Health Impacts of Air Pollution Reduction Scenarios in Rome: A Comparative Assessment

Abstract Rome is facing challenges driven by climate change and the complex demands of mitigation planning. Among these, long- term exposure to air pollution stands out as a major threat to public health. This study, carried out within the national PNC CLIMA project, evaluates health co-benefits of different city air quality policy scenarios, estimating how different policy choices may provide different health co-benefits in terms of reduction of air pollution related deaths. Baseline PM2.5 and NO2 concentrations for 2019 were obtained using a spatiotemporal model, while mortality and population data were sourced from the Open Salute Lazio platform and from each of the 23,455 census tracts of Rome, respectively. Two counterfactual scenarios of PM2.5 and NO2 concentrations were analyzed: (I) reduction to EU limit values, and (II) reduction to Regional Air Quality Plan. Health impacts were estimated as the number of deaths attributable to concentrations exceeding the 2021 WHO Air Quality Guidelines (5 µg/m³ for PM2.5, 10 µg/m³ for NO2), using relative risks of 1.12 (1.06–1.18) and 1.04 (1.03–1.06) per 10 µg/m3 increments in PM2.5 and NO2, respectively, as exposure-response functions. In the baseline scenario, 2,348 (95% CI: 1,249-3,345) deaths were attributed to PM2.5 and 1,803 (95% CI: 1,374-2,620) to NO2, accounting for 10.2% and 7.9% of total mortality, respectively. Considering scenario I, deaths decreased to 1,262 (95% CI: 658-1,820) for PM2.5 (- 46.3%) and 862 (95% CI: 653-1,269) for NO2 (- 52.2%). Scenario II would yield even larger benefits, with only 900 (95% CI: 468-1,302) deaths from PM2.5 and 712 (95% CI: 540-1,045) from NO2 - representing reductions of 61.7% and 60.5%, compared to the baseline. Lowering air pollution concentrations in Rome to the WHO Guideline concentrations could prevent over 1,400 PM2.5-related deaths annually. These findings underscore the importance of aligning climate mitigation policies with public health goals to maximise health co-benefits. Key messages • Reducing PM2.5 and NO2 to EU standards could cut pollution-related deaths in Rome by over 45%. • Aligning climate mitigation policies with public health goals is key to maximising co-benefits.