Could air pollution be the other public health emergency?

June 25, 2021

Air pollution in Skopje, North Macedonia. Photo: UNDP / Sumaya Agha

It’s been more than a year since the pandemic was declared, and it’s  even more clear that many of the root causes of climate change also increase the risk of pandemics. Global warming, deforestation, ecosystems degradation and loss of critical habitats - to name a few amongst many. And there is no question that what we do today will determine how well we handle similar risks and shocks in the future.

And yet air pollution still remains one of the biggest challenges today.  

Europe and Central Asia is one of the most carbon intensive regions in the world, with 88 percent of its primary energy supply coming from fossil fuels, significantly contributing to air pollution. The main sources of air pollution arise from burning of fossil fuels in energy production, households, transport, and from industrial and agricultural activities. Although important steps have been made in the last three decades here in the region, with natural gas displacing coal, the direct impact of air pollution on human health is still a challenge that requires more attention.

In 2019 alone, 6.7 million deaths were associated with air pollution, ranking the problem itself as the  fourth leading risk factor for death and disability worldwide. WHO has already proven links between air pollution and diseases like asthma, cancer, pulmonary illnesses and heart problems. Recent studies also reveal links to diabetes, neurodevelopmental disorders, and preterm birth to low birth weight.

If we look at the regional figures, the picture is even more alarming.  

The following chart gives us a quick snapshot from the region through PM2.5 concentrations.  PM2.5 (particles less than 2.5 micrometers in diameter), is one of the main air pollutants posing the greatest health risk. These fine particles can damage the human respiratory system by penetrating deep into the lung and impairing lung function. This can leave the body and early immune response more vulnerable to various infections – such as Covid-19.

While lockdowns caused global air pollution declines in 2020, the annual mean concentration of PM2.5 still exceeded the WHO recommended value in all of the following capital cities in the region last year.

Data source: IQAir, 2020.

The years of potential life lost due to outdoor air pollution in Eastern Europe, Southeast Europe, the Caucasus and Central Asia, for instance, is 20 percent higher than in Western Europe.

In Tajikistan, for example, 80 percent of the population was exposed to the highest levels of PM2.5 concentrations in 2017, according to WHO thresholds.

In Skopje, North Macedonia, one of the most polluted cities in Europe, 2018 PM10 levels were  14 times higher than what health experts consider to be acceptable. 

In 2020, urban areas in Bosnia and Herzegovina, Serbia and Turkey commonly experienced two or more months during which average air quality was classified as unhealthy.

Recent studies link air pollution to the coronavirus disease.

Long-term exposure to air pollution can suppress early immune response to the infection and increase pre-existing conditions such as risk stroke, diabetes and hypertension, and many others. Initial studies have shown that air pollution can also catalyze the spread of the virus – small air particles, such as PM2.5 and PM10, could carry the virus on their surfaces, thus increasing exposure to the risk of infection particularly in high-population density areas.

Size of a coronavirus virion compared to the sizes of PM10 and PM2.5. Image:

WHO has confirmed the link between the underlaying impacts of air pollution and COVID-19, and experts from Harvard University have shown that an increase of only 1 microgram in PM2.5 is associated with an 11 percent increase in the COVID-19 death rate.

In Serbia, a UNDP study showed that short-term exposure to the main air pollutants is correlated with an increase in the number of COVID-19 cases.

Pollution doesn’t stop at the border

As the development community looks to integrated ways to recover from the pandemic, addressing the problem of air pollution should be front and center to “build back better” in recovery efforts.  

Air pollution is a transboundary environmental problem that requires multiple resources, partnerships, and diverse capacities to leverage the best practices. UNDP’s Istanbul Regional Hub’s new advocacy report “Tackling air pollution in Europe and Central Asia for improved health and a greener future” assesses the links between air pollution, climate and health, and explores holistic solutions with a set of policy interventions for major economic activities like industry, transport, health (health-care) waste, as well as domestic household activities such as heating and cooking.

Green transport: For example, growth in transport is a major contributor to air pollution in many countries of the region. Bishkek has 420,000 cars registered, whereas the city is designed for a maximum of 50,000 cars. The growing import of end-of-life vehicles also exacerbates existing air pollution issues, considering that many cars, especially older/used models, do not have catalytic converters and smog control equipment. It is critical to upgrade vehicle emission and fuel quality standards, develop retrofitting programmes for heavy-duty vehicles, and promote shared mobility as well as clean transport technologies like electric vehicles.

Photo: Agon Nimani/UNDP Kosovo

Efficient heating: There is little awareness of alternative and less polluting methods of domestic heating in the region, and many households lack proper insulation. Pollution from inefficient stoves could also impact women and children even more as Covid-related restrictions keep them indoors. It is essential to promote clean and efficient heating systems (compared with existing coal stoves), while implementing mandatory building codes for energy efficiency and energy saving and improving building insulation.

Cleaner waste: Despite progress with recycling in some countries, uncontrolled dumping and burning of solid waste are still an unfortunate reality. When waste is burned, the resulting toxins and particulate matters can cause respiratory and neurological diseases. Most waste generated in the region is disposed of in open dumps; where it releases methane emissions and leachates contaminate soil and ground water. Emissions from solid waste disposal are predicted to increase to 2.6 billion tonnes of CO2 equivalent by 2050. It is necesary to devise strategies on how to provide incentives for circular economies, develop integrated waste management strategies (with improvements in waste prevention, segregation, collection, recycling, treatment and disposal facilities) and ban open burning of accumulated waste.

The report also examines international and corporate frameworks (e.g. the EU Green Deal, Paris Agreement and UNDP’s Climate Promise, 2030 Agenda for Sustainable Development) and explores a set of interconnected policy interventions related to nature, climate, energy, and socio-economic themes with solutions to frame air pollution prevention as response to post-covid-19 recovery efforts.

Let’s not forget, the problem is all around us whether we realize it or not.

It might be difficult to visualize but air pollution threatens everyone, especially the most vulnerable. We must demonstrate the benefits of tackling air quality for economic development, justice and the climate-health nexus more clearly to increase funders and diversify partners. We should also promote research studies on air pollution’s financial impact, as it puts a significant economic burden on labour productivity, healthcare expenditures and agricultural crop yields. Demonstrating these costs helps influence governments, which can encourage them to redirect public finance to investments that could bring social, economic and environmental benefits for the whole society.  

As UNDP, we believe that clean air is a fundamental right, and everyone has the right to breathe. We will continue to identify solutions to achieve cleaner air, which will bring significant benefits to our health, environment and economy.

Read UNDP's new report:Tackling air pollution in Europe and Central Asia for improved health and a greener future

This is part of a series of articles on air pollution in Europe and Central Asia. Around the region, UNDP is working to tackle the problem of air pollution, from getting a sense of its breadth to finding the causes behind it to informing policy and encouraging greener development - so that everyone can breath cleaner air.