Veronica Southerland and colleagues1 reported that between the years 2000 and 2019, most of the world's urban population lived in areas with unhealthy concentrations of fine particulate matter (PM2·5). The global average urban PM2·5 concentration in 2019 was 35 μg/m3, which is seven times the 5 μg/m3 limit set by WHO in its 2021 guidelines, resulting in more than 1·8 million deaths in 2019. Among the world's regions, the Western Pacific, where our country Philippines is located, is experiencing the highest levels of PM2·5-attributable mortality, exceeding the global urban average. Indeed, the Philippines is not exempt from the enormous health burden of air pollution.

Based on available studies, the current PM2·5 concentrations in urban areas in the Philippines exceed the WHO guideline value. During the dry season, PM2·5 concentration reaches 58·4 μg/m3 in traffic sites in the megacity of Metro Manila. Air pollution continues to negatively impact the health of Filipinos. For instance, traffic enforcers in Metro Manila, who are constantly exposed to high PM2·5 concentrations, are 1·24 times more likely to have chronic obstructive pulmonary disease.

The current COVID-19 pandemic also compounded the problem of air pollution in urban cities in the Philippines. A study of Asian countries, including the Philippines, showed a higher COVID-19 mortality risk for those populations consistently exposed to poorer air quality than those living in settings with clean air. Moreover, the negative impact of air pollution also takes a massive toll on the country's economy. A 2021 report estimated that air pollution costs the Philippines approximately US$87 billion annually due to health-care and welfare costs and labour and economic productivity loss.

Even after three decades since the passage of the country's Clean Air Act, the Philippines is still nowhere near achieving comprehensive air pollution control. An urgent priority is to raise the country's PM2·5 limits to WHO standards, which will send a strong signal to industry to urgently tackle the sources of air pollution, for instance by shifting to renewable energy and designing low-carbon transport modalities. These measures will be good not only for population health but also for planetary health. The sources of ambient air pollutants are also the major emitters of greenhouse gases that continue to exacerbate climate change, which will further endanger people's health in the Philippines, one of the world's most climate-vulnerable countries, for decades to come.

This article was published in The Lancet Planetary Health.