Costs and Benefits of Household Fuel Policies and Alternative Strategies in the Jing-Jin-Ji Region

Air pollution is still one of the most severe problems in northern China, especially in the Jing-Jin-Ji region around Beijing. In recent years, China has implemented many stringent policies to address the air quality issue, including promoting energy transition toward cleaner fuels in residential sectors. But until 2020, even in the Jing-Jin-Ji region, nearly half of the rural households still use solid fuels for heating. For residents who are not covered by the clean heating campaign, we analyze five potential mitigation strategies and evaluate their environmental effects as well as the associated health benefits and costs. We estimate that substitution with electricity or gas would reduce air pollution and premature mortality more strongly, while the relatively low investment costs of implementing clean coal or biomass pellet lead to a larger benefit-cost ratio, indicating higher cost efficiency. Hence, clean coal or biomass pellet could be transitional substitution options for the less developed or remote areas which cannot afford a total transition toward electricity or natural gas in the short term.

Clean air in Europe for all! Taking stock of the proposed revision to the ambient air quality directives: a joint ERS, HEI and ISEE workshop report

Ambient air pollution is a major public health concern and comprehensive new legislation is currently being considered to improve air quality in Europe. The European Respiratory Society (ERS), Health Effects Institute (HEI), and International Society for Environmental Epidemiology (ISEE) organised a joint meeting on May 24, 2023 in Brussels, Belgium, to review and critically evaluate the latest evidence on the health effects of air pollution and discuss ongoing revisions of the European Ambient Air Quality Directives (AAQDs). A multi-disciplinary expert group of air pollution and health researchers, patient and medical societies, and policy representatives participated. This report summarises key discussions at the meeting.

New concentration-response functions for seven morbidity endpoints associated with short-term PM2.5 exposure and their implications for health impact assessment

BACKGROUND

Morbidity burdens from ambient air pollution are associated with market and non-market costs and are therefore important for policymaking. The estimation of morbidity burdens is based on concentration-response functions (CRFs). Most existing CRFs for short-term exposures to PM2.5 assume a fixed risk estimate as a log-linear function over an extrapolated exposure range, based on evidence primarily from Europe and North America.

OBJECTIVES

We revisit these CRFs by performing a systematic review for seven morbidity endpoints previously assessed by the World Health Organization, including data from all available regions. These endpoints include all cardiovascular hospital admission, all respiratory hospital admission, asthma hospital admission and emergency room visit, along with the outcomes that stem from morbidity, such as lost work days, respiratory restricted activity days, and child bronchitis symptom days.

METHODS

We estimate CRFs for each endpoint, using both a log-linear model and a nonlinear model that includes additional parameters to better fit evidence from high-exposure regions. We quantify uncertainties associated with these CRFs through randomization and Monte Carlo simulations.

RESULTS

The CRFs in this study show reduced model uncertainty compared with previous CRFs in all endpoints. The nonlinear CRFs produce more than doubled global estimates on average, depending on the endpoint. Overall, we assess that our CRFs can be used to provide policy analysis of air pollution impacts at the global scale. It is however important to note that improvement of CRFs requires observations over a wide range of conditions, and current available literature is still limited.

DISCUSSION

The higher estimates produced by the nonlinear CRFs indicates the possibility of a large underestimation in current assessments of the morbidity impacts attributable to air pollution. Further studies should be pursued to better constrain the CRFs studied here, and to better characterize the causal relationship between exposures to PM2.5 and morbidity outcomes.

Urban-rural disparity in global estimation of PM2·5 household air pollution and its attributable health burden

BACKGROUND

Polluting fuels and inefficient stove technologies are still a leading cause of premature deaths worldwide, particularly in low-income and middle-income countries. Previous studies of global household air pollution (HAP) have neither considered the estimation of PM2·5 at national level nor the corresponding attributable mortality burden. Additionally, the effects of climate and ambient air pollution on the global estimation of HAP-PM2·5 exposure for different urban and rural settings remain largely unknown. In this study, we include climatic effects to estimate the HAP-PM2·5 exposure from different fuel types and stove technologies in rural and urban settings separately and the related attributable global mortality burden.

METHODS

Bayesian hierarchical models were developed to estimate an annual average HAP-PM2·5 personal exposure and HAP-PM2·5 indoor concentration (including both outdoor and indoor sources). Model variables were selected from sample data in 282 peer-reviewed studies drawn and updated from the WHO Global HAP dataset. The PM2·5 exposure coefficients from the developed model were applied to the external datasets to predict the HAP-PM2·5 exposure globally (personal exposure in 62 countries and indoor concentration in 69 countries). Attributable mortality rate was estimated using a comparative risk assessment approach. Using weighted averages, the national level 24 h average HAP-PM2·5 exposure due to polluting and clean fuels and related death rate per 100 000 population were estimated.

FINDINGS

In 2020, household use of polluting solid fuels for cooking and heating led to a national-level average personal exposure of 151 μg/m3 (95% CI 133-169), with rural households having an average of 171 μg/m3 (153-189) and urban households an average of 92 μg/m3 (77-106). Use of clean fuels gave rise to a national-level average personal exposure of 69 μg/m3 (62-76), with a rural average of 76 μg/m3 (69-83) and an urban average of 49 μg/m3 (46-53). Personal exposure-attributable premature mortality (per 100 000 population) from the use of polluting solid fuels at national level was on average 78 (95% CI 69-87), with a rural average of 82 (73-90) and an urban average of 66 (57-75). The average attributable premature mortality (per 100 000 population) from the use of clean fuels at the national level is 62 (54-70), with a rural average of 66 (58-74) and an urban average of 52 (47-57). The estimated HAP-PM2·5 indoor concentration shows that the use of polluting solid fuels resulted in a national-level average of 412 μg/m3 (95% CI 353-471), with a rural average of 514 μg/m3 (446-582) and an urban average of 149 μg/m3 (126-173). The use of clean fuels (gas and electricity) led to an average PM2·5 indoor concentration of 135 μg/m3 (117-153), with a rural average of 174 μg/m3 (154-195) and an urban average of 71 μg/m3 (63-80). Using time-weighted HAP-PM2·5 indoor concentrations, the attributable premature death rate (per 100 000 population) from the use of polluting solid fuels at the national level is on average 78 (95% CI 72-84), the rural average being 84 (78-91) and the urban average 60 (54-66). From the use of clean fuels, the average attributable premature death rate (per 100 000 population) at the national level is 59 (53-64), the rural average being 68 (62-74) and the urban average 45 (41-50).

INTERPRETATION

A shift from polluting to clean fuels can reduce the average PM2·5 personal exposure by 53% and thereby lower the death rate. For all fuel types, the estimated average HAP-PM2·5 personal exposure and indoor concentrations exceed the WHO's Interim Target-1 average annual threshold. Policy interventions are urgently needed to greatly increase the use of clean fuels and stove technologies by 2030 to achieve the goal of affordable clean energy access, as set by the UN in 2015, and address health inequities in urban-rural settings.

FUNDING

Wellcome Trust, The Lancet Countdown, the Engineering and Physical Sciences Research Council, and the Natural Environment Research Council.

Analysis of the air pollution reduction and climate change mitigation effects of the Three-Year Action Plan for Blue Skies on the "2+26" Cities in China

City clusters play an important role in air pollutant and greenhouse gas (GHG) emissions reduction in China, primarily due to their high fossil energy consumption levels. The "2 + 26" Cities, i.e., Beijing, Tianjin and 26 other perfectures in northern China, has experienced serious air pollution in recent years. We employ the Greenhouse Gas and Air Pollution Interactions and Synergies model adapted to the "2 + 26" Cities (GAINS-JJJ) to evaluate the impacts of structural adjustments in four major sectors, industry, energy, transport and land use, under the Three-Year Action Plan for Blue Skies (Three-Year Action Plan) on the emissions of both the major air pollutants and CO₂ in the "2 + 26" Cities. The results indicate that the Three-Year Action Plan applied in the "2 + 26" Cities reduces the total emissions of primary fine particulate matter with an aerodynamic diameter of ≤ 2.5 μm (PM_2.5), SO₂, NO_x, NH₃ and CO₂ by 17%, 25%, 21%, 3% and 1%, respectively, from 2017 to 2020. The emission reduction potentials vary widely across the 28 prefectures, which may be attributed to the differences in energy structure, industrial composition, and policy enforcement rate. Among the four sectors, adjustment of industrial structure attains the highest co-benefits of CO₂ reduction and air pollution control due to its high CO₂ reduction potential, while structural adjustments in energy and transport attain much lower co-benefits, despite their relatively high air pollutant emissions reductions, primarily resulting from an increase in the coal-electric load and associated carbon emissions caused by electric reform policies..

The CUSSH programme: supporting cities' transformational change towards health and sustainability

This paper describes a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods the Complex Urban Systems for Sustainability and Health (CUSSH) project will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st Century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.

Potential for future reductions of global GHG and air pollutants from circular waste management systems

The rapidly rising generation of municipal solid waste jeopardizes the environment and contributes to climate heating. Based on the Shared Socioeconomic Pathways, we here develop a global systematic approach for evaluating the potentials to reduce emissions of greenhouse gases and air pollutants from the implementation of circular municipal waste management systems. We contrast two sets of global scenarios until 2050, namely baseline and mitigation scenarios, and show that mitigation strategies in the sustainability-oriented scenario yields earlier, and major, co-benefits compared to scenarios in which inequalities are reduced but that are focused solely on technical solutions. The sustainability-oriented scenario leaves 386 Tg CO2eq/yr of GHG (CH4 and CO2) to be released while air pollutants from open burning can be eliminated, indicating that this source of ambient air pollution can be entirely eradicated before 2050.

A system dynamics-based scenario analysis of residential solid waste management in Kisumu, Kenya

The problem of solid waste management presents an issue of increasing importance in many low-income settings, including the progressively urbanised context of Kenya. Kisumu County is one such setting with an estimated 500 t of waste generated per day and with less than half of it regularly collected. The open burning and natural decay of solid waste is an important source of greenhouse gas (GHG) emissions and atmospheric pollutants with adverse health consequences. In this paper, we use system dynamics modelling to investigate the expected impact on GHG and PM_2.5 emissions of (i) a waste-to-biogas initiative and (ii) a regulatory ban on the open burning of waste in landfill. We use life tables to estimate the impact on mortality of the reduction in PM_2.5 exposure. Our results indicate that combining these two interventions can generate over 1.1 million tonnes of cumulative savings in GHG emissions by 2035, of which the largest contribution (42%) results from the biogas produced replacing unclean fuels in household cooking. Combining the two interventions is expected to reduce PM_2.5 emissions from the waste and residential sectors by over 30% compared to our baseline scenario by 2035, resulting in at least around 1150 cumulative life years saved over 2021–2035. The contribution and novelty of this study lies in the quantification of a potential waste-to-biogas scenario and its environmental and health impact in Kisumu for the first time.

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We present a system dynamics study of solid waste management in Kisumu, Kenya.

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Scenarios involve a waste-to-biogas initiative and a ban on open burning in landfill.

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Combined scenario generates 1.1m tonnes cumulative GHG savings by 2035.

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Largest contribution (42%) is from biogas substituting traditional cooking fuels.

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Combined scenario may save 1,150 cumulative life years by 2035, plus ~220 more p.a.

The CUSSH programme: learning how to support cities’ transformational change towards health and sustainability

The Complex Urban Systems for Sustainability and Health (CUSSH) project is a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods it will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.

The public health implications of the Paris Agreement: a modelling study

BACKGROUND

nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying "well below 2°C", which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence.

METHODS

Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario).

FINDINGS

Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity.

INTERPRETATION

A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the "well below 2°C" commitment across a range of regional and economic contexts.

FUNDING

This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1).

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises

For the Chinese, French, German, and Spanish translations of the abstract see Supplementary Materials section.

Reducing global air pollution: the scope for further policy interventions

Over the last decades, energy and pollution control policies combined with structural changes in the economy decoupled emission trends from economic growth, increasingly also in the developing world. It is found that effective implementation of the presently decided national pollution control regulations should allow further economic growth without major deterioration of ambient air quality, but will not be enough to reduce pollution levels in many world regions. A combination of ambitious policies focusing on pollution controls, energy and climate, agricultural production systems and addressing human consumption habits could drastically improve air quality throughout the world. By 2040, mean population exposure to PM2.5 from anthropogenic sources could be reduced by about 75% relative to 2015 and brought well below the WHO guideline in large areas of the world. While the implementation of the proposed technical measures is likely to be technically feasible in the future, the transformative changes of current practices will require strong political will, supported by a full appreciation of the multiple benefits. Improved air quality would avoid a large share of the current 3-9 million cases of premature deaths annually. At the same time, the measures that deliver clean air would also significantly reduce emissions of greenhouse gases and contribute to multiple UN sustainable development goals. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Mitigation pathways towards national ambient air quality standards in India

Exposure to ambient particulate matter is a leading risk factor for environmental public health in India. While Indian authorities implemented several measures to reduce emissions from the power, industry and transportation sectors over the last years, such strategies appear to be insufficient to reduce the ambient fine particulate matter (PM_2.5) concentration below the Indian National Ambient Air Quality Standard (NAAQS) of 40 μg/m³ across the country. This study explores pathways towards achieving the NAAQS in India in the context of the dynamics of social and economic development. In addition, to inform action at the subnational levels in India, we estimate the exposure to ambient air pollution in the current legislations and alternative policy scenarios based on simulations with the GAINS integrated assessment model. The analysis reveals that in many of the Indian States emission sources that are outside of their immediate jurisdictions make the dominating contributions to (population-weighted) ambient pollution levels of PM_2.5. Consequently, most of the States cannot achieve significant improvements in their air quality and population exposure on their own without emission reductions in the surrounding regions, and any cost-effective strategy requires regionally coordinated approaches. Advanced technical emission control measures could provide NAAQS-compliant air quality for 60% of the Indian population. However, if combined with national sustainable development strategies, an additional 25% population will be provided with clean air, which appears to be a significant co-benefit on air quality (totaling 85%).

Air Quality Improvement Co-benefits of Low-Carbon Pathways toward Well Below the 2 °C Climate Target in China

This research links the Integrated MARKAL-EFOM system model of China (China TIMES) and the Greenhouse Gas and Air Pollution Interactions and Synergies model (GAINS) to assess the co-benefits of air quality improvement under the Nationally Determined Contribution (NDC) and the well below 2 °C (WBD2) target. Results show that the industry sector and power sector are the key sources necessary to reduce air pollutant emissions, mainly due to the phasing out of fossil fuels. The electrification in the building sector will be another main source by which to decrease PM_2.5 emissions. The adoption of various low-carbon constraints and further air pollutant control strategies will significantly alleviate the current air pollution problems in China by reducing the concentration and scope of the air pollutants and reducing the corresponding number of premature deaths. A stricter air pollutant control strategy will lead to increases in air pollutant control costs; however, the low-carbon targets will help reduce these costs in the long run. Compared to the current national policy, within the same air pollutant control strategy, the reduction of air pollutant control cost can cover the incremental CO₂ mitigation cost under the NDC target, while this cannot be realized under the WBD2 target.

Mitigation pathways of air pollution from residential emissions in the Beijing-Tianjin-Hebei region in China

Air pollution is one of the most harmful consequences of China's rapid economic development and urbanization. Particularly in the Beijing-Tianjin-Hebei (BTH) regions, particulate matter concentrations have consistently exceeded the national air quality standards. Over the last years, China implemented ambitious measures to reduce emissions from the power, industry and transportation sectors, with notable success during the 11th and 12th Five Year Plan (FYP) periods. However, such strategies appear to be insufficient to reduce the ambient PM_2.5 concentration below the National Air Quality Standard of 35 μg m^-3 across the BTH region within the next 15 years. We find that a comprehensive mitigation strategy for the residential sector in the BTH region would deliver substantial air quality benefits. Beyond the already planned expansion of district heating and natural gas distribution in urban centers and the foreseen curtailment of coal use for households, such a strategy would redirect some natural gas from power generation units towards the residential sector. Rural households would replace biomass for cooking by liquid petroleum gas (LPG) and electricity, and substitute coal for heating by briquettes. Jointly, these measures could reduce the primary PM_2.5 and SO₂ emissions by 28% and 11%, respectively, and the population-weighted PM_2.5 concentrations by 13%, i.e., from 68 μg m^-3 to 59 μg m^-3. We estimate that such a strategy would reduce premature deaths attributable to ambient and indoor air pollution by almost one third.

Mitigating ammonia emission from agriculture reduces PM2.5 pollution in the Hai River Basin in China

The Hai River Basin (HRB), one of the most populated areas in China, is experiencing high NH₃ emissions, mostly from agricultural sources, and suffering from strongly enhanced PM_2.5 concentrations in all urban areas. Further population growth and urbanization projected until 2030 may exacerbate this situation. Here, the NUFER (NUtrient flows in Food chains, Environment and Resources use) and GAINS (Greenhouse gas - Air pollution Interactions and Synergies) models have been coupled for the first time to understand possible changes of agricultural NH₃ emission between 2012 and 2030 and their impacts on ambient PM_2.5 concentrations, and to explore options to improve this situation. Results show that agricultural ammonia emissions in the HRB were 1179kt NH₃ in 2012, 45% of which was from the hotspots at or near conurbation areas, including Beijing-Tianjin, Tangshan-Qinhuangdao, Shijiazhuang-Baoding, Dezhou, Handan-Liaocheng, and Xinxiang. Without intervention, agricultural ammonia emissions will further increase by 33% by 2030. The impacts of several scenarios were tested with respect to air pollution. Compared to the business-as-usual scenario, a scenario of improved technology and management combined with human diet optimization could greatly reduce emission (by 60%), and lead to 22-43% and 9-24% decrease of the secondary inorganic aerosols and PM_2.5 concentrations, respectively, in the hotspots of NH₃ emissions. Our results further confirmed that ammonia control is needed for air pollution abatement strategies (SO₂, NO_x and primary PM reduction) to be effective in terms of PM_2.5.

Detection of growth rate-dependent product formation in miniaturized parallel fed-batch cultivations

Saccharomyces cerevisiae is a popular expression system for recombinant proteins. In most cases, production processes are performed as carbon-limited fed-batch cultures to avoid aerobic ethanol formation. Especially for constitutive expression systems, the specific product formation rate depends on the specific growth rate. The development of optimal feeding strategies strongly depends on laboratory-scale cultivations, which are time and resource consuming, especially when continuous experiments are carried out. It is therefore beneficial for accelerated process development to look at alternatives. In this study, S. cerevisiae AH22 secreting a heterologous endo-polygalacturonase (EPG) was characterized in microwell plates with an enzyme-based fed-batch medium. Through variation of the glucose release rate, different growth profiles were established and the impact on EPG secretion was analyzed. Product formation rates of 200-400 U (gx h)-1 were determined. As a reference, bioreactor experiments using the change-stat cultivation technique were performed. The growth-dependent product formation was analyzed over dilution rates of D = 0.01-0.35 with smooth change of D at a rate of 0.003 h-2. EPG production was found to be comparable with a qp of 400 U (gx h)-1 at D = 0.27 h-1. The presented results indicate that parallel miniaturized fed-batch cultures can be applied to determine product formation profiles of putative production strains. With further automation and parallelization of the concept, strain characterization can be performed in shorter time.