i STATE OF GLOBAL AIR / 2018 The State of Global Air is a collaboration between the Institute for Health Metrics and Evaluations Global Burden of Disease Project and the Health Effects Institute. STATE OF GLOBAL AIR/2018 A SPECIAL REPORT ON GLOBAL EXPOSURE TO AIR POLLUTION AND ITS DISEASE BURDEN The State of Global Air is a collaboration between the Health Effects Institute and the Institute for Health Metrics and Evaluations Global Burden of Disease Project. Citation: Health Effects Institute. 2018. State of Global Air 2018. Special Report. Boston, MA:Health Effects Institute. What is the State of Global Air? The State of Global Air report brings into one place the most recent information available on levels and trends in air quality and health for countries around the globe. This year we focus not only on ambient (outdoor) air pollution but also, for the first time, on household air pollution from the burning of solid fuels for cooking and heating, a major contributor to pollution both inside and outside the home. Who is it for? The report is designed to introduce citizens, journalists, policy makers, and scientists to efforts to estimate and track human exposure to outdoor and household air pollution and their impacts on health as part of the comprehensive Global Burden of Disease project. How can I explore the data? This report has a companion interactive website, which provides the tools to explore, compare, and download data tables and graphics with the latest outdoor and household air pollution levels and associated burden of disease. These data are available for individual countries and geographic and economic regions, as well as for highlighting trends from 1990 to 2016. Where will I find information on: The Global Burden of Disease and State of Global Air projects page 1 Exposure to Ambient Air Pollution: Levels and Trends page 3 Exposure to Household Air Pollution from Burning of Solid Fuels: Levels and Trends page 6 Burden of Disease Attributable to Air Pollution page 9 The Key to Air Quality Progress: Understanding the Major Sources of Air Pollution page 16 Numbers, Numbers Everywhere page 19 1 STATE OF GLOBAL AIR / 2018 S tudies from across the world have documented the many ways in which air pollution can affect peoples health, in- cluding making it difficult to breathe for those with asth- ma or other respiratory diseases, sending the young and old to hospital or causing them to miss school or work, and contributing to early death from heart and lung dis- ease. New studies continue to broaden our understanding of the wide range of effects that air pollution can have on human health. This State of Global Air 2018 report presents the latest analysis of worldwide air pollution exposures and health impacts. It draws from the most recent evidence (produced in 2016) as part of the Global Burden of Disease (GBD) project of the Institute for Health Metrics and Evaluation (IHME) (published in 2017; see Additional Resources at the end of this report). As it did last year, the report offers a global update on outdoor, or ambient, air pollution. The most recent GBD analysis has continued to identify ambient air pollution as one of the most important risk factors contributing to death and disability (see “Defining Ambient Air Pollution” textbox). Ambient particulate matter (particulate matter less than or equal to 2.5 micrometers in aerodynamic diameter, or PM2.5), one compo- nent of air pollution, ranked as the 6th-highest risk factor for early death (see Figure 1). Worldwide exposure to PM2.5 contributed to 4.1 million deaths from heart disease and stroke, lung cancer, chronic lung disease, and respiratory infections in 2016. PM2.5 was responsible for a substan- tially larger number of attributable deaths than other more well-known risk factors (such as alcohol use, physical inactivity, or high sodium in- take) and for an equivalent number of attributable deaths as high cho- lesterol and high body mass index. Ozone, another important component of outdoor air pollution, whose levels are on the rise around the world, contributed to 234,000 deaths from chronic lung disease. However, the GBD initiative has also documented that millions of people around the world are exposed to air pollution in their homes arising from the use of solid fuels (e.g., coal, wood, and dung) for cooking and heating. The GBD 2016 analysis estimates that ex- posure to “household air pollution” also has a substantial impact on health and is ranked 8th in risk factors for early death, with 2.6 million attributable deaths in 2016. Both individually and collectively, ambient air pollution and household air pollution impose a substantial burden on public health. To offer a more comprehensive per- spective on air pollution, this years State of Global Air 2018 provides additional data on: Household air pollution global, regional, and country-level estimates of the proportion of populations exposed to household air p