17 February 2025  | Spotlight

Addressing Lao PDR’s complex air pollution situation

The impacts of air pollution on health are lethal. In 2019, outdoor air pollution contributed to an estimated 4.2 million premature deaths as a result of cardiovascular and respiratory diseases, strokes, cancer and other health impacts, alongside the broader impacts on climate change.

Tragically, while the issue is global, with numerous sources, people in low- and middle-income countries are disproportionately impacted. 62% of these premature deaths occur in WHO’s South-East Asia and Western Pacific Regions.

Lao PDR is one such country facing. Annual PM2.5 exposure levels (a measurement of harmful 2.5-micron-width air pollution particles) are four times higher than WHO-recommended safe levels. Air pollution increases the risk of stroke, heart disease, and lower respiratory infections (along with other health impacts), which are among the leading causes of death in Lao PDR. PM2.5 levels peak amid “burning season” across roughly March-April each year, which sees air pollution levels spike, although levels increase from December onwards.

“Addressing air pollution has been and remains a challenge for every nation,” said Shinee Enkhtsetseg, Coordinator, Air Quality, Energy and Health/WHO ACE.

“In Lao PDR contributing sources include heavy industry, household and commercial waste burning, vehicle emissions, forest fires, transboundary emissions from other countries – and widespread slash-and-burn agriculture. Unfortunately, this multi-sectoral issue is one of the most challenging and complex that we currently face.”

Recognizing the significant risk, WHO Lao PDR works to proactively combat air pollution with the Ministry of Natural Resources and Environment (MONRE), and Ministry of Health (MOH), supported by WHO’s Asia-Pacific Centre for Environment and Health in the Western Pacific Region.

“We are taking a multi-pronged, multi-sector approach,” said WHO Lao PDR Climate and Environment Team Lead Oyuntogos Lkahasuren. “This includes working to ensure national policies and air quality guidelines are fit-for-purpose, expanding coverage of the national air quality monitoring network to rural provinces where there are hot spots, and increasing people’s awareness of the dangers of air pollution – and the actions they can take.”

One of the most significant contributions has been the expansion of real-time air quality monitoring sensors across Lao PDR. Previously, MONRE used eight high-fidelity fixed-location/stationary sites for air quality monitoring, providing 24-hour-a-day measurement of multiple air pollution indicators – but – coverage was limited, while the stationary units and operational support were costly.

With WHO support, an 15 additional real time monitoring units were added to the network for 2024’s “burning season”, accompanied by monitoring and reporting training for local officials. These real time monitoring units were lower-cost, and, add to the network of real-time data to enable more effective responses by officials. The real time monitoring units were deployed across urban and rural areas in Phongsaly, Xiengkhuang, Huaphanh, Xayaboury, Bolikhamxay, Sekong, Attapue, Champasack, Salavanh, Khammouan, Vientiane Province and Vientiane Capital. Another 13 are currently being installed. 

“The locations were strategically selected based on population density and pollution sources,” says Vanhna Phanphongsa, Deputy Head of Division the Natural Resources and Environment Research Institute (NRERI). “They provide vital data on air quality and increase our daily coverage – and importantly – allow province health officials to have more evidence-based discussions with stakeholders in terms of health impacts and emission reduction.”

This work was combined with Communications for Health (C4H)-supported efforts to improve the accessibility of daily air quality data, and develop a clear, unified, visual risk-grade guide, incorporating recommend actions at various levels for different groups (i.e. general public, high-risk individuals). Once created the Ministry of Health began publishing daily air pollution updates and advice throughout the air pollution period via their highly popular Facebook page – and continues to do so.

With air quality data and guidance more accessible, the focus shifted to better educating the general public and high-risk groups on air pollution harms, along with steps to reduce air pollution, and protect health.

Extensive WHO-supported multi-sector collaboration – involving MOH, MONRE, the Ministry of Agriculture and Forestry, Ministry of Planning and Investment, Ministry of Information, Culture and Tourism, and others – supported the development of a joint MOH/MONRE communications campaign to educate the public.

“Informed by extensive community focus group discussions in urban and rural area, and nationwide online surveys, the campaign had three phases,” said WHO Lao PDR Risk Communications Specialist Outhikone Souphome In.

“First, we encouraged source reduction ahead of the worst “burning season” period, before shifting to warnings of worsening air quality levels, and then finally hazard-focused reminders when air pollution levels dangerously peaked. It represented a tremendous increase in communication quality and volume compared to previous years – the Ministries drove efforts to highlight this significant danger, alongside prevention and protection actions, and started a national conversation about air pollution.”

Recognizing air pollution impacts people differently, the Ministry of Health tailored messaging to rural communities (where crop burning is prevalent, but research indicated a lower perception of this as a source of air pollution overall) and high-risk populations (such as the elderly, pregnant women, and those with pre-existing health conditions). Communications efforts were also conducted with major ethnic minority communities and media platforms – as groups are often highly-represented in Lao PDR’s rural areas.

The campaign deployed ahead of and throughout the burning season, across radio, television, social media, newspapers - and direct outreach to impacted groups.

Particular highlights were MOH/MONRE’s first joint media conference, to bridge ‘air quality’ and health aspects of the issue, as well as an extensive social media campaign.

Hundreds of radio advertisements and “DJ mentions” – including in Hmong and Khmu ethnic minority languages – were aired, supported by newspaper advertising, expert interviews and more. Social media content alone reached more than half of Lao PDR’s population.

“Overall, the campaign was impactful in driving the national discussion on air pollution forward, as well as making it easier for people to monitor and understand air pollution in their location, and the steps they could take to reduce it and protect themselves,” said Visith Khamlusa, Director of the Ministry of Health’s Centre for Health Statistics and Information.

“Surveys showed air pollution as one of the public’s most pressing health concerns, indicating people are highly engaged and aware.”

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While current efforts are small but important steps, they highlight two of the most pressing needs to truly address air pollution – multi-sector collaboration, and policy-solutions.

“Unfortunately, knowing about air pollution, or wearing a good quality mask, does not fix the issue,” said Dr Tim Armstrong, WHO Lao PDR Representative, “particularly when it comes reducing air pollution emissions, or making sure effective protective solutions are truly accessible to all. There is much more work to be done.”

“Air pollution harms cannot be escaped, only mitigated,” continued Dr Armstrong. “While people can contribute to reducing emissions, policy change and action at the national level is the real solution. It is not one person’s responsibility to solve this problem – the priority must be reducing air pollution at the source.”

To support this crucial area, WHO Lao PDR is also supporting a review of the National Air Quality Guidelines and Standards in Lao PDR. Collaboratively, MONRE and WHO are in the early stages of reviewing and reforming policies and regulations to create more stringent and achievable air quality standards. The setting of clear targets, and developing roadmaps to reach these goals, is essential – particularly when it comes to reduction and mitigation efforts.

Unfortunately, the challenge is a significant one – slash-and-burn agriculture is one of the largest contributors to air pollution in Lao PDR, due to its status as a traditional and effective practice with a long history across the region.