) and heavy sea traffic which has increased through the years owing mainly to an
expansion of the containerships terminals but also to the continuous growth of cruise ship market in recent years and a non
declining need for coastal passenger transportation due to the unique landscape of the country with hundreds of islands in
the Aegean Sea. Especially the passenger port facilities are very close to Piraeus city which is built-in the greater Athens area.

Ship emission and their impacts

Air emissions of shipping may be grouped, subject to their general impact, to: emissions causing air pollution and emis-
sions contributing to the climate change phenomenon. The first category includes emissions of SOx, NOx, PM, CO and VOC
whereas the second one includes CO2, HCFC, and CH4. The focus of this study is on the health impacts of ship air emissions.
Ship emissions having human health impacts may be further categorized in primary and secondary pollutants. The primary
pollutants are emissions that have immediate effects in the proximity of the emission source (local effects). Secondary pol-
lutants derive when emissions are transformed during their distribution in the atmosphere to produce other pollutants. This
transformation is subject to chemical reactions and may take place far away (some hundreds of kilometers) from the emis-
sion source.

Particulate matter
Particulate matter (PM) emissions represent the most significant air pollutant of shipping which creates health damage
costs (Rabl, 2001). PM emissions are found in various types and components, however they are usually divided in PM2.5 and
PM10 subject to the particle size (diameter). There is sufficient evidence that there exist a link between particle levels and
hospital admissions and emergency room visits, even death from heart or lung diseases (Denisis, 2009). WHO (2014) con-
cluded that ‘‘the evidence for a causal link between PM2.5 and adverse health outcomes in humans have been confirmed
and strengthened and, thus, clearly remain valid”. PM emissions are mostly primary pollutants and their impact on human
health is experienced in the proximity of the source hence they are important contributors to local impacts.

Nitrogen emissions
Most nitrogen oxides (NOx) emitted in the form of NO which is rapidly oxidized in the atmosphere to NO2 and then to nitric
acid and other nitrates. NO is usually considered harmless as it is a reducing and not an oxidizing agent (Rabl, 2001). NO2 pri-
mary affects the respiratory system (EEA, 2013). Short-term exposure to NO2 can change the lung function in sensitive pop-
ulation groups and long-term exposure can lead to more serious effects such as increased susceptibility to respiratory
infection (EEA, 2013). Epidemiological studies have shown that long-term exposure to NO2 is possibly associated with an
increase of symptoms of bronchitis in asthmatic children (EEA, 2013). NO2 is also correlated with other pollutants (especially
PM), making it difficult to distinguish the effects of NO2 from those of other pollutants (EEA, 2013). There isn’t sustainable
evidence for direct health impacts of NO2 except maybe for morbidity of children and therefore it seems that the main damage
of NOx is the result of its second pollutants, O3 and nitrates (Rabl, 2001). Nitrate particles can be transported long distances by
winds and inhaled deep into people’s lungs increasing illness and premature death (from asthma and bronchitis).

Sulfur emissions
Oxidation of SO2 creates acidic deposition (Holleman and Wiberg, 2001) called acid rain, which can cause adverse effects
on aquatic ecosystems in rivers and lakes, damage to forests, and acidification of soils (EEA, 2013). With regard to health
impacts sulfate particles which are secondary pollutants of SO2 can be transported long distances by winds and inhaled deep
into people’s lungs increasing illness and premature death from heart and lung disorders, such as asthma and bronchitis.
Moreover, SO2 as a primary pollutant can contribute to respiratory problems, particular in children and elderly, and aggra-
vate existing heart and lung diseases (Denisis, 2009). According to epidemiological studies SO2 can affect the respiratory sys-
tem and lung functions, and cause irritation of the eyes (EEA, 2013). Overall, sulfur oxides as well as nitrogen oxides have
some immediate effects on human health but can harm human health even at the regional level since they are transformed
into secondary pollutants (sulfates and nitrates respectively) far away from the emission source.

Other ship air pollutants

Apart from the aforementioned emissions there are other ship air pollutants having health effects, such as carbon monox-
ide (CO), volatile organic compounds (VOC) and ozone (O3). For CO, there is evidence that its direct impacts appear to be
statistically significant, however the estimated damage costs are low, even for the transport sector (Rabl, 2001). VOC contain
hydrocarbons (HC), some of which are carcinogenic. Other harmful components of VOC are the polycyclic aromatic hydro-
carbons (PAHs) which are ubiquitously distributed human mutagens and carcinogen (Choi et al., 2006). Recent epidemiolog-
ical studies have proven that daily exposures to ozone increases mortality and respiratory morbidity rates and other health
effects from long-term exposures, however these results are not conclusive and will need further confirmation (WHO, 2008).
In response to the effects of ship air pollution, the International Maritime Organisation (IMO) which is the formal regu-
lating body of the maritime sector has recently adopted (2010 and 2011) specific regulations for reducing air pollution from
PM (IMO, 2015) as well as sulfur and nitrogen oxides in specific areas around the world, the so called Emission Control Areas
(ECA). European counties have also put in force specific measures for the reduction of ship air pollution in harbor areas
(European Commission, 2015).
 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165 157

Emissions external cost

One usual way to express the impact of air pollution is by using the external cost concept. External cost occurs when the
activities of one group of persons have an impact (which is not fully accounted or compensated for) on another group
(ExternE, 2005). Monetary estimates for the corresponding external costs are required for the final results. Apart from air
pollution other external cost drivers of shipping are: discharges into the sea (marine pollution), solid and liquid waste gen-
eration onboard, resource consumption (e.g. use of fuels), and ship recycling.
For the case of shipping, air pollution is the external cost driver creating major impacts to human health and environmen-
tal impacts (ExternE, 2005). Since there is no consensus yet, on external cost values created by emissions contributing to
climate change, this study has chosen not to deal with climate change external costs.
Various studies dealt with estimations of external cost of ship emissions. ExternE (2005), estimated the external cost of
air pollution from shipping in the port of Venice at 24 million Euros. Friedrich and Bickel (2001) estimated the external cost
of inland shipping for Netherlands and found at 321 million Euros and the cost in euro per 100 vkm due to airborne emis-
sions of container ships on different routes: In Piraeus 9300 €/vkm, in Iraklio 900 €/vkm., in the Aegean Sea 1000 €/vkm, in
the trip Felixstowe–Rotterdam 1200 €/vkm and in the trip Rotterdam–Felixstowe 1050 €/vkm. CAFÉ project series (2005),
calculated for the European Seas the external cost of air pollution from maritime transport at 45 billion euro. Maffii et al.
(2007) estimated the total external costs of air pollution for 2006 for the EU ocean-going fleet and the world fleet and found
them to be 40 billion euro and 184 billion euro respectively. In an external cost estimation for a specific case of a container
ship sailing between Rotterdam and Gothenburg, Lee et al. (2010) found that the round trip would create 399,498 euro of air
pollution external costs. Nash et al. (2008) calculated the air pollution costs of inland water transport for two selected tra-
jectories on the Rhine and the Danube and found that environmental costs range between 0.17 and 0.41 cent per tkm. For the
inland waterway transport from Basel to Rotterdam, Schmid et al. (2001) estimated for a vessel carrying 200 TEU the exter-
nal costs of air pollution depending the upstream–downstream shipping and the results are for air pollution down-
stream:18.54 €/LU (loading unit), upstream: 4.95 €/LU. Gallagher (2005) analyzed the total emissions and the economic
costs of shipping emissions in the United States from 1993 to 2001 and found that the economic costs of SOx pollution range
from $697 million to $3.9 billion and the costs from NOx emissions are $3.7 billion. Berechman and Tseng (2012) estimated
the costs of key exhaust pollutants from shipping in the port of Kaohsiung in Taiwan to be 119.2 million $.
The rest of the paper is developed as follows:
First, the methodology and tools used in this study are briefly described (Methodology and tools) followed by the descrip-
tion and results of the case study (‘Description of case study’ and ‘Results of the case study’ accordingly). Finally, the ‘Con-
clusions’ section presents the main conclusions from the work and makes suggestions for improvements and further
research on the topic in the future.

Methodology and tools

The impact pathway approach

The study uses the impact pathway approach (IPA), which is a well-known method for calculating the external costs of air
pollutants and it was initially adopted in a series of research projects under the title ExternE. These projects were funded by
the European Commission, Directorate-General (DG) Research, and have focused on the assessment of external impacts and
associated costs resulting from the supply and use of energy (Friedrich and Bickel, 2001). The IPA is an analytical ‘‘bottom up”
method starting from the micro-structure of the pollutant and going all the way up to the affected receptors. Although it is a
relatively complex method it offers increased reliability and accuracy in the results compared with other frequently used
methods. The basic steps of the IPA method are:

1. Source emission estimations: Identification and quantification of emissions in the source (emissions inventory).
2. Atmospheric dispersion modeling: A calculation of pollutant concentrations in the affected area is taking place. The area
analysis is divided into local scale and regional scale. In the regional scale secondary pollutants are also taken into
account. Different plume models may are used (i.e. Gaussian for local and Eulerian or Lagrangian trajectory models for
regional scale).
3. Impact assessment: Dose–Response functions (DRF) also known as Exposure-Response functions (ERF) are used for the
quantification of impacts. ERF correlate the quantity of a pollutant that affects a receptor to the physical impact on this
receptor (ExternE, 2005). Quantification of damage requires the corresponding ERF to be known. They can be linear or
non-linear and may contain thresholds (critical loads) (Friedrich and Bickel, 2001).
4. Quantification of external cost: The monetary valuation step has the goal to account for all relevant costs, market and
non-market (ExternE, 2005). With regard to the health impacts the market costs include the cost of medical treatment
for the illness, wage and productivity losses where the non-market costs take into account the willingness-to-pay
(WTP) to avoid the risk of pain and suffering. Air pollution damage costs are dominated by non-market goods, especially
mortality.
158 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165

Atmospheric dispersion

The atmospheric dispersion of air pollutants is modeled using a specific algorithm which models the dispersion of pollu-
tants in a 3D Gaussian plume and predicts local changes in air pollution concentrations using local meteorological data. The
Gaussian plume is a model that is detailed enough in the description of turbulent diffusion and vertical mixing but neglects
chemical reactions and therefore it represents an economic way for predicting the concentration of the primary pollutants at
the local scale (ExternE, 2005). For the dispersion of pollutants at the regional level the Simple Uniform World Model
(SUWM) is used. However, as already stated, the secondary pollutants are formed a long distance away from the emission
source thus local conditions have little influence on the damage costs, making the SUWM more accurate for regional health
impact assessment.

Exposure response functions – receptors

Exposure-Response functions (ERF) are used for the quantification of emissions impacts on human health. The ERF is the
response to a given exposure of a pollutant in terms of atmospheric concentration, rather than an ingested dose (Friedrich
and Bickel, 2001). ERF can be linear or non-linear and may contain thresholds (critical loads). They correlate the quantity of a
pollutant that affects a receptor to the physical impact on this receptor. Quantification of damage requires the corresponding
ERF to be known, thus the ERF are central ingredients in the impact pathway analysis. Epidemiological studies help scientists
to study the human health and its related illnesses, ultimately leading to the formation of the ERF. Epidemiological studies
have the advantage of studying the response under realistic conditions; thus they assess the effects of pollutants on real pop-
ulations of people. Their disadvantage is that these functions are being updated in rare intervals of ten years or more. The ERF
functions used in this study are included in the specialized software which has been used in the case study (ERF values are
provided in Table A1 of Appendix A).

Damage cost calculations

Air pollution health costs are estimated with the so-called Willingness to Pay (WTP) approach, reflecting the society’s
willingness to pay in order to protect the valued items of Life and Health. The damage cost is calculated at local and regional
level. The damage cost estimation is made by using the QUERI model (incorporated in the RiskPoll software), which inte-
grates the Gaussian dispersion model for the local scale and the SUWM for the regional scale calculations. Local impacts
are determined using a 5 by 5 km gridded population distribution (entered by the user manually or using a Gaussian-
shaped function). The regional impact is based on the SUWM evaluation, reduced by the SUWM local damage cost estimate
to avoid double counting the local impact.

Tools

The RiskPoll software is a suite of impact assessment programs designed to estimate health and environmental risks from
toxic metals and airborne emissions. This software has been selected mainly because it employs the IPA with an extensive
list of ERFs. Furthermore the software is free, transparent, relatively simple to use, requires low amount of input data and
provides results that are reasonably accurate & reliable as determined by comparison with results calculated by sophisti-
cated environmental impact assessment codes.

Description of the case study

The goal of the case study is to apply the IPA methodology in order to estimate the external health costs of primary pol-
lutants (PM2.5, PM10 NOx and SOx) and secondary pollutants (nitrates and sulfates) emitted from coastal passenger ships and
cruise ships calling the port of Piraeus in one year. The port of Piraeus is the largest port in Greece and holds the seventh
highest passenger traffic in Europe, servicing about 9 million passengers annually (European Commission, 2013). The pas-
senger terminal is part of the city of Piraeus while the freight terminals of the port of Piraeus are not urbanized
(Tzannatos, 2010). According to the 2011 census, Piraeus is the fourth largest municipality in Greece, with a population
of 163,688 people.
The methodology that has been used is the impact pathway approach – IPA and the calculations have been made using
the RiskPoll software. Table 1 shows the overview of the case study.

Input data – assumptions

Emissions data
Using an in-port ship activity-based methodology, Tzannatos (2010) estimated the emissions of 124 cruise and 59 coastal
passenger ships for the passenger port of Piraeus during a twelve-month period (2008–2009). The ship operations consid-
ered are: the berthing time, the manoeuvring time and finally the arrival and departure time (one hour each). The total
NOx emissions were 1790 tons, and SO2 and PM2.5 emissions were 722 and 99 tons, respectively. Emissions of PM2.5 are
 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165 159

Table 1
Case study overview.

Case study: external health cost of coastal ferries and cruise ships at Piraeus port
Time period
Ships included
Emissions Inventory
Pollutants into consideration
Meteorological data
Range of local area examined
Range of regional area examined
Local population data (400 cells)
Exposure-Response functions (ERF)
Unit damage costs
(Annual estimation – port stay, maneuvering)
124 cruise and 59 coastal passenger ships
Based on Tzannatos (2010)
PM10, PM2.5, NOx, SO2, nitrates and sulfates
National Observatory of Athens
56 km (metropolitan Athens area)
+500 km (Greece)
ELSTAT (Hellenic Statistical Authority)
ExternE (values as of September 28th 2004)
ExternE (€)

calculated as a portion of PM10. More explicitly, it is considered that the emission of PM2.5 is equal to 0.92  PM10 (EPA, 1999,
2009) and PM2.5 ERF values are the PM10, values scaled by 1.67 (Spadaro, 2003a,b,c; Rabl, 2001; Friedrich and Bickel, 2001;
ExternE, 2005; Dockery and Pope, 1994).

Meteorological data
Detailed meteorological data are needed for the local level pollutant dispersion modeling. Hourly values of wind speed,
direction and ambient temperature for the period 4/6/2012–30/11/13 (19 months in total) recorded in the nearest meteo-
rological station (located 5 km from Piraeus port) were obtained from the National Observatory of Athens.

Pollutants and emissions source characteristics

It is assumed, that there is constant emission source located at the center of the port, which is reasonable since the port
has non-stop passenger traffic throughout the year and the berthing locations are spaced 500 m or less from each other
inside a 2 by 2 km cell. It is assumed that the stationary source is in the middle of that cell. This assumption is required
in order to use the Gaussian model of the QUERI algorithm (stationary source with a constant emission through the year).
Finally, typical values of a passenger/cruise ship have been used as input at the optional data: stack height, stack diam-
eter, flow velocity and gas temperature.
Emission rate (tons/yr) and deposition velocity (cm/s) are inputs for the dispersion calculations. The deposition velocity is
an indicator of the atmospheric pollutant removal rate. Emission rate was taken from Tzannatos (2010). Mean values for Eur-
ope were used for the deposition velocity (k) as reported by Spadaro (2003a,b,c).
The emission source coordinates are: 23.63706 (longitude) and 37.94222 (latitude). The optional data values of the emis-
sions source which are required by the software typical values were chosen:

1. Stack height: 25 m, (General Arrangement of typical coastal passenger vessel)

2. Stack diameter: 5 m, (General Arrangement of typical coastal passenger vessel)
3. Flow velocity: 10 m/s, (EIA report, 2013)
4. Gas temperature: 600 K, (Kyrtatos, 1993)

Receptors (at local and regional level)

The distribution of inhabitants per square cell (400 cells in total) was set up using available population census released by
the Hellenic Statistical Authority (ELSTAT, 2001, 2011). The local domain has an effective radius of 56 km equivalent to a
square-shaped (cells) domain, with sides equal to 100 km as proposed by Spadaro (2003a,b,c). This area covers approxi-
mately the entire greater metropolitan Athens area where almost half of the country’s population is located. The regional
radius is 500 km, which covers a large portion of the total territory of Greece.

Exposure response functions (ERF) and monetary values

The ERF (values as of September, 2004) and unit damage costs (in Euro) of the ExternE project were used for emissions of
PM10, SO2 and NOx. The ERF values for PM2.5 have been calculated as function of the PM10 values (according to ExternE). The
health impacts implemented at that these ERF functions are:

1. Mortality, expressed in Years of Lost Life (YOLL), per person per lg/m3 of pollutant per yr. As the ERF for long-term
mortality are not available for SO2, only the acute mortality contribution is calculated.
2. Chronic bronchitis, expressed in cases chronic bronchitis per person per lg/m3 of pollutant per yr.
3. Net restricted activity days (net RADs), expressed in net RADs per person per lg/m3 of pollutant per yr. It is assumed
that the days in hospital for respiratory admissions (RHA), congestive heart failure (CHF) and cerebrovascular condi-
tions (CVA) are also restricted activity days (RAD).
4. Respiratory hospital admissions (RHA), expressed in RHA per person per lg/m3 of pollutant per yr.
160 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165

5. Cerebrovascular hospital admissions, expressed in cerebrovascular hospital admissions per person per lg/m3 of pollu-
tant per yr.
6. Chronic cough in children, expressed in cases chronic cough in children per person per lg/m3 of pollutant per yr.
7. Congestive heart failure in elderly, expressed in cases congestive heart failure in elderly per person per lg/m3 of pollu-
tant per yr.
8. Cough in asthmatic adults, expressed in cases cough in asthmatic adults in elderly per person per lg/m3 of pollutant
per yr.
9. Bronchodilator use in asthmatic adults, expressed in cases Bronchodilator use in asthmatic adults per person per lg/m3
of pollutant per yr.
10. Lower respiratory symptoms in asthmatic adults, expressed in cases lower respiratory symptoms in asthmatic adults
per person per lg/m3 of pollutant per yr.
11. Cough in asthmatic children, expressed in cases cough in asthmatic children in elderly per person per lg/m3 of pollutant
per yr.
12. Bronchodilator use in asthmatic children, expressed in cases bronchodilator use in asthmatic children per person per
lg/m3 of pollutant per yr.
13. Bronchodilator use in asthmatic children, expressed in cases bronchodilator use in asthmatic children per person per
lg/m3 of pollutant per yr.
14. Lower respiratory symptoms in asthmatic children, expressed in cases lower respiratory symptoms in asthmatic children
per person per lg/m3 of pollutant per yr.

Results of the case study

Concentration contours

Concentration contours per air pollutant were developed with the help of the concentration profiles. The contours illus-
trate how the pollutants are spread within the local domain. The red color indicates the area with the highest concentrations
(see Figs. 1 and 2).
Even the highest concentrations of air pollutants in the case study are well below the maximum permitted limit values for
Greece (for example: the limit value for PM2.5 is 26 lg/m3 which is an order of magnitude higher than the highest value cal-
culated in the case study). The location where pollutants reach their highest concentration is at the area of Neo Ikonio, Per-
ama (coordinates from emission source (X, Y) = ( 2.5 km, 2.5 km).

External (health) cost

The case study has estimated the external cost in health resulting from air pollutants emitted by coastal passenger ships
and cruise ships calling at the port of Piraeus in one year (2008–2009). The total external cost in health is 26.314.700 Euro,
which is the integration of the external costs of all air primary and secondary pollutants under examination: PM10, PM2.5,
NOx, SO2, sulfates and nitrates.
Results per pollutant are provided in the following figure. The estimated health cost is not negligible at the local level
(Athens metropolitan area). Particles cause the higher external health cost, 61% of the total (PM2.5 is the most important con-
tributor). NOx emissions have no external cost in health as primary pollutants but are the primary contributors to health cost
at the regional level (overall they are responsible for 25% of the total health cost) (see Fig. 3).
Mortality cost (which illustrates the willingness to pay for protecting the value item of life), dominate the overall health
cost. The presentence of mortality’s and morbidity’s costs in the overall external cost are 67% and 33% respectively. The pol-
lutant with the biggest mortality external cost as well as the biggest morbidity external cost is PM2.5 (6.5 m € and
324.000,00 € respectively). Nitrates and sulfates have only regional impacts, while PM10, PM2.5 and SO2 have both local
impacts and regional impacts. However the contribution of particles to external health cost is observed mainly at the local
level (85% of their external cost is local). Analytic results of the case study are provided in Table A2, of Appendix A.

Health cost per person

Fig. 4 shows the yearly external cost in health per receptor at local and regional level. It is reminded that since the local
radius is 56 km the local area is covering approximately the entire greater Athens metropolitan area (3.8 million inhabitants
according to country’s census 2011). Moreover the regional level (radius over 500 km) corresponds to roughly the entire
Greek territory. Port emissions of PM2.5 add 2.2 € to the annual external (health) cost of an Athens inhabitant, emissions
of PM10 add 1.4 € and emissions of SO2 add another 0.1 €. The total annual external cost in health for one Athens inhabitant
due to port emissions is nearly 4 €. It is once more stated that nitrates and sulfates are not contributors to the aforemen-
tioned cost since their total impact occurs at the regional level. At the regional level, nitrates represent the largest contribut-
ing category of air pollutants with an annual external cost of 1 € per person followed by the sulfates 0.4 €. The total external
cost per year in health outside the greater Athens area is 1.7 € per inhabitant.
 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165 161

Fig. 1. PM2.5 – dispersion at the local domain.

Fig. 2. SO2 – dispersion at the local domain.

12000000
9749000 PM10
10000000
External cost (€)

PM2.5
8000000
6374000 6639000
S02
6000000

4000000 Sulfates
2959000
2000000 Nitrates
593700
0

Fig. 3. Results of health external cost per pollutant.

162 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165

3€
PM10

External cost (€/person)

2.2
2€ PM2.5

1.4
SO2
0.95
1€
Sulfates
0.4
0.1 0.1 0.2 0.01
Nitrates
0€
Local Regional

Fig. 4. External cost per person (local and regional level).

Health cost range – uncertainty

There is a great uncertainty in the cost evaluations as the following Fig. 5 shows (an order of magnitude is a typical range
in the final health cost estimation). Uncertainty is due to data, modeling and ethical variations. However, the results are still
useful especially for comparison (i.e. cost of different sectors) and decision making purposes. The uncertainty of economic
valuation for Mortality and for all the pollutants is shown in Fig. 5 below.

Valuation – comparisons with other sectors

In order to obtain an evaluation of the results derived from the present work a comparison has been made with the indus-
trial sector.
The comparison made is between external costs of PM10 emissions of the present study and the corresponded costs of the
industrial sector in the metropolitan area of Athens. According to the Institute for Environmental Research and Sustainable
Development (IERSD) (2007), the air pollution impacts of the land based industrial activity in the Athens metropolitan area
are mostly attributed to emissions of PM10. These emissions are responsible for about half of the externalities created from
human activities in the region, reaching a total annual cost of 94.3 m €. Since the aforementioned study refers only to emis-
sions of PM10, only this emission type is used as the comparison basis. It is noted that the results of the present study also
depict that this particular type of port emissions is one of the main contributor to external cost creation (the other one is
PM2.5). The comparison unit is the annual external (health) cost of PM10 per person living in Athens area. According to

Mortality (YOLL) - Range

€10,00,00,000.00
External cost (€)

€1,00,00,000.00

€10,00,000.00

€1,00,000.00
PM10 Sulfates Nitrates SO2 PM2.5

Fig. 5. External cost per person (local and regional).

30 €
25.9
Annual Health Cost

25 €
Industrial
(€/person)

20 € sector
15 €
Shipping
10 € sector
5€ 1.4
0€
PM10

Fig. 6. Comparison of annual health cost per person in Athens.

 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165 163

the IERSD study, the industrial sector corresponds to a 25.9 annual external cost per Athens inhabitant, while the passenger
port emissions of Piraeus correspond to a 1.4 € (which is 5.7 percent of the industrial sector cost). It is however noted that the
industrial sector in Athens according to IERSD includes nearly 9000 land based industries while the emissions data in the
port of Piraeus derive from a data sample of only 183 ships. This indicates that the external cost obtained in the present study
is not negligible and should be interpreted accordingly by decision makers. The results of the comparisons made in are
shown in Fig. 6.

Conclusions

Large portion of air pollution external cost falls in the category of health cost. This study has developed a methodology for
making assessments of health cost from ships at port. The methodology is based on the Impact Pathway Assessment (IPA),

Table A1
ERF and monetary values.

Pollutant ERF name Endpoint type ERF Unit cost (€)

PM10 Mortality YOLL Long-term mortality 3.90E 04 50,000
PM10 Chronic Bronchitis Morbidity 3.92E 05 169,300
PM10 Net restricted activity days Morbidity 1.98E 02 110
PM10 Respiratory hospitalization Morbidity 2.07E 06 4320
PM10 Cerebrovascular hospitalization Morbidity 5.04E 06 16,730
PM10 Chronic cough, children Morbidity 4.14E 04 240
PM10 Congestive heart failure, elderly Morbidity 2.59E 06 3260
PM10 Cough, adult asthmatics Morbidity 9.39E 03 45
PM10 Bronchodilator use, adult asthmatics Morbidity 4.56E 03 40
PM10 Lower respiratory symptoms, adult asthmatics Morbidity 1.70E 03 8
PM10 Cough, children asthmatics Morbidity 1.87E 03 45
PM10 Bronchodilator use, children asthmatics Morbidity 5.43E 04 40
PM10 Lower respiratory symptoms, children asthmatics Morbidity 7.20E 04 8
Sulfates Mortality YOLL Long-term mortality 3.90E 04 50,000
Sulfates Chronic Bronchitis Morbidity 3.92E 05 169,300
Sulfates Net Restricted activity days Morbidity 1.98E 02 110
Sulfates Respiratory hospitalization Morbidity 2.07E 06 4320
Sulfates Cerebrovascular hospitalization Morbidity 5.04E 06 16,730
Sulfates Chronic cough, children Morbidity 4.14E 04 240
Sulfates Congestive heart failure, elderly Morbidity 2.59E 06 3260
Sulfates Cough, adult asthmatics Morbidity 9.39E 03 45
Sulfates Bronchodilator use, adult asthmatics Morbidity 4.56E 03 40
Sulfates Lower respiratory symptoms, adult asthmatics Morbidity 1.70E 03 8
Sulfates Cough, children asthmatics Morbidity 1.87E 03 45
Sulfates Bronchodilator use, children asthmatics Morbidity 5.43E 04 40
Sulfates Lower respiratory symptoms, children Morbidity 7.20E 04 8
Nitrates Mortality YOLL Long-term mortality 1.95E 04 50,000
Nitrates Chronic Bronchitis Morbidity 1.96E 05 169,300
Nitrates Net Restricted activity days Morbidity 9.89E 03 110
Nitrates Respiratory hospitalization Morbidity 1.035E 06 4320
Nitrates Cerebrovascular hospitalization Morbidity 2.52E 06 16,730
Nitrates Chronic cough, children Morbidity 2.07E 04 240
Nitrates Congestive heart failure, elderly Morbidity 1.30E 06 3260
Nitrates Cough, adult asthmatics Morbidity 4.69E 03 45
Nitrates Bronchodilator use, adult asthmatics Morbidity 2.28E 03 40
Nitrates Lower respiratory symptoms, adult asthmatics Morbidity 8.48E 04 8
Nitrates Cough, children asthmatics Morbidity 9.34E 04 45
Nitrates Bronchodilator use, children asthmatics Morbidity 2.71E 04 40
Nitrates Lower respiratory symptoms, children asthmatics Morbidity 3.60E 04 8
SO2 Mortality YOLL Short-term mortality 5.34E 06 75,000
SO2 Respiratory hospitalization Morbidity 2.40E 06 4320
PM2.5 Mortality YOLL Long-term mortality 6.51E 04 50,000
PM2.5 Chronic Bronchitis Morbidity 6.55E 05 169,300
PM2.5 Net Restricted activity days Morbidity 3.31E 02 110
PM2.5 Respiratory hospitalization Morbidity 3.46E 06 4320
PM2.5 Cerebrovascular hospitalization Morbidity 6.42E 06 16,730
PM2.5 Chronic cough, children Morbidity 6.91E 04 240
PM2.5 Congestive heart failure, elderly Morbidity 4.33E 06 3260
PM2.5 Cough, adult asthmatics Morbidity 15.68E 03 45
PM2.5 Bronchodilator use, adult asthmatics Morbidity 7.62E 03 40
PM2.5 Lower respiratory symptoms, adult asthmatics Morbidity 2.84E 03 8
PM2.5 Cough, children asthmatics Morbidity 3.12E 03 45
PM2.5 Bronchodilator use, children asthmatics Morbidity 9.07E 04 40
PM2.5 Lower respiratory symptoms, children asthmatics Morbidity 12.02E 04 8
164 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165

Table A2
Case study results.

Pollutant Exposure response function Impact Damage cost Lower cost Upper cost Local impact (%)
PM10 Mortality YOLL 8.50E+01 4.25E+06 1.42E+06 1.28E+07 84.8
PM10 Chronic Bronchitis 8.54E+00 1.45E+06 4.83E+05 4.35E+06 84.8
PM10 Net Restricted activity days 4.32E+03 4.75E+05 1.58E+05 1.43E+06 84.8
PM10 Respiratory hospitalization 4.51E 01 1.95E+03 6.50E+02 5.85E+03 84.8
PM10 Cerebrovascular hospitalization 1.10E+00 1.84E+04 6.13E+03 5.52E+04 84.9
PM10 Chronic cough, children 9.02E+01 2.17E+04 7.23E+03 6.51E+04 84.8
PM10 Congestive heart failure, elderly 5.64E 01 1.84E+03 6.13E+02 5.52E+03 84.8
PM10 Cough, adult asthmatics 2.05E+03 9.21E+04 3.07E+04 2.76E+05 84.8
PM10 Bronchodilator use, adult asthmatics 9.94E+02 3.98E+04 1.33E+04 1.19E+05 84.8
PM10 Lower respiratory symptoms, adult asthmatics 3.71E+02 2.96E+03 9.87E+02 8.88E+03 84.8
PM10 Cough, children asthmatics 4.08E+02 1.83E+04 6.10E+03 5.49E+04 84.8
PM10 Bronchodilator use, children asthmatics 1.18E+02 4.73E+03 1.58E+03 1.42E+04 84.9
PM10 Lower respiratory symptoms, children asthmatics 1.57E+02 1.26E+03 4.20E+02 3.78E+03 84.8
Sulfates Mortality YOLL 3.95E+01 1.97E+06 6.57E+05 5.91E+06 (0)
Sulfates Chronic Bronchitis 3.97E+00 6.72E+05 2.24E+05 2.02E+06 (0)
Sulfates Net Restricted activity days 2.00E+03 2.20E+05 7.33E+04 6.60E+05 (0)
Sulfates Respiratory hospitalization 2.10E 01 9.05E+02 3.02E+02 2.72E+03 (0)
Sulfates Cerebrovascular hospitalization 5.10E 01 8.53E+03 2.84E+03 2.56E+04 (0)
Sulfates Chronic cough, children 4.19E+01 1.01E+04 3.37E+03 3.03E+04 (0)
Sulfates Congestive heart failure, elderly 2.62E 01 8.55E+02 2.85E+02 2.57E+03 (0)
Sulfates Cough, adult asthmatics 9.50E+02 4.28E+04 1.43E+04 1.28E+05 (0)
Sulfates Bronchodilator use, adult asthmatics 4.62E+02 1.85E+04 6.17E+03 5.55E+04 (0)
Sulfates Lower respiratory symptoms, adult asthmatics 1.72E+02 1.38E+03 4.60E+02 4.14E+03 (0)
Sulfates Cough, children asthmatics 1.89E+02 8.52E+03 2.84E+03 2.56E+04 (0)
Sulfates Bronchodilator use, children asthmatics 5.50E+01 2.20E+03 7.33E+02 6.60E+03 (0)
Sulfates Lower respiratory symptoms, children asthmatics 7.29E+01 5.83E+02 1.94E+02 1.75E+03 (0)
Nitrates Mortality YOLL 8.86E+01 4.43E+06 1.48E+06 1.33E+07 (0)
Nitrates Chronic Bronchitis 8.90E+00 1.51E+06 5.03E+05 4.53E+06 (0)
Nitrates Net Restricted activity days 4.49E+03 4.94E+05 1.65E+05 1.48E+06 (0)
Nitrates Respiratory hospitalization 4.70E 01 2.03E+03 6.77E+02 6.09E+03 (0)
Nitrates Cerebrovascular hospitalization 1.14E+00 1.91E+04 6.37E+03 5.73E+04 (0)
Nitrates Chronic cough, children [Dockery 1989] 9.40E+01 2.26E+04 7.53E+03 6.78E+04 (0)
Nitrates Congestive heart failure, elderly 5.90E 01 1.92E+03 6.40E+02 5.76E+03 (0)
Nitrates Cough, adult asthmatics 2.13E+03 9.58E+04 3.19E+04 2.87E+05 (0)
Nitrates Bronchodilator use, adult asthmatics 1.04E+03 4.14E+04 1.38E+04 1.24E+05 (0)
Nitrates Lower respiratory symptoms, adult asthmatics 3.85E+02 3.08E+03 1.03E+03 9.24E+03 (0)
Nitrates Cough, children asthmatics 4.24E+02 1.91E+04 6.37E+03 5.73E+04 (0)
Nitrates Bronchodilator use, children asthmatics 1.23E+02 4.92E+03 1.64E+03 1.48E+04 (0)
Nitrates Lower respiratory symptoms, children asthmatics 1.64E+02 1.31E+03 4.37E+02 3.93E+03 (0)
SO2 Mortality YOLL 7.72E+00 5.79E+05 1.45E+05 2.32E+06 85.5
SO2 Respiratory hospitalization 3.47E+00 1.50E+04 5.00E+03 4.50E+04 85.5
PM2.5 Mortality YOLL 1.30E+02 6.50E+06 2.17E+06 1.95E+07 84.8
PM2.5 Chronic Bronchitis 1.31E+01 2.22E+06 7.40E+05 6.66E+06 84.8
PM2.5 Net Restricted activity days 6.61E+03 7.27E+05 2.42E+05 2.18E+06 84.8
PM2.5 Respiratory hospitalization 6.91E 01 2.99E+03 9.97E+02 8.97E+03 84.8
PM2.5 Cerebrovascular hospitalization 1.28E+00 2.15E+04 7.17E+03 6.45E+04 84.8
PM2.5 Chronic cough, children 1.38E+02 3.31E+04 1.10E+04 9.93E+04 84.9
PM2.5 Congestive heart failure, elderly 8.65E 01 2.82E+03 9.40E+02 8.46E+03 84.8
PM2.5 Cough, adult asthmatics 3.13E+03 1.41E+05 4.70E+04 4.23E+05 84.8
PM2.5 Bronchodilator use, adult asthmatics 1.52E+03 6.09E+04 2.03E+04 1.83E+05 84.8
PM2.5 Lower respiratory symptoms, adult asthmatics 5.67E+02 4.54E+03 1.51E+03 1.36E+04 84.8
PM2.5 Cough, children asthmatics 6.23E+02 2.81E+04 9.37E+03 8.43E+04 84.8
PM2.5 Bronchodilator use, children asthmatics 1.81E+02 7.25E+03 2.42E+03 2.18E+04 84.8
PM2.5 Lower respiratory symptoms, children asthmatics 2.40E+02 1.92E+03 6.40E+02 5.76E+03 84.8

which has been used by the ExternE, a series of research projects funded by the European Commission, Directorate-General
(DG) Research.
The overall external cost in health caused by air pollutants emitted from all coastal passenger ships and cruise ships in the
port of Piraeus is of 26 million €. Health costs have been calculated at the local (greater Athens area) as well as the regional
level (entire territory of Greece). The higher health costs occur at the local level and are caused by particulate matter emis-
sions. It can be stated that the health impact of ship port emissions in Piraeus port is not negligible although it remains much
less than the corresponding costs originated from the industrial sector.
There exists great uncertainty (data, modeling, ethical) in the estimation of this external cost. Methodological uncertain-
ties involve mainly the accuracy of the dispersion models used. Therefore, a new dispersion model explicitly developed for
air pollutants emitted by the ship funnel taking into also account analytical meteorological data and most importantly the
ship movements (manoeuvring in port or traveling in open sea) would increase the validity of impact assessment and
 S.D. Chatzinikolaou et al. / Transportation Research Part D 40 (2015) 155–165 165

corresponding results. Finally, it would be interesting to explore possible changes in the external health costs from the appli-
cation of different technologies (like cold ironing) or emission reduction solutions for shipping.
Future improvements that would increase the validity of health cost estimation in shipping mainly concern the treatment
of data and methodological uncertainties. Detailed and robust inventories of ship emissions at port might be available by the
use of ship movements inside the port area (i.e. utilizing the Automatic Identification System, AIS). Accurate emission factors
are also needed which would reflect the actual loading condition of ship engines, the real operating profiles (time at port, at
manoeuvring, sailing time) and the type and quality of fuels used.
In concluding, it is noted that health impact assessments illustrate a sound basis for decision support related to environ-
mental issues and should be further exploited. The interest in health cost estimates is expected to grow in the future since, at
least at European level, there are official strategies promoting the introduction of measures to internalise the external cost of
transport into market transactions (which might force modal shift to sea in the future).

Appendix A

Table A1 shows details of the ERF that were used in this study.
Table A2 shows the analytic results of the case study (impact and damage cost per pollutant).

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