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Cleaner air would offer major health benefits in the Balkans


Brussels, 15 December 2014 – Three briefings released today highlight the heavy toll on health resulting from exposure to poor air quality in Bulgaria, Serbia, and Montenegro. (1) Energy production and use is of particular concern as a source of air pollution.

  • Air Pollution and Health in Bulgaria: Facts, Figures and Recommendations
    available in English - Bulgarian
  • Air Pollution and Health in Montenegro: Facts, Figures and Recommendations
    available in English - Montenegrin
  • Air Pollution and Health in Serbia: Facts, Figures and Recommendations
    available in English - Serbian

Highly polluted air in many Balkan countries causes particularly serious health effects in this region. Despite having a population of only seven million people, Bulgaria is ranked number one in terms of the annual premature deaths due to this cause in Europe. Bulgaria’s more than 11,000 premature deaths due to poor air quality can be compared with 4,000 deaths in Switzerland, a country with a similar sized population.

In second place, 10,000 deaths in Serbia and Montenegro are due to polluted air, with populations of seven million and 620,000 respectively. Romania ranks third, Poland ranks fourth and Hungary sixth. (2)

While the effects of poor air quality on respiratory and cardiovascular disease are well known, latest scientific findings compound the risks to children’s health. For example, evidence is growing that maternal exposure to air pollution is contributing to a greater risk of her baby being born with low birth weight or pre-term. Other studies point to the risk of maternal exposure leading to the development of chronic diseases in her child later in life, including obesity, diabetes and hormone-related cancers, such as of the breast, prostate and testes.

Poor air quality stems from many sources, such as industrial processes, transport, or agriculture; but air pollution from energy generation and use, including coal power plants is of particular concern in the Balkans. Figures from HEAL’s report “The Unpaid Health Bill, How coal power plants make us sick” show 18,200 premature deaths each year in Europe result from exposure to air pollution associated with coal-fired power plants. (3) Approximately 2,000 of these deaths occur in Bulgaria and another 2,000 in Serbia, a total of 22% taking place in these two countries alone. (4)

History has shown rapid improvements in public health following stronger regulation to improve air quality. For example, the ban on coal burning in Dublin, Ireland in the 1990s resulted in an 8% reduction in total mortality in the city as well as reductions of 13% in respiratory disease and 7% in cardiovascular disease.

During the past year, the national debate on energy decisions in Germany and Poland has included a discussion of the impact of poor air pollution on health and the harm from coal power generation in particular. (5) The new briefings recommend that medical professionals in Bulgaria, Serbia and Montenegro systematically consider environmental factors when diagnosing patients, check and inform on the air quality situation, and engage in policy developments on energy choices. (1)

“We would like to see doctors and other health professionals highlighting the costs to health of coal and encouraging national decision makers to take these costs into account in energy decisions,” says Vlatka Matkovic Puljic, HEAL’s Project Coordinator on Energy and Health, for South and Central Eastern European countries. “Choosing to build new coal power plants would be detrimental to efforts aimed at tackling chronic disease and protecting children’s health.”


Notes to Editors available in the Information release here


Anne Stauffer, Deputy Director, Health and Environment Alliance (HEAL), Email:, Mobile: +32 473 711092

Vlatka Matkovic Puljic, Project Coordinator on Energy and Health, for South and Central Eastern European countries, HEAL, Email:, Tel: +32 2 234 36 42, Mobile:+32 474 894935

Diana Smith, HEAL Communications and Media Adviser, HEAL, Email:, mobile: +33 6 33 04 2943

Last updated on 18 December 2014

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The Health and Environment Alliance (HEAL) is a leading European not-for-profit organisation addressing how the environment affects health in the European Union (EU). We demonstrate how policy changes can help protect health and enhance people’s quality of life. Read more »


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