Assessing Health Impact of Air Pollution in Macedonian Cities

In regard the broad range of adverse health outcomes related to exposure to particulate air pollution, there are only few epidemiological data to be found for the countries of the former Yugoslav republics. Particulate outdoor air pollution is a major public health concern in the cities of former Yugoslav Republic of Macedonia. Objective: To estimate the range of attributable deaths of outdoor air pollution by particulate matter (PM 2.5 ), and health gains from implementation of targeted policy that would reduce the concentrations to EU or WHO limit values. Methods: Health Impact Assessment, the counterfactual approach has been applied. To estimate the health gain three hypothetical scenarios were set up. Results: In selected cities 1,903 human lives (excess deaths) are lost annually due to PM 2.5 exposures (22.3% of total all-cause (natural) mortality). The mortality rate attributable to PM 2.5 exposures (per 100,000 populations) is highest in the city of Tetovo 301; Bitola 234; Skopje 208. If the limit values of the PM 2.5 particles comply with the existing EU and WHO limit values, 908 lives could be saved, and 1547 respectively. Estimated excess deaths caused by lung cancer attributable to PM 2.5 are 181 representing 40.0% of the total mortality. Conclusions: The estimated impact on mortality and health gains of potential reduction policies are of high significance. Despite the limitations, this assessment provides valuable input to national and local authorities to become aware about the magnitude of the problem.