Air pollution, a health emergency without safety thresholds
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There are no thresholds below which air pollution does not pose health risks. At the same time, reducing the level of pollutants leads to a rapid improvement in the health status of the population. Air pollution remains a health emergency in the world, in Europe and in Italy. This is confirmed by data from the European Environment Agency. And this is recalled by ISDE, the association of doctors for the environment, which in Italy has recently published its new “Position Paper on air pollution”, edited by Dr. Paolo Bortolotti, member of the ISDE Italy Executive Board, with the contribution of numerous experts and researchers (1).
Air Pollution and Premature Deaths
Air pollution is the main environmental risk to public health in Europe and Italy. According to the World Health Organization (WHO), every year in the world about 8,1 million people die prematurely due to polluted air. Europeans are also exposed to concentrations of pollutants higher than those recommended by the World Health Organization and will have to wait until January 1, 2030 for the entry into force of the new European Directive on air quality, which revises downwards the limits set for pollutants.
According to the European Environment Agency, in the EU almost 240 thousand deaths per year can be attributed to exposure to fine particulate matter PM 2,5. For Italy, Deaths attributable to PM 2,5 are estimated at over 48 thousand, in practice a fifth of the 239 thousand victims estimated in the EU-27, while 9.620 are the deaths attributable to nitrogen dioxide and 13.640 are those attributable to ozone pollution.
"The environment we live in plays a crucial role in determining our health and that of our communities. According to an analysis conducted by the World Health Organization (WHO), 23% of deaths worldwide — and a whopping 26% among children under five — can be traced back to modifiable environmental factors. The State of Global Air (SoGA) report, for example, highlighted that in 2021, air pollution caused approximately 8,1 million deaths globally. In addition to these tragic statistics, millions of people live with debilitating chronic diseases every day, placing a significant burden on healthcare systems and economies across countries.” (Introduction to the ISDE dossier by Roberto Romizi, President of ISDE Italy).
The effects on human health
The pathological clinical conditions associated with air pollution are not only respiratory diseases. There are many others, including cardiovascular, cerebrovascular, neurodegenerative diseases, diabetes, high blood pressure, premature births, low birth weight.
The ISDE dossier remember that the impact on human health is always there, even at low thresholds.
"Mounting evidence show a causal relationship between exposure to air pollution and acute lower respiratory tract infections, chronic obstructive pulmonary disease, asthma and lung cancer. Both short- and long-term exposure to air pollution has a serious impact on respiratory health. Harmful effects occur even at very low levels of pollutant concentrations and there are no detectable thresholds below which exposure can be considered safe for the entire population”. (ISDE Position Paper)
If air pollution gets worse the health status of the population, the impact is resolved in a wide-ranging action. It not only affects the frail but also worsens the health status of those who are less frail, with the result that the "pool" of frail people is never exhausted. One of the essays hosted in the Position Paper highlights that there is no "threshold effect" below which one can be safe.
"An evaluation subsequent to the studies we have cited, estimated that every 10 ug/m3 more of long-term exposure to PM2.5 produces an increase in the risk, i.e. the probability of death from “natural” causes, i.e. non-violent causes, of 8% (EEA, 2023). Let us remember that the link between the concentration of fine particulate matter and “natural” mortality is linear, i.e. there is a direct proportionality between the two, and that for PM2.5 there is no no-effect threshold".
Studies Program which used mathematical models to investigate the causal link between a reduction in exposure levels to air pollution and health effects.
It turns out that "deaths attributable to particulate matter decrease within a few years of a reduction in exposure; this also applies to diseases such as lung cancer: the decrease in PM2.5 concentrations leads to a decrease in the risk of mortality from lung cancer already 3 years after the moment in which pollution has decreased; for total mortality the decrease is even more sudden".
All this provides important information on environmental policies to be undertaken because "measures to reduce pollution levels can have almost immediate benefits on the health of the population".
Towards Cartagena
The first WHO World Conference on air pollution and health took place in Geneva in 2018. The second will take place in Cartagena from 25 to 27 March 2025 (2).
On the topic “accelerating action for clean air, clean energy access and climate change mitigation”, the Conference aims to highlight multi-sectoral solutions for “prevent communicable and non-communicable diseases, save lives, protect children's health and limit climate change worldwide".
Numerous objectives that the WHO gives itself:
- share the latest evidence on the health risks from air pollution,
- take stock of the progress made since the launch of the UN Sustainable Development Goals,
- highlight the health and climate benefits of tackling air pollution,
- leverage climate and development finance to tackle air pollution and
- ensure a just energy transition.
- E”mobilize, enhance and empower health professionals to “prescribe” clean air for health”.
Sabrina Bergamini
Note
(1) ISDE Italia: Air pollution is a health emergency. Urgent measures are needed to protect public health. Our position paper has been published. ISDE News. 3.2.25 https://tinyurl.com/23737nwa
(2) Second Global Conference on Air Pollution and Health. World Health Organization https://tinyurl.com/mtbc8mt2
