Cleaner air for safer health!

Good air quality is a requirement for preserving the exquisite balance of life on earth for humans, plants, animals and natural resources.

Real-time information on air pollution in Kosovo

Introduction

NIPH has a statutory task to advise the government and population regarding health prevention and protection from (among others) the harmful effects of environmental hazards.

Furthermore, NIPH has a role:

  • To advise the government on the public health and behavior change interventions to protect the air quality (AQ) and population health.
  • To advise the population on behavior change to prevent (reduce) air pollution (AP).
  • To advise the general public as well as vulnerable groups on the impact of airpollution on their health, when and how to avoid and at least minimize exposure.
  • To support health professionals in protecting patient health from AP’s harmful effects.

This process requires both understanding of air pollution phenomena and how these conditions interact with health and in particular with vulnerable people. Understanding this will enable them to send early warnings and explain them 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 the AP problem.

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What is Air Quality?

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)

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What is Air Pollution?

Clean air is a mixture of nitrogen (78%), oxygen (21%), carbon dioxide (CO2), argon, water vapor and some other inert gases.

From other side, air pollution refers to release of substances in the atmosphere that are harmful to humans, living organisms or plants, and cause damage to climate or materials. Air pollution consists of chemicals or particles in the air that can harm the health of humans, animals and plants. It also may cause damage to buildings. Pollutants in the air take many forms: they can be 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 sulphates, 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 functions and developing of diseases like asthma, emphysema, bronchitis lung cancer, brain damage as well as ischemic heart diseases and stroke as leading causes of death. Symptoms like cough, 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 has been 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 concentrations currently measured (or observed) in cities of Europe and North America1

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 diseases1.

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 system1

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Air Quality in Kosovo

Many cities in Kosovo suffer from poor air quality, with ambient concentrations of particulate matter with a diameter of 2.5 micrometers or less (PM2.5) significantly exceeding the national2 and European Union standards and global air quality guidelines for PM2.5 established by the World Health Organization.

Kosovo’s air quality policy and law

Kosovo is being under process of adopting European air protection law into national legislation3:

  • The law No. 03/L-025 on Environmental Protection (2009)4 aims to “promote the establishment of healthy environment for population of Kosovo by bringing gradually the standards for environment of European Union”;
  • The law No. 03/L-160 on Air Protection from Pollution (2010)5 gives basic legal framework for harmonizing environmental standards in Kosovo with those of the EU in order to “regulate and guarantee the rights of citizens to live in a healthy and clean air environment, whilst protecting human health, fauna, flora and natural and cultural values of the environment”;
  • The law No. 06/L-079 on Energy Efficiency (2018)6 this law “establishes the legal framework necessary to promote and improve energy efficiency in the Republic of Kosovo with the aim at defining energy efficiency targets and achieving these targets through implementation of energy efficiency action plans, development of energy services market and other energy efficiency measures”
  • The law No. 03/L-043 on Integrated Prevention Pollution Control (2009)7 – harmonising law with EU regarding industrial activities;
  • The law No. 03-L-214 on Environmental Impact Assessment (2010)8;

The law on Air Protection from Pollution is the most important legal instrument for air quality management. It sets framework for air quality managements and is a legal base document for the following administrative instruction:

  • The administrative instruction on limited values of air quality Nr. 02/2011, established the Ministry of Environment and Spatial Planning as the competent authority for assessing air quality, and set the reference methods and criteria that are specified in the EU Directive 2008/50/EC (CAFÉ Directive – Directive 2008/50/EC of the European Parliament and of the Council of 21 May 2008 on ambient air quality and cleaner air for Europe)9 and 2004/107/EC (Directive 2004/107/EC of the European Parliament and of the Council of 15 December 2004 relating to arsenic, cadmium, mercury, nickel and polycyclic aromatic hydrocarbons in ambient air)10; Regarding European law it establishes limit values for main pollutants, methods of air quality management (establishing zones and agglomeration, introducing Air Quality Plans) and reporting and public information rules;
  • The administrative instruction 15/2010 Administrative Instruction No. 15/2010 on Criteria for Defining of Air Quality Monitoring Points, Number and Frequency Of Measurements, Classification of Pollutants Which Are Monitored, The Methodology Of Work, Form And Timing11 defining criteria for the implementation of the air quality monitoring system;
  • Administrative Instruction (Grk) No. 21/2013 For Arsenic, Cadmium, Mercury, Nickel And Polycyclic Aromatic Hydrocarbons In Air12 – sets target value for the concentration of arsenic, cadmium, nickel and benzo (a) pyrene, and establishes requirements for air quality assessment;
  • Administrative Instruction (Grk) No. 08/2016 For The Allowed Norms Of Discharges In Air From Mobile Sources13 – the administrative instruction sets up the allowed norms of the discharges in air by mobile ground sources – roads vehicles, and measures for their implementation.

The Strategy on Air Quality 2013-2022 sets out an action plan for the next ten years. There are the following measures planned: implementation of the existing air legislation, emissions reduction from individual sources, mobile sources and public activities, reduce greenhouse gas emissions.14

Summarizing: the air standards of Kosovo are the same as in European Union legislation.

Kosovo’s air quality standards

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 Kosovo’s standards are summarized in the table below. These apply over differing periods of time because the observed health impacts associated with the various pollutants occur over different exposure times.

 

The air pollution in the capital city of Pristina rivals that of big cities like Beijing, Mumbai, and New Delhi. Especially in winter, urban areas face severe smog episodes, caused by the increased demand for heat from the residential and commercial sector, which is mainly provided by burning solid fuels. Such levels of air pollution are unsafe for Kosovo’s population of 1.9 million and cause significant deleterious 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. Results of the first emission inventory and air quality modeling carried out as a part of this project confirm the major role of domestic heating in high air pollution. Small combustion sector (domestic heating has the major – above 85% share in total emission in this sector) has the largest contribution to PM10 and PM2.5 annual concentrations for most urban areas. The average share of small combustion sector in PM10 concentration is about 50% (PM10) and 57% (PM2.5). Domestic heating contributes to PM10 and PM2.5 concentration at level of 56% and 58% in Pristina . Additional sources of exposure to PM2.5 include energy, industry, agriculture, and others. National-level source apportionment is not a replacement for smaller-or city-level source apportionment studies that would allow more in-depth understanding of the contributions of other sectors such as transport, which may be more important at the local level, or of air pollution hot spots16.

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Air Quality Portal

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 Hydrometeorological 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 give answers for the citizens: what is 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 modelling.

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 methodology17. 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 modelling 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 in 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 modelling. Weather Research and Forecasting Model (WRF – meteorological prognostic model) is used for weather forecast calculations. Forecasts can be switched on using Menu position in the AQP. They are available at two levels: for entire Kosovo and for Pristina with more detailed modelling and higher resolution maps. Forecasts provides an estimate of what air quality will be in the coming hours and days in a selected place and allows planning activities to reduce exposure to high pollution levels (poor AQI).

AQP functionalities are prepared additionally in the form of 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:

  • visualization of current AQ Index, pollutant concentrations, values of weather parameters and health recommendations for selected points in Kosovo and for monitoring stations,
  • all data are visualized in hourly resolution and for 3-days forecast,
  • displaying map of Kosovo with marked monitoring stations and pop-up windows with detailed information about the selected station,
  • storing favorite places in a list ‘My places’,
  • adding to ‘My places’ by address, selecting from the monitoring station list, pointing on the map and by current location from GPS,
  • displaying list of all monitoring stations with station parameters and details.

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 Air Quality Index in Kosovo go to https://niph-rks.org and https://kosovo-airquality.org/ or visit Facebook/IKSHPK.

KHMI air quality measurements are used in other air quality websites like:

It has to be mentioned that some of these websites use different air quality index (for instance based on USA EPA methodology), therefore the air quality index values and health recommendation may differ from those in the AQP (which uses European methodology). The websites for AQI calculation may also use measurements carried out by low cost sensors which have much higher uncertainty and information obtained from them should be carefully managed.

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Air emission inventory and air emission modeling for Kosovo

Air emission inventory and air quality modeling are very important parts of air quality management process. The first detailed air emission inventory and the first air quality modeling have been carried out as a part of this project.

Air emission inventory was prepared for the whole Kosovo area. 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.

Emission inventory includes the following emission sources:

  • Small combustion – domestic, public and business services heating (and cooking). It includes space heating, cooking and water heating for domestic houses and space heating for services: covering municipal sector, trade and services sector and public utility facilities. Domestic heating accounts for over 85% of total PM emission in this sector.
  • Transport – traffic emission, taking into account national, regional, county and municipal roads, emissions from vehicle tires and brake wear, road surface wear, and PM resuspension are also included.
  • Industry (point and area sources) – it includes emission from IPPC installations (with integrated environmental permits or applying for IPPC), landfills and quarries.
  • Agriculture (crops and breeding) – emissions from agriculture, areas under cultivation, livestock husbandry and the use of fertilizers and agricultural machinery.

Detailed description of emission methodology is included in the report: “TASK D1: Emission inventory: Detailed methodology for the inventory of emissions of substances in Kosovo and the scope of the electronic database”.

Air emission inventory is one of the most important input data for air quality modelling and air quality forecast presented in the AQP.

The air quality modelling provides information on spatial distribution of air pollution (where the air pollution is the worst or the best), indicates the area wit air quality standard exceedances and gives information which emission sources are responsible for high pollution level. Air quality modelling for 201818 year supports also the air quality monitoring system with spatial distribution of pollution in the area of the country (not only at measurements points). The modelling results confirmed that the worst problem with air quality is caused by particulate matter (PM10 and PM2.5) in urban areas.

According to the modelling results, there are many areas of PM10 and PM2.5 in Kosovo where PM concentrations are above limit values (see figures below – red colours). Generally, areas of high PM10 and PM2.5 concentrations overlap with location of main emission sources: large cities and main roads. There are the following regions with very high PM pollution (above acceptable level – standard): 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 concentration for most of the urban areas. The average share of small combustion sector in PM10 concentration is about 50% (PM10) and 57% (PM2.5), the highest shares of this sector reach 65% – 79%. Domestic heating contributes to PM10 and PM2.5 concentrations at level of 56% and 58% in Pristina.

Exceedances areas of NO2 annual concentration limit are small and concentrated in a few cities like: Pristina, Fushe Kosovo, Obiliq, Ferizaj, Gjilan, Prizren and others. The excedances are also observed along the main roads especially highway and 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 annual concentration for most of the urban areas. The average share of transport sector in NO2 concentration is about 57%, the highest shares of this sector reach 76% – 77%. Transport contributes to NO2 concentration at level of 61% in Pristina.

There are no predicted exceedances of hourly and daily limits for SO2.

Figures below present spatial distribution of PM10, PM2.5 and NO2 in Kosovo based on modelling for 2018 year (red colours mean concentrations above limit values).

 

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Air Quality Index AQI

-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:

  • particulate matter (PM10),
  • fine particulate matter (PM2.5),
  • ozone (O3),
  • nitrogen dioxide (NO2),
  • sulphur dioxide (SO2).

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).

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AP Health effects

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:

  • Accelerated aging of the lungs;
  • Loss of lung capacity and decreased lung function;
  • Development of diseases such as asthma, bronchitis, emphysema, and possibly lung cancer.
  • Ischemic heart disease and stroke which cause 80 % of premature deaths due to air pollution.

Beware of the symptoms like

  • cough, phlegm, chest tightness, wheezing, shortness of breath
  • chest tightness, chest pain (angina pectoris), palpitations, shortness of breath, unusual fatigue, coronary artery disease, abdominal rhythms, congestive heart failure, stroke

Finally and always important – Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution.

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AP Sensitive Groups

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 project, defines two main sensitive groups among Kosovo population. They include:

Sensitive groups (more sensitive to health effects of air pollution): children, pregnant women and care givers to children, 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 which include:

  • People with, lung disease (COPD, asthma, lung cancer) or heart disease (heart attack, congestive heart failure, coronary artery disease) and diabetes are more sensitive to air pollution.
  • Older people are at higher risk because of weakening of the heart and lungs and an increased likelihood of health problems such as heart attacks, heart failure and stroke, asthma attacks and lung cancer, but also dementia and diabetes.
  • Children are also more vulnerable to air pollution because they have a less-developed respiratory system. Because of their size, children inhale more air per kilogram of body weight than adults. There is an increasing body of evidence that links air pollution to brain development and learning outcomes among children like psychological and behavioral problems later in childhood including symptoms of attention deficit hyperactivity disorder (ADHD), anxiety, and depression; and a four-point drop in IQ by the age of 5 among a sample of children exposed in utero to toxic air pollution.19 Furthermore PM2.5 exposure during the fifth and sixth years of life affects working memory, with boys showing much higher vulnerability including reduction in conflict network performance, reduction in the working memory and an increase in the conflict attentional network20
  • Pregnant women – exposure to air pollution during pregnancy can increase the risk of miscarriage, premature birth and low birthweight. Premature birth is birth that happens too soon, before 37 weeks of pregnancy. People participating in strenuous sports or work outdoors breathe more deeply and rapidly, allowing more air pollution to enter their lungs. They may experience symptoms like eye, nose or throat irritation, coughing or difficulty breathing when air pollution levels are high.
  • Low income socioeconomic groups – are much more affected from AP than the wealthier citizens. Main reasons are low standard of heating, housing, indoor pollution and education (families in poorer nations are more dependent on burning wood, coal and kerosene for cooking and heating).
  • Communities in areas of higher pollution, such as close to busy roads or industrial zones are significantly more exposed to the pollutants emitted from various types vehicles on the road.
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AP Health Advisories

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.

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Health Advisory for Government

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 1 describes the public health advisories directed at the government of Kosovo (either national or municipal) which must be continuously (during the whole year) implemented.

Policies

Improving air quality is not an economic loss, it can rather go hand in hand with economic growth

  1. In the hierarchy of interventions with preventing, reducing or replacing polluting activities to reduce emissions is the first priority.
  2. Actions to reduce the concentration of air pollution once it has occurred is the second priority,
  3. Individual avoidance of exposure is the third.

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 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:

  • Ban on burning coal sludge or wood with moisture content above 30%. Introducing fines for breaking the rules.
  • Implementation of local low-stack emission reduction programs like subsidies for replacement of heating devices based on solid fuels.
  • Inventory of stoves, boilers and fireplaces prior to a program for replacing solid fuel heating devices
  • Replacement of heating systems based on solid fuel by connection to the municipal heating system, gas heating, electric heating, oil heating, heat pump.
  • Expansion and modernization of municipal heating networks and gas distribution networks to connect new users.
  • Thermo-modernization of buildings and support of energy efficient buildings in housing and public utilities.
  • Subsidies for bills for low income residents who incur increased heating costs after replacement of stoves.
  • Reduction of emissions from transport (ban on import of old used ( non-ecofriendly) cars, tax on diesel, bypass roads of cities, improved public transportation, bicycle lanes etc.).
  • Environmental education and changing behavior campaign for residents: public service announcements on TV or radio, public events, leaflets, posters, play-based behavior change campaigns targeting school age children,
  • Distribution of plants.
  • Establish continuous assessment of the effectiveness of public health interventions.
  • Better inform the public.*

Emissions

Main areas for potential actions and interventions to reduce the impact of air pollution are:

  • Domestic heating
  • Vehicles and fuels
  • Spatial planning – more green surfaces in the cities Industry (energy power etc.)
  • Agriculture
  • Promote behavioral change and healthy lifestyle approach – walking, using bicycles, ban on smoking inside restaurants and on the street

Concentration

  • Establish and maintain a AQ monitoring system
  • Inform the public through AQ portals hosted by NIPH and KHMI

Exposure

  • То аvoid planning and building kindergartens, schools, play-grounds, prenatal and postnatal care facilities etc. in a heavy polluted zones
  • Inform and advise the public
  • Establish an unique environment and health information system (database)* which will include basic environmental, health and mortality data of importance to assess the air pollution health risks to the population

Effects

  • Educate, prepare and support the health & care system and professionals
  • Support Health Impact Assessment studies
  • Inform and advise the public regarding the assessed health risks and the measures to be taken in order to prevent or minimize them

* Activities to be delivered or initiated within the scope of the project

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Health Advisory for General Population

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 (HA) and behavior change (BC) advisories.

Emission (BC)

  • Public transport to be used more regularly, and the private cars only when is necessary.
  • Prefer eco-traveling, be aware that old, and poorly maintained cars, buses and trucks are emitting much more pollution compared to well-maintained vehicles.
  • Lower temperatures in houses to reduce emissions.
  • Do not burn waste.
  • Manage indoor air quality*
  • Try not to smoke indoors especially close to the children, pregnant women and older people to avoid indoor pollution health effects.

Concentration (BC)

  • Be aware where and when the air pollution levels are high.

Exposure (BC)

  • Check the daily AQHI** in your area on niph-rks.org and kosovo-airquality.org or visit Facebook/IKSHPK
  • Avoid intensive activities at locations in spaces with high level of air pollution- find alternatives as physical activity is important for your health.
  • Choose easier outdoor activities (like walking instead of running) so you don’t breathe as deeply.
  • Avoid busy roads and highways where PM levels may be higher due to emissions from cars and trucks.
  • Stay at home when PM concentration outside is very poor or extremely poor
  • Spend time outside when and where air quality is good
  • Wear masks (with proven efficiency)*** – look for public health advice

Effects (HA)

  • Improve & maintain good health
  • Strengthen immune system
  • Have healthy food with a lot of fruit and vegetables
  • Consult your doctor or NIPH for use of supplements
  • Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution.

*Test for radon and fix if there is a problem; Reduce asthma triggers such as mold and dust mites; do not let people smoke indoors; keep all areas clean and dry. Clean up any mold and get rid of excess water or moisture. Always ventilate when using products that can release pollutants into the air; if products must be stored following use, make sure to close tightly. Inspect fuel-burning appliances regularly for leaks, and make repairs when necessary; consider installing a carbon monoxide alarm.21

**Air Quality Health Index – the Air Quality Health Index or “AQHI” is a scale designed to help you understand what the air quality around you means to your health. It is a health protection tool that is designed to help you make decisions to protect your health by limiting short-term exposure to air pollution and adjusting your activity levels during increased levels of air pollution. It also provides advice on how you can improve the quality of the air you breathe.

*** Masks or particulate respirators may help in special circumstances if you have to be outside for long periods of time. 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 changes and have a rating of at least N-95 meaning that the mask is adequate for filtering out 95% or most of the PM2.5 particles, – The fitting of the mask is very important. Masks should provide a tight seal around the wearer’s mouth and nose. This may be particularly difficult to achieve especially for children. • Dust masks should not be relied upon for protection. Paper “comfort” or “dust” masks are designed only to trap large particles, such as sawdust and offer little protection from fine particles22.

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Health Advisory for Children and Pregnant Women

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 premature birth and low birthweight, and possibly fetal and infant deaths. Premature birth is birth that happens too soon, before 37 weeks of pregnancy.

Emission

  • Manage indoor air quality.

Exposure

  • Check the daily AQHI in your area on niph-rks.org and kosovo-airquality.org or visit Facebook/IKSHPK.
  • Select wisely route to and from school to avoid high levels of pollution
  • Tell parents to protect ‘us’ from exposure to air pollution
  • Stay at home when AQHI in your area is poor, very poor or extremely poor
  • If you must go out during poor level of AQHI put mask on

Effects

  • Improve & maintain good health
  • Strengthen immune system
  • Have healthy food with a lot of fruit and vegetables
  • Consult your physician or NIPH for using supplements (Vit C, Vit E, A, B)
  • Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution.
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Health Advisory for Elderly People

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.

Emission

  • Protect the AQ near elderly homes

Concentration

  • Manage indoor air quality, avoid smoking in the house

Exposure

  • Check the daily AQHI in your area on niph-rks.org and kosovo-airquality.org or visit Facebook/IKSHPK
  • Avoid (intensive) activities at locations in spaces with high level of air pollution- find alternatives (physical activity is important for your health)
  • Choose easier outdoor activities (like walking instead of running) so you don’t breathe as deeply.
  • Stay at home when AQHI in your area is poor, very poor or extremely poor
  • Be outside when and where AQHI is good or fair
  • Wear masks (with proven efficiency)11 – look for public health advise

Effects

  • Improve & maintain good health
  • Strengthen immune system
  • Apply flu vaccination
  • Have healthy food with a lot of fruit and vegetables
  • Consult your physician or NIPH for using supplements (Vit C, Vit E, A, B)
  • Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution.
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Health Advisory for people with chronic diseases

Air pollution can aggravate heart disease and 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.

Ill people, 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 for these conditions. Also, for people with a medical condition such as heart failure or air pollution, can further reduce the ability of the heart to properly pump blood. Very small particles are the pollutants of 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 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 also may be at increased risks, possibly because they more likely to have underlying cardiovascular disease.

Emission

  • Protect the AQ near hospitals or medical facilities

Concentration

  • Manage indoor air quality, avoid smoking in the house

Exposure

  • Check the daily AQHI in your area on niph-rks.org and kosovo-airquality.org or visit Facebook/IKSHPK levels
  • Know when and where particle pollution may be unhealthy and plan your activities accordingly
  • Avoid (intensive) activities at locations in spaces with high level of air pollution- find alternatives (physical activity is important for your health)
  • Choose easier outdoor activities (like walking instead of running) so you don’t breathe as deeply.
  • Stay at home when AQHI is poor, very poor or extremely poor
  • Spend time outside when and when AQHI is good
  • Wear masks (with proven efficiency)11 – look for public health advise

Effects

  • Get to know how sensitive you are to air pollution – consult your physician
  • Know the warning signs of asthma, heart attack and stroke- consult your health care provider
  • People with asthma may find they need to use their inhaler more often.
  • Keep your quick relief medicine on hand when you are active outdoors
  • Strengthen immune system
  • Have healthy food with a lot of fruit and vegetables
  • Consult your physician or NIPH for using supplements (Vit C, Vit E, A, B)
  • Visit your family doctor or health clinic if you feel unwell experiencing any adverse effects from air pollution.
Read More

Health Advisory for Health Professionals

Public health and health care professionals have a vital role in supporting communities, families, and individuals to take action against the health impacts of 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. 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).

Exposure

  • Patient education – lets patients know when it’s a good idea to switch up outdoor activities to reduce the amount of pollution exposure.

Effects

Improve your knowledge in order to give relevant medical advice to:

  • Explain what air pollutants/size particles, what the greatest health concern are and where and when they are a problem.
  • Identify how particle pollution exposure affects the cardiovascular and respiratory systems.
  • Identify how particle pollution exposure can affect the general population.
  • Recognize population (patients) at risk from AP (children, pregnant women, elderly, children and adult asthma, COPD, heart disease and stroke, diabetes).
  • Explain the purpose and use of the Air Quality Index for advising patients how to protect their health.
  • Discuss methods to reduce exposure during high particle pollution events.
  • Advise what they should do when the AQ limits are exceeded, how to react and stay calm.
  • Address typical patient questions and clinical scenarios relating to particle pollution exposure.
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NIPH work in AQ and health impact assessment in Kosovo

NIPH has a statutory task to advise the government and population regarding health prevention and protection from (among others) the harmful effects of environmental hazards.

Furthermore, NIPH has a role:

  • To advise the government on the public health and behavior change interventions to protect the air quality (AQ) and population health.
  • To advise the population on behavior change to prevent (reduce) air pollution (AP).
  • To advise the general public as well as vulnerable groups on the impact of airpollution on their health, when and how to avoid and at least minimize exposure.
  • To support health professionals in protecting patient health from AP’s harmful effects.

This process requires both understanding of air pollution phenomena and how these conditions interact with health and in particular with vulnerable people. Understanding this will enable them to send early warnings and explain them 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 the AP problem.

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Acronyms

  • AAP- Ambient Air Pollution
  • AP- Air Pollution
  • AQ- Air Quality
  • AQI- Air Quality Index
  • AQHI- Air Quality Health Index
  • AQP- Air Quality Portal
  • BC- Behavior Change
  • CAMS- Copernicus Atmosphere Monitoring Service (European air quality models)
  • CO- Carbon monoxide
  • CSOs- Civil Society Organizations
  • COPD- Chronic Obstructive Pulmonary Disease
  • EH- Environment and Health
  • EHE- Environment and Health Expert
  • GSI- Gender and Social Inclusion
  • HA- Health Advisories
  • HIA- Health Impact Assessment
  • IHD- Ischemic Heart Diseases
  • KHMI- Kosovo Hydro Meteorological Institute
  • MCC- Millennium Challenge Corporation
  • MESP- Kosovo Ministry of Environment and Spatial Planning
  • MFK- Millennium Foundation Kosovo
  • NGOs- Non-Governmental Organizations
  • O3- Ozone
  • NIPH- National Institute of Public Health
  • NO2- Nitrogen dioxide
  • O&BC- Outreach & Behavior Change
  • PM- Particulate Matter
  • SO2- Sulphur dioxide
  • VOCs- Volatile Organic Compounds
  • WHO- World Health Organization
  • WRF- Weather Research and Forecasting Model (meteorological prognostic model)

Good air quality is a requirement for preserving
the exquisite balance of life on earth for humans,
plants, animals and natural resources.

Good air quality is a requirement for preserving
the exquisite balance of life on earth for humans,
plants, animals and natural resources.

Look for
information!

Check daily air quality at
airqualitykosovo.rks-gov.net
or Download the free
smartphone app