Modelling PM2.5 reduction scenarios for future cardiopulmonary disease reduction

Long-term PM2.5 exposure is a risk factor for cardiovascular and respiratory mortality. Here a global health impact assessment was conducted utilizing seven future scenarios evaluating strategies to reduce PM2.5 exposure. Strategies included reducing fossil fuel use, air pollution control, adopting cleaner cooking methods and combinations thereof. Under current trends, air quality is projected to improve by 2050; nevertheless, the absolute attributable burden of ischaemic heart disease, stroke and chronic obstructive pulmonary disease remains high in many regions. Cleaner cooking fuel use is effective in the short term (by 2030) in South and Central America, Asia, and Africa for reducing PM2.5-related deaths. In the long term (by 2050) for most regions, only strategies that simultaneously target ambient and cooking-related PM2.5 resulted in sustained improvements that expand beyond current trends for reducing disease burden across these three health outcomes. In the Asian region, for example, under current trends, the population-attributable fraction decreases from 35% in 2015 to 18% in 2050. In the scenario combining universal clean cooking and climate policy, it drops further to 15%, and when all strategies are combined, it reaches as low as 11% by 2050. With all strategies combined, the average global population-weighted PM2.5 exposure from both ambient and cooking sources is reduced by nearly two-thirds (66 µg m−3 compared with 26 µg m−3). For North Africa and the Middle East region, the population-attributable fraction remains high across all scenarios. Additional strategies beyond those mentioned here are required to further improve air quality. It is recommended to pursue climate mitigation alongside universal access to cleaner household fuels to maximize cardiopulmonary health benefits.