European city residents in 30 different countries pay a total of €166 billion per year or €385 million per city in health costs related to air pollution, a new report has found.

This works out to air pollution costing the average European city resident €1,276 per year, according to the study conducted for the European Public Health Alliance.

That’s based on a calculation of the costs of premature death, medical treatment, lost working days and more associated with air pollution in 432 major European cities.

Whereas Bucharest, Romania, topped the list for the highest costs per capita associated with air pollution, five Italian cities made the top ten list due to high levels of pollution and high overall costs: Milan, Padua, Venice, Brescia, and Turin.

Meanwhile, London had the highest total damage cost due to air pollution, which sets residents back €11.4 billion per year.

That’s because when grouped by city, rather than per capita cost, people living in larger and more expensive cities faced the highest pollution costs due to “population density, higher earnings and expenses”, the report said.

“Our study reveals the magnitude of the damage toxic air is causing to people’s health and the huge health inequalities that exist between and within countries in Europe,” said Sascha Marschang, the European Public Health Alliance (EPHA)’s acting secretary-general.

Transport is a main source of urban air pollution and Marschang encourages small changes to reduce costs.

“To a large extent, the situation can be influenced by transport policies and cities can reduce costs by switching to zero-emission urban mobility. Governments and the European Union should bear these costs in mind for transport policy in order to support, not to hinder, a healthy recovery from the COVID-19 pandemic,” Marschang said in a statement.

The report, carried out by independent research organisation CE Delft, is the largest of its kind and analysed data from Eurostat and official monitors, the public health alliance said in a statement.

The European Environment Agency (EEA) estimates that there are around 400,000 premature deaths in Europe per year due to air pollution.

The report focussed on outdoor pollution associated with particulate matter, ozone and nitrogen dioxide, air pollutants that cause the most illness and death according to the EEA.