How much is air pollution costing our health

This is happening everywhere

About this report

In many European cities, air pollution poses a significant threat to human health. For Europe, the World Health Organization estimate for the number of premature deaths attributed to air pollution is over 500,000 (WHO Europe, 2018), with 400,000 early deaths in the EU-28.

Mortality and morbidity caused by air pollution imposes a significant loss of welfare for European citizens. Globally, air pollution is considered as the fourth highest cause of death among all health risks, exceeded only by high blood pressure, diet and smoking (HEI, 2018).

This new report Health costs of air pollution in European cities and the linkage with transport by CE Delft, commissioned by a consortium of public interest NGOs in ten European countries ( Spain, France, Germany, Poland, Slovakia, Hungary, Romania, Bulgaria, The Netherlands, Italy) led by the European Public Health Alliance is the largest of its kind and follows up on the 2018 study on Health Impacts and Health Impacts of Diesel Emissions in the EU, in nine European countries.  It uses a comprehensive common methodology to uniquely examine the health costs of air pollution for 432 cities across all EU countries, Norway, Switzerland and the United Kingdom.

In this way cities can be compared with each other and conclusions can be drawn on which cities are most adversely affected by air pollution. The report also investigates to what extent air pollution can be reduced by transport-related mitigation policies.  Through planning, organizing and regulating various modes of transport, city governments can have decisive influence on  air quality.

Key Findings

The report quantifies the monetary value of medical treatment, premature death, lost working days and other health costs caused by the three air pollutants, causing the most illness and death: particulate matter (PM), ozone (O₃) and nitrogen dioxide (NO₂).

  • For all 432 cities in our sample (total population: 130 million inhabitants), the social costs quantified were over € 166 billion in 2018. or €385 million per city on average, per year. 
  • Those living in big, expensive cities tend to face the highest costs due to population density, higher earnings and expenses. The five cities with the highest social costs are London (€ 11.38 billion, followed by Bucharest, (€ 6.35 billion), Berlin (€ 5.24 billion), Warsaw (€ 4.22 billion) and Rome (€4.11 billion).
  • In 2018, on average every inhabitant of a European city suffered a welfare loss of over € 1,250 a year owing to direct and indirect health losses associated with poor air quality, equivalent to 3.9% of income earned in cities.  In many cities in Bulgaria, Romania and Poland the health-related social costs are between 8-10% of income earned.
  • Premature mortality is the largest component in social costs. For the 432 cities investigated, the average contribution of mortality to total social costs is 76.1%. The largest share of this is related to pollution of PM2.5. Conversely, the average contribution of morbidity (diseases) is 23.9%. The development of Chronic Obstructive Pulmonary Disease (COPD) contribute to the largest morbidity related costs from air pollution.

The costs calculated in this study are likely to become higher if the costs from COVID-19 are properly included. Co-morbidities feature prominently in the mortality of COVID-19 patients and among the most important of these are those associated with air pollution. Poor air quality tends to increase mortality from COVID-19 cases, and therefore, the social costs of poor air quality may be higher than estimated in this research.

Where are costs highest in Europe?

The top three cities with the highest healthcare costs, per country


What the report tells us

  • Reducing air pollution in European cities should be among the top priorities in any attempt to improve the welfare of city populations in Europe.
  • As car ownership and journey times to work tend to be positively correlated with higher levels of air pollution, national and city level governments have an important role to play in influencing transportation habits and thus improving air quality through transport policies. 
  • Transport policy decisions affecting urban mobility should also take into account the social costs.The social costs should also be assessed when calculating the transition of urban mobility from the internal combustion engine to zero emission alternatives, including e-mobility.
  • More detailed research is needed on the relationship between local transport policies and air pollution. Transport policies which improve air quality can have co-benefits for public health if they also stimulate increased physical activity such as walking or cycling.
  • Improving the network of monitoring stations in cities is necessary so that a more accurate relationship between human health and air pollution can be assessed. Without a systemic and uniform way of measuring air pollution the related social costs may be being seriously underestimated.

Read our other reports about the effects of transport-related air pollution

diesel cars

Health impacts and health costs of diesel emissions in the EU

Air pollution and transport policies at city level

Project partners

Environmental and public health organisations are working in nine European countries to raise awareness of the impact of transport pollution and to bring about change.  Find out more about our partners and what they are doing to ensure #CleanAirHealthyCities