EC Pulmonology and Respiratory Medicine

Ambient air pollution is the textbook negative externality: those who emit do not bear the full social cost of their emissions, and the resulting overproduction of pollutants imposes a quantifiable pulmonary burden on populations who had no part in creating it. This review synthesizes peer-reviewed evidence published primarily between 2015 and 2025 on three intersecting questions. First, how does economic theory frame air pollution as a market failure, and what does that failure cost in healthcare expenditure, lost productivity, and life expectancy? Second, what biological mechanisms translate unpriced fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) exposures into chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and accelerated lung function decline? Third, which policy instruments-Pigouvian taxes, cap-and-trade systems, command-and-control regulation, and engineered green infrastructure-have actually delivered measurable respiratory health improvements? Comparative case studies of Delhi, Beijing, and London anchor the analysis. Delhi exemplifies the unmitigated externality, with the institutional-death share attributable to respiratory disease approximately doubling over 18 years and never-smoker youth exhibiting 12 - 17% lower spirometry values than peers in clean-air regions. Beijing anchors China’s national clean-air programme, which cut nationwide PM2.5 by 48% and prevented 308,000 premature deaths in seven years. London’s six-decade arc-from the 12,000-death Great Smog of 1952 to the diminishing returns of the modern Ultra Low Emission Zone-shows both the persistence of intergenerational pulmonary damage and the inadequacy of single-instrument policy. The review concludes that pulmonologists treating COPD, asthma, and lung cancer in polluted megacities are managing the downstream clinical consequences of an unresolved upstream economic failure, and that durable respiratory health protection requires integrated economic-epidemiological policy frameworks rather than isolated regulatory interventions.

Keywords: Air Pollution; Market Failure; Externality; COPD; PM2.5; Delhi; Pigouvian Tax; Lung Function; Environmental Economics; Respiratory Health

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