Air Pollution in Macedonia: The Growing Health and Economic Threat


Air pollution is a global phenomenon that has reached concerning levels, especially in low and middle-income economies, in the past decade. There are numerous reasons behind the raising levels of air pollution, a lot of them not well understood. Some of the most frequently cited reasons are the burning of biomass (i.e. wood, coal and oil) for domestic heating mainly by poor households, dust from soil, industry (steel, electricity, and cement production) and traffic (WHO, 2018).

Air Pollution in Macedonia

Air pollution in Macedonia exceeds all safety levels, with the capital city of Skopje being ranked as the third most polluted city in Europe in terms of particulate matter air pollution (PM2.5) by the World Health Organization (WHO) in 2016 (WHO, 2018). The most recent data gathered over a span of several years shows that Skopje’s annual mean for 2018 was 40 µg/m3), which is four times higher than the annual WHO guideline (10 µg/m3), and 60 per cent greater than the official Macedonian target and European guideline  (25 µg/m3), with winter being the worst period. 

Particulate Matter Air Pollution and its Effect on Health

Air pollution is caused by several factors that comes in different forms such as carbon monoxide, ozone, sulfur dioxide, and nitrogen dioxide pollution, but Particulate Matter (PM) pollution is the most damaging for human health and has the worst record for exceeding guidelines in North Macedonia.

PM are microscopic liquid or solid particles suspended in the air and are measured at two main levels: less than 10 micrometers (PM10) and less than 2.5 micrometers (PM2.5). PM2.5 is particularly dangerous because of its size. It is smaller than most bacteria and can penetrate the lungs and bloodstream causing and worsening a range of chronic diseases such as ischemic heart disease, stroke, lung cancer, lower respiratory infections, chronic respiratory diseases, diabetes and dementia.

PM air pollution is responsible for the deaths of around 7 million people globally each year, which is more people than AIDS, malaria, and tuberculosis combined (Landrigan et al.,2018). In Macedonia, PM air pollution was the eighth largest mortality risk factor in 2018, and was linked to 7.3 per cent of deaths (The Institute for Health Metrics and Evaluation, 2016). When its severity is weighted by the level of exposure faced by the whole population, PM air pollution is ranked higher than smoking in terms of risk to the general population. In terms of life expectancy, PM air pollution decreases life expectancy in Macedonia by 0.81 years.

Air Pollution and its Effect on the Economy

PM air pollution is not only a major health hazard, but also poses a serious threat to the global and local economic growth and financial gain. Air pollution has a serious impact on economic growth through increasing medical expenditure, decrease in work productivity and rise in premature death toll (Landrigan et al., 2018).

Increase in medical spending is an issue, and it is especially concerning in countries with a rapidly aging population and a rising mortality rate. Air pollution presents an extra health cost, which further adds to the country’s expenditure, increasing the total cost to almost 3.5 per cent of the total country’s GDP, which for Macedonia in 2018 totaled to around 397 million USD (Landrigan et al., 2018).

Air pollution also affects job performance and workplace productivity that inevitably results in missed days at work, inability to adhere to deadlines, impaired job results as well as lost GDP. The World Bank estimates that the productivity impact of air pollution for a country like Macedonia is around 0.13 per cent of GDP, approximately 4.7 million USD for Macedonia.

Air pollution also leads to premature death toll that directly affects businesses by significantly reducing the labor hours put into the job. This reduction in labor hours results in reduction in total profits, which contributes to a decrease in the total GDP of the country.

Call to Action

PM air pollution poses a threat both to people’s health as well as the economy’s growth, imposing an enormous cost on Macedonia. To resolve this major health crisis, bold and prompt action is necessary. Some of the immediate steps that need to be taken are avoiding dirty fuels and technologies in transport and energy production, stopping uncontrolled burning of solid waste and agricultural waste, reducing the use of fertilizers in agriculture, improving the heating options for families, switch from fossil fuels to clean fuels and clean technologies, as well as green, clean cities.

This topic will be the focus of this year’s Macedonia2025 Summit, which will serve as an opportunity to discuss this major concern and gain beneficial insights from environmental experts, policy makers, innovative business leaders, activists, and businesses that lead with a good example. The abovementioned stakeholders will share their expertise in their respective fields, thus addressing the health risks of air pollution.




Landrigan, Philip J, Richard Fuller, Nereus J R Acosta, Olusoji Adeyi, Robert Arnold, Niladri (Nil) Basu, Abdoulaye Bibi Baldé, et al. “The Lancet Commission on Pollution and Health.” The Lancet 391, no. 10119 (February 2018): 462–512.

The Institute for Health Metrics and Evaluation. “Global Health Data: Global Burden of Disease (GBD) Compare Tool,” 2016. The Institute for Health Metrics and Evaluation.

WHO. “WHO Global Ambient Air Quality Database (Update 2018),” 2018.