Clean air – and better health – in Europe and elsewhere

In Europe, 2013 was the ‘year of air’, and in late December the European Commission announced a ‘new policy package’ aimed at cleaning up Europe’s air – by 2030. If apparently unambitious in its timeframe, the policy seems sensible because of the extremely damaging effects of air pollution on health. Risks of respiratory and cardiovascular diseases, including lung cancer, are associated with air pollution; these are illnesses that are likely to be borne disproportionately by people of low socioeconomic status. These risks provide a strong incentive on their own for action to reduce disease, limit healthcare costs and improve work productivity. The policy also cites damage to natural and built environments caused by air pollution. By 2030, the policy estimates that spending some €3.3 billion per year on pollution mitigation across Europe could yield much greater annual aggregate savings worth at least €40 billion.

National emission ceilings have been proposed for sulphur dioxide, nitrogen oxides, methane, non-methane volatile organic compounds, ammonia, and particulate matter < 2.5µm (PM2.5) in diameter. These ceilings become more stringent over the period 2020-30. For example, the 28 EU states each have specific targets to attain a reduction of anthropogenic sulphur dioxide emissions, from a 2005 base, with a mean fall of 59% for any year from 2020-29 and 81% for any year from 2030. However, the road to cleaner air in Europe is likely to be uneven. The financial costs of reducing air pollution could increase the price of power in individual states and thereby constrain economic competitiveness, for instance; currently, no fewer than 17 countries in the bloc contravene air quality standards and are subject to legal action by the EU.

The health hazards of airborne pollutants were recently well illustrated by the ESCAPE study. Including data from 22 European countries, Beelen et al documented an association between mortality and average annual exposure to PM2.5 (hazard ratio 1.07 [95% CI 1.02 to 1.13] per 5µg/m³). Such findings provide strong evidence for the benefits to health that should be achieved by a tightening of European air quality standards – the current community-wide annual mean limit for PM2.5 is 25µg/m³, whereas the World Health Organization’s 2005 air quality guidelines recommend a substantially lower limit of 10µg/m³.

Europe and its people are right to be concerned about the adverse effects of poor air quality on health, as are many others around the globe. In developing countries especially, air pollution presents a serious and immediate risk to health. In China for example, the dizzying pace of industrialisation and economic transformation has been accompanied by severe air pollution in Beijing and other major cities. It is estimated that outdoor air pollution leads to 350,000-500,000 premature deaths in China each year. Although efforts to combat air pollution in China are essential, these sobering numbers illustrate the growing threat of outdoor air pollution in developing economies, reflecting heavy use of fossil fuels by road traffic, for power generation and in industry. The burden of lung and cardiovascular disease is, also, exacerbated in many countries by the use of tobacco and by indoor air pollution from cooking, among other sources.

Europe’s efforts to improve air quality are welcome, and will rightly be scrutinised over the long period during which the new regulations are to be enacted. As the world emerges from a painful period of economic contraction and uncertainty, it is important that gradually returning economic growth is harnessed to policies and incentives that lead to improvements in health and a sustained improvement in air quality in all countries – developed and developing.