European cities could avoid an extra 114,000 premature deaths every year by meeting the new WHO air quality guidelines
An update of the ISGlobal Ranking of Cities shows that the new air pollution recommendations could save up to 58,000 additional deaths for PM2.5 and 56,000 for NO2 compared to the previous recommendations
IMAGE: AIR POLLUTION MAXIMUM LEVELS view more
CREDIT: BARCELONA INSTITUTE FOR GLOBAL HEALTH (ISGLOBAL)
Barcelona, November 10, 2021-. A health impact assessment from the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, has concluded that European cities could avoid an extra 114,000 premature deaths every year if they met the new air quality guidelines presented by the World Health Organization (WHO) in September 2021 compared to the previous guidelines.
These estimates are an update of a study originally published in January 2021 in The Lancet Planetary Health, in which ISGlobal researchers showed that European cities could avoid up to 51,000 premature deaths per year by meeting WHO’s previous air quality guidelines, which had been in place since 2005. After the publication of the new guidelines, the research team performed a new assessment of the mortality burden attributable to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in the same 1,000 European cities included in the original study. The overall results have been published in a letter in The Lancet Planetary Health, while the specific results for each city have been published on the ISGlobal Ranking of Cities website.
The updated results show that achieving the new air quality guidelines for PM2.5 would result in a 113% increase in the number of deaths that could be avoided in European cities compared to the previous air quality guidelines from 2005, avoiding 109,188 premature deaths each year. For NO2, achieving the new recommended levels could prevent up to 57,030 premature deaths, 56,130 more than the 900 avoidable deaths estimated for the former NO2, recommended levels.
Going further, meeting the lowest levels of PM2.5 and NO2 observed in any city, could prevent 125,000 and 79,000 annual premature deaths, respectively.
Avoidable deaths in European cities | ||
| PM2.5 | NO2 |
2005 WHO guidelines | 51,213 | 900 |
2021 WHO guidelines | 109,188 | 57,030 |
“Even though there is no safe exposure threshold below which air pollution becomes innocuous, these new results show how the new WHO global air quality guidelines offer a much better framework for protecting human health and prevent a large number of deaths”, says ISGlobal researcher Sasha Khomenko, first author of the study.
The new data show that the number of avoidable deaths is much higher if the new WHO reference levels are adopted as targets. This effect is much more noticeable in the case of NO2. Among the cities with the highest mortality attributable to this pollutant, Madrid would go from avoiding 206 annual deaths if the old WHO recommendations were met to avoiding 1,966 using the new targets. Antwerp would go from 22 avoidable annual deaths to 254; Turin from 34 to 562; Paris from 185 to 2,135; Milan from 103 to 1,864 and Barcelona from 82 to 1,554.
Nearly 100% of the population above recommended levels
One statistic that shows how far European cities have to go to achieve clean air is the percentage of the population living in areas with concentrations of air pollutants higher than those recommended by the WHO. While under the previous WHO recommendations this percentage was 84% for PM2.5 and 9% for NO2, under the new recommendations these figures rise to 99.8% and 99.7% of the urban population, respectively. It should be noted, however, that the study was based on air pollution data for 2015.
“Since the current levels of air pollution in European cities are putting more than 100,000 lives at stake every year, the EU should align its legislation to match the WHO recommendations”, says Mark Nieuwenhuijsen, senior author of the study and Director of the Urban Planning, Environment and Health Initiative at ISGlobal. “In turn, local, regional and national governments should set the reduction of air pollution as a priority. We urgently need to reduce fossil fuel use, remove private cars and add more green spaces in our cities. This will not only reduce air pollution, but also contribute to climate action, which is one of our highest priorities for humankind”, he adds.
Current European directives stipulate an upper limit of 25 µg/m3 for annual mean PM2.5 and 40 µg/m3 for annual mean NO2.
Air Pollution Maximum Levels (annual mean) | |||
| New 2021 WHO Guidelines | 2005 WHO Guidelines | EU directives |
PM2.5 | 5 µg/m3 | 10 µg/m3 | 25 µg/m3 |
NO2 | 10 µg/m3 | 40 µg/m3 | 40 µg/m3 |
Full data on www.isglobalranking.org
From November 11, 2021, updated avoidable mortality data using the new WHO recommendations for the 1,000 cities included in the study will be available at www.isglobalranking.org, where the recently published ranking of mortality associated with lack of access to green space is also available.
The update of the WHO's air quality recommendations has not changed the position of the cities within the rankings of mortality associated with excess air pollution.
CAPTION
European Cities with the Highest Mortality Due to Air Pollution
CREDIT
Barcelona Institute for Global Health (ISGlobal)
Top 10 cities with the highest mortality burden
The ten cities with the highest mortality burden due to PM2.5:
- Brescia (Italy)
- Bergamo (Italy)
- Karviná (Czech Republic)
- Vicenza (Italy)
- Silesian Metropolis (Poland)
- Ostrava (Czech Republic)
- Jastrzębie-Zdrój (Poland)
- Saronno (Italy)
- Rybnik (Poland)
- Havířov (Czech Republic)
The ten cities with the highest mortality burden due to NO2:
- Madrid (metropolitan area) (Spain)
- Antwerp (Belgium)
- Turin (Italy)
- Paris (metropolitan area) (France)
- Milan (metropolitan area) (Italy)
- Barcelona (metropolitan area) (Spain)
- Mollet del Vallès (Spain)
- Brussels (Belgium)
- Herne (Germany)
- Argenteuil-Bezons (France)
CAPTION
European Cities with the Lowest Mortality Due to Air Pollution
CREDIT
Barcelona Institute for Global Health (ISGlobal)
Top 10 cities with the lowest mortality burden
The ten cities with the lowest mortality burden attributable to PM2.5:
- Reykjavík (Iceland)
- Tromsø (Norway)
- Umeå (Sweden)
- Oulu (Finland)
- Jyväskylä (Finland)
- Uppsala (Sweden)
- Trondheim (Norway)
- Lahti (Finland)
- Örebro (Sweden)
- Tampere (Finland)
The ten cities with the lowest mortality burden attributable to NO2:
- Tromso (Norway)
- Umeå (Sweden)
- Oulu (Finland)
- Kristiansand (Norway)
- Pula (Croatia)
- Linköping (Sweden)
- Galway (Ireland)
- Jönköping (Sweden)
- Alytus (Lithuania)
- Trondheim (Norway)
CAPTION
Avoidable Deaths in European Cities
CREDIT
Barcelona Institute for Global Health (ISGlobal)
JOURNAL
The Lancet Planetary Health
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Health impacts of the new WHO air quality guidelines in European cities
ARTICLE PUBLICATION DATE
10-Nov-2021
Two leading US physicians say doctors now need to screen and treat patients for exposure to air pollution
In addition to expanded role for health care, governments
action needed to reduce air pollutants linked to 5.5
million annual cardiovascular deaths worldwide
Peer-Reviewed PublicationChestnut Hill, Mass. (11/11/2021) – With numerous studies documenting air pollution’s link to heart-related illness and death, two leading American physicians are calling on their peers to begin screening patients for exposure to indoor and outdoor air pollution and recommending interventions in order to limit exposure and improve cardiovascular health, the researchers write in the New England Journal of Medicine.
In addition, governments have a primary responsibility, as stewards of public health, to adopt technologies and regulations that reduce air pollution – measures that will also contribute to efforts to combat climate change, write Philip J. Landrigan, MD, director of the Global Public Health and the Common Good Program at Boston College, and Sanjay Rajagopalan, MD, chief of cardiovascular medicine at UH Harrington Heart & Vascular Institute, the Herman K. Hellerstein, MD, Chair in Cardiovascular Research, and director of the Case Cardiovascular Research Institute at the Case Western Reserve School of Medicine.
Cardiovascular diseases are the world’s leading cause of death and disability, responsible for 18.6 million deaths worldwide in 2019, including 957,000 deaths in the United States. That same year, an estimated 5.5 million cardiovascular deaths were linked to air pollution – including 200,000 deaths in the United States, though the authors note that number could be up to ten times higher, based on a number of studies.
The grim statistics illustrate that it is now necessary for physicians, who have long addressed heart health from standpoints of nutrition, diet, smoking and exercise, to play a greater role helping patients recognize their risk factors for exposure to pollutants and recommending evidence-based strategies in response, the co-authors argue.
“The first step in preventing pollution-related cardiovascular disease is to overcome neglect of pollution in disease prevention programs, medical education, and clinical practice and acknowledge that pollution is a major, potentially preventable risk factor for cardiovascular disease,” Landrigan and Rajagopalan write in the journal.
In addition to obtaining patient histories of pollution exposure, doctors can provide guidance on pollution avoidance. They might recommend minimizing exercise on “bad air” days, avoiding exposure on the job, and avoiding the use of pollution-emitting devices – from fireplaces to incense sticks. Preventative recommendations could include the use of facemasks, in-home air cleaners, and air conditioning.
“What has been missing from this whole conversation about cardiovascular disease is the impact of environmental factors outside of an individual’s control,” said Landrigan, a pediatrician and epidemiologist whose pioneering work led to the removal of lead from gasoline. “It is time to bring these issues into the conversation.”
Landrigan, director of Boston College’s Global Observatory on Pollution and Health, added “The scientific knowledge is not brand new. It has been recognized for at least a decade that air pollution and lead are important causes for heart disease and stroke. However, that scientific knowledge hasn’t yet translated to clinical practice in office, hospital at bedside. We think it is time for that to change. We are hoping this will change the practice of individual doctors and NPs, and that it will change the advice that prominent professional organizations give to their members and the public.”
In addition to the call to action for their fellow physicians, Landrigan and Rajagopalan want to bring the issue of pollution to the attention of the world’s leading medical, health, and physician associations to enlist their members in the effort to control pollution. The American Heart Association has already issued guidance on steps individuals can take to protect themselves from air pollution, they note.
But the global scale of the problem is so great that physicians and health care providers cannot be expected to resolve it on their own, the physicians say. Governments, currently grappling with the global response to climate change at the COP26 meetings in Glasgow, Scotland, can use those same efforts to improve cardiovascular health.
“An enduring reduction in pollution-related cardiovascular disease will require more than changing individual behaviors,” they write in the journal. “It will necessitate widescale control of pollution at its sources. The most effective strategy for achieving this goal is a rapid, government-supported transition from all fossil fuels — coal, gas, and oil — to clean, renewable energy. Household air pollution in low-income countries is most effectively controlled by providing poor families with affordable access to cleaner fuels.”
It will take government action to lead the way, they argue: “Lasting prevention of pollution-related cardiovascular disease can be achieved only through government-supported interventions on a societal scale that control pollution at its source and encourage a rapid transition to clean energy.”
JOURNAL
New England Journal of Medicine
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
People
ARTICLE PUBLICATION DATE
11-Nov-2021
Researchers link pollution to cardiovascular disease, develop strategies to reduce exposure and encourage government intervention
IMAGE: “UNTIL NOW, PREVENTION OF CARDIOVASCULAR DISEASES HAS FOCUSED ALMOST EXCLUSIVELY ON INDIVIDUAL BEHAVIORAL AND METABOLIC RISK FACTORS,” SAID SANJAY RAJAGOPALAN, MD, CHIEF OF CARDIOVASCULAR MEDICINE AND THE HERMAN K. HELLERSTEIN, MD, CHAIR IN CARDIOVASCULAR RESEARCH AT UH HARRINGTON HEART & VASCULAR INSTITUTE, AND DIRECTOR OF THE CASE CARDIOVASCULAR RESEARCH INSTITUTE AT THE CASE WESTERN RESERVE SCHOOL OF MEDICINE. “POLLUTION REDUCTION HAS RECEIVED SCANT ATTENTION IN PROGRAMS FOR CARDIOVASCULAR DISEASE CONTROL AND HAS BEEN LARGELY ABSENT FROM GUIDELINES.” view more
CREDIT: UH / CWRU
CLEVELAND--In a new review article, published today in The New England Journal of Medicine, researchers from University Hospitals (UH), Case Western Reserve University and Boston College discuss evidence linking pollution and cardiovascular disease. The research team highlights strategies for reducing individual exposure to pollution, and the importance of government-supported interventions encouraging clean energy.
The researchers note that pollution was estimated to be responsible for nine million deaths worldwide in 2019, 5.1 million of which were due to cardiovascular disease. They explain that while these numbers are high, they likely undercut the full contribution of pollution to the global burden of cardiovascular disease, as they are based on a subset of known environmental risk factors. Attribution of health effects to pollutants can be complex, given their ubiquitous presence in the environment and the expanding list of chemicals associated with human health effects.
“Until now, prevention of cardiovascular diseases has focused almost exclusively on individual behavioral and metabolic risk factors,” said Sanjay Rajagopalan, MD, chief of cardiovascular medicine and the Herman K. Hellerstein, MD, Chair in Cardiovascular Research at UH Harrington Heart & Vascular Institute, and director of the Case Cardiovascular Research Institute at the Case Western Reserve School of Medicine. “Pollution reduction has received scant attention in programs for cardiovascular disease control and has been largely absent from guidelines.”
Philip J. Landrigan, MD, MSc, FAAP, Director of the Program for Global Public Health and the Common Good, Director of the Global Observatory on Pollution and Health, and Professor of Biology at the Schiller Institute for Integrated Science and Society at Boston College collaborated with Dr. Rajagopalan on the review. The researchers emphasize that their overarching goal is to persuade all physicians of the importance of considering pollution as a risk factor when working with their patients to prevent and control cardiovascular disease.
The article provides an overview of the cardiometabolic health effects of pollutants for physicians, and outlines strategies for reducing pollution exposure. The researchers explain that the first step in preventing pollution-related cardiovascular disease is to emphasize the role of pollution in disease prevention programs, medical education and clinical practice, and acknowledge that pollution is a major, potentially preventable risk factor for cardiovascular disease.
The article also addresses the direct link between environmental pollutants like air pollution and contribution to climate change. This is especially important given that this paper comes at the heels of the 26th UN Climate Change Conference (COP 26) in Glasgow, Scotland.
“One of the important takeaways from COP26 is that the efforts to cut emissions, adapt to climate threats and deal with health problems are often carried out independently,” emphasized Dr. Rajagopalan. “By keeping the focus on health effects of pollutants, many of which are exacerbated by and contribute to climate change, there is a much higher chance of engagement by stakeholders.”
CAPTION
The researchers note that pollution was estimated to be responsible for nine million deaths worldwide in 2019, 5.1 million of which were due to cardiovascular disease (Fig. 2B).
CREDIT
UH / CWRU / BC
The researchers note many ways in which individual physicians can bring the environmental lens to their patients.
“Physicians can qualitatively assess exposure risk in patients when relevant, assess individual susceptibility, and provide guidance on pollution avoidance,” said Dr. Rajagopalan. “Patients at very high risk, for instance, include individuals with pre-existing atherosclerotic cardiovascular disease, diabetes or chronic kidney disease, or individuals in special demographic categories including the elderly and transplant recipients.”
The team explains that physicians can take collective action through professional societies to persuade elected officials to reduce pollution levels for all patients across the United States. They emphasize that the most effective of these actions will be a massive, rapid shift away from fossil fuels to clean, renewable energy, with the added benefit of slowing the rate of climate change.
Prevention of pollution-related cardiovascular disease through a large-scale transition from fossil fuels to clean, renewable energy will not only reduce cardiovascular disease and associated deaths, but also benefit humanity by slowing the rate of climate change. The research team concludes that the global epidemic of cardiovascular disease can only be contained through a multipronged strategy that combines pollution prevention with control of individual risk factors.
CAPTION
The researchers note many ways in which individual physicians can bring the environmental lens to their patients. “Physicians can qualitatively assess exposure risk in patients when relevant, assess individual susceptibility, and provide guidance on pollution avoidance,” said Dr. Rajagopalan. (Fig. 4A).
CREDIT
UH / CWRU / BC
Rajagopalan, S. and Landrigan, P. “Pollution and the Heart.” The New England Journal of Medicine. DOI: 10.1056/NEJMra2030281.
About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 23 hospitals (including 5 joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Oxford University and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.
Case Western Reserve University is one of the country's leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,800 undergraduate and 6,300 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.
CAPTION
The team explains that physicians can take collective action through professional societies to persuade elected officials to reduce pollution levels for all patients across the United States. They emphasize that the most effective of these actions will be a massive, rapid shift away from fossil fuels to clean, renewable energy, with the added benefit of slowing the rate of climate change. (Fig. 4B).
CREDIT
UH / CWRU / BC
JOURNAL
New England Journal of Medicine
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Pollution and the Heart
ARTICLE PUBLICATION DATE
10-Nov-2021
