LIST OF ABBREVIATIONS  5

LIST OF FIGURES  7

LIST OF TABLES  7

EXECUTIVE SUMMARY  8

1. INTRODUCTION  12

1.1. Background of the study  12

1.2. Scope and objectives of the study  12

1.3. Analytical scope and limitations  13

2. PM2.5/PM10 AND HUMAN HEALTH  14

2.1. Health effects on mortality and chronic diseases  16

2.1.1. All-cause mortality  16

2.1.2. Respiratory health  19

2.1.3. Cardiovascular health  23

2.1.4. Neurological and mental health  27

2.1.5. Cancer  31

2.1.6. Metabolic, endocrine, and other chronic diseases  34

2.1.7. Other outcomes  37

2.1.8. Reproductive health  39

2.1.9. Pregnancy outcomes  41

2.1.10. Foetal outcomes  44

2.1.11. Child health and development  50

2.2. Impacts on vulnerable and high-risk populations  52

2.2.1. Health effects across the life course  52

2.2.2. People with pre-existing health conditions  56

2.2.3. Socially or economically disadvantaged groups  59

3. TRENDS ACROSS THE EU  60

3.1. Trends in PM2.5 and PM10 concentrations across Member States  61

3.1.1. Long-term trends across Member States (2013–2023)  61

3.1.2. Sources of PM2.5 and PM10  64

3.2. Disparities in health burden  66

3.2.1. Long-term trends in attributable deaths  67

3.2.2. Recent trends in burden of disease (2021–2023)  69

3.2.3. PM10 health impacts  71

3.3. Age-based and socioeconomic disparities  72

3.3.1. Age-specific health impacts across Member States  72

3.3.2. Socioeconomic inequalities across Member States  73

4. EU LEGAL AND POLICY FRAMEWORKS  76

4.1. Current EU legislation  76

4.1.1. Key instruments (direct effects)  77

4.1.2. Other instruments with indirect co-benefits  97

4.2. The ambition and effectiveness of the AAQD  105

4.2.1. Assessment of the ambition of the acquis  105

4.2.2. Assessment of the effectiveness of the acquis  113

5. CASE STUDIES  120

5.1. EU Member States  121

5.2. Summary table on alignment  130

5.3. Non-EU countries  131

5.3.1. United Kingdom  131

5.3.2. Norway  132

5.3.3. China  134

6. POLICY RECOMMENDATIONS  136

6.1.1. Strengthening the ambition and coherence of EU air quality standards  139

6.1.2. Closing the agricultural ammonia gap through cross-instrument policy coherence  140

6.1.3. Strengthening implementation and enforcement at Member State level  141

6.1.4. Closing sectoral policy gaps and addressing policy coherence failures  143

6.1.5. Improving health integration, evidence, and public communication  144

7. CONCLUSIONS  146