Sadly, air pollution has become a major cause of death in Europe.

The European Environment Agency (EEA) estimated that at least 239,000 deaths in the EU were caused by exposure to air pollution above the World Health Organisation (WHO) recommended concentrations.

Air pollution is linked to problems including lung cancer, heart and respiratory diseases, stroke and poor birth outcomes. It is particularly dangerous for older people, causing about 4% of all deaths among adults 65 and above.

While all EU countries report nitrogen dioxide levels – which also contribute to issues like smog and acid rain – are above WHO-recommended levels, some are hit harder by air pollution than others, including one tiny landlocked country in the southeast of Europe.

Serbia follows behind in second place, along with Albania, Bulgaria, and Montenegro.

According to Unicef, in February 2024, Skopje, North Macedonia’s capital, was once again among the world’s top 10 most polluted cities. It also revealed that one in nine (11.6%) infant deaths in the country were linked to air pollution.

Residents in the capital also revealed to The Guardian in 2023 that the air “feels and tastes like burnt plastic” and were wearing masks “for air pollution before Covid”.

“The biggest divide in Europe we see is east and west [and this] aligns very much with GDP and socioeconomic backgrounds of the two regions,” Zorana Jovanovic Andersen, an environmental epidemiology professor at the University of Copenhagen and member of the European Respiratory Society’s environment and health committee, told Euronews Health.

In December, stricter air quality rules were enacted to bring the EU closer to WHO standards by 2030 and oblige member states to monitor pollutants like fine particulate matter (PM2.5), black carbon, and ammonia.

The plan is “one of the biggest public health interventions for a generation,” said Mark Nieuwenhuijsen, director of the Barcelona Institute for Global Health’s urban planning, environment, and health initiative, for Euronews Health.

Overall, exposure to PM2.5 caused about 239,000 premature deaths in Europe in 2021, while another 48,000 people died as a result of nitrogen dioxide exposure, according to the EEA.

The updated EU directive also gives citizens with pollution-related health problems the right to sue their government if it does not comply with EU air quality rules.

Some countries have already taken steps to curb their pollution levels. Denmark, for example, could become the first country in the world to impose a carbon tax on livestock farming in 2030.