WHO:Clean air for health

This text is taken from the WHO report "Health and Environment in Europe: Progress Assessment", 2010, ISBN 978 92 890 4198 0. [1]

Regional priority goal III: We aim to prevent and reduce respiratory disease due to outdoor and indoor air pollution, thereby contributing to a reduction in the frequency of asthmatic attacks, in order to ensure that children can live in an environment with clean air.

Key messages

• The incidence of infant deaths from respiratory disease has been falling in most countries but is still significant (12% of infant deaths overall), particularly in the eastern part of the Region. Asthma and allergies are important and increasing causes of childhood illness.
• Air pollution, especially particulate matter, causes significant health problems throughout the Region, reducing life expectancy in more polluted areas by over one year.
• After substantial decreases in outdoor air pollution in most of the Region in the 1990s, progress in the last decade has been minimal.
• WHO guidelines and EU legislation form the basis for national policies on healthy air throughout Europe. They also drive new policy development, such as that related to second-hand tobacco smoke.
• Damp and mould are now established as major indoor air quality problems which disproportionately affect the health of disadvantaged populations. Although approaches to reduce and eliminate damp and mould from buildings exist, relevant public policies need to be strengthened.
• Even though regulations introducing spaces free of tobacco smoke have proved highly efficient in reducing the health impacts of tobacco, they have yet to be introduced or developed in large parts of the Region.

Clean air and its public health significance – new insights

Knowledge about the links between health and air quality has significantly advanced in the last two decades. There is more evidence about the role of pollutants in the aetiology of respiratory diseases and new insights have been gained into the impacts of fine particulate matter on cardiovascular health. Hundreds of studies throughout the world confirm the association of mortality, or hospital admissions, with levels of the most common urban air pollutants. The results of this research, combined with data on air quality in Europe, indicate that the pollution of air with fine particulate matter leads to a nine-month shortening of life expectancy in Europe. New studies among children indicate that exposure not only increases the prevalence of respiratory symptoms but also raises the incidence of new respiratory diseases. New studies also indicate substantial gains in public health resulting from improvements in air quality, for example, the attribution of 15% of the overall increase in life expectancy to the reduction of fine particulate matter in the United States (2). This evidence has been reviewed and summarized by WHO in the updated Air quality guidelines, and is being used to design new approaches and regulations to reduce the health risks of pollution.

New evidence is also accumulating on the burden of disease due to indoor air pollution. The risks to health of exposure to second-hand tobacco smoke have been widely recognized and are reflected by widespread programmes to eliminate tobacco smoke from indoor spaces. Other hazards common in indoor air, such as biological contaminants arising from damp and mould, have been well characterized by the newly published WHO Guidelines for indoor air quality – dampness and mould. An understanding of these links is an essential element of action to reduce the burden of disease and to benefit public health.

Considering this new research information, this chapter reviews the background patterns of diseases affected by common air pollutants, presents the distribution and trends in exposure in European populations, and characterizes the inherent risks and the opportunities for their reduction.

The burden of respiratory disease

The rates of infant death from respiratory disease have fallen in all sub-regions and in nearly all countries since the mid- to late-1990s. Present rates still, however, account for over 12% of total infant deaths, a substantial burden.