Global air pollution is set to become a major killer unless air quality and access to vital medical support is improved.

A major new worldwide modelling study led by researchers at Stockholm Environment Institute (SEI) at the University of York has challenged the international focus on air pollution. The new study finds that reducing population vulnerability is as important as cutting emissions for saving lives.

The research revealed that while reducing exposure to pollutants is critical, measures such as universal access to quality healthcare and poverty reduction played a crucial, and often overlooked, role in saving lives over the last 30 years.

“A population’s risk of harm from air pollution is shaped by a complex set of socioeconomic and health factors, including pre-existing medical conditions, smoking and the quality and accessibility of medical care. In some regions where air quality has not improved, air pollution mortality rates have still dropped exclusively because of reductions in these vulnerability factors,” the research warned.

“While cleaning our air remains a critical goal, our findings demonstrate that reducing emissions is only part of the solution,” said Chris Malley, lead author of the study from SEI at the University of York. “To improve public health, we must also focus on the factors that make people susceptible to harm. Integrating healthcare improvements and poverty reduction into air quality strategies is an essential tool for protecting the world’s most vulnerable populations from the deadly effects of air pollution.”

The study’s key findings included:

• Between 1990 and 2019, global air pollution mortality rates decreased by 45%. Approximately 52% of the decrease in global air pollution mortality rates was due to reductions in vulnerability, rather than just lower pollution levels.

• Without the global actions that reduced people’s vulnerability to air pollution, an estimated 1.7 million more people would have died from air pollution-related causes in 2019 alone.

• Global poverty plummeted from 45% in 1990 to 21% in 2019, acting as a massive, unintended shield against the health burdens of smog.

• Public health efforts such as reducing obesity, cutting smoking rates, and treating hypertension are rarely included in air pollution strategies, despite their significant impact on reducing mortality.

Researchers also were at pains to highlight the benefits of combining reductions in air pollution exposure with efforts to strengthen resilience. Both Europe and North America saw similar declines in air pollution exposure between 1990 and 2019. However, reductions in air pollution-related mortality were almost twice as large in Europe, reflecting greater progress in reducing vulnerability through health and social improvements.

The study concluded that air quality strategies must evolve to include interventions that reduce non-air-pollution health determinants to complement traditional exposure reduction efforts.