High health costs for air pollution in cities

By: Christer Ågren

A new study by CE Delft for the European Public Health Alliance (EPHA) has examined data from 432 cities in the EU, the UK, Norway and Switzerland covering a total population of 130 million people. The report quantifies the monetary value of premature deaths, medical treatments, lost working days and other health costs due to exposure to three health damaging air pollutants: particulate matter (PM), ozone (O₃) and nitrogen dioxide (NO₂).

Added together, air pollution costs for city residents amount to €166 billion per year, or €385 million per city on average. The larger the population affected by high pollution levels, the higher the number of people who lose working days and have a shorter life expectancy.

With its 8.8 million inhabitants, London has the highest social cost, amounting to €11.38 billion a year, well ahead of other European cities such as Bucharest (€6.35 bn), Berlin (€5.24 bn), Warsaw (€4.22 bn), Rome (€4.14 bn) and Paris (€3.6 bn).

When costs per capita are examined instead, Bucharest ranks first with €3,004 per year. Poorer cities tend to lose a higher share of income, especially in highly polluted and densely populated cities in central and eastern Europe, where wages are lower. In many cities in Bulgaria, Romania and Poland the health-related social costs are up to 8–10 per cent of income earned.

However, five of the top ten ranking cities with the highest per capita costs are in Italy. Citizens of Milan, Padua, Venice, Brescia and Turin face average financial impacts of between €2,843 and €2,076, according to the study. See table.

Particulate matter causes the vast majority of costs, 82.5 per cent on average, followed by NO₂ (15%) and ozone (2.5%), but these proportions vary considerably between cities.

Transport is a major source of urban air pollution, with an annual cost of €67–80 billion in the EU28 in 2016, according to a previous EPHA report. Emissions from diesel vehicles were estimated to be responsible for more than four-fifths of these costs.

This new study shows that even small changes to transport habits and city policies can make a substantial difference to such costs. A one-per-cent increase in the average journey time to work increases the costs of PM10 emissions by 0.29 per cent and those of NO₂ emissions by 0.54 per cent, the study found. And a one per cent increase in the number of cars in a city increases overall costs by almost 0.5 per cent.

EPHA Acting Secretary General Sascha Marschang said: “Our study reveals the magnitude of the damage toxic air is causing to people’s health and the huge health inequalities that exist between and within countries in Europe. To a large extent, the situation can be influenced by transport policies and cities can reduce costs by switching to zero-emission urban mobility. Governments and the European Union should bear these costs in mind for transport policy in order to support, not to hinder, a healthy recovery from the COVID-19 pandemic.”

CE Delft researchers used the latest complete data from Eurostat and official monitoring stations, from 2018, to calculate the harm caused and the resulting costs. It should be noted that indoor air pollution, a significant cause of illness, was not included in the study.

Air pollution is the number one cause of premature deaths from environmental factors in Europe, according to the European Environment Agency (EEA). The problem is greatest in cities, where about three-quarters of EU citizens live. According to the 2019 EEA assessment of air quality in Europe, excess levels of PM2.5 caused more than 400,000 early deaths annually, followed by NO₂ (71,000) and ozone (15,000) in 2016.

Christer Ågren

Source: EPHA press release, 21 October 2020.

More information, including a full list of cities analysed, and a link to the report “Health costs of air pollution in European cities and the linkage with transport” is available at: https://cleanair4health.eu

In this issue


The clock is ticking to achieve the 1.5°C goal of the Paris Agreement. To be clear right from the start: this goal deserves every effort that mankind can pull off. In the name of realism, this is the goal we must focus on now, given the current level of progress in reducing greenhouse gases. However, damage to marine ecosystems will not be avoided even if we reach this goal1. In fact, damage already occurs at current levels of warming, as evidenced by the bleaching of coral reefs2. This may be an inconvenient truth when our current goal is 1.5°C.

Read more