In South Africa, energy production contributes to 23% of the ambient PM2.5 levels. (Waldo Swiegers/Bloomberg via Getty Images)
Outdoor air pollution was linked to 45 out of 100 000 deaths in South Africa in 2019, a new report by the Health Effects Institute has revealed.
The analysis of the state of air quality and related health impacts in Africa was produced by the State of Global Air initiative, which is a collaboration between the United States-based Health Effects Institute, the Institute for Health Metrics and Evaluation’s Global Burden of Disease project.
Air pollution is the second-leading risk factor for death across the continent, behind malnutrition, the report found. Dirty air contributed to an estimated 1.1-million deaths in Africa in 2019, with 63% of these deaths associated with exposure to household air pollution.
The annual cost of health damage because of disease-related air pollution amounts to an average of 6.5% of GDP across Africa. In Egypt, Ghana, Democratic Republic of the Congo, Kenya and South Africa the combined annual cost of health damage from exposure is more than $5.4-billion.
The report described how an extensive body of scientific evidence, gathered over several decades, links long-term exposures to air pollution with an increased risk of illness and death from chronic conditions such as ischemic heart disease, lung cancer, obstructive pulmonary disease, stroke and type 2 diabetes.
Some of the highest air pollution levels on the planet
Most of the African continent faces severe health impacts caused by air pollution, with several countries having some of the highest levels of air pollution in the world. “Africa experiences some of the worst air pollution and some of the most severe health consequences relative to the rest of the world … This large, populous and dynamic continent is home to five of the world’s 10 most heavily polluted countries in terms of ambient [outdoor] fine particulate matter (PM2.5).”
Ambient (outdoor) fine-particle air pollution is referred to as PM2.5 – airborne particles measuring 2.5µm or less in aerodynamic diameter. Exposure to PM2.5 can result in cardiovascular (heart), respiratory (lung) and other types of disease.
In sub-Saharan Africa, an estimated 75% of the population relies on burning solid fuels, such as coal, wood, charcoal and dung, for cooking, exposing over 800-million people to high concentrations of harmful pollutants at home every day.
“Air pollution exposures from household use of solid fuels and fossil fuel sources combine with demographic and other shifts affecting the underlying health of the population. This causes uneven impacts across countries in a region where rates of chronic (long-term), noncommunicable conditions (heart disease and diabetes) are rapidly rising in relation to the burdens imposed by communicable diseases such as diarrhoeal disease, lower respiratory tract infections and malaria.”
Most countries in Africa lack national air-quality standards, including some of the most populous countries, such as Democratic Republic of the Congo, Egypt and Ethiopia. Just 17, including South Africa, have adopted legislative instruments containing air-quality standards.
Children under five at high risk
Newborns and children under five years old in these regions are at particularly high risk from household air pollution linked to the use of solid fuels for cooking, it said.
The analysis found that in 2019, 14% of all deaths in children under five across Africa were linked to air pollution. About 236 000 newborns die within the first month of life from air pollution exposure, with 80% of those coming from household air pollution.
“Africa is home to some of the most heavily polluted countries in the world,” said Caradee Wright, chief specialist scientist at the South African Medical Research Council, who was a reviewer of the report.
“The estimates given in this report help us understand the extent of these exposures in ambient and household settings so that we can find appropriate measures to reduce exposure and the associated burden of disease, especially from particulate matter.
The report, she said, gives evidence of the substantial threat air pollution poses to the health, and even lives, of babies and children under the age of five. “This vulnerable group needs special attention to mitigate their exposure, for example, through policy and intensive awareness campaigns with practical solutions for mothers and caregivers.”
South Africa in top 10
South Africa was ranked in fourth position among the 10 countries across Africa with the highest number of deaths linked to PM2.5, with the country recording 25 800 deaths in 2019. Egypt was in top position (90 600), followed by Nigeria (68 500) and Morocco (27 000).
In Africa, PM2.5 comes from many of the same sources found elsewhere in the world, including the use of solid fuels for cooking; fossil fuel (coal, oil, and gas) use for energy production; vehicles; industrial and semi-industrial activities, such as artisanal mining; agriculture; forest fires and open waste fire pits.
In parts of Africa, windblown dust, a natural source of air pollution, is also a major contributor to PM2.5 levels.
In South Africa, energy production contributes to 23% of the ambient PM2.5 levels, according to the report, which notes how although a lack of monitoring stations makes estimates uncertain, limited monitoring and modelled estimates indicate that most people in Africa breathe unhealthy levels of PM2.5 pollution.
Clean energy
Access to clean forms of energy will be crucial in determining Africa’s air-quality future as well as improved public health, the report said. “As the world’s nations convene in Egypt for COP27, Africa will consider how energy transitions can be designed to be efficient, economically feasible, sustainable and environmentally friendly – a complex challenge that requires a nuanced conversation at the nexus of energy, climate, air quality and health.”
Many of the solutions to reduce air pollution support efforts to tackle climate change in Africa, Wright said. “The most pressing one is the need for a transition from coal-fired power stations, that emit sulphur dioxide that contributes to global heating, to using renewable options for power generation.
Electricity made from renewable energy in the home is the cleanest form of energy, not only for the household but for the environment.
“Also, by stopping the burning of wood and coal in homes, particulate matter concentrations also decrease – black carbon, a particulate pollutant from combustion, contributes to global heating, so reducing burning in dwellings has a positive effect on the atmosphere and climate change.”
Complex problem
Wright said effective solutions for air pollution to reduce the health threats, especially for vulnerable children under five in Africa, “require collaboration and complexity” because air pollution comes from many different sources.
“We need policy and legislation to mandate industry to meet minimum emission standards. We need stringent monitoring and inspections to stop illegal waste-burning and programmes that encourage people to bring items, such as tyres, to regulated service providers who dispose of them or repurpose them, rather than burning tyres.”
Africa is a dusty continent, she said. “There will always be background dust but we must manage how we treat and use land to reduce exposing soil and increasing dust levels. We also rely on biomass burning, for example, for firebreaks, and protecting areas from potential fires – this also contributes to air pollution and requires monitoring or alternate practices that are less air-pollution intensive.”
Finding solutions for household air pollution where families and young children are exposed to the burning of “dirty fuels” in their homes is one of the biggest challenges for the continent.
Starting fires outside, and letting the smoke die off, before bringing them indoors is one option, Wright said.
“Whether people have the agency and choice to take up cleaner energy options for cooking, heating and lighting is a much more complicated question. It would be a great health advantage if electricity generated by renewable energy was provided at affordable cost to all dwellings in South Africa.”
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