Abstract
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review.
Highlights
Despite efforts to control and reduce air pollution in many countries, ambient air pollution in both urban and rural areas was estimated to have been associated with up to 3.7 million premature deaths worldwide in 2012, with a significant proportion of these deaths in Asia [1]
This review aimed to examine health equity associated with air pollution control strategies, to provide scientific suggestions for further studies on air pollution control strategies, and importantly, to provide evidence on the effectiveness of air pollution control strategies in Europe, which may be transferable to Asian countries where air pollution is posing a very significant public health challenge
In most of the articles, the target pollutants were particulate matter (PM10, PM2.5 ), followed by NOx, SO2 and ozone, and the pollutant concentrations were assessed by real-time monitoring, model simulation or were set as targeted concentrations according to guidelines or seniors
Summary
Despite efforts to control and reduce air pollution in many countries, ambient (outdoor) air pollution in both urban and rural areas was estimated to have been associated with up to 3.7 million premature deaths worldwide in 2012, with a significant proportion of these deaths in Asia (mainly inChina and India) [1]. Air pollution has been associated with multiple diseases, such as cardiovascular diseases, asthma exacerbations, lung cancer, and diminished life expectancy [2–6]. These negative health impacts varied according to the socioeconomic position (SEP) and health condition of individuals [1]. Research findings showed that people with disadvantaged social-economic status were more likely to be exposed to higher air pollutant concentrations in ambient environments, at home, in school, in occupational environments, in the neighbourhood, and in commuting [7–13]. Epidemiological studies showed that specific population groups, such as the elderly, young children and people with pre-existing respiratory or cardiovascular conditions, are more likely to be affected by air pollutants, indicating that air pollution could increase health inequity [11,14,15]. Works Regulation Act (1906) and the Clean Air Act (1956) following the “Great London
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