The health risk seems to be rising in most African countries but without monitoring, effective intervention is difficult.
Each year, air pollution contributes to more than 8 million premature deaths globally. This tragic statistic is closely intertwined with the climate crisis yet is rarely talked about in conversations about climate change.
As a continent, Africa faces unique challenges with air quality. The widespread use of biomass for cooking and heating along with the open burning of agricultural waste produce vast quantities of pollutants. Meanwhile, rapid urbanisation and increasing motorisation have led to a rapid growth of transport-related emissions, which now comprise an estimated 40% of air pollution sources on the continent. This situation is made worse by drier and hotter conditions, partly due to climate change, which increase airborne dust from dry land and wildfires.
The carbon emissions that lead to air pollution accelerate the climate emergency, but also have more immediate deadly effects. The 2024 World Heart Report suggests air pollution contributes to 1.9 million deaths from cardiovascular disease (CVD) and just under a million from strokes each year.
This threat is a challenge worldwide, but of greatest concern where air quality measurement is non-existent. In sub-Saharan Africa, which recorded over 1 million deaths related to cardiovascular disease in 2021, the interaction of natural dust storms with "man-made" sources of pollution can make air quality monitoring uniquely complex. Yet the region dangerously lacks air pollution monitoring infrastructure, making it difficult for policymakers to act with the urgency and effectiveness necessary.
Air pollution in Africa
With the support of the World Heart Federation and the Clean Air Fund, we conducted a review to capture a picture of available research on air pollution and CVD in Africa. Surprisingly, we found only six studies using hospital data to look at the links between these two phenomena, most confined to South Africa. Though limited in number and scope, these studies corroborated the connection between several air pollutants and cardiovascular deaths and disease.
To get a fuller picture and generate evidence-based interventions tailored to African communities, proper monitoring of air pollutants is needed. Without this, our understanding of local air pollution will remain limited, leading to poorer health outcomes for people who may be exposed. Understanding the level of air pollution in a region is imperative to reducing its harm, improving awareness of the environmental determinants of health, and shaping adequate air quality measures in public health strategies.
Adequate ground monitoring stations are needed to provide a detailed characterisation of the sources of regional-specific air pollution. Yet in Africa, only 24 of 54 countries are currently set up to measure air quality in some capacity. Even then, this fails to cover all key air pollutants known to cause ill-health. Moreover, testing is unevenly distributed and skewed towards urban settings.
It is similarly worrying that only 30% of countries in Africa are currently legally required to monitor air quality, and only 18% of countries must make this data public. By contrast, 95% of countries in Europe are obliged to check air quality. Meanwhile, regulations in both Europe and the US ensure public access to this information, with many governments providing real-time air quality data.
This discrepancy is especially concerning given estimates that suggest air pollution rose between 2010 and 2019 in 60% of African countries. This is a remarkable divergence from the trends in Europe and South-East Asia where all countries reported declines.
The investments needed
Fixing the current picture in Africa will take a collective effort, including to pool vital funds. The latest research from the Clean Air Fund shows that only 1% of international development funding targeted outdoor air pollution projects from 2018 to 2022. Some of the most polluted low- and middle-income countries, particularly in Africa, are becoming "funding deserts" that are neglected almost entirely.
Yet our findings confirmed that investment, both domestic and international, must be targeted towards three key initiatives to make a difference.
First, better monitoring of air quality in different regions of Africa must be implemented as comprehensively as possible, offering a more detailed characterisation of the sources of air pollution active in each area.
Second, more study is required on exposure to air pollutants in different African settings, and the impact this has on CVD. This includes both urban and rural environments, accounting for risk variations in different communities. It also means recording health outcomes not only in traditional hospital settings but outside of them. These steps will aid our understanding of both short- and long-term interactions between air pollution and health.
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Finally, communities need the support and capacity to measure the results of mitigation strategies for reducing emissions and exposure. The ability to accurately assess air quality can empower authorities to produce better strategies and guidelines for public health.
In 2015, the UN set out to reduce premature deaths from non-communicable diseases like CVD by 33% by 2030, under the SDG Target 3.4. In Africa and other regions where air pollution is a major threat, this will require much enhanced monitoring and targeted action.
Dr Mark Miller is a Reader at the University of Edinburgh and Chair of the Air Pollution and Climate Change Expert Group at the World Heart Federation. Professor Mariachiara Di Cesare is the Director of the Institute of Public Health and Wellbeing at the University of Essex and a Member of the Science Committee at the World Heart Federation.
