Mediacentre

Ambient(outdoor)airqualityandhealth
FactsheetN313
UpdatedMarch2014

Keyfacts
Airpollutionisamajorenvironmentalrisktohealth.Byreducingair
pollutionlevels,countriescanreducetheburdenofdiseasefrom
stroke,heartdisease,lungcancer,andbothchronicandacute
respiratorydiseases,includingasthma.
Thelowerthelevelsofairpollution,thebetterthecardiovascularand
respiratoryhealthofthepopulationwillbe,bothlongandshortterm.
The"WHOAirqualityguidelines"provideanassessmentofhealth
effectsofairpollutionandthresholdsforhealthharmfulpollution
levels.
Ambient(outdoorairpollution)inbothcitiesandruralareaswas
estimatedtocause3.7millionprematuredeathsworldwidein2012.
Some88%ofthoseprematuredeathsoccurredinlowandmiddle
incomecountries,andthegreatestnumberintheWHOWestern
PacificandSouthEastAsiaregions.
Policiesandinvestmentssupportingcleanertransport,energy
efficienthousing,powergeneration,industryandbettermunicipal
wastemanagementwouldreducekeysourcesofurbanoutdoorair
pollution.
Reducingoutdooremissionsfromhouseholdcoalandbiomass
energysystems,agriculturalwasteincineration,forestfiresand
certainagroforestryactivities(e.g.charcoalproduction)would
reducekeyruralandperiurbanairpollutionsourcesindeveloping
regions.
ReducingoutdoorairpollutionalsoreducesemissionsofCO 2 and
shortlivedclimatepollutantssuchasblackcarbonparticlesand
methane,thuscontributingtothenearandlongtermmitigationof
climatechange.
Inadditiontooutdoorairpollution,indoorsmokeisaserioushealth
riskforsome3billionpeoplewhocookandheattheirhomeswith
biomassfuelsandcoal.

Background
Outdoorairpollutionisamajorenvironmentalhealthproblemaffecting
everyoneindevelopedanddevelopingcountriesalike.
WHOestimatesthatsome80%ofoutdoorairpollutionrelated
prematuredeathswereduetoischaemicheartdiseaseandstrokes,
while14%ofdeathswereduetochronicobstructivepulmonarydisease
oracutelowerrespiratoryinfectionsand6%ofdeathswereduetolung
cancer.
Somedeathsmaybeattributedtomorethanoneriskfactoratthesame
time.Forexample,bothsmokingandambientairpollutionaffectlung

cancer.Somelungcancerdeathscouldhavebeenavertedbyimproving
ambientairquality,orbyreducingtobaccosmoking.
A2013assessmentbyWHOsInternationalAgencyforResearchon
Cancer(IARC)concludedthatoutdoorairpollutioniscarcinogenicto
humans,withtheparticulatemattercomponentofairpollutionmost
closelyassociatedwithincreasedcancerincidence,especiallycancer
ofthelung.Anassociationalsohasbeenobservedbetweenoutdoorair
pollutionandincreaseincanceroftheurinarytract/bladder.
Ambient(outdoorairpollution)inbothcitiesandruralareaswas
estimatedtocause3.7millionprematuredeathsworldwideperyearin
2012thismortalityisduetoexposuretosmallparticulatematterof10
micronsorlessindiameter(PM 10 ),whichcausecardiovascularand
respiratorydisease,andcancers.
Peoplelivinginlowandmiddleincomecountriesdisproportionately
experiencetheburdenofoutdoorairpollutionwith88%(ofthe3.7
millionprematuredeaths)occurringinlowandmiddleincomecountries,
andthegreatestburdenintheWHOWesternPacificandSouthEast
Asiaregions.Thelatestburdenestimatesreflecttheverysignificant
roleairpollutionplaysincardiovascularillnessandprematuredeaths
muchmoresothanwaspreviouslyunderstoodbyscientists.
Mostsourcesofoutdoorairpollutionarewellbeyondthecontrolof
individualsanddemandactionbycities,aswellasnationaland
internationalpolicymakersinsectorliketransport,energywaste
management,buildingsandagriculture.
Therearemanyexamplesofsuccessfulpoliciesintransport,urban
planning,powergenerationandindustrythatreduceairpollution:
forindustry:cleantechnologiesthatreduceindustrialsmokestack
emissionsimprovedmanagementofurbanandagriculturalwaste,
includingcaptureofmethanegasemittedfromwastesitesasan
alternativetoincineration(foruseasbiogas)
fortransport:shiftingtocleanmodesofpowergeneration
prioritizingrapidurbantransit,walkingandcyclingnetworksincities
aswellasrailinterurbanfreightandpassengertravelshiftingto
cleanerheavydutydieselvehiclesandlowemissionsvehiclesand
fuels,includingfuelswithreducedsulfurcontent
forurbanplanning:improvingtheenergyefficiencyofbuildingsand
makingcitiesmorecompact,andthusenergyefficient
forpowergeneration:increaseduseoflowemissionsfuelsand
renewablecombustionfreepowersources(likesolar,windor
hydropower)cogenerationofheatandpoweranddistributedenergy
generation(e.g.minigridsandrooftopsolarpowergeneration)
formunicipalandagriculturalwastemanagement:strategiesfor
wastereduction,wasteseparation,recyclingandreuseorwaste
reprocessingaswellasimprovedmethodsofbiologicalwaste
managementsuchasanaerobicwastedigestiontoproducebiogas,
arefeasible,lowcostalternativestotheopenincinerationofsolid
waste.Whereincinerationisunavoidable,thencombustion
technologieswithstrictemissioncontrolsarecritical.
Inadditiontooutdoorairpollution,indoorsmokeisaserioushealthrisk
forsome3billionpeoplewhocookandheattheirhomeswithbiomass
fuelsandcoal.Some4.3millionprematuredeathswereattributableto
householdairpollutionin2012.Almostallofthatburdenwasinlow

middleincomecountriesaswell.
The2005"WHOAirqualityguidelines"offerglobalguidanceon
thresholdsandlimitsforkeyairpollutantsthatposehealthrisks.The
Guidelinesindicatethatbyreducingparticulatematter(PM 10 )pollution
from70to20microgramspercubicmetre(g/m),wecancutair
pollutionrelateddeathsbyaround15%.
TheGuidelinesapplyworldwideandarebasedonexpertevaluationof
currentscientificevidencefor:
particulatematter(PM)
ozone(O 3 )
nitrogendioxide(NO 2 )and
sulfurdioxide(SO 2 ),inallWHOregions.

Particulatematter
Definitionandprincipalsources

PMaffectsmorepeoplethananyotherpollutant.Themajorcomponents
ofPMaresulfate,nitrates,ammonia,sodiumchloride,blackcarbon,
mineraldustandwater.Itconsistsofacomplexmixtureofsolidand
liquidparticlesoforganicandinorganicsubstancessuspendedinthe
air.Themosthealthdamagingparticlesarethosewithadiameterof10
micronsorless,(PM 10 ),whichcanpenetrateandlodgedeepinside
thelungs.Chronicexposuretoparticlescontributestotheriskof
developingcardiovascularandrespiratorydiseases,aswellasoflung
cancer.
Airqualitymeasurementsaretypicallyreportedintermsofdailyor
annualmeanconcentrationsofPM 10 particlespercubicmeterofair
volume(m 3 ).Routineairqualitymeasurementstypicallydescribesuch
PMconcentrationsintermsofmicrogramspercubicmeter(g/m 3 ).
Whensufficientlysensitivemeasurementtoolsareavailable,
concentrationsoffineparticles(PM 2.5 orsmaller),arealsoreported.
Healtheffects

Thereisaclose,quantitativerelationshipbetweenexposuretohigh
concentrationsofsmallparticulates(PM 10 andPM 2.5 )andincreased
mortalityormorbidity,bothdailyandovertime.Conversely,when
concentrationsofsmallandfineparticulatesarereduced,related
mortalitywillalsogodownpresumingotherfactorsremainthesame.
Thisallowspolicymakerstoprojectthepopulationhealthimprovements
thatcouldbeexpectedifparticulateairpollutionisreduced.
Smallparticulatepollutionhavehealthimpactsevenatverylow
concentrationsindeednothresholdhasbeenidentifiedbelowwhichno
damagetohealthisobserved.Therefore,theWHO2005guidelinelimits
aimedtoachievethelowestconcentrationsofPMpossible.
Guidelinevalues
PM 2.5
10g/m 3 annualmean
25g/m 3 24hourmean
PM 10
3

20g/m 3 annualmean
50g/m 3 24hourmean
Inadditiontoguidelinevalues,theAirQualityGuidelinesprovideinterim
targetsforconcentrationsofPM 10 andPM 2.5 aimedatpromotinga
gradualshiftfromhightolowerconcentrations.
Iftheseinterimtargetsweretobeachieved,significantreductionsin
risksforacuteandchronichealtheffectsfromairpollutioncanbe
expected.Progresstowardstheguidelinevalues,however,shouldbe
theultimateobjective.
TheeffectsofPMonhealthoccuratlevelsofexposurecurrentlybeing
experiencedbymanypeoplebothinurbanandruralareasandin
developedanddevelopingcountriesalthoughexposuresinmanyfast
developingcitiestodayareoftenfarhigherthanindevelopedcitiesof
comparablesize.
"WHOAirQualityGuidelines"estimatethatreducingannualaverage
particulatematter(PM 10 )concentrationsfromlevelsof70g/m 3 ,
commoninmanydevelopingcities,totheWHOguidelinelevelof20
g/m 3 ,couldreduceairpollutionrelateddeathsbyaround15%.
However,evenintheEuropeanUnion,wherePMconcentrationsin
manycitiesdocomplywithGuidelinelevels,itisestimatedthataverage
lifeexpectancyis8.6monthslowerthanitwouldotherwisebe,dueto
PMexposuresfromhumansources.
Indevelopingcountries,indoorexposuretopollutantsfromthe
householdcombustionofsolidfuelsonopenfiresortraditionalstoves
increasestheriskofacutelowerrespiratoryinfectionsandassociated
mortalityamongyoungchildrenindoorairpollutionfromsolidfueluseis
alsoamajorriskfactorforcardiovasculardisease,chronicobstructive
pulmonarydiseaseandlungcanceramongadults.
ThereareseriousriskstohealthnotonlyfromexposuretoPM,butalso
fromexposuretoozone(O 3 ),nitrogendioxide(NO 2 )andsulfurdioxide
(SO 2 ).AswithPM,concentrationsareoftenhighestlargelyintheurban
areasoflowandmiddleincomecountries.Ozoneisamajorfactorin
asthmamorbidityandmortality,whilenitrogendioxideandsulfurdioxide
alsocanplayaroleinasthma,bronchialsymptoms,lunginflammation
andreducedlungfunction.

Ozone(O 3 )
Guidelinevalues

O3
100g/m 3 8hourmean
Therecommendedlimitinthe2005AirQualityGuidelineswasreduced
fromthepreviouslevelof120g/m 3 inpreviouseditionsofthe"WHO
AirQualityGuidelines"basedonrecentconclusiveassociations
betweendailymortalityandlowerozoneconcentrations.
Definitionandprincipalsources

Ozoneatgroundlevelnottobeconfusedwiththeozonelayerinthe
upperatmosphereisoneofthemajorconstituentsofphotochemical

smog.Itisformedbythereactionwithsunlight(photochemicalreaction)
ofpollutantssuchasnitrogenoxides(NO x )fromvehicleandindustry
emissionsandvolatileorganiccompounds(VOCs)emittedbyvehicles,
solventsandindustry.Asaresult,thehighestlevelsofozonepollution
occurduringperiodsofsunnyweather.
Healtheffects

Excessiveozoneintheaircanhaveamarkedeffectonhumanhealth.
Itcancausebreathingproblems,triggerasthma,reducelungfunction
andcauselungdiseases.InEuropeitiscurrentlyoneoftheair
pollutantsofmostconcern.SeveralEuropeanstudieshavereportedthat
thedailymortalityrisesby0.3%andthatforheartdiseasesby0.4%,
per10g/m 3 increaseinozoneexposure.

Nitrogendioxide(NO 2 )
Guidelinevalues

NO 2
40g/m 3 annualmean
200g/m 3 1hourmean
ThecurrentWHOguidelinevalueof40g/m 3 (annualmean)wassetto
protectthepublicfromthehealtheffectsofgaseous.
Definitionandprincipalsources

Asanairpollutant,NO 2 hasseveralcorrelatedactivities.
Atshorttermconcentrationsexceeding200g/m 3 ,itisatoxicgas
whichcausessignificantinflammationoftheairways.
NO2isthemainsourceofnitrateaerosols,whichformanimportant
fractionofPM 2.5 and,inthepresenceofultravioletlight,ofozone.
ThemajorsourcesofanthropogenicemissionsofNO 2 arecombustion
processes(heating,powergeneration,andenginesinvehiclesand
ships).
Healtheffects

Epidemiologicalstudieshaveshownthatsymptomsofbronchitisin
asthmaticchildrenincreaseinassociationwithlongtermexposureto
NO 2 .ReducedlungfunctiongrowthisalsolinkedtoNO 2 at
concentrationscurrentlymeasured(orobserved)incitiesofEuropeand
NorthAmerica.

Sulfurdioxide(SO 2 )
Guidelinevalues

SO 2
20g/m 3 24hourmean
500g/m 3 10minutemean
ASO 2 concentrationof500g/m 3 shouldnotbeexceededover
averageperiodsof10minutesduration.Studiesindicatethata
proportionofpeoplewithasthmaexperiencechangesinpulmonary
functionandrespiratorysymptomsafterperiodsofexposuretoSO 2 as
shortas10minutes.
The(2005)revisionofthe24hourguidelineforSO 2 concentrationsfrom
3

125to20g/m 3 wasbasedonthefollowingconsiderations.
Healtheffectsarenowknowntobeassociatedwithmuchlower
levelsofSO 2 thanpreviouslybelieved.
Agreaterdegreeofprotectionisneeded.
AlthoughthecausalityoftheeffectsoflowconcentrationsofSO 2 is
stilluncertain,reducingSO 2 concentrationsislikelytodecrease
exposuretocopollutants.
Definitionandprincipalsources

SO 2 isacolourlessgaswithasharpodour.Itisproducedfromthe
burningoffossilfuels(coalandoil)andthesmeltingofmineraloresthat
containsulfur.ThemainanthropogenicsourceofSO 2 istheburningof
sulfurcontainingfossilfuelsfordomesticheating,powergenerationand
motorvehicles.
Healtheffects

SO 2 canaffecttherespiratorysystemandthefunctionsofthelungs,
andcausesirritationoftheeyes.Inflammationoftherespiratorytract
causescoughing,mucussecretion,aggravationofasthmaandchronic
bronchitisandmakespeoplemorepronetoinfectionsoftherespiratory
tract.Hospitaladmissionsforcardiacdiseaseandmortalityincreaseon
dayswithhigherSO 2 levels.WhenSO 2 combineswithwater,itforms
sulfuricacidthisisthemaincomponentofacidrainwhichisacauseof
deforestation.

WHOresponse
WHOdevelopsandproduces"Airqualityguidelines"recommending
exposurelimitstokeyairpollutants.
WHOcreatesdetailedhealthrelatedassessmentsofdifferenttypes
ofairpollutants,includingparticulatesandblackcarbonparticles,
ozone,etc.
WHOproducesevidenceregardingthelinkageofairpollutionto
specificdiseases,suchascardiovascularandrespiratorydiseases
andcancers,aswellasburdenofdiseaseestimatesfromexistingair
pollutionexposures,globalandregional.
WHOs"Healthinthegreeneconomy"seriesisassessingthehealth
cobenefitsofclimatemitigationandenergyefficientmeasuresthat
reduceairpollutionfromhousing,transport,andotherkeyeconomic
sectors.
WHOsworkon"Measuringhealthgainsfromsustainable
development"hasproposedairpollutionindicatorsasamarkerof
progressfordevelopmentgoalsrelatedtosustainabledevelopmentin
citiesandtheenergysector.
WHOassistsMemberStatesinsharinginformationonsuccessful
approaches,onmethodsofexposureassessmentandmonitoringof
healthimpactsofpollution.
TheWHOcosponsored"PanEuropeanProgrammeonTransport
HealthandEnvironment(ThePEP)",hasbuiltamodelofregional,
MemberStateandmultisectoralcooperationformitigationofair
pollutionandotherhealthimpactsinthetransportsector,aswellas
toolsforassessingthehealthbenefitsofsuchmitigationmeasures.

Formoreinformationcontact:
WHOMediacentre
Telephone:+41227912222
Email:mediainquiries@who.int

Relatedlinks
WHOAirqualityguidelines2005
globalupdate
WHOGlobalHealthObservatory
Recentdataonairquality.
Airpollutionandcancer:IARCs
2013assessment
Reviewofevidenceonthehealth
aspectsofairpollution
(REVIHAAP)
Healthinthegreeneconomy
series
Measuringhealthgainsfrom
sustainabledevelopment
WHO'sworkonindoorairpollution
andhealth
WHORegionalOfficeforEurope's
workonairquality
Moregeneralinformationonair
pollution
Prevalenceoffatalandnonfatal
violence