Air Quality Strategies on Public Health and Health Equity in Europe—A Systematic Review

Abstract

Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review.

Distributional cost effectiveness analysis of West Yorkshire low emission zone policies

“…Few studies have evaluated the health inequality impacts of air quality strategies, and inconsistent results indicate that beneficial effects cannot be presumed. (Wang et al, )…”

“…Few studies have evaluated the health inequality impacts of air quality strategies, and inconsistent results indicate that beneficial effects cannot be presumed. (Wang et al, 2016) The West Yorkshire zone was identified as having the fourth most significant NO 2 concentration issues in the United Kingdom, with exposure concentrated in deprived inner-city areas. Exposure to atmospheric particles smaller than 2.5 μm (PM 2.5 ) was estimated to be responsible for 1 in 20 deaths in the area, and a health impact assessment showed that efforts to reduce this mortality would produce the largest benefits in the most deprived areas (Cooper, Lomas, Jones, Crowther, & Gent, 2015).…”

Local action on outdoor air pollution to improve public health

“…Effective control of traffic-related air pollution requires national action, supplemented by action by local authorities, as well as public health and healthcare professionals, employers in all sectors, and the public (Wang et al 2016). To address the need for evidence based measures, the National Institute for Health and Care Excellence (NICE), jointly with Public Health England (PHE), have published a guideline on the effectiveness of local interventions aiming to reduce emissions, ambient concentration levels and personal exposure to road-traffic-related air pollution (NICE 2017a).…”

Air Quality, Health and Community Action

“…Shandas et al [74] have made use of spatial analysis to understand the community structure, population distribution, and air quality at the neighbor- A systematic review of 15 recent publications resulted in four strategies to improve urban air quality: general regulations on air emissions, road traffic related interventions, energy generation related interventions, and greenhouse gas emission reduction interventions [92]. Particulate matter and nitrogen dioxide were the pollutants of greatest concern in these 15 papers.…”

“…The establishment of low emission zones and congestion charging schemes have been successful in reducing PM2.5 and nitrogen dioxide concentrations in the areas of the cities where they have been implemented. More than 200 low emission zones have been implemented in Europe [92]. Regulations that encourage electric vehicle purchase and use in cities improve air quality and reduce greenhouse gas emissions.…”