WMA Declaration on Prevention and Reduction of Air Pollution to Improve Air Quality

Adopted by the 75^th WMA General Assembly, Helsinki, Finland, October 2024

PREAMBLE

The impact of air pollution on health – especially among vulnerable populations – necessitates targeted guidelines for healthcare professionals. By recognizing air pollution’s unique characteristics, this declaration aims to advocate for better health, foster cross-border collaboration, and reinforce the connection between environmental quality and human well-being.

Air pollution and its impact on health

Air pollution poses a major global environmental risk to human health, contributing significantly to avoidable morbidity and mortality worldwide. 8.1 million premature deaths occur each year due to the combined effects of ambient and household air pollution.

Air pollutants are a leading risk factor for the burden of non-communicable diseases, leading to stroke, myocardial infarctions, lung cancer as well as chronic respiratory illnesses. It also increases the risk of childhood asthma and asthma severity.

Air pollutants are a diverse range of harmful substances that contaminate the air we breathe. These include gases such as sulphur dioxide, nitrogen oxides, carbon monoxide, methane, and volatile organic compounds, as well as particulate matter like smoke, soot (black carbon), and fine dust.

In 2022, WHO estimated that 99% of the global population was exposed to air pollution concentrations that exceeded WHO’s air quality limits.

While no region of the world has been spared, low and middle-income countries bear the largest burden of premature mortality associated with air pollution.

Without implementation of aggressive interventions, the number of premature deaths caused by ambient air pollution is projected to rise by over 50% by the year 2050.

The sources of air pollution

Fossil fuel combustion, petrol- and diesel-powered vehicle emissions have been highlighted as the major contributor to air pollution-related mortalities, particularly in urban areas.

Diesel soot is a proven carcinogen with toxic effects on cardiovascular and respiratory systems.

Household air pollution, caused largely by open cooking fires and inefficient stoves, is a leading risk factor for childhood mortality, contributing to approximately 50% of deaths from acute lower respiratory infections, including pneumonia, in children under the age of five.

Beyond traditional airborne pollutants, biological air pollution – airborne pathogens such as bacteria, viruses, and fungi, particularly indoors – has gained attention.

Infected individuals can contribute to such air contamination, emphasizing the need for appropriate prevention strategies and comprehensive air quality control.

Plastics contribute to air pollution directly through its open-air combustion and through microplastics carried by wind and air currents.

RECOMMENDATIONS

The WMA acknowledges the severity of consequences stemming from air pollution and urges the following stakeholders to promptly take action to achieve clean air:

The WMA and its constituent members should:

1. Engage with local, regional, and national authorities to raise public awareness about the health impacts of air pollution and the importance of its prevention.
2. Work together with governments to develop and implement strategies to improve air quality, as identified in the WHO air quality guidelines, and mitigate the effects of air pollution. These strategies should consider the local context and reflect the latest scientific evidence.
3. Advocate for and support the integration of health impacts of air pollution and its solutions into medical curricula and professional educational programs, fostering a comprehensive understanding and proactive approach among healthcare professionals.
4. Encourage collaboration between organised medicine and other stakeholders, including government agencies and international organizations, to develop best practices for minimising greenhouse gas emissions and plastic use in healthcare settings.

The WMA urges governments to:

5. Recognise that air pollution negatively impacts human health and environmental sustainability and that existing health inequities exacerbate susceptibility to environmental hazards.
6. Recognise the important role of social and environmental determinants of health and strive to include these in policy-making processes, for example by conduction of health equity impact assessments.
7. Allocate resources and funding for reducing and monitoring air quality and implement effective pollution prevention and control measures, particularly in densely populated areas, in line with WHO’s air quality standards.
8. Enhance early warning systems for anticipated poor air quality periods and prepare health systems to handle air pollution-related health impacts effectively.
9. Implement measures that improve air quality, such as increasing access to clean energy and creating green spaces.
10. Take measures toward sustainable healthy transport by implementing strategies to decarbonise the transportation sector, such as enforcing stricter vehicle emission standards, promoting public transportation and implementing cycling and walking infrastructure.
11. Invest in and support research and innovation for cleaner healthcare sector technologies and practices.
12. Establish guidelines and standards for acceptable levels of biological contaminants in indoor air, including policies to reach those objectives such as by ensuring adequate ventilation and air filtration.
13. Strive towards good environmental governance by developing sustainable strategies, policies, and measures to address environmental hazards and take a precautionary principle approach to protect health.

The WMA recommends that international and intergovernmental agencies:

14. Recognize and promote access to clean, breathable air free from harmful pollutants as a basic human right for all people worldwide.
15. Work with governments to update public health policies, prioritize air pollution control and strengthen efforts in health promotion and pollution reduction.
16. Advocate for the maximum reduction of all sources of air pollution, recognising that it is critical for sustainability that anthropogenic (human) activities operate within the safe limits of the Earth’s ecosystem.
17. Promote and support governments in conducting health impact assessments across relevant policy sectors, empowering them to proactively reduce exposure to air pollution and safeguard public health.

The WMA urges individual physicians to:

18. Stay informed regarding health effects of air pollution.
19. Consider air pollution as a potential environmental risk factor in relevant patient consultations and where relevant, promote lifestyle modifications and preventive measures that minimize exposure to pollutants.