Report on the Public Health Implications of Air Pollution in the Context of Sustainable Development Goals

Introduction: Air Quality as a Cornerstone of Sustainable Development

Air quality is a critical determinant of public health and a foundational element for achieving the United Nations Sustainable Development Goals (SDGs). An extensive body of research indicates a significant negative correlation between exposure to ambient air pollutants and human health, directly impeding progress on SDG 3 (Good Health and Well-being). The widespread nature of this issue, particularly in urban and industrializing nations, also presents substantial challenges to SDG 11 (Sustainable Cities and Communities) and SDG 13 (Climate Action). This report synthesizes findings from numerous studies to outline the severe impacts of air pollution on human health, with a specific focus on reproductive, cardiovascular, and respiratory systems, framing these challenges within the SDG agenda.

Impact on Good Health and Well-being (SDG 3)

The imperative of SDG 3 is to ensure healthy lives and promote well-being for all at all ages. Air pollution emerges as a primary environmental threat that undermines multiple targets within this goal, from reproductive health to the prevention of non-communicable diseases.

Threats to Reproductive Health and Male Fertility

A growing volume of evidence links exposure to common air pollutants with diminished male reproductive health, a critical aspect of well-being and population sustainability.

• Particulate Matter (PM2.5 and PM10): Numerous studies have established an association between exposure to particulate matter air pollution and a decline in semen quality. Research highlights negative impacts on sperm motility, morphology, and concentration, which are crucial for fertility. This directly affects the well-being of individuals and families, a core component of SDG 3.
• Ozone (O3) and Gaseous Pollutants: Exposure to ground-level ozone and other gaseous pollutants like sulfur dioxide has also been shown to alter semen quality. These findings suggest that a wide range of pollutants prevalent in modern environments can impair spermatogenesis and overall reproductive function.
• Implications for SDG 3.7: These environmental impacts on fertility create barriers to achieving SDG Target 3.7, which calls for universal access to sexual and reproductive health-care services. Environmental health protection must be integrated into public health strategies to safeguard reproductive capabilities.

Increased Incidence of Non-Communicable Diseases and Mortality

Air pollution is a major risk factor for a range of non-communicable diseases (NCDs), directly challenging the objective of SDG Target 3.4 to reduce premature mortality from NCDs.

1. Cardiovascular Disease: Research confirms that environmental factors, including air pollution, are significant contributors to cardiovascular disease.
2. Respiratory Conditions: Exposure to PM2.5 and ozone is strongly linked to increased daily mortality and hospital admissions for respiratory issues, including pediatric asthma, particularly in industrializing nations.
3. Other Chronic Conditions: Studies have also identified associations between air pollution and the incidence of hypertension and diabetes, further contributing to the global burden of NCDs.

Challenges to Sustainable Cities and Climate Action (SDG 11 & SDG 13)

The sources and impacts of air pollution are intrinsically linked to urban development and climate change, making it a cross-cutting issue that affects multiple SDGs.

Urban Air Quality and Sustainable Communities (SDG 11)

SDG 11 aims to make cities and human settlements inclusive, safe, resilient, and sustainable. However, high concentrations of ambient air pollutants in urban centers directly contradict this goal.

• Environmental Impact of Cities: The health consequences documented—from reduced fertility to increased mortality—underscore the failure to meet SDG Target 11.6, which focuses on reducing the adverse per capita environmental impact of cities, including by paying special attention to air quality.
• Health Inequities: The burden of air pollution is often disproportionately borne by vulnerable populations within cities, exacerbating health inequities and undermining the goal of inclusive communities.

Intersections with Climate Action (SDG 13)

The pollutants harming human health often share common sources with greenhouse gas emissions, such as the combustion of fossil fuels. Therefore, addressing air quality is an integral part of climate mitigation strategies under SDG 13.

• Co-benefits of Action: Policies aimed at reducing air pollution by transitioning to cleaner energy and transport systems simultaneously advance public health objectives (SDG 3) and climate goals (SDG 13).
• Global Guidelines: Adherence to the World Health Organization (WHO) Global Air Quality Guidelines is a critical step for governments to protect citizens and contribute to a more sustainable, low-carbon future.

Supporting Research and Evidence Base

1. Zhao Y, Zhu Q, Lin J, Cai J. Association of exposure to particulate matter air pollution with semen quality among men in China. JAMA Netw Open. 2022;5(2):e2148684.
2. Cosselman KE, Navas-Acien A, Kaufman JD. Environmental factors in cardiovascular disease. Nat Rev Cardiol. 2015;12(11):627–42.
3. Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA. Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax. 2014;69(7):660–5.
4. Jassal MS. Pediatric asthma and ambient pollutant levels in industrializing nations. Int Health. 2015;7(1):7–15.
5. Turner MC, Jerrett M, Pope CA 3, Krewski D, Gapstur SM, Diver WR, Beckerman BS, Marshall JD, Su J, Crouse DL, et al. Long-term ozone exposure and mortality in a large prospective study. Am J Respir Crit Care Med. 2016;193(10):1134–42.
6. Moolgavkar SH, McClellan RO, Dewanji A, Turim J, Luebeck EG, Edwards M. Time-series analyses of air pollution and mortality in the United States: a subsampling approach. Environ Health Perspect. 2013;121(1):73–8.
7. Lin S, Liu X, Le LH, Hwang SA. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008;116(12):1725–30.
8. Coogan PF, White LF, Jerrett M, Brook RD, Su JG, Seto E, Burnett R, Palmer JR, Rosenberg L. Air pollution and incidence of hypertension and diabetes mellitus in black women living in Los Angeles. Circulation. 2012;125(6):767–72.
9. Sokol RZ, Kraft P, Fowler IM, Mamet R, Kim E, Berhane KT. Exposure to environmental ozone alters semen quality. Environ Health Perspect. 2006;114(3):360–5.
10. World Health O. WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organization; 2021.
11. Legare C, Droit A, Fournier F, Bourassa S, Force A, Cloutier F, Tremblay R, Sullivan R. Investigation of male infertility using quantitative comparative proteomics. J Proteome Res. 2014;13(12):5403–14.
12. Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res. 2019.
13. Li WN, Jia MM, Peng YQ, Ding R, Fan LQ, Liu G. Semen quality pattern and age threshold: a retrospective cross-sectional study of 71,623 infertile men in China, between 2011 and 2017. Reprod Biol Endocrinol. 2019;17(1):107.
14. Chen GX, Li HY, Lin YH, Huang ZQ, Huang PY, Da LC, Shi H, Yang L, Feng YB, Zheng BH. The effect of age and abstinence time on semen quality: a retrospective study. Asian J Androl. 2022;24(1):73–7.
15. La Maestra S, De Flora S, Micale RT. Does second-hand smoke affect semen quality? Arch Toxicol. 2014;88(6):1187–8.
16. Wang N, Gu H, Gao Y, Li X, Yu G, Lv F, Shi C, Wang S, Song M, Zhang S. Study on influencing factors of semen quality in fertile men. Front Physiol. 2022;13:813591.
17. Henry TD, Porucznik CA, Honda TJ, VanDerslice JA, Blackburn BE, Cox KJ, Carrell DT. Differential impacts of particulate air pollution exposure on early and late stages of spermatogenesis. Ecotoxicol Environ Saf. 2021;220: 112419.
18. Sun Y, Chen C, Liu GG, Wang M, Shi C, Yu G, Lv F, Wang N, Zhang S. The association between iodine intake and semen quality among fertile men in China. BMC Public Health. 2020;20(1):461.
19. Tian XJ, Wang XC, Ye B, Li CL, Zhang Y, Ma L. The effects of exposure to ozone on sperm quality in Wuhan. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51(3):197–202.
20. Wu L, Jin L, Shi T, Zhang B, Zhou Y, Zhou T, Bao W, Xiang H, Zuo Y, Li G, et al. Association between ambient particulate matter exposure and semen quality in Wuhan, China. Environ Int. 2017;98:219–28.
21. Liu Y, Zhou Y, Ma J, Bao W, Li J, Zhou T, Cui X, Peng Z, Zhang H, Feng M, et al. Inverse association between ambient sulfur dioxide exposure and semen quality in Wuhan, China. Environ Sci Technol. 2017;51(21):12806–14.
22. Lao XQ, Zhang Z, Lau AKH, Chan T-C, Chuang YC, Chan J, Lin C, Guo C, Jiang WK, Tam T, et al. Exposure to ambient fine particulate matter and semen quality in Taiwan. Occup Environ Med. 2018;75(2):148–54.
23. Huang X, Zhang B, Wu L, Zhou Y, Li Y, Mao X, Chen Y, Wang J, Luo P, Ma J, et al. Association of exposure to ambient fine particulate matter constituents with semen quality among men attending a fertility center in China. Environ Sci Technol. 2019;53(10):5957–65.
24. Zhou N, Jiang C, Chen Q, Yang H, Wang X, Zou P, Sun L, Liu J, Li L, Li L, et al. Exposures to atmospheric PM10 and PM10-2.5 affect male semen quality: results of MARHCS study. Environ Sci Technol. 2018;52(3):1571–81.
25. Guan Q, Chen S, Wang B, Dou X, Lu Y, Liang J, Ni R, Yang C, Wang H, Baktash MB, et al. Effects of particulate matter exposure on semen quality: a retrospective cohort study. Ecotoxicol Environ Saf. 2020;193: 110319.
26. Cheng Y, Tang Q, Lu Y, Li M, Zhou Y, Wu P, Li J, Pan F, Han X, Chen M, et al. Semen quality and sperm DNA methylation in relation to long-term exposure to air pollution in fertile men: a cross-sectional study. Environ Pollut. 2022;300: 118994.
27. Cheng Y, Zhu J, Tang Q, Wang J, Feng J, Zhou Y, Li J, Pan F, Han X, Lu C, et al. Exposure to particulate matter may affect semen quality via trace metals: evidence from a retrospective cohort study on fertile males. Chemosphere. 2024;346:140582.
28. Zhang HT, Zhang Z, Cao J, Tang WH, Zhang HL, Hong K, Lin HC, Wu H, Chen Q, Jiang H. Ambient ozone pollution is associated with decreased semen quality: longitudinal analysis of 8945 semen samples from 2015 to 2018 and during pollution-control period in Beijing, China. Asian J Androl. 2019;21(5):501–7.
29. Cheng Y, Feng J, Wang J, Zhou Y, Bai S, Tang Q, Li J, Pan F, Xu Q, Lu C, et al. Alterations in sperm DNA methylation may as a mediator of paternal air pollution exposure and offspring birth outcomes: insight from a birth cohort study. Environ Res. 2024;244: 117941.
30. Sun S, Zhao J, Cao W, Lu W, Zheng T, Zeng Q. Identifying critical exposure windows for ambient air pollution and semen quality in Chinese men. Environ Res. 2020;189: 109894.
31. Huang G, Zhang Q, Wu H, Wang Q, Chen Y, Guo P, Zhao Q. Sperm quality and ambient air pollution exposure: a retrospective, cohort study in a Southern Province of China. Environ Res. 2020;188: 109756.
32. Wu W, Chen Y, Cheng Y, Tang Q, Pan F, Tang N, Sun Z, Wang X, London SJ, Xia Y. Association between ambient particulate matter exposure and semen quality in fertile men. Environ Health. 2022;21(1):16.
33. Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, et al. Explaining the Black-White disparity in preterm birth: a consensus statement from a multi-disciplinary scientific work group convened by the March of Dimes. Front Reprod Health. 2021;3:684207.
34. Santi D, Vezzani S, Granata AR, Roli L, De Santis MC, Ongaro C, Donati F, Baraldi E, Trenti T, Setti M, et al. Sperm quality and environment: a retrospective, cohort study in a Northern Province of Italy. Environ Res. 2016;150:144–53.
35. Wang X, Tian X, Ye B, Zhang Y, Li C, Liao J, Zou Y, Zhang S, Zhu Y, Yang J, et al. Gaseous pollutant exposure affects semen quality in central China: a cross-sectional study. Andrology. 2019;8(1):117–24.
36. Hansen C, Luben TJ, Sacks JD, Olshan A, Jeffay S, Strader L, Perreault SD. The effect of ambient air pollution on sperm quality. Environ Health Perspect. 2010;118(2):203–9.
37. Zhou L, Li L, Hao G, Li B, Yang S, Wang N, Liang J, Sun H, Ma S, Yan L, et al. Sperm MtDNA copy number, telomere length, and seminal spermatogenic cells in relation to ambient air pollution: results of a cross-sectional study in Jing-Jin-Ji region of China. J Hazard Mater. 2021.
38. Ma Y, Zhang J, Cai G, Xia Q, Xu S, Hu C, Cao Y, Pan F. Inverse association between ambient particulate matter and semen quality in central China: evidence from a prospective cohort study of 15,112 participants. Sci Total Environ. 2022;833: 155252.
39. Lopalco P, Vitale R, Cho YS, Totaro P, Corcelli A, Lobasso S. Alteration of cholesterol sulfate/seminolipid ratio in semen lipid profile of men with oligoasthenozoospermia. Front Physiol. 2019;10:1344.
40. Wang YC, Lin YK. Mortality and emergency room visits associated with ambient particulate matter constituents in metropolitan Taipei. Sci Total Environ. 2016;569–570:1427–34.
41. Wang L, Luo D, Liu X, Zhu J, Wang F, Li B, Li L. Effects of PM(2.5) exposure on reproductive system and its mechanisms. Chemosphere. 2021;264(Pt 1):128436.
42. Cao XN, Yan C, Liu DY, Peng JP, Chen JJ, Zhou Y, Long CL, He DW, Lin T, Shen LJ, et al. Fine particulate matter leads to reproductive impairment in male rats by overexpressing phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway. Toxicol Lett. 2015;237(3):181–90.
43. Jiang L, Lin X, Jiang J, Qiu C, Zheng S, Zhao N, Shu Z, Qian Y, Qiu L. METTL3-m6A-SIRT1 axis affects autophagic flux contributing to PM2.5-induced inhibition of testosterone production in Leydig cells. Sci Total Environ. 2024;918: 170701.
44. Damiao Gouveia AC, Skovman A, Jensen A, Koponen IK, Loft S, Roursgaard M, Moller P. Telomere shortening and aortic plaque progression in apoliprotein E knockout mice after pulmonary exposure to candle light combustion particles. Mutagenesis. 2018;33(3):253–61.
45. Qiu L, Chen M, Wang X, Qin X, Chen S, Qian Y, Liu Z, Cao Q, Ying Z. Exposure to concentrated ambient PM2.5 compromises spermatogenesis in a mouse model: role of suppression of Hypothalamus-Pituitary-Gonads axis. Toxicol Sci. 2018;162(1):318–26.
46. Zhou L, Su X, Li B, Chu C, Sun H, Zhang N, Han B, Li C, Zou B, Niu Y, et al. PM2.5 exposure impairs sperm quality through testicular damage dependent on NALP3 inflammasome and miR-183/96/182 cluster targeting FOXO1 in mouse. Ecotoxicol Environ Saf. 2019;169:551–63.
47. Radwan M, Jurewicz J, Polanska K, Sobala W, Radwan P, Bochenek M, Hanke W. Exposure to ambient air pollution–does it affect semen quality and the level of reproductive hormones? Ann Hum Biol. 2016;43(1):50–6.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s references extensively discuss the adverse health effects of air pollution. This includes increased mortality, cardiovascular disease, asthma, hypertension, diabetes, and significant impacts on reproductive health, particularly male infertility and semen quality. These topics are central to ensuring healthy lives and promoting well-being for all at all ages.
• SDG 11: Sustainable Cities and Communities: The references consistently focus on “ambient air pollution,” “particulate matter (PM2.5, PM10),” and “ozone,” which are major environmental challenges in urban and industrial areas. The issue of air quality is a critical component of making cities and human settlements inclusive, safe, resilient, and sustainable.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Explanation: Several references link environmental factors and air pollution to non-communicable diseases. For instance, Reference 2 discusses “Environmental factors in cardiovascular disease,” and Reference 8 connects air pollution to the “incidence of hypertension and diabetes mellitus.” These studies highlight the role of pollution in diseases that cause premature mortality.
2. Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
   • Explanation: A significant portion of the article’s references (e.g., 1, 9, 17, 19, 20, 21, 22, and many others) are dedicated to the association between air pollution and negative impacts on “semen quality,” “sperm quality,” and “male infertility.” This directly relates to reproductive health and the ability of individuals to have children.
3. Target 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.
   • Explanation: This target is directly addressed. References 3, 5, and 6 explicitly study the link between air pollutants like PM2.5 and ozone with “daily mortality.” Furthermore, references on “hospital admissions” for asthma (Reference 7) and other health issues caused by pollution demonstrate the connection to reducing illnesses.

SDG 11: Sustainable Cities and Communities

1. Target 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management.
   • Explanation: The entire premise of the referenced studies revolves around the health impacts of poor “air quality.” Reference 10, which cites the “WHO global air quality guidelines,” explicitly names key urban pollutants like “particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide.” Addressing these pollutants is fundamental to reducing the adverse environmental impact of cities.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3 Targets

• Mortality and Morbidity Rates (Target 3.9): The articles imply the use of mortality and morbidity rates as key indicators.
  • References 3, 5, and 40 mention tracking “mortality” and “hospital admissions” or “emergency room visits” associated with air pollutants. This aligns with Indicator 3.9.1 (Mortality rate attributed to household and ambient air pollution).
• Reproductive Health Metrics (Target 3.7): While official SDG indicators are specific, the articles strongly imply the use of clinical reproductive health metrics.
  • The repeated analysis of “semen quality” and “sperm quality” in numerous studies (e.g., 1, 9, 13, 16, 28, 35) serves as a direct, measurable indicator of male reproductive health, which is a component of this target.

Indicators for SDG 11 Target

• Air Pollutant Concentration Levels (Target 11.6): The articles are based on measuring the concentration of specific air pollutants.
  • Reference 10 explicitly lists the pollutants covered by WHO guidelines: “particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide.” These are the exact metrics used for Indicator 11.6.2 (Annual mean levels of fine particulate matter (e.g. PM2.5) in cities).

4. Summary Table of SDGs, Targets, and Indicators

Source: bmcpublichealth.biomedcentral.com