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Reducing air pollution in low- and middle-income countries: an economic perspective.

Health is highly influenced by the quality of the air we breathe. Exposure to pollution is a major cause of non-communicable disease (NCD) morbidity and mortality, especially in low- and middle-income countries (LMICs). A UNDP report published in 2022 highlighted the dramatic effects of air pollution especially in Asia. NCDs, including stroke, heart disease, diabetes, lung cancer, and pulmonary disease, are a key development challenge. There are two main sources that impact the quality of air: ambient air pollution (AAP) which describes outdoor air pollution, and household air pollution (HAP) which describes indoor pollution. It is estimated that as much as one-fifth of AAP worldwide is attributable to domestic sources such as fuel burning for cooking.

AAP has become one of the most pronounced global environmental hazards and is a major risk factor for numerous chronic diseases, posing a major threat to economic development. In some settings, such as North America and Europe, countries have managed to decrease exposure to AAP. However, other regions have made little progress in mitigating this environmental hazard. Although there is no truly safe level of exposure to PM2.5 (dangerous fine particulate matter), WHO Air Quality Guidelines recently reduced its recommended exposure level from an annual average of 10 µg/m³ to an annual average of 5 µg/m³ to minimize the excess health burden from AAP-attributable diseases.

HAP has also been cited as one of the major causes for LMICs being unable to achieve the Sustainable Development Goals (SDGs). HAP is the world’s leading environmental health risk, causing acute respiratory tract infections, chronic obstructive pulmonary disease, lung cancer, cardiovascular disease, cataracts, burns and poisonings, asthma, and low birthweight and perinatal mortality (SDG 3), especially among women and young children who spend the most time in and around cooking areas. Traditional cookstoves often powered by biomass emit significantly more pollutants with global warming potential than more efficient cookstoves undercutting climate action (SDG 13).

Tackling the air pollution problem requires a multisectoral approach with political willingness from the environment, health, economic, and infrastructure sectors. National discourse is needed around which interventions to implement. Besides budgetary considerations, other non-financial facets like available capacity and the infrastructure need to be taken into account when deciding on actions to tackle air pollution. This process should be accompanied by evidence-based strategies to understand intended and unintended effects of action on the health burden and its associated costs.

In 2020, UNDP in partnership with European Commission embarked on a three-year global project called “Advancing Health and Environmental Sustainability through Action on Pollution” in three countries: India, Mongolia, and Ethiopia. The overall goal of the project is to address pollution as a key environmental determinant of NCDs as part of broader efforts to respond to environmental degradation and the changing climate. The project will contribute toward lowering NCD morbidity and mortality through strengthened multisectoral action on the environment and health by scaling up successful initiatives on combating air pollution. Triangulate Health ltd is leading the Mongolian investment case.

In conclusion, the field of air pollution and its effects on various other sectors is of high political relevance. We are therefore anticipating seeing more and more national multi-stakeholder discourse around air pollution with the need for economic analyses in this area.

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