Air pollution inequalities in Europe: A deeper understating of challenges in Eastern Europe and pathways forward towards closing the gap between East and West

Air pollution is the biggest environmental stressor responsible for over 420,000 premature deaths in Europe in 2022,1 from cardiovascular diseases, chronic and infectious respiratory diseases, lung cancer, and type-2 diabetes.2 Air pollution levels in Europe have declined in the last decades, which has, at least in part, been attributed to successful European Union (EU) legislation. Ambient Air Quality Directive (AAQD)3 in 2008 set air quality standards (annual mean 25 µg/m3 for particulate matter with diameter <2.5 µm [PM2.5] and 40 µg/m3 for nitrogen dioxide [NO2]). These declines are most prominent in Western and Northern Europe, and there are still notable disparities in air pollution levels within and across countries in Europe,4 interlinked closely with socioeconomic inequalities (Figure 1 and Table 1). The Eastern European region, alongside Northern Italy, stands out as the most polluted in Europe, where many countries struggle to comply with current limit values and exceed many times World Health Organization (WHO) Air Quality Guidelines. The main air pollution sources in Eastern Europe are coal-dependent energy and outdated industry sectors, the widespread use of wood and coal for residential heating and cooking, old vehicle fleets, agricultural practices with high emissions of ammonia, poor waste management with industrial burning of waste materials, and open landfill waste burning still a common practice.6 These are rooted in poverty and socioeconomic and geopolitical systems dating back to the Soviet era, the civil war in the 1990s in former Yugoslavia and surrounding areas in the Balkans that has further destabilized the region, and similar current political instability and wars, such as Ukraine, all posing setbacks to economic development and access to clean energy. In Western Europe, major sources include traffic in urban areas, in lesser part local industry, energy production and wood burning for residential heating, and transboundary pollution. In Denmark, for example, more than 50% of PM2.5 comes from secondary sources from Eastern Europe. Another explanation for high pollution in Eastern Europe is that urbanization unfolded differently between the Eastern and Western regions, shaped by their unique historical, economic, and political paths. These differences have significantly influenced urban development patterns, socioeconomic conditions, and the environmental challenges each region faces. Key differences between Eastern and Western European stem from several factors: (1) economic disparities: Western Europe possesses greater financial resources to invest in climate adaptation, green infrastructure, and environmental initiatives, while Eastern Europe often depends on EU funding to modernize outdated systems; (2) regulatory frameworks: Western European countries have historically implemented stricter environmental policies and enforcement, whereas Eastern Europe has faced delays in aligning with EU standards due to transitional economies and governance challenges; (3) technological advancement: Western European cities lead in adopting smart technologies for pollution control, waste management, and urban planning, while Eastern Europe is still catching up; (4) cultural and historical factors: decades of industrial reliance and limited environmental awareness during the socialist era have left a legacy of pollution and inadequate infrastructure in Eastern Europe. Air pollution levels are up to several-fold higher in Eastern compared with Western countries (Figure 1), with the highest median PM2.5 in 2022 of 32, 30, and 23 µg/m3 measured in Bosnia and Herzegovina, Northern Macedonia, and Serbia, respectively, and lowest of 3, 5, 5, and 5 µg/m3 in Iceland, Estonia, Finland, and Sweden, respectively.7 As the EU has just in 2024 adopted new, much stricter air quality standards, in new revised AAQD with lower limit values of 10 µg/m3 for PM2.5 and 20 µg/m3 for NO2, and is preparing to revise other environmental and climate directives, there will be growing pressure on Eastern European governments to adopt new measures and speed up actions and policies to reach new standards. Corresponding to air pollution levels, Eastern European region suffers the highest air pollution-related health burden, with the highest rates of air pollution-related premature deaths1 (Figure 1) and cardiovascular diseases.5 This presents a major challenge for the EU to achieve a reduction in PM2.5-related premature deaths by 55% and the share of people disturbed by noise by 30% by 2030,4 as set out by EU Green Deal Zero Pollution Ambition.