Addressing the Cardiovascular Crisis: Insights from the World Heart Report 2024

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The “World Heart Report 2024: Clearing the Air to Address Pollution’s Cardiovascular Health Crisis” comprehensively analyses the intricate relationship between air pollution and cardiovascular diseases (CVDs). Compiled by a team of experts and supported by the Novartis Foundation, the report underscores the urgent need for global action to mitigate the profound health impacts of air pollution.

The Staggering Impact of Air Pollution

Air pollution remains one of our most pressing environmental health crises. In 2019 alone, nearly seven million deaths were attributed to air pollution, surpassing the fatalities from wars, malaria, tuberculosis, HIV, and other infectious diseases combined. “These figures are likely underestimates, and the true impact of air pollution remains underappreciated, even within health communities,” the report notes. The cardiovascular effects are particularly alarming, with exposure linked to the exacerbation of all major cardiovascular diseases.

According to the report, 70% of the 4.2 million deaths in 2019 attributed to ambient air pollution were due to cardiovascular conditions, primarily ischaemic heart disease (IHD) and stroke. Similarly, household air pollution accounted for 3.2 million deaths, with a significant portion from IHD and stroke. The ubiquity of air pollution exposure and its effects on cardiovascular health represents a staggering challenge for global health.

Regional Disparities and Vulnerabilities

The burden of air pollution is not evenly distributed globally. Lower-income countries bear a disproportionate share of this burden, with significant regional differences in mortality and morbidity. Regions outside the Americas and Europe experienced the most significant rises in IHD and stroke deaths attributable to ambient air pollution from 2010 to 2019. Europe saw declines in deaths from both conditions during the same period.

The report highlights that over 2 billion people worldwide still rely on polluting fuels such as wood, coal, crop waste, or charcoal paired with inefficient stoves for cooking. This reliance exacerbates the health impacts of household air pollution, particularly in lower-income countries. “The Global South’s burden is exacerbated by gaps in air pollution monitoring, policy, and health interventions and heightened vulnerabilities to the climate crisis and its environmental events,” the report states.

The Role of PM2.5 in Health

Particulate matter (PM2.5) is identified as the key pollutant for human health, with global levels remaining alarmingly high. Despite awareness of its harms, PM2.5 concentration levels declined globally by just 1% annually between 2010 and 2019. The report indicates that the global average level of PM2.5 was 31.7 µg/m³ in 2019, far above the World Health Organization’s (WHO) recommended air quality guidance level of 5 µg/m³. “While hitting these targets is paramount for countries to protect the health and wellbeing of their populations, few countries have reached or are even close to reaching recommended levels,” the report emphasises.

The Economic Cost of Air Pollution

Beyond health impacts, air pollution has significant economic implications. The World Bank estimates that the global cost of health damages associated with exposure to air pollution is US $8.1 trillion (€7.47 trillion), equivalent to 6.1% of the global GDP, with 1.2 billion annual workdays lost. Predictions indicate global air pollution-related healthcare costs will surge from US $21 billion (€19.35 billion) in 2015 to US $176 billion (€162.21 billion) in 2060. These figures highlight the urgent need for comprehensive strategies to mitigate air pollution and its profound health, societal, and economic consequences.

Case Studies and Recommendations

The report presents case studies of successful air quality interventions at city and national levels, demonstrating that effective strategies can yield significant health benefits. For example, implementing clean air policies in cities like London and New Delhi has led to measurable improvements in air quality and health outcomes.

To address the global air pollution crisis, the report provides several key recommendations:

1. Adopt WHO Guidelines: All countries must adopt the new WHO global guidelines on air quality. This includes making a roadmap of strategies to meet the interim targets outlined by WHO while progressing to the overall guideline level. Policies should be multifaceted and multi-sectoral, encompassing health, housing, city design, transport, and agriculture.
2. Fossil Fuel Non-Proliferation: WHF supports the implementation of a global fossil fuel non-proliferation treaty. Country commitments to these treaties must be maintained, ideally through legally binding agreements, and suitable implementation strategies must be employed to reduce fossil fuel use rapidly.
3. Improve Monitoring and Modelling: Countries, particularly in low- and middle-income countries (LMICs), should urgently improve air pollution monitoring and modelling. This includes expanding the stationary monitoring network in rural and urban areas to provide more accurate estimates of air pollution levels and trends.
4. Increase Funding for Research: Multilaterals, philanthropies, and countries must increase funding for multidisciplinary air pollution research and technological innovations to improve air quality and implement interventions to reduce air pollution.
5. Conduct Additional Studies: Health and research agencies at country, regional, and global levels should conduct additional studies into the cardiovascular effects of air pollution and the role of the cardiovascular system in the disease of other organs. This should include the study of less-well-researched air pollutants to effectively target the most harmful pollutants.

In Summary

The World Heart Report 2024 underscores the critical need for global action to address the cardiovascular health crisis caused by air pollution. With clear evidence linking air pollution to increased mortality and morbidity from cardiovascular diseases, the report calls for urgent and comprehensive strategies to mitigate air pollution’s impacts. By adopting WHO guidelines, implementing fossil fuel non-proliferation treaties, improving monitoring, increasing research funding, and conducting additional studies, countries can protect public health and achieve significant health, societal, and economic benefits.

The report aptly concludes, “A long-term vision is needed to realise these benefits, but the commitment to address them is needed now.” The World Heart Federation, with its extensive network of heart foundations, scientific societies, and patient organisations, is committed to promoting policies and actions that protect cardiovascular health and advocating for urgent efforts to stem the major contributors to air pollution.