A Review of the Increasing Impact and Effects of Air Pollution Throughout Life and Before Birth

Introduction

Air pollution is a major contributor to global morbidity and mortality, with nearly 6.7 million deaths worldwide attributed to air pollution in 2019 [1]. In the past decade, more than 30,000 studies have been published on the health effects of air pollution, many of them by the World Health Organization (WHO) [2,3]. The WHO continues to declare air pollution as a public health emergency and the most significant environmental threat to human health, and as a leading cause of premature death for up to 7 million people annually from stroke, heart disease, lung cancer, and respiratory infections [3]. The effects of environmental and domestic air pollution affect nearly the entire global population, causing unhealthy air, especially in low-income nations, and requiring urgent action through cleaner energy, transport, and waste management [3]. The main components of air pollution are associated with burning fossil fuels (Table 1) [2,3]. In 2021, the WHO updated the 2005 global air quality guidelines and identified the effects of the main environmental and domestic air pollution from particulate matter of a diameter ≤10 μm (PM10) or ≤2.5 μm (PM2.5), ozone, nitrogen dioxide, and sulfur dioxide (Table 1) [2,3].

Toxic particles in the air, mainly PM2.5, are inhaled and enter the bloodstream, affecting multiple organ systems in all age groups and the fetus in pregnant women [4]. The respiratory effects of air pollution are well-known and include pneumonia, asthma, and chronic obstructive pulmonary disease (COPD) [4,5]. Less well-known effects include cardiovascular diseases such as ischemic heart disease and stroke, neurological diseases such as dementia, the effects on male and female fertility, and on the mother and fetus, including low birth weight infants and stillbirths [5]. Although many studies have focused on the effects of air pollution on lung health, there is increasing evidence that air pollution impacts health at all stages of the life cycle and affects fetal development, birth outcomes, maternal health, child development, and all major systems from childhood to adulthood to old age (Table 2) [3,6]. This article aims to review what is currently known about the components of air pollution and their impact on human health, and to introduce recent global and European environmental and health recommendations.

Components of Air Pollution

At the beginning of 2026, the WHO estimates that up to 99% of the global population now lives in areas where air pollution levels exceed the WHO air quality guidelines, resulting in 4.2 million annual deaths from environmental air pollution (Table 1) [2,3]. Also, because 2.4 billion people heat their homes and cook their food with fuels that produce airborne pollutants, 3.2 million people die prematurely each year from household air pollution [6]. Environmental (ambient) and household (domestic) air pollution both result from incomplete combustion of fuels, gas generation, or chemical reactions between gases [6]. Evidence shows that environmental air pollutants with the strongest evidence for harmful effects on human health from short-term and long-term exposure include particulate matter (PM), ozone, nitrogen dioxide, and sulfur dioxide [6]. Table 1 summarizes the main environmental (ambient) and domestic (household) air pollutants and WHO guideline values [2,3]

Particulate matter (PM) is the name given to inhalable particles of specific sizes, composed of nitrates, sulphate, ammonia, sodium chloride, black carbon, mineral dust, or water [2,6]. Particulate matter is defined by particle size or aerodynamic diameter and includes particles with diameters of 2.5 μm (PM2.5) and 10 μm (PM10). Examples of PM10 include pollen and wind-blown dust, while the finer PM2.5 particles are associated with combustion of fuels or chemical reactions between gases and include black carbon (soot) [2,6]. Importantly, when PM2.5 and PM10 are inhaled, they can penetrate the lung through the alveoli and enter the bloodstream, which explains their association with lung disease, cardiovascular disease (including ischemic heart disease), and cerebrovascular disease (stroke) [6]. The ability of PM2.5 and PM10 to enter the bloodstream also explains their effects on perinatal outcomes [6].

Sulfur dioxide is a water-soluble colorless gas derived from the combustion of fossil fuels for industry, domestic heating, and power generation [6]. Inhalation of sulfur dioxide is associated with exacerbations of asthma and chronic lung disease [6].

Nitrogen dioxide is a water-soluble gas and a strong oxidant that forms in the environment from the high-temperature combustion of fuels used for transportation, heating, industry, and power generation [2,6]. Household sources of nitrogen oxides include fireplaces, furnaces, and gas ovens and stoves [6]. Inhalation of nitrogen dioxide can irritate the airways and aggravate respiratory diseases [6]. Importantly, nitrogen dioxide is a major ozone precursor [6].

Lead dust is mainly a household contaminant, derived from paint, plumbing materials, batteries, cosmetics, and gasoline [6]. Since 1999, lead has been emitted less frequently from vehicle exhaust due to international restrictions on its use [6]. Lead toxicity is a health risk for children and pregnant women, and is toxic to the central nervous system, causing seizures and coma [6].

Ground-level ozone is a common air pollutant in cities. Ozone is a major component of smog, formed by photochemical reactions with volatile compounds emitted by industry and vehicles [6]. Although the greatest concentrations of ozone occur above ground level and during sunny days, ozone is also a household pollutant [6]. Inhalation of high levels of ozone can impair breathing, trigger asthma attacks, reduce lung function, and lead to chronic lung diseases [6].

Carbon monoxide (CO) is an odorless and colorless gas that is an important household (domestic) air pollutant produced by the incomplete combustion of fossil (carbonaceous) fuels, mainly coal, wood, petrol, and natural gas in lamps, stoves, open fires, and fireplaces [6]. Environmental carbon monoxide pollution comes mainly from motor vehicles [6]. Inhaled carbon monoxide can rapidly diffuse across alveolar walls and into the bloodstream, reducing the ability of red blood cells to bind and carry oxygen [6]. The symptoms of mild carbon monoxide toxicity include hypoxia, breathing difficulties, exhaustion, and dizziness, but exposure to high levels of carbon monoxide can be fatal [6]. It is important to consider the adverse health outcomes from air pollution across different stages of life, including the effects on fertility, pregnancy outcomes, fetal and child development, child health, and the associations with adult disease, including cardiovascular and lung disease, mental health, cancer, and the effects on longevity (Table 2) [3,6].

Fetal Development and Low Birth Weight

Each year, more than 20 million infants are born with low birth weight, 15 million are born prematurely (before 37 weeks of gestation), and all these factors contribute to increased infant mortality [7]. Air pollution can affect long-term health, even before birth [7]. Inhaled air pollutants can enter the bloodstream, cross the placenta, and interact with the developing fetus [7,8]. Exposure to air pollution during pregnancy is experienced by the fetus and is supported by recent studies on the association between air pollution and gestational age at birth, birth weight, miscarriages, and the incidence of stillbirth [7,8]. Particles inhaled by the mother may affect the developing fetus in several ways, including by direct chemical effects, or by inducing inflammation that affects the maternal circulation, and by directly affecting the fetus [9,10]. Exposure of the pregnant mother to air pollution is associated with multiple adverse effects, including oxidative stress, inflammation, and increased blood pressure (pre-eclampsia) [10]. Inhaled particulate pollutants can alter blood flow between the umbilical cord and placenta, and reduce oxygen levels, which may be the mechanism for delayed fetal growth [9].

Pregnancy Loss and Birth Outcomes

Epidemiological data have shown that countries with the most environmental (ambient) pollution from PM2.5 have a significantly increased rate of pregnancy loss (both stillbirth and miscarriage) [11]. In 2021, Xue and colleagues assessed data from 34,197 mothers from South Asia, including India, Pakistan, and Bangladesh, and with measured levels of PM2·5 exposure between 2000 and 2016 [11]. After adjustment for maternal age, temperature, humidity, and seasonal variation, each 10 μg/m3 increment in PM2·5 was associated with an odds ratio for pregnancy loss of 1·03 (95% CI; range 1·02–1·05) [11]. Also, for the period 2000–16, an estimated 349,681 pregnancy losses per year were attributed to environmental air pollution >40 μg/m3, accounting for 7.1% of the total annual burden of pregnancy loss in South Asia [11].

Both low birth weight and preterm birth are risk factors for early mortality and increased adult morbidity [7]. In 2021, Ghosh and colleagues evaluated the global burden of low birth weight and preterm birth and the impact on reduced birth weight and gestational age associated with environmental and household PM2.5 pollution in 2019 [9]. This literature review and analysis showed that environmental and household PM2.5 levels were associated with reduced birth weight and gestational age, and neonatal and infant mortality, particularly in low-income and middle-income countries [9]. Also, the average reduction in gestational age attributable to PM2.5 exposure was 0.4–0.7 weeks (3–5 days) [9]. In 2017, Malley and colleagues reported findings from a global study of preterm births associated with maternal exposure to PM2.5 air pollution [12]. This study showed that 18% of all preterm births worldwide were associated with an annual average PM2.5 concentration >10 μg/m3 [12]. Recent estimates have shown that, worldwide, more than 2 million low-weight births and up to 6 million pre-term births could be avoided if PM2.5 pollution exposure during pregnancy was reduced from 2.4 to 5.9 μg/m3, which is a concentration range close to the WHO recommendations (of 5 μg/m3) [2,9].

Male Fertility

Most studies on the effects of air pollution on human fertility have investigated male fertility and have highlighted adverse associations with sperm parameters, including quantity, quality, and motility [13]. In 2022, Zhao and colleagues in China examined sperm quality in >30,000 men and identified an association between PM2.5 air pollution levels and sperm motility [13]. A recently published cross-sectional study by Fouks and colleagues evaluated 21,851 semen samples collected between 2005 and 2022 from men >18 years undergoing fertility evaluation in the US [14]. Increased PM2.5 exposure was associated with increased sperm DNA fragmentation, but with greater effects in men of lower socioeconomic status [14]. These authors also suggested that sperm DNA fragmentation could be a biomarker of environmental and social stress in men [14].

Childhood Lung Development

Childhood and adolescence are characterized by rapid growth of organ systems and increased neural development of the central nervous system, which means that there are expected effects of air pollution exposure that impact health, development, and vulnerability to chronic disease as they age [15]. In 2019, Mudway and colleagues evaluated lung function and lung volume in 2,000 children (age 8 to 9 years) in London, UK, between 2009 and 2014 at the beginning of the implementation of the Low Emission Zone regulations to reduce air pollution from vehicles [15]. Up to 5% of the expected lung volume was lost due to air pollution, due to exposure to nitrogen dioxide associated with exhaust from diesel-fuelled vehicles [15]. In 2000, Gauderman and colleagues published findings from a study of children in Southern California [16]. The study was undertaken over 4 years from 1993, involving three cohorts of children in the fourth, seventh, or tenth grade, and evaluated average exposure to ambient air pollutants with lung function testing [16]. In the fourth-grade child cohort, significant deficits in lung function were associated with exposure to PM10, PM2.5, nitrogen dioxide, and inorganic acid vapor, but not with ozone [16]. The estimated growth rate for children in the most polluted communities compared with the least polluted was predicted to result in a cumulative reduction in lung function of up to 5.0% during the 4-yr study period, with greater deficits in children who spent more time outdoors [16]. These findings were supported by the European Study of Cohorts for Air Pollution Effects (ESCAPE), which analysed data from up to 6,000 children from five European birth cohorts and showed that air pollution was associated with reduced lung function in children aged 6 and 8 years [17].

In 2023, Yu and colleagues reported findings from the prospective Swedish birth cohort BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology) spirometry study, which evaluated the associations between changes in ambient air pollution levels and lung function from childhood to young adulthood [18]. At year 8, beginning in 2002, with 16-year and 24-year follow-up, 1,509 participants underwent 3,837 spirometry measurements [18]. Measurements of ambient air pollution levels included PM2.5, PM10, black carbon, and nitrogen dioxide, were evaluated at residential addresses as air pollution control measures reduced these levels [18]. Reduced air pollution levels were significantly associated with improved lung function, which persisted and were not modified by asthma, overweight, early-life air pollution exposure, or dietary variations [18]. These study findings are important as they show that long-term reductions in air pollution can result in recovery of lung function between childhood and adolescence [18].

Childhood Asthma

Patients with asthma have worsening symptoms, increased hospital admissions, and increased mortality during and after periods of increased air pollution, particularly seen in children with asthma [19]. Experimental studies, including human exposure studies, have shown that air pollution, particularly with pollutants derived from traffic exhaust, results in lung inflammation, increases airway hypersensitivity, and sensitizes the airway to subsequent allergenic immune challenges [20]. In 2019, Orellano and colleagues reviewed 21 publications that showed a significant association between asthma exacerbations in children requiring hospitalization and air pollution levels of PM2.5, nitrogen dioxide, and sulfur dioxide [21]. These findings were supported by a systematic review and meta-analysis of 21 epidemiological studies published between 2000 and 2016 [22]. Significant associations were identified between the development of asthma in children and exposure to traffic-related air pollution, including PM2.5, PM10, black carbon, and nitrogen dioxide [22]. These findings were supported by the 2022 US Health Effects Institute review of 118 studies on children and traffic pollution [23].

Childhood Cardiovascular Development

There have been few long-term studies on the effects of air pollution on cardiovascular development and disease association in children and adolescents. However, studies in the US and the Netherlands have evaluated an association between arteriosclerosis (narrowing of arteries) in adolescents and traffic-related air pollution, including PM2.5 and nitrogen dioxide [24,25]. In 2023, Karamanos and colleagues studied 3,824 adolescents aged 11 to 16 years in the city of London as part of the Determinants of Adolescent Social Well-being and Health (DASH) cohort [26]. An evaluation of changes in blood pressure and long-term exposure to PM2.5 and nitrogen dioxide identified significant associations: PM2.5 levels were associated with an increase in systolic blood pressure, and nitrogen dioxide levels were associated with a decrease in systolic blood pressure [26].

Childhood Cognitive and Behavioral Development

Until 1999, the main concern regarding air pollution from traffic and harm to children’s brain function was from lead, which was used as an additive in petrol [27]. Lead was banned in petrol in European countries from 1999 [27]. Only recently has attention turned to the effects of other constituents of air pollution and associations with cognition, inattention, and hyperactivity in children. In 2016, Forns and colleagues reported the findings from a study investigating the effects of traffic-related air pollution and noise on behavioral development in children aged 7–11 years during 2012–13 in Barcelona, Spain [28]. This study was part of the BREATHE (BRain dEvelopment and Air polluTion ultrafine particles in scHool childrEn) project [28]. Indoor and outdoor concentrations of elemental carbon, black carbon, and nitrogen dioxide were measured at schools, and noise levels were measured inside classrooms [28]. Child behavioral development and attention deficit/hyperactivity disorder criteria were assessed [28]. The study found that increased levels of traffic-related air pollution were associated with behavioral problems in children, and that noise exposure was associated with symptoms of attention deficit/hyperactivity disorder [28].

In 2018, Alemany and colleagues reported the findings from a study of APOE genotypes for 1,667 children aged 7–11 years attending 39 schools in or near Barcelona [29]. This study also evaluated average annual outdoor concentrations of elemental carbon, polycyclic aromatic hydrocarbons (PAHs), and nitrogen dioxide at each school [29]. Magnetic resonance imaging (MRI) brain scans evaluated basal ganglia volume in 163 children between 2012 and 2014 [29]. The results showed that carriers of the APOEɛ4 allele and levels of PAHs, elemental carbon, and nitrogen dioxide air pollutants had significantly higher scores for behavior problems, inattentiveness, and a smaller volume of the caudate nucleus on MRI of the basal ganglia [29]. These findings indicate that long-term exposure to traffic-related air pollution can lead to cognitive and behavioral impairment in children, with genetic susceptibility that has similarities to that reported in Alzheimer’s disease [29].

Mental Health in Children and Adolescents

Factors that can affect the physical health and development of children and adolescents can also affect their mental health [30]. Although there have been increasing studies on the roles of diseases, such as diabetes, and on social and behavioral factors in mental illness in childhood, only recently has attention been given to the possible effects of air pollution in childhood to adolescence [30]. In 2019, Roberts and colleagues reported findings from a long-term study of 284 same-sex twins living in London from the age of 12 years into adolescence, investigating the relationship between air pollution exposure and mental health and behavior [31]. This study was part of the Environmental Risk (E-Risk) Longitudinal Twin Study [31]. Evaluations for anxiety, depression, conduct disorder, or attention-deficit/hyperactivity disorder were done at ages 12 and 18 years [31]. Annualized exposure to PM2.5 and nitric oxide concentrations was estimated from children’s home addresses at age 12 [31]. The results showed that by 18 years of age, adolescents with higher yearly air pollution exposure levels at the age of 12 years had a significantly increased risk of a major depressive disorder or a conduct disorder [31]. More recently, Reuben and colleagues extended this study to evaluate 2,232 children born between January 1994 and December 1995 in England and Wales, with follow-up to age 18 [32]. In this study, the authors investigated PM2.5 and outdoor nitrogen oxide levels, and their association with general psychopathology as the primary outcome and internalizing, externalizing, and thought disorder symptoms as secondary outcomes [32]. At 18 years, study participants exposed to higher levels of outdoor nitrogen oxide experienced a significant increase in psychopathology during the transition to adulthood and identified air pollution as a risk factor for adolescent psychopathy [32].

Lung Disease in Adults

Since the 1950s, the association between vehicular and industrial air pollution in cities (smog) has been recognized [7]. However, it took several decades to establish the impact of long-term exposure to air pollution and to distinguish these effects from other environmental factors [7]. The US Health Effects Institute study reviewed 22 studies in 12 high-income countries and identified 267,413 emergency department visits and hospitalizations due to asthma, and found associations with levels of air pollutants, including PM2.5, nitrogen dioxide, and ozone [23]. Previous studies have shown that adults with asthma are less affected by air pollution than children [19,21]. People aged 65 and older are more susceptible to air pollution than other adults, with even short-term exposure being associated with increased morbidity, including increased hospitalizations, from chronic obstructive pulmonary disease (COPD) exacerbations [33].

Cardiovascular Disease in Adults

The cardiovascular system is adversely affected by air pollution at all stages of life. In 1993, in the Six Cities Study, Dockery and colleagues identified the association between air pollution levels and increased hospitalizations and cardiac mortality [34]. In 2014, the ESCAPE project in Europe identified that acute ischemic cardiac events were associated with air pollution levels over a ten-year period and with effects at PM2.5 concentrations below the current European limit of 25 μg/m3 and below 15 μg/m3 [35]. In 2022, the US Health Effects Institute published the findings from a systematic review of published studies on the effects of long-term exposure to traffic-related pollution [23]. This review identified 352 studies over 40 years with data analysis that identified a significant association with deaths from peripheral vascular disease and ischemic heart disease [23].

Recent studies have shown that air pollution can exacerbate cardiac toxicity associated with certain treatments for cancer [36,37]. Air pollutants, including PM2.5, PM10, and gaseous emissions, including nitrogen dioxide and ozone, are associated with impaired cardiovascular outcomes, including impaired diastolic function and cardiac remodeling [36,38]. Analysis of epidemiological studies has shown that long-term exposure to PM2.5 is of concern, as each 10 μg/m3 increase in PM2.5 is associated with a 74.8% increased risk of heart failure [39]. In 2021, Coleman and colleagues reported the outcomes from a US population study of patients with cancer and cancer survivors and identified that PM2.5 was associated with a 1.32-fold increase in cardiovascular mortality, which was significantly increased in patients who received radiation therapy or chemotherapy [40].

A recently reported cohort study by Jung and colleagues included 580 patients with advanced breast cancer treated with anthracyclines and/or trastuzumab [37]. During and following treatment, cardiac function and remodeling were evaluated using laboratory tests, echocardiography, and evaluation of left ventricular ejection fraction (LVEF) [37]. The average three-year concentrations of PM2.5, PM10, nitrogen dioxide, and ozone were recorded [37]. At three-year follow-up, PM2.5 and ozone exposure were independently associated with reduced cardiac remodeling and function in treated patients with advanced breast cancer [37]. The authors concluded that cancer patients receiving potentially cardiotoxic therapies should consider reducing their exposure to environmental pollutants [37].

Mental Health, Cognition, and Dementia

There has been recent and increasing awareness that air pollution affects long-term mental health as well as cognitive decline and dementia [41]. In 2014, Stafoggia and colleagues identified a significant link between long-term exposure to high levels of PM2.5 and an increased risk of stroke across 11 cohorts in the study [42]. This association was observed even at ambient concentrations below the EU limits, with a 5 μg/m≥ increase in PM2.5 levels associated with a 19% increased risk of stroke [42]. In 2021, Bakolis and colleagues published findings from a prospective longitudinal population-based mental health survey of 1,698 adults (in 1,075 households) living in London between 2008 and 2013 [43]. Increased air concentrations of pollutants associated with traffic pollution, nitrogen dioxide, and PM2.5, were associated with 18–39% increased risk of mental disorders, including psychosis [43].

In 2022, Castellani and colleagues developed a policy agenda for research into the association between air pollution and dementia with recommendations to address knowledge gaps and identify social determinants that could be targeted, including transportation and urban planning [44]. The impact of ambient and household PM2.5 on brain health was highlighted in these recommendations [44]. In 2023, Thompson and colleagues identified 86 published studies on the effects of air pollution on adult cognition and identified evidence supporting an association, mainly with PM2.5 and nitrogen dioxide [45]. The finding that long-term exposure to air pollutants, including PM2.5, PM10, and nitrogen dioxide, is linked to decreased cognitive function, particularly in older adults, is important evidence that could drive policies to reduce air pollution [45].

Air Pollution and Cancer

In 1993, the Six Cities Study identified an association between long-term exposure to air pollutants and lung cancer in smokers and non-smokers [34]. In October 2013, the International Agency for Research on Cancer (IARC), the WHO specialized cancer agency, classified environmental air pollution and its major components, PM2.5 and PM10, as Group 1 carcinogens (carcinogenic to humans) [46,47]. Also in 2013, data from the ESCAPE study evaluated the association between air pollution and lung cancer incidence in a prospective study of 17 European cohorts [48]. This study also identified an association between air pollution and the incidence of bladder cancer [48]. Experimental and epidemiological studies on the association between air pollutants and human cancer have been supported by mechanistic studies [46,47].

There is a causal link between outdoor (ambient) air pollutants, mainly PM2.5, and lung cancer incidence and mortality [46]. In 2023, Hill and colleagues reported findings from a study of 32,957 cases of EGFR-mutated lung cancer and identified a significant association with PM2.5 levels [49]. Therefore, global increases in air pollution may also explain the reported increase in rates of lung cancer in non-smokers and never-smokers [50]. Air pollution also increases the risk of other types of cancer and reduces survival in cancer patients [51]. Chronic inflammation, oxidative stress, and direct DNA damage, which are carcinogenic factors, are facilitated by the ability of inhaled pollutants to enter the bloodstream [46,51]. However, even with increasing amounts of data on these associations, air pollution is still overlooked in predictive modelling of cancer risk and in public health recommendations and interventions [51].

International Recommendations on Air Pollution and Health

The WHO Ambient Air Quality Database (V6.1) was developed to compile global data on ground-based measurements of annual mean concentrations of nitrogen dioxide and particulate matter (PM10 and PM2.5), which are associated with the burning of fossil fuels [52]. Data is included from cities, towns, and areas near human settlements where human exposure to air pollution may occur [52]. This database has been updated since 2011, and the sixth version (V6.1) was released in January 2024 and includes data from more than 7,000 human settlements in more than 120 Member States [52].

In May 2025, at the 78th World Health Assembly (WHA78), the WHO Member States approved a new global roadmap to address the global crisis of air pollution and the effects on health and mortality [53]. This roadmap aims to set a target to halve premature deaths from air pollution by 2040 with integrated strategies to reduce pollution from energy and transport, and to prevent health problems related to air pollution [53]. Currently, approximately 99% of the world’s population lives in areas that exceed the WHO 2021 safe air quality guideline limits [2]. Currently, ambient air pollution is estimated to cause more than 4.2 million deaths globally each year [3]. Household air pollution, mainly from the use of inefficient cooking fuels, accounts for up to 3 million annual deaths worldwide [3,6]. Mortality from the effects of air pollution currently ranks as the main global cause of death from non-communicable disease, with low-income and middle-income countries being most affected, with up to 90% of the burden of mortality due to pollution [3].

In industrialized countries, such as the UK, and in large industrial cities, such as London, the combination of burning fossil fuels and the increased use of vehicles powered by them resulted in dramatic effects on health, which changed public policy in the 1950s [7]. The UK Clean Air Acts of the 1950s and 1960s initially led to rapid improvements in air quality, but air pollution in the UK has since worsened [7]. In 2016, the Royal College of Physicians (RCP) Working Party on Air Pollution and Health provided estimates of the increased morbidity and mortality due to air pollution and advised the introduction of a new Clean Air Act to address pollution from motor vehicles [7].

On 1st December 2025, the European Environmental Agency (EEA) issued an updated statement following an evaluation of the effects of air pollution in the European Union (EU) Member States [54]. The EEA highlighted air pollution as the single largest environmental health risk in Europe, resulting in premature death and disease [54]. In this recent statement, the EEA has estimated that in 2023, 182,000 premature deaths occurred in the 27 EU Member States due to PM2.5 at levels above the WHO recommendations [54]. The EEA identified that fine particulate matter, PM2.5, remains the air pollutant with the most substantive impact on health [54]. In Europe, most of the people now live in towns and cities where air pollution can reach high levels [54]. Short-term and long-term exposure to air pollution can lead to a wide range of diseases in adults [54]. Children and adolescents are particularly vulnerable to the effects of air pollution, which can damage health in childhood and increase the risk of diseases later in life [54]. Therefore, children are particularly vulnerable to the effects of air pollution [54]. In Europe, PM2.5 is the air pollutant driving the most significant health problems, with residential and commercial energy consumption as the principal sources of particulate matter, and agriculture as an important source of PM10 [54]. The EEA has reported that between 2005 and 2023, emissions of PM2.5 and PM10 fell by 38% and 36%, respectively [54].

Following the publication of the 2021 WHO air quality guidelines [2], on 23rd October 2024, the European Union (EU) set standards for reducing key air pollutants in the Ambient Air Quality Directives (2024/2881) [55]. The new EU standards are more closely aligned with the recent WHO recommendations and include a zero-pollution action plan to reduce air, water, and soil pollution by 2030, with further targets for 2050 [55]. The two main targets for air pollution are to reduce premature deaths by more than 55% (compared to 2005) and to reduce air pollution threats to biodiversity by 25% (compared to 2005) [55].

Conclusions

The global health burden from air pollution may yet reach a peak due to the cumulative effects of long-term exposure across all systems and at all ages. There is also increasing evidence of the effects of air pollution on human health throughout life and before birth, highlighting the need to develop local, national, and global policies to address modifiable environmental risks and protect human health at all stages of life.