Mortality linked to particulate pollution remains highSanté publique France conducted a quantitative health impact assessment (EQIS) of air pollution to estimate its impact on health. The Santé publique France study provides a new national estimate of the burden of PM2.5² fine particulate pollution linked to human activity3. These new data update the latest estimate published in 2000 in the European CAFE study, which reported more than 40,000 pollution-related deaths in France. The current estimate stands at 48,000 deaths per year, confirming the same order of magnitude as the European study.

Air pollution does not affect only large cities. While the effects of this pollution are more significant in large cities, medium-sized and small cities as well as rural areas are also affected:

• in urban areas with more than 100,000 inhabitants, the results show, on average, a loss of 15 months of life expectancy at age 30 due to PM2.5;

• in areas with populations between 2,000 and 100,000, the loss in life expectancy is 10 months on average;

• in rural areas, an estimated 9 months of life expectancy are lost on average.

Proven health gains if air quality were improvedResearch by Santé publique France highlights significant potential health benefits associated with improved air quality. The results show that the most ambitious scenarios for reducing pollution levels lead to significant health benefits. For example, if all municipalities were able to achieve the PM2.5 levels observed in the 5% least polluted municipalities within the same urbanization class, 34,000 deaths could be prevented each year (an average gain of 9 months in life expectancy).

To conduct an EQIS on air pollution, the WHO recommends relying on a pollutant-health effect pair for which scientific knowledge is sufficient not only to quantify the health impact but also to establish its validity. The "PM2.5 fine particulate matter – mortality" pair meets this condition. The results of the air pollution EQIS are indeed based on a PM2.5–mortality relationship derived from French and European epidemiological studies, which all epidemiologists consider to be causal in nature.Furthermore, PM2.5 is representative of pollution as a whole: including additional pollutants such as ozone would not significantly increase the estimated impact but would weaken the estimate, as the ozone-mortality relationship is less robust than the PM2.5–mortality relationship. Pollution levels (PM2.5) were estimated in 36,219 municipalities in France for the years 2007–2008.⁵ Various scenarios for reducing pollution levels were ultimately tested, and the corresponding impacts—expressed in terms of the number of preventable deaths and the average gain in life expectancy for a 30-year-old—⁶ were compared.

Pollution spikes have a much smaller impact on health than chronic exposure. Santé publique France also conducted a study⁷ in 17 cities in France from 2007 to 2010 to calculate the contribution of pollution spikes to health effects. The results confirm previous monitoring studies: it is daily, long-term exposure to pollution that has the greatest impact on health, with pollution spikes having only a marginal effect.

Possible measures to improve health and quality of life for allNumerous studies⁸ worldwide have quantified the health benefits of various intervention policies: changes in fuel composition, implementation of congestion pricing, cycling, reduction of industrial emissions, etc. Most of these studies conclude that there are improvements in health outcomes in terms of mortality, life expectancy, hospitalizations for asthma, the prevalence of respiratory and cardiovascular diseases, and premature births…

Through this research, Santé publique France confirms that air pollution has significant public health consequences in France. The studies show that implementing measures aimed at sustainably reducing air pollution would considerably improve the health and quality of life of the population. Santé publique France’s air and health monitoring program will be expanded to include the study of pollution-related diseases, such as cardiovascular diseases, cancer, and asthma.