Air pollution is barely acknowledged in the draft political declaration for the upcoming fourth UN High-Level Meeting on Non-communicable Diseases (NCDs) and Mental Health. The omission of the world’s leading contributor to disease threatens global progress in tackling heart disease, respiratory diseases, stroke, cancer, and other chronic illnesses.

Since the last UN General Assembly High-Level Meeting on non-communicable diseases (NCDs) in 2018, air pollution has leapfrogged tobacco as a cause of disease and premature death worldwide.

Government representatives negotiating ahead of September’s meeting in New York City must commit to addressing this global health emergency of air pollution as the leading contributor to the global disease burden, causing more than one in ten deaths globally. 

Without clean air action, leaders will miss a golden opportunity to reduce the pressure on healthcare, improve the lives of billions of people living with NCDs, and prevent millions of cases of cardiovascular and respiratory disease, lung cancer, diabetes, mental health and neurological conditions including dementia.

In 2019, 99% of the world’s population was breathing air polluted beyond safe levels, according to WHO’s global air quality guidelines. The 2024 State of Global Air report by the Health Effects Institute shows that outdoor air pollution—driven largely by fossil fuels, transport, waste burning, and agriculture—causes 4.7 million deaths each year, while  household air pollution from cooking and heating with polluting fuels adds another 3.1 million deaths. 

That’s eight million preventable deaths every year—a staggering, unacceptable toll representing real people losing their lives to the very air they breathe.

The declaration of leaders meeting at UNGA must reflect the urgency of the issue, the life-saving potential of clean air, the cost-savings this offers to health services, and clearly call for integrated action on air pollution.

The unquestioned science

Almost everyone on earth breathes polluted air, with an impact far beyond the lungs. Fine particulate matter (PM2.5) enters the airways and is tiny enough to pass into the circulatory system and can reach nearly every organ, where it contributes to heart attacks, strokes, kidney disease, depression, anxiety, and impaired brain development in children. It also increases risks during pregnancy, including of miscarriage, stillbirth and low birth weight.

People living with NCDs are hit hardest. Air pollution causes more than a quarter of all deaths from ischaemic heart disease and stroke, almost half of all deaths from chronic obstructive pulmonary disease (COPD), and nearly a third of deaths from lung cancer, while worsening patients’ quality of life, prognosis and healthcare access. 

Countries are already off track to achieve SDG target 3.4—reducing premature NCD mortality by one-third by 2030. Most will find it impossible to meet this target without real action to reduce air pollution.

The good news is that proven, cost-effective solutions to allow us all breathe easier exist. Ministers of Health unanimously approved an updated WHO global roadmap on air pollution and health at last month’s World Health Assembly, including a target to halve mortality from anthropogenic air pollution by 2040. 

Progress towards the WHO Air Quality Guideline levels for healthy air is already underway in some regions. The European Union recently updated its Ambient Air Quality Directive, while China cut PM air pollution by more than half over the last decade, proving that clean air is compatible with rapid economic development. City mayors from every continent are showing leadership too, with 50 cities committing to stepping up clean air action earlier this year. 

Where the burden hits hardest 

Like tobacco, alcohol and other major risk NCD factors, air pollution imposes an acutely unfair burden of disease on the lowest-income countries, and most marginalised communities. Ninety-five per cent of deaths linked to air pollution are of people in low- and middle-income countries, due to toxic pollution and under-resourced health systems. 

Despite the scale of this crisis, air pollution remains drastically underfunded. According to the State of Global Air Quality Funding 2024 report, clean air initiatives received less than 1% of international development funding between 2018 and 2022. This chronic neglect is not just a public health failure—it’s an economic catastrophe, with a toll counted in lost lives and livelihoods worldwide. 

The World Bank estimates that the cost of air pollution at US$6 trillion annually—equivalent to 5% of global GDP—from lost labour income due to illness and premature death, reduced productivity, and increased healthcare expenditures. In some of the hardest-hit countries, especially in South and South-East Asia and sub-Saharan Africa, air pollution costs exceed 10% of national GDP. 

These economic wounds stall development, entrench poverty, overwhelm fragile health systems and reveal a stark disconnect: the world is losing trillions to an entirely preventable crisis while making virtually no investment to stop it.

Fossil fuels: the overlooked driver 

NCD Alliance (NCDA) has voiced strong concerns over the draft political declaration, particularly the absence of any mention of fossil fuels—by far the leading driver of air pollution. Reducing fossil fuel extraction and use, phasing out subsidies, and ensuring just transition to clean energy must be central to NCD prevention efforts, but such commitments are currently absent.

NCD Alliance recommends clearly acknowledging the public health emergency posed by air pollution calls on governments to include an additional tracer target: “at least 80% of countries have adopted air quality standards to align with WHO air quality guideline level by 2030.” 

Air pollution was recognized as a major NCD risk factor by leaders at the last High-Level Meeting on NCDs in 2018, together with mental health and neurological conditions as one of the major NCD groups, creating a “5×5” framework for the NCD response. Since then, the evidence has only grown stronger on health impacts of air pollution, climate change and environmental degradation.

NCDA therefore calls for the stronger inclusion of air pollution, food systems and climate change in the text, and urges leaders to address this important nexus. Failure to do so would ignore emerging risks and lead to missed opportunities for more integrated, efficient, and forward-looking action.

Political momentum building

At the 2nd WHO Global Conference on Air Pollution and Health in March 2025, governments and stakeholders endorsed a bold goal: halving the health impacts of air pollution by 2040. That target was formally approved by the 78th World Health Assembly. Achieving it would prevent three-to-four million premature deaths annually—most of them from NCDs. 

This aligns with the Sustainable Development Goals, including SDG 3.4 (reduce premature NCD mortality), SDG 3.9 (substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution), SDG 7.1 (ensure universal access to affordable, reliable and modern energy services) and SDG 11.6 (improve air quality in cities).

Leading health organizations have joined the call to action, singling out air pollution as a deadly yet underfunded and solvable crisis. The Union for International Cancer Control (UICC) has identified air pollution as a missed opportunity to improve cancer survival, noting significant differences in prognosis in more polluted countries and cities.

The World Heart Federation (WHF) has also sounded the alarm on air pollution as an under-addressed driver of cardiovascular disease, with over half of the nearly eight million annual air pollution-related deaths are due to cardiovascular conditions, according to its 2024 World Heart Report. 

WHF urges governments to adopt the 2021 WHO air quality guidelines as legally binding standards and to align clean air targets with climate and urban planning policies. Their message is clear: protecting heart health means tackling pollution at its source—especially fossil fuels—and integrating environmental, health, and economic agendas.

A test of global leadership

Omitting air pollution from the NCD agenda is not just an oversight—it’s a dangerous misstep. The upcoming High-Level Meeting is a unique opportunity to correct course. World leaders must explicitly commit to act on air pollution as a major NCD risk factor in their political declaration. 

This should include developing national air quality standards that align with WHO guidelines, curbing emissions from key sources, and evaluating the cost savings from cleaner air to inform health system planning and budgets. Governments and donors must step up with stronger investments in clean air, especially for the most affected communities.

Clean air is not a luxury—it is a human right, especially for people living with NCDs. 

Leaders have the power to reverse this public health failure and economic disaster while delivering clear public health policy success: hospital admissions falling within days and weeks, healthier babies born in the ensuing months, and NCD trends continuing to improve over decades.

The science is beyond doubt, the solutions are proven, and Ministers of Health and Environment have committed on the international stage. The world now needs leaders to recognize the urgency of this crisis and seize this opportunity to save both lives and money. Including air pollution in the NCD agenda is not optional—it is vital.

About the authors

Alison Cox is the Policy, Advocacy and Accountability Director of the NCD Alliance, a global network of civil society organisations dedicated to transforming the fight against noncommunicable diseases.

Nina Renshaw is a career-long advocate for clean air, joining Clean Air Fund as Head of Health in 2022. She has twenty years of experience of international policy and advocacy in diverse fields, including health, environment, economy, transport and international development.

Image Credits: Giorgia Galletoni , CC, Patrick Gruban.