2024 State of the Air report: 39% of Americans breathe polluted, unhealthy air daily

Key takeaways:

• From 2020 to 2022, many Americans lived in areas with poor short-term and/or year-round particle pollution levels.
• The American Lung Association is calling for stronger ozone pollution limits.

Implementing the recent stronger standard for fine particulate pollution revealed that 131 million Americans breathe unhealthy, polluted air where they live, according to a press release from the American Lung Association.

“The U.S. Environmental Protection Agency (EPA) has recently finalized a lot of the new air pollution rules that we called for them to do last year,” Katherine Pruitt, BA, senior director of nationwide clean air policy at the American Lung Association, told Healio. “There are a lot of new things coming to clean up particle pollution and address climate change. Now our ask is that the EPA finish the job.”

This message from the American Lung Association comes with its yearly State of the Air report that presents data on air pollution levels across the U.S., with this year’s containing information from 2020 to 2022.

Notably, the 2024 edition marks the 25th anniversary of the report and covers air quality during the COVID-19 pandemic.

Pruitt told Healio the American Lung Association was not expecting to see a dramatic change in air quality due to the pandemic, and this line of thinking proved to be true based on findings from the report.

“We can't point to any significant improvement in air quality during that time,” she said.

Compared with last year’s report, Pruitt said the number of people living with unhealthy air went up by 11 million.

“Although we’ve done a lot as a nation to clean up sources of air pollution, we still find that 131 million people, or 39% of the population, are living with unhealthy air,” she said.

However, this major elevation is partially due to the change the EPA made to the National Ambient Air Quality Standard for fine particulate pollution in February 2024 from 12 µg/m³ to 9 µg/m³.

Particle, ozone pollution

When taking a closer look at the three types of air pollution included in this report, Pruitt specifically noted that short-term particle pollution is only getting worse with passing years.

According to the release, this year’s number of people living in counties with unhealthy spikes in particle pollution was the highest seen in 14 years at 65 million people.

Further, out of all the State of the Air reports, this year’s had the most days when particle pollution levels were deemed “very unhealthy” and “hazardous.”

The report found that areas with the most short-term particle pollution included Bakersfield, Fresno-Madera-Hanford and Visalia in California; Fairbanks, Alaska; and Eugene-Springfield, Oregon. Four of these places made last year’s worst five list.

In terms of year-round particle pollution, Pruitt pointed out that consideration of the new EPA standard revealed a significant number of people who live in areas with harmful pollution.

After applying this new standard, Pruitt and colleagues found that 90.7 million people resided in counties that received a failing grade for air quality, which is greater than last year’s number of people living in failing areas by 71.9 million.

“The previous standard was doing a disservice to the breathers of the United States,” Pruitt said. “Last year, only 17 counties in six western states got failing marks. This year, 119 counties in 28 states — much more distributed around the country — are now being recognized as having annual particle pollution that’s unhealthy to breathe.”

Similar to last year’s report, people of color had a higher likelihood of residence in these areas compared with white individuals.

Bakersfield again ranked first on the most polluted cities list, followed by Visalia and Fresno-Madera-Hanford in California, Eugene-Springfield in Oregon and San Jose-San Francisco-Oakland in California. Last year’s worst five list included three of these cities.

“The level of annual particle pollution got a little bit worse this year compared to last year, but not very much,” Pruitt told Healio. “It really is that the new standard is allowing us to more accurately convey the risk to people’s health from the air they’ve probably been breathing for years and didn’t know was unhealthy.”

According to the release, the number of people exposed to unhealthy ozone pollution went down by 2.4 million people. Pruitt, however, noted that ozone pollution still impacts more than 100 million people.

The top five cities with the most ozone pollution from this year’s report were the same as last year’s: Los Angeles-Long Beach, Visalia, Bakersfield and Fresno-Madera-Hanford in California and Phoenix-Mesa in Arizona.

Pruitt told Healio a combination of factors determines a city’s pollution levels, including emission sources, weather, climate and topography.

“Places like California’s Inland Valley or Salt Lake City that are in a basin surrounded by mountains hold air in an area, which makes a difference,” she said.

Even though California has a lot of cities with the most pollution, Pruitt said the state works hard to clean up the air.

“California is really trying to do what they can within the context of the Clean Air Act to reduce their emissions sources, but they've just got a lot of factors stacked against them,” she said.

The cleanest places to live are also highlighted in the State of the Air report, and this year, five cities received this honor by having no high ozone or particle pollution days, as well as the lowest year-round particle pollution levels, according to the release:

• Bangor, Maine
• Johnson City-Kingsport-Bristol, Tennessee-Virginia
• Lincoln-Beatrice, Nebraska
• Urban Honolulu, Hawaii
• Wilmington, North Carolina

“These cities continue to monitor their air; they have both ozone and PM monitors, which many other clean communities do not,” Pruitt said. “In our opinion, that is a benefit to the citizenry that live there because they have information about the quality of the air they’re breathing.”

Looking ahead to next year’s report, the American Lung Association plans to incorporate the EPA’s change to the Air Quality Index announced in February 2024.

“The changes that were made to the Air Quality Index will lower the range of concentrations of short-term particle pollution that get designated as purple (very unhealthy) or maroon (hazardous),” Pruitt said. “That means that more days presumably will fall into those categories, and again, provide a more accurate health message to people living in those areas.”

Who’s at risk, precautions to take

The State of the Air report also highlights individuals who are more susceptible to air pollution and have greater health risks linked to air pollution.

According to the report, these individuals include people of color, people living in low-income areas, people who have a history of smoking, children, older adults, pregnant women and the unborn, and those with health conditions including asthma, COPD, diabetes, heart disease and lung cancer.

People who work outside, people without a house and people who live in low-income areas also face a heightened likelihood of experiencing the negative impacts of air pollution due to increased exposure, Pruitt told Healio.

When asked how these vulnerable individuals can take precautions against pollution, Pruitt said they should always look at their local air quality levels and keep track of what levels affect them since this varies from person to person.

During these times, it is important that individuals modify their activity patterns to reduce exposure.

“Depending on the pollution, that might mean being more active in the morning, spending more time indoors and reducing the strenuousness with which you exercise if you are exercising outdoors so that your heart and breathing rates aren’t as elevated and you’re not taking in as much bad air,” Pruitt said.

Those with a chronic condition such as asthma or COPD should also plan to discuss medication adjustments on days with poor air quality with their health care provider, Pruitt added.

Taking action

When asked how individuals can lower the pollution they produce, Pruitt emphasized the importance of lower and zero-emission choices for transportation and energy. These choices will help reduce the amount of fossil fuel emissions that result in ozone and particle pollution.

“If you’re able to go with zero-emission appliances or zero-emission vehicles, this is an opportune time to do that,” she said.

Individuals who want to speak up for cleaner air can also join the American Lung Association’s Lung Action Network.

In addition to changes made by individuals, changes are also needed at each level of government. For more information on action to take at each level, please visit https://www.lung.org/research/sota.

As a final note, Pruitt said the American Lung Association acknowledges and thanks the EPA for finalizing the air pollution rules it called for last year. However, the fight for clean air does not stop here.

“The Lung Association is urging EPA to set long overdue stronger national limits on ozone pollution similar to what they did for particle pollution this year,” she said. “Stronger ozone pollution limits would help people protect themselves and drive cleanup of polluting sources and communities around the country.”

Additionally, states play a major role in putting the EPA’s finalizations in motion.

“The states really need to take this seriously and move quickly to implement the finalized rules,” Pruitt said. “They should be protected and funded by Congress.”

References:

• 2024 ‘State of the Air’ report reveals most ‘hazardous’ air quality days in 25 years. https://www.lung.org/media/press-releases/sota-2024. Published April 24, 2024. Accessed April 24, 2024.
• State of the Air 2024 report. https://www.lung.org/getmedia/dabac59e-963b-4e9b-bf0f-73615b07bfd8/State-of-the-Air-2024.pdf. Published April 24, 2024. Accessed April 24, 2024.