Air Quality


Category Description

Indoor and outdoor air pollution are leading threats to human health (World Health Organization, 2006a, p. 87). Air pollution is produced by the natural or human-caused release of harmful contaminants into the atmosphere (World Health Organization, 2014). Air pollution is a global issue, affecting individuals across all countries and socioeconomic groups (World Health Organization, 2016a). The EPI uses three indicators to measure air quality: household solid fuel use, PM2.5 average exposure, and PM2.5 exceedance.

Particulate matter (PM) exposure is associated with significant adverse health effects (Kloog, Ridgway, Koutrakis, Coull, & Schwartz, 2013; World Health Organization, 2016a). These particulates can penetrate the human lung, leading to higher incidences of cardiovascular and respiratory disease (Goldberg, 2008). Recent research suggests that around five million people die prematurely every year due to air pollution, accounting for approximately one in every ten deaths annually (World Bank & Institute for Health Metrics and Evaluation, 2016). Reducing air pollution levels globally can therefore improve human health today and in future generations.

Indicators Included

  1. Household solid fuels. We measure household air pollution as the health risk posed by the incomplete combustion of solid fuels, using the number of age-standardized disability-adjusted life years (DALYs) lost per 100,000 persons due to this risk.
  2. PM2.5 exposure. As a measure of chronic exposure, we use the population-weighted average ambient concentration of PM2.5 in each country.
  3. PM2.5 exceedance. As a measure of acute exposure, we use the proportion of the population in each year that is exposed to ambient PM2.5 concentrations that exceed WHO thresholds of 10, 15, 25, and 35 micrograms per meter cubed (µg/m3) (World Health Organization, 2006a). These four proportions are averaged to produce a summary of the distribution of exposure levels in the country’s population.
Air Quality Indicators
Household solid fuels DALY rate
PM2.5 exposure μg/m3
PM2.5 exceedance % population

Category Overview

Air pollution’s widespread and substantial effects on human and environmental health make it an issue of global concern. Exposure to airborne pollution is the fourth leading cause of premature death globally (World Bank & Institute for Health Metrics and Evaluation, 2016, p. 22).  According to a recent study conducted by the World Bank and the Institute for Health Metrics and Evaluation (IHME), approximately 5.5 million people die prematurely from air pollution each year (World Bank & Institute for Health Metrics and Evaluation, 2016, p. 22). Most of these deaths stem from respiratory diseases; even in small amounts, air pollution may reduce the quality of one’s overall health (Goldemberg, United Nations Development Programme, United Nations, & World Energy Council, 2000; World Bank & Institute for Health Metrics and Evaluation, 2016; World Health Organization, 2006a).

While air pollution consists of a mix of different pollutants, particulate matter (PM) is among the deadliest (World Health Organization, 2016a). Fine PM is defined as 2.5 microns or less in diameter (PM2.5). PM2.5 is small enough to lodge into human lungs and has the potential to cause serious heart and lung disease (Goldberg, 2008). As seen in Figure 5–1, PM2.5 pollution affects all people. Young children, pregnant women, and the elderly are especially vulnerable. The World Health Organization (WHO) reports that acute respiratory infections are the second-largest cause of death in children under five (World Health Organization, 2017a).

Map 5-1

Map 5–1. Disability-Adjusted Life Years lost due to PM2.5.
Source: Institute for Health Metrics and Evaluation.

Household solid fuel use emits significant amounts of particulate matter. Household air pollution (HAP) occurs from the incomplete combustion of solid fuels, which is predominantly from biomass burning, such as wood, crop wastes, charcoal, coal, and dung, in households (Bonjour et al., 2013; World Health Organization, 2006b, 2016b). In poorly ventilated households, the incomplete combustion process produces a substantial amount of particulate emissions, which causes significant amounts of age-standardized disability-adjusted life years (DALYs) worldwide, as seen in Map 5–2 (Desai, Mehta, & Smith, 2004, pp. 8–10). The World Health Organization (WHO) estimates that incomplete combustion in these households can have fine particle concentrations up to 100 times higher than acceptable levels (World Health Organization, 2016a). Reducing air pollution in the home will bring substantial health and development benefits.

Map 5-2
Map 5–2. Disability-Adjusted Life Years lost due to household air pollution.
Source: Institute for Health Metrics and Evaluation.

Environmental: Air pollution harms the environment many ways. Pollutants can mix in the air or with rain and accumulate on plants, soils, and water. Examples of such impacts are discussed in Table 5–1.

Table 5–1. Environmental impacts from air pollution.
Source: Chislock, Doster, Zitomer, & Wilson, 2013; Environmental Protection Agency, 2017; Environmental Protection Agency, 2017b; Pope & Dockery, 2006.

Acid rain

Acid rain is precipitation that contains significant amounts of nitric and sulfuric acids. These acids are formed through nitrogen oxides and sulfur oxides that are released into the air (Environmental Protection Agency, 2017b).


Eutrophication is a process in which excess nutrients exacerbate blooms of algae in water. The increase in algae blooms have the potential to kill fish and cause a loss of plant life (Chislock, Doster, Zitomer, & Wilson, 2013).

Ground-level ozone

Ground-level ozone can lead to decreases in crop and tree productivity, abridged growth of trees, and a greater susceptibility of plants to disease and pests (Pope & Dockery, 2006).


Haze is caused when sunlight comes into contact with pollution particles in the air, reducing our visibility (Environmental Protection Agency, 2017).

Social: Impacts from air pollution have serious consequences for public health and well-being. Adverse health effects occur from exposure to pollutants even at lower concentrations (World Health Organization, 2014, p. 1). In 2013, WHO’s International Agency for Research on Cancer established that outdoor air pollution is carcinogenic to humans (World Health Organization, 2013, p. 1). In combination, PM2.5, nitrous oxides (NOX), and volatile organic compounds (VOCs) interact to form ground-level ozone, which is a highly toxic and reactive pollutant (World Health Organization, 2017c). Sulfur dioxide (SO2) and NOx can transport far distances and react in the atmosphere to form very fine nitrate and sulfate particles (Lockwood, 2009). The burden of air pollution is thus a major challenge to sustainability.

Economic: Air pollution has significant costs for society by damaging people’s health. According a joint study conducted by the World Bank and the IHME, air pollution cost the global economy approximately US$225 billion in 2013 alone due to lost labor, and about US$5 trillion per year as a result of productivity losses and a degraded quality of life (World Bank and Institute for Health Metrics and Evaluation, 2016, pp. 50, 52).

Global Impact

The pervasive social and environmental impacts of air pollution make it an important marker for sustainable development across all levels of economic development. The drivers behind pollution differ by economic structure, however, and developing countries have different problems than developed countries. Air pollution is an important indicator for environmental quality and public health in developing regions, as economic expansion contributes to higher pollution levels (World Bank and Institute for Health Metrics and Evaluation, 2016). Differences in the sources and severity of air pollution across country income groups require different solutions. Some nations, for example, should prioritize access to clean fuels, while others should concentrate efforts on emissions abatement in key sectors.

In order to improve public health and well-being, access to clean and affordable energy is necessary, especially for women and children in developing regions (Desai, Mehta, & Smith, 2004). Globally, almost three billion people continue to depend on solid fuels for cooking and heating (World Health Organization, 2014), including 90% of the rural sub-Saharan African population and 75% of the rural population in China and India (Pachauri, Rao, Nagai, & Riahi, 2012). Women and children experience the highest exposure levels from HAP due to their customary household roles (Pachauri & Rao, 2013; World Health Organization, 2014, p. 1). Data further suggests that exposure to HAP during pregnancy increases the risk of still birth, early birth, lower birth weight, and stunting of children (World Health Organization, 2017c).

Air pollution is both directly and indirectly related to numerous Sustainable Development Goals and Targets.

Goal 3, Target 9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination

Goal 7, Target 1: By 2030, ensure universal access to affordable, reliable and modern energy services

Goal 9, Target 4: By 2030, upgrade infrastructure and retrofit industries to make them sustainable, with increased resource-use efficiency and greater adoption of clean and environmentally sound technologies and industrial processes, with all countries taking action in accordance with their respective capabilities

Goal 11, Target 1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums

Goal 11, Target 6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management

Goal 12, Target 2: By 2030, achieve the sustainable management and efficient use of natural resources

Goal 12, Target 4: By 2020, achieve the environmentally sound management of chemicals and all wastes throughout their life cycle, in accordance with agreed international frameworks, and significantly reduce their release to air, water and soil in order to minimize their adverse impacts on human health and the environment

International Organizations

Climate and Clean Air Coalition to Reduce Short-Lived Climate Pollutants (CCAC): The CCAC was launched by the United Nations Environment Programme along with six countries to raise awareness and reduce short-lived climate pollutants in order to protect health, agriculture, and the environment.

Global Alliance for Clean Cookstoves (GACC): The GACC is a non-profit organization operating under the UN to improve indoor air quality. One of the groups key objectives is for 100 million homes adopt clean stoves and fuels by 2020.

Sustainable Energy for All (SEforALL): SEforALL was launched by the UN and works to ensure universal access to modern energy services, double the global rate of improvement in energy efficiency, and double the share of renewable energy in the global energy mix by 2030 (Sustainable Energy for All, 2017).

United Nations Environment Programme (UNEP): The UNEP is the agency within the UN to coordinate and implement environmental actions. As one of their many duties, the UNEP works to implement the SDGs.

United Nations Children’s Fund (UNICEF): UNICEF’s environment team works in over 190 countries and territories to improve the lives of children globally.

World Health Organization (WHO): The WHO is a specialized agency of the UN working on international health initiatives. One of WHO’s health topics of focus is the public health impacts of air pollution.

Multilateral Efforts

Clean Cooking Forum 2017 (CCF): The UN Foundation’s Global Alliance for Clean Cookstoves held its forum in New Delhi, India in October 2017 (United Nations Foundation, 2016).

Global Platform on Air Quality and Health (Global Platform): The Global Platform is WHO’s collaboration with organizations working to implement and monitor air pollution abatement strategies. The Global Platform convened in 2014 and 2015 to “systematically consolidate data on air quality and health by bringing together information on air pollution exposure from different sources” (World Health Organization, 2017b). The final reports of these consultations are expected to be released soon.

Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030 (The Global Strategy): The Global Strategy is a collaboration led by the WHO working to put women, children and adolescents at the center of the SDGs. The Global Strategy focuses on improving access to clean sources of household energy.

WHA68.8: Health and the environment: addressing the health impacts of air pollution: Delegates at the World Health Assembly adopted Resolution WHA68.8 to address the impacts of air pollution, identifying air pollution as the world’s largest single environmental risk.

The WHO and the United Nations Children’s Fund’s Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD): The program’s goal is to achieve universal access to drinking water in both health care facilities and homes by 2025. A core focus of the initiative is on improving indoor air quality (World Health Organization, 2016b, p. 7).


One of the salient characteristics of air pollution is its spatial distribution. Once emitted, air pollution is capable of travelling long distances. Pollution is often not confined to any one country. Harms to both people and nature, therefore, have the potential to occur far from where the pollutants are initially discharged (World Health Organization, 2016b). Since the impacts from air pollution are widespread and broad, it would be helpful to obtain data connecting emissions, ambient concentrations, and consequent harms to human health.

Estimates of air pollution exposure vary by data collection technique. Air quality is measured by both satellite and ground-based methods (Engel-Cox, Kim Oanh, van Donkelaar, Martin, & Zell, 2013). Ground-based measurements are generally taken where a higher number of populations are exposed to PM2.5, which provides accurate data for local planning purposes (Engel-Cox et al., 2013). Ground-level measurements, however, are not taken in much of the world, with especially few measurements in many low-income areas (Hsu, Reuben, Shindell, de Sherbinin, & Levy, 2013, p. 562; Institute for Health Metrics and Evaluation & Health Effects Institute, 2017, p. 5). Satellite-based measurements provide estimates in areas where no ground-based measurements are obtainable (Engel-Cox et al., 2013, p. 585). Satellite monitoring can therefore provide a more complete air pollution picture globally. Synthesizing these two methods may environmental and public health practitioners with a more comprehensive measurement of air quality globally.

We focus on three indicators of exposure to air pollution, measuring PM2.5 and HAP. These indicators capture a substantial portion of the global variation in health impacts due to air quality, either because of the direct threat posed by these pollutants or because they are correlated with threats posed by other pollutants (World Health Organization, 2016b).

Box 5–1. False data and reporting distorts pollution estimates.

Despite the significant advances made in air quality monitoring technologies over the past 50 years (Engel-Cox et al., 2013), unreliable data continue to pose serious concerns for quality analysis. Without reliable data and information, environmental protection agencies will not have an appropriate gauge of local circumstances, cannot undertake appropriate pollution (and emissions control) benchmarking, and thus will not be positioned to make informed policy decisions. 

Data reliability issues – problems with false reporting – are particularly acute Russia and China. In June 2017, seven staffers of the Environmental Protection Department in China’s Shaanxi Province were accused of tampering with air quality monitors and changing readings to show decreased levels of PM2.5 and sentenced to over one year of prison (Connor, 2016; Shepherd, 2017). Major coal-dependent areas within China have admitted to falsifying data about their GDP, making trends about emissions intensity difficult to interpret. For example, Inner Mongolia inflated data for, “added value of industrial enterprises of a certain scale,” by 40% in 2016. Liaoning province revealed they faked data for five years, while Binhai included the commercial activities of companies only registered in the area for tax purposes in their GDP (Zhang, Pong, & Hornby, 2018). According to China’s latest environmental protection law, which entered into force in 2015, anyone found guilty of altering air quality data will be held as accountable for the damages of the pollution they permit to occur (Ministry of Environmental Protection, 2016; Reuters, 2016). China’s leadership on improving data accuracy as a foundation for improved air quality shows that progress can be made – and that public health gains can be quickly achieved by addressing pollution problems more forthrightly.

Household Solid Fuels

Indicator Background

HAP use is a significant environmental risk factor. Incomplete combustion of solid fuels produces a substantial amount of particulate emissions worldwide (World Health Organization, 2006a, 2017a). Humans exposed to HAP at high concentrations often suffer significant, negative health effects (World Health Organization, 2006b, pp. 62–66). Because exposure to HAP is often higher than other forms of air pollution, reducing the use of household solid fuels may improve human health to a greater degree than other air pollution abatement efforts (Goldemberg et al., 2000). The household solid fuel indicator is measured in DALYs lost due to HAP per 100,000 persons.

Data Description

The DALY rate from household solid fuel use comes from IHME’s Global Burden of Disease (GBD) study available at Data are gathered through nationally reported household surveys that estimate the proportion of household solid fuel as the predominate fuel source in a country (Bonjour et al., 2013).


Despite the strong relationship between the use of household solid fuels and health outcomes, our metric has multiple limitations. The limited knowledge regarding the size of the population exposed to various sources of air pollution, as well as imperfect data for the burden of air pollution-related diseases, are two of the primary reasons why multiple assumptions are necessary. Furthermore, standardization and double-counting issues, which emerge from the differing quality of data across countries, further complicate efforts to construct a global inventory or comparison of air pollution data. Finally, the type of predominant air pollution varies by regions. In urban areas, outdoor air pollution is the primary concern. Conversely, in rural regions, HAP is the more predominant issue.

Box 5–2. India’s LPG connection scheme.

Over the last decade, approximately 800 million people have gained access to improved cookstoves, largely due to efforts in China and Brazil (Pachauri, Brew-Hammond, et al., 2012, p. 1419). These countries have been successful in transitioning to cleaner fuels because of strong government commitments to both the distribution and the improved affordability of stoves. The Chinese government, for example, has committed to providing all citizens with a basic standard for living, establishing local energy offices that provide training and installation support (Pachauri, Brew-Hammond, et al., 2012, p. 1437). Similarly, the Brazilian government has implemented policies that use targeted financial assistance to support access to liquefied petroleum gas (LPG) for low-income families (Lucon, Coelho, & Goldemberg, 2004).

Building on the efforts of China and Brazil’s historic gains in access, the Government of India has made a concerted effort to expand access to modern cooking fuels. India has the world’s largest population without access to modern energy services. Over 800 million people rely on traditional biomass for cooking (Bhojvaid et al., 2014). The Pradhan Mantra Uijwala Yojana (PMUY) is a welfare scheme launched by the Government of India to provide 50 million LPG connections and stoves to below-poverty line (BPL) women by the year 2019 (Jacob, 2017). The scheme, which entered the implementation stage in March 2016, operates through a direct benefits transfer. Eligible women can apply for a LPG connection by submitting an application along with proof of identity and a bank account. When an application is approved, the applicant receives a direct transfer of funds straight into her bank account, which she may then use to purchase her LPG connection (Government of India, 2016).

India is nearly half way to its 2019 target of 50 million stoves. As of May 2017, over 20 million families had signed up for LPG connections (Mishra, 2017). A survey undertaken in 12 districts in Uttar Pradesh after the program was implemented showed that PMUY has helped save women an average of one to two hours per day that was previously used to collect fuels for cooking and heating the household (Mishra, 2017). In implementing this policy, the Government of India has made a concerted attempt to address the needs of BPL households and women. If its goals are realized, PMUY has the potential to positively impact the lives of millions of BPL households by providing them with access to safe, affordable cooking technologies and fuels.

PM2.5 Average Exposure and PM2.5 Exceedance

Indicator Background

Both chronic and acute PM exposure are associated with significant adverse health effects (Kloog, Ridgway, Koutrakis, Coull, & Schwartz, 2013; World Health Organization, 2016a). While chronic exposure is the biggest danger to mortality, exposure to high concentrations of PM2.5 in short intervals can also aggravate both lung and heart conditions. These acute pollution events degrade human quality of life, increase hospital admissions, and cause premature death (World Health Organization, 2006a).

We use two indicators for PM2.5: exposure and exceedance. Exposure to ambient air pollution is represented by population-weighted annual average concentrations, which take into account the proportions of the population living with different levels of pollution.

  1. PM2.5 exposure. This indicator is a measure of the average amount of fine particulate matter in micrograms per cubic meter. PM2.5 average exposure serves as a measure of the amount a person would be exposed to on a typical day in their country (Engel-Cox et al., 2013).
  2. PM2.5 exceedance. This indicator is a measure of the weighted average of the percentage of the population exposed to elevated levels of PM2.5, by measuring instances when PM2.5 concentrations exceeded 10, 15, 25, and 35 μg/m3, which are the WHO’s air quality guidelines and interim targets (World Health Organization, 2016a).
Table 5-2. WHO PM2.5 Guidelines.
Source: World Health Organization, 2006a
PM2.5 10 μg/m3 annual mean guideline
15 μg/m3 interim target 3
25 μg/m3 interim target 2
35 μg/m3 interim target 1

WHO Air Quality Guidelines provide a basis for global limits on air pollutants that pose significant human health risks. Guidelines are available for particulate matter, ozone, nitrogen dioxide, and sulfur dioxide to help countries measure and monitor their progress over time. However, almost 90% of the world’s population currently live in areas that exceed WHO thresholds for air pollution (World Bank & Institute for Health Metrics and Evaluation, 2016).

Data Description 

Data for population-weighted exposure estimates of PM2.5 come from a synthesis of multiple datasets. The satellite-derived measurements were gathered by van Donkelaar et al. (van Donkelaar et al., 2016)and based on data obtained from the Tropospheric Emissions Monitoring Internet Service (TEMIS). Population data were obtained by the Earth Observing System Data and Information System, Gridded Population of the World, v4 at the NASA Socioeconomic Data and Applications Center (SEDAC) hosted by the Center for International Earth Science Information Network (CIESIN) at Columbia University’s Earth Institute (Center for International Earth Science Information Network - CIESN - Columbia University, 2016).

Data for these indicators are generated using satellite observations combined with ground-based measurements to correct for any potential bias. Using this method allows the PM2.5 indicators to be generated across countries and on a global scale (de Sherbinin, 2015). Population-weighting allows regions with higher air pollution and more individuals nearby to signify higher overall averages (de Sherbinin, 2015). Values are available from 2008–2015 for 228 countries and territories.

Ideally, monitoring data for PM2.5 would be collected throughout the year over numerous years. Most countries globally, however, do not operate robust systems of air quality monitoring stations, so other methods for measuring air quality are needed to provide a reliable view of pollution levels worldwide (Engel-Cox et al., 2013; Institute for Health Metrics and Evaluation & Health Effects Institute, 2017, p. 5). For these areas, satellite measurements are used to estimate exposures to PM2.5 (World Health Organization, 2016a).


Many factors make it hard to compare measurements of PM2.5 across multiple countries, including the locations of measurement stations, differences in measurement methods, and differences in the duration of air pollution measurement records. For example, if measurements were only taken for a portion of the year, the reported data may differ from the actual annual averages (van Donkelaar et al., 2016). Further, measurement issues could arise if monitors are disproportionately affected by one source of pollution (Brauer et al., 2016).

Box 5–3. Air pollution leads to as many premature deaths in India as in China.

Premature deaths from air pollution in China have begun to stabilize, while India has seen a steady rise in air pollution levels and PM2.5-related deaths – see Figure 5–1. Both trends are significant. China and India combined made up approximately 52% of the 4.2 million deaths globally in 2015 (Institute for Health Metrics and Evaluation & Health Effects Institute, 2017, p. 8).

Figure 5-1
Figure 5–1. Annual deaths attributable to PM2.5.
Source: Institute for Health Metrics and Evaluation.

China has taken several steps over the past ten years to reduce the number of deaths related to air pollution. Among other policy initiatives, the country restricts traffic flow and construction activities during time periods with heavy pollution. One of the most heavily polluted cities in the world, Beijing, broadcasted a ‘red alert’ pollution warning level for the first time in 2015, which forced the government to implement policies to limit the human exposure to dangerous pollution levels (British Broadcasting Corporation News, 2016). Due in part to government regulation, China has made substantial progress implementing effective policies that target air pollution.

Meanwhile, India has made little progress reducing air pollution levels (Rowlatt, 2016). In November 2017, the government in Delhi declared a state of emergency. Particulate matter levels reached recorded highs of 969 ug/m(for real-time updates, the US embassy’s air quality index can be accessed at The WHO considers anything over 25 ug/mto be unsafe (World Health Organization, 2006a). To put this into perspective, news sites were reporting that breathing the air in Delhi was “equivalent to smoking 44 cigarettes a day” (Wu, 2017). Arvind Kejriwal, Delhi's chief minister, even described the city as “a gas chamber” (Kejriwal, 2017). Blaming farmers who clear fields by burning crops, Kejriwal went on to say, “[e]very year this happens during this part of the year. We have to find a [solution] to crop burning in adjoining states” (Kejriwal, 2017).

Like Beijing, the government in Delhi has started to implement policies targeting their air pollution levels. These strategies include shutting down schools and suspending construction projects (Institute for Health Metrics and Evaluation & Health Effects Institute, 2017; World Bank and Institute for Health Metrics and Evaluation, 2016). If appropriate measures are enacted, India can learn from the success of the actions taken in China to decrease the levels of air pollution.


Global Trends

Air quality remains a prominent risk to both public health and the environment. Countries can improve the overall health of their population by reducing exposure to air pollutants. Pollution is particularly severe in places such as India and China, where greater levels of economic development contribute to higher pollution levels (World Bank and Institute for Health Metrics and Evaluation, 2016).

Table 5–3. Global trends in Air Quality.
Note: Metrics are in units of age-standardized Disability Adjusted-Life Years lost due to each risk. Current refers to the most recently available data, and Baseline refers to historic data approximately ten years previous to Current.
Indicator Metric Score
  Baseline Current Baseline Current
Household solid fuels 1,906.3 1,107.0 14.77 22.1
PM2.5 exposure 25.7 27.07 36.73 33.24
PM2.5 exceedance 41.11 43.45 52.72 50.03

At the global scale, DALYs lost due to air pollution have declined over the last decade. Global trends, however, hide regional inequalities. Air pollution in many low-income and developing countries, however, is higher due to a greater use of household solid fuels for cooking and heating homes (Desai, Mehta, & Smith, 2004). Conversely, most high-income and developed countries see small effects from household solid fuels. Countries with continued high scores, such as Australia and Barbados, show long-term commitments to reducing the levels of air pollution. Large populations, however, still experience severe impacts stemming from poor air quality, notably in India, China, and Pakistan – see Table 5–5.

Leaders & Laggards

Table 5–4. Leaders in Air Quality.
Rank Country Score
1 Australia 100.00
1 Barbados 100.00
3 Jordan 99.61
4 Canada 99.28
5 Denmark 99.16
6 Finland 99.00
7 New Zealand 98.99
8 Brunei Darussalam 98.76
9 Iceland 98.55
10 United States of America 97.52

Changes in global air quality over the course of a decade reveal important regional trends. Our results find that most European, North American, and Latin American countries have comparably higher scores, that we may associate with lower pollution levels and lower DALY rates. Many Central and South American countries, for example, have implemented successful fuel switching campaigns aimed at reducing household air pollution. Smart subsidies and other forms of financial assistance are key components of policies on LPG access, including Brazil and Peru (Lucon et al., 2004).

Table 5–5. Laggards in Air Quality.
Rank Country Score
171 Myanmar 36.57
172 Republic of Congo 23.84
173 Laos 23.37
174 Tajikistan 23.22
175 Dem. Rep. Congo 22.57
176 Pakistan 15.69
177 China 14.39
178 India 5.75
179 Bangladesh 4.12
180 Nepal 3.94

Nearly all countries at the lower end of the global ranking are African or Asian nations. The most significant decrease in air quality and global air quality ranking over the past ten years has occurred in Singapore. Singapore’s score dropped by almost 30 points, causing them to fall 111 spots in our ranking. While Singapore received high scores for household solid fuels both in 2016 and in 2005, their substantially lower scores for PM2.5 exposure and exceedance account for significantly decreased air quality scores. In 2015, fires swept through Indonesia causing the most significant reason for Singapore’s drop in ranking (Weisse & Goldman, 2017). The Ministry of the Environment and Water Resources has reported that, over the past two years, Singapore has not met its PM2.5 target, PM10 target, and ozone target, and is not are not on track to meet WHO’s air quality targets by 2020 (Othman, 2017). In speaking about Singapore’s current trajectory, Masagos Zulkifli, Singapore’s Minister of Environment and Water Resources, emphasized that Singapore is committed to findings ways to address air pollution. “Unfortunately if you look at our trajectory, we are not meeting our targets and therefore we need to do more to ensure that our air pollution issue is being addressed” (Othman, 2017).

While neither leaders, nor laggards, countries in the Middle East, such as Bahrain, Iraq, Kuwait, Oman, Saudia Arabia, and United Arab Emirates, experienced the most substantial increases in their scores over the past decade due to decreasing levels of air pollution-related DALYs. Bahrain and Iraq improved their air quality and thus increased their scores most significantly, jumping up in the rankings by 47 and 46 places, respectively. Our World in Data reports that one reason DALY rates have substantially improved are the effects of increased wealth and quality of life in the region (Ritchie & Roser, 2017).

Our findings illustrate the impacts of air pollution on human health globally. Increasing our knowledge on the links between air pollution and disease is fundamental to reduce the public health burden worldwide, and we can begin to lessen the effects of air pollution (Institute for Health Metrics and Evaluation & Health Effects Institute, 2017).


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