Reductions in air pollution will deliver many benefits to human health including significant declines in deaths from pneumonia. The estimated 2.5 million pneumonia deaths that occurred in 2019 will rise massively in 2020 after COVID-19 deaths are included. No other infection causes so many deaths, according to the Global Burden of Disease (GBD).
Air pollution is the leading risk factor for death from pneumonia. An estimated 30% (749,200) of all pneumonia deaths in 2019 were attributable to air pollution according to the GBD. Of all causes of air pollution, it is particulate matter measuring less than 2.5 micrometers in diameter - less than a 30th of the diameter of a human hair - that causes the largest burden of disease. This "PM2.5" is emitted both outdoors and indoors, from vehicles, coal-burning power plants, industrial activities, waste burning, farming practices, and household cooking and heating using coal, charcoal, wood, agricultural residue, animal dung, and kerosene.
Both outdoor and indoor sources of PM2.5 contribute to pneumonia deaths, but not equally. The majority (56%) of air pollution-related pneumonia deaths are from household sources, while 44% are from outdoor sources. While air-pollution related deaths from household sources have been falling since 2000, deaths from outdoor air pollution are actually rising, driven by increase across Africa and Asia.
Not all populations are equally vulnerable to air pollution-related pneumonia deaths. It is the very young and the very old who are at greatest risk. 40% of air pollution-related pneumonia deaths are among children under five years while 35% are among adults over 70 years.
Household air pollution is a greater risk for pneumonia among children while outdoor air pollution disproportionately affects respiratory health among older adults. 70% of air pollution-related pneumonia deaths among children are caused by household air pollution while 57% of air pollution-related pneumonia deaths among older adults are caused by outdoor air pollution.
Air pollution-related deaths are concentrated in 40 low- and middle-income countries (LMICs). Almost two-thirds of these countries are in Africa and 33% are in Asia. Of great concern are the 20 countries with the largest numbers of air pollution-related pneumonia deaths and the 17 Sub-Saharan countries where air pollution contributes to more than 50% of all pneumonia deaths, most of them among children under five years.
It is important to note that the leading causes of air pollution-related pneumonia deaths and the most affected populations differ markedly within LMICs. For example, in India the greatest burden of death is caused by outdoor air pollution impacting older adults, while in Nigeria it is the disproportionate impact of household air pollution among children under five that contributes the most.
Despite efforts to increase household access to clean cooking fuels and technologies, there has been scant progress in countries with heavy burdens of pneumonia. Since 2010, only eight of the 40 LMICs on the Scorecard have achieved more than 50% population access to clean cooking.
It is vital that governments in all 40 countries introduce policies that target both the leading causes of air pollution-related pneumonia deaths and their most vulnerable populations.
Specifically the Every Breath Counts Coalition is calling on governments to:
1. Set national targets to reduce air pollution-related pneumonia deaths by 50% by 2030.
2. Introduce new measures to achieve the target including by:
Increasing the proportion of households with access to clean cooking fuels and technologies to above 70%
Reducing average PM2.5 exposure by 50% (or until it achieves the updated WHO targets of not more than 5?g/m3 per year and 15 µg/m3 for more than three days per year)
Establishing a multi-sector, multi-government Clean Air Taskforce with representation from the health, energy, agriculture, industry, and urban development ministries in national, state, and local governments
3. Publish progress to the target as part of national pneumonia control strategies using Global Burden of Disease data.
Investments to reduce air pollution and the risk of pneumonia death will help countries accelerate progress to several of the Sustainable Development Goals for health, including:
3.2.1 Reduce child (0-4 years) deaths to at least 25 per 1,000 births
3.9.1 Reduce % of adult (15+ years) deaths attributable to PM2.5 air pollution
7.1.2 Increase % population with access to clean fuels and technologies for cooking to 100%
11.6.2 Reduce annual mean levels of fine particulate matter (PM2.5 and PM10) in cities
In this critical year for climate action with COP26, it is vital that the health sector works together with the climate change and clean air movements to put air pollution reduction center-stage of global and national health agendas.
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