Air pollution can harm anyone’s health, but some individuals are more vulnerable than others to its health-related adverse effects. A global air pollution vulnerability index compiled by Healthnews identifies countries with populations most susceptible to atmospheric pollutants. Researchers analyzed 175 countries, and the results show that four out of seven G7 countries are in the top 50 list, while the U.S. is the most vulnerable of all to air pollution.
A staggering 99% of the global population breathes air that exceeds the safety limits laid out in the World Health Organization’s guidelines, breathing in high levels of pollutants produced by motor vehicles, industrial facilities, and forest fires, among other sources.
Exposure to air pollutants has been associated with an increased risk of premature death, cancer, cardiovascular and respiratory diseases.
To identify countries with the highest health risks from air pollution, the Healthnews team created a global air pollution vulnerability index.
A global analysis of vulnerability to air pollution
The index is based on the analysis of the size of the population most vulnerable to air pollution, including children and older adults, in each country. Additionally, the researchers looked at the fertility rate, a metric providing some insights into the number of pregnant individuals within the population who could also be susceptible to air pollutants.
The prevalence of cardiovascular and chronic respiratory disease and the incidence of lung, trachea, and bronchus cancer in each country were also used as metrics because these underlying conditions generally increase an individual’s vulnerability.
Moreover, the analysis included each country’s ranking on the Human Development Index, which measures health, knowledge, and standard of living, as people of lower socio-economic status are more likely to experience health-related adverse effects of air pollution.
The graph below shows a complete composition of the air pollution vulnerability index.
The composite index value for each country ranges from 0 to 100, with higher scores suggesting that a country is more vulnerable to health risks caused by air pollution compared to countries with lower index scores.
Learn more about the index composition, research, and analysis methods in the Methodology section.
So, are you eager to learn which countries are the most vulnerable to air pollution? The world map below presents the global analysis of vulnerability to air pollution, highlighting each country's rank and index score.
Top 15 countries most vulnerable to air pollution
According to Healthnews research, the top 15 most vulnerable nations represent diverse world regions.
Eight countries among the top 15 are in Africa. Three Middle Eastern nations, as well as one in Central Asia, all torn by war or economic instability, also rank high in the index, sharing spots in the top 15.
However, living in advanced economies may not necessarily reduce vulnerability. Two European and one North American country that belong to the Group of Seven (G7) are among the 15 most vulnerable nations according to the analysis, with the Northern American country found as the most susceptible to health-related adverse effects of air pollution.
Seven countries in the top 15 list are among the lowest-ranked countries on the Human Development Index. Moreover, seven countries rank among the top 30 with the largest underage population.
Ten countries from the top 15 list rank in the top 20 for the prevalence of at least one underlying health condition or disease analyzed.
Based on Healthnews research, the list below includes 15 countries where populations are most vulnerable to health risks caused by air pollution.
#1 United States of America
More than 35 million Americans live with chronic respiratory diseases like asthma and chronic obstructive pulmonary disease. Over 610,000 people in the U.S. have lung and bronchus cancer, according to 2021 data. Smoking and occupational exposures, alongside air pollution, are the common causes of these conditions. However, despite considerable efforts to improve air quality in the country following the introduction of the Clean Air Act in 1970, one in three Americans still breathe polluted air.
- Air pollution susceptibility index score: 49.30
- Ranks 1st for chronic respiratory disease prevalence
- Ranks 16th for lung, trachea, and bronchus cancer incidence
- Ranks 36th for the size of the population of 65 years old and older
#2 Afghanistan
Afghanistan is a landlocked country located in South Central Asia, which is currently enduring a severe humanitarian crisis that emerged after the Taliban took power in 2021. With more than half (52%) of Afghans being underage and a high fertility rate of 4.52 births per woman, the very young country’s population is particularly susceptible to the risks posed by air pollutants.
- Air pollution susceptibility index score: 48.75
- Ranks 11th for the size of the population under the age of 18
- Ranks 15th for total fertility rate
- Ranks 164th in the Human Development Index
#3 France
France is one of the three G7 countries making it to the top 15 list, along with the U.S. (#1) and the UK (#14). The country has one of the oldest populations globally, with one in five (approx. 22%) French people over 65. France carries a relatively heavy burden of cardiovascular disease, which could be partly explained by widespread smoking (approx. 30% of the population) and sedentary lifestyle (approx. 89%).
- Air pollution susceptibility index score: 48.05
- Ranks 9th for the lung, trachea, and bronchus cancer incidence
- Ranks 10th for the size of the population of 65 years old and older
- Ranks 23rd for the cardiovascular disease prevalence
#4 Sudan
Sudan is an African country located at the southern edge of the Sahara. About one in ten (approx. 10%) of the Sudanese people have a cardiovascular disease, which could be attributed to high rates of hypertension (high blood pressure) and poor control of the condition. The armed conflict that broke out in 2023 further complicates providing care, as healthcare infrastructure and professionals have faced regular attacks, leaving 70–80% of health facilities in the largest cities barely functioning.
- Air pollution susceptibility index score: 47.03
- Ranks 9th for cardiovascular disease prevalence
- Ranks 17th for total fertility rate
- Ranks 152nd in the Human Development Index
#5 Yemen
Yemen is a Middle Eastern country bordering Saudi Arabia and Oman. Data from this war-torn country is scarce, although there is some evidence pointing to Yemeni people chewing khat leaves, a recreational stimulant drug, as one of the drivers of high cardiovascular disease rates. Nearly half (46%) of all health facilities in the country are only partially functioning or completely out of service as one of the largest humanitarian crises globally continues.
- Air pollution susceptibility index score: 47.01
- Ranks 15th for cardiovascular disease prevalence
- Ranks 24th for the size of the population under the age of 18
- Ranks 168th in the Human Development Index
#6 Sao Tome and Principe
Sao Tome and Principe is the second smallest and least populous African country, made up of two volcanic islands. Relatively high rates of cardiovascular disease in the country may be explained by lifestyle factors. More than half (approx. 52%) of the population is not engaged in vigorous physical activity, and approximately 39% has an increased blood pressure.
- Air pollution susceptibility index score: 46.79
- Ranks 18th for cardiovascular disease prevalence
- Ranks 33rd for the size of the population under the age of 18
- Ranks 124th in the Human Development Index
#7 Lebanon
Lebanon is located in the Levant region bordering the Mediterranean Sea. Cardiovascular disease is highly prevalent in the country, where half (approx. 55%) of the population smokes, and four in ten adult men and three in ten adult women have obesity. Lebanon’s economic collapse in 2019 caused an electricity crisis, which resulted in the increased use of diesel generators, potentially worsening air quality for those already vulnerable to air pollutants.
- Air pollution susceptibility index score: 45.50
- Ranks 8th for cardiovascular disease prevalence
- Ranks 47th for chronic respiratory disease prevalence
- Ranks 60th for lung, trachea, and bronchus cancer incidence
#8 Madagascar
Madagascar is an island country lying off the southeastern coast of Africa. More than 95% of households in the country use biomass fuel daily, and exposure to this fuel may increase the risk of developing respiratory diseases, especially in children. With nearly half (48%) of the population being underage, rampant chronic respiratory diseases make Madagascans vulnerable to air pollution.
- Air pollution susceptibility index score: 45.27
- Ranks 23rd for chronic respiratory disease prevalence
- Ranks 31st for the size of the population under the age of 18
- Ranks 160th in the Human Development Index
#9 Syrian Arab Republic
More than a decade of civil war and economic decay upended the lives of millions of Syrians and left the country’s healthcare system on the brink of collapse, with only about 50% of health facilities fully functioning. At the same time, Syria sees some of the highest rates of cardiovascular disease globally, mainly attributed to rising trends in risk factors, including smoking, obesity, and high blood pressure. High levels of trauma and stress may have a devastating impact on mental health, often leading to the adoption of harmful coping mechanisms like smoking.
- Air pollution susceptibility index score: 45.26
- Ranks 5th for cardiovascular disease prevalence
- Ranks 56th for the size of the population under the age of 18
- Ranks 140th in the Human Development Index
#10 Somalia
Somalia is the easternmost country on the continent and lies in the Horn of Africa. It is a predominantly young nation, with over 80% of the population being under the age of 35. The country’s population has nearly tripled in the past 50 years, partly due to the limited access to modern contraception, with only about 15% of women using birth control.
- Air pollution susceptibility index score: 43.99
- Ranks 3rd for total fertility rate
- Ranks 5th for the size of the population under the age of 18
- Ranks 175th in the Human Development Index
#11 Central African Republic
As its name suggests, the Central African Republic (CAR) is located in the center of Africa. It is among the world's poorest and most fragile countries, where more than half of the population is under the age of 18. Although the CAR's fertility rate is one of the highest globally, with 5.9 births per woman, the country also has the sixth-highest under-five mortality rate, with 116 deaths per 1,000 births.
- Air pollution susceptibility index score: 43.83
- Ranks 1st for the size of the population under the age of 18
- Ranks 5th for the total fertility rate
- Ranks 173rd in the Human Development Index
#12 Niger
Niger, a landlocked western African country, has the highest fertility rate of 6.7 births per woman. The rate is partly driven by child marriage, which has been misconstrued as a path to economic prosperity and a higher social status. As many as 28% of girls in Niger marry before the age of 15. Moreover, having multiple children is often seen as a way to secure inheritance and wealth, and, thus, gain autonomy and power within the community.
- Air pollution susceptibility index score: 43.62
- Ranks 1st for total fertility rate
- Ranks 2nd for the size of the population under the age of 18
- Ranks 172nd in the Human Development Index
#13 Mozambique
Mozambique, a Southeast African country bordering the Indian Ocean, ranks high in the air pollution susceptibility index due to having a predominantly young population — about 54% of Mozambicans are underage. One in five women in the country marry before the age of 15, and the rest have little freedom to make their reproductive decisions, resulting in a high fertility rate. For example, secretly obtaining a contraceptive could lead to domestic violence.
- Air pollution susceptibility index score: 43.43
- Ranks 8th for the size of the population under the age of 18
- Ranks 14th for total fertility rate
- Ranks 165th in the Human Development Index
#14 United Kingdom
The United Kingdom is a country in Western Europe and the sixth-largest economy in the world. Respiratory diseases are highly prevalent in the country and are the third biggest cause of death. Some of the risk factors for the conditions include smoking (approx. 12% of adults smoke), poor housing conditions, exposure to occupational hazards, and air pollution, which is considered to be the largest environmental risk to public health. In 2019, the country’s government laid out the Clean Air Strategy, which aims to reduce emissions from transport, farming, industry, and private homes.
- Air pollution susceptibility index score: 43.22
- Ranks 2nd for chronic respiratory disease prevalence
- Ranks 22nd for lung, trachea, and bronchus cancer incidence
- Ranks 29th for the size of the population of 65 years old and older
#15 Rwanda
Rwanda, a landlocked country in east-central Africa, carries a high burden of chronic respiratory disease, often caused by smoking. Studies suggest that exposure to passive smoking, biomass smoke, as well as smoke from wood and charcoal stoves may cause respiratory diseases in non-smokers. In 2017, 83% of households in the country relied on biomass fuel; however, its exposure may be minor since many Rwandans cook outdoors.
- Air pollution susceptibility index score: 43.00
- Ranks 10th for chronic respiratory disease prevalence
- Ranks 36th for the size of the population under the age of 18
- Ranks 145th in the Human Development Index
Vulnerability to air pollution: global trends
The top 50 countries most vulnerable to air pollution represent geographically diverse regions, with a strong emphasis on Africa. The chart below provides the continental distribution of countries in the top 50 list.
Please note that the analysis compares the number of nations in each continent rather than the area size of countries. If the land area covered was evaluated, North America, not Africa, would be the most vulnerable continent since the U.S. is the third-largest country in the world.
According to the analysis, four out of G7 countries — the U.S., France, the United Kingdom, and Canada — are in the top 50 countries list.
Many of the top 50 countries possibly share similar developmental and socio-economical issues. For instance, over half of the countries (28 (56%)) in the top 50 list have one of the world’s lowest values in the Human Development Index (from the bottom 50 list on the Index).
Four Southeast Asian nations dominate the list of the 15 countries least vulnerable to air pollution, with Singapore scoring 17.92 as the absolute leader globally. Three South American countries — Colombia, Ecuador, and Chile — are also among the most resistant.
The vulnerability of the population to air pollution does not necessarily correlate with the level of air pollution in that country. For example, Bangladesh, the world's most polluted country in 2023, ranks 150th on the susceptibility index. Meanwhile, some vulnerable countries like France and the U.K. are more socio-economically developed and may have stricter environmental policies.
Moreover, susceptibility to air pollution is not necessarily correlated with the death rate attributed to air pollution in the country. This is because air pollution-related deaths also depend on the country's development and economic level, as well as the healthcare system and its accessibility to a broad population.
Below is a summary of the complete data, offering insights into global trends and regional patterns based on Healthnews analysis.
Methodology
Healthnews conducted a global air pollution vulnerability analysis in the report, covering data from 175 countries.
At first, the Healthnews researchers examined which risk factors can make individuals more susceptible or vulnerable to the adverse health-related outcomes of relatively increased pollution levels.
The team analyzed the most recent medical information from scientific publications and leading global environmental and public health authorities, including the U.S. Environmental Protection Agency, the European Environment Agency, the UK Office for Health Improvement & Disparities, Environment and Climate Change Canada, and American Lung Association State of the Air.
Based on the conducted research, the team selected seven populations potentially most vulnerable to air pollution.
- The elderly. Older people are at a generally higher risk for adverse air pollution effects due to diminished lung function, weakened immune system, and a high probability of having underlying health conditions or diseases.
- Children. Children are typically more susceptible to health-related adverse effects from air pollution and are more likely to be exposed to air pollutants than adults.
- People with underlying health conditions, like cardiovascular diseases, chronic respiratory diseases, and lung, trachea, and bronchus cancer. Air pollution generally puts people with these diseases and health conditions at more significant health risks than those without.
- Pregnant individuals. Research suggests that exposure to air pollution during pregnancy may be associated with premature birth, low birth weight, and stillbirth.
- People of low socio-economic status. Lower socio-economic status is typically associated with underlying health problems, poor nutrition, higher stress, and other factors that may be linked to the increase of an individual's vulnerability to air pollution. Additionally, people from these communities tend to be exposed to higher levels of air pollution due to living near major pollution sources or jobs requiring outdoor labor.
It is important to note that belonging to any population mentioned above has no prognostic potential for any specific person. Please also be informed that other factors, such as diabetes, smoking history, outdoor activity level, genetic predisposition, or others, may also affect vulnerability to air pollution.
The Healthnews team selected specific metrics based on their nature and global data availability from reputable sources to create the index by representing the most vulnerable populations identified. The team collected the most recent data available for each metric for all countries analyzed. The table below summarizes all the metrics selected for the index and other related information.
During the data analysis, the team first evaluated the data quality and relevant statistical parameters, including standard data distribution measurements and outlier identification. Subsequently, the min–max normalization method standardized all the metric data to 0–100 ranges, and the correlation values were examined afterward.
After the steps outlined above were completed, the team prepared datasets for the final analysis. Based on the research results, correlation analysis, and the current team’s knowledge of the topic, weights were assigned to each metric, and composite index scores for each country were calculated.
Please note that each country's composite index score ranges from 0 to 100, and a higher index score suggests that a country is more vulnerable to air pollution than a lower index score.
40 resources
- United States Environmental Protection Agency. Research on health effects from air pollution.
- European Environment Agency. Air pollution.
- Office for Health Improvement & Disparities. Air pollution: applying all our health.
- Government of Canada. Health impacts from air pollution.
- American Lung Association. Health impact of air pollution.
- United Nations. World Population Prospects 2024.
- Our World in Data. Prevalence rate of cardiovascular diseases.
- Frontiers in Medicine. Global, regional, and national burden of chronic respiratory diseases and associated risk factors, 1990–2019: results from the Global Burden of Disease Study 2019.
- World Bank Group. Fertility rate, total (births per woman).
- United Nations Human Development Programme (Human Development Report 2023-24). Human Development Data.
- World Health Organization (International Agency for Research on Cancer). Incidence, both sexes, in 2022.
- American Lung Association. Working to defeat lung cancer.
- National Cancer Institute. Cancer stat facts: lung and bronchus cancer.
- WHO. Chronic respiratory diseases.
- American Lung Association. 1 in 3 people breathe unhealthy air: new report finds.
- International Rescue Committee. Millions of Afghans endure.
- European Society of Cardiology. EAPC country of the month - France.
- Cardiovascular Journal of Africa. The state of heart disease in Sudan.
- WHO. Sudan surpasses 100 attacks on healthcare since 2023 armed conflict began.
- Heart Views. Khat chewing and cardiovascular disease.
- WHO. Yemen health emergency.
- Lifestyle and Epidemiology. Lifestyle and cardiovascular risk factors: urban population versus rural population in Sub-Saharan Africa.
- Tobacco Use Insights. Smoking habits and nicotine dependence among the general Lebanese population before and during both the economic crisis and COVID-19 pandemic.
- Global Nutrition Report. Lebanon.
- Washington Institute. The devastating impact of Lebanon’s environmental failures.
- Respiratory Medicine and Research. Impact of biomass fuel smoke on respiratory health of children under 15 years old in Madagascar.
- UNICEF. Syrian crisis.
- Relief International. Out of sight: obstacles in accessing breast cancer treatment in Syria.
- BMC Public Health. Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006.
- United Nations Development Programme. Somalia’s human development story: a new chapter begins.
- United Nations Population Fund. So many mouths to feed: addressing high fertility in famine-stricken Somalia.
- World Bank Group. The World Bank in Central African Republic.
- World Bank Blogs. Can Niger escape the demographic trap?
- Girls Not Brides. Niger.
- United Nations Population Fund. Causes and consequences of population growth in Mozambique.
- NHS. Respiratory disease.
- Office for National Statistics. Adult smoking habits in the UK: 2023.
- Office for Health Improvement & Disparities. Air pollution: applying All Our Health.
- Respiratory Medicine. Prevalence of atopy, asthma and COPD in an urban and a rural area of an African country.
- Modern Energy Cooking Services. Rwanda e-cooking market assessment.
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