List Shows 10 Most & Least Polluted States in the U.S.

Posted on September 13, 2022 by Respro® UK Ltd

According to new reports, not all states across the country fare the same when it comes to air quality.

Over the years, numerous studies have shown that pollution hurts kids and adults in dangerous and insidious ways. And when it comes to air pollution, even though the United States has some of the cleanest air of industrialized nations, even that pretty clean air is not clean enough — because air pollution is a major killer in the United States, associated with 100,000 to 200,000 deaths each year. Water pollution, too, can be incredibly harmful for kids’ health and development. And that harm is not felt equally, according to a new report that shows that some states have far, far more polluted air and water than others.

As part of U.S. News and World Report data from 2021 used to compile its “Best States” list, the publication also looked at air and water pollution levels and ranked states on whether they had clean or dirty water and air.

“Pollution was determined based on air and water emissions from industry and utilities,” The Hill explained in a write-up of the report. The data also investigated the “overall measures to long-term human health effects, using information from the Environmental Protection Agency.”

From there, the states were ranked in order of pollution and air quality levels from best to worst.

States with the lowest pollution levels:

Vermont

New Hampshire

South Dakota

New Mexico

Wyoming

California

Rhode Island

Maine

Colorado

Idaho

States with the highest pollution levels:

Nevada

Indiana

Delaware

Utah

Ohio

Oregon

Tennessee

Illinois

Alabama

Texas

Why should parents care about the pollution levels of their state?

A recent study from Boston College on air quality in Massachusetts — a state ranked 17th best on this US News list — found that air quality in particular is a massive issue in the country, impacting both adults and kids. However, the impact on children has long-lasting consequences. The researchers found that consistent air pollution exposure was linked to babies being born with low birth weight, more kids being diagnosed with asthma, and an average drop of two IQ points in children.

Unfortunately, the health impact kids experience due to pollution isn’t felt equally by all kids across the country. Low-income and marginalized communities are exposed to more air pollution than wealthy families.

What’s worse is that all of these negative health effects happen below the EPA’s air pollution standard.

“All of these adverse health effects occur at fine particulate matter pollution levels below the U.S. Environmental Protection Agency (EPA)’s current annual standard of 12 micrograms per cubic meter,” said lead author Philip J. Landrigan, M.D., a Boston College Professor of Biology. “So even for a state like Massachusetts, which registered below that standard, air pollution is a formidable public health threat that needs urgently to be addressed.” “Clearly, current EPA air pollution standards are not adequately protecting public health,” Landrigan said.

The amount of pollution in Massachusetts falls comfortably into the category in which children are at significant risk of long-lasting health impacts, according to the World Health Organization.

In terms of water pollutants, children “don’t need as much toxicant” to be harmed, environmental health researcher Abby Mutic told Fatherly. In the United States, well water isn’t subject to federal regulations, and about 20% of Americans get their water from wells. Water contaminants can harm the health of children by, for example, causing lead poisoning and increasing the risk of conditions such as cancer.

List Shows 10 Most & Least Polluted States in the U.S.
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Cancer breakthrough is a ‘wake-up’ call on danger of air pollution

Posted on September 12, 2022 by Respro® UK Ltd

Scientists uncover link between car fumes and lung cancer that helps explain why so many non-smokers develop disease

Scientists have uncovered how air pollution causes lung cancer in groundbreaking research that promises to rewrite our understanding of the disease.

The findings outline how fine particulates contained in car fumes “awaken” dormant mutations in lung cells and tip them into a cancerous state. The work helps explain why so many non-smokers develop lung cancer and is a “wake-up call” about the damaging impact of pollution on human health.

“The risk of lung cancer from air pollution is lower than from smoking, but we have no control over what we all breathe,” said Prof Charles Swanton of the Francis Crick Institute, who presented the findings at the European Society for Medical Oncology conference in Paris on Saturday.

“Globally, more people are exposed to unsafe levels of air pollution than to toxic chemicals in cigarette smoke, and these new data link the importance of addressing climate health to improving human health.”

Smoking remains the biggest cause of lung cancer, but outdoor air pollution causes about one in 10 cases in the UK, and an estimated 6,000 people who have never smoked die of lung cancer every year. Globally, about 300,000 lung cancer deaths in 2019 were attributed to exposure to fine particulate matter, known as PM2.5, contained in air pollution.

However, the biological basis for how air pollution causes cancer has remained unclear. Unlike smoking or sun exposure, which directly cause DNA mutations linked to lung and skin cancer, air pollution does not cause cancer by triggering such genetic changes.

Instead, those with non-smoking lung cancer tend to carry mutations that are also seen in healthy lung tissue – small errors that we accumulate in our DNA throughout life and which normally remain innocuous.

“Clearly these patients are getting cancer without having mutations, so there’s got to be something else going on,” said Swanton, who is also Cancer Research UK’s chief clinician. “Air pollution is associated with lung cancer but people have largely ignored it because the mechanisms behind it were unclear.

”The latest work unveils this mechanism through a series of meticulous experiments showing that cells carrying dormant mutations can turn cancerous when exposed to PM2.5 particles. The pollutant is the equivalent of the ignition spark on a gas hob.

In laboratory studies, Swanton’s team showed that mice that had been engineered to carry mutations in a gene called EGFR, linked to lung cancer, were far more likely to develop cancer when exposed to the pollutant particles. They also revealed that the risk is mediated by an inflammatory protein, called interleukin-1 beta (IL1B), released as part of the body’s immune response to PM2.5 exposure. When the mice were given drugs to block the protein, they were less vulnerable to the pollutants.

The work explains a previous incidental finding in a clinical trial of a heart disease drug, made by Novartis, that people on the drug – an IL1B-inhibitor – had a marked reduction in lung cancer incidence. This could pave the way for a new wave of cancer-preventing medicines, Swanton said.

The team also analysed samples of healthy lung tissue, taken during patient biopsies, and found that the EGFR mutation was found in one in five of the normal lung samples. This suggests that we all carry dormant mutations in our cells that have the potential to turn into cancer – and chronic exposure to air pollution increases the odds of that happening.

“It’s a wake-up call on the impact of pollution on human health,” said Swanton. “You cannot ignore climate health. If you want to address human health, you have to address climate health first.”

Rosamund Kissi-Debrah, whose nine-year-old daughter Ella’s death in 2013 was attributed by a coroner to illegal levels of air pollution, said there continues to be a “lack of joined-up thinking” about pollution and health. “You can pump all the money you want into the NHS, but unless you clear up the air, more and more people will become ill,” she said. “My concern regarding global health is that every year we churn out the figures – air pollution causes nine million premature deaths – but no one is held accountable.”

Prof Tony Mok, of the Chinese University of Hong Kong and who was not involved in the research, said: “We have known about the link between pollution and lung cancer for a long time, and we now have a possible explanation for it. As consumption of fossil fuels goes hand in hand with pollution and carbon emissions, we have a strong mandate for tackling these issues – for both environmental and health reasons.”

Prof Allan Balmain, a cancer geneticist at the University of California, San Francisco, said the findings also had implications for our understanding of how smoking causes cancer. “Both air pollution and cigarette smoke contain lots of promoting substances. This has been known since the early 1960s but has essentially been ignored, as everyone was focused on mutations,” he said. “The tobacco companies are now saying that smokers should switch to vaping as this reduces exposure to mutagens, and therefore the cancer risk is going to go away. This is not true, as our cells get mutations anyway, and there is evidence that vaping can induce lung disease and cause inflammation similar to promoters.”

Cancer breakthrough is a ‘wake-up’ call on danger of air pollution | Cancer research | The Guardian
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Prenatal exposure to air pollution increases risk of childhood allergic rhinitis and asthma

Posted on September 9, 2022 by Respro® UK Ltd

In a recent study published in the Journal of Allergy and Clinical Immunology, researchers assessed the impact of prenatal exposure to air pollution on immune perturbations. 

There is evidence that long-term exposure to air pollution in early life adversely affects children’s respiratory health and increases asthma risk in childhood. Additionally, associations have been observed between particulate matter having diameters less than 2.5 and less than 10 µm (PM2.5 and PM10) as well as nitrogen dioxide (NO2) with respiratory diseases in individuals aged between four and seven years. The mechanisms involved in these associations are, however, still unclear.

About the study

In the present study, researchers investigated the potential mechanisms involved in the manifestation of allergy and asthma in childhood due to prenatal exposure to air pollution.

The COPSAC2010 cohort study involves a prospective mother-child cohort of 700 children born to women living in Zealand, Denmark, with enrolment beginning in week 24 of pregnancy. During pregnancy, the trial comprised randomized interventions with high-dose vitamin D and fish oil.

The team linked the COPSAC-derived data with individual-level maternal and child home address history recorded from conception to the most recent follow-up day, including moving, emigration, immigration, and death dates. This data was obtained using the unique personal identification numbers assigned by the Danish Civil Registration System. Ambient PM2.5, PM10, and NO2 concentrations were modeled at each residential address. The Operational Street Pollution Model (OSPM®) was used to calculate the local impact of traffic at the street level.

Furthermore, the contribution of long-distance transport and regional background as a result of non-local sources was computed. The team estimated the time-weighted mean for each participant from conception to birth (prenatal exposure), from birth to the deoxyribonucleic acid methylation (DNAm) sampling point (total postnatal exposure), and in the year preceding the sampling point at age six. In addition, the researchers estimated three short-term exposure characteristics: the first four weeks of life (postnatal first four weeks), the initial six months of life (postnatal first six months), and the month before the age six-year sample point.

To measure airway immune mediators, nasal mucosal lining fluid samples were obtained using a synthetic absorptive matrix at four weeks and six years of age. At six months, inflammatory markers in the blood were measured with high-sensitivity immunoassays, which were based on electrochemiluminescence. In addition, DNA methylation and gene expression were measured in the respiratory epithelium at six years.

Results

The prenatal mean (IQR) values for ambient NO2 were 18.8 ug/m3, PM25 was 10.1 ug/m3, and PM10 was 15.3 ug/m3. Significant positive connections existed between the pollutants, especially between prenatal exposure to PM10 and PM25. The relationships between birth urbanicity and prenatal exposure to PM10, PM25, and NO2 were low and moderate. At six years old, 22.4% of children had asthma at some point in their lives, 23.7% were sensitized to inhalant allergens, 7.4% had asthma at the time, and 6.7% had allergic rhinitis.

With elevated levels of interleukin-8 (IL-8) and decreased levels of IL-1 across all air pollution components, prenatal exposure to air pollution exposure was significantly correlated to systemic inflammatory markers found in blood at the age of six months. Furthermore, elevated NO2 exposure was associated with decreased levels of IL-6. After accounting for urbanicity, these correlations mainly remained unaltered. Prenatal air pollution’s early-life systemic immunological “fingerprint” was strongly linked to an elevated risk of asthma at age six, but not allergic sensitization or rhinitis.

Nose mucosal immune mediators at age six were not significantly correlated with prenatal air pollution exposure. After multiple testing was taken into account, there were also no conclusive links between postnatal air pollution exposure and immune mediator levels at six. This finding was also consistent when the exposure window was limited to the year before the age of six was sampled.

In nasal epithelial cells in six-year-old subjects, the team found correlations between prenatal exposure to air pollution and gene expression. Notably, following a false discovery rate (FDR) 5% adjustment, higher prenatal NO2 exposure resulted in increased expression of AKAP9. Using an FDR of 15%, it was observed that exposure to more PM2.5 was linked to higher expression of CCL2 and lower expression of RP11-420K14. On the other hand, prenatal PM10 exposure was linked to lower expression of LINC00644 and RP11-420K14. The postnatal air pollution exposure, the four-week nasal mucosal immune mediator fingerprint, and gene expression did not show any significant relationships.

Although the direction of the association had increased OR with increased exposure across all disease endpoints, with the exception of allergic rhinitis and PM, there were no statistically significant direct correlations between prenatal exposure to air pollution and asthma and allergy endpoints at age six years. However, after postnatal air pollution exposure was taken into account, the team found a nominally significant correlation between NO2 and allergy sensitization.

Overall, the study findings highlighted a link between prenatal exposure to ambient air pollution, specifically NO2, PM2.5, and PM10, and the early life immunological profile of the airways, which was associated with the later emergence of allergic airway disease.

Prenatal exposure to air pollution increases risk of childhood allergic rhinitis and asthma
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There’s no safe level of air pollution

Posted on September 8, 2022 by Respro® UK Ltd

Emissions that meet air-quality standards still cause illness and early death. Planning decisions need to help drive down exposure.

It might seem reasonable to think air pollution is only a problem when the sky is thick with brown smog. But a new study is further proof the problem starts much earlier and well below the minimum air-quality standards.

Worse, the research shows the negative effects increase most rapidly at lower levels of exposure. And they hit poorer people hardest.

The policy implications of these findings are critical: there is no safe amount of air pollution. Treating reference standards as a licence to pollute up to those concentrations and a free pass to allow continued emissions below those concentrations cannot be accepted based on the current evidence.

Air-pollution regulations, such as those in the United States, do not provide enough protection from worsening symptoms of asthma, according to a 2022 US study on the relationship between pollution levels and asthma-related hospitalisations for people on Medicaid. Described by the study’s researchers as the most disadvantaged population in the United States, Medicaid recipients include people on very low incomes, people with disabilities and people aged over 65.

The study investigated the exposureresponse relationship between exposure to pollutants and people’s health response. It found increased concentrations of nitrogen dioxide and fine particulate matter were associated with an increased risk of hospitalisation for asthma over the following six days after exposure.

Importantly, the study showed that the increased risk of hospitalisation for each unit increase in pollutant exposure was greatest for those people whose exposure levels were well below the existing US minimum air-quality standard. In general, the effect was the same regardless of differences in individual characteristics, except it was stronger in people who had only had a single admission to hospital than in those with multiple previous admissions.

Some characteristics of communities made them more susceptible to the negative effects of both pollutants: low population density, higher average body mass index, greater distance to the nearest hospital, and greater neighbourhood disadvantage.

The study has two important implications. First and perhaps surprisingly the slope of the exposureresponse relationship is steeper at lower degrees of exposure. The response is strongest at lower levels of exposure. Second, in policy terms there are substantial benefits in reducing exposure to air pollution, and in preventing increases in exposure, even at concentrations well below reference standards or proposed thresholds.

The present study joins several others that did not find a concentration below which negative health effects from air pollution do not occur. Steeper slopes at lower concentrations of fine particulates have also been demonstrated for daily mortality and for cardiovascular hospitalisations.

A link between the risk of death from all causes and long-term exposure to both fine particulates and nitrogen dioxide has been demonstrated in places such as Australia that have relatively low-range exposure without evidence of a safe’ lower threshold and with evidence of a steeper slope at lower concentrations. Both lifetime cumulative exposure and current exposure to nitrogen dioxide that are well below usual reference standards affect Australian primary-school children’s risk of having asthma.

The finding that those living in disadvantaged neighbourhoods were at greatest risk of experiencing more asthma hospitalisations when exposed to higher amounts of air pollution is important. It supports evidence of a similar interaction in relation to the negative impact of air pollution on risk of stroke and represents an effect that is over and above the association between disadvantage and the risk of higher air-pollutant exposures. Researchers are still working to pinpoint the mechanism that drives this association, but the link is clear.

Transport, industry and planning decisions need to consider the importance of minimising exposure to pollutants and the need to avoid any increases in these emissions, particularly where vulnerable populations may be exposed. Concern about vulnerable populations, particularly those who are disadvantaged, but also the very young and the very old and those with preexisting health conditions, has important implications for decisions on the location of sensitive facilities such as schools, aged-care facilities and hospitals.

This is an immense challenge. Human-made emissions of fine particulate matter and nitrogen dioxide exist in just about every part of the world, with transport, agriculture, energy, mining and construction sectors all playing a role. The good news is the actions to reduce carbon pollution (to combat global warming) and those required to ensure clean, safe air share benefits. As a global community, we need to do all we can to achieve these benefits. 

There’s no safe level of air pollution – The Week
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Heatwaves and wildfires to worsen air pollution: UN

Posted on September 7, 2022 by Respro® UK Ltd

More frequent and intense heatwaves and wildfires driven by climate change are expected to worsen the quality of the air we breathe, harming human health and ecosystems, the UN warned Wednesday.

A new report from the UN’s World Meteorological Organization (WMO) cautioned that the interaction between pollution and climate change would impact hundreds of millions of people over the coming century, and urged action to rein in the harm.

The WMO’s annual Air Quality and Climate Bulletin examined the impacts of large wildfires across Siberia and western North America in 2021, finding that they produced widespread increases in health hazards, with concentrations in eastern Siberia reaching “levels not observed before”.

Tiny particles with a diameter of less than 2.5 micrometres (PM2.5) are considered particularly harmful since they can penetrate deep into the lungs or cardiovascular system.

“As the globe warms, wildfires and associated air pollution are expected to increase, even under a low emissions scenario,” WMO chief Petteri Taalas said in a statement.

“In addition to human health impacts, this will also affect ecosystems as air pollutants settle from the atmosphere to Earth’s surface.”

‘Foretaste of the future’

At the global scale, there has been a reduction over the past two decades in the total burned area, as a result of decreasing numbers of fires in savannas and grasslands.

But WMO said that some regions like western North America, the Amazon and Australia were seeing far more fires.

Even beyond wildfires, a hotter climate can drive up pollution and worsen air quality.

Taalas pointed out that severe heatwaves in Europe and China this year, coupled with stable high atmospheric conditions, sunlight and low wind speeds, had been “conducive to high pollution levels,” warning that “this is a foretaste of the future.”

“We expect a further increase in the frequency, intensity and duration of heatwaves, which could lead to even worse air quality,” he said.

This phenomenon is known as the “climate penalty”, which refers to how climate change amplifies ground-level ozone production, which negatively impacts air quality.

In the stratosphere, ozone provides important protection from cancer-causing ultraviolet rays, but closer to the ground it is very hazardous for human health.

If emission levels remain high, this climate penalty is expected to account for “a fifth of all surface ozone concentration increase,” WMO scientific officer Lorenzo Labrador told reporters.

He warned that most of that increase will happen over Asia, “and there you have about one quarter of the entire world population.”

The WMO called for action, stressing that “a worldwide carbon neutrality emissions scenario would limit the future occurrence of extreme ozone air pollution episodes.”

The report points out that air quality and climate are interconnected, since chemicals that worsen air quality are normally co-emitted with greenhouse gases.

“Changes in one inevitably cause changes in the other,” it said.

Heatwaves and wildfires to worsen air pollution: UN
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Simple measures can go a long way to combating air pollution in schools

Posted on September 6, 2022 by Respro® UK Ltd

Most UK primary schools experience levels of pollution which exceed the safe levels set out by the World Health Organization, yet simple measures can cut outdoor and indoor exposure of toxins by almost half, according to a new study from the University of Surrey.

Working with a select number of London schools, researchers from Surrey’s Global Centre for Clean Air Research (GCARE) investigated whether putting up a green screen along the perimeter fence of a school, installing air purifiers in classrooms, and organising school street initiatives during pick-up and drop-off hours, improved air quality of classrooms and playgrounds. These initiatives were funded by Impact on Urban Health.

The researchers found that air purifiers in classrooms reduced indoor pollution concentrations by up to 57%, and the School Streets initiative, which stops motor vehicles driving past schools at the start and end of school days, reduced particle concentrations by up to 36%. Green screens at the school boundary reduced some of the most dangerous outdoor particle levels coming from roads by up to 44%, depending on wind conditions.

Prashant Kumar, founding Director of the Global Centre for Clean Air Research (GCARE) at the University of Surrey, said:

“Everybody, especially our children, deserves to live and work where the air is as clean and safe as possible. Unfortunately, the reality is far from ideal, with many of our schools unwittingly exposing children to harmful pollutants. The problem is particularly bad at schools near busy roads.”

Our research offers hope to many who care about this issue, as the results show that taking reasonable action can make a positive difference.”

Ten million students worldwide spend 30% of their daily lives at school, with 70% of this time being spent indoors. Currently, 7,000 UK schools breach the World Health Organization’s air quality limits, leaving children vulnerable to respiratory diseases, affected lung and brain health, behavioural problems, and increased risk of cancer.

Kate Langford, Programme Director of the Health Effects of Air pollution programme at Impact on Urban Health, funders of the research, said:

“Every child has the right to learn in an environment that keeps them safe and healthy. But, every day, children are exposed to dangerously high levels of air pollution in and around schools.

“Our partnership with Arup, Global Action Plan and the University of Surrey has shown there are practical ways that we can protect children in and around schools and can help guide schools to implement these solutions.

“These measures now need to be combined with efforts from local authorities at regional and national levels to improve air quality and create healthier places for children to live, learn and play.”

Larissa Lockwood, Director of Clean Air at Global Action Plan, said:

“Schools should be safe places of learning, not places where students are at risk of health hazards. There is no safe level of air pollution, but children are particularly vulnerable to its impacts including the development of organs and their ability to learn. Services like the London Schools Pollution Helpdesk ensure that schools have access to advice on what they can do to reduce exposure to air pollution, including the measures tested in this research. But this needs to be rolled out nationally — all children must be protected from the health effects of air pollution in their everyday lives.”

Professor Prashant Kumar concluded:

“My simple plea to decision-makers in the UK is this: simple actions speak louder than words. By giving every school resources to implement one of the measures detailed in our research, they could make a world of difference to tens of thousands of children in this country.”

The study was co-designed by Global Action Plan and Arup and supported by Impact on Urban Health.

The research was published in the journal Atmospheric Environment. Schools looking to implement changes can use a toolkit for guidance and should seek advice from an air quality specialist.

Story Source:Materials provided by University of Surrey. Note: Content may be edited for style and length.

Simple measures can go a long way to combating air pollution in schools — ScienceDaily
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Toxic air ‘is linked to a new illness every year’ expert warns

Posted on September 1, 2022 by Respro® UK Ltd

AIR pollution will put health and social systems in the UK under increasing strain, an expert warns. Professor Frank Kelly said filthy air is linked to new illnesses every year, and not just associated with the lungs.

A government research group last month found pollution is likely to increase the risk of dementia. And even small amounts can increase the risk of death, a study released this week discovered.

Professor Kelly, from the school of public health at Imperial College London, said: “Over the last 10 to 15 years, research has shown that the effects go way beyond the lungs.

“Every year there’s something new linked to it. Some researchers suggest it’s linked to poorer skin conditions, others have linked it to obesity, and even childhood obesity.

“It affects metabolism and upsets some of the hormonal balance. This leads to changes which we just associated with overeating. But it’s more complicated than that.

“We used to think air pollution was bad for your lungs. We worried about asthma and chronic obstructive pulmonary disease.”

Prof Kelly warned people to be aware of exposure within their homes. He said if people cook with gas or fry a lot of food, they produce significant levels of pollution indoors.

He added: “Increasingly, we’re aware you get exposed to a lot of pollution in your home, just through lifestyle. We’ve changed the way we clean our homes enormously.

“Our parents would probably have used vinegar and water for cleaning.

“Now we’ve got these complex cleaning agents, which have a whole range of pretty toxic chemicals in them – that’s why they’re so good at removing biological contaminants.

“But, on the other hand, residual chemicals end up in our home and we’re breathing them in.”

Toxic air ‘is linked to a new illness every year’ expert warns | UK | News | Express.co.uk
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Human Rights Watch: Air Pollution Killing Thousands in Bosnia

Posted on August 30, 2022 by Respro® UK Ltd

Watchdog organisation says Bosnia’s dependency on coal and wood for heat and electricity generation kills thousands of people each year.

Human Rights Watch has again drawn attention to the problem of air pollution in Bosnian cities. “Nine per cent of the country’s deaths are due to air pollution and an estimated 3,300 people die prematurely every year as a result of exposure to ambient PM2.5 air pollution,” an HRW report published on Monday says. 

Bosnia and Herzegovina produces electricity by burning lignite, a low-quality type of coal found in abundance in the country, in outdated coal plants.

However, Bosnia’s complex governance system creates extra difficulties in tackling air pollution as there is no national environment body and almost no coordination between different levels of government. 

“Despite the health and climate impacts, the government has remained steadfastly committed to use of coal, particularly for electricity,” HRW notes. 

It says the state government also does not take adequate steps to inform citizens about the health risks of air pollution, or how to mitigate those risks. 

“Air pollution affects everyone but there is a disproportionate impact on older people, children, and those with preexisting respiratory or cardiovascular problems,” the watchdog organisation continues. 

It estimates that air pollution reduces the country’s GDP by as much as 21.5 per cent through lost work and school days, and healthcare and fuel costs.  

Beside burning wood and coal for heating and electricity, “low fuel quality standards, aging industrial plants, lack of effective public transportation and older diesel vehicles” also contribute to air pollution, HRW adds. 

Because air pollutants easily travel across borders, the impact of the country’s polluted air extends into the EU. A 2019 study using 2016 data recorded 3,000 premature deaths in the EU from air pollution in the Western Balkans, and it is estimated to cost the EU between 3.1 and 5.8 billion euros each year.

The WHO, HRW says, has identified air pollution as the “single biggest environmental threat to human health,” with estimates of over seven million people dying prematurely from it annually, including 4.2 million from outdoor (or ambient) air pollution.

Human Rights Watch: Air Pollution Killing Thousands in Bosnia | Balkan Insight
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