European Parliament study on health effects of fine particles in Brussels, EU; no safe PM2.5 threshold identified

European Parliament study on health effects of fine particles in Brussels, EU; no safe PM2.5 threshold identified

Health effects of fine particles - Assessing the health burden of fine particles and options for stronger EU action

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Health effects of fine particles Assessing the health burden of fine particles and options for stronger EU action Policy Department for Transformation, Innovation and Health Directorate-General for Economy, Transformation and Industry Authors: Mike BEKE, Arnau DEDEU DUNTON, Nicky VULHOP, Fleur WIJER, Marija JEVTIC, Vlatka MATKOVIC PE 786.419 - August 2026 EN STUDY Requested by the ENVI and SANT Committees

Abstract This study examines the health effects of fine particulate matter (PM2.5 and PM10), trends in exposure, and the effectiveness of EU legal and policy frameworks. It draws on an umbrella review of 198 systematic reviews, quantitative analysis of exposure trends, stakeholder interviews, and comparative case studies across EU Member States. The study shows consistent health effects of PM2.5 exposure across multiple disease categories and identifies persistent inequalities in exposure across populations and regions, with no safe threshold for PM2.5 exposure identified. It proposes evidence-based policy recommendations to reduce health impacts across the EU. The study was provided by the Policy Department for Transformation, Innovation and Health at the request of the Committee on Environment, Climate and Food Safety (ENVI) and the Committee on Public Health (SANT).

Health effects of fine particles Assessing the health burden of fine particles and options for stronger EU action

This document was requested by the European Parliament’s Committee on Environment, Climate and Food Safety (ENVI) and the Committee on Public Health (SANT).

AUTHORS Dr. Mike Beke, Principal Researcher, Ecorys Arnau Luke Dedeu Dunton, Senior Researcher, Ecorys Nicky Vulhop, Researcher, Ecorys Fleur Wijer, Junior Researcher, Ecorys Dr. Marija Jevtic, Expert Researcher, University of Novi Sad, Faculty of Medicine Dr. Vlatka Matkovic, Expert Researcher, Health and Environmental Alliance (HEAL) ACKNOWLEDGEMENTS The authors would like to thank Rana Orhan Pees for the preparation of this study. CONTRACTOR Contractor: Ecorys CONTACTS IN THE EUROPEAN PARLIAMENT Coordination: Kristi POLLUVEER, Ioana-Alice POSTU Editorial assistance: Marleen LEMMENS To give feedback or obtain copies, please write to: ecti-poldep-b@europarl.europa.eu PEER REVIEW This study was subject to an external peer review. VERSION Original: English Manuscript completed in August 2026 BIBLIOGRAPHIC REFERENCE FOR THIS PAPER BEKE, M. et al. 2026. Health effects of fine particles - Assessing the health burden of fine particles and options for stronger EU action. Brussels: European Parliament, Policy Department for Transformation, Innovation and Health DISCLAIMER The opinions expressed in this publication are those of the authors only and should not be considered as representative of the European Parliament’s official position. ARTIFICIAL INTELLIGENCE Microsoft Copilot 2026.6.2 was used to improve the readability of the text and broaden the range of sources available to the authors. AI-generated content in this text has been reviewed by the authors. COPYRIGHT © European Union, 2026 Image on cover: MaciejBledowski / stock.adobe.com LICENCE The reuse of this document is authorised under a Creative Commons Attribution 4.0 International (CC-BY 4.0) licence (https://creativecommons.org/licenses/by/4.0/). To use or reproduce elements that are not owned by the European Union, permission may need to be sought directly from the respective rightholders. IDENTIFIERS PE 786.419 ECTI/B/ENVI/IC/2025-026 Print ISBN 978-92-848-3755-7 | doi: 10.2861/9609234 | QA-01-26-181-EN-C PDF ISBN 978-92-848-3754-0 | doi: 10.2861/9577658 | QA-01-26-181-EN-N

Health effects of fine particles

3 PE 786.419 CONTENTS LIST OF ABBREVIATIONS 5 LIST OF FIGURES 7 LIST OF TABLES 7 EXECUTIVE SUMMARY 8

INTRODUCTION 12 1.1. Background of the study 12 1.2. Scope and objectives of the study 12 1.3. Analytical scope and limitations 13

PM2.5/PM10 AND HUMAN HEALTH 14 2.1. Health effects on mortality and chronic diseases 16 2.1.1. All-cause mortality 16 2.1.2. Respiratory health 19 2.1.3. Cardiovascular health 23 2.1.4. Neurological and mental health 27 2.1.5. Cancer 31 2.1.6. Metabolic, endocrine, and other chronic diseases 34 2.1.7. Other outcomes 37 2.1.8. Reproductive health 39 2.1.9. Pregnancy outcomes 41 2.1.10. Foetal outcomes 44 2.1.11. Child health and development 50 2.2. Impacts on vulnerable and high-risk populations 52 2.2.1. Health effects across the life course 52 2.2.2. People with pre-existing health conditions 56 2.2.3. Socially or economically disadvantaged groups 59

TRENDS ACROSS THE EU 60 3.1. Trends in PM2.5 and PM10 concentrations across Member States 61 3.1.1. Long-term trends across Member States (2013–2023) 61 3.1.2. Sources of PM2.5 and PM10 64 3.2. Disparities in health burden 66 3.2.1. Long-term trends in attributable deaths 67 3.2.2. Recent trends in burden of disease (2021–2023) 69 3.2.3. PM10 health impacts 71

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PE 786.419 4 3.3. Age-based and socioeconomic disparities 72 3.3.1. Age-specific health impacts across Member States 72 3.3.2. Socioeconomic inequalities across Member States 73

EU LEGAL AND POLICY FRAMEWORKS 76 4.1. Current EU legislation 76 4.1.1. Key instruments (direct effects) 77 4.1.2. Other instruments with indirect co-benefits 97 4.2. The ambition and effectiveness of the AAQD 105 4.2.1. Assessment of the ambition of the acquis 105 4.2.2. Assessment of the effectiveness of the acquis 113

CASE STUDIES 120 5.1. EU Member States 121 5.2. Summary table on alignment 130 5.3. Non-EU countries 131 5.3.1. United Kingdom 131 5.3.2. Norway 132 5.3.3. China 134

POLICY RECOMMENDATIONS 136 6.1.1. Strengthening the ambition and coherence of EU air quality standards 139 6.1.2. Closing the agricultural ammonia gap through cross-instrument policy coherence 140 6.1.3. Strengthening implementation and enforcement at Member State level 141 6.1.4. Closing sectoral policy gaps and addressing policy coherence failures 143 6.1.5. Improving health integration, evidence, and public communication 144

CONCLUSIONS 146 ANNEX 1. METHODOLOGY 149 Research design 149 Data sources 149 Stakeholder consultation 150 Case study selection and design 150 ANNEX 2. LIST OF INTERVIEWED STAKEHOLDERS AND GUIDE 150 Questionnaire EU institutions and agencies 151 Questionnaire EU-level experts, academics 152 Questionnaire National competent authorities 153 ANNEX 3. BURDEN OF DISEASE BETWEEN 2021 AND 2023 154 ANNEX 4. BIBLIOGRAPHY 160

Health effects of fine particles

5 PE 786.419 LIST OF ABBREVIATIONS AAQD Ambient Air Quality Directive ADHD Attention Deficit/Hyperactivity Disorder AFC Antral Follicle Count AMD Age-related Macular Degeneration AMH Anti-Müllerian Hormone ASD Autism Spectrum Disorder BAT Best Available Techniques CKD Chronic Kidney Disease COPD Chronic Obstructive Pulmonary Disease DALY Disability-Adjusted Life Year DED Dry Eye Disease EEA European Environment Agency EPBD Energy Performance of Buildings Directive FEV₁ Forced Expiratory Volume in one second FVC Forced Vital Capacity FQD Fuel Quality Directive GBD Global Burden of Disease IHD Ischaemic Heart Disease IVF In Vitro Fertilisation LBW Low Birth Weight LGA Large for Gestational Age MI Myocardial Infarction

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PE 786.419 6 NAFLD Non-Alcoholic Fatty Liver Disease PEF Peak Expiratory Flow PM Particulate Matter PPD Postpartum Depression PTB Pulmonary Tuberculosis SARS Severe Acute Respiratory Syndrome SIDS Sudden Infant Death Syndrome SLD Steatotic Liver Disease SLE Systemic Lupus Erythematosus TB Tuberculosis TLBW Term Low Birth Weight TRAP Traffic-Related Air Pollution WHO World Health Organization

Health effects of fine particles

7 PE 786.419 LIST OF FIGURES Figure 1: All-cause mortality 16 Figure 2: Respiratory health 19 Figure 3: Cardiovascular health 23 Figure 4: Neurological and mental health 27 Figure 5: Cancer 31 Figure 6: Metabolic, endocrine, and other chronic diseases 34 Figure 7: Other outcomes 37 Figure 8: Reproductive health 39 Figure 9: Pregnancy outcomes 41 Figure 10: Child health and development 50 Figure 11: Health effects across the life course 52 Figure 12: People with pre-existing health conditions 56 Figure 13: Annual average concentrations of PM2.5 and PM10 in EU Member States, 62 Figure 14: Annual average concentrations of PM2.5 in EU Member States at NUTS 2 level 64 Figure 15: Deaths per 100k of affected population attributed to PM2.5 68 Figure 16: Health burden attributed to PM2.5 in DALYs at NUTS2 level, 2023 70 Figure 17: Population-weighted concentration of PM2.5 in the richest and poorest quintile 74 Figure 18: Ratio of PM2.5 population weighted concentrations: poorest /richest quintile 75

LIST OF TABLES Table 1: Study structure 13 Table 2: PM limit values 105 Table 3: Summary of the gap between EU policy and WHO health evidence on PM2.5 105 Table 4: Summary of ambition and effectiveness 119 Table 5: Country summary – PM2.5/PM10 case studies 130 Table 6: Summary of recommendations 137 Table 7: Overview of case study countries 150 Table 8: List of interviewed stakeholders 151 Table 9: Disability Adjusted Life Years per 100k affected people 2021 154 Table 10: Disability Adjusted Life Years per 100k affected people 2022 155 Table 11: Disability Adjusted Life Years per 100k affected people 2023 158

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PE 786.419 8 EXECUTIVE SUMMARY This study examines the health effects of fine particulate matter (PM2.5 and PM10), trends in exposure, and the effectiveness of EU legal and policy frameworks. It draws on an umbrella review of 198 systematic reviews, quantitative analysis of exposure trends, stakeholder interviews, and comparative case studies across EU Member States. The study finds no safe threshold for PM2.5 exposure, shows consistent health effects across multiple disease categories, and documents persistent inequalities in exposure across populations and regions. It proposes evidence-based policy recommendations to reduce health impacts across the EU. The study was prepared by Ecorys for the Policy Department for Transformation, Innovation and Health at the request of the Committee on Environment, Climate and Food Safety (ENVI) and the Committee on Public Health (SANT). Background Fine particulate matter, microscopic airborne particles known as PM2.5 (particles smaller than 2.5 micrometres in diameter) and PM10 (particles smaller than 10 micrometres), is one of the most serious environmental threats to public health in the European Union (EU). These particles are small enough to pass deep into the lungs and enter the bloodstream, but they may also affect the body through other pathways, including direct transport via the olfactory system to the brain, where they trigger inflammation, damage blood vessels and organs, and disrupt the body’s immune and nervous systems. These effects are not limited to the lungs: the same biological pathways explain why long- term exposure to fine particles is consistently linked to heart attacks, strokes, diabetes, dementia, cancer, and premature death. Critically, harmful effects are observed even at relatively low levels of exposure. Scientists have not identified any concentration of P