The effect of future ambient air pollution on human premature mortality to 2100 using output from the ACCMIP model ensemble

Continued Rise in Health Burden from Ambient PM2.5 in India under SSP Scenarios Until 2100 despite Decreasing Concentrations

Forecasting alterations in ambient air pollution and the consequent health implications is crucial for safeguarding public health, advancing environmental sustainability, informing economic decision making, and promoting appropriate policy and regulatory action. However, predicting such changes poses a substantial challenge, requiring accurate data, sophisticated modeling methodologies, and a meticulous evaluation of multiple drivers. In this study, we calculate premature deaths due to ambient fine particulate matter (PM2.5) exposure in India from the 2020s (2016-2020) to the 2100s (2095-2100) under four different socioeconomic and climate scenarios (SSPs) based on four CMIP6 models. PM2.5 concentrations decreased in all SSP scenarios except for SSP3-7.0, with the lowest concentration observed in SSP1-2.6. The results indicate an upward trend in the five-year average number of deaths across all scenarios, ranging from 1.01 million in the 2020s to 4.12-5.44 million in the 2100s. Further analysis revealed that the benefits of reducing PM2.5 concentrations under all scenarios are largely mitigated by population aging and growth. These findings underscore the importance of proactive measures and an integrated approach in India to improve atmospheric quality and reduce vulnerability to aging under changing climate conditions.

Interplay of Climate Change and Air Pollution- Projection of the under-5 mortality attributable to ambient particulate matter (PM2.5) in South Asia

Ambient fine particulate matter (PM2.5) pollution is a leading health risk factor for children under- 5 years, especially in developing countries. South Asia is a PM2.5 hotspot, where climate change, a potential factor affecting PM2.5 pollution, adds a major challenge. However, limited evidence is available on under-5 mortality attributable to PM2.5 under different climate change scenarios. This study aimed to project under-5 mortality attributable to long-term exposure to ambient PM2.5 under seven air pollution and climate change mitigation scenarios in South Asia. We used a concentration-risk function obtained from a previous review to project under-5 mortality attributable to ambient PM2.5. With a theoretical minimum risk exposure level of 2.4 μg/m3, this risk function was linked to gridded annual PM2.5 concentrations from atmospheric modeling to project under-5 mortality from 2010 to 2049 under different climate change mitigation scenarios. The scenarios were developed from the Aim/Endues global model based on end-of-pipe (removing the emission of air pollutants at the source, EoP) and 2 °C target measures. Our results showed that, in 2010-2014, about 306.8 thousand under-5 deaths attributable to PM2.5 occurred in South Asia under the Reference (business as usual) scenario. The number of deaths was projected to increase in 2045-2049 by 36.6% under the same scenario and 7.7% under the scenario where EoP measures would be partially implemented by developing countries (EoPmid), and was projected to decrease under other scenarios, with the most significant decrease (81.2%) under the scenario where EoP measures would be fully enhanced by all countries along with the measures to achieve 2 °C target (EoPmaxCCSBLD) across South Asia. Country-specific projections of under-5 mortality varied by country. The current emission control strategy would not be sufficient to reduce the number of deaths in South Asia. Robust climate change mitigation and air pollution control policy implementation is required.

Substantially reducing global PM2.5-related deaths under SDG3.9 requires better air pollution control and healthcare

The United Nations' Sustainable Development Goal (SDG) 3.9 calls for a substantial reduction in deaths attributable to PM2.5 pollution (DAPP). However, DAPP projections vary greatly and the likelihood of meeting SDG3.9 depends on complex interactions among environmental, socio-economic, and healthcare parameters. We project potential future trends in global DAPP considering the joint effects of each driver (PM2.5 concentration, death rate of diseases, population size, and age structure) and assess the likelihood of achieving SDG3.9 under the Shared Socioeconomic Pathways (SSPs) as quantified by the Scenario Model Intercomparison Project (ScenarioMIP) framework with simulated PM2.5 concentrations from 11 models. We find that a substantial reduction in DAPP would not be achieved under all but the most optimistic scenario settings. Even the development aligned with the Sustainability scenario (SSP1-2.6), in which DAPP was reduced by 19%, still falls just short of achieving a substantial (≥20%) reduction by 2030. Meeting SDG3.9 calls for additional efforts in air pollution control and healthcare to more aggressively reduce DAPP.

China's carbon-neutral policies will reduce short-term PM2.5-associated excess incidence of cardiovascular diseases

China's carbon-neutral target could have benefits for ambient fine particulate matter (PM2.5)-associated mortality. Although previous studies have researched such benefits, the potential impact on cardiovascular disease incidence burden is yet to be investigated thoroughly. Here, we first estimate the association between short-term PM2.5 exposure and the incidence of stroke and coronary heart disease (CHD) via a case-crossover study before projecting future changes in short-term PM2.5-associated excess incidence across China from 2025 to 2060 under three different emission scenarios. We find that, compared to the 2015-2020 baseline, average PM2.5 concentrations nationwide in 2060 under SSP119 (an approximation of a carbon-neutral scenario) are projected to decrease by 81.07%. The short-term PM2.5-related excess incidence of stroke and CHD is projected to be reduced to 3,352 cases (95% confidence interval: 939, 5,738)-compared with 34,485 cases under a medium-emissions scenario (SSP245)-and is expected to be accompanied by a 95% reduction in the related economic burden. China's carbon-neutral policies are likely to bring health benefits for cardiovascular disease by reducing short-term PM2.5-related incidence burden.

Improving consistency in estimating future health burdens from environmental risk factors: Case study for ambient air pollution

Future changes in exposure to risk factors should impact mortality rates and population. However, studies commonly use mortality rates and population projections developed exogenously to the health impact assessment model used to quantify future health burdens attributable to environmental risks that are therefore invariant to projected exposure levels. This impacts the robustness of many future health burden estimates for environmental risk factors. This work describes an alternative methodology that more consistently represents the interaction between risk factor exposure, population and mortality rates, using ambient particulate air pollution (PM2.5) as a case study. A demographic model is described that estimates future population based on projected births, mortality and migration. Mortality rates are disaggregated between the fraction due to PM2.5 exposure and other factors for a historic year, and projected independently. Accounting for feedbacks between future risk factor exposure and population and mortality rates can greatly affect estimated future attributable health burdens. The demographic model estimates much larger PM2.5-attributable health burdens with constant 2019 PM2.5 (∼10.8 million deaths in 2050) compared to a model using exogenous population and mortality rate projections (∼7.3 million), largely due to differences in mortality rate projection methods. Demographic model-projected PM2.5-attributable mortality can accumulate substantially over time. For example, ∼71 million more people are estimated to be alive in 2050 when WHO guidelines (5 µg m-3) are achieved compared to constant 2019 PM2.5 concentrations. Accounting for feedbacks is more important in applications with relatively high future PM2.5 concentrations, and relatively large changes in non-PM2.5 mortality rates.

Reductions in premature deaths from heat and particulate matter air pollution in South Asia, China, and the United States under decarbonization

Following a sustainable development pathway designed to keep warming below 2 °C will benefit human health. We quantify premature deaths attributable to fine particulate matter (PM2.5) air pollution and heat exposures for China, South Asia, and the United States using projections from multiple climate models under high- and low-emission scenarios. Projected changes in premature deaths are typically dominated by population aging, primarily reflecting increased longevity leading to greater sensitivity to environmental risks. Changes in PM2.5 exposure typically have small impacts on premature deaths under a high-emission scenario but provide substantial benefits under a low-emission scenario. PM2.5-attributable deaths increase in South Asia throughout the century under both scenarios but shift to decreases by late century in China, and US values decrease throughout the century. In contrast, heat exposure increases under both scenarios and combines with population aging to drive projected increases in deaths in all countries. Despite population aging, combined PM2.5- and heat-related deaths decrease under the low-emission scenario by ~2.4 million per year by midcentury and ~2.9 million by century's end, with ~3% and ~21% of these reductions from heat, respectively. Intermodel variations in exposure projections generally lead to uncertainties of <40% except for US and China heat impacts. Health benefits of low emissions are larger from reduced heat exposure than improved air quality by the late 2090s in the United States. In contrast, in South and East Asia, the PM2.5-related benefits are largest throughout the century, and their valuation exceeds the cost of decarbonization, especially in China, over the next 30 y.

Significant human health co-benefits of mitigating African emissions

Future African aerosol emissions, and therefore air pollution levels and health outcomes, are uncertain and understudied. Understanding the future health impacts of pollutant emissions from this region is crucial. Here, this research gap is addressed by studying the range in the future health impacts of aerosol emissions from Africa in the Shared Socioeconomic Pathway (SSP) scenarios, using the UK Earth System Model version 1 (UKESM1), along with human health concentration-response functions. The effects of Africa following a high-pollution aerosol pathway are studied relative to a low-pollution control, with experiments varying aerosol emissions from industry and biomass burning. Using present-day demographics, annual deaths within Africa attributable to ambient particulate matter are estimated to be lower by 150 000 (5th-95th confidence interval of 67 000-234 000) under stronger African aerosol mitigation by 2090, while those attributable to O3 are lower by 15 000 (5th-95th confidence interval of 9000-21 000). The particulate matter health benefits are realised predominantly within Africa, with the O3-driven benefits being more widespread - though still concentrated in Africa - due to the longer atmospheric lifetime of O3. These results demonstrate the important health co-benefits from future emission mitigation in Africa.

Health effects of carbonaceous PM2.5 compounds from residential fuel combustion and road transport in Europe

Exposure to fine particulate matter (PM2.5) is associated with an increased risk of morbidity and mortality. In Europe, residential fuel combustion and road transport emissions contribute significantly to PM2.5. Toxicological studies indicate that PM2.5 from these sources is relatively more hazardous, owing to its high content of black and organic carbon. Here, we study the contribution of the emissions from these sectors to long-term exposure and excess mortality in Europe. We quantified the impact of anthropogenic carbonaceous aerosols on excess mortality and performed a sensitivity analysis assuming that they are twice as toxic as inorganic particles. We find that total PM2.5 from residential combustion leads to 72,000 (95% confidence interval: 48,000-99,000) excess deaths per year, with about 40% attributed to carbonaceous aerosols. Similarly, road transport leads to about 35,000 (CI 23,000-47,000) excess deaths per year, with 6000 (CI 4000-9000) due to carbonaceous particles. Assuming that carbonaceous aerosols are twice as toxic as other PM2.5 components, they contribute 80% and 37%, respectively, to residential fuel combustion and road transport-related deaths. We uncover robust national variations in the contribution of each sector to excess mortality and emphasize the importance of country-specific emission reduction policies based on national characteristics and sectoral shares.

Enhancing health resilience in Japan in a changing climate

Climate change poses significant threats to human health, propelling Japan to take decisive action through the Climate Change Adaptation Act of 2018. This Act has led to the implementation of climate change adaptation policies across various sectors, including healthcare. In this review, we synthesized existing scientific evidence on the impacts of climate change on health in Japan and outlined the adaptation strategies and measures implemented by the central and local governments. The country has prioritized tackling heat-related illness and mortality and undertaken various adaptation measures to mitigate these risks. However, it faces unique challenges due to its super-aged society. Ensuring effective and coordinated strategies to address the growing uncertainties in vulnerability to climate change and the complex intersectoral impacts of disasters remains a critical issue. To combat the additional health risks by climate change, a comprehensive approach embracing adaptation and mitigation policies in the health sector is crucial. Encouraging intersectoral communication and collaboration will be vital for developing coherent and effective strategies to safeguard public health in the face of climate change.

Particulate Matter Pollution Remains a Threat for Cardiovascular Health: Findings From the Global Burden of Disease 2019

Background Particulate matter (PM) pollution is a significant risk factor for cardiovascular diseases, causing substantial disease burden and deaths worldwide. This study aimed to investigate the global burden of cardiovascular diseases attributed to PM from 1990 to 2019. Methods and Results We used the GBD (Global Burden of Disease) study 2019 to investigate disability-adjusted life-years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to PM as well as its subgroups. It was shown that all burden measures' age-standardized rates for PM were in the same decreasing trend, with the highest decline recorded for deaths (-36.7%). However, the all-age DALYs increased by 31%, reaching 8.9 million in 2019, to which YLLs contributed the most (8.2 million [95% uncertainty interval, 7.3 million-9.2 million]). Men had higher deaths, DALYs, and YLLs despite lower years lived with disability in 2019 compared with women. There was an 8.1% increase in the age-standardized rate of DALYs for ambient PM; however, household air pollution from solid fuels decreased by 65.4% in the assessed period. Although higher in men, the low and high sociodemographic index regions had the highest and lowest attributed YLLs/YLDs ratio for PM pollution in 2019, respectively. Conclusions Although the total age-standardized rate of DALYs for PM-attributed cardiovascular diseases diminished from 1990 to 2019, the global burden of PM on cardiovascular diseases has increased. The differences between men and women and between regions have clinical and policy implications in global health planning toward more exact funding and resource allocation, in addition to addressing inequity in health care access.

The Air Pollution Human Health Burden in Different Future Scenarios That Involve the Mitigation of Near-Term Climate Forcers, Climate and Land-Use

Elevated surface concentrations of ozone and fine particulate matter (PM2.5) can lead to poor air quality and detrimental impacts on human health. These pollutants are also termed Near-Term Climate Forcers (NTCFs) as they can also influence the Earth's radiative balance on timescales shorter than long-lived greenhouse gases. Here we use the Earth system model, UKESM1, to simulate the change in surface ozone and PM2.5 concentrations from different NTCF mitigation scenarios, conducted as part of the Aerosol and Chemistry Model Intercomparison Project (AerChemMIP). These are then combined with relative risk estimates and projected changes in population demographics, to estimate the mortality burden attributable to long-term exposure to ambient air pollution. Scenarios that involve the strong mitigation of air pollutant emissions yield large future benefits to human health (25%), particularly across Asia for black carbon (7%), when compared to the future reference pathway. However, if anthropogenic emissions follow the reference pathway, then impacts to human health worsen over South Asia in the short term (11%) and across Africa (20%) in the longer term. Future climate change impacts on air pollutants can offset some of the health benefits achieved by emission mitigation measures over Europe for PM2.5 and East Asia for ozone. In addition, differences in the future chemical environment over regions are important considerations for mitigation measures to achieve the largest benefit to human health. Future policy measures to mitigate climate warming need to also consider the impact on air quality and human health across different regions to achieve the maximum co-benefits.

Air pollution and associated health impact and economic loss embodied in inter-provincial electricity transfer in China

As the largest producer and consumer of coal in the world, China heavily relies on coal resources for thermal power generation. Owing to the unbalanced distribution of energy resources, electricity transfer among regions in China plays a key role in promoting economic growth and ensuring energy safety. However, little is known about air pollution and the related health impacts resulting from electricity transfer. This study assessed PM_2.5 pollution and related health and economic losses attributable to the inter-provincial electricity transfer in mainland China in 2016. The results show that a large amount of virtual air pollutant emissions were transferred from energy-abundant northern, western and central China to well-developed and populated eastern coastal regions. Correspondingly, the inter-provincial electricity transfer dramatically reduced the atmospheric levels of PM_2.5 and related health and economic losses in eastern and southern China, while increasing those in northern, western and central China. The health benefits attributable to inter-provincial electricity transfer were mainly found in Guangdong, Liaoning, Jiangsu and Shandong, whereas the extra health loss is concentrated in Hebei, Shanxi, Inner Mongolia, and Heilongjiang. Overall, the inter-provincial electricity transfer led to an extra increase of 3600 (95 % CI: 3200-4100) PM_2.5-related deaths and 345 (95 % CI: 294-389) million USD of economic loss in China in 2016. The results could assist air pollution mitigation strategies for the thermal power sector in China by strengthening the cooperation between suppliers and consumers of electricity.

Impacts of emissions policies on future UK mortality burdens associated with air pollution

Air pollution is the greatest environmental risk to public health. Future air pollution concentrations are primarily determined by precursor emissions, which are driven by environmental policies relating to climate and air pollution. Detailed health impact assessments (HIA) are necessary to provide quantitative estimates of the impacts of future air pollution to support decision-makers developing environmental policy and targets. In this study we use high spatial resolution atmospheric chemistry modelling to simulate future air pollution concentrations across the UK for 2030, 2040 and 2050 based on current UK and European policy projections. We combine UK regional population-weighted concentrations with the latest epidemiological relationships to quantify mortality associated with changes in PM_2.5 and NO₂ air pollution. Our HIA suggests that by 2050, population-weighted exposure to PM_2.5 will reduce by 28% to 36%, and for NO₂ by 35% to 49%, depending on region. The HIA shows that for present day (2018), annual mortality attributable to the effects of long-term exposure to PM_2.5 and NO₂ is in the range 26,287 - 42,442, and that mortality burdens in future will be substantially reduced, being lower by 31%, 35%, and 37% in 2030, 2040 and 2050 respectively (relative to 2018) assuming no population changes. Including population projections (increases in all regions for 30+ years age group) slightly offsets these health benefits, resulting in reductions of 25%, 27%, and 26% in mortality burdens for 2030, 2040, 2050 respectively. Significant reductions in future mortality burdens are estimated and, importantly for public health, the majority of benefits are achieved early on in the future timeline simulated, though further efforts are likely needed to reduce impacts of air pollution to health.

Future air quality and premature mortality in Korea

We simulate air quality in Korea for the present, the near-term, and the long-term future conditions under the Shared Socioeconomic Pathways (SSP1: most sustainable pathway with strong emissions control, SSP3: most challenging pathway with mild emissions control) using a chemical transport model. Simulated future concentrations of NO₂, SO₂, and fine particulate matter (PM_2.5), show, in general, lower values compared to the present with varying degrees depending on SSP scenarios. Significant reductions in precursor emissions result in a decrease in O₃ concentrations under a NO_x-limited environment in the long-term future under SSP1. Under SSP3, O₃ increases in the future under a VOC-limited regime, driven by increased CH₄ levels and biogenic VOC emissions under the warming climate. Concentrations of PM_2.5 and its components, including sulfate, nitrate, ammonium, and organic aerosols (OA), generally decrease in the long-term future under both scenarios. However, the contribution of biogenic secondary OA (BSOA) to PM_2.5 will increase in the future. Simulated results are used to estimate cardiorespiratory mortality changes with concentration-response factors from epidemiologic studies in Korea based on national health surveys and Korean cohorts, using projected population structures from the SSP database. The cardiorespiratory health burden of long-term exposure to O₃, NO₂, SO₂, and PM_2.5 is estimated to be 10,419 (95 % confidence interval: 1271-17,142), 8630 (0-18,713), 3958 (0-9272), and 10,431 (1411-20,643) deaths in 2019. We find that the total cardiorespiratory excess mortality due to air pollutants under SSP1 decreases by 8 % and 95 % in 2045 and 2095, respectively. Under SSP3, excess mortality increases by 80 % in 2045, and decreases by 22 % in 2095, resulting in a substantial difference in the health outcomes depending on the emission scenario. We also find that the BSOA contribution to total PM_2.5 will differ by region, emphasizing the potential health impact of BSOA on a local scale in the future.

Sources of PM2.5-Associated Health Risks in Europe and Corresponding Emission-Induced Changes During 2005-2015

We present a newly developed approach to characterize the sources of fine particulate matter (PM_2.5)-related premature deaths in Europe using the chemical transport model GEOS-Chem and its adjoint. The contributions of emissions from each individual country, species, and sector are quantified and mapped out at km scale. In 2015, total PM_2.5-related premature death is estimated to be 449,813 (257,846-722,138) in Europe, 59.0% of which were contributed by domestic anthropogenic emissions. The anthropogenic emissions of nitrogen oxides, ammonia, and organic carbon contributed most to the PM_2.5-related health damages, making up 29.6%, 23.2%, and 16.8%, respectively of all domestic anthropogenic contributions. Residential, agricultural, and ground transport emissions are calculated to be the largest three sectoral sources of PM_2.5-related health risks, accounting for 23.5%, 23.0%, and 19.4%, respectively, of total anthropogenic contributions within Europe. After excluding the influence of extra-regional sources, we find eastern European countries suffered from more premature deaths than their emissions caused; in contrast, the emissions from some central and western European regions contributed premature deaths exceeding three times the number of deaths that occurred locally. During 2005-2015, the first decade of PM_2.5 regulation in Europe, emission controls reduced PM_2.5-related health damages in nearly all European countries, resulting in 63,538 (46,092-91,082) fewer PM_2.5-related premature deaths. However, our calculation suggests that efforts to reduce air pollution from key sectors in some countries can be offset by the lag in control of emissions in others. International cooperation is therefore vitally important for tackling air pollution and reducing corresponding detrimental effects on public health.

Increases in ozone-related mortality in China over 2013-2030 attributed to historical ozone deterioration and future population aging

We systematically examine historical and future changes in premature respiratory mortalities attributable to ozone (O₃) exposure (O₃-mortality) in China and identify the leading cause of respective change for the first time. The historical assessment for 2013-2019 is based on gridded O₃ concentrations generated by a multi-source-data-fusion algorithm; the future prediction for 2019-2030 uses gridded O₃ concentrations projected by four Coupled Model Intercomparison Project Phase 6 (CMIP6) models under three Shared Socioeconomic Pathways (SSP) scenarios. During 2013-2019, national annual O₃-mortality is 176.3 thousand (95%CI: 123.5-224.0 thousand) averaged over 2013-2019 with an increasing trend of 14.1 thousand yr^-1 (95%CI: 10.2-17.4 thousand yr^-1); sensitivity experiments show that the O₃-mortality varies at a rate of +12.7 (95%CI: 9.2-15.6), +5.8 (95%CI: 4.0-7.4), +1.0 (95%CI: 0.7-1.2), -5.4 (95%CI: -6.9 to -3.7) thousand yr^-1, owing to changes in O₃ concentration, population age structure, population size, mortality rate for respiratory disease, respectively. The deterioration of O₃ air quality, shown as significant increase in O₃ concentration, is identified as the primary factor which contributes 90.1 % of 2013-2019 O₃-mortality rise. Compared with O₃-mortality estimated in this study, the widely-used O₃-mortality assessment method based on urban-site-dominant O₃ measurements generates close national O₃-mortality but overestimates (underestimates) provincial O₃-mortality in coastal (central) provinces. From 2019 to 2030, national O₃-mortality is projected to increase by 50.4-103.7 thousand under different SSP scenarios. The change in age structure (i.e. population aging) alone will result in significant O₃-mortality rises of 137.9-160.5 thousand. Compared with 2013-2019 rapid O₃ increase (+2.5 μg m^-3 yr^-1 at national level), O₃ concentrations are projected to increase at a lower rate (+0.4 μg m^-3 yr^-1 in SSP5-8.5) or even decrease (-0.7 μg m^-3 yr^-1 in SSP1-2.6) from 2019 to 2030. Therefore, population aging, in place of O₃ air quality deterioration, will become the leading cause of future O₃-mortality rises during the coming decade.

Present-day and future PM2.5 and O3-related global and regional premature mortality in the EVAv6.0 health impact assessment model

We used the EVAv6.0 system to estimate the present (2015) and future (2015-2050) global PM_2.5 and O₃-related premature mortalities, using simulated surface concentrations from the GISS-E2.1-G Earth system model. The PM_2.5-related global premature mortality is estimated to be 4.3 and 4.4 million by the non-linear and linear models, respectively. Ischemic heart diseases are found to be the leading cause of PM_2.5-related premature deaths, contributing by 35% globally. Both long-term and short-term O₃-related premature deaths are estimated to be around 1 million, globally. Overall, PM_2.5 and O₃-related premature mortality leads to 5.3-5.4 million premature deaths, globally. The global burden of premature deaths is mainly driven by the Asian region, which in 2015 contributes by 75% of the total global premature deaths. An increase from 6.2% to 8% in the PM_2.5 relative risk as recommended by the WHO leads to an increase of PM_2.5-related premature mortality by 28%, to 5.7 million. Finally, bias correcting the simulated PM_2.5 concentrations in 2015 leads to an increase of up to 73% in the global PM_2.5-related premature mortality, leading to a total number of global premature deaths of up to 7.7 million, implying the necessity of bias correction to get more robust health burden estimates. PM_2.5 and O₃-related premature mortality in 2050 decreases by up to 57% and 18%, respectively, due to emission reductions alone. However, the projected increase and aging of the population leads to increases of premature mortality by up to a factor of 2, showing that the population exposed to air pollution is more important than the level of air pollutants, highlighting that the population dynamics should be considered when setting up health assessment systems.

Mortality Attributable to Ambient Air Pollution: A Review of Global Estimates

Since the publication of the first epidemiological study to establish the connection between long-term exposure to atmospheric pollution and effects on human health, major efforts have been dedicated to estimate the attributable mortality burden, especially in the context of the Global Burden of Disease (GBD). In this work, we review the estimates of excess mortality attributable to outdoor air pollution at the global scale, by comparing studies available in the literature. We find large differences between the estimates, which are related to the exposure response functions as well as the number of health outcomes included in the calculations, aspects where further improvements are necessary. Furthermore, we show that despite the considerable advancements in our understanding of health impacts of air pollution and the consequent improvement in the accuracy of the global estimates, their precision has not increased in the last decades. We offer recommendations for future measurements and research directions, which will help to improve our understanding and quantification of air pollution-health relationships.

Long-term trends of atmospheric hot-and-polluted episodes (HPE) and the public health implications in the Pearl River Delta region of China

Air pollution and extreme heat have been responsible for more than a million deaths in China every year, especially in densely urbanized regions. While previous studies intensively evaluated air pollution episodes and extreme heat events, a limited number of studies comprehensively assessed atmospheric hot-and-polluted-episodes (HPE) - an episode with simultaneously high levels of air pollution and temperature - which have potential adverse synergic impacts on human health. This study focused on the Pearl River Delta (PRD) region of China due to its high temperature in summer and poor air quality throughout a year. We employed geostatistical downscaling to model meteorology at a spatial resolution of 1 km, and applied a machine learning algorithm (XGBoost) to estimate a high-resolution (1 km) daily concentration of particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5) and ozone (O₃) for June to October over 20 years (2000-2019). Our results indicate an increasing trend (∼50%) in the frequency of HPE occurrence in the first decade (2000-2010). Conversely, the annual frequency of HPE occurrence reduced (16.7%), but its intensity increased during the second decade (2010-2019). The northern cities in the PRD region had higher levels of PM_2.5 and O₃ than their southern counterparts. During HPEs, regional daily PM_2.5 exceeded the World Health Organization (WHO) and Chinese guideline levels by 75% and 25%, respectively, while the O₃ exceeded the WHO O₃ standard by up to 69%. Overall, 567,063 (95% confidence interval (CI): 510,357-623,770) and 52,231 (95%CI: 26,116-78,346) excessive deaths were respectively attributable to exposure to PM_2.5 and O₃ in the PRD region. Our findings imply the necessity and urgency to formulate co-benefit policies to mitigate the region's air pollution and heat problems.

Non-Fossil Methane Emissions Mitigation From Agricultural Sector and Its Impact on Sustainable Development Goals

The agriculture sector contributes to ∼40% of methane emissions globally. Methane is also 28 times (Assessment Report 5) more potent greenhouse gas than CO2. In this study, we assess the impact of measures for mitigating methane emissions from the agricultural sector on the achievement of all the 17 United Nations’ Sustainable Development Goals (SDGs). A keyword literature review was employed that focused on finding the synergies and trade-offs with non-fossil methane emissions from the agricultural sector and respective SDGs’ targets. The results were in broad consensus with the literature aimed at finding the relationship between SDGs and measures targeting climate change. There is a total of 88 synergies against eight trade-offs from the 126 SDGs’ targets that were assessed. It clearly shows that measures to mitigate methane emissions from the agricultural sector will significantly help in achieving the SDGs. Since agriculture is the primary occupation and the source of income in developing countries, it can further be inferred that methane mitigation measures in developing countries will play a larger role in achieving SDGs. Measures to mitigate methane emissions reduce poverty; diversify the source of income; promote health, equality, education, sanitation, and sustainable development while providing energy and resource security to the future generations.

Local mortality impacts due to future air pollution under climate change scenarios

The health impacts of global climate change mitigation will affect local populations differently. However, most co-benefits analyses have been done at a global level, with relatively few studies providing local level results. We aimed to quantify the local health impacts due to fine particles (PM_2.5) under the governance arrangements embedded in the Shared Socioeconomic Pathways (SSPs1-5) under two greenhouse gas concentration scenarios (Representative Concentration Pathways (RCPs) 2.6 and 8.5) in local populations of Mozambique, India, and Spain. We simulated the SSP-RCP scenarios using the Global Change Analysis Model, which was linked to the TM5-FASST model to estimate PM_2.5 levels. PM_2.5 levels were calibrated with local measurements. We used comparative risk assessment methods to estimate attributable premature deaths due to PM_2.5 linking local population and mortality data with PM_2.5-mortality relationships from the literature, and incorporating population projections under the SSPs. PM_2.5 attributable burdens in 2050 differed across SSP-RCP scenarios, and sensitivity of results across scenarios varied across populations. Future attributable mortality burden of PM_2.5 was highly sensitive to assumptions about how populations will change according to SSP. SSPs reflecting high challenges for adaptation (SSPs 3 and 4) consistently resulted in the highest PM_2.5 attributable burdens mid-century. Our analysis of local PM_2.5 attributable premature deaths under SSP-RCP scenarios in three local populations highlights the importance of both socioeconomic development and climate policy in reducing the health burden from air pollution. Sensitivity of future PM_2.5 mortality burden to SSPs was particularly evident in low- and middle- income country settings due either to high air pollution levels or dynamic populations.

Secondary organic aerosol association with cardiorespiratory disease mortality in the United States

Fine particle pollution, PM2.5, is associated with increased risk of death from cardiorespiratory diseases. A multidecadal shift in the United States (U.S.) PM2.5 composition towards organic aerosol as well as advances in predictive algorithms for secondary organic aerosol (SOA) allows for novel examinations of the role of PM2.5 components on mortality. Here we show SOA is strongly associated with county-level cardiorespiratory death rates in the U.S. independent of the total PM2.5 mass association with the largest associations located in the southeastern U.S. Compared to PM2.5, county-level variability in SOA across the U.S. is associated with 3.5× greater per capita county-level cardiorespiratory mortality. On a per mass basis, SOA is associated with a 6.5× higher rate of mortality than PM2.5, and biogenic and anthropogenic carbon sources both play a role in the overall SOA association with mortality. Our results suggest reducing the health impacts of PM2.5 requires consideration of SOA.

Long-Term Exposure to Low-Level NO2 and Mortality among the Elderly Population in the Southeastern United States

BACKGROUND

Mounting evidence has shown that long-term exposure to fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] and ozone (O3) can increase mortality. However, the health effects associated with long-term exposure to nitrogen dioxide (NO2) are less clear, in particular the evidence is scarce for NO2 at low levels that are below the current international guidelines.

METHODS

We constructed a population-based full cohort comprising all Medicare beneficiaries (aged ≥65, N=13,590,387) in the southeastern United States from 2000 to 2016, and we then further defined the below-guideline cohort that included only those who were always exposed to low-level NO2, that is, with annual means below the current World Health Organization guidelines (i.e., ≤21 ppb). We applied previously estimated spatially and temporally resolved NO2 concentrations and assigned annual means to study participants based on their ZIP code of residence. Cox proportional hazards models were used to examine the association between long-term exposure to low-level NO2 and all-cause mortality, adjusting for potential confounders.

RESULTS

About 71.1% of the Medicare beneficiaries in the southeastern United States were always exposed to low-level NO2 over the study period. We observed an association between long-term exposure to low-level NO2 and all-cause mortality, with a hazard ratio (HR)= 1.042 (95% CI: 1.040, 1.045) in single-pollutant models and a HR= 1.047 (95% CI: 1.045, 1.049) in multipollutant models (adjusting for PM2.5 and O3), per 10-ppb increase in annual NO2 concentrations. The penalized spline indicates a linear exposure-response relationship across the entire NO2 exposure range. Medicare enrollees who were White, female, and residing in urban areas were more vulnerable to long-term NO2 exposure.

CONCLUSION

Using a large and representative cohort, we provide epidemiological evidence that long-term exposure to NO2, even below the national and global ambient air quality guidelines, was approximately linearly associated with a higher risk of mortality among older adults, independent of PM2.5 and O3 exposure. Improving air quality by reducing NO2 emissions, therefore, may yield significant health benefits. https://doi.org/10.1289/EHP9044.

Temporal and spatial distribution of health, labor, and crop benefits of climate change mitigation in the United States

Societal benefits from climate change mitigation accrue via multiple pathways. We examine the US impacts of emission changes on several factors that are affected by both climate and air quality responses. Nationwide benefits through midcentury stem primarily from air quality improvements, which are realized rapidly, and include human health, labor productivity, and crop yield benefits. Benefits from reduced heat exposure become large around 2060, thereafter often dominating over those from improved air quality. Monetized benefits are in the tens of trillions of dollars for avoided deaths and tens of billions for labor productivity and crop yield increases and reduced hospital expenditures. Total monetized benefits this century are dominated by health and are much larger than in previous analyses due to improved understanding of the human health impacts of exposure to both heat and air pollution. Benefit-cost ratios are therefore much larger than in prior studies, especially those that neglected clean air benefits. Specifically, benefits from clean air exceed costs in the first decade, whereas benefits from climate alone exceed costs in the latter half of the century. Furthermore, monetized US benefits largely stem from US emissions reductions. Increased emphasis on the localized, near-term air quality-related impacts would better align policies with societal benefits and, by reducing the mismatch between perception of climate as a risk distant in space and time and the need for rapid action to mitigate long-term climate change, might help increase acceptance of mitigation policies.

Estimates of country level temperature-related mortality damage functions

Many studies project that climate change is expected to cause a significant number of excess deaths. Yet, in integrated assessment models that determine the social cost of carbon (SCC), human mortality impacts do not reflect the latest scientific understanding. We address this issue by estimating country-level mortality damage functions for temperature-related mortality with global spatial coverage. We rely on projections from the most comprehensive published study in the epidemiology literature of future temperature impacts on mortality (Gasparrini et al. in Lancet Planet Health 1:e360–e367, 2017), which estimated changes in heat- and cold-related mortality for 23 countries over the twenty-first century. We model variation in these mortality projections as a function of baseline climate, future temperature change, and income variables and then project future changes in mortality for every country. We find significant spatial heterogeneity in projected mortality impacts, with hotter and poorer places more adversely affected than colder and richer places. In the absence of income-based adaptation, the global mortality rate in 2080–2099 is expected to increase by 1.8% [95% CI 0.8–2.8%] under a lower-emissions RCP 4.5 scenario and by 6.2% [95% CI 2.5–10.0%] in the very high-emissions RCP 8.5 scenario relative to 2001–2020. When the reduced sensitivity to heat associated with rising incomes, such as greater ability to invest in air conditioning, is accounted for, the expected end-of-century increase in the global mortality rate is 1.1% [95% CI 0.4–1.9%] in RCP 4.5 and 4.2% [95% CI 1.8–6.7%] in RCP 8.5. In addition, we compare recent estimates of climate-change induced excess mortality from diarrheal disease, malaria and dengue fever in 2030 and 2050 with current estimates used in SCC calculations and show these are likely underestimated in current SCC estimates, but are also small compared to more direct temperature effects.

Contribution of fine particulate matter to present and future premature mortality over Europe: A non-linear response

The World Health Organization estimates that around 7 million people die every year from exposure to fine particles (PM2.5) inpolluted air. Here, the number of premature deaths in Europe from different diseases associated to the ambient exposure to PM2.5 have here been studied both for present (1991-2010) and future periods (2031-2050, RCP8.5 scenario). This contribution combines different state-of-the-art approaches (use of high-resolution climate/chemistry simulations over Europe for providing air quality data; use of different baseline mortality data for specific European regions; inclusion of future population projections and dynamical changes for 2050 obtained from the United Nations (UN) Population Projections or use of non-linear exposure-response functions) to estimate the premature mortality due to PM2.5. The mortality endpoints included in this study are Lung Cancer (LC), Chronic Obstructive Pulmonary Disease (COPD), Cerebrovascular Disease (CEV), Ischemic Heart Disease (IHD), Lower Respiratory Infection (LRI) and other Non-Communicable Diseases (other NCDs). Different risk ratio and baseline mortalities for each disease end each age range have been estimated individually. The results indicate that the annual excess mortality rate from fine particulate matter in Europe is 904,000 [95% confidence interval (95% CI) 733,100-1,067,800], increasing by 73% in 2050s (1,560,000; 95% CI 1,260,000-1,840,000); meanwhile population decreases from 808 to 806 million according to the UN estimations. The results show that IHD is the main cause of premature mortality in Europe associated to PM2.5 (around 48%) both for the present and future periods. Despite several marked regional differences, premature deaths associated to all the endpoints included in this study will increase in the future period due to the climate penalty but especially because of changes in the population projected and its aging.

The mortality cost of carbon

Many studies project that climate change can cause a significant number of excess deaths. Yet, in integrated assessment models (IAMs) that determine the social cost of carbon (SCC) and prescribe optimal climate policy, human mortality impacts are limited and not updated to the latest scientific understanding. This study extends the DICE-2016 IAM to explicitly include temperature-related mortality impacts by estimating a climate-mortality damage function. We introduce a metric, the mortality cost of carbon (MCC), that estimates the number of deaths caused by the emissions of one additional metric ton of CO2. In the baseline emissions scenario, the 2020 MCC is 2.26 × 10‒4 [low to high estimate -1.71× 10‒4 to 6.78 × 10‒4] excess deaths per metric ton of 2020 emissions. This implies that adding 4,434 metric tons of carbon dioxide in 2020-equivalent to the lifetime emissions of 3.5 average Americans-causes one excess death globally in expectation between 2020-2100. Incorporating mortality costs increases the 2020 SCC from $37 to $258 [-$69 to $545] per metric ton in the baseline emissions scenario. Optimal climate policy changes from gradual emissions reductions starting in 2050 to full decarbonization by 2050 when mortality is considered.

Particulate Matter and Premature Mortality: A Bayesian Meta-Analysis

BACKGROUND

We present a systematic review of studies assessing the association between ambient particulate matter (PM) and premature mortality and the results of a Bayesian hierarchical meta-analysis while accounting for population differences of the included studies.

METHODS

The review protocol was registered in the PROSPERO systematic review registry. Medline, CINAHL and Global Health databases were systematically searched. Bayesian hierarchical meta-analysis was conducted using a non-informative prior to assess whether the regression coefficients differed across observations due to the heterogeneity among studies.

RESULTS

We identified 3248 records for title and abstract review, of which 309 underwent full text screening. Thirty-six studies were included, based on the inclusion criteria. Most of the studies were from China (n = 14), India (n = 6) and the USA (n = 3). PM_2.5 was the most frequently reported pollutant. PM was estimated using modelling techniques (22 studies), satellite-based measures (four studies) and direct measurements (ten studies). Mortality data were sourced from country-specific mortality statistics for 17 studies, Global Burden of Disease data for 16 studies, WHO data for two studies and life tables for one study. Sixteen studies were included in the Bayesian hierarchical meta-analysis. The meta-analysis revealed that the annual estimate of premature mortality attributed to PM_2.5 was 253 per 1,000,000 population (95% CI: 90, 643) and 587 per 1,000,000 population (95% CI: 1, 39,746) for PM₁₀.

CONCLUSION

253 premature deaths per million population are associated with exposure to ambient PM_2.5. We observed an unstable estimate for PM₁₀, most likely due to heterogeneity among the studies. Future research efforts should focus on the effects of ambient PM₁₀ and premature mortality, as well as include populations outside Asia. Key messages: Ambient PM_2.5 is associated with premature mortality. Given that rapid urbanization may increase this burden in the coming decades, our study highlights the urgency of implementing air pollution mitigation strategies to reduce the risk to population and planetary health.

Regional Features of Long-Term Exposure to PM2.5 Air Quality over Asia under SSP Scenarios Based on CMIP6 Models

This study investigates changes in fine particulate matter (PM_2.5) concentration and air-quality index (AQI) in Asia using nine different Coupled Model Inter-Comparison Project 6 (CMIP6) climate model ensembles from historical and future scenarios under shared socioeconomic pathways (SSPs). The results indicated that the estimated present-day PM_2.5 concentrations were comparable to satellite-derived data. Overall, the PM_2.5 concentrations of the analyzed regions exceeded the WHO air-quality guidelines, particularly in East Asia and South Asia. In future SSP scenarios that consider the implementation of significant air-quality controls (SSP1-2.6, SSP5-8.5) and medium air-quality controls (SSP2-4.5), the annual PM_2.5 levels were predicted to substantially reduce (by 46% to around 66% of the present-day levels) in East Asia, resulting in a significant improvement in the AQI values in the mid-future. Conversely, weak air pollution controls considered in the SSP3-7.0 scenario resulted in poor AQI values in China and India. Moreover, a predicted increase in the percentage of aged populations (>65 years) in these regions, coupled with high AQI values, may increase the risk of premature deaths in the future. This study also examined the regional impact of PM_2.5 mitigations on downward shortwave energy and surface air temperature. Our results revealed that, although significant air pollution controls can reduce long-term exposure to PM_2.5, it may also contribute to the warming of near- and mid-future climates.

Future air pollution related health burdens associated with RCP emission changes in the UK

Three Intergovernmental Panel on Climate Change (IPCC) Representative Concentration Pathways (RCPs) are used to simulate future ozone (O₃), nitrogen dioxide (NO₂), and fine particulate matter (PM_2.5) in the United Kingdom (UK) for the 2050s relative to the 2000s with an air quality model (AQUM) at a 12 km horizontal resolution. The present-day and future attributable fractions (AF) of mortality associated with long-term exposure to annual mean O₃, NO₂ and PM_2.5 have accordingly been estimated for the first time for regions across England, Scotland and Wales. Across the three RCPs (RCP2.6, RCP6.0 and RCP8.5), simulated annual mean of the daily maximum 8-h mean (MDA8) O₃ concentrations increase compared to present-day, likely due to decreases in NO_x (nitrogen oxides) emissions, leading to less titration of O₃ by NO. Annual mean NO₂ and PM_2.5 concentrations decrease under all RCPs for the 2050s, mostly driven by decreases in NO_x and sulphur dioxide (SO₂) emissions, respectively. The AF of mortality associated with long-term exposure to annual mean MDA8 O₃ is estimated to increase in the future across all the regions and for all RCPs. Reductions in NO₂ and PM_2.5 concentrations lead to reductions in the AF estimated for future periods under all RCPs, for both pollutants. Total mortality burdens are also highly sensitive to future population projections. Accounting for population projections exacerbates differences in total UK-wide MDA8 O₃-health burdens between present-day and future by up to a factor of ~3 but diminishes differences in NO₂-health burdens. For PM_2.5, accounting for future population projections results in additional UK-wide deaths brought forward compared to present-day under RCP2.6 and RCP6.0, even though the simulated PM_2.5 concentrations for the 2050s are estimated to decrease. Thus, these results highlight the sensitivity of future health burdens in the UK to future trends in atmospheric emissions over the UK as well as future population projections.

How will air quality effects on human health, crops and ecosystems change in the future?

Future air quality will be driven by changes in air pollutant emissions, but also changes in climate. Here, we review the recent literature on future air quality scenarios and projected changes in effects on human health, crops and ecosystems. While there is overlap in the scenarios and models used for future projections of air quality and climate effects on human health and crops, similar efforts have not been widely conducted for ecosystems. Few studies have conducted joint assessments across more than one sector. Improvements in future air quality effects on human health are seen in emission reduction scenarios that are more ambitious than current legislation. Larger impacts result from changing particulate matter (PM) abundances than ozone burdens. Future global health burdens are dominated by changes in the Asian region. Expected future reductions in ozone outside of Asia will allow for increased crop production. Reductions in PM, although associated with much higher uncertainty, could offset some of this benefit. The responses of ecosystems to air pollution and climate change are long-term, complex, and interactive, and vary widely across biomes and over space and time. Air quality and climate policy should be linked or at least considered holistically, and managed as a multi-media problem. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Mapping the Urban Population in Residential Neighborhoods by Integrating Remote Sensing and Crowdsourcing Data

Where urban dwellers live at a fine scale is essential for the planning of services and response to city emergencies. Currently, most existing population mapping approaches considered census data as observational data for specifying models. However, census data usually have low spatial resolution and low frequency. Here, we presented a framework for mapping populations in residential neighborhoods with 30 m spatial resolution with little dependency upon census data. The framework integrated remote sensing and crowdsourcing data. The observational populations and number of households at residential neighborhood scale were obtained from real-time crowdsourcing data instead of census data. We tested our framework in Beijing. We found that (1) the number of households from a real estate trade platform could be a good proxy for accurate observational population. (2) The accuracy of the mapping population in residential neighborhoods was reasonable. The mean absolute percentage error was 47.26% and the R2 was 0.78. (3) Our framework shows great potential in mapping the population in real time. Our findings expand the knowledge in estimating urban population. In addition, the proposed framework and approach provide an effective means to quantify population distribution data for cities, which is particularly important for many of the cities worldwide lacking census data at the residential neighborhood scale.

Projections of Ambient Temperature- and Air Pollution-Related Mortality Burden Under Combined Climate Change and Population Aging Scenarios: a Review

PURPOSE OF REVIEW

Climate change will affect mortality associated with both ambient temperature and air pollution. Because older adults have elevated vulnerability to both non-optimal ambient temperature (heat and cold) and air pollution, population aging can amplify future population vulnerability to these stressors through increasing the number of vulnerable older adults. We aimed to review recent evidence on projections of temperature- or air pollution-related mortality burden (i.e., number of deaths) under combined climate change and population aging scenarios, with a focus on evaluating the role of population aging in assessing these health impacts of climate change. We included studies published between 2014 and 2019 with age-specific population projections.

RECENT FINDINGS

We reviewed 16 temperature projection studies and 15 air pollution projection studies. Nine of the temperature studies and four of the air pollution studies took population aging into account by performing age-stratified analyses that utilized age-specific relationships between temperature or air pollution exposures and mortality (i.e., age-specific exposure-response functions (ERFs)). Population aging amplifies the projected mortality burden of temperature and air pollution under a warming climate. Compared with a constant population scenario, population aging scenarios lead to less reduction or even increases in cold-related mortality burden, resulting in substantial net increases in future overall (heat and cold) temperature-related mortality burden. There is strong evidence suggesting that to accurately assess the future temperature- and air pollution-related mortality burden of climate change, investigators need to account for the amplifying effect of population aging. Thus, all future studies should incorporate age-specific population size projections and age-specific ERFs into their analyses. These studies would benefit from refinement of age-specific ERF estimates.

Climate and air-quality benefits of a realistic phase-out of fossil fuels

The combustion of fossil fuels produces emissions of the long-lived greenhouse gas carbon dioxide and of short-lived pollutants, including sulfur dioxide, that contribute to the formation of atmospheric aerosols¹. Atmospheric aerosols can cool the climate, masking some of the warming effect that results from the emission of greenhouse gases¹. However, aerosol particulates are highly toxic when inhaled, leading to millions of premature deaths per year^2,3. The phasing out of unabated fossil-fuel combustion will therefore provide health benefits, but will also reduce the extent to which the warming induced by greenhouse gases is masked by aerosols. Because aerosol levels respond much more rapidly to changes in emissions relative to carbon dioxide, large near-term increases in the magnitude and rate of climate warming are predicted in many idealized studies that typically assume an instantaneous removal of all anthropogenic or fossil-fuel-related emissions^1,4-9. Here we show that more realistic modelling scenarios do not produce a substantial near-term increase in either the magnitude or the rate of warming, and in fact can lead to a decrease in warming rates within two decades of the start of the fossil-fuel phase-out. Accounting for the time required to transform power generation, industry and transportation leads to gradually increasing and largely offsetting climate impacts of carbon dioxide and sulfur dioxide, with the rate of warming further slowed by reductions in fossil-methane emissions. Our results indicate that even the most aggressive plausible transition to a clean-energy society provides benefits for climate change mitigation and air quality at essentially all decadal to centennial timescales.

Comparison of health and economic impacts of PM2.5 and ozone pollution in China

Many studies have reported associations between air pollution and health impacts, but few studies have explicitly differentiated the economic effects of PM_2.5 and ozone at China's regional level. This study compares the PM_2.5 and ozone pollution-related health impacts based on an integrated approach. The research framework combines an air pollutant emission projection model (GAINS), an air quality model (GEOS-Chem), a health model using the latest exposure-response functions, medical prices and value of statistical life (VSL), and a general equilibrium model (CGE). Results show that eastern provinces in China encounter severer loss from PM_2.5 and more benefit from mitigation policy, whereas the lower income western provinces encounter severer health impacts and economic burdens due to ozone pollution, and the impact in southern and central provinces is relatively lower. In 2030, without control policies, PM _2.5 pollution could lead to losses of 2.0% in Gross Domestic Production (GDP), 210 billion Chinese Yuan (CNY) in health expenditure and a life loss of around 10,000 billion, while ozone pollution could contribute to GDP loss by 0.09% (equivalent to 78 billion CNY), 310 billion CNY in health expenditure, and a life loss of 2300 billion CNY (equivalent to 2.7% of GDP). By contrast, with control policies, the GDP and VSLs loss in 2030 attributable to ambient air pollution could be reduced significantly. We also find that the health and economic impacts of ozone pollution are significantly lower than PM_2.5, but are much more difficult to mitigate. The Chinese government should promote air pollution control policies that could jointly reduce PM_2.5 and ozone pollution.

Indian annual ambient air quality standard is achievable by completely mitigating emissions from household sources

Exposures to ambient and household fine-particulate matter (PM2.5) together are among the largest single causes of premature mortality in India according to the Global Burden of Disease Studies (GBD). Several recent investigations have estimated that household emissions are the largest contributor to ambient PM2.5 exposure in the country. Using satellite-derived district-level PM2.5 exposure and an Eulerian photochemical dispersion model CAMx (Comprehensive Air Quality Model with Extensions), we estimate the benefit in terms of population exposure of mitigating household sources--biomass for cooking, space- and water-heating, and kerosene for lighting. Complete mitigation of emissions from only these household sources would reduce India-wide, population-weighted average annual ambient PM2.5 exposure by 17.5, 11.9, and 1.3%, respectively. Using GBD methods, this translates into reductions in Indian premature mortality of 6.6, 5.5, and 0.6%. If PM2.5 emissions from all household sources are completely mitigated, 103 (of 597) additional districts (187 million people) would meet the Indian annual air-quality standard (40 μg m-3) compared with baseline (2015) when 246 districts (398 million people) met the standard. At 38 μg m-3, after complete mitigation of household sources, compared with 55.1 μg m-3 at baseline, the mean annual national population-based concentration would meet the standard, although highly polluted areas, such as Delhi, would remain out of attainment. Our results support expansion of programs designed to promote clean household fuels and rural electrification to achieve improved air quality at regional scales, which also has substantial additional health benefits from directly reducing household air pollution exposures.

The impact of human health co-benefits on evaluations of global climate policy

The health co-benefits of CO2 mitigation can provide a strong incentive for climate policy through reductions in air pollutant emissions that occur when targeting shared sources. However, reducing air pollutant emissions may also have an important co-harm, as the aerosols they form produce net cooling overall. Nevertheless, aerosol impacts have not been fully incorporated into cost-benefit modeling that estimates how much the world should optimally mitigate. Here we find that when both co-benefits and co-harms are taken fully into account, optimal climate policy results in immediate net benefits globally, overturning previous findings from cost-benefit models that omit these effects. The global health benefits from climate policy could reach trillions of dollars annually, but will importantly depend on the air quality policies that nations adopt independently of climate change. Depending on how society values better health, economically optimal levels of mitigation may be consistent with a target of 2 °C or lower.

Effects of fossil fuel and total anthropogenic emission removal on public health and climate

Anthropogenic greenhouse gases and aerosols are associated with climate change and human health risks. We used a global model to estimate the climate and public health outcomes attributable to fossil fuel use, indicating the potential benefits of a phaseout. We show that it can avoid an excess mortality rate of 3.61 (2.96-4.21) million per year from outdoor air pollution worldwide. This could be up to 5.55 (4.52-6.52) million per year by additionally controlling nonfossil anthropogenic sources. Globally, fossil-fuel-related emissions account for about 65% of the excess mortality, and 70% of the climate cooling by anthropogenic aerosols. The chemical influence of air pollution on aeolian dust contributes to the aerosol cooling. Because aerosols affect the hydrologic cycle, removing the anthropogenic emissions in the model increases rainfall by 10-70% over densely populated regions in India and 10-30% over northern China, and by 10-40% over Central America, West Africa, and the drought-prone Sahel, thus contributing to water and food security. Since aerosols mask the anthropogenic rise in global temperature, removing fossil-fuel-generated particles liberates 0.51(±0.03) °C and all pollution particles 0.73(±0.03) °C warming, reaching around 2 °C over North America and Northeast Asia. The steep temperature increase from removing aerosols can be moderated to about 0.36(±0.06) °C globally by the simultaneous reduction of tropospheric ozone and methane. We conclude that a rapid phaseout of fossil-fuel-related emissions and major reductions of other anthropogenic sources are needed to save millions of lives, restore aerosol-perturbed rainfall patterns, and limit global warming to 2 °C.

Current and Future Disease Burden From Ambient Ozone Exposure in India

Long-term ambient ozone (O₃) exposure is a risk factor for human health. We estimate the source-specific disease burden associated with long-term O₃ exposure in India at high spatial resolution using updated risk functions from the American Cancer Society Cancer Prevention Study II. We estimate 374,000 (95UI: 140,000-554,000) annual premature mortalities using the updated risk function in India in 2015, 200% larger than estimates using the earlier American Cancer Society Cancer Prevention Study II risk function. We find that land transport emissions dominate the source contribution to this disease burden (35%), followed by emissions from power generation (23%). With no change in emissions by 2050, we estimate 1,126,000 (95UI: 421,000-1,667,000) annual premature mortalities, an increase of 200% relative to 2015 due to population aging and growth increasing the number of people susceptible to air pollution. We find that the International Energy Agency New Policy Scenario provides small changes (+1%) to this increasing disease burden from the demographic transition. Under the International Energy Agency Clean Air Scenario we estimate 791,000 (95UI: 202,000-1,336,000) annual premature mortalities in 2050, avoiding 335,000 annual premature mortalities (45% of the increase) compared to the scenario of no emission change. Our study highlights that critical public health benefits are possible with stringent emission reductions, despite population growth and aging increasing the attributable disease burden from O₃ exposure even under such strong emission reductions. The disease burden attributable to ambient fine particulate matter exposure dominates that from ambient O₃ exposure in the present day, while in the future, they may be similar in magnitude.

Data Integration for the Assessment of Population Exposure to Ambient Air Pollution for Global Burden of Disease Assessment

Air pollution is a leading global disease risk factor. Tracking progress (e.g., for Sustainable Development Goals) requires accurate, spatially resolved, routinely updated exposure estimates. A Bayesian hierarchical model was developed to estimate annual average fine particle (PM_2.5) concentrations at 0.1° × 0.1° spatial resolution globally for 2010-2016. The model incorporated spatially varying relationships between 6003 ground measurements from 117 countries, satellite-based estimates, and other predictors. Model coefficients indicated larger contributions from satellite-based estimates in countries with low monitor density. Within and out-of-sample cross-validation indicated improved predictions of ground measurements compared to previous (Global Burden of Disease 2013) estimates (increased within-sample R² from 0.64 to 0.91, reduced out-of-sample, global population-weighted root mean squared error from 23 μg/m³ to 12 μg/m³). In 2016, 95% of the world's population lived in areas where ambient PM_2.5 levels exceeded the World Health Organization 10 μg/m³ (annual average) guideline; 58% resided in areas above the 35 μg/m³ Interim Target-1. Global population-weighted PM_2.5 concentrations were 18% higher in 2016 (51.1 μg/m³) than in 2010 (43.2 μg/m³), reflecting in particular increases in populous South Asian countries and from Saharan dust transported to West Africa. Concentrations in China were high (2016 population-weighted mean: 56.4 μg/m³) but stable during this period.

Assessment and economic valuation of air pollution impacts on human health over Europe and the United States as calculated by a multi-model ensemble in the framework of AQMEII3

The impact of air pollution on human health and the associated external costs in Europe and the United States (US) for the year 2010 are modeled by a multi-model ensemble of regional models in the frame of the third phase of the Air Quality Modelling Evaluation International Initiative (AQMEII3). The modeled surface concentrations of O3, CO, SO2 and PM2.5 are used as input to the Economic Valuation of Air Pollution (EVA) system to calculate the resulting health impacts and the associated external costs from each individual model. Along with a base case simulation, additional runs were performed introducing 20 % anthropogenic emission reductions both globally and regionally in Europe, North America and east Asia, as defined by the second phase of the Task Force on Hemispheric Transport of Air Pollution (TF-HTAP2). Health impacts estimated by using concentration inputs from different chemistry-transport models (CTMs) to the EVA system can vary up to a factor of 3 in Europe (12 models) and the United States (3 models). In Europe, the multi-model mean total number of premature deaths (acute and chronic) is calculated to be 414 000, while in the US, it is estimated to be 160 000, in agreement with previous global and regional studies. The economic valuation of these health impacts is calculated to be EUR 300 billion and 145 billion in Europe and the US, respectively. A subset of models that produce the smallest error compared to the surface observations at each time step against an all-model mean ensemble results in increase of health impacts by up to 30 % in Europe, while in the US, the optimal ensemble mean led to a decrease in the calculated health impacts by ~ 11 %. A total of 54 000 and 27 500 premature deaths can be avoided by a 20 % reduction of global anthropogenic emissions in Europe and the US, respectively. A 20 % reduction of North American anthropogenic emissions avoids a total of ~ 1000 premature deaths in Europe and 25 000 total premature deaths in the US. A 20 % decrease of anthropogenic emissions within the European source region avoids a total of 47 000 premature deaths in Europe. Reducing the east Asian anthropogenic emissions by 20 % avoids ~ 2000 total premature deaths in the US. These results show that the domestic anthropogenic emissions make the largest impacts on premature deaths on a continental scale, while foreign sources make a minor contribution to adverse impacts of air pollution.

Residential energy use emissions dominate health impacts from exposure to ambient particulate matter in India

Exposure to ambient fine particulate matter (PM_2.5) is a leading contributor to diseases in India. Previous studies analysing emission source attributions were restricted by coarse model resolution and limited PM_2.5 observations. We use a regional model informed by new observations to make the first high-resolution study of the sector-specific disease burden from ambient PM_2.5 exposure in India. Observed annual mean PM_2.5 concentrations exceed 100 μg m⁻³ and are well simulated by the model. We calculate that the emissions from residential energy use dominate (52%) population-weighted annual mean PM_2.5 concentrations, and are attributed to 511,000 (95UI: 340,000–697,000) premature mortalities annually. However, removing residential energy use emissions would avert only 256,000 (95UI: 162,000–340,000), due to the non-linear exposure–response relationship causing health effects to saturate at high PM_2.5 concentrations. Consequently, large reductions in emissions will be required to reduce the health burden from ambient PM_2.5 exposure in India.

Exposure to ambient particulate matter is a key contributor to disease in India and source attribution is vital for pollution control. Here the authors use a high-resolution regional model to show residential emissions dominate particulate matter concentrations and associated premature mortality.

Ambient PM2.5 exposure and expected premature mortality to 2100 in India under climate change scenarios

Premature mortality from current ambient fine particulate (PM_2.5) exposure in India is large, but the trend under climate change is unclear. Here we estimate ambient PM_2.5 exposure up to 2100 by applying the relative changes in PM_2.5 from baseline period (2001-2005) derived from Coupled Model Inter-comparison Project 5 (CMIP5) models to the satellite-derived baseline PM_2.5. We then project the mortality burden using socioeconomic and demographic projections in the Shared Socioeconomic Pathway (SSP) scenarios. Ambient PM_2.5 exposure is expected to peak in 2030 under the RCP4.5 and in 2040 under the RCP8.5 scenario. Premature mortality burden is expected to be 2.4-4 and 28.5-38.8% higher under RCP8.5 scenario relative to the RCP4.5 scenario in 2031-2040 and 2091-2100, respectively. Improved health conditions due to economic growth are expected to compensate for the impact of changes in population and age distribution, leading to a reduction in per capita health burden from PM_2.5 for all scenarios except the combination of RCP8.5 exposure and SSP3.

Quantified, Localized Health Benefits of Accelerated Carbon Dioxide Emissions Reductions

Societal risks increase as Earth warms, but also for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate even if they lead to identical warming [1]. Accelerating carbon dioxide (CO₂) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations [2]. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits [3, 4]. However, 2°C trajectories not relying on negative emissions or 1.5°C trajectories require elimination of most fossil fuel related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing ambition of 21^st century CO₂ reductions by 180 GtC; an amount that would shift a 'standard' 2°C scenario to 1.5°C or could achieve 2°C without negative emissions. The decreased air pollution leads to 153±43 million fewer premature deaths worldwide, with ~40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

Long-term trends in the ambient PM2.5- and O3-related mortality burdens in the United States under emission reductions from 1990 to 2010

Concentrations of both fine particulate matter (PM2.5) and ozone (O3) in the United States (US) have decreased significantly since 1990, mainly because of air quality regulations. Exposure to these air pollutants is associated with premature death. Here we quantify the annual mortality burdens from PM2.5 and O3 in the US from 1990 to 2010, estimate trends and inter-annual variability, and evaluate the contributions to those trends from changes in pollutant concentrations, population, and baseline mortality rates. We use a fine-resolution (36 km) self-consistent 21-year simulation of air pollutant concentrations in the US from 1990 to 2010, a health impact function, and annual county-level population and baseline mortality rate estimates. From 1990 to 2010, the modeled population-weighted annual PM2.5 decreased by 39 %, and summertime (April to September) 1 h average daily maximum O3 decreased by 9 % from 1990 to 2010. The PM2.5-related mortality burden from ischemic heart disease, chronic obstructive pulmonary disease, lung cancer, and stroke steadily decreased by 54% from 123 700 deaths year-1 (95% confidence interval, 70 800-178 100) in 1990 to 58 600 deaths year-1 (24 900-98 500) in 2010. The PM2.5-related mortality burden would have decreased by only 24% from 1990 to 2010 if the PM2.5 concentrations had stayed at the 1990 level, due to decreases in baseline mortality rates for major diseases affected by PM2.5. The mortality burden associated with O3 from chronic respiratory disease increased by 13% from 10 900 deaths year-1 (3700-17 500) in 1990 to 12 300 deaths year-1 (4100-19 800) in 2010, mainly caused by increases in the baseline mortality rates and population, despite decreases in O3 concentration. The O3-related mortality burden would have increased by 55% from 1990 to 2010 if the O3 concentrations had stayed at the 1990 level. The detrended annual O3 mortality burden has larger inter-annual variability (coefficient of variation of 12%) than the PM2.5-related burden (4%), mainly from the inter-annual variation of O3 concentration. We conclude that air quality improvements have significantly decreased the mortality burden, avoiding roughly 35 800 (38%) PM2.5-related deaths and 4600 (27%) O3-related deaths in 2010, compared to the case if air quality had stayed at 1990 levels (at 2010 baseline mortality rates and population).

HTAP2 multi-model estimates of premature human mortality due to intercontinental transport of air pollution and emission sectors

Ambient air pollution from ozone and fine particulate matter is associated with premature mortality. As emissions from one continent influence air quality over others, changes in emissions can also influence human health on other continents. We estimate global air pollution-related premature mortality from exposure to PM_2.5 and ozone, and the avoided deaths from 20% anthropogenic emission reductions from six source regions, North America (NAM), Europe (EUR), South Asia (SAS), East Asia (EAS), Russia/Belarus/Ukraine (RBU) and the Middle East (MDE), three global emission sectors, Power and Industry (PIN), Ground Transportation (TRN) and Residential (RES) and one global domain (GLO), using an ensemble of global chemical transport model simulations coordinated by the second phase of the Task Force on Hemispheric Transport of Air Pollution (TF-HTAP2), and epidemiologically-derived concentration-response functions. We build on results from previous studies of the TF-HTAP by using improved atmospheric models driven by new estimates of 2010 anthropogenic emissions (excluding methane), with more source and receptor regions, new consideration of source sector impacts, and new epidemiological mortality functions. We estimate 290,000 (95% CI: 30,000, 600,000) premature O₃-related deaths and 2.8 million (0.5 million, 4.6 million) PM_2.5-related premature deaths globally for the baseline year 2010. While 20% emission reductions from one region generally lead to more avoided deaths within the source region than outside, reducing emissions from MDE and RBU can avoid more O₃-related deaths outside of these regions than within, and reducing MDE emissions also avoids more PM_2.5-related deaths outside of MDE than within. Our findings that most avoided O₃-related deaths from emission reductions in NAM and EUR occur outside of those regions contrast with those of previous studies, while estimates of PM_2.5-related deaths from NAM, EUR, SAS and EAS emission reductions agree well. In addition, EUR, MDE and RBU have more avoided O₃-related deaths from reducing foreign emissions than from domestic reductions. For six regional emission reductions, the total avoided extra-regional mortality is estimated as 6,000 (-3,400, 15,500) deaths/year and 25,100 (8,200, 35,800) deaths/year through changes in O₃ and PM_2.5, respectively. Interregional transport of air pollutants leads to more deaths through changes in PM_2.5 than in O₃, even though O₃ is transported more on interregional scales, since PM_2.5 has a stronger influence on mortality. For NAM and EUR, our estimates of avoided mortality from regional and extra-regional emission reductions are comparable to those estimated by regional models for these same experiments. In sectoral emission reductions, TRN emissions account for the greatest fraction (26-53% of global emission reduction) of O₃-related premature deaths in most regions, in agreement with previous studies, except for EAS (58%) and RBU (38%) where PIN emissions dominate. In contrast, PIN emission reductions have the greatest fraction (38-78% of global emission reduction) of PM_2.5-related deaths in most regions, except for SAS (45%) where RES emission dominates, which differs with previous studies in which RES emissions dominate global health impacts. The spread of air pollutant concentration changes across models contributes most to the overall uncertainty in estimated avoided deaths, highlighting the uncertainty in results based on a single model. Despite uncertainties, the health benefits of reduced intercontinental air pollution transport suggest that international cooperation may be desirable to mitigate pollution transported over long distances.

Climate change impacts on human health over Europe through its effect on air quality

This review examines the current literature on the effects of future emissions and climate change on particulate matter (PM) and O₃ air quality and on the consequent health impacts, with a focus on Europe. There is considerable literature on the effects of climate change on O₃ but fewer studies on the effects of climate change on PM concentrations. Under the latest Intergovernmental Panel on Climate Change (IPCC) 5th assessment report (AR5) Representative Concentration Pathways (RCPs), background O₃ entering Europe is expected to decrease under most scenarios due to higher water vapour concentrations in a warmer climate. However, under the extreme pathway RCP8.5 higher (more than double) methane (CH₄) abundances lead to increases in background O₃ that offset the O₃ decrease due to climate change especially for the 2100 period. Regionally, in polluted areas with high levels of nitrogen oxides (NO_x), elevated surface temperatures and humidities yield increases in surface O₃ - termed the O₃ climate penalty - especially in southern Europe. The O₃ response is larger for metrics that represent the higher end of the O₃ distribution, such as daily maximum O₃. Future changes in PM concentrations due to climate change are much less certain, although several recent studies also suggest a PM climate penalty due to high temperatures and humidity and reduced precipitation in northern mid-latitude land regions in 2100.A larger number of studies have examined both future climate and emissions changes under the RCP scenarios. Under these pathways the impact of emission changes on air quality out to the 2050s will be larger than that due to climate change, because of large reductions in emissions of O₃ and PM pollutant precursor emissions and the more limited climate change response itself. Climate change will also affect climate extreme events such as heatwaves. Air pollution episodes are associated with stagnation events and sometimes heat waves. Air quality during the 2003 heatwave over Europe has been examined in numerous studies and mechanisms for enhancing O₃ have been identified.There are few studies on health effects associated with climate change impacts alone on air quality, but these report higher O₃-related health burdens in polluted populated regions and greater PM_2.5 health burdens in these emission regions. Studies that examine the combined impacts of climate change and anthropogenic emissions change under the RCP scenarios report reductions in global and European premature O₃-respiratory related and PM mortalities arising from the large decreases in precursor emissions. Under RCP 8.5 the large increase in CH₄ leads to global and European excess O₃-respiratory related mortalities in 2100. For future health effects, besides uncertainty in future O₃ and particularly PM concentrations, there is also uncertainty in risk estimates such as effect modification by temperature on pollutant-response relationships and potential future adaptation that would alter exposure risk.

The Interplay of Climate Change and Air Pollution on Health

PURPOSE OF REVIEW

Air pollution significantly affects health, causing up to 7 million premature deaths annually with an even larger number of hospitalizations and days of sick leave. Climate change could alter the dispersion of primary pollutants, particularly particulate matter, and intensify the formation of secondary pollutants, such as near-surface ozone. The purpose of the review is to evaluate the recent evidence on the impacts of climate change on air pollution and air pollution-related health impacts and identify knowledge gaps for future research.

RECENT FINDINGS

Several studies modelled future ozone and particulate matter concentrations and calculated the resulting health impacts under different climate scenarios. Due to climate change, ozone- and fine particle-related mortalities are expected to increase in most studies; however, results differ by region, assumed climate change scenario and other factors such as population and background emissions. This review explores the relationships between climate change, air pollution and air pollution-related health impacts. The results highly depend on the climate change scenario used and on projections of future air pollution emissions, with relatively high uncertainty. Studies primarily focused on mortality; projections on the effects on morbidity are needed.

Co-benefits of global, domestic, and sectoral greenhouse gas mitigation for US air quality and human health in 2050

Reductions in greenhouse gas (GHG) emissions can bring ancillary benefits of improved air quality and reduced premature mortality, in addition to slowing climate change. Here we study the co-benefits of global and domestic GHG mitigation on US air quality and human health in 2050 at fine resolution using dynamical downscaling of meteorology and air quality from global simulations to the continental US, and quantify for the first time the co-benefits from foreign GHG mitigation. Relative to the reference scenario from which RCP4.5 was created, global GHG reductions in RCP4.5 avoid 16000 PM_2.5-related all-cause deaths yr^-1 (90% confidence interval, 11700-20300), and 8000 (3600-12400) O₃-related respiratory deaths yr^-1 in the US in 2050. Foreign GHG mitigation avoids 15% and 62% of PM_2.5- and O₃-related total avoided deaths, highlighting the importance of foreign mitigation for US health. GHG mitigation in the US residential sector brings the largest co-benefits for PM_2.5-related deaths (21% of total domestic co-benefits), and industry for O₃ (17%). Monetized benefits for avoided deaths from ozone and PM_2.5 are $137 ($87-187) per ton CO₂ at high valuation and $45 ($29-62) at low valuation, of which 31% are from foreign GHG reductions. These benefits likely exceed the marginal cost of GHG reductions in 2050. The US gains significantly greater air quality and health co-benefits when its GHG emission reductions are concurrent with reductions in other nations. Similarly, previous studies estimating co-benefits locally or regionally may greatly underestimate the full co-benefits of coordinated global actions.