Improved air quality could save 200,000 lives per year

By: Christer Ågren

A new health impact study by the Barcelona Institute for Global Health (ISGlobal) has estimated the mortality burden attributable to air pollution in more than 1,000 cities in 31 European countries (EU-28, Norway, Switzerland and Iceland).

The study, published in The Lancet Planetary Health, includes a ranking of the cities with the highest rates of mortality attributable to each of the two air pollutants studied: fine particulate matter (PM2.5) and nitrogen dioxide (NO₂).

The findings show that 51,000 and 900 premature deaths could be prevented each year, respectively, if all the cities analysed were to achieve the PM2.5 and NO₂ levels recommended by the World Health Organization (WHO).

However, if all of the cities were to match the air quality levels of the least polluted city on the list, even more deaths could be prevented. Specifically, the number of premature deaths that could be prevented each year by reducing PM2.5 and NO₂ concentrations to the lowest measured levels are 125,000 and 79,000, respectively.

When ranking the cities it was found that the top ten cities with the highest mortality burden due to PM2.5 were all in Italy, Poland or the Czech Republic (see Table).

  Particulate matter (PM2.5) Nitrogen dioxide (NO2)

Brescia (Italy)

Madrid (metropolitan area) (Spain)
2 Bergamo (Italy) Antwerp (Belgium)
3 Karviná (Czech Republic) Turin (Italy)
4 Vicenza (Italy) Paris (metropolitan area) (France)
5 Silesian Metropolis (Poland) Milan (metropolitan area) (Italy)
6 Ostrava (Czech Republic) Barcelona (metropolitan area) (Spain)
7 Jastrzębie-Zdrój (Poland) Mollet del Vallès (Spain)
8 Saronno (Italy) Brussels (Belgium)
9 Rybnik (Poland) Herne (Germany)
10 Havířov (Czech Republic) Argenteuil-Bezons (France)

“For PM2.5, the cities with the highest mortality burden were in Italy’s Po Valley, southern Poland and the eastern Czech Republic. This is because PM2.5 is emitted not only by motor vehicles but also by other sources of combustion, including industry, household heating, and the burning of coal and wood,” said researcher Sasha Khomenko, lead author of the study.

The highest rates of mortality attributable to NO₂, a toxic gas associated primarily with motor-vehicle traffic, were found in large cities in countries such as Spain, Belgium, Italy and France.

On the other hand, the top ten cities with the lowest mortality burden were all in Iceland, Norway, Sweden and Finland, with Tromso in Norway reporting the lowest mortality burden associated with NO₂, and Reykjavik in Iceland the lowest mortality burden associated with PM2.5.

“Our findings support the evidence suggesting that there is no safe exposure threshold below which air pollution is harmless to health. They also suggest that the European legislation currently in force does not do enough to protect people’s health. Therefore, the maximum NO₂ and PM2.5 levels allowed by law should be revised,” said Mark Nieuwenhuijsen, senior author of the study.

“We need an urgent change from private motorised traffic to public and active transportation and a reduction of emissions from industry, airports and ports,” Sasha Khomenko said to Agence France Presse, adding that a ban on domestic wood and coal burning would help heavily polluted cities in central Europe.


Christer Ågren


Source: ISGlobal press release, 19 January 2021.

The study: “Premature mortality due to air pollution in European cities: a health impact assessment”, by S. Khomenko et. al. The Lancet Planetary Health.

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