In This Article Expand or collapse the "in this article" section Air Quality: Health Effects

  • Introduction
  • General Overviews
  • Early Severe Episodes
  • Intervention/Natural-Experiment Studies
  • Adverse Birth and Pregnancy Outcomes
  • Biological Mechanisms/Toxiciology

Public Health Air Quality: Health Effects
C. Arden Pope
  • LAST REVIEWED: 23 February 2011
  • LAST MODIFIED: 23 February 2011
  • DOI: 10.1093/obo/9780199756797-0122


Ambient air pollution has long been implicated as a contributor to adverse health effects. Severe air-pollution episodes in the early and mid–20th century demonstrated that extreme exposure to air pollution can result in serious illness or death. Beginning around 1990 there was a dramatic growth in epidemiological research regarding the contribution of air-pollution exposure to cardiopulmonary disease and mortality. Daily time-series and related studies indicate that short-term exposure exacerbates existing cardiovascular and pulmonary disease and increases the risk of becoming symptomatic, requiring medical attention, or even of dying. Population-based cross-sectional studies and cohort-based studies indicate that long-term repeated exposures increase the risk of chronic pulmonary and cardiovascular disease and death. Various intervention or natural-experiment studies have provided both indirect and direct evidence that public-policy efforts that reduce air pollution can result in improved health. Toxicological research, in concert with epidemiological research, has attempted to elucidate mechanistic pathways that link exposure to air pollution and cardiopulmonary disease and mortality. This research suggests that general mechanistic pathways include pulmonary and systemic oxidative stress and inflammation, enhanced initiation and progression of atherosclerosis, and altered cardiac autonomic function. Attempts to evaluate the constituents or characteristics of air pollution most responsible for these health effects have generally implicated combustion-related fine particles and associated air pollutants as being largely responsible.

General Overviews

By the 1970s and 1980s there was general agreement on a link between respiratory and cardiovascular diseases and very high concentrations of air pollution, but, as discussed in Holland, et al. 1979, there was a prevailing view that compelling evidence of significant health effects at low to moderate levels of pollution exposure was lacking. During the relatively short period of the early to mid-1990s, several epidemiological research studies reported air-pollution health effects at unexpectedly low concentrations of air pollution, and a sudden increase of subsequent research has provided additional evidence. Articles and books reviewing this literature, such as Bascom, et al. 1996 and Holgate, et al. 1999, increasingly began to suggest that there was growing consistent and coherent evidence that air pollution, common in modern cities, contributed to respiratory disease. Other reviewers, including Vedal 1997, emphasized inconsistencies, disagreements in interpretation, and gaps in knowledge. Phalen 2002 also emphasized that gaps in knowledge remained but further highlighted the lack of consensus regarding the appropriate public-policy response. However, recent reviews such as Brunekreef and Holgate 2002 and Pope and Dockery 2006 have reflected the swelling evidence base and growing consensus that significant, relevant, and biologically plausible health effects of air pollution occur, even at common levels of exposure. The updated scientific statement from the American Heart Association (Brook, et al. 2010) reviews the mounting evidence that ambient air pollution contributes to cardiovascular disease.

  • Bascom, R., P. A. Bromberg, D. L. Costa, R. Devlin, D. W. Dockery, M. W. Frampton, W. Lambert, J. M Samet, F. E. Speizer, and M. Utell. 1996. Health effects of outdoor air pollution. American Journal of Respiratory and Critical Care Medicine 153:3–50.

    An authoritative report from the American Thoracic Society that addressed the health effects of a wide range of air pollutants. They documented various health effects of particulate matter, sulfur dioxide, nitrogen dioxide, ozone, and other pollutants, including at moderate levels of exposure.

  • Brook, Robert, Sanjay Rajagopalan, C. Arden Pope III, Jeffrey R. Brook, Aruni Bhatnagar, Ana V. Diez-Roux, Fernando Holguin, Yuling Hong, Russell V. Luepker, Murray A. Mittleman, Annette Peters, David Siscovick, Sidney C. Smith Jr., Laurie Whitsel, and Joel D. Kaufman. 2010. Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation 121:2331–2378.

    DOI: 10.1161/CIR.0b013e3181dbece1

    This updated American Heart Association scientific statement provides a relatively comprehensive review and evaluation of the recent but rapidly growing epidemiological, toxicological, and related research. It concludes that the overall evidence is consistent with a causal relationship between fine particulate pollution exposure and cardiovascular disease morbidity and mortality.

  • Brunekreef, Bert, and Stephen T. Holgate. 2002. Air pollution and health. Lancet 360:1233–1242.

    DOI: 10.1016/S0140-6736(02)11274-8

    A relatively concise review that primarily addresses the health effects of particulate matter, ozone, and nitrogen dioxide.

  • Holgate, Stephen T., Jonathan M. Samet, Hillel S. Koren, and Robert L. Maynard, eds. 1999. Air pollution and health. San Diego, CA: Academic.

    A large (1,065 pages, forty-four chapters, and sixty-eight contributing authors) book edited by eminent air-pollution and health scientists, intended to provide inclusive coverage of air pollution issues in one volume. It covers a broad range of air pollutants and issues and provides evidence that air pollution continues to be a public health concern worthy of further research and public-policy efforts.

  • Holland, W. W., A. E. Bennett, I. R. Cameron, C. du V. Florey, S. R. Leeder, R. S. F. Schilling, A. V. Swan, and R. E. Waller. 1979. Health effects of particulate pollution: reappraising the evidence. American Journal of Epidemiology 110:525–659.

    A special authoritative report by eminent British researchers on health effects of particulate-matter air pollution that filled the entire issue of the journal. They concluded that there were significant health effects at very high exposures, but that there was not compelling evidence of substantive health effects at low to moderate levels of exposure.

  • Phalen, Robert F. 2002. The particulate air pollution controversy: A case study and lessons learned. Boston: Kluwer Academic.

    A relatively concise book (128 pages) written by a well-respected inhalation toxicologist that is skeptical of how air-pollution science is being used to motivate environmental and public-health policy. It contains a review of the particulate-air-pollution and health science and addresses scientific and public-health controversies and limitations surrounding this literature.

  • Pope, C. Arden, III, and Douglas W. Dockery. 2006. Health effects of fine particulate air pollution: Lines that connect. Journal of the Air & Waste Management Association 56:709–742.

    An invited critical review that focused on knowledge gained in the previous ten years. It concluded that, although important gaps in scientific knowledge remain, recent research has connected many of the gaps and has provided persuasive evidence that common exposures to fine particulate and related air pollution contribute to adverse cardiopulmonary health.

  • Vedal, Sverre. 1997. Ambient particles and health: Lines that divide. Journal of the Air & Waste Management Association 47:551–581.

    An invited critical review of particulate air pollution and health literature written by a well-respected expert in the field. In addition to providing an insightful review of the literature, major sources of controversy and important gaps in knowledge are discussed and evaluated in terms of their scientific and public-policy importance.

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