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According to the latest European Environment Agency (EEA) air quality health assessment, 253,000 deaths could have been avoided in the EU if the fine particulate matter concentrations had met WHO recommendations.

Air pollution levels are still too high across Europe

Air pollution is posing a significant threat to our health.

According to the latest European Environment Agency (EEA) air quality health assessment, 253,000 deaths could have been avoided in the EU if the fine particulate matter (PM2.5) concentrations had met WHO recommendations. 

Exposure to air pollution causes or aggravates certain diseases like lung cancer, heart disease, asthma, and diabetes, according to new estimates of health impacts.

Further measures to reduce air pollution to WHO guideline levels would prevent these 253,000 attributable deaths. It would also decrease the number of individuals suffering from chronic health issues caused by air pollution, including diseases like diabetes and asthma. 

The EEA briefing presents the latest information, estimated for the year 2021, of the harm to human health caused by three key air pollutants: fine particulate matter, nitrogen dioxide, and ozone.

Attributable deaths remain too high

Between 2005 and 2021, the number of deaths in the EU attributable to fine particulate matter, one of the most damaging air pollutants, fell by 41 per cent. 

Still, air pollution continues to be the top environmental health risk to Europeans, causing chronic illness and attributable deaths, especially in cities and urban areas.

According to the latest EEA estimates, at least 253,000 deaths in the EU in 2021 were attributable to exposure to PM2.5 pollution above the WHO recommended concentration. Nitrogen dioxide (NO2) pollution above the WHO recommended concentration led to 52,000 deaths. 

Both PM2.5 and NO2 estimations consider long-term exposure. Short-term exposure to ozone (daily) led to 22,000 attributable deaths in the EU.

Air pollution also causes ill health and adds significant costs to health care systems. These WHO recommended concentrations are set based on the level of pollution above which there is strong evidence of associated health effects.

In Norway, it was estimated that 293 and 87 deaths were attributed to long-term exposure to PM2.5 and NO2, respectively. Short-term exposure to ozone is responsible for 79 deaths.

The assessment is done for individual pollutants to avoid larger uncertainties in the estimations, in particular double counting.

The figure shows years of life lost per 100,000 inhabitants (YLL rate) due to long-term exposure to PM2.5 concentration levels in 2021 across Europe.

Health impacts of key air pollutants on disease

This year's assessment includes a new element: Measuring the health burden related to specific diseases that are aggravated or cause by air pollution. 

The total health burden associated with each of these diseases depends not only on the attributable deaths linked to the disease, but also on the health burden of living with the effects of the disease on a daily basis.

For some diseases, such as ischemic heart disease and cancer, the majority of the health burden is linked to mortality. However, there is also a significant health burden associated with living with the debilitating health effects of diseases such as diabetes and asthma, typically over many years or decades. 

Therefore, when we consider the health effects of air pollution, it is important to look beyond just the number of attributable deaths. We should also consider the long-term impacts these diseases, like asthma, have on the daily quality of life of European citizens.

PM2.5 exposure-related illnesses:

  • Ischemic heart disease: 87,893 attributable deaths
  • Stroke: 64,171 attributable deaths
  • Diabetes mellitus: 42,671 attributable deaths
  • Chronic obstructive pulmonary disease: 19,233 attributable deaths
  • Lung cancer: 18,334 attributable deaths
  • Asthma: Less than 10  attributable deaths

NO2 exposure-related illnesses:

  • Diabetes mellitus: 18,227 attributable deaths
  • Stroke: 17,937 attributable deaths
  • Asthma: 788 attributable deaths

ETC HE and NILU's role

The EEA briefing is largely supported by the work done by the ETC HE published as an Eionet Report. NILU, the German Environment Agency/Umweltbundesamt (UBA), the Czech Hydrometeorological Institute (CHMI) and EEA are authoring this important assessment of the burden of disease of air pollution.

NILU is responsible for collecting the all-cause mortality estimations done by the EEA and summarising the results. UBA has estimated the cause-specific mortality and morbidity for estimating the burden of disease associated with air pollution, and CHMI produces the air quality maps used for the estimations.

The EEA briefing’s findings were presented at the 4th Clean Air Forum 2023 in Rotterdam. Together with the briefing, the EEA also published country fact sheets where detailed burden of disease information at country level can be found. There is also a Norwegian fact sheet.

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