Air pollution is the leading risk factor for 2.2 million annual deaths from pneumonia, responsible for an estimated 30% (651,200) of all pneumonia deaths in 2021 according to the Global Burden of Disease. Of all causes of air pollution, it is particulate matter measuring less than 2.5 micrometers in diameter – less than a 30th of the diameter of a human hair – that causes the largest burden of disease. This "PM2.5" is emitted both outdoors and indoors, from vehicles, coal-burning power plants, industrial activities, waste burning, farming practices, and household cooking and heating using coal, charcoal, wood, agricultural residue, animal dung, and kerosene.
Both household and outdoor sources of PM2.5 contribute to pneumonia deaths, but not equally. The majority (55%) of air pollution-related pneumonia deaths are from household sources, while 45% are from outdoor sources. While air-pollution related deaths from household sources have been falling since 2010, deaths from outdoor air pollution are actually rising, driven by the sharp increase across Asia (26%).
Not all populations are equally vulnerable to air pollution-related pneumonia deaths. It is the very young and the very old who are at greatest risk. Thirty percent of all air pollution-related pneumonia deaths are among children under five years while 42% are among adults over 70 years. Household air pollution is a greater risk for pneumonia among children while outdoor air pollution disproportionately harms respiratory health among older adults. Seventy percent of air pollution-related pneumonia deaths among children are caused by household air pollution, while 58% of air pollution-related pneumonia deaths among older adults are caused by outdoor air pollution.
To focus attention on the toxic relationship between air pollution and pneumonia, Every Breath Counts released an Air Pollution and Pneumonia Scorecard ranking the 20 countries with the most air pollution-related pneumonia deaths. Ten of these countries are in Africa, nine in Asia, and one in Latin America. Of great concern is the subset of countries where air pollution is contributing to more than 50% of all pneumonia deaths, most of them among children under five.
It is important to note that the leading causes of air pollution-related pneumonia deaths and the most affected populations differ markedly across the countries on the list. For example, in India the greatest burden of death is caused by outdoor air pollution impacting older adults, while in Nigeria it is household air pollution among children under five that causes most deaths. Despite efforts to increase household access to clean cooking fuels and technologies, there has been limited progress in countries with heavy burdens of pneumonia. Since 2010, only half of the 20 countries on the scorecard have achieved more than 50% population access to clean cooking.
It is vital that governments in all 20 countries introduce policies that target both the leading causes of air pollution-related pneumonia deaths and their most vulnerable populations. Specifically, the Every Breath Counts Coalition is calling on national governments to embrace a national target to reduce air pollution-related pneumonia deaths by 50% by 2030, to report regularly on national progress, and to accelerate measures to achieve the target including:
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- Increasing the proportion of households with access to clean cooking fuels and technologies to above 70%
- Reducing average PM2.5 exposure by 50% or until achievement of the updated WHO targets of not more than 5μg/m3 per year and 15 µg/m3 for more than three days per year
- Establishing a multi-sector, multi-government Clean Air Taskforce with representation from the health, energy, agriculture, industry, and urban development ministries across national, state, and local governments to drive progress
Investments to reduce air pollution and the risk of pneumonia death will help countries accelerate progress to several of the Sustainable Development Goals for health, including:
- 3.2.1 Reduce child (0-4 years) deaths to at least 25 per 1,000 births
- 3.9.1 Reduce % of adult (15+ years) deaths attributable to PM2.5 air pollution
- 7.1.2 Increase % population with access to clean fuels and technologies for cooking to 100%
- 11.6.2 Reduce annual mean levels of fine particulate matter (PM2.5 and PM10) in cities
In this critical year for climate action with COP29, it is vital that the health sector works together with the climate change and clean air movements to put air pollution reduction center-stage of global and national respiratory health agendas.
Read the Air Pollution and Pneumonia Scorecard
Published for the International Day of Clean Air, September 2024
