Even low-level air pollution may harm health

A hazy cityscape with the world in the foreground and a factory burning fossil fuels with a dark cloud of pollution rising into the sky

A new scientific report supports research suggesting that even low levels of pollution — well below the current national regulatory cutoffs — may harm our health.

Outdoor air pollution stems largely from the burning of fossil fuels (coal, gas, oil), which generate noxious gases, smog, and soot. Smog, which makes air look hazy, is created by ground-level ozone. Soot is fine particles — you may see a dusting of soot on a windowsill, for example. The burning of fossil fuels is a major contributor to climate change that occurs over years, but it has more immediate health effects.

How can air pollution affect our health?

Research links increased levels of fine particles in the air that are tiny enough to be easily inhaled (called PM2.5) to more hospitalizations for heart disease, stroke, diabetes, and pneumonia. It also worsens existing lung disease, known as chronic obstructive pulmonary disease (COPD), and may cause other serious health problems. Both long-term exposure and short-term exposure seem to matter to our health.

A 2021 study looked at global models of pollution levels and risk assessments of the world population over 14 years. It tied fossil fuel alone to nearly nine million premature deaths worldwide in 2018 — that’s one in five deaths — including more than 350,000 in the United States. Most of these deaths are due to heart attacks and strokes.

People with underlying health conditions like asthma, heart disease, or diabetes, older adults, and people who live in low-income communities, which are often situated near polluting sources, are among those who are more likely to be harmed by air pollution.

How does low-level pollution affect us?

In the US, air pollution has improved quite a bit since the passage of the 1970 Clean Air Act. Current air quality standards set by the Environmental Protection Agency (EPA) spell out a certain annual threshold of particulates aimed at protecting health. But as we learn more about complex relationships between pollution and our ecosystem, growing evidence suggests that harm may occur at PM2.5 levels lower than the current standard.

The new Health Effects Institute report (note: automatic download) studied 68 million older Americans from all but two states across the US over a 16-year period.

The researchers had set themselves an incredibly challenging question to answer. There are innumerable variables to calculate: an individual’s exposure to pollution based on where they live, the independent contribution of the major air pollutants separately, health and behavior confounders that factor into mortality, and more.

The study drew on Medicare demographic and mortality data from more than 68 million Americans ages 65 and older. Calculations of yearly average pollution exposures came from multiple sources, including the EPA Air Quality System monitoring and satellite-derived data. The authors adjusted for many factors known to affect health, such as socioeconomic status, smoking, and body mass index. They developed several statistical models, all of which demonstrated similar results: between 2000 and 2016, death rates rose by 6% to 8% for each incremental increase in PM2.5 exposure.

Just how small were these increases in exposure to air pollution? Particle pollution is measured in micrograms per cubic meter of air (μg/m3). Each time exposure levels rose by 10 μg/m3, death rates also rose by 6% to 8%. Excess deaths occurred even at low levels of PM2.5 exposure (2.8 μg/m3), which is well below the current EPA standards cutoff. The study authors estimate that adjusting the cutoff down from the current level of 12 μg/m3 to 10 μg/m3 could save more than 143,000 lives over 10 years.

What are the limitations of this study?

One limitation is that the variety of data are compiled at different levels: the individual, zip code, and county level. For example, pollution exposure is estimated in clusters by zip code. Yet someone living near a highway may have higher exposure than another person living further from the highway in the same zip code.

Additionally, the groups with the lowest PM2.5 exposure most likely exclude many cities and include a higher proportion of rural areas. Rural areas tend to be less dense, have fewer air quality data points, and may have zip codes spanning greater distances. Details like these may affect the certainty of conclusions that can be drawn. Nonetheless, this study has many groundbreaking features with sound science.

Staying healthy: The bottom line

Air pollution is known to contribute to disease and death. Now we have more evidence suggesting that this is true even at low levels of pollution. Currently the US is considering whether to adjust regulatory cutoffs for annual fine particulate matter pollution known as PM2.5 to protect human health.

But don’t wait. You can take steps described in my previous blog post to reduce your exposure (and contribution) to pollution, and thus your health risks. And some of these steps have the added benefit of combatting climate change and improving planetary health.

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Long-lasting healthy changes: Doable and worthwhile

Graphic of the words "old habits" and "new habits" on torn blue paper

I’ve been a physician for 20 years now, and a strong proponent of lifestyle medicine for much of it. I know that it’s hard to make lasting, healthy lifestyle changes, even when people know what to do and have the means to do it. Yet many studies and my own clinical experience as a Lifestyle Medicine-certified physician have shown me a few approaches that can help make long-lasting healthy lifestyle changes happen.

What is lifestyle medicine?

In the US, lifestyle medicine is built around six pillars: eating healthy foods; exercising regularly; easing stress; getting restful sleep; quitting addictive substances like tobacco and limiting alcohol; and nurturing social connections.

How will this help you? Here’s one example. A study published this summer in the Journal Neurology followed over 70,000 health professionals for more than two decades. Those who reported eating a diet high in colorful fruits and vegetables had a significantly lower risk of subjective memory loss — which is a sign of dementia — compared with those who did not.

A multitude of studies over many years have mined health data on this same cohort. Harvard T.H. Chan School of Public Health nutrition expert Dr. Walter Willett observed that, based on these studies, four combined healthy lifestyle factors — a healthy diet, not smoking, engaging in moderate activity, and avoiding excess weight — could prevent about 70% to 80% of coronary heart disease and 90% of type 2 diabetes. The catch, he noted, is that only about 4% of people participating in these studies attained all four.

Abundant research shows healthy lifestyle factors protect us against serious, often disabling health problems: diabetes, high blood pressure, dementia, heart disease, strokes, cancer, and more. Clearly, taking steps toward a healthier lifestyle can make a big difference in our lives, but it can be hard to change our habits. Below are a few tips to help you start on that path.

Find motivation

What motivates you? Where will you find good reasons to change? Yes, studies show that being at a healthy weight and shape is associated with a longer life and lower risk of many chronic diseases. However, in my experience, only emphasizing weight or waist size isn’t helpful for long-term healthy lifestyle change. Indeed, studies have shown that focusing too much on those numbers is associated with quitting a health kick, whereas small goals related to positive actions were associated with successful long-term lifestyle change.

Examples of this include aiming for at least 21 minutes of activity per day and/or five servings of fruits and vegetables per day. (These activity and nutrition goals are actually recommendations of the American Heart Association, FYI!) If we strive to live healthy so that we can live a long, healthy life, we have a greater chance of long-term success — which typically will result in weight and waist loss.

Put healthy habits on automatic

Healthy choices can become more automatic if you remove the “choice” part. For example, take the thinking out of every eating or activity decision by planning ahead for the week to come:

  • Choose a basic menu for meals and build in convenience. Focus on simple, healthy recipes. Frozen produce is healthful, easy to keep on hand, and sometimes less expensive than fresh. Shopping the salad bar costs more, but could help on busy nights.
  • Jot down your activity schedule. Choose some physical activity most days — the more vigorous and the longer the better, but anything counts! Even as little as 10 minutes of light to moderate activity per week has been associated with a longer life span.
  • Track food and activity choices each day. Using an app or notebook for this can help you become more aware and accountable. Try noting barriers, too, and brainstorm workarounds for overly busy days and other issues that push you off track.

Understand how emotions affect you

If feeling stressed, angry, or sad is a trigger for overeating or another unhealthy activity, it’s important to recognize this. Writing down triggers over the course of a week can enhance your awareness. Building better stress management habits can help you stick to a healthy lifestyle plan. Getting sufficient restful sleep and scheduling personal time, regular activity, and possibly meditation, therapy, or even just chats with good friends are all steps in the right direction.

A healthy lifestyle is key to a long, healthy life, and is attainable. Success may require some thoughtful trial and error, but don’t give up! I have seen all kinds of patients at all ages make amazing changes, and you can, too.