The maritime transport sector is vital for global trade, yet it continues to be a significant source of air pollution in port cities due to its reliance on fossil fuels. This review summarizes empirical and epidemiological evidence on the emissions of Heavy Fuel Oil and transitional alternatives, such as Liquefied Natural Gas, with a focus on their contribution to local concentrations. Shipping-related emissions account for a substantial proportion of air pollution across multiple coastal urban regions, particularly during maneuvering and hoteling operations. The reviewed studies consistently associate these emissions with an increased risk of respiratory and cardiovascular morbidity and premature mortality among populations living near ports. While sulphur-focused regulations, notably IMO 2020, have achieved significant reductions in SO2 emissions, the literature indicates that nitrogen oxides and fine particulate matter remain largely unmitigated. This review concludes that existing regulatory frameworks only partially address the health-related externalities of maritime transport. To address this market failure, the review argues for an integrated policy approach that combines market-based measures with port-level incentives and operational controls to reduce emissions at berth, thereby aligning shipping practices with public health objectives and the sustainable development goals.
Borges et al. (Tue,) studied this question.