Health impacts of air pollution in Canada, 2021 report


A large body of scientific evidence has accumulated over the past 25 years attributing a wide range of adverse health effects to ambient (outdoor) air pollution exposure. These effects range in severity from respiratory symptoms to the development of disease and premature death. Significant advances in the health and atmospheric sciences over the last two decades have also made it possible to estimate the number of deaths and illnesses associated with air pollution. In Canada and internationally, health impact assessments identify air pollution as one of the largest risk factors for premature death and disability.

In this report, air pollution is defined as pollutants that scientific studies have associated with wide-ranging health effects and to which the population is ubiquitously exposed in the outdoor environment. These pollutants include fine particulate matter (PM2.5), ground-level ozone, and nitrogen dioxide (NO2). This is an update to previous health impacts of air pollution reports published by Health Canada. It relies on data and scientific knowledge, including ambient air pollution exposure estimates and demographic data from 2014 to 2017. The approach for quantitatively estimating the population health impacts of air pollution is well established by international health science organizations. In alignment with established approaches, Health Canada estimated 1) exposures to ambient air pollution across Canada, 2) the associated adverse health impacts in the population and 3) the corresponding economic costs of these health impacts. This analysis accounts for national demographics, including population counts, age profiles and baseline health status. Health impacts are presented nationally, as well as by province and territory (using 2016 population data).

This report considers Canadians’ exposure to above-background levels. Above-background levels correspond to the difference between ambient concentrations and background concentrations. Background concentrations are equivalent to minimum ambient air pollution levels, such as those present in remote areas uninfluenced by human activity. The above-background air pollution is comprised mostly of human-source (anthropogenic) emissions, but it also includes emissions from natural events such as forest fires. Exposure to air pollutants in indoor environments was not considered. The focus on above-background air pollution is relevant to air quality management in Canada because policies and regulations to improve air quality generally target anthropogenic emissions. The national average exposure to above-background air pollution estimates were 4.3 µg/m3 for PM2.5, 7.2 ppb for NO2, 13.2 ppb for annual ozone and 14.4 ppb for summer ozone. These averages are population-weighted to account for the geographic distribution of the Canadian population.

Health Canada estimates that above-background air pollution, including air pollution from human sources in North America, contributes to 15,300 premature deaths per year in Canada. Footnote 1 This includes an estimated 6,600 premature deaths in Ontario, 4,000 in Quebec, 1,900 in British Columbia and 1,400 in Alberta. National morbidity or nonfatal health outcomes include 2.7 million asthma symptom days and 35 million acute respiratory symptom days per year, with the total economic cost of all health impacts attributable to air pollution for the year being $120 billion (2016 CAD). This is equivalent to approximately 6% of Canada’s 2016 real gross domestic product.

The mortality estimates reported in this assessment are based on risk information from epidemiological studies deemed to be the most relevant to Canada. The mortality endpoints include all-cause mortality Footnote 2 associated with long-term exposure to ambient PM2.5, and short-term exposure to NO2 and annual ozone, as well as respiratory mortality associated with long-term exposure to warm-season ozone. All risk information contributing to Health Canada’s mortality estimates was derived from Canadian cohort and time-series studies, with the exception of chronic exposure respiratory mortality associated with ozone that was derived from an American cohort. In the context of this analysis, short-term exposure is related to effects that occur a few days after an elevation in ambient air pollution (i.e. acute health effects), while long-term exposure refers to exposures averaged over the years preceding the development of disease or death (i.e. chronic health effects).

In addition to the effects of changes in air pollution exposure over time, population growth also influences the overall health burden of air pollution, leading to a greater number of exposed individuals and resulting in an overall net increase in premature deaths attributable to air pollution. These variations in population can be standardized by presenting the death rates per 100,000 population. The current estimate of 15,300 premature deaths is equivalent to 42 premature deaths per 100,000 Canadians. Health Canada estimated, in 2017, 14,400 premature deaths per year, and, in 2019, 14,600 premature deaths per year, which were equivalent to 41–42 deaths per 100,000 Canadians. Footnote 3

In this analysis, the air pollution-associated premature death and nonfatal effect counts are based on exposure to ambient concentrations of PM2.5, NO2 and ozone exclusively. These pollutants are included because there is robust epidemiological evidence of their adverse health impacts as well as the ability to accurately estimate the spatial distribution of their ambient concentrations across Canada. However, owing to data limitations and knowledge gaps, not all health effects that have been associated with exposure to PM2.5, NO2 and ozone in the scientific literature can currently be quantified. Further, there are other air contaminants that contribute to air pollution health impacts, but they are beyond the scope of this work. The quantitative estimates of population health effects provided in this report are therefore assumed to underestimate the full impact of exposure to air pollution in Canada. Overall, this analysis indicates that despite the relatively low levels of air pollutants in Canada compared to other regions of the world, air pollution continues to impact population health.

The full report:


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