The NCD Integrated Support (NIS) unit works to ensure that environmental risk factors (listed below) are considered in all aspects of NCD services, especially at primary health care level, and that all national health actors are aware of them. For example, it is important to create training opportunities on environmental risk factors, such as air pollution and climate change. Air pollution is one of the main NCD risk factors, ranking just below high blood pressure and tobacco. Thus, ensuring air quality improvements would greatly improve the health of populations.

• Environmental risk factors for health cause about 23% of all global deaths. About two thirds of these are attributable to NCDs. These risk factors are defined as all the external physical, chemical, biological, and work-related factors that affect a person’s health.

• The environmental risk factors include pollution, radiation, noise, land use patterns, work environment, and climate change. Early life exposure to environmental risks such as chemicals, radiation, and air pollutants might increase NCD risk throughout the life course.

• Air pollution is the main environmental risk factor, and the fourth risk factor for health overall. Of the 7 million deaths caused by air pollution, almost all (85%) are due to NCDs; including ischemic heart disease, stroke, COPD, asthma and lung cancer.

• Climate change is another important environmental risk factor for health. Heat waves, other extreme weather events and forest fires, as well as food and water insecurity are among the climate change impacts which may trigger and exacerbate NCDs. People living with NCDs are especially vulnerable, and climate change increases the global burden of cardiovascular, respiratory, kidney diseases, and cancer.

• NCDs, air pollution and climate change are major health crises of this century, and they are strongly interlinked. They erode gains in health and development and quality of life, hitting poor and marginalized people the hardest.

• The enormous impact of environmental determinants on NCDs puts health systems in every country under further strain and imposes significant health costs, which need to be better understood. Without decisive action on these risk factors, SDG3 and specifically SDG3.4 and SDG3.8 will be unattainable. Action on environmental determinants should be integrated as a priority for health systems strengthening and resilience.