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been returned for every $1 invested in air pollution control since 1970 (Landrigan et al. 2018a). Greater health benefits in the future are possible. For example, Shindell et al. (2018) examined the human health benefits of achieving a 2°C scenario: the decreased air pollution was calculated to lead to approximately 150 million fewer premature deaths worldwide with about 40% of these prevented deaths during the next 40 years, but the assumptions and extrapolations seem optimistic.

control measures that are beneficial for climate change and vice versa (that is, action to mitigate climate change that will also reduce pollution). Two prime examples are the use of renewables for electricity generation, which reduces emissions both of GHGs and of locally acting pollutants from fossil fuel combustion, and modal shifts in transport towards more active and lower emission modes. These examples are discussed further below. Connecting the climate policy agenda with public health issues can potentially mobilise additional support and enthusiasm for environmental sustainability (German National Academy of Sciences Leopoldina 2015), helping to make the case to policy-makers who want to see impact in the short term. The Leopoldina analysis emphasises the broader priorities for ascertaining health co-benefits, as follows. •

Accelerate the move away from fossil fuels40 and the move towards clean energy sources.

Acknowledge the overall climate-health nexus.

Appreciate the major benefits of reduced air pollution.

Promote measures that help to mitigate climate change and improve health.

Among the global evidence for specific co-benefits (see, for example, Haines et al. 2009; Whitmee et al. 2015; Chang et al. 2017) are studies on the following. •

Household energy. For example, replacing solid fuels for domestic use with clean fuels could avert many of the 3 million premature deaths annually due to household air pollution worldwide. If the solid fuel is replaced by electricity generated from clean renewable sources it would also contribute to climate change mitigation.

Electricity generation. For example, reducing coal use would also reduce both GHG emissions and particulate air pollution resulting in near-term health benefits (West et al. 2013; Markandya et al. 2018). Air quality improvements in high-income countries yield substantial economic gains as well as reducing deaths from cardiovascular and respiratory diseases (and these gains are likely to be underestimates of public health impact (Graffzivin and Neidell 2018)) but see further discussion of the challenges of economic assessment in section 4.8. For example, in the USA, an estimated US$30 in benefits has

Urban transport. For example, modelling studies suggest that low-carbon transport and increasing active travel would lead to lower GHG emissions and decrease the burden of disease arising from sedentary behaviour. A broader study on the issues involved in the decarbonisation of transport was recently published by EASAC (2019)41.

Agriculture and food systems. For example, reducing consumption of animal source food and increasing fruit and vegetable consumption would be expected to reduce cardiovascular and other non-communicable diseases (see subsequently) and lead to reduced GHG emissions from livestock production.

In the following sections we provide further information on some of these health co-benefits of the low-carbon economy, in the European context. 4.4  Case study in mitigation: sustainability and health gains in European cities Urban policies are critically important for the future of planetary health because, globally, 85% of GDP and 75% of energy-related GHG emissions are associated with cities. A recent study of data from 25 EU cities estimated that life expectancy could be increased by up to approximately 22 months if long-term PM2.5 concentration was reduced to the WHO guideline level in the most polluted cities (WHO Europe 2017a). Ongoing work by WHO Europe is estimating the health benefits of reducing PM2.5, sulfur dioxide and NOx in line with the Paris Agreement: preventable premature mortality from reduced air pollution in 2030 (if all countries implemented their intended nationally determined contributions to mitigate emission levels) could amount to 74,000 fewer deaths in the WHO Europe region, accompanied by 49,000 fewer hospital admissions, 1.9 million fewer asthma attacks, 350,000 avoided cases of bronchitis in children and 50,000 fewer in adults, and 17 million fewer lost work days.

40  According to Eurostat data, the main EU sources of GHGs are: electricity and heat production > manufacturing industry and construction > transport > residential/commercial > agriculture (EEA 8/2017 ‘Analysis of key trends and drivers in greenhouse gas emissions in the EU between 1990 and 2015’). The contribution by agriculture will be higher if land use changes are counted as in EASAC (2017b). The agricultural production of ammonia, which contributes to particulate air pollution, and of methane, a precursor of tropospheric ozone, also contributes to human health problems. 41


Climate change and health  |  June 2019  |  35

The imperative of climate action to protect human health in Europe  

Opportunities for adaptation to reduce the impacts and for mitigation to capitalise on the benefits of decarbonisation. The pace and extent...

The imperative of climate action to protect human health in Europe  

Opportunities for adaptation to reduce the impacts and for mitigation to capitalise on the benefits of decarbonisation. The pace and extent...