Why IAQ Policies Matter: Difference between revisions

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The Importance of Clean Air and Today's Air Quality Concerns

The concern over air quality dates back to ancient times, with even Hippocratic principles of environmental health addressing this issue⁽¹⁾. As far back as 1306, King Edward of England took action by passing legislation that prohibited the burning of sea-coal due to its combustion emissions⁽²⁾. Clean air stands as a fundamental cornerstone of life, encompassing not only human existence but also the broader biosphere. Unfortunately, contemporary human activities such as industrial processes, energy generation, residential heating, and transportation persist in generating pollutants that significantly degrade air quality. The repercussions of this deterioration are vast, with air pollution inflicting significant harm upon the environment and ecosystems⁽³⁾.

Beyond the catastrophic environmental damage, the consequences of these activities reverberate profoundly in terms of human health and overall well-being. Outdoor and indoor air pollution collectively contribute to an alarming annual toll of 6.7 million premature deaths⁽⁴⁾. In fact, it is now estimated to be on par with other major global risks such as unhealthy diet and tobacco smoking⁽⁵⁾. Air pollution is now recognised as the single biggest environmental threat to human life⁽⁶⁾. Within the European Union, the consequences for citizens' quality of life remain substantial, especially in urban hubs where persistently inadequate air quality standards pose an ongoing health risk⁽⁷⁾. The economic impact is also substantial, as air pollution is projected to cost the European Union an annual total of 330 billion euros⁽⁸⁾. This financial burden encompasses the consequences of disease exacerbated by air pollution, as well as the associated loss of productivity and elevated healthcare expenses⁽⁹⁾.

Understanding Indoor Air: Challenges and Differences from Outdoor Air

While the prevailing perception is that pollution primarily poses a risk outdoors⁽¹⁰⁾, it is important to recognise that indoor environments can harbour pollution levels that are not only comparable but often exceed those found outdoors⁽¹¹⁾. Indoor Air Quality (IAQ) can be significantly compromised by elements like smoke, mould and chemicals present in certain paints, furnishings, and cleaning products⁽¹²⁾. In contrast to ambient air quality, which pertains to outdoor settings, indoor air quality encompasses the air within and surrounding buildings, with an emphasis on the comfort, well-being, and health of occupants. Given that Europeans spend 90% of their time indoors⁽¹³⁾ and that indoor spaces can sometimes be more polluted than outdoor areas⁽¹⁴⁾, comprehending the full scope of this issue and devising strategies to enhance air quality is seen as paramount both in Europe and globally.

Since the 1970s, the matter of IAQ has garnered considerable attention, with the World Health Organization addressing it in various documents and forums⁽¹⁵⁾. This problem is acknowledged as a pressing concern spanning low, middle, and high-income countries alike⁽¹⁶⁾. Individuals can encounter air pollutants in a range of indoor settings, encompassing private residences, offices, educational institutions, and public transportation systems⁽¹⁷⁾. The complexity arises from the fact that indoor air often comprises a blend of diverse pollutants, making it intricate to pinpoint the health implications linked to specific exposures⁽¹⁸⁾. Furthermore, the quality of indoor air is influenced by a multitude of factors, including the activities conducted in each space, the quality of building materials and finishes, the furnishings present, and even the level of occupancy, among others⁽¹⁹⁾. Moreover, it's worth noting that indoor environments can also be impacted by outdoor pollutants seeping in⁽²⁰⁾.

International Normative Framework

Air, vital for human existence, is acknowledged as a fundamental right. In this vein, the World Health Organisation Regional Office in Europe released its inaugural Air Quality Guidelines for Europe, assessing health risks posed by 28 chemical air pollutants⁽⁹⁸⁾. The second edition, published in 2000, expanded on these recommendations and introduced guideline values for additional substances, emphasising the need to mitigate health implications tied to air pollution. Since then, WHO has periodically issued updates, with the 2006 publication offering health-based guideline levels for major pollutants like particulate matter, ozone, nitrogen dioxide, and sulfur dioxide, contributing to global pollution abatement efforts⁽⁹⁹⁾.

In the subsequent years, mounting evidence on air pollution's adverse health impacts prompted renewed focus. Acknowledging the changing landscape, the World Health Organisations efforts were reinforced by the Sixty-eighth World Health Assembly's resolution WHA68.8 in 2015, advocating for intensified measures to safeguard populations from air pollution's health risks⁽¹⁰⁰⁾. The advent of the United Nations Sustainable Development Goals further amplified the impetus to address air pollution exposure and its health burdens, underlining its significance in global health agendas.

Concurrently, recognising the substantial health risks linked to household fuel combustion for cooking and heating, the World Health Organisation introduced specific guidelines to address IAQ in 2010. The Guidelines for indoor air quality: household fuel combustion provided evidence-based norms for clean household energy sources, such as solar, electricity, biogas, and natural gas, while emphasising the importance of achieving emission rate targets to safeguard health and the environment.

Indoor Air Quality and the Sustainable Development Goals

The Sustainable Development Goals are a set of 17 interconnected objectives established by the United Nations in 2015 to address a wide range of global challenges and ensure a more sustainable and equitable future for all. These goals encompass diverse areas such as poverty, hunger, health, education, gender equality, clean water, affordable and clean energy, decent work, and climate action, among others. These goals aim to tackle both social and environmental issues, with a focus on eradicating poverty and inequality while safeguarding the planet's ecosystems. They provide a universal framework for governments, organisations, and individuals to collaborate and take concerted actions to create positive and lasting impacts on people's lives and the planet we share.

IAQ is intricately linked to the achievement of several Sustainable Development Goals, reflecting its profound impact on global health and environmental sustainability. The World Health Organisation plays a significant role by aligning its efforts with these international commitments. As the custodian agency for reporting on SDG indicator 7.1.2, the World Health Organisation maintains the global household energy database to monitor the transition to cleaner fuels and stove combinations in households, addressing the urgent need to increase global clean fuels and technologies usage¹¹⁷.

IAQ interventions are also paramount for Goal Area 3 which focuses on promoting healthier living environments and addressing targets related to preventable deaths in new-borns and children, reducing non-communicable disease mortality, and minimising deaths and illnesses caused by hazardous chemicals and pollution. The World Health Organisation also support assessments of disease burden caused by household air pollution stemming from polluting fuels and technologies, highlighting the direct link between IAQ and SDG 3 – Good Health and Well-Being¹¹⁸.

Achieving targets set out in Goal Area 11 – Sustainable Cities and Communities – also requires IAQ interventions in order to support the development of inclusive, safe, resilient, and sustainable urban environments. Several key targets, including ensuring access to safe housing and basic services, providing sustainable transport systems, and addressing air quality concerns, underscore the significance of IAQ improvements within the urban context¹¹⁹.

Moreover, Goal Area 3 – Climate Action – holds a critical perspective on the role of IAQ in mitigating the impacts of climate change. This is underscored by the focus of targets 13.2 and 13.3, which emphasise the integration of climate change measures into policies and the enhancement of awareness. Given that indoor air pollution stands as a significant contributor to ambient air pollution, there is a critical imperative to intertwine climate action with IAQ initiatives¹²⁰.

The international normative framework for addressing air quality, both in a broader sense and with specific regard to IAQ, is anchored in the Sustainable Development Goals and the guidelines set forth by the World Health Organization, along with other pertinent technical documents. This framework not only guides European legislation but also shapes the global understanding of the importance of air quality management.

References

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(21) The World Health Organisation, “WHO Guidelines for Indoor Air Quality,” the WHO regional office for Europe, 2010. Available online: https://www.who.int/publications/i/item/9789289002134

(22) The World Health Organisation, Household Air Pollution, 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(23) The World Health Organisation, Household Air Pollution, 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(24) The European Commission, “Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: A Europe that Protects: Clean Air for All,” the European Commission, 17 May 2018. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:52018DC0330

(25) The European Commission, “Air”, 2023. Available online: https://environment.ec.europa.eu/topics/air_en

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(27) The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm

(28) The United States Environmental Protection Agency, “Introduction to Indoor Air Quality,” The United States Environmental Protection Agency, 16 May 2023. Available online: https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality#:~:text=Indoor%20Air%20Quality%20(IAQ)%20refers,and%20comfort%20of%20building%20occupants.

(29) The United States Environmental Protection Agency, “Introduction to Indoor Air Quality,” The United States Environmental Protection Agency, 16 May 2023. Available online: https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality#:~:text=Indoor%20Air%20Quality%20(IAQ)%20refers,and%20comfort%20of%20building%20occupants.

(30) The United States Environmental Protection Agency, “Introduction to Indoor Air Quality,” The United States Environmental Protection Agency, 16 May 2023. Available online: https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality#:~:text=Indoor%20Air%20Quality%20(IAQ)%20refers,and%20comfort%20of%20building%20occupants.

(31) The United States Environmental Protection Agency, “Introduction to Indoor Air Quality,” The United States Environmental Protection Agency, 16 May 2023. Available online: https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality#:~:text=Indoor%20Air%20Quality%20(IAQ)%20refers,and%20comfort%20of%20building%20occupants.

(32) Maria del Carmen González-Caballero ET AL, “Pollution, Indoor Air,” Elsevier Reference Collection in Biomedical Sciences, 2023: https://www.sciencedirect.com/science/article/abs/pii/B9780128243152006801 ; The United States Environmental Protection Agency, “Introduction to Indoor Air Quality,” The United States Environmental Protection Agency, 16 May 2023. Available online: https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality#:~:text=Indoor%20Air%20Quality%20(IAQ)%20refers,and%20comfort%20of%20building%20occupants.

(33) Directorate General for Health and Consumer Affairs, “Indoor Air Quality,” the European Commission, 2008. Available online: https://ec.europa.eu/health/scientific_committees/opinions_layman/en/indoor-air-pollution/l-2/5-pollutant-mixtures.htm#0 ; The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm ; The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(34) Directorate General for Health and Consumer Affairs, “Indoor Air Quality,” the European Commission, 2008. Available online: https://ec.europa.eu/health/scientific_committees/opinions_layman/en/indoor-air-pollution/l-2/5-pollutant-mixtures.htm#0

(35) Directorate General for Health and Consumer Affairs, “Indoor Air Quality,” the European Commission, 2008. Available online: https://ec.europa.eu/health/scientific_committees/opinions_layman/en/indoor-air-pollution/l-2/5-pollutant-mixtures.htm#0

(36) The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(37) Directorate General for Health and Consumer Affairs, “Indoor Air Quality,” the European Commission, 2008. Available online: https://ec.europa.eu/health/scientific_committees/opinions_layman/en/indoor-air-pollution/l-2/5-pollutant-mixtures.htm#0

(38) The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm

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(40) The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm

(41) The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(42) The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(43) The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm

(44) The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm

(45) Sarah Darby et al, “Radon in Homes and Risk of Lung Cancer: collaborative analysis of individual data from 13 European case-control studies,” National Library of Medicine, 27 January 2005. Available online: https://www.bmj.com/content/330/7485/223.long ; The European Commission, “Air”, 2023. Available online: https://environment.ec.europa.eu/topics/air_en

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(47) The National Institute of Environmental Health Sciences, “Indoor Air Quality,” 12 July 2023. Available online: https://www.niehs.nih.gov/health/topics/agents/indoor-air/index.cfm

(48) The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(49) The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

(98) The World Health Organisation, “The Air Quality Guidelines for Europe,” the World Health Organisation, 1987. Available online: https://apps.who.int/iris/handle/10665/107364

(99) The World Health Organisation, “WHO Global Air Quality Guidelines,” the World Health Organisation, 2021. Available online: https://apps.who.int/iris/bitstream/handle/10665/345334/9789240034433-eng.pdf?sequence=1&isAllowed=y

(100) The World Health Organisation, “WHO Global Air Quality Guidelines,” the World Health Organisation, 2021. Available online: https://apps.who.int/iris/bitstream/handle/10665/345334/9789240034433-eng.pdf?sequence=1&isAllowed=y

117 The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

118 The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

119 The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

120 The United States Environmental Protection Agency, “Introduction to Indoor Air Quality,” The United States Environmental Protection Agency, 16 May 2023. Available online: https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality#:~:text=Indoor%20Air%20Quality%20(IAQ)%20refers,and%20comfort%20of%20building%20occupants. ; The World Health Organisation, “Household Air Pollution,” 28 November 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

@@ Line 8: / Line 8: @@
 Since the 1970s, the matter of IAQ has garnered considerable attention, with the World Health Organization addressing it in various documents and forums<sup><small>(15)</small></sup>. This problem is acknowledged as a pressing concern spanning low, middle, and high-income countries alike<sup><small>(16)</small></sup>. Individuals can encounter air pollutants in a range of indoor settings, encompassing private residences, offices, educational institutions, and public transportation systems<sup><small>(17)</small></sup>. The complexity arises from the fact that indoor air often comprises a blend of diverse pollutants, making it intricate to pinpoint the health implications linked to specific exposures<sup><small>(18)</small></sup>. Furthermore, the quality of indoor air is influenced by a multitude of factors, including the activities conducted in each space, the quality of building materials and finishes, the furnishings present, and even the level of occupancy, among others<sup><small>(19)</small></sup>. Moreover, it's worth noting that indoor environments can also be impacted by outdoor pollutants seeping in<sup><small>(20)</small></sup>.
-== Indoor Air Quality Relationship to Human Health ==
-Air stands as a fundamental life-building element, and the quality of indoor air in settings like homes, schools, public structures, healthcare facilities, and private residences plays a pivotal role in people's well-being and overall health<sup><small>(21)</small></sup>. Globally, household air pollution caused a staggering loss of 86 million healthy life years in 2019, with the heaviest burden borne by women and children in low- and middle-income nations<sup><small>(22)</small></sup>. An estimated 3.2 million deaths in 2020 were attributed to household air pollution, including over 237,000 deaths of children under five<sup><small>(23)</small></sup>. In the European Union, air pollution in its entirety emerges as the foremost environmental health concern, causing an estimated 400,000 premature deaths annually<sup><small>(24)</small></sup>. Poor air quality is associated with a range of severe health issues, including asthma, chronic obstructive pulmonary disease, cardiovascular disorders, strokes, and lung cancer, among others<sup><small>(25)</small></sup>, while also intensifying morbidity and mortality related to cardiovascular and respiratory conditions<sup><small>(26)</small></sup>.
-'''Both short-term''' and '''long-term exposure''' to indoor air pollution can give rise to various health complications<sup><small>(27)</small></sup>. Short-term effects encompass symptoms such as eye, nose, and throat irritation, along with headaches, dizziness, and fatigue, which are generally transient and treatable<sup><small>(28)</small></sup>. However, these symptoms can exacerbate pre-existing conditions like asthma<sup><small>(29)</small></sup>. Conversely, certain health consequences may manifest only after prolonged and repeated periods of exposure<sup><small>(30)</small></sup>. Sustained exposure to particulate matter and other pollutants in household air pollution can inflame airways and lungs, impair immune responses, and diminish blood's oxygen-carrying capacity<sup><small>(31)</small></sup>, potentially leading to respiratory diseases, heart ailments, and cancer<sup><small>(32)</small></sup>.
-Furthermore, '''specific demographic groups''', including children, women, the elderly, and individuals with pre-existing conditions, as well as socioeconomically disadvantaged households, are especially '''vulnerable''' to indoor air pollution<sup><small>(33)</small></sup>. Vulnerability depends on the specific pollutant and a group's susceptibility to it<sup><small>(34)</small></sup>. Studies indicate children's heightened susceptibility to pollutants like tobacco smoke, lead, and phosphorous-containing pesticides, which can cause coughing, bronchitis, worsened asthma, and other respiratory illnesses<sup><small>(35)</small></sup>. Globally, almost half of all deaths from lower respiratory infections in children under five are attributed to inhaling particulate matter from household pollution<sup><small>(36)</small></sup>. Elderly individuals might be particularly vulnerable to air pollution due to reduced chemical elimination capacity with age, though they may also exhibit reduced sensitivity to certain effects like eye or nose irritation. People with cardiovascular issues are more susceptible to particles, while those with respiratory ailments like asthma are more prone to various air pollutants<sup><small>(37)</small></sup>.
-Indoor air pollution, including particulate matter, allergens, endotoxin, and mould, has been linked to '''compromised health''' and '''performance''' in both children and adults<sup><small>(38)</small></sup>. Certain chemicals may induce irritation of the eyes and upper airways, affecting cognitive abilities<sup><small>(39)</small></sup>. Direct links have also been established between exposure to nitric oxide and adverse cognitive outcomes, including reduced verbal abilities and executive functioning<sup><small>(40)</small></sup>.
-Among the 3.2 million global deaths attributed to household air pollution, 21% result from lower '''respiratory''' infections, particularly affecting children<sup><small>(41)</small></sup>. Additionally, 19% are related to chronic pulmonary disease and 6% to lung cancer<sup><small>(42)</small></sup>. The presence of mould and humidity levels, impacting mould prevalence indoors, correlates with long-term health effects, notably asthma severity<sup><small>(43)</small></sup>. Moreover, household pollution exposure during pregnancy has also been linked to altered lung development, subsequently elevating the risk of pneumonia within a child's first year<sup><small>(44)</small></sup>. Specific pollutants like radon, asbestos, arsenic, tobacco smoke, and others in indoor air have been associated with cancer, especially lung cancer<sup><small>(45)</small></sup>.
-Research has also shown that markers of '''cardiovascular''' disease can manifest even at ozone levels lower than WHO guidelines<sup><small>(46)</small></sup>. In healthy adults, short-term exposure to both indoor and outdoor ozone has been linked to elevated blood platelets, a clotting risk factor, and increased blood pressure<sup><small>(47)</small></sup>. Astonishingly, 32% of the 3.2 million global deaths due to household pollution exposure result from ischemic heart disease, while an additional 23% stem from stroke due to pollutants from solid fuels and kerosene in indoor environments<sup><small>(48)</small></sup>. Evidence also points to connections between household air pollution and low birth weight, tuberculosis, cataracts, and cancers of the nasopharynx and larynx<sup><small>(49)</small></sup>.
-However, the '''complete scope of health effects stemming from indoor air pollution remains largely unknown''', characterised by numerous gaps in knowledge. This issue exhibits a complexity and prevalence that surpasses the current grasp of research.
 == International Normative Framework ==