When the World Health Organization (WHO) released its new Global Air Quality guidelines earlier this month for the first time since 2005, it cited an overwhelming body of evidence showing how air pollution severely impacts health at even lower concentrations than previously understood. And while concentrations still largely exceed levels published by the WHO in 2005 for several pollutants in many areas around the world, the organization has now set more aggressive targets along with a phased approach in the hopes it can encourage countries to redouble their efforts to abate air pollution for protecting public health.

The price of inaction is clear: The burden of disease from both ambient and household air pollution exposure continues to grow. Children’s health is largely impaired by reduced long growth and function, respiratory infections and aggravated asthma resulting from breathing poor air quality. In adults, major causes of premature death attributable to air pollution are heart disease and stroke, and there is emerging evidence of diabetes and neurodegenerative conditions, among other effects.  Every year, exposure to air pollution causes some 7 million premature deaths and results in the loss of millions more healthy years of life.

In a recent conversation, Dr. Maria Neira, the WHO’s Director of Public Health, Environment and Social Determinants, suggested that policymakers examine what they will gain from implementing stricter air quality standards, in addition to the consequences of inaction.

Dr. Maria Neira, World Health Organization


Health benefits of taking action

Dr. Neira argues that we should reframe our approach to focus on the multiple benefits of reducing pollution. “If the world stops burning fossil fuels, we will see an incredible benefit to public health,” Dr. Neira said. Not only could we prevent a significant percentage of chronic diseases, she says, “You could have more walking in the city. You could have more physical activity. You could take back your city.”

Dr. Neira, who wanted to be a physician since she was a child growing up in Spain, began her career as an endocrinologist, providing her a fist-hand look at the body’s feedback to endocrine disruptors like air pollution emissions. She later served as the medical director for Médecins Sans Frontières (Doctors without Borders) in refugee camps in El Salvador and Honduras. That experience prompted her to work in public health. “I couldn’t accept the fact that I was treating patients and then sending them back into conditions that were causing diseases,” she says. “I realized I could make a bigger impact if I worked on sanitation problems or children breathing poor air.”

Slowing climate change, benefitting public health

Now, charged with the leading of the WHO prevention arm, Dr. Neira examines the multitude of factors that can influence health, including diet and the environment.  She hopes that in addition to adopting stricter air quality standards, countries will begin to look more closely at the health benefits associated with combating climate change. She argues that the cost savings in health—from the reduction in chronic diseases to increased productivity—would outweigh the investments needed to end our dependence on fossil fuels. Showing that kind of positive outcome in a similar way that current models illustrate economic benefits, would be “the indicator we would dream about.”

While climate change and air pollution impact vulnerable populations more acutely, Dr. Neira notes that dirty air and its impacts are harmful across all sectors of society. “In Europe we have 400,000 deaths every year due to air pollution.” When you add the cost of related hospital visits and the loss of work days, the impacts represent an overall cost to society, she says. Cities known for higher levels of air pollution may even find themselves less attractive to businesses, if they cannot lure top talent to live with their families, she says, citing Shanghai as a prime example.

Following positive examples

cyclists travel in special traffic lane
Social distancing requirements for COVID-19 brought many cities like Bogota, Columbia to expand bicycling infrastructure.

Countries like Canada and those in Scandinavia are trending in the right direction because their clean air and climate policies, Dr. Neira says. She also noted that mayors with the political will to transform their cities with low emission, sustainable interventions are seeing positive results. Bogota, Colombia, and Bilbao, Spain, are examples of industrialized cities that are now becoming “a pleasure to see.” However, “national politicians need to go farther.”

Need for additional research

While the WHO cited a wealth of research in its decision to lower emissions standards, Dr. Neira says scientists still have plenty of areas for future study. “I think most of the research now needs to go to interventions,” she says. “And whether we can prove those interventions are impactful or not.” Measuring health gains from changing traffic patterns or agricultural practices could help determine which interventions countries adopt. Researchers should examine whether interventions are cost-effective, how soon their impacts can be measured and how beneficial they are to both the environment and human health. “We have to prioritize those that have the biggest public health impact in the shortest possible period of time,” she concluded.