nature medicine Review article
https://doi.org/10.1038/s41591-025-03929-8
Air pollution interventions for health Received: 12 March 2025 Accepted: 30 July 2025 Published online: 21 August 2025 Check for updates
John S. Ji 1 , Francesca Dominici Maria Neira6
, Nelson Gouveia
2,3
, Frank J. Kelly
4
5
&
Air pollution, a leading environmental health risk, claims millions of lives yearly, impacting health across the lifespan. Despite widespread acknowledgement of air pollution-related disease burdens, eliminating air pollution remains challenging. Many regions are reliant on fossil fuels or biomass for basic survival, and developed economies striving to reduce air pollution face persistent barriers. Climate change complicates intervention efforts, as rising temperatures and extreme weather (for example, wildfires, dust storms) intensify air pollution. Traditional interventions may falter under worsening climate conditions, requiring integrated mitigation, adaptation and resilient infrastructure to yield environmental and health benefits. In this narrative Review, we evaluate multilevel interventions at the national, community and individual levels, discussing what works and does not work, with illustrative case examples. No single intervention suffices; efficacy depends on context, shaped by enforcement and equity. Integrated strategies are needed to address the root causes of air pollution and mitigate the devastating health impacts.
Air pollution is a leading environmental risk factor that impairs health across the lifespan and causes millions of premature deaths annually1. The World Health Organization (WHO) estimates that 99% of the global population breathes air that fails to meet WHO safety guidelines, with low- and middle-income countries (LMICs) having the highest exposure due to fossil fuel reliance and infrastructure2–5. Epidemiological and mechanistic studies reveal that air pollution disrupts nearly every organ system, driving adverse effects on the lungs6, heart7, brain, central nervous system8, immune system9,10 and others11 (Fig. 1). Quasi-experimental studies demonstrate that air pollution is associated with pregnancy complications and adverse birth outcomes, such as preeclampsia, gestational diabetes, congenital malformations, preterm birth and low birth weight12–22. As a leading yet modifiable risk factor for myriad negative health effects, air pollution demands urgent, evidence-based interventions to advance global health equity and reduce its devastating toll. The ‘State of Global Air 2024’ report found that air pollution accounted for 8.1 million deaths globally in 2021, making it the second leading risk factor for death behind high blood pressure1. Alarmingly, more than 700,000 deaths in children under 5 years of age were linked
to air pollution, representing 15% of all global deaths in this age group. Although these adverse health outcomes in children are largely driven by acute conditions such as lower respiratory infections, the overall disease burden from air pollution is dominated by long-term impacts. Chronic diseases, including heart disease, stroke, diabetes, lung cancer and chronic obstructive pulmonary disease, account for nearly 90% of the disease burden from air pollution. Despite its ubiquity, air pollution remains underrecognized as a health determinant. Its complexity arises from a dynamic mixture of particulate matter, nitrogen dioxide (NO2), ozone (O3) and other pollutants from combustion, traffic and secondary reactions, driving acute crises and chronic risks, with mixture effects complicating control (Fig. 2). Air pollution intertwined with climate change poses complex challenges from evolving transportation emissions, pollutant mixtures and climate-driven air quality shifts, which challenge current intervention policies. Climate change drives new emission sources, like wildfires and O3 from warming, while urbanization concentrates exposure in ‘megacities’; of note, more than half of the global population will live in megacities by 2050 (refs. 23–25).
1 Vanke School of Public Health, Tsinghua University, Beijing, China. 2Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3Harvard Data Science Initiative, Cambridge, MA, USA. 4Faculty of Medicine, Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil. 5Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London, London, UK. 6Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland. e-mail: johnji@tsinghua.edu.cn
Nature Medicine | Volume 31 | September 2025 | 2888–2900
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