Ambient air pollution is one of eight global risk factors for deaths and accounts for 38.44 all causes death rates attributable to ambient PM pollution, while in Bosnia and Herzegovina, it is 58.37. We have estimated health endpoints and possible gains if two policy scenarios were implemented and air pollution reduction achieved. Real-world health and recorded PM pollution data for 2018 were used for assessing the health impacts and possible gains. Calculations were performed with WHO AirQ+ software against two scenarios with cut-off levels at country-legal values and WHO air quality recommendations. Ambient PM2.5 pollution is responsible for 16.20% and 22.77% of all-cause mortality among adults in Tuzla and Lukavac, respectively. Our data show that life expectancy could increase by 2.1 and 2.4 years for those cities. In the pollution hotspots, in reality, there is a wide gap in what is observed and the implementation of the legally binding air quality limit values and, thus, adverse health effects. Considerable health gains and life expectancy are possible if legal or health scenarios in polluted cities were achieved. This estimate might be useful in providing additional health burden evidence as a key component for a clean air policy and action plans.
The COVID-19 pandemic has brought a renewed interest in urban environment and healthy living and the changes in urban environments which can make for a healthier living. Today, more than 50% of the global population lives in urban areas, and in Europe the number is 75%. We present a narrative review to explore considerations and necessary requirements to achieve health and well-being within strategies for healthy design and urban planning whilst rethinking urban spaces for a post-COVID-19 and carbon-neutral future. The achievement of health and well-being demands healthy design strategies, namely, (1) moving from the concept of infrastructure for processes to the infrastructure for healthy living—requirements for healthy places, cycling, walking, disintegrating the role of polluting traffic from the urban environments, social vulnerability and equality; (2) physical space that will achieve standards of ‘liveable communities’—open, green space requirements and standards for any built environment; (3) mainstreaming ‘in-the-walking distance’ cities and neighbourhoods for healthy physical activities for daily living; (4) exploring any of the new concepts that connect the nexus of urban spaces and public health and improving of the population’s well-being. Public health needs to be prioritised systematically in planning of built environments, energy generations, sustainable food production, and nutrition.
Although the pandemic has caused substantial losses in economic prosperity and human lives, it has also some positive impacts on the environment. Restricted mobility, complete closure, less traffic and industry have led to improved air quality especially in urban settings. Not only is air pollution an important determinant of chronic diseases, such as heart and lung disorders, but it has also been shown that poor air quality increases the risk of COVID-19. In this article, we review some of the findings on changes in air quality during the pandemic, and its potential effects on health. We need to continue to monitor the effects of change in air quality, due to COVID-19 lockdown or other factors, but also keep all our efforts to improve air quality even faster and more persistent, bringing the pollution levels below what WHO recommends are safe to live with.
In 2019, 21.1 % of the EU-27 population were at risk of poverty or social exclusion. Energy poverty is one of many poverty forms and it is a widespread problem across Europe, as between 50 and 125 million people are unable to afford proper indoor thermal comfort. Energy poverty is linked to low household income, high energy costs and energy inefficient homes. These challenges are deeply connected with SDG7 and SDG1, and also produce environmental pollution. The roots of energy poverty are in polluting fuels that are the cheapest and at hand to the population in (risk of) poverty. Biomass heating is the inefficient use in old stoves and the lack of wood drying before use (the loss of up to 50% of the energy and higher energy costs of heating). Biomass and coal is also a major contributor to poor air quality in many European regions, especially in eastern part of the EU and Western Balkans. Biomass smoke contains health-damaging substances (particulate matter, PAHs etc). Studies on indoor air pollution show concentrations of PM10 may extremely exceed standards for ambient air pollution levels and put the people (mostly women and children), at increased risk of health impacts. Biomass burning also leads to the release of black carbon, which is not only a concern for health, but also as short-lived climate change forcer (SDG 13). A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40,000 deaths per year. The inefficient use of the biomass means higher costs for already ‘disadvantaged' citizens and those in risk of (energy) poverty. Energy poverty is a distinct form of poverty associated with a range of adverse consequences for people's health and wellbeing (respiratory diseases, CVD, mental health, and stress associated with unaffordable energy bills). Poverty and energy issues as environmental and health challenges should seen through SDG 1 and SDG 7, but also through SDG 8, SDG1 1 and SD G3.
Air pollution is the main environmental driver associated with health. It is well documented that poor air quality is responsible for increased risk of mortality and morbidity. The social cost of mortality in 2015 was estimated in 3 trillion (OECD, 2016). The Western Balkans (WB) comprise Albania, Bosnia and Herzegovina, Kosovo*, North Macedonia, Montenegro and Serbia covering area of 218 750 km2 and a population of 19.9 million with total GDP of €94.2 billion (Banja et al., 2020). The WB was selected for this study because it is one of the air pollution hotspots in Europe where the levels of PM2.5, PM10, NO2 and O3 are frequently above the EU Air Quality Directive guidelines. This situation has been associated with a higher proportion of premature deaths attributable to air pollution exposure (4-19% of total deaths) in this region compared to EU member states (EEA, 2021). The health impacts including mortality and morbidity were estimated for particulate matter PM2.5, ozone (O3) and nitrogen dioxide (NO2) at country and city level on the basis of exposure in 2019 derived from monitoring stations and model estimations. Mortality impacts were parameterised using the number of premature deaths. Morbidity costs included: chronic bronchitis, hospital admissions due to respiratory diseases, hospital admissions due to cardiovascular diseases, bronchitis in children, asthma in children, reduced activity days and work lost days. The costs of mortality attributable to air pollution were estimated on the basis of non-market welfare based methods (WTP approach) while morbidity costs were estimated mainly with market based methods combining both direct and indirect costs. The 2019 health costs, both per capita and as share of the GDP, associated with air pollution in the WB were considerably higher than those in EU27.
In 2019, the European Environment Agency has shown that the fine particulate matter PM2.5 caused more than 25 000 premature deaths in six Western Balkans countries alone, namely Albania 4 000, Bosnia and Herzegovina 5 900, Kosovo* 2 800, Montenegro 900, North Macedonia 3 400 and Serbia 11 400. In the same year, more than 2 200 lives were lost due to nitrogen dioxide (NO2) and ozone (O3) pollution. Air pollution and climate change are major health problems in the region. Health experts in the Western Balkans region have joined forces to highlight the importance of air quality actions and achieving zero air pollution as a prevention intervention for public health. We brought together a call for the Western Balkans policy-makers to invite them to commit to full alignment of all national air quality standards with the World Health Organization guidelines, to establish regional intersectoral cooperation to accelerate the moving to zero pollution, to including health authorities, public health institutes, and medical societies, patient representative and all health care experts and providers; to end direct or indirect public subsidies of polluting processes, especially fossil fuel activities such as coal power plants; to finalise the process of the ratification of the Convention on Long-range Transboundary Air Pollution and its protocols; to support modelling to establish economy-wide emission reduction commitments for the five main pollutants; to develop and implement Air Quality Strategies; to increase the uptake of Best Available Technologies (BAT) in accordance with the Industrial Emissions Directive; to establish an adequate air quality monitoring system, and to including through accreditation of air quality monitoring networks. Public health experts from the WB, united in the regional call, highlight the urgent need for improvements in air quality in the region together with a zero air pollution objective and a timeline to reach it.
Nature deprivation under COVID-19 lead to reduced well-being. Urban design interventions were also identified as an important contributor to the restoration of community confidence, choice, and safety. Factors related to sociodemographic, housing and lockdown were linked to changes in exposure to nature during the pandemic lockdown. Changes in exposure to nature and mental health outcomes during the COVID-19 lockdown were strongly linked. Especially young people had an increased number of mental health problems. Children and youth were more bored and worried in comparison with the pre-pandemic period. The educational institutions worldwide were closed or changed to online education during the pandemic, leading to great disturbance in students’ education and outdoor events. All “green infrastructure” (GI) resources (including parks, gardens etc.) received great attention as “essential infrastructure” supporting well-being. But, the quality, functionality and position of GI in urban areas showed inequality in distribution. Frequently, societies with greater ethnic diversity, lower income and larger health inequality suffered from unsatisfactory or lack of access. GI is important in decision-making to address inequality. This work will also present an open-air activity for all generations: A reflective walk through the oldest part of Novi Sad (EU Capital of Culture 2022), as a part of Project Reflective citizens in Novi Sad. This walking tour was led by pupils from primary school - where all generations spend useful time in open space and a safe atmosphere walking tour, learning and listening about the cultural history of the oldest part of the city. It is vital to enhance urban planning and design practices in making healthier and more resilient communities. It is necessary to underline the importance of planning green spaces that need time to form in urban areas, and which have proven to be very important for mental health in the midst of the pandemic crisis.
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