Background:
Reducing the mortality burden associated with urban air pollution constitutes a public health priority, and evidence of unequal exposure and susceptibility across population subgroups is growing. Many European countries have implemented low emission zones (LEZs) in densely populated city centers. Although LEZs decrease air pollution exposure and health impacts, evidence is lacking on their impact across neighborhoods and socio-economic groups.
Objectives:
The aim of this study was to evaluate the most equitable approach to implementing the second phase of the LEZ in Paris, France. We also present a literature review of the studies evaluating the benefits associated with LEZs in Europe.
Methods:
A health impact assessment (HIA) was conducted to quantify changes in air pollution exposure and expected health benefits by socioeconomic group and neighborhood related to four hypothetical scenarios for the second phase of the LEZ based on French Deprivation Index scores. The study focused on NO2 and PM2.5 as air pollutants and evaluated the impact of the LEZ on the inequitable burden of childhood asthma and all-cause premature adult mortality. We also conducted an economic evaluation associated with the LEZ benefits on prevented deaths and asthma cases.
Results:
The scenario with the largest LEZ perimeter and the most stringent vehicle standards prevented the highest number of cases and produced the most equitable distribution of health benefits, especially childhood asthma. It is expected that 810 deaths and 3200 cases of asthma could be prevented from the LEZ extension in this scenario. These results were distributed heterogeneously across three socioeconomic (SES) groups, most noticeably with asthma cases as 230, 180, and 210 cases were avoided per 100,000 inhabitants in high, medium, and low SES groups, respectively. We found substantial economic benefits associated with LEZ, with estimates ranging from €0.76 billion to €2.36 billion for prevented deaths. The benefits associated with asthma reduction ranged from €2.3 million to €8.3 million.
Discussion:
Conducting HIAs with a focus on equity will further inform policy makers of the impact of LEZ models on air pollution, health, and environmental justice. Developing these systematic methods and applying them to future LEZs and other air pollution policies will increase their effectiveness to reduce the burden of ambient air pollution on society and the environment.

We propose a structural econometric model that incorporates altruism towards other household members into the willingness to pay for a public good. The model distinguishes preferences for public good improvements for oneself from preferences for improvements for other household members. We test for three different types of altruism - ‘pure self-interest’, ‘pure altruism’ and ‘public-good-focused non-pure altruism’. Using French contingent valuation data regarding air quality improvements, we find positive and significant degrees of concern for children under the age of 18, which are explained by determinants related to health and subjective air quality assessment. All other forms of pure or air-quality-focused altruism within the family are insignificant, including for children over 18, siblings, spouses, and parents. This result suggests that benefit estimates that do not consider altruism could undervalue improvements in air quality in France.

In September 2021, the World Health Organization decided to implement stronger air quality guidelines for protecting health, based on the last decade of research. Ambient air pollution (AAP) was already the first environmental risk to health in terms of number of premature deaths, and this decision suggests that the risk was seriously underestimated. This chapter covers the relationship between AAP and health from an economic perspective. The first part presents the major regulated air pollutants and their related health effects, the way population exposure is measured, and the individual vulnerability and susceptibility to AAP-related effects. Then, the main approaches that estimate the relationships between health effects and air pollutants are covered: pure observational and interventional/quasi-experimental studies. Up-to-date reviews of the most robust relationships, and of the main findings of interventional/causal inference methods, are detailed. Next, impact assessments studies are tackled and some recent global assessments of health impacts due to AAP are presented. Once calculated, the health impacts can be expressed in monetary terms to enter the decision-making process. The relevant approaches for valuing market and nonmarket health impacts – market prices, revealed and stated preferences – are critically outlined, and their adequation with the AAP context examined. Finally, the economic health-related impacts of AAP are presented and discussed, with specific sections devoted to the necessity of an interdisciplinary approach and inequity-related issues at national and international levels. This chapter concludes with a widening of the perspective that tackles interactions between AAP on the one hand and climate change and indoor pollution on the other hand.

Les analyses coûts-bénéfices constituent un moyen pour le décideur public comme privé de rationaliser ses choix. Le processus semble transparent et le traitement des préférences égalitaire, puisque les préférences de chaque individu sont prises en compte de façon similaire lors de l’agrégation. Toutefois, en présence de composantes non marchandes évaluées sur la base des préférences de la population, les individus sont limités dans l’expression de leurs préférences, à la fois par leur revenu et par leur besoin de subsistance. Nous étudions les conséquences de ces contraintes sur la révélation des préférences et sur l’évaluation monétaire des biens non marchands. Nous trouvons qu’elles amènent à favoriser implicitement les préférences des individus à revenu élevé. Se pose alors la question de la correction des évaluations monétaires lors du traitement des préférences individuelles.