Air pollution remains one of the main environmental risks to health in Europe, despite the progress achieved over recent decades. Reductions in industrial emissions, changes in transport and the development of EU air quality policies have contributed to a gradual decline in several pollutants. However, the health impacts remain substantial and unevenly distributed across the population. In this context, the European Union is currently advancing the implementation of the new Air Quality Directive, which updates legal limit values and brings them closer to the recommendations of the World Health Organization.
Last week, we took part in the Fifth EU Clean Air Forum 2025, organised by the European Commission and held in Bonn. The event brought together EU institutions, national authorities, researchers and civil society organisations to assess the current state of air quality in the EU and to discuss the steps needed to reach levels that better protect public health.
The forum coincided with the release of new data that again underline the scale of the problem. The latest report from the European Environment Agency, Harm to human health from air pollution in Europe: burden of disease status 2025, estimates that around 182,000 premature deaths in the European Union in 2023 were attributable to long-term exposure to fine particulate matter (PM2.5), even though this figure represents a 57% reduction compared with 2005. Despite this progress, the impact remains substantial, and 95% of the urban population in Europe is still exposed to air pollution levels above WHO recommendations, particularly for PM2.5.
The report also highlights that the effects of air pollution go far beyond premature mortality. Continuous exposure to pollutants such as PM2.5, nitrogen dioxide and ozone is associated with a loss of healthy life years and with the development of diseases that affect people over long periods of time.
In recent years, it has become increasingly evident that the health effects of air pollution are broader than previously assumed. While the links with cardiovascular and respiratory diseases and lung cancer are well established, more recent research has expanded this picture. Associations are now identified with other conditions such as diabetes and childhood asthma and, increasingly, with neurological impacts, including cognitive decline and dementia. According to the EEA report, this relationship is based on recent and still emerging scientific evidence; it does not establish a direct causal link but does indicate a potentially significant impact of long-term exposure to air pollution on cognitive health.
Despite limitations in current knowledge, available evidence suggests that air pollution is contributing to a growing number of years lived with dementia-related disability across Europe. Among the diseases analysed, dementia would account for the highest number of years lived with disability, far exceeding those linked to diabetes, asthma or cardiovascular complications. For example, for every year lived with disability from diabetes attributable to PM2.5 exposure, more than three years are lived with disability from dementia.
Another important aspect highlighted by the report is the recognition of health effects that do not immediately manifest as a specific disease. Long-term exposure to air pollution can trigger biological processes such as inflammation or microvascular damage that produce no short-term symptoms but influence ageing and increase the likelihood of developing health problems later in life. Incorporating these effects into assessments provides a more accurate understanding of the real impact of air pollution, including harms that for many years were not accounted for in health evaluations.
Regarding ozone, the EEA estimates that in 2023 exposure above recommended levels was associated with around 63,000 premature deaths in the European Union. For nitrogen dioxide —a pollutant closely linked to road traffic— the estimated figure was 34,000 deaths. Although average concentrations of these pollutants have fallen in many countries, exposure remains particularly high in large urban areas, where most of the population lives.
Spain is no exception. The report shows a progressive reduction in the impact attributable to fine particulate matter, in line with the EU trend. Nevertheless, a significant share of the population remains exposed to PM2.5 concentrations above WHO guidelines, especially in urban and metropolitan areas. The report also notes that exposure to nitrogen dioxide continues to be a major issue in cities with dense traffic.
The EEA stresses a central message: improvements in air quality do not immediately translate into better health outcomes. Many of the health effects of air pollution accumulate over years, meaning that benefits for public health appear gradually. This makes sustained measures to reduce exposure essential, with particular attention to vulnerable groups such as children, older people and those living in highly polluted areas.
These issues were central to discussions at the EU Clean Air Forum, where participants emphasised the need for effective implementation of EU air quality legislation and for policies that further reduce exposure, especially in urban environments. At Salud por Derecho, we share this perspective. The EEA’s findings show that, despite progress, air pollution continues to cause preventable health problems and premature deaths in Europe and in Spain. This underscores the need to place health protection and equity at the heart of public decision-making.
