Air pollution (AP) remains a major concern for public health in France, as it does worldwide, as confirmed by reports from Santé publique France, the World Health Organization (WHO), and the international literature.

The WHO notes that AP is one of the greatest environmental risks to health and remains the fourth leading risk factor for mortality worldwide, and that by reducing AP levels, countries can reduce the burden of disease attributable to strokes, heart disease, lung cancer, and chronic or acute respiratory conditions, including asthma, to name only the most well-documented health effects. In France, 40,000 premature deaths are attributable to it each year.

Health risks associated with air pollution are likely to change due to climatic conditions, emission reduction policies, and shifts in emission sources. It therefore appears necessary to ensure epidemiological surveillance of this risk.

Epidemiological surveillance of the health effects of air quality

Pursuant to the LAURE, the Law on Air and the Rational Use of Energy of December 30, 1996, Article 3 of which stipulates that “the State shall ensure […] the monitoring of air quality and […] its effects on health,” Santé publique France established an epidemiological surveillance system for air pollution as early as 1997—the first of its kind to our knowledge—with the creation of the Air and Health Surveillance Program (Psas).

Objectives of the PSAS

The PSAS aims both to better understand the health impacts of air pollution and to develop advocacy arguments useful for evaluating and shaping public policies with the goal of protecting public health.

More specifically, the specific objectives of PSAS are:

• to deepen knowledge of the links between exposure to air pollution and short- and long-term health and to monitor the evolution of this knowledge;

• develop concentration-risk functions (CRFs) for health and air pollution indicators and update them regularly to conduct quantitative health impact assessments (EQIS-PA);

• quantify the public health and economic impacts of exposure to air pollution using EQIS-PA and economic analyses, and provide public health and environmental professionals and local stakeholders with:

  • assessments of the expected health and economic benefits of actions aimed at reducing pollution levels;

  • appropriate guidelines and tools for conducting EQIS-PA;

• contribute to national, European, and international expertise on the health effects of air pollution;

• inform the public and support¹ decision-makers in implementing local, national, and European public policies for air quality management.

Supporting local stakeholders and promoting local actions

The Psas was designed as a long-term monitoring program intended to adapt and keep pace with evolving knowledge, regulations, pollution measurements, and health data to best meet society’s expectations regarding the protection of public health.

Thus, in recent years, Santé publique France, in collaboration with its partners, has been committed to supporting local stakeholders such as local governments, the Regional Directorates for the Environment, Planning, and Housing (DREAL), and the Regional Health Agencies (ARS). To this end, EQIS-PA guides and tools have been developed in partnership with the WHO, and training sessions for local partners are organized with the French Agency for Ecological Transition (ADEME) and the School of Advanced Studies in Public Health (EHESP), with support from the WHO.

Furthermore, as part of the Cepem research project, the Psas has compiled an inventory of actions undertaken by local stakeholders to improve air quality, particularly in relation to transportation and mobility. The study extensively addresses the specific characteristics, success factors, and challenges associated with measures implemented in public transportation and mobility policies. The main challenge is to build a knowledge hub around proven actions to equip stakeholders who can use this study and promote the replication of the identified measures across the entire country.

Learn more:

• Air Quality and Health: What Measures Have Local Authorities Implemented?

Contribution to research projects

Santé publique France contributed to the research component of the CEPEM project, which aims to analyze the impacts of pollution episodes/peaks on the health of the exposed population and to evaluate the effectiveness of specific public policies implemented, within the broader context of the health burden associated with air pollution. This component aimed to understand the epidemiological characteristics of the relationship between daily levels of several air pollutants and the risk of mortality and hospitalizations, and then to put them into perspective with the regulatory thresholds defined within the framework of public policies. No effect thresholds were identified for PM10 and PM2.5 particles or NO2. Nevertheless, we were able to identify a threshold for ozone, ranging from 90 to 120 µg/m³ depending on the health indicator studied, above which daily ozone concentrations appear to increase health risks; however, this threshold is below the regulatory limits currently in effect.

Learn more:

Pascal M, Wagner V, Alari A, Corso M, Le Tertre A. Extreme heat and acute air pollution episodes: A need for joint public health warnings? Atmospheric Environment. 2021;249:118249.

Wagner V, Pascal M, Corso M, Alari A, Benmarhnia T, Le Tertre A. On the supra-linearity of the relationship between air pollution, mortality, and hospital admission in 18 French cities. Int Arch Occup Environ Health. 2023;96(4):551-563.

Linkage Plans

The PSAS’s activities align with the recommendations of the National Health and Environment Plans (PNSE) and the National Plan for the Reduction of Air Pollutant Emissions (PRÉPA). Closely linked to the impacts of climate change, the program also aligns with the Paris Climate Agreement.

PSAS activities also align with the recommendations of the Global Platform on Air and Health and the WHO Urban Health Initiative (UHI), which aim to catalyze more effective action on air pollution and greenhouse gases to achieve the United Nations Sustainable Development Goals – UN SDGs 3, 7, 10, 11, and 13.

PSAS Partners

To achieve its objectives, Psas has relied since its inception on a multidisciplinary network of partners:

• regional: accredited air quality monitoring associations (AASQA), Regional Health Agencies (ARS), Regional Health Observatories (ORS), etc.;

• national: ADEME, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Interprofessional Technical Center for Air Pollution Studies (CITEPA), EHESP, the National Institute for Industrial Environment and Risks (Ineris), the National Institute of Health and Medical Research (Inserm), Central Laboratory for Air Quality Monitoring (LCSQA), Météo France…;

• International: WHO, European Environment Agency (EEA), European Respiratory Society (ERS), Health Effects Institute (HEI), Public Health England (PHE), U.S. Centers for Disease Control and Prevention (US-CDC), U.S. Environmental Protection Agency (US-EPA)...

PSAS Air and Health Team

• At the national level, PSAS is coordinated by the Health, Environment, and Occupational Health Directorate of Santé publique France (DSET), contact: dse-air-climat@santepubliquefrance.fr

• At the regional level, the Regional Directorate (DIRE) participates in the PSAS through its regional units.

International Projects

Santé publique France is actively involved in environmental health initiatives at the international level, and the Psas plays an active role in this effort:

Preventive measures to mitigate the harmful effects of air pollution

As part of its mission to protect the public from the harmful effects of outdoor and/or indoor air pollution, Santé publique France has compiled a list of various websites designed to inform the public:

• http://www.tetesenlair.education/category/source/air-paca/

• https://www.lairetmoi.org/accueil.html

• https://www.petitesaffiches.fr/sante,065/sante-changez-d-air-avec-muse,8886.html

• http://projet-please.com/

• https://abc-dair.org/

• https://www.airducation.eu/

• www.prevention-maison.fr/

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