Most people say they would never go back to the days when restaurants, offices, and even airplanes were filled with cigarette smoke. Someday, we may be able to talk about air pollution in the same way – but governments will have to take a similar road to get there.

It’s now known that air pollution, largely created by the production and combustion of fossil fuels, finds its way into every part of the body, causing a wide range of deadly diseases. So why aren’t we seeing posters with gruesome photos and warnings that fossil fuels kill, every time we pull in to the petrol station? The fight against tobacco hasn’t been easy – and it’s far from over – but some significant, life-saving steps have been made. Thanks to policies by governments, as well as international conventions like WHO’s 2003 Framework Convention on Tobacco Control, warning messages, anti-tobacco campaigns, smoke-free zones, and additional taxes on tobacco products are now a part of everyday life. Why haven’t we achieved the same for air pollution?

A difficult road: taking on the fossil fuels industry

According to the World Health Organization, tobacco kills over 8 million people every year, with about 1.2 million of those deaths occurring in non-smokers who suffered the consequences of second-hand smoke. Air pollution, on the other hand, kills about 7 million people each year – and not one of them chose to breathe contaminated air.

We now know that toxic air pollution, largely caused by the burning of fossil fuels, seeps into every cell in the body. Women and children are the most affected, because of their increased exposure to household air pollution, which is responsible for 4 million deaths each year, mainly in Africa and Asia where fossil fuels are used for cooking in poorly ventilated areas. Polluted air even reaches unborn babies. Yet fossil fuel production and consumption is still not being treated as a public health issue.

In light of the damage that burning fossil fuels does to our health, ecosystems and climate, it may come as a shock to many to hear that our governments still heavily subsidise the industry. Globally, governments provide nearly USD $300 billion in pre-tax subsidies for fossil fuels. Yet fossil fuels impose more than USD $2.7 trillion in health costs. Of course, the industry will fight as if their lives depended on it – with little regard for ours – to retain such generous support.

We’ve seen how unhealthy commodity industries have responded to NCD activists who challenge them. The tobacco industry wrote the playbook on how to influence politicians to put companies’ interests above public health. Similar tactics have since been deployed by alcohol, junk food, soft drinks and polluter lobbies, including fossil fuels. We’ve seen the CEO of Shell just this week claim in the media that there is no alternative to investing in fossil fuels, because consumers demand it – arguments reminiscent of the tobacco industry decades ago. But modern consumers and voters have become more savvy and far less likely to accept the blame for the toll of killer products. On the contrary, we’re seeing an unprecedented wave of protests around the world, against air pollution, climate breakdown and extinctions, with a new generation taking the lead.

Stepping away from fossil fuels

The battle against air pollution and the fossil fuels industry is only beginning – but it is well underway. Recognition of the rapid health benefits of action will accelerate the transition. In 2018, the World Health Organization acknowledged air pollution as a major health risk factor, placing it alongside tobacco, harmful use of alcohol, unhealthy diets, and physical inactivity. There have also been a number of national and provincial initiatives that have achieved true successes.

Some of these are outlined in the NCD Alliance 2019 report Burning Problems, Inspiring Solutions, such as the fossil fuel subsidy reform in Indonesia, and the Ontario coal-phase out. Important lessons can also be taken from “first-movers” who have taken pioneering steps to end support for and use of fossil fuels, like France, which passed legislation in 2017 banning all oil and gas exploration and extraction by 2040. In early 2018, Ireland took its first steps towards a similar legislation.

New Zealand and Belize announced an end to new offshore exploration activities for oil and gas, and in May 2018, Costa Rica’s newly-elected President announced a plan to permanently ban fossil fuels and to make Costa Rica the first fully decarbonised country in the world.

These are just a few of the crucial actions taking place around the world that can inspire and guide others in the fight against air pollution from fossil fuels. Some key areas for actions have also been identified. These include:

• Naming and addressing fossil fuels as the root cause of air contamination and the resulting NCDs, just as was done with tobacco. This also involves raising awareness among the population of the negative health effects, both locally and globally, of the combustion of fossil fuels, beyond the environmental ones.

• Regulating and implementing government measures to curb the production and use of fossil fuels through the many instruments available, such as getting market prices right through subsidy reform, taxation measures, and the introduction of regulations banning the specific production and consumption of certain products.

• Defining adequate, fair and just transition plans away from unhealthy commodities, recognising the needs of those groups depending on oil, gas and coal, whether they be consumers or employees.

Easy wins against the fossil fuels industry – as with other unhealthy commodity industries – are unlikely. However, as with tobacco and sugary drinks, the evidence linking pollution from fossil fuels and rampant NCDs is undeniable. Progress may be slow, but with patience and perseverance, change will be achieved.