Clearing the air over Europe, and elsewhere

Abstract

In Europe, 2013 was the “year of air”, and in late December the European Commission announced a new policy package aiming to clean up Europe's air—by 2030. If apparently unambitious in its timeframe, the policy seems sensible because of the extremely damaging effects of air pollution on health. Risks of respiratory and cardiovascular diseases, including lung cancer, are associated with air pollution, illnesses that are likely to be borne disproportionately by people of low socioeconomic status. These risks provide a strong incentive on their own for action to reduce disease, limit health-care costs, and improve working productivity; in addition, the policy cites damage to natural and built environments caused by air pollution. By 2030, the policy estimates that spending some €3·3 billion per year on pollution mitigation across Europe could yield much greater annual aggregate savings worth at least €40 billion. National emission ceilings have been proposed for sulphur dioxide, nitrogen oxides, methane, non-methane volatile organic compounds, ammonia, and particulate matter of diameter smaller than 2·5 μm (PM2·5), which become more stringent over the period 2020–30. For example, the 28 EU states each have specific targets to attain a reduction of anthropogenic sulphur dioxide emissions, from a 2005 base, with a mean fall of 59% for any year from 2020–29 and 81% for any year from 2030. However, the road to cleaner air in Europe is likely to be uneven. The financial costs of reducing air pollution could increase the prices of power in individual states and thereby constrain economic competitiveness, for instance; currently, no fewer than 17 countries in the bloc contravene air quality standards and are subject to legal action by the EU. The health hazards of airborne pollutants have recently been well illustrated by the ESCAPE study. Including data from 22 European countries, Rob Beelen and colleagues documented an association between mortality and average annual exposure to PM2·5 (hazard ratio 1·07 [95% CI 1·02–1·13] per 5 μg/m3). Such findings provide strong evidence for the benefits to health that could and should be achieved by a tightening of European air quality standards—the current community-wide annual mean limit for PM2·5 is 25 μg/m3, whereas WHO's 2005 air quality guidelines recommend a substantially lower limit of 10 μg/m3. Europe and its people are right to be concerned about the adverse effects of poor air quality on health, as are many others around the globe. In developing countries especially, air pollution presents a serious and immediate risk to health. To pick China as an example, the dizzying pace of industrialisation and economic transformation has been accompanied by severe and well-publicised air pollution in Beijing and other major cities. It has been estimated that outdoor air pollution leads to between 350 000 and 500 000 premature deaths in China each year. In a recent Lancet Comment, Zhu Chen and colleagues described China's efforts to curb air pollution, noting plans to achieve reductions in the 5 year period 2013–17, and that annual PM2·5 in Beijing, for example, should be “controlled” at 60 μg/m3 in 2017. Although efforts to combat air pollution in China are essential, these sobering numbers illustrate the growing threat of outdoor air pollution in developing economies, reflecting heavy use of fossil fuels by road traffic, for power generation, and in industry. The burden of lung and cardiovascular disease is, also, too greatly exacerbated in many countries by the use of tobacco and by indoor air pollution from cooking, among other sources. Europe's efforts to improve air quality are welcome, and will rightly receive detailed scrutiny over the long period during which the new regulations are to be enacted. In the UK, there are signs that the political environment is becoming less supportive to economic incentives underpinning the shift in power generation from fossil fuels to renewable alternatives. Such debates are unavoidable as countries balance the competing priorities of economic growth, industrial development, and individual health and wellbeing, which will be weighed differently in individual countries according to political priorities and their position along the development trajectory. As the world emerges from a painful period of economic contraction and uncertainty, it is important that gradually returning economic growth is harnessed to policies and incentives that lead to improvements in health, including tobacco control, limiting the damage caused by road traffic, and a sustained improvement in air quality in all countries, developed and developing.