ArticlePDF Available

Air Pollution and Health – A Science-Policy Initiative



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 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 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 Development Goals.
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
productivity losses.
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
Development Goals.
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:
* 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
Leopoldina (
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 fulllment
of sustainable development. Air pollution is estimated to contribute to at least 5 million premature deaths
each year across the world. No one remains unaected 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 benet of human health and well-being, to the benet 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 Aects 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
ill health.
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
worst offenders.
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
Author Information
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,
Aurora, U.S.A.
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),
Geneva, Switzerland.
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 Statement
Funding for this article was provided by the US National
Academy of Sciences and the US National Academy of
Competing Interests
The authors have no competing interests to declare.
Further Readings
Integrated Assessments
1. European Environment Agency. Air Quality
in Europe — 2018. EEA Report. DOI: https://doi.
2. International Energy Agency. Energy and Air Pollu-
tion. World Energy Outlook Special Report. Paris; 2016.
EnergyandAirPollution.pdf (accessed 21 Nov 2018).
3. Landrigan PJ, Fuller R, Acosta NJR, et al. The
Lancet Commission on pollution and health. The
Lancet. 2018; 391: 462–512. DOI: https://doi.
4. United Nations Environment Programme.
Healthy Environment, Healthy People. Thematic
Report, Ministerial Policy Review Session. 2016 UNEA
2 Inf. Doc 5.
(accessed 10 May 2019).
5. World Health Organization. Burden of disease
from the joint effects of household and ambient
Air pollution for 2016. Geneva; 2018. https://www.
results_May2018.pdf (accessed 9 Nov 2018).
Health Eects
6. Atkinson RW, Kang S, Anderson HR, et al.
Epidemiological time series studies of PM2.5
and daily mortality and hospital admissions: A
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy Initiative Art. 140, page 5 of 9
systematic review and meta-analysis. Thorax.
2014; 69: 660–5. DOI:
7. Balakrishnan K, Dey S, Gupta T, et al. The
impact of air pollution on deaths, disease burden,
and life expectancy across the states of India: The
Global Burden of Disease Study 2017. The Lancet
Planetary Health. 2019; 3: e26–39. DOI: https://doi.
8. Bowe B, Xie Y, Li T, et al. The 2016 global and
national burden of diabetes mellitus attributable
to PM2.5 air pollution. The Lancet Planetary Health.
2018; 2: e301–12. DOI:
9. Brook RD, Rajagopalan S, Pope CA, et al. Par-
ticulate matter air pollution and cardiovascular
disease: An update to the scientific statement
from the American Heart Association. Circulation.
2010; 121: 2331–78. DOI:
10. Burke KE. Mechanisms of aging and development —
A new understanding of environmental damage to
the skin and prevention with topical antioxidants.
Mechanisms of Ageing and Development. 2018;
172: 123–30. DOI:
11. Calderón-Garcidueñas L, Calderón-Garcidueñas
A, Torres-Jardón R, et al. Air pollution and your brain:
What do you need to know right now. Primary Health
Care Research & Development. 2015; 16: 329–45. DOI:
12. Chen H, Kwong JC, Copes R, et al. Exposure to
ambient air pollution and the incidence of demen-
tia: A population-based cohort study. Environment
International. 2017; 108: 271–7. DOI: https://doi.
13. Cohen AJ, Brauer M, Burnett R, et al. Estimates
and 25-year trends of the global burden of disease
attributable to ambient air pollution: An analysis
of data from the Global Burden of Diseases Study
2015. The Lancet. 2017; 389: 1907–18. DOI: https://
14. Contreras ZA, Heck JE, Lee PC, et al. Prenatal air
pollution exposure, smoking, and uterine vascular
resistance. Environ Epidemiol. 2018; 2. DOI: https://
15. Dadvand P, Figueras F, Basagaña X, et al. Ambient
Air Pollution and Preeclampsia: A Spatiotemporal
Analysis. Environ Health Perspect. 2013; 121: 1365–
71. DOI:
16. Dimakakou E, Johnston H, Streftaris G, et al.
Exposure to Environmental and Occupational Par-
ticulate Air Pollution as a Potential Contributor to
Neurodegeneration and Diabetes: A Systematic
Review of Epidemiological Research. International
Journal of Environmental Research and Public Health.
2018; 15: 1704. DOI:
17. Ding A, Yang Y, Zhao Z, et al. Indoor PM2.5 expo-
sure affects skin aging manifestation in a Chinese
population. Sci Rep. 2017; 7: 15329. DOI: https://
18. Di Q, Wang Y, Zanobetti A, et al. Air Pollution and
Mortality in the Medicare Population. New England
Journal of Medicine. 2017; 376: 2513–22. DOI:
19. Eze IC, Hemkens LG, Bucher HC, et al. Associa-
tion between Ambient Air Pollution and Diabetes
Mellitus in Europe and North America: Systematic
Review and Meta-Analysis. Environ Health Perspect.
2015; 123: 381–9. DOI:
20. Gauderman WJ, Urman R, Avol E, et al. Associa-
tion of Improved Air Quality with Lung Develop-
ment in Children. New England Journal of Medicine.
2015; 372: 905–913. DOI:
21. Guxens M, Garcia-Esteban R, Giorgis-Allemand
L, et al. Air Pollution During Pregnancy and
Childhood Cognitive and Psychomotor Devel-
opment. Epidemiology. 2014; 25: 636–47. DOI:
22. Health Effects Institute. State of Global Air 2019.
Boston, MA.
(accessed 18 Apr 2019).
23. Hoek G, Krishnan RM, Beelen R, et al. Long-term
air pollution exposure and cardio-respiratory
mortality: a review. Environmental Health. 2013;
12: 43. DOI:
24. International Agency for Research on Cancer
(IARC). Outdoor air pollution; 2016. http://www. (accessed 5
Oct 2018).
25. Kaufman JD, Adar SD, Barr RG, et al. Association
between air pollution and coronary artery calcifi-
cation within six metropolitan areas in the U.S.A.
(the Multi-Ethnic Study of Atherosclerosis and Air
Pollution): a longitudinal cohort study. The Lancet.
2016; 388: 696–704. DOI:
26. Kirrane EF, Bowman C, Davis JA, et al. Asso-
ciations of ozone and PM2.5 concentrations with
Parkinson’s disease among participants in the
Agricultural Health Study. J Occup Environ Med.
2015; 57: 509–17. DOI:
27. Krutmann J, Bouloc A, Sore G, et al. The skin
aging exposome. Journal of Dermatological Science.
2017; 85: 152–61. DOI:
28. Landrigan PJ. Air pollution and health. The Lancet
Public Health. 2017; 2: e4–5. DOI: https://doi.
29. Lee P-C, Liu L-L, Sun Y, et al. Traffic-related air
pollution increased the risk of Parkinson’s dis-
ease in Taiwan: A nationwide study. Environment
International. 2016; 96: 75–81. DOI: https://doi.
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy InitiativeArt. 140, page 6 of 9
30. Leiser CL, Hanson HA, Sawyer K, et al. Acute
effects of air pollutants on spontaneous preg-
nancy loss: a case-crossover study. Fertility and
Sterility. 2019; 111(2): 341–347. DOI: https://doi.
31. Lelieveld J, Evans JS, Fnais M, et al. The contribu-
tion of outdoor air pollution sources to premature
mortality on a global scale. Nature. 2015; 525: 367–
71. DOI:
32. Li T, Zhang Y, Wang J, et al. All-cause mortality risk
associated with long-term exposure to ambient PM2.5
in China: a cohort study. The Lancet Public Health.
2018; 3: e470–7. DOI:
33. Malley CS, Kuylenstierna JCI, Vallack HW, et al.
Preterm birth associated with maternal fine par-
ticulate matter exposure: A global, regional and
national assessment. Environment International.
2017; 101: 173–82. DOI:
34. McConnell R, Berhane K, Gilliland F, et al. Prospec-
tive study of air pollution and bronchitic symptoms
in children with asthma. Am J Respir Crit Care Med.
2003; 168: 790–7. DOI:
35. Newby DE, Mannucci PM, Tell GS, et al. Expert
position paper on air pollution and cardiovascular
disease. Eur Heart J. 2015; 36: 83–93. DOI: https://
36. Ngoc L, Park D, Lee Y, et al. Systematic Review and
Meta-Analysis of Human Skin Diseases Due to Par-
ticulate Matter. International Journal of Environmen-
tal Research and Public Health. 2017; 14: 1458. DOI:
37. Paul KC, Haan M, Mayeda ER, et al. Ambient Air
Pollution, Noise, and Late-Life Cognitive Decline
and Dementia Risk. Annual Review of Public Health.
2019; 40: 203–20. DOI:
38. Pedersen M, Giorgis-Allemand L, Bernard C, et
al. Ambient air pollution and low birthweight: a
European cohort study (ESCAPE). The Lancet Res-
piratory Medicine. 2013; 1: 695–704. DOI: https://
39. Pedersen M, Stayner L, Slama R, et al. Ambient
air pollution and pregnancy-induced hypertensive
disorders: A systematic review and meta-analysis.
Hypertension. 2014; 64: 494–500. DOI: https://doi.
40. Pope III CA and Dockery DW. Health Effects of
Fine Particulate Air Pollution: Lines that Connect.
Journal of the Air & Waste Management Association.
2006; 56: 709–42. DOI:
41. Power MC, Adar SD, Yanosky JD, et al. Exposure
to air pollution as a potential contributor to cogni-
tive function, cognitive decline, brain imaging, and
dementia: A systematic review of epidemiologic
research. NeuroToxicology. 2016; 56: 235–53. DOI:
42. Puri P, Nandar SK, Kathuria S, et al. Effects of air
pollution on the skin: A review. Indian Journal of Der-
matology, Venereology, and Leprology. 2017; 83: 415.
43. Lee KK, Miller MR and Shah ASV. Air Pollution
and Stroke. Journal of Stroke. 2018; 20: 2–11. DOI:
44. Raaschou-Nielsen O, Andersen ZJ, Beelen R,
et al. Air pollution and lung cancer incidence
in 17 European cohorts: prospective analyses
from the European Study of Cohorts for Air Pol-
lution Effects (ESCAPE). The Lancet Oncology.
2013; 14: 813–22. DOI:
45. World Health Organization. Resolution WHA68.8:
Health and the environment: Addressing the health
impact of air pollution. World Health Organization;
wha68/a68_r8-en.pdf (accessed 8 Nov 2018).
46. Ritz B, Lee P-C, Hansen J, et al. Traffic-Related
Air Pollution and Parkinson’s Disease in Denmark:
A Case-Control Study. Environ Health Perspect.
2016; 124: 351–6. DOI:
47. Ritz B, Liew Z, Yan Q, et al. Air pollution and
autism in Denmark. Environmental Epidemiol-
ogy. 2018; 2: e028. DOI:
48. Rückerl R, Schneider A, Breitner S, et al. Health
effects of particulate air pollution: A review of epi-
demiological evidence. Inhalation Toxicology. 2011;
23: 555–92. DOI:
49. Samoli E, Stergiopoulou A, Santana P, et al. Spa-
tial variability in air pollution exposure in relation to
socioeconomic indicators in nine European metro-
politan areas: A study on environmental inequality.
Environmental Pollution. 2019; 249: 345–53. DOI:
50. Shah ASV, Lee KK, McAllister DA, et al. Short term
exposure to air pollution and stroke: Systematic
review and meta-analysis. BMJ. 2015; 350: h1295.
51. Shindell D, Faluvegi G, Seltzer K, et al. Quantified,
localized health benefits of accelerated carbon diox-
ide emissions reductions. Nature Climate Change.
2018; 8: 291–5. DOI:
52. Shiraiwa M, Ueda K, Pozzer A, et al. Aerosol Health
Effects from Molecular to Global Scales. Environ
Sci Technol. 2017; 51: 13545–67. DOI: https://doi.
53. Stanek LW, Brown JS, Stanek J, et al. Air Pollution
Toxicology—A Brief Review of the Role of the Sci-
ence in Shaping the Current Understanding of Air
Pollution Health Risks. Toxicol Sci. 2011; 120: S8–27.
54. Stieb DM, Chen L, Eshoul M, et al. Ambient air pol-
lution, birth weight and preterm birth: A systematic
review and meta-analysis. Environmental Research.
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy Initiative Art. 140, page 7 of 9
2012; 117: 100–11. DOI:
55. Suades-González E, Gascon M, Guxens M, et al.
Air Pollution and Neuropsychological Development:
A Review of the Latest Evidence. Endocrinology.
2015; 156: 3473–82. DOI:
56. Taylor C, Golding J and Emond A. Adverse
effects of maternal lead levels on birth outcomes
in the ALSPAC study: a prospective birth cohort
study. BJOG. 2015; 122: 322–8. DOI: https://doi.
57. Thurston GD, Kipen H, Annesi-Maesano I, et al. A
joint ERS/ATS policy statement: What constitutes an
adverse health effect of air pollution? An analytical
framework. Eur Respir J. 2017; 49. DOI: https://doi.
58. Vrijheid M, Casas M, Gascon M, et al. Environ-
mental pollutants and child health — A review of
recent concerns. International Journal of Hygiene
and Environmental Health. 2016; 219: 331–42. DOI:
59. Wang B, Xu D, Jing Z, et al. Mechanisms in endocri-
nology: Effect of long-term exposure to air pollution
on type 2 diabetes mellitus risk: a systemic review
and meta-analysis of cohort studies. European Jour-
nal of Endocrinology. 2014; 171: R173–82. DOI:
60. World Health Organization. Fact sheet on
household air pollution and health. 2018. https://
household-air-pollution-and-health (accessed 18
Feb 2019).
61. World Health Organization. Fact sheet on
ambient (outdoor) air quality and health. 2018.
(accessed 18 Feb 2019).
62. Wu J, Ren C, Delno RJ, et al. Association
between Local Traffic-Generated Air Pollution and
Preeclampsia and Preterm Delivery in the South
Coast Air Basin of California. Environ Health Perspect.
2009; 117: 1773–9. DOI:
63. Wu J, Laurent O, Li L, et al. Adverse Reproductive
Health Outcomes and Exposure to Gaseous and
Particulate-Matter Air Pollution in Pregnant Women.
Research on Reproductive Health Effects Inst. 2016;
Emissions of Air Pollutants
64. Apte JS, Messier KP, Gani S, et al. High-Resolution
Air Pollution Mapping with Google Street View Cars:
Exploiting Big Data. Environ Sci Technol. 2017; 51:
6999–7008. DOI:
65. Beekmann M, Prévôt ASH, Drewnick J, et al. In
situ, satellite measurement and model evidence
on the dominant regional contribution to fine
particulate matter levels in the Paris megacity.
Atmospheric Chemistry and Physics. 2015; 15:
9577–9591. DOI:
66. Beelen R, Raaschou-Nielsen O, Stafoggia M, et
al. Effects of long-term exposure to air pollution on
natural-cause mortality: An analysis of 22 European
cohorts within the multicentre ESCAPE project.
The Lancet. 2014; 383: 785–795. DOI: https://doi.
67. Belis CA, Karagulian F, Larsen BR and Hopke PK.
Critical review and meta-analysis of ambient par-
ticulate matter source apportionment using recep-
tor models in Europe. Atmospheric Environment.
2013; 69: 94–108. DOI:
68. Bond TC, Bhardwaj E, Dong R, et al. Historical
emissions of black and organic carbon aerosol from
energy-related combustion, 1850–2000. Global
Biogeochemical Cycles. 2007; 21. DOI: https://doi.
69. Braspenning Radu O, van den Berg M, Klimont
Z, et al. Exploring synergies between climate and air
quality policies using long-term global and regional
emission scenarios. Atmospheric Environment.
2016; 140: 577–91. DOI:
70. Brook RD, Rajagopalan S, Pope CA 3rd, et al.
Particulate matter air pollution and cardiovascular
disease: An update to the scientific statement from
the American Heart Association. Circulation. 2010;
121: 2331–2378. DOI:
71. Brown JS. Nitrogen dioxide exposure and airway
responsiveness in individuals with asthma. Inhala-
tion Toxicology. 2015; 27: 1–14. DOI:
72. Burnett R, Chen H, Szyszkowicz M, et al. Global
estimates of mortality associated with long-term
exposure to outdoor fine particulate matter.
PNAS. 2018; 115: 9592–9597. DOI: https://doi.
73. Butt EW, Rap A, Schmidt A, et al. The impact of
residential combustion emissions on atmospheric
aerosol, human health, and climate. Atmospheric
Chemistry and Physics. 2016; 16: 873–905. DOI:
74. Cesaroni G, Forastiere F, Stafoggia M, et al.
Long term exposure to ambient air pollution
and incidence of acute coronary events: prospec-
tive cohort study and meta-analysis in 11 Euro-
pean cohorts from the ESCAPE Project. BMJ.
2014; 348: f7412. DOI:
75. Clifford A, Lang L, Chen R, et al. Exposure to air
pollution and cognitive functioning across the life
course — A systematic literature review. Environmen-
tal Research. 2016; 147: 383–398. DOI: https://doi.
76. Chen H, Huang Y, Shen H, et al. Modeling temporal
variations in global residential energy consumption
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy InitiativeArt. 140, page 8 of 9
and pollutant emissions. Applied Energy. 2016;
184: 820–9. DOI:
77. Dave P, Bhushan M and Venkataraman C.
Aerosols cause intraseasonal short-term suppres-
sion of Indian monsoon rainfall. Scientic Reports.
2017; 7: 17347. DOI:
78. Dawn Alas H, Müller T and Birmili W. Spatial Char-
acterization of Black Carbon Mass Concentration
in the Atmosphere of a Southeast Asian Megacity:
An Air Quality Case Study for Metro Manila, Phil-
ippines. Aerosol and Air Quality Research. 2018;
18: 2301–2317. DOI:
79. Franklin BA, Brook R and Pope CA 3rd. Air pol-
lution and cardiovascular disease. Current Problems
in Cardiology. 2015; 40: 207–38. DOI: https://doi.
80. Gallardo L, Escribano J, Dawidowski L, et al.
Evaluation of vehicle emission inventories for car-
bon monoxide and nitrogen oxides for Bogotá,
Buenos Aires, Santiago, and São Paulo. Atmospheric
Environment. 2012; 47: 12–9. DOI: https://doi.
81. Gidden MJ, Riahi K, Smith SJ, et al. Global emis-
sions pathways under different socioeconomic sce-
narios for use in CMIP6: a dataset of harmonized
emissions trajectories through the end of the cen-
tury. Geoscientic Model Development. 2019; 12:
1443–75. DOI:
1443 -2019
82. Hassler B, McDonald BC, Frost GJ, et al.
Analysis of long-term observations of NOX and
CO in megacities and application to constrain-
ing emissions inventories. Geophysical Research
Letters. 2016; 43: 9920–30. DOI: https://doi.
83. Huang Y, Shen H, Chen Y, et al. Global organic
carbon emissions from primary sources from
1960 to 2009. Atmospheric Environment. 2015;
122: 505–512 DOI:
84. Ibarra-Espinosa S, Ynoue R, O’Sullivan S, et al.
VEIN v0.2.2: An R package for bottom-up vehicular
emissions inventories. Geoscientic Model Devel-
opment. 2018; 11: 2209–2229. DOI: https://doi.
85. Janssens-Maehout G, Crippa M and Guizarddi D,
et al. HTAP_v2.2: A mosaic of regional and global
emission grid maps for 2008 and 2010 to study
hemispheric transport of air pollution. Atmospheric
Chemistry and Physics. 2015; 15: 11411–11432. DOI:
86. Jimenez JL, Canagaratna MR, Donahue NM, et
al. Evolution of organic aerosols in the atmosphere.
Science. 2009; 326: 1525–1529. DOI: https://doi.
87. Klimont Z, Kupainen K, Heyes C, et al. Global
anthropogenic emissions of particulate matter
including black carbon. Atmospheric Chemistry and
Physics. 2017; 17: 8681–8723. DOI: https://doi.
88. Lamarque JF, Bond TC, Eyring V, et al. Historical
(1850–2000) gridded anthropogenic and biomass
burning emissions of reactive gases and aerosols:
Methodology and application. Atmospheric Chemis-
try and Physics. 2010; 10: 7017–7039. DOI: https://
89. Liu J, Mauzerall DL, Chen Q, et al. Air pollutant
emissions from Chinese households: A major and
underappreciated ambient pollution source. Pro-
ceedings of the National Academy of Sciences. 2016;
113: 7756–7761. DOI:
90. Madrazo J, Clappier A, Belalcazar LC, et al.
Screening differences between a local inventory
and the Emissions Database for Global Atmospheric
Research (EDGAR). Science of The Total Environ-
ment. 2018; 631–632: 934–941. DOI: https://doi.
91. van der Werf GR, Randerson, JT, Giglio L, et
al. Global fire emissions and the contribution of
deforestation, savanna, forest, agricultural, and
peat fires (1997–2009). Atmospheric Chemistry and
Physics. 2010; 10: 11707–11735. DOI: https://doi.
92. van Donkelaar A, Martin RV, Brauer M, et al.
Global Estimates of Fine Particulate Matter using a
Combined Geophysical-Statistical Method with Infor-
mation from Satellites, Models, and Monitors. Environ-
mental Science and Technology. 2016; 50: 3762–3772.
Economic Costs and Benets
93. Amann M, Holland M, Maas R, et al. Costs, benefits
and economic impacts of the EU clean air strategy and
their implications on innovation and competitive-
ness. IIASA report. Laxenburg; 2017. http://ec.europa.
nomic_impact_report.pdf (accessed 10 May 2019).
94. Roy R and Braathen NA. The Rising Cost of Ambient
Air Pollution thus far in the 21st Century — Results
from the BRIICS and the OECD Countries. OECD
Environment Working Papers; 2017. DOI: https://doi.
95. US Environmental Protection Agency Ofce
of Air and Radiation. The Benefits and Costs of
the Clean Air Act from 1990 to 2020 — Summary
Report. 2011.
pdf (accessed 16 Nov 2018).
96. The World Bank. The cost of air pollution: strength-
ening the economic case for action. The World Bank;
Cost-of-PollutionWebCORRECTEDfile.pdf (accessed
10 May 2019).
97. World Health Organization. Health risks
of air pollution in Europe — HRAPIE project.
Academy of Science of South Africa et al: Air Pollution and Health – A Science-Policy Initiative Art. 140, page 9 of 9
Recommendations for concentration-response func-
tions for cost-benefit analysis of particulate matter,
ozone and nitrogen dioxide. WHO Regional Ofce
for Europe. Copenhagen; 2013. http://www.euro.
(accessed 10 May 2019).
Policies and Actions
98. Boyd DR. Report of the Special Rapporteur on
human rights obligations relating to the enjoyment
of a safe, clean, healthy and sustainable environ-
ment. Human Rights Council; 2019. https://undocs.
org/A/HRC/40/55 (accessed 28 May 2019).
99. DeShazo J, Sheldon TL and Carson RT. Design-
ing policy incentives for cleaner technologies:
Lessons from California’s plug-in electric vehicle
rebate program. Journal of Environmental Econom-
ics Management. 2017; 84: 18–43. DOI: https://doi.
100. Figueres C, Landrigan PJ and Fuller R. Tackling
air pollution, climate change, and NCDs: Time to
pull together. The Lancet. 2018; 392: 1502–3. DOI:
101. Fuller R, Rahona E, Fisher S, et al. Pollution
and non-communicable disease: time to end the
neglect. The Lancet Planetary Health. 2018; 2(3):
e96–8. DOI:
102. Haines A and Landrigan PJ. It’s time to con-
sider pollution in NCD prevention. The Lancet.
2018; 392: 1625–6. DOI:
103. Kutlar Joss M, Eeftens M, Gintowt E, et al. Time
to harmonize national ambient air quality stand-
ards. International Journal of Public Health. 2017;
62: 453–462. DOI:
104. Samet JM and Gruskin S. Air pollution, health,
and human rights. The Lancet Respiratory Medicine.
2015; 3: 98–100. DOI:
105. United Nations Environment Programme. Min-
isterial declaration of the United Nations Envi-
ronment Assembly at its third session: Towards
a pollution-free planet. UNEP/EA.3/L.19; 2017.
rial-declaration (accessed 28 May 2019).
106. Watts N, Amann M, Ayeb-Karlsson S, et al.
The Lancet Countdown on health and climate
change: From 25 years of inaction to a global
transformation for public health. The Lancet. 2018;
391: 581–630. DOI:
107. World Bank Group. Independent Evaluation
Group. Toward a clean world for all: An IEG evalu-
ation of the World Bank Group’s support for pol-
lution management. Washington, DC: World Bank;
pollution (accessed 10 May 2019).
108. World Health Organization. Global action plan
for the prevention and control of noncommuni-
cable diseases 2013–2020. Geneva; 2013. https://
(accessed 10 May 2019).
109. World Health Organization. Resolution WHA68.8:
Health and the environment: Addressing the health
impact of air pollution. Geneva; 2015. http://apps.
pdf (accessed 8 Nov 2018).
110. World Health Organization. Air pollution and
child health: prescribing clean air. Geneva; 2018.
tion-child-health/en/ (accessed 31 Oct 2018).
111. World Health Organization. Air quality guide-
lines. Global update 2005. Particulate matter, ozone,
nitrogen dioxide and sulfur dioxide. WHO Regional
Ofce for Europe. Copenhagen; 2006. http://www.
dioxide (accessed 10 May 2019).
112. World Health Organization. Review of evidence
on health aspects of air pollution — REVIHAAP. Tech-
nical Report. WHO Regional Ofce for Europe. Copen-
hagen; 2013.
technical-report-final-version.pdf?ua=1 (accessed
28 May 2019).
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
Science-Policy Initiative.
Annals of Global Health
. 2019; 85(1):140, 1–9. DOI:
Published: 16 December 2019
Copyright: © 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution
4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited. See
Annals of Global Health
is a peer-reviewed open access journal published by Ubiquity Press. OPEN ACCESS
Full-text available
Nitrogen dioxide (NO2) is linked to poor air quality and severe human health impacts, including respiratory and cardiovascular diseases and being responsible annually for approximately 23,500 premature deaths in the UK. Automated air quality monitoring stations continuously record pollutants in urban environments but are restricted in number (need for electricity, maintenance and trained operators), only record air quality proximal to their location and cannot document variability of airborne pollutants at finer spatial scales. As an alternative, passive sampling devices such as Palmes-type diffusion tubes can be used to assess the spatial variability of air quality in greater detail, due to their simplicity (e.g. small, light material, no electricity required) and suitability for long-term studies (e.g. deployable in large numbers, useful for screening studies). Accordingly, a one passive diffusion tube sampling approach has been adapted to investigate spatial and temporal variability of NO2 concentrations across the City of Manchester (UK). Spatial and temporal detail was obtained by sampling 45 locations over a 12-month period (361 days, to include seasonal variability), resulting in 1080 individual NO2 measurements. Elevated NO2 concentrations, exceeding the EU/UK limit value of 40 µg m−3, were recorded throughout the study period (N = 278; 26% of individual measurements), particularly during colder months and across a wide area including residential locations. Of 45 sampling locations, 24% (N = 11) showed annual average NO2 above the EU/UK limit value, whereas 16% (N = 7) showed elevated NO2 (> 40 µg m−3) for at least 6 months of deployment. Highest NO2 was recorded in proximity of highly trafficked major roads, with urban factors such as surrounding building heights also influencing NO2 dispersion and distribution. This study demonstrates the importance of high spatial coverage to monitor atmospheric NO2 concentrations across urban environments, to aid identification of areas of human health concern, especially in areas that are not covered by automated monitoring stations. This simple, reasonably cheap, quick and easy method, using a single-NOx diffusion tube approach, can aid identification of NO2 hotspots and provides fine spatial detail of deteriorated air quality. Such an approach can be easily transferred to comparable urban environments to provide an initial screening tool for air quality and air pollution, particularly where local automated air quality monitoring stations are limited. Additionally, such an approach can support air quality assessment studies, e.g. lichen or moss biomonitoring studies.
Full-text available
RESUMO Este artigo descreve as condições atuais da rede de monitoramento de qualidade do ar no Brasil. Os resultados revelam que apenas dez estados e o DF realizam o monitoramento através de 371 estações ativas - 80% delas na Região Sudeste. Outras informações relevantes são: (i) 41,2% das estações nacionais são privadas; no estado do Rio de Janeiro elas representam 60% do total de suas estações, enquanto no estado de São Paulo, 100% das estações são públicas; (ii) o MP10 é o poluente mais monitorado em 62,8% das estações e o MP2,5 em apenas 25,9% delas; e, (iii) a comunicação dos dados de monitoramento em tempo real à população ocorre em cinco estados. Após trinta anos de sua criação, a Rede Nacional de Qualidade do Ar encontra-se incompleta, e insuficientemente implantada, inviabilizando uma adequada gestão da qualidade do ar pelos órgãos ambientais.
Full-text available
This paper aims to provide scientific support for decision-making in the field of improving air quality by evaluating pollution reduction measures included in the current Spanish policy framework of the 1st National Air Pollution Control Program (NAPCP). First, the health impacts of air quality are estimated by using the concentrations estimated by multiscale air quality modeling and the recommended concentration–response functions (CRF), specifically as a result of exposure to particulate matter (PM), nitrogen dioxide (NO2), and ozone (O3). Second, the associated external costs are calculated by monetization techniques. Two scenarios are analyzed: a package including existing measures (WM2030) and a package with additional measures (WAM2030). Compared with the baseline scenario, an improvement was found in the health effects of NO2, PM10, and PM2.5, while for O3 there was a slight worsening, mainly due to the increase in the O3 metric used (SOMO35), which increases over some urban areas. Despite this, the monetary valuation of the total effects on health as a whole shows external benefits due to the adoption of measures (WM2030), compared with the reference scenario (no measures) of more than € 17.5 billion and, when considering the additional measures (WAM2030), benefits of about € 58.1 billion.
Since the publication of the last American Heart Association scientific statement on air pollution and cardiovascular disease in 2010, unequivocal evidence of the causal role of fine particulate matter air pollution (PM2.5, or particulate matter ≤2.5 μm in diameter) in cardiovascular disease has emerged. There is a compelling case to provide the public with practical personalized approaches to reduce the health effects of PM2.5. Such interventions would be applicable not only to individuals in heavily polluted countries, high-risk or susceptible individuals living in cleaner environments, and microenvironments with higher pollution exposures, but also to those traveling to locations with high levels of PM2.5. The overarching motivation for this document is to summarize the current evidence supporting personal-level strategies to prevent the adverse cardiovascular effects of PM2.5, guide the use of the most proven/viable approaches, obviate the use of ineffective measures, and avoid unwarranted interventions. The significance of this statement relates not only to the global importance of PM2.5, but also to its focus on the most tested interventions and viable approaches directed at particulate matter air pollution. The writing group sought to provide expert consensus opinions on personal-level measures recognizing the current uncertainty and limited evidence base for many interventions. In doing so, the writing group acknowledges that its intent is to assist other agencies charged with protecting public health, without minimizing the personal choice considerations of an individual who may decide to use these interventions in the face of ongoing air pollution exposure.
Full-text available
Background: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers. Objective: The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions. Methods: An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies. Results: The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting. Discussion: This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice.
Full-text available
We present a suite of nine scenarios of future emissions trajectories of anthropogenic sources, a key deliverable of the ScenarioMIP experiment within CMIP6. Integrated assessment model results for 14 different emissions species and 13 emissions sectors are provided for each scenario with consistent transitions from the historical data used in CMIP6 to future trajectories using automated harmonization before being downscaled to provide higher emissions source spatial detail. We find that the scenarios span a wide range of end-of-century radiative forcing values, thus making this set of scenarios ideal for exploring a variety of warming pathways. The set of scenarios is bounded on the low end by a 1.9 W m⁻² scenario, ideal for analyzing a world with end-of-century temperatures well below 2 ∘C, and on the high end by a 8.5 W m⁻² scenario, resulting in an increase in warming of nearly 5 ∘C over pre-industrial levels. Between these two extremes, scenarios are provided such that differences between forcing outcomes provide statistically significant regional temperature outcomes to maximize their usefulness for downstream experiments within CMIP6. A wide range of scenario data products are provided for the CMIP6 scientific community including global, regional, and gridded emissions datasets.
Full-text available
Exposure to ambient air pollution and noise is ubiquitous globally. A strong body of evidence links air pollution, and recently noise, to cardiovascular conditions that eventually may also affect cognition in the elderly. Data that support a broader influence of these exposures on cognitive function during aging is just starting to emerge. This review summarizes current findings and discusses methodological challenges and opportunities for research. Although current evidence is still limited, especially for chronic noise exposure, high exposure has been associated with faster cognitive decline either mediated through cerebrovascular events or resulting in Alzheimer's disease. Ambient environmental exposures are chronic and affect large populations. While they may yield relatively modest-sized risks, they nevertheless result in large numbers of cases. Reducing environmental pollution is clearly feasible, though lowering levels requires collective action and long-term policies such as standard setting, often at the national level as well as at the local level.
Full-text available
The current report presents an updated overview and analysis of air quality in Europe from 2000 to 2016. It reviews the progress made towards meeting the air quality standards established in the two EU Ambient Air Quality Directives and towards the World Health Organization (WHO) air quality guidelines (AQGs). It also presents the latest findings and estimates on population and ecosystem exposure to the air pollutants with the greatest impacts and effects. The evaluation of the status of air quality is based mainly on reported ambient air measurements, in conjunction with modelling data and data on anthropogenic emissions and their evolution over time.
Full-text available
Background: Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. Methods: We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure-response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss. Findings: The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0-112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8-56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09-1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55-0·79) from ambient particulate matter pollution and 0·48 million (0·39-0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6-1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana. Interpretation: India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO 2 ), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO 2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO 2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO 2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.
Objective: To investigate the relationship between acute exposure to air pollutants and spontaneous pregnancy loss. Design: Case-crossover study from 2007 to 2015. Setting: An academic emergency department in the Wasatch Front area of Utah. Patient(s): A total of 1,398 women who experienced spontaneous pregnancy loss events. Intervention(s): None. Main outcome measure(s): Odds of spontaneous pregnancy loss. Result(s): We found that a 10-ppb increase in 7-day average levels of nitrogen dioxide was associated with a 16% increase in the odds of spontaneous pregnancy loss (odds ratio [OR] = 1.16; 95% confidence interval [CI] 1.01-1.33; P=.04). A 10-μg/m3 increase in 3-day and 7-day averages of fine particulate matter were associated with increased risk of spontaneous pregnancy loss, but the associations did not reach statistical significance (OR3-day average = 1.09; 95% CI 0.99-1.20; P=.05) (OR7-day average = 1.11; 95% CI 0.99-1.24; P=.06). We found no evidence of increased risk for any other metrics of nitrogen dioxide or fine particulate matter or any metric for ozone. Conclusions: We found that short-term exposure to elevated levels of air pollutants was associated with higher risk for spontaneous pregnancy loss.