Air pollution is the single largest environmental health risk in Europe and a major cause of premature death and disease. Latest estimates by the European Environment Agency (EEA) show that fine particulate matter (PM2.5) continues to cause the most substantial health impacts.

Most Europeans live in areas, especially cities, where air pollution can reach high levels. Both short- and long-term exposure to air pollution can lead to a wide range of diseases, including stroke, chronic obstructive pulmonary disease, trachea, bronchus and lung cancers, aggravated asthma and lower respiratory infections. The World Health Organization (WHO) provides evidence of links between exposure to air pollution and type 2 diabetes, obesity, systemic inflammation, Alzheimer’s disease and dementia. The International Agency for Research on Cancer has classified air pollution, in particular PM2.5, as a leading cause of cancer. A recent global review found that chronic exposure can affect every organ in the body, complicating and exacerbating existing health conditions.

Children and adolescents are particularly vulnerable because their bodies, organs and immune systems are still developing. Air pollution damages health during childhood and increases the risk of diseases later in life, yet children can do little to protect themselves or influence air quality policies.

Health impacts of air pollution

Note: Particulate matter with a diameter of 2.5 µm or less (PM2.5), particulate matter with a diameter of 10 µm or less (PM10), ozone (O3), nitrogen dioxide (NO2), benzo[a]pyrene (BaP) and sulphur dioxide (SO2).

Fine particulate matter (PM2.5) is the air pollutant driving the most significant health problems and premature mortality. In 2021, 97% of the urban population was exposed to concentrations of fine particulate matter above the health-based guideline level set by the World Health Organization.

238,000 premature deaths

due to fine particulate matter above WHO-guideline level

The EEA estimates that, in 2020, approximately 238,000 premature deaths were attributable to PM2.5 in the 27 EU Member States. In 2020, premature deaths attributed to exposure to fine particulate matter fell by 45% in the EU-27, compared to 2005.

Residential, commercial and institutional energy consumption was the principal source of particulate matter in 2020. The manufacturing and extractive industry was also a significant source, while agriculture was an equally important source of PM10. Between 2005 and 2020, emissions of particulate matter, PM10 and PM2.5, fell by 30% and 32%, respectively.

In 2021, the World Health Organization (WHO) published new air quality guidelines following a systematic review of the latest scientific evidence demonstrating how air pollution damages human health. The European Union (EU) has also set standards for key air pollutants in the ambient air quality directives. In the European Green Deal, the European Commission committed to further improving air quality and to aligning EU air quality standards more closely with the WHO recommendations. This commitment was echoed in the zero pollution action plan, which set a vision for 2050 to reduce air, water and soil pollution to levels no longer considered harmful to health and natural ecosystems. In addition, the zero pollution action plan introduced targets for 2030, two of which focus on air and aim to:

  • reduce the health impacts of air pollution (premature deaths) by more than 55%, compared to 2005;
  • reduce the share of EU ecosystems where air pollution threatens biodiversity by 25%, compared to 2005.

Stricter air quality standards would also contribute to the objectives of Europe’s Beating Cancer Plan. Air pollution is a known cause of cancer in Europe; in particular, lung cancer (EEA, 2022).

In terms of the past trend, from 2005 to 2020, premature deaths attributed to PM2.5 exposure in the EU-27 fell by 33% to reach 238,000. Should air quality continue to improve, and the number of premature deaths per year continue to fall at a comparable rate in the future, then the zero pollution target would be achieved by 2032, as shown in the figure below.

European Commission proposes new rules for cleaner air

In October 2022, the European Commission published a proposal for a revision of the Ambient Air Quality Directive. Key measures are listed below.

  • Stricter thresholds for pollution, more closely aligned with new limits set by the World Health Organization.
  • Enhancing the right to clean air, improved access to justice.
  • Current law does not include provisions for citizens to claim compensation for health damage due to air pollution. The new rules will bring more effective penalties and compensation possibilities for violating air quality rules.
  • Strengthened rules for air quality monitoring to support preventive action and targeted measures.
  • Requirements to improve air quality modelling, especially if and where air quality is poor.
  • Better public information.

The above measures are aligned with other legislative proposals, such as the revision of the Industrial Emissions Directive and recent proposals on the Euro 7 emission standards for road vehicles, which will support the achievement of stricter air quality standards.

Inequalities in exposure and vulnerability to air pollution in Europe

Air pollution affects people in different ways. Older people, children and those with pre-existing health conditions are more sensitive to the health impacts of air pollution. In addition, the most deprived people in society often have poorer health and less access to high-quality medical care, increasing their vulnerability.

There is strong evidence linking lower socio-economic status to increased exposure to air pollution. In large parts of Europe, poorer people are more likely to live next to busy roads or industrial areas and thus, face higher levels of exposure to air pollution. At the same time, exposure patterns vary across European cities. In some cities, wealthier people live in central, polluted areas, while in other European cities central areas are inhabited by poorer communities.

In Europe, regions characterised by lower GDP per capita are found to have higher levels of PM2.5 and tend to occur in Eastern and South-eastern Europe. This pattern is largely driven by the combustion of low-quality solid fuels (e.g. coal and wood) in low-efficiency ovens for domestic heating in those areas. The higher population exposure to PM2.5 in particular regions, translates into higher numbers of premature deaths attributed to air pollution.

Mapping mortality attributed to PM2.5 against regional wealth in Europe

Besides premature death, air pollution also causes morbidity. People live with diseases related to exposure to air pollution; this is a burden in terms of personal suffering as well as significant costs on the healthcare sector. In 2019, exposure to PM2.5 led to 175,702 years lived with disability (YLDs) due to chronic obstructive pulmonary disease in 30 European countries. At the same time, exposure to NO2 led to 175,070 YLDs due to diabetes mellitus (also known as Type 2 diabetes) in 31 European countries. That same year, 12,253 people across 23 European countries were admitted to the hospital with lower respiratory infections resulting from acute exposure to ozone.

The interactive map viewer shows the spatial distribution of population-weighted concentrations of PM2.5 (as an indication of population exposure) across Europe and the associated mortality. The viewer also allows to display data against GDP per capita as a proxy for the average socio-economic characteristics of the population in each region. The data is presented for NUTS3 regions (between 150,000 and 800,000 inhabitants).

Interactive map: Associations between exposure to PM2.5, mortality and GDP per capita

GDP per capita - Eurostat; Premature deaths, years of life lost and population-weighted concentrations are based on an EEA analysis of interpolated annual statistics of reported monitoring data from 2018 (see Map 9.1 in EEA, 2020) and the Geostat 2011 population grid data set.

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