Urban air pollution in Latin America and the Caribbean: health perspectives

In the last few years, air pollution has become a major issue in some countries of Latin America and the Caribbean because of urban development and growing industrialization. In addition to industrial processes often concentrated in the cities, vehicle emission and stationary-source fuel combustion are the primary sources of air pollution. Although air-quality standards have been established in some Latin American countries, these are frequently exceeded. Adverse health effects of air pollution have been mainly associated with the following pollutants: sulfur dioxide and particulate matter, photochemical oxidants, nitrogen dioxide and carbon monoxide, and lead. Short-term as well as long-term effects can be expected at levels exceeding WHO guidelines. The Latin American urban areas most affected by anthropogenic pollutant emissions are: the area of S?o Paulo (Brazil), the city of Santiago (Chile) and the metropolitan area of Mexico City. However, situations similar to those prevailing in these cities could well occur in other cities of Latin America and the Caribbean. The population exposed to air-pollutant levels exceeding WHO guidelines can be estimated to 81 million or 26.5% of the total urban population of Latin America and 19% of its total population. These estimates correspond to 30 million children (0-14), 47 million adults (15-59) and 4 million elderly people (60+). To date a very limited number of epidemiological studies have been carried out to determine the potential health effects of air pollutants in Latin America. To obtain a rough estimate, a scenario was hypothesized in which subjects living in cities would be exposed to a given level of air pollutant, using data from the international literature to extrapolate the expected number of events in different strata of the hypothetical population. The estimated health effects are considerable and warrant priority control intervention. This is true although epidemiological studies are needed to evaluate the health impact of specific pollutant compounds as well as their interactions in Latin American populations exposed to high levels of pollution.     

The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City

Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and S?o Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration-response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children's medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly 21 to 165 billion Dollars (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration-response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies.     

How Can Urban Policies Improve Air Quality and Help Mitigate Global Climate Change: a Systematic Mapping Review

Tackling climate change at the global level is central to a growing field of scientific research on topics such as environmental health, disease burden, and its resulting economic impacts. At the local level, cities constitute an important hub of atmospheric pollution due to the large amount of pollutants that they emit. As the world population shifts to urban centers, cities will increasingly concentrate more exposed populations. Yet, there is still significant progress to be made in understanding the contribution of urban pollutants other than CO₂, such as vehicle emissions, to global climate change. It is therefore particularly important to study how local governments are managing urban air pollution. This paper presents an overview of local air pollution control policies and programs that aim to reduce air pollution levels in megacities. It also presents evidence measuring their efficacy. The paper argues that local air pollution policies are not only beneficial for cities but are also important for mitigating and adapting to global climate change. The results systematize several policy approaches used around the world and suggest the need for more in-depth cross-city studies with the potential to highlight best practices both locally and globally. Finally, it calls for the inclusion of a more human rights-based approach as a mean of guaranteeing of clean air for all and reducing factors that exacerbate climate change.     

Urban Environmental Health Hazards and Health Equity

This paper outlines briefly how the living environment can affect health. It explains the links between social and environmental determinants of health in urban settings. Interventions to improve health equity through the environment include actions and policies that deal with proximal risk factors in deprived urban areas, such as safe drinking water supply, reduced air pollution from household cooking and heating as well as from vehicles and industry, reduced traffic injury hazards and noise, improved working environment, and reduced heat stress because of global climate change. The urban environment involves health hazards with an inequitable distribution of exposures and vulnerabilities, but it also involves opportunities for implementing interventions for health equity. The high population density in many poor urban areas means that interventions at a small scale level can assist many people, and existing infrastructure can sometimes be upgraded to meet health demands. Interventions at higher policy levels that will create more sustainable and equitable living conditions and environments include improved city planning and policies that take health aspects into account in every sector. Health equity also implies policies and actions that improve the global living environment, for instance, limiting greenhouse gas emissions. In a global equity perspective, improving the living environment and health of the poor in developing country cities requires actions to be taken in the most affluent urban areas of the world. This includes making financial and technical resources available from high-income countries to be applied in low-income countries for urgent interventions for health equity. This is an abbreviated version of a paper on “Improving the living environment” prepared for the World Health Organization Commission on Social Determinants of Health, Knowledge Network on Urban Settings.     

Particulate matter pollution in African cities

Rapid urban population growth, air pollution emissions, and changing patterns of disease in African cities may increase the burden of air pollution-related morbidity and mortality in coming decades. Yet, air monitoring is limited across the continent and many countries lack air quality standards. This paper focuses on particulate matter (PM) pollution, one of the most relevant and widely used indicators of urban air quality. We provide an overview of published PM monitoring studies in Africa, outline major themes, point out data gaps, and discuss strategies for addressing particulate air pollution in rapidly growing African cities. Our review reveals that, although few studies have reported annual mean levels of coarse and fine particles, collective evidence from short- and long-term air monitoring studies across urban Africa demonstrates that pollution levels often exceed international guidelines. Furthermore, pollution levels may be rising as a result of increased motor vehicle traffic building on already high background concentrations of PM in many locations due to climatic and geographic conditions. Biomass burning and industrial activities, often located in cities, further exacerbate levels of PM. Despite the health risks this situation presents, air quality programs, particularly in sub-Saharan Africa, have been stalled or discontinued in recent years. Implementation of systematic PM data collection would enable air pollution-related health impact assessments, the development of strategies to reduce the air pollution health burden, and facilitate urban planning and transportation policy as it relates to air quality and health.     

International expert workshop on the analysis of the economic and public health impacts of air pollution: workshop summary

Forty-nine experts from 18 industrial and developing countries met on 6 September 2001 in Garmisch-Partenkirchen, Germany, to discuss the economic and public health impacts of air pollution, particularly with respect to assessing the public health benefits from technologies and policies that reduce greenhouse gas (GHG) emissions. Such measures would provide immediate public health benefits, such as reduced premature mortality and chronic morbidity, through improved local air quality. These mitigation strategies also allow long-term goals--for example, reducing the buildup of GHG emissions--to be achieved alongside short-term aims, such as immediate improvements in air quality, and therefore benefits to public health. The workshop aimed to foster research partnerships by improving collaboration and communication among various agencies and researchers; providing a forum for presentations by sponsoring agencies and researchers regarding research efforts and agency activities; identifying key issues, knowledge gaps, methodological shortcomings, and research needs; and recommending activities and initiatives for research, collaboration, and communication. This workshop summary briefly describes presentations made by workshop participants and the conclusions of three separate working groups: economics, benefits transfer, and policy; indoor air quality issues and susceptible populations; and development and transfer of dose-response relationships and exposure models in developing countries. Several common themes emerged from the working group sessions and subsequent discussion. Key recommendations include the need for improved communication and extended collaboration, guidance and support for researchers, advances in methods, and resource support for data collection, assessment, and research.     

Indoor air pollution in developing countries: a major environmental and public health challenge

Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels.     

Public health impacts of city policies to reduce climate change: findings from the URGENCHE EU-China project

Background

Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments.

Methods

Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response functions. Additionally there were literature reviews, three longitudinal observational studies and two cross sectional surveys.

Results

There are four key findings. Firstly introduction of electric cars may confer some small health benefits but it would be unwise for a city to invest in electric vehicles unless their power generation fuel mix generates fewer emissions than petrol and diesel. Second, adopting policies to reduce private car use may have benefits for carbon dioxide reduction and positive health impacts through reduced noise and increased physical activity. Third, the benefits of carbon dioxide reduction from increasing housing efficiency are likely to be minor and co-benefits for health and wellbeing are dependent on good air exchange. Fourthly, although heating dwellings by in-home biomass burning may reduce carbon dioxide emissions, consequences for health and wellbeing were negative with the technology in use in the cities studied.

Conclusions

The climate-change reduction policies reduced CO₂ emissions (the most common greenhouse gas) from cities but impact on global emissions of CO₂ would be more limited due to some displacement of emissions. The health and wellbeing impacts varied and were often limited reflecting existing relatively high quality of life and environmental standards in most of the participating cities; the greatest potential for future health benefit occurs in less developed or developing countries.

     

Estimating the global public health implications of electricity and coal consumption

Background: The growing health risks associated with greenhouse gas emissions highlight the need for new energy policies that emphasize efficiency and low-carbon energy intensity.Objectives: We assessed the relationships among electricity use, coal consumption, and health outcomes.Methods: Using time-series data sets from 41 countries with varying development trajectories between 1965 and 2005, we developed an autoregressive model of life expectancy (LE) and infant mortality (IM) based on electricity consumption, coal consumption, and previous year’s LE or IM. Prediction of health impacts from the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) integrated air pollution emissions health impact model for coal-fired power plants was compared with the time-series model results.Results: The time-series model predicted that increased electricity consumption was associated with reduced IM for countries that started with relatively high IM (> 100/1,000 live births) and low LE (< 57 years) in 1965, whereas LE was not significantly associated with electricity consumption regardless of IM and LE in 1965. Increasing coal consumption was associated with increased IM and reduced LE after accounting for electricity consumption. These results are consistent with results based on the GAINS model and previously published estimates of disease burdens attributable to energy-related environmental factors, including indoor and outdoor air pollution and water and sanitation.Conclusions: Increased electricity consumption in countries with IM < 100/1,000 live births does not lead to greater health benefits, whereas coal consumption has significant detrimental health impacts.     

Indoor air pollution from biomass fuels: a major health hazard in developing countries

Background

Nearly 3 billion people live without electricity today. This energy poverty means that they have to resort to biomass fuels for their household energy needs. When burned, these fuels release a mixture of toxic chemicals in their smoke, which is often over twenty times greater than World Health Organization (WHO) and Environmental Protection Agency recommended guideline limits.

Aim

This review details factors that contribute to indoor air pollution, its effects on health, and discusses corrective measures to consider when planning intervention strategies to stem the high morbidity and mortality trend.

Methods

The term developing countries is defined using the 2008 United Nations Conferences on Trade and Development Handbook. PubMed, Google Scholar and Science Direct databases from 1990 to 2011 were searched using the key terms: indoor air pollution, biomass fuel, particulate matter, health risks, and developing countries. Bibliographies of all relevant articles were also screened to find further eligible articles. Inclusion criteria were peer-reviewed articles and technical reports from global health organizations such as the WHO and United Nations Development Program. Exclusion criteria were articles focused on modern energy, developed countries, and non-English publications.

Results

The review discusses the extent of indoor air pollution related to use of biomass for cooking and assesses its impact on various health and social problems, including lung diseases, adverse pregnancy outcomes and human development, especially in vulnerable populations. It also offers strategies to mitigate problems related to indoor air pollution.

Conclusions

Biomass fuel is a major cause of indoor air pollution and is a significant health hazard in developing countries. A thorough understanding of the connection between choice of fuel for household needs and health impact of long-term exposure to pollutants from smoke generated during use of biomass for cooking is required so that appropriate intervention strategies and policies can be established to protect vulnerable populations.     

The burden of disease from indoor air pollution in developing countries: comparison of estimates

Four different methods have been applied to estimate the burden of disease due to indoor air pollution from household solid fuel use in developing countries (LDCs). The largest number of estimates involves applying exposure-response information from urban ambient air pollution studies to estimate indoor exposure concentrations of particulate air pollution. Another approach is to construct child survival curves using the results of large-scale household surveys, as has been done for India. A third approach involves cross-national analyses of child survival and household fuel use. The fourth method, referred to as the 'fuel-based' approach, which is explored in more depth here, involves applying relative risk estimates from epidemiological studies that use exposure surrogates, such as fuel type, to estimates of household solid fuel use to determine population attributable fractions by disease and age group. With this method and conservative assumptions about relative risks, 4-5 percent of the global LDC totals for both deaths and DALYs (disability adjusted life years) from acute respiratory infections, chronic obstructive pulmonary disease, tuberculosis, asthma, lung cancer, ischaemic heart disease, and blindness can be attributed to solid fuel use in developing countries. Acute respiratory infections in children under five years of age are the largest single category of deaths (64%) and DALYs (81%) from indoor air pollution, apparently being responsible globally for about 1.2 million premature deaths annually in the early 1990s.     

Understanding urban exposure environments: new research directions for informing implementation of U.S. air quality standards

This article explores the role that scientific information can play in improving implementation of National Ambient Air Quality Standards and discusses some of the key policy-relevant questions related to implementation that could be informed by advances in the scientific research. This article expands on the concept of urban exposure environments as useful constructs in helping to improve research into the roles of air pollution mixtures and population exposure patterns in air pollution health effects. Recommendations for potential research areas related to urban exposure environments are discussed, including (1) improving the understanding of the role that individual pollutants play within the overall mixture of pollutants that determine air quality and health outcomes in an urban area, (2) understanding the causes of heterogeneity (or similarity) across urban areas in the relative risks associated with air pollution, and (3) improving air quality characterization within urban exposure environments, recognizing the complex air pollution mixtures in many environments which may result from emissions from multiple sources, including regional and local contributors. Informed implementation policies focused on multipollutant risk-based management objectives guided by an improved understanding of multipollutant exposures are likely to lead to greater improvements in public health through more effective and efficient emissions controls.     

Moving urban trips from cars to bicycles: impact on health and emissions

Objective: To estimate the effects on health, air pollution and greenhouse gas emissions if short trips (≤7 km) were undertaken by bicycle rather than motor car. Method: Existing data sources were used to model effects, in the urban setting in New Zealand, of varying the proportion of vehicle kilometres travelled by bicycle instead of light motor vehicle. Results: Shifting 5% of vehicle kilometres to cycling would reduce vehicle travel by approximately 223 million kilometres each year, save about 22 million litres of fuel and reduce transport‐related greenhouse emissions by 0.4%. The health effects would include about 116 deaths avoided annually as a result of increased physical activity, six fewer deaths due to local air pollution from vehicle emissions, and an additional five cyclist fatalities from road crashes. In economic terms, including only fatalities and using the NZ Ministry of Transport Value of a Statistical Life, the health effects of a 5% shift represent net savings of about $200 million per year. Conclusion: The health benefits of moving from cars to bikes heavily outweigh the costs of injury from road crashes. Implications: Transport policies that encourage bicycle use will help to reduce air pollution and greenhouse emissions and improve public health.     

Air pollution and population health: a global challenge

“Air pollution and population health” is one of the most important environmental and public health issues. Economic development, urbanization, energy consumption, transportation/motorization, and rapid population growth are major driving forces of air pollution in large cities, especially in megacities. Air pollution levels in developed countries have been decreasing dramatically in recent decades. However, in developing countries and in countries in transition, air pollution levels are still at relatively high levels, though the levels have been gradually decreasing or have remained stable during rapid economic development. In recent years, several hundred epidemiological studies have emerged showing adverse health effects associated with short-term and long-term exposure to air pollutants. Time-series studies conducted in Asian cities also showed similar health effects on mortality associated with exposure to particulate matter (PM), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and ozone (O₃) to those explored in Europe and North America. The World Health Organization (WHO) published the “WHO Air Quality Guidelines (AQGs), Global Update” in 2006. These updated AQGs provide much stricter guidelines for PM, NO₂, SO₂ and O₃. Considering that current air pollution levels are much higher than the WHO-recommended AQGs, interim targets for these four air pollutants are also recommended for member states, especially for developing countries in setting their country-specific air quality standards. In conclusion, ambient air pollution is a health hazard. It is more important in Asian developing countries within the context of pollution level and population density. Improving air quality has substantial, measurable and important public health benefits.     

Air pollution: a tale of two countries

The fast growing economies and continued urbanization in Asian countries have increased the demand for mobility and energy in the region, resulting in high levels of air pollution in cities from mobile and stationary sources. In contrast, low level of urbanization in Australia produces low level of urban air pollution. The World Health Organization estimates that about 500,000 premature deaths per year are caused by air pollution, leaving the urban poor particularly vulnerable since they live in air pollution hotspots, have low respiratory resistance due to bad nutrition, and lack access to quality health care. Identifying the differences and similarities of air pollution levels and its impacts, between Indonesia and Australia, will provide best lesson learned to tackle air pollution problems for Pacific Basin Rim countries.     

Particulate pollution in Ulaanbaatar, Mongolia

The World Health Organization (WHO) listed the air pollution in Ulaanbaatar (Mongolia) among the top 5 cities with the worst air quality in the world. Air quality in the winter season reaches highs of 750 μg/m³ for daily average fine particulates (PM) due to increased coal combustion and lower mixing heights (<200 m), coupled with the city’s geography surrounded by mountains, which further restricts the vertical and horizontal dispersion of the pollutants. The annual average concentrations in 2010–2011 ranged 136?±?114 μg/m³ (the WHO guideline for fine PM is 10 μg/m³). The single largest source of particulate pollution in Ulaanbaatar is coal and biomass combustion in households and heat-only boilers, followed by power plants. In this paper, we present sector-specific emissions for 2010 accounting for 62,000 tons of fine PM, 55,000 tons of sulfur dioxide, and 89,000 tons of nitrogen oxide emissions. The inventory is spatially disaggregated at 0.01° resolution on a GIS platform for use in a chemical transport model (ATMoS). The modeled concentrations for the urban area ranged 153?±?70 μg/m³, when overlaid on gridded population, resulted in estimated 1,000–1,500 premature deaths per year due to outdoor air pollution. This study also highlights the linkages between indoor and outdoor air pollution. In these harsh temperate conditions, with 50 % of the emissions originating from Ger households, they are as big a health risk for indoor air quality as they are for outdoor air quality. Any intervention improving combustion efficiency or providing clean fuel for these stoves will have a combined benefit for indoor air quality, outdoor air quality, and climate policy. The analysis shows that aggressive pollution control measures are imperative to protect the population in Ulaanbaatar from excess exposure levels, and implementation of control measures like the introduction of heat efficient stoves, clean coal for heating boilers, and urban transport planning will result in significant health benefits, which surpass any costs of institutional, technical, and economic interventions.     

Reducing Health Risks from Indoor Exposures in Rapidly Developing Urban China

Background: Over the past two decades there has been a large migration of China’s population from rural to urban regions. At the same time, residences in cities have changed in character from single-story or low-rise buildings to high-rise structures constructed and furnished with many synthetic materials. As a consequence, indoor exposures (to pollutants with outdoor and indoor sources) have changed significantly.Objectives: We briefly discuss the inferred impact that urbanization and modernization have had on indoor exposures and public health in China. We argue that growing adverse health costs associated with these changes are not inevitable, and we present steps that could be taken to reduce indoor exposures to harmful pollutants.Discussion: As documented by China’s Ministry of Health, there have been significant increases in morbidity and mortality among urban residents over the past 20 years. Evidence suggests that the population’s exposure to air pollutants has contributed to increases in lung cancer, cardiovascular disease, pulmonary disease, and birth defects. Whether a pollutant has an outdoor or an indoor source, most exposure to the pollutant occurs indoors. Going forward, indoor exposures can be reduced by limiting the ingress of outdoor pollutants (while providing adequate ventilation with clean air), minimizing indoor sources of pollutants, updating government policies related to indoor pollution, and addressing indoor air quality during a building’s initial design.Conclusions: Taking the suggested steps could lead to significant reductions in morbidity and mortality, greatly reducing the societal costs associated with pollutant derived ill health.     

Transport and land-use policies in Delhi

Current transportation policies in mega-cities worldwide lead to major threats to health through traffic injuries, air pollution, noise, reduction in physical activities, and adverse impact on urban quality of life. In addition, a large section of the population in cities in low-income countries has to live in informal-sector, substandard housing. Many transportation policies fail to take enough account of their impacts on poverty and social exclusion, and they neglect the access and transportation demands of the more economically disadvantaged groups of society, who rely mostly on public transportation, walking, and cycling. Delhi, the capital city of India, is an interesting case because failure to consider the broad spectrum of health effects that may result from transport and land-use policies and investments has resulted in decisions that penalize the least affluent groups of the population and make it more difficult for them to get to jobs, education, health care, amenities, and services.     

应用伤残调整寿命年评价我国城市大气颗粒物污染的人群健康效应

目的 评价大气颗粒物污染引起我国城市居民伤残调整寿命年(disability adjusted life years,DALYs)的损失.方法 以2006年我国656个城市的城市人口作为暴露人口,以国家控制大气质量监测体系中各城市的可吸入颗粒物(particulate matter with an aerodynamic diameter less than 10 microns,PM_(10))年均浓度为暴露水平,应用DALYs指标,评价我国城市大气颗粒物污染的人群健康效应.结果 2006年大气颗粒物污染能引起我国城市居民(50.66±9.52)万例早逝,(15.66±4.12)万例慢性支气管炎患者,(1264.05±522.97)万例内科门诊患者,(9.99±5.04)万例心血管疾病住院患者和(7.20±0.82)万例呼吸系统疾病住院患者.2006年归因于城市大气颗粒物污染的DALYs损失总计为(526.22±99.43)万人年,其中由早逝引起的百分率为96.26%(506.55/526.22).城市颗粒物污染越重,城市人口越多,则相应的DALYs损失越大.结论 大气颗粒物污染已对我国城市居民的健康造成了较大的影响,从公共卫生的角度说明了加强治理大气污染的必要性和迫切性.     

Apheis: public health impact of PM10 in 19 European cities

STUDY OBJECTIVE: Apheis is a public health surveillance system that aims to provide European, national, regional, and local decision makers, environmental health professionals, and the general public with up to date and easy to use information on air pollution and public health. This study presents the health impact assessment done in 19 cities of Western and Eastern European countries. DESIGN: Apheis developed guidelines for gathering and analysing data on air pollution and the impact on public health. Apheis has analysed the acute and chronic effects of fine particles on premature mortality using the estimates developed by Aphea2 study and two American cohort studies. This health impact assessment was performed for different scenarios on the health benefits of reducing levels of particles less than 10 microm in size (PM(10)). MAIN RESULTS: PM(10) concentrations were measured in 19 cities (range: 14-73 microg/m(3)). The population covered in this health impact assessment includes nearly 32 million inhabitants. The age standardised mortality rates (per 100 000 people) range from 456 in Toulouse to 1127 in Bucharest. Reducing long term exposure to PM(10) concentrations by 5 microg/m(3) would have "prevented" between 3300 and 7700 early deaths annually, 500 to 1000 of which are associated with short term exposure. CONCLUSIONS: Apheis shows that current levels of air pollution in urban Europe have a non-negligible impact on public health, and that preventive measures could reduce this impact, even in cities with low levels of air pollution.