essay on impact of environmental pollution on public health

REVIEW article

Environmental and health impacts of air pollution: a review.

• 1 Delphis S.A., Kifisia, Greece
• 2 Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
• 3 Centre Hospitalier Universitaire Vaudois (CHUV), Service de Médicine Interne, Lausanne, Switzerland
• 4 School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom

One of our era's greatest scourges is air pollution, on account not only of its impact on climate change but also its impact on public and individual health due to increasing morbidity and mortality. There are many pollutants that are major factors in disease in humans. Among them, Particulate Matter (PM), particles of variable but very small diameter, penetrate the respiratory system via inhalation, causing respiratory and cardiovascular diseases, reproductive and central nervous system dysfunctions, and cancer. Despite the fact that ozone in the stratosphere plays a protective role against ultraviolet irradiation, it is harmful when in high concentration at ground level, also affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide, sulfur dioxide, Volatile Organic Compounds (VOCs), dioxins, and polycyclic aromatic hydrocarbons (PAHs) are all considered air pollutants that are harmful to humans. Carbon monoxide can even provoke direct poisoning when breathed in at high levels. Heavy metals such as lead, when absorbed into the human body, can lead to direct poisoning or chronic intoxication, depending on exposure. Diseases occurring from the aforementioned substances include principally respiratory problems such as Chronic Obstructive Pulmonary Disease (COPD), asthma, bronchiolitis, and also lung cancer, cardiovascular events, central nervous system dysfunctions, and cutaneous diseases. Last but not least, climate change resulting from environmental pollution affects the geographical distribution of many infectious diseases, as do natural disasters. The only way to tackle this problem is through public awareness coupled with a multidisciplinary approach by scientific experts; national and international organizations must address the emergence of this threat and propose sustainable solutions.

Approach to the Problem

The interactions between humans and their physical surroundings have been extensively studied, as multiple human activities influence the environment. The environment is a coupling of the biotic (living organisms and microorganisms) and the abiotic (hydrosphere, lithosphere, and atmosphere).

Pollution is defined as the introduction into the environment of substances harmful to humans and other living organisms. Pollutants are harmful solids, liquids, or gases produced in higher than usual concentrations that reduce the quality of our environment.

Human activities have an adverse effect on the environment by polluting the water we drink, the air we breathe, and the soil in which plants grow. Although the industrial revolution was a great success in terms of technology, society, and the provision of multiple services, it also introduced the production of huge quantities of pollutants emitted into the air that are harmful to human health. Without any doubt, the global environmental pollution is considered an international public health issue with multiple facets. Social, economic, and legislative concerns and lifestyle habits are related to this major problem. Clearly, urbanization and industrialization are reaching unprecedented and upsetting proportions worldwide in our era. Anthropogenic air pollution is one of the biggest public health hazards worldwide, given that it accounts for about 9 million deaths per year ( 1 ).

Without a doubt, all of the aforementioned are closely associated with climate change, and in the event of danger, the consequences can be severe for mankind ( 2 ). Climate changes and the effects of global planetary warming seriously affect multiple ecosystems, causing problems such as food safety issues, ice and iceberg melting, animal extinction, and damage to plants ( 3 , 4 ).

Air pollution has various health effects. The health of susceptible and sensitive individuals can be impacted even on low air pollution days. Short-term exposure to air pollutants is closely related to COPD (Chronic Obstructive Pulmonary Disease), cough, shortness of breath, wheezing, asthma, respiratory disease, and high rates of hospitalization (a measurement of morbidity).

The long-term effects associated with air pollution are chronic asthma, pulmonary insufficiency, cardiovascular diseases, and cardiovascular mortality. According to a Swedish cohort study, diabetes seems to be induced after long-term air pollution exposure ( 5 ). Moreover, air pollution seems to have various malign health effects in early human life, such as respiratory, cardiovascular, mental, and perinatal disorders ( 3 ), leading to infant mortality or chronic disease in adult age ( 6 ).

National reports have mentioned the increased risk of morbidity and mortality ( 1 ). These studies were conducted in many places around the world and show a correlation between daily ranges of particulate matter (PM) concentration and daily mortality. Climate shifts and global planetary warming ( 3 ) could aggravate the situation. Besides, increased hospitalization (an index of morbidity) has been registered among the elderly and susceptible individuals for specific reasons. Fine and ultrafine particulate matter seems to be associated with more serious illnesses ( 6 ), as it can invade the deepest parts of the airways and more easily reach the bloodstream.

Air pollution mainly affects those living in large urban areas, where road emissions contribute the most to the degradation of air quality. There is also a danger of industrial accidents, where the spread of a toxic fog can be fatal to the populations of the surrounding areas. The dispersion of pollutants is determined by many parameters, most notably atmospheric stability and wind ( 6 ).

In developing countries ( 7 ), the problem is more serious due to overpopulation and uncontrolled urbanization along with the development of industrialization. This leads to poor air quality, especially in countries with social disparities and a lack of information on sustainable management of the environment. The use of fuels such as wood fuel or solid fuel for domestic needs due to low incomes exposes people to bad-quality, polluted air at home. It is of note that three billion people around the world are using the above sources of energy for their daily heating and cooking needs ( 8 ). In developing countries, the women of the household seem to carry the highest risk for disease development due to their longer duration exposure to the indoor air pollution ( 8 , 9 ). Due to its fast industrial development and overpopulation, China is one of the Asian countries confronting serious air pollution problems ( 10 , 11 ). The lung cancer mortality observed in China is associated with fine particles ( 12 ). As stated already, long-term exposure is associated with deleterious effects on the cardiovascular system ( 3 , 5 ). However, it is interesting to note that cardiovascular diseases have mostly been observed in developed and high-income countries rather than in the developing low-income countries exposed highly to air pollution ( 13 ). Extreme air pollution is recorded in India, where the air quality reaches hazardous levels. New Delhi is one of the more polluted cities in India. Flights in and out of New Delhi International Airport are often canceled due to the reduced visibility associated with air pollution. Pollution is occurring both in urban and rural areas in India due to the fast industrialization, urbanization, and rise in use of motorcycle transportation. Nevertheless, biomass combustion associated with heating and cooking needs and practices is a major source of household air pollution in India and in Nepal ( 14 , 15 ). There is spatial heterogeneity in India, as areas with diverse climatological conditions and population and education levels generate different indoor air qualities, with higher PM 2.5 observed in North Indian states (557–601 μg/m 3 ) compared to the Southern States (183–214 μg/m 3 ) ( 16 , 17 ). The cold climate of the North Indian areas may be the main reason for this, as longer periods at home and more heating are necessary compared to in the tropical climate of Southern India. Household air pollution in India is associated with major health effects, especially in women and young children, who stay indoors for longer periods. Chronic obstructive respiratory disease (CORD) and lung cancer are mostly observed in women, while acute lower respiratory disease is seen in young children under 5 years of age ( 18 ).

Accumulation of air pollution, especially sulfur dioxide and smoke, reaching 1,500 mg/m3, resulted in an increase in the number of deaths (4,000 deaths) in December 1952 in London and in 1963 in New York City (400 deaths) ( 19 ). An association of pollution with mortality was reported on the basis of monitoring of outdoor pollution in six US metropolitan cities ( 20 ). In every case, it seems that mortality was closely related to the levels of fine, inhalable, and sulfate particles more than with the levels of total particulate pollution, aerosol acidity, sulfur dioxide, or nitrogen dioxide ( 20 ).

Furthermore, extremely high levels of pollution are reported in Mexico City and Rio de Janeiro, followed by Milan, Ankara, Melbourne, Tokyo, and Moscow ( 19 ).

Based on the magnitude of the public health impact, it is certain that different kinds of interventions should be taken into account. Success and effectiveness in controlling air pollution, specifically at the local level, have been reported. Adequate technological means are applied considering the source and the nature of the emission as well as its impact on health and the environment. The importance of point sources and non-point sources of air pollution control is reported by Schwela and Köth-Jahr ( 21 ). Without a doubt, a detailed emission inventory must record all sources in a given area. Beyond considering the above sources and their nature, topography and meteorology should also be considered, as stated previously. Assessment of the control policies and methods is often extrapolated from the local to the regional and then to the global scale. Air pollution may be dispersed and transported from one region to another area located far away. Air pollution management means the reduction to acceptable levels or possible elimination of air pollutants whose presence in the air affects our health or the environmental ecosystem. Private and governmental entities and authorities implement actions to ensure the air quality ( 22 ). Air quality standards and guidelines were adopted for the different pollutants by the WHO and EPA as a tool for the management of air quality ( 1 , 23 ). These standards have to be compared to the emissions inventory standards by causal analysis and dispersion modeling in order to reveal the problematic areas ( 24 ). Inventories are generally based on a combination of direct measurements and emissions modeling ( 24 ).

As an example, we state here the control measures at the source through the use of catalytic converters in cars. These are devices that turn the pollutants and toxic gases produced from combustion engines into less-toxic pollutants by catalysis through redox reactions ( 25 ). In Greece, the use of private cars was restricted by tracking their license plates in order to reduce traffic congestion during rush hour ( 25 ).

Concerning industrial emissions, collectors and closed systems can keep the air pollution to the minimal standards imposed by legislation ( 26 ).

Current strategies to improve air quality require an estimation of the economic value of the benefits gained from proposed programs. These proposed programs by public authorities, and directives are issued with guidelines to be respected.

In Europe, air quality limit values AQLVs (Air Quality Limit Values) are issued for setting off planning claims ( 27 ). In the USA, the NAAQS (National Ambient Air Quality Standards) establish the national air quality limit values ( 27 ). While both standards and directives are based on different mechanisms, significant success has been achieved in the reduction of overall emissions and associated health and environmental effects ( 27 ). The European Directive identifies geographical areas of risk exposure as monitoring/assessment zones to record the emission sources and levels of air pollution ( 27 ), whereas the USA establishes global geographical air quality criteria according to the severity of their air quality problem and records all sources of the pollutants and their precursors ( 27 ).

In this vein, funds have been financing, directly or indirectly, projects related to air quality along with the technical infrastructure to maintain good air quality. These plans focus on an inventory of databases from air quality environmental planning awareness campaigns. Moreover, pollution measures of air emissions may be taken for vehicles, machines, and industries in urban areas.

Technological innovation can only be successful if it is able to meet the needs of society. In this sense, technology must reflect the decision-making practices and procedures of those involved in risk assessment and evaluation and act as a facilitator in providing information and assessments to enable decision makers to make the best decisions possible. Summarizing the aforementioned in order to design an effective air quality control strategy, several aspects must be considered: environmental factors and ambient air quality conditions, engineering factors and air pollutant characteristics, and finally, economic operating costs for technological improvement and administrative and legal costs. Considering the economic factor, competitiveness through neoliberal concepts is offering a solution to environmental problems ( 22 ).

The development of environmental governance, along with technological progress, has initiated the deployment of a dialogue. Environmental politics has created objections and points of opposition between different political parties, scientists, media, and governmental and non-governmental organizations ( 22 ). Radical environmental activism actions and movements have been created ( 22 ). The rise of the new information and communication technologies (ICTs) are many times examined as to whether and in which way they have influenced means of communication and social movements such as activism ( 28 ). Since the 1990s, the term “digital activism” has been used increasingly and in many different disciplines ( 29 ). Nowadays, multiple digital technologies can be used to produce a digital activism outcome on environmental issues. More specifically, devices with online capabilities such as computers or mobile phones are being used as a way to pursue change in political and social affairs ( 30 ).

In the present paper, we focus on the sources of environmental pollution in relation to public health and propose some solutions and interventions that may be of interest to environmental legislators and decision makers.

Sources of Exposure

It is known that the majority of environmental pollutants are emitted through large-scale human activities such as the use of industrial machinery, power-producing stations, combustion engines, and cars. Because these activities are performed at such a large scale, they are by far the major contributors to air pollution, with cars estimated to be responsible for approximately 80% of today's pollution ( 31 ). Some other human activities are also influencing our environment to a lesser extent, such as field cultivation techniques, gas stations, fuel tanks heaters, and cleaning procedures ( 32 ), as well as several natural sources, such as volcanic and soil eruptions and forest fires.

The classification of air pollutants is based mainly on the sources producing pollution. Therefore, it is worth mentioning the four main sources, following the classification system: Major sources, Area sources, Mobile sources, and Natural sources.

Major sources include the emission of pollutants from power stations, refineries, and petrochemicals, the chemical and fertilizer industries, metallurgical and other industrial plants, and, finally, municipal incineration.

Indoor area sources include domestic cleaning activities, dry cleaners, printing shops, and petrol stations.

Mobile sources include automobiles, cars, railways, airways, and other types of vehicles.

Finally, natural sources include, as stated previously, physical disasters ( 33 ) such as forest fire, volcanic erosion, dust storms, and agricultural burning.

However, many classification systems have been proposed. Another type of classification is a grouping according to the recipient of the pollution, as follows:

Air pollution is determined as the presence of pollutants in the air in large quantities for long periods. Air pollutants are dispersed particles, hydrocarbons, CO, CO 2 , NO, NO 2 , SO 3 , etc.

Water pollution is organic and inorganic charge and biological charge ( 10 ) at high levels that affect the water quality ( 34 , 35 ).

Soil pollution occurs through the release of chemicals or the disposal of wastes, such as heavy metals, hydrocarbons, and pesticides.

Air pollution can influence the quality of soil and water bodies by polluting precipitation, falling into water and soil environments ( 34 , 36 ). Notably, the chemistry of the soil can be amended due to acid precipitation by affecting plants, cultures, and water quality ( 37 ). Moreover, movement of heavy metals is favored by soil acidity, and metals are so then moving into the watery environment. It is known that heavy metals such as aluminum are noxious to wildlife and fishes. Soil quality seems to be of importance, as soils with low calcium carbonate levels are at increased jeopardy from acid rain. Over and above rain, snow and particulate matter drip into watery ' bodies ( 36 , 38 ).

Lastly, pollution is classified following type of origin:

Radioactive and nuclear pollution , releasing radioactive and nuclear pollutants into water, air, and soil during nuclear explosions and accidents, from nuclear weapons, and through handling or disposal of radioactive sewage.

Radioactive materials can contaminate surface water bodies and, being noxious to the environment, plants, animals, and humans. It is known that several radioactive substances such as radium and uranium concentrate in the bones and can cause cancers ( 38 , 39 ).

Noise pollution is produced by machines, vehicles, traffic noises, and musical installations that are harmful to our hearing.

The World Health Organization introduced the term DALYs. The DALYs for a disease or health condition is defined as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences ( 39 ). In Europe, air pollution is the main cause of disability-adjusted life years lost (DALYs), followed by noise pollution. The potential relationships of noise and air pollution with health have been studied ( 40 ). The study found that DALYs related to noise were more important than those related to air pollution, as the effects of environmental noise on cardiovascular disease were independent of air pollution ( 40 ). Environmental noise should be counted as an independent public health risk ( 40 ).

Environmental pollution occurs when changes in the physical, chemical, or biological constituents of the environment (air masses, temperature, climate, etc.) are produced.

Pollutants harm our environment either by increasing levels above normal or by introducing harmful toxic substances. Primary pollutants are directly produced from the above sources, and secondary pollutants are emitted as by-products of the primary ones. Pollutants can be biodegradable or non-biodegradable and of natural origin or anthropogenic, as stated previously. Moreover, their origin can be a unique source (point-source) or dispersed sources.

Pollutants have differences in physical and chemical properties, explaining the discrepancy in their capacity for producing toxic effects. As an example, we state here that aerosol compounds ( 41 – 43 ) have a greater toxicity than gaseous compounds due to their tiny size (solid or liquid) in the atmosphere; they have a greater penetration capacity. Gaseous compounds are eliminated more easily by our respiratory system ( 41 ). These particles are able to damage lungs and can even enter the bloodstream ( 41 ), leading to the premature deaths of millions of people yearly. Moreover, the aerosol acidity ([H+]) seems to considerably enhance the production of secondary organic aerosols (SOA), but this last aspect is not supported by other scientific teams ( 38 ).

Climate and Pollution

Air pollution and climate change are closely related. Climate is the other side of the same coin that reduces the quality of our Earth ( 44 ). Pollutants such as black carbon, methane, tropospheric ozone, and aerosols affect the amount of incoming sunlight. As a result, the temperature of the Earth is increasing, resulting in the melting of ice, icebergs, and glaciers.

In this vein, climatic changes will affect the incidence and prevalence of both residual and imported infections in Europe. Climate and weather affect the duration, timing, and intensity of outbreaks strongly and change the map of infectious diseases in the globe ( 45 ). Mosquito-transmitted parasitic or viral diseases are extremely climate-sensitive, as warming firstly shortens the pathogen incubation period and secondly shifts the geographic map of the vector. Similarly, water-warming following climate changes leads to a high incidence of waterborne infections. Recently, in Europe, eradicated diseases seem to be emerging due to the migration of population, for example, cholera, poliomyelitis, tick-borne encephalitis, and malaria ( 46 ).

The spread of epidemics is associated with natural climate disasters and storms, which seem to occur more frequently nowadays ( 47 ). Malnutrition and disequilibration of the immune system are also associated with the emerging infections affecting public health ( 48 ).

The Chikungunya virus “took the airplane” from the Indian Ocean to Europe, as outbreaks of the disease were registered in Italy ( 49 ) as well as autochthonous cases in France ( 50 ).

An increase in cryptosporidiosis in the United Kingdom and in the Czech Republic seems to have occurred following flooding ( 36 , 51 ).

As stated previously, aerosols compounds are tiny in size and considerably affect the climate. They are able to dissipate sunlight (the albedo phenomenon) by dispersing a quarter of the sun's rays back to space and have cooled the global temperature over the last 30 years ( 52 ).

Air Pollutants

The World Health Organization (WHO) reports on six major air pollutants, namely particle pollution, ground-level ozone, carbon monoxide, sulfur oxides, nitrogen oxides, and lead. Air pollution can have a disastrous effect on all components of the environment, including groundwater, soil, and air. Additionally, it poses a serious threat to living organisms. In this vein, our interest is mainly to focus on these pollutants, as they are related to more extensive and severe problems in human health and environmental impact. Acid rain, global warming, the greenhouse effect, and climate changes have an important ecological impact on air pollution ( 53 ).

Particulate Matter (PM) and Health

Studies have shown a relationship between particulate matter (PM) and adverse health effects, focusing on either short-term (acute) or long-term (chronic) PM exposure.

Particulate matter (PM) is usually formed in the atmosphere as a result of chemical reactions between the different pollutants. The penetration of particles is closely dependent on their size ( 53 ). Particulate Matter (PM) was defined as a term for particles by the United States Environmental Protection Agency ( 54 ). Particulate matter (PM) pollution includes particles with diameters of 10 micrometers (μm) or smaller, called PM 10 , and extremely fine particles with diameters that are generally 2.5 micrometers (μm) and smaller.

Particulate matter contains tiny liquid or solid droplets that can be inhaled and cause serious health effects ( 55 ). Particles <10 μm in diameter (PM 10 ) after inhalation can invade the lungs and even reach the bloodstream. Fine particles, PM 2.5 , pose a greater risk to health ( 6 , 56 ) ( Table 1 ).

Table 1 . Penetrability according to particle size.

Multiple epidemiological studies have been performed on the health effects of PM. A positive relation was shown between both short-term and long-term exposures of PM 2.5 and acute nasopharyngitis ( 56 ). In addition, long-term exposure to PM for years was found to be related to cardiovascular diseases and infant mortality.

Those studies depend on PM 2.5 monitors and are restricted in terms of study area or city area due to a lack of spatially resolved daily PM 2.5 concentration data and, in this way, are not representative of the entire population. Following a recent epidemiological study by the Department of Environmental Health at Harvard School of Public Health (Boston, MA) ( 57 ), it was reported that, as PM 2.5 concentrations vary spatially, an exposure error (Berkson error) seems to be produced, and the relative magnitudes of the short- and long-term effects are not yet completely elucidated. The team developed a PM 2.5 exposure model based on remote sensing data for assessing short- and long-term human exposures ( 57 ). This model permits spatial resolution in short-term effects plus the assessment of long-term effects in the whole population.

Moreover, respiratory diseases and affection of the immune system are registered as long-term chronic effects ( 58 ). It is worth noting that people with asthma, pneumonia, diabetes, and respiratory and cardiovascular diseases are especially susceptible and vulnerable to the effects of PM. PM 2.5 , followed by PM 10 , are strongly associated with diverse respiratory system diseases ( 59 ), as their size permits them to pierce interior spaces ( 60 ). The particles produce toxic effects according to their chemical and physical properties. The components of PM 10 and PM 2.5 can be organic (polycyclic aromatic hydrocarbons, dioxins, benzene, 1-3 butadiene) or inorganic (carbon, chlorides, nitrates, sulfates, metals) in nature ( 55 ).

Particulate Matter (PM) is divided into four main categories according to type and size ( 61 ) ( Table 2 ).

Table 2 . Types and sizes of particulate Matter (PM).

Gas contaminants include PM in aerial masses.

Particulate contaminants include contaminants such as smog, soot, tobacco smoke, oil smoke, fly ash, and cement dust.

Biological Contaminants are microorganisms (bacteria, viruses, fungi, mold, and bacterial spores), cat allergens, house dust and allergens, and pollen.

Types of Dust include suspended atmospheric dust, settling dust, and heavy dust.

Finally, another fact is that the half-lives of PM 10 and PM 2.5 particles in the atmosphere is extended due to their tiny dimensions; this permits their long-lasting suspension in the atmosphere and even their transfer and spread to distant destinations where people and the environment may be exposed to the same magnitude of pollution ( 53 ). They are able to change the nutrient balance in watery ecosystems, damage forests and crops, and acidify water bodies.

As stated, PM 2.5 , due to their tiny size, are causing more serious health effects. These aforementioned fine particles are the main cause of the “haze” formation in different metropolitan areas ( 12 , 13 , 61 ).

Ozone Impact in the Atmosphere

Ozone (O 3 ) is a gas formed from oxygen under high voltage electric discharge ( 62 ). It is a strong oxidant, 52% stronger than chlorine. It arises in the stratosphere, but it could also arise following chain reactions of photochemical smog in the troposphere ( 63 ).

Ozone can travel to distant areas from its initial source, moving with air masses ( 64 ). It is surprising that ozone levels over cities are low in contrast to the increased amounts occuring in urban areas, which could become harmful for cultures, forests, and vegetation ( 65 ) as it is reducing carbon assimilation ( 66 ). Ozone reduces growth and yield ( 47 , 48 ) and affects the plant microflora due to its antimicrobial capacity ( 67 , 68 ). In this regard, ozone acts upon other natural ecosystems, with microflora ( 69 , 70 ) and animal species changing their species composition ( 71 ). Ozone increases DNA damage in epidermal keratinocytes and leads to impaired cellular function ( 72 ).

Ground-level ozone (GLO) is generated through a chemical reaction between oxides of nitrogen and VOCs emitted from natural sources and/or following anthropogenic activities.

Ozone uptake usually occurs by inhalation. Ozone affects the upper layers of the skin and the tear ducts ( 73 ). A study of short-term exposure of mice to high levels of ozone showed malondialdehyde formation in the upper skin (epidermis) but also depletion in vitamins C and E. It is likely that ozone levels are not interfering with the skin barrier function and integrity to predispose to skin disease ( 74 ).

Due to the low water-solubility of ozone, inhaled ozone has the capacity to penetrate deeply into the lungs ( 75 ).

Toxic effects induced by ozone are registered in urban areas all over the world, causing biochemical, morphologic, functional, and immunological disorders ( 76 ).

The European project (APHEA2) focuses on the acute effects of ambient ozone concentrations on mortality ( 77 ). Daily ozone concentrations compared to the daily number of deaths were reported from different European cities for a 3-year period. During the warm period of the year, an observed increase in ozone concentration was associated with an increase in the daily number of deaths (0.33%), in the number of respiratory deaths (1.13%), and in the number of cardiovascular deaths (0.45%). No effect was observed during wintertime.

Carbon Monoxide (CO)

Carbon monoxide is produced by fossil fuel when combustion is incomplete. The symptoms of poisoning due to inhaling carbon monoxide include headache, dizziness, weakness, nausea, vomiting, and, finally, loss of consciousness.

The affinity of carbon monoxide to hemoglobin is much greater than that of oxygen. In this vein, serious poisoning may occur in people exposed to high levels of carbon monoxide for a long period of time. Due to the loss of oxygen as a result of the competitive binding of carbon monoxide, hypoxia, ischemia, and cardiovascular disease are observed.

Carbon monoxide affects the greenhouses gases that are tightly connected to global warming and climate. This should lead to an increase in soil and water temperatures, and extreme weather conditions or storms may occur ( 68 ).

However, in laboratory and field experiments, it has been seen to produce increased plant growth ( 78 ).

Nitrogen Oxide (NO 2 )

Nitrogen oxide is a traffic-related pollutant, as it is emitted from automobile motor engines ( 79 , 80 ). It is an irritant of the respiratory system as it penetrates deep in the lung, inducing respiratory diseases, coughing, wheezing, dyspnea, bronchospasm, and even pulmonary edema when inhaled at high levels. It seems that concentrations over 0.2 ppm produce these adverse effects in humans, while concentrations higher than 2.0 ppm affect T-lymphocytes, particularly the CD8+ cells and NK cells that produce our immune response ( 81 ).It is reported that long-term exposure to high levels of nitrogen dioxide can be responsible for chronic lung disease. Long-term exposure to NO 2 can impair the sense of smell ( 81 ).

However, systems other than respiratory ones can be involved, as symptoms such as eye, throat, and nose irritation have been registered ( 81 ).

High levels of nitrogen dioxide are deleterious to crops and vegetation, as they have been observed to reduce crop yield and plant growth efficiency. Moreover, NO 2 can reduce visibility and discolor fabrics ( 81 ).

Sulfur Dioxide (SO 2 )

Sulfur dioxide is a harmful gas that is emitted mainly from fossil fuel consumption or industrial activities. The annual standard for SO 2 is 0.03 ppm ( 82 ). It affects human, animal, and plant life. Susceptible people as those with lung disease, old people, and children, who present a higher risk of damage. The major health problems associated with sulfur dioxide emissions in industrialized areas are respiratory irritation, bronchitis, mucus production, and bronchospasm, as it is a sensory irritant and penetrates deep into the lung converted into bisulfite and interacting with sensory receptors, causing bronchoconstriction. Moreover, skin redness, damage to the eyes (lacrimation and corneal opacity) and mucous membranes, and worsening of pre-existing cardiovascular disease have been observed ( 81 ).

Environmental adverse effects, such as acidification of soil and acid rain, seem to be associated with sulfur dioxide emissions ( 83 ).

Lead is a heavy metal used in different industrial plants and emitted from some petrol motor engines, batteries, radiators, waste incinerators, and waste waters ( 84 ).

Moreover, major sources of lead pollution in the air are metals, ore, and piston-engine aircraft. Lead poisoning is a threat to public health due to its deleterious effects upon humans, animals, and the environment, especially in the developing countries.

Exposure to lead can occur through inhalation, ingestion, and dermal absorption. Trans- placental transport of lead was also reported, as lead passes through the placenta unencumbered ( 85 ). The younger the fetus is, the more harmful the toxic effects. Lead toxicity affects the fetal nervous system; edema or swelling of the brain is observed ( 86 ). Lead, when inhaled, accumulates in the blood, soft tissue, liver, lung, bones, and cardiovascular, nervous, and reproductive systems. Moreover, loss of concentration and memory, as well as muscle and joint pain, were observed in adults ( 85 , 86 ).

Children and newborns ( 87 ) are extremely susceptible even to minimal doses of lead, as it is a neurotoxicant and causes learning disabilities, impairment of memory, hyperactivity, and even mental retardation.

Elevated amounts of lead in the environment are harmful to plants and crop growth. Neurological effects are observed in vertebrates and animals in association with high lead levels ( 88 ).

Polycyclic Aromatic Hydrocarbons(PAHs)

The distribution of PAHs is ubiquitous in the environment, as the atmosphere is the most important means of their dispersal. They are found in coal and in tar sediments. Moreover, they are generated through incomplete combustion of organic matter as in the cases of forest fires, incineration, and engines ( 89 ). PAH compounds, such as benzopyrene, acenaphthylene, anthracene, and fluoranthene are recognized as toxic, mutagenic, and carcinogenic substances. They are an important risk factor for lung cancer ( 89 ).

Volatile Organic Compounds(VOCs)

Volatile organic compounds (VOCs), such as toluene, benzene, ethylbenzene, and xylene ( 90 ), have been found to be associated with cancer in humans ( 91 ). The use of new products and materials has actually resulted in increased concentrations of VOCs. VOCs pollute indoor air ( 90 ) and may have adverse effects on human health ( 91 ). Short-term and long-term adverse effects on human health are observed. VOCs are responsible for indoor air smells. Short-term exposure is found to cause irritation of eyes, nose, throat, and mucosal membranes, while those of long duration exposure include toxic reactions ( 92 ). Predictable assessment of the toxic effects of complex VOC mixtures is difficult to estimate, as these pollutants can have synergic, antagonistic, or indifferent effects ( 91 , 93 ).

Dioxins originate from industrial processes but also come from natural processes, such as forest fires and volcanic eruptions. They accumulate in foods such as meat and dairy products, fish and shellfish, and especially in the fatty tissue of animals ( 94 ).

Short-period exhibition to high dioxin concentrations may result in dark spots and lesions on the skin ( 94 ). Long-term exposure to dioxins can cause developmental problems, impairment of the immune, endocrine and nervous systems, reproductive infertility, and cancer ( 94 ).

Without any doubt, fossil fuel consumption is responsible for a sizeable part of air contamination. This contamination may be anthropogenic, as in agricultural and industrial processes or transportation, while contamination from natural sources is also possible. Interestingly, it is of note that the air quality standards established through the European Air Quality Directive are somewhat looser than the WHO guidelines, which are stricter ( 95 ).

Effect of Air Pollution on Health

The most common air pollutants are ground-level ozone and Particulates Matter (PM). Air pollution is distinguished into two main types:

Outdoor pollution is the ambient air pollution.

Indoor pollution is the pollution generated by household combustion of fuels.

People exposed to high concentrations of air pollutants experience disease symptoms and states of greater and lesser seriousness. These effects are grouped into short- and long-term effects affecting health.

Susceptible populations that need to be aware of health protection measures include old people, children, and people with diabetes and predisposing heart or lung disease, especially asthma.

As extensively stated previously, according to a recent epidemiological study from Harvard School of Public Health, the relative magnitudes of the short- and long-term effects have not been completely clarified ( 57 ) due to the different epidemiological methodologies and to the exposure errors. New models are proposed for assessing short- and long-term human exposure data more successfully ( 57 ). Thus, in the present section, we report the more common short- and long-term health effects but also general concerns for both types of effects, as these effects are often dependent on environmental conditions, dose, and individual susceptibility.

Short-term effects are temporary and range from simple discomfort, such as irritation of the eyes, nose, skin, throat, wheezing, coughing and chest tightness, and breathing difficulties, to more serious states, such as asthma, pneumonia, bronchitis, and lung and heart problems. Short-term exposure to air pollution can also cause headaches, nausea, and dizziness.

These problems can be aggravated by extended long-term exposure to the pollutants, which is harmful to the neurological, reproductive, and respiratory systems and causes cancer and even, rarely, deaths.

The long-term effects are chronic, lasting for years or the whole life and can even lead to death. Furthermore, the toxicity of several air pollutants may also induce a variety of cancers in the long term ( 96 ).

As stated already, respiratory disorders are closely associated with the inhalation of air pollutants. These pollutants will invade through the airways and will accumulate at the cells. Damage to target cells should be related to the pollutant component involved and its source and dose. Health effects are also closely dependent on country, area, season, and time. An extended exposure duration to the pollutant should incline to long-term health effects in relation also to the above factors.

Particulate Matter (PMs), dust, benzene, and O 3 cause serious damage to the respiratory system ( 97 ). Moreover, there is a supplementary risk in case of existing respiratory disease such as asthma ( 98 ). Long-term effects are more frequent in people with a predisposing disease state. When the trachea is contaminated by pollutants, voice alterations may be remarked after acute exposure. Chronic obstructive pulmonary disease (COPD) may be induced following air pollution, increasing morbidity and mortality ( 99 ). Long-term effects from traffic, industrial air pollution, and combustion of fuels are the major factors for COPD risk ( 99 ).

Multiple cardiovascular effects have been observed after exposure to air pollutants ( 100 ). Changes occurred in blood cells after long-term exposure may affect cardiac functionality. Coronary arteriosclerosis was reported following long-term exposure to traffic emissions ( 101 ), while short-term exposure is related to hypertension, stroke, myocardial infracts, and heart insufficiency. Ventricle hypertrophy is reported to occur in humans after long-time exposure to nitrogen oxide (NO 2 ) ( 102 , 103 ).

Neurological effects have been observed in adults and children after extended-term exposure to air pollutants.

Psychological complications, autism, retinopathy, fetal growth, and low birth weight seem to be related to long-term air pollution ( 83 ). The etiologic agent of the neurodegenerative diseases (Alzheimer's and Parkinson's) is not yet known, although it is believed that extended exposure to air pollution seems to be a factor. Specifically, pesticides and metals are cited as etiological factors, together with diet. The mechanisms in the development of neurodegenerative disease include oxidative stress, protein aggregation, inflammation, and mitochondrial impairment in neurons ( 104 ) ( Figure 1 ).

Figure 1 . Impact of air pollutants on the brain.

Brain inflammation was observed in dogs living in a highly polluted area in Mexico for a long period ( 105 ). In human adults, markers of systemic inflammation (IL-6 and fibrinogen) were found to be increased as an immediate response to PNC on the IL-6 level, possibly leading to the production of acute-phase proteins ( 106 ). The progression of atherosclerosis and oxidative stress seem to be the mechanisms involved in the neurological disturbances caused by long-term air pollution. Inflammation comes secondary to the oxidative stress and seems to be involved in the impairment of developmental maturation, affecting multiple organs ( 105 , 107 ). Similarly, other factors seem to be involved in the developmental maturation, which define the vulnerability to long-term air pollution. These include birthweight, maternal smoking, genetic background and socioeconomic environment, as well as education level.

However, diet, starting from breast-feeding, is another determinant factor. Diet is the main source of antioxidants, which play a key role in our protection against air pollutants ( 108 ). Antioxidants are free radical scavengers and limit the interaction of free radicals in the brain ( 108 ). Similarly, genetic background may result in a differential susceptibility toward the oxidative stress pathway ( 60 ). For example, antioxidant supplementation with vitamins C and E appears to modulate the effect of ozone in asthmatic children homozygous for the GSTM1 null allele ( 61 ). Inflammatory cytokines released in the periphery (e.g., respiratory epithelia) upregulate the innate immune Toll-like receptor 2. Such activation and the subsequent events leading to neurodegeneration have recently been observed in lung lavage in mice exposed to ambient Los Angeles (CA, USA) particulate matter ( 61 ). In children, neurodevelopmental morbidities were observed after lead exposure. These children developed aggressive and delinquent behavior, reduced intelligence, learning difficulties, and hyperactivity ( 109 ). No level of lead exposure seems to be “safe,” and the scientific community has asked the Centers for Disease Control and Prevention (CDC) to reduce the current screening guideline of 10 μg/dl ( 109 ).

It is important to state that impact on the immune system, causing dysfunction and neuroinflammation ( 104 ), is related to poor air quality. Yet, increases in serum levels of immunoglobulins (IgA, IgM) and the complement component C3 are observed ( 106 ). Another issue is that antigen presentation is affected by air pollutants, as there is an upregulation of costimulatory molecules such as CD80 and CD86 on macrophages ( 110 ).

As is known, skin is our shield against ultraviolet radiation (UVR) and other pollutants, as it is the most exterior layer of our body. Traffic-related pollutants, such as PAHs, VOCs, oxides, and PM, may cause pigmented spots on our skin ( 111 ). On the one hand, as already stated, when pollutants penetrate through the skin or are inhaled, damage to the organs is observed, as some of these pollutants are mutagenic and carcinogenic, and, specifically, they affect the liver and lung. On the other hand, air pollutants (and those in the troposphere) reduce the adverse effects of ultraviolet radiation UVR in polluted urban areas ( 111 ). Air pollutants absorbed by the human skin may contribute to skin aging, psoriasis, acne, urticaria, eczema, and atopic dermatitis ( 111 ), usually caused by exposure to oxides and photochemical smoke ( 111 ). Exposure to PM and cigarette smoking act as skin-aging agents, causing spots, dyschromia, and wrinkles. Lastly, pollutants have been associated with skin cancer ( 111 ).

Higher morbidity is reported to fetuses and children when exposed to the above dangers. Impairment in fetal growth, low birth weight, and autism have been reported ( 112 ).

Another exterior organ that may be affected is the eye. Contamination usually comes from suspended pollutants and may result in asymptomatic eye outcomes, irritation ( 112 ), retinopathy, or dry eye syndrome ( 113 , 114 ).

Environmental Impact of Air Pollution

Air pollution is harming not only human health but also the environment ( 115 ) in which we live. The most important environmental effects are as follows.

Acid rain is wet (rain, fog, snow) or dry (particulates and gas) precipitation containing toxic amounts of nitric and sulfuric acids. They are able to acidify the water and soil environments, damage trees and plantations, and even damage buildings and outdoor sculptures, constructions, and statues.

Haze is produced when fine particles are dispersed in the air and reduce the transparency of the atmosphere. It is caused by gas emissions in the air coming from industrial facilities, power plants, automobiles, and trucks.

Ozone , as discussed previously, occurs both at ground level and in the upper level (stratosphere) of the Earth's atmosphere. Stratospheric ozone is protecting us from the Sun's harmful ultraviolet (UV) rays. In contrast, ground-level ozone is harmful to human health and is a pollutant. Unfortunately, stratospheric ozone is gradually damaged by ozone-depleting substances (i.e., chemicals, pesticides, and aerosols). If this protecting stratospheric ozone layer is thinned, then UV radiation can reach our Earth, with harmful effects for human life (skin cancer) ( 116 ) and crops ( 117 ). In plants, ozone penetrates through the stomata, inducing them to close, which blocks CO 2 transfer and induces a reduction in photosynthesis ( 118 ).

Global climate change is an important issue that concerns mankind. As is known, the “greenhouse effect” keeps the Earth's temperature stable. Unhappily, anthropogenic activities have destroyed this protecting temperature effect by producing large amounts of greenhouse gases, and global warming is mounting, with harmful effects on human health, animals, forests, wildlife, agriculture, and the water environment. A report states that global warming is adding to the health risks of poor people ( 119 ).

People living in poorly constructed buildings in warm-climate countries are at high risk for heat-related health problems as temperatures mount ( 119 ).

Wildlife is burdened by toxic pollutants coming from the air, soil, or the water ecosystem and, in this way, animals can develop health problems when exposed to high levels of pollutants. Reproductive failure and birth effects have been reported.

Eutrophication is occurring when elevated concentrations of nutrients (especially nitrogen) stimulate the blooming of aquatic algae, which can cause a disequilibration in the diversity of fish and their deaths.

Without a doubt, there is a critical concentration of pollution that an ecosystem can tolerate without being destroyed, which is associated with the ecosystem's capacity to neutralize acidity. The Canada Acid Rain Program established this load at 20 kg/ha/yr ( 120 ).

Hence, air pollution has deleterious effects on both soil and water ( 121 ). Concerning PM as an air pollutant, its impact on crop yield and food productivity has been reported. Its impact on watery bodies is associated with the survival of living organisms and fishes and their productivity potential ( 121 ).

An impairment in photosynthetic rhythm and metabolism is observed in plants exposed to the effects of ozone ( 121 ).

Sulfur and nitrogen oxides are involved in the formation of acid rain and are harmful to plants and marine organisms.

Last but not least, as mentioned above, the toxicity associated with lead and other metals is the main threat to our ecosystems (air, water, and soil) and living creatures ( 121 ).

In 2018, during the first WHO Global Conference on Air Pollution and Health, the WHO's General Director, Dr. Tedros Adhanom Ghebreyesus, called air pollution a “silent public health emergency” and “the new tobacco” ( 122 ).

Undoubtedly, children are particularly vulnerable to air pollution, especially during their development. Air pollution has adverse effects on our lives in many different respects.

Diseases associated with air pollution have not only an important economic impact but also a societal impact due to absences from productive work and school.

Despite the difficulty of eradicating the problem of anthropogenic environmental pollution, a successful solution could be envisaged as a tight collaboration of authorities, bodies, and doctors to regularize the situation. Governments should spread sufficient information and educate people and should involve professionals in these issues so as to control the emergence of the problem successfully.

Technologies to reduce air pollution at the source must be established and should be used in all industries and power plants. The Kyoto Protocol of 1997 set as a major target the reduction of GHG emissions to below 5% by 2012 ( 123 ). This was followed by the Copenhagen summit, 2009 ( 124 ), and then the Durban summit of 2011 ( 125 ), where it was decided to keep to the same line of action. The Kyoto protocol and the subsequent ones were ratified by many countries. Among the pioneers who adopted this important protocol for the world's environmental and climate “health” was China ( 3 ). As is known, China is a fast-developing economy and its GDP (Gross Domestic Product) is expected to be very high by 2050, which is defined as the year of dissolution of the protocol for the decrease in gas emissions.

A more recent international agreement of crucial importance for climate change is the Paris Agreement of 2015, issued by the UNFCCC (United Nations Climate Change Committee). This latest agreement was ratified by a plethora of UN (United Nations) countries as well as the countries of the European Union ( 126 ). In this vein, parties should promote actions and measures to enhance numerous aspects around the subject. Boosting education, training, public awareness, and public participation are some of the relevant actions for maximizing the opportunities to achieve the targets and goals on the crucial matter of climate change and environmental pollution ( 126 ). Without any doubt, technological improvements makes our world easier and it seems difficult to reduce the harmful impact caused by gas emissions, we could limit its use by seeking reliable approaches.

Synopsizing, a global prevention policy should be designed in order to combat anthropogenic air pollution as a complement to the correct handling of the adverse health effects associated with air pollution. Sustainable development practices should be applied, together with information coming from research in order to handle the problem effectively.

At this point, international cooperation in terms of research, development, administration policy, monitoring, and politics is vital for effective pollution control. Legislation concerning air pollution must be aligned and updated, and policy makers should propose the design of a powerful tool of environmental and health protection. As a result, the main proposal of this essay is that we should focus on fostering local structures to promote experience and practice and extrapolate these to the international level through developing effective policies for sustainable management of ecosystems.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

IM is employed by the company Delphis S.A.

The remaining authors declare that the present review paper was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: air pollution, environment, health, public health, gas emission, policy

Citation: Manisalidis I, Stavropoulou E, Stavropoulos A and Bezirtzoglou E (2020) Environmental and Health Impacts of Air Pollution: A Review. Front. Public Health 8:14. doi: 10.3389/fpubh.2020.00014

Received: 17 October 2019; Accepted: 17 January 2020; Published: 20 February 2020.

Reviewed by:

Copyright © 2020 Manisalidis, Stavropoulou, Stavropoulos and Bezirtzoglou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ioannis Manisalidis, giannismanisal@gmail.com ; Elisavet Stavropoulou, elisabeth.stavropoulou@gmail.com

† These authors have contributed equally to this work

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Air Pollution and Health—New Advances for an Old Public Health Problem

• 1 Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis
• Original Investigation Short-Term Exposure to PM 2.5 and NO 2 and Mortality in 4 Countries Yiqun Ma, MPhil; Federica Nobile, MSc; Anne Marb, MSc; Robert Dubrow, MD, PhD; Massimo Stafoggia, PhD; Susanne Breitner, ScD; Patrick L. Kinney, ScD; Kai Chen, PhD JAMA Network Open

The link between air pollution exposure and increased mortality and morbidity is firmly supported by a broad evidence base. The 2015 Global Burden of Diseases Study, a 195-country investigation, found fine particulate matter (ie, particles with an aerodynamic diameter ≤2.5 μm [PM 2.5 ]) to be the fifth ranking worldwide mortality risk factor, with an attributed 4.2 million premature deaths. 1 Yet these impacts are not equally distributed. Worsening air quality, in conjunction with population growth, has driven absolute increases in air pollution–associated illness in low- and middle-income nations. Furthermore, while air quality has improved in high-income nations, geographic disparities persist among economically and racially disparate communities where air pollution remains stubbornly elevated. 2 Prioritizing air quality improvements in the most affected areas will yield the greatest public health benefits, but quantifying the level of improvement needed is an evolving question.

Improvement in air quality can be attributed to policies that set regulatory air pollution standards or guidelines protective of human health. Epidemiological data and evidence are used by environmental agencies, such as the World Health Organization, the US Environmental Protection Agency, and the European Union, to determine appropriate regulatory targets for criteria air pollutants, including PM 2.5 , ozone, and nitrogen dioxide ( no 2 ). However, the decision-making behind regulatory standards relies on up-to-date exposure and health information derived using appropriate methods. In the US, the Clean Air Act requires an independent review of the most relevant air pollution and health literature assessed through a weight-of-evidence approach. Weight-of-evidence relies on the examination of multiple evidentiary lines crossing different scientific disciplines, including epidemiological cohorts, animal-based toxicologic studies, and controlled human exposures or clinical findings, to determine causality. 3 The strength of this approach is to ensure that identified air pollution and health effects are not restricted to a single line of study and consider the full body of scientific inquiry.

So, why should we pursue studies of air pollution and health when the existing literature is so robust? The identification of appropriate regulatory thresholds depends on up-to-date investigations that support, dispute, or identify new air pollution and health associations. This observational study by Ma and colleagues 4 evaluated the association between acute PM 2.5 and no 2 air pollution exposure with 8.96 million mortality events in 4 separate global regions: Jiangsu, China; California, US; south-central Italy; and Germany. The findings in the study by Ma et al 4 confirm previously identified associations of increased mortality with greater PM 2.5 and no 2 exposure. 5 Ma et al 4 also observed heterogeneity in the strength of associations of mortality with the highest air pollution risks identified in south-central Italy for PM 2.5 and Germany for no 2 . However, the novel aspect of their work was the methodological application of a 2-way interactive fixed-effect model used to infer the air pollution and mortality association. Ma et al 4 argued that this econometric-derived approach has advantages over more traditional time-series modeling by controlling for both measured and unmeasured time-varying spatial unit–specific confounders. Ma and colleagues 4 further compared their findings with a more familiar time-series model and demonstrated robustness in the air pollution and mortality association using both approaches. This methodological comparison not only validates prior air pollution and health studies that use time-series methods 6 but provides evidentiary rigor for the validity of both methods when reconsidering regulatory standards.

While the study by Ma et al 4 presents an alternative statistical approach for estimating air pollution health effects, there are other noteworthy advances in the air pollution and health literature. First, there have been new developments in air pollution exposure modeling. Initial population-level health assessments used regulatory monitoring networks that provided criterion-standard measurements but were spatially limited and insufficient for evaluating small-scale exposure variability. Over the last 2 decades, newly developed air pollution models that use regression or machine-learning techniques allow the incorporation of hundreds of indicator exposure variables, such as land-use, source proximity (eg, roadways, industrial facilities), and remotely sensed satellite pollution measures to estimate fine-scale air pollution. 7 Air quality models provide several benefits, including broad geographic coverage of both urban and rural areas and a highly resolved spatial scale down to 1 kilometer or smaller. Data at this resolution are critical for addressing air pollution–related concerns around community disparities in exposure and identifying local pollution hot spots, both important tenets of environmental justice. A second advancement has been the identification of systemic air pollution impacts through additional adverse health outcomes. The diseases most frequently associated with air pollution have been cardiovascular and respiratory outcomes, but other research has elucidated potential associations with neurological outcomes (eg, Alzheimer, Parkinson disease), cancers, kidney disease, and perinatal health. 8 Although the exploration of mechanistic pathways between environmental exposure and these health outcomes is an area of active research, it is suspected that air pollution–induced inflammatory response and the continuous formation of reactive oxygen species may result in chronic harm to biological systems. The uptake of metals through ultrafine particles and their transport through the circulatory system and across blood-brain and placental barriers is another risk factor, particularly for neurological dysfunction.

A third advancement has been recognition that climate change will play a crucial role in current and future air quality. Under current climate projections, air pollution–attributed mortality is expected to increase annual US deaths by nearly 25 000 in the year 2095. 9 Climate change can impact air quality and health through direct increases in air pollution concentrations. Individual events, like wildfires or dust storms, will directly result in greater pollutant emissions, while meteorological shifts (eg, extreme temperatures, cloud cover, precipitation) will promote the secondary formation of ozone and particulate matter. Climate change will also increase the likelihood of simultaneous poor air quality events during extreme weather conditions, such as heatwaves or drought. 10 The compound occurrence of elevated air pollution and extreme weather highlights the potential for climate change to act as a risk multiplier that will magnify adverse health outcomes beyond any single event.

Studies, like this report by Ma et al, 4 present critical pieces of scientific evidence to quantify air pollution health effects and support the selection of appropriate regulatory standards and guidelines. Additionally, assessing the full public health impacts of air pollution relies on innovative advances in methods, exposure assessment, and identification of alternative disease outcomes. Continued research into the health effects of air pollution supports not only scientifically robust policy but prepares practitioners and leaders to objectively address the future challenges of air pollution and climate change.

Published: March 1, 2024. doi:10.1001/jamanetworkopen.2023.54551

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Berman JD. JAMA Network Open .

Corresponding Author: Jesse D. Berman, PhD, Division of Environmental Health Sciences, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN 55455 ( [email protected] ).

Conflict of Interest Disclosures: None reported.

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Berman JD. Air Pollution and Health—New Advances for an Old Public Health Problem. JAMA Netw Open. 2024;7(3):e2354551. doi:10.1001/jamanetworkopen.2023.54551

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Air pollution: The invisible health threat

Who trains health workers to battle air pollution and protect global health..

“In the realm of public health, the detrimental effects of air pollution have long been a cause for concern. A disconcerting reality persists: the issue of air pollution remains inadequately integrated into the educational curricula of health professionals. By equipping health professionals with comprehensive knowledge and practical skills to understand, assess, and mitigate the health risks associated with air pollution, we can empower them to take proactive measures that protect people’s health.”  Maria Neira, Director Department Environment, Climate Change and Health, WHO

Air pollution is a public health emergency

Each day, as we take a breath, an invisible storm of particles and molecules infiltrates our bodies, posing a threat not only to our lungs. Yet, have you ever  truly pondered the significance of clean air as an important determinant of your health and wellbeing? Yet, it is a question that warrants your consideration, for you likely find yourself among the vast majority – 99% of people exposed to air pollution levels that exceed those recommended by WHO  in their latest guidelines published in 2021 .

Air pollution is a major environmental threat and one of the main cases of death among all risk factors, ranking just below hypertension, tobacco smoking and high glucose . WHO estimates that, globally, air pollution  is responsible for about 7 million premature deaths per year from ischemic heart disease, stroke, chronic obstructive pulmonary disease and lung cancer, but also from acute respiratory infections such as pneumonia which mainly affects children in low- and middle-income countries . Being recognized as one of the main risk factors for Non-Communicable Diseases, a growing and consistent body of evidence shows that air pollution health effects also include preterm and low-birthweight, asthma as well as cognitive and neurological impairment basically having the potential to impact our whole body, way beyond our lungs. Air pollution is a threat also for public health economy as it imposes enormous global health  costs representing 6.1% of the global gross domestic product (more than US$ 8 trillion in 2019).

Breathing for tomorrow: training the next generation of health workers

Put yourself in the shoes of a family doctor, faced with a young girl who frequently suffers from asthma attacks. As you embark on the journey of gathering her medical history, you realize that there might be more to the story than meets the eye. Could air pollution be an underlying risk factor worth considering in your patient’s assessment? What additional questions would you pose? How would you advise her to reduce her risk?

At present, health workers are often not aware of the health  impacts of air pollution. This risk factor is not sufficiently addressed in the curricula of health professionals, with only 12% of medical schools world- wide including it as part of for- mal education, a study from the International Association of Medical Students’ Associations reports. As research is showing that a strong incorporation of air pollution and health as part of clinical disease guidelines is missing , the results from a World Heart Federation members survey indicates that while air pollution is recognized as one of the major risk factors for cardiovascular diseases, less than 50% of the responders felt that they have access to any tools and resources they need to better educate themselves and others .

Yet, the international community recently recognized that the health workforce should play a more prominent role in the battle for clean air. The World Health Assembly resolutions WHA68.8,9 “Health and the environment: addressing the health impact of air pollution” , and A69/18,10 “Road map for an enhanced global response to the adverse health effects of air pollution” request WHO to strengthen the capacity of the health sector to address the adverse health effects of air pollution.

In a landmark collaboration with more than 30 international experts, the World Health Organization has developed the first WHO Air Pollution and Health Training toolkit targeting health workers (APHT) set to be  unveiled at the end of 2023. The toolkit will be made of download- able and interactive resources to train health care workers, and beyond. In preparation for the toolkit launch, a freely accessible OpenWHO online training will be released on the occasion of the UN International Day for Clean Air and Blue Sky on 7 September 2023.

Training the trainers: a pilot workshop in Ghana

“If health workers are aware, they can train their peers and advise people in their neighborhoods and communities on how to reduce their risk” , said Edward Owusu, District Control Officer at the Regional Health Directorate, Central Ghana. Edward is one of the almost fifty health professionals that gathered in  Kumasi, Ghana, in June 2022 during a one-week pilot workshop of the APHT toolkit led by WHO in collaboration with Ghana Health Service. WHO also invited experts from the Global Family Doctors (WONCA) and University of Ghana .

Participants were exposed to a set of training modules and multiple interactive sessions, tackling introductory modules about air pollution and health as well as specific modules for clinicians and care-givers addressing cardiovascular and respiratory diseases as well as the health effects of air pollution on newborns, children and pregnant women. Using a train-the-trainer approach, the pilot workshop allowed health professionals to gain appropriate skills and knowledge to act as trainers with peer colleagues in the health  sector and in the communities they serve. The development of a clinical approach to air pollution was enhanced using clinical case scenarios specifically designed to improve the clinical reason- ing of health professionals, taking environmental risk factors into proper consideration when assessing the health status of a patient, and providing guidance for exposure reduction. A field visit to hot spot air pollution sites was also organized. Piloting directly with the target audience ensure relevance and provide invaluable feedback for future adaptation and implementation on the ground.

Clean air interventions as a win-win-opportunity

A reduction in air pollution emissions is a “win–win” opportunity  to simultaneously protect human health and the environment and to address climate change mitigation, as the combustion of fossil fuels contributes to increasing the levels of some air pollutants.

In addition to interventions that can take place in sectors like household energy, transportation, power generation and industry, agriculture, and housing , building the capacity of the health sector on air pollution and health is essential to reduce the burden of disease. Health workers have a central role to play in this effort while engaging in multi-sectoral action and advocate for clean air interventions that aim at lowering emissions of pollutants – and promote the collaboration between all civil  society relevant actors, political parties, and institutions for policy implementation.  Their action is an unprecedented opportunity to protect and pro- mote both people’s health and wellbeing as well as the planet.

While health care workers cannot reduce the emissions of air pollution alone, the constant trust being given to them and being at the front line of prevention and care, is a strong basis for providing guidance to individuals, patients and communities . Primary prevention and addressing root causes of ill-health remains crucial and needs to be strengthened, as it is cost-effective but often under-funded and over- looked. The health argument needs to be central to policy making in various sectors for a healthy planet with healthy people. WHO leadership is now needed more than ever.

Content from:  Special Edition: Serving the People of International Organizations in Geneva since 1949

Air Pollution

WHO's work on Air Quality, Energy and Health

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National Institute of Environmental Health Sciences

Your environment. your health., air pollution and your health, introduction.

Air Pollution

Air pollution is a familiar environmental health hazard. We know what we’re looking at when brown haze settles over a city, exhaust billows across a busy highway, or a plume rises from a smokestack. Some air pollution is not seen, but its pungent smell alerts you.

It is a major threat to global health and prosperity. Air pollution, in all forms, is responsible for more than 6.5 million deaths each year globally , a number that has increased over the past two decades.

What Is Air Pollution?

Air pollution is a mix of hazardous substances from both human-made and natural sources.

Vehicle emissions, fuel oils and natural gas to heat homes, by-products of manufacturing and power generation, particularly coal-fueled power plants, and fumes from chemical production are the primary sources of human-made air pollution.

Nature releases hazardous substances into the air, such as smoke from wildfires, which are often caused by people; ash and gases from volcanic eruptions; and gases, like methane, which are emitted from decomposing organic matter in soils.

Traffic-Related Air Pollution (TRAP), a mixture of gasses and particles, has most of the elements of human-made air pollution: ground-level ozone, various forms of carbon, nitrogen oxides, sulfur oxides, volatile organic compounds, polycyclic aromatic hydrocarbons, and fine particulate matter.

Ozone , an atmospheric gas, is often called smog when at ground level. It is created when pollutants emitted by cars, power plants, industrial boilers, refineries, and other sources chemically react in the presence of sunlight.

Noxious gases , which include carbon dioxide, carbon monoxide, nitrogen oxides (NOx), and sulfur oxides (SOx), are components of motor vehicle emissions and byproducts of industrial processes.

Particulate matter (PM) is composed of chemicals such as sulfates, nitrates, carbon, or mineral dusts. Vehicle and industrial emissions from fossil fuel combustion, cigarette smoke, and burning organic matter, such as wildfires, all contain PM.

A subset of PM, fine particulate matter (PM 2.5) is 30 times thinner than a human hair. It can be inhaled deeply into lung tissue and contribute to serious health problems. PM 2.5 accounts for most health effects due to air pollution in the U.S.

Volatile organic compounds (VOC) vaporize at or near room temperature—hence, the designation volatile. They are called organic because they contain carbon. VOCs are given off by paints, cleaning supplies, pesticides, some furnishings, and even craft materials like glue. Gasoline and natural gas are major sources of VOCs, which are released during combustion.

Polycyclic aromatic hydrocarbons (PAH) are organic compounds containing carbon and hydrogen. Of more than 100 PAHs known to be widespread in the environment, 15 are listed in the Report on Carcinogens . In addition to combustion, many industrial processes, such as iron, steel, and rubber product manufacturing, as well as power generation, also produce PAHs as a by-product. PAHs are also found in particulate matter.

Air Pollution and Climate Change

Air pollution and climate change affect each other through complex interactions in the atmosphere. Air pollution is intricately linked with climate change because both problems come largely from the same sources, such as emissions from burning fossil fuels. Both are threats to people’s health and the environment worldwide. Read more: Health Impacts of Air Quality .

What is NIEHS Doing?

Over its 50-plus year history, NIEHS has been a leader in air pollution research. The institute continues to fund and conduct research into how air pollution affects health and the population groups who are most affected.

How does air pollution affect our health?

When the National Ambient Air Quality Standards were established in 1970, air pollution was regarded primarily as a threat to respiratory health. In 1993, NIEHS researchers published the landmark Six Cities Study , which established an association between fine particulate matter and mortality.

Air pollution exposure is associated with oxidative stress and inflammation in human cells, which may lay a foundation for chronic diseases and cancer. In 2013, the International Agency for Research on Cancer of the World Health Organization (WHO) classified air pollution as a human carcinogen .

Many studies have established that short-term exposure to higher levels of outdoor air pollution is associated with reduced lung function, asthma, cardiac problems, emergency department visits, and hospital admissions . Mortality rates related to air pollution are also a concern. Exposure to the air pollutant PM2.5 is associated with an increased risk of death .

A team of researchers, partially funded by NIEHS, found that deaths decreased after air pollution regulations were implemented and coal-powered plants were retired. The study data covered 21 years. More specifically, they found exposure to PM2.5 from coal was associated with a mortality risk that was twice as high as the risk from exposure to PM2.5 from all sources. PM2.5 from coal is high in sulfur dioxide, black carbon, and metals.

Public health concerns related to high air pollution exposures include cancer, cardiovascular disease, respiratory diseases, diabetes mellitus, obesity, and reproductive, neurological, and immune system disorders.

Research on air pollution and health effects continually advances.

• A large study of more than 57,000 women found living near major roadways may increase a woman’s risk for breast cancer .
• Occupational exposure to benzene, an industrial chemical and component of gasoline, can cause leukemia and is associated with non-Hodgkin’s Lymphoma .
• A long-term study, 2000-2016, found an association between lung cancer incidence and increased reliance on coal for energy generation.
• Using a national dataset of older adults, researchers found that 10-year long exposures to PM2.5 and NO2 increased the risks of colorectal and prostate cancers .

Cardiovascular Disease

• Fine particulate matter can impair blood vessel function and speed up calcification in arteries .
• NIEHS researchers established links between short-term daily exposure by post-menopausal women to nitrogen oxides and increased risk of hemorrhagic stroke .
• For some older Americans, exposure to TRAP can result in lowered levels of high-density lipoprotein , sometimes called good cholesterol, increasing their risk for cardiovascular disease.
• According to a National Toxicology Program (NTP) report , TRAP exposure also increases a pregnant woman’s risk for dangerous changes in blood pressure, known as hypertensive disorders, which are a leading cause of pre-term birth, low birth weight, and maternal and fetal illness and death.

Respiratory Disease

• Air pollution can affect lung development and is implicated in the development of emphysema , asthma, and other respiratory diseases, such as chronic obstructive pulmonary disease (COPD).
• Increases in asthma prevalence and severity are linked to urbanization and outdoor air pollution. Children living in low-income urban areas tend to have more asthma cases than others. Research published in 2023 tied two air pollutants, ozone and PM2.5, to asthma-related changes in children’s airways.
• In a study of 50,000 women across the country, long-term exposure to PM2.5, PM10, and nitrogen dioxide were linked to chronic bronchitis .
• In 2020, a major public health challenge was confluence of the COVID-19 pandemic and wildfires across the western U.S. Building on a well-established connection between air pollution and respiratory-tract infections, a study linked exposure to wildfire smoke with more severe cases of COVID-19 and deaths .

Whom does air pollution affect the most?

Air pollution affects everyone’s health, but certain groups may be harmed more. Almost 9 out of 10 people who live in urban areas worldwide are affected by air pollution.

NIEHS-funded research indicates there are racial or ethnic and socioeconomic disparities in air pollution emissions. Air pollution emissions have decreased over past decades but the changes vary by demographics . This research found that people with annual incomes above $70,000 generally experience greater declines in industry, energy, transportation, residential, and commercial-related emissions than do people with lower incomes.

The NIEHS-funded Children’s Health Study at the University of Southern California is one of the largest studies of the long-term effects of air pollution on children’s respiratory health. Among its findings:

• Higher air pollution levels increase short-term respiratory infections, which lead to more school absences.
• Children who play several outdoor sports and live in high ozone communities are more likely to develop asthma.
• Children living near busy roads have an increased chance of developing asthma.
• Children who were exposed to high levels of air pollutants were more likely to develop bronchitis symptoms in adulthood .
• Living in communities with higher pollution levels can cause lung damage .

Other studies on women and children

• Breathing PM 2.5, even at relatively low levels, may alter the size of a child's developing brain , which may ultimately increase the risk for cognitive and emotional problems later in adolescence.
• In a large-scale study that looked at more than 1 million birth records, prenatal PM2.5 exposure was associated with an increased risk of cerebral palsy . While this finding adds to knowledge about environmental risk factors for cerebral palsy development and how to reduce the chance of it developing, further studies are needed. Prenatal exposure to PAHs was associated with brain development effects, slower processing speed, attention-deficit and hyperactivity disorder (ADHD) symptoms, and other neurobehavioral problems in urban youth .
• Prenatal exposure to air pollution may play a role in the development of ADHD-related behavior problems in childhood.
• Prenatal exposure to particulate matter was associated with low birth weight .
• Women exposed to high levels of fine particulate matter during pregnancy, particularly in the third trimester, may have up to twice the risk of having a child with autism .
• Second and third trimester exposure to PM2.5 might increase the chance of those children having high blood pressure in early life .
• A large study of more than 300,000 women found long-term exposure to air pollution, especially ozone and PM2.5, during and after pregnancy increases the risk of postpartum depression .
• The study with data on more than 5 million babies assessed associations between prenatal exposure to wildfire smoke and the risk of preterm birth. The researchers found that exposure to high levels of wildfire particulate matter during any period of pregnancy was associated with a greater chance of preterm birth .

Older adults

• Alzheimer’s disease and related dementias are a public health challenge for aging populations. NIEHS-funded researchers at the University of Washington identified a link between air pollution and dementias. This well-conducted study adds considerable evidence that ambient air fine particles increase risk of dementias . Conversely, a multi-year study published in 2022 shows improved air quality is associated with lower risk of dementia in older women. The researchers also stated this decline in dementia risk was equivalent to taking nearly 2 1/2 years off the age of the women studied.
• A large, nationally representative study looked at PM2.5 from many sources and incident dementia. Emissions from agriculture, traffic, coal combustion, and wildfires, in particular, were associated with increased rates of dementia .
• Air pollution was linked to a greater chance of developing several neurological disorders , including Parkinson's disease, Alzheimer's disease, and other dementias. Hospital admissions data from 63 million older adults in the U.S., obtained over 17 years (2000-2016), was analyzed along with estimated PM2.5 concentrations by zip code to conduct the study. Another study with data from 10-year long exposures also found a relationship between CO and PM2.5 and an increased chance of developing Parkinson’s disease .
• Osteoporosis affects women more than men. A large study associated high levels of air pollutants with bone damage , particularly in the lumbar spine, among postmenopausal women. This study expands previous findings linking air pollution and bone damage.
• Nutrients may counter some harmful effects from air pollution. A 2020 study found omega-3 fatty acids , obtained by eating certain fish, may protect against PM2.5-associated brain shrinkage in older women.

Rural dwellers

• NIEHS supported a translational research project,  Addressing Air Pollution and Asthma (1MB) , that may lead to improved health for children suffering from asthma. They found that certain agricultural practices contribute to poor air quality and asthma among children. The team combined high-efficiency particulate air (HEPA) cleaners and a home-based education program to reduce children’s exposure to pollutants in the home.
• Exposure to smoke from agricultural burns for as little as two weeks per year may worsen children's respiratory health outcomes, according to research supported by NIEHS. The study was conducted in response to community concerns about children's heath in Imperial Valley, a rural, agricultural area in southern California. Such agricultural burning is done to clear post-harvest crop remnants. This form of clearing is inexpensive, and farmers in the area do not have other economical methods for disposing of waste.
• In the rural U.S., large-scale animal feeding operations might compromise regional air quality through emission of pollutants, such as ammonia gas. A study found acute lung function problems in children with asthma in such areas.

NIEHS and community involvement

NIEHS supports community participation in the research process and encourages collaborative approaches that build capacity in communities to address environmental health concerns. Community-engaged research and citizen science are two types of collaborative research approaches.

For example, NIEHS grant recipients developed community-level tactics and public policies for reducing exposure to TRAP:

• Using high-efficiency particulate air (HEPA) filtration.
• Building land-use buffers and vegetation barriers.
• Improving urban design with gardens, parks, and street-side trees.
• Creating active-travel options, such as bicycling and walking paths.

Why improving air quality matters

• Air pollution and birth outcomes are linked as global public health concerns. Researchers analyzed indoor and outdoor air pollution data from all inhabited continents along with key pregnancy outcomes. Their findings indicate efforts to reduce PM2.5 exposure could lead to significant reductions in the number of low-birth weight and pre-term birth infants worldwide . Air pollution reduction would be especially beneficial for children born in low- and middle-income countries.
• Among children in Southern California, decreases in ambient nitrogen dioxide and PM 2.5 were associated with fewer cases of asthma .
• Bronchitis symptoms declined as pollution levels dropped in the Los Angeles region.
• Improving air quality may improve cognitive function and reduce dementia risk, according to studies supported in part by NIH and the Alzheimer's Association.
• When fossil-fuel power plants close, nearby air pollution is reduced. A study found the incidence of preterm births went down within 5 kilometers of retired coal and oil-powered plant locations.

Further Reading

Stories from the environmental factor (niehs newsletter).

• Wildfire Smoke: Effects on Male Fertility, Offspring Studied by Expert (August 2024)
• Air Pollution May Trigger DNA Modifications Tied to Alzheimer’s Disease (April 2024)
• Scientific Journeys: Using AI to Track a Major Source of Pollution (March 2024)
• Burn Pits’ Complex Emissions Simulated in NIEHS Grantee’s Laboratory (December 2023)
• Indoor Wood-burning May Be Linked to Lung Cancer in U.S. Women (September 2023)
• Everyday Air Pollution Can Harm Brain Development in Adolescents (September 2023)
• Wildfire Smoke, Other Air Pollution Can Harm Brain Health, Expert Says (August 2023)
• Burning Plastic Can Affect Air Quality, Public Health (August 2022)
• Interventions Needed to Slow Climate-driven Air Pollution, Researchers Note (March 2022)
• Air Pollution and Forever Chemicals Continue to Pose Health Risks (March 2022)
• Air Pollution Affects Children’s Brain Structure (February 2022)
• Increasing Evidence Links Air Pollution With Breast Cancer (November 2021)
• Fine Particulate Air Pollution Associated With Higher Dementia Risk (September 2021)

Printable Fact Sheets

Fact sheets.

Breast Cancer: Why the Environment Matters

Climate Change and Human Health

Lung Health and Your Environment

Partnerships for Environmental Public Health (PEPH)

• When Wildfires Hit Close to Home is about NIEHS-funded research on the complexity of urban wildfires and how they may affect human health.
• Wildfire Smoke and Children's Health

Additional Resources

• Air Pollution Linked to Dementia Cases (September 2023) – In this edition of NIH Research Matters, read about findings from the Health and Retirement Study, funded by the National Institute on Aging, that showed higher air pollution exposure was linked to an increased risk of dementia. After consideration of all sources, fine particulate matter, or PM2.5, from agriculture and wildfires were specifically associated with an increased risk of dementia. Reducing such exposures might help lower the incidence of dementia. The study was published in JAMA Internal Medicine.
• AirNow , a tool developed in partnership by several government agencies, allows you to monitor air quality in real time anywhere in the U.S. Simply enter your zip code as indicated on the website.
• EPA's Air Sensor Toolbox provides information on the operation and use of air-sensor monitoring systems for technology developers, air-quality managers, citizen scientists, and the public.
• NIH Climate Change and Health Initiative – This solutions-focused research initiative aims to reduce the health consequences associated with extreme weather events and evolving climate conditions. NIH has a strong history of creating innovative tools, technologies, and data-driven solutions to address global environmental problems.
• Smoke-ready Toolbox for Wildfires is a compendium of resources from the EPA to help educate you about the risks of smoke exposure and actions that protect your health.

Related Health Topics

• Exposure Science
• Gene and Environment Interaction
• Lung Diseases

This content is available to use on your website.

• Open access
• Published: 21 August 2024

The costs, health and economic impact of air pollution control strategies: a systematic review

• Siyuan Wang 1 ,
• Rong Song 2 ,
• Zhiwei Xu 3 ,
• Mingsheng Chen 4 , 5 ,
• Gian Luca Di Tanna 6 ,
• Laura Downey 1 ,
• Stephen Jan 1 &
• Lei Si 7 , 8  

Global Health Research and Policy volume  9 , Article number:  30 ( 2024 ) Cite this article

Metrics details

Air pollution poses a significant threat to global public health. While broad mitigation policies exist, an understanding of the economic consequences, both in terms of health benefits and mitigation costs, remains lacking. This study systematically reviewed the existing economic implications of air pollution control strategies worldwide.

A predefined search strategy, without limitations on region or study design, was employed to search the PubMed, Scopus, Cochrane Library, Embase, Web of Science, and CEA registry databases for studies from their inception to November 2023 using keywords such as “cost–benefit analyses”, “air pollution”, and “particulate matter”. Focus was placed on studies that specifically considered the health benefits of air pollution control strategies. The evidence was summarized by pollution control strategy and reported using principle economic evaluation measurements such as net benefits and benefit–cost ratios.

The search yielded 104 studies that met the inclusion criteria. A total of 75, 21, and 8 studies assessed the costs and benefits of outdoor, indoor, and mixed control strategies, respectively, of which 54, 15, and 3 reported that the benefits of the control strategy exceeded the mitigation costs. Source reduction (n = 42) and end-of-pipe treatments (n = 15) were the most commonly employed pollution control methodologies. The association between particulate matter (PM) and mortality was the most widely assessed exposure-effect relationship and had the largest health gains (n = 42). A total of 32 studies employed a broader benefits framework, examining the impacts of air pollution control strategies on the environment, ecology, and society. Of these, 31 studies reported partially or entirely positive economic evidence. However, despite overwhelming evidence in support of these strategies, the studies also highlighted some policy flaws concerning equity, optimization, and uncertainty characterization.

Conclusions

Nearly 70% of the reviewed studies reported that the economic benefits of implementing air pollution control strategies outweighed the relative costs. This was primarily due to the improved mortality and morbidity rates associated with lowering PM levels. In addition to health benefits, air pollution control strategies were also associated with other environmental and social benefits, strengthening the economic case for implementation. However, future air pollution control strategy designs will need to address some of the existing policy limitations.

Air pollution is a major environmental and public health problem affecting millions of people worldwide [ 1 ]. According to the World Health Organisation (WHO), it is among the leading causes of mortality, with exposure to indoor and outdoor air pollution associated with approximately 6.7 million premature deaths in 2019 [ 2 ]. In addition to its health impacts, air pollution has environmental, ecological, and economic consequences [ 3 ]. For example, one economic impact relates to the substantial costs associated with treating and managing air pollution-induced illnesses [ 4 , 5 ], as well as indirect societal expenditures resulting from the loss of productivity due to reduced working days [ 6 ]. The World Bank estimated that the overall cost of air pollution on health and well-being was approximately $8.1 trillion U.S. dollars, or 6.1% of GDP, in 2019 [ 7 ].

The need to reduce the environmental and health impacts of air pollution has been recognized for several decades. Many developed countries have implemented comprehensive multi-pollutant control strategies aimed at mitigating the health effects of key pollutants, including particulate matter (PM), ozone, nitrogen dioxide, and sulfur dioxide [ 8 , 9 ]. In recent years, developing countries with large populations have also begun tightening air quality standards. For example, China implemented the National Clean Air Action Plan (2013–2017) and followed it with the Three-Year Action Plan for Clean Air starting in 2018 to jointly lower emissions from various pollution sources [ 10 , 11 ]. Health assessment studies have consistently highlighted the substantial health and economic benefits associated with reducing air pollution through these measures [ 12 , 13 , 14 ].

Despite the substantial health benefits of air quality control strategies, their implementation comes at a cost. The magnitude of benefits and costs is primarily dependent on the relative nature of the control strategy, the size and setting of the intervention, the specific exposure and health endpoints considered, and the assumptions of the underlying economic evaluation [ 15 ]. Some high-income countries require a regular assessment of the relative costs and benefits of proposed environmental regulations, including air pollution regulations. For example, the US Environmental Protection Agency (EPA) has been required by law to conduct several comprehensive cost–benefit analyses of the Clean Air Act [ 16 ].

On a global scale, there is a gap in the systematic analysis of the costs and health benefits of air pollution control strategies. While the evidence base strongly supports that lowering exposure to air pollution is beneficial to health and reduces the burden on health systems, air pollution control strategies often come at significant costs. Thus, there is an imperative need to understand the relative costs and benefits of such interventions to ensure evidence-based air policies, particularly in resource limited settings. This study sought to fill this gap by systematically reviewing the economic impact of air pollution control strategies. The objective was to identify successful pollution control strategies, summarize economic evaluation methodologies, and highlight existing policy limitations. The findings are intended to inform the design of more optimal and targeted air policies, particularly in low- and middle-income country (LMIC) settings where there is a critical need to deliver cost-effective interventions to control pollution.

Search strategy

Six databases, including PubMed, Scopus, The Cochrane Library, Embase, Web of Science, and the CEA registry, were searched using a predefined strategy developed by combining keywords such as “air pollution”, “particle matter”, and “cost–benefit analyses”. The searches included the period from each database's inception to November 2023, without limitations on study design or region. Detailed summaries of the strategy search strategies are shown in Online Appendix 1.

Study selection, eligibility, and exclusion criteria

The database searches identified studies that explored the public health impact of air pollution control strategies, focusing on those that specifically assessed health benefits as part of the cost–benefit evaluation. Studies were included in the analysis if they: 1) were economic evaluation studies (cost–benefit analysis) of air pollution control strategies; 2) reported health and economic benefits of air pollution control strategies; and 3) were published in English. Studies that were not peer-reviewed articles, such as government reports or conference abstracts, were excluded.

Data extraction

Two reviewers (SW and RS) independently screened the title, abstract, and full text of each study. Conflicts were resolved through consultations with a third reviewer (LS). Information from the final included studies was gathered using a data extraction sheet developed following the initial phase of the literature review. The following data elements were extracted: study identification information (authors, year of publication, and country of conduct), study design (perspective, scope, and settings), type of intervention (outdoor intervention, indoor intervention, or mixed intervention), pollution control method (source reduction methods or end-of-pipe treatments), pollution control strategy category, pollutant type targeted, study methodologies (methodologies that modeled emissions, estimated costs, and estimated benefits), cost estimates, benefit estimates, cost–benefit estimates and sensitivity analysis estimates. A full list of the extracted elements is provided in Online Appendix 2.

A narrative synthesis was used to summarize the findings. Economic evidence were summarized using standard cost–benefit measurements that define an intervention as effective if the net benefit (total benefit minus total cost) is positive or the benefit–cost ratio (total benefit divided by total cost) is > 1 [ 17 ]. We followed the general principles for evidence synthesis reviews and reported the findings using PRISMA reporting guidelines (Online Appendix 3) [ 18 ].

Quality appraisal and risk of bias assessment

The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) reporting guidance for economic evaluations was used to conduct a risk of bias assessment [ 19 ]. CHEERS 2022 includes 28 items, all of which were used to assess the quality of the included studies. We assessed the quality of evidence following the reporting guidance from the CHEERS 2022 Explanation and Elaboration report [ 20 ]. In the absence of a validated scoring system for the checklist, a qualitative assessment of the completeness of reporting for each item was conducted [ 19 ].

Characteristics of the included studies

The search strategy yielded 4966 records across the six databases, from which 4,402 unique records were identified for title, abstract, and full-text screening. A total of 104 studies were ultimately found to meet the inclusion criteria. The selection process, developed using the PRISMA flowchart, is shown in Fig.  1 .

PRISMA flow diagram of study selection

Economic evaluation studies were identified that examined the cost–benefit ratio of several air pollution control strategies across various countries, with some dating back over 50 years. Overall, there was a relatively balanced distribution of studies conducted in low- and middle-income settings as well as high-income settings (n = 48 and 47, respectively), and most studies were published within the last decade (n = 74). Outdoor interventions, which sought to reduce local or ambient air pollution, were the most common type of pollution control strategy (n = 75; 72%). Meanwhile, 21 studies assessed the cost–benefit ratio of indoor interventions that aimed to lower exposure at the individual or household level. A total of eight studies evaluated control strategies that incorporated both indoor and outdoor interventions. Most pollution control strategies sought to mitigate emissions or pollutants directly from their origin (n = 42), while others employed end-of-pipe treatments to reduce pollution after its release, often through the use of filtration systems, scrubbers, or other pollution control devices (n = 15). A table of the included studies is shown in Online Appendix 4 and the study characteristics are summarized in Table  1 .

Pollution control strategies by category

Pollution control strategies involving a variety of control methods aimed at reducing both outdoor and indoor pollution were identified. Specific examples of outdoor interventions included transitions to cleaner energy and fuel sources [ 21 , 22 ], tighter vehicle emission regulations [ 23 ], and improved agriculture practices and technologies such as intercropping and low-emissions animal housing systems [ 24 , 25 ]. Another type of outdoor pollution control method was the use of end-of-pipe treatments for high-emission sources, such as retrofitting coal-fired power plants with scrubbers [ 26 ] or using particle filters and oxidation catalysts for diesel vehicles [ 27 ]. Common indoor pollution control strategies included interventions that encourage the use of cleaner and improved stoves [ 28 , 29 ], and promoting clean air ventilators in workplaces and households [ 30 ]. Air pollution control strategies grouped by intervention type and pollution control methodology are summarized in Table  2 .

Economic evaluation modeling of air pollution control strategies

The Impact Pathway Approach (IPA) [ 114 ], which connects interrelated modules for different aspects of the evaluation process, was commonly used to evaluate the effects of ambient air pollution on human health. This is a multistep approach that establishes links between emissions, exposure, and effects by estimating pollutant emissions and dispersion, then modeling exposure of the target population to assess health impacts, quantify the costs, and compare the benefits and mitigation costs. While methodologies for estimating costs and benefits varied by intervention and study context, most studies employed dose–response parameters to assess health gains from reduced pollution exposure. Subsequently, economic evaluation modeling techniques, such as the Value of Statistical Life (VSL) or Cost of Illness (COI), were employed to quantify the economic health benefits. A summary of the evaluation process, including the emissions, chemical transport, and health assessment models, as well as the cost–benefit assessment, are shown in Fig.  2 .

Analytical sequence for the economic evaluation of air pollution control strategies

The IPA also uses Integrated Assessment Models (IAMs) to assess the health impacts of a broad range of policy scenarios or technological interventions. IAMs incorporate geographical, populational, and industry-specific data to estimate the emission and dispersion of primary and secondary pollutants and model populational exposure to assess health and economic impacts. The choice of modules was largely dependent on the specific setting of the study, as well as the control policy being considered. For example, the Global Change Assessment Model (GCAM) and the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model were two commonly used IAMs for estimating the impact of both air pollution and climate change-related policies on emissions. In addition, the Comprehensive Air Quality Model with Extension (CAMx) and the Community Multiscale Air Quality (CMAQ) model were often used to model pollutant atmospheric concentrations, while the Benefits Mapping and Analysis Program (BENMAP) was used to assess health impacts.

Costs associated with air pollution interventions encompass several elements. These include initial investment costs, such as research and development of cleaner technologies [ 84 ], as well as operating and maintenance expenses, such as heavy vehicle inspection and maintenance programs [ 43 ]. Finally, mitigation costs are compared against intervention benefits using standard economic evaluation metrics such as computing net benefits or benefit–cost ratios.

Health benefit assessment

Most studies used dose–response parameters to predict health outcomes from changes in exposure and then compared the money saved by health gains to the costs of mitigation. However, the choice of parameters varied depending on the nature of the exposure, the setting of the study, and the selected health endpoints. Most of the studies focused on evaluating the economic benefit of lowering particulate matter (n = 84), which is considered the most important factor affecting human health. Other hazardous gases, including NO X , SO X , and O 3 (n = 34, 32, 19, respectively), were also considered. Premature deaths, cardiovascular diseases, and respiratory diseases (chronic obstructive pulmonary disease, lung cancer, chronic bronchitis, and ischaemic heart disease) were the most widely assessed health endpoints (n = 53, 43, and 44, respectively). Some studies also considered the benefit of increased productivity from a drop in the number of restricted working days (n = 18). In studies evaluating the economic health benefit of reducing premature deaths, the VSL approach was the most common methodology used. The Willingness to Pay (WTP) and COI methods were also used to quantify disease burden, and the Human Capital (HC) approach was used to evaluate losses in productivity.

Economic impact of air pollution control strategies

There was widespread economic evidence in support of implementing air pollution controls. Table 3 summarizes the cost-benefit results by pollution control category. Of the 104 studies analyzed, 72 (69%) reported that the benefits of the control strategy outweighed the costs. Most studies evaluated outdoor interventions, with 54 of 75 finding positive evidence in favor of these interventions. Of the 21 studies assessing indoor interventions, 15 showed positive results. Eight studies examined the cost–benefit ratio of both outdoor and indoor interventions, of which three reported net positive results. The number of studies that reported benefits exceeding costs, benefits exceeding costs for parts of the intervention, and costs exceeding benefits are presented in Table  1 . Except for transport regulations, the pollution control categories showed consistently positive economic results. Of the 13 studies assessing transport regulations, only three reported positive outcomes, while six indicated mixed results and four reported negative cost–benefit outcomes. In 41 studies investigating the impact of uncertainties on cost–benefit outcomes, several key variables were consistently analyzed, including discount rates, VSL figures, cost parameters, and dose–response models. In some instances, adopting lower VSL figures and projecting higher mitigation costs helped to shift the economic assessment of the intervention from cost-beneficial to non-cost-beneficial [ 22 , 48 , 58 , 115 , 116 ].

Social, environmental, and ecological benefits

A total of 32 studies [ 14 , 25 , 29 , 31 , 32 , 33 , 42 , 47 , 48 , 52 , 60 , 61 , 73 , 84 , 87 , 92 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 116 , 117 , 118 , 119 , 120 , 121 ] considered the broader social, environmental, or ecological benefits of pollution control strategies. Of these, 16 studies [ 25 , 29 , 33 , 42 , 47 , 48 , 52 , 84 , 100 , 102 , 103 , 104 , 105 , 106 , 107 , 120 ] estimated the environmental benefits of reducing CO 2 emissions by employing a carbon market price or CO 2 abatement cost. Other studies (n = 18) valued the additional morbidity improvements and productivity gains from reducing the number of restricted days and increasing the number of working days. Krewitt et al. [ 117 ] used exposure–response functions from open-top chamber experiments to quantify the economic benefit of increased crop yield from reduced SO 2 emission. Partially positive or positive cost–benefit results were demonstrated in 31 of the 32 studies. In addition, nine out of 10 studies showed that environmental policies, particularly long-term policies aimed at mitigating greenhouse gas emissions, may also have short-term secondary air pollution benefits, contributing to positive economic evidence in support of the policy.

Risk of bias assessment and quality appraisal of evidence

The results of the quality assessment under the CHEERS 2022 framework are shown in Online Appendix 5. All studies reported on items 6 and 7, providing relevant contextual information regarding the setting, location, and intervention or scenario of consideration. Most studies (n = 60, 74, 85, 72, respectively) adhered to the reporting criteria for items 1, 2, 3, and 9 (title, abstract, background, and time horizon). Additionally, a total of 85, 100, 99 and 88 studies reported on the selection, measurement and valuation of outcomes and costs (items 11, 12, 13 and 14, respectively). Few studies (n = 6, 2) considered the heterogeneity and distributional effects of the outcomes (items 18 and 19). No studies reported on items 8, 21, and 25 (perspective, engagement with patient, and effects of engagement with patients). Meanwhile, a total of 44 and 41 studies characterized and reported on uncertainty (items 20 and 24), and a total of 59 and 42 studies disclosed the funding source and competing interests, respectively (items 27 and 28).

Our review of the economic evidence suggests that economic assessments of air pollution control strategies face several key uncertainties at each stage of the evaluation process, including emissions projection, exposure modeling, and quantification of the benefits and costs. Cost uncertainties primarily stemmed from the cost data, the cost model, and the choice of discounting factors for operating and maintenance costs. The uncertainties relating to benefit estimation were considerably larger. Two commonly acknowledged factors across all studies were the choice of an appropriate Concentration Response Function (CRF) to estimate the health effects of exposure and the selection of a VSL figure to monetize health gains. Differences in air pollutant composition, population age structure, and the quality of public health systems contributed to varying exposure-effect relationships across different populations and regions. Thus, it is critical to select concentration–response functions that are tailored to the specific context of each study. The choice of appropriate VSL and CRF proved particularly challenging for many studies conducted in low- and middle-income settings that lack supporting epidemiologic and economic evidence. Many of these studies used the benefits transfer method to estimate an approximate figure by adjusting VSL estimates from developed countries, despite existing literature showing the limitations of this approach [ 109 ]. Other studies used concentration–response functions established from epidemiologic studies in developed countries that may not reflect the appropriate populational or environmental context. The choice of valuation methods also greatly influences the benefits estimation. For example, studies employing contingent valuation estimates may inadvertently overstate the economic benefits, while those utilizing the COI approach may not fully encompass all economic benefits [ 122 ].

We find that studies measuring both economic and health benefits were more likely to report positive economic results from the control strategies. However, the methods varied in the types and sizes of social and environmental benefits considered. For example, the environmental benefits from reduced carbon dioxide emissions and time savings associated with indoor cooking interventions generally outweighed the corresponding health benefits. This was not typically the case for outdoor interventions. In some studies [ 101 ], the standalone health benefits were insufficient to cover mitigation costs, while the addition of social benefits resulted in net positive results. These findings highlight the importance of an integrated or holistic approach in the evaluation framework.

While this study highlighted overwhelming economic evidence in support of various air pollution control strategies, it also revealed a need to address policy limitations and barriers. This includes ensuring equality among different socioeconomic and geographical populations. Air pollution is a major cause of health inequalities worldwide, particularly for women, elders, and people of low socioeconomic status [ 123 , 124 , 125 ]. Thus, future control policies and policy evaluations will need to target these priority groups. Despite the epidemiologic evidence demonstrating the disproportionate health impacts of air pollution on elders and infants, only six of the 104 studies included in this review considered the distributional effects and heterogeneity of outcomes on different subpopulations [ 124 , 126 ]. While air pollution has a similar impact on the health of men and women, particular occupational or social norms can lead to disproportionately high levels of exposure among some groups of women, such as housewives who are using inefficient stoves in low- and middle-income settings. This suggests a need for targeted interventions and evaluations in this population [ 28 ]. Despite overall net positive outcomes for society, specific cohorts, particularly rural populations, or people living in regions of low socioeconomic status, may experience net economic losses due to disproportionately high mitigation costs [ 93 ]. Clean air has substantial positive health and social benefits that spill over to society. However, without government subsidies, costs are disproportionately borne by individuals or private sectors, posing challenges to implementation [ 105 ]. Thus, economic evaluations should consider assessing the private and social cost-benefits separately.

This study had a few limitations. First, the review was limited to peer-reviewed articles, potentially omitting relevant grey literature. The lack of all available information, including government documents that evaluate environmental air interventions, may contribute to a biased or incomplete interpretation of the full economic evidence. Second, this study has potential publication bias, including funding biases from governments or organizations with vested interests and the selective reporting of studies with positive health and economic outcomes. These biases may skew the overall economic results in favor of certain policies and underrepresent alternative approaches or outcomes. Third, due to variability in outcome measurements and analytical methodologies used by the included studies, it was not feasible to conduct a meta-analysis or otherwise quantitatively synthesize the overall economic evidence.

This study systematically reviewed economic evidence on the costs and benefits of air pollution control strategies across different countries and timeframes. Nearly 70% of the studies reported data in support of the control policies, with particularly strong economic evidence identified by those using a broader benefits framework. While there was broad economic support for air pollution control in general, the findings also underscore the scarcity of economic and epidemiological evidence needed to substantiate such economic evaluations, particularly within LMICs. In addition, there is a pressing need to prioritize environmental and economic equity in the development of targeted interventions, especially among vulnerable populations in LMICs who are at higher risk for air pollution-related illness due to existing geographical, health, or socioeconomic disparities. The insights gained from this review will help to inform the design of future air pollution control policies and the economic evaluations of related interventions.

Availability of data and materials

The data used and/or analyzed during the current study are extracted from included studies and are available from the corresponding author on reasonable request.

Abbreviations

Environmental Protection Agency

Impact Pathway Approach

Integrated Assessment models

Global Change Assessment Model

Greenhouse Gas and Air Pollution Interactions and Synergies

Comprehensive Air Quality Model with Extension

Community Multiscale Air Quality model

Benefits Mapping and Analysis Program

Local Air Pollution

Global Climate Change

Value of Statistical Life

Concentration Response Function

Willingness to pay

Cost of Illness

Human Capital

Low- and middle-income countries

High income countries

Particle matter

Chronic Obstructive Pulmonary Disease

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This study was funded by the National Natural Science Foundation of China (Grant Number: 71874086, 72174093). SW receives the University of New South Wales University Postgraduate Award (UPA Award).

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Siyuan Wang, Laura Downey & Stephen Jan

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School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia

School of Health Policy and Management, Nanjing Medical University, Nanjing, China

Mingsheng Chen

Jiangsu Health Vocational College, Nanjing, China

Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland

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Wang, S., Song, R., Xu, Z. et al. The costs, health and economic impact of air pollution control strategies: a systematic review. glob health res policy 9 , 30 (2024). https://doi.org/10.1186/s41256-024-00373-y

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Environmental pollution is one of the fundamental factors directly affecting climate change. Due to the active production and human use of fossil fuel products, industrial enterprises’ activities exert intense pressure on the environment. Air pollution has a direct negative impact not only on the climatic situation but also on people’s health throughout the country. The most vulnerable category of the population to climate change is adults over 65 since external factors most strongly influence their health.

Industrial enterprises for the extraction and processing of fossil fuels are located throughout the United States of America. Moreover, agricultural activities and natural disasters, such as seasonal forest fires, substantially impact the ecological situation. Moreover, given the air masses’ movement and the cyclical nature of many biological processes, it is fair to conclude that air pollution problems are national. First of all, the increased content of heavy particles such as CO2, N2O, and NH3 has a severe impact on the human respiratory system. The lungs receive additional stress due to respiratory diseases such as asthma and chronic objective pulmonary illness.

Furthermore, the lack of pure oxygen in the body harms other human organs: the brain, heart, and digestive system. According to new data from the World Health Organization (WHO) (2018), 9 out of 10 people breathe air with an increased concentration of pollutants. The WHO estimates that 7 million people die each year from the effects of inhaling air-containing particulate matter causing diseases such as stroke, heart disease, lung cancer, and pneumonia (World Health Organization, 2018). Older people are most vulnerable to environmental pollution, as their level of immunity weakens with age.

The negative impact of human-made pollution sources is actively affecting climate change. First of all, the above factors affect the increase in temperature in the atmosphere. According to the Lancet Countdown, temperature-related deaths in people over 65 have increased by 50% in the past twenty years (Watts et al., 2020). In the southern regions, there is an increased risk associated with an increase in atmospheric temperature, which in the long term will lead to droughts, floods, and, as a result, food crises. In addition, high temperatures increase the rate at which infectious diseases such as malaria spread, which also poses additional risks in some countries (Fairweather, 2020). Thus, the problem of climate change is not only national but also goes to the global level.

To solve this problem, a systematic and comprehensive approach is required, the application of which will take a relatively long period. In climate change, due to air pollution, the main force to prevent environmental disasters need to change the approach to the production of substances from fossil fuels. First of all, increased taxation and legislative acts limiting the number of harmful products will reduce the burden on the environment. Recent technological solutions allow the use of renewable energy sources with increasing efficiency. Large companies gradually lose the need to use coal or petroleum products. Conglomerates continue to use them due to low prices. Therefore, government intervention is needed, aimed not to adjusting the market as a harmful environmental consequence.

Due to the rapid development and massive use of modern technologies by the population, people’s way of life has changed. In the twenty-first century, the world community is ready to actively assist the government by applying the principles of conscious consumption and reducing the emissions of solid and gaseous waste into nature. People are beginning to use public transport, bicycles, and other transportation, emitting several times fewer emissions than cars.

Moreover, the environmental agenda is growing: citizens choose special packaging of products, strive to sort waste into categories, and the state needs to support private initiatives at the federal and local levels (Akhtar & Palagiano, 2018). First of all, it is necessary to create all the conditions to make it easier for people to choose environmentally friendly products, create additional waste sorting centers, and raise citizens’ education in environmental matters. This can be done both by legislative acts, there and by local decisions.

The problem of climate change and air pollution is global. Accordingly, a considerable number of people are subject to changes that affect their daily life. Consequently, there is an additional burden on the health care system. If the current trend continues, the situation runs the risk of spiraling out of control due to medical institutions’ limited capacity. The pandemic of the COVID-19 virus, which has spread worldwide, has demonstrated the existence of vulnerabilities in the healthcare system (Richardson, 2020). In cases where many people need the qualified help, medical institutions may not cope with the load. In the event of critical climate changes, implying global cataclysms, the healthcare system will not be able to cope with the task.

To sum up, climate change is primarily due to the high level of harmful substances emissions into the atmosphere. According to statistics, every year, more and more people over 65 years old directly feel the consequences of the changes. First of all, to reduce environmental change, it is necessary to introduce stringent measures for large industrial enterprises and agricultural centers. Increasing ecological awareness of the population also favorably contributes to curbing global warming and, as a result, reduces people’s vulnerability to disease.

Akhtar, R., & Palagiano, C. (2018). Climate change and air pollution . Switzerland: Springer International Publishing.

Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Beagley, J., Belesova, K.,… & Capstick, S. (2020). The 2020 report of The Lancet Countdown on health and climate change: Responding to converging crises. The Lancet . Web.

World Health Organization. (2018). Air pollution and child health: Prescribing clean air: Summary (WHO Reference Number WHO/CED/PHE/18.01). Web.

Richardson, S. J., et al. (2020). Research with older people in a world with COVID-19: identification of current and future priorities, challenges and opportunities. Age and Ageing, 49 (6), 901-906.

Fairweather, V., Hertig, E., and Traidl‐Hoffmann, C. (2020). A brief introduction to climate change and health. Allergy, 75(9), 2352-2354. Web.

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IvyPanda. (2022, September 17). Environmental Pollution and Its Effect on Health. https://ivypanda.com/essays/environmental-pollution-and-its-effect-on-health/

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IvyPanda . 2022. "Environmental Pollution and Its Effect on Health." September 17, 2022. https://ivypanda.com/essays/environmental-pollution-and-its-effect-on-health/.

1. IvyPanda . "Environmental Pollution and Its Effect on Health." September 17, 2022. https://ivypanda.com/essays/environmental-pollution-and-its-effect-on-health/.

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What is environmental health?

Examining a massive influence on our health: the environment..

We've been reporting on environmental health for 20 years. But what is environmental health? You've got questions, and we have answers.

Environmental health is a branch of public health that monitors the relationship between human health and the environment, examining aspects of both our natural and human-made environment and their effect on human wellbeing.

What is an example of environmental health?

Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart.

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Environmental health is a broad area of study — everything from the climate to the food we eat to the air we breathe plays into environmental health. A few specific examples include:

• Air pollution: Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart such as asthma and increased risk of heart attacks or stroke.
• Water contamination: Drinking lead-contaminated water can cause IQ loss, behavioral issues, learning disabilities and more. Infants and young children are most at risk.
• Toxic chemicals in consumer products: Phthalates, a class of chemicals that are widely used in consumer products, are known endocrine-disruptors, meaning they hijack your body’s hormones and can cause a wide array of health impacts including increased risk of cancer and fertility issues.

What is the role of environmental health?

The role of environmental health research is to examine areas of the environment that impact our health so that we can make personal and policy changes to keep ourselves safe and improve human health and wellbeing.

Why is environmental health important?

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Environmental health impacts every one of us.

We reap the benefits of clean air, clean water, and healthy soil. If our environment is unhealthy, with toxic chemicals saturating our resources and pollution abundant, then our health also suffers.

It is also an important field of study because it looks at the “unseen” influences on your health.

Many individuals may not associate their health problems with air or water quality, or with what clothes they wear, makeup and household goods they use, or food they eat.

That’s because not every example of environmental health problems are obvious: some chemicals, for example, build up slowly over time in your body: a small dose may not seem to bring harm, but repeated small doses can lead to later impacts.

• BPA absorbed through plastic containers, cans, receipts, etc. lingers in the body and the build-up over time increases risk of cancer, diabetes, liver failure, and more.
• PFAS are known as ‘forever chemicals ’— they don’t break down and are widely used, so small exposures are frequent and contribute to immune system and reproductive damages, heightened cholesterol levels, and more.
• Mercury from eating seafood and shellfish can impact neurological development of fetuses in the womb, and populations that regularly consume mercury-heavy seafood have shown mild cognitive impairment.

Also, individual susceptibility can differ: for example, one member of a household can experience illness, asthma, migraines, etc. from chemicals found in their water supply while another member of the same household is just fine, such as the case in a young girl’s reaction to benzene in her water from living near fracking wells.

Certain variables play a role in susceptibility and level of adverse health effects such as age, gender, pregnancy, and underlying health conditions. Studies suggest fetuses, infants and children are much more at risk to experience lifelong health problems from toxic chemical exposure.

Rate, duration, and frequency of exposure to toxic chemicals and other influences from our environment all factor into our health.

Good environmental health = good human health.

What environmental health problems affect our health?

Two women extracting from a well in Senegal.

Credit: JordiRamisa

There are many environmental health issues that affect human health. These include:

Air pollution — nine out of 10 people currently breathe air that exceeds the World Health Organization’s guideline limits for air pollution worldwide. This mainly affects people in low and middle-income countries, but in the United States, people that live in cities, or near refineries or factories, are often affected as well.

Air pollution also ramps up during wildfire season.

Read more: Breathless: Pittsburgh's asthma epidemic and the fight to stop it

Water pollution — as of 2014, every year more people die from unsafe water than from all forms of violence, including war. Water is the ‘universal solvent’, meaning it can dissolve more substances than any other liquid on Earth. Thus, it is too easy for toxic chemicals to enter our water supply.

Read more: Sacred Water: Environmental justice in Indian Country

Lack of access to health care — yes, this is an environmental health issue! Having an accessible health care system is part of one’s environment. Difficulty getting health care can further impact one’s health.

Poor infrastructure — from “food deserts” to lack of transportation services, living in an area with poor infrastructure can impact your health.

Read more: Agents of Change: Amplifying neglected voices in environmental justice

Climate change — climate change-induced heat waves, increased frequency and severity of large storms, droughts, flooding, etc. have resulted in health problems and even death.

Chemical pollution — chemical pollution can be sneaky: the chemicals in your everyday products, from shampoo to deodorant to your clothing to the food you eat, can directly affect your health. These chemicals are often not on the label or regulated at all.

Read more: Exposed: How willful blindness keeps BPA on shelves and contaminating our bodies

How can we improve our environmental health?

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Educate yourself. Environmental health is a broad topic, so this can seem overwhelming. Start by taking stock of your own personal environment. Look up air pollution monitoring in your area. Get your water tested to see its chemical makeup. Evaluate the products you use in your life — personal products like shampoo and deodorant, household cleaners, air fresheners, the foods that you eat — and see what you’re bringing into your home.

Explore the Environmental Working Group's guides to check your products for toxic chemicals.

We have additional guides to help you learn more about environmental health. Find guides to plastic pollution , environmental justice , glyphosate , BPA , PFAS and more in the Resources tab at the top of our website.

As individuals we have the power to improve some of our environmental health, but there is a pressing need for systemic change and regulation on a policy level.

We’re actively working with scientists to share their research and knowledge with politicians to advocate for science-backed policy change. But we need your help. Contact your representatives to let them know that environmental health is important to you — whether it’s air pollution in your area, contaminated water, plastic pollution, food deserts in your area, or chemicals in consumer products.

Subscribe to Above the Fold , our daily newsletter keeping you up-to-date on environmental health news.

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Public Health Opportunities to Address the Health Effects of Air Pollution

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• Date: Nov 07 2017
• Policy Number: 201711

Key Words: Air Quality, Asthma, Environment, Environmental Health

Millions of Americans live in areas where air pollution levels are high enough to cause both acute and chronic health effects. Those Americans most exposed to air pollution are often low-income families and people of color living in close proximity to industrial air pollution sources and freeways. APHA believes that breathing clean air is a basic right of all people and that more robust funding and enforcement of air quality programs under the Clean Air Act are needed to ensure that improvements to the nation’s air quality continue. The U.S. Environmental Protection Agency (EPA) should aggressively address localized exposures to hazardous air pollutants and provide leadership in implementing innovative miniaturized monitoring technologies that promise to change the paradigm for air quality exposure assessment in the United States. State and local agencies and health departments should collaborate with the EPA to address disproportionate exposures to air pollution in communities, improve communication with industry and the public on steps to reduce exposures, and incorporate air quality information into professional training, university degree programs, and K–12 science curricula. Health professionals should help government officials and the public recognize how the health benefits associated with clean air, including reduced hospital visits and fewer missed days at school and work due to illness, far outweigh the costs of air pollution control. Finally, APHA calls upon the public and government agencies and health departments to forcefully defend policies aimed at fighting climate change because of the air quality benefits associated with reduced global warming and greater reliance on renewable energy sources.

Relationship to Existing APHA Policy Statements

This policy statement builds upon and replaces APHA Policy Statement 200017 (Confirming Need for Protective National Health Based Air Quality Standards). It is also consistent with the following policy statements that reference or are related to air pollution:

• APHA Policy Statement 20157:  Public Health Opportunities to Address the Health Effects of Climate Change
• APHA Policy Statement 20147: Preventing Environmental and Occupational Health Effects of Diesel Exhaust
• APHA Policy Statement 20125: The Environmental and Occupational Health Impacts of High-Volume Hydraulic Fracturing of Unconventional Gas Reserves
• APHA Policy Statement 20046: Affirming The Necessity of a Secure, Sustainable and Health Protective Energy Policy
• APHA Policy Statement 200012: Reducing the Rising Rates of Asthma

This new policy statement is also consistent with a number of older statements, many of which have been archived. Included among these older policy statements are 8912 (Public Health Control of Hazardous Air Pollutants) and 8530 (Ambient Air Quality Standards for Short-term Exposure to Sulfur Dioxide).

Problem Statement

Under the Clean Air Act, the United States has made substantial progress in reducing air pollutants that threaten public health and damage crops and materials. Despite this progress, poor air quality and localized exposures to hazardous air pollutants remain problems in many urban areas, representing significant health risks for millions of Americans. Children and older adults are particularly at risk, and low-income and minority populations often suffer disproportionately from air pollution. More progress in implementing the Clean Air Act is needed for everyone to enjoy their right to clean air.

Emissions of the six common pollutants for which there are national ambient air quality standards—carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter, and sulfur dioxide—have decreased by 65% since 1980.[1,2] This is an impressive accomplishment, particularly given that factors tending to increase pollution (e.g., population growth, national energy consumption, vehicle miles driven, and gross domestic product) have steadily risen at the same time. Nevertheless, in 2015 about 121 million Americans still lived in counties having air pollution levels exceeding one or more of the national ambient air quality standards.[1,2] These Americans, in addition to many others who are sensitive to air pollution (especially children, pregnant women, older adults, and people with compromised immune systems), are at increased risk for lung and heart disease, asthma, chronic cough, throat irritation, shortness of breath, and other adverse health conditions.[3–12]

Many Americans are also exposed to unacceptable levels of hazardous air pollutants (also known as toxic air pollutants or, simply, air toxics).[13–17] Air toxics are known or suspected to cause cancer and other serious health conditions, including neurological effects, reproductive problems, and birth defects. There are many types of air toxics (the Clean Air Act lists 188 of them), but the ones contributing most to national cancer risks are believed to be acetaldehyde, benzene, diesel emissions, and formaldehyde, while those contributing most to non-cancer risks are believed to be acrolein, chlorine, and diesel particulate matter.[14,16] Air toxics are not as widespread as the six ambient pollutants discussed above, and they tend to represent more of a localized problem for people living in close proximity to certain industrial air pollution sources and freeways. In its latest national air toxics assessment (released in December 2015), the U.S. Environmental Protection Agency (EPA) found an elevated cancer risk from exposure to air toxics, particularly in urban areas, with the risk greater than 100 in 1 million in about 130 census tracts.[14] Both industrial operations and mobile sources contribute to this risk.

While everyone is at increased risk of health effects from air pollution exposures, children, pregnant women, and older adults are especially vulnerable.[8–10] Children breathe more than adults on a body-weight basis (e.g., a 3-month-old infant breathes 35 times more air per body weight than an adult), and substantial lung development occurs through adolescence. Children are also more likely to spend time outdoors breathing polluted air, and, through oral exploration, infants and toddlers may be exposed to dirt and other objects contaminated by air pollution. In addition, air pollutants can interfere with development of the nervous, reproductive, and metabolic systems during childhood.[18–22] In the case of pregnant women, compensatory cardiopulmonary system changes that occur during pregnancy are essential to maintaining the pregnancy but may also render women exposed to air pollution vulnerable to cardiopulmonary effects. These effects can contribute to poor health outcomes during pregnancy and beyond for both mother and baby.[8–10] Finally, the bodies of older adults are less able to compensate for exposure to air pollution, often due to existing conditions such as chronic obstructive pulmonary disease, asthma, and diabetes.[5,23–25] Air pollution exposure also increases the risk for cardiovascular events.[23] The result is that older adults living in polluted environments may increase medication use and spend more time in the doctor’s office and emergency room. In addition to children and older adults, people who work or exercise outdoors, who are obese, or who have lung diseases such as asthma are more susceptible to polluted air.[5,10,11]

Exposure to the highest levels of air pollution generally occurs in urban areas, where air pollution concentrations can reach unacceptable levels due to the proximity and density of industrial, commercial, and mobile sources. The EPA is particularly concerned about elevated concentrations of ground-level ozone and fine particulate matter (i.e., particles with a diameter of less than 2.5 micrometers), which are implicated in a number of adverse health outcomes.[26,27] For example, ozone can inflame the airways, causing chest pain, coughing, wheezing, and shortness of breath, and these conditions can be worse in people with existing lung disease, including asthma. Fine particles can harm the cardiovascular system and cause respiratory disease, sometimes resulting in premature death. Ozone and fine particles also contribute to climate change, which in turn can create more ground-level ozone. (Climate change contributes to heat waves as well, which increase power demand for air conditioning, resulting in more air pollution.) More than 45 million Americans in urban areas live, work, or attend school within 300 feet of a major roadway, airport, or railroad, each of which is a major source of polluted air.[27] With the EPA’s latest mobile source rules, mobile sources are becoming much cleaner, but more work needs to be done to ensure that the standards are vigorously enforced, especially in vulnerable communities.[28]

There is increasing awareness that air toxics also constitute a significant health risk in urban environments, particularly for low-income families and people of color who often live closest to freeways and sources of industrial air toxics.[29–31] This represents a serious environmental equity problem for millions of Americans residing in urban areas, who are disproportionately exposed to high levels of air pollution because of where they live. Often these low-income families and people of color are underrepresented in pollution abatement programs, and they may face economic constraints that prevent them from moving to cleaner environments and create barriers to receiving medical care. The result is that polluted air represents an impediment to economic opportunity and security. Many health professionals consider clean air a basic right for all people, and for a number of years the EPA has called for greater attention to environmental justice, defined by the agency as “the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.”[29] However, there is still much work to be done to address disparities in air pollution exposure.

Unfortunately, very limited federal research funding has been allocated to studying environmental justice, and it is difficult to estimate the extent of the problem, particularly with respect to the long-term effects of exposure to air toxics. Nevertheless, we know that among the 24 million Americans suffering from asthma, minority communities are disproportionately affected. For example, African American children are four times more likely than White children to be hospitalized for asthma, and they are seven times more likely to die from an asthma attack. Similarly, Hispanics are 60% more likely than non-Hispanic Whites to visit a hospital for severe asthma symptoms.[29]

One of the most egregious sources of air pollution is electric power generation with fossil fuels.[8–10,17] There are about 1,400 coal- and oil-fired electric power plants in the United States, and many still do not have advanced pollution control equipment. In addition to being the largest domestic source of carbon dioxide (the most widespread global warming gas in the United States), these electric power plants are responsible for 62% of the nation’s arsenic air pollution, 60% of sulfur dioxide, 50% of mercury, 22% of chromium, and 13% of nitrogen oxides. The EPA has a number of rules limiting emissions from electric power plants using fossil fuels, including rules for mercury, sulfur dioxide, nitrogen oxides, and particulates. To comply with these rules, some plants have installed expensive emission controls while others have shut down, in some cases to be replaced by cleaner renewable energy (e.g., solar, wind, and geothermal power). Also, state and local agencies are promoting power plant emission reductions by developing green building standards and implementing energy-efficiency and renewable energy policies.

In addition to regulating ambient air pollutants and air toxics, the Clean Air Act requires a reduction in pollutants that deplete the Earth’s stratospheric ozone layer, which is located between 10 and 25 miles above the Earth’s surface. The stratospheric ozone layer plays a crucial role in reducing the amount of ultraviolet (UV) radiation that reaches the Earth’s surface and in preventing skin cancer. Skin cancer is the most common form of cancer diagnosed in the United States, and the majority of skin cancer cases are caused by exposure to UV radiation from the sun. The surgeon general reports that nearly 5 million people in the United States are treated for skin cancer each year, at an annual cost of about $8 billion, and nearly 9,000 people die annually from melanoma, the most dangerous form of skin cancer.[32] The EPA, in collaboration with the National Weather Service, has developed a UV index to forecast the risk of overexposure to ultraviolet radiation according to local weather conditions and other factors.[33]

Air pollution does not recognize international boundaries. Thus, air pollutants originating in the more industrialized regions of the world, including the United States, Europe, and China, routinely drift to other regions, worsening existing air quality problems. For example, a recent study showed that the transport of ozone and its precursors from China can offset U.S. air quality gains, and other studies have documented the presence of ozone, ozone precursors, and particulate matter originating along the U.S. East Coast at remote Atlantic and European ground stations.[34–36] The international community has taken steps to address the cross-boundary transport of air pollution through the United Nations Convention on Long-range Transboundary Air Pollution.

Of course, public health concerns about air pollution are not limited to the United States. According to the World Health Organization (WHO), 92% of the world’s population in 2014 was living in areas where WHO air quality guidelines were not met; in addition, outdoor air pollution caused 3 million premature deaths in 2012, mostly in low- and middle-income countries in the Western Pacific and Southeast Asia.[37] About 72% of these premature deaths were caused by ischemic heart disease and strokes, 14% by chronic obstructive pulmonary disease or acute lower respiratory infections, and 14% by lung cancer. Some deaths were attributed to more than one risk factor occurring at the same time, for example air pollution and smoking, which are both associated with lung cancer. (WHO also estimates that about 4.3 million premature deaths in 2012 were caused by indoor air pollution associated with use of biomass and coal for cooking and heating.) WHO’s International Agency for Research on Cancer has determined that outdoor air pollution as a broad category is carcinogenic, especially the particulate matter component.[38]

A problem in regulating air pollution is that generally we cannot see it. For example, gaseous pollution is usually invisible, and fine particulate air pollution is much too small to see with the unaided eye. This highlights the challenge and also the importance of communicating air pollution risks to the public. The EPA has made great strides in communicating air pollution health risks, for example by providing daily air quality reports through its AirNow Air Quality Index; this index is routinely included in local and national weather reports, particularly during air pollution episodes.[39,40] (The index translates air pollution data into numbers and colors that help people know when to modify their activities, such as limiting outdoor exercise or remaining indoors.) State and local agencies need to make better use of the Air Quality Index to trigger certain events, such as providing reduced-fare or free public transportation or banning fireplace and woodstove use when air quality is poor. 

Indoor air quality refers to the quality of the air we breathe inside buildings, such as offices, factories, homes, schools, and hospitals. Because Americans spend about 90% of their time indoors, poor indoor air quality can be an even greater concern for some people than outdoor air pollution.[41–44] For example, the EPA estimates that indoor air pollution levels can be two to five times higher than outdoor levels and, occasionally, more than 100 times higher. Reducing indoor air pollution in schools is especially important because children are more sensitive to air pollutants and spend much of their day inside school buildings, which tend to be more densely occupied than homes and offices. The EPA does not regulate indoor air quality, but it does issue guidelines to reduce exposures and offer grants for research and training. Unfortunately, this program has been curtailed in recent years, despite mounting evidence of the adverse health effects of poor indoor air quality.[45–49] Irritation of the eyes, nose, and throat is an increasingly common complaint inside buildings. Other concerns range from headaches, dizziness, and fatigue to more serious, long-term issues such as respiratory and heart disease and cancer. Researchers also fear that climate change may worsen existing indoor air quality problems and introduce new problems.[50,51]

A growing concern of APHA is preserving the strength, integrity, and independence of the EPA. Many Americans have recently witnessed on TV news broadcasts the horrendous air pollution episodes routinely occurring in Beijing, where strong evidence has emerged of an association between fine particulate pollution, emergency room admissions, and respiratory disease morbidity, particularly among women and older adults.[52] Without the protections of the Clean Air Act and a strong and independent EPA, it is not inconceivable that we would return to the days when dense smog darkened the daylight hours in our large cities, filling our emergency rooms with the individuals most sensitive to air pollution, especially children, pregnant women, and older adults. Furthermore, a strong and independent EPA is needed to protect the public from new chemicals in the environment, many of which are known or suspected carcinogens. Low-income and minority communities are particularly vulnerable to these toxic air emissions.

Evidence-Based Strategies to Address the Problem

Recommended strategies are centered around increasing EPA funding for ambient and community-scale air toxics programs, focusing more resources on environmental justice issues, developing and validating advanced monitoring and data analysis technologies, and promoting clean power (greenhouse gas reduction) programs because of the air quality co-benefits. The rationale for these strategies is presented below.

There is a critical need for Congress and the White House to increase funding to the EPA, making up for recent budget cuts and providing additional funding for innovation and research. During the period 2010 to 2016, when the EPA’s budget dropped 21% and positions were reduced by 11%, the nation’s air quality programs experienced commensurate reductions in key initiatives aimed at implementing and enforcing the Clean Air Act. Budget increases are needed across the board, but particularly for the national ambient air quality program, the maximum achievable control technology program for air toxics, and various area source and urban pollution initiatives. These and other key provisions of the Clean Air Act are behind schedule or not even being addressed due to budget shortfalls.

One important air quality initiative that has not received sufficient funding concerns community-scale air toxics. There is an impressive knowledge base on air toxics nationwide, particularly those toxic pollutants listed in the Clean Air Act, but little is known about air toxics exposures on a local scale in many communities throughout the United States. Although there are thousands of air quality monitors for ambient air quality pollutants, surprisingly only 29 air monitoring stations exist nationwide for air toxics under the EPA’s National Air Toxics Assessment program.[14] This results in a paucity of air toxics exposure data for people living close to industrial and commercial air toxics sources and virtually no data for rural areas. Another shortcoming of the air toxics monitoring program is that most monitoring involves only the 188 toxic air pollutants listed in the 1990 Clean Air Act amendments, with little or no monitoring taking place for any new toxic chemicals developed since then. Most community-scale air toxics funding at the federal level is limited to an EPA $10 million competitive grant program for state and local agencies, and there is no assurance that this program will be continued.[26]

The deficit in air toxics monitoring is all the more serious because many low-income families and people of color live in inner-city and industrial areas where air toxics concentrations would be expected to be highest and where little monitoring currently takes place. This is a serious environmental equity issue that needs to be addressed. Because many air toxics chemicals are suspected or confirmed carcinogens, it is incumbent upon the federal government, under the EPA’s leadership, to allocate resources toward understanding air toxics exposures at the community scale, thereby ensuring that air toxics rules target sources associated with the greatest risk to public health while addressing environmental equity concerns in our cities.

Another critical air quality need that is not being adequately addressed involves the development and validation of advanced monitoring technologies and associated data analyses. The development of miniaturized, low-cost air quality monitors represents an important step forward in assessing air pollution exposure and public health risk. Several organizations are involved with the miniaturization of air quality monitors, and we are quickly approaching a time when tens of thousands of environmentally conscious citizens will pin these miniature monitors to their clothing while shopping or going to and from work. (Other monitors may be placed on auto rooftops, providing real-time air quality data, similar to the way today’s GPS systems amass data on traffic conditions and recommend alternate routes.) This will create vast amounts of data, potentially collected and transmitted through smart phones or smart watches, that must be managed and analyzed. And for the first time, the federal government may find itself having little control over the collection and analysis of air quality data and interpretation of exposure levels (including spatial and temporal factors) for potential health consequences.

Because different manufacturers are involved in developing and marketing these miniature monitoring devices, an urgent need is evolving for validating the accuracy and precision of the monitored data, possibly by third-party organizations subject to EPA standards and oversight. In addition, computer systems and software must be developed to collect, analyze, and interpret potentially tens of millions of data points collected daily from across the United States. Also, educational material will be needed to help the public understand what the data mean and what actions are required to minimize exposures (e.g., understanding why there may be a high particulate pollution reading at a bus stop but not in the park a block away and what this mean for one’s health). Once these issues are addressed, the miniaturization of air quality monitoring devices will revolutionize the way we collect environmental data and protect the public from high levels of exposure. 

Finally, the public health community must do all it can to preserve the goals of the EPA’s Clean Power Plan (CPP), even if the plan itself does not survive at the federal level. (The CPP is currently under review by the Trump administration.) Although the CPP is designed to reduce greenhouse gas emissions from the power sector, there are also substantial public health benefits to be realized by concomitant reductions in other pollutants, including sulfur dioxide, nitrogen oxides, and particulates that contribute to dangerous urban soot and smog.[45,46,53,54] Through reductions in these pollutants, the EPA estimates that 3,600 premature deaths, 1,700 heart attacks, 90,000 asthma attacks, and 300,000 missed work and school days could be avoided every year under the CPP. The dollar value of these benefits is estimated at between $14 and $34 billion annually. Regardless of whether there is a federal CPP requirement, the states need to implement the provisions of the CPP or similar provisions, along with energy-efficiency and renewable energy requirements, to realize the maximum health and dollar benefits for their states.

If clean air strategies, including public outreach programs, are to be successful, collaboration with a range of public and private organizations (e.g., industry trade associations, nonprofit groups, and environmental organizations) will be essential. Equally important is the involvement of local community groups having firsthand experience with air pollution and environmental justice issues in their neighborhoods. Tribal organizations are often overlooked and also need to be involved in environmental assessment actions involving their territories, including air pollution originating outside of territorial boundaries. Ultimately, the primary objective must be to build a strong constituency for the Clean Air Act so that when Congress debates the merits of the act and funding for the EPA, a wide spectrum of Americans and American businesses will defend clean air programs.

One strategy not recommended is amending the Clean Air Act. While there is more work to be done to fully implement the provisions of this landmark clean air legislation, the act already provides the tools and regulatory mechanisms necessary to continue making progress on the nation’s most serious air quality challenges.[24] There has been some discussion in Congress over the years about whether the act should be revised to take costs into consideration when setting national ambient air quality standards. (Currently, the EPA performs a cost-benefit analysis as part of its regulatory impact analysis, but costs are not used to set the levels of the standards.) However, most air quality managers and many legislators believe that these standards should be based solely on the exposure levels needed to protect public health without regard to costs, and this policy statement is in agreement. (Costs are considered later when states decide on the most practicable and cost-effective approaches to comply with the standards.) More work is needed to fully implement the act, but there is little to be gained at this time from changing the legislation itself.

Opposing Arguments/Evidence

Air pollution regulation is under greater scrutiny now than at perhaps any time since the Clean Air Act legislation was enacted in 1970. Most of the arguments against air pollution regulation focus on the costs of pollution control relative to the health benefits, on damage to the competitiveness of American industry and loss of jobs, and on the importance of decentralizing regulatory actions (i.e., giving states and communities more autonomy in setting regulations because, it is argued, they better understand local issues and circumstances). Other arguments are driven by the desire of some state and industry leaders to expand fossil fuel production, particularly coal mining.

It is true that air pollution controls at electric power facilities and in other industries can be quite expensive, sometimes costing billions of dollars on a nationwide basis. However, studies have consistently demonstrated that the costs of air pollution control are far outweighed by the benefits to society: improved public health, fewer sick days for students and workers, and reduced health care expenses. For example, the Obama administration’s climate change rules for power plants, which also reduce urban soot and smog, would achieve up to four dollars in health benefits for every dollar invested in complying with the rules.[46] (These rules are currently under review by the Trump administration.) Also, the EPA’s Second Prospective Study estimates that the benefits of air pollution control under the Clean Air Act substantially exceed costs, ranging from a factor of 3 to 90 depending on assumptions.[47] Finally, according to the Office of Management and Budget’s 2015 Report to Congress on the Benefits and Costs of Federal Regulations and Agency Compliance With the Unfunded Mandates Reform Act, costs for 22 rules issued by the EPA air program office ranged from $36.6 to $44.1 billion, whereas benefits ranged from $157.4 to $777.9 billion (in 2010 dollars).[48] Thus, a strong argument can be made for air pollution regulation when considering benefits to American society as a whole. Furthermore, there is no evidence that air pollution controls make American industry less competitive.[49] Quite to the contrary, industries with state-of-the-art environmental controls tend to be more energy efficient, resource conscious, and innovative, and they are valued as good corporate citizens in their communities.

Interest in decentralizing pollution regulations away from Washington, D.C., is a manifestation of a broader political argument about the role of government that has been around since the founding of our country. While this argument was present when Congress first drafted the Clean Air Act, there was a stronger interest in establishing a “level playing field” among the states.[55] Without federal regulation applying uniformly to all states, each state would be free to develop regulations as stringent or lenient as it wished, without regard to regulations developed by other states. This scenario would present two problems. First, if one state’s regulations are tougher than another state’s, industries may tend to move to the state with the least stringent (and, thus, least costly) regulations. Second, because air pollution crosses boundaries between states, air pollution from states with lenient regulations may drift toward states with stringent regulations, worsening air quality in those states and negating the benefits of their tougher regulations. Congress judged that air pollution regulations set at the federal level (while still giving states some flexibility to set more stringent regulations) would largely avoid these problems. Thus, the Clean Air Act was born. The argument about decentralizing federal power will always be present, but other issues aside, public health benefits more from national ambient air quality regulations set and enforced by the federal government, which is in the best position to conduct research, assess health risks, and apply rules uniformly across the nation.

A particularly contentious issue concerns the potential loss of coal mining jobs due to air pollution controls that discourage the use of coal, especially in electric utility power plants (e.g., limits on mercury, sulfur, and particulate emissions). However, coal mining has been in decline for a number of years largely as a result of other economic factors, including the availability of less expensive natural gas, the retirement of many older coal-burning power plants, and the proliferation of renewable energy sources (e.g., solar panels and wind turbines). In 2016, only 55% of electric power generation and fuel technology workers were employed at traditional coal, oil, and gas facilities, while in that same year the solar energy workforce increased by 25% and wind energy employment increased by 32%.[56] Regardless of whether tough environmental regulations are in place, it is just a matter of time before renewable energy and low-emission natural gas facilities come to dominate the U.S. energy sector.

Action Steps

Therefore, APHA:

• Calls upon Congress and the White House to reexamine the costs and benefits of clean air and to increase funding for Clean Air Act programs aimed at improving air quality for all Americans, including the 121 million Americans living in areas violating one or more of the six health-based federal air quality standards for ambient air pollutants. APHA also calls upon Congress and the White House to provide greater funding for research on toxic air pollutant exposures in urban areas, particularly for low-income families and people of color, and to increase funding for indoor air quality research and training.
• Calls upon Congress, the White House, and members of the  public health community to resist all efforts to weaken the health protections afforded by the Clean Air Act, the nation’s landmark clean air legislation, which has achieved dramatic improvements in air quality since its enactment in 1970. In particular, the national ambient air quality standards should continue to be based solely on protecting public health, and costs should not be considered in setting the levels of the standards.
• Calls upon the EPA to increase its assessment and control of toxic air pollutants, including new and exotic chemicals not previous investigated, using all available regulatory mechanisms under the Clean Air Act. In addition, APHA calls upon the EPA to collect data necessary to assess disproportionate toxic air pollutant exposures among low-income families and people of color living in close proximity to industrial facilities and other toxic air pollutant sources and to take all measures available to reduce such exposures to safe levels.
• Calls upon the EPA to continue efforts at reducing pollutants that deplete the Earth’s stratospheric ozone layer, being mindful of the 5 million Americans treated for skin cancer every year. The EPA’s UV index, developed in collaboration with the National Weather Service, is useful for preventing overexposure to sunlight, and both organizations need to increase public outreach about this important tool and the hazards of sunburn.
• Calls upon state and local environmental offices and health departments to collaborate with EPA regional offices in assessing and remediating environmental justice concerns in their communities, including exposures to smog and toxic air pollutants and the disproportionate number of asthma cases among people of color. Assessing exposures near public housing and schools in the vicinity of freeways, industrial facilities, and power plants should be a priority, and the impact of land-use planning and infrastructure decisions on air pollution exposure needs to be reexamined.
• Calls upon the EPA and state and local environmental offices and health departments to expand their outreach to urban populations to better educate the public about the hazards of air pollution, including indoor air quality, and the steps individuals can take to reduce their exposure. Health professionals should help government officials and the public recognize how the health benefits associated with clean air, such as reduced hospital visits and fewer missed days at school and work due to illness, far outweigh the costs of air pollution control. In planning and conducting outreach efforts, collaboration with industry trade associations, nonprofit groups, and environmental organizations is essential.
• Calls upon the EPA to provide leadership in implementing innovative miniaturized monitoring technologies that will provide real-time air quality data on a local scale, allowing individuals to assess their personal exposures and take appropriate actions to reduce exposures. These technologies will change the air quality monitoring paradigm, and EPA leadership is urgently needed to validate technologies, manage the vast quantities of data sure to be generated, and provide health information in a format and over a time scale useful to the public.
• Calls upon the public, government agencies, and health departments to defend the goals of the Clean Power Plan and calls upon states to implement its provisions in the most expeditious manner, recognizing the co-benefits to air quality and public health that will ensue from reducing greenhouse gases and other air pollutants from electric power plants using fossil fuels. These co-benefits include avoided premature deaths, heart attacks, asthma attacks, and missed work and school days and potentially billions of dollars in reduced health care costs.
• Calls upon educators to ensure that training programs for health professionals, including public health, medical, and nursing programs, and science education programs for postsecondary and K–12 science students include air quality learning objectives in their curricula (e.g., fundamentals of air pollution assessment and control, health risk assessment, environmental justice). All health professionals and students should be informed about steps individuals and communities can take to reduce air pollution, and they should be made aware of services such as the Air Quality Index that can help individuals take appropriate actions to reduce exposures on days when air quality is poor.

10.  Calls upon individuals and local communities to actively promote clean air through activities such as conserving energy at work and home, driving hybrid and electric vehicles, using public transportation or ride sharing whenever possible, visiting local schools to talk about environmental conservation, sponsoring science fairs and asthma awareness days, disseminating information about the Air Quality Index and the UV index, supporting smart growth and green community programs, and working with community leaders to establish clean air policies and initiatives. Everyone can set an example for young people by thinking globally and acting locally.

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2. Environmental Protection Agency. Our nation’s air: status and trends through 2015. Available at: https://gispub.epa.gov/air/trendsreport/2016. Accessed January 7, 2018.

3. Bachmann J. Will the circle be unbroken: a history of the U.S. national ambient air quality standards. J Air Waste Manag Assoc. 2007;57:652–697.

4. Carlsten C, Rider C. Traffic-related air pollution and allergic disease: an update in the context of global urbanization. Curr Opin Allergy Clin Immunol. 2017;17:85–89.

5. Centers for Disease Control and Prevention. Air pollution and respiratory health. Available at: https://www.cdc.gov/nceh/airpollution. Accessed January 7, 2018.

6. Cromar KR, Gladson LA, Perlmutt LD, Ghazipura M, Ewart GW. American Thoracic Society and Marron Institute report: estimated excess morbidity and mortality caused by air pollution above American Thoracic Society-recommended standards, 2011–2013. Ann Am Thorac Soc. 2016;13:1195–1201.

7. Environmental Protection Agency. Research on health and environmental effects of air quality. Available at: https://www.epa.gov/air-research/research-health-and-environmental-effects-air-quality. Accessed January 7, 2018.

8. Mannucci PM. Effects on health of air pollution: a narrative review. Intern Emerg Med. 2015;10:657–662.

9. Nadadur SS, Hollingsworth JW. Air Pollution and Health Effects. London, England: Springer; 2015.

10. Phalen RN, Phalen RF. Introduction to Air Pollution Science: A Public Health Perspective. Burlington, MA: Jones and Bartlett Learning; 2013.

11. Roberts JD, Voss JD, Knight B. The association of ambient air pollution and physical inactivity in the United States. PLoS One. 2014;9:3.

12. Wellbery C, Sarfaty M. The health hazards of air pollution—implications for your patients. Am Fam Physician. 2017;95:146–148.

13. Environmental Protection Agency. Health and environmental effects of hazardous air pollutants. Available at: https://www.epa.gov/haps/health-and-environmental-effects-hazardous-air-pollutants. Accessed January 7, 2018.

14. Environmental Protection Agency. National air toxics assessment. Available at: https://www.epa.gov/national-air-toxics-assessment. Accessed January 7, 2018.

15. McCarthy MC, O’Brien TE, Charrier JG, Hafner HR. Characterization of the chronic risk and hazard of hazardous air pollutants in the United States using ambient monitoring data. Environ Health Perspect. 2009;117:790–796.

16. Multiple Air Toxics Exposure Study in the South Coast Air Basin. Diamond Bar, CA: South Coast Air Quality Management District; 2015.

17. Sunderland EM, Driscoll C, Hammitt J, et al. Benefits of regulating hazardous air pollutants from coal and oil-fired utilities in the United States. Environ Sci Technol. 2016;50:2117–2120.

18. Brockmeyer S, D’Angiulli A. How air pollution alters brain development: the role of neuroinflammation. Transl Neurosci. 2016;7:24–30.

19. Greenberg N. Different effects of long-term exposures to SO2 and NO2 air pollutants on asthma severity in young adults. J Toxicol Environ Health A. 2016;79:342–351.

20. Grineski SE, Clark-Reyna SE, Collins TW. School-based exposure to hazardous air pollutants and grade point average: a multi-level study. Environ Res. 2016;147:164–171.

21. Lavigne É. Maternal exposure to ambient air pollution and risk of early childhood cancers: a population-based study in Ontario, Canada. Environ Int. 2017;100:139–147.

22. Sullivan M. Reducing lead in air and preventing childhood exposure near lead smelters: learning from the U.S. experience. New Solutions. 2015;25:78–101.

23. Brook RD, Franklin B, Cascio W, et al. Air pollution and cardiovascular disease: a statement for healthcare professionals from the Expert Panel on Population and Prevention Science of the American Heart Association. Circulation. 2004;109:2655–2671.

24. Kariisa M, Foraker R, Pennell M, et al. Short- and long-term effects of ambient ozone and fine particulate matter on the respiratory health of chronic obstructive pulmonary disease subjects. Arch Environ Occup Health. 2015;70:56–62.

25. Liu Y. Impact of air quality guidelines on COPD sufferers. Int J Chron Obstruct Pulmon Dis. 2016;11:839–872.

26. Environmental Protection Agency. Urban air toxics. Available at: https://www.epa.gov/urban-air-toxics. Accessed January 7, 2018.

27. Environmental Protection Agency. Near roadway air pollution and health: frequently asked questions. Available at: https://www.epa.gov/air-research/near-roadway-air-pollution-and-health-frequent-questions. Accessed January 7, 2018.

28. Environmental Protection Agency. Regulations to reduce mobile source pollution. Available at: https://www.epa.gov/mobile-source-pollution/regulations-reduce-mobile-source-pollution. Accessed January 7, 2018.

29. Environmental Protection Agency. Environmental justice. Available at: https://www.epa.gov/environmentaljustice. Accessed January 7, 2018.

30. Guillerm N, Cesari G. Fighting ambient air pollution and its impact on health: from human rights to the right to a clean environment. Int J Tuberc Lung Dis. 2015;19:887–897.

31. Pratt GC. Traffic, air pollution, minority and socio-economic status: addressing inequities in exposure and risk. Int J Environ Res Public Health. 2015;12:5355–5372.

32. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC: U.S. Department of Health and Human Services; 2014.

33. Environmental Protection Agency. UV index. Available at: https://www.epa.gov/sunsafety/uv-index-1. Accessed January 7, 2018.

34. Lin M, Fiore A, Horowitz L, et al. Transport of Asian ozone pollution into surface air over the western United States in spring. J Geophys Res. 2012;117:D21.

35. National Oceanic and Atmospheric Administration. Long-range transport. Available at: https://www.gfdl.noaa.gov/long-range-transport. Accessed January 7, 2018.

36. An Assessment of Long-Range Transport of Key Air Pollutants to and from the United States. Washington, DC: National Academies Press; 2010.

37. Ambient Air Pollution: A Global Assessment of Exposure and Burden of Disease. Geneva, Switzerland: World Health Organization; 2016.

38. Giannadaki D, Lelieveld J, Pozzer A. Implementing the US air quality standard for PM2.5 worldwide can prevent millions of premature deaths per year. Environ Health. 2016;15:88.

39. Air Quality Index: A Guide to Air Quality and Your Health. Washington, DC: Environmental Protection Agency; 2014.

40. Environmental Protection Agency. AirNow. Available at: https://www.airnow.gov. Accessed January 7, 2018.

41. Bentayeb M. Indoor air pollution and respiratory health in the elderly. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2013;48:1783–1789.

42. Breysse PN, Diette G, Matsui E, et al. Indoor air pollution and asthma in children. Proc Am Thorac Soc. 2010;7:102–106.

43. Centers for Disease Control and Prevention. Indoor air quality. Available at: https://www.cdc.gov/nceh/airpollution/airquality/default.htm. Accessed January 7, 2018.

44. Uzoigwe JC, Prum T, Bresnahan E, Garelnabi M. The emerging role of outdoor and indoor air pollution in cardiovascular disease. N Am J Med Sci. 2013;5:445–453.

45. Driscoll CT. US power plant carbon standards and clean air and health co-benefits. Nature Climate Change. 2015;5:535–540.

46. Environmental Protection Agency. Complying with President Trump’s executive order on energy independence. Available at: https://www.epa.gov/cleanpowerplan/clean-power-plan-existing-power-plants. Accessed January 7, 2018.

47. Benefits and Costs of the Clean Air Act 1990–2020: The Second Prospective Study. Washington, DC: Environmental Protection Agency; 2011.

48. 2015 Report to Congress on the Benefits and Costs of Federal Regulations and Agency Compliance With the Unfunded Mandates Reform Act. Washington, DC: Office of Management and Budget; 2015.

49. Environmental Protection Agency. The Clean Air Act and the economy. Available at: https://www.epa.gov/clean-air-act-overview/clean-air-act-and-economy. Accessed January 7, 2018.

50. Committee on the Effect of Climate Change on Indoor Air Quality and Public Health, Institute of Medicine. Climate Change, the Indoor Environment, and Health. Washington, DC: National Academies Press; 2011.

51. Potera C. Climate change impacts indoor environment. Environ Health Perspect. 2011;119:A382.

52. Guan WJ. Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action. Lancet. 2016;388:1939–1951.

53. Buonocore JJ. An analysis of costs and health co-benefits for a U.S. power plant carbon standard. PLoS One. 2016;11:6.

54. Harvard T.H. Chan School of Public Health. Clean air and health benefits of Clean Power Plan hinge on key policy decisions. Available at: https://www.hsph.harvard.edu/news/press-releases/clean-power-plan-health-benefits-hinge-on-policy-decisions/. Accessed January 7, 2018.

55. Environmental Protection Agency. Evolution of the Clean Air Act. Available at: https://www.epa.gov/clean-air-act-overview/evolution-clean-air-act. Accessed January 7, 2018.

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Environmental Effects on Public Health: An Economic Perspective

In this article we critically review the economic literature on the effects of environmental changes on public health, in both the developed and the developing world. We first focus on the economic methodologies that are available for the evaluation of the effects (social costs and benefits) of environmental changes (degradation/preservation) on public health. Then, we explain how the monetary valuations of these effects can feed back in the construction of economic policy for creating agent-specific incentives for more efficient public health management, which is also equitable and environmentally sustainable. Our exposition is accompanied by a synthesis of the available quantitative empirical results.

Every minute, five children in developing countries die from malaria or diarrhoea. Every hour, 100 children die as a result of exposure to indoor smoke from solid fuels. Every day, nearly 1,800 people in developing cities die as a result of exposure to urban air pollution. Every month, nearly 19,000 people in developing countries die from unintentional poisonings.

Source: Health and Environment: Tools for Effective Decision-Making: the WHO/UNEP Health and Environment Linkages Initiative Review of Initial Findings, 2004.

1. Introduction

The environment affects our health in a variety of ways. The interaction between human health and the environment has been extensively studied and environmental risks have been proven to significantly impact human health, either directly by exposing people to harmful agents, or indirectly, by disrupting life-sustaining ecosystems [ 1 ]. Although the exact contribution of environmental factors to the development of death and disease cannot be precisely determined, the World Health Organization (WHO) has estimated that thirteen million deaths annually are attributable to preventable environmental causes [ 1 ]. The report also estimates that 24% of the global disease burden (healthy life years lost) and 23% of all deaths (premature mortality) are attributable to environmental factors, with the environmental burden of diseases being 15 times higher in developing countries than in developed countries, due to differences in exposure to environmental risks and access to health care.

However, huge economic development and population growth result in continuing environmental degradation. Intensification of agriculture, industrialization and increasing energy use are the most severe driving forces of environmental health problems. For countries in the early stages of development the major environmental hazards to health are associated with widespread poverty and severe lack of public infrastructure, such as access to drinking water, sanitation, and lack of health care as well as emerging problems of industrial pollution. However, environmental health hazards are not limited to the developing world. Although at a lesser extend, environmental risks are also present in wealthier countries and are primarily attributed to urban air and water pollution. Occurrences of Asthma are rising dramatically throughout the developed countries, and environmental factors appear to be at least partly to blame [ 1 ]. The Millennium Ecosystem Assessment [ 2 ] synthesis report warns that the erosion of ecosystems could lead to an increase in existing diseases such as malaria and cholera, as well as a rising risk of new diseases emerging.

Climate change is also posing risks to human population health and well-being and thus is emerging as a serious concern worldwide [ 3 – 6 ]. In 2000 climate change was estimated to be responsible for approximately 2.4% of worldwide diarrhoea and 6% of malaria [ 1 ]. According to the IPCC third assessment report the world temperature is expected to further rise during the century, implying increased health threats for human populations, especially in low-income countries. Reviewing the US literature addressing health impacts of climate variability and change Ebi et al. [ 7 ], conclude that climate change is expected to increase morbidity and mortality risks from climate-sensitive health outcomes such as extreme heat events, floods, droughts and fires. A spread in vector–borne diseases, like malaria, is also expected [ 8 , 9 ]. A study in Mexico revealed that lower greenhouse gases emissions would result in avoidance of some 64,000 premature deaths over a twenty year period [ 4 ]. Leading death causes worldwide (2004) are summarized in Table 1 .

The 10 leading causes of death by broad income group (2004).

Source: World Health Organization [ 10 ].

This paper provides a review of the literature on valuation studies eliciting monetary values associated with reduced environmental risk and in particular focusing on reduced indoor and outdoor air pollution, enhanced water quality and climate change mitigation. The findings of the valuation studies have important policy implications, since the environmental risk factors that are studied can largely be avoided by efficient and sustainable policy interventions. Minimizing exposure to environmental risk factors by enhancing air quality and access to improved sources of drinking and bathing water, sanitation and clean energy is found to be associated with significant health benefits and can contribute significantly to the achievement of the Millennium Development Goals of environmental sustainability, health and development.

2. Economic Valuation Techniques

Quantifying the impacts of environmental degradation on human health is essential for the development of well-informed policies by the health sector and consequently many valuation studies have been conducted worldwide the past decades addressing environmental risks to public health. The main approaches for health impact valuations can be broadly classified into revealed and stated preference techniques. The first take into account observable market information which can be adjusted and used for revealing an individual’s valuation. Revealed preferences include cost of illness, human capital surveys, hedonic pricing and the Quality Adjusted Life Year studies. In stated preferences studies the market for the good is ‘constructed’ through the use of questionnaires. The two most-well-known stated preference methods are the Contingent Valuation Method (CVM) and the Choice Experiments (CE).

Cost of illness studies measure the direct (medical costs, nursing care, drugs) and indirect (opportunity) economic costs associated with a disease and estimate the potential savings from the eradication of the disease. Human capital surveys estimate the productivity loss measured in workdays due to illness. This approach also values loss of life based on the foregone earnings associated with premature mortality. The notion is that people should be willing to pay at least as much as the value of the income they would lose by dying prematurely.

Damage costs estimates from environmental hazards for the economy as a whole are also obtained through general equilibrium macroeconomic modeling. These studies assess welfare impacts in a national or international level by examining all the sectors of the economy and estimating environmental health impacts on parameters of the economy like income and consumption.

The Quality Adjusted Life Year (QALY) studies measure both the quality and quantity of life. The values for a Life Year range from 0, implying death, to 1, implying a year of perfect health. Therefore, QALYs provide an indication of the benefits from a healthcare intervention in terms of health-related quality. Combined with the costs of providing different interventions, a cost-effectiveness analysis (cost per QALY) can follow to allow for comparisons of different interventions. A monetary value can also be placed on a QALY to estimate the dollar benefits of a health intervention or policy and allow for a subsequent cost-benefit analysis. Stated Willingness to Pay, elicited through a contingent valuation study or a discrete choice study, is often used, to monetize QALYs. Other methods to value a QALY include time-trade-offs, standard gamble and the visual analogue scale. Hedonic pricing methods assess differences in the price of housing in polluted or unpolluted areas, or the difference in wages between hazardous and non-hazardous jobs. Variations in housing prices and wages reflect the value of health damages avoided to those individuals and therefore reveal individual’s willingness to pay to avoid damages.

Stated preference approaches include the Contingent Valuation Method and Choice Experiments. The respective differences between the two methodologies relate to the way in which the economic values are elicited. In a contingent valuation questionnaire respondents are presented with a valuation scenario that describes the changes in the provision of the public good resulting from the policy under evaluation and, in the simplest open-ended format, are asked about their maximum Willingness to Pay for the policy to be implemented. Grounded on Lancaster’s theory of value [ 11 ], choice experiments describe the good under evaluation in terms of its characteristics, attributes, and the levels these attributes take. One of the attributes is usually price, so that the marginal value of the other attributes can be evaluated in monetary terms. Accordingly, respondents are presented with a set of alternatives constructed from different combinations of the levels of attributes, and are asked to choose their most preferred. Similarly a choice experiment can be used to examine policy implications of a policy or management strategy with policy impacts being the attributes to be valued.

Before valuing the health damage the establishment of a dose-response function relating pollutant concentrations to health impacts is required [ 12 ]. The impacts of environmental degradation on mortality, expressed as the increase in the probability of premature death, and quality of life, expressed as reduction of the morbidity risk, are thus initially considered. Accordingly respondents are asked to either state their willingness to pay for a prevention scenario (stated preference approach) or the benefits are elicited through the costs that would be saved if the risk was eradicated (cost of illness studies). Benefits are mainly reported by calculating the Value of a Statistical Life (For a review of the literature calculating the value of a statistical life based on labor and housing market data see Viscusi and Aldy [ 13 ].). The Value of Statistical Life (VSL) is calculated by dividing the value of a small risk change by the actual change in risk and thus captures the effect of small changes in the risk of premature death for a large population of potentially exposed people [ 14 ].

Since primary data collection to establish the dose response functions or proceed with the valuations can be expensive and time-demanding, there is substantial policy interest in using benefit transfer techniques. In this context, original values from existing studies are transferred to policy sites after correcting for certain parameters. Given the number of valuation studies, several meta-analyses studies have been recently conducted. Following this approach valuation estimates from existing studies are collected and the determinants of these estimates are examined. In a meta-analysis regression, therefore, the dependent variable is a common summary statistic, such as a predicted variable for the Willingness to Pay, whereas the independent variables include characteristics of the primary data, study design, valuation method, sample size, model specification, econometric methods, date of publication [ 15 ]. Meta-analyses can feedback the establishment of value transfer functions to estimate values for policy sites of interest based on properly adjusted information from existing studies on similar sites, study sites [ 16 ].

Each of the methods described has its own strengths and limitations. The choice between these methods should be case-study driven, that is, it should be a function of case-study-specific data availability and socio-economic-political framework. In human capital surveys it is often difficult to assign wages for housework or non-cash labour. Hedonic methods require a well functioning market for housing or labour, which internalizes the health risks associated with a location or a job. The cost of illness approach fails to capture the full damage of illness, such as psychological suffering and physical pain and should be thus treated as a lower bound of the total value of health risks aversion [ 17 ]. Using QALY to estimate the damage costs may also lead to underestimations [ 18 ]. Opponents of QALYs use argue that these measures cannot in general appropriately represent individual preferences for health, while they are consistent with the utility theory under very restrictive conditions [ 19 ]. QALYs finally ignore the distributional effects arising from the dependence of WTP on income. Macroeconomic modelling is often based on simplistic assumption regarding the economy while many impacts are unquantifiable and are thus not modelled [ 5 ].

The contingent valuation method (CVM), although widely used, has been criticised for its lack of reliability since it is associated with biases, such as hypothetical bias, strategic bias, yes-saying bias and embedding effect [ 20 , 21 ]. Hypothetical bias contends that respondents may be prepared to reveal their true values but are not capable of knowing these values without participating in a market in the first place. Strategic bias occurs when respondents deliberately under- or overstate their WTP. Respondents may understate their WTP if they believe that the actual fees they will pay for provision of the environmental resources will be influenced by their response to the CV question. Conversely, realising that payments expressed in a CV exercise are purely hypothetical, respondents may overstate their true WTP in the hope that this may increase the likelihood of a policy being accepted. Yea-saying bias indicates that respondents may express a positive WTP because they feel good about the act of giving for a social good although they believe that the good itself is unimportant while embedding bias implies that WTP is not affected by the scale of the good being offered. To address these, the Blue Ribbon Panel under the auspices of NOAA [ 22 ] has made recommendations regarding best practice guidelines for the design and implementation of contingent valuation studies.

Comparing the stated preference methods for environmental valuation Boxall et al. [ 23 ] argue that choice experiments (CEs) have important advantages over others valuation methods mainly because of their experimental nature which enables the representation of different states of the environment using attributes and levels of specific choice situations. The latter has a clear benefit compared to other valuation methods as it leads respondents to explicitly make trade-offs between the various attributes of the situation and thus provides policy-makers with valuable information about public preferences for many states of the environment. Environmental health effects of a policy or project can therefore be explicitly addressed and valued. Both CVM and CEs studies represent preferences that are consistent with utility theory, with CEs being also able to solve for some of the biases present in the CVM. Therefore it is our opinion that the application of CEs should be further enhanced in health economics to evaluate health impacts of environmental policies.

3. Economic Assessment of Environmental Health Impacts: Empirical Evidence

There is increasing recognition that linked environment and health impacts require economic assessment in order to receive adequate consideration in policy [ 1 ]. Consequently, a huge increase in the number of valuation studies trying to quantify the environmental impacts on human health in monetary terms and elicit public preferences for health and environmental policies that reduce the risk of illness or mortality has been experienced in recent years.

In the subsequent sections important applications of the valuation techniques that have been conducted to estimate social benefits associated with increased air and water quality as well as climate change aversion are reviewed. Limitations of the existing research are addressed in the concluding section and directions for future work are suggested. For quick reference a table summarizing each study’s main features (that is author, case study country, environmental hazard and valuation result) can be found in the Appendix . All valuations have been converted to 2006 euros (2006 average $0.797 = 1 euro).

3.1. Air Quality

Air pollution is a major environmental risk to health and is estimated to cause approximately two million premature deaths worldwide per year [ 24 ]. A reduction of air pollution is expected to reduce the global burden of disease from respiratory infections, heart disease, and lung cancer. As air quality is a major concern for both developed and developing countries, a large number of empirical studies attempting to monetize the benefits to health generated by improved air quality have appeared in the literature worldwide.

Pearce [ 12 ] provides a summary of the main studies conducted to that day valuing health damages from air pollution in the developing world. In particular, valuation estimates for health symptoms and risks of mortality attributable to particulate matter, lead, nitrogen and sulphur oxides and low level ozone are reported. The main conclusion from the literature review is that some forms of air pollution, notably inhalable particulate matter and ambient lead, are serious matters for concern in the developing world since they are associated with severe health damages in monetary terms.

Since then a number of valuation studies have been conducted in developing countries estimating social benefits from air pollution reduction in terms of either averted mortality or averted morbidity due to air pollution mitigation strategies. To provide economic estimations of health risk reductions authors rely on existing epidemiological studies that establish the relationship between pollution concentrations and health hazards. Valuation studies are then conducted to monetize health outcomes given the number of exposures and the associated risk predicted from the dose-response functions.

In the literature addressing air pollution in both developed and developing world, contingent valuation studies are mainly implemented. The health consequences from alternative pollution abatement policies are explicitly stated in the valuation scenario and respondents are asked their maximum willingness to pay to contribute in the implementation costs of the policy under evaluation.

Mortality and mobility effects of air pollution have been studied through contingent valuation in the developing world [ 25 – 28 ]. To provide economic grounds for supporting investment in air pollution abatement a cost benefit-analysis is often applied [ 29 – 31 ]. Results from valuation studies adopting a benefit transfer framework to circumvent the time and money demands of conducting an original study are also reported in the literature [ 32 , 33 ]. A cost of illness approach is employed by Gupta [ 34 ] to estimate the monetary benefits to individuals from health damages avoidance due to air pollution reduction in India. Health costs are considered to be incurred due to adverse effects of air pollution on health i.e., the loss in wages due to workdays lost from work and expenditures on mitigating activities. While the majority of studies addressed outdoor air pollution, Chau et al. [ 35 ] combine revealed and stated preference techniques to estimate the monetary benefit gains from improved indoor air quality. Authors conduct a meta-analysis to estimate the concentration-response coefficients for different health outcomes to which they then assigned economic value based on existing values from the literature. Findings indicate that there would be some benefit gains for the owners-employers and the society if certain regular filter sets were adopted. The amount of benefit gains by the owners-employers increases with the average salary level of employees and duration that they stay in offices.

Hedonic studies have been also applied to estimate a relationship between housing prices and housing attributes, including health risks associated with air pollution. The value people place on reduced health risks through improved air quality are inferred by their willingness to pay more for houses with better air quality, all else being equal. Delucchi et al. [ 36 ] provide a meta analysis of hedonic pricing studies addressing health risks from air pollution. Comparing results with studies applying the damage function approach, authors find evidence that hedonic price analysis does not capture all of the health costs of air pollution because individuals are not fully informed about all of the health effects to incorporate them into property values.

According to the authors’ knowledge, in developed countries environmental health studies are limited and all consist of contingent valuation studies in Europe. To assess morbidity risk reduction benefits, Navrud [ 37 ] conduct a contingent valuation study to estimate the willingness-to-pay (WTP) to avoid additional days of seven light health symptoms (coughing, sinus congestion, throat congestion, eye irritation, and headache, shortness of breath and acute bronchitis) and asthma. Mean WTP for an environmental program that would result to reduced health risks (avoiding one additional day of the health symptoms) ranges from 16.62 euros for coughing to 44.2 for the shortness of breath. Mortality risks reduction, expressed as extension in life expectancy, is addressed by Alberini et al. [ 38 ], Desaigues et al. [ 39 ] and Chilton et al. [ 40 ]. Finally, Aunan et al. [ 30 ] implement a cost-benefit analysis to estimate the net benefits of an energy saving program in Hungary that would result to significant emissions reductions. The analysis indicates that the main benefit from reduction of the concentrations of pollutants relates to improved human health. The estimated annual benefit of improved health conditions alone is likely to exceed the investments needed to implement the program even under the lowest estimates. A cost-benefit analysis is also applied by Larson et al. [ 41 ] to assess the efficiency of five projects leading to 25-fold reduction in mortality risk due to particulate emissions in Russia. The Value of a Statistical Life was transferred to Russia after adjustment to estimate benefits of reduced mortality. The total net present benefit of all five projects is found about $40 million which justify the undertaking of the projects on economic grounds.

3.2. Water Quality

Contact with unsafe drinking or bathing water can impose serious risks (both acute and delayed) to human health [ 42 , 43 ]. Microbe contamination of groundwater due to sewage outfalls and high concentration of nutrients in marine and coastal waters due to agricultural runoff are among the most serious threats [ 44 ]. According to the European Commission’s (EC) recent statistics, 20 percent of all surface water in the EU is seriously threatened by pollution [ 45 ]. In the infrastructurally disadvantaged developing world the water contamination problem is even more prominent [ 46 ].

Although epidemiological studies have provided evidence of severe morbidity attributed to polluted water the issue has received limited attention in terms of valuation studies. Only few studies explicitly address health effects of drinking and bathing water quality to inform efficient water resources management policies mainly in high income countries.

The health risks involved in bathing in polluted sea water are explicitly accounted in the study of Machato and Murato [ 47 ], who employed stated preference techniques to evaluate the multiple benefits of improving the quality of marine recreational waters on the Estoril coast in Portugal. Based on evidence from existing epidemiological dose-response functions a contingent valuation survey was employed to allow for a direct estimate of the health benefits of reduced water pollution. Results indicate that health risk reductions are only a small fraction of the total social benefits of water quality improvements. The sample mean WTP to avoid gastroenteritis was found to be € 55.56. Bathing water quality related health benefits are also studied by Johnson et al. [ 48 ], who adopted a benefit-transfer approach to evaluate health benefits associated with improved bathing water quality in Scotland. A dose-response function between the concentration of Intestinal Enterococci in bathing water and the probability of contracting gastro-enteritis was first determined and then the annual benefits of illness risk reduction were estimated on the WTP values from a stated preference study in England. Health benefits from a reduction in the risk of illness resulting from swimming in contaminated waters were found to be € 348.000 annually. Georgiou et al. [ 49 ] conducted a cost-benefit analysis to inform policy-makers in UK on the efficiency of the proposed measures to revise seawater quality standards set by the 1976 EC Bathing Water Quality Directive. Benefits were estimated based on data from a contingent valuation study and were then related to their costs. Results indicate that mean WTP amounts, representing the economic benefits of the revision are of the same order of magnitude as the estimated potential cost increases in average annual household water bills necessary to implement the revision.

Deviating from the contingent valuation framework, Dwight et al. [ 43 ] apply the cost of illness approach and Shuval [ 50 ] calculate the disability-adjusted life years (DALY), to quantify the health burden from illnesses associated with exposure to polluted recreational coastal waters. In the former study, health data on illness-related lost activity days and medical care use were used and the economic burden per gastrointestinal illness was estimated at € 31.9, the burden per acute respiratory disease at € 66.94, the burden per ear ailment at € 32.95, and the burden per eye ailment at € 23.81. In the later, the total estimated impact of the human disease attributable to marine pollution by sewage is about three million DALY per year, with an estimated economic loss of some11.16 billion euros per year.

In the developing world, health damages from drinking water contamination are examined by Dasgupta [ 46 ] and Maddison et al. [ 51 ] The former study estimates a health production function to derive the total cost of illness related to Diarrhoeal diseases in urban India,. Annual health costs are calculated and aggregated over the whole population are found to equal € 2,821,587. The latter estimates aggregate willingness to pay to avoid health risks, including various cancers, associated with consumption of arsenic contaminated groundwater in Bangladesh. Based on Value of Statistical Life estimation from studies in India, authors report an aggregate WTP of $2.7 billion annually to avoid mortality and morbidity cases.

3.3. Climate Change

An understanding of the likely impacts of climate change on human welfare is crucial for making an informed decision about the best response strategy to the enhanced greenhouse effect. Consequently, a number of studies have attempted the evaluation of climate change-related health hazards.

Bell et al. [ 17 ] review the literature on valuation studies assessing health consequences from greenhouse gases. Results from multiple studies provide strong evidence that the public health benefits related to greenhouse gases mitigation strategies are substantial. The review, however, is restricted to health benefits from air pollution exposure. Benefits from greenhouse gases mitigation policies are also addressed by Burtraw et al. [ 52 ]. Authors examine the US electricity sector and value changes to human health resulting from carbon emissions based on concentration response functions. Results indicate health-related ancillary benefits from further reductions in carbon emissions under a € 23.15 carbon tax to be about € 7.41 per metric ton of carbon reduced in the year 2010.

A review of the literature evaluating the welfare impacts of climate change, including climate variation-related diseases is also presented in Tol [ 5 ]. However the studies included provide a total cost estimation of the climate change in $ per tonne of carbon and health effects are not distinguished. Based on the existing literature, Tol concludes that policy response to climate change should be dominated by adaptation, not by mitigation.

Welfare losses associated with health impacts induced by global warming are also estimated by Bosello et al. [ 9 ]. Authors apply a general equilibrium macroeconomic model to infer costs estimates relating to cardiovascular and respiratory disorders, diarrhoea, malaria, dengue fever and schistosomiasis occurrences through changes in labour productivity and demand for health care. Consistent with the literature, results imply the welfare costs (or benefits) of health impacts contribute substantially to the total costs of climate change both in terms of GDP and investment.

Bateman et al. [ 53 ] apply a contingent valuation study to assess WTP for reductions in the skin cancer risks associated with exposure to solar UV radiation. A common valuation scenario was applied to four countries (New Zealand, Scotland, England, and Portugal) across which objectively measured risk levels, for example cancer rates, vary substantially. Authors intended to examine whether scientifically established health risks are reflected in WTP for risk reductions in these countries and results confirm that differences in stated WTP between countries reflects the variation in risk levels between those countries.

Health effects from illnesses associated with climate change are also examined in the developing world by Tseng et al. [ 54 ] using the dengue fever in Taiwan as a case study. The relationship between climate conditions and the number of people infected by dengue fever was first established and the monetary assessment was then attempted applying a contingent valuation study. Results indicate that people would pay € 15.78, € 70.35 and € 111.62 per year in order to reduce the probabilities of dengue fever inflection by 12%, 43%, and 87%, respectively.

4. The Use of Valuation Results in Policy Design

Climate change and anthropogenic forcing threaten environmental stability and with it ecosystems’ capacity to provide goods and services that can be translated to economic benefits for humans including values associated with health quality and death mitigation. Although environmental goods and services have value to society, are often neglected in policy-making as they are not traded in markets and as such are not priced. A primary cause for environmental degradation and consequent health hazards is failure to identify and internalize in decision-making the economic value of ecosystems. Given the public nature of the environmental resources, market data, if available at all, can lead to misleading decisions regarding the significance of resources protection resulting in further resources depletion and degradation. Therefore economic valuation is extremely crucial to provide the correct economic indicators and signals for the design of efficient and sustainable economic policies.

In the absence of markets, valuation studies can provide policy-makers with the necessary information to acknowledge the contribution of health benefits in the social welfare associated with environmental resources justifying the need for policy intervention to eliminate health effects from environmental hazards. Further, preference elicitation for different socio-economic groups and knowledge of the marginal valuation each group attaches to environmental improvements through valuation studies allows for equity considerations to be taken into account in the formulation of policy responses.

Once aggregated over the full range of beneficiaries, monetary benefits estimated through valuation studies can be compared with the costs of the relevant environmental or health intervention policies through cost-benefit analysis to derive useful information on the efficiency of the planned policy. Welfare changes from alternative policy initiatives can be also assessed and the impact of social, economic and attitudinal characteristics on individual valuation can be examined. In this respect, valuation studies are significant for policy-making to guide the selection of economic instruments to allocate resources among socially valuable endeavours [ 55 ].

Economic instruments should provide the necessary incentives to all different stakeholders to act in a sustainable way. To halt environmental degradation and associated health effects economic instruments should intend to provide incentives for adopting preventative measures and refraining from polluting activities. Instruments for natural resources management include standards and quotas, abstraction and pollution taxes, subsidies and tradable permits. Taxes, subsidies and quotas are fiscal policy instruments that can internalize the external costs created by natural resources use and if set at the social optimal level can ensure full cost pricing of the environmental goods and services, a necessary condition for sustainability. Tradable permits systems have been implemented in a number of countries for several pollutants and are also intoduced by the Kyoto protocol with the intention of reducing the greenhouse gases emissions in the contracting counties. Under tradable emission permits, a market for environmental quality is created in which the right to use the environment as a waste sink is priced, and traded [ 56 ]. Further liability systems (legal liability, non-compliance charges) intending to internalize and recover the costs of environmental damage through legal action causes can be established. All instruments should be consistent with the ‘polluter pays principle’ which ensures that the cost of environmental pollution is charged to users and should intend full cost recovery of the environmental damage. Distributional, environmental and sustainability effects of the implementation of each instrument should also be considered and valuation studies can be really informative in this respect. This is particularly valid for the the developing countries where decision makers are faced with the challenge of mitigating environmental risks while supporting economic growth. To ensure environmental protection while enhancing economic development, economic instruments should be properly designed and implemented and in this respect information from valuation studies is crucial.

Information from valuation studies can also assist the design of efficient insurance programs to mitigate health effects resulting from environmental stresses. Knowledge of social perception of the effects of health risks is crucial for the formulation of optimal risk mitigation/hedging strategies. These strategies should be able to allocate the aggregate social health risk between socio-economic groups in order to provide efficient, equitable and sustainable coverage against environmental health hazards.

5. Concluding Remarks

Environmental degradation poses a significant threat to human health worldwide. Harmful consequences of this degradation to human health are already being felt and could grow significantly worse over the next 50 years [ 2 ]. Because environment and health are so intimately linked, so too should be environmental and health policies. However, health impacts are non-marketed and thus hard to quantify in monetary terms. The subsequent risk of being ignored in policy-making is a major concern worldwide. To address this challenge a number of valuation studies have been conducted in both developing and developed countries applying different methods to capture health benefits from improved environmental quality. Valuation results are crucial for the formulation of economic instruments to internalize the externalities created by the public nature of environmental resources. The application of fiscal instruments, the introduction of charge systems and/or the creation of emission markets can only promote sustainable outcomes if set at a social optimal level. Elicitations of the preferences and valuations of different social groups through valuations is therefore essential. This paper reviews the main literature in the field. Although not exhaustive, applied research cited in this review provides substantial evidence of strong correlation between exposure to environmental hazards and health risks and reveals that there are significant values associated with longevity and health quality in both developed and developing world justifying the need for policy interventions.

Enhancing air quality and securing adequate supplies of safe drinking water is associated with significant benefits for human health and well-being. Significant benefits are also found to be associated with bathing water quality socially justifying the costs for abatement policies. Climate change effects mitigation is also of great importance in terms of public health benefits. However, certain limitations of the existing literature have been identified.

Pearce [ 12 ] argued that a major weakness of the air pollution damage literature has been the focus on outdoor pollution. Still, remarkably few studies have measured indoor air pollution which could be the focus of future research. It is also noteworthy that only contingent valuation studies have been conducted when stated preference techniques are applied to elicit public preferences for improved air quality. However the Contingent Valuation method is found to be associated with several biases (strategic bias, yes-saying bias and embedding effect among others) and thus the Choice Experiment method could provide more reliable results [ 57 ]. Future valuation efforts could therefore apply this relatively new stated preference method to assess the social benefit associated with policies attempting to improve air quality. Finally there are considerably few valuation studies on environmental health risks of air pollution in Europe.

Regarding health hazards relating to water, although an international consensus has emerged in policy regarding water quality based on growing concern on environmental and health issues there are few valuation studies eliciting public preferences for improved water quality and subsequently reduced illness risk. The need for economic analysis is, however, highly acknowledged as explicitly manifested in the recently adopted EU Water Framework Directive (2000/60/EC) [ 58 ] which calls for the application of economic principles, economic methods and economic instruments for achieving good water status for all EU waters in the most effective manner [ 59 , 60 ]. Given European and international calls for sustainable water resources management, authors believe that valuing health benefits from surface and groundwater water quality improvements could be a challenging direction for future research especially in the developing world where water quality issues are particularly prominent and the lack of valuations studies is noteworthy.

Moreover, to provide accurate monetary estimates of the benefits of reduced health symptoms associated with environmental hazards, collaboration between economists and epidemiologists should be further enhanced to establish more informed dose-response functions and accordingly formulate the valuation scenarios. Finally, since health benefits from environmental improvements accrue in the long run their assessment should recognize their long-run nature. It follows that discounting and the subsequent selection of a social discount rate to discount future benefits from a policy intervention is crucial to determine whether a policy passes a cost-benefit analysis test taking sustainability and inter-generational equity into consideration [ 61 ].

Summary of Valuation Studies

Environmental Effects on Public Health: An Economic Perspective

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Essay On Impact of Environmental pollution on public health

Essay On Impact of Environmental Pollution on public health

Hello My Dear Friend, In this post “ Essay On Impact of Environmental Pollution on public health “, We will be going to read about the Impact of Environmental Pollution on Public Health as an Essay in detail. So…

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Introduction

Pollution in the environment has become a major global concern, posing a substantial threat to human health.

Over the last few decades, increased industrialization, urbanization, and population growth have resulted in the release of dangerous chemicals into the environment.

These pollutants, which include toxins in the air, water, and soil, have far-reaching repercussions for human health.

The purpose of this article is to investigate the influence of environmental pollution on public health and the actions that can be implemented to reduce its negative consequences.

Air Pollution and Respiratory Diseases

The increased prevalence of respiratory disorders is one of the most evident and immediate effects of environmental pollution on public health.

Particulate matter, nitrogen oxides, sulfur dioxide, and volatile organic compounds are among the harmful pollutants released into the atmosphere by car emissions, industrial activity, and the combustion of fossil fuels.

Prolonged exposure to these contaminants can cause asthma, bronchitis, and chronic obstructive pulmonary disease (COPD).

According to studies, air pollution aggravates pre-existing respiratory diseases and may even contribute to premature death.

Water Pollution and Waterborne Diseases

Water pollution is another major contributor to public health issues. Untreated industrial waste, agricultural runoff, and poor disposal of home chemicals pollute water bodies, rendering them unsafe for human consumption.

Waterborne diseases such as cholera, typhoid, and dysentery spread as a result of this contamination.

Furthermore, the presence of heavy metals and hazardous chemicals in drinking water causes long-term health problems such as organ damage, developmental disorders, and an increased chance of cancer.

Soil Pollution and Food Contamination

Soil pollution, which can lead to food contamination, is another way that environmental pollution affects human health.

Toxins accumulate in the soil as a result of the usage of chemical fertilizers, pesticides, and poor waste disposal practices.

These toxins are subsequently absorbed by plants, eventually entering the food chain and reaching humans via contaminated crops, meat, and dairy products.

Long-term exposure to contaminated food can result in a variety of health issues, including organ damage, hormonal imbalances, and an increased risk of cancer.

Impact on Mental Health

Environmental pollution has a substantial impact on mental health in addition to physical health. Air pollution has been related to an increased risk of mental diseases such as depression, anxiety, and cognitive loss in studies.

Continuous exposure to contaminated settings can result in chronic stress, poor cognitive function, and a lower quality of life.

Furthermore, pollution-induced degradation of natural landscapes and biodiversity loss can contribute to emotions of loneliness, unhappiness, and a lower sense of well-being.

Children and Vulnerable Populations

Children and vulnerable populations, such as the elderly and people with pre-existing health concerns, are more exposed to the negative impacts of pollution.

Their developing organs and weakened immune systems make infants more vulnerable to respiratory infections, allergies, and other pollution-related health problems.

Furthermore, environmental exposure during pregnancy might harm fetal development and raise the chance of birth abnormalities and developmental disorders.

Mitigation Measures

It is critical to establish effective mitigation measures to combat the negative impacts of environmental pollution on public health.

To reduce pollution and safeguard human health, governments, industries, and individuals must collaborate. Among the most important strategies are:

1. Encourage the use of renewable energy sources to reduce reliance on fossil fuels and reduce air pollution. 2. Improving industrial practices in order to reduce emissions and install more stringent pollution control measures. 3. Improving waste management systems to prevent dangerous compounds from being released into the environment. 4. Promoting environmentally friendly agricultural practices that reduce the usage of artificial fertilizers and pesticides. 5. Raising public knowledge about the effects of pollution on health and encouraging individuals to take action, such as lowering automobile emissions and saving water.

Pollution in the environment is a huge hazard to public health, affecting many elements of human well-being.

Air pollution, water pollution, soil pollution, and food contamination all lead to a variety of health issues, including respiratory diseases, waterborne illnesses, and mental disorders.

Children and vulnerable communities are especially vulnerable. To preserve public health, proactive steps to limit pollution and encourage sustainable practices are required.

We can create a healthier and more sustainable future for all by prioritizing environmental conservation and implementing cleaner technologies.

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Brown researcher awarded grant to evaluate the environmental impacts of wood pellet production

A team led by Professor Erica Walker has received federal funding to conduct the first air-quality and community noise assessment of Mississippi communities impacted by the production of wood pellets.

As the global demand for clean energy alternatives surges, the wood pellet industry, often touted as a sustainable fuel option, is projected to nearly double in size by 2026. 

In the United States, the industry’s growth is most pronounced in the rural South, where 91 wood pellet manufacturing plants are situated, constituting 75% of U.S. production . Mississippi alone is home to seven wood pellet plants, four fully operational and three soon to open (or in early development) that are anticipated to be the largest in the world.

But this growing industry is facing scrutiny over its environmental, health and social impacts; similar to fossil fuel refineries, wood pellet plants are more than twice as likely to be located in predominantly Black and poor communities.

Erica Walker, RGSS Assistant Professor of Epidemiology at the Brown University School of Public Health, and her team of researchers have received a $5.8 million grant from the National Institute of Environmental Health Sciences for their investigations into the emissions from wood pellet plants in Mississippi. This work represents the first study of wood pellet emissions on human health in the United States.

“It is fascinating–but not surprising–that predominantly Black and/or poor communities across Mississippi are being asked to undergird the shift to renewable and sustainable energy production,” Walker said. “When these large wood pellet companies move into these communities, they are bringing with them environmental externalities, which may negatively impact the towns and cities nearby. This award,” she said, “provides us with the opportunity to actually spell out what these environmental externalities are and to what extent they may negatively impact the health and well-being of the surrounding community.”

In collaboration with Dr. Krystal Martin from Greater Greener Gloster Project , Dr. Courtney Roper from the University of Mississippi, and Dr. Sharelle Barber from Drexel University, Walker is expanding her research into the emissions from the industry in the state of Mississippi—specifically noise, particulate matter, black carbon, ozone, nitrogen dioxide and volatile organic compounds (VOCS)—which potentially exceed the thresholds established by the Clean Air Act by up to five times .

Walker and her team have spent the last year enrolling families with children—collecting survey and biological information—with the aim of understanding how these emissions are impacting children across the life course. They are focused on the Mississippi town of Gloster , home to 897 people, of which 71% are Black and 38.6% live in poverty, with an annual median income of $22,131.

They point out that vulnerable populations and children in particular are impacted by air pollution emitted from wood pellet production. Proximity to these plants is associated with a statistically significant higher risk of hospitalization for respiratory illnesses and increased asthma-like symptoms in children.

“Mississippi's children rank 49th in overall child well-being according to a recent KidsCount report,” Walker said. “I am excited about being able to consider the exposome (air, noise, water, visual and soil) pollution and follow the health of these young children until adulthood.” 

Walker’s preliminary findings are the first air-quality and noise measurements taken in a Mississippi-based wood pellet-impacted community. She and her team measured their results against an air and noise pollution monitoring campaign in Mendenhall, Mississippi, a town with no current industrial activity. In Mendenhall , 34% of residents are Black, 35.8% live in poverty and residents have an annual median income of $35,956. 

“When comparing air and noise pollution concentrations in Gloster to those in Mendenhall,” the authors write in their first report, “air and noise pollutant concentrations in Gloster are magnitudes higher, even after adjusting for meteorological conditions.”

“ I was born and raised in extreme poverty in Mississippi. While my community didn't have a large wood pellet company, the soundtrack of my childhood included the incessant loud noise and vibrations from the freight trains that would haul Mississippi-made products to ports to ship throughout the world. Would I have made it to a physically and mentally healthy adulthood if these activities were right in my backyard? This funding will allow me to answer this question. ”

Over the next five years, and with the support of the NIH, the team will be launching a study quantifying the health impacts of wood pellet manufacturing in three types of communities: those with an operational wood pellet plant, those with a proposed wood pellet plant, and those with no wood pellet plants and no (or limited) industrial manufacturing.

They will be conducting a combined noise and air pollution assessment and will use these measurements to assess their impact on children’s respiratory health and stress.

They will also engage the community by providing research training for Mississippi-based high-school, community college, undergraduate and graduate students, as well as older adults – who will be using the environmental-literacy awareness tools and the app developed by Walker, NoiseScore .

“I was born and raised in extreme poverty in Mississippi. While my community didn't have a large wood pellet company, the soundtrack of my childhood included the incessant loud noise and vibrations from the freight trains that would haul Mississippi made products to ports to ship throughout the world,” Walker said. “Would I have made it to a physically and mentally healthy adulthood if these activities were right in my backyard? This funding will allow me to answer this question and provide insights into what is leading Mississippi to rank 49th in overall child well-being.”

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