Air pollution is a major, preventable and manageable
threat to people’s health, well-being and the fulfillment
of sustainable development. Air pollution is estimated
to contribute to at least 5 million premature deaths each
year across the world. No one remains unaffected by dirty
air, but the adverse impacts of air pollution fall most heav-
ily upon vulnerable populations, such as children, women,
and people living in poverty — groups to whom States have
special obligations under international human rights law.
Poor air quality threatens human life, population health,
and the future prosperity of children. Air pollution also
threatens the sustainability of the earth’s environment, as
clean air is as vital to life on earth as clean water.
The scientific evidence is unequivocal: air pollution can
harm health across the entire lifespan. It causes disease,
disability and death, and impairs everyone’s quality of life.
It damages lungs, hearts, brains, skin and other organs; it
increases the risk of disease and disability, affecting virtu-
ally all systems in the human body.
The costs of air pollution to society and the economies
of low- and middle-income countries are enormous. These
economic losses are so significant that they can undercut
sustainable development. Economic growth that accepts
air pollution and ignores the public health and environ-
mental impacts is unsustainable and unethical.
Combustion of fossil fuels and biomass is the most sig-
nificant source of air pollution globally. These are also
significant sources of short-lived climate pollutants such
as black carbon, methane, ground-level ozone and the
main sources of CO2 emissions. Many of the solutions to
air pollution issues will also have a positive impact on cli-
mate change mitigation and can make important contri-
butions to meeting a 1.5°C climate target.
Public and private investments in tackling air pollution
are insufficient and do not match the scale of the prob-
lem. Opportunities to create synergies between air pollu-
tion control, climate change mitigation and sustainable
development are many, but have not been fully realized.
Air pollution is a preventable problem. But without
renewed action, air pollution exposure will continue to be
a significant contributor to global mortality. Coupled with
ageing, population growth and urbanization, more people
will suffer and die each year.
Air pollution can be cost-effectively controlled through
a combination of policies, legislation, regulation, stand-
ards and enforcement coupled with implementing new
technologies and increasing social awareness. Air pol-
lution control fosters economic growth and benefits
national economies by averting disease and preventing
The National Academies of Sciences and Medicine of
South Africa, Brazil, Germany and the United States of
America are calling upon government leaders, business
and citizens to take urgent action on reducing air pol-
lution throughout the world — to the benefit of human
health and well-being, to the benefit of the environment
and as a condition towards sustainable development. Air
pollution is a cross-cutting aspect of many UN Sustainable
Our five National Academies of Sciences and Medicine
propose the adoption of a global compact on air pollution
to make air pollution control and reduction a priority for all.
Academy of Science of South Africa, et al. Air Pollution and
Health – A Science-Policy Initiative.
Annals of Global Health
85(1):140, 1–9. DOI: https://doi.org/10.5334/aogh.2656
* Academy of Science of South Africa, ZA
† Brazilian Academy of Sciences, BR
‡ German National Academy of Sciences Leopoldina, DE
§ U. S. National Academy of Medicine, US
‖ U. S. National Academy of Sciences, US
Corresponding academy: German National Academy of Sciences
EXPERT CONSENSUS DOCUMENTS, RECOMMENDATIONS, AND WHITE PAPERS
Air Pollution and Health – A Science-Policy Initiative
Academy of Science of South Africa*
, Brazilian Academy of Sciences†, German National
Academy of Sciences Leopoldina‡, U. S. National Academy of Medicine§ and U. S.
National Academy of Sciences‖
Air pollution is a major, preventable and manageable threat to people’s health, well-being and the fulllment
of sustainable development. Air pollution is estimated to contribute to at least 5 million premature deaths
each year across the world. No one remains unaected by dirty air, but the adverse impacts of air pollu-
tion fall most heavily upon vulnerable populations, such as children, women, and people living in poverty
— groups to whom States have special obligations under international human rights law. The National
Academies of Sciences and Medicine of South Africa, Brazil, Germany and the United States of America
are calling upon government leaders, business and citizens to take urgent action on reducing air pollution
throughout the world — to the benet of human health and well-being, to the benet of the environment
and as a condition towards sustainable development. Air pollution is a cross-cutting aspect of many UN
Sustainable Development Goals.
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy InitiativeArt. 140, page 2 of 9
Air Pollution Aects the Health of Everyone
Clean air is essential for life and health. Air pollution is the
largest environmental cause of disease and early death in
the world today. It has been associated with at least 5 million
premature deaths every year. While air pollution impacts
everyone, the burden of disease is highest among the poor
and the powerless, minorities and the marginalized.
Air pollution affects people from the beginning until
the end of life, causing a wide range of acute and chronic
diseases from the earliest stages of child development to
extreme old age. Particularly sensitive populations include
infants in the womb, children, the elderly, and people
with pre-existing chronic diseases. Almost all organs, sys-
tems and processes in the human body may be impacted:
the lungs, the heart, the brain, the vascular system, the
metabolism, and reproduction.
Air pollution is a major cause of pneumonia, bronchitis
and asthma in infants and children. It slows the growth of
the developing lungs of children and adolescents. It con-
tributes to heart disease including cardiac arrhythmias
and acute myocardial infarction, stroke, cancer, asthma,
chronic obstructive pulmonary disease, diabetes, allergies,
eczema, and skin ageing. There is emerging and growing
evidence that air pollution contributes to dementia in
adults and impacts brain development in children.
Women in low-income countries are disproportionately
affected by exposure to household air pollution from the
use of solid fuels (coal and biomass) for cooking, and they
bear the greatest burden of pollution-related disease.
Women also bear the main burden of caring for other
household members suffering from air pollution-related
The risks of air pollution vary across societies, with vul-
nerability varying among individuals. Factors that affect
individual vulnerability include age, gender, education,
socioeconomic status, location and residence, fuels used
for cooking and heating, and occupation. Biological fac-
tors that increase individual vulnerability include genetic
susceptibility and underlying diseases, such as asthma,
heart disease or diabetes.
Diseases related to air pollution cause productivity
losses that can reduce gross domestic product, cause work
and school absenteeism, and perpetuate existing societal
inequalities. These diseases also result in health care costs
that in rapidly industrializing countries can consume as
much as 7% of national health budgets.
The global economic burden of disease caused by air
pollution (both outdoor and indoor) across 176 countries
was estimated to be USD 3.8 trillion in 2015. The health
and economic benefits of action against air pollution will
generally far outweigh the costs of action.
There is an ethical imperative to work together to pro-
tect everyone against the health risks of air pollution,
which are sustained by the population as an unpaid
adverse consequence of actions by polluters.
Combustion of Fossil Fuels and Biomass is the
Main Source of Air Pollution
The air pollutants of greatest concern for human health
are airborne particulate matter. The unfiltered emissions
of combustion contain significant concentrations of
ultrafine, fine and large particles, including black carbon,
as well as harmful gases.
Air pollution is a complex mixture of different compo-
nents. Levels of fine particles (PM2.5 mass concentration)
along with ozone serve as a robust indicator for regulatory
purposes; with black carbon as a proxy for emissions from
The main sources of combustion-related air pollution
are: A. stationary combustion facilities; B. household
heating and cooking; C. controlled biomass burning
and waste combustion; and D. mobile sources. The rela-
tive importance of these sources varies from country to
A Stationary sources include power plants, manufac-
turing facilities and mining with limited emission
controls. Facilities that burn coal or other poor qual-
ity fuels or that rely on diesel-powered generators
due to a lack of grid reliability are generally the
B Households are an important source of air pollution,
especially in low-income countries that rely on bio-
mass fuels for heating and cooking. They are also a
place where people are greatly exposed.
C Controlled biomass burning sources related to agri-
cultural waste burning and to land and forest clear-
ance are important sources of air pollution in devel-
oping countries. Additional uncontrolled biomass
burning is related to residential and other waste
D Mobile sources of air pollution include petroleum-
powered cars, trucks, and buses; in both the pri-
vate and public sectors. They are the main source
of air pollution in cities. Old and poorly maintained
vehicles that burn low-grade fuels are especially
hazardous. Emissions from ships and aircraft are the
major mobile sources of air pollution near ports and
There are synergies between air pollution control and
climate change mitigation as they share common sources
and, to a large extent, solutions; while the majority of air
pollutants also impact the climate. They also aggravate
each other in multiple ways, e.g. greenhouse gases, such
as methane, contribute to the formation of ground-level-
ozone, and levels of ground-level ozone increase with
rising temperatures and rising temperatures increase the
frequency of wildfires; which in turn further elevate levels
of particulate air pollution.
Black carbon from combustion impacts health but also
regional temperatures, precipitation and extreme weather.
The Arctic and glaciated regions such as the Himalayas are
particularly vulnerable to melting as a result of deposited
black carbon which heats the surface. Changing rain pat-
terns from black carbon aerosol-cloud interactions can
have far-reaching consequences for both ecosystems and
human livelihoods, for example by disrupting monsoons,
and droughts which are critical for agriculture in large
parts of Asia and Africa.
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy Initiative Art. 140, page 3 of 9
Call to Action
The five National Academies of Sciences and Medicine
of South Africa, Brazil, Germany and the United States of
America are issuing a call to action to government leaders,
business and citizens to reduce air pollution in all coun-
tries. This call is underpinned by unequivocal scientific
evidence on the health impacts of air pollution.
Many existing agreements, resolutions, conventions
and initiatives already address aspects of air pollu-
tion. These include the Montreal Protocol, the United
Nations Economic Commission for Europe Convention
on Long-range Transboundary Air Pollution, the WHO
Framework Convention on Tobacco Control, and the
World Health Assembly resolution on the health impact
of air pollution.
Therefore, the Academies propose adoption of a global
compact on air pollution. This would ensure sustained
engagement at the highest level and make air pollution
control and reduction a priority for all. It would also
encourage policymakers and other key partners, includ-
ing the private sector, to integrate emission control and
reduction into national and local planning, development
processes, and business and finance strategies. For such
a process to be successful, there would need to be both
political leadership and partnerships including working
together with existing multinational structures.
The Academies recognize that no perfect solution fits
all situations in all countries. Nevertheless, urgent action
is needed in the following areas:
There are many policy and technological solutions to
reduce harmful products of combustion. For stationary
sources this includes implementation of emission con-
trols for industry and power plants or changing to clean
fuels. For households this includes provision of access to
clean household fuels. For controlled biomass burning
this includes enforcement of rules to eliminate garbage
burning and new agricultural techniques to reduce crop
burning. For mobile sources this includes promoting
and investing in sustainable mass transport and urban
Effective policies and technologies need to be shared.
Where applicable, these strategies should urgently be put
into action in countries at every level of economic devel-
opment across the world. Some solutions enjoy a high
degree of consensus. Where that consensus is lacking or
where the policy choice depends importantly on context
(given the heterogeneity in legal systems, geography, eco-
nomic development stage, sources of pollution), tailoring
of policies is needed, although there are universal actions
that are needed in many parts of the world.
There is a need to collect the success stories in control-
ling air pollution from cities and countries and to extract
lessons from those stories and share those lessons with
countries now beginning to grapple with the issue.
Population exposure is directly related to population
density, pollutant concentration and duration of expo-
sure. In optimizing the costs and benefits of actions taken
to improve air quality priority should be given to the pol-
lution sources where population exposure can be reduced
cost-effectively, and to reducing exposures to the poorest
members of society, recognizing that these two metrics
may at times conflict.
Sufficient monitoring of key pollution metrics, espe-
cially PM2.5 concentrations and population exposures, is
a critical need in all countries. An additional need is for
follow-on statistical analyses that can be used to assess the
success of policy actions.
Co-benefits amongst policy instruments need to be
identified. Priority should be given to policies that maximize
synergies across multiple development goals, including
climate change mitigation and food security. Energy effi-
ciency improvements provide reductions in both CO2 and
harmful products of combustion, as do many other strate-
gies to mitigate climate change such as greater reliance on
renewable energy and electrification of transport.
Efforts need to be made to devise strategies for the
implementation of solutions. These strategies may
include building institutional capacity, improving gov-
ernance, and fostering mechanisms for cross-agency
collaborations and enforcement. Using the tools of risk
assessment and cost-benefit analysis will help in choosing
policy designs and targets. Air pollution control policies
should be designed to deliver cost-effective reductions
in exposures. Ideally, they should also deliver benefits in
other areas, such as climate, or other sectors, such as agri-
culture. Polluters could be incentivized to find the cheap-
est ways of reducing pollution and thereby exposures.
This call for action requires mobilizing finance and
substantial investment in opportunities to reduce air
pollution. Increased funding is also needed for research,
pollution monitoring, infrastructure, management and
control, and stakeholder interaction.
Finally, there needs to be advocacy for action where
citizens are informed and inspired to reduce their air
pollution footprint and advocate for bold commitments
from the public and private sectors.
This statement has first been published in June 2019. It is
available in all official UN-languages and in German and
Portuguese on www.air-pollution.health.
Academies Working Group
Maria de Fatima Andrade, Professor of Meteorology and
Atmospheric Sciences, University of São Paulo, São Paulo,
Paulo Artaxo, Professor of Environmental Physics,
University of São Paulo, São Paulo, Brazil.
Simone Georges El Khouri Miraglia, Associate Professor
and Leader of the Laboratory of Economics, Health and
Environmental Pollution (LESPA), Federal University of
São Paulo, São Paulo, Brazil.
Nelson Gouveia, Associate Professor of Epidemiology,
University of São Paulo, São Paulo, Brazil.
Alan J. Krupnick, Senior Fellow, Resources for the Future,
Washington, DC, U.S.A.
Jean Krutmann, Scientific Director, IUF — Leibniz Research
Institute for Environmental Medicine, Düsseldorf,
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy InitiativeArt. 140, page 4 of 9
Philip J. Landrigan, Professor of Biology and Director,
Program in Global Public Health and the Common Good,
Boston College, Boston, U.S.A.
Kristy Langerman, Senior Lecturer, University of
Johannesburg, Johannesburg, South Africa.
Tafadzwa Makonese, Senior Researcher and Lab Manager,
University of Johannesburg, Johannesburg, South Africa.
Angela Mathee, Director MRC Environment & Health
Research Unit, South African Medical Research Council
(SAMRC), Johannesburg, South Africa.
Stuart Piketh, Professor of Environmental Science,
North-West University, Potchefstroom, South Africa.
Beate Ritz, Professor of Epidemiology and Environmental
Health Sciences, University of California, Los Angeles,
Paulo H. N. Saldiva, Director, Institute of Advanced Studies,
University of São Paulo, São Paulo, Brazil.
Jonathan Samet, Dean, Colorado School of Public Health,
Tamara Schikowski, Head of Research Group
“Environmental epidemiology of lung, brain and skin
aging”, IUF — Leibniz Research Institute for Environmen-
tal Medicine, Düsseldorf, Germany.
Alexandra Schneider, Head of Research Group
“Environmental Risks”, Institute of Epidemiology,
Helmholtz Zentrum München — German Research Center
for Environmental Health, Neuherberg, Germany.
Kirk R. Smith, Professor of Global Environmental Health,
University of California, Berkeley, U.S.A. and Director,
Collaborative Clean Air Policy Centre, Delhi, India.
Claudia Traidl-Hoffmann, Chair and Institute of
Environmental Medicine, UNIKA-T, Technical University
of Munich and Helmholtz Zentrum München — German
Research Center for Environmental Health, Augsburg,
Alfred Wiedensohler, Head of Department for
Experimental Aerosol and Cloud Microphysics, Leibniz
Institute for Tropospheric Research, Leipzig, Germany.
Caradee Wright, Specialist Scientist, South African Medical
Research Council (SAMRC), Parktown, South Africa.
Invited External Experts
David Richard Boyd, United Nations Special Rapporteur on
Human Rights and the Environment, Office of the United
Nations High Commissioner for Human Rights (OHCHR),
Valentin Foltescu, Senior Science and Programme Officer,
Climate and Clean Air Coalition Secretariat, United
Nations Environment, New Delhi, India.
Richard Fuller, Lancet Commission on Pollution and
Health Co-Chair, Pure Earth and Global Alliance on Health
and Pollution, New York, U.S.A.
Dorota Jarosińska, Programme Manager, World Health
Organization, European Centre for Environment and
Health, Bonn, Germany.
Jacqueline Myriam McGlade Former Chief Scientist,
United Nations Environment, Nairobi, Kenya.
Drew Shindell, Duke University Durham, NC, U.S.A. and
Chair of the Scientific Advisory Panel, Climate and Clean
Air Coalition, Paris, France.
Marcos Cortesao Barnsley Scheuenstuhl, Executive
Director of International Affairs, Brazilian Academy of
Sciences (ABC), Rio de Janeiro, Brazil.
John P. Boright, Director of International Affairs, U.S.
National Academy of Sciences (NAS), Washington, DC,
Siyavuya Bulani, Senior Liaison Officer, Academy of
Science of South Africa (ASSAf), Pretoria, South Africa.
Margaret Hamburg, Foreign Secretary, U.S. National
Academy of Medicine (NAM), Washington, DC, U.S.A.
Kathrin Happe, Deputy Head of Department of Science —
Policy — Society, German National Academy of Sciences
Leopoldina, Halle (Saale), Germany.
Jan Nissen, Senior Officer, Department of International
Relations, German National Academy of Sciences Leopol-
dina, Halle (Saale), Germany.
Isabel Scheer, Assistant, Department of International Rela-
tions, German National Academy of Sciences Leopoldina,
Halle (Saale), Germany.
Funding for this article was provided by the US National
Academy of Sciences and the US National Academy of
The authors have no competing interests to declare.
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How to cite this article: Academy of Science of South Africa, Brazilian Academy of Sciences, German National Academy of
Sciences Leopoldina, U. S. National Academy of Medicine and U. S. National Academy of Sciences. Air Pollution and Health – A
Annals of Global Health
. 2019; 85(1):140, 1–9. DOI: https://doi.org/10.5334/aogh.2656
Published: 16 December 2019
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