OUTDOOR AIR POLLUTION: SOURCES, HEALTH EFFECTS AND SOLUTIONS

Definition Air Pollution

According to the World Health Organization, air pollution is contamination of the indoor
or outdoor environment by any chemical, physical or biological agent that modifies the natural
characteristics of the atmosphere. Household combustion devices, motor vehicles, industrial
facilities and forest fires are common sources of air pollution. Pollutants of major public health
concern include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulfur dioxide.

The AQI is an index for reporting daily air quality. It tells you how clean or polluted your
air is, and what associated health effects might be a concern for you. The AQI focuses on health
effects you may experience within a few hours or days after breathing polluted air. EPA
calculates the AQI for five major air pollutants regulated by the Clean Air Act: ground-level
ozone, particle pollution (also known as particulate matter), carbon monoxide, sulfur dioxide,
and nitrogen dioxide. For each of these pollutants, EPA has established national air quality
standards to protect public health .Ground-level ozone and airborne particles are the two
pollutants that pose the greatest threat to human health in this country.

How Does the AQI Work?

Think of the AQI as a yardstick that runs from 0 to 500. The higher the AQI value, the
greater the level of air pollution and the greater the health concern. For example, an AQI value of
50 represents good air quality with little potential to affect public health, while an AQI value
over 300 represents hazardous air quality.

An AQI value of 100 generally corresponds to the national air quality standard for the
pollutant, which is the level EPA has set to protect public health. AQI values below 100 are
generally thought of as satisfactory. When AQI values are above 100, air quality is considered to
be unhealthy-at first for certain sensitive groups of people, then for everyone as AQI values get
higher.
 Understanding the AQI

The purpose of the AQI is to help you understand what local air quality means to your
health. To make it easier to understand, the AQI is divided into six categories:

Air Quality Index Levels of Health

Colors
(AQI) Values Concern

When the AQI is ..air quality conditions ...as symbolized by

in this range: are: this color:

0 to 50 Good Green

51 to 100 Moderate Yellow

Unhealthy for
101 to 150 Orange
Sensitive Groups

151 to 200 Unhealthy Red

201 to 300 Very Unhealthy Purple

301 to 500 Hazardous Maroon

Note: Values above 500 are considered Beyond the AQI. Follow recommendations for
the Hazardous category. Additional information on reducing exposure to extremely high
levels of particle pollution is available here.
 Each category corresponds to a different level of health concern. The six levels of health
concern and what they mean are:

"Good" AQI is 0 to 50. Air quality is considered satisfactory, and air pollution poses little
or no risk.

"Moderate" AQI is 51 to 100. Air quality is acceptable; however, for some pollutants
there may be a moderate health concern for a very small number of people. For example,
people who are unusually sensitive to ozone may experience respiratory symptoms.

"Unhealthy for Sensitive Groups" AQI is 101 to 150. Although general public is not
likely to be affected at this AQI range, people with lung disease, older adults and children
are at a greater risk from exposure to ozone, whereas persons with heart and lung disease,
older adults and children are at greater risk from the presence of particles in the air.

"Unhealthy" AQI is 151 to 200. Everyone may begin to experience some adverse health
effects, and members of the sensitive groups may experience more serious effects.

"Very Unhealthy" AQI is 201 to 300. This would trigger a health alert signifying that
everyone may experience more serious health effects.

"Hazardous" AQI greater than 300. This would trigger a health warnings of emergency
conditions. The entire population is more likely to be affected.

AQI colors

EPA has assigned a specific color to each AQI category to make it easier for people to
understand quickly whether air pollution is reaching unhealthy levels in their communities. For
example, the color orange means that conditions are "unhealthy for sensitive groups," while red
means that conditions may be "unhealthy for everyone," and so on.

Air Quality Numerical Meaning

Index Levels of Health
 Concern Value

Air quality is considered

Good 0 to 50 satisfactory, and air pollution poses little
or no risk.

Air quality is acceptable; however,

for some pollutants there may be a
Moderate 51 to 100 moderate health concern for a very small
number of people who are unusually
sensitive to air pollution.

Members of sensitive groups may

Unhealthy for
101 to 150 experience health effects. The general
Sensitive Groups
public is not likely to be affected.

Everyone may begin to experience

health effects; members of sensitive
Unhealthy 151 to 200
groups may experience more serious
health effects.

Health alert: everyone may

Very Unhealthy 201 to 300
experience more serious health effects.

Health warnings of emergency

Hazardous 301 to 500 conditions. The entire population is more
likely to be affected.
 Sources of Outdoor Air Pollution

Although there are hundreds of sources of outdoor air pollution, the source categories that
are the largest contributors to most air pollutants in many locations are: vehicle emissions;
stationary power generation; other industrial and agricultural emissions; residential heating and
cooking; re-emission from terrestrial and aquatic surfaces; the manufacturing, distribution, and
use of chemicals; and natural processes (Unger et al., 2010)

Sources of air pollutants can be divided into several types. Sources are commonly
classified into three broad groups:

Primary: A primary source results from the direct emissions from an air pollution
source.
Secondary: A secondary source results from the formation of a pollutant in the
atmosphere from the chemical reaction of precursors emitted from air pollution
sources.
Re-emission sources: A re-emission source results from primary or secondary
pollutants depositing on the Earths terrestrial or aquatic surfaces, followed by re-
emission to the atmosphere.

Not all pollutants fall exclusively into one group, but in many locations, the classification
of a pollutant into these categories can provide insight into exposure gradients. Secondary and
re-emission sources tend to have smaller temporal and spatial concentration gradients than
primary sources, due to the physical processes controlling their emissions. Primary sources can
be further subdivided into:

Point sources: Point sources emissions are from emissions stacks and tend to lead
to very large spatial and temporal gradients in concentration.
 Mobile sources: Mobile sources are associated with transportation and tend to
have large spatial gradients close to roadways but tend to be more homogeneous
away from roadways in urban areas.
Area sources. Area sources are sources with relatively dispersed emissions over
large areas and lead to relatively constant source contributions over space but can
have very large temporal changes in emissions. In addition, fugitive sources,
including VOCs and dust, result from the leakage of gases from storage and
handling facilities and the resuspension of dust, respectively.

Air Pollution: Why Should We Care?

Why should we care? Air pollution harms human health, affects food security, hinders
economic development, contributes to climate change and degrades the environment upon which
our very livelihoods depend. The monetary value placed on the health impact of air pollution
estimates of US $1.6 trillion for the European region of the World Health Organization (WHO)
alone serves to quantify a problem that goes well beyond financial matters. Children are
particularly vulnerable to the devastating impacts of air pollution as their respiratory systems are
still developing. But so are the elderly and frail, and it is increasingly understood that air
pollution spares no one.

Activities in sectors such as transport, waste, energy and agriculture are responsible for
releasing either primary air pollutants or chemical substances reacting with others and forming
secondary pollutants in the atmosphere. While numerous sectors are involved and the impacts
are felt not only locally, but also globally, responses are all too often taken on a narrow sectoral
basis, failing to consider the urgency of addressing air pollution as an international and pressing
problem with multiple and far-reaching impacts.

The exponential rise of urbanized areas is also a significant factor in increased air
pollution. Today the majority of our population lives in cities that on the one hand tend to be
sources of air pollution, but on the other are also where the impacts of air pollution are most felt.
Air pollution knows no political boundaries: emissions from sources in one country can be
transported and deposited in neighbouring countries, sometimes even thousands of kilometers
away. In 2010, for example, experts estimated that only 36 per cent of the concentrations of fine
particulate matter (PM2.5) in Georgia and only 23 per cent of those in Kyrgyzstan came from
national sources. In 1979, realizing the need for a common transboundary response to the
problem, some 30 Governments and the European Community signed the Convention on Long-
range Transboundary Air Pollution (Air Convention) within the framework of the United Nations
Economic Commission for Europe (UNECE).

Air Pollutants

According to the United States Environmental Protection Agency, there are 6 major air
pollutants:

1. Ground level Ozone: Ground level or "bad" ozone is not emitted directly into
the air, but is created by chemical reactions between oxides of nitrogen (NOx) and
volatile organic compounds (VOC) in the presence of sunlight. Emissions from
industrial facilities and electric utilities, motor vehicle exhaust, gasoline vapors,
and chemical solvents are some of the major sources of NOx and VOC.
2. Particulate Matter: PM stands for particulate matter (also called particle
pollution): the term for a mixture of solid particles and liquid droplets found in the
air. Some particles, such as dust, dirt, soot, or smoke, are large or dark enough to
be seen with the naked eye. Others are so small they can only be detected using an
electron microscope. Particle pollution includes:
PM10 : inhalable particles, with diameters that are generally 10
micrometers and smaller; and
PM2.5 : fine inhalable particles, with diameters that are generally 2.5
micrometers and smaller.
3. Carbon Monoxide: CO is a colorless, odorless gas that can be harmful when
inhaled in large amounts. CO is released when something is burned. The greatest
sources of CO to outdoor air are cars, trucks and other vehicles or machinery that
burn fossil fuels.
4. Lead: Sources of lead emissions vary from one area to another. At the national
level, major sources of lead in the air are ore and metals processing and piston-
engine aircraft operating on leaded aviation fuel. Other sources are waste
 incinerators, utilities, and lead-acid battery manufacturers. The highest air
concentrations of lead are usually found near lead smelters. As a result of EPA's
regulatory efforts including the removal of lead from motor vehicle gasoline,
levels of lead in the air decreased by 98 percent between 1980 and 2014.
5. Sulfur Dioxide: The largest source of SO2 in the atmosphere is the burning of
fossil fuels by power plants and other industrial facilities. Smaller sources of
SO2 emissions include: industrial processes such as extracting metal from ore;
natural sources such as volcanoes; and locomotives, ships and other vehicles and

heavy equipment that burn fuel with a high sulfur content.

6. Nitrogen Dioxide: NO2 is one of a group of highly reactive gases known as
oxides of nitrogen or nitrogen oxides (NOx). Other nitrogen oxides include nitrous
acid and nitric acid. NO2 is used as the indicator for the larger group of nitrogen
oxides. NO2 primarily gets in the air from the burning of fuel. NO 2 forms from
emissions from cars, trucks and buses, power plants, and off-road equipment.

Air Pollution and Health

Around the world, every year 7 million people equivalent to the entire population of
Bulgaria die prematurely because of combined indoor and outdoor air pollution (WHO, 2014).
This represents more than the annual combined death rate of the big killer diseases malaria,
tuberculosis and AIDS. The scientific evidence of disturbing links between air pollution and
health continues to build. In accordance with recent WHO estimates, exposure to air pollution is
a more important risk factor for major non-communicable diseases than previously thought. Air
pollution is the largest contributor to the burden of disease from the environment. Air pollution
causes and exacerbates a number of diseases, ranging from asthma to cancer, pulmonary illnesses
and heart disease.

The International Agency for Research on Cancer has classified outdoor air pollution and
particulate matter, one of its major components, as carcinogenic to humans. Individual studies on
the health effects of air pollution for different countries estimate that mortality related to air
pollution is even higher than what WHO finds.
 In France, the calculated number of deaths from ambient PM and ozone pollution in 2010
was over 17 000 (OECD, 2014). In the United Kingdom, in the city of London alone, air
pollution (from PM2.5 and NO2 ) was estimated to cause nearly 9 500 early deaths in 2010
(Walton et al., 2015). In 2010, 94 500 premature deaths in the Russian Federation were caused
by ambient particulate matter pollution (WHO, 2015). In Kazakhstan, the estimated mortality
risk attributable to air pollution in general is 16 000 cases per year (Kenessariyev et al., 2013).
The number of life years lost in South-Eastern Europe, Eastern Europe, the Caucasus and Central
Asia due to outdoor air pollution is 20 per cent higher than in Western Europe (WHO and
OECD, 2015).

The main air pollutants affecting health are nitrogen oxides (NOx), sulphur oxides (SOx),
ozone and particulate matter with the latter especially particulate matter below 2.5 microns
being of greatest concern, as these tiny particles penetrate deep into the lungs, affecting both the
respiratory and vascular systems. Both the extent and duration of the exposure influence health
outcomes. Nearly every single individual in the European region is affected by air pollution with
over 90 per cent of the residents being exposed to annual levels of outdoor fine particulate matter
above WHO air quality guidelines. While the data for Eastern Europe, the Caucasus and Central
Asia are less robust, there is cause for concern. In particular, trends in recent years indicate
increasing emissions from a growing transport sector as a result of economic development and
increasing purchasing power but also because of an ageing car fleet and poor quality fuel (WHO,
2004). Transport-related emissions may amount to more than 80 per cent of the air pollution in
cities in Eastern Europe, Central Asia and the Caucasus (OECD, 2007). In 2005, WHO published
an update of its public health guidelines for different air pollutants, the first version of which was
developed in 1987. To this day in the EU, however, concentrations of particulate matter and
ozone are well above levels recommended by WHO, even though they have dropped in the last
decade.

Ambient (outdoor) air quality and health

Outdoor air pollution is a major environmental health problem affecting everyone in

developed and developing countries alike.
 WHO estimates that in 2012, some 72% of outdoor air pollution-related premature
deaths were due to ischaemic heart disease and strokes, while 14% of deaths were due to
chronic obstructive pulmonary disease or acute lower respiratory infections, and 14% of
deaths were due to lung cancer.

Some deaths may be attributed to more than one risk factor at the same time. For
example, both smoking and ambient air pollution affect lung cancer. Some lung cancer deaths
could have been averted by improving ambient air quality, or by reducing tobacco smoking.

A 2013 assessment by WHOs International Agency for Research on Cancer (IARC)

concluded that outdoor air pollution is carcinogenic to humans, with the particulate matter
component of air pollution most closely associated with increased cancer incidence,
especially cancer of the lung. An association also has been observed between outdoor air
pollution and increase in cancer of the urinary tract/bladder.

Ambient (outdoor air pollution) in both cities and rural areas was estimated to cause 3
million premature deaths worldwide per year in 2012; this mortality is due to exposure to
small particulate matter of 10 microns or less in diameter (PM 10), which cause cardiovascular
and respiratory disease, and cancers.

People living in low- and middle-income countries disproportionately experience the

burden of outdoor air pollution with 87% (of the 3 million premature deaths) occurring in
low- and middle-income countries, and the greatest burden in the WHO Western Pacific and
South-East Asia regions. The latest burden estimates reflect the very significant role air
pollution plays in cardiovascular illness and premature deaths much more so than was
previously understood by scientists.

Most sources of outdoor air pollution are well beyond the control of individuals and
demand action by cities, as well as national and international policymakers in sector like
transport, energy waste management, buildings and agriculture.
 Policies To Reduce Air Pollution

There are many examples of successful policies in transport, urban planning, power
generation and industry that reduce air pollution:

for industry: clean technologies that reduce industrial smokestack emissions;

improved management of urban and agricultural waste, including capture of methane gas
emitted from waste sites as an alternative to incineration (for use as biogas);

for transport: shifting to clean modes of power generation; prioritizing rapid urban
transit, walking and cycling networks in cities as well as rail interurban freight and passenger
travel; shifting to cleaner heavy duty diesel vehicles and low-emissions vehicles and fuels,
including fuels with reduced sulfur content;

for urban planning: improving the energy efficiency of buildings and making cities
more compact, and thus energy efficient;

for power generation: increased use of low-emissions fuels and renewable

combustion-free power sources (like solar, wind or hydropower); co-generation of heat and
power; and distributed energy generation (e.g. mini-grids and rooftop solar power
generation);

for municipal and agricultural waste management: strategies for waste reduction,
waste separation, recycling and reuse or waste reprocessing; as well as improved methods of
biological waste management such as anaerobic waste digestion to produce biogas, are
feasible, low cost alternatives to the open incineration of solid waste. Where incineration is
unavoidable, then combustion technologies with strict emission controls are critical.

In addition to outdoor air pollution, indoor smoke is a serious health risk for some 3
billion people who cook and heat their homes with biomass fuels and coal. Some 4.3 million
premature deaths were attributable to household air pollution in 2012. Almost all of that
burden was in low-middle-income countries as well.
 The 2005 "WHO Air quality guidelines" offer global guidance on thresholds and
limits for key air pollutants that pose health risks. The Guidelines indicate that by reducing
particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre (g/m), we can
cut air pollution-related deaths by around 15%.

Particulate matter

Definition and principal sources

PM affects more people than any other pollutant. The major components of PM are
sulfate, nitrates, ammonia, sodium chloride, black carbon, mineral dust and water. It consists
of a complex mixture of solid and liquid particles of organic and inorganic substances
suspended in the air. The most health-damaging particles are those with a diameter of 10
microns or less, ( PM10), which can penetrate and lodge deep inside the lungs. Chronic
exposure to particles contributes to the risk of developing cardiovascular and respiratory
diseases, as well as of lung cancer.

Air quality measurements are typically reported in terms of daily or annual mean
concentrations of PM10 particles per cubic meter of air volume (m3). Routine air quality
measurements typically describe such PM concentrations in terms of micrograms per cubic
meter (g/m3). When sufficiently sensitive measurement tools are available, concentrations of
fine particles (PM2.5 or smaller), are also reported.

Health effects

There is a close, quantitative relationship between exposure to high concentrations of

small particulates (PM10 and PM2.5) and increased mortality or morbidity, both daily and over
time. Conversely, when concentrations of small and fine particulates are reduced, related
mortality will also go down presuming other factors remain the same. This allows
policymakers to project the population health improvements that could be expected if
particulate air pollution is reduced.
 Small particulate pollution have health impacts even at very low concentrations
indeed no threshold has been identified below which no damage to health is observed.
Therefore, the WHO 2005 guideline limits aimed to achieve the lowest concentrations of PM
possible.

Guideline values

PM2.5
10g/m3 annual-mean
25 g/m3 24-hour mean

PM10
20g/m3 annual-mean
50 g/m3 24-hour mean

In addition to guideline values, the Air Quality Guidelines provide interim targets for
concentrations of PM10 and PM2.5 aimed at promoting a gradual shift from high to lower
concentrations.

If these interim targets were to be achieved, significant reductions in risks for acute
and chronic health effects from air pollution can be expected. Progress towards the guideline
values, however, should be the ultimate objective.

The effects of PM on health occur at levels of exposure currently being experienced

by many people both in urban and rural areas and in developed and developing countries
although exposures in many fast-developing cities today are often far higher than in
developed cities of comparable size.

"WHO Air Quality Guidelines" estimate that reducing annual average particulate
matter (PM10) concentrations from levels of 70 g/m3, common in many developing cities, to
the WHO guideline level of 20 g/m3, could reduce air pollution-related deaths by around
15%. However, even in the European Union, where PM concentrations in many cities do
comply with Guideline levels, it is estimated that average life expectancy is 8.6 months lower
than it would otherwise be, due to PM exposures from human sources.

In developing countries, indoor exposure to pollutants from the household combustion

of solid fuels on open fires or traditional stoves increases the risk of acute lower respiratory
infections and associated mortality among young children; indoor air pollution from solid fuel
use is also a major risk factor for cardiovascular disease, chronic obstructive pulmonary
disease and lung cancer among adults.

There are serious risks to health not only from exposure to PM, but also from
exposure to ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2). As with PM,
concentrations are often highest largely in the urban areas of low- and middle-income
countries. Ozone is a major factor in asthma morbidity and mortality, while nitrogen dioxide
and sulfur dioxide also can play a role in asthma, bronchial symptoms, lung inflammation and
reduced lung function.

Ozone (O3)

Guideline values

O3
100 g/m3 8-hour mean

The recommended limit in the 2005 Air Quality Guidelines was reduced from the
previous level of 120 g/m3 in previous editions of the "WHO Air Quality Guidelines" based
on recent conclusive associations between daily mortality and lower ozone concentrations.

Definition and principal sources

Ozone at ground level not to be confused with the ozone layer in the upper
atmosphere is one of the major constituents of photochemical smog. It is formed by the
reaction with sunlight (photochemical reaction) of pollutants such as nitrogen oxides (NO x)
from vehicle and industry emissions and volatile organic compounds (VOCs) emitted by
 vehicles, solvents and industry. As a result, the highest levels of ozone pollution occur during
periods of sunny weather.

Health effects

Excessive ozone in the air can have a marked effect on human health. It can cause
breathing problems, trigger asthma, reduce lung function and cause lung diseases. In Europe
it is currently one of the air pollutants of most concern. Several European studies have
reported that the daily mortality rises by 0.3% and that for heart diseases by 0.4%, per 10
g/m3 increase in ozone exposure.

Nitrogen dioxide (NO2)

Guideline values

NO2
40g/m3 annual-mean
200 g/m3 1-hour mean

The current WHO guideline value of 40 g/m3 (annual mean) was set to protect the
public from the health effects of gaseous.

Definition and principal sources

As an air pollutant, NO2 has several correlated activities.

At short-term concentrations exceeding 200 g/m3, it is a toxic gas which causes

significant inflammation of the airways.

NO2 is the main source of nitrate aerosols, which form an important fraction of
PM2.5 and, in the presence of ultraviolet light, of ozone.

The major sources of anthropogenic emissions of NO 2 are combustion processes

(heating, power generation, and engines in vehicles and ships).
 Health effects

Epidemiological studies have shown that symptoms of bronchitis in asthmatic children

increase in association with long-term exposure to NO 2. Reduced lung function growth is also
linked to NO2 at concentrations currently measured (or observed) in cities of Europe and
North America.

Sulfur dioxide (SO2)

Guideline values

SO2
20g/m3 24-hour-mean
500 g/m3 10-minute mean

A SO2 concentration of 500 g/m3 should not be exceeded over average periods of 10
minutes duration. Studies indicate that a proportion of people with asthma experience changes
in pulmonary function and respiratory symptoms after periods of exposure to SO 2 as short as
10 minutes.

The (2005) revision of the 24-hour guideline for SO 2 concentrations from 125 to 20
g/m3 was based on the following considerations.

Health effects are now known to be associated with much lower levels of SO 2than
previously believed.

A greater degree of protection is needed.

Although the causality of the effects of low concentrations of SO 2 is still uncertain,

reducing SO2 concentrations is likely to decrease exposure to co-pollutants.
 Definition and principal sources

SO2 is a colourless gas with a sharp odour. It is produced from the burning of fossil
fuels (coal and oil) and the smelting of mineral ores that contain sulfur. The main
anthropogenic source of SO2 is the burning of sulfur-containing fossil fuels for domestic
heating, power generation and motor vehicles.

Health effects

SO2 can affect the respiratory system and the functions of the lungs, and causes
irritation of the eyes. Inflammation of the respiratory tract causes coughing, mucus secretion,
aggravation of asthma and chronic bronchitis and makes people more prone to infections of
the respiratory tract. Hospital admissions for cardiac disease and mortality increase on days
with higher SO2 levels. When SO2 combines with water, it forms sulfuric acid; this is the main
component of acid rain which is a cause of deforestation.

WHO response

WHO Member States recently adopted a resolution and a road map for an enhanced
global response to the adverse health effects of air pollution.

WHO develops and produces "Air quality guidelines" recommending exposure limits
to key air pollutants.

WHO creates detailed health-related assessments of different types of air pollutants,

including particulates and black carbon particles, ozone, etc.

WHO produces evidence regarding the linkage of air pollution to specific diseases,
such as cardiovascular and respiratory diseases and cancers, as well as burden of disease
estimates from existing air pollution exposures, at country, regional, and global levels.

WHOs "Health in the green economy" series is assessing the health co-benefits of
climate mitigation and energy efficient measures that reduce air pollution from housing,
transport, and other key economic sectors.
 WHOs work on "Measuring health gains from sustainable development" has
proposed air pollution indicators as a marker of progress for development goals related to
sustainable development in cities and the energy sector.

WHO assists Member States in sharing information on successful approaches, on

methods of exposure assessment and monitoring of health impacts of pollution.

The WHO co-sponsored "Pan European Programme on Transport Health and

Environment (The PEP)", has built a model of regional, Member State and multi-sectoral
cooperation for mitigation of air pollution and other health impacts in the transport sector, as
well as tools for assessing the health benefits of such mitigation measures.