WHO air quality database: relevance, history and future developments

Air pollution is the second most important risk factor for noncommunicable diseases, but air quality monitoring is lacking in many low- and middle-income countries. The World Health Organization (WHO) recently released its 2022 updated air quality database status report. This report contains data from about 6743 human settlements, a sixfold increase from 1102 settlements in its first publication in 2011, which shows that air pollution is increasingly recognized as a health priority at global and national levels. However, progress varies across the world. More than 90% of the settlements in the database are in high- and middle-income countries and areas mainly in China, Europe, India and North America. The database is crucial for increasing awareness of air pollution, and for calculating global exposures and the corresponding burden of disease attributable to air pollution. This article describes the progress made and challenges in collecting air quality data. The database uses official data sources which can be difficult to access and assess, because air quality monitoring is done by different government bodies or uses varying monitoring methods. These air quality data can be used by the health sector to engage in discussions on monitoring air quality to protect public health, and facilitate multisectoral engagement of United Nations agencies to support countries to conform with the 2021 WHO air quality guidelines. Although air pollution levels in most countries are higher than those recommended in the guidelines, any action policy-makers take to reduce air pollution will help reduce the burden of air pollution on health.

Assessing capabilities of conducted ambient air pollution health effects studies in 22 Eastern Mediterranean countries to adopt air quality standards: a review

Purpose

The Eastern Mediterranean Region (EMR) countries suffer from exposure to high levels of ambient air pollutants due to dust storms and have unique climatic as well as topographic and socio-economic conditions which lead to adverse health effects on humans. The purpose of the review was to evaluate the quantity and quality of published articles on air pollution and health-based studies in 22 EMR countries to determine if they can be applied to adopting air quality standards.

Methods

We designed a review based on a broad search of the literature in the Scopus, PubMed, and web of science (WOS) databases published from January 1, 2000, to January 2, 2022, using combinations of the following relevant terms: air pollution, health, and EMR countries. The generic eligibility criteria for this review were based on the population, exposure, comparator, outcome, and study design (PECOS) statement.

Results

The search results showed that following the PRISMA approach, of 2947 identified articles, 353 studies were included in this review. The analysis of the types of studies showed that about 70% of the studies conducted in EMR countries were Health Burden Estimation studies (31%), Ecological and time trend ecological studies (23%), and cross-sectional studies (16%). Also, researchers from Iran participated in the most published relevant studies in the region 255 (~ 63%) and just 10 published documents met all the PECOS criteria.

Conclusion

The lack of sufficient studies which can meet the PECOS appraising criteria and the lack of professionals in this field are some of the issues that make it impossible to use as potential documents in the WHO future studies and adopt air quality standards.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-023-00862-1.

Ambient Air Quality Standards and Policies in Eastern Mediterranean Countries: A Review

Objectives: National ambient air quality standards (NAAQS) are critical tools for controlling air pollution and protecting public health. We designed this study to 1) gather the NAAQS for six classical air pollutants: PM_2.5, PM₁₀, O₃, NO₂, SO₂, and CO in the Eastern Mediterranean Region (EMR) countries, 2) compare those with the updated World Health Organizations Air Quality Guidelines (WHO AQGs 2021), 3) estimate the potential health benefits of achieving annual PM_2.5 NAAQS and WHO AQGs per country, and 4) gather the information on air quality policies and action plans in the EMR countries. Methods: To gather information on the NAAQS, we searched several bibliographic databases, hand-searched the relevant papers and reports, and analysed unpublished data on NAAQS in the EMR countries reported from these countries to the WHO/Regional office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE). To estimate the potential health benefits of reaching the NAAQS and AQG levels for PM_2.5, we used the average of ambient PM_2.5 exposures in the 22 EMR countries in 2019 from the Global Burden of Disease (GBD) dataset and AirQ+ software. Results: Almost all of the EMR countries have national ambient air quality standards for the critical air pollutants except Djibouti, Somalia, and Yemen. However, the current standards for PM_2.5 are up to 10 times higher than the current health-based WHO AQGs. The standards for other considered pollutants exceed AQGs as well. We estimated that the reduction of annual mean PM_2.5 exposure level to the AQG level (5 μg m^-3) would be associated with a decrease of all natural-cause mortality in adults (age 30+) by 16.9%-42.1% in various EMR countries. All countries would even benefit from the achievement of the Interim Target-2 (25 μg m^-3) for annual mean PM_2.5: it would reduce all-cause mortality by 3%-37.5%. Less than half of the countries in the Region reported having policies relevant to air quality management, in particular addressing pollution related to sand and desert storms (SDS) such as enhancing the implementation of sustainable land management practices, taking measures to prevent and control the main factors of SDS, and developing early warning systems as tools to combat SDS. Few countries conduct studies on the health effects of air pollution or on a contribution of SDS to pollution levels. Information from air quality monitoring is available for 13 out of the 22 EMR countries. Conclusion: Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs and enhanced air quality monitoring are essential elements for reduction of air pollution and its health effects in the EMR.

Communicating the Risks of Air Pollution to the Public: A Perspective from Jordan and Lebanon

BACKGROUND

Communicating air pollution to the public is essential in reducing exposure to air pollutants through increasing awareness and promoting precautionary actions. However, one way to approach the public is through healthcare professionals who are considered public health leaders and could influence the public's opinion. The current study aimed to investigate the perception of health experts about communicating air pollution to the public.

METHODS

Personal interviews of 32 health professionals were conducted to report their opinions about communication of air pollution through an open-ended questionnaire. Interview questions were focused on 5 themes: common air pollutants and health risks, goals and barriers of communication, types of information to disseminate, target groups, and vehicles of communication.

RESULTS

Interviewees agreed that air pollution should be communicated to the public. Major barriers to achieving effective communication were people's poor comprehension and lack of interest of policymakers. The levels of pollution, associated health risks, and ways to protect one's self were the most frequently reported types of information to distribute. Most interviewees focused on patients with pre-existing conditions and children as the main target groups. Further, social media and text messages were preferred as vehicles of communication.

CONCLUSION

Although not all interviewees had a clear idea of how to develop and implement a communication system, most of them agreed on its importance in protecting the public. More emphasis on this topic and further investigations are expected to increase the interest of health care professionals in communicating the risks of air pollution and advocating for public health policies regarding air pollution.

Source apportionment, identification and characterization, and emission inventory of ambient particulate matter in 22 Eastern Mediterranean Region countries: A systematic review and recommendations for good practice

Little is known about the main sources of ambient particulate matter (PM) in the 22 Eastern Mediterranean Region (EMR) countries. We designed this study to systematically review all published and unpublished source apportionment (SA), identification and characterization studies as well as emission inventories in the EMR. Of 440 articles identified, 82 (11 emission inventory ones) met our inclusion criteria for final analyses. Of 22 EMR countries, Iran with 30 articles had the highest number of studies on source specific PM followed by Pakistan (n = 15 articles) and Saudi Arabia (n = 8 papers). By contrast, there were no studies in Afghanistan, Bahrain, Djibouti, Libya, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. Approximately 72% of studies (51) were published within a span of 2015-2021.48 studies identified the sources of PM_2.5 and its constituents. Positive matrix factorization (PMF), principal component analysis (PCA) and chemical mass balance (CMB) were the most common approaches to identify the source contributions of ambient PM. Both secondary aerosols and dust, with 12-51% and 8-80% (33% and 30% for all EMR countries, on average) had the greatest contributions in ambient PM_2.5. The remaining sources for ambient PM_2.5, including mixed sources (traffic, industry and residential (TIR)), traffic, industries, biomass burning, and sea salt were in the range of approximately 4-69%, 4-49%, 1-53%, 7-25% and 3-29%, respectively. For PM₁₀, the most dominant source was dust with 7-95% (49% for all EMR countries, on average). The limited number of SA studies in the EMR countries (one study per approximately 9.6 million people) in comparison to Europe and North America (1 study per 4.3 and 2.1 million people respectively) can be augmented by future studies that will provide a better understanding of emission sources in the urban environment.

"Our planet, our health": saving lives, promoting health and attaining well-being by protecting the planet - the Eastern Mediterranean perspectives

Cognizant that every human has the right to the highest attainable standard of health, the World Health Organization (WHO) is promoting the health and well-being of all by all. To achieve this mission in the Eastern Mediterranean Region (EMR), a strategic vision was adopted calling on Member States and partners to anchor solidarity and action to achieve Health for All by All in the Region. The vision focuses on the need to address the environmental causes of diseases while targeting the Sustainable Development Goals (SDGs), and fulfilling the human rights to live in a healthy environment.

"Our planet, our health": saving lives, promoting health and attaining well-being by protecting the planet - the Eastern Mediterranean perspectives

Cognizant that every human has the right to the highest attainable standard of health, the World Health Organization (WHO) is promoting the health and well-being of all by all. To achieve this mission in the Eastern Mediterranean Region (EMR), a strategic vision was adopted calling on Member States and partners to anchor solidarity and action to achieve Health for All by All in the Region. The vision focuses on the need to address the environmental causes of diseases while targeting the Sustainable Development Goals (SDGs), and fulfilling the human rights to live in a healthy environment.

Air quality and health impacts in the Eastern Mediterranean Region: an eye on COVID-19

Air quality is intimately linked to human activities, climate, atmosphere and ecosystems. Many of the anthropogenic contributors to air pollution are also sources of greenhouse gases including CO2 and other short-lived climate pollutants, such as Ozone and black carbon, which greatly contribute to the climate change phenomenon and its adverse effects on human health. Unfortunately, fragile and dry ecosystems prevailing in most of our countries in the Eastern Mediterranean Region may be implicated for exacerbation of this air pollution and climate change dilemma even more severely.

Challenges in Environmental Health Research and Sustainability in a Less Developed Country: a Case Study From Jordan

PURPOSE OF REVIEW

Environmental health research covers many aspects of the complex natural world and how environmental hazards, mainly caused by human activities, can affect population health. Researchers in this field have investigated environmental risks dose or exposure-response relationship, challenged hypotheses and interpreted data and results to solve problems. Researchers investigating environmental issues support the concept of environmental justice (EJ) and understand that they bear more responsibilities because they work to influence the policymakers' decisions in order to minimise hazardous exposure on populations. The environmental justice term has been widely used to describe unequal exposure of anthropogenic pollution or environmentally hazardous exposure to a group of people based on race, colour, national origin or income. The term has been defined and disseminated in many countries through governmental and non-governmental organisations. In Jordan, the government has carried the responsibilities to reduce the disproportionate exposure to environmental pollution between citizens and to promote the concepts of EJ. This review has highlighted the role of non-governmental organisations and the laws and regulations that prohibit assault to the environment and ensure the compliance of private and public organisations to minimise the effect of the undesirable environmental actions. Moreover, it addressed and discussed different possible sources of pollution and areas of heavy hazards exposure.

RECENT FINDINGS

In this review, we highlighted the main causes of lack of research on the EJ in Jordan and the effect of income and ethnicity background. We also recommended applying the responsible conduct of research principles and guidelines to commence researches that can affect policymakers in this field in Jordan.

The environmental health nexuses within the Strategic Roadmap: regional work priorities for the WHO Eastern Mediterranean Region (Editorial)

The Eastern Mediterranean Region (EMR) is a diverse region in terms of income, development, health and environmental conditions. The environment and ecosystems are under serious pressures with adverse impacts on human health and well-being. Environmental Health (EH) is an area of growing importance for EMR, and environmental risk factors such as air, water and soil pollution, chemical exposures, climate change and radiation, contribute to more than 100 diseases and injuries, and environmental hazards are responsible for about 22% of the total burden of disease in the Region.

Long-term trends and health impact of PM2.5 and O3 in Tehran, Iran, 2006-2015

The main objectives of this study were (1) investigation of the temporal variations of ambient fine particulate matter (PM_2.5) and ground level ozone (O₃) concentrations in Tehran megacity, the capital and most populous city in Iran, over a 10-year period from 2006 to 2015, and (2) estimation of their long-term health effects including all-cause and cause-specific mortality. For the first goal, the data of PM_2.5 and O₃ concentrations, measured at 21 regulatory monitoring network stations in Tehran, were obtained and the temporal trends were investigated. The health impact assessment of PM_2.5 and O₃ was performed using the World Health Organization (WHO) AirQ+ software updated in 2016 by WHO European Centre for Environment and Health. Local baseline incidences in Tehran level were used to better reveal the health effects associated with PM_2.5 and O₃. Our study showed that over 2006-2015, annual mean concentrations of PM_2.5 and O₃ varied from 24.7 to 38.8 μg m^-3 and 35.4 to 76.0 μg m^-3, respectively, and were significantly declining in the recent 6 years (2010-2015) for PM_2.5 and 8 years (2008-2015) for O₃. However, Tehran citizens were exposed to concentrations of annual PM_2.5 exceeding the WHO air quality guideline (WHO AQG) (10 μg m^-3), U.S. EPA and Iranian standard levels (12 μg m^-3) during entire study period. We estimated that long-term exposure to ambient PM_2.5 contributed to between 24.5% and 36.2% of mortality from cerebrovascular disease (stroke), 19.8% and 24.1% from ischemic heart disease (IHD), 13.6% and 19.2% from lung cancer (LC), 10.7% and 15.3% from chronic obstructive pulmonary disease (COPD), 15.0% and 25.2% from acute lower respiratory infection (ALRI), and 7.6% and 11.3% from all-cause annual mortality in the time period. We further estimated that deaths from IHD accounted for most of mortality attributable to long-term exposure to PM_2.5. The years of life lost (YLL) attributable to PM_2.5 was estimated to vary from 67,970 to 106,706 during the study period. In addition, long-term exposure to O₃ was estimated to be responsible for 0.9% to 2.3% of mortality from respiratory diseases. Overall, long-term exposure to ambient PM_2.5 and O₃ contributed substantially to mortality in Tehran megacity. Air pollution is a modifiable risk factor. Appropriate sustainable control policies are recommended to protect public health.

Respiratory health outcomes and air pollution in the Eastern Mediterranean Region: a systematic review

Exposure to air pollution can cause detrimental health and be an economic burden. With newly developed equipment, monitoring of different air pollutants, identifying the sources, types of air pollutants and their corresponding concentrations, and applying mitigation intervention techniques became a crucial step in public health protection. Countries in the Eastern Mediterranean Region (EMR) are highly exposed to dust storms, have high levels of particulate matter (PM) concentrations, and have a unique climatic as well as topographic and socio-economic structure. This is the first study conducted to systemically and qualitatively assess the health impacts of air pollution in the EMR, identify susceptible populations, and ascertain research and knowledge gaps in the literature to better inform decisions by policy makers. We screened relevant papers and reports published between 2000 and 2014 in research databases. A total of 36 published studies met the inclusion criteria. A variety of indoor and outdoor exposures associated with various acute and chronic respiratory health outcomes were included. Respiratory health outcomes ranged in severity, from allergies and general respiratory complaints to lung cancer and mortality. Several adverse health outcomes were positively associated with various indoor/outdoor air pollutants throughout the EMR. However, epidemiological literature concerning the EMR is limited to a few studies in a few countries. More research is needed to elucidate the health outcomes of air pollution. Standardized reliable assessments on the national level for various air pollutants in different regions should be implemented and made publically available for researchers to utilize in their research. Moreover, advancing and utilizing more sound epidemiological designs and studies on the effect of air pollution on the respiratory health outcomes is needed to portray the actual situation in the region.