Perspectives | Health

The air is slowly but surely killing us

By - 20.01.2023

The dramatic medical consequences of polluted air in southeast Europe.

The data is unequivocal — the air we breathe makes our lives significantly shorter and of a poorer quality.

The single biggest environmental risk factor for human health globally but also in Europe is air pollution. It is estimated that ambient air pollution (that is, outdoor air pollution) caused 4.2 million premature deaths worldwide in 2016 alone. Around 91% of these premature deaths occurred in low-income and middle-income countries (also called developing nations).

Air pollution is a risk for all-cause mortality, as well as for specific diseases. According to data from the World Health Organization (WHO), illnesses associated with breathing polluted air include strokes, lung cancer and other types of cancer, ischemic heart disease, increased risk of adverse pregnancy outcomes in case of exposure of pregnant women (low-birth weight), diabetes and more.

Based on scientific data, pollutants with the most substantial evidence for public health concern include particulate matter (PM), carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2). Microparticles with a diameter of 2.5-10 micrometers penetrate deep into the lungs, enter the bloodstream and travel to organs causing systemic damage to tissues and cells and deposit themselves in blood vessels.

Speaking of the adverse effects on health, in order for the aforementioned diseases to occur, long-term — and even decades-long — exposure to polluted air is necessary. However, it is a well-known fact from various data available in the scientific literature that certain effects can be caused by short-term episodes of highly polluted air. The most notable such event was the 1952 Great Smog of London.

Exposure to high levels of particulate matter, for example, can lead to reduced lung function, respiratory infections and aggravated asthma from short-term exposure. It is estimated that in children, exposure to elevated levels of nitrogen dioxide, which originates from traffic combustion products, can also cause asthma, and not only worsen its symptoms.

Children are the most susceptible part of the population when it comes to the effects of polluted air, while other groups include the elderly and pregnant women. Genetic factors, pre-existing diseases, dietary, and sociodemographic factors also influence individual susceptibility to air pollution.

Breathing polluted air resulted in more than 56,000 deaths in Southeast Europe in 2019.

In southeast Europe, more than 95% of the population lives in areas where the average annual concentration of the smallest particles (the most harmful ones) exceeds the WHO recommended maximum of 5 μg/m3.

According to estimates by the Boston-based Health Effects Institute, every tenth death case in southeast European countries is linked to exposure to polluted air. Data from their studies shows that breathing polluted air resulted in more than 56,000 deaths in southeast Europe in 2019. Residents of these countries suffer a shortened life expectancy of one year or more due to exposure to air pollution alone. In addition, 68% of deaths linked to air pollution occur in people older than 70.

Out of the deaths caused by or linked to air pollution, it was established that:

-22.7% of all deaths resulted from chronic obstructive pulmonary disease, 

-18.7% from diabetes, 

-17% from lung cancer, 

-15.8% ischemic brain blood vessel disease (stroke), 

-14.8% from ischemic heart disease, 

-13.5% of deaths from lower respiratory tract infections, and 

-7.7% of neonatal deaths (newborns up to 28 days old).

According to estimates of a recent analysis titled “State of Global Air — special report on air quality and health in Serbia,” air pollution was the seventh leading cause of death in Serbia, resulting in 12,700 deaths across the country due to long-term exposure to polluted air.

Regardless of the fact that the Republic of Serbia has undergone a decrease in the average annual values for PM2.5 and ozone in the last 10 years, standardized mortality rates have increased significantly compared to the world’s average or the average of developed European countries (the impact of ozone excluded). 

The problem isn’t minimized by the fact that the situation is similar in all countries across southeast Europe, in fact, it’s exacerbated, since we disperse and send large amounts of pollution to each other because we share similar problems in the energy sector, including energy poverty, traffic pollution, waste management, etc.

As already mentioned, there are certain effects caused by short-term episodes of highly polluted air. Experts residing in the Republic of Serbia have also examined these effects and published several studies that analyze this phenomenon.

For example, data from the doctoral dissertation of Dr. Nataša Dragić from the Institute of Public Health of Vojvodina demonstrates that in the city of Novi Sad, during episodes of pollution caused by high values of PM2.5, the number of hospital admissions increases due to cardiovascular and cerebrovascular diseases in men over 65. 

For this reason, it is necessary to issue a timely warning alongside public health advice during periods of extreme pollution, especially for the sake of children, senior citizens, people suffering from chronic diseases and pregnant women.

In order to provide clean air region-wide, local, national and regional cooperation is necessary.

Activities designed to decrease the use of fossil fuels can lead to fresher air and better health of populations throughout the region. Access to clean energy remains a key point for this part of Europe. A major portion of the population in the region is not able to afford heating from clean energy or does not have access to centralized heating systems. Apart from that, the production of electricity relies on energy intensive and polluting lignite or gas-fired power plants.

Fossil fuel combustion in other sectors also contributes significantly to PM2.5 exposure, including, in particular, traffic and old diesel engines with high pollutant emissions.

Coal remains the primary source of energy across the region, including power generation and heating during the winter, which causes a relatively high burden of PM2.5-related diseases compared to other parts of Europe. In Serbia, for example, coal makes up almost a quarter (26%) of total PM2.5.

In order to provide clean air region-wide, local, national, and regional cooperation is necessary. The body of data published on air pollution and its effects on health is steadily growing. At this point, it is not only vital to expand and increase access to data about air quality and support the creation health-related evidence, but also to support interaction and collaboration between researchers, doctors and practitioners with the goal of having decision-makers focus on making informed steps and conducting activities that can decrease the level of air pollution.

At this link, you can access the repository of expert literature on the impact of polluted air on health in southeast Europe.

Feature image: Majlinda Hoxha / K2.0.

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