Atmospheric Pollution and Mortality in Portugal : Quantitative Assessment of the Environmental Burden of Disease Using the Airq+ Model

The healthy environment is one dimension of sustainable development in the United Nations 2030 Agenda but the efforts to achieve the SDGs so far were insufficient and uneven across countries. In Portugal, such insufficiencies are evidenced by the statistical monitoring of the Agenda 2030 for the period 2010 – 2019, which does not report data on indicator 3.9.1 “Mortality rate attributed to household and ambient air pollution” due to shortness and irregularity of the available data series. Although national authorities concluded that the evolution of indicator 11.6.2 “Annual mean levels of fine particulate matter (e.g. PM2.5 and PM10) in cities” occurred in the desirable path, such interpretation does not fit well the paradigm followed by the AirQ+ model developed by the WHO to assess the impact of PM2.5 on health at all concentration levels. Nor is it compatible with the view that the SDGs and targets are integrated and indivisible, since any assessment of progress in air quality should not be interpreted independently of progress in reducing the number of deaths and illnesses from air contamination in exposures to multiple pollutants.The present work describes the application of the AirQ+ model developed by the WHO to calculate how much of specific health outcomes is attributable to long-term exposure to atmospheric NO2, PM2.5, and O3 in the population of various municipalities in Portugal, from 2010 to 2019. Linear Mixed Models were used for data analysis and have shown that (i) approximately 5000 deaths per year are attributable to exposure to mixtures of NO2 and PM2.5; (ii) the spatial distribution of the proportion of deaths attributable to NO2, PM2.5 and O3 differ significantly between locations, and (iii) that AirQ+ is a useful tool for the purpose of effective Public Health policymaking and reporting on the national progress to implement the 2030 Agenda