Fighting ambient air pollution and its impact on health: from human rights to the right to a clean environment.

STATE OF THE ART

INT J TUBERC LUNG DIS 19(8):887–897 Q 2015 The Union http://dx.doi.org/10.5588/ijtld.14.0660

STATE OF THE ART SERIES The global burden of chronic respiratory disease Series editor: Guy Marks Guest editor: Nils Billo NUMBER 5 IN THE SERIES

Fighting ambient air pollution and its impact on health: from human rights to the right to a clean environment N. Guillerm,* G. Cesari† *The International Union Against Tuberculosis and Lung Disease, Paris, France; †The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland SUMMARY

Clean air is one of the basic requirements of human health and well-being. However, almost nine out of 10 individuals living in urban areas are affected by air pollution. Populations living in Africa, South-East Asia, and in low- and middle-income countries across all regions are the most exposed. Exposure to outdoor air pollution ranks as the ninth leading risk factor for mortality, killing 3.2 million people each year, especially young children, the elderly, persons with lung or cardiovascular disease, those who work or exercise outdoors and low-income populations. In October 2013, the International Agency for Research on Cancer (IARC) classified outdoor air pollution as carcinogenic to humans, calling air pollution ‘a major environmental health problem’. Human rights and environmental

norms are powerful tools to combat air pollution and its impact on health. The dependence of human rights on environmental quality has been recognised in international texts and by human rights treaty bodies. The growing awareness of the environment has already yielded considerable legislative and regulatory output. However, the implementation of standards remains a pervasive problem. In the fight against violations of norms, citizens have a crucial role to play. We discuss the relevance of a yet to be proclaimed standalone right to a healthy environment. K E Y W O R D S : air quality; inequalities; right to health; government and corporate accountability; public participation

CLEAN AIR IS ONE OF THE BASIC requirements of human health and well-being. Humans breathe thousands of litres of air each day. However, during the process of economic development, air pollution has been and continues to be a significant health hazard worldwide.1 According to the World Health

Organization (WHO) 2014 ambient (outdoor) air pollution database, which was based on measures made in 1600 cities in 91 countries, almost nine out of 10 individuals living in urban areas are affected by air pollution.2 Ambient air pollution refers to air pollution in outdoor environments. Urban outdoor air pollution refers to the outdoor air pollution experienced by populations living in urban areas. Common sources of ambient air pollution include fumes from vehicles, and emissions from factories, agriculture (including land clearing activities) and power plants. Emissions from households using coal and biomass for cooking and heating can contribute to the level of urban outdoor air pollution.3 Ambient air pollution is largely man-made, but some air pollutants have natural sources.4 The most common ambient air pollutants include particulate matter (PM), sulphur dioxide (SO2),

NG and GC contributed equally to this manuscript

[Previous articles in the series: Editorial: Marks G, Billo N E. Chronic respiratory disease: the forgotten NCD? Int J Tuberc Lung Dis 2014; 18: 1261. No 1: Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis 2014; 18: 1269–1278. No 2: Reddel H K, Jenkins C R, Partridge M R. Self-management support and other alternatives to reduce the burden of asthma and chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2014; 18: 1396–1406. No 3: Burney P, Jarvis D, Perez-Padilla R. The global burden of chronic respiratory disease in adults. Int J Tuberc Lung Dis 2015; 19: 10–20. No 4: Chiang C-Y, A¨ıtKhaled N, Bissell K, Enarson D A. Management of asthma in resourcelimited settings: role of low-cost corticosteroid/b-agonist combination inhaler. Int J Tuberc Lung Dis 2015; 19: 129–136.]

Correspondence to: Nathalie Guillerm, TB and HIV Department, International Union Against Tuberculosis and Lung Disease, 68 bd Saint Michel Paris 75006, France. Tel: (þ33) 1 56 80 28 30. Fax: (þ33) 1 43 29 90 87. e-mail: nguillerm@ theunion.org

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The International Journal of Tuberculosis and Lung Disease

TRENDS AND INEQUALITIES IN EXPOSURE TO AMBIENT AIR POLLUTION

Figure 1 Per capita carbon emissions from 1950 to 2010. Source: http://cdiac.esd.ornl.gov/trends/emis/glo_2010.html.10

nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO) and carbon dioxide (CO2). PM is a mixture of solid particles and liquid droplets found in the air. PM is formed through chemical reactions, fuel combustion, industrial processes, farming and unpaved roads or during road construction. Particle pollution includes coarse particles with diameters .2.5 lm and ,10 lm (PM10), and fine particles with diameters 62.5 lm (PM2.5). The greatest source of SO2 emissions is fossil fuel combustion at power plants (73%) and other industrial facilities (20%).5 NO2 is part of a group of gaseous air pollutants produced as a result of road traffic and other fossil fuel combustion processes. O3 (or tropospheric O3 or ground-level O3) does not exist naturally; it results from human actions that cause chemical reactions between oxides of nitrogen (NOx) and volatile organic compounds (VOC). CO is produced as a result of fuel combustion from vehicles and engines. CO2 is the primary greenhouse gas emitted through human activities; while CO2 emissions come from a variety of natural sources, human-related emissions are responsible for the increase that has occurred in the atmosphere since the industrial revolution.6

According to the World Bank, 53% of the world’s population was living in urban areas in 2012.7 Urban outdoor air pollution therefore already concerns most of humanity. It is expected that 6.4 billion people will be living in cities by 2050.8 Globally, the emission of certain air pollutants is increasing, as illustrated by per capita carbon emissions, which doubled from 1950 to 2010 (Figure 1).9,10 Annual mean PM10 levels increased by 6% between 2011 and 2014.2 Although air pollution is a global phenomenon, populations living in Africa, South-East Asia, and in low- and middle-income countries (LMICs) across all regions were most exposed to PM10 between 2008 and 2012 (Figure 2).2 Those living in cities in LMICs experience this burden disproportionately. The most at-risk populations in terms of air pollution exposure include young children, the elderly,11 people with lung diseases such as asthma, chronic bronchitis and emphysema, people with cardiovascular disease, people who work or exercise outdoors (certain industries)12 and low-income populations.13 In urban areas across the world, the highest annual mean PM10 levels occur in cities in Latin America, Asia, Africa and the Middle East, due to industrialisation and urbanisation (Figure 3).14 As shown in Figure 3, in most large cities in highincome countries, PM10 levels are generally ,20 or 30 lg/m3. It is interesting to note that in some large cities in China a slight reduction in PM10 levels has been noted during the economic development in the last few decades.15 However, communities living in Chinese cities continue to endure much higher hazardous levels of exposure to PM2.5 than US cities (Figure 4).16 Other cities where populations are exposed to extremely high PM concentrations include Peshawar

Figure 2 PM10 levels by region for the last available year, 2008–2012. PM10 ¼ particulate matter of .2.5 lm and ,10 lm diameter. Source: http://www.who.int/phe/health_topics/outdoorair/databases/cities/en/.2 LMIC ¼ low- and middle-income country; EMR ¼ Eastern Mediterranean Region; SEAR ¼ South-East Asian Region; WPR ¼ Western Pacific Region; HIC ¼ high-income country.

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Figure 3 PM10 levels (lg/m3) in a selection of urban areas, 2008–2013. Source: http://gamapserver.who.int/mapLibrary/app/ searchResults.aspx.14 This image can be viewed online in colour at http://www.ingentaconnect.com/content/iuatld/ijtld/2015/ 00000019/00000008/art00006

and Rawalpindi, in North-East Pakistan, where PM10 levels reached an annual mean of respectively 540 lg/ m3 and 448 lg/m3 between 2008 and 2012. India is also very heavily affected; the cities of Gwalior, south of New Delhi, and Raipur, central India, are extremely polluted, with PM10 levels of respectively 329 and 305 lg/m3. This compares to Switzerland, Sweden, Finland, Norway, the United States, New Zealand and Australia, which have annual mean PM10 levels of 22 lg/m3.14 Populations living in LMICs have only just started to experience the effects of ambient air pollution. As illustrated by the Environmental Kuznets curve

(Figure 5),17 it is expected that under the same circumstances as those experienced in high-income countries (i.e., no use of clean non-pollutant energies for economic growth), air quality will continue to deteriorate in most developing countries until economic development has been completed. Ambient air pollution is a challenge of the future for many. By contrast, most industrialised countries have now started to experience a reduction in air pollutant levels. Pope et al. reported that PM2.5 concentrations fell by a third from the early 1980s to the late 1990s across all major US metropolitan areas.18

Figure 4 Exposure to PM2.5 in A) Chinese cities compared to B) US cities. WHO ¼ World Health Organization; PM2.5 ¼ particulate matter of 62.5 lm diameter.16 (Permission)

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Figure 5 Environmental Kuznets curve.17 (with permission from the author https://futurechallenges.org/local/its-not-thateasy-being-green/)

HEALTH EFFECTS OF AMBIENT AIR POLLUTION No one can dispute the health effects of air pollution today, as acute exposures to high concentrations of air pollutants are known to exacerbate existing cardiopulmonary disorders.19 According to the Global Burden of Disease study, exposure to outdoor air pollution ranks as the ninth leading risk factor for mortality, and outdoor air pollution is responsible for 3.2 million deaths each year.20 In China alone, urban ambient air pollution is estimated to lead to the loss of more than 25 million disability-adjusted life-years annually.21 The WHO has set the maximum acceptable annual mean for PM10 exposure at 20 lg/m3. As seen previously, PM10 levels have crossed this threshold in many large cities worldwide. Fine PM has the most significant effect on human health.22 According to Chen et al.,1 now that PM levels are being measured more and more widely and globally, there is substantial evidence that PM exposure increases respiratory mortality and morbidity (hospital admissions, outpatient and emergency room visits, asthma attacks, acute respiratory infection of young children, etc.)20 in cities in industrialised and developing countries alike, with the majority of deaths occurring in LMICs.13 Although evidence of the impact of ambient air pollution levels is more scarce for morbidity than for mortality, it does exist. Short-term effects of exposure to ambient air pollution include irritation of the eyes, nose and throat, and upper respiratory infections such as bronchitis and pneumonia. Others include headaches, nausea and allergic reactions. Short-term air pollution can aggravate the medical conditions of individuals with asthma and emphysema. In a study from Hwang et al., the effects of air pollution on daily clinic visits for lower respiratory tract illness in Taiwan during 1998 were monitored. The study included 50 townships and city districts in Taiwan where ambient air monitoring stations of the Taiwan Air Quality Monitoring Network are located. It was found that high levels of PM10, NO2, CO and SO2 showed significant effects on daily clinic visits due to lower respiratory tract illness, including acute

bronchitis, acute bronchiolitis and pneumonia.11 In another study, Hwang et al. reported that NO2 exposure was related to increased absence from school among schoolchildren due to respiratory illness in the subsequent 3 days.23 Some studies have also demonstrated an increase in emergency hospital admissions for asthma, as well as in hospital admissions for chronic obstructive pulmonary disease (COPD),24 when SO2 and NO2 levels increase.25,26 An effect of NO2 has been noted in most panel studies evaluating aggravation of asthma in children, showing a clear effect of NO2 on the incidence of viral infections among asthma patients.27 Asthma prevalence is increasing worldwide as communities adopt modern lifestyles and become urbanised, and through exposure to outdoor air pollution.28,29 There is also evidence of chronic adverse health effects from long-term exposure to air pollutants, particularly PM. A 10 lg/m3 increase in PM2.5 is associated with an increase in risk of lung cancer mortality.30 A report from the prospective Cancer Prevention II study of the American Cancer Society, which included 500 000 participants, showed that for each 10 lg/m3 increase in fine PM, air pollution was associated with a 6% increase in all-cause mortality, a 9% increase in risk of cardiopulmonary mortality and a 14% increase in risk of lung cancer.30 In October 2013, the specialised cancer agency of the WHO, the International Agency for Research on Cancer (IARC), classified outdoor air pollution as carcinogenic to humans, and called air pollution ‘a major environmental health problem’. Based on the independent review of more than 1000 scientific papers from large epidemiological studies on five continents that included millions of people living in Europe, North and South America, and Asia, the IARC evaluation showed an increasing risk of lung cancer with increasing levels of exposure to PM and air pollution.4 According to the WHO, by reducing annual mean outdoor concentrations of PM10 from 70 to 20 lg/m3, the target level set out in the 2005 WHO Air Quality Guidelines, 15% of long-term mortality (i.e., deaths) from air pollution could be averted. Reaching these lower levels of air pollution will also reduce respiratory and cardiovascular diseases and increase life expectancy among local populations. In addition, actions to reduce urban air pollution will also cut emissions of greenhouse gases and other pollutants that contribute to climate change. Climate change produces a number of adverse effects on health (other health impacts), including those from drought and extreme weather events (e.g., windstorms, floods), such as water-borne and food-borne diseases. It also increases the prevalence of vector-borne diseases such as dengue or malaria.31 In the light of the evidence confirming the existence of air pollution and its negative impact on health, are


common citizens condemned to suffer in silence, or do they have tools at their disposal to combat this environmental problem?

DEPENDENCE OF INTERNATIONALLY GUARANTEED HUMAN RIGHTS ON THE ENVIRONMENT International texts Adopted by the United Nations (UN) General Assembly in 1948, the Universal Declaration of Human Rights (UDHR),32 set out for the first time in history basic civil, political, economic, social and cultural rights that all human beings should enjoy. Together with the International Covenant on Civil and Political Rights (ICCPR)33 and its two Optional Protocols,34,35 and the International Covenant on Economic, Social and Cultural Rights (ICESCR),36 it forms the ‘International Bill of Human Rights’. This Bill of Human Rights is complemented by a number of other universal instruments, most of which were adopted before environmental protection became a matter of international concern. This explains why the right to a healthy environment is absent from the pioneering human rights documents. However, the UDHR protects the right to life and a standard of living adequate for health and well-being, rights from which the right to a healthy environment can be inferred. The right to life is reiterated in the ICCPR, and the right to an adequate standard of living and to the highest attainable standard of health in the ICESCR. Some global human rights treaties make explicit reference to environmental threats to human rights, particularly the right to health. Article 12, para 2(b) of the ICESCR provides that the steps parties must take to achieve the full realisation of the right to health ‘shall include those necessary for the improvement of all aspects of environmental and industrial hygiene’.36 Article 24 of the UN Convention on the Rights of the Child provides that States parties ‘shall take appropriate measures to combat disease and malnutrition through the provision of adequate nutritious foods and clean drinking water, taking into consideration the dangers and risks of environmental pollution’.37 While there are few references to environmental matters in international human rights treaties, the recognition that the enjoyment of human rights, such as the rights to life and health, depends upon environmental quality was clearly expressed in the 1972 Declaration of the UN Conference on the Human Environment (Stockholm Declaration), which states that ‘both aspects of man’s environment, the natural and the man-made, are essential to his well-being and to the enjoyment of basic human rights—even the right to life itself’.38

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International and regional human rights treaty bodies International human rights treaty bodies have interpreted their respective human rights instruments in a manner that recognises the environmental dimensions of protected rights. In General Comment 14, issued in 2000, the Committee on Economic, Social and Cultural Rights, the body of independent experts that monitors the implementation of the ICESCR by its States parties, interpreted Article 12, para 2(b) of the Covenant to comprise, inter alia, ‘the prevention and reduction of the population’s exposure to harmful substances such as radiation and harmful chemicals or other detrimental environmental conditions that directly or indirectly impact upon human health’.39 The Committee on Economic, Social and Cultural Rights further recognised that the right to health ‘embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life and extend to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions and a healthy environment’.39 General Comment 14 also calls on States parties to formulate national policies with the objective of ‘reducing and eliminating pollution of air, water and soil, including pollution by heavy metals such as lead from gasoline’.39 The Committee on the Rights of the Child has cited air pollution as one of the impediments to the realisation of an adequate standard of living. In its Concluding Observations on Pakistan, the Committee stated that: ‘The Committee is very concerned at the high number of children living in poverty, the shortage of adequate housing, clean water, adequate sanitation and sewage and the problem of air pollution, all of which have a serious negative impact on the living conditions of children in the State party, causing injuries, sickness and death’.40 The linkages between human rights and the environment have been further developed by regional human rights treaty bodies. In a number of decisions, the African Commission on Human and People’s Rights, the European Court of Human Rights, the European Committee of Social Rights and the InterAmerican Commission and the Court of Human Rights have recognised that environmental harm can cause not only violation of the right to health, but also of the rights to life, property and privacy.41

ENVIRONMENTAL NORMS The development of environmental norms, in particular air quality standards Since the early 1990s, the international community has repeatedly stressed that development must be sustainable and, in particular, must protect the

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Table Comparison of ambient air quality standards in the United States, the European Union, China and India with WHO interim targets and air quality guidelines China56

Pollutant Carbon monoxide, mg/m3 Nitrogen dioxide, lg/m3 Ozone, lg/m3 PM2.5, lg/m3 PM10, lg/m3 Sulphur dioxide, lg/m3

India59

WHO47

Average time

European Union49

United States54

Grade I*

Grade II†

Industrial, rural and other area

Ecologically sensitive area

Interim target 1‡

Interim target 2‡

Interim target 3‡

AQG

24 h 8h 1h Annual 24 h 1h 8h 1h Annual 24 h Annual 24 h Annual 24 h 3h 1h

— 10 40

— 10§ 40§¶ 100§¶

200 120¶ — 25¶ —¶ 40¶ 50 — 125¶ — 350

188 147§¶ — 15¶ 35¶ —¶ 150¶ — —¶ 1310§ 197§

4 — 10 40 80 200 100 160 15¶ 35¶ 40¶ 50 20 50¶ — 150

4 — 10 40 80 200 160¶ 200 35¶ 75¶ 70¶ 150¶ 60 150¶ — 500

— 2 4 40 80 —¶ 100 180 40¶ 60¶ 60¶ 100¶ 50 80¶ — —

— 2 4 30 80 —¶ 100 180 40¶ 60¶ 60¶ 100¶ 20 80¶ — —

— — — — — — 160 — 35 75 70 150 — 125 — —

— — — — — — — — 25 50 50 100 — 50 — —

— — — — — — — — 15 37.5 30 75 — — — —

— — 30 40 — 200 100 — 10 25 20 50 — 20 — —

¶

* Grade I standards apply to special regions such as national parks. † Grade II standards apply to all other areas, including urban and industrial areas. ‡ Interim targets are proposed as incremental steps in a progressive reduction of air pollution and are intended for use in areas with high pollution levels. § These values have been converted from the US system (ppm/ppb) using the relevant molecular weight. ppm ¼ (mg/m3 value)(24.45)/(molecular weight); 24.45 is a conversion factor that represents the volume of one mole of gas. ¶ Standard is either more lenient than in the WHO’s AQG or non-existent. WHO ¼ World Health Organization; AQG ¼ air quality guidelines; PM2.5 ¼ particulate matter of 62.5 lm diameter; PM10 ¼ particulate matter of .2.5 lm and ,10 lm diameter; ppm ¼ parts per million; ppb ¼ parts per billion.

environment on which present and future generations depend. Already proclaimed in Principle 4 of the 1992 Rio Declaration on Environment and Development,42 the need to ensure environmental sustainability has been recognised as Goal 7 of the Millennium Development Goals.43 The growing awareness of the importance of the environment has already yielded considerable legislative and regulatory output in various fields, including that of air quality. In recognition of the transnational nature of air pollution, the United Nations Economic Commission for Europe (UNECE) Convention on Long-Range Transboundary Air Pollution was adopted in 1979.44 This was the first legally binding international instrument to address problems of air pollution on a broad, regional basis.45 It now has 51 parties, including the European Union (EU), EU member States, the United States and Canada.46 At the international level, too, non-binding air quality guidelines were adopted for the first time by the WHO in 1987. Revised in 1997 and 2005, they are designed to support and guide countries in the development of their own national air quality standards by suggesting limits as well as interim targets for PM, O3, NO2 and SO2 levels.47 At the EU level, the main components of the air quality policy framework are the 2005 EU Thematic Strategy on Air Pollution;48 the 2001 National Emission Ceilings Directive, establishing national emission ceilings for 2010 for all Member States covering the four main pollutants;49 the Ambient Air

Quality Directives,50,51 setting local air quality limits that may not be exceeded anywhere in the EU; and source-specific legislation designed to limit emissions in specific economic sectors.52 In December 2013, the European Commission adopted a new clean air policy package with the aim of further reducing the impact of harmful emissions from industry, traffic, energy plants and agriculture on human health and the environment.53 At the national level, air quality standards have been adopted by an increasing number of countries. Passed in 1970 and amended in 1977 and 1990, the US Clean Air Act (CAA) authorised the development of comprehensive federal and state regulations to limit emissions from both stationary (industrial) and mobile sources.54 The CAA requires the Environmental Protection Agency (EPA) to periodically review the science upon which the National Ambient Air Quality standards are based and the standards themselves.54 In China, following its adoption in 1987, the Air Pollution Prevention and Control Law was amended in 1995 and 2000.55 New ambient air quality standards adopted in February 2012 prescribed the first-ever limits for PM2.5 levels in the country.56 In September 2013, the Action Plan for Air Pollution Prevention and Control was released to improve the air quality of the entire country by 2017, with a focus on three key regions: Beijing, Shanghai and Guangzhou.57 In India, the Air (Prevention and Control of Pollution) Act58 was passed by Parliament in 1981; the first ambient air quality standards were adopted


in 1982 by the Central Pollution Control Board (CPCB) and revised in 1994, and again in 2009.59 Although air quality standards have been adopted by an increasing number of countries, in many parts of the world they are more lenient than the WHO Air Quality Guidelines (Table).47,49,54,58,59 The implementation of environmental norms Not only do national ambient air quality standards often fall short of WHO guidelines, the implementation of these already weak standards remains a pervasive problem. For example, since the EU’s PM10 pollution thresholds in Directive 1999/30/EC entered into force in January 2005,60 the limits have not been respected in 17 Member States, prompting the European Commission to take action against them in 2013.61 In China, only three of the 74 cities monitored by the central government managed to meet official minimum standards for air quality in 2013.62 Governments have adopted a number of policies and programmes to encourage and compel the behavioural changes required to achieve compliance.63 Compliance monitoring is generally considered to include both self-monitoring by the regulated entity, and governmental inspections and investigations.63 Enforcement refers to actions taken by the government against violators to compel compliance with the law.63 These provisions generally give a governmental entity authority to impose sanctions.63 The role of citizens In the fight against environmental degradation, citizens have a crucial role to play. While the enjoyment of human rights depends on the quality of the environment, environmental protection requires the effective exercise of certain human rights, such as the rights to information, public participation in decision-making and access to justice. Those procedural rights that support environmental protection are widely expressed in human rights instruments. They are also found in the 1992 Rio Declaration, in which Principle 10 states: ‘. . . States shall facilitate and encourage public awareness and participation by making information widely available. Effective access to judicial and administrative proceedings, including redress and remedy, shall be provided.’ Procedural rights are also recognised in global and regional environmental treaties. The clearest example is the 1998 Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters (Aarhus Convention),64 adopted under the auspices of the UNECE, which takes a very comprehensive approach to the recognition of the importance of the right to information, public participation and access to justice in environmental matters. The Aarhus Convention is important in the present debate because it gives

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particular emphasis to public interest activism by non-governmental organisations (NGOs), insofar as claimants with a ‘sufficient interest’ are empowered to engage in public interest litigation even when their own rights or the rights of victims of a violation are not at issue.65 The broader public interest approach of the Aarhus Convention thus contrasts with the narrower focus of human rights treaties on the rights of victims of a violation.65 The Convention contains the legal possibility for any UN Member State to become a Party. If non-UNECE States do not wish to accede to the Aarhus Convention, which is generally perceived as European, the convention could serve as a model for the development of a global convention or of other regional conventions on environmental access rights.66

Examples of civil lawsuits in the field of air pollution In 1996, more than 500 asthma patients filed an air pollution lawsuit in Japan against the national government, the Metropolitan Expressway Public Corporation, the Tokyo metropolitan government and seven auto manufacturers.67 The final settlement, which was proposed by the Tokyo High Court in 2007, not only required the automakers to pay compensation to the plaintiffs, it also imposed on all defendants to contribute to a financial assistance programme to cover the medical costs of the asthma patients.67 In addition, the National and Tokyo governments were required to take anti-pollution measures and policies.67 In the United States, in January 2013, a suit filed by Earthjustice led to a ruling by the US Court of Appeals for the District of Columbia Circuit requiring the EPA to implement stronger requirements to clean up PM levels.68 In December 2011, ClientEarth, an environmental campaigning group, filed a suit against the UK Government for failing to comply with EU air quality legislation.69 The Supreme Court declared in its May 2013 decision that the Government was failing in its legal duty to protect people from the harmful effects of air pollution and confirmed that because the Government was in breach of the EU Air Quality Directive, ‘the way is open to immediate enforcement action at national or European level’.70 In China, while enforcement of pollution laws and regulations by the state is still weak, citizens living in the vicinity of polluting firms have become increasingly active.71 They have resorted not only to legal action, through tort litigation against companies and administrative litigation against enforcement authorities, but also to political action, including complaints and petitions, media involvement, demonstrations, blockades and physical action against industry premises.71 In March 2014, a Chinese man in the smoggy northern city of Shijiazhuang, capital of

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Figure 6 Recognition of the right to a healthy environment as of 2012.79 Q2012. From The constitutional right to a healthy environment, by David R Boyd. Reproduced by permission of Taylor and Francis Group, LLC. (http://www.tandfonline.com)

Hebei Province, became the first person in the country to sue the government over the country’s dangerous air pollution levels.72

RECOGNISING A NEW RIGHT TO A HEALTHY ENVIRONMENT? Despite the adoption of numerous environmental norms, no global agreement sets out an explicit right to a healthy environment. However, while it is not yet recognised at the global level, the right to a clean environment has been affirmed by several binding regional instruments, namely the 1981 African Charter on Human and Peoples’ Rights,73 the 1988 Additional Protocol to the American Human Rights Convention on Economic and Social Rights74 and the 2004 Revised Arab Charter on Human Rights.75 Although the 1950 European Convention on Human Rights does not include an explicit right to a healthy environment,76 the Aarhus Convention refers to ‘the right of every person of present and future generations to live in an environment adequate to his or her health and well-being’. In South-East Asia, the right to a healthy environment has been recognised, albeit in a non-binding document, in the 2012 Association of Southeast Asian Nations Human Rights Declaration.77 Following their recognition in regional instruments, environmental rights and corresponding state obligations have been further developed by regional jurisprudence. The African Commission on Human and Peoples’ Rights has concluded that the right to environment is a justiciable right that must be

integrated into and balanced with the right to development.78 At the national level, since the mid-1970s more than 90 States have granted constitutional status to the right to a healthy environment.79 Taking into account constitutional provisions, national legislation, court decisions and ratification of an international agreement, 177 of the world’s 193 member nations gave recognition to this right as of 2012 (Figure 6).78 Given the broad interpretation of existing human rights treaty provisions as requiring the protection of the environment, there is ongoing debate about whether or not recognising an explicit standalone right to a healthy environment would add to the existing protections. Adopting a specific right to a healthy environment does present several advantages. As the UN Independent Expert on Human Rights and the Environment stated in October 2013: ‘It sends a signal, to the public, to government agencies and to all other stakeholders, that protection of the environment is at the same level of importance as other fundamental human rights. It opens up new avenues for legal implementation through legislative and judicial action. And it may help to provide a basis for international cooperation in the protection of the environment’.80 Research has shown that the incorporation of the right to a healthy environment in a country’s constitution leads directly to stronger environmental laws and increased implementation and enforcement of these laws, as citizens, commu-


nities and NGOs draw attention to and report violations and lobby for additional resources for environmental monitoring and protection.79

CONCLUSION Air pollution represents a major threat both to health and to the environment. Despite the adoption of numerous international, national and regional norms, effective compliance still lags behind. The human rights to life, to health and to an adequate standard of living are powerful tools available to citizens to strengthen the enforcement of existing laws and regulations. Since 1998, the Aarhus Convention has significantly enhanced public participation in environmental decision-making and access to justice and information. Beyond the procedural innovations of this Convention, adopting a standalone right to a healthy environment would give greater weight to the global public interest in protecting the environment. Conflicts of interest: none declared.

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i

RESUME

L’air sain est l’une des conditions indispensables a` la santé et au bien-être de l’Homme. Cependant, près de neuf personnes sur 10 vivant dans des zones urbaines sont affectées par la pollution de l’air. Les populations vivant en Afrique, dans le sud-est de l’Asie et dans les pays a` faible et moyen revenu de toutes les régions du monde sont les plus exposées. La pollution de l’air extérieur représente le neuvième principal facteur de risque de mortalité, tuant 3,2 millions de personnes chaque année, surtout les jeunes enfants, les personnes ag´ ˆ ees, les personnes atteintes de maladies respiratoires ou de maladies cardio-vasculaires, les personnes qui travaillent ou font du sport a` l’exte´ rieur et les populations a` faible revenu. En octobre 2013, le Centre international de Recherche sur le Cancer a class e´ la pollution de l’air ext e´ rieur comme cancérogène pour l’homme, et a qualifié la pollution de

l’air de « problème majeur de santé environnementale ». Les droits de l’Homme et les normes environnementales sont des outils puissants pour lutter contre la pollution de l’air et son impact sur la santé. La dépendance des droits de l’Homme vis-à-vis de la qualité de l’environnement a e´ té reconnue dans plusieurs textes internationaux et par les organes de suivi des traités relatifs aux droits de l’Homme. La prise de conscience grandissante concernant l’importance de l’environnement a déja` produit des re´ sultats conside´ rables en matie` re le´ gislative et re´ glementaire. Cependant, la mise en œuvre des standards minimaux demeure un problème persistant. Dans la lutte contre la violation des normes admises, les citoyens ont un role ˆ crucial a` jouer. On termine par une discussion au sujet de la pertinence qu’il y aurait a` proclamer un droit a` un environnement sain.

RESUMEN

La buena calidad del aire es uno de los requisitos primordiales de la salud y el bienestar del ser humano. Sin embargo, cerca de nueve de cada 10 personas que viven en las zonas urbanas estań expuestas a la contaminaci on ´ ambiental. Las poblaciones ma´ s ´ expuestas viven en Africa, el sureste asia´tico y en los pa´ıses de ingresos bajos y medios en todas las regiones. La exposicion ´ a la contaminacion ´ ambiental representa el noveno factor de riesgo ma´s importante de mortalidad y es responsable de la muerte de 3,2 millones de personas cada ano, los ancianos ˜ sobre todo en los ninos ˜ pequenos, ˜ y las personas aquejadas de enfermedades respiratorias, enfermedad cardiovascular, las que trabajan o practican ejercicios al aire libre y las poblaciones de bajos ingresos. En octubre del 2013, el Centro Internacional de Investigaciones sobre el Ca´ ncer clasific o´ la contaminacion ´ atmosférica como carcinogena ´ para el ser humano y la definio´ como ‘un problema mayor de

salud ambiental’. Los derechos humanos y las normas ambientales constituyen instrumentos solidos ´ para combatir la contaminaci on ´ ambiental y sus repercusiones en materia de salud. El hecho de que los derechos humanos dependan de la calidad del medioambiente ha sido reconocido en documentos internacionales y por los organos ´ creados en virtud de tratados de derechos humanos. La sensibilizacion ´ creciente sobre la importancia del medioambiente ya ha tenido consecuencias legislativas y normativas considerables. Sin embargo, la aplicaci on ´ de las normas sigue siendo un problema omnipresente. En la batalla contra la transgresion ´ de las normas, los ciudadanos tienen una funcion ´ esencial que pueden ejercer. Se concluye con un ana´lisis sobre la pertinencia de un derecho independiente, aun no proclamado, a gozar de un medioambiente sano.

Acute Impact of Hourly Ambient Air Pollution on Preterm Birth.

The Impact of Individual Anthropogenic Emissions Sectors on the Global Burden of Human Mortality due to Ambient Air Pollution.

Interpreting the International Right to Health in a Human Rights-Based Approach to Health.

Ambient air pollution and stroke.

Exposure to Ambient Air Pollution and Premature Rupture of Membranes.

The impact of ambient air pollution on suicide mortality: a case-crossover study in Guangzhou, China.

Health Effects of Ambient Air Pollution in Developing Countries.

Effects of Ambient Air Pollution Exposure on Olfaction: A Review.

Modelling of human exposure to air pollution in the urban environment: a GPS-based approach.

Health effects of ambient air pollution: do different methods for estimating exposure lead to different results?

A Review of Epidemiological Research on Adverse Neurological Effects of Exposure to Ambient Air Pollution.

From ideals to tools: applying human rights to maternal health.

Impact of traffic-related air pollution on health.

Can the Air Pollution Index be used to communicate the health risks of air pollution?

Effects of short- and long-term exposures to ambient air pollution on COPD.

Estimating personal exposures from ambient air pollution measures: using meta-analysis to assess measurement error.

STROBE-Long-Term Exposure to Ambient Fine Particulate Air Pollution and Hospitalization Due to Peptic Ulcers.

Proximity to traffic, ambient air pollution, and community noise in relation to incident rheumatoid arthritis.

The health burden of pollution: the impact of prenatal exposure to air pollutants.

Erectile dysfunction and exposure to ambient Air pollution in a nationally representative cohort of older Men.

Addressing the burden of disease attributable to air pollution in India: the need to integrate across household and ambient air pollution exposures.

Air pollution and health.

Ambient Particulate Matter Air Pollution Exposure and Mortality in the NIH-AARP Diet and Health Cohort.

Air pollution and health.