A grave public health crisis looms over Europe, as a comprehensive investigation has unveiled that nearly everyone on the continent resides in areas plagued by hazardous levels of air pollution.

This alarming revelation stems from an analysis that employed cutting-edge methodologies, including satellite imagery and data from over 1,400 ground monitoring stations. The study paints a bleak portrait of polluted air, with 98% of Europe’s population living in regions with high levels of fine particulate pollution that exceed the World Health Organization’s (WHO) guidelines. Moreover, nearly two-thirds of Europeans dwell in areas where air quality surpasses the WHO’s standards by more than double.

North Macedonia ranks as the worst-hit European country, with almost 60% of its populace residing in areas where PM2.5 levels (tiny airborne particles primarily originating from fossil fuel combustion) are more than four times the WHO guidelines. Disturbingly, certain regions, including the capital, Skopje, experience air pollution nearly six times the recommended levels.

Eastern Europe, except for Italy, exhibits significantly worse air quality compared to Western Europe. In Italy, more than a third of residents in the Po Valley and surrounding northern regions breathe air four times the WHO’s threshold for the most perilous airborne particulates.

This study collaborated with pollution experts to produce an interactive map highlighting the most severely impacted areas on the continent. The measurements pertain to PM2.5, which can penetrate the lungs and bloodstream, affecting numerous organs. The WHO’s guidelines stipulate that annual average PM2.5 concentrations should not exceed 5 micrograms per cubic meter (µg/m³). Alarmingly, just 2% of Europe’s population resides in areas meeting this limit. It is estimated that PM2.5 pollution causes approximately 400,000 annual deaths in Europe.

“This is a severe public health crisis,” said Roel Vermeulen, a professor of environmental epidemiology at Utrecht University who led the team of researchers across the continent that compiled the data. “What we see quite clearly is that nearly everyone in Europe is breathing unhealthy air.”

Additional findings from the research include:

• Nearly all residents in seven Eastern European countries – Serbia, Romania, Albania, North Macedonia, Poland, Slovakia, and Hungary – are exposed to air pollution levels twice the WHO recommendations.
• More than half the populations of North Macedonia and Serbia endure air quality with four times the WHO’s figures.
• In Germany, three-quarters of the population live in areas with more than double the WHO’s recommended levels. Spain and France exhibit figures of 49% and 37%, respectively.
• In the UK, three-quarters of the population live in areas where exposure is between one and two times the WHO guidelines, with nearly a quarter exceeding the limit by more than two times.
• Approximately 30 million Europeans inhabit regions with PM2.5 concentrations at least four times the WHO guidelines.
• In contrast, Sweden features no areas where PM2.5 exceeds twice the WHO’s figures, and certain regions in northern Scotland fall below the WHO threshold.

PM2.5 pollution primarily originates from traffic, industry, domestic heating, and agriculture, and its adverse effects often disproportionately affect impoverished communities.

Air pollution has gained prominence as a critical issue in Europe, with mounting pressure on the European Union to take more extensive measures to combat this escalating public health crisis. Recently, the European Parliament voted to adopt WHO guidelines for PM2.5 by 2035, setting legally binding annual concentration limits of 5µg/m³, down from the current 25µg/m³.

However, experts emphasise the need for urgent action. A growing body of evidence reveals that air pollution has far-reaching consequences, impacting almost every organ in the body and linking to various health issues, from heart and lung diseases to cancer, diabetes, depression, mental illness, cognitive impairment, and low birth weight. Recent studies even implicate air pollution in 1 million stillbirths annually and the presence of billions of toxic air pollution particles in the hearts of young people in urban areas.

Dr. Hanna Boogaard, an expert on air pollution in Europe at the US Health Effects Institute, underscores the importance of this analysis in informing the debate about air pollution and its impact in Europe, where it leads to hundreds of thousands of annual deaths.

“These deaths are preventable and the estimate does not include millions of cases of non-fatal diseases, years lived with disability, attributable hospitalisations, or health effects from other pollutants.”

She said the move to toughen up the EU’s limit provided “a unique opportunity to be bold … and maximise public health benefits for Europe and beyond.”

Research further highlights the injustice of air pollution, indicating that poorer communities are more likely to reside in areas with the worst air quality. Barbara Hoffmann, a professor of environmental epidemiology at the University of Düsseldorf, describes air pollution as an issue of “environmental injustice.”

“The countries that are hit most are also the countries with the lowest mean income, with a few notable exceptions – this illustrates the degree of environmental injustice we are experiencing in the EU. Cleaning up the air specifically in eastern Europe is urgently needed to provide equal opportunities for a healthy life across Europe.”

This data was compiled by researchers at Utrecht University in the Netherlands and the Swiss Tropical and Public Health Institute as part of the EU-funded Expanse project. They employed a range of sources, including high-resolution satellite data, pollution monitoring stations, and land use information, to model annual average PM2.5 levels across Europe in 2019.

While pollution levels may not have significantly changed since then, areas that have implemented stringent anti-pollution measures may have seen some improvements. This research provides one of the most accurate and comprehensive assessments of air pollution across the continent to date.

Vermeulen said: “This is the best data that there is available at the moment … Now we need politicians to be bold and ambitious and take the necessary urgent steps to tackle this crisis.”