Air pollution inequalities in Europe: A deeper understating of challenges in Eastern Europe and pathways forward towards closing the gap between East and West

Abstract

What this study adds: In this commentary, we address the environmental inequalities in Europe, specifically related to air pollution exposure and related health burden disparities between Western and Eastern Europe. We first, provide a background for the causes of these inequalities and links with socioeconomic and demographic circumstances. We showcase, in more detail, air quality levels, monitoring, health research, and burden situation in four Eastern European countries (Serbia, Poland, Latvia, and Bulgaria), and briefly explain links with road traffic noise and climate change challenges in the region. At the end, we summarize several pathways and recommendations for going forward and overcoming air pollution exposure and the health burden gap in Europe.Background Air pollution is the biggest environmental stressor responsible for over 420,000 premature deaths in Europe in 2022,1 from cardiovascular diseases, chronic and infectious respiratory diseases, lung cancer, and type-2 diabetes.2 Air pollution levels in Europe have declined in the last decades, which has, at least in part, been attributed to successful European Union (EU) legislation. Ambient Air Quality Directive (AAQD)3 in 2008 set air quality standards (annual mean 25 µg/m3 for particulate matter with diameter <2.5 µm [PM2.5] and 40 µg/m3 for nitrogen dioxide [NO2]). These declines are most prominent in Western and Northern Europe, and there are still notable disparities in air pollution levels within and across countries in Europe,4 interlinked closely with socioeconomic inequalities (Figure 1 and Table 1). The Eastern European region, alongside Northern Italy, stands out as the most polluted in Europe, where many countries struggle to comply with current limit values and exceed many times World Health Organization (WHO) Air Quality Guidelines. The main air pollution sources in Eastern Europe are coal-dependent energy and outdated industry sectors, the widespread use of wood and coal for residential heating and cooking, old vehicle fleets, agricultural practices with high emissions of ammonia, poor waste management with industrial burning of waste materials, and open landfill waste burning still a common practice.6 These are rooted in poverty and socioeconomic and geopolitical systems dating back to the Soviet era, the civil war in the 1990s in former Yugoslavia and surrounding areas in the Balkans that has further destabilized the region, and similar current political instability and wars, such as Ukraine, all posing setbacks to economic development and access to clean energy. In Western Europe, major sources include traffic in urban areas, in lesser part local industry, energy production and wood burning for residential heating, and transboundary pollution. In Denmark, for example, more than 50% of PM2.5 comes from secondary sources from Eastern Europe. Another explanation for high pollution in Eastern Europe is that urbanization unfolded differently between the Eastern and Western regions, shaped by their unique historical, economic, and political paths. These differences have significantly influenced urban development patterns, socioeconomic conditions, and the environmental challenges each region faces. Key differences between Eastern and Western European stem from several factors: (1) economic disparities: Western Europe possesses greater financial resources to invest in climate adaptation, green infrastructure, and environmental initiatives, while Eastern Europe often depends on EU funding to modernize outdated systems; (2) regulatory frameworks: Western European countries have historically implemented stricter environmental policies and enforcement, whereas Eastern Europe has faced delays in aligning with EU standards due to transitional economies and governance challenges; (3) technological advancement: Western European cities lead in adopting smart technologies for pollution control, waste management, and urban planning, while Eastern Europe is still catching up; (4) cultural and historical factors: decades of industrial reliance and limited environmental awareness during the socialist era have left a legacy of pollution and inadequate infrastructure in Eastern Europe. Air pollution levels are up to several-fold higher in Eastern compared with Western countries (Figure 1), with the highest median PM2.5 in 2022 of 32, 30, and 23 µg/m3 measured in Bosnia and Herzegovina, Northern Macedonia, and Serbia, respectively, and lowest of 3, 5, 5, and 5 µg/m3 in Iceland, Estonia, Finland, and Sweden, respectively.7 As the EU has just in 2024 adopted new, much stricter air quality standards, in new revised AAQD with lower limit values of 10 µg/m3 for PM2.5 and 20 µg/m3 for NO2, and is preparing to revise other environmental and climate directives, there will be growing pressure on Eastern European governments to adopt new measures and speed up actions and policies to reach new standards. Corresponding to air pollution levels, Eastern European region suffers the highest air pollution-related health burden, with the highest rates of air pollution-related premature deaths1 (Figure 1) and cardiovascular diseases.5 This presents a major challenge for the EU to achieve a reduction in PM2.5-related premature deaths by 55% and the share of people disturbed by noise by 30% by 2030,4 as set out by EU Green Deal Zero Pollution Ambition. Table 1. - Illustrating differences between selected (coauthors’ countries of residence) Western and Eastern European countries in health, economic power, air pollution levels, health impacts, and sources Country Population in 2024 Life expectancy in 2022a GDPb in EUR per capita, 2022 PM2.5 (µg/m3), 2022c PM2.5-related deaths/100,000 in 2022d West Denmark 5,961,200 81.3 48,500 8 318 France 68,402,000 82.3 35,200 10 500 East Bulgaria 6,445,500 74.2 22,500 15 1,729 Latvia 1,871,900 74.5 25,000 10 645 Serbia 6,605,200 75.2 9,059 23 2,159 Poland 36,620,970 77.2 28,200 16 1,541 EU (27 members) 447,559,200 80.6 36,000 - - Sources: EUROSTAT:ahttps://ec.europa.eu/eurostat/databrowser/view/demo_mlexpec/default/table?lang=en;bhttps://ec.europa.eu/eurostat/databrowser/view/sdg_10_10__custom_12528861/bookmark/table?lang=en&bookmarkId=3b840ba1-9c24-41f2-88d6-ccea828df7ff;cEEA5;dEEA.1 Figure 1.: Concentrations of PM2.5 in 2022 from official EU (EEA) monitoring stations (37 countries) in relation to the EU limit value (25 µg/m3) (A). Number of deaths attributed to PM2.5 above WHO guidelines of 5 µg/m3 per country in 20221 (B).In this commentary, we summarize the discussions from the workshop titled “Environmental Justice in Europe: Closing the Gap in Air Pollution Health Effects Between East and West” held at the International Society for Environmental Epidemiology Young Conference in Rennes, 5–7 June 2024. We highlight specific air pollution issues in four Eastern European countries—Bulgaria, Latvia, Serbia, and Poland—and compare them with two Western European countries, Denmark and France. These Western countries were selected due to their relevance to the coauthors, who are residents of these nations, and because they were mentioned during the workshop in discussions about the differences in air pollution between East and West (with Serbia being a non-EU member, and Poland, Latvia, and Bulgaria being EU member states). Additionally, we briefly explore the links between air pollution and other related environmental exposures, such as road traffic noise, which shares common sources with traffic-related air pollution. We also address the intersection of air pollution with climate change, as both are driven by greenhouse gas emissions—primarily from fossil fuel burning for energy production and residential heating. Finally, we outline potential strategies for reducing the air pollution gap between Eastern and Western Europe. The countries selected for the workshop were chosen to reflect the geographical, cultural, environmental, political, and climatic diversity of Eastern Europe. This range spans from the colder, less polluted northern regions (Latvia) to the warmer southern countries (Serbia, Bulgaria). The group includes both older EU member states (Poland, Latvia) and newer members (Bulgaria), as well as a non-EU country (Serbia). The countries also represent a spectrum of pollution levels and associated health burdens, from the most polluted in Europe (Serbia) to those that have made progress in environmental improvements due to EU membership (Latvia, Bulgaria, and Poland). Showcasing air quality issues in four Eastern European countries Air pollution in Serbia The latest report from the Serbian Environmental Protection Agency from 2023 concludes that air quality was category III (worst) for the majority of the largest cities in Serbia,8 with PM10 and PM2.5 as dominant pollutants. The annual mean of PM10 ranged from 14 to 60 µg/m3, with annual EU Directive 2008 and Serbian limit value (40 µg/m3) exceeded in nine of 25 cities, and daily limit value (50 µg/m3) exceeded in more than 60% of monitoring stations. The annual mean of PM2.5 ranged between 13 and 37 µg/m3 and exceeded the annual limit value (25 µg/m3) in 11 cities. The European Environmental Agency (EEA) report for the same year, based on the 13 monitoring stations from Serbia, showed PM10 concentrations ranging from 40 to 103 µg/m3, and for PM2.5 concentrations at five stations ranged between 10 and 20 µg/m3, between 20 and 25 µg/m3 in two stations, and was >25 µg/m3 at four stations.7 WHO air quality guidelines for PM10 and PM2.5, were exceeded at all monitoring stations in Serbia. Serbian national air quality monitoring network is quite comprehensive, with 96 stations in 2023,8 with 82 measuring PM10, 55 PM2.5, and 36 O3. National network is supplemented with local regional and municipality monitoring networks that cover all or some selected regulated pollutants. The question of availability and access to air quality data is, however, another issue. Data for national (automatic) network can be found online,9 but with irregular, sparse spatial and temporal coverage. WHO has in a special report on Serbia from 2019 recognized poor air quality, as well as important data limitations and gaps, calling for action.10 Epidemiological research on the health effects of air pollution is difficult due lack of air pollution models with appropriate temporal and spatial resolution, as well as the lack of cohorts or access to administrative health data for research. However, some local time-series studies have illustrated short-term air pollution impact on cardiovascular,11 cerebrovascular,12 and chronic obstructive pulmonary disease hospital admissions,13 as well as with all-cause mortality during the COVID-19 pandemic.14 Although there is a substantial collection of health and lifestyle data in Serbia, for example, the Serbian National Survey,15 Health Statistical Yearbook,16 and the National registers for diabetes, cancer, and acute coronary syndrome, these data are reported at an aggregate level, and not accessible at an individual level, nor linkable to each other, address data, etc., as needed for epidemiological research. Air pollution in Poland Although air quality in Poland has been improving, it still ranks very poorly among EU countries. According to the EEA report17 and data from the Polish State Environmental Monitoring,18 in 2022, most pollutants in Poland met the EU air quality standards.3 Exceptions include daily PM10 levels and extraordinarily high concentrations of benzo(a)pyrene (BaP), for which the target concentration was met in only 21 of 165 monitoring stations. For daily PM10 concentrations in 2022, the median was 42 µg/m3, with the highest concentrations exceeding 80 µg/m3 (the limit value is 50 µg/m3), while annual limits (40 µg/m3) were met at all monitoring stations (median and maximum concentrations were 24 and 37 µg/m3, respectively). Minor and infrequent exceedances were also recorded for NO2 (with a median concentration at the level of 13 µg/m3) in several large cities. Although PM2.5 air quality standards are met in most locations (median concentration was 17 µg/m3 and the maximum 26 µg/m3), Poland remains the country with among the highest concentrations of this pollutant. WHO guidelines for PM10, PM2.5, and NO2, are exceeded at all stations. Air quality monitoring system in Poland is quite well with monitoring stations, of which are or stations. of PM10 is out in stations and PM2.5 in stations. The of this system is the of traffic 20 in the In the of the growing of traffic-related air in cities, this of the monitoring system The and residential heating a in air quality, responsible for of PM2.5, of PM10, and of emissions in This is also the dominant of with over from fuel In cities, road significantly to being a of NO2 and some NO2 emissions from for of but in large cities, this share can reach The current air quality situation in Poland a to health and The EEA that the of of due to PM2.5 exposure in Poland is and the of deaths to PM2.5, NO2, and are several local studies on the effects of short-term exposure to air which have links with and chronic obstructive pulmonary disease hospital cardiovascular and hospital improvements in further in the of air pollutants in Poland, from the residential are to quality of in the In to the of this to a major air quality in Poland from the widespread of and is the high of in the highest concentration of this among all EU countries. In 2022, the median annual concentrations of this exceeded with a maximum of higher than the WHO concentration and the current EU target level with air quality standards will change the new AAQD comes The new standards for PM10 and PM2.5 be met at and of monitoring stations, The situation for NO2 also change, with exceedances about of compared with the current levels not be met at about of monitoring stations. Air pollution in Latvia The of air pollution in Latvia are by the of Air pollution in Latvia is by the for and Data by this are in with the report from and report on a air quality with a level of PM2.5 lower than in Latvia 14 However, the are based on the measures from measuring of four are in cities in regions, and another four in the which is the with the largest in Latvia in two stations are in the areas, is out of the in the region where the of is and only is in the major road of the The of stations and their about the quality of the The on air pollution by the is based on traffic However, traffic has a on air pollution in major sources of air pollution are and industry and but on the air pollution by these sources was not by in their last report in According to the last the mean concentrations in the cities were for PM2.5 and for For the concentrations of in at the stations were for PM2.5 and for stations out of the areas and concentrations of PM10, but not According to the data from the at the PM10 is in the level of with the level of PM10 exceeded 50 are local studies on air pollution health effects in Latvia, as there are studies or air pollution the to be not in data for air pollution and monitoring For example, there was another air pollution on of the major in the This showed the highest measures of air but it was in as a of a traffic and was a very of studies and a lack of data on major sources of air the on air quality in Latvia remains Air pollution in Bulgaria According to a report by the of and in the 2022, the was not to PM2.5 above the annual mean exposure The exposure for PM2.5 for 2022 was However, of the was to PM10 above EU standards. mean PM10 exceedances were at of monitoring stations, with of those in In the the was also to annual mean NO2 above EU standards. According to the annual for PM10 µg/m3) and NO2 µg/m3) reported by the the WHO guidelines values for these pollutants exceeded in Bulgaria is also to to the EU for where of In 2022, heating by burning fuel was the major of PM2.5 and PM10 while to emissions The major of NO2 was road by coal Air quality monitoring in the country is in with current EU standards, but with monitoring stations nine five the spatial is about 10 of those PM2.5 and their not all such as with high concentrations of for heating and and where the majority of the such fuel some have a local network of monitoring stations, such as where were within the have been about the of the data from these Bulgaria similar challenges in air pollution and health as other countries. According to the in 2022, deaths were to PM2.5, to NO2, and to Between and of the annual deaths from cardiovascular and respiratory in Bulgaria can be attributed to air with the majority due to PM2.5 from residential heating and on fuel and emissions from all are to PM2.5 levels exceeding the WHO annual and PM2.5 exposure is the main to at least from air pollution ranks air pollution the for premature mortality in the some cities and by the of sources and and have as of the cities in the in of PM2.5-related Additionally, many are and on and coal for heating their and of these health of air pollution are also in 2019 were at of the or Air pollution and related are by and which have for greater between and the of the and local in air pollution-related health Air pollution and health research in Bulgaria has been but studies still from air quality and lack of limited data on some pollutants from monitoring stations, and reliance on there is a for in environmental and a of and between with of the some notable include the of research respiratory health and of both and effects of air pollution. include a health in that found higher of poor health with higher NO2 time-series of of air and on the of the urban in health in a of over Air noise, and climate change in Eastern Europe change is that the of urbanization and traffic will in the decades and climate in urban areas the air compared with with climate change and this will lead to more urban and higher health for report has found that the impact of in Europe is with more and in Eastern and Eastern climate change out that regions are more to climate change, some Eastern European Additionally, by high air pollution levels, the health will on the of air pollution and more air pollution-related deaths on with high In to and more Eastern European cities are to a range of climate that are closely to air pollution. These include exposure due to higher and more a in and the associated and a greater of and that from to European cities. more will lead to the of in the The warmer climate will also new and air quality and health more climate and health measures for cities, more be that of urban and include the of The impact of cities and urbanization on air quality is well but still of urban climate and air quality be more and on and traffic noise traffic is of the dominant sources of air pollution in urban areas, and also a of another major stressor in urban areas, traffic noise is the biggest environmental stressor air which is growing from the research and of the EU is to in and premature levels or are across Europe driven by economic in The noise are in Eastern European cities many of which are with high traffic have older and vehicle and of and lack of in noise reduction At the same there are poor noise data, in the lack of noise monitoring in of 15 Eastern European countries. of quality noise awareness research on the health effects of noise, and with air in Eastern European in air pollution reduction measures in Eastern Europe, it is important to noise and that address both air pollution between Eastern and Western Europe are several and for forward to speed up air pollution reduction in Eastern and Europe and reducing the gap between East and for about air pollution levels and and in those specific The Eastern European region is by lower of environmental issues by poor and lack of about health and compared with Western at all levels and and can be in awareness and of on environmental as a pressure on governments for pollution reduction In it is important to provide about air pollution as well as about related issues such as noise and climate change for local research and in environmental is a lack of local on the health effects of air pollution and related exposures, due to poor research infrastructure of data on exposure or health, or and lack of in research and in and environmental As from Western Europe is not to Eastern Europe due to differences in air pollution sources and and health of the there is a for local in data and research studies are needed to the impact of air noise, and climate on health in Eastern Europe. are also for local awareness of local and can be by research between Western and Eastern and of and to and infrastructure for research in Eastern Europe. with In to the lack of for policies in Eastern Europe, it often East and that recommendations are from daily and have the cultural, and economic and of people most by air or noise and of change among these which is policies to At the same as the and of are in Eastern European countries, are to environmental issues and clean air actions and environmental standards from their This is a unique to the gap between and people and use to air pollution from local to and regional can an important in with to air pollution reduction measures in urban planning, climate traffic planning, between Western and Eastern European countries and cities in on successful air pollution reduction policies and which can be from West to air quality in Eastern Europe is not just a Pollution is over EU countries and For example, in Denmark, up to 50% of PM2.5 comes from from and Eastern the for a and to achieve air pollution across Europe. at the EU level, it is to policies and measures that than air pollution in Eastern Europe to inequalities and the gap between East and The EU provide the financial to Eastern European countries with the lowest to them to energy out adopt industrial the use of for residential heating and cooking, and and and infrastructure in cities. Additionally, it is important to local to these by that the economic in will the and to and air quality has in Europe over the decades, disparities between East and West that Eastern European to the most polluted and the highest air pollution health to several times higher air pollution mortality rates than in Western European countries. This large air pollution burden in Europe is and reducing and it be of the in EU Green Deal Zero Pollution At the 2024 International Society for Environmental Epidemiology workshop in Rennes, we the air pollution situation with from four Eastern European countries (Latvia, Serbia, Poland, and and workshop and actions to address the air pollution gap in Europe, and provide clean air for (1) data and access to on air pollution exposure and health effects for in Eastern (2) invest in research and in environmental to local on the health of air as well as related noise, climate change and their (3) and in policies and measures to (4) between Western and Eastern European countries and cities to share successful governance models for air pollution at the EU level, policies that air pollution in Eastern Europe and provide the financial for their of The that they have of with to the of this

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