Health impacts of air pollution

During 2005–2021, air pollution in North Macedonia decreased, mainly due to the reduced use of fossil fuels for electrical energy production, the gasification of heating plants and certain improvements of domestic heating supported by governmental subsidies. However, the country is still exposed to particulate matter concentrations that exceed the annual limit values of the EU and especially those of the World Health Organization. According to European Environment Agency data, in 2005–2022 in North Macedonia, the number of premature deaths attributable to exposure to concentrations of particulate matter with a diameter of 2.5 μm or less (PM_2.5) that exceeded the World Health Organization’s annual limit decreased by nearly 43% (see graph). According to national estimations, in 2019–2021, 4 175 deaths were attributed to exposure to PM_2.5, which is 17.0% of the total all-cause mortality (for those aged 30 or over) in the country. The estimated attributable mortality rate is 348.4 per 100 000 inhabitants, which is a significantly higher rate than that in the previous three-year period (2018–2020: 319.4 per 100 000 inhabitants). This can be explained by the high level of excess mortality in the country during the COVID-19 pandemic.