Open Access Maced J Med Sci electronic publication ahead of print, published on February 06, 2019 as https://doi.org/10.3889/oamjms.2019.149 _______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 1 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2019.149 eISSN: 1857-9655 Public Health Losing Years of Human Life in Heavy Polluted Cities in Macedonia Mirjana Dimovska 1, 2* , Renata Mladenovska 3 1 Institute of Public Health of Republic of Macedonia, Skopje, Republic of Macedonia; 2 Faculty of Medicine, Ss “Cyril and Methodius” University of Skopje, Skopje, Republic of Macedonia; 3 Centre for Public Health-Skopje, Skopje, Republic of Macedonia Citation: Dimovska M, Mladenovska R. Losing Years of Human Life in Heavy Polluted Cities in Macedonia. Open Access Maced J Med Sci. https://doi.org/10.3889/oamjms.2019.149 Keywords: Environmental burden of disease; Particulate air pollution; Years of Life Lost; Health Gain *Correspondence: Mirjana Dimovska. Institute of Public Health of the Republic of Macedonia, Skopje, Republic of Macedonia; Faculty of Medicine, Ss “Cyril and Methodius” University of Skopje, Skopje, Republic of Macedonia. E- mail: mirjana.dimovska@medf.ukim.edu.mk Received: 28-Jan-2019; Revised: 03-Feb-2019; Accepted: 04-Feb-2019; Online first: 06-Feb-2019 Copyright: © 2019 Mirjana Dimovska, Renata Mladenovska. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: Part of this work was funded by EU Twinning programme Project MK 12 IB EN 01 (Further strengthening the capacities for effective implementation of the Acquis in the field of air quality) Competing Interests: The authors have declared that no competing interests exist Abstract INTRODUCTION: The urban air pollution will deteriorate globally, by 2050 outdoor particulate air pollution and ground-level ozone is projected to become the top cause of environmentally related deaths worldwide. AIM: To assess the burden of diseases due to particulate air pollution and health benefits form the pollution reduction policies. METHODS: Environmental burden of disease methodology has been applied. Environmental data for population exposure, total years of life lost from all causes, and relevant concentration-response functions have been used in estimation. RESULTS: The estimated disease burden from all causes (excl. external) is 30,256 YLL (19,436-40,625 95% CI) in Skopje Region, and 10,343 YLL (6,224-14,785 95% CI) in Tetovo. In terms of cardiopulmonary mortality, the estimated disease burden is 9,282/100,000 in Tetovo, in the Skopje Region 3,784/100,000 respectively. Annually in Tetovo 1,645 years of healthy life are lost, while in the Skopje Region 3,936 due to lung cancer premature mortality. The estimated health gain is significant, for the three selected health outcomes if EU limit values are reached, 41-42% of the estimated burden in Skopje Region will be eliminated, and 74-77% in Tetovo. CONCLUSION: the estimated impact of particulate air pollution on mortality is significant and not negligible. The same applies to the health and well-being of the population if the EU or WHO limit levels are reached. Introduction The Global Burden of Diseases Study (GBD; 2015) estimates that pollution-related disease was responsible for 9 million premature deaths in 2015, presenting 16% of total global mortality. Out of it, 4.2 million (3.7–4.8) premature deaths are attributable to ambient particulate air pollution, whereas 2.9 (2.2– 3.6) due to indoor air pollution [1]. According to the World Health Organization (WHO), in the European region of the WHO, the exposure of suspended particles is responsible for reducing every person's life expectancy by an average of almost a year, mainly due to the increased risk of cardiovascular, respiratory diseases and lung cancer [2]. Air pollution emphasizes the inequalities, disproportionately affecting mostly the poorest and vulnerable group's particularly children. Children are affected even at low-dose exposures to pollutants during the windows of vulnerability in utero and early infancy as well. Disease caused by pollution is most prevalent among minorities and the marginalised [3]. Air pollution often serves as an indicator of the economically sustainable development of a country because sources of air pollution are also the main