A global threat has taken hold. It’s almost impossible to escape. It lurks in the air, indoors and outdoors, seeping into every organ of the body. It’s weakening our hearts and lungs, forcing more people to rely on inhalers just to catch their breath. It's burdening already overstretched national healthcare systems.

It sounds like a transmittable disease, but it’s even more widespread. It's air pollution. Some 99% of us worldwide are breathing it every day.

As the healthcare mantra goes, prevention is better than cure. The benefits of cleaner air extend beyond our personal health, to the collective public, environmental and economic health. And, like the global response to the COVID-19 pandemic, air pollution calls for speedy, coordinated cross-border political leadership.

Polluted air is everywhere. It’s released from wood and kerosene cooking stoves, diesel and petrol vehicles, coal-fired power stations, wildfires, waste incineration and more. It’s closely linked to lung and heart diseases, cancer and asthma, but it can also affect dementia, depression, brain development, premature birth, miscarriage and infertility. It’s killing seven million people a year and shaving over two years off the average life expectancy.

One of those victims is Ella Adoo-Kissi-Debrah, daughter of one of the writers of this blog, Rosamund. Ella died at the age of nine in 2013. Ella is the first person in the world to have air pollution listed as a cause of death on her death certificate, after a UK coroner’s inquest concluded that illegal levels of air pollution from the traffic near her London home contributed significantly to her acute asthma.

Nearly ten years later, it’s time to finally step up and save the lives of future Ellas. World leaders can make three big changes to protect the air we share. We call on them in conjunction with the International Clean Air Day for blue skies, to start acting.


Global Air Quality Guidelines

First, they must follow the World Health Organization’s Global Air Quality Guidelines that protect human health and the environment. These guidelines, updated a year ago, reflect the latest consensus-backed science on air pollutants and health.

If we make them the guiding light for national, regional and local air quality regulation and political decisions, we will save lives. Cutting fine particulate matter (PM2.5) pollution, for example, emitted from the burning of fossil fuels and wood, in line with WHO guidelines would reduce deaths linked to PM2.5 by 80%. That’s 3.3 million people.

This will also save money. The health damages linked to PM2.5 pollution amounted to $8.1 trillion in 2019, according to the World Bank. That’s 6.1% of global GDP.

The UK has a golden opportunity to act now, by setting air quality targets under the new Environment Act to fully align with WHO science as soon as possible. This is achievable and desirable. If implemented, existing government plans would lead the UK to meet the WHO’s interim guidelines by 2030, according to Imperial College London.

This would reduce the number of coronary heart disease cases by 3,000 every year and deliver £380 billion in benefits between 2018 and 2034, in the form of reduced healthcare costs and higher productivity. A concerted, cross-government effort could, therefore, lead the UK to fully achieve these guidelines by 2030 or soon after and reap bigger benefits.


Raise awareness of air pollution

Second, world leaders must raise awareness of the dangers of air pollution, the benefits of clean air and the solutions to the problem, both across healthcare and society as a whole.

Doctors and nurses can inform patients about the environmental drivers of illness and how to minimise exposure. By recognising air pollution as a global health risk – the way we have with cigarettes – healthcare professionals can help galvanise public understanding and the political will to tackle the problem.

Ella and her family were never warned that nearby traffic pollution could be exacerbating her asthma. A lot more is known now, yet people still don’t fully understand the risks or how to protect themselves. This requires widespread, government-backed public health campaigns and increased monitoring and communication of air-quality levels.


Make health the focus of climate action and social equity

Third, world leaders must put health at the core of climate action and social equity. The fight for clean air can accelerate the reduction of climate-warming emissions, the shift to cheaper and more reliable energy sources and justice for the marginalised and most vulnerable communities.

Low- and middle-income countries bear the biggest burden from dirty air, accounting for 91% of premature deaths linked to all outdoor air pollutants. They’re most reliant on old, inefficient, fossil-fuelled vehicles and energy sources, with fewer alternative options.

We can confront these crises more effectively and fairly if we address them as one – and foster support across all sectors of the economy. Replacing coal- and gas-fired power plants, for example, with solar and wind energy will reduce both air pollution and reliance on the volatile commodity prices that push up our energy bills. Choosing renewables over wood-burning biomass in households and industries will reduce air pollution and conserve land for food farming and trees that absorb carbon dioxide.

COVID-19 has proven humanity’s inbuilt ability to rise up and act to protect the health of our most vulnerable people. We need to do the same with air pollution. Ella lost her right to a healthy life because the traffic near her home periodically exceeded WHO air-quality guidelines. Now we know better. We must act.