Clean Air for All – How polluted air harms human health

Pollution in the air we breathe can cause a wide range of adverse health impacts, from respiratory illnesses to heart disease to stroke. This “silent killer,” according to the World Health Organization (WHO), is responsible for about seven million premature deaths each year, mostly in poor and middle-income countries. Reducing air pollution helps prevent diseases and untimely deaths, but also, indirectly, ensures economic stability and protects the environment, says the Health and Environment Alliance (HEAL).

On September 7, 2020, the world marked the first ever International Day of Clean Air for blue skies, with the theme “Clean Air for All.” On that day, Balkan Green Energy News published an article titled Clean Air for All – a lesson on key air pollutants, the first in a series of texts aimed at demystifying the topic of air pollution and providing useful and relevant information and knowledge about this increasingly important issue. The second one addressed the main polluters, while in this text we deal with the health impacts of air pollution.

Air pollutants enter the human body through the respiratory system and lungs, some of them reaching the bloodstream and then traveling and causing harm to other internal organs. Long-term exposure to air pollution can cause or aggravate ischemic heart disease (coronary heart disease), stroke, lung cancer, and respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). It also weakens the immune system, compromising its ability to fight off infection.

Air pollution increases the risk of pneumonia, making it responsible for the deaths of nearly a million children under five years of age each year. Children and the elderly, as well we those with pre-existing health conditions, are more likely to suffer from negative health effects of polluted air than other groups.

According to WHO data, air pollution is responsible for 25%, or 2.4 million, of all heart disease deaths worldwide, as well as for 24% (1.4 million) of all deaths from stroke, and 43% (1.8 million) of all deaths from lung disease and lung cancer.

Even short-term exposure to air pollution can be deadly

Short-term exposure to outdoor air pollution, for example during spikes in pollution levels, can cause asthma attacks and acute bronchitis, increase susceptibility to respiratory infections, and cause heart attacks and arrhythmias in people with a heart condition. Studies have suggested that episodes of high pollution increase hospitalizations and mortality for cardiovascular and respiratory diseases.

Healthy people, too, may experience temporary symptoms from short-term exposure to air pollution, such as cough and shortness of breath as well as the irritation of the eyes, nose, and throat.

Household (indoor) pollution kills 3.8 million people a year, mainly in less developed countries

People can be exposed to air pollution outdoors (ambient pollution), but they also breathe polluted air in homes (indoor or household pollution) where solid fuels, animal dung, or kerosene are used for cooking and heating. This is the case with about 3 billion people around the world, according to the WHO.

Of the total of some seven million early deaths attributed to air pollution in 2016, as many as 3.8 million were caused by household pollution, mostly in low- and middle-income countries, according to the WHO. Women and young children are the hardest hit since they spend the most time around the domestic hearth.

About 4.2 million premature deaths each year are attributed to outdoor pollution

At the same time, outdoor pollution, whose main sources include residential energy for cooking and heating, transportation (vehicles), power generation, agriculture, waste incineration, and industry, was responsible for an estimated 4.2 million premature deaths, 91% of which occurred in low- and middle-income countries. The main culprit, according to the WHO, is fine particulate matter (PM2.5), which causes cardiovascular and respiratory diseases, and cancers.

Particulate matter (PM) is the biggest threat to health

When it comes to human health, particulate matter (PM) is widely considered the most dangerous pollutant. Particles with a diameter of 2.5 micrograms or less (PM2.5) are particularly hazardous due to their size, which allows them to get into the bloodstream and cause cardiovascular and cerebrovascular damage. Particulate matter also increases mortality, especially for cardiovascular diseases. According to the WHO, a rise in annual PM2.5 concentration of 10 µg/m3 increases overall mortality among adults by 6%.

Ground-level ozone (O3), or “bad ozone,” can narrow the airways, making it harder for the respiratory system to provide oxygen, but it can also aggravate respiratory diseases such as bronchitis and asthma, cause lung damage, wheezing, chest pain, dry throat, headache, or nausea, reduce resilience to infections, and lead to increased fatigue.

Other key air pollutants harmful to human health include sulfur dioxide (SO2), which can cause weakness, cough, bronchitis, impaired lung function, and the aggravation of existing respiratory and cardiovascular diseases, and nitrogen oxides (NOx), which cause respiratory diseases, as well as cancers.

Europe’s annual death toll from air pollution estimated at about 400,000

In Europe, the number of premature deaths due to air pollution has been estimated at some 400,000 a year, according to the European Environment Agency (EEA). In 2018, 417,000 early deaths in 41 European countries were attributed to PM2.5, O3, and nitrogen dioxide (NO2), of which 379,000 in the 28 member states of the European Union (EU), according to the EEA’s latest air quality report.

The figures, though grim, are actually an improvement on 2009, which was achieved thanks to policies and measures implemented over the past decade to reduce air pollution in Europe, according to the EEA. However, the report also finds that nearly three quarters of the EU’s urban population is exposed to air pollution levels above the WHO air quality guidelines (AQG).

9 out of 10 people in the world breathe polluted air by WHO standards

According to the WHO’s estimates, 9 out 10 people in the world live in places where outdoor air pollution levels exceed the AQG values. The WHO recommends an annual mean value of 10μg/m3 for PM2.5, while the EU’s mandatory limit is 20μg/m3. In several Balkan countries, the latest available data (for 2016 or 2017) shows concentrations above 20μg/m3.

Up to 5,000 early deaths in 19 Balkan cities attributed to air pollution

Countries in the Western Balkans are particularly hard hit by the adverse health effects of air pollution, due to their reliance on fossil fuels for energy production and household heating as well as their old vehicle and machinery fleets in the transportation, construction, and agriculture sectors, according to HEAL.

Air pollution is directly responsible for up to one in five premature deaths in 19 Western Balkan cities covered by a study conducted by the United Nations Environment Program (UN Environment). The study shows that the total number of premature deaths directly attributable to air pollution in these cities is nearly 5,000 a year.

HEAL calls for intersectoral and regional cooperation to tackle air pollution in Western Balkans

To tackle the air pollution problem, HEAL recommends Western Balkan countries to strengthen intersectoral cooperation, noting that public institutions in charge of environmental protection, health care, finances, and energy do not work together on devising the regulatory framework, but rather stick to their own respective areas only. The organization also calls for improving regional cooperation, which would help implement fundamental reforms and mitigate the impact on health and the environment.

Another recommendation is to increase the transparency of public institutions by including all stakeholders in policymaking. Srđan Kukolj, health and energy adviser for the Balkan region at HEAL, says it is necessary to increase the participation of the scientific community in the decision-making process, while heads of state are advised to build the future of the Western Balkans based on new scientific knowledge and to abandon obsolete and inefficient practices in the field of health care and environmental protection.

COVID-19 and air pollution: too early to speak of causality

Air pollution causes a number of diseases that put people in a high-risk category when it comes to severe outcomes of COVID-19, and studies so far have shown a correlation between high pollution levels and fatal outcomes. However, proper epidemiological studies that could determine whether air pollution contributes to COVID-19 mortality are still under way, and it is therefore too early to speak of a causal relationship.

On the other hand, this year’s lockdown measures to stop the spread of coronavirus have resulted in improvements in air quality, thanks mainly to reduced demand for transportation, according to the EEA. However, the agency does not yet have estimates on the potential positive health impacts of the cleaner air during 2020.