Abstract
Long-term PM2.5 exposure is a risk factor for cardiovascular and respiratory mortality. Here a global health impact assessment was conducted utilizing seven future scenarios evaluating strategies to reduce PM2.5 exposure. Strategies included reducing fossil fuel use, air pollution control, adopting cleaner cooking methods and combinations thereof. Under current trends, air quality is projected to improve by 2050; nevertheless, the absolute attributable burden of ischaemic heart disease, stroke and chronic obstructive pulmonary disease remains high in many regions. Cleaner cooking fuel use is effective in the short term (by 2030) in South and Central America, Asia, and Africa for reducing PM2.5-related deaths. In the long term (by 2050) for most regions, only strate…
Abstract
Long-term PM2.5 exposure is a risk factor for cardiovascular and respiratory mortality. Here a global health impact assessment was conducted utilizing seven future scenarios evaluating strategies to reduce PM2.5 exposure. Strategies included reducing fossil fuel use, air pollution control, adopting cleaner cooking methods and combinations thereof. Under current trends, air quality is projected to improve by 2050; nevertheless, the absolute attributable burden of ischaemic heart disease, stroke and chronic obstructive pulmonary disease remains high in many regions. Cleaner cooking fuel use is effective in the short term (by 2030) in South and Central America, Asia, and Africa for reducing PM2.5-related deaths. In the long term (by 2050) for most regions, only strategies that simultaneously target ambient and cooking-related PM2.5 resulted in sustained improvements that expand beyond current trends for reducing disease burden across these three health outcomes. In the Asian region, for example, under current trends, the population-attributable fraction decreases from 35% in 2015 to 18% in 2050. In the scenario combining universal clean cooking and climate policy, it drops further to 15%, and when all strategies are combined, it reaches as low as 11% by 2050. With all strategies combined, the average global population-weighted PM2.5 exposure from both ambient and cooking sources is reduced by nearly two-thirds (66 µg m−3 compared with 26 µg m−3). For North Africa and the Middle East region, the population-attributable fraction remains high across all scenarios. Additional strategies beyond those mentioned here are required to further improve air quality. It is recommended to pursue climate mitigation alongside universal access to cleaner household fuels to maximize cardiopulmonary health benefits.
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Data availability
Most data relevant to the results are provided in Supplementary Information and are available via Zenodo at https://doi.org/10.5281/zenodo.17206910 (ref. [51](https://www.nature.com/articles/s41893-025-01676-9#ref-CR51 “Weber, E. Code for modelling PM2.5 reduction scenarios for future cardiopulmonary disease reduction. Zenodo https://doi.org/10.5281/zenodo.17206910
(2025).“)). If additional data are needed, they are available upon request from the corresponding author.
Code availability
Code and PM2.5 data used for the models introduced here are available via Zenodo at https://doi.org/10.5281/zenodo.17206910 (ref. [51](https://www.nature.com/articles/s41893-025-01676-9#ref-CR51 “Weber, E. Code for modelling PM2.5 reduction scenarios for future cardiopulmonary disease reduction. Zenodo https://doi.org/10.5281/zenodo.17206910
(2025).“)).
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Acknowledgements
We acknowledge funding from the European Research Council (ERC) under the Horizon Europe programme (PICASSO project; grant agreement ID 819566). The funder had no role in the study design, data collection, data analysis, writing of the report or data interpretation. D.v.V. and V.D. received funding from the European Union’s Horizon Europe programme under grant agreement no. 101081604. We acknowledge the following contributions: M. Harmsen provided insight into precursor emissions. M. van der Marel helped with the HOMES model code validation. M. Van Den Berg created IMAGE’s version of the TM5-FAAST submodel. We thank R. Ghosh for advising E.W. on early stages of the work about MR-BRT curves.
Author information
Author notes
These authors contributed equally: George Downward, Maria Gabriela Matias de Pinho, Detlef van Vuuren.
Authors and Affiliations
Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
Eartha Weber, Vassilis Daioglou, Maria Gabriela Matias de Pinho & Detlef van Vuuren 1.
PBL Netherlands Environmental Assessment Agency, The Hague, The Netherlands
Vassilis Daioglou, Laszlo Vreedenburgh, Jonathan Doelman & Detlef van Vuuren 1.
Department Population Health Sciences, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
George Downward 1.
Institute for Risk Assessment Sciences, Division of Environmental Epidemiology University Medical Center, Utrecht, The Netherlands
George Downward
Authors
- Eartha Weber
- Vassilis Daioglou
- Laszlo Vreedenburgh
- Jonathan Doelman
- George Downward
- Maria Gabriela Matias de Pinho
- Detlef van Vuuren
Contributions
E.W. conducted the health impact analyses, made all figures, conceptualized the use of HOME’s model in this type of analysis and wrote the first draft. V.D. ran the energy modules of the IMAGE model for all scenarios and provided proportions of fuel usage for the SSP2 Baseline scenario. L.V. ran the TM5-FAAST analyses. J.D. ran the land model and provided results for the waste burning scenario. D.v.V. conceptualized the scenarios, provided supervision and leadership, and secured the funding for the study. G.D. and M.G.M.d.P. jointly supervised this work. All listed co-authors edited and revised the final drafts.
Corresponding author
Correspondence to Eartha Weber.
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Supplementary information
Supplementary Information
Appendices A–F. Tables with all 26 region results, including uncertainty intervals for 7 different scenarios and 3 different health outcomes. Sensitivity analysis of the above with longer distribution of cooking times. Input data for Fig. 2 and functions explained.
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Weber, E., Daioglou, V., Vreedenburgh, L. et al. Modelling PM2.5 reduction scenarios for future cardiopulmonary disease reduction. Nat Sustain (2025). https://doi.org/10.1038/s41893-025-01676-9
Received: 09 January 2025
Accepted: 02 October 2025
Published: 14 November 2025
Version of record: 14 November 2025
DOI: https://doi.org/10.1038/s41893-025-01676-9