We breathe the same air, but Not everyone pays the same price in healthA comprehensive study led by the Barcelona Institute for Global Health (ISGlobal), in collaboration with the Barcelona Supercomputing Center-National Supercomputing Center (BSC-CNS), concludes that European regions with More poverty and less renewable energy They concentrate the greatest risk of death associated with air pollution. This inequality in the price in health It is one of the central axes of the analysis.
The research paints a picture of a Europe divided in two: on one side, the areas of north and west of the continentOn the one hand, there are the regions with stronger economies, better healthcare systems, and a more advanced energy transition; on the other hand, there are the regions of south and east, with lower income and a strong dependency on fossil fuelswhere air pollution has a much more severe health impacteven when pollution levels are similar.
An unprecedented European macro-study
The work, published in the journal Nature MedicineIt relies on a mortality database from the project EARLY-ADAPT Which collects 88,8 million deaths registered between 2003 and 2019 in 653 contiguous regions of 31 European countrieswith a total population of 521 million people. That is, a very detailed map of how pollution and social conditions combine across the continent.
To estimate actual exposure to pollution, the team used advanced machine learning models capable of calculating, day by day, the levels of the main air pollutants: fine particulate matter (PM)2.5), coarse particles (PM10), nitrogen dioxide (NO2) and tropospheric ozone (O3)In particular, the dynamics of tropospheric ozone This is key in seasonal episodes that affect public health. This data was cross-referenced with daily mortality and regional socioeconomic indicators.
In addition to pollution, scientists incorporated into their models socioeconomic statistics and renewable energy consumption data from Eurostat. With all this, they built epidemiological models designed to analyze How the risk of dying from air pollution varies according to the social, economic and energy context and how those risks have changed throughout the 21st century.
The greater the poverty, the greater the health damage.
One of the clearest conclusions of the study is that The effects of air pollution do not depend solely on what we breathe.but also of who breathes it and in what conditions they liveTwo regions with similar concentrations of pollutants can experience very different health impacts depending on their level of wealth, the quality of their healthcare system, or the demographic structure of their population. Therefore, the analysis complements exposure measurement with studies on atmospheric pollution and its unequal impact on the population.
The regions with higher GDP per capita, lower poverty rate, and greater life expectancy, mostly located in northern and western Europe, present a clearly lower risk of mortality associated with air pollutionIn contrast, the most disadvantaged areas in the south and east of the continent suffer significantly higher risks, in some cases doubling those of wealthier regions, despite sharing comparable pollution levels.
These differences have not remained static. Throughout the period 2003-2019, the wealthier regions have achieved a significant reduction in the risk of death associated with PM2.5, MP10 and not2However, in many areas with lower income or lower life expectancyImprovements have been timid and, in some cases, increases in mortality linked to these pollutants have even been observed.
The authors point to several factors that would explain this gap. In regions with more resources there is usually better-equipped health systems, stronger public health programsgreater social awareness of the effects of pollution and greater capacity to implement strict environmental policiesAll of this helps to mitigate the health impact of pollution, while in poorer areas the population is more exposed and has fewer institutional defenses.
As the ISGlobal researcher points out Zhaoyue Chen, first author of the work, to have detailed estimates of risk of mortality attributable to air pollution in each region and time It allows for much more precise identification. which groups and territories are most vulnerable and therefore, where prevention efforts should be concentrated.
Energy transition and pollution: less fumes, less vulnerability
The study does not limit itself to describing social inequality, but also analyzes the role of transition to renewable energyThe research assesses how the deployment of clean technologies influences both the direct reduction of pollution as in the reduction of the vulnerability of the population in the face of its effects on health.
The results quantify this impact with very concrete figures. The increase in the use of renewable energy in Europe over the last two decades is associated with a 15% drop in PM pollution2.5, of 54% in PM10 and 20% in NO2These improvements in air quality, in turn, translate into a 12% reduction in pollution-attributable mortality for PM2.5, of 52% for PM10 and 20% for NO2.
However, the effect of the energy transition goes beyond cleaning the air. Regions that have advanced earlier and more strongly in renewable energy also register a lower vulnerability of its population to pollution. This is largely because the commitment to renewables is often accompanied by social and infrastructural improvementsMore sustainable public transport, greener and more walkable citiesCleaner technologies in industry and the home, and stricter environmental regulations.
The research team points out that renewable energy is a central pillar of sustainable climate and environmental policiesBut he insists that its deployment must also be understood as a public health toolReducing fossil fuel emissions means fewer fine particles and toxic gases in the air and, at the same time, an urban and social environment that better protects citizens from the harms of pollution.
However, the progress of renewables in Europe has been clearly unequalWhile numerous northern countries have registered a rapid and sustained growth of clean energy, several southern and eastern states—such as Italy, Poland, Malta or Cyprus— they maintain a high dependence on fossil fuelsThis translates into less pollution reduction and a continuation of health vulnerability.
A two-speed Europe in health and energy
This combination of social and energy factors paints a picture of what many experts describe as “a two-speed Europe”On one side are the regions that have invested heavily in renewable energy, green infrastructure and emissions controls; on the other, those that continue to suffer from high levels of poverty and a lower capacity to transform their energy model.
Explains Joan Ballester Claramunt, principal investigator of the EARLY-ADAPT project and senior author of the study, Western European countries have tended to allocate more resources to renewable energy and improved air quality. However, Many Eastern European countries still depend on external financing and are at an earlier stage in the integration of clean technologies and pollution control measures.
This gap is clearly reflected in public health. In the poorest regions of the south and east, the population endures a double charge: greater exposure to pollutants and greater risk of mortality for the same level of exposureIn wealthier areas, on the other hand, progress in the energy transition and the greater robustness of healthcare systems has allowed for a much faster reduction of the risks associated with pollution.
The researcher from CIEMAT Yolanda Lechón It highlights that the main contribution of this work is to integrate, within a single analytical framework, socioeconomic factors, pollution levels and energy transition on such a large sample of deaths in Europe. Unlike previous studies focused almost exclusively on exposure to pollutants, this analysis systematically incorporates the unequal vulnerability of the population and its evolution in parallel with the deployment of renewables.
Lechón acknowledges that the study is based on models and aggregated data —which can smooth out very subtle local variations—, but emphasizes that its scale and integrated approach make it a reference of great scientific rigor to understand how climate policies translate into real health benefits and who is being left behind in that process.
Equity and public health at the heart of environmental policies
The authors insist that the results send a clear message to policymakers: The energy transition cannot be framed solely as a climate or technological issueIt is, above all, a question of equity and public healthIf investments in clean energy and improved air quality are not prioritized for the most vulnerable regions, the risk is that the transition will end further widening existing inequalities.
To avoid this, the study proposes that environmental policies explicitly integrate the health equity as one of its central axes. That implies strengthen public health infrastructure In the most affected areas, improve healthcare for the most vulnerable groups and deploy epidemiological surveillance and early warning systems in the face of pollution episodes, especially in regions with high poverty and less access to health services.
Along these lines, some of the data and models generated by the research have been incorporated into Forecaster.Health, an early warning system based on impacts that It issues warnings about mortality risks associated with temperature and air pollution. for particularly vulnerable population groups. Tools of this type allow us to anticipate risk scenarios and better allocate resources.
The study also emphasizes the importance of expand and improve environmental and health monitoring throughout Europe. As the BSC researcher points out. Carlos Pérez García-PandoIt is urgent to have tracking systems that allow detect regional disparities, evaluate the effectiveness of the policies implemented and to ensure that investments reach where they are most needed.
Although the analysis is focused on the European context, the authors warn that Its implications are global.In many low- and middle-income countries, the accelerated urban growth and industrial expansion advance faster than investments in clean energy and environmental protection, which may further increase the vulnerability of large segments of the population to the effects of air pollution. This dynamic is comparable to that observed in some of the most polluted countries in the worldwhere exposure and lack of infrastructure combine.
What this means for Spain and Southern Europe
For countries like Spain, Italy or GreeceLocated in southern Europe, the conclusions of this study are of particular relevance. These are territories that combine frequent episodes of pollution —particularly from tropospheric ozone in the warmer months— with marked socioeconomic and territorial inequalitiesboth between regions and between urban and rural areas.
In the Spanish case, the study suggests that the push to renewable energy —wind, solar photovoltaic, solar thermal, among others— can be translated into significant additional health benefitsBeyond its contribution to the fight against climate change, it also makes clear that this progress must be accompanied by... specific public health policies adapted to the characteristics of each territory.
Among the recommended measures are the reinforcement of the epidemiological surveillance on respiratory and cardiovascular diseases related to pollution, the implementation of early warning systems for high pollution episodes, improving access to healthcare for vulnerable populations (elderly people, children, patients with chronic illnesses) and one greater coordination between environmental and health policiesIn particular, the relationship between pollution and Cardiovascular health This should be considered in the planning of these measures.
This integrated approach implies that the energy transition in Spain and in the rest of southern Europe it is not conceived solely as a strategy to reduce CO2 emissions2but as a key lever to reduce health inequalities and improve the overall well-being of the populationUltimately, it's about prioritizing those territories where the combination of poverty, poor air quality and limited deployment of renewables It places citizens in a situation of particularly high health risk.
Taken together, the evidence gathered by this study confirms that The poorest European regions are also the most exposed and least protected from the effects of air pollutionWhere the energy transition is progressing more decisively, the population breathes cleaner air and is better protected from its impacts; where it stagnates, a health gap widens across the map of Europe. Focusing environmental, energy, and public health policies on these territories is not only a matter of climate justice, but also of social justice and the right to health for millions of people.