New WHO has issued new Global Air Quality Guidelines (AQGs) that reduce levels of key air pollutants, some of which also contribute to climate change.

Since WHO’s last 2005 global update, there has been a marked increase of evidence that shows how air pollution affects different aspects of health. For that reason, and after a systematic review of the accumulated evidence, WHO has adjusted almost all the AQGs levels downwards, warning that exceeding the new air quality guideline levels is associated with significant risks to health.

Recommended 2021 AQG levels compared to 2005 air quality guidelines. Source: WHO

Every year, exposure to air pollution is estimated to cause 7 million premature deaths and result in the loss of millions more healthy years of life. In children, this could include reduced lung growth and function, respiratory infections and aggravated asthma. In adults, ischaemic heart disease and stroke are the most common causes of premature death attributable to outdoor air pollution, and evidence is also emerging of other effects such as diabetes and neurodegenerative conditions. This puts the burden of disease attributable to air pollution on a par with other major global health risks such as unhealthy diet and tobacco smoking.

WHO’s new guidelines recommend air quality levels for 6 pollutants, where evidence has advanced the most on health effects from exposure. When action is taken on these classical pollutants—particulate matter (PM), ozone (O₃), nitrogen dioxide (NO₂) sulfur dioxide (SO₂) and carbon monoxide (CO)—it also has an impact on other damaging pollutants.

The health risks associated with particulate matter equal or smaller than 10 and 2.5 microns (µm) in diameter (PM₁₀ and PM_2.5, respectively) are of particular public health relevance. Both PM_2.5 and PM₁₀ are capable of penetrating deep into the lungs but PM_2.5 can even enter the bloodstream, primarily resulting in cardiovascular and respiratory impacts, and also affecting other organs.

PM is primarily generated by fuel combustion in different sectors, including transport, energy, households, industry, and from agriculture. In 2013, outdoor air pollution and particulate matter were classified as carcinogenic by WHO’s International Agency for Research on Cancer (IARC).

The guidelines also highlight good practices for the management of certain types of particulate matter (for example, black carbon/elemental carbon, ultrafine particles, particles originating from sand and dust storms) for which there is currently insufficient quantitative evidence to set air quality guideline levels. They are applicable to both outdoor and indoor environments globally, and cover all settings.

Disparities in air pollution exposure are increasing worldwide, WHO said, particularly as low- and middle-income countries are experiencing growing levels of air pollution because of large-scale urbanization and economic development that has largely relied on the burning of fossil fuels.

Global assessments of ambient air pollution alone suggest hundreds of millions of healthy life years of life lost, with the greatest attributable disease burden seen in low and middle-income countries. The more exposed to air pollution they are, the greater the health impact, particularly on individuals with chronic conditions (such as asthma, chronic obstructive pulmonary disease, and heart disease), as well as older people, children and pregnant women.

In 2019, more than 90% of the global population lived in areas where concentrations exceeded the 2005 WHO air quality guideline for long term exposure to PM_2.5. Countries with strong policy-driven improvements in air quality have often seen marked reduction in air pollution, whereas declines over the past 30 years were less noticeable in regions with already good air quality.

The goal of the guideline is for all countries to achieve recommended air quality levels. Conscious that this will be a difficult task for many countries and regions struggling with high air pollution levels, WHO has proposed interim targets to facilitate stepwise improvement in air quality and thus gradual, but meaningful, health benefits for the population.

Almost 80% of deaths related to PM_2.5 could be avoided in the world if the current air pollution levels were reduced to those proposed in the updated guideline, according to a rapid scenario analysis performed by WHO. At the same time, the achievement of interim targets would result in reducing the burden of disease, of which the greatest benefit would be observed in countries with high concentrations of fine particulates (PM_2.5) and large populations.

While not legally-binding, like all WHO guidelines, AQGs are an evidence-informed tool for policy-makers to guide legislation and policies, in order to reduce levels of air pollutants and decrease the burden of disease that results from exposure to air pollution worldwide. Their development has adhered to a defined methodology, implemented by a guideline development group. It was based on evidence obtained from six systematic reviews that considered more than 500 papers. The development of these global AQGs was overseen by a steering group led by the WHO European Centre for Environment and Health.

Resources

• WHO global air quality guidelines. Particulate matter (PM_2.5 and PM₁₀), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.