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Poor air quality shortens lives, increases medical costs and reduces productivity

Evidence shows us that exposure to poor air quality shortens lives, increases medical costs and reduces productivity through lost working days.

A significant proportion of Europe's urban population lives in cities where European Union (EU) air quality standards are regularly exceeded – in urban areas, Particulate Matter (PM) 2.5 alone was estimated to contribute to 1,709,000 premature deaths between 2015 and 2019.

North Macedonia has the worst urban air quality in Europe according to the European Environment Agency for Air Pollution in Europe’s latest report. This situation is driven by its location in a valley surrounded by mountains that trap pollution and further complicated by a temperature inversion - a natural phenomenon which causes warm air to remain above cool air. Socio-economic factors including low average incomes, energy poverty and reliance on solid fuels for cooking, heating and lighting all contribute to high levels of household and outdoor air pollution.

Skopje, Bitola, and Tetovo are reported as being among the 10 most polluted cities in Europe in 2017. Poor air quality in North Macedonia also contributes to significant morbidity and mortality - PM air pollution was the eighth largest mortality risk factor in 2016, linked to 7.3% of deaths."

Skopje, Bitola, and Tetovo are reported as being among the 10 most polluted cities in Europe in 2017. Poor air quality in North Macedonia also contributes to significant morbidity and mortality - PM air pollution was the eighth largest mortality risk factor in 2016, linked to 7.3% of deaths and is estimated to decrease life expectancy by 0.81 years.

In Spring 2022 , Dr William Avis and Professor Francis Pope visited the country to meet Local and National Government, Civil Society and the International development community - discussing air pollution, its impact on North Macedonia and opportunities to address this silent killer.

The University of Birmingham experts’ visit was made possible by the International Organization for Migration (IOM) and national research partners, the South East European University (SEEU). Meetings promoted a systems thinking approach to addressing air pollution challenges. Participants explored how change happens and whether a ‘tipping point’ could be reached where coalitions of change agents could exploit windows of opportunity and drive action.

It became clear that collective and multi-stakeholder cooperation is needed to address pollution across sectors - supported by the creation of spaces and places of discussion and debate to explore ways of presenting evidence in forms that stakeholders want and can act upon. Meaningful partnerships would involve citizens, civil society, private sector and government at all levels - key ingredients for development of a coalition for change to drive air quality improvement both locally and nationally.

These coalitions for change must exploit windows of opportunity in order to be successful. North Macedonia’s accession to the European Union provides one such opportunity. This is governed by Article 49 of the Treaty on EU which stipulates that a state that wishes to apply for membership must satisfy a number of conditions - including adapting national institutions, standards and infrastructure to meet its obligations such as those around air quality. North Macedonia’s application to join EU was approved in 2020 and the country is implementing EU laws and standards.

With renewed attention on environmental issues, a range of actors are working to understand the causes and consequences of air pollution and drive action:

  • The North Macedonian Government have committed to reducing air pollution – identifying sources of air pollution. The Ministry of Environment has concluded that a combination of measures aimed at changing heating methods of households and small firms, improving construction practices, and supporting integrated transport solutions are needed. There is also a need to strengthen capacities for inspection, supervision and control of air pollution.
  • SEEU is pioneering the development of low-cost sensors, calibrated to local conditions and deployed according to local priorities. These gather data on how air pollution varies across urban landscapes and measure the impact of indoor air pollutants on vulnerable groups. They also help to understand the efficacy of interventions to improve air quality. SEEU is forging connections with national and local government to ensure accuracy of data and that this data is acted upon.
  • Civil Society Organisations such as Eco Guerrilla have been active in cities such as Tetova, mobilising campaigns and advocating for action to address air quality issues. Such movements are essential for ensuring communication of the causes and consequences of air pollution and efforts to encourage uptake of interventions. They are influencing the context in which policies are developed and action initiated.

The IOM, in partnership with the University of Birmingham and SEEU are looking to support these coalitions of change agents and drive action to address poor air quality in Tetova by:

  • Producing low-cost air-quality monitors that can be deployed according to identified needs and priorities;
  • Leading air pollution monitoring, collection and dissemination of air quality data by trusted actors.
  • Delivering contextually appropriate communication campaigns that illustrate the impact of poor air quality on particular locations, populations and occupations; and

Alongside this, the University of Birmingham and Clean Air Fund are creating internationally supported development opportunities to develop air quality management capacity. By supporting and investing in locally-led approaches to address the challenge of air pollution, the partners hope to reach a tipping point where coalitions of change agents can exploit windows of opportunity and drive change.

William Avis (University of Birmingham), Mennan Selimi (South East European University), Professor Francis Pope (University of Birmingham), Vanja Lazaridis (International Organization for Migration)