Health impacts of air pollution in Europe, 2021

Policy context 

In 2021, the World Health Organization (WHO) published new air quality guidelines, updating the 2005 air quality guidelines on the basis of a systematic review of the latest scientific evidence of how air pollution damages human health.

The European Union (EU) has also set standards for key air pollutants in the ambient air quality directives. Where levels exceed these standards, Member States should prepare an air quality plan or programme to address the sources responsible and ensure compliance. Although these values were based on the 2005 WHO air quality guidelines, they also reflect the technical and economic feasibility of their attainment across EU Member States. The EU air quality standards are therefore less demanding than the WHO air quality guidelines.

Under the European Green Deal’s Zero Pollution Action Plan, the European Commission set the 2030 goal of reducing the number of premature deaths caused by PM_2.5 by at least 55% compared with 2005 levels. To this end, the European Commission initiated a revision of the ambient air quality directives, aiming to align the air quality standards more closely with WHO recommendations. The revision also aims to strengthen provisions on air quality monitoring and modelling, and on the development of air quality plans to help local authorities achieve cleaner air. In parallel, stricter requirements are also foreseen to tackle air pollution at source, such as from agriculture, industry, transport, buildings and energy.

This chapter directly supports the revision of EU air quality rules by providing a preliminary analysis of the health benefits of moving closer to WHO recommendations on air quality in the EU. It also assesses progress towards the Zero Pollution Action Plan target of reducing the health impacts of air pollution by more than 55% by 2030.

Potential health benefits of achieving the EU limit values and WHO guideline levels for fine particulate matter

The EEA undertook a preliminary assessment of the potential benefits to human health — in terms of avoided premature deaths — of reducing fine particulate matter (PM_2.5) air pollution across the EU to meet limit values established by the EU and guidelines set by WHO in 2021. Annual mean concentrations of PM_2.5 in 2019 were taken as the point of departure and the following five standards and guideline levels were considered:

• EU limit value of 25 µg/m³
• EU indicative limit value of 20 µg/m³
• 2021 WHO interim target 3 of 15 µg/m³
• 2021 WHO interim target 4 of 10 µg/m³ (the 2005 WHO air quality guideline)
• 2021 WHO air quality guideline of 5 µg/m³

Table 1 describes the minimum health benefits that would have been achieved if, in 2019, all areas in the EU-27 had met the range of air quality concentrations for PM_2.5 included in the EU standards and WHO guideline levels. It also shows the percentage change in relation to the situation in 2005, allowing for comparison with the target in the Zero Pollution Action Plan. Table 2 presents the minimum health benefits by country.

It is important to note that the assessment assumes that all areas in the EU-27 that were above each standard or guideline for PM_2.5 in 2019, had instead reached each respective standard or guideline, while all other areas maintained the concentrations observed in 2019. As such, these estimates represent the minimum benefits that would result from improvements in air quality across the EU. The measures required to bring down concentrations in areas that were above a certain standard or guideline in 2019 would also reduce concentrations in areas already below the respective level, in particular for the WHO interim targets 3 and 4. Additional reductions in premature deaths would therefore also be seen in those areas and these benefits are not captured in this analysis, making it an underestimate of the potential health benefits.

Table 1. Theoretical health benefits, in terms of reductions in premature deaths, that would have been attained for the EU-27 in 2019 if the different EU limit values and WHO guidelines for PM_2.5 had been met across Europe 

Note: The WHO interim targets and guidelines are drawn from the updated guidelines published in 2021.

Had the EU limit value for PM_2.5 of 25 µg/m³ been attained across Europe in 2019, the estimated number of premature deaths would remain unchanged compared to the estimation with the 2019 real concentrations.

Had the EU indicative limit value of 20 µg/m³ been attained, only 1% fewer deaths would have been expected in the EU-27 and around 2% fewer across all 41 countries included in the analysis.

In contrast, had the WHO interim target 4 for PM_2.5 of 10 µg/m³ been attained everywhere in Europe in 2019, premature deaths would have been at least 21% lower in the EU-27, and 22% lower across all 41 countries.

Finally, had the new WHO air quality guideline for PM_2.5 of 5 µg/m³ been attained across Europe in 2019, the related premature deaths would have been 58% lower than in 2019 in both the EU-27 and all the European countries considered. Work is ongoing in the context of the revision of the EU ambient air quality directives to determine whether achieving PM_2.5 concentrations of 5 µg/m³ is technically feasible across the EU, given the influence of geographical features in some areas.  

Map 1. Minimum benefits for each country, in terms of reductions in premature deaths, had the WHO air quality guideline for PM_2.5 of 5 µg/m³ been achieved in all areas of Europe that had mean annual concentrations above the guideline in 2019

Progress towards the Zero Pollution Action Plan target on air pollution

The Zero Pollution Action Plan sets the target of improving air quality, with a focus on PM_2.5, in order to reduce the number of premature deaths caused by air pollution in the EU by a minimum of 55%, relative to 2005 levels. The EEA estimates that 456,000 premature deaths were attributable to exposure to PM_2.5 in 2005 in the 27 Member States of the EU. Achieving a 55% reduction would imply that premature deaths fell to 205,000 per year.

In terms of the past trend, from 2005 to 2019 premature deaths attributed to PM_2.5 exposure in the EU 27 fell by 33% to reach 307,000 (see Figure 1). Should air quality continue to improve, and the number of premature deaths per year continue to fall at a comparable rate in the future, then the target would be achieved by 2032, as shown in Figure 1. However, continuously reducing concentrations of particulate matter in ambient air over the next decade will be demanding. To meet the target, Member States will need to fully implement their national air pollution control programmes (NACPCs), as well as measures needed to reach the 2030 climate and energy targets (European Commission, 2021). Furthermore, the trends in aging and urbanisation of the European population counteract some of the health gains associated with the reduction in ambient air pollution concentrations. An older population is more sensitive to air pollution and a higher rate of urbanisation typically means that more people are exposed to PM_2.5 concentrations, which tend to be higher in cities.

Figure 1. Premature deaths attributed to PM_2.5 in the EU-27 from 2005-2019, and distance to the target of a 55% reduction in the 2005 levels of premature deaths

Note: To estimate premature deaths, all-cause (natural) mortality is considered in people aged over 30 years for all concentrations, assuming a linear increase in the risk of mortality of 6.2% for a 10 μg/m³ increase in concentrations of PM_2.5
The trend in premature deaths is based on a future projection of the past rate of reduction in premature deaths.
Source: ETC/ATNI, 2021
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The analysis of the potential benefits of meeting different EU limit values and WHO guideline levels indicates that the target to reduce premature deaths by 55% can only be met by lowering concentrations of PM_2.5 across the EU to levels comparable to the 2021 WHO air quality guideline.  

Had the WHO interim target 4 for PM_2.5 of 10 µg/m³ (the 2005 WHO air quality guideline) been attained across the EU-27 in 2019, this would have delivered a reduction in premature deaths of at least 47% on 2005 levels (see Figure 2 and Table 1). This would not have been sufficient to meet the Zero Pollution Action Plan target in full in 2019, although it is important to note that this does not capture the benefits of reducing pollution in areas that were already at 10 µg/m³ or less in 2019.

However, had the new WHO air quality guideline for PM_2.5 of 5 µg/m³ been attained across the EU-27 in 2019, then this would have delivered a reduction in premature deaths of at least 72% compared with 2005 levels (see figure 2).

Bringing PM_2.5 concentrations closer to the 2021 WHO air quality guideline would therefore deliver significant health benefits in Europe. EU air quality standards are a crucial policy tool driving improvements in air quality. The closer alignment of EU air quality standards with WHO recommendations would therefore represent an important step towards cleaner air in Europe. 

Figure 2. Percentage reduction on 2005 premature deaths that reaching different EU limit values and WHO guidelines across the EU-27 could deliver

Note: The graph presents the estimated minimum reduction in premature deaths due to exposure to PM_2.5 compared with 2005, had different EU limit values and WHO guidelines for PM_2.5 been met in the EU-27 in 2019.

Health impacts of air pollution in Europe in 2019

Estimations of the mortality in 2019 linked to exposure to the air pollutants deemed most harmful for human health are presented in this final section.

In 2019 in the EU-27:

• 307,000 premature deaths were attributed to exposure to PM_2.5
• 40,400 premature deaths were attributed to exposure to nitrogen dioxide (NO₂)
• 16,800 premature deaths were attributed to exposure to ozone (O₃)

In 2019 in the 41 European countries considered:

• 373,000 premature deaths were attributed to exposure to PM_2.5
• 47,700 premature deaths were attributed to exposure to NO₂
• 19,070 premature deaths were attributed to exposure to O₃ 

The number of premature deaths attributed to air pollution fell in 2019 compared to 2018. The greatest decrease was for NO₂, with a reduction of 16% in the associated premature deaths. Premature deaths attributed to exposure to fine particulate matter decreased by 11%, while those attributed to exposure to ozone decreased by 9%.

Table 3 presents the total country population, the population-weighted mean concentrations, and the estimated number of attributable premature deaths by country.

Table 4 presents years of life lost (YLL), and the YLL per 100,000 inhabitants associated with exposure to PM_2.5, NO₂ and O₃ concentration levels in 2019.

The sections below provide information at country level on the health impacts of key pollutants. For specific information on the pollutants, concentrations and their sources, please see the chapter on Europe’s air quality status 2021 - update.

Additional information on the data and the methodology used can be found in the Eionet ETC/ATNI report 10/2021, Health risk assessments of air pollution.

• PM_2.5
• NO₂
• O₃