essay on impact of environmental pollution on public health

Environmental Pollution Effects on Health

Introduction, physical effects, psychological effects, behavioral effects.

Humans do not live in a vacuum but in a damaged environment that impacts individuals’ health every second of their existence. People cannot avoid air as they must breathe, water as they must drink, or land as they must eat what is grown in it. When polluted substances from the environment come to a human’s organism, they affect its health system causing various illnesses, diseases, and development abnormalities. Environmental pollution varies in forms but influences all people leading to physical, psychological, and behavioral harmful effects.

Contaminated environment causes physical disabilities due to humans’ interaction with it.

For example, lead emissions that come to the environment from “ore and metals processing”, “leaded aviation gasoline”, “manufacturing batteries”, “coal burning”, “typecasting”, and “older housings” are extremely dangerous when absorbed by a human body as lead “cannot be decomposed by microorganisms” (Zhang, Wilson, Hou, & Meng, 2015, p. 21). Hence, lead damages a human’s neurological, hematological, immunological, and reproductive systems causing physical disabilities.

Moreover, even low concentration of lead hurts children when their body is exposed to toxic nature of lead. According to Zhang et al. (2015), lead causes “lowered intelligence quotient”, “learning deficiency”, “cognitive deficits”, “lower vocabulary and grammatical-reasoning ability”, “longer reaction time”, “poorer hand-eye coordination”(p. 22). Therefore, children received lead toxins in their body experience neurological disabilities resulting in problems at school, low performance, difficulties with motivation and lack of concentration.

Finally, air pollution that is impossible to avoid can be fatal. According to Anders, Thundiyil, and Stolbach (2012), particulate matter (PM) in the air “contributes to approximately 800,000 premature deaths each year, ranking it the 13th leading cause of mortality worldwide (p. 166).

In addition, “acute exposure to PM causes changes in coagulation and platelet activation providing a more proximal link between PM and coronary artery disease” (Anders, Thundiyil, & Stolbach, 2012, p. 168). Hence, PM severely damages cardiovascular and respiratory systems of humans affected by air pollution increasing human mortality.

Psychological balance of a human is disrupted by noise pollution, for example. If noise level exceeds certain norms, it is called noise pollution. Hence, “continuous noise of level greater than 30 dB” causes problems with falling asleep and having a deep sleep (Shahid & Bashir, 2013, p. 43). Hence, lack of sleep significantly lowers work or study performance of people exposed to noise pollution.

Moreover, constant noise makes a human easily annoyed, irritated, and even aggressive. According to Shahid and Bashir (2013), indirect effects of noise pollution result in “lack of peace of mind, enjoyment of one’s own property and the enjoyment of loneliness” (p. 42). Thus, noise pollution causes psychological discomfort for those imposed to it.

Furthermore, excessive noise disturbs communication process. Speech interference affects concentration and leads to “fatigue, uncertainty and lack of self-confidence, irritation, misunderstandings, decreased working capacity and problem in human relations” (Shahid & Bashir, 2013, p. 42). Therefore people are psychologically affected by noise pollution when noise level exceeds norms.

Environmental pollution causes not only physical and psychological health troubles but also affects behavioral patterns of a human. According to Shahid and Bashir (2013), “direct effects” of noise pollution include “aggressive behavior associating with pre-existing anger and alcohol or other psychoactive agents” (p. 43). Speech and sleep disturbances caused by noise pollution also provoke harmful effects of individuals’ behavior.

Moreover, recent studies reveal connection between air pollution and autism disorder. Results of a study conducted by Volk et al. (2014) testify that “subjects with both MET rs1858830 CC genotype and high air pollutant exposures were at increased risk of autism spectrum disorder compared with subjects who had both the CG/GG” (p. 44).

Although “complex phenotypic presentation’ of autism disorders suggested “multiple genetic and environmental factors contribute to risk” before, the recent studies showed correlation between air pollution and increased autism spectrum disorder risk (Volk et al., 2014, p. 45). Additionally, in children “prenatal polycyclic aromatic hydrocarbon exposure has been associated with intelligence (IQ) deficits at age 5 years as well as with increased anxiety, depression, and inattention at age 6–7” (Volk et al., 2014, p. 45).

However, indoor PM exposure “can be reduced by the usage of air conditioning and particulate filters, decreasing indoor combustion for heating and cooking, and smoking cessation” (Anders, Thundiyil, & Stolbach, 2012, p. 166). Nonetheless, children living next to highways with high level of air pollution and particular matter are exposed to increased autism spectrum disorder risk.

Environmental contaminations such as lead taxation, noise and air pollution harmfully affect physical, psychological health and behavioral patterns of adults and children.

Toxicant lead emissions cause physical and neurological disabilities leading to illnesses for adults and children. Moreover, noise pollution results in sleep disturbance, speech interference and emotional discomfort of individuals. Finally, air contamination put children to a higher risk of autism spectrum disorders. Therefore, there is an evident correlation between pollution and health problems caused by today’s air, water, land, and noise contaminations, which affect health of all human beings.

Anders, J., Thundiyil, J., & Stolbach, A. (2012). Clearing the air: A review of the effects of particulate matter air pollution on human health. Journal of Medical Toxicology, 8 (2), 166–175.

Shahid, M. A. K., & Bashir, H. (2013). Psychological and physiological effects of noise pollution on the residents of major cities of Punjab (Pakistan). Peak Journal of Physical and Environmental Science Research, 1 (4), 41-50.

Volk, H. E., Kerin, T., Lurmann, F., Hertz-Picciotto, I., McConnell, R., & Campbell, D. B. (2014). Autism spectrum disorder: interaction of air pollution with the MET receptor tyrosine kinase gene. Epidemiology, 25 (1), 44-47.

Zhang, R., Wilson, V. L., Hou, A., & Meng, G. (2015). Source of lead pollution, its influence on public health and the countermeasures. International Journal of Health, Animal Science and Food Safety, 2 (1), 18-31.

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REVIEW article

Environmental and health impacts of air pollution: a review.

• 1 Delphis S.A., Kifisia, Greece
• 2 Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
• 3 Centre Hospitalier Universitaire Vaudois (CHUV), Service de Médicine Interne, Lausanne, Switzerland
• 4 School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom

One of our era's greatest scourges is air pollution, on account not only of its impact on climate change but also its impact on public and individual health due to increasing morbidity and mortality. There are many pollutants that are major factors in disease in humans. Among them, Particulate Matter (PM), particles of variable but very small diameter, penetrate the respiratory system via inhalation, causing respiratory and cardiovascular diseases, reproductive and central nervous system dysfunctions, and cancer. Despite the fact that ozone in the stratosphere plays a protective role against ultraviolet irradiation, it is harmful when in high concentration at ground level, also affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide, sulfur dioxide, Volatile Organic Compounds (VOCs), dioxins, and polycyclic aromatic hydrocarbons (PAHs) are all considered air pollutants that are harmful to humans. Carbon monoxide can even provoke direct poisoning when breathed in at high levels. Heavy metals such as lead, when absorbed into the human body, can lead to direct poisoning or chronic intoxication, depending on exposure. Diseases occurring from the aforementioned substances include principally respiratory problems such as Chronic Obstructive Pulmonary Disease (COPD), asthma, bronchiolitis, and also lung cancer, cardiovascular events, central nervous system dysfunctions, and cutaneous diseases. Last but not least, climate change resulting from environmental pollution affects the geographical distribution of many infectious diseases, as do natural disasters. The only way to tackle this problem is through public awareness coupled with a multidisciplinary approach by scientific experts; national and international organizations must address the emergence of this threat and propose sustainable solutions.

Approach to the Problem

The interactions between humans and their physical surroundings have been extensively studied, as multiple human activities influence the environment. The environment is a coupling of the biotic (living organisms and microorganisms) and the abiotic (hydrosphere, lithosphere, and atmosphere).

Pollution is defined as the introduction into the environment of substances harmful to humans and other living organisms. Pollutants are harmful solids, liquids, or gases produced in higher than usual concentrations that reduce the quality of our environment.

Human activities have an adverse effect on the environment by polluting the water we drink, the air we breathe, and the soil in which plants grow. Although the industrial revolution was a great success in terms of technology, society, and the provision of multiple services, it also introduced the production of huge quantities of pollutants emitted into the air that are harmful to human health. Without any doubt, the global environmental pollution is considered an international public health issue with multiple facets. Social, economic, and legislative concerns and lifestyle habits are related to this major problem. Clearly, urbanization and industrialization are reaching unprecedented and upsetting proportions worldwide in our era. Anthropogenic air pollution is one of the biggest public health hazards worldwide, given that it accounts for about 9 million deaths per year ( 1 ).

Without a doubt, all of the aforementioned are closely associated with climate change, and in the event of danger, the consequences can be severe for mankind ( 2 ). Climate changes and the effects of global planetary warming seriously affect multiple ecosystems, causing problems such as food safety issues, ice and iceberg melting, animal extinction, and damage to plants ( 3 , 4 ).

Air pollution has various health effects. The health of susceptible and sensitive individuals can be impacted even on low air pollution days. Short-term exposure to air pollutants is closely related to COPD (Chronic Obstructive Pulmonary Disease), cough, shortness of breath, wheezing, asthma, respiratory disease, and high rates of hospitalization (a measurement of morbidity).

The long-term effects associated with air pollution are chronic asthma, pulmonary insufficiency, cardiovascular diseases, and cardiovascular mortality. According to a Swedish cohort study, diabetes seems to be induced after long-term air pollution exposure ( 5 ). Moreover, air pollution seems to have various malign health effects in early human life, such as respiratory, cardiovascular, mental, and perinatal disorders ( 3 ), leading to infant mortality or chronic disease in adult age ( 6 ).

National reports have mentioned the increased risk of morbidity and mortality ( 1 ). These studies were conducted in many places around the world and show a correlation between daily ranges of particulate matter (PM) concentration and daily mortality. Climate shifts and global planetary warming ( 3 ) could aggravate the situation. Besides, increased hospitalization (an index of morbidity) has been registered among the elderly and susceptible individuals for specific reasons. Fine and ultrafine particulate matter seems to be associated with more serious illnesses ( 6 ), as it can invade the deepest parts of the airways and more easily reach the bloodstream.

Air pollution mainly affects those living in large urban areas, where road emissions contribute the most to the degradation of air quality. There is also a danger of industrial accidents, where the spread of a toxic fog can be fatal to the populations of the surrounding areas. The dispersion of pollutants is determined by many parameters, most notably atmospheric stability and wind ( 6 ).

In developing countries ( 7 ), the problem is more serious due to overpopulation and uncontrolled urbanization along with the development of industrialization. This leads to poor air quality, especially in countries with social disparities and a lack of information on sustainable management of the environment. The use of fuels such as wood fuel or solid fuel for domestic needs due to low incomes exposes people to bad-quality, polluted air at home. It is of note that three billion people around the world are using the above sources of energy for their daily heating and cooking needs ( 8 ). In developing countries, the women of the household seem to carry the highest risk for disease development due to their longer duration exposure to the indoor air pollution ( 8 , 9 ). Due to its fast industrial development and overpopulation, China is one of the Asian countries confronting serious air pollution problems ( 10 , 11 ). The lung cancer mortality observed in China is associated with fine particles ( 12 ). As stated already, long-term exposure is associated with deleterious effects on the cardiovascular system ( 3 , 5 ). However, it is interesting to note that cardiovascular diseases have mostly been observed in developed and high-income countries rather than in the developing low-income countries exposed highly to air pollution ( 13 ). Extreme air pollution is recorded in India, where the air quality reaches hazardous levels. New Delhi is one of the more polluted cities in India. Flights in and out of New Delhi International Airport are often canceled due to the reduced visibility associated with air pollution. Pollution is occurring both in urban and rural areas in India due to the fast industrialization, urbanization, and rise in use of motorcycle transportation. Nevertheless, biomass combustion associated with heating and cooking needs and practices is a major source of household air pollution in India and in Nepal ( 14 , 15 ). There is spatial heterogeneity in India, as areas with diverse climatological conditions and population and education levels generate different indoor air qualities, with higher PM 2.5 observed in North Indian states (557–601 μg/m 3 ) compared to the Southern States (183–214 μg/m 3 ) ( 16 , 17 ). The cold climate of the North Indian areas may be the main reason for this, as longer periods at home and more heating are necessary compared to in the tropical climate of Southern India. Household air pollution in India is associated with major health effects, especially in women and young children, who stay indoors for longer periods. Chronic obstructive respiratory disease (CORD) and lung cancer are mostly observed in women, while acute lower respiratory disease is seen in young children under 5 years of age ( 18 ).

Accumulation of air pollution, especially sulfur dioxide and smoke, reaching 1,500 mg/m3, resulted in an increase in the number of deaths (4,000 deaths) in December 1952 in London and in 1963 in New York City (400 deaths) ( 19 ). An association of pollution with mortality was reported on the basis of monitoring of outdoor pollution in six US metropolitan cities ( 20 ). In every case, it seems that mortality was closely related to the levels of fine, inhalable, and sulfate particles more than with the levels of total particulate pollution, aerosol acidity, sulfur dioxide, or nitrogen dioxide ( 20 ).

Furthermore, extremely high levels of pollution are reported in Mexico City and Rio de Janeiro, followed by Milan, Ankara, Melbourne, Tokyo, and Moscow ( 19 ).

Based on the magnitude of the public health impact, it is certain that different kinds of interventions should be taken into account. Success and effectiveness in controlling air pollution, specifically at the local level, have been reported. Adequate technological means are applied considering the source and the nature of the emission as well as its impact on health and the environment. The importance of point sources and non-point sources of air pollution control is reported by Schwela and Köth-Jahr ( 21 ). Without a doubt, a detailed emission inventory must record all sources in a given area. Beyond considering the above sources and their nature, topography and meteorology should also be considered, as stated previously. Assessment of the control policies and methods is often extrapolated from the local to the regional and then to the global scale. Air pollution may be dispersed and transported from one region to another area located far away. Air pollution management means the reduction to acceptable levels or possible elimination of air pollutants whose presence in the air affects our health or the environmental ecosystem. Private and governmental entities and authorities implement actions to ensure the air quality ( 22 ). Air quality standards and guidelines were adopted for the different pollutants by the WHO and EPA as a tool for the management of air quality ( 1 , 23 ). These standards have to be compared to the emissions inventory standards by causal analysis and dispersion modeling in order to reveal the problematic areas ( 24 ). Inventories are generally based on a combination of direct measurements and emissions modeling ( 24 ).

As an example, we state here the control measures at the source through the use of catalytic converters in cars. These are devices that turn the pollutants and toxic gases produced from combustion engines into less-toxic pollutants by catalysis through redox reactions ( 25 ). In Greece, the use of private cars was restricted by tracking their license plates in order to reduce traffic congestion during rush hour ( 25 ).

Concerning industrial emissions, collectors and closed systems can keep the air pollution to the minimal standards imposed by legislation ( 26 ).

Current strategies to improve air quality require an estimation of the economic value of the benefits gained from proposed programs. These proposed programs by public authorities, and directives are issued with guidelines to be respected.

In Europe, air quality limit values AQLVs (Air Quality Limit Values) are issued for setting off planning claims ( 27 ). In the USA, the NAAQS (National Ambient Air Quality Standards) establish the national air quality limit values ( 27 ). While both standards and directives are based on different mechanisms, significant success has been achieved in the reduction of overall emissions and associated health and environmental effects ( 27 ). The European Directive identifies geographical areas of risk exposure as monitoring/assessment zones to record the emission sources and levels of air pollution ( 27 ), whereas the USA establishes global geographical air quality criteria according to the severity of their air quality problem and records all sources of the pollutants and their precursors ( 27 ).

In this vein, funds have been financing, directly or indirectly, projects related to air quality along with the technical infrastructure to maintain good air quality. These plans focus on an inventory of databases from air quality environmental planning awareness campaigns. Moreover, pollution measures of air emissions may be taken for vehicles, machines, and industries in urban areas.

Technological innovation can only be successful if it is able to meet the needs of society. In this sense, technology must reflect the decision-making practices and procedures of those involved in risk assessment and evaluation and act as a facilitator in providing information and assessments to enable decision makers to make the best decisions possible. Summarizing the aforementioned in order to design an effective air quality control strategy, several aspects must be considered: environmental factors and ambient air quality conditions, engineering factors and air pollutant characteristics, and finally, economic operating costs for technological improvement and administrative and legal costs. Considering the economic factor, competitiveness through neoliberal concepts is offering a solution to environmental problems ( 22 ).

The development of environmental governance, along with technological progress, has initiated the deployment of a dialogue. Environmental politics has created objections and points of opposition between different political parties, scientists, media, and governmental and non-governmental organizations ( 22 ). Radical environmental activism actions and movements have been created ( 22 ). The rise of the new information and communication technologies (ICTs) are many times examined as to whether and in which way they have influenced means of communication and social movements such as activism ( 28 ). Since the 1990s, the term “digital activism” has been used increasingly and in many different disciplines ( 29 ). Nowadays, multiple digital technologies can be used to produce a digital activism outcome on environmental issues. More specifically, devices with online capabilities such as computers or mobile phones are being used as a way to pursue change in political and social affairs ( 30 ).

In the present paper, we focus on the sources of environmental pollution in relation to public health and propose some solutions and interventions that may be of interest to environmental legislators and decision makers.

Sources of Exposure

It is known that the majority of environmental pollutants are emitted through large-scale human activities such as the use of industrial machinery, power-producing stations, combustion engines, and cars. Because these activities are performed at such a large scale, they are by far the major contributors to air pollution, with cars estimated to be responsible for approximately 80% of today's pollution ( 31 ). Some other human activities are also influencing our environment to a lesser extent, such as field cultivation techniques, gas stations, fuel tanks heaters, and cleaning procedures ( 32 ), as well as several natural sources, such as volcanic and soil eruptions and forest fires.

The classification of air pollutants is based mainly on the sources producing pollution. Therefore, it is worth mentioning the four main sources, following the classification system: Major sources, Area sources, Mobile sources, and Natural sources.

Major sources include the emission of pollutants from power stations, refineries, and petrochemicals, the chemical and fertilizer industries, metallurgical and other industrial plants, and, finally, municipal incineration.

Indoor area sources include domestic cleaning activities, dry cleaners, printing shops, and petrol stations.

Mobile sources include automobiles, cars, railways, airways, and other types of vehicles.

Finally, natural sources include, as stated previously, physical disasters ( 33 ) such as forest fire, volcanic erosion, dust storms, and agricultural burning.

However, many classification systems have been proposed. Another type of classification is a grouping according to the recipient of the pollution, as follows:

Air pollution is determined as the presence of pollutants in the air in large quantities for long periods. Air pollutants are dispersed particles, hydrocarbons, CO, CO 2 , NO, NO 2 , SO 3 , etc.

Water pollution is organic and inorganic charge and biological charge ( 10 ) at high levels that affect the water quality ( 34 , 35 ).

Soil pollution occurs through the release of chemicals or the disposal of wastes, such as heavy metals, hydrocarbons, and pesticides.

Air pollution can influence the quality of soil and water bodies by polluting precipitation, falling into water and soil environments ( 34 , 36 ). Notably, the chemistry of the soil can be amended due to acid precipitation by affecting plants, cultures, and water quality ( 37 ). Moreover, movement of heavy metals is favored by soil acidity, and metals are so then moving into the watery environment. It is known that heavy metals such as aluminum are noxious to wildlife and fishes. Soil quality seems to be of importance, as soils with low calcium carbonate levels are at increased jeopardy from acid rain. Over and above rain, snow and particulate matter drip into watery ' bodies ( 36 , 38 ).

Lastly, pollution is classified following type of origin:

Radioactive and nuclear pollution , releasing radioactive and nuclear pollutants into water, air, and soil during nuclear explosions and accidents, from nuclear weapons, and through handling or disposal of radioactive sewage.

Radioactive materials can contaminate surface water bodies and, being noxious to the environment, plants, animals, and humans. It is known that several radioactive substances such as radium and uranium concentrate in the bones and can cause cancers ( 38 , 39 ).

Noise pollution is produced by machines, vehicles, traffic noises, and musical installations that are harmful to our hearing.

The World Health Organization introduced the term DALYs. The DALYs for a disease or health condition is defined as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences ( 39 ). In Europe, air pollution is the main cause of disability-adjusted life years lost (DALYs), followed by noise pollution. The potential relationships of noise and air pollution with health have been studied ( 40 ). The study found that DALYs related to noise were more important than those related to air pollution, as the effects of environmental noise on cardiovascular disease were independent of air pollution ( 40 ). Environmental noise should be counted as an independent public health risk ( 40 ).

Environmental pollution occurs when changes in the physical, chemical, or biological constituents of the environment (air masses, temperature, climate, etc.) are produced.

Pollutants harm our environment either by increasing levels above normal or by introducing harmful toxic substances. Primary pollutants are directly produced from the above sources, and secondary pollutants are emitted as by-products of the primary ones. Pollutants can be biodegradable or non-biodegradable and of natural origin or anthropogenic, as stated previously. Moreover, their origin can be a unique source (point-source) or dispersed sources.

Pollutants have differences in physical and chemical properties, explaining the discrepancy in their capacity for producing toxic effects. As an example, we state here that aerosol compounds ( 41 – 43 ) have a greater toxicity than gaseous compounds due to their tiny size (solid or liquid) in the atmosphere; they have a greater penetration capacity. Gaseous compounds are eliminated more easily by our respiratory system ( 41 ). These particles are able to damage lungs and can even enter the bloodstream ( 41 ), leading to the premature deaths of millions of people yearly. Moreover, the aerosol acidity ([H+]) seems to considerably enhance the production of secondary organic aerosols (SOA), but this last aspect is not supported by other scientific teams ( 38 ).

Climate and Pollution

Air pollution and climate change are closely related. Climate is the other side of the same coin that reduces the quality of our Earth ( 44 ). Pollutants such as black carbon, methane, tropospheric ozone, and aerosols affect the amount of incoming sunlight. As a result, the temperature of the Earth is increasing, resulting in the melting of ice, icebergs, and glaciers.

In this vein, climatic changes will affect the incidence and prevalence of both residual and imported infections in Europe. Climate and weather affect the duration, timing, and intensity of outbreaks strongly and change the map of infectious diseases in the globe ( 45 ). Mosquito-transmitted parasitic or viral diseases are extremely climate-sensitive, as warming firstly shortens the pathogen incubation period and secondly shifts the geographic map of the vector. Similarly, water-warming following climate changes leads to a high incidence of waterborne infections. Recently, in Europe, eradicated diseases seem to be emerging due to the migration of population, for example, cholera, poliomyelitis, tick-borne encephalitis, and malaria ( 46 ).

The spread of epidemics is associated with natural climate disasters and storms, which seem to occur more frequently nowadays ( 47 ). Malnutrition and disequilibration of the immune system are also associated with the emerging infections affecting public health ( 48 ).

The Chikungunya virus “took the airplane” from the Indian Ocean to Europe, as outbreaks of the disease were registered in Italy ( 49 ) as well as autochthonous cases in France ( 50 ).

An increase in cryptosporidiosis in the United Kingdom and in the Czech Republic seems to have occurred following flooding ( 36 , 51 ).

As stated previously, aerosols compounds are tiny in size and considerably affect the climate. They are able to dissipate sunlight (the albedo phenomenon) by dispersing a quarter of the sun's rays back to space and have cooled the global temperature over the last 30 years ( 52 ).

Air Pollutants

The World Health Organization (WHO) reports on six major air pollutants, namely particle pollution, ground-level ozone, carbon monoxide, sulfur oxides, nitrogen oxides, and lead. Air pollution can have a disastrous effect on all components of the environment, including groundwater, soil, and air. Additionally, it poses a serious threat to living organisms. In this vein, our interest is mainly to focus on these pollutants, as they are related to more extensive and severe problems in human health and environmental impact. Acid rain, global warming, the greenhouse effect, and climate changes have an important ecological impact on air pollution ( 53 ).

Particulate Matter (PM) and Health

Studies have shown a relationship between particulate matter (PM) and adverse health effects, focusing on either short-term (acute) or long-term (chronic) PM exposure.

Particulate matter (PM) is usually formed in the atmosphere as a result of chemical reactions between the different pollutants. The penetration of particles is closely dependent on their size ( 53 ). Particulate Matter (PM) was defined as a term for particles by the United States Environmental Protection Agency ( 54 ). Particulate matter (PM) pollution includes particles with diameters of 10 micrometers (μm) or smaller, called PM 10 , and extremely fine particles with diameters that are generally 2.5 micrometers (μm) and smaller.

Particulate matter contains tiny liquid or solid droplets that can be inhaled and cause serious health effects ( 55 ). Particles <10 μm in diameter (PM 10 ) after inhalation can invade the lungs and even reach the bloodstream. Fine particles, PM 2.5 , pose a greater risk to health ( 6 , 56 ) ( Table 1 ).

Table 1 . Penetrability according to particle size.

Multiple epidemiological studies have been performed on the health effects of PM. A positive relation was shown between both short-term and long-term exposures of PM 2.5 and acute nasopharyngitis ( 56 ). In addition, long-term exposure to PM for years was found to be related to cardiovascular diseases and infant mortality.

Those studies depend on PM 2.5 monitors and are restricted in terms of study area or city area due to a lack of spatially resolved daily PM 2.5 concentration data and, in this way, are not representative of the entire population. Following a recent epidemiological study by the Department of Environmental Health at Harvard School of Public Health (Boston, MA) ( 57 ), it was reported that, as PM 2.5 concentrations vary spatially, an exposure error (Berkson error) seems to be produced, and the relative magnitudes of the short- and long-term effects are not yet completely elucidated. The team developed a PM 2.5 exposure model based on remote sensing data for assessing short- and long-term human exposures ( 57 ). This model permits spatial resolution in short-term effects plus the assessment of long-term effects in the whole population.

Moreover, respiratory diseases and affection of the immune system are registered as long-term chronic effects ( 58 ). It is worth noting that people with asthma, pneumonia, diabetes, and respiratory and cardiovascular diseases are especially susceptible and vulnerable to the effects of PM. PM 2.5 , followed by PM 10 , are strongly associated with diverse respiratory system diseases ( 59 ), as their size permits them to pierce interior spaces ( 60 ). The particles produce toxic effects according to their chemical and physical properties. The components of PM 10 and PM 2.5 can be organic (polycyclic aromatic hydrocarbons, dioxins, benzene, 1-3 butadiene) or inorganic (carbon, chlorides, nitrates, sulfates, metals) in nature ( 55 ).

Particulate Matter (PM) is divided into four main categories according to type and size ( 61 ) ( Table 2 ).

Table 2 . Types and sizes of particulate Matter (PM).

Gas contaminants include PM in aerial masses.

Particulate contaminants include contaminants such as smog, soot, tobacco smoke, oil smoke, fly ash, and cement dust.

Biological Contaminants are microorganisms (bacteria, viruses, fungi, mold, and bacterial spores), cat allergens, house dust and allergens, and pollen.

Types of Dust include suspended atmospheric dust, settling dust, and heavy dust.

Finally, another fact is that the half-lives of PM 10 and PM 2.5 particles in the atmosphere is extended due to their tiny dimensions; this permits their long-lasting suspension in the atmosphere and even their transfer and spread to distant destinations where people and the environment may be exposed to the same magnitude of pollution ( 53 ). They are able to change the nutrient balance in watery ecosystems, damage forests and crops, and acidify water bodies.

As stated, PM 2.5 , due to their tiny size, are causing more serious health effects. These aforementioned fine particles are the main cause of the “haze” formation in different metropolitan areas ( 12 , 13 , 61 ).

Ozone Impact in the Atmosphere

Ozone (O 3 ) is a gas formed from oxygen under high voltage electric discharge ( 62 ). It is a strong oxidant, 52% stronger than chlorine. It arises in the stratosphere, but it could also arise following chain reactions of photochemical smog in the troposphere ( 63 ).

Ozone can travel to distant areas from its initial source, moving with air masses ( 64 ). It is surprising that ozone levels over cities are low in contrast to the increased amounts occuring in urban areas, which could become harmful for cultures, forests, and vegetation ( 65 ) as it is reducing carbon assimilation ( 66 ). Ozone reduces growth and yield ( 47 , 48 ) and affects the plant microflora due to its antimicrobial capacity ( 67 , 68 ). In this regard, ozone acts upon other natural ecosystems, with microflora ( 69 , 70 ) and animal species changing their species composition ( 71 ). Ozone increases DNA damage in epidermal keratinocytes and leads to impaired cellular function ( 72 ).

Ground-level ozone (GLO) is generated through a chemical reaction between oxides of nitrogen and VOCs emitted from natural sources and/or following anthropogenic activities.

Ozone uptake usually occurs by inhalation. Ozone affects the upper layers of the skin and the tear ducts ( 73 ). A study of short-term exposure of mice to high levels of ozone showed malondialdehyde formation in the upper skin (epidermis) but also depletion in vitamins C and E. It is likely that ozone levels are not interfering with the skin barrier function and integrity to predispose to skin disease ( 74 ).

Due to the low water-solubility of ozone, inhaled ozone has the capacity to penetrate deeply into the lungs ( 75 ).

Toxic effects induced by ozone are registered in urban areas all over the world, causing biochemical, morphologic, functional, and immunological disorders ( 76 ).

The European project (APHEA2) focuses on the acute effects of ambient ozone concentrations on mortality ( 77 ). Daily ozone concentrations compared to the daily number of deaths were reported from different European cities for a 3-year period. During the warm period of the year, an observed increase in ozone concentration was associated with an increase in the daily number of deaths (0.33%), in the number of respiratory deaths (1.13%), and in the number of cardiovascular deaths (0.45%). No effect was observed during wintertime.

Carbon Monoxide (CO)

Carbon monoxide is produced by fossil fuel when combustion is incomplete. The symptoms of poisoning due to inhaling carbon monoxide include headache, dizziness, weakness, nausea, vomiting, and, finally, loss of consciousness.

The affinity of carbon monoxide to hemoglobin is much greater than that of oxygen. In this vein, serious poisoning may occur in people exposed to high levels of carbon monoxide for a long period of time. Due to the loss of oxygen as a result of the competitive binding of carbon monoxide, hypoxia, ischemia, and cardiovascular disease are observed.

Carbon monoxide affects the greenhouses gases that are tightly connected to global warming and climate. This should lead to an increase in soil and water temperatures, and extreme weather conditions or storms may occur ( 68 ).

However, in laboratory and field experiments, it has been seen to produce increased plant growth ( 78 ).

Nitrogen Oxide (NO 2 )

Nitrogen oxide is a traffic-related pollutant, as it is emitted from automobile motor engines ( 79 , 80 ). It is an irritant of the respiratory system as it penetrates deep in the lung, inducing respiratory diseases, coughing, wheezing, dyspnea, bronchospasm, and even pulmonary edema when inhaled at high levels. It seems that concentrations over 0.2 ppm produce these adverse effects in humans, while concentrations higher than 2.0 ppm affect T-lymphocytes, particularly the CD8+ cells and NK cells that produce our immune response ( 81 ).It is reported that long-term exposure to high levels of nitrogen dioxide can be responsible for chronic lung disease. Long-term exposure to NO 2 can impair the sense of smell ( 81 ).

However, systems other than respiratory ones can be involved, as symptoms such as eye, throat, and nose irritation have been registered ( 81 ).

High levels of nitrogen dioxide are deleterious to crops and vegetation, as they have been observed to reduce crop yield and plant growth efficiency. Moreover, NO 2 can reduce visibility and discolor fabrics ( 81 ).

Sulfur Dioxide (SO 2 )

Sulfur dioxide is a harmful gas that is emitted mainly from fossil fuel consumption or industrial activities. The annual standard for SO 2 is 0.03 ppm ( 82 ). It affects human, animal, and plant life. Susceptible people as those with lung disease, old people, and children, who present a higher risk of damage. The major health problems associated with sulfur dioxide emissions in industrialized areas are respiratory irritation, bronchitis, mucus production, and bronchospasm, as it is a sensory irritant and penetrates deep into the lung converted into bisulfite and interacting with sensory receptors, causing bronchoconstriction. Moreover, skin redness, damage to the eyes (lacrimation and corneal opacity) and mucous membranes, and worsening of pre-existing cardiovascular disease have been observed ( 81 ).

Environmental adverse effects, such as acidification of soil and acid rain, seem to be associated with sulfur dioxide emissions ( 83 ).

Lead is a heavy metal used in different industrial plants and emitted from some petrol motor engines, batteries, radiators, waste incinerators, and waste waters ( 84 ).

Moreover, major sources of lead pollution in the air are metals, ore, and piston-engine aircraft. Lead poisoning is a threat to public health due to its deleterious effects upon humans, animals, and the environment, especially in the developing countries.

Exposure to lead can occur through inhalation, ingestion, and dermal absorption. Trans- placental transport of lead was also reported, as lead passes through the placenta unencumbered ( 85 ). The younger the fetus is, the more harmful the toxic effects. Lead toxicity affects the fetal nervous system; edema or swelling of the brain is observed ( 86 ). Lead, when inhaled, accumulates in the blood, soft tissue, liver, lung, bones, and cardiovascular, nervous, and reproductive systems. Moreover, loss of concentration and memory, as well as muscle and joint pain, were observed in adults ( 85 , 86 ).

Children and newborns ( 87 ) are extremely susceptible even to minimal doses of lead, as it is a neurotoxicant and causes learning disabilities, impairment of memory, hyperactivity, and even mental retardation.

Elevated amounts of lead in the environment are harmful to plants and crop growth. Neurological effects are observed in vertebrates and animals in association with high lead levels ( 88 ).

Polycyclic Aromatic Hydrocarbons(PAHs)

The distribution of PAHs is ubiquitous in the environment, as the atmosphere is the most important means of their dispersal. They are found in coal and in tar sediments. Moreover, they are generated through incomplete combustion of organic matter as in the cases of forest fires, incineration, and engines ( 89 ). PAH compounds, such as benzopyrene, acenaphthylene, anthracene, and fluoranthene are recognized as toxic, mutagenic, and carcinogenic substances. They are an important risk factor for lung cancer ( 89 ).

Volatile Organic Compounds(VOCs)

Volatile organic compounds (VOCs), such as toluene, benzene, ethylbenzene, and xylene ( 90 ), have been found to be associated with cancer in humans ( 91 ). The use of new products and materials has actually resulted in increased concentrations of VOCs. VOCs pollute indoor air ( 90 ) and may have adverse effects on human health ( 91 ). Short-term and long-term adverse effects on human health are observed. VOCs are responsible for indoor air smells. Short-term exposure is found to cause irritation of eyes, nose, throat, and mucosal membranes, while those of long duration exposure include toxic reactions ( 92 ). Predictable assessment of the toxic effects of complex VOC mixtures is difficult to estimate, as these pollutants can have synergic, antagonistic, or indifferent effects ( 91 , 93 ).

Dioxins originate from industrial processes but also come from natural processes, such as forest fires and volcanic eruptions. They accumulate in foods such as meat and dairy products, fish and shellfish, and especially in the fatty tissue of animals ( 94 ).

Short-period exhibition to high dioxin concentrations may result in dark spots and lesions on the skin ( 94 ). Long-term exposure to dioxins can cause developmental problems, impairment of the immune, endocrine and nervous systems, reproductive infertility, and cancer ( 94 ).

Without any doubt, fossil fuel consumption is responsible for a sizeable part of air contamination. This contamination may be anthropogenic, as in agricultural and industrial processes or transportation, while contamination from natural sources is also possible. Interestingly, it is of note that the air quality standards established through the European Air Quality Directive are somewhat looser than the WHO guidelines, which are stricter ( 95 ).

Effect of Air Pollution on Health

The most common air pollutants are ground-level ozone and Particulates Matter (PM). Air pollution is distinguished into two main types:

Outdoor pollution is the ambient air pollution.

Indoor pollution is the pollution generated by household combustion of fuels.

People exposed to high concentrations of air pollutants experience disease symptoms and states of greater and lesser seriousness. These effects are grouped into short- and long-term effects affecting health.

Susceptible populations that need to be aware of health protection measures include old people, children, and people with diabetes and predisposing heart or lung disease, especially asthma.

As extensively stated previously, according to a recent epidemiological study from Harvard School of Public Health, the relative magnitudes of the short- and long-term effects have not been completely clarified ( 57 ) due to the different epidemiological methodologies and to the exposure errors. New models are proposed for assessing short- and long-term human exposure data more successfully ( 57 ). Thus, in the present section, we report the more common short- and long-term health effects but also general concerns for both types of effects, as these effects are often dependent on environmental conditions, dose, and individual susceptibility.

Short-term effects are temporary and range from simple discomfort, such as irritation of the eyes, nose, skin, throat, wheezing, coughing and chest tightness, and breathing difficulties, to more serious states, such as asthma, pneumonia, bronchitis, and lung and heart problems. Short-term exposure to air pollution can also cause headaches, nausea, and dizziness.

These problems can be aggravated by extended long-term exposure to the pollutants, which is harmful to the neurological, reproductive, and respiratory systems and causes cancer and even, rarely, deaths.

The long-term effects are chronic, lasting for years or the whole life and can even lead to death. Furthermore, the toxicity of several air pollutants may also induce a variety of cancers in the long term ( 96 ).

As stated already, respiratory disorders are closely associated with the inhalation of air pollutants. These pollutants will invade through the airways and will accumulate at the cells. Damage to target cells should be related to the pollutant component involved and its source and dose. Health effects are also closely dependent on country, area, season, and time. An extended exposure duration to the pollutant should incline to long-term health effects in relation also to the above factors.

Particulate Matter (PMs), dust, benzene, and O 3 cause serious damage to the respiratory system ( 97 ). Moreover, there is a supplementary risk in case of existing respiratory disease such as asthma ( 98 ). Long-term effects are more frequent in people with a predisposing disease state. When the trachea is contaminated by pollutants, voice alterations may be remarked after acute exposure. Chronic obstructive pulmonary disease (COPD) may be induced following air pollution, increasing morbidity and mortality ( 99 ). Long-term effects from traffic, industrial air pollution, and combustion of fuels are the major factors for COPD risk ( 99 ).

Multiple cardiovascular effects have been observed after exposure to air pollutants ( 100 ). Changes occurred in blood cells after long-term exposure may affect cardiac functionality. Coronary arteriosclerosis was reported following long-term exposure to traffic emissions ( 101 ), while short-term exposure is related to hypertension, stroke, myocardial infracts, and heart insufficiency. Ventricle hypertrophy is reported to occur in humans after long-time exposure to nitrogen oxide (NO 2 ) ( 102 , 103 ).

Neurological effects have been observed in adults and children after extended-term exposure to air pollutants.

Psychological complications, autism, retinopathy, fetal growth, and low birth weight seem to be related to long-term air pollution ( 83 ). The etiologic agent of the neurodegenerative diseases (Alzheimer's and Parkinson's) is not yet known, although it is believed that extended exposure to air pollution seems to be a factor. Specifically, pesticides and metals are cited as etiological factors, together with diet. The mechanisms in the development of neurodegenerative disease include oxidative stress, protein aggregation, inflammation, and mitochondrial impairment in neurons ( 104 ) ( Figure 1 ).

Figure 1 . Impact of air pollutants on the brain.

Brain inflammation was observed in dogs living in a highly polluted area in Mexico for a long period ( 105 ). In human adults, markers of systemic inflammation (IL-6 and fibrinogen) were found to be increased as an immediate response to PNC on the IL-6 level, possibly leading to the production of acute-phase proteins ( 106 ). The progression of atherosclerosis and oxidative stress seem to be the mechanisms involved in the neurological disturbances caused by long-term air pollution. Inflammation comes secondary to the oxidative stress and seems to be involved in the impairment of developmental maturation, affecting multiple organs ( 105 , 107 ). Similarly, other factors seem to be involved in the developmental maturation, which define the vulnerability to long-term air pollution. These include birthweight, maternal smoking, genetic background and socioeconomic environment, as well as education level.

However, diet, starting from breast-feeding, is another determinant factor. Diet is the main source of antioxidants, which play a key role in our protection against air pollutants ( 108 ). Antioxidants are free radical scavengers and limit the interaction of free radicals in the brain ( 108 ). Similarly, genetic background may result in a differential susceptibility toward the oxidative stress pathway ( 60 ). For example, antioxidant supplementation with vitamins C and E appears to modulate the effect of ozone in asthmatic children homozygous for the GSTM1 null allele ( 61 ). Inflammatory cytokines released in the periphery (e.g., respiratory epithelia) upregulate the innate immune Toll-like receptor 2. Such activation and the subsequent events leading to neurodegeneration have recently been observed in lung lavage in mice exposed to ambient Los Angeles (CA, USA) particulate matter ( 61 ). In children, neurodevelopmental morbidities were observed after lead exposure. These children developed aggressive and delinquent behavior, reduced intelligence, learning difficulties, and hyperactivity ( 109 ). No level of lead exposure seems to be “safe,” and the scientific community has asked the Centers for Disease Control and Prevention (CDC) to reduce the current screening guideline of 10 μg/dl ( 109 ).

It is important to state that impact on the immune system, causing dysfunction and neuroinflammation ( 104 ), is related to poor air quality. Yet, increases in serum levels of immunoglobulins (IgA, IgM) and the complement component C3 are observed ( 106 ). Another issue is that antigen presentation is affected by air pollutants, as there is an upregulation of costimulatory molecules such as CD80 and CD86 on macrophages ( 110 ).

As is known, skin is our shield against ultraviolet radiation (UVR) and other pollutants, as it is the most exterior layer of our body. Traffic-related pollutants, such as PAHs, VOCs, oxides, and PM, may cause pigmented spots on our skin ( 111 ). On the one hand, as already stated, when pollutants penetrate through the skin or are inhaled, damage to the organs is observed, as some of these pollutants are mutagenic and carcinogenic, and, specifically, they affect the liver and lung. On the other hand, air pollutants (and those in the troposphere) reduce the adverse effects of ultraviolet radiation UVR in polluted urban areas ( 111 ). Air pollutants absorbed by the human skin may contribute to skin aging, psoriasis, acne, urticaria, eczema, and atopic dermatitis ( 111 ), usually caused by exposure to oxides and photochemical smoke ( 111 ). Exposure to PM and cigarette smoking act as skin-aging agents, causing spots, dyschromia, and wrinkles. Lastly, pollutants have been associated with skin cancer ( 111 ).

Higher morbidity is reported to fetuses and children when exposed to the above dangers. Impairment in fetal growth, low birth weight, and autism have been reported ( 112 ).

Another exterior organ that may be affected is the eye. Contamination usually comes from suspended pollutants and may result in asymptomatic eye outcomes, irritation ( 112 ), retinopathy, or dry eye syndrome ( 113 , 114 ).

Environmental Impact of Air Pollution

Air pollution is harming not only human health but also the environment ( 115 ) in which we live. The most important environmental effects are as follows.

Acid rain is wet (rain, fog, snow) or dry (particulates and gas) precipitation containing toxic amounts of nitric and sulfuric acids. They are able to acidify the water and soil environments, damage trees and plantations, and even damage buildings and outdoor sculptures, constructions, and statues.

Haze is produced when fine particles are dispersed in the air and reduce the transparency of the atmosphere. It is caused by gas emissions in the air coming from industrial facilities, power plants, automobiles, and trucks.

Ozone , as discussed previously, occurs both at ground level and in the upper level (stratosphere) of the Earth's atmosphere. Stratospheric ozone is protecting us from the Sun's harmful ultraviolet (UV) rays. In contrast, ground-level ozone is harmful to human health and is a pollutant. Unfortunately, stratospheric ozone is gradually damaged by ozone-depleting substances (i.e., chemicals, pesticides, and aerosols). If this protecting stratospheric ozone layer is thinned, then UV radiation can reach our Earth, with harmful effects for human life (skin cancer) ( 116 ) and crops ( 117 ). In plants, ozone penetrates through the stomata, inducing them to close, which blocks CO 2 transfer and induces a reduction in photosynthesis ( 118 ).

Global climate change is an important issue that concerns mankind. As is known, the “greenhouse effect” keeps the Earth's temperature stable. Unhappily, anthropogenic activities have destroyed this protecting temperature effect by producing large amounts of greenhouse gases, and global warming is mounting, with harmful effects on human health, animals, forests, wildlife, agriculture, and the water environment. A report states that global warming is adding to the health risks of poor people ( 119 ).

People living in poorly constructed buildings in warm-climate countries are at high risk for heat-related health problems as temperatures mount ( 119 ).

Wildlife is burdened by toxic pollutants coming from the air, soil, or the water ecosystem and, in this way, animals can develop health problems when exposed to high levels of pollutants. Reproductive failure and birth effects have been reported.

Eutrophication is occurring when elevated concentrations of nutrients (especially nitrogen) stimulate the blooming of aquatic algae, which can cause a disequilibration in the diversity of fish and their deaths.

Without a doubt, there is a critical concentration of pollution that an ecosystem can tolerate without being destroyed, which is associated with the ecosystem's capacity to neutralize acidity. The Canada Acid Rain Program established this load at 20 kg/ha/yr ( 120 ).

Hence, air pollution has deleterious effects on both soil and water ( 121 ). Concerning PM as an air pollutant, its impact on crop yield and food productivity has been reported. Its impact on watery bodies is associated with the survival of living organisms and fishes and their productivity potential ( 121 ).

An impairment in photosynthetic rhythm and metabolism is observed in plants exposed to the effects of ozone ( 121 ).

Sulfur and nitrogen oxides are involved in the formation of acid rain and are harmful to plants and marine organisms.

Last but not least, as mentioned above, the toxicity associated with lead and other metals is the main threat to our ecosystems (air, water, and soil) and living creatures ( 121 ).

In 2018, during the first WHO Global Conference on Air Pollution and Health, the WHO's General Director, Dr. Tedros Adhanom Ghebreyesus, called air pollution a “silent public health emergency” and “the new tobacco” ( 122 ).

Undoubtedly, children are particularly vulnerable to air pollution, especially during their development. Air pollution has adverse effects on our lives in many different respects.

Diseases associated with air pollution have not only an important economic impact but also a societal impact due to absences from productive work and school.

Despite the difficulty of eradicating the problem of anthropogenic environmental pollution, a successful solution could be envisaged as a tight collaboration of authorities, bodies, and doctors to regularize the situation. Governments should spread sufficient information and educate people and should involve professionals in these issues so as to control the emergence of the problem successfully.

Technologies to reduce air pollution at the source must be established and should be used in all industries and power plants. The Kyoto Protocol of 1997 set as a major target the reduction of GHG emissions to below 5% by 2012 ( 123 ). This was followed by the Copenhagen summit, 2009 ( 124 ), and then the Durban summit of 2011 ( 125 ), where it was decided to keep to the same line of action. The Kyoto protocol and the subsequent ones were ratified by many countries. Among the pioneers who adopted this important protocol for the world's environmental and climate “health” was China ( 3 ). As is known, China is a fast-developing economy and its GDP (Gross Domestic Product) is expected to be very high by 2050, which is defined as the year of dissolution of the protocol for the decrease in gas emissions.

A more recent international agreement of crucial importance for climate change is the Paris Agreement of 2015, issued by the UNFCCC (United Nations Climate Change Committee). This latest agreement was ratified by a plethora of UN (United Nations) countries as well as the countries of the European Union ( 126 ). In this vein, parties should promote actions and measures to enhance numerous aspects around the subject. Boosting education, training, public awareness, and public participation are some of the relevant actions for maximizing the opportunities to achieve the targets and goals on the crucial matter of climate change and environmental pollution ( 126 ). Without any doubt, technological improvements makes our world easier and it seems difficult to reduce the harmful impact caused by gas emissions, we could limit its use by seeking reliable approaches.

Synopsizing, a global prevention policy should be designed in order to combat anthropogenic air pollution as a complement to the correct handling of the adverse health effects associated with air pollution. Sustainable development practices should be applied, together with information coming from research in order to handle the problem effectively.

At this point, international cooperation in terms of research, development, administration policy, monitoring, and politics is vital for effective pollution control. Legislation concerning air pollution must be aligned and updated, and policy makers should propose the design of a powerful tool of environmental and health protection. As a result, the main proposal of this essay is that we should focus on fostering local structures to promote experience and practice and extrapolate these to the international level through developing effective policies for sustainable management of ecosystems.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

IM is employed by the company Delphis S.A.

The remaining authors declare that the present review paper was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: air pollution, environment, health, public health, gas emission, policy

Citation: Manisalidis I, Stavropoulou E, Stavropoulos A and Bezirtzoglou E (2020) Environmental and Health Impacts of Air Pollution: A Review. Front. Public Health 8:14. doi: 10.3389/fpubh.2020.00014

Received: 17 October 2019; Accepted: 17 January 2020; Published: 20 February 2020.

Reviewed by:

Copyright © 2020 Manisalidis, Stavropoulou, Stavropoulos and Bezirtzoglou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ioannis Manisalidis, giannismanisal@gmail.com ; Elisavet Stavropoulou, elisabeth.stavropoulou@gmail.com

† These authors have contributed equally to this work

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Article Contents

Introduction, advances in understanding air pollution’s effects on health, the global burden of disease due to air pollution, major uncertainties and research needs, air pollution: the emergence of a major global health risk factor.

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Hanna Boogaard, Katherine Walker, Aaron J Cohen, Air pollution: the emergence of a major global health risk factor, International Health , Volume 11, Issue 6, November 2019, Pages 417–421, https://doi.org/10.1093/inthealth/ihz078

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Air pollution is now recognized by governments, international institutions and civil society as a major global public health risk factor. This is the result of the remarkable growth of scientific knowledge enabled by advances in epidemiology and exposure assessment. There is now a broad scientific consensus that exposure to air pollution increases mortality and morbidity from cardiovascular and respiratory disease and lung cancer and shortens life expectancy. Although air pollution has markedly declined in high-income countries, it was still responsible for some 4.9 million deaths in 2017, largely in low- and middle-income countries, where air pollution has increased over the past 25 y. As governments act to reduce air pollution there is a continuing need for research to strengthen the evidence on disease risk at very low and very high levels of air pollution, identify the air pollution sources most responsible for disease burden and assess the public health effectiveness of actions taken to improve air quality.

Air pollution is a major global public health risk factor. Although levels have declined in high-income countries (HICs) over the past 25 y, they have risen sharply over that same period in China, India and other low- and middle-income countries (LMICs), and threaten public health and economic development. 1–3

There is now broad expert consensus that exposure to air pollution causes a range of adverse health effects, based on evidence from a large scientific literature that has grown exponentially since the mid-1990s. 4–8 Based on that evidence, the Global Burden of Disease (GBD) project estimated that in 2017 air pollution ranked among the leading risk factors for global mortality, and the United Nations’ Sustainable Development Goals call for major reductions in exposure to air pollution by 2030. 9

Below we summarize the recent evolution of knowledge on the adverse health effects of air pollution and the burden of disease attributable to it and discuss directions for future research.

Human exposure

Air pollution is a complex mixture of gases and particles whose sources and composition vary spatially and temporally. Fine particle mass with aerodynamic diameters <2.5 μm (PM 2.5 ) and ground-level (tropospheric) ozone are indicators of two relatively distinct air pollution mixtures commonly used to quantify exposure to air pollution and its health effects. 10

Methods to assess exposure to ambient air pollution have improved significantly over the past decade. Early cohort studies characterized exposure by assigning the average concentration measured at one or a few ground-based monitors within a city to each participant. 11 , 12 Recent developments in satellite-based remote sensing, land use regression models and ‘hybrid’ models now provide air pollution exposure estimates that cover entire countries with high spatial resolution 13–15 and have made possible epidemiologic studies and assessments of disease burden across the globe in both highly polluted and relatively clean areas. 16 , 17

Levels of ambient PM 2.5 have declined in HICs over the past 25 y, due in large part to air quality management programs implemented by governments, such as the US Clean Air Act, 18 and the most recent data from China indicate that an aggressive 5-y plan to reduce air pollution begun in 2013 has begun to reduce levels of PM 2.5 . 1 Nonetheless, in 2017 >90% of the world’s population resided in areas where ambient PM 2.5 levels exceeded the WHO’s air quality guideline of 10 μg/m 3 , with many LMICs experiencing high levels of ambient PM 2.5 ( Figure 1 ), levels of which have increased over the past 3 decades. 1 , 2

Annual average population-weighted mean PM 2.5 concentrations in 2017. 1 , 2

Exposure to PM 2.5 household air pollution from the burning of solid fuels for cooking has declined, although millions of the global poor still rely on solid fuels for both cooking and heating. 1 Levels of tropospheric ozone have increased slightly in most countries over the same 25 y period. 1 , 2

Adverse health effects

Air pollution exposure causes a range of adverse health effects. 4 , 5 Historically, air pollution research has focused on adverse effects on the respiratory system, 19 but numerous epidemiologic studies now link long-term exposure to air pollution and cardiovascular morbidity and mortality, 20 , 21 evidence of which is buttressed by toxicologic and mechanistic research. 4 , 22 Recent studies have also linked exposure to PM 2.5 with type 2 diabetes incidence and mortality, adverse reproductive outcomes and neurologic effects. 23 The International Agency for Research on Cancer recently declared air pollution, and PM specifically, to be known human carcinogens. 8 The most recent estimates of the global burden of disease attributable to air pollution include the effects of exposure on mortality from ischemic heart disease, cerebrovascular disease (ischemic stroke and hemorrhagic stroke), lung cancer, chronic obstructive pulmonary disease and lower-respiratory infections and type 2 diabetes. 2

Exposure–response relationships

Quantifying public health impacts of air pollution exposure requires mathematical functions relating exposure to health responses, usually in terms of a relative risk, but until recently studies of long-term exposure and morbidity and mortality have been conducted only in HICs with relatively low air pollution levels. The integrated exposure response (IER) function was developed to estimate mortality relative risks across the global exposure range and is now used by both the GBD collaboration and WHO to estimate the burden of disease attributable to PM 2.5 . 2 , 24 , 25 The IER function combines relative risk estimates from various PM 2.5 sources, including active and passive smoking. A PM 2.5 exposure–response function (global exposure mortality model [GEMM]) based only on ambient PM 2.5 studies has recently been developed that provides estimates of mortality relative risk that are greater than those from the IER function and result in burden estimates that are two to three times higher. 26 These differences reflect current uncertainty about key assumptions underlying the IER and GEMM models and therefore about the true size of the PM 2.5 mortality relative risks. 27 Recently published Chinese studies are helping to reduce this uncertainty. 28 , 41

Air pollution, both outdoor and household burning of solid fuels, was the fifth leading risk factor for mortality following diet, high blood pressure, tobacco and high fasting blood glucose, contributing to 4.9 million deaths worldwide, or 8.7% of global mortality in 2017. Age-standardized mortality rates attributable to air pollution were highest in East and South Asia and sub-Saharan Africa and lowest in the high-income Asia-Pacific region, North America and Western Europe ( Figure 2 ).

Age-standardized mortality rates per 100 000 attributable to air pollution in 2017. 1 , 2

Ambient PM 2.5 was the eighth leading global risk factor, contributing to 2.9 million deaths (5.2% of all global deaths), largely due to mortality from cardiovascular disease. Household air pollution from indoor burning of solid fuels for cooking ranked 13th, contributing to 1.6 million deaths (2.9% of global mortality). Tropospheric ozone contributed to an additional 472 000 deaths from chronic respiratory disease.

Global mortality attributable to ambient PM 2.5 increased from 1990 to 2017, while mortality from household air pollution from the burning of solid fuels for cooking declined markedly over the same period. 1 Trends in attributable deaths from ambient PM 2.5 air pollution largely reflect changes in mortality from cardiovascular disease as well as demographic changes. 2

In 2016, PM 2.5 exposure reduced average global life expectancy at birth by approximately 1 y, with reductions of approximately 1.2–1.9 y in highly polluted countries of Asia and Africa. In China, life expectancy was reduced by an estimated 1.3 y. Meeting the WHO air quality guideline (10 μg/m 3 ) could increase global life expectancy by a population-weighted median of 0.6 y, a benefit of similar magnitude to eradicating lung and breast cancer. 1 , 30

Despite the remarkable growth in knowledge about air pollution and health, there is a range of issues that warrant additional research. 29 , 31 Several are of particular importance.

How large is the risk of mortality due to living in places with very high and very low levels of air pollution?

Studies of air pollution and health are needed in LMICs to buttress estimates of the current burden of disease and to track progress in reducing exposure and disease as actions are taken to improve air quality. China, which has experienced some of the highest levels of air pollution in the world, has implemented aggressive air quality management plans that have reduced PM 2.5 levels by ≥25% on average over the last 5 y, 1 and Chinese researchers are conducting an ambitious research program to document the adverse effects of exposure and measure changes in health as air quality improves. 29

Because of the considerable and continuing improvement in air quality in HICs over the past 25 y, there remains a need to determine whether the adverse effects of air pollution persist at the lowest ambient levels and to estimate the benefits from further tightening air pollution regulations. Early results from a research program by the Health Effects Institute (HEI) in very large populations in the USA, Canada and Europe report adverse health effects of air pollution even at levels below the current US PM 2.5 standard and WHO air quality guidelines. 32 , 33

How do major air pollution sources, such as coal burning and transportation, contribute to air pollution exposure and disease burden, and what can we expect if emissions from major sources are reduced?

Air quality regulations improve air quality by reducing emissions from major air pollution sources such as coal and biomass burning and transportation, so understanding how major air pollution sources contribute to air pollution exposure and disease burden is critical. In 2014, the HEI began the Global Burden of Disease Major Air Pollution Sources project, which quantified the burden of disease in China and India attributable to current emissions of PM 2.5 pollution and documented the reduction in disease burden that would result under four policy-relevant future scenarios based on anticipated emissions reductions, and others have also addressed this issue. 34–36 An HEI-funded project is now underway to estimate major source contributions to air pollution in 195 countries.

Although current evidence does not clearly identify differences in the toxicity of PM 2.5 from different sources, there is a need for continuing research on this issue. 4 , 29 , 37 , 38

If action is taken to reduce air pollution, will it make a difference in population health?

Action is now underway or in the planning stages to reduce high levels of air pollution in China, India and other LMICs, and HIC governments are considering reductions in ambient air pollution to even cleaner levels. Accountability studies designed to assess whether such actions lead to the expected health benefits have now been conducted in many locations, and more are underway, including in China. In some cases, such studies have provided evidence for the benefits of specific actions and policies, but in other cases their evidence has been weaker than had been originally anticipated. This experience has been recently reviewed and recommendations have been offered for the design and conduct of future studies. 39 , 40

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• respiration disorders
• respiratory tract diseases
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Confronting plastic pollution to protect environmental and public health

* E-mail: [email protected] (LG); [email protected] (JE)

Affiliation Public Library of Science, San Francisco, California, United States of America

Affiliation Center for the Advancement of Public Action, Bennington College; Beyond Plastics, Bennington, Vermont, United States of America

• Liza Gross, 
• Judith Enck

Published: March 30, 2021

• https://doi.org/10.1371/journal.pbio.3001131
• Reader Comments

A new collection of evidence-based commentaries explores critical challenges facing scientists and policymakers working to address the potential environmental and health harms of microplastics. The commentaries reveal a pressing need to develop robust methods to detect, evaluate, and mitigate the impacts of this emerging contaminant, most recently found in human placentas.

Citation: Gross L, Enck J (2021) Confronting plastic pollution to protect environmental and public health. PLoS Biol 19(3): e3001131. https://doi.org/10.1371/journal.pbio.3001131

Copyright: © 2021 Gross, Enck. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: Liza Gross is a current paid employee of the Public Library of Science.

The explosive production of affordable plastic goods during the 1950s ushered in an era of disposable living, fueled by an addiction to convenience and consumerism, that has created one of the world’s most vexing pollution problems. Plastic, for all its uses, has left a trail of debris from the deepest ocean trenches to the remotest polar reaches. Plastic pollutes throughout its life cycle, from its beginnings as a by-product of greenhouse gas-emitting oil and natural gas refining to its degradation-resistant end as increasingly fragmented shards of micro-and nanoplastics in atmospheric currents, alpine snow, estuaries, lakes, oceans, and soils. Researchers are finding microplastics in the gut or tissue of nearly every living thing they examine, including the placentas of unborn children.

The first sign of this burgeoning crisis came nearly half a century ago, when marine biologists first spotted tiny plastic pellets stuck to tiny marine organisms and seaweed in the North Atlantic’s Sargasso Sea. Describing their discovery in 1972, the scientists predicted, presciently, that “increasing production of plastics, combined with present waste disposal practices, will probably lead to greater concentrations on the sea surface” [ 1 ].

Researchers have struggled to keep tabs on plastic production and waste ever since. The first global assessment of mass-produced plastics, reported in 2017, estimated that manufacturers had produced 8,300 million metric tons of virgin plastics, creating 6,300 million metric tons of plastic waste—with only 9% recycled, 12% incinerated, and the rest either piling up in landfills or entering the environment [ 2 ].

Some 15 million metric tons of plastic enters the oceans every year [ 3 ], choking marine mammals, invading the guts of fish and seabirds, and posing unknown risks to the animals, and people, who eat them. Plastics release toxic chemicals added during manufacturing as they splinter into smaller and smaller fragments, with half-lives ranging from 58 to 1,200 years [ 4 ]. Persistent organic pollutants have a high affinity for plastic particles, which glom on to these contaminants as do pathogens in the ocean, presenting additional risks to marine life and the food web. Scientists once viewed freshwater lakes and rivers as primarily conduits for plastic, delivering trash from land to the sea, but now realize they’re also repositories.

Plastic production increased from 2 million metric tons a year in 1950 to 380 million metric tons by 2015 and is expected to double by 2050 [ 2 ]. Petrochemical companies’ embrace of fracking has exacerbated the crisis by producing large amounts of ethane, a building block for plastic.

Recognizing the scope and urgency of addressing the plastic pollution crisis, PLOS Biology is publishing a special collection of commentaries called “Confronting plastic pollution to protect environmental and public health.”

In commissioning the collection, we aimed to illuminate critical questions about microplastics’ effects on environmental and human health and explore current challenges in addressing those questions. The collection features three evidence-based commentaries that address gaps in understanding while flagging research priorities for improving methods to detect, evaluate, and mitigate threats associated with this emerging contaminant.

Environmental ecotoxicologist Scott Coffin and colleagues address recent government efforts to assess and reduce deleterious effects of microplastics, which challenge traditional risk-based regulatory frameworks due to their particle properties, diverse composition, and persistence. In their Essay, “Addressing the environmental and health impacts of microplastics requires open collaboration between diverse sectors” [ 5 ], the authors use California as a case study to suggest strategies to deal with these uncertainties in designing research, policy, and regulation, drawing on parallels with a similar class of emerging contaminants (per- and polyfluoroalkyl substances).

In “Tackling the toxics in plastics packaging” [ 6 ], environmental toxicologist Jane Muncke focuses on a major driver of the global plastic pollution crisis: single-use food packaging. Our throwaway culture has led to the widespread use of plastic packaging for storing, transporting, preparing, and serving food, along with efforts to reduce plastic waste by giving it new life as recycled material. But these efforts ignore evidence that chemicals in plastic migrate from plastic, making harmful chemicals an unintentional part of the human diet. Addressing contamination from food packaging is an urgent public health need that requires integrating all existing knowledge, she argues.

Much early research on microplastics focused on ocean pollution. But the ubiquitous particles appear to be interfering with the very fabric of the soil environment itself, by influencing soil bulk density and the stability of the building blocks of soil structure, argue Matthias Rillig and colleagues in their Essay. Microplastics can affect the carbon cycle in numerous ways, for example, by being carbon themselves and by influencing soil microbial processes, plant growth, or litter decomposition, the authors argue in “Microplastic effects on carbon cycling processes in soils” [ 7 ]. They call for “a major concerted effort” to understand the pervasive effects of microplastics on the function of soils and terrestrial ecosystems, a monumental feat given the immense diversity of the particles’ chemistry, aging, size, and shape.

The scope and effects of plastic pollution are too vast to be captured in a few commentaries. Microplastics are everywhere and researchers are just starting to get a handle on how to study the influence of this emerging contaminant on diverse environments and organisms. But as the contributors to this collection make clear, the pervasiveness of microplastics makes them nearly impossible to avoid. And the uncertainty surrounding their potential to harm people, wildlife, and the environment, they show, underscores the urgency of developing robust tools and methods to understand how a material designed to make life easier may be making it increasingly unsustainable.

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Essay On Impact of Environmental pollution on public health

Essay On Impact of Environmental Pollution on public health

Hello My Dear Friend, In this post “ Essay On Impact of Environmental Pollution on public health “, We will be going to read about the Impact of Environmental Pollution on Public Health as an Essay in detail. So…

Let’s Start…

Introduction

Pollution in the environment has become a major global concern, posing a substantial threat to human health.

Over the last few decades, increased industrialization, urbanization, and population growth have resulted in the release of dangerous chemicals into the environment.

These pollutants, which include toxins in the air, water, and soil, have far-reaching repercussions for human health.

The purpose of this article is to investigate the influence of environmental pollution on public health and the actions that can be implemented to reduce its negative consequences.

Air Pollution and Respiratory Diseases

The increased prevalence of respiratory disorders is one of the most evident and immediate effects of environmental pollution on public health.

Particulate matter, nitrogen oxides, sulfur dioxide, and volatile organic compounds are among the harmful pollutants released into the atmosphere by car emissions, industrial activity, and the combustion of fossil fuels.

Prolonged exposure to these contaminants can cause asthma, bronchitis, and chronic obstructive pulmonary disease (COPD).

According to studies, air pollution aggravates pre-existing respiratory diseases and may even contribute to premature death.

Water Pollution and Waterborne Diseases

Water pollution is another major contributor to public health issues. Untreated industrial waste, agricultural runoff, and poor disposal of home chemicals pollute water bodies, rendering them unsafe for human consumption.

Waterborne diseases such as cholera, typhoid, and dysentery spread as a result of this contamination.

Furthermore, the presence of heavy metals and hazardous chemicals in drinking water causes long-term health problems such as organ damage, developmental disorders, and an increased chance of cancer.

Soil Pollution and Food Contamination

Soil pollution, which can lead to food contamination, is another way that environmental pollution affects human health.

Toxins accumulate in the soil as a result of the usage of chemical fertilizers, pesticides, and poor waste disposal practices.

These toxins are subsequently absorbed by plants, eventually entering the food chain and reaching humans via contaminated crops, meat, and dairy products.

Long-term exposure to contaminated food can result in a variety of health issues, including organ damage, hormonal imbalances, and an increased risk of cancer.

Impact on Mental Health

Environmental pollution has a substantial impact on mental health in addition to physical health. Air pollution has been related to an increased risk of mental diseases such as depression, anxiety, and cognitive loss in studies.

Continuous exposure to contaminated settings can result in chronic stress, poor cognitive function, and a lower quality of life.

Furthermore, pollution-induced degradation of natural landscapes and biodiversity loss can contribute to emotions of loneliness, unhappiness, and a lower sense of well-being.

Children and Vulnerable Populations

Children and vulnerable populations, such as the elderly and people with pre-existing health concerns, are more exposed to the negative impacts of pollution.

Their developing organs and weakened immune systems make infants more vulnerable to respiratory infections, allergies, and other pollution-related health problems.

Furthermore, environmental exposure during pregnancy might harm fetal development and raise the chance of birth abnormalities and developmental disorders.

Mitigation Measures

It is critical to establish effective mitigation measures to combat the negative impacts of environmental pollution on public health.

To reduce pollution and safeguard human health, governments, industries, and individuals must collaborate. Among the most important strategies are:

1. Encourage the use of renewable energy sources to reduce reliance on fossil fuels and reduce air pollution. 2. Improving industrial practices in order to reduce emissions and install more stringent pollution control measures. 3. Improving waste management systems to prevent dangerous compounds from being released into the environment. 4. Promoting environmentally friendly agricultural practices that reduce the usage of artificial fertilizers and pesticides. 5. Raising public knowledge about the effects of pollution on health and encouraging individuals to take action, such as lowering automobile emissions and saving water.

Pollution in the environment is a huge hazard to public health, affecting many elements of human well-being.

Air pollution, water pollution, soil pollution, and food contamination all lead to a variety of health issues, including respiratory diseases, waterborne illnesses, and mental disorders.

Children and vulnerable communities are especially vulnerable. To preserve public health, proactive steps to limit pollution and encourage sustainable practices are required.

We can create a healthier and more sustainable future for all by prioritizing environmental conservation and implementing cleaner technologies.

Finally, Thanks For Reading “ Essay On Impact of Environmental Pollution on public health “.

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Air Pollution: Public Health Impact Qualitative Research

Introduction.

Over the years, environmentalists have intensified research on air pollution. Air pollution has been attributed to activities such as air travel, coal mining, and geological storage, among others. Consequently, this has increased health-associated risks in societies. The paper will summarize articles on human activities and their effects on human health.

International Air Travel and Greenhouse Gas Emissions: A Proposal for an Adaptation Levy

This article begins by recounting the benefits of air travel as well as its expansion throughout the world. According to the authors, Cameron and Benito, globalization was essential in driving commercial aviation. The article begins by exploring the nature and scale of challenges associated with greenhouse emissions in aviation. It argues that increase in emissions is a direct result of increase in growth of air travel since World War II.

Using various examples such as those from the European Union, the article cites increase in use of aviation fuel as a source of emissions in air travel.

Despite the fact that pollution from aviation forms about 4% of total air pollution by green house gasses, IATA has continued to pursue implementation of a proposal aimed at minimizing air pollution. The article cites inadequacies in current policies aimed at reducing carbon emissions. It suggests a proposal, which fronts for emission minimization incentives and charges, among others.

According to the article, aviation emissions are increasing at an alarming rate. In fact, it proposes major changes in policies to address potential challenges caused by air pollution. It also faults Kyoto Protocol for exclusion of policy changes aimed at reducing air pollution.

The article; therefore, put forward an IATAL to help tackle environmental issues arising from air travel. The authors believe that IATAL would provide stability in the industry more than the current scheme of auction. Moreover, they argue that IATAL would be accepted throughout the world since it addresses the repercussions of climate change (Hepburn & Müller, 2010, pp. 830-849).

Issue profile: environmental issues and the geological storage of CO2

This article relates environmental issues with carbon dioxide emissions. It begins by reaffirming the fact that increased carbon dioxide emission is likely to bring about oceanic acidification and climate change. These changes are expected to bring with them severe repercussions for humanity and ecosystems.

The paper explores strategies being sought to help minimize emissions, which include geological storage for carbon dioxide emissions. According to the article, existing studies only focus on gas and oil regulatory framework. However, the authors believe that if studies are also focused on non-oil reservoir formations, the frameworks utilized above may be inconclusive.

The paper goes on to state that the level of concern for uncontrolled carbon dioxide emissions is high in Europe. In fact, the authors also believe that release of such emissions from their storage sites are causing concerns among regulators. In essence, the paper calls for a new framework that would apply for both oil and non-oil reservoirs.

Moreover, the paper recommends that the effects of chronic and acute contact of ecosystems with carbon dioxide be evaluated. Additionally, it recommends inclusion of specific information addressing leakages from storage sites. The paper explores data to evaluate its capability in assisting regulators to implement these changes. Sadly, the amount of data is inadequate to help regulators.

It therefore exposes the gaps in assessing possible impacts of carbon dioxide leakages on subsurface, terrestrial, and marine ecosystems. The authors also believe that knowledge on impacts of carbon dioxide leakage would enable regulators to refine risk assessments.

Additionally, it would provide limits and data on recovery rates. Furthermore, it would also help in assessing ecosystem changes for CCS sites in future (West, Pearce, Bentham & Maul, 2005, pp. 250-259).

Opencast coal mining in India: Analyzing and addressing the air environmental impacts

This article explores air environmental impacts of opencast coal mining in India. It begins by arguing that opencast mining causes more environmental issues than underground mining. Among the concerns raised in the article is deterioration of air quality, among others, which affect not only the surrounding but also the mining area. Nonetheless, the paper describes opencast mining to be a success in India.

This, the article argues, is attributed to the rising need for energy. Moreover, increased concerns for underground mining have also led to shifting technologies on opencast mining. The paper utilizes factal analysis to provide an understanding of air pollutants and their effects in opencast mining. The paper recommends numerous ways of reducing air pollution in opencast mining.

Some of the recommendations pointed include monitoring of wind direction and pollution concentrations around the mines, use of green belt, dust control, and water spraying, among others. The paper also argues that opencast mining pollution is caused mainly by generation of dust. Moreover, the paper notes high levels of pollutants, which are hazardous to human health.

The article also explains the process of factal analysis as well as its outcome in analyzing pollution in India from opencast mining. Moreover, the article recommends a practical scheme for minimizing air pollution opencast mining. It also suggests that this methodology be extended to other site types (Ghose, 2007, pp. 71-87).

Article on Public Heath

This article explains how air pollution contributes to morbidity and mortality. It does this by estimating the effects of traffic related air pollution and impact of outdoor pollution on public health. This study was conducted in three European countries namely Austria, Switzerland, and France. Impacts of air pollution were quantified using epidemiology based exposure-response functions for an increase in particulate matter.

The cases that were attributable to air pollution were classified according to ages namely, 30 years, 25 years, 20 years, and 15 years respectively. This was then modeled for each square kilometer. Asthma attacks in both adults and children were explored, as well as restricted activity days, among others.

Findings indicated that over 40000 that represent over 6% of death cases (mortality) were caused by air pollution on a yearly basis. In addition, motorized traffic caused nearly half of all mortality arising from air pollution. Moreover, this attributed to 16 million person-day restricted activities, over 500000 of asthma attacks, over 290000 of bronchitis in children and over 25000 new cases of bronchitis in adults.

The paper estimated the impact of air pollution in public health. It suggests that although individual concerns from air pollution are minimal, public health concern are substantial. Besides, it affirms that public health targets air pollution as its main areas of concern in Europe.

Finally, it suggests that results from the study are resourceful in assessment of environmental health-policy options (Kunzli, Kaiser, Medina, Studnicka, Chanel, Filliger &… Sommer, 2000, p. 795).

Air pollution is an area of concern to the world at large. The paper explores various air pollutants such as dust, carbon dioxide emissions, and green house gas emissions. In this regard, the paper explores various articles on opencast coals mining, aviation emissions, and geological storage of carbon dioxide and public health concerns in air pollution.

Notably, each of the articles provides recommendations for reducing air pollution. For instance, change in policies is mentioned profoundly in the articles, among other measures. In essence, the articles show that studies on air pollution are important for its mitigation.

Ghose, M. K. (2007). Opencast coal mining in India: Analyzing and addressing the air environmental impacts. Environmental Quality Management, 16 (3), 71-87.

Hepburn, C., & Müller, B. (2010). International Air Travel and Greenhouse Gas Emissions: A Proposal for an Adaptation Levy. World Economy, 33 (6), 830-849.

Kunzli, N., Kaiser, R., Medina, S., Studnicka, M., Chanel, O., Filliger, P., &… Sommer, H. (2000). Public-health impact of outdoor and traffic-related air pollution: a European assessment. Lancet, 356 (9232), 795.

West, J. M., Pearce, J., Bentham, M., & Maul, P. (2005). Issue profile: environmental issues and the geological storage of CO2. European Environment: The Journal of European Environmental Policy (Wiley), 15 (4), 250-259.

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Environmental Pollution and its Impact on Public Health: A Critical Review

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The earth is a victim of on slaughter of a materialistic civilization and industrialization. As a result there is rapid depletion of natural resources. Life on the earth being posed to severe threats, nature has started sending us warning signals in the form of droughts, floods, tsunamis, vast changes in climatic patterns, global warming, acid rains, sprawling desertification, depletion of atmospheric ozone shield and many hitherto unheard diseases.1 In the last 100 years mankind managed top destroy much of what took nature millions of years to create on the earth. At no point of time in the history of our planet has so much damage been done. Mankind has poisoned the river systems through out the world and this, in turn, has upset the ecological balance of the rivers and oceans. Trees are indiscriminately being chopped down because of the greed of man

Prof.Dr.Suaad AL-Taai

Air pollution is very important topic for those interested in studying the environment because of its importance and the damage caused by it to human, animal and plant life. This research addresses the concept of air pollution, its causes, and its danger, and sheds light on the influence of climate elements on environmental pollution and the effect of temperature, rain, humidity, wind direction and speed, and atmospheric pressure on the increase or decrease of air pollution. This research discusses the sources of air pollution, including natural ones, including dust, smoke resulting from fires, erupting volcanoes, and others, including those resulting from human uses such as the use of fuel and others. The research addressed the damages caused by the emission of gases in its various sources. This research work discusses the types of air pollutants and methods of measuring them, as well as the sources and causes of indoor air pollution. The research sheds light on the effects of air pollution on environmental pollution due to the escalation of toxic gases that cause serious diseases to humans and other living organisms. The research deals with ways to reduce air pollution, most notably the search for an alternative source of energy, improving vehicle engines, agriculture and increasing green spaces.

Journal of Pharmaceutical Research International

savita pohekar

Air pollution is the major environmental pollution that contains different types of gases, dust particles, small molecules, etc. Smoke and other hazardous gases, such as carbon, sulfur, and nitrogen oxides, are the primary causes of air pollution. Otherwise, air pollution is the contaminated air that poisonous effect on people&#39;s health. Most air pollution is affected by auto-rickshaw drivers. Auto drivers doing very stressful works which have been associated with environmental interaction factors. So the auto drivers are working within the environment, auto drivers are exposed to climate changes and poor road conditions. So the drivers are exposed to air pollution, dust, droplets, job insecurity, noise and vibration, business demands, damage to equipment, an excessive number of stops, schedule-related pressure, among others. Drivers’ social role is also reflected in the responsibility of passengers and pedestrians ‘lives and other vehicles.

Pollution and its direct and indirect negative effects on humans, and animals is one of the most important issues that researchers have been studying and searching for radical solutions. Therefore, the research sheds light on the definition of pollution, its causes and environmental effects, its most important types, especially radioactive, industrial and household waste, and their levels of risk. The research focuses on the issue of air pollution resulting from fumes, smoke, and gases emitted from cars, factories, volcanic eruptions, and others. It also absorbs the problem of soil and water pollution due to the failure to properly treat factory, household and other waste, and the use of chemical fertilizers and pesticides harmful to water, air and soil. The research addresses the topic of noise pollution, and its causes by limiting loud noises from radio, television, cars, airplanes, music, etc.

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The Effects of Climate Change

The effects of human-caused global warming are happening now, are irreversible for people alive today, and will worsen as long as humans add greenhouse gases to the atmosphere.

• We already see effects scientists predicted, such as the loss of sea ice, melting glaciers and ice sheets, sea level rise, and more intense heat waves.
• Scientists predict global temperature increases from human-made greenhouse gases will continue. Severe weather damage will also increase and intensify.

Earth Will Continue to Warm and the Effects Will Be Profound

Global climate change is not a future problem. Changes to Earth’s climate driven by increased human emissions of heat-trapping greenhouse gases are already having widespread effects on the environment: glaciers and ice sheets are shrinking, river and lake ice is breaking up earlier, plant and animal geographic ranges are shifting, and plants and trees are blooming sooner.

Effects that scientists had long predicted would result from global climate change are now occurring, such as sea ice loss, accelerated sea level rise, and longer, more intense heat waves.

The magnitude and rate of climate change and associated risks depend strongly on near-term mitigation and adaptation actions, and projected adverse impacts and related losses and damages escalate with every increment of global warming.

Intergovernmental Panel on Climate Change

Some changes (such as droughts, wildfires, and extreme rainfall) are happening faster than scientists previously assessed. In fact, according to the Intergovernmental Panel on Climate Change (IPCC) — the United Nations body established to assess the science related to climate change — modern humans have never before seen the observed changes in our global climate, and some of these changes are irreversible over the next hundreds to thousands of years.

Scientists have high confidence that global temperatures will continue to rise for many decades, mainly due to greenhouse gases produced by human activities.

The IPCC’s Sixth Assessment report, published in 2021, found that human emissions of heat-trapping gases have already warmed the climate by nearly 2 degrees Fahrenheit (1.1 degrees Celsius) since 1850-1900. 1 The global average temperature is expected to reach or exceed 1.5 degrees C (about 3 degrees F) within the next few decades. These changes will affect all regions of Earth.

The severity of effects caused by climate change will depend on the path of future human activities. More greenhouse gas emissions will lead to more climate extremes and widespread damaging effects across our planet. However, those future effects depend on the total amount of carbon dioxide we emit. So, if we can reduce emissions, we may avoid some of the worst effects.

The scientific evidence is unequivocal: climate change is a threat to human wellbeing and the health of the planet. Any further delay in concerted global action will miss the brief, rapidly closing window to secure a liveable future.

Here are some of the expected effects of global climate change on the United States, according to the Third and Fourth National Climate Assessment Reports:

Future effects of global climate change in the United States:

U.S. Sea Level Likely to Rise 1 to 6.6 Feet by 2100

Global sea level has risen about 8 inches (0.2 meters) since reliable record-keeping began in 1880. By 2100, scientists project that it will rise at least another foot (0.3 meters), but possibly as high as 6.6 feet (2 meters) in a high-emissions scenario. Sea level is rising because of added water from melting land ice and the expansion of seawater as it warms. Image credit: Creative Commons Attribution-Share Alike 4.0

Climate Changes Will Continue Through This Century and Beyond

Global climate is projected to continue warming over this century and beyond. Image credit: Khagani Hasanov, Creative Commons Attribution-Share Alike 3.0

Hurricanes Will Become Stronger and More Intense

Scientists project that hurricane-associated storm intensity and rainfall rates will increase as the climate continues to warm. Image credit: NASA

More Droughts and Heat Waves

Droughts in the Southwest and heat waves (periods of abnormally hot weather lasting days to weeks) are projected to become more intense, and cold waves less intense and less frequent. Image credit: NOAA

Longer Wildfire Season

Warming temperatures have extended and intensified wildfire season in the West, where long-term drought in the region has heightened the risk of fires. Scientists estimate that human-caused climate change has already doubled the area of forest burned in recent decades. By around 2050, the amount of land consumed by wildfires in Western states is projected to further increase by two to six times. Even in traditionally rainy regions like the Southeast, wildfires are projected to increase by about 30%.

Changes in Precipitation Patterns

Climate change is having an uneven effect on precipitation (rain and snow) in the United States, with some locations experiencing increased precipitation and flooding, while others suffer from drought. On average, more winter and spring precipitation is projected for the northern United States, and less for the Southwest, over this century. Image credit: Marvin Nauman/FEMA

Frost-Free Season (and Growing Season) will Lengthen

The length of the frost-free season, and the corresponding growing season, has been increasing since the 1980s, with the largest increases occurring in the western United States. Across the United States, the growing season is projected to continue to lengthen, which will affect ecosystems and agriculture.

Global Temperatures Will Continue to Rise

Summer of 2023 was Earth's hottest summer on record, 0.41 degrees Fahrenheit (F) (0.23 degrees Celsius (C)) warmer than any other summer in NASA’s record and 2.1 degrees F (1.2 C) warmer than the average summer between 1951 and 1980. Image credit: NASA

Arctic Is Very Likely to Become Ice-Free

Sea ice cover in the Arctic Ocean is expected to continue decreasing, and the Arctic Ocean will very likely become essentially ice-free in late summer if current projections hold. This change is expected to occur before mid-century.

U.S. Regional Effects

Climate change is bringing different types of challenges to each region of the country. Some of the current and future impacts are summarized below. These findings are from the Third 3 and Fourth 4 National Climate Assessment Reports, released by the U.S. Global Change Research Program .

• Northeast. Heat waves, heavy downpours, and sea level rise pose increasing challenges to many aspects of life in the Northeast. Infrastructure, agriculture, fisheries, and ecosystems will be increasingly compromised. Farmers can explore new crop options, but these adaptations are not cost- or risk-free. Moreover, adaptive capacity , which varies throughout the region, could be overwhelmed by a changing climate. Many states and cities are beginning to incorporate climate change into their planning.
• Northwest. Changes in the timing of peak flows in rivers and streams are reducing water supplies and worsening competing demands for water. Sea level rise, erosion, flooding, risks to infrastructure, and increasing ocean acidity pose major threats. Increasing wildfire incidence and severity, heat waves, insect outbreaks, and tree diseases are causing widespread forest die-off.
• Southeast. Sea level rise poses widespread and continuing threats to the region’s economy and environment. Extreme heat will affect health, energy, agriculture, and more. Decreased water availability will have economic and environmental impacts.
• Midwest. Extreme heat, heavy downpours, and flooding will affect infrastructure, health, agriculture, forestry, transportation, air and water quality, and more. Climate change will also worsen a range of risks to the Great Lakes.
• Southwest. Climate change has caused increased heat, drought, and insect outbreaks. In turn, these changes have made wildfires more numerous and severe. The warming climate has also caused a decline in water supplies, reduced agricultural yields, and triggered heat-related health impacts in cities. In coastal areas, flooding and erosion are additional concerns.

1. IPCC 2021, Climate Change 2021: The Physical Science Basis , the Working Group I contribution to the Sixth Assessment Report, Cambridge University Press, Cambridge, UK.

2. IPCC, 2013: Summary for Policymakers. In: Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Stocker, T.F., D. Qin, G.-K. Plattner, M. Tignor, S.K. Allen, J. Boschung, A. Nauels, Y. Xia, V. Bex and P.M. Midgley (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA.

3. USGCRP 2014, Third Climate Assessment .

4. USGCRP 2017, Fourth Climate Assessment .

Related Resources

A Degree of Difference

So, the Earth's average temperature has increased about 2 degrees Fahrenheit during the 20th century. What's the big deal?

What’s the difference between climate change and global warming?

“Global warming” refers to the long-term warming of the planet. “Climate change” encompasses global warming, but refers to the broader range of changes that are happening to our planet, including rising sea levels; shrinking mountain glaciers; accelerating ice melt in Greenland, Antarctica and the Arctic; and shifts in flower/plant blooming times.

Is it too late to prevent climate change?

Humans have caused major climate changes to happen already, and we have set in motion more changes still. However, if we stopped emitting greenhouse gases today, the rise in global temperatures would begin to flatten within a few years. Temperatures would then plateau but remain well-elevated for many, many centuries.

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Unending lessons from Sg Kim Kim disaster

Monday, 01 Apr 2024

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JOHOR BARU: Five years after the Sungai Kim Kim toxic pollution case sickened thousands and forced over a hundred schools in Pasir Gudang to temporarily close, the incident continues to serve as an important lesson for the state.

Johor state exco member Ling Tian Soon said the incident showed how serious pollution could get and how it could significantly harm the public and environment.

“The government spent more than RM6mil to remove pollutants from the river. On top of that, public health was affected as many people were hospitalised.

ALSO READ: Stop passing the buck, be systematic in tackling pollution, activists urge

“This shows just how devastating pollution can be to both the people and the environment. This serves as an important lesson to take such issues seriously,” he said in an interview.

Ling, who holds the health and environment portfolio, said the incident sparked an important conversation about such issues and helped pave the way for amendments to the Environmental Quality Act 1974.

In March 2019, toxic pollution in Sungai Kim Kim resulted in more than 4,000 people falling ill and the temporary closure of 111 schools in Pasir Gudang.

In December last year, a lorry driver was fined RM100,000 for causing pollution through the illegal disposal of scheduled waste in Sungai Kim Kim.

The man, N. Maridass, was found to have released oil sludge into the river, which is scheduled waste listed in the First Schedule of the Environmental Quality (Scheduled Wastes) Regulations 2005.

P Tech Resources Sdn Bhd, which faced eight charges under the Environmental Quality (Clean Air) Regulations 2014, was fined RM40,000 for each charge, or a total of RM320,000.

ALSO READ: Ramping up enforcement

Ling said the fines meted out were not commensurate with the crime and its impact.

“The Johor government welcomes the move to amend the Act to increase penalties for those involved in environmental crimes, especially as the state has seen first-hand the impact of pollution.

“With the amendments, we hope to see those committing such irresponsible acts get heavier penalties, including a (mandatory) prison sentence,” he said.

Related stories:

Tags / Keywords: Sungai Kim Kim , Pollution , Environment , NGOs

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Biden-Harris Administration finalizes strongest-ever pollution standards for cars that position U.S. companies and workers to lead the clean vehicle future, protect public health, address the climate crisis, save drivers money

Final standards will expand consumer choice in clean vehicles and build on historic progress in U.S. auto manufacturing under President Biden’s Investing in America agenda

March 20, 2024

WASHINGTON – Today, March 20, the U.S. Environmental Protection Agency announced final national pollution standards for passenger cars, light-duty trucks, and medium-duty vehicles for model years 2027 through 2032 and beyond. These standards will avoid more than 7 billion tons of carbon emissions and provide nearly $100 billion of annual net benefits to society, including $13 billion of annual public health benefits due to improved air quality, and $62 billion in reduced annual fuel costs, and maintenance and repair costs for drivers. The final standards deliver on the significant pollution reductions outlined in the proposed rule, while accelerating the adoption of cleaner vehicle technologies. EPA is finalizing this rule as sales of clean vehicles, including plug-in hybrid and fully electric vehicles, hit record highs last year.

EPA projects an increase in U.S. auto manufacturing employment in response to these final standards, consistent with the broader Biden-Harris Administration commitment to create good-paying, union jobs leading the clean vehicle future. Strong standards have historically contributed to the U.S. leading the world in the supply of clean technologies, with corresponding benefits for American global competitiveness and domestic employment. Since President Biden took office, companies have announced more than $160 billion in investment in U.S. clean vehicle manufacturing and the U.S. auto manufacturing sector has added more than 100,000 jobs.

These standards will provide greater certainty for the auto industry, catalyzing private investment, creating good-paying union jobs, and invigorating and strengthening the U.S. auto industry. Over the next decade, the standards, paired with President Biden’s historic Investing in America agenda and investments in U.S. manufacturing, will set the U.S. auto sector on a trajectory for sustained growth. Additionally, the final standards will lower costs for consumers. Once fully phased in, the standards will save the average American driver an estimated $6,000 in reduced fuel and maintenance over the life of a vehicle.

EPA Administrator Michael S. Regan will join President Biden’s National Climate Advisor Ali Zaidi today at an event in Washington, DC to announce the final standards and how they build on President Biden’s historic climate and economic record. The event will be livestreamed starting at noon EDT.

“With transportation as the largest source of U.S. climate emissions, these strongest-ever pollution standards for cars solidify America’s leadership in building a clean transportation future and creating good-paying American jobs, all while advancing President Biden’s historic climate agenda,” said EPA Administrator Michael S. Regan . “The standards will slash over 7 billion tons of climate pollution, improve air quality in overburdened communities, and give drivers more clean vehicle choices while saving them money. Under President Biden’s leadership, this Administration is pairing strong standards with historic investments to revitalize domestic manufacturing, strengthen domestic supply chains and create good-paying jobs.” 

“President Biden is investing in America, in our workers, and in the unions that built our middle class and established the U.S. auto sector as a leader in the world,” said President Biden’s National Climate Advisor Ali Zaidi . “The President’s agenda is working. On factory floors across the nation, our autoworkers are making cars and trucks that give American drivers a choice – a way to get from point A to point B without having to fuel up at a gas station. From plug-in hybrids to fuel cells to fully electric, drivers have more choices today. Since 2021, sales of these vehicles have quadrupled and prices continue to come down. This growth means jobs, and it means we are moving faster and faster to take on the climate crisis – all thanks to the President’s leadership.”

Statement from United Automobile Workers : “The EPA has made significant progress on its final greenhouse gas emissions rule for light-duty vehicles. By taking seriously the concerns of workers and communities, the EPA has come a long way to create a more feasible emissions rule that protects workers building ICE vehicles, while providing a path forward for automakers to implement the full range of automotive technologies to reduce emissions.”

Light- and Medium-Duty Vehicle Final Standards

The final standards announced today, the “Multi Pollutant Emissions Standards for Model Years 2027 and Later Light-Duty and Medium-Duty Vehicles,” build on EPA’s existing emissions standards for passenger cars and light trucks for model years 2023 through 2026. The standards continue the technology-neutral and performance-based design of previous EPA standards for cars, pickups, and vans, and leverage advances in clean car technologies to further reduce both climate pollution and smog- and soot-forming emissions. EPA is finalizing the same standard proposed for MY 2032 while allowing additional time for the auto sector to scale up clean vehicle manufacturing supply chains in the first three years covered by the rule.

Annually, the net benefits to society for the light- and medium-duty final rule are estimated to be $99 billion. The final rule is expected to avoid 7.2 billion tons of CO2 emissions through 2055, roughly equal to four times the emissions of the entire transportation sector in 2021. It will also reduce fine particulate matter and ozone, preventing up to 2,500 premature deaths in 2055 as well as reducing heart attacks, respiratory and cardiovascular illnesses, aggravated asthma, and decreased lung function.

EPA received extensive feedback on the proposed rule, including through written comments, testimony at public hearings, and other stakeholder engagements. The final standards were informed by the best available data in the public record and rigorous technical assessments. Like the proposal, EPA’s final rule gives manufacturers the flexibility to efficiently reduce emissions and meet the performance-based standards through the mix of technologies they decide is best for them and their customers. EPA’s analysis considers a broad suite of available emission control technologies, and projects that consumers will continue to have a wide range of vehicle choices under the final rule, including advanced gasoline vehicles, hybrids, plug-in hybrid electric vehicles, and full battery electric vehicles.

Compared to the existing MY 2026 standards, the final MY 2032 standards represent a nearly 50% reduction in projected fleet average GHG emissions levels for light-duty vehicles and 44% reductions for medium-duty vehicles. In addition, the standards are expected to reduce emissions of health-harming fine particulate matter from gasoline-powered vehicles by over 95%. This will improve air quality nationwide and especially for people who live near major roadways and have environmental justice concerns.

Investing in America’s Clean Transportation Future

The final rule reflects the significant investments in clean vehicle technologies that industry is already making domestically and abroad, as well as ongoing U.S. market shifts and increasing consumer interest in clean vehicles. The Biden-Harris Administration is also directly supporting communities across America in moving towards a cleaner transportation future, including by building a national network of EV chargers and alternative-fuel stations; ensuring domestic manufacturers have the critical minerals and materials they need to make EV batteries; and funding clean transit and clean school buses, with priority for underserved communities. President Biden’s Investing in America agenda is focused on growing the American economy from the bottom up and the middle out – from rebuilding our nation’s infrastructure, to creating a manufacturing and innovation boom, to building a clean-energy economy that will combat climate change and make our communities more resilient.

Here's what leaders are saying about the final rule:

“I’ve always said Michigan automakers are the best in the world. And this is their moment,” said Senator Debbie Stabenow (MI) . “I appreciate EPA’s commitment to engaging with our automakers and autoworkers to develop an ambitious but achievable final rule. It represents an opportunity for union workers to continue to build the vehicles of the future right here in the U.S. and tackle the climate crisis.”

“My priority will always be to protect American jobs and our environment, keep the United States at the forefront of automotive manufacturing, technology, and innovation, and keep our domestic industry strong and competitive,” said Congresswoman Debbie Dingell (MI-06) . “The EPA has worked with all stakeholders to reach this final rule that includes hybrid and electric vehicles, and ensure these goals are achievable. It’s important to protect vehicle choice – the number of available models has doubled in the last three years, and in the last year sticker prices are down 20%. We need to continue to work on making sure that these vehicles are affordable to everyone, that we have the infrastructure in place to make them accessible and practical for consumers, and bring jobs back to the U.S. The bottom line is that the future of the industry must be created in America and driven by American workers, and we are all committed to working together toward that future.”

“The future is electric. Automakers are committed to the EV transition – investing enormous amounts of capital and building cutting edge battery electric vehicles, plug-in hybrids, traditional hybrids and fuel cell vehicles that drive efficiency and convert petroleum miles to electric miles,” said John Bozzella, President and CEO, Alliance for Automotive Innovation . “Consumers have tons of choices. But pace matters. Moderating the pace of EV adoption in 2027, 2028, 2029 and 2030 was the right call because it prioritizes more reasonable electrification targets in the next few (very critical) years of the EV transition. These adjusted EV targets – still a stretch goal – should give the market and supply chains a chance to catch up. It buys some time for more public charging to come online, and the industrial incentives and policies of the Inflation Reduction Act to do their thing. And the big one? The rules are mindful of the importance of choice to drivers and preserves their ability to choose the vehicle that’s right for them.”

“This is a day to celebrate American achievement. The step EPA is taking today will slash climate pollution and air pollution,” said Amanda Leland, Executive Director of Environmental Defense Fund . “It will bring more jobs for workers, more choices and more savings for consumers, and a healthier future for our children. The U.S. has leapt forward in the global race to invest in clean vehicles, with $188 billion and nearly 200,000 jobs on the way. Jobs in communities across the country, in places like Michigan, Nevada, and Kentucky. These clean car standards will help supercharge economic expansion and make America stronger.”

“These standards make clear that securing America’s global leadership in manufacturing and securing a better future are 100% aligned,” said Albert Gore, Executive Director of the Zero Emission Transportation Association . “We have everything we need today to meet and exceed this standard, and that means more of the vehicles sold in America will be made in America.”

Learn more information about the final rule .

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Advancing Global Health through Environmental and Public Health Tracking

Paolo lauriola.

1 National Research Council, Institute of Clinical Physiology, Unit of Environmental Epidemiology and Disease Registries, 56124 Pisa, Italy

Helen Crabbe

2 Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK; [email protected] (H.C.); [email protected] (T.F.); [email protected] (G.S.L.)

Behrooz Behbod

3 Centre for Medical Education, Cardiff University, United Kingdom, Cardiff CF14 4XW, UK

4 Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; vog.cdc@1yaf

Sylvia Medina

5 Direction of Environmental and Occupational Health, Santé Publique France, 94415 Saint Maurice, France; [email protected]

Jan C. Semenza

6 Scientific Assessment Section, European Centre for Disease Prevention and Control, 169 73 Solna, Sweden, Sweden; [email protected]

Sotiris Vardoulakis

7 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra 2601, Australia; [email protected]

8 Vital Strategies, New York, NY 10005, USA; gro.seigetartslativ@ssakd

Ariana Zeka

9 Environmental Health and Epidemiology, Brunel University, London UB8 3PH, UK; [email protected]

10 Medical University Centre “Nene Teresa”, Rruga e Dibres, #370 Tirana, Albania

Irma Khonelidze

11 National Center for Disease Control and Public Health, 0198 Tbilis, Georgia; [email protected]

Matthew Ashworth

12 Institute of Environmental Science and Research Limited, Kenepuru, Porirua 5240c, New Zealand; [email protected]

Kees de Hoogh

13 Swiss Tropical and Public health Institute, Basel, Switzerland, 4051 Basel, Switzerland; [email protected]

14 University of Basel, Basel, 4001 Basel, Switzerland

Xiaoming Shi

15 National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; nc.cdcanihc@mxihs

Brigit Staatsen

16 National Institute for Public Health and the Environment, 3720BA Bilthoven, The Netherlands; [email protected] (B.S.); [email protected] (D.H.)

Lisbeth E. Knudsen

17 Department of Public Health, Denmark University of Copenhagen, 1353 Copenhagen, Denmark; kd.uk.dnus@keil

Tony Fletcher

18 London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

Danny Houthuijs

Giovanni s. leonardi.

Global environmental change has degraded ecosystems. Challenges such as climate change, resource depletion (with its huge implications for human health and wellbeing), and persistent social inequalities in health have been identified as global public health issues with implications for both communicable and noncommunicable diseases. This contributes to pressure on healthcare systems, as well as societal systems that affect health. A novel strategy to tackle these multiple, interacting and interdependent drivers of change is required to protect the population’s health. Public health professionals have found that building strong, enduring interdisciplinary partnerships across disciplines can address environment and health complexities, and that developing Environmental and Public Health Tracking (EPHT) systems has been an effective tool. EPHT aims to merge, integrate, analyse and interpret environmental hazards, exposure and health data. In this article, we explain that public health decision-makers can use EPHT insights to drive public health actions, reduce exposure and prevent the occurrence of disease more precisely in efficient and cost-effective ways. An international network exists for practitioners and researchers to monitor and use environmental health intelligence, and to support countries and local areas toward sustainable and healthy development. A global network of EPHT programs and professionals has the potential to advance global health by implementing and sharing experience, to magnify the impact of local efforts and to pursue data knowledge improvement strategies, aiming to recognise and support best practices. EPHT can help increase the understanding of environmental public health and global health, improve comparability of risks between different areas of the world including Low and Middle-Income Countries (LMICs), enable transparency and trust among citizens, institutions and the private sector, and inform preventive decision making consistent with sustainable and healthy development. This shows how EPHT advances global health efforts by sharing recent global EPHT activities and resources with those working in this field. Experiences from the US, Europe, Asia and Australasia are outlined for operating successful tracking systems to advance global health.

1. Introduction

Traditionally, environmental health problems have been addressed by controlling a single pollutant or exposure. However, today’s complex environmental health problems require more innovative and holistic solutions that address not only a single pollutant or exposure, but the multifactorial effects of the environmental and environmental change on human health, and the systems that guide those effects. Considerations also need to be made at the individual, local, national and international levels.

In fact, issues facing ‘planetary health’ [ 1 ] and the related concept of ‘ecological public health’ [ 2 ] may be the ultimate ‘wicked problems’ of our time [ 3 ].

According to the Lancet Planetary Health’s editor-in-chief Raffaella Bosurgi, “While public health is about health protection and health promotion within the health systems and global health looks at how to improve the health of populations worldwide, planetary health broadens this discussion by looking at the societies, civilisations and the ecosystems on which they depend. Planetary health offers an exciting opportunity to find alternative solutions for a better and more resilient future. It aims not only to investigate the effects of environmental change on human health, but also to study the political, economic, and social systems that govern those effects” [ 4 ].

Haines et al. described one holistic approach [ 5 ]: Planetary Health Watch, a proposed monitoring and forecasting system that links human health and environmental indicators in time and space, and which “…could improve the effectiveness of adaptation and mitigation strategies, assess progress towards nationally and internationally agreed targets, act as an early warning system, and hold decision-makers accountable. Indicators for inclusion in the system should be prioritised using transparent criteria, including relevance, sensitivity, sustainability, scalability, accuracy, economic viability, and consistency”.

Accordingly, information on the pollution of air, water, soil, food as well as consumer products may be used in more than one way to recognise multiple links with health, wellbeing and environmental sustainability, and support activities directed at maximising these. For this to be feasible, appropriately aggregated and linked data needs to be shared with a wide range of users, who can both contribute and gain data and interpretative frameworks consistent with their respective sphere of activity. Legal, ethical, professional and technical aspects need to be addressed for such linkages to be feasible and for access to data by users who can contribute to relevant activities.

Environmental and Public Health Tracking (EPHT) could be a concrete tool to pursue such a need [ 6 ]. EPHT can be defined as: “The ongoing collection, integration, analysis, and interpretation of data about environmental hazards, exposure to environmental hazards, human health effects potentially related to exposure to environmental hazards. It includes dissemination of information learned from these data and implementation of strategies and actions to improve and protect public health” [ 7 ].

It is an approach that helps to increase the understanding of environmental public health and global health, improve the comparability of risks between different areas of the world, enable transparency and trust among citizens, institutions and the private sector, and inform preventive decision making.

This paper aims to show how EPHT advances global health efforts by sharing recent global EPHT activities and resources with those working in this field. We describe experiences of systems in the US, Europe, Asia and Australasia and outline the components for operating successful tracking systems to advance global health. It is noteworthy that, as a whole, these systems didn’t implement new informative flows; however, first and foremost, they integrated those that were already running by integrating disciplines, institutions and professionals.

2. Why and How Environment and Public Health Tracking Can Help Environment and Health Integration

EPHT is also a helpful tool for strengthening the established Driving Forces, Pressures, State, Exposures, Health Effects and Actions (DPSEEA) framework [ 8 ]. EPHT promotes a systematic integration of the aforementioned DPSEEA components, taking into account both environmental and health parameters, in the context of realistic drivers, pressure and states.

EPHT aims to promote a resilient society by analysing complex datasets, addressing different audiences and supporting environmental health messaging tailored to each audience:

The public : information to support individual changes in attitudes and collective actions.

Professionals and stakeholders : tailored information to health professionals, land planners, environmental managers and researchers.

Decision-makers : integrated health and environmental information to inform decisions and create opportunities to reduce the multiplicative impacts associated with rapid urbanisation, globalization and climate/social/economic change.

Such general and generic categories also include resource managers, planners, economists, conservationists, indigenous and locally impacted communities, community developers and many other essential stakeholders. They are all strategically important, taking into account the dynamics which interrelates the two central issues on how population health may be improved: individual behaviour and social and economic factors [ 9 , 10 ].

The EPHT approach strives to achieve its vision of “Healthy Informed Communities” by empowering environmental and public health practitioners, healthcare providers, community members, policymakers and others to make information-driven decisions that affect health while maintaining appropriate data protection measures [ 11 ]. We now need a global perspective, demanding “new coalitions and partnerships across many different disciplines” [ 12 ]. These challenging objectives should be delivered from the perspective of providing comprehensive integration within a “planetary” framework for environmental and public health outcomes; this must be considered the ultimate goal [ 13 , 14 , 15 ].

In summary, EPHT is an instrument which can support the cross-sectoral integration of information to assist decision-making in support of the greatest ambitions for global and planetary health outcome by means a comprehensive and ecological public health prevention approach.

3. The Concepts

EPHT aims to merge, integrate, analyse and interpret environmental hazards, exposures and health data [ 16 ] ( Figure 1 ) to provide information for public health decision-makers to reduce the environmental burden of disease.

Environmental Public Health Tracking Components [ 17 ].

Accurate and timely surveillance data permit public health authorities to determine disease impacts and trends, recognise clusters and outbreaks, identify populations and geographic areas most affected, and assess the effectiveness of public health interventions [ 18 ]. By effectively linking standardised environmental and health data in an ongoing manner, and translating it into meaningful information ( Figure 2 ), EPHT can help to protect the health of the public.

A conceptual framework for integrated environmental health monitoring [ 19 ].

Thus, EPHT represents a modern surveillance system, the essence of proactive public health practice, with the ultimate goal to guide public health preventive action.

Ideally, exposure tracking includes the systematic measurement of harmful environmental agents to which individuals are exposed. Exposure tracking also helps evaluate the effectiveness of public health policies by monitoring changes over time. It needs to be closely coordinated with ongoing hazard tracking. This involves the monitoring of individuals, communities or population groups for the presence of an environmental agent or its metabolites by means of Human Bio Monitoring (HBM) investigations. Exposure (and hazard) tracking is sufficient for public-health surveillance when the causal link between exposure and health effect has been established with sufficient time latency between exposure and effect in cases where the concentration-response functions are known, and where exposure measurements are representative of the population’s exposure. Examples of these situations include exposure to chemicals in drinking water [ 20 ].

The final component of environmental public health surveillance is health effects tracking, which represents traditional public health surveillance efforts. Examples of these situations are lead poisoning [ 21 ], hospital admissions for bronchiolitis [ 22 ] and some congenital malformations [ 23 ]. The key target of such a system is the primary prevention of chronic disease. Public health in the 21st century has the potential to recognise the environmental precursors of noncommunicable and communicable diseases. The case has been made in several specific instances, for example, where diabetes ( Figure 3 ) has been associated with lifestyle factors and environmental exposure, including chronic exposure to cadmium and arsenic [ 24 , 25 ]; similar levels of causation apply to most noncommunicable diseases.

Levels of causation and corresponding types of intervention [ 26 ].

By highlighting the various potential levels of prevention interventions, the framework proposed for diabetes can be extended to other public health issues, as recognised by the WHO STEP-wise approach to the surveillance of noncommunicable diseases [ 26 ], where STEP established a conceptual framework that recognises the potential for prevention interventions at all levels; however, it has not yet achieved integration with the evidence base from environmental epidemiology. Therefore, improved coordination between noncommunicable and communicable disease programs with the evidence base from environmental epidemiology is called for, to put to use the available evidence on precursors of disease (i.e., environmental exposures) within a public health conceptual framework. In this way, it will be much more feasible to motivate and design the development of effective interventions at the appropriate level, to benefit from all available evidence and, thereby, to achieve the WHO goal of “Health in all policies” [ 27 ]. The two classical components of traditional surveillance include monitoring data on exposure and/or health outcomes [ 28 ].

A key distinction between EPHT and traditional surveillance is the emphasis on data integration across hazard, exposure and health information systems [ 3 ]; this could also be called “risk tracking”, which involves quantifying and monitoring, at the population level, trends in the relationship between environmental hazards, exposures and health indicators.

To ensure the success of an EPHT programme, there is a need to involve several different constituencies in public health activities. Specifically, there is a demand for timely, accessible, accurate, representative and interpretable information about our environment and health for the public, media, researchers and policymakers, including input from specific interest and community groups, as well as the public health community at large.

4. Some Experiences of Environmental Public Health Tracking

Tracking activities have been conducted throughout the world. In many countries, they have adopted the label ‘tracking’ (e.g., the U.S., the U.K., Australia and China), whilst in others, different labelling has been used, not necessarily calling it ‘tracking’ (e.g., France, Italy, Brazil, Canada, New Zealand) [ 20 ], even though environmental health systems contain the same components of EPHT ( Table 1 ), but without a clear and systematic strategy to integrate hazard, exposure and health data to be properly addressed to communication. Hereafter some experiences in which authors are involved are briefly described.

Tracking activities around the globe that are collaborating in an international EPHT network (INPHET) [ 16 ].

In 2000, the Pew Environmental Health Commission released a report on the state of environmental public health in the United States [ 7 ]. They recommended the development of a system to track and link environmental agents, exposures and related diseases because there was a lack of basic information that could document possible links between these factors. In 2002, the National Environmental Public Health Tracking Program (Tracking Program) was created at the Center for Disease Control and Prevention. Since its inception, the Tracking Program has worked closely with a community of funded state and local health departments to build capacity and infrastructure to develop the National Environmental Public Health Tracking Network (Tracking Network), an integrated network of environmental health surveillance data at the local, state and national levels.

The Tracking Network currently provides surveillance data on 20 different environmental and health topic areas ( Figure 4 ) and there are over 420 different environmental health measures that are publicly available. The application of these data is key to supporting evidence-based decision making and public health actions within state and local programs to help promote healthy and informed communities. For example, at the national level, Strosnider et al. [ 29 ] examined the associations between ground-level ozone and fine particulate pollution and ER visits for asthma, chronic obstructive pulmonary disease (COPD) and respiratory infections. While previous studies focused on single cities, the authors leveraged the data available via the Tracking Program to look at the association between air pollution and respiratory ER visits across hundreds of U.S. counties. At the state and local levels, there have been efforts to use tracking program resources and/or data in establishing unique and diverse partnerships, developing innovative ways to use the data and resources, and identifying approaches to making the data more accessible, all to improve public health at the local, state and national levels [ 30 ].

Environmental Health topics investigated by the US EPHT [ 31 ].

Meanwhile, EPHT in England [ 32 ] includes several programmes of surveillance of environmental hazards, exposures and health outcomes [ 33 ], e.g., population exposure estimation of arsenic in private water supplies [ 34 ], the burden of disease of carbon monoxide poisoning, [ 35 ] lead exposure in children [ 36 , 37 ], developing methods of risk prioritisation to support environmental public health interventions [ 38 ] and guidance for investigating non-infectious disease clusters from potential environmental causes. [ 39 ] The English EPHT programme has adopted an approach providing common governance for disparate themes, with the flexibility to establish surveillance structures and functions appropriate to specific information needs. Recent developments include developing national systems for enhanced air pollution exposure surveillance and weather data for public health use [ 33 ]. At a local level, the concepts of EPHT have been applied by Sandwell Metropolitan Borough Council, an urban local government in the Midlands, to identify the largest environmental public health concerns for the local authority area to help prioritise interventions [ 40 ].

In France, environmental-health surveillance has been built developing environmental-health dimensions of routine surveillance data systems. The overall concept of public-health surveillance at the national public health agency, Santé Publique France, formerly known as French Institut de Veille Sanitaire (InVS), is based on the observation that a complex changing environment creates new situations and emerging risks for which specific surveillance techniques are required ( Figure 5 ).

Public Health Surveillance at Santé publique France.

Regarding specific surveillance, the European Apheis and Aphekom surveillance projects on air pollution and health [ 41 ], coordinated by Santé publique France, were designed to meet the information needs of environmental and public health institutions by performing health-impact assessments on the short- and long-term effects of air pollution over time using routine mortality and hospital admissions data. These initiatives were successful because they built on a Europe-wide collaborative network from the bottom up to stimulate cooperation and facilitate decision-making on the local and national levels [ 42 ]. In France, the surveillance programme on air pollution and health (Psas) has already celebrated its 23 rd anniversary, supporting French policies on air pollution at the local and national levels [ 43 ].

After the 2003 heatwave in France, Santé Public France developed SurSaUD [ 44 ] ® , a Syndromic Surveillance system (SyS) complementing traditional specific surveillance systems, capable of detecting new threats to public health as diverse as environmental phenomena or emerging infectious diseases. The Triple-S (Syndromic Surveillance Survey Assessment towards guidelines for Europe) project, also coordinated by Santé Public France, outlined SyS activities in Europe [ 45 ]. It assessed SyS, intending to produce guidelines for human and veterinary SyS in the Member States, as well as a proposal for a European SyS strategy.

Examples of the complementarity between specific and SyS in environmental health in France include the Heat Health Watch Warning System, Cold-related diseases, Carbon Monoxide surveillance, Poisoning surveillance and Xynthia storm (2010) [ 46 ], and industrial accidents like the health monitoring of a gas leak at the Lubrizol company (2013) [ 47 ].

There are many other examples of tracking activities carried out across the world ( Table 1 ). These countries have shared their experiences of developing EPHT and form an international network [ 16 ].

In summary, we have outlined some global examples of environmental and health information integration, which highlights the notion that factual and common constraints can be overcome.

Such reviews of tracking and similar programmes around the world indicate that EPHT has the potential to facilitate the translation of science into public health practice and go beyond just providing data or information to users and stakeholders, helping generate intelligence that is sufficiently mature to be translated into actions [ 30 ]. This recognition led to the creation of the International Network on Public Health and Environment Tracking (INPHET) in 2013 [ 16 ].

Following meetings in Europe and the USA [ 16 ], efforts have been made to identify INPHET goals aligned with broader public health needs while retaining a focus on environmental health surveillance. This network operates voluntarily, with political and intellectual independence, promoting scientific rigour in environmental and public health decision-making. Several workshop and symposiums have been held to demonstrate its application [ 16 ].

However, the EPHT tool is not yet widely available in most regions which are vulnerable to environmental hazards in the world. Some efforts are underway in some Low- and Middle-Income Countries (LIMCs) such as Georgia [ 63 ], Turkey [ 63 ], Ghana, Ethiopia, Myanmar and Tonga, to show its application and usefulness.

More generally, a detailed and comprehensive description of those experiences could be helpful to realise that it is possible to implement such organisation, but the ‘governance’ of these programmes must also be tailored according to the social, cultural and political setting. Such an issue is supported by the efforts of INPHET.

5. Extending EPHT Capacity

The core infrastructure of EPHT within national public health agencies can deliver both the capacity to support ongoing concerns regarding hazardous pollutants and chemicals in drinking water, land, food and air, and new perspectives on the central value of ecological and social factors in affecting health and wellbeing in the course of multiple transitions currently experienced by society. The latter perspectives are explored initially in research partnerships between national public health agencies operating EPHT programmes and academic or other relevant research institutions. An example is the establishment of “Health Protection Research Units” in the UK, providing 5-year research programmes on topics such as Health Impact of Environmental Hazards [ 71 ] contributing methods for indoor air tracking, and Environmental Change and Health [ 72 ] addressing the role of ecological factors such as those affecting the distribution of vectors [ 73 ], climate variability affecting infectious diseases [ 74 , 75 , 76 ] or coastal changes affecting toxin-producing algae [ 77 ], as well as social factors affecting use of green spaces and related health benefits [ 78 ].

Novel interpretative frameworks could first be tested and documented in a “experimental” research setting, in studies codesigned and coproduced with public health agencies including EPHT operators [ 79 , 80 ]. This process facilitated appreciation of the value of the mentioned alternative interpretative frameworks as components of the routine operations of public health agencies including provision of advice and EPHT. For some topics, the usual delay between research and practice could be considerably shortened by these arrangements. This type of collaboration illustrates the capacity for EPHT to act as a fast transmission chain from existing information frameworks to their transformation into public health tools capable of systematic consideration and integration of ecological and social factors. This process means that EPHT may support mainstream public health operations and partnerships in making a transition toward more appropriate consideration of ecological and social factors in health protection and health improvement activities.

The process briefly summarised here for the case of EPHT in England has been applied in different forms to other settings and countries.

While the specific modalities vary in terms of form and amount of research fund allocation and its relationship with EPHT, a common pattern is emerging where EPHT connects with a range of research approaches and results, and aims to integrate them into everyday environmental health activities.

6. The Future

The continued development of EPHT activities around the world will help support improvements in environmental health. In aligning with the WHO Health in All Policies (HiAP) strategy [ 81 ], EPHT can provide a beneficial approach to public health practice in an era of diminishing resources and increasing demand, where scientific evidence can support interventions in a range of sectors, such as transportation, housing, energy, waste management, land use and climate change. However, action at international, national, regional and local levels must be taken to improve and protect global health as soon as knowledge and intelligence become appropriately mature to be able to effectively address, monitor and evaluate progress against public health risks. Many actions to improve the environment can have multiple health co-benefits, such as policies promoting active travel in cities which can reduce air pollution and noise from vehicle traffic and, at the same time, help improve physical activity and respiratory and cardiovascular health [ 82 ].

EPHT will also promote strong and enduring relationships and partnerships across all tiers of the local and national government, across public health and environmental agencies, and with both the private sector and the general public/NGO community. Along this line, the focus should be placed on the issues described in Section 5 .

7. Governance: Principles to Direct EPHT

The collective experience of EPHT operators in several countries points to several fundamental principles for the good governance of such an operation. Such principles have developed over decades, and therefore, may not appear innovative; however, they are valid based on a widely experienced practice.

Sustainability : This principle refers to the need for any surveillance/tracking system to produce useful outputs on an ongoing basis. Such a need is founded on minimal human resources, skills and capability to be maintained. It also relates to the sustainability of inputs of data feeds and the ability to produce regular outputs of surveillance, such as annual reports.

Competence : In principle, any public health surveillance/tracking system requires leadership by a public health agency, operation by staff trained in epidemiology and public health information systems.

Integration : A worthwhile goal for an EPHT system is to contribute to addressing the overall preventable burden of disease. Starting from a topic within this broad agenda will require integration of complex environmental, exposure and health information.

Accountability : An EPHT has the potential to produce influential information for decision-makers and officials in a range of public agencies. Typically, this will require a multidisciplinary collaboration where competencies from several departments or organisations are contributing to the same agreed surveillance/tracking goal. For these reasons, accountability via a clear and an agreed governance approach is necessary (i.e., through appropriate Terms of References).

Transparency : Specific tasks of members of a surveillance/tracking working group can be allocated by a mechanism agreed within the working group itself and in consultation with general policies and practices. This will typically involve adopting a governance tool for recognising the task and role of the group.

In other words, governance should essentially aim to federate data providers and standardise the methods of data collection and analysis at the level of each established partnership. The above governance principles are largely consistent with dimensions recognised by OCAP principles (ownership, control, access, and possession) [ 83 ].

8. Ethical Dimensions

The four principles of beneficence, nonmaleficence, justice and respect for autonomy are included in ethics guidelines drafted for public health professionals. They are particularly relevant in the field of EPHT because any activity which is capable of changing the extent of emissions or pollution necessarily requires a careful balancing of several contrasting considerations in the interest of optimally addressing the needs of society. Although the following do not provide an exhaustive account of how the principles are applied, they can be used as a framework to support ethical decision making.

8.1. Beneficence

8.1.1. confidentiality and privacy.

Maintaining the confidentiality of personally identifiable data (PID) is a key feature of any research study, and is also relevant to the management of data assets part of a public health surveillance programme such as EPHT. It is important that participants are treated with respect and dignity at all times [ 84 ], although EPHT mostly will benefit from assembling data assets from data collected for other reasons, thus not adding a burden to participants while being careful to preserve anonymity.

8.1.2. Data Storage and Data Sharing.

Hard (quantitative) and soft (intelligence) data [ 85 ] need to be stored securely, should be anonymised and archived for a period appropriate to the purpose; as EPHT focuses on noncommunicable disease, holding aggregated data over decades would be necessary for comparisons over time (20–30 years).

8.2. Nonmaleficence.

8.2.1. minimise risk, disruption and harm.

Nonmaleficence is achieved by assembling data assets for an EPHT programme that minimises risk, disruption and harm to both study participants and the source population. These risks should be fully assessed, quantified and mitigated or minimised if possible. If a risk is discovered as part of EPHT-based analyses that might adversely affect well-being, it should be communicated to the individuals/populations concerned [ 84 ].

8.2.2. Precautionary Principle

Another example of nonmaleficence is the ‘Precautionary Principle’. This essentially means that “When human activities may lead to harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm [ 84 , 86 , 87 ], though not advocated by all” [ 88 ].

8.3. Autonomy (Including Informed Consent).

8.3.1. the distinction between data for research and public health surveillance.

An important consideration when applying for ethics approval is to establish the status of the EPHT programme and data assets. Accurate definitions may be necessary to discern the level of ethical approval required [ 89 ].

8.3.2. Institutional Review Boards/Research Ethics Boards

There are numerous names for groups of people officially established to decide whether a research project can ethically and legally be approved, such as Institutional Review Boards, Research Ethics Boards, and Research Ethics Committees (RECs). Their constitution may differ across time and jurisdictions, with various experts brought in if required by the type of study being assessed [ 90 ], but they should always contain representatives of the population involved [ 84 ].

8.3.3. Informed Consent

The International Society of Environmental Epidemiology (ISEE) Guidelines state that there must be full disclosure of relevant aspects of the study, such as its purpose and any potential hazards, to the study participants before explicit prior, documented informed consent is obtained. [ 84 ].

8.4. Justice

8.4.1. epht obligations to society.

Obligations to society involve ensuring objectivity in the process of designing of an EPHT data asset and reporting of the outcome of specific analyses, as well as the overarching obligation to deliver only high-quality public health surveillance, supported by relevant research which will materially improve the understanding of a particular subject.

8.4.2. EPHT Programme Obligations to Funders/Sponsors, Employers and Colleagues

These obligations need to be identified early in the research process and involve the population concerned at all stages of the study, from initiation to publication [ 84 ]

9. Examples of Priorities for EPHT Activities

Taking into account what can be reasonably and practically implemented in the near future, and the needs of many countries in particular in LMICs, we suggest some issues to which efforts should be devoted. They could be some realistic field in which to apply the ‘holistic’ framework of EPHT because of a new and emerging environmental health challenge relevant to planetary health.

9.1. EPHT in Urban City Planning

Evidence-based interventions to develop an integrated approach to improve air quality and climate change adaptation in cities are being implemented. EPHT can help evaluate urban policies to combat extreme temperatures, air pollution, noise, promote green spaces, sustainable urban development, etc. as urged for example by the WHO [ 91 ], Climate Clean Air Coalition’s Urban Health Initiative [ 92 ] and Healthy Polis Initiative [ 93 ].

9.2. EPHT in Industrially Contaminated Sites

Development of industry and its products has brought many benefits to modern societies, including a reduction in deprivation. Conversely, it has also generated a large amount of hazardous materials, in many cases where some of the most disadvantaged and vulnerable communities live. Such activities may harm health and wellbeing due to chemical exposure and socio-economic deprivation [ 94 ]. Industrially contaminated sites (ICS) represent a long-term legacy of past and current development, a probable lasting cause of preventable noncommunicable disease and a living reminder of the inherent lack of sustainability of the linear economy. There is an urgent need to identify the most suitable interventions aimed at prevention of ill-health in affected communities, to facilitate better social and economic development while minimising exposure to harmful compounds associated with ICS.

9.3. EPHT and Socio-Economic Development

In LMICs, there is a strong need for economic development. Historical patterns worked well economically for the high-income world but resulted in burdening the environment and health across the globe and in particular for LMIC. The solution requires a technological and intellectual transition in all countries; an alternative route to economic prosperity that preserves resources and limits carbon emissions is urgently needed. EPHT can be a helpful tool with which to work towards informed, healthy, sustainable and equitable prosperity in these developing economies.

10. Conclusions

Environmental public health issues are becoming increasingly complex. Globalisation, population growth and overconsumption are placing significant stresses on the environment and health.

Socioeconomic diversity across the world must be taken into account, which is closely related to a geographic diversity in data/information availability and ability to use these resources to inform decision-making.

EPHT can contribute to reducing socioeconomic and environmental inequality across communities, countries and regions, by sharing experiences, knowledge, information and data. Hence, EPHT networking activities must support local, regional, national and global improvements in the environment and reductions in its impact on health, which will be achieved by strengthening and sharing a common philosophy among public health professionals working in environmental health around the world. It requires governance efforts for the integration of a wide range of scientific disciplines and people, from institutional decision-makers and officials in public health agencies to representatives of the civil society. In sum, this article:

• Indicates that difficulties encountered in integrating disciplines, professional profiles and institution can be effectively overcome by focusing on the final goal of environmental health prevention and promotion. Some successful stories are herein described in different countries, either under the banner of EPHT or not, but with the same function;
• Introduces the experience of countries, where such an approach is being implemented nationally, whilst taking the opportunity to collaborate with other countries (hubs);
• Focuses on some lessons learned in performing such experiences, first and foremost from the ethical point of view;
• Discusses the concept of EPHT, aiming at sharing opportunities to develop it towards more ambitious goals (planetary health);
• Clarifies the context in which such an ecological public heath tool might be essential to attaining global health goal, but also to moving towards the ultimate goal of Planetary Health.
• In other words, it aims at creating a community of health professionals and researchers who could share experiences, proposals, and thoughts in the field of practical, effective environmental health prevention and promotion.

Acknowledgments

The authors are grateful for the support to this work provided by the Scientific Committee of the International Network on Public Health & Environment Tracking.The authors thank the reviewers for improvements and suggestions made on earlier drafts to improve the article. We also thank the various countries listed for providing examples of tracking in countries.

Author Contributions

Conceptualization Ideas: P.L., H.C., B.B., F.Y., S.M., J.C.S, S.V., D.K., A.Z., I.K., M.A., K.d.H., X.S., B.S., L.E.K., T.F., D.H. and G.S.L.; funding acquisition: G.S.L. and P.L.; supervision: P.L., G.S.L. and H.C.; writing—original draft preparation: P.L., H.C., B.B., F.Y., S.M., J.C.S., S.V., D.K., A.Z., I.K., M.A., K.d.H., X.S., B.S., L.E.K., T.F., D.H. and G.S.L.; writing—review and editing preparation: P.L., H.C., B.B., F.Y., S.M., J.C.S., S.V., D.K., A.Z., I.K., M.A., K.d.H., X.S., B.S., L.E.K., T.F., D.H. and G.S.L. All authors have read and agreed to the published version of the manuscript.

This work was partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU), Health Impact of Environmental Hazards at King’s College London in partnership with Public Health England (PHE) in collaboration with Imperial College London, London, UK; and by the NIHR HPRU in Environmental Change and Health at the London School of Hygiene and Tropical Medicine in partnership with PHE, and in collaboration with the University of Exeter, University College London, and the Met Office.

Conflicts of Interest

The authors declare no conflict of interest.