Air pollution is killing millions — it’s time to hold ourselves accountable for the harm it causes

The COVID-19 pandemic has claimed the lives of more than six million people — that figure is shocking and a tragedy.

But perhaps more shocking, though, is that people worldwide have been victims of another silent killer for years — one that now kills more people every year than COVID has in two: air pollution.

Estimates by the World Health Organization (WHO) reveal that 7 million people lose their lives every year as a result of air pollution. WHO estimates that 9 in 10 people breathe air containing high levels of pollutants.

Breathing fine particulate matter — known as PM2·5 — can exacerbate not only chronic lung diseases, but also harm lung development, lead to higher rates of breast cancer, cause earlier onset of neurological diseases like Alzheimer’s and Parkinson’s and increase heart attacks and stroke.

An estimated 90% of children worldwide grow up breathing polluted air, direct harm that is completely out of their control and which could have implications for the rest of their lives.

Air pollution is a global health crisis that has largely flown under the radar for years, but one that will increasingly take centre-stage as the fight against climate change ramps up.

Many air pollutants are also greenhouse gases, and, as such, they accelerate climate change. This means the impacts of air pollution occur both directly — when it causes health issues — and indirectly, by accelerating climate change.

As temperatures rise, an increased occurrence of extreme weather events and rising sea levels will pose further threats to human health. This makes tackling air pollution an important priority for planetary health, a concept that describes the interactions between human health and the environments we depend on.

These risks are concentrated in cities where a growing number — now more than 70% — of people worldwide live. Accelerating efforts to tackle air pollution in cities has the potential to slow and reverse the trajectory of a rising burden of disease caused by the phenomenon.

This is demonstrated in a recent study that found declines in PM2·5 levels in the early phase of the pandemic were associated with significantly fewer heart attacks across the United States. But this potential remains largely untapped.

Accountability for health is largely siloed within the health sector and away from construction, transport, housing and urban development — all of which can play a critical role in determining the quality of the air we breathe.

What is required is a cross-cutting approach that aligns the core business of organisations with the critical goal of improving air quality.

The 2022 theme of World Health Day was Our Planet, Our Health. This concept challenges us to imagine a world where clean air is available to all, and where people have control of their health and that of the planet.

With global economic systems in post-pandemic recovery mode, we are presented with a historic opportunity to build healthy, livable and sustainable cities. This will require meaningful and actionable commitments from those designing and financing the urban projects that shape the future of cities.

Healthy and sustainable cities will require institutionalised mechanisms for inclusive and participatory urban health governance that includes young people. These activities must be supported by robust and reliable real-time data on how urban environments are changing, and how the changes influence health.

Air pollution is an entry point to planetary health. To catalyze action for clean air — to improve health and tackle climate change — we must reform how we think about accountability for air pollution and health.

Implementers, funders, educators and civil society as a whole can play a role in this movement to health-proof and climate-proof our futures.

For implementers, we propose participatory measurement and governance of urban decision-making, centred on planetary health. Given the interdependencies between air pollution, climate change and health, policy actors have an opportunity to implement innovative reforms of the overarching systems that govern health.

One example of such an approach is an integrated community-oriented primary health and climate care system, which links climate resilience with primary prevention of disease. The backbone of such a system is the integrated surveillance of disease, socio-economic determinants of health, and environmental risks such as air pollution.

Such a system could identify sources of spikes in air pollution, for example, or identify increases in hospital admissions due to childhood asthma.

Additionally, implementers — also including those in the private sector responsible for designing and building urban development and infrastructure projects — can commit to centring planetary health in all urban infrastructure development initiatives.

Investors and funders can prioritise support for projects that promote cross-sectoral collaboration to broaden access to healthy urban environments. This could be through initiatives that support the establishment of cross sectoral offices, such as the Rockefeller 100 Resilient Cities initiative, or by exploring the potential of public-private partnerships like social impact bonds.

Another approach funders could consider against the rising air pollution is supporting entrepreneurial challenges that encourage collaboration on innovative solutions to tackle planetary health challenges.

Education and research institutions should accelerate efforts to build their pipeline of intersectional thinkers through joint degree programs or courses.

Existing examples include Sunway University’s development of a planetary health curriculum, for all undergraduate students irrespective of degree. We also recommend an increase in funding for catalytic planetary health research across disciplines, and in partnership with non-academic collaborators.

Individuals and civil society organisations can play a role, too, by engaging in activities that harness and integrate advocacy on climate and health for evidence-informed activism, and to inform decision-making priorities. One example is the UrbanBetter Cityzens Initiative, which engages young people in sensing their environments — like air quality measurements — and the way these factors influence their health, with a view to informing initiatives to shape urban design and development for planetary health.