Air Pollution: Health Policy And Action

Air pollution is a major environmental health hazard, causing an estimated 6.5 million to 7 million deaths each year globally. It is a mix of hazardous substances from both human-made and natural sources, with outdoor air pollution causing 4.2 million premature deaths worldwide per year. This is due to exposure to fine particulate matter, which causes cardiovascular and respiratory disease, and cancers. As a result, health policies regarding air pollution are vital to protecting public health. The World Health Organization (WHO) is a leading advocate for policies and programmes to reduce ambient and household air pollution, and supports countries by providing evidence, building institutional capacity and leveraging the health argument to convene sectors to tackle air pollution. The American Lung Association also supports the formulation, execution and enforcement of health and environmental laws and policies to address these factors, and clean up contributing sources.

The health impact of air pollution

Air pollution is a mix of hazardous substances from both human-made and natural sources. It is a major threat to global health and prosperity. According to the World Health Organization (WHO), air pollution kills an estimated seven million people worldwide every year, with 9 out of 10 people breathing air containing high levels of pollutants. Outdoor air pollution in both cities and rural areas was estimated to cause 4.2 million premature deaths worldwide per year in 2019.

The main outdoor pollution sources include residential energy for cooking and heating, vehicles, power generation, agriculture/waste incineration, and industry. Practices such as redlining have contributed to disproportionate exposure to air pollution in economically disadvantaged communities of color. People of color are also more likely to be living with chronic conditions that make them more susceptible to the health impacts of air pollution.

Air pollution is a mix of contaminants in the atmosphere, such as dust, fumes, gas, mist, odor, smoke, or vapor, in quantities and durations that can be harmful to human health. The main pathway of exposure from air pollution is through the respiratory tract. Breathing in these pollutants leads to inflammation, oxidative stress, immunosuppression, and mutagenicity in cells throughout the body, impacting the lungs, heart, and brain, among other organs, and ultimately leading to disease. Fine particulate matter, such as PM2.5, is of particular concern as it can be inhaled deeply into the lungs and contribute to serious health problems, including systemic inflammation and carcinogenicity. Ozone, or smog, is also a powerful lung irritant, causing inflammation and damage to the small airways, impacting multiple body systems.

The health impacts of air pollution include respiratory diseases such as asthma, cardiac problems, strokes, heart diseases, lung cancer, and acute and chronic respiratory diseases. Air pollution is also associated with diabetes mellitus, obesity, and reproductive, neurological, and immune system disorders. Maternal exposure to air pollution is associated with adverse birth outcomes, such as low birth weight, pre-term birth, and small for gestational age births. A growing body of evidence also suggests that air pollution may affect neurological development in children.

Addressing air pollution is key to protecting public health. Policies and investments that support sustainable land use, cleaner household energy and transport, energy-efficient housing, and better waste management can effectively reduce key sources of ambient air pollution. The WHO supports countries in developing evidence-based policies and interventions to tackle air pollution and protect populations from its health risks.

Clean air legislation

Clean air is considered a basic human right by many health professionals. Air pollution is a major environmental health problem that affects people in low-, middle-, and high-income countries. It is the second-highest risk factor for noncommunicable diseases, causing an estimated seven million deaths worldwide every year. Outdoor air pollution alone caused 4.2 million premature deaths in 2019, with 68% of those deaths caused by ischaemic heart disease and stroke. Other causes include chronic obstructive pulmonary disease, acute lower respiratory infections, and lung cancers.

The World Health Organization (WHO) supports countries in protecting public health through evidence-based policies and actions. WHO provides technical support to its member states in the development of normative guidance, tools, and advice on health issues related to air pollution and its sources. WHO also promotes interventions and initiatives for healthy sectoral policies, addressing key risks to health from indoor and outdoor air pollution, and contributing to achieving health co-benefits from climate change mitigation policies.

In the United States, the Clean Air Act (CAA) is the primary law governing air pollution control activities. Passed in 1970 with strong bipartisan support, it was the first environmental law to give the federal government a serious regulatory role and established the architecture of the US air pollution control system. The Act defines the role of the US Environmental Protection Agency (EPA) and state, local, and tribal air programs in protecting and improving the nation's air quality and stratospheric ozone layer by regulating emissions from mobile and stationary sources. The EPA seeks to provide industry with flexibility in controlling emissions while maintaining accountability for achieving reductions. The Clean Air Act has achieved dramatic reductions in air pollution, with a 50% decline in emissions of key air pollutants since 1990. However, air pollution in the US continues to harm people's health and the environment.

The EPA has called for greater attention to environmental justice, defined 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." Low-income families and people of color are often underrepresented in pollution abatement programs and may face constraints in accessing cleaner environments or medical care.

To address air pollution, policies and investments supporting cleaner transport, energy-efficient homes, power generation, industry, and better municipal waste management are needed. These policies offer a "win-win" strategy for both climate and health, reducing the burden of disease from air pollution and contributing to climate change mitigation.

Environmental justice

In the United States, the Clean Air Act has led to substantial progress in reducing air pollutants. However, racial and socioeconomic inequities persist, with people of colour and low-income communities disproportionately impacted by air pollution. These communities often face economic constraints, preventing them from accessing cleaner environments and healthcare. Environmental justice seeks to address these disparities by advocating for fair treatment and meaningful involvement of all people, regardless of race, colour, national origin, or income, in the development and enforcement of environmental laws and policies.

The American Lung Association, through initiatives like "Stand Up For Clean Air," is actively working to bring health and environmental justice to the forefront of climate change conversations. They advocate for the formulation, execution, and enforcement of health and environmental laws that address the factors contributing to disproportionate exposure in vulnerable communities.

To achieve environmental justice, policies must be strengthened and enforced to reduce dangerous pollution for all communities. This includes supporting sustainable land use, cleaner energy sources, cleaner vehicles, energy-efficient housing, improved waste management, and addressing indoor air pollution.

Additionally, the health sector can play a crucial role in environmental justice by adopting climate-friendly policies and low-carbon development paths. Health professionals should help government officials and the public recognize the significant health benefits of clean air, which include reduced hospital visits and fewer missed days at work and school. By addressing air pollution, nations can protect public health and work towards a more equitable future.

Health sector leadership

Advocacy and Policy Development

Health sector leaders advocate for policies that protect public health from the detrimental effects of air pollution. This includes engaging with policymakers and providing scientific evidence to influence decision-making. For example, the World Health Organization (WHO) leads global efforts by offering guidance on air quality thresholds and limits to safeguard public health. Similarly, the American Lung Association advocates for science-based emission reduction requirements and legislative measures to mitigate climate change and protect vulnerable populations.

Collaboration and Multi-Sectoral Approach

Addressing air pollution requires collaboration between various sectors, including energy, transport, waste management, urban planning, and agriculture. Health sector leaders facilitate this collaboration by engaging with stakeholders from diverse disciplines and sectors. For instance, India's Health Ministry's Steering Committee on Air Pollution brought together experts from epidemiology, environment, energy, transport, public policy, and economics to develop health-focused strategies.

Education and Outreach

Health sector leaders play a crucial role in educating the public about the hazards of air pollution and promoting actions to reduce exposure. They collaborate with government officials, community organizations, and industry partners to raise awareness and provide information on the health benefits of clean air. This includes outreach to vulnerable populations, such as low-income communities and people with pre-existing health conditions, to ensure equitable access to information and resources.

Monitoring and Data Collection

Health sector leaders contribute to the development and implementation of innovative monitoring technologies to assess air quality and exposure levels. They collaborate with organizations like the Environmental Protection Agency (EPA) to validate these technologies, manage data, and provide health information to the public in a useful format. This real-time data helps individuals and communities understand their personal exposure levels and take appropriate actions to mitigate risks.

Capacity Building and Technical Support

Evidence-Based Decision-Making

Health sector leaders emphasize the importance of using scientific evidence and health data to drive policy development and interventions. This includes conducting research, analyzing health trends, and utilizing epidemiological evidence to inform decision-making. By grounding policies and strategies in robust scientific evidence, health sector leaders can ensure the effectiveness and sustainability of their efforts to mitigate air pollution's health impacts.

Air pollution monitoring

Air pollution is a major environmental health hazard that affects everyone, but certain groups are more vulnerable than others. It is responsible for an estimated 6.5 to 7 million deaths each year globally, with 4.2 million of those being premature deaths caused by exposure to fine particulate matter. The major outdoor pollution sources include residential energy for cooking and heating, vehicles, power generation, agriculture/waste incineration, and industry. Indoor sources include open fires or simple stoves for cooking fuelled by kerosene, biomass, coal, or animal dung.

To address this issue, the World Health Organization (WHO) has been working with countries to monitor air pollution and improve air quality. WHO supports countries by providing evidence, building institutional capacity, and leveraging the health argument to convene sectors to tackle air pollution. WHO also leads or participates in various intergovernmental partnerships and coalitions to ensure that public health impacts from air pollution are well-integrated into policies. For example, since 2013, WHO has collaborated with the Climate and Clean Air Coalition (CCAC) to support actions to reduce emissions of short-lived climate pollutants. Additionally, the WHO Air Quality and Health Unit works in three cross-cutting areas: knowledge, evidence, and measuring progress; interventions and initiatives for healthy sectoral policies; and providing technical support to member states.

The American Lung Association (ALA) also plays a significant role in advocating for healthy air policies. They support the development and implementation of adaptation action plans that identify health threats and outline evidence-based actions to protect health. ALA supports increasing air pollution monitoring near roadways, freight hubs, ports, and other high-emission areas. They also promote an integrated approach to address the underlying roots of disparities in exposures and negative health outcomes, prioritizing disproportionately burdened communities for investment and community-informed cleanup programs.

At the community level, collaborative research approaches such as community-engaged research and citizen science have been effective in addressing environmental health concerns. For instance, grant recipients have developed community-level tactics and public policies for reducing exposure to traffic-related air pollution, improving urban design with green spaces, and creating active travel options.

Overall, addressing air pollution requires concerted action by local, national, and regional policymakers and program planners working in sectors like energy, transport, waste management, urban planning, and agriculture. By implementing policies and investments that support cleaner energy sources, efficient waste management, sustainable land use, and improved indoor air quality, significant progress can be made in reducing air pollution and protecting public health.

Frequently asked questions