Editorial
The air that we breath
Air pollution remains one of the biggest and most These two papers add to the already strong evidence
immediate environmental threats to human health, for the negative health effects of air pollution around
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leading to millions of premature deaths each year the world; however, what constitutes safe levels of air
Tony McConnell/
and the loss of millions more healthy years of life. It pollutants is still under investigation and there is some
has been linked to a range of adverse health effects, evidence that even very low levels of air pollution can
including cardiovascular and respiratory disease, cancer, have negative health consequences. Massimo Stafoggia
neurological effects, and birth outcomes. This month and co-authors address this question by investigating For the full NO2 and paediatric
asthma paper see Articles
The Lancet Planetary Health publishes a collection of associations between low-level air pollution (PM2·5, NO2, Lancet Planet Health 2022:
four Articles (three from the issue and one published black carbon, and O3) and mortality in large population- published online Jan 5.
https://doi.org/10.1016/
online first) exploring the health impacts of ambient air based cohorts from Belgium, Denmark, England, the S2542-5196(21)00350-8
pollution. Netherlands, Norway, Italy, and Switzerland. They find See Articles page e49
In the first of these papers, Veronica Southerland and that long-term exposure to levels of PM2·5 and NO2 well See Articles page e9
co-authors examine PM2·5 concentrations and associated below European annual limit values, US EPA standards See Articles page e40
mortality trends in over 13 000 cities globally between and WHO air quality guidelines was associated with For the revised Global Air
Quality Guidelines see https://
2000–19. They find that PM2·5 concentrations and mortality across the seven large European cohorts. www.who.int/news/item/22-09-
associated mortality burdens have declined in some parts Common emissions sources, primarily related to fossil 2021-new-who-global-air-
quality-guidelines-aim-to-save-
of the world, but that PM2·5 remains an important public fuel combustion, mean there are many links between millions-of-lives-from-air-
health risk factor in urban areas worldwide. Interestingly, air pollution and climate change policy and indeed a pollution
decreasing PM2·5 concentrations (for example, African, number of modelling studies have shown that climate
European, and North and South American cities policies have substantial health co-benefits through
experienced 18%, 21%, and 29% decreases in PM2·5 reduced air pollution. The final paper in this collection
concentrations) did not always correspond to a by Lara Aleluia Reis and co-authors investigates whether
proportionate decrease in PM2·5-attributable mortality there might be an optimal climate change and air
rates, revealing that other demographic factors, such pollution policy mix. To do this they developed and
as an ageing population and poor general health, are implemented a benefit–cost, integrated air quality climate
influential drivers of pollution-related mortality burdens. modelling framework that seeks to maximise regional
A second and related paper by Susan Anenberg and co- welfare, internalising air pollution’s economic impacts on
authors examined 1 km resolution NO2 concentrations human mortality under climate constraints. They find that
(constructed by adjusting a coarser resolution dataset accounting for air pollution’s economic impacts leads to
using land use data) along with population and an estimated 1·62 million lives saved by 2050, three times
baseline asthma rates to estimate paediatric asthma their estimated co-benefits of climate policies alone. This
incidence attributable to NO2 between 2000–19 in strongly suggests that air quality controls are needed
over 13 000 urban areas worldwide. They found that in even if ambitious decarbonisation policies are in place and
2019, there were 1·85 million new paediatric asthma that these need not jeopardise climate policy objectives.
cases associated with NO2; 8·5% of all new paediatric Furthermore, they find that global and regional welfare
asthma cases reported that year. In urban areas, NO2 increases when air pollution impacts are internalised, with
was responsible for 16% of all new paediatric asthma no negative repercussions on global inequality.
cases in 2019. Over the course of the study period WHO recently revised their Global Air Quality Guidelines,
the number of paediatric asthma cases in urban areas recommending much more stringent pollution limits to
that could be attributed to NO2 pollution remained protect health. The papers highlighted here reveal the
steady but the rate per 100 000 children decreased tremendous potential for improved health and wellbeing
by 11% as the urban population grew. Despite effective as well as climate policy synergies if tackling air pollution
air quality management benefiting children’s respiratory is made a political priority. ■ The Lancet Planetary Health
health in many regions, current NO2 levels contribute Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open
substantially to paediatric asthma incidence. Access article under the CC BY 4.0 license.
www.thelancet.com/planetary-health Vol 6 January 2022 e1
