The second Global Conference on Air Pollution and Health of the World Health Organization (WHO) is underway in the Colombian coastal city of Cartagena. Hosted by the WHO and the Government of Colombia, this convening aims to build global support and commitments for halving the number of global deaths from air pollution by 2040 from the 2015 level.
Nearly seven million people die prematurely due to air pollution-related diseases globally, with disproportionate impacts on developing countries and vulnerable communities worldwide. About 2.1 billion die due to energy poverty in households. Nine out of 10 people breathe air quality that breaches WHO guidelines. Some 2.7 billion children under 15 years are exposed to unsafe levels of air pollution. Global health cost of air pollution is an astounding $8.1 trillion — 6.1 per cent of the global gross domestic product.
“Air pollution is the biggest public health challenge. We have to progress with commitment and take pledges. There cannot be any excuses for inaction,” Maria Neira, who heads WHO’s work on climate, environment and health, said while inaugurating the convention.
Neira further explained to Down to Earth that going forward, the role of legislation to operationalise WHO guidelines, such as the directive from the European Parliament, will be critical to pace up transition. This will require stronger political space and expanded roles of city mayors/authorities, stronger alignment with climate action as well as health arguments for climate action for effective leveraging. Also, in the changed geo-political situation, the perception and support of the general population and their embracing of green policies will be conducive for advancement of political action on zero pollution.
The gathering of scientists, political leaders, civil society, practitioners, vulnerable groups including youth and indigenous communities, has highlighted the need for evidence-based coordinated multi-sector action to address the public health emergency and equity in delivery of welfare.
Myriad evidence presented during the four-day-long event once again reconfirmed how each and every organ system in the human body is impacted by air pollution. As pollutants enter the bloodstream, they trigger oxidative stress, inflammation in the lungs, carcinogenic effects, and finally lead to short- and long-term effects on nearly all organ systems. A lot of effects due to exposure to air pollution are known today.
The most stunning spotlight has been on brain health that scientists have tracked through different stages of growth — from the foetus in the womb to late adulthood. Stark evidence shows the changes in brain function and structural connectivity in the pre-natal stage, decreased motor and cognitive functions in infancy, increased risk for neurodevelopmental disorders such as autism, increased risk of anxiety, depression, psychosis, and suicides among young adults, and increased risk for cerebrovascular diseases and dementia among the elderly.
Interestingly, as global efforts to clean up air are gathering momentum, global scientific attention is also beginning to ascertain the public health gains from accelerated action. Studies are being carried out to show how deaths, illness and health costs can be avoided and reduced if action can improve air quality.
A study presented from France showed that if WHO guidelines are met, avoidable asthma cases in the age group of 0-17 and 18-39 years can be significant and avoidable health and well-being benefits can be as high as $3.2 billion and $446 billion respectively for each of these age groups.
Scientists further emphasised the health benefits of energy transition and underscored the importance of accounting for lifecycle emissions for informed decision-making and avoiding trade-offs.
Combustion sources — vehicles, industry, power generation, etc — are among the key drivers of energy demand that also have a strong bearing on the quantum and toxicity of emissions. This makes transition towards clean and renewable energy critical. A 2024 Lancet study was presented to show that deaths from fossil fuel-derived outdoor air pollution has already fallen by 6.9 per cent — from 2.25 million in 2016 to 2.09 million in 2021. About 59 per cent of this decline has been due to the efforts to reduce pollution from coal burning – “demonstrating life-saving potential of coal phase out.”
Scientists are also looking at different components of particulate mass more granularly to understand the differentiated impacts. The key focus is on black carbon that is not only a health disrupter but also a heat trapper and a climate rogue.
According to Lidia Morawska, a leading air pollution scientist from Queensland University, Australia, the evidence on health effects of black carbon has increased substantially showing a very strong link with all causes, cardiovascular and respiratory disease and lung cancer, and childhood asthma.
In fact, this association of black carbon with mortality is independent from the overall effect of PM2.5 mass and this will require specific strategies to target sources that have higher ratio of black carbon that largely include diesel and a range of incomplete combustion like cooking stoves, brick kilns etc. This will have to inform prioritisation of policy action.
The continued global challenge of energy poverty and inequity in exposures hogged considerable attention. Kalpana Balakrishna, a leading air pollution scientist from the Ramachandra Medical College and a WHO expert, said energy poverty is a real danger for the poor. Even though the Ujjwala programme in India has expanded LPG coverage to include 80 million more households, resource poor households are still facing economic barriers. As investments are not being scaled up to address this inequity, energy transition is becoming unjust.
The global community has expressed deep concern over inadequate investments to address air pollution globally. It has been underscored that the climate and development finance need to be harnessed at scale to tackle air pollution and ensure a just energy transition.
Jane Burston, founder and chief executive of Clean Air Fund, pointed out that only one per cent of the international development aid was available for outdoor air quality projects during 2018-2022. This can go up to 9 per cent if projects with air quality co-benefits are also included. While increasing investments, a stable regulatory environment should also be maintained. “Integrate air quality criteria with finance and design of sectoral action,” emphasised Burston.
The global convening has not been confined to just techno-centric debate. It has articulated the human story of suffering and trauma associated with disease burden, and also the angst and passion of campaigners building awareness to influence policies.
The most compelling is the poignant story of a mother — Rosamund Adoo-Kissi-Debrah — who lost her daughter Ella to a severe asthma attack triggered by air pollution in London in 2013 and fought a hard legal battle to get air pollution recognised and certified as the cause of Ella’s death.
On the other hand, representatives of the medical community provided undeniable testimony from what they see in their daily lives. There were a string of stories from doctors — Arvind Kumar, Sun Karu Touray, representatives from heart and lung foundations from across the world, asthma networks for children — providing the most compelling evidence from their practice.
At the same time, the convening aiming to build hope for change has also captured the efforts and real change on the ground that have demonstrated progress and improvement in air quality.
Mete Coban, deputy mayor of London, presented potential evidence of air quality benefits from the implementation of air quality policies, including the expansion of ultra-low emissions zones in London. Monthly NO2 levels have fallen sharply between 2010 and 2023. The estimate of potential benefits shows that this change can help 300,000 Londoners avoid sizable disease burden in the coming decades.
Similarly, Javi Lopez of the European Parliament highlighted the expected benefits from the notable air quality directive that aligns the ambient air quality standards with the WHO guidelines to drive real world change.
It also emerged that in the local to global connect, empowering cites to act and drive change can be a game changer. This was emphasised by Priya Shankar, Director at Bloomberg Philanthropy who is helping to build the network of Mayors on clean air. Several mayors from the cities of the Global South present in the conference have shared the changes underway in their cities and the opportunities for cross learning.
Clearly, the resounding message from this gathering of the air quality and health community is — build action to scale to transform reality.