Move over tobacco, air pollution is the next major public health target

GENEVA (AN) — Tobacco's stigma has a new rival — air pollution — as the World Health Organization called attention to 7 million deaths a year that it said are the result of simply breathing.

As much as 91% of the world's population breathes unhealthy air, WHO said in explaining why it convened its first global conference on air pollution and health this week to find effective remedies. WHO's Director-General Tedros Adhanom Ghebreyesus called air pollution the "new tobacco," a reference to cancer-causing chemicals and other harmful effects on public health.

“The world has turned the corner on tobacco. Now it must do the same for the ‘new tobacco’ — the toxic air that billions breathe every day,” Ghebreyesus wrote in an op-ed article for The Guardian. “No one, rich or poor, can escape air pollution. It is a silent public health emergency.”

WHO's conference coincided with the European Environment Agency's new study showing air pollution led to more than half a million premature deaths across Europe in 2015, mainly from particulate matter or PM2.5. Tiny particles of solid and liquid droplets, measuring 2.5 microns across, are formed by fuel combustion and road traffic and easily inhaled, damaging lung tissue.

EEA said the study found gradual improvement in air quality across Europe — the number of premature deaths is about half the level it was in 1990 — but air pollution remains too high and "continues to exceed European Union and WHO limits and guidelines." The study provided a snapshot of 28 E.U. and 11 non-E.U. nations from 2000 to 2016.

An invisible killer

EEA's Executive Director Hans Bruyninckx called air pollution "an invisible killer" that will require greater effort to address the causes.

"In terms of air pollution, road transport emissions are often more harmful than those from other sources, as these happen at ground level and tend to occur in cities, close to people," he said. "That is why it is so important that Europe redoubles its efforts to reduce emissions caused by transport, energy and agriculture and invest in making them cleaner and more sustainable."

A third of the millions of deaths each year from stroke, lung cancer and heart disease are due to air pollution, according to WHO, the United Nations' health agency. That is equivalent to nearly 7 million deaths a year from tobacco — 6 million from direct tobacco use and 890,000 from non-smokers exposed to second-hand smoke.

Air pollution kills nearly triple the number of people whose cardiovascular-related deaths are blamed on the use of too much sodium, WHO said by comparison. An estimated 2.5 million deaths a year could be prevented if global salt consumption were cut to the recommended level.

WHO's three-day conference at its headquarters in Geneva was expected to draw 600 delegates. It called attention to the threats of dirty air, rising temperatures and growing populations. Half the population has no access to clean fuels or technologies as the world gets hotter and more crowded.

Air pollution kills 600,000 children a year

Air pollution exposure is linked to a wide range of poor health outcomes in children, including infant mortality, asthma, disorders in neurodevelopment and childhood cancers. WHO argues policy makers can protect children by "prescribing" clean air for them.

About 93% of the world's children under the age of 15 breathe dirty air that compromises their health and development, according to WHO.

Air pollution is said to cause more than half the deaths from acute lower respiratory infection in children less than five years old among lower middle income countries. In 2016, WHO said, it caused the deaths of an estimated 600,000 children from acute lower respiratory infections.

Poor ambient air quality in cities and households are a leading killer in rural and urban homes, WHO said, and such deaths disproportionately affect women, children, elderly and impoverished people.

In Manchester, England, for example, King’s College London said in June it estimated 1.6 million life years will be lost in Greater Manchester over the coming century due to poisonous air. "This is equivalent to each of us having our life expectancy reduced by six months," the IPPR think tank said.

Patchwork of agreements

Cutting back on toxic elements of air can reduce short-lived climate pollutants and carbon emissions, slowing climate change. Everything from agriculture to marine life to water supplies is affected. It can raise worker productivity and lower healthcare risks from noise, obesity and traffic accidents.

No single global treaty specifically covers air pollution. But U.N.-led global targets and regional treaties provide a patchwork of agreements. The 2015 Paris Agreement on climate change highlighted important “co-benefits for adaptation, health and sustainable development.”

The U.N.'s 17 Sustainable Development Goals for ending poverty, protecting the planet and promoting peace by 2030 include targets for reducing air pollution and the negative health impacts from household, urban, regional and other pollution sources that do not respect borders.

The U.N. Economic Commission for Europe, or UNECE, one of five regional U.N. commissions, has an air pollution treaty. The UNECE Convention on Long-range Transboundary Air Pollution, with 51 nations from three continents, took effect in 1983 with eight protocols to cut specific air pollutants.

A world of dirty air

Health concerns revolve around two main types of air pollution: outdoor and indoor. The latter results mainly from the use of open fires or basic stoves in poorly ventilated spaces.

Household air pollution kills 4 million people a year and tends to affect nations in Africa and Asia, where polluting fuels and technologies are used every day particularly at home for cooking, heating and lighting. Women and children, who spend more time indoors, tend to be the most affected.

The most worrisome air pollutant is PM, but others include nitrogen dioxide from road traffic or indoor gas cookers; sulphur dioxide from burning fossil fuels; and ground-level ozone caused by the reaction of sunlight with pollutants from vehicle emissions.

The problems are exacerbated in China and India, each home to more than 1.3 billion people, which together account for a third of the world's 7.6 billion population.

China, as the world's biggest producer and consumer of coal and a major factory producer, has some of the worst air pollution in the world. It also has many older cars on its roads. Some cities have tried switching power sources from coal to natural gas and using more electric taxis and buses.

China’s capital Beijing and much of industrial northern China have hundreds of millions of people that have experienced levels of air pollution more than 10 times above WHO's guidelines, where levels of PM2.5 are a regular concern for public health advocates.

Flights have been canceled at Beijing Capital International Airport and sections of the city's outermost highway have been shut down at times due to poor visibility. WHO's air pollution data in March pronounced India as host to the world’s 10 most polluted cities.

This month, authorities in the Indian capital region of New Delhi said air quality already was more than six times higher than WHO considers safe — and they were preparing for a major Hindu festival featuring massive fireworks that cause more toxic smog and dust.

Residents were advised to avoid jogging outdoors in the early morning and after sunset, and to wear masks as a precaution and keep medicine nearby if they suffer from asthma.

WHO's Ghebreyesus, a former Ethiopian minister and board chair of The Global Fund to Fight AIDS, Tuberculosis and Malaria, said air pollution does not have to be "an inevitable march toward disaster" despite the problem worsening in many parts of the world.

"No person, group, city, country or region can solve the problem alone," he said. "We need strong commitments and actions from everyone: government decision makers, community leaders, mayors, civil society, the private sector and even the individual."