Air pollution and heart disease are undermining Africa’s future

Dr Mark Miller is the chair of the World Heart Federation Air Pollution and Climate Change Expert Group, and Professor Mariachiara Di Cesare is director of the Institute of Public Health and Wellbeing at University of Essex, and member of the World Heart Federation Science Committee.

Each year, air pollution is linked to more than eight million early deaths globally, making it the most critical environmental risk factor for human health.

Yet, despite its proven links with cardiovascular disease (CVD) - the world’s biggest killer - there remains a concerning lack of reliable air quality monitoring in many parts of the world.

Recent research across Africa continues to expose a perfect storm of limited air quality monitoring infrastructure, rising rates of pollution and increasing cases of heart disease.

How can we stop this from tipping over into a serious public health crisis?

Pollution and public health

Air pollution contributes to a range of cardiovascular issues, including heart disease, hypertension, stroke and heart failure.

While its effects are widespread, certain regions are disproportionately affected, particularly those with limited healthcare infrastructure and without the means to mitigate air quality issues.

In Africa, rates of cardiovascular disease are rising rapidly. In 2021 alone, sub-Saharan countries collectively recorded more than a million CVD-related deaths, while by 2030, CVD is expected to overtake infectious diseases as the leading cause of death in the region.

More than half of CVD-related deaths in Africa today occur early: between the ages of 30 and 70 years.

These statistics call for a serious review of air quality. With the support of the World Heart Federation (WHF) and the Clean Air Fund, we assessed existing research to capture the impact of air pollution and CVD in Africa.

Surprisingly, there were only six studies using hospital data to look at the links between air pollution and cardiovascular disease.

Most of these were confined to South Africa, where the sources of air pollution and the types of health conditions may not be representative of less affluent African countries. Despite limited data, the links between several air pollutants and cardiovascular deaths and disease were clear.

Africa’s data challenge

Accurate air pollution data is crucial to understanding its impact. The WHF’s 2024 World Heart Report assessed estimates of air pollution in Africa, finding 60% of countries in Africa show an increase in pollution levels of fine particles in the air.

Ground monitoring stations are needed to provide a better understanding of air pollution. Yet only 24 of 54 countries in Africa are currently set up to measure air quality in some capacity – and even then, this does not cover all key air pollutants known to cause ill-health.

The World Heart Report highlights the need for legislative change and enforcement. The report found that only 30% of countries in Africa are currently legally required to monitor air quality, and only 18% must inform their populations accordingly.

Calls for investment

Between 2018 and 2022, only 1% of all international development funding targeted outdoor air pollution projects.

Yet our research findings were unequivocal that investment, both domestic and international, must be directed towards these initiatives to make a difference.

Better monitoring of air quality in different regions of Africa must be implemented as comprehensively as possible, offering a more detailed characterisation of the sources of air pollution in each area.

In addition, more study is required on exposure to air pollutants in different African settings, and the impact this has on cardiovascular disease. This includes both urban and rural environments. It also means measuring out-of-hospital events to aid our understanding of both long-term and short-term interactions between air pollution and cardiovascular health.

Finally, communities need the capacity to evaluate their mitigation strategies for reducing air pollution emissions and exposure. This will allow them to improve these figures and produce more tailored guidelines for public health.

The United Nations’ agenda for sustainable development aims to reduce premature deaths from non-communicable diseases, like cardiovascular disease, by 33% by 2030. 

But this target is only achievable if regions such as Africa improve air quality. And to do this, we need investments in data, health infrastructure, and the capacity to mitigate pollution. Without action, the health of millions will continue to be at risk.