Good air quality is a requirement for preserving the exquisite balance of life on earth for humans, plants, animals and natural resources.
NIPH is a public health institution that has a statutory task to advise the government and population regarding public health. The functions of the NIPH include[1]:
This analytical process requires both understanding of air pollution phenomena, and how these conditions interact with health and in particular with vulnerable people. Understanding this issue will enable sending early warnings and explain it to the general public, NGO’s and the media. The use of air quality messages/alerts/indices is in essence an exposure reduction program, which is the first priority of any government dealing with air pollution.
[1] Law no. 02/l-78 on Public Health
Air is a mixture of nitrogen (78%), oxygen (21%), carbon dioxide (CO2) and some inert gases. It also consists of water vapors of varying quantity.
Air quality is about how healthy the air that we breathe is. Clean air is considered to be a basic requirement of human health and well-being. However, air pollution continues to pose a significant threat to health worldwide.
Air quality refers to the condition of the air within our surrounding. Good air quality pertains to the degree which the air is clean, clear and free from pollutants such as smoke, dust and smog among other gaseous impurities in the air. Air quality is determined by assessing a variety of pollution indicators. Good air quality is a requirement for preserving the exquisite balance of life on earth for humans, plants, animals and natural resources.
Air quality depends also on the proximity to the source and altitude at which pollutants are released; meteorological conditions, including wind and heat; chemical transformations (reactions to sunlight, pollutant interactions)
Clean air is a mixture of nitrogen (78%), oxygen (21%), carbon dioxide (CO2), argon, water vapor and some other inert gases.
Clean air is a mixture of nitrogen (78%), oxygen (21%), carbon dioxide (CO2), argon, water vapor and other inert gases. Air pollution refers to release of substances in the atmosphere that are harmful to humans, living organisms or plants, and cause damage to climate, materials and buildings. Air pollution consists of chemicals or particles: gases, solid particles, or liquid droplets. Primary air pollution is emitted from domestic or municipal heating systems, factories, cars, large combustion sources like power plants, agriculture or natural sources like volcanoes. Air pollution is most common in large cities where emissions from many different sources are cumulated.
The particulate matter (PM) is a common proxy indicator for air pollution. It affects more people than any other pollutant. The major components of PM are sulfates, nitrates, ammonia, sodium chloride, black carbon, soot, mineral dust and water. It consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. There is a close, quantitative relationship between exposure to high concentrations of small particulates (PM10 and PM2.5) and increased mortality or morbidity, both daily and over time. While particles with a diameter of 10 microns or less, (≤ PM10) can penetrate and lodge deep inside the lungs, the even more health-damaging particles are those with a diameter of 2.5 microns or less (≤ PM2.5). PM2.5 can penetrate the lung barrier and enter the blood system. Chronic exposure to particles contributes to the risk of accelerated aging of the lungs, with loss of lung capacity and decrease of lung function, and development of diseases like asthma, emphysema, bronchitis lung cancer, brain damage as well as IHD and stroke as leading causes of death. Symptoms like coughing, phlegm, wheezing, chest tightness, chest pain, palpitations, shortness of breath and unusual fatigue are the most common symptoms among the people affected by the air particles pollution.
Sulphur dioxide (SO2) is a colorless, poor-smelling, toxic gas formed when fuel containing sulfur, such as coal and oil, is burned. SO2 is formed in various industrial and energy combustion processes. This gas can cause respiratory problems such as bronchitis, nose, throat and lung irritation. It may cause coughing, wheezing, phlegm and asthma attacks. The effects are worse when exercising. Sulphur dioxide is linked to cardiovascular disease.
Nitrogen dioxide (NO2) is the main source of nitrate aerosols, which form an important fraction of PM2.5 and, in the presence of ultraviolet light, of ozone. The major sources of anthropogenic emissions of NO2 are combustion processes (heating, power generation, and engines in vehicles and ships). NO2 is a toxic gas which causes significant inflammation of the airways. Epidemiological studies have shown that symptoms of bronchitis in asthmatic children increase in association with long-term exposure to NO2. Reduced lung function growth is also linked to NO2 at currently measured (or observed) concentrations in cities of Europe and North America2.
Ozone (O3) at ground level – not to be confused with the ozone layer in the upper atmosphere – is one of the major constituents of photochemical smog. It is formed by the reaction of sunlight (photochemical reaction) with pollutants such as nitrogen oxides (NOx) from vehicle and industry emissions and Volatile Organic Compounds (VOCs) emitted by vehicles, solvents and industry. As a result, the highest levels of ozone pollution occur during periods of sunny weather. Excessive ozone in the air can have a marked effect on human health. It can cause breathing problems, trigger asthma, reduce lung function and cause lung diseases[2].
Volatile Organic Compounds (VOCs) are gaseous compounds emitted by industry, road vehicles, household heating, and power generation. VOCs include a variety of chemicals that can cause eye, nose and throat irritation, shortness of breath, headaches, fatigue, nausea, dizziness and skin problems. Higher concentrations may cause irritation of the lungs, as well as damage to the liver, kidney, or central nervous system2.
[2] WHO, Health Topic Ambient (outdoor) air pollution, Fact sheets, 2 May 2018. https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health) (accessed October 28, 2020).
Institutional responsibilities of KHMI and KEPA for Air Quality in Kosovo
KHMI is a national institution, scientific and professional in the field of meteorology, hydrology, climate, air, water and soil which acts within Ministry of Environment and has a duty to carry out the following activities[3]:
The institutional responsibilities of KEPA regarding air pollution are defined by Law on environmental protection No. 03/L-025:
The role of NIPH regarding environmental health is described in section 8.1 of this document.
Many cities in Kosovo suffer from poor air quality, with ambient concentrations of particulate matter (PM) with a diameter of 2.5 micrometers or less (PM2.5) significantly exceeding the national[5] and European Union standards and global air quality guidelines for PM2.5 established by WHO.
The law on Air Protection from Pollution 03/L-160 is the most important legal instrument for air quality management. It sets a framework for air quality managements and is a legal base document:
The Strategy on Air Quality in Kosovo 2013-2022 sets out an action plan for a ten-year period. The following measures are planned: implementation of the existing air legislation, emissions reduction from individual sources, mobile sources and public activities, reduce greenhouse gas emissions.[9]
The air standards of Kosovo follow European Union air quality directives.
Kosovo’s air quality standards are based on the EU’s air quality directives (2008/50/EC Directive on Ambient Air Quality and Cleaner Air for Europe and 2004/107/EC Directive on heavy metals and polycyclic aromatic hydrocarbons in ambient air) and set pollutant concentrations thresholds that shall not be exceeded in a given period of time. The most important standards in Kosovo are summarized in Table 1. These apply over differing periods of time because the observed health impacts associated with the various pollutants occur over different exposure times. The information regarding the allowable number of days or hours during the year with concentrations over the limit is also included.
Table 1 Kosovo’s air quality standards
| Kosovo’s air quality standards based on EU Air Quality Directive | |||
| Pollutant | Averaging Period | Objective and concentration | Other information* |
| PM2.5 | Annual | 25 µg/m3 | |
| PM10 | Daily (24-hour mean) | 50 µg/m3 | Not to exceed more than 35 days per year |
| Annual | 40 µg/m3 | ||
| SO2 | hourly | 350 µg/m3 | Not to be exceed more than 24 hours per year |
| Daily (24-hour mean) | 125 µg/m3 | Not to be exceed more than 3 days per year | |
| NO2 | Hourly | 200 µg/m3 | Not to be exceed more than 18 hours per year |
| Annual | 40 µg/m3 | ||
The air pollution in the capital city of Pristina competes with the levels of large polluted cities like Beijing, Mumbai, and New Delhi. Especially in the winter, urban areas face severe smog episodes, caused by the increased demand for heat from the residential and commercial sector, which is burning solid fuels. Such levels of air pollution are unsafe for Kosovo’s population of 1.9 million and cause significant deterioration of health impacts. Recent reports indicate that the residential sector is the largest source of exposure to harmful PM2.5 associated with the burning of solid fuels in individual houses. For example, results of the first emission inventory and air quality modeling in Kosovo carried out as a part of the MCC funded project “Supply of project management, air quality information management, behavior change and communication services’’ confirm the major role of domestic heating in high air pollution. Domestic heating has the major – above 85% share in total emission of PM10 and PM2.5 in annual concentrations for most urban areas. Domestic heating contributes to PM10 and PM2.5 concentration at level of 56% and 58% in Pristina[10]. Additional sources of exposure to PM2.5 include energy, industry, agriculture, and others.
[3] Law No. 06/L-035 on Hydrometeorological Activities.
[4] Administrative instruction no. 02/ 2011 on air quality assessment, appendix viii and law on air protection from pollution/ articles 24 and 25.
[5] https://gzk.rks-gov.net/ActsByCategoryInst.aspx?Index=3&InstID=1&CatID=6
[6] https://gzk.rks-gov.net/ActDetail.aspx?ActID=7900
[7] https://gzk.rks-gov.net/ActDocumentDetail.aspx?ActID=10346
[8] https://gzk.rks-gov.net/ActDetail.aspx?ActID=15113
[9] Air Quality in Kosovo: Towards European Standards, Institution of Development Policy, 2019
[10] TASK D3: Model and model outputs – Modeling Methodology and Results
Air Quality information is a substantial part of the health advisories process.
Air Quality Portal (AQP) Kosovo is a public service providing near real-time and historic air quality information as well as a 3-day air quality forecast: today, tomorrow and next day. Information visualized on maps powered by Terria Map and hosted by the Kosovo Hydro Meteorological Institute (KHMI) was developed by NIRAS and ATMOTERM in consultation with stakeholders, the Kosovo Ministry of Environment and Spatial Planning (MESP), Kosovo National Institute for Health (NIPH) and the Millennium Foundation Kosovo (MFK).
One of the main purposes of AQP is to provide answers to citizens: what is the pollution level and how to reduce impact of pollution on citizen’s health. Information about air pollution consists of two elements: current air quality based on measurements in 12 Kosovo official monitoring stations and air quality forecast based on mathematical modeling.
Measurements presented on the main map of AQP show current air concentrations of the following pollutants: PM10, PM2.5, NO2, SO2, CO, NO, O3 and basic weather conditions in monitoring stations location. This information is calculated into an Air Quality Index (AQI) according to the European Union methodology. AQI reflects the potential impact of air quality on health, driven by the pollutant for which concentrations are highest due to associated health impacts. By clicking on monitoring stations, information on AQI, health advice and pollutant concentrations will appear. The markers are color coded to reflect the AQI level which allows the user to quickly obtain information on the air pollution level.
Measurement, however accurate, only provides air quality information at the location of the monitoring station. Implementing mathematical air quality modeling enables the calculation of air quality over the entire area of Kosovo and also the calculation of the air quality forecast. Such forecasts are based on weather forecasting and air pollution dispersion models of the atmosphere. The AQP includes forecasts of four pollutants: PM10, PM2.5, NO2 and O3. It uses a Calpuff model for regional and urban scales and the Copernicus Atmosphere Monitoring Service (CAMS ensemble – Eulerian air quality models) for boundary conditions and ozone modeling. Weather Research and Forecasting Model (WRF – meteorological prognostic model) is used for weather forecast calculations. Forecasts can be switched on through the Menu function in the AQP. They are available at two levels: for entire Kosovo and for Pristina with more detailed modeling and higher resolution maps. Forecasts provide an estimate of what air quality will be in the coming hours and days in a selected place, and allow planning activities to reduce exposure to high pollution levels (poor AQI).
AQP functionalities are prepared additionally in the form of a mobile application which makes getting air quality information much easier.
The smartphone application provides an easy to use solution for iOS and Android platforms to visualize air quality data in a simple graphical format. The dissemination of information by smartphone application is the most effective way to inform citizens “What is the air quality today and in two consecutive days?” and what they should do in case of high pollution levels. The application includes information like health effects for every level of pollution and recommended actions with specific advice for sensitive and vulnerable populations. It provides also values of weather parameters.
The main functionalities of the smartphone application are:
The AQP may be also used by specialists, scientists, government institutions or universities. The data part of AQP provides reports in excel and graphs which can be very useful for more specific air quality analyses.
For more information on air quality and the Air Quality Index in Kosovo go to http://ihmk-rks.net/?page=1,5 or visit https://www.facebook.com/ihmk.rks/
KHMI air quality measurements are used in EEA air quality website: https://airindex.eea.europa.eu/Map/AQI/Viewer/
It should be noted that some of the air quality websites available on the internet use different air quality indices (for instance based on USA EPA methodology). Therefore, the air quality index values and health recommendation may differ from those presented in the AQP (which uses European methodology).
The emission inventory and air quality modeling are very important parts of the air quality management process. The first national air emission inventory of such level of detail and the first national air quality model were prepared as a part of the MCC funded project “Supply of project management, air quality information management, behavior change and communication services.
The air emission inventory was prepared for the whole of Kosovo. The work was done in cooperation with KEPA and with the use of inputs from a project by Japan International Cooperation Agency (JICA). The base year for the development of emission database data was 2018, the year for which input data (measurements data, statistical data and other) has the best availability. The emission inventory included the following pollutants: PM10, PM2.5, nitrogen oxides (NOx), sulfur dioxide (SO2), carbon monoxide (CO), total non-methane volatile organic compounds (NMVOC), arsenic, cadmium, mercury and lead.
The emission inventory includes the following emission sources:
In relation to total emission from all sources (small combustion, transport, industry, agriculture) – small combustion accounts for 69% (PM10) and 84% (PM2.5) of total PM emission, transport (roads) for 12% and 7%, industry (industry and quarries) for 17% and 8% and agriculture for 3% and 1% respectively. Shares of emission from various sectors are different in the case of NO2: small combustion – 5%, transport (roads) – 32%, industry – 56% and agriculture – 9%.
Sectors contributions to emission of NO2 and PM2.5 are presented in the pie charts below.
Figure 1 Share of individual sectors in PM2.5 and NO2 emissions
Emission data bases were prepared in Excel files. The structure of the database is presented in Figure 2.
Figure 2 Emission database structure
The air emission inventory is one of the most important input sources for the air quality modeling and air quality forecast presented in the AQP.
The air quality modeling provides information on spatial distribution of air pollution (where the air pollution is the worst or the best), indicates the area with air quality standard exceedances and gives information which emission sources are responsible for high pollution levels. Air quality modeling for 2018 supports the air quality monitoring system with the spatial distribution of pollution in the area of the country (not only at measurements points). The modeling results confirmed that the greatest problem is particulate matter (PM10 and PM2.5) in urban areas.
According to the modeling results, there are many areas of PM10 and PM2.5 in Kosovo where PM concentrations are above limit values (see Figure 2). Generally, areas of high PM10 and PM2.5 concentrations overlap with location of the main emission sources such as large cities and main roads. The regions with very high PM pollution (exceeding national standards): Pristina region, Prizren region, Mitrovice, Gjilan, Gjakova and Ferizaj region. Exceedances are predicted also in smaller cities.
Small combustion (domestic heating) has the largest contribution to PM10 and PM2.5 annual concentrations in most of the urban areas. The average share of the small combustion sector in PM10 concentration is about 50% (PM10) and 57% (PM2.5). Domestic heating contributes to PM10 and PM2.5 concentrations at level of 56% and 58% in Pristina.
Exceedances of NO2 annual concentrations are small and concentrated in a few cities like: Pristina, Fushe Kosovo, Obiliq, Ferizaj, Gjilan, Prizren and others. The exceedances are also observed along main roads especially highways and the regional road from Ferizaj via Pristina to Mitrovica. There are no predicted exceedances of NO2 hourly concentrations in the territory of Kosovo.
In the case of NO2, transport has the largest contribution to the annual concentration for most of the urban areas. The average contribution the of transport sector to NO2 concentrations is about 57% nationally and 61% in Pristina.
There are no predicted exceedances of hourly and daily limits for SO2.
Figure 2 present spatial distribution of PM10, PM2.5 and NO2 in Kosovo based on modeling for 2018 year (red colors mean concentrations above limit values).
Figure 2 36th the highest daily concentration of PM10 and annual concentration of PM2.5 and NO2 in Kosovo in 2018
-The Air Quality Index allows users to understand more about air quality where they live, work or travel. Displaying up-to-date information for Kosovo, users can gain insights into the air quality in regions and cities.
The Index is based on concentration values for up to five key pollutants, including:
It reflects the potential impact of air quality on health, driven by the pollutant for which concentrations are poorest due to associated health impacts. Concentrations values for up to five key pollutants (PM10, PM2.5, SO2, NO2 and ozone) determine the index level that reflects air quality at each monitoring station. The index corresponds to the poorest level for any of five pollutants, according to the table shown below. For forecast 4 pollutants are used: ozone, nitrogen dioxide, and particulate matter (PM10 and PM2.5).
Air pollution has significant health, environmental and economic impacts. The negative impact is especially evident in the health of citizens, especially those living in urban areas and areas near intensive traffic and industrial areas.
Air pollution is recognized as one of the leading contributors to the global environmental burden of diseases. Every year thousands of people are admitted to hospital suffering from the effects of air pollution and some of them die prematurely.
Air pollution affects people on a daily basis but long-term exposure to lower doses poses a greater threat to human health. Depending on the length of time you are exposed, your health status, and the concentration of pollutants, air pollution can have a negative effect on our health.
When microscopic air pollutants enter the body, penetrating deep into the respiratory and circulatory system, they can have effects on various different organs and systems, not just the respiratory system.Microscopic air pollutants interfere negatively in maturation of brain and mental development of children.
Long-term exposure to polluted air could cause serious and permanent health effects such as:
Beware of the symptoms like
Finally and always important – Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution.
Vulnerability exists because of a more than average risk of health effects after exposure (health vulnerability) or because of a more than average risk of relevant information not being received or appreciated (information vulnerability).
Vulnerability exists because of a more than average risk of health effects after exposure (health vulnerability) or because of a more than average risk of relevant information not being received or appreciated (information vulnerability).
The Gender and Social Inclusion Policy of the MCC funded AQ project defines two main sensitive groups among Kosovo population. They include:
Sensitive groups (more sensitive to health effects of air pollution): children, pregnant women, older people, people with existing health problems (primarily existing respiratory and cardiovascular disease).
Sensitive (disadvantaged) groups with a risk of information vulnerability: low income groups experiencing or at risk of experiencing poverty, people living with a disability, women, minority groups: Serbs, Bosnians, Roma, Ashkali and Egyptians.
Regarding health vulnerabilities, there is a strong body of evidence confirming the sensitivity of certain population groups to air pollution exposure:
[13] UNICEF. Danger in the Air. How air pollution may be affecting the brain development of young children around the world. 2017.
[14] Project BREATH 2011/16; Rivas et al., Association between early life exposure to air pollution and working memory and attention. Environmental Health Perspectives. 2019. doi: https://doi.org/10.1289/EHP3169 (accessed October 28, 2020).
[15] UNICEF, Clear the Air for children: The impact of air pollution on children, October 2016. https://www.unicef.org/publications/files/UNICEF_Clear_the_Air_for_Children_30_Oct_2016.pdf (accessed October 28, 2020).
Health Advisories are defined as public health information to government, health professionals and different population groups regarding health effects of Air Pollution and actions advised to be taken to protect human health as well to reduce air pollution. Having this in mind the Health Advisories cover the four categories of the air pollution process like emission, concentration, exposure and health effects.
Besides running policies and sets of various actions for proper air quality management, the government is the main organization with a responsibility to inform the public on air quality and health effects, and explain the way air pollutants are emitted and the consequences of these actions. The way of informing the public needs to be transparent and open for involvement of civil society, NGOs, media and the public.
Table 2 describes the public health advisories directed at the government of Kosovo (either national or municipal) which must be continuously implemented during the whole year.
Table 2 Health Advisories for Government.
Policies
Improving air quality is not an economic loss, it can rather go hand in hand with economic growth
As action is taken some groups may need particular support. Some evidence-based actions may disproportionally affect some groups of people. For example, those whose livelihoods depend on driving services but who do not have access to or the resources for cleaner vehicles, may need particular support because some of the most effective interventions target road vehicle emissions. Without such support, action on air quality may have the adverse impact of increasing inequalities.
There are many policies that the government can apply at the national level.
A special budget should be allocated for the issue of air pollution at both municipal and government levels, since current budget is insufficient to deal with air pollution. Example of effective measures include:
Emissions
Main areas for potential actions and interventions to reduce the impact of air pollution are:
Concentration
Exposure
Effects
Although the general population is not considered as a sensitive group, they will suffer from health effects related to the exposure to air pollution when the exposure is over a long time (many years) or when the exposure levels are high. In the end, the general population will suffer as well although not so severely as vulnerable people.
Advisories issued to the population could be a mixture of health and behavior change actions and measures (HA) (Table 3 and Annex 1).
Table 3 Health Advisory for General Population.
Emission (BC)
Concentration (BC)
Exposure (BC)
Effects (HA)
* Do not let people smoke indoors; avoid using anything that burns, such as coal, wood burning stoves, kerosene, etc..; use fuel efficient stoves and vent exhaust outdoors if must use solid fuels for heating or cooking; keep all areas clean and dry. Clean up any mold and remove excess moisture. Always ventilate when using products that can release pollutants into the air; if products must be stored following use, make sure to close them tightly. Inspect fuel-burning appliances regularly for leaks, and make repairs when necessary; consider installing a carbon monoxide alarm.[16]
Masks or particulate respirators may help in special circumstances if you have to be outside whilst pollution levels are high although scientific evidence is limited on their effectiveness against air pollution. Masks need to be of a special type and require special fitting. Masks should be disposable, regularly changed and have a rating of at least N-95 meaning that the mask is adequate for filtering out 95% of PM2.5 particles. Masks should provide a tight seal around the wearer’s mouth and nose. This may be particularly difficult for children. Paper or cloth “comfort” or “dust” masks offer little protection from fine particles[17].
[16] EPA, Care for your air: A Guide to indoor air quality, September, 2008. (PDF). https://www.epa.gov/sites/production/files/2014-08/documents/careforyourair.pdf (accessed October 28, 2020).
[17] WHO International South East-Asia Region, Health Topics Air Pollution, 11 November, 2019. https://www.who.int/docs/default-source/searo/wsh-och-searo/preventing-the-harmful-effects-of-air-pollution2019.pdf?sfvrsn=79c97dcd_2 (accessed October 28, 2020).
Children are likely to experience increased risk for several reasons. Their lungs are still developing, they spend more time at high activity levels, and they are more likely to have asthma or acute respiratory diseases, which can be aggravated when PM levels are high.
Exposure to air pollution during pregnancy can increase the risk of miscarriage, premature birth and low birthweight. Premature birth is birth that happens before 37 weeks of pregnancy.
Table 4 Health Advisory for Children and Pregnant women
Emission
Concentrations
Exposure
Effects
As people age, their bodies are less able to compensate the effects of Air Pollution. Elderly people are expected to have an immune system with a lower protective status. They need to avoid exposure and ensure optimal health conditions (food and supplements, vaccination, etc.). Older adults are at increased risks from air pollution probably because they may have undiagnosed heart or lung disease or diabetes. Many studies show that when particle levels are high, older adults are more likely to be hospitalized. They are best kept away from emissions and stay at home in cleaner air (Table 5).
Table 5 Health Advisory for Older People
Emission
Concentration
Exposure
Effects
Air pollution can aggravate heart disease and cause stroke, lung diseases such as chronic obstructive pulmonary disease or asthma, and diabetes. This leads to increased medication use, more visits to health care providers, admissions to emergency rooms and hospitals, and even death.
People with a compromised health status would be affected more than general population by exposure to air pollution and should protect themselves and be assisted in doing that by proper food and additives, and possible vaccination against flu.
Medical studies show that air pollution can trigger heart attacks, stroke, and irregular heart rhythms—especially in people who are already at risk of these conditions. Also, for people with heart conditions, air pollution can further reduce the ability of the heart to properly pump blood. Very small particles are the pollutants are of the greatest concern for triggering these effects.
When ozone and particle pollution are in the air, adults and children with asthma are more likely to have poor health symptoms. Two key air pollutants which can affect asthma are particle pollution (found in haze, smoke, and dust), and ozone (found in smog). Air pollution can make it harder to breathe. It can also cause other symptoms, like coughing, wheezing, chest discomfort, and a burning feeling in the lungs. People with diabetes may also be at increased risks, possibly because they are more likely to have underlying cardiovascular disease (Table 6).
Table 6 Health Advisory for people with chronic disease
Emission
Concentration
Exposure
Effects
Public health and health care professionals have a vital role in supporting communities, families, and individuals to act against the health impacts of poor air quality. Many of the individuals suffering from air pollution have existing health conditions, which can be exacerbated by poor air quality. Therefore, it is important that health care professionals are equipped to provide support and advice to reduce exposure and offer measures to be taken to reduce any avoidable risks (Table 7). Other public health teams can also influence the general population by providing whole system approaches. This is crucial to reduce the health impacts associated with air pollution to help people live longer and healthier lives.
An easy way physicians and other health professionals can help reduce risk from exposure is through patient education. The simple steps of advising patients to check the air quality daily, and informing them of ways to minimize exposure to particle pollution, can help reduce overall risk of particle pollution-related health effects, particularly in individuals with heart and lung disease. Note that this patient education is consistent with the recommendations of public health and health experts (consult with NIPH).
Table 7 Health Advisories for Health Professionals
Exposure
Effects
Improve your knowledge in order to give relevant medical advice to:
Air pollution in Kosovo and in particular in Pristina forms a stressor for public health in particular for vulnerable groups. The Kosovo National Institute of Public Health (NIPH) is responsible for informing and advising the general public on health issues in particular who and how to protect themselves and the ones they are responsible for against the harmful health effects associated with exposure to air pollutants.
A recent report by the World Bank for Kosovo, estimates that about 760 people die prematurely every year in Kosovo because of exposure to Outdoor Air Pollution. Of the total number of deaths attributable to air pollution, 90 percent are from Ischemic heart diseases (IHD) and stroke combined. About 53 percent of IHD and 63 percent of strokes occur in people of productive age before attaining the age of 70. Population age groups between 50 and 69 years old carry the largest share (about 45 percent) of the total health burden associated with exposure to AAP, followed by people over 70 years of age[18].
The results of the study conducted by NIPH scientists in the period 2010-2012, showed a consistent positive association between particulate air pollution and hospital admissions for respiratory and cardiovascular diseases across all ages and diagnosis in Kosovo. The relative risk for hospitalization in both genders was 8.2 times higher after 55 years of age. From a total number of cases 54.6% were diagnosed with IHD. Incidence of cardiovascular hospital admission was higher in males than in females. Similarly, the hospital admission during the air pollution episodes was increased for the children patients in the Pristina Pediatric Clinic[19]
Good air quality is a requirement for preserving
the exquisite balance of life on earth for humans,
plants, animals and natural resources.
Summary table for the Health Advisories to the general population and sensitive groups linked with the Air Quality Index information*
| Air Quality Index | General population | Sensitive populations** | ||
|
Good
|
The air quality is good. Enjoy your usual outdoor activities. | 
|
The air quality is good. Enjoy your usual outdoor activities. |  |
| Fair
|
Enjoy your usual outdoor activities. |  |
Enjoy your usual outdoor activities. |  |
Moderate |
No need to modify your usual outdoor activities unless you experience symptoms such as coughing and throat irritation |  |
Stay at home if you do not need to go out. Adults and children with lung problems, and adults with heart problems, who experience symptoms, should consider reducing strenuous physical activity, particularly outdoors. If you have to go out wear masks with proven efficiency***. Strengthen immune system. Have healthy food with a lot of fruit and vegetables. Consult your physician. Visit your family doctor or health clinic if you feel unwell or are experiencing any adverse effects from air pollution. |  |
Poor |
Anyone experiencing discomfort such as sore eyes, cough or sore throat should consider reducing activity, particularly outdoors. Strengthen immune system. Have healthy food with a lot of fruit and vegetables. Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution. |  |
Stay at home if you do not need to go out. Adults and children with lung problems, and adults with heart problems, should reduce strenuous physical activity, particularly outdoors, and particularly if they experience symptoms. Pregnant women should stay indoors. People with asthma may find they need to use their inhaler more often. Older people should also reduce physical exertion. If you have to go out wear masks with proven efficiency***. Strengthen immune system. Have healthy food with a lot of fruit and vegetables. Consult your physician. Visit your family doctor or health clinic if you feel unwell or are experiencing any adverse effects from air pollution. |  |
Very poor |
Stay at home or reduce physical exertion, particularly outdoors, especially if you experience symptoms such as cough or sore throat. Strengthen immune system. Have healthy food with a lot of fruit and vegetables. Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution. | 
|
Stay at home if you do not need to go out. Adults and children with lung problems, adults with heart problems, and older people, should avoid strenuous physical activity. Pregnant women should stay indoors. People with asthma may find they need to use their inhaler more often. If you have to go out wear masks with proven efficiency***. Strengthen immune system. Have healthy food with a lot of fruit and vegetables. Consult your physician. Visit your family doctor or health clinic if you feel unwell or are experiencing any adverse effects from air pollution. |  |
Extremely poor |
Stay at home or reduce physical exertion, particularly outdoors, especially if you experience symptoms such as cough or sore throat. Strengthen immune system. Have healthy food with a lot of fruit and vegetables. Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution. |  |
Stay at home if you do not need to go out. Adults and children with lung problems, adults with heart problems, and older people, should avoid strenuous physical activity. Pregnant women should stay at home. People with asthma may find they need to use their inhaler more often. If you have to go out wear masks with proven efficiency***. Strengthen immune system. Have healthy food with a lot of fruit and vegetables Consult your physician. Visit your family doctor or health clinic if you feel unwell or are experiencing any adverse effects from air pollution. | . |
* For more information, go to Health Advisories (https://www.niph.org)
** Adults and children with respiratory problems, adults with heart conditions, pregnant women, elderly and other sensitive groups (see details on Health Advisories on ajri.niph-rks.org or facebook/IKSHP.
*** Masks or particulate respirators may help in special circumstances if you have to be outside whilst pollution levels are high although scientific evidence is limited on their effectiveness against air pollution. Masks need to be of a special type and require special fitting. Masks should be disposable, regularly changed and have a rating of at least N-95 meaning that the mask is adequate for filtering out 95% of PM2.5 particles. Masks should provide a tight seal around the wearer’s mouth and nose. This may be particularly difficult for children. Paper or cloth “comfort” or “dust” masks offer little protection from fine particles17.
Check daily air quality at
airqualitykosova.rks-gov.net
or Download the free
smartphone app
