This is the third and final Perspective in our air pollution series. The first Perspective looked at the urgent need to recognise and address air pollution as a non-commuincable disease (NCD) risk factor. The second examined the legal and regulatory measures available to governments to address air pollution. And in our final Perspective we consider the obstacles to regulation of air pollution as a NCD risk factor. Factors such as the fragmentation between governance mechanisms and stakeholders; the need for greater recognition and inclusion of air pollution regulatory interventions within NCD strategies and plans; and industry opposition and legal challenges that need to be addressed if air pollution is to be more effectively recognised within the public health agenda.
Fragmentation between governance mechanisms and stakeholders
One of the primary challenges in the regulation of air pollution as a NCD risk factor, is the current fragmentation in the regulation of air pollution across levels of governance, sectors, and key actors.
Effective coordination to address air pollution is required across municipal, national, regional, and international levels of governance. As evidenced from our second Perspective in the series, current frameworks to address air pollution occur through a piecemeal array of global, regional and domestic instruments, with no specific global strategic framework or policy in relation to air pollution. In the absence of a unified set of commitments, national action to address air pollution will remain inconsistent; attempts to unite and build connections between implicated policy areas, such as climate change and health, will be rendered difficult; and accountability mechanisms will continue to be limited. Coordinated governance mechanisms are required to address air pollution.
In terms of cross-sectoral approaches, air pollution has traditionally been regarded as an environmental concern, yet successful recognition and regulation of air pollution as a NCD risk factor requires the incorporation of air pollution within health ministry agendas and beyond, including energy, transport, finance and agricultural sectors of government in order to effectively address the root causes of pollutants. Yet multisectoral coordination remains a major challenge. Encouragingly, while Parties to the United Nations Framework Convention on Climate Change (UNFCCC) made no reference to health in the 2009 Copenhagen Accord, the subsequent Paris Agreement in 2015 acknowledges that Parties should, when taking action to address climate change, respect, promote and consider their respective obligations on the right to health. Nonetheless, the disconnect between the development of climate change mitigation, air quality and NCD prevention policies at a national level remains despite the fact that major greenhouse gases originate from the same sources of air pollutants. To facilitate effective multisectoral coordination, there is a need for heightened understanding and awareness of the sources, impacts of, and solutions to, address air pollution, including the broader social, health and gender dimensions of pollution.
Greater coordination is required between the major global actors responsible for advancing the air pollution mitigation agenda, within the framework of achieving relevant goals under the 2030 Agenda for Sustainable Development. At the inaugural session of the United Nations Environment Assembly in June 2014, Resolution 1/7 Strengthening the role of the [UN Environment] in Promoting Air Quality identified opportunities for strengthened cooperation on air pollution within the UN system, including with the WHO. The first WHO Global Conference on Air Pollution and Health, held from 30 October to 1 November 2018, was organised in collaboration with UN Environment, World Meteorological Organization (WMO), the Secretariat of the UNFCCC, the Climate and Clean Air Coalition to Reduce Short-Lived Climate Pollutants, the United Nations Economic Commission for Europe, and the World Bank. The conference provided a valuable opportunity for collaboration between the major international actors and highlighted the need for further collaboration between health, environmental and sustainable development stakeholders to address air pollution.
Need for greater integration of air pollution in NCD strategies and instruments
Following the inclusion of air pollution as a NCD risk factor in the Outcome Document of the Third UN HLM on NCDs in September 2018, there is a clear need for greater recognition and inclusion of specific interventions to address air pollution within NCD strategies and plans. One notable gap is in the Global Action Plan on NCDs.
The Global Action Plan on NCDs aims to operationalise the commitments made at the first United Nations High-level Meeting of the General Assembly on the Prevention and Control of NCDs in 2011. The Action Plan states that the four risk factors of tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity are the ‘most important’ in the sphere of NCDs. It states that exposure to environmental hazards, such as ambient and household air pollution, ‘may’ cause chronic respiratory diseases, without referencing the links to cardiovascular disease and cancer – merely stating that some air pollution sources, including fumes from solid fuels, ‘may’ cause lung cancer. The incorporation of stronger language, based on the Third UN HLM on NCDs and emerging evidence recognising air pollution as a major NCD risk factor in the next Global Action Plan on NCDs would provide greater support to countries seeking to address air pollution as a NCD risk factor.
Appendix 3 of the Global Action Plan on NCDs outlines ‘best buys’ (i.e. cost-effective) interventions to address NCDs and includes reference to access to improved stoves and cleaner fuels to reduce indoor air pollution. However, with the exception of an intervention addressing exposure to second-hand smoke, the best buys do not list cost-effective interventions to address ambient air pollution. An update to Appendix 3, endorsed at the 70th World Health Assembly as recently as May 2017, missed the opportunity to explore and include emerging research on cost-effective interventions to address ambient air pollution.
Industry opposition and legal challenges
Attempts to control air pollution have ignited industry efforts to thwart regulation. Private sector interests have reportedly adopted strategies similar to those observed in tobacco, alcohol and unhealthy diet control to undermine effective regulation including action to undermine the credibility of scientific evidence, derailing the process of policy development, and challenging the legal basis of regulatory measures. As an example, high-sulphur diesel and gasoline which contribute to air pollution are regularly utilised in Africa. However, there are documented attempts of lobbying by industry against improved access to cleaner fuel.
Drawing parallels to tobacco, alcohol and unhealthy diet regulation, it is evident that countries seeking to introduce regulatory measures that reduce the sources of air-pollutants need to be mindful of obligations under domestic, regional and international law, including trade and investment agreements to ensure they will not be subject to legal challenge. For example, efforts by Canada to introduce domestic renewable energy measures were held by the Appellate Body of the World Trade Organization (WTO) as being inconsistent with non-discrimination obligations under the WTO Agreement on Trade-Related Investment Measures and the General Agreement on Tariffs and Trade.
Air pollution is increasingly becoming recognised as a NCD risk factor as evidenced by its incorporation into WHO normative instruments, such as WHO Air Pollution Road Map, the Outcome Document of the Third UN HLM on NCDs and the WHO Thirteenth General Programme of Work 2019-2023. The debilitating health effects of air pollution have resulted in a greater understanding of the need to identify and address air pollution as more than solely an ‘environmental’ concern. Nonetheless, this recognition must be translated into cost-effective regulation interventions, requiring air pollution to be placed on the agendas of health, energy, transport, finance and agricultural sectors of government, with stronger coordination required across municipal, national, regional, and international levels of governance and relevant stakeholders.
Moving towards a 5x 5 NCD agenda requires recognition of air pollution as a NCD risk factor within key global NCD instruments. This will also provide a vital opportunity for governments to fully acknowledge and address the interdependent and indivisible relationship between the three dimensions of sustainable development: environmental, social, and economic development. With an estimated 7 million deaths each year resulting from air pollution and 90 per cent of these deaths occurring in low- and middle-income countries, recognition of air pollution as a key NCD risk factor is critical to ensure air pollution is given the urgent attention and regulatory action it requires.
For more information contact:
Elle Spring, Communications and Stakeholder Engagement Manager, McCabe Centre, +61 420 803 471, firstname.lastname@example.org
 United Nations Environment Programme, ‘Towards a Pollution-Free Planet’ (Background Report No 978-92-807-3669-4, UN Environment, September 2017).
 Paris Agreement, opened for signature 13 December 2015, C.N.92.2016 (entered into force 4 November 2016) preamble.
 See, eg, Yulia Yamineva and Seita Romppanen, ‘Is Law Failing to Address Air Pollution? Reflections on International and EU Developments’ (2017) 26(3) Review of European, Comparative & International Environmental Law 189.
 United Nations Environment Programme, above n 1, 43.
 Strengthening the role of the United Nations Environment Programme in promoting air quality, UNEA Res 1/7, 1st sess, UNEP/EA.1/Res. 1/7 (27 June 2014).
 World Health Organization, Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 (2013) <http://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng.pdf?sequence=1>.
 World Health Organization, Preparation for the Third High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, to be Held in 2018, WHA Res 70.11, 70th sess, 10th plen mtg, WHO Doc WHA70/2017/REC/1 (31 May 2017) Annex 3; See also UN Environment, above n 1; World Health Organisation, ‘Ambient air pollution: Interventions & tools’ (2018) <http://www.who.int/airpollution/ambient/interventions/en/>; World Health Organization, Reducing Global Health Risks Through Mitigation of Short-Lived Climate Pollutants. Scoping Report For Policy-makers (2015).
 Philip J Landrigan et al, ‘The Lancet Commission on Pollution and Health’ (2018) 391 The Lancet 462, 491<https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32345-0.pdf>.
 ‘Dirty Fuel – How Swiss Traders Flood Africa with Toxic Fuels’ (Public Eye, 2016).
 Canada — Measures Relating to the Feed-in Tariff Program, WT/DS426/AB/R, 6 May 2013.