Zoltán Massay-Kosubek

In the context of shaping the Future of Europe, the health community can bring the Wind of Change to the EU institutional renewal process by making the case for the added value of EU action on air pollution at European, national and local level, by pointing out the health benefits.

Why is air pollution the most European challenge?

Nothing is more important European issue than the air we breathe; air pollution does not recognise borders. Air pollution, being a health threat, is often seen as an environmental issue although it is a perfect case to demonstrate that health benefits often can be identified in other, non-health EU policies.

Air pollution as the most important environmental determinant of health

Despite increasing awareness of the health impacts of air pollution over decades and various policy initiatives at international, European, national and regional / local levels, air pollution remains the largest environmental health risk health in Europe.

Health burden – The disease burden and the costs imposed on national health systems across Europe are unacceptable: According to the European Environment Agency, health impacts attributable to exposure to air pollution indicate that PM2.5 concentrations were responsible for about 428 000 premature deaths originating from long-term exposure in Europe (41 countries), of which around 399,000 deaths in the EU28 (2014). The estimated impact of exposure to NO2 and O3 concentrations in 2014 is around 75,000 and 13,600 premature deaths per year respectively in the EU28. Heart disease and stroke are the most common reasons for premature death attributable to air pollution and are responsible for 80% of cases; followed by lung diseases and lung cancer.

Economic costs – The OECD forecast projects that the market costs of air pollution (reduced productivity, additional health expenditure, crop losses, etc.) will increase to 2% of European GDBP by 2060. However, this is estimated to be equivalent to just one tenth of the non-market costs, including illness, ecosystem damage and climate change.

Why is policy decision needed on EU policy action on air?

Air pollution has been one of Europe’s main political concerns since the late 1970s and EU policy on air quality aims to develop and implement appropriate instruments to improve air quality.
What is get measured get done. First and foremost there are data on the magnitude of the problem: Background information can be found in the Air Quality Guidelines of the WHO present the key pollutants and their effects on health and the European Environment Agency monitors the air pollution effects and data. The European Union has developed an extensive body of legislation which establishes health based standards and objectives for a number of pollutants present in the air based on two pillars: the present air pollution in the air and tackling the sources.

The first pillar is the EU Ambient (Outdoor) Air Quality Directives AAQ (Directives 2008/50/EC and 2004/107/EC) set air quality standards and requirements to ensure that Member States adequately monitor and/or assess air quality on their territory, in a harmonised and comparable manner.
The second pillar is the National Emissions Ceilings Directive (NEC Directive 2016/2284/EU) – which entered into force on 31 December 2016. This Directive sets national reduction commitments for the five pollutants (sulphur dioxide, nitrogen oxides, volatile organic compounds, ammonia and fine particulate matter) responsible for significant health benefits.

Air and the Future of Europe

Air policy was in the spotlight in 2014 already: by implementing the philosophy of political discontinuity, the Juncker commission was ready to withdraw the then-draft NEC directive and only because of a strong, joint campaign call from the health and environmental community changed their mind. Ahead of the EU political renewal, when the Future of the EU Health policy is in dark clouds, air quality can be the trump card for the health community to demonstrate the health case and the EU added value on action.

Tackling air pollution and greenhouse gas emissions requires similar approaches and serves both health and mitigates climate change; a transition towards a sustainable food system can deliver better nutrition, climate change mitigation and a more efficient natural resource use, while helping to prevent antimicrobial resistance . Policies that reduce greenhouse gas emissions, whilst also delivering cleaner air, increased physical activity, reduced road traffic accidents and better mental health, can deliver enormous health and wellbeing benefits now and in the future.

Harvesting the low hanging fruits: health and economic benefits of cleaning Europe’s air at EU, national and local level

The recent dieselgate demonstrated the value of implementation of any kind of policy. The continuation is not indifferent from a health point of view: the health costs of diesel pollution shall not be underestimated. A study by IIASA found that roughly 10,000 premature deaths a year (EU28 plus Norway and Switzerland) can be attributed to NOx emissions from diesel cars, vans, and light commercial vehicles, of which approximately half are due to the excessive NOx emissions. Even if the health burden of air pollution became the narrative and policy decision was made about the need of action, those decision have to be actually implemented at all level in Europe to make that change tangible for EU citizens by making their life longer and healthier and to bring actual savings to national budgets via healthcare savings.

Towards more EU level action on the ambient air quality directive?

The opening window of opportunity to bring clean air into EU policies is the current revision of the AAQ directives. Following the recent reflection process within the Commission on whether the AAQ Directives are fit for purpose and continue to provide the appropriate legislative framework to ensure protection from adverse impacts on, and risks to, human health and the environment. The next step in the process could be a public consultation in Spring 2018 for which the health community should be prepared.

Ensuring full implementation of air quality standards at national level.

There are various ways ensuring national compliance with EU law. The EU is just about to consider legal actions against Member states for breaching ensuring clean air for their citizens but not respecting EU standards.
The legal battle also continues in the court room where EU action on coal pollution is challenged and should be defended.

Going local, being vocal to advocate for change

Given the implications of air pollution to Non-Communicable Diseases, local authorities have the responsibility to create the healthiest local environment including transport. There are plenty of opportunities within the hands of cities to implement complementary actions. Intorducing air pollution tolls or banning diesel vehicles from cities are definitely among the options

How to bring fresh air into the institutional renewal?

In order to bring policy change, the health community can and should frame air pollution, as primarily and mainly a human health issue, advocate for policy decisions to tackle this health threat and monitor the implementation of those decisions at European, national and local level by harvesting the low hanging fruits of change: saved healthy lives and economic savings making national budgets and healthcare systems more sustainable.

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