This document discusses air pollution and its impacts on public health. It notes that air pollution from both indoor and outdoor sources contributes significantly to non-communicable diseases (NCDs) such as heart disease, stroke, cancer and respiratory diseases. Small particulate matter (PM2.5) is highlighted as a major risk factor that penetrates deep into lungs and affects health. The World Health Organization (WHO) estimates that air pollution contributes to around 7 million deaths globally per year. The document calls for stronger policies and interventions to reduce air pollution and protect public health.

1. Public health and environment1 |
Air Pollution and Health –
Evidence, impacts and policy
options: the future direction of
clean air policy
Dr Carlos Dora
Coordinator
Department of Public Health and Environment
Key messages for mini-campaign

2. Public health and environment2 |
2 in 3 deaths are from NCDs
Cardiovascular disease, mainly heart
disease, stroke
Cancer
Chronic respiratory diseases
Diabetes
Injuries
Today Enormous Burden of NCDs
Costs: Trillions of U$ dollars

3. Public health and environment3 |
Vulnerable (urban, older) populations
are growing rapidly

4. Public health and environment4 |
Risk factors for NCDs most often
considered:
• Tobacco
• Physical inactivity
• Diet (fat, sugar, fiber…)
• Excess use of alcohol

5. Public health and environment5 |
PM<10mm – Coarse
PM<2.5mm – Fine
PM<1mm – Ultrafine
Medgadget .com
Air Pollution is a major risk to NCDs
Substantial new evidence showing that particles smaller than 2.5mm
penetrate deep into the lungs and effect the body more systematically
leading to diseases like stroke, heart disease, in addition to the
cancers, COPD and pneumonia/URLI.

6. Public health and environment6 |
Lungs exposed to tobacco and to Indoor air
pollution
Pathology slides - Courtesy Prof. Saldiva, São Paulo, Brazil

7. Public health and environment7 |
“Review of evidence on health aspects of air
pollution - REVIHAAP”, WHO 2013
selected conclusions on PM (A1)
Confirm and strengthen results form the 2005 WHO Guidelines on
Air Quality and Health.
–New studies on short- and long-term effects;
–Long-term exposures to PM2.5 are a cause of
cardiovascular mortality and morbidity;
–More insight on physiological effects and plausible
biological mechanisms linking short- and long-term PM2.5
exposure with mortality and morbidity;
–Studies linking long-term exposure to PM2.5 to several new
health outcomes (e.g. atherosclerosis, adverse birth
outcomes, childhood respiratory disease).
7

8. Public health and environment8 |
Meta-analysis of the association between long-term
exposure to PM2.5 and cardiovascular mortality
1.00 2.001.15
Study %
weight
RR (95%CI)
per 10 µg/m3
Hoeketal,EnvHealth2013
8
2002
2011
2011
2011
2012
2013
2012
2011
2007
2008
Pub.
year

9. Public health and environment9 |
Mortality and long-term exposure to PM2.5
Cesaronietal.EHP2013
c= % increase in risk per 10
µg/m3
c=10
%
c=6%c=4%
AQG EU LV
9
Results of a cohort study in Rome
(1.3 million adults followed from
2001 to 2010)
PM2.5: 3-dimensional Eulerian model (1x1 km)

10. Public health and environment10 |
Carotid artery wall thickness (=risk of atherosclerosis)
and long-term PM2.5 exposure
AQG EU LV
Bauer et al, JACC 2010
%change
inarterywall
thickness
Home outdoor PM2.5 (µg/m3)
10
Heinz Nixdorf RECALL study, Ruhr region, Germany

11. Public health and environment11 |
Long term O3 exposure and risk of
death due to respiratory causes
ACS cohort of 448 thousand adults followed for 18 years
11Jerrett et al, NEJM 2009
RR per 10 ppb = 1.040 (95% CI
1.010 - 1.067)
(2-pollutant model with O3 and
PM2.5)

12. Public health and environment12 |
Short-term exposure to ozone, mortality and hospital
admissions
European cities in the APHENA study
Outcome
Per cent increase in deaths/admissions (95% CI)
per 10 µg/m3 increment in daily maximum
1-hour ozone concentrations
Single pollutant Adjusted for PM10
All-cause mortality a 0.18 (0.07–0.30) 0.21 (0.10–0.31)
Cardiovascular mortality: 75
years and older a
0.22 (0.00–0.45) 0.21 (-0.01–0.43)
Cardiovascular mortality:
younger than 75 years a
0.35 (0.12–0.58) 0.36 (0.10–0.62)
Respiratory mortality b 0.19 (-0.06–0.45) 0.21 (-0.08–0.50)
Cardiac admissions: older than
65 years a
-0.10 (-0.46–0.27) 0.64 (0.36–0.91)
Respiratory admissions: older
than 65 years b
0.19 (-0.28–0.67) 0.32 (0.05–0.60)
12
a lag 0-1 results; b lag 1 results Katsouyanni et al 2009

13. Public health and environment13 |
REVIHAAP: Indoor, occupational and commuting
exposures vary more than exposure to OAP
•In the absence of tobacco smoke:
Commuting can increase exposures to PM, NO2, CO and
benzene, and is a major contributor to the exposure to UFP, BC
and metals (Fe, Ni and Cu in the underground);
Ambient air dominates population exposures to NO2 (not gas
appliances), PM2.5, BC, O3, CO and SO2 (also BaP, As, Cd, Ni and
Pb);
The high end of the individual exposures to PM10-2.5 and
naphthalene originate from indoor sources and commuting;
Solid fuel fired indoor fireplaces and stoves, where used in
suboptimal conditions, dominate the high end of the exposures to
PM2.5, BC, UFP, CO, benzene and BaP of the affected individuals.
13

14. Public health and environment14 |
IARC 2012 finding: Diesel a carcinogen
LONDON/GENEVA (Reuters) - The air we breathe is laced with
cancer-causing substances and is being officially classified as
carcinogenic to humans, the World Health Organization's cancer
agency said on Thursday.

15. Public health and environment15 |
Ischemic and thrombotic effects of diluted diesel
exhaust inhalation in men with coronary heart
disease
Myocardial ischemia during 15-minute
exercise-induced stress and exposure to
diesel exhaust or filtered air in 20
subjects
Millsetal,NEJM2007
15

16. Public health and environment16 |
Deaths attributed to HAP + Outdoor Air
Pollution
~ 7 million deaths globally in 2012
AP a main RF for around 1/5 of NCDs

17. Public health and environment17 |
Estimating human exposure to air
pollution
Burden of disease is estimated from:
1. Air pollution concentrations & human exposure
2. Evidence from epidemiology about the health impacts of
air pollution
1. Diseases affected
2. Disease response to levels of AP (dose-response curves)
3. Baseline disease rates
4. Counterfactual – e.g. zero pollution, lowest existing
levels.

18. Public health and environment18 |
Estimates of outdoor air pollution exposures
used by WHO for BOD estimates
Brings together existing data from:
1. Urban ground monitoring stations – pollutant
concentrations
2. Satellite remote sensing (sparsely covereed areas)
3. Estimates of air pollution levels based on emissions
from sectors (e.g. transport, industry, power production,
etc.)
Mathematical models - combining information from monitoring, from
satellite remote sensing, chemical transport models to fill gaps and improve
estimates

19. Public health and environment19 |
Burden is from household as well as
ambient air pollution
Indoor Air Pollution
~50% of all pneumonia deaths among children under 5
~30% of all COPD (Chronic obstructive pulmonary disease) deaths
~18% of disease & deaths from ischaemic heart disease
Outdoor Air pollution
~22 % of disease & deaths from ischaemic heart disease
~15 % of deaths from pneumonia in children under 5
~5% of COPD deaths – (from ambient ozone pollution)
Air pollution also is a factor in: Cancers, Asthma (ozone), Cataracts,
Adverse pregnancy outcomes, TB
(WHO, 2009/Lim, Lancet, 2012)

20. Public health and environment20 |
4.3 million deaths were attributed to
household air pollution exposure in 2012
• Over half of deaths from
childhood pneumonia are
attributed to the exposure to
HAP
• 88% of these deaths are to non-
communicable diseases like
cardiovascular disease and
chronic obstructive pulmonary
disease (COPD).
534,000
12%
272,000
6%
928,000
22%1,462,000
34%
1,096,000
26%
ALRI
Lung cancer
COPD
Stroke
IHD

21. Public health and environment21 |
HAP Exposure, 2012
• 2.9 billion people
exposed or…
• 42% of the global
population
• % exposed has
decreased, but the
absolute # exposed
has remained
relatively constant

22. Public health and environment22 |
Existing WHO Air Quality Guidelines (AQG)
• Global update (ambient)
2005:
– PM2.5, PM10
– Chapter on IAP
• Indoor AQG:
– Dampness and Mould:
2009
– Selected pollutants: 2010
– Household fuel
combustion: this project

23. Public health and environment23 |
New Air Quality
Guidelines:
for fuels and technologies
used for cooking, heating
and lighting in the home:
1. Don't use Kerosene
2. Don't use Coal
3. Use only very
efficient cookstoves
(following emission rates
provided by WHO)
4. Use clean fuels – LPG,
Biogas, ethanol…

24. Public health and environment24 |

25. Public health and environment25 |
Household air pollution data base
(WHO)
• Data from over 800 household surveys
• Survey information about fuels and technologies used for
cooking,
• Now adding questions on heating, lighting, stacking
• Base for estimates of IAP and related mortality

26. Public health and environment26 |
Energy solutions that work in
your context
• Test them to check they are clean
– Using the emission rates given in the guidelines
• Evaluate actual use and satisfaction of user
– To avoid fuel stacking
• Evaluate health benefits and air pollution
reductions in a sample of users/non users
– To demonstrate costs and benefits

27. Public health and environment27 |
Extensive Evidence Reviews
• Fuel use: Global; for cooking, heating & lighting
• Emissions: range of technology & fuel options, how
relate to AQG
• Levels: HAP and exposure
• Health impacts of HAP: risk for pneumonia, COPD,
lung cancer, etc., including exposure-response.
• Burns and poisoning: risks, burden and interventions
• Intervention impacts: HAP/exposure in routine use
• Adoption at scale: barriers and enablers,
costs/benefits, finance

28. Public health and environment28 |
Model linking emissions to air quality
Inputs:
• Emission rates:
– PM2.5
– CO
• Kitchen volume
• Air exchange
rate
• Duration of use
(hours per day)
Outputs:
• Predicted
average
concentrations
of:
– PM2.5
– CO
Assumes uniform mixing of pollutants and air in kitchen

29. Public health and environment29 |
Focus on emissions reductions – why?
• Outdoor  indoor
• Evidence base stronger
than for other approaches
• Implementation practicality
– via design, production,
standards, etc
• Some options (clean fuels),
are relatively independent
of user behaviour.

30. Public health and environment30 |
3.7 million deaths were attributed to
ambient air pollution exposure in 2012
Breakdown of by disease
~21 % of all deaths from
ischaemic heart disease (IHD)
~23% of all deaths due to stroke
~13 % of all deaths to chronic
obstructive pulmonary disease
(COPD)

31. Public health and environment31 |
Urban Air Quality Data (WHO)
1600 cities, but sparse coverage for Africa, Latin America, Middle East
– no coverage in rural areas

32. Public health and environment32 |
First World Health
Assembly Resolution on
Air Pollution and Health
7 million deaths a year due to household and
ambient air pollution

33. Public health and environment33 |
The resolution:
• key role health authorities in raising awareness about
the potential to save lives and reduce health costs, if air
pollution is addressed effectively.
• Need for strong cooperation between different sectors
and integration of health concerns into all national,
regional and local air pollution-related policies.
• It urges Member States to develop air quality
monitoring systems and health registries to improve
surveillance for all illnesses related to air pollution;
• It urges Member States to strengthen international
transfer of expertise, technologies and scientific data
in the field of air pollution.

34. Public health and environment34 |
Asks the WHO Secretariat:
• To build capacity to implement the "WHO air quality guidelines"
and "WHO indoor air quality guidelines;
• Regularly update the WHO guidelines
• Compile and analyse data on air quality, health
• Conduct cost-benefit assessment of mitigation measures;
• disseminate evidence-based best practices on effective indoor and
ambient air quality interventions and policies related to health
• Advance research into air pollution’s health effects and
effectiveness.
• Propose a road map for an enhanced global response by the
health sector that reduces the adverse health effects of air pollution.

35. Public health and environment35 |
collaborate, as appropriate, with relevant international, regional and
national stakeholders, to compile and analyse data on air
quality, with particular emphasis on health
related aspects of air quality
to create, enhance and update, in cooperation with relevant United Nations
agencies and programmes a public information tool of WHO analysis,
including policy and cost-efficiency
aspects, of specific and available clean air technologies to address the
prevention and control of air pollution, and its impacts on health;
advise and support tools to assist the health and other
sectors at all levels of government, especially the local level and in urban
areas, taking into account different sources of pollution in tackling air
pollution and their health effects;
raise awareness of the public health risks of air pollution and th
multiple benefits of Improved air quality, in particular in the
context of the discussions on the post
- 2015 development agenda
cooperation with relevant United Nations agencies

36. Public health and environment36 |
Focus on the sources of AP: Energy-efficient
homes reduce air pollution & other housing risks
such as...
Housing risks
• Indoor/outdoor air pollution
• Damp, mould & allergens
• Poor indoor ventilation
• Planning, transport access
• Urban waste, sanitation & water
• Heat Island
• Storms/flooding
Health impacts
• Chronic/acute respiratory disease
• Allergies, respiratory disease
• Respiratory disease
• Physical inactivity, NCDs, traffic injuries
• Water and sanitation-borne disease
• Strokes
• Injuries/poverty

37. Public health and environment37 |
« Improved
insulation saved
0.26 months of
life per person »
(UK Warm Front
Programme)
Housing that is good for health
Reduction of
respiratory
illness by 9% to
20% and
increase of
individual
productivity
between 0.48%
and 11% with
natural
ventilation
startegies
« Reduced
wheezing, days-off
school, doctors'
visits were reported
by occupants of
insulated homes
« (NZ Insulation
study)
Photo 1
(graphic, table,
map, etc) zone

38. Public health and environment38 |
Health co-benefits in housing
Energy-efficient heating, cooling and natural ventilation
can reduce strokes and respiratory illness as well as
TB and vector-borne diseases;
A focus on slums /sub-standard housing - where needs
are greatest/benefits could be multiplied
Solar hot water heating - India
Slum in Mexico City

39. Public health and environment39 |
Light a billion lives – solar substitutes kerosene, India
Solar hot water heating is an fast-growing, popular technology in
Turkey, China, South Africa, Middle East, etc.
China is mass marketing next-generation solar PV & passive. Below
passive solar "combi" hot water space heating raised night-time
winter temperatures from 6-8º C lows in village near Beijing
Health co-benefits in energy

40. Public health and environment40 |
Cape Town, South Africa's Kuyasa neighborhood slum upgrade: First
to be financed by UN Clean Development Mechanism (CDM). Solar
hot water systems, sewage and insulation (below) will help reduce
heat-related, respiratory and waterborne diseases.
Health Impact Assessment of urban innovations
can demonstrate health benefits and enhance
global support and financing for scale-up

41. Public health and environment41 |
A significant fraction of NCDs is attributable to
exposure to traffic-related air pollution
Source: APHEKOM

42. Public health and environment42 |
Gain in life expectancy (months) in 25 Aphekom cities for a
decrease in PM2.5 to WHO AQG (10 μg/m3) (age 30+)

43. Public health and environment43 |
•
Better fuels and engines help, but
private vehicle transport increases
congestion, injuries, pollution, and
physical inactivity.
Rapid transit/NMT improves access
to schools, jobs & services for poor,
children, women, elderly & disabled,
improving equity. It can reduce injury,
cardiovascular disease & support
healthy physical activity.
Cycling to work reduced premature
mortality by 30% among commuter
groups in Shanghai & Copenhagen.
'Healthy' urban transport can reduce chronic
disease, injuries and improve health equity

44. Public health and environment44 |

45. Public health and environment45 |
Evidence: Health outcomes directly linked to type of
urban infrastructure investment
Infrastructure for different travel modes (including presence and proximity of infrastructure)
Increased walking, cycling or active
transport
94,133,138,144,146,147,154,175,223–229
Less active transport
179
Increased physical
activity
104,154,155,160,176,184,223,228,230–239
Reduced BMI or
obesity
111,118,119,165,224,234,238–240
Reduced air pollution-related effects
234
Improved reported health status
224
Reductions in specific health problems
222,224
More infrastructure
facilitating walking
(including general
assessments of
“walkability” of
neighbourhoods as
well as presence of
specific features, e.g.
pavements)
Lower mortality / higher life expectancy
47
Increased walking, cycling or active
transport
94,136–139,141,144,171,175,241–243
More infrastructure
facilitating cycling
Increased physical
activity
27,104,157,159,161,184,244
Increased walking, cycling or active
transport
44,133,140,146
Less walking, cycling or
active transport
89,94,150,152,179,245
Increased physical activity
103,140,157,159,182
Reduced BMI or obesity
113,117
More infrastructure
facilitating public
transport use
Reduced air pollution-related effects
246
Increased walking, cycling or active
transport
245,247
Less infrastructure
facilitating car travel
(including parking,
motorways)
Reduced BMI or obesity
73
Review of
studies on
infrastructure
investment,
physical
activity and
health –
WHO/Health in Green
Economy
(forthcoming)

46. Public health and environment46 |
Effectiveness of interventions - BCA:
WHO tool for estimating health economic
gains from cycling
HEAT for cycling and user guide from
www.euro.who.int/transport/policy/20070503_
1

47. Public health and environment47 |
Access to clean/sustainable energy in
Health Care
• Adopt energy efficient medical technologies
• Substitute diesel generators for sustainable sources (solar, hydro…)
• Access to sustainable transport
• Energy efficient buildings …
Solar suitcase powering a health
care facility in Nigeria.
Solar powered refrigerator in
Vietnam.

48. Public health and environment48 |
A vision of
health &
equity in
Sustainable
Development

49. Public health and environment49 |
Preventing disease – addressing their route causes in
the environment and in development

50. Public health and environment50 |
Global Platform on Air Quality and Health
• To ensure best estimates of human exposure to air pollution will continue to
be regularly available for Burden of Disease estimates, as well as to ensure
accountability, transparency and wide access of these results worldwide.
• Established in January 2014,
• A wide collaboration with international agencies including UNECE, WMO,
UNEP, JRC, IIASA, World Bank, space research agencies (e.g. NASA,
JAXA), as well as national agencies and research institutions.
• Yearly meetings to update on progress and results.
• Task forces to provide improvements in methods and outputs from one year
to the next.
First year
– improvements in data integration and statistical fusion, (using data from
monitors, atmospheric transport models and satellite remote sensing).
– First database of source apportionment studies (n=500)

51. Public health and environment51 |
Second year:
• Data fusion: Global air quality data as a result of fusion from various data sources,
report on progress and work ahead,
• Emission sources information, including from emission inventories and source
apportionment
• Exposure-risk relationship: Integrated dose-response functions that relate levels of
air pollution indoors and outdoors to a range of diseases, report on progress and work
ahead.
• Surface monitoring: key air pollution indicators to be monitored, minimum data sets
for health purposes; systematic data collection and display;
• Automated Data acquisition, portable monitors etc. quality of outputs form different
sources,
• Household air pollution: exposure assessment, progress in IAP data, availability of
exposure data from Europe
New task forces proposed:
• Data fusion and synthesis – further improvements
• Models for integrating Household and Ambient Air Polluton exposure estimates
• Guidance on the collection of ground measurement data.
• Guidance on source apportionment studies.

52. Public health and environment52 |
Establishment of a web-based resource providing access/
web linkage to:
• Results from the platform – methods, tools, results
• Tools for estimating health impacts from air pollution at local level
• Exposure-response functions
• Air quality databases:
– WHO ambient air quality in cities,
– WHO household air pollution database,
– Joint ambient/ household air pollution (future)
• Analysis of trends.
• Burden of disease estimates.
• Awareness raising and communication tools.
• Collection of cost-effective interventions/ best practices to address
air pollution and health.

53. Public health and environment53 |
Priorities for addressing the health
impacts of air pollution
1. Indicators for SDGs linking health, air
pollutants and its sources (Note to UN
Statistics Divison)
2. Road map for implementing the WHA
resolution on air pollution and health
3. Targeted actions/early wins – Global
Platform AQH, implementation of
IAQ guidelines

54. Public health and environment54 |
Health indicators for Post-2015
Sustainable Development
WHO related health to SD policies,
through the
• Defining health-relevant indicators
for sustainable development goals
(EB 136/30)
•Convened consultation on health
indicators for Rio + 20
themes/disseminated through civil
society/government partners at the
conference
•Constributions to the UN Statistics
Commission 2015-2016

55. Public health and environment55 |
SDG 11: cities
Goal 11 Make cities and human settlements
inclusive, safe, resilient and sustainable.
Target 11.7 By 2030, reduce the adverse per capita environmental
impact of cities, including by paying special attention to
air quality, municipal and other waste management.

56. Public health and environment56 |
Target Current Indicator Recommended update to indicator
11.7
Level of ambient particulate
matter (PM10 and PM2.5)
Annual mean levels of fine particulate
matter (i.e. PM2.5) air pollution in cities
(population weighted)

57. Public health and environment57 |
Data sources
• WHO urban air quality data base – 1600 cities
• Global platform air quality and health –
cooperation with many partners, facilitated by
WHO, currently improving estimates for many
more cities, synthesizing data from:
– Satellite remote sensing
– Emission inventories and source apportionment studies
– Air pollutant transport models
– Ground level monitoring of air quality

58. Public health and environment58 |
SDG 7: Energy
Goal 7 Ensure access to affordable, reliable, sustainable, and
modern energy for all
Target 7.1 By 2030, ensure universal access to affordable, reliable
and modern energy services
Target Indicators currently
proposed
Recommended update to
indicator
7.1 7.1.1 Percentage of
population with electricity
access
n/a
7.1.2 Percentage of
population with primary
reliance on non-solid
fuels (%)
Percentage of population
with primary reliance on
clean fuels and technologies
at the household level*
* Recommandation 4 WHO guidelines

59. Public health and environment59 |
Recommendation 4:
– Household combustion of kerosene is
discouraged
Rationale:
– High levels of emissions of PM and other
health-damaging emissions.
– Epidemiologic studies suggest links to
tuberculosis, cancer, respiratory disease,
adverse birth outcomes, etc., but are not
of adequate consistency/quality.
– Kerosene use carries substantial risks of
burns and poisoning.

60. Public health and environment60 |
Recommendation 1:
For 90% of homes to meet the WHO
AQGs for PM2.5, emission rates should
not exceed the emission rate targets
(ERTs) set out on the right.
Emissions rate
targets (ERT)
Emission
rate
(mg/min)
Percentage of
kitchens
meeting AQG
(10 µg/m3)
Percentage of
kitchens
meeting AQG
IT-1 (35 µg/m3)
Unvented
Final 0.23 90% 100%
Vented
Final 0.80 90% 100%
Recommendation 2:
• Promote clean fuels where and when possible
• For many, it will take time to meet AQGs (especially
PM2.5), so intermediate steps (solid fuel stoves) may be
required
• Solid fuels: test emissions (ref Recommendation #1), use
best possible options
• Monitor use and air pollution (not just laboratory)
Rationale:
– Health evidence: need low levels for
major health benefits (ALRI)
– In practice, solid fuel stoves not
achieving low levels (some vented
wood stoves 35-70 µg/m3)
– Even clean fuel users well above IT-
1 (other sources)
– Based on evidence, requires (near)
exclusive use of clean fuels to
achieve AQG (PM2.5).
Recommendation 3:
Unprocessed coal should not be used as a household fuel
Rationale:
– High levels of emissions of PM and other health-damaging emissions.
– Epidemiologic studies suggest links to tuberculosis, cancer, respiratory
disease, adverse birth outcomes, etc., but are not of adequate
consistency/quality.

61. Public health and environment61 |
Data source: WHO household energy data base*:
Population Primarily Relying on Solid fuels for cooking in 2012
• based on over 800 household surveys,
• being upgraded to include: fuels and technologies for lighting, heating and cooking as well as fuel stacking
Used as input to SE4All and other global energy tracking

62. Public health and environment62 |
SDG 3: Health
Goal 3 Ensure healthy lives and promote well-being for all
at all ages
Target 3.9 By 2030, substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water and soil
pollution from contamination.
Target Current Indicator Recommended update to
indicator
3.9 3.9.1 Population in urban areas exposed
to outdoor air pollution levels above
WHO guideline values
3.9.1. Mean levels of exposure
to ambient air pollution
(population weighted)
Rationale: dicotomous value (WHO guideline levels)
is a good target but a poor measure to track progress,
and annual levels are linked to health
OR: Mean levels of exposure to ambient and indoor air pollution

63. Public health and environment63 |
Alternative SDG 3: Health
Goal 3 Ensure healthy lives and promote well-being for all
at all ages
Target 3.9 By 2030, substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water and soil
pollution from contamination.
Target Current Indicator Recommended update to
indicator
3.9 3.9.1 Population in urban areas exposed
to outdoor air pollution levels above
WHO guideline values
3.9.1. Mean levels of exposure
to ambient and indoor air
pollution (population weighted)
Using initially both indicators for AAP and IAP, and
later an integrated indicator of AP exposure.

64. Public health and environment64 |
Data sources
• WHO urban air quality data base – 1600 cities
• Global platform air quality and health –cooperation with many
partners, facilitated by WHO, currently improving estimates for many
more cities, synthesizing data from:
– Satellite remote sensing
– Emission inventories and source apportionment studies
– Air pollutant transport models
– Ground level monitoring of air quality
• WHO household energy data base:
– based on over 800 household surveys,
– being upgraded to include: fuels and technologies for lighting, heating and
cooking as well as fuel stacking
– Further data integration of all the above under the
global platform on air quality and health – being
prepared

65. Public health and environment65 |
Monitoring and reporting.
Member States commit to redouble their efforts on:
• strengthening international cooperation
• collecting and utilizing data relevant to the health
outcomes of air quality,
• working towards harmonization of health-
related indicators which could be used by
decision makers
• optimize the linkages (of health surveillance)
with monitoring systems of air pollutants

66. Public health and environment66 |
Monitoring and reporting.
request the WHO to:
• provide enhanced cooperation between WHO relevant international regional and national stakeholders,
• compile and analyse data on air quality, with particular emphasis on the health-related aspects of air quality,
• take account of sources of air pollution in tackling their health effects
• cooperate with relevant UN agencies and programmes to create, enhance and update a public information tool of
WHO analysis, including policy and cost-efficiency aspects.

67. Public health and environment67 |
Making the link - Health benefits from Policies to
Mitigate Climate Change and Air Pollution
Transport,energy,landuse
policies/Combustion
Air pollution (PM)
Climate change (CO2)
Local/
short term
health
impacts
Global/long
term health
impacts
Climate change (SLCPs)
Injuries, physical activity,
noise, diet,