Air pollution is claiming 26,000 lives prematurely every year in South Africa, making it one of the country’s deadliest yet least visible public health threats. This stark reality was highlighted last week Friday when the department of health commemorated World Environmental Health Day at Birchwood Hotel and Conference Centre in Ekurhuleni.
Health minister Dr Aaron Motsoaledi described air pollution as a “silent killer” that drives severe health problems and premature deaths without being immediately visible.
“According to the South African Medical Research Council, the most vulnerable are children and the elderly. Poor air quality is now one of the leading environmental health risks. The tiny particles we breathe daily don’t just irritate our lungs, they are silent drivers of non-communicable diseases, heart disease, stroke, chronic respiratory conditions and even cancers,” Motsoaledi said.
He warned that clean air was not merely an environmental issue but a human rights imperative.
Globally, the World Health Organization (WHO) estimates that 7-million people die prematurely every year due to air pollution. Africa accounts for 1.1-millions of those deaths. Studies show South Africa has the fourth-highest number of deaths linked to particulate matter pollution on the continent, with nearly 100% of the population breathing air that exceeds WHO guideline levels.
Dr Kevin Makadzange, programme management officer for WHO South Africa, added that children are disproportionately affected.
“Exposure to polluted air impairs lung development and impacts health from the earliest stages of life,” he said.
He said unsafe water, poor sanitation, hazardous chemicals and climate change compound the risks, especially for communities already battling poverty and weak health systems.
Regulations under pressure
South Africa’s air pollution is governed by the National Environmental Management: Air Quality Act of 2004, which sets emission standards and requires municipalities to draw up air quality management plans.
Key regulatory tools include atmospheric emission licences, pollution prevention plans and controlled fuels regulations. The department of forestry, fisheries and the environment monitors compliance, alongside provinces and municipalities. But enforcement remains inconsistent, particularly in pollution hotspots such as Mpumalanga’s Highveld, where coal-fired power stations dominate.
“Health in All Policies, supported by WHO, is essential to ensure health is integrated into energy, transport, housing, mining, agriculture and finance decisions. Our choices in these areas directly impact whether people live healthy, dignified and productive lives,” Makadzange said.
Without enough skilled staff on the ground, and the right resources in place, our efforts to prevent disease will always fall short
— Health minister Dr Aaron Motsoaledi
Motsoaledi admitted that budget shortfalls are hampering efforts to combat pollution. South Africa has only 4,000 environmental health practitioners, with no replacements for the 100 who retired in 2019.
“Without enough skilled staff on the ground, and the right resources in place, our efforts to prevent disease will always fall short,” he said.
Xolani Pakati, deputy president of the South African Local Government Association (Salga), agreed that practitioners play a critical role but lack support.
“The resources are not always sufficient. It is important that the department of health and other stakeholders work with Salga to review a sustainable budget,” he said.
Motsoaledi said the shortage is not just a staffing issue but a public health crisis with direct consequences for food safety, workplace conditions and community well-being. He reminded delegates of past outbreaks, including listeriosis in 2017 and last year’s foodborne illness that disproportionately affected children.
To address this, he announced the creation of a ministerial advisory committee on foodborne illnesses to strengthen surveillance, improve risk communication and advance public education.
Looking ahead
The WHO urged South Africa to adopt five priorities over the next two years:
- Adopt stronger air quality standards aligned to WHO guidelines, focusing on hotspots
- Accelerate a just energy transition through clean energy, sustainable transport and safe household cooking
- Strengthen monitoring systems by integrating air, water and waste data with health outcomes
- Invest in climate-resilient health facilities with clean power, safe water and proper waste management
- Protect children from toxic exposures by enforcing lead paint standards and tackling legacy pollution
“Clean air, safe water, climate resilience and toxic-free environments are not luxuries,” Makadzange said. “They form the core of human health, fairness and dignity.”
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