INTRODUCTION

The interactions between humans and their physical surroundings have been extensively

studied, as multiple human activities influence the environment. The environment is a coupling

of the biotic (living organisms and microorganisms) and the abiotic (hydrosphere, lithosphere,

and atmosphere).

Human activities have an adverse effect on the environment by polluting the water we

drink, the air we breathe, and the soil in which plants grow. Although the industrial revolution

was a great success in terms of technology, society, and the provision of multiple services, it also

introduced the production of huge quantities of pollutants emitted into the air that are harmful to

human health. Without any doubt, the global environmental pollution is considered an

international public health issue with multiple facets. Social, economic, and legislative concerns

and lifestyle habits are related to this major problem. Clearly, urbanization and industrialization

are reaching unprecedented and upsetting proportions worldwide in our era. Anthropogenic air

pollution is one of the biggest public health hazards worldwide, given that it accounts for about 9

million deaths per year

In this work, I shall discuss the effects that the environment can have on human health. I

shall also discuss the link the link between poor air quality and worse health outcomes from

Covid-19.

1. EFFECTS OF THE ENVIRONMENT ON HEALTH

Environment means what surrounds us. It may be living or non-living things. It includes

physical, chemical and other natural forces. Living things live in their environment. They

constantly interact with it and adapt themselves to conditions in their environment. In the
environment there are different interactions between animals, plants, soil, water, and other living

and non-living things.

The word environment is used to talk about many things. People in different fields of

knowledge use the word environment differently. Electromagnetic environment is radio

waves and other electromagnetic radiation and magnetic fields. The environment of a galaxy

may mean the interstellar medium, or it may mean other nearby galaxies.

In psychology and medicine, a person's environment is the people, physical things and

places that the person lives with. The environment affects the growth and development of the

person. It may affect the person's behavior, body and mind.

The conditions of living organisms in an environment are affected by the weather and

climate changes in the environment. They are also greatly affected by other living things

(Wikipedia)

Over the years it has been observed that one of our man's greatest scourges is air

pollution, on account not only of its impact on climate change but also its impact on public and

individual health due to increasing morbidity and mortality. There are many pollutants that are

major factors in disease in humans. Among them, Particulate Matter (PM), particles of variable

but very small diameter, penetrate the respiratory system via inhalation, causing respiratory and

cardiovascular diseases, reproductive and central nervous system dysfunctions, and cancer.

Despite the fact that ozone in the stratosphere plays a protective role against ultraviolet

irradiation, it is harmful when in high concentration at ground level, also affecting the respiratory

and cardiovascular system.

 Furthermore, nitrogen oxide, sulfur dioxide, Volatile Organic Compounds (VOCs),

dioxins, and polycyclic aromatic hydrocarbons (PAHs) are all considered air pollutants that are

harmful to humans. Carbon monoxide can even provoke direct poisoning when breathed in at

high levels. Heavy metals such as lead, when absorbed into the human body, can lead to direct

poisoning or chronic intoxication, depending on exposure. Diseases occurring from the

aforementioned substances include principally respiratory problems such as Chronic Obstructive

Pulmonary Disease (COPD), asthma, bronchiolitis, and also lung cancer, cardiovascular events,

central nervous system dysfunctions, and cutaneous diseases. Last but not least, climate change

resulting from environmental pollution affects the geographical distribution of many infectious

diseases, as do natural disasters. The only way to tackle this problem is through public awareness

coupled with a multidisciplinary approach by scientific experts; national and international

organizations must address the emergence of this threat and propose sustainable solutions.

An indispensable element that man in any environment comes in contact with in an

environment is air. However, the air can polluted. Air pollution has various health effects. The

health of susceptible and sensitive individuals can be impacted even on low air pollution days.

Short-term exposure to air pollutants is closely related to COPD (Chronic Obstructive Pulmonary

Disease), cough, shortness of breath, wheezing, asthma, respiratory disease, and high rates of

hospitalization (a measurement of morbidity).

The long-term effects associated with air pollution are chronic asthma, pulmonary

insufficiency, cardiovascular diseases, and cardiovascular mortality. According to a Swedish

cohort study, diabetes seems to be induced after long-term air pollution exposure. Moreover, air

pollution seems to have various malign health effects in early human life, such as respiratory,
cardiovascular, mental, and perinatal disorders, leading to infant mortality or chronic disease in

adult age.

National reports have mentioned the increased risk of morbidity and mortality. These

studies were conducted in many places around the world and show a correlation between daily

ranges of particulate matter (PM) concentration and daily mortality. Climate shifts and global

planetary warming could aggravate the situation. Besides, increased hospitalization (an index of

morbidity) has been registered among the elderly and susceptible individuals for specific

reasons. Fine and ultrafine particulate matter seems to be associated with more serious illnesses,

as it can invade the deepest parts of the airways and more easily reach the bloodstream.

Air pollution mainly affects those living in large urban areas, where road emissions

contribute the most to the degradation of air quality. There is also a danger of industrial

accidents, where the spread of a toxic fog can be fatal to the populations of the surrounding

areas. The dispersion of pollutants is determined by many parameters, most notably atmospheric

stability and wind.

In developing countries, the problem is more serious due to overpopulation and

uncontrolled urbanization along with the development of industrialization. This leads to poor air

quality, especially in countries with social disparities and a lack of information on sustainable

management of the environment. The use of fuels such as wood fuel or solid fuel for domestic

needs due to low incomes exposes people to bad-quality, polluted air at home. It is of note that

three billion people around the world are using the above sources of energy for their daily

heating and cooking needs. In developing countries, the women of the household seem to carry

the highest risk for disease development due to their longer duration exposure to the indoor air

pollution. Due to its fast industrial development and overpopulation, China is one of the Asian
countries confronting serious air pollution problems. The lung cancer mortality observed in

China is associated with fine particles. As stated already, long-term exposure is associated with

deleterious effects on the cardiovascular system. However, it is interesting to note that

cardiovascular diseases have mostly been observed in developed and high-income countries

rather than in the developing low-income countries exposed highly to air pollution. Extreme air

pollution is recorded in India, where the air quality reaches hazardous levels. New Delhi is one

of the more polluted cities in India. Flights in and out of New Delhi International Airport are

often canceled due to the reduced visibility associated with air pollution. Pollution is occurring

both in urban and rural areas in India due to the fast industrialization, urbanization, and rise in

use of motorcycle transportation. Nevertheless, biomass combustion associated with heating and

cooking needs and practices is a major source of household air pollution in India and in Nepal.

There is spatial heterogeneity in India, as areas with diverse climatological conditions and

population and education levels generate different indoor air qualities, with higher

PM2.5 observed in North Indian states (557–601 μg/m3) compared to the Southern States (183–

214 μg/m3). The cold climate of the North Indian areas may be the main reason for this, as

longer periods at home and more heating are necessary compared to in the tropical climate of

Southern India. Household air pollution in India is associated with major health effects,

especially in women and young children, who stay indoors for longer periods. Chronic

obstructive respiratory disease (CORD) and lung cancer are mostly observed in women, while

acute lower respiratory disease is seen in young children under 5 years of age.

Accumulation of air pollution, especially sulfur dioxide and smoke, reaching 1,500

mg/m3, resulted in an increase in the number of deaths (4,000 deaths) in December 1952 in

London and in 1963 in New York City (400 deaths). An association of pollution with mortality
was reported on the basis of monitoring of outdoor pollution in six US metropolitan cities. In

every case, it seems that mortality was closely related to the levels of fine, inhalable, and sulfate

particles more than with the levels of total particulate pollution, aerosol acidity, sulfur dioxide, or

nitrogen dioxide.

Furthermore, extremely high levels of pollution are reported in Mexico City and Rio de

Janeiro, followed by Milan, Ankara, Melbourne, Tokyo, and Moscow.

Based on the magnitude of the public health impact, it is certain that different kinds of

interventions should be taken into account. Success and effectiveness in controlling air pollution,

specifically at the local level, have been reported. Adequate technological means are applied

considering the source and the nature of the emission as well as its impact on health and the

environment. The importance of point sources and non-point sources of air pollution control is

reported by Schwela and Köth-Jahr. Without a doubt, a detailed emission inventory must record

all sources in a given area. Beyond considering the above sources and their nature, topography

and meteorology should also be considered, as stated previously. Assessment of the control

policies and methods is often extrapolated from the local to the regional and then to the global

scale. Air pollution may be dispersed and transported from one region to another area located far

away. Air pollution management means the reduction to acceptable levels or possible elimination

of air pollutants whose presence in the air affects our health or the environmental ecosystem.

Private and governmental entities and authorities implement actions to ensure the air quality. Air

quality standards and guidelines were adopted for the different pollutants by the WHO and EPA

as a tool for the management of air quality. These standards have to be compared to the

emissions inventory standards by causal analysis and dispersion modeling in order to reveal the
problematic areas. Inventories are generally based on a combination of direct measurements and

emissions modeling.

As an example, we state here the control measures at the source through the use of

catalytic converters in cars. These are devices that turn the pollutants and toxic gases produced

from combustion engines into less-toxic pollutants by catalysis through redox reactions. In

Greece, the use of private cars was restricted by tracking their license plates in order to reduce

traffic congestion during rush hour.

Concerning industrial emissions, collectors and closed systems can keep the air pollution

to the minimal standards imposed by legislation.

Current strategies to improve air quality require an estimation of the economic value of

the benefits gained from proposed programs. These proposed programs by public authorities, and

directives are issued with guidelines to be respected.

In Europe, air quality limit values AQLVs (Air Quality Limit Values) are issued for

setting off planning claims. In the USA, the NAAQS (National Ambient Air Quality Standards)

establish the national air quality limit values. While both standards and directives are based on

different mechanisms, significant success has been achieved in the reduction of overall emissions

and associated health and environmental effects. The European Directive identifies geographical

areas of risk exposure as monitoring/assessment zones to record the emission sources and levels

of air pollution, whereas the USA establishes global geographical air quality criteria according to

the severity of their air quality problem and records all sources of the pollutants and their

precursors.
 In this vein, funds have been financing, directly or indirectly, projects related to air

quality along with the technical infrastructure to maintain good air quality. These plans focus on

an inventory of databases from air quality environmental planning awareness campaigns.

Moreover, pollution measures of air emissions may be taken for vehicles, machines, and

industries in urban areas.

Technological innovation can only be successful if it is able to meet the needs of society.

In this sense, technology must reflect the decision-making practices and procedures of those

involved in risk assessment and evaluation and act as a facilitator in providing information and

assessments to enable decision makers to make the best decisions possible. Summarizing the

aforementioned in order to design an effective air quality control strategy, several aspects must

be considered: environmental factors and ambient air quality conditions, engineering factors and

air pollutant characteristics, and finally, economic operating costs for technological improvement

and administrative and legal costs. Considering the economic factor, competitiveness through

neoliberal concepts is offering a solution to environmental problems.

Many factors influence the health of a population, including diet, sanitation, socio-

economic status, literacy, and lifestyle. These factors have changed significantly during the

economic transitions that have shaped present society and resulted in a considerable increase of

life expectancy in OECD regions (Ruwaard and Kramers, 1998). Recent studies show that the

major determinants affecting life expectancy in OECD regions from 1970 to 1992 were better

working conditions, and increased GDP and health expenditure per capita. However, they also

indicate that during the same period the negative impacts of air pollution on human health

increased in OECD countries (Or, 2000)

2. A LINK BETWEEN POOR AIR QUALITY AND WORSE HEALTH OUTCOMES

FROM COVID-19

Air pollution is the greatest environmental health risk factor worldwide (Cohen et al., 2017).

But has it also contributed to worse COVID-19 outcomes? Arguably, yes! Evidence that air

pollution has systemic effects on cardiopulmonary and respiratory systems has led several

researchers to speculate that it could increase COVID-19 incidence, severity, and mortality

(Pozzer et al., 2020; Villeneuve and Goldberg, 2020).

Air pollution could exacerbate COVID-19 prognosis in multiple ways. Both acute and long-

term exposure to air pollution increase susceptibility to and severity of respiratory and

cardiovascular diseases by increasing oxidative stress and inflammation (Ciencewicki and

Jaspers, 2007; Mehta et al., 2013). Particulate matter can reach the alveolar sacs in the lungs and

travel further into the bloodstream, causing an inflammatory response that triggers and

exacerbates respiratory diseases, including COVID-19 (Lai et al., 2021). Furthermore, other

pollutants such as NOX,O3, SO2 and CO create oxidative stress, lung damage, and endothelial

dysfunction (Lai et al., 2021). In addition to weakening the respiratory and immune system, air

pollution has been hypothesized to aggravate COVID-19 infection severity through the

overexpression of the angiotensin converting enzyme 2 (ACE-2), a coronavirus receptor, on

surfaces of the respiratory tract (Paital and Agrawal, 2020).

In Europe and North America, air pollution is particularly harmful to aging and urban

populations and continues to harm vulnerable groups. In 2016, more than 400,000 and 70,000

European deaths were attributable to PM2.5 and NO2, respectively, and the urban population of

the EU-27 and the UK continue to be exposed to pollution levels exceeding WHO thresholds

(Khomenko et al., 2021; Sicard et al., 2021). Likewise, in Canada and in the U.S., three out of 10
people live in areas where ambient air quality standards are not met (United Nations, 2017).

Furthermore, around 26% of the population in Europe and 23% of the U.S. and Canada

population is 60 years or older (United Nations, 2019). For the elderly, long-term exposure to

even low levels of air pollution can increase the risk of respiratory conditions (Danesh Yazdi et

al., 2021).

It is currently unclear to what extent air pollution is exacerbating significant COVID-19

risks. Since 2020 hundreds of studies have investigated the association between exposure to air

pollution and COVID-19. Many of the earlier studies use limited datasets and are prone to

several confounding factors, which warrants caution in interpreting their results (Contini and

Costabile, 2020). While existing prior systematic reviews suggest that air pollution may be

linked to COVID-19 outcomes (see Marquès and Domingo (2022) for a recent review), most

studies are from the very early stages of the pandemic and/or include limited evidence from

North America and Europe, places where both air pollution and COVID-19 outcomes are likely

to be less prone to measurement error (Maleki et al., 2021; Copat et al., 2020; Katoto et al.,

2021). In this short time, the air pollution-COVID literature has increased exponentially and now

covers additional pollutants, making it possible to ascertain potential heterogeneity of effects

across PM, nitrous oxides, ozone, carbon monoxide and other pollutants known to be harmful to

human health.

It is important to note that the understanding of COVID-19 is dynamic, and new research may

have been published since then. Here is a summary of the link based on information available up

to that point:

1. Respiratory System Vulnerability:

 - Poor air quality, especially high levels of air pollution, can contribute to respiratory issues and

compromise the respiratory system's health. Conditions such as asthma, chronic obstructive

pulmonary disease (COPD), and other respiratory diseases may be exacerbated by exposure to

pollutants.

2. Increased Susceptibility to Infections:

- Exposure to air pollution has been associated with increased susceptibility to respiratory

infections. This may include viral infections like influenza and, potentially, respiratory infections

caused by viruses such as SARS-CoV-2, which causes COVID-19.

3. Inflammatory Response:

- Air pollution can trigger an inflammatory response in the respiratory system. Inflammation in

the lungs may make individuals more susceptible to severe respiratory outcomes when infected

with respiratory viruses, including the virus responsible for COVID-19.

4. Compromised Immune Function:

- Prolonged exposure to air pollution has been linked to compromised immune function. A

weakened immune system may be less effective in mounting a robust response to viral

infections, potentially leading to more severe COVID-19 outcomes.

5. Cardiovascular Effects:

- Air pollution is not limited to respiratory effects; it can also have cardiovascular impacts.

Cardiovascular diseases have been identified as a risk factor for severe COVID-19 outcomes.

Poor air quality may contribute to the overall burden on the cardiovascular system.

6. Regional Variations:
 - Regions with consistently poor air quality may experience a higher baseline of respiratory

and cardiovascular issues. In the context of a pandemic like COVID-19, this could contribute to

a higher prevalence of severe cases and worse health outcomes.

7. Public Health Implications:

- The link between air quality and COVID-19 outcomes underscores the importance of

addressing environmental factors for public health. Policies and measures aimed at improving air

quality may have broader implications for reducing the impact of respiratory infections,

including COVID-19.

CONCLUSION

Conclusively, more than 12 million people around the world die every year because they

live or work in unhealthy environments. Healthy People 2030 focuses

on reducing people’s exposure to harmful pollutants in air, water, soil, food, and

materials in homes and workplaces. Environmental pollutants can cause health problems like

respiratory diseases, heart disease, and some types of cancer. People with low incomes are more

likely to live in polluted areas and have unsafe drinking water. In addition, children and pregnant

women are at higher risk of health problems related to pollution. Tracking environmental

pollutants is key to figuring out where and how people are exposed. Laws and policies to

reduce different types of pollution can also help prevent many serious health problems and

deaths. Until today, researchers and health professionals continue to investigate and monitor

these relationships to inform public health strategies and interventions.

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