Air Pollution Monitoring and Its Health Impact in Belarus

Abstract

The chapter contains information on the state of air pollution in the Republic of Belarus and Minsk, including emissions and concentrations of pollutants. Organization of air quality monitoring system overviews monitoring network and monitoring posts, list of controlled substances, frequency, and organization of sampling. The chapter contains applied methods for evaluating the results of laboratory monitoring of atmospheric air pollution, and complex indicators are used to assess the degree of atmospheric pollution. The main results of studies of the impact of atmospheric air pollution in the Republic of Belarus on the state of public health conducted during the last 20 years will be discussed.

1. Introduction

Atmospheric air is a significant component of the human environment and has a multi-vector impact on human health, which can be realized both directly by inhaling atmospheric air and due to the migration of harmful substances from the atmosphere into soil, water, and accumulation in food. At the individual level, the time a person spends outdoors largely determines the degree of influence of atmospheric air on health. However, at the population level, despite the professional and age affiliation, the state of the atmospheric air is in second place after socioeconomic factors in the structure of economic losses in the gross domestic product of developed countries from mortality and morbidity of the population associated with the negative impact of environmental factors [1].

According to the World Health Organization, air pollution is the most important environmental risk factor for public health in the European Region [2]. An increase in the degree of atmospheric air pollution (ceteris paribus) is manifested by an increase in the incidence of acute respiratory infections in the population by 6–7% due to nonspecific influence [3].

At the same time, large contingents of the population of cities are exposed to atmospheric pollution, where the degree of atmospheric air pollution is characterized by a multicomponent and dynamic composition. The amount of chemicals in the atmospheric air of populated areas reaches several tens, sometimes hundreds [3, 4, 5, 6].

Assessment of atmospheric air quality in settlements and its impact on the health of the population are widely used to make urban planning decisions with the active growth of settlements, the construction and reconstruction of industrial enterprises, and the expansion of residential development through the use of the territory adjacent to enterprises and other facilities.

2. Methods

2.1 Analytical laboratory control

Methods of analytical laboratory control are used in the study of the degree of air pollution in the Republic of Belarus on the basis of data obtained from the following sources:

• stationary observation posts of the Republican Center for Radiation Control and Environmental Monitoring of the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus,

• route posts of institutions of the Ministry of Health of the Republic of Belarus, carrying out state sanitary supervision, and

• mobile (under-torch) posts (industrial control).

2.1.1 Stationary posts

Stationary posts are observation points of the National Environmental Monitoring System of the Republic of Belarus, included in the State Register of observation points of the Republic of Belarus. The Ministry of Natural Resources and Environmental Protection of the Republic of Belarus coordinates the work in the field of atmospheric air monitoring. At present, monitoring of the state of atmospheric air is carried out in 19 industrial cities of the republic, including regional centers—Figure 1.

Figure 1.

Location of stationary observation posts of the Republican Center for Radiation Control and Environmental Monitoring.

There are 67 stationary posts installed in the cities [7]. In Minsk—12 stations, in Mahilyow, Homiel, and Vitsebsk—5 each, in Brest and Hrodna—4 each; in other industrial centers—1–3 stations. Regular observations cover the territories where almost 87% of the population of large- and medium-sized cities of the republic lives. In all cities, the concentrations of the main pollutants are determined:

• particulate matter (undifferentiated dust/aerosol),

• sulfur dioxide,

• carbon monoxide, and

• nitrogen dioxide.

Concentrations of priority-specific pollutants are also measured:

• formaldehyde,

• ammonia,

• phenol,

• hydrogen sulfide, and

• carbon disulfide.

When choosing a priority list of specific substances, emissions of each substance (data from the National Statistical Committee of the Republic of Belarus), the size of the city, maximum allowable concentrations, and dispersion coefficients are taken into account. In all controlled cities, the content of lead and cadmium in the air is determined, in 16 cities—benz/a/pyrene, in 9 cities—hydrocarbons. Automatic stations measure concentrations of PM₁₀ and ground-level ozone. Measurements of the concentrations of PM_2.5 microns in size are carried out in Minsk (the area of Geroev 120 Divizii St.) and Zhlobin (the area of Prigorodnaya St.) [7].

Stationary posts are designed to obtain information on maximum and average daily concentrations. Observations of the state of atmospheric air in a discrete mode are carried out daily on working days, at 1, 7, 13, and 19 hours (air samples are taken by a technician into absorption devices or aerosol filters for 20 minutes and delivered to the laboratory, where the subsequent chemical analysis is carried out). At automatic stationary posts, measurements are carried out by continuous sampling, during all day and night. Air quality is determined by several thousand measurements per year.

2.1.2 Route posts

Route posts carry out air quality control as part of the state sanitary supervision of institutions of the Ministry of Health of the Republic of Belarus. Route post is designed for regular air sampling when it is not possible (not feasible) to establish a stationary post or it is necessary to study the state of air pollution in certain areas, for example, in new residential areas. Observations at route posts are carried out using a mobile laboratory, which is equipped with the necessary instruments. One car attends around 4–5 points per working day. The order in which the vehicle goes around the selected waypoints should be the same in order to ensure that the concentrations of impurities are determined at the same time. Route posts are located in places selected on the basis of a mandatory preliminary study of urban air pollution by industrial emissions, vehicle emissions, and other sources and the study of meteorological conditions for the dispersion of impurities through episodic observations. Posts must be installed first of all in those residential areas where the highest average levels of pollution are possible, then in the administrative center of the settlement and in residential areas with various types of buildings, as well as in parks and recreation areas. The most polluted areas include zones of the highest maximum one-time and average daily concentrations created by emissions from industrial enterprises, as well as motor transport routes. At the route posts, the content of specific impurities of the priority list, characteristic of nearby emission sources, is monitored. For example, in Minsk list of chemicals includes the following:

• acrolein,

• benzene,

• 1,3—butadiene,

• particulate matter (undifferentiated dust/aerosol),

• sulfur dioxide,

• nitrogen dioxide,

• carbon monoxide,

• phenol,

• xylene, and

• formaldehyde.

Considering the variety of substances present in the air of the city, this list allows us to focus on the most dangerous pollutants for health, which are subject to control in the first place.

The duration of air sampling at route posts for determining maximum concentrations of impurities is 20–30 minutes, and sampling is made few times per month. Further, air samples are delivered to the laboratory, where a chemical study of air samples is carried out, then the data are sent for further analysis.

2.1.3 Mobile (under-torch) posts

Mobile (under-torch) posts carry out industrial control of air pollution. A mobile (under-torch) post is designed for sampling under a smoke (gas) torch in order to identify the zone of influence of a source of industrial emissions. Observations under the torch of the enterprise are also carried out with the help of an equipped car. During a work shift (8 hours), one machine can carry out observations at 8–10 points. Mobile posts are points located at fixed distances from the source. They move in accordance with the direction of the torch of the surveyed emission source (according to wind direction).

To determine the maximum concentrations of pollutants that are created by emissions from enterprises to a particular area of the city, as well as the size of the zone of impurity distribution from a given enterprise, under-torch observations are organized, that is, measurements of impurity concentrations under the axis of the plume of emissions from pipes of industrial enterprises. The location of the points where air samples are taken to determine the concentrations of harmful substances varies depending on the direction of the torch. Torch observations are carried out in the area of a separate emission source or a group of sources both within the city and outside it.

Sampling during under-torch observations is carried out at distances of 0.5, 1, 2, 3, 4, 6, 8, 10, 15, and 30 km from the source of pollution on the leeward side of it. More often, observations should be made at distances of 10–40 average pipe heights from the source, where the probability of the appearance of a maximum concentration is especially high. Observations are carried out for specific substances characteristic of a given enterprise. Air sampling under the torch is carried out at a height of 1.5–3.5 m from the ground in accordance with the methodology used for observations at a stationary post. Under-torch observations should be carried out at the time of measurements at stationary and route posts and additionally at other times in order to study the distribution of maximum concentrations at different hours of the day.

2.2 Evaluation of the results of laboratory measurements

After determining the concentrations of polluting chemicals in the atmospheric air, the obtained values are evaluated in accordance with the current hygienic standards [8]. When comparing the obtained concentrations with their hygienic standards, it is necessary to comply with the averaging periods—the maximum acute concentrations are compared with the values of the maximum standards, the average daily—with the average daily, etc. In Republic of Belarus, there are three types of standards—maximum acute, average daily, and average annual.

Assessment taking into account the effect of the summation of the harmful effects of pollutants is also made. After assessing the content of individual pollutants in the atmospheric air, it is necessary to check whether they have a summation effect in accordance with Table 3 of the Hygiene Standard [8]. With the simultaneous content in the atmospheric air of several pollutants with the effect of summation, the sum of the ratios of the actual concentrations of each of them in the air to their standards should not exceed one (Eq. (1)):

$$\frac{\mathrm{C}}{\text{Stndr}}+\frac{{\mathrm{C}}_1}{{\text{Stndr}}_1}+\dots +\frac{{\mathrm{C}}_{\mathrm{n}}}{{\text{Stndr}}_{\mathrm{n}}}\le 1$$E1

where.

C, C₁…C_n are concentrations of pollutants with the summation effect, μg/m³.

Stndr, Stndr₁… Stndr_n are the values of hygienic standards for pollutants with the summation effect, μg/m³.

The assessment of the joint content of polluting chemicals in the atmospheric air, taking into account the effects of summation, is carried out only if the pollution contains all the substances included in the summation group. If at least one substance is missing, then it is considered that the summation group has not formed, and the assessment is not carried out.

The above hygiene standards (both for individual substances and for summation groups) are legally valid—if they are exceeded, measures must be taken to reduce the content of pollutants.

2.3 Complex indicators of atmospheric pollution

2.3.1 Complex indicator P

Hygienic assessment of the degree of atmospheric air pollution with the simultaneous presence of several pollutants in Belarus is carried out according to the value of the “P” indicator, which takes into account the multiplicity of exceeding the hygiene standard, the hazard class of the substance, and the amount of chemical substances present in the atmospheric air together.

Complex indicator “P” represents atmospheric air as a dynamic environment with a certain general level of pollution that has a diverse impact on the health of the population, which makes it possible not to study separately the processes of exposure to each of the pollutants. This method takes into account the combined action of pollutants according to the type of incomplete summation.

Calculation of the complex indicator “P” is carried out according to the following formula Eq. (2):

$${\mathbf{P}}_{\mathbf{i}}\mathbf{=}\sum _{\mathbf{i}\mathbf{=}\mathbf{1}}^{\mathbf{n}}{\mathbf{K}}_{\mathbf{i}}^{\mathbf{2}}$$E2

where

K_i is isoefficiency concentrations of pollutants, which are calculated according to the following Eq. (3):

$${\mathbf{K}}_{\mathbf{i}}=\left(\frac{\mathbf{C}}{\mathbf{\text{Stndr}}}\right)\ast \mathbf{i}$$E3

where.

C is concentration of pollutant, μg/m³,

Stndr is value of hygienic standard for pollutant, μg/m³, and

i is isoefficiency coefficient that depends on substance hazard class:

• 1st class—2;

• 2nd class—1.5;

• 3rd class—1; and

• 4th class—0.8.

Hygienic assessment of the degree of atmospheric air pollution by a complex of pollutants is carried out in accordance with Table 1.

Degree of atmospheric air pollution	Value of complex indicator “P” with the number; atmospheric pollutants
	2–3 pollutants	4–9 pollutants	10–20 pollutants	21 and more pollutants
I—admissible	Up to 1.6	Up to 3	Up to 5	Up to 7.1
II—weak	1.7–3.2	3.1–4.8	5.1–6.4	7.2–8
III—moderate	3.3–6.4	4.9–9.6	6.5–12.8	8.1–16
IV—strong	6.5–12.8	9.7–19.2	12.9–25.6	16.1–32
V—dangerous	12.9 and more	19.3 and more	25.7 and more	32.1 and more

Table 1.

Hygienic assessment of the degree of atmospheric air pollution by the complex of pollutants.

The first degree is safe for the health of the population, with pollution of the II–V degree, and the frequency of adverse effects increases with an increase in the degree of atmospheric pollution—Table 2.

Degree of atmospheric air pollution	Prognosed risk level	Prognosed gradations of population health	Measures to be taken
I—admissible	1: 10000000; (10^−7; Е-07), acceptable risk level	Adaptation (baseline incidence)	Low priority. The current risk management system is sufficient. No additional measures required
II—weak	1: 1000000; (10^−6; Е-06), acceptable risk level	Compensation/resistance (baseline incidence)	Low priority. The current risk management system is sufficient. No additional measures required
III—moderate	1: 100000; (10^−5; Е-05), risk is considered high enough	Adaptation stress (significant excess of baseline incidence)	Medium priority. Hazard identification and risk mitigation decisions
IV—strong	1: 10000; (10^−4; Е-04), risk is assessed as unacceptable	Overstrain of adaptation (significant excess of the highest limit of the baseline incidence)	High priority. Hazard identification, health risk assessment studies and simultaneous implementation of emergency risk reduction measures
V—dangerous	1: 1000; (10^−3; Е-03), risk is assessed as unallowable	Disruption of adaptation (exceeding baseline incidence by several times)	High priority. Urgent adoption of a set of emergency measures to reduce the risk

Table 2.

Prognosed gradations of population health and risk levels depending on the degree of atmospheric air pollution.

It should be noted that the complex indicator P has no legal force (the measures indicated in the tables are advisory in nature) and is more often used in scientific research or when comparing territories with a heterogeneous composition of atmospheric air pollution.

2.3.2 Complex air pollution index

Complex air pollution index (CAPI) is a quantitative measure of the level of air pollution created by several chemicals present in the atmosphere of a city. The index allows us to present an integral level of air pollution in the city with one number. When calculating complex air pollution index, as a rule, data on the main five substances are used, which make the maximum contribution to the level of atmospheric air pollution in the territory under consideration.

Calculation of complex air pollution index is carried out according to the following formula (Eq. (4)):

$$\text{CAPI}=\sum _{\mathrm{k}=5}^{\mathrm{n}}{\left(\frac{\mathrm{C}}{\text{Stndr}}\right)}^{\mathrm{i}}$$E4

where C is concentration of pollutant, μg/m³,

Stndr is value of hygienic standard for pollutant, μg/m³, and

i is isoefficiency coefficient that depends on substance hazard class:

• 1st class—1.7;

• 2nd class—1.3;

• 3rd class—1; and

• 4th class—0.9.

Usually, complex air pollution index is calculated for all pollutants, and then, it is necessary to determine five main ones that make the maximum contribution to the value of complex air pollution index. The resulting value is denoted by index 5 (CAPI₅) and can be used to compare the level of air pollution in different areas, regardless of which five substances are included in this indicator. Assessment of the level of atmospheric pollution by the value of CAPI₅ is carried out in accordance with Table 3.

CAPI5	Level of atmospheric pollution
≤ 5	Low
6 < CAPI ≤8	Average
9 ≤ CAPI <15	Above average
CAPI >15	Well above average

Table 3.

Level of atmospheric pollution by the value of CAPI₅.

Complex air pollution index also has no legal force; in case of obtaining high values, preventive measures to reduce the concentrations of pollutants can only be advisory in nature. In addition, in contrast to the сomplex indicator P, there is no scale for CAPI that allows us to predict possible effects on population health. This indicator is more often accepted in the ecological field and also allows us to compare areas with different compositions of atmospheric pollution.

3. Results

3.1 Air pollution sources in Belarus

The entry of pollutants into the atmospheric air occurs as a result of the activity of natural and anthropogenic sources, as well as a result of the regional and transboundary transfer. Of the greatest interest among these sources are anthropogenic, as they make a significant contribution to the formation of atmospheric air pollution and are also the most accessible for correction and development of preventive measures.

According to the Ministry of Natural Resources and Environmental Protection [5], the National Statistical Committee [6], the share of emissions from stationary sources is about 38.5% of total emissions from all sources in the territory of the Republic of Belarus—Figure 2.

Figure 2.

Dynamics of emissions into the atmospheric air of the Republic of Belarus from stationary and mobile sources in 1990–2020.

In addition, there is a tendency to reduce both the total amount of emissions into the atmospheric air from stationary and mobile sources. Geographically, the largest share of emissions was registered in Minsk region, Brest region, and Vitsebsk region—Figure 3.

Figure 3.

Emissions of harmful substances into the atmospheric air in regions of the Republic of Belarus from stationary and mobile sources in 2020.

The composition of emissions from pollution sources by substances as of 2020 was presented by carbon monoxide (46.98% of emissions), hydrocarbons (30.23%), nitrogen dioxide (10.65%), sulfur dioxide (4.81%), and particulate matter (undifferentiated dust/aerosol) (3.96%)—Figure 4.

Figure 4.

Dynamics of emissions of harmful substances into the atmospheric air of the Republic of Belarus from stationary and mobile sources in 1990–2020.

At the same time, 99.82% of emissions of sulfur dioxide and 84.85% of carbon monoxide were formed due to stationary sources, and 64.02% of emissions of nitrogen dioxide, 57.17% of hydrocarbons, and 52.16% of undifferentiated solid particles were formed due to stationary sources.

Data on the quantitative and qualitative composition of emissions from stationary sources are formed on the basis of information provided by enterprises in the form of statistical reporting. By 2020, the main share of emissions was accounted for agriculture, forestry and fisheries (34.2%), manufacturing industry (33.8%), and electricity generation (21.4%). The largest contribution in the manufacturing industry was made by oil refining (43.1%). The qualitative composition of emissions from stationary sources is diverse and varies significantly depending on the characteristics of the technological process of the facility. Despite the fact that the contribution of emissions from stationary sources to emissions from all sources is about a third, the adverse effects associated with the operation of these sources are of great importance due to the possibility of releasing hazardous compounds, as well as compounds with long-term effects (carcinogenesis, teratogenicity, embryotoxicity, etc.). The distribution and dispersion of emissions from stationary sources depend on many conditions: the temperature of the ejected air jet, the height of the source of emission, the climatic and meteorological characteristics of the area. These indicators are constant for each stationary source of emissions, which makes it easier to predict the spread of pollutants and allows to develop effective measures to reduce the adverse impact of released chemicals on public health.

The share of emissions from mobile sources in 2020 was 61.5% in the composition of gross emissions from all sources on the territory of the Republic of Belarus [6]. The value of gross emissions from mobile sources is determined by the calculation method based on specific emission indicators per unit of fuel used for generalized groups of vehicles and environmental classes, as well as data on the volume of fuel consumed for transport operations [6]. The largest number of emissions from mobile sources falls on the city of Minsk and the Minsk region, and Grodno regions [5]. The qualitative composition of emissions from mobile sources is relatively constant and is represented by carbon monoxide, hydrocarbons, nitrogen oxides, particulate matter, and sulfur oxides. The distribution and dispersion of emissions from mobile sources are also related to the natural, climatic, and meteorological characteristics of the area; however, it is more difficult to predict the real impact of emissions from mobile sources on public health due to the variable number of emission sources and the time of their operation.

Thus, the qualitative and quantitative composition of atmospheric air pollution in the Republic of Belarus is due to the anthropogenic effect of stationary and mobile sources of emissions. There is a constant collection and processing of information on the composition and amount of chemicals emitted into the atmospheric air, the territorial distribution of sources, and their contribution to the value of gross emissions from all sources. In most cases, data on the qualitative and quantitative composition of emissions from each source are obtained by calculation.

3.2 Concentrations of pollutants in atmospheric air of Belarus

According to information from stationary observation posts of the Republican Center for Radiation Control and Environmental Monitoring of the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus during period from 2005 to 2020 [5], the following average annual concentrations of the main pollutants in the atmospheric air were recorded in the largest cities of the Republic—Figure 5.

Figure 5.

Annual concentrations in μg/m³ of PM10, NO2, SO2, CO from stationary observation posts in biggest cities for period 2005–2020.

*In some cases, there were no average annual concentration, since measurements were not carried out or there were not enough of them to calculate the average daily concentration.

*Red line marks annual level of hygienic standard for pollutant.

As it is seen from Figure 5, mostly there was a trend toward a decrease in the content of the main pollutants. Values of the average annual concentrations were obtained by mathematical averaging of the concentrations received from stationary observation posts on a daily basis. Also, daily concentrations of tropospheric ozone were mathematically averaged to the annual concentrations—Figure 6.

Figure 6.

Annual concentrations in μg/m³ of tropospheric ozone from stationary observation posts in biggest cities for period 2005–2020.

*In some cases, there were no average annual concentration, since measurements were not carried out or there were not enough of them to calculate the average daily concentration.

In all cases, concentrations of tropospheric ozone did not exceed level of hygienic standard. Thus, the level of pollution in large cities of Belarus remains quite intense. However, there has been a downward trend in the concentrations of major pollutants over the past 15 years.

4. Discussion

4.1 Impact of air pollution on health

Impact of air pollution on public health is beyond doubt. An objective quantitative and qualitative assessment of the effects of atmospheric air pollution are difficult due to the heterogeneity and variability of the chemical composition of pollution and physical properties of the environment itself, differences in individual sensitivity of different population groups, the impossibility of excluding the effects of other factors (nutrition, living conditions, professional factors, etc.), and the inability to simulate the impact of the entire air environment in laboratory conditions. In this regard, studies of the effect of polluting chemicals contained in the atmospheric air on the health of the population are represented by a large number of studies of various designs. Among them, the main following results in Belarus can be distinguished:

A group of studies was devoted to studying the effect of hydrocarbons on the state of public health: atmospheric air pollution with hydrocarbons was found to be the cause of a statistically significant increase in incidence rate from 1.5 to 7 times of 19 types of diseases in population: diseases of the upper respiratory tract and respiratory organs, peripheral nervous, cardiovascular system, allergic diseases, and oncological diseases [4].

In Mahilyow, a significant relationship was found between incidence rate of chronic diseases of the tonsils and adenoids, pneumonia, bronchial asthma, and high levels of dust in the atmosphere in the adult population. The same authors studied the content of phenol and formaldehyde in the atmosphere of Homiel and revealed that increased content of pollutants was associated with an increase in the incidence rates of pneumonia in the adult population. Аuthors also determined the value of complex indicator “P” for some districts of Minsk and established that the actual level of the children incidence rate of bronchial asthma exceeded the calculated indicator based on the regression mathematical model from 0.54 to 2.06 times. A significant relationship was also established between the total air pollution in Minsk and children incidence rates of chronic diseases of the tonsils and adenoids, bronchial asthma, and in Hrodna—chronic pharyngitis [9].

Correlation analysis made by other group of research studies highlighted a positive correlation between asthma incidence rate and concentrations of particulate matter (dust/aerosol undifferentiated in composition), lead, ammonia, and nitrogen dioxide in Minsk [10].

In addition, the issue of the presence and composition of pollen allergens in the atmospheric air of Minsk and the relationship between the content of these allergens and the manifestations of bronchial asthma in children have been studied quite widely and in detail [11].

Dependence of prevalence levels among the population with infections of the upper respiratory tract and value of complex indicator “P” was established, which was described by a linear type equation y = 218.97 + 12.73x (r = 0.54, p = 0.001). According to the data obtained, an increased value of complex indicator “P” by 1 entails an increase in the prevalence by 12.73 cases per 1000 population. Among studied infections of the upper respiratory environmental conditioning was found for acute nasopharyngitis, pharyngitis, tonsillitis, and bronchitis, as well as for acute respiratory diseases [12].

Using the risk assessment methodology, a group of Belarusian authors calculated health risk levels from air pollution in large cities of Belarus. Performed calculations of the health risk values for the child population showed that high risk of prevalence rates was typical for Vitsebsk and Homiel, an increased one—for Hrodna, Minsk, Mahilyow, and a minimum one for Brest. Among certain diseases, neoplasms, infectious diseases, diseases of the endocrine system, blood and hematopoietic tissues, nervous system, and respiratory organs had a high risk. For adult population, high health risk of incidence rates was recorded for Brest, Vitsebsk, Minsk, and Mahilyow. It was confirmed that the value of complex indicator “P” is quite consistent with the expected level of health of the population [13].

To date, a sufficiently large amount of data have been accumulated, indicating that air pollution contributes to the formation of the incidence of various diseases all over the world. Thus, the presence of significantly higher incidence rates of myocardial infarction (by 1.43 times) and ischemic cardiomyopathy (by 1.12 times) was found among the population living in the area of major transport routes [14]. An analysis of more than 20 studies of the content of particulate matter of various fractions in the atmospheric air and stroke incidence rates indicates the presence of a statistically significant relationship between these indicators: in the countries of North America and Europe, for every 10 μg/m³ increase in the content of particulate matter up to 10 μm, 1.062 times increased risk of stroke [15]. Studies of the degree of air pollution in Ireland showed that the introduction of bans on the burning of coal significantly reduced the incidence of respiratory diseases [16]. Air pollution can lead to an increase in the incidence of noncommunicable diseases among the population, including not only respiratory, but also cardiovascular diseases: hypertension, myocardial infarction, angina pectoris, chronic pharyngitis, chronic bronchitis, and bronchial asthma [17, 18]. At the same time, the incidence rate indicates an already formed reaction in the body to an adverse effect in the form of a disease, which makes it difficult to quickly analyze the level of the adverse effect of the factor and develop effective preventive measures.

The impact of polluted atmospheric air on the human body can be assessed according to laboratory tests of human blood. In this case, blood parameters can be biomarkers of the impact of atmospheric air pollution on the body, which will allow assessing the adverse effects of the factor more quickly and accurately, comparable to the use of incidence rates. Quite widely in the literature are studies of the effect of air pollution on blood counts. Exposure to the particulate matter contained in the atmospheric air can cause a decrease in the content of high-density lipoproteins [19]. Combined exposure to PM_2.5 and black carbon for 3 months or more causes a decrease in the content of high-density lipoproteins in the blood, more pronounced among the female population [20].

The combined effect of nitrogen dioxide, sulfur dioxide, and carbon monoxide exposure in the air can lead to a decrease in the iron content in the blood serum and to the development of iron deficiency anemia [21]. In China, an increase in blood glucose levels was found with 4 days of exposure to sulfur dioxide, nitrogen dioxide, and PM₁₀, and this effect was more pronounced among women, the elderly, and overweight people [22].

5. Conclusion

Control over the state of atmospheric air in the Republic of Belarus is carried out regularly by the Ministry of Health and the Ministry of Natural Resources and Environmental Protection. Special attention is paid to the content of the main pollutants, specific pollutants (in the area of industrial enterprises), as well as their combinations, which have a proven effect of summation in the joint presence (45 summation groups).

Over the past 20 years, there has been a decrease in both the content of individual pollutants in the atmospheric air and the amount of emissions from stationary and mobile sources, and today, there is almost no excess of national air quality standards for the average annual content of individual pollutants.

Nevertheless, the effects of atmospheric air pollution remain the object of close attention and have been proven to contribute to the formation of the health status of the population. In connection with the foregoing, a promising direction in the policy for the control of atmospheric air pollution in the Republic of Belarus is the assessment of pollution levels according to complex indicators that take into account the entire spectrum of pollution and the fact of simultaneous exposure of a person to a large number of pollutants in concentrations not exceeding the values of hygienic standards. However, the absence of the above complex indicators of legal force at the moment does not allow taking active preventive measures on the basis of these indicators.

Acknowledgments

The authors express their gratitude to the National Statistical Committee of the Republic of Belarus, the Center for Radiation Control and Environmental Monitoring of the Republic of Belarus, and the Ministry of Health of the Republic of Belarus for using their publicly available data.

Conflict of interest

The authors declare no conflict of interest.