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Reductions in vulnerability to air pollution since 1990 saved the lives of about 1.7 million people in 2019, according to new research.

Particle pollution improved in 139 out of 193 countries. The greatest gains were achieved in Europe and North America, with smaller reductions across Africa and Asia.

Breathing outdoor particle pollution led to an estimated 3.8 million early deaths in 1990. By 2019 this figure had risen to 5.1 million. As the population grows, and if particle pollution stays at current levels, the global death toll from air pollution is predicted to be more than 10 million people a year by 2050.

Dr Chris Malley, of the University of York, the first author of the new research, said: “Air pollution is the second-largest risk factor for early death globally. Traditionally, our response has focused on reducing the levels of pollution people breathe, but this is only part of the story.”

Wider health improvements can make people less vulnerable to air pollution. Malley said: “The scale of this impact is immense. Had we not reduced vulnerability, an additional 1.7 million people would have died from air pollution in 2019.”

Malley’s work highlights that global poverty rates plummeted from 45% in 1990 to 21% in 2019, and about 15% of the global population gained access to essential health services between 2000 and 2021. These changes acted as a massive shield against the health burdens of smog.

Malley said: “I previously assumed that equivalent reductions in pollution would yield similar health benefits everywhere, but the impact of cleaner air is significantly larger when achieved alongside reductions in vulnerability.”

Europe and North America achieved similar decreases in air pollution between 1990 and 2019, but Europe’s reduction in the rate of air pollution-attributable deaths was almost double that in North America. This was because Europe was more effective in reducing vulnerability through healthcare and social factors.

In the UK there are still opportunities to decrease air pollution vulnerabilities. A separate study of more than 300,000 people in the UK found that lung problems from air pollution were especially pronounced in people with lower incomes. For the same air pollution exposure, people with lower incomes had approximately twice the lung function decline and three times the increased risk of chronic obstructive pulmonary disease compared with those of higher income.

Prof Anna Hansell, of the University of Leicester, who led the study, said: “For those in more deprived areas, the problems come not just from higher exposure to air pollution but also higher vulnerability to the effects of air pollution due to poorer health, together with reduced access to things that maintain health like a good diet, ability to exercise and good health service access.”

Malley concluded: “In many nations, the average age of the population is rising, and the elderly remain one of the groups most vulnerable to the effects of air pollution. Maximum health benefits from every unit of pollution reduced are only realised when people’s vulnerability is reduced at the same time.

“Actions include expanding access to quality medical care, promoting physical activity and healthy diets, and improving postnatal care for children in high-pollution areas.”