Intended for healthcare professionals

Opinion

# Too little effort in tackling pollution is resulting in too many lives being lost

BMJ 2022; 377 (Published 16 June 2022) Cite this as: BMJ 2022;377:o1481
1. Elaine Mulcahy, director
1. The UK Health Alliance on Climate Change

We need to do much more, much faster, writes Elaine Mulcahy

Outdoor air pollution accounted for 2.9 million deaths globally in 2000. Less than 20 years later, in 2019, that figure had risen to 4.5 million. The air we breathe is causing one in every six of us to die prematurely, and little is being done about it. In fact, the problem is getting worse.

The 2017 Lancet Commission on pollution and health was a stark warning of the global burden of pollution on health and economic development.1 It found that pollution was responsible for an estimated 9 million deaths and economic losses totalling US $4.6 trillion (6.2% of global economic output) in 2015. It noted the deep inequity of pollution, with low-income and middle-income countries carrying the greatest burden of deaths and economic losses. Since then, we have been going backwards. The updated report published in May 2022, based on data from 2019, shows that little progress is being made.2 Since 2000, deaths caused by ambient air pollution and toxic chemical pollution have increased by 66%. This increase has been driven by industrialisation, uncontrolled urbanisation, population growth, fossil fuel combustion, and an absence of adequate national or international chemical policy. And despite declines in deaths from household air and water pollution, most notably in Africa where improvements in water supply, sanitation, antibiotics, treatments and cleaner fuels have contributed to reduced mortality, this has been offset by increases in ambient air pollution and toxic chemical pollution. Overall, pollution still causes more than 9 million deaths each year globally. This figure has not changed since 2015. The number of deaths caused by pollution is on a par with smoking, and globally, the impact of pollution on health is greater than war, terrorism, malaria, HIV, tuberculosis, drugs, and alcohol.2 Yet, the report says that despite strong and growing evidence for pollution contributions to non-communicable disease morbidity and mortality, international and national NCD control programmes focus almost exclusively on behavioural and metabolic risk factors such as tobacco use, exercise, and obesity, while ignoring pollution. Likewise, the ministries for finance, urban development, and energy, which make key investment decisions that shape options on energy choices and development pathways, are rarely involved in pollution control. There seems to be a disconnect. The authors of the report say, “We cannot continue to ignore pollution. We are going backwards” and call for a large-scale, rapid transition away from all fossil fuels to clean, renewable energy for preventing pollution while also slowing down climate change, achieving a double benefit for planetary health. The UN Environment Programme recently published the mid-term strategy 2022-25 with an emphasis on the planetary crises of climate change, biodiversity, pollution, and waste.3 Their vision is that tackling these challenges will achieve climate stability, living in harmony with nature and moving towards a pollution free-planet. The strategy outlines the transformative shift that is needed to deliver this vision, saying it will require a recalibration of our economies and societies towards more sustainable and equitable models. Pollution is a global problem that requires a global effort. Pollutants can travel long distances in wind, water, in the food chain and consumer products, and while wealthier countries displace much of their pollution footprint overseas, lower-income countries are experiencing increasing levels of pollution domestically. Emissions from export production in China, for example, has risen by more than 60%, driven by manufacture of goods destined for the OECD. To date, the international funding response to tackle pollution has been insufficient. The Lancet Commission reports that official development assistance (ODA) contributions to international conventions and frameworks concerning pollutants and chemicals amounted to just US$860 million in 2016-18, completely inadequate for the scale of a problem that accounts for global economic losses equivalent to 6.2% of GDP (US \$4.5 trillion) annually.

Air pollution accounts for 82% of the total economic losses and is also the major cause of death—accounting for 6.5 million deaths every year. Outdoor air pollution accounts for 4.5 million of these deaths. Pollutants including methane, black carbon, and hydrofluorocarbons (HFCs) are a major contributing factor to both outdoor air pollution and climate warming. These short-lived climate pollutants cause significant harm in their relatively short lifespan (about 15 years), and the Lancet Commission report authors say that reducing SLCPs are the strongest lever available to slow that rate of warming in the next few decades. The Intergovernmental Panel on Climate Change (IPCC) has reported that pathways to limit warming must include deep reductions in climate emissions, including short-lived climate pollutants.

The Climate and Clean Air Coalition says that solutions to cut short-lived climate pollutants can be implemented today with existing technologies.4 They outline actions we can take including replacing and properly disposing of HFCs in refrigeration and air conditioning, reducing methane from waste and agriculture, and reducing black carbon emissions from household cooking, lighting and heating, and transport, and reducing methane leaks from oil and gas production. They say that with a concerted global effort to implement these solutions, methane emissions could be cut by at least 40% and black carbon by up to 70% by 2030, and 99.5% of HFCs by 2050 (compared to 2010 levels).

The evidence of the harm of pollution to both human and planetary health are indisputable. It is a burden that transcends borders and demands a global response, yet there has been little effort in most countries to prioritise action against pollution or to act on the recommendations of the 2017 Lancet Commission.

In 2020, a paper published in the Philosophical Transactions of the Royal Society modelled a “Clean Air” scenario that would drastically improve air quality throughout the world, resulting in a reduction in population exposure to particulate matter (PM2.5) by 75% relative to 2015, and by 80% compared to a future without additional policies.5 Such reductions would deliver substantial progress towards achieving the WHO target of 5mcg/m3 in large areas of the world, delivering multiple co-benefits for human and planetary health.

The Clean Air scenario demonstrated how future air quality will be mainly determined by policy decisions and their implementation, and that decisions in four policy areas will be critical: environmental policies focusing on pollution controls, energy, and climate policies aimed at global temperature stabilisation in line with the Paris Agreement, policies to transform the agricultural production systems, and policies to shift human food consumption patterns towards largely plant-based diets.

Importantly, they say that action in policy domains such as energy, climate, food, and agriculture needs a coordinated, multi-sectoral air quality management approach to resolve the air pollution problem.

Last year, the world’s global health community spoke out in an editorial published simultaneously in 220+journals calling for emergency action to limit global temperature increases, restore biodiversity and protect health.6 A report by the Academy of Medical Sciences and the Royal Society of Medicine has called for a stronger focus on health within the international climate narrative, and for the UK government to advocate for this: “By integrating the protection and promotion of human health in all actions to address climate change in the UK and demonstrating the potential health gains of the net-zero transition, the UK can take a global leadership role.”7

In the UK, the Environment Targets and Nature Green Recovery Paper currently open for consultation provides an opportunity for ambitious targets to be set, with clear monitoring and reporting systems in place to drive the transformational change that’s needed.8 On air pollution, the proposed target falls way short of ambition, international guidance, and expectation.

Evidence has shown that with the right political, industrial and societal will to deliver, adopting the World Health Organisation interim target of 10 µg/m3 by 2030 is achievable, and even at that still falls significantly short of the recommended target of 5 µg/m3, which should be the ultimate aim. A target of 10 µg/m3 by 2040 would mean that a child born today will still be breathing dirty air by the age of 20, and that is not good enough.

## Footnotes

• Competing interests: none declared.

• Provenance and peer review: not commissioned, not peer reviewed.

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