The study thus expands our understanding of the impact of ambient air pollution in France: it shows that, beyond mortality, exposure to this pollution also has significant consequences for the onset of chronic respiratory, cardiovascular, and metabolic diseases. Eight of these diseases were included in the study, based on available data and under various scenarios for reducing pollution.

The study estimates that between 12% and 20% of new cases of respiratory diseases in children (i.e., between 7,000 and nearly 40,000 cases, depending on the disease and the pollutant in question) and between 7% and 13% of new cases of respiratory, cardiovascular, or metabolic diseases in adults (i.e., between 4,000 and 78,000 cases, depending on the disease and pollutant in question) are attributable annually to long-term exposure to ambient air pollution linked to human activities. It also highlights that reducing concentrations of fine particulate matter (PM2.5) and nitrogen dioxide (NO²) to levels equivalent to WHO guideline values would prevent a large proportion of these cases.

Furthermore, the study provides an economic assessment of these impacts across mainland France.

In the context of the recent adoption of the new European directive on ambient air quality and the “Clean Air for Europe” program, these new data reaffirm the public health stakes surrounding air pollution and encourage sustained efforts to reduce pollution from all sources across the entire country.

Tens of thousands of cases of diseases that could be prevented by reducing levels of fine particulate matter and nitrogen dioxide in ambient air

Through this study, Santé publique France sought to assess, in mainland France for the period 2016–2019, the impact of the population’s exposure to ambient air pollution on the development of eight diseases that have a scientifically proven link to exposure to PM2.5 and/or NO2, namely:

• Respiratory diseases: lung cancer, chronic obstructive pulmonary disease (COPD), asthma in children and adults, pneumonia, and other acute lower respiratory tract infections (excluding influenza);

• cardiovascular diseases: stroke, acute myocardial infarction, hypertension;

• metabolic: type 2 diabetes.

This study complements the findings published by the Agency in 2021, which indicated that mortality linked to ambient air pollution remains a significant risk in France, with 40,000 deaths attributable to fine particulate matter each year.

This study was conducted in partnership, on the health side, with INERIS, ORS Île-de-France, CREAI-ORS Occitanie, Citepa, and the Clinical Investigation Center 1401 – Clinical Epidemiology (Inserm/Bordeaux University Hospital), and on the economic side with the Aix-Marseille School of Economics (Aix-Marseille University/CNRS). It drew on the methodology used in the World Health Organization (WHO) EMAPEC project, “Estimation of Morbidity Due to Air Pollution and Its Economic Impacts,” to which Santé publique France also contributed.

The results highlight that, beyond its impacts on mortality, exposure to air pollution constitutes a significant health burden in mainland France in terms of the incidence of the eight chronic diseases studied.

Depending on the disease and pollutant studied, between 12% and 20% of new cases of respiratory diseases in children (i.e., between 7,000 and nearly 40,000 cases), and between 7% and 13% of new cases of respiratory, cardiovascular or metabolic diseases in adults (i.e., between 4,000 and 78,000 cases) are attributable annually to long-term exposure to anthropogenic pollution in mainland France.

The study shows that reducing PM2.5 and NO2 concentrations to levels equivalent to WHO guideline values would prevent 75% of these cases of diseases linked to exposure to PM2.5 associated with human activities and nearly 50% for NO2. For example, compliance with the WHO guideline value for PM2.5 would prevent nearly 30,000 new cases of asthma among children aged 0 to 17.

Furthermore, the study suggests that the expected health benefits would generally be greater in more disadvantaged and more urbanized areas. However, these results must be interpreted with caution and will need to be confirmed by further research, given the high variability of these results across different levels of deprivation within and between regions.

A Major Economic Impact

The study also estimates that in mainland France, the population’s exposure to ambient air pollution represents an annual economic impact in terms of health and well-being for the diseases studied. This impact is estimated at 12.9 billion euros for PM2.5, or nearly 200 euros per year per capita, and at 3.8 billion euros for NO2, or 59 euros per year per capita.

If WHO guideline values were met, these benefits would be 9.6 billion euros (or 148 euros per year per capita) and 1.7 billion euros (or 26 euros per year per capita), respectively.

Taking action to reduce air pollution is a priority

The results of this study underscore the importance, in terms of public health, of continuing and strengthening the measures implemented by public authorities to meet the objectives of the new European directive on ambient air quality and “Clean Air for Europe.” This directive aims to first lower the European Union’s air quality standards and then eventually align them with the WHO’s most recent guideline values. These actions involve continuing efforts to reduce pollution from all sources across the entire territory through strategies and action plans implemented at the national and local levels.

In the “European Green Deal,” the European Commission has committed to further improving air quality and aligning EU standards more closely with WHO recommendations. In its “Zero Pollution” action plan, the European Commission thus commits to reducing the impact of air pollution on health by more than 55% by 2030.

Santé publique France emphasizes that compliance with WHO guideline values would, in the long term, significantly reduce overall mortality and morbidity attributable to air pollution in France, contributing to achieving the objective of the “WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases,” namely a one-third reduction in the risk of dying from a chronic disease by 2030.