Environmental Research 100 (2006) 431–440 The avoidable health effects of air pollution in three Latin American cities: Santiago, Sa˜o Paulo, and Mexico City Michelle L. Bell a,Ã , Devra L. Davis b , Nelson Gouveia c , Vı´ctor H. Borja-Aburto d , Luis A. Cifuentes e a Yale University, New Haven, CT 06511, USA b University of Pittsburgh, Pittsburgh, PA 15260, USA c University of Sa˜o Paulo, Sa˜o Paulo, Brazil d Mexican Institute of Social Security, Mexico DF, Mexico e Pontificia University of Chile, Santiago, Chile Received 22 February 2005; received in revised form 31 July 2005; accepted 4 August 2005 Available online 19 September 2005 Abstract Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and Sa˜o Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration–response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children’s medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly $21 to $165 billion (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration–response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies. r 2005 Elsevier Inc. All rights reserved. Keywords: Air pollution; Fossil fuel; Mortality; Particulate matter; Ozone 1. Introduction Developing regions often face critical air pollution problems due to the rapid growth of transportation and industry sources and the large number of people exposed. Three of the world’s four largest cities can be found in the rapidly developing world, where many are plagued by severe air pollution (Davis and Saldiva, 1999; Molina and Molina, 2004). Further, some populations in these areas often lack adequate access to basic health care and sound nutrition and are especially vulnerable to environmental contamination. Current levels of air pollutants have been associated with health events from mortality to chronic respiratory and cardiac problems and low birth weight (Holgate et al., 1999). Over 100 million people in Latin America and the Caribbean live in areas with air pollution concentrations above the health-based World Health Organization (WHO) guidelines (WHO, 2000). Latin America is increasingly urbanized and faces related air quality problems, such as those associated with growth in transportation networks. About three quarters of ARTICLE IN PRESS www.elsevier.com/locate/envres 0013-9351/$ - see front matter r 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.envres.2005.08.002 Ã Corresponding author. Fax: +1 203 432 3817. E-mail address: michelle.bell@yale.edu (M.L. Bell).