Inequities in air pollution exposure and gaps in air quality monitoring

Air pollution is the world’s single largest environmental health risk factor. It responsible for an estimated 7 to 9 million deaths each year, of which more than 70% are due noncommunicable diseases (NCDs).1Lelieveld J. Evans J.S. Fnais M. Giannadaki D. Pozzer A. The contribution outdoor air sources premature mortality on a global scale.Nature. 2015; 525: 367-371Crossref PubMed Scopus (2772) Google Scholar,2Landrigan P.J. Fuller R. Acosta N.J. Adeyi O. Arnold Baldé A.B. et al.The Lancet Commission Pollution and Health.Lancet. 2018; 391: 462-512Abstract Full Text PDF (1573) Scholar death toll from currently 3 times greater that malaria, HIV/AIDS, tuberculosis combined.2Landrigan Numerous publications have covered various pollutants their negative impacts respiratory cardiovascular following both short-term chronic exposures. Here, we highlight some current pressing issues actions needed resolve them. Despite substantial improvements in quality standards many countries over recent decades, 92% world population remains exposed unhealthy levels pollution. However, although clearly problem, it disproportionately affects low- middle-income (LMICs). Approximately 97% cities with populations 100,000 inhabitants do not meet World Health Organization guidelines LMICs compared 49% high-income (HICs). In addition being affected by ambient pollution, billion people worldwide 90% rural households indoor use solid fuels domestic cooking heating. Compared HICs, incur higher proportion disability-adjusted life years lost as result attributable pollution–related deaths.2Landrigan most LMICs, this disease burden has increased significantly decades along growing ageing population.2Landrigan Yet, experience highest exposures bear brunt burden, monitoring exposure research often lacking these countries.3Burns Boogaard H. Polus S. Pfadenhauer L.M. Rohwer A.C. Van Erp A.M. al.Interventions reduce effects health: abridged Cochrane systematic review.Environ Int. 2020; 135105400Crossref (33) Fig 1, show mean annual population-weighted mass concentration particles less 2.5 ?m size (PM2.5) country, well location all existing PM2.5 ground monitors. With exception India China, sparse Africa particular concentrations exceed targets set Interim Target-1, yet no available. We also know within-country socioeconomic racial ethnic disparities outcomes exist HICs. United States, studies shown minorities poorer communities tend live closer proximity pollutants.4Mikati I. Benson A.F. Luben T.J. Sacks J.D. Richmond-Bryant Disparities distribution particulate matter emission race poverty status.Am J Public Health. 108: 480-485Crossref (130) Furthermore, equivalent increases values been linked associations adverse black Hispanic white populations.4Mikati These even apparent LMICs: article published New York Times (https://www.nytimes.com/interactive/2020/12/17/world/asia/india-pollution-inequality.html) reported experienced course day 2 children Delhi, one whom lived slum other city’s upper middle class neighborhoods. first child was consistently throughout day, his daily approximately 4 child. This if chronic, could 5 additional potential lost. Effectively improving mitigating increasing necessitates multipronged approach, including inform policy, better monitoring, setting-specific interventions. Although now understanding further address gaps knowledge such long-term exposure,5Tonne C. A call epidemiology where is.Lancet Planet 2017; 1: e355-e356Abstract (10) relative toxicity different sources,1Lelieveld cognitive development. Other remaining challenges include characterizing joint independent multipollutant exposures, risks ultrafine matter,6Schraufnagel D.E. particles.Exp Mol Med. 52: 311-317Crossref (149) primary versus secondary matter. issue, however, need bigger efforts data limited.7Prabhakaran P. Jaganathan Walia G.K. Wellenius G.A. Mandal Kumar K. al.Building capacity India.Environ Epidemiol. 4: 3117Crossref Gaps apportionment how vary among urban, periurban, environments. addition, household trials demonstrated drastic reductions cleaner biomass, interventions remain uncertain.8Mortimer Balmes J.R. Cookstove tribulations: what decrease pollution?.Ann Am Thorac Soc. 15: 539-541Crossref (20) To determine accurate exposure-response relationships intervention strategies, ground-level required, particularly stations few far between (Fig 1). Where measurements lacking, satellite chemical transport models can be adopted estimate pollutant concentrations. Recent seen rapid development low-cost sensors, utilized supplement available stations. important devices undergo appropriate control validation verify performance precision. Ultimately, regulations legislation, into effectiveness interventions, key reducing there individual-level strategies minimize personal Limiting physical activity outdoors days high minimizing near-road exposure, infiltration indoors pollutants. Strategies lower avoiding fuels, ventilating isolating areas, using high-efficiency filters.9Carlsten Salvi Wong G.W. Chung K.F. Personal minimise advice providers, patients public.Eur Respir 551902056Crossref (29) Readily general public information campaigns raise awareness provide guidance mitigation would help facilitate increase adoption practices. At policy level, move measures cut energy consumption necessary bringing down safe levels. especially implemented areas or none exist. number implemented, evidence mixed, pointing improved study design analysis methods, uniform evaluations.3Burns From perspective, specific choice needs context setting may require combination cases multiple rather source contribute heavily Successful mitigate multifaceted approach involves only affordable clean fuel but education behavioral messaging bring about change cultural views behaviors promote exclusive fuel.10Checkley W, Williams KN, Kephart JL, Fandiño-Del-Rio M, Steenland NK, Gonzales GF al. Effects cardiopulmonary Peru: randomized controlled trial. Crit Care Med https://doi.org/10.1164/rccm.202006-2319OC. Accessed December 11, 2020.Google extensive body scientific linking morbidity mortality, recently begun receiving attention, largely absent prevention. landmark ruling 2020 attracted media recorded cause British girl who died 2013 asthma attack, marking instance explicitly person’s (https://www.bbc.com/news/uk-england-london-55330945#:?:text=A%20nine%2Dyear%2Dold%20girl,east%20London%2C%20died%20in%202013). 9-year old, black, Lewisham southeast London, within 25 meters major circular road she used walk get school. 2018 report highlighted fact at station mile her home had exceeded European Union legal limits guidelines. case raised questions government’s commitment tackling shined light faced disadvantaged communities. hope encourages policymakers, just Kingdom worldwide, standards. note relevant combating climate change, economic benefits associated costs. summary, factors illness worldwide. become resources www.openaq.org access information, prioritize resource-poor settings highest, driving inequities health. target improve around world.