Public health measures are those not aimed at individuals but at society as a whole, or subgroups within society. Physicians are charged not only with promoting the health of their own patients, but as a profession we (and health care professions in general) are charged with promoting the public health.

Public health measures, however, are highly likely to cross into politically charged areas. This should not deter the promotion of public health.

Issues that we deal with regularly involving public health include vaccination programs and laws surrounding vaccine requirements, fluoridation of public water supplies, helmet laws, and even gun laws. We have never, however, written about air pollution as a public health concern (except for dubious claims that air pollution is linked to autism).

The health risk of air pollution

Air pollution as a health risk is nothing new, but several recent studies are focusing attention on this issue. Recently the Royal College of Physicians produced a report in which they claim that 40,000 deaths per year in the UK can be attributed to poor air quality, both indoors and outdoors.

This has a significant societal cost in both premature death and financial cost, which they estimate at £20 billion per year. The primary negative health outcomes from air pollution relate to asthma and heart disease.

While they discuss a large number of sources of poor air quality, the two biggest contributors by far are cars and power plants.

Individuals can have an impact, especially on air quality in the home. They recommend making sure that any gas or solid fuel burners are kept in good repair, that the home is energy efficient, keep your house well ventilated, and be aware of the effect that products with strong scents can have on air quality.

The biggest impact, however, can only be had at a societal level.

A 2008 systematic review of the total societal costs of air pollution shows how complicated such calculations can be. However, they estimate that the direct medical costs for the US alone are in the range of $40 billion per year, with additional intangible costs of around $5 billion per year.

A recent analysis just published this year estimates the total societal cost for air pollution in the US in 2011 to have been $131 billion. The majority of these costs are from effects on public health. There was some good news in the report as well, the total costs are down from $175 billion in 2002. The authors cannot be sure of the cause of this decrease but speculate that it may be due in part to air pollution regulation.

The primary source of these costs according to the report is power generation, and specifically sulfur dioxide, but nitrogen oxides, ammonia, volatile organic compounds, and fine particulate matter were also important.

Air pollution and climate change

This is where the issue becomes highly political – one of the primary concerns of those who reject the scientific consensus on anthropogenic climate change is that proposed fixes would have a huge economic cost without a clear benefit. While that is not a valid reason to deny the scientific consensus, it may not even be a valid concern.

The health care costs of air pollution alone are likely to be greater than the cost of addressing air pollution. While carbon dioxide itself is not a direct health concern, energy production methods that release CO2 also tend to release pollutants that are a health concern.

Even if we ignore the political controversy over climate change, it would be cost effective as a society if we put a priority on shifting our energy production away from fossil fuels and toward renewable sources, and to shift our transportation away from gasoline-burning vehicles to zero-emission vehicles. Reducing CO2 emissions would be a massive side benefit, but not even necessary to make these measures cost effective.

Conclusion: Reducing air pollution helps your health, the economy, and the environment

Air pollution is a huge public health concern, costing tens of thousands of lives per year in a country the size of the UK, and conservatively costing tens of billions of dollars in health care costs and premature death. Worldwide the cost is in the trillions.

Addressing the main sources of air pollution, energy production and automobiles, is a public health concern.

From a practical point of view, however, it is critical to recognize that measures to reduce air pollution are cost effective. We don’t even have to make an economic trade off or sacrifice. Controlling air pollution is a win-win, saving lives and money.

Soaring health care costs is a major concern for every industrial nation. While there is no one solution to this complex problem, we can’t afford not to pick the low hanging fruit. The cost of health care is so great, in fact, that it may outweigh other sectors, such as the energy sector.

It may be politically advantageous to focus on the obvious win-wins in the climate debate. Reducing air pollution is cost effective when you consider the health costs to society, whatever your views on climate change. This could be a back door strategy for achieving political consensus on tackling air pollution, with addressing CO2 production as an incidental bonus.


Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.