Bucharest, Sofia, and Zagreb are on the list of the 24 cities with the highest total damage from air pollution, according to a study conducted by CE Delft on health-related social costs in 432 cities in the European Union, United Kingdom, Norway and Switzerland.

In total, over 130 million people live in the places covered in the 30 countries, with an average of 301,754 inhabitants per city. In 2018, total social costs for all 432 cities surpassed EUR 166 billion. The average cost per city is over EUR 385 million, the study finds.

Social costs are costs affecting welfare and comprise both direct health care expenditures and indirect health impacts

Social costs affect welfare and they comprise both direct health care expenditures (e.g. for hospital admissions) and indirect health impacts (e.g. diseases such as chronic obstructive pulmonary disease, or reduced life expectancy due to air pollution). They affect welfare because people have a clear preference for healthy life years in a good and clean environment.

Air pollution in cities stems from transport activities, household heating and a range of other activities including agriculture and industry. The study focused on the role of transport in explaining the social costs.

A 1% increase in the average journey time to work increases the social costs of PM10 emissions by 0.29% and those of NO2 emissions by 0.54%. A 1% increase in the number of cars in a city increases overall social costs by almost 0.5%, the Health costs of air pollution in European cities and the linkage with transport study reads.

Every inhabitant of a European city suffered a welfare loss of over EUR 1,250 a year on average

In 2018, every inhabitant of a European city suffered an average welfare loss of over EUR 1,250 a year owing to direct and indirect health losses associated with poor air quality. It is equivalent to 3.9% of income earned in cities.

There is a substantial spread between the figures among cities. In the Romanian capital Bucharest, total welfare loss amounts to over EUR 3,000 per capita/year, while in Santa Cruz de Tenerife in Spain it is under EUR 400.

In Bulgaria, Romania and Poland, health-related social costs are between 8% and 10% of income earned

In many cities in Bulgaria, Romania and Poland, health-related social costs are 8% to 10% of income earned. Most relate to premature mortality: for the 432 cities investigated, the average contribution of mortality to total social costs is 76.1%.