“Stressed” About Air Pollution
Time for Personal Action
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Article, see p 618
The modern era has borne witness to a dramatic shift in the global burden of disease toward noncommunicable illnesses associated with economic affluence (eg, diabetes mellitus, heart diseases).1 Although primeval problems menacing humanity since the dawn of time such as undernutrition/famine, unsafe drinking water, and infectious diseases persist (and may worsen in the future as a result of climate change), their relative importance has been considerably reduced during the past half-century.1,2 In contrast, anthropogenic ambient air pollution (mainly particulate matter <2.5 μm [PM2.5]) remains a recalcitrant and growing threat to global health and well-being. As of 2015, exposure to ambient PM2.5 ranked fifth—closely following hypertension, smoking, high glucose, and elevated cholesterol, respectively—as a leading global risk factor for morbidity and mortality.2 PM2.5 promotes many illnesses, including cancer and lung disease. However, the greatest portion of death and disability is from cardiovascular events (myocardial infarction, stroke, heart failure), and, as such, air pollution has been formally recognized by both the American Heart Association and European Society of Cardiology as an independent risk factor.3,4
Most recent estimates are that 4.2 million deaths (7.6% of total global mortality and 700 000 more deaths in 2015 compared with 1990)2 are attributable to ambient PM2.5. Cardiovascular diseases account for ≈57% of these deaths, with South and East Asia contributing ≈60% of total PM2.5-related mortality. Despite substantial improvements in air quality throughout much of North America, the population-weighted PM2.5 exposure has increased worldwide from 1990 (39.7 μg/m3) to 2015 (44.2 μg/m3).2 This increase was largely because of a worsening of air quality and population growth across Asia, Africa, and the Middle East. These facts paint a stark picture highlighting the clear …