Air pollution: tackling a critical driver of the global NCD crisis

Air pollution is the second leading risk factor for noncommunicable diseases (NCDs) after tobacco smoking. Despite being a critical driver of the global NCD burden, air pollution often remains overlooked in the global NCD response. By recognizing and addressing this gap, we have a powerful opportunity to save lives, protect livelihoods, and advance both human and planetary health. 

Outdoor (ambient) air pollution – driven by fossil fuel-based energy production, waste burning, transportation, residential energy use, industrial processes, and agricultural burning and other processes – is estimated to  cause 4.2 million premature deaths each year. Nearly 90% of these deaths occur in low- and middle-income countries, where air quality is often poorest, particularly in the WHO South-East Asia and Western Pacific Region.

Yet, we are virtually all exposed to poor air quality. In 2019, 99% of the world’s population was breathing air with pollutant levels that exceeded health-based recommendations of the WHO Air quality guidelines.

Household air pollution caused by cooking and heating with polluting and inefficient fuels and technologies further contributes to the global burden, placing women and children at particular risk due to greater exposure. Together, ambient and household air pollution are responsible for nearly 7 million premature deaths each year, more than 10% of all global deaths[i]. 

Poor air quality also comes at a staggering economic cost. According to the World Bank, health damage from air pollution accounts for over six percent of global gross domestic products, with some countries losing more than 10% of their national economic output[ii]. Yet, less than one percent of global development aid is invested in improving air quality in low- and middle-income countries, where people are most at risk[iii]. 

A silent threat to every organ

Air pollution affects virtually every organ and system in the body.  83% of premature deaths linked to air pollution are from chronic diseases including ischemic heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease (COPD). Air pollution is also responsible for millions of cardiovascular disease and stroke cases each year. 

Tiny inhalable particles in the air – less than 2.5 micrometers in size – are among the deadliest pollutants. They are small enough to reach deep into the lungs and from there enter the bloodstream, causing inflammation and damage. 

Emerging evidence links air pollution to further health conditions including asthma, diabetes, impaired kidney function, as well as cognitive decline, dementia, and mental health disorders such as depression and anxiety[iv],[v]. 
 

Children, young people and pregnant women are among the most vulnerable populations to the health risks posed by poor air quality. In younger populations, air pollution exposure is linked to impaired lung development, learning difficulties, as well as cognitive and behavioral problems. These impacts are often lifelong with increased risk of chronic diseases later in life, such as asthma, and posing serious challenges to both individual well-being and public health. Polluted air can also disrupt reproductive health, and contribute to adverse pregnancy outcomes, including low birth weight, premature birth, and miscarriage[vi].

A global target, a major opportunity

At the  Second WHO Global Conference on Air Pollution and Health and by adopting the updated Road Map on the health sector’s response to adverse effects of air pollution at the 78th World Health Assembly, WHO Member States recently committed to halving the health impact of air pollution by 2040 compared to 2015 levels. 

Achieving this target requires a multisectoral approach, both reducing pollution and improving NCD prevention and control. In an unprecedented show of unity, almost 50 million health professionals, patients, advocates, representatives from civil society organizations, and individuals from around the world have signed  a call for urgent action to reduce air pollution and to protect people’s health from its devastating impacts, by:

• enforcing robust measures to stop polluting the air, cutting emissions at source, and swiftly implementing the full  WHO global air quality guidelines;
• ensuring just and inclusive clean energy transition and fossil fuel phase out in a fair and equitable manner;
• strengthening actions for clean air, better monitoring and surveillance, and institutional capacity to limit air pollution and mitigate climate change;
• increasing domestic and international funding to elevate clean air as a priority on global and national health and political agendas; and
• building intersectoral workforces with the skills and capacity to design and implement policies to tackle air pollution, focusing on continuous awareness raising, training, research, and sharing best public health practices, especially in the most affected countries.

Halving the health impact of air pollution would prevent about 4 million deaths annually, including close to 3 million deaths from NCDs. 

Building on country success stories

Already, there are success stories from countries with robust legislation and air quality standards, and from initiatives such as clean household energy transitions, greener urban transport policies and waste management strategies. 

EU Member States and countries in the European Economic Area (EEA) have implemented clean air policies and reached relatively low levels of air pollution, because of the commitments set out in the EU Clean Air Directive which are legally binding. Recently, the EU adopted new air quality standards that are more aligned with WHO recommendations, also introducing the possibility of allowing people to seek compensation for health damages if air quality rules are not respected. 

India, Ghana, Kenya and Nepal, among other countries, are putting programmes in place to provide cleaner and affordable energy options for cooking, including Liquefied Petroleum Gas (LPG), ethanol and e-cooking for low-income households and in rural areas. China has managed to improve air quality significantly since 2013, while also ensuring continued economic growth.  

Cities are also stepping up. In London, ultra-low emission zones have helped cut pollution and improve respiratory health. Bogotá, Colombia, is deploying a 100% electric bus fleet, Paris has cut air pollution in half over the past 20 years thanks to strong actions to reduce traffic, increase pedestrian and bicycle lanes and increase the area of green spaces in the city.

A wake-up call for the health sector

Health systems are on the front lines of this crisis – carrying the burden of increased air pollution-related health-care costs, and with health-care workers seeing the consequences of air pollution first-hand – but are often not sufficiently equipped to address air pollution and its health impacts. We need a shift: health systems must be empowered to lead in air pollution prevention and response. 

This requires raising awareness across the health workforce, patients, and the general public about the health risks of air pollution and its links to climate change, along with practical strategies to reduce emissions and exposure. Air pollution must be fully integrated into health education – from medical and public health curricula to continuing professional development and clinical guidelines.

Health workers should be supported to take on leadership roles in shaping policies that improve air quality, placing public and patient health at the center of decision-making. Stronger collaboration between health and non-health sectors is essential to advance clean air action. At the same time, health systems must reduce their own environmental footprint while continuing to deliver high-quality, accessible care.

Lessons from tobacco control

Another highly relevant example to learn from is the  Framework Convention on Tobacco Control (FCTC), which galvanized a global movement that has saved millions of lives. Its playbook contains many tried-and-tested tools that can be adapted to tackle air pollution: taxing pollution, regulating emissions, creating clean air zones, and using bold public communication campaigns to warn of risks and rally support. An  MPOWER initiative, adopted for air pollution, would also facilitate the collaboration between cities, civil society, and governments in the fight for clean and safe air.

A pivotal moment to take action on air pollution: the Fourth UN High-level Meeting on the prevention and control of NCDs

The Fourth High-level Meeting of the UN General Assembly on the prevention and control of NCDs and the promotion of mental health and well-being (HLM4) in September presents a new opportunity to fully integrate air pollution into the global NCD agenda. To prevent millions of NCD deaths in the next decade and reduce air pollution by half, key measures should include:  

1. ensuring robust air quality governance at country level, which includes setting air quality standards aligned with WHO air quality guidelines;
2. cutting emissions of air pollutants through transitioning away from fossil fuel production and use, through air pollution reducing actions in the energy, industry and transport sectors, and stop the burning of waste and agricultural residues in line with the target to halve the health impact of air pollution by 2040; and
3. improving the understanding and awareness of air pollution as a major NCD risk factor and strengthening institutional capacity, particularly within the health sector, decision-makers at city, regional and country levels and communities and vulnerable groups at risk. 

About the series

This commentary is part of a series highlighting priority areas to accelerate progress in the global NCD and mental health response and address related global health equity challenges ahead of the Fourth High-Level Meeting of the United Nations General Assembly (UNHLM4) in 2025. Discover the full series on the  Road to 2025 campaign webpage.