Air pollution gets ignored in UNGA noncommunicable disease declaration

The U.N. political declaration on noncommunicable diseases, or NCDs, set to be adopted at the 80th session of the United Nations General Assembly later this week, fails to sufficiently factor in air pollution, said experts — despite evidence showing it to be the largest risk factor for premature death and disease globally. NCDs are a key topic of discussion at this year’s UNGA, with heads of state set to meet on Thursday, Sept. 25, to sign a “new, ambitious and achievable Political Declaration.” Reducing premature mortality from NCDs by one-third by 2030 is one of the U.N. Sustainable Development Goals. But progress toward achieving this target is already off track. And experts tell Devex that a lack of decisive action on air pollution threatens to derail it further. “Overall, progress on tackling air pollution has been incredibly disappointing,” said Jane Burston, CEO and founder of Clean Air Fund, a philanthropic foundation tackling global air pollution. “Not enough is being done quickly enough, given the huge health burden.” Air pollution was responsible for 8.1 million deaths globally in 2021, according to a report from Health Effects Institute, making it more deadly than tobacco use. Most glaringly, the political declaration makes no mention of fossil fuels, the leading cause of air pollution — an omission which “is like pledging to tackle smoking without mentioning tobacco,” Burston said. Experts were also disappointed that more concrete targets on committing to implementing national air quality standards, in line with a new road map by the World Health Organization, were not included in the final declaration. At the World Health Assembly earlier this year, heads of state approved a target of halving the mortality rate from human-caused air pollution by 2040. A reiteration of this commitment in the United Nations political declaration “was something we were initially pushing as a target,” said Liz Arnanz Daugan, policy and advocacy manager at NCD Alliance, a civil society network working on NCD prevention. “Unfortunately, that didn't go through,” she said. Air pollution was recognized as a major NCD risk factor at the last high-level meeting on NCDs in 2018. But since then, “the uptake has been quite inadequate nationally,” said Arnanz Daugan. A commitment to set targets in line with WHO’s new road map on air quality standards would also help to ensure international accountability, Burston said. Without countries reporting progress within a U.N. system, “it’s going to be very hard to track whether we’re meeting these new WHO targets,” she said. Health impacts Globally, 99% of people are exposed to unsafe levels of air pollution, according to WHO air quality guidelines. In cities such as Delhi, India, pollution levels can reach 30 to 35 times the safe limit during the winter months of October to January, when dropping temperatures combine with crop stubble burning season and industrial pollution to form a toxic smog. India is also witnessing a surge in NCDs: 62% of deaths in the country were NCD-caused in 2016, compared to 38% in 1990. Dr. Arvind Kumar, a chest surgeon working in Delhi, said he has seen “a sea change in the color of lungs of people here” since he started working over three decades ago, which he attributes to growing exposure to air pollution. Whereas previously, most lung cancer patients were elderly tobacco users, now “the differentiation between smokers and nonsmokers has almost vanished, and I see black, black deposits on the lungs of people, whether they are smokers or not,” he said. Most worryingly, he said, these black deposits can be found on the lungs of children as young as 7 years old. But the impact of air pollution on human health goes beyond just the lungs, with a growing body of evidence pointing toward a huge variety of health harms. One study in the U.K. found that the risk of suffering from a stroke was 7% higher in the areas with the worst levels of pollution, while heart failure risk increased by 27%. Other research has found links between air pollution and adverse pregnancy outcomes, diabetes, and dementia. “From head to toe, there is no organ which escapes the ill effect of air pollution,” Kumar said. “The lung takes the worst hit, but thereafter, all other organs get affected.” Data gaps With the evidence on the health impacts of air pollution still emerging, the estimated burden of disease “is very likely to be an underestimate,” Arnanz Daugan said. Kumar argued that even the data already available is sufficient to push for action. “Is it scary enough and dangerous enough to make us act immediately? The answer is a clear yes,” he said. But better data could help to target cost-effective interventions and hold governments accountable. Over one-third of countries globally have no data at all on air pollution levels. Air pollution monitoring would help countries to assess progress toward targets and help civil society organizations to hold policymakers to account, Burston said. But they are also “important for understanding what the sources [of pollution] are in what proportion, so that you can tackle the right thing and so that you can prioritize action,” she said. Better data on the health benefits of reductions in air pollution levels could also help to incentivize action, Arnanz Daugan said. During the 2008 Beijing Olympics, for example, China took drastic steps to combat air pollution, resulting in babies born on average 23 grams heavier compared to the years before and after, a study published in the journal Environmental Health Perspectives found. “There is this understanding that usually air pollution interventions take way too long to have a return on investment,” Arnanz Daugan said. “There is a growing body of evidence where it shows that actually, short-term health benefits can already be recorded within one year of intervention.” The economic case However, evidence on this sort of return to investment is lacking. At the World Health Assembly in 2019, WHO was mandated to “prepare a menu of policy options and cost-effective interventions” to guide member states on reducing the number of deaths attributable to air pollution. In the lead-up to this week’s high-level meeting, WHO released a list of “Best Buys” for NCDs — the most cost-effective solutions that countries could implement to tackle NCDs. But the list failed to include interventions to address air pollution. “There is a mandate that hasn’t been followed up,” Arnanz Daugan said. “Given the public health emergency that air pollution is, it is a missed opportunity that we should see WHO working on moving forward.” In response to a request for comment, WHO said that “work is ongoing to provide the evidence and tools to support countries select the 'best buy' air pollution interventions in key sectors for their local context.” In the absence of evidence on the cost-effectiveness of addressing air pollution, finance ministries often fail to deliver the necessary budgets, perceiving action on air pollution as a cost rather than an investment, Burston said. Initiatives to reduce air pollution received less than 1% of international development funding from 2018 to 2022, according to a report from Clean Air Fund. There needs to be “an increase in the recognition that clean air is an economic asset, and that these investments will actually save many more millions than they will cost,” she said. The World Bank estimates that the global cost of air pollution from decreased labor productivity, health care costs, and premature death is $6 trillion per year, or 5% of global gross domestic product. “There are massive productivity harms. But those facts are not well known,” Burston said. Given the absence of a WHO list of “Best Buys” for air pollution, the U.N. political declaration was an opportunity to step in to provide concrete targets for countries seeking to tackle air pollution, Arnanz Daugan said. “We saw the process of this year’s high-level meeting on NCDs and mental health as a key opportunity to recreate commitment on air pollution and be more specific on what can be done,” she said. While the declaration falls short on some fronts, it “does bring specific commitments,” she said, such as calling for safe and accessible public transport options and promoting access to less polluting solutions for cooking and electricity generation. Burston said that the fact that air pollution is being discussed at UNGA at all is a “reason for hope.” “It has been baffling to us why air pollution has had so little visibility on the international stage, given how large a percentage of deaths it causes every year,” she said. “This is a glimmer of high-level attention to the issue, and [a reminder that] we just need to keep on the case.”