There is no “safe level” of air pollution

Srdjan Kukolj HEAL

Photo: HEAL


October 15, 2021






October 15, 2021





Author: Srdjan Kukolj, Consultant, Health and Environment Alliance (HEAL)

The World Health Organization (WHO) recently published its long-awaited new guidelines for air quality, which have been updated for the first time since 2005. Following this publication, health experts urge decision-makers to protect the health of millions of people and step up on efforts to reduce air pollution. National air quality standards need to be fully aligned with WHO guidelines, in order to contribute to better health for people, and reduce the overall health cost burden.

WHO, after a systematic review of the accumulated evidence, recommends lower values for several pollutants, most notably for particulate matter PM2.5, which causes the greatest health burden, for which a new annual concentration of 5 µg/m³ is now recommended (the current EU’s annual standard is 25µg/m³); for nitrogen dioxide (NO2), which has come under intense scrutiny in discussions on road transport and inner-city driving bans, a new annual concentration of 10 µg/m³ is now recommended (from previously 40 µg/m³).

Air pollution is the biggest threat to the environment in the European region and globally, and one of the five main risk factors for non-communicable and chronic diseases. In Europe, poor air quality causes about 400,000 premature deaths annually. According to the latest estimates of the number of deaths in 2019 in the Western Balkans, air pollution from PM2.5 particles is responsible for a total of 32,340 deaths per year (Republic of Serbia 14,600, Bosnia and Herzegovina 5,100, Albania 5,000, Kosovo* 4,000, North Macedonia 3,000 and Montenegro 640). Due to their extremely small size and ability to absorb sulfates, nitrates, carbon, ammonium, hydrogen ions, lipopolysaccharides (LPS), metals and water, PM particles are a major threat to human health.

The latest report of the European Environment Agency (EEA) on the state of air quality in Europe shows that the countries of the Western Balkans are still far from achieving clean air, which is urgently needed for better health. Analysing the data for almost a decade, EEA points to the fact that the Republic of Serbia is one of the countries with the highest concentrations of PM2.5 in Europe, along with other countries in the Western Balkans such as Albania, Kosovo* and North Macedonia. The results of the analysis indicate that the Republic of Serbia, from 2009 to 2018, did not do much to prevent health harm from PM2.5 particles, while the situation with nitrogen dioxide (NO2) concentrations is different. PM2.5 concentrations were minimally reduced, with only 0.2 µg/m³ lower levels in 2018 compared to 2009, and the number of premature deaths (14,600 per year) remained the same, because of the enormous air pollution. The reduction of nitrogen dioxide (NO2) concentrations by 1.4 µg/m³ resulted in a reduction in the total number of premature deaths, 430 in 2018, while in 2009 the number was 970. The Republic of Serbia is currently developing the first national Program for air protection, with an Action Plan that should bring better air quality to people in Serbia and the region.

Particles in the PM2.5 size range (2.5 microns in diameter) can travel deep into the respiratory tract, reaching the lungs, the blood vessels, our organs including the brain. Exposure to small particles can cause short-term health effects such as eye, nose, throat and lung irritation, coughing, sneezing, runny nose and difficulty breathing. Exposure to PM particles can also affect lung function and worsen medical conditions such as asthma and heart disease. Scientific studies link an increase in daily exposure to PM2.5 with an increased number of admissions to respiratory and cardiovascular hospitals, emergency visits and deaths. Studies also demonstrate that long-term exposure to PM2.5 particles causes an increased rate of chronic bronchitis, lung function failure, and increased mortality from lung cancer and heart disease. People suffering from respiratory and cardiovascular disease, children and the elderly are especially vulnerable to PM2.5 pollution. Recent research underlines that children are particularly at risk of impacts of the air pollution, as their lungs, heart, brain, respiratory, immune and nervous systems are still developing. Their health can already be endangered before birth, with lifelong consequences.

Health groups call on the leaders of the Western Balkan countries to harmonize national air quality standards with the World Health Organization Global air quality guidelines. Health experts should be actively involved in these decision-making processes to ensure the timely integration of public health measures into environmental policies. Compliance with WHO recommendations brings multiple benefits – reduced incidence of chronic diseases and premature deaths, reduced overall health costs and, most importantly, better health and higher productivity of people.

On the road to membership in the European Union, the countries of the Western Balkans still have a lot to do to provide their citizens with clean air. In addition to pollution from road traffic, industrial-construction-agricultural activities, household and district heating, waste incineration, public health is very threatened by the operation of coal-fired power plants that emit enormous amounts of PM particles, sulfur dioxide and nitrogen oxides every year.

Regional cooperation is essential to achieving a healthier and more sustainable future. The leaders of this region urgently need to move away from polluting practices, especially from burning fossil fuels, and commit to integrated, effective measures that will lead to a significant reduction in the health burden due to air pollution in the region, which has so far left an unacceptably large burden for public health.

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