Low Emission Zones (LEZs) : don’t forget the impact on health
Press release from the French Academy of Medicine
November 28, 2025
Low Emission Zones (LEZs) were established by laws passed in 2019 and 2021 to reduce air pollution and associated health risks. These zones are urban areas where the most polluting vehicles are banned from circulation.
Air pollution in cities has a direct impact on public health, causing approximately40,000 deaths per year in France (1.2). WHO estimates this impact at 4.2 million premature deaths per year worldwide. This mortality is associated with exposure to major pollutants, emitted in particular by combustion engines, whose emissions account for more than 80% of nitrogen dioxide and around one third of fine particles PM 2.5 (with a diameter of less than 2.5 μm) and PM 10 (with a diameter of less than 10 μm). These pollutants can cause respiratory or cardiovascular diseases and cancers (3,4).
The transition to electric vehicles from 1.4 to 14.6 electric vehicles per 1,000 inhabitants between 2013 and 2019 led to a significant reduction of 3.2% per 20 vehicles per 1,000 inhabitants in emergency room visits for asthma (5). A 9-year longitudinal follow-up of 5,305 people with an average age of 74 showed an accelerated decline in age-related performance of nearly one quarter every 5 years on average (2.6 ± 3 months) in subjects chronically exposed to vehicle pollution (6).
As climate change forecasts exacerbate other risk factors in urban heat islands, reducing pollution is a public health priority. Around 300 urban areas in 13 European countries, including around 60 in France, have introduced LEZs, with the effective results of reducing pollution and achieving a good overall acceptance in general (7,8). However, sometimes they are implemented without taking into account the access constraints imposed on people with no other means of transport (local residents; residents who live far from their workplace and have no access to public transport; delivery drivers, etc.), These LEZs have attracted criticism, even though exemptions and consultations were planned.
During a vote on the bill to ‘simplify’ economic life, Parliament abruptly abolished LEZs without seeking an alternative solution that would protect everyone’s health while preserving necessary access to these areas for people with no other means of access.
The French Academy of Medicine emphasizes the importance of promoting urban development policies aimed at limiting emissions of pollutants linked to motor vehicle traffic while structuring low- or zero-pollution means of transport for citizens.
It considers that maintaining LEZs remains relevant in terms of public health, but in keeping necessary specific access and recommends:
– to extend the momentum for improving air quality in cities by adapting the proposed measures judiciously to make them both effective and more acceptable to citizens (for example, by limiting the exclusion of LEZs to vehicles in transit; by setting up long-stay car parkings at the entrance to these zones, and by encouraging a transition to low-emission vehicles and soft mobility);
– to organize a campaign to explain and promote air quality related to health, aimed at citizens who are often unfamiliar with these issues;
– to bear in mind that the sudden abolition of LEZs in France would reintroduce pollution with proven health risks in cities, contrary to public health prevention objectives;
– to remain vigilant and strict in the implementation of European standards on the control of pollution from combustion engine vehicles, both in terms of production and procedures for their regular inspection after sale.
References
1- Medina S., Adélaïde L., Wagner V., et al., Impact de la pollution de l’air ambiant sur la mortalité en France métropolitaine. Réduction en lien avec le confinement du printemps 2020 et nouvelles données sur le poids total pour la période 2016-2019, Santé publique France, 23 août 2021. (https://www.santepubliquefrance.fr/determinants-de-sante/pollution-et-sante/air/documents/enquetes-etudes/impact-de-pollution-de-l-air-ambiant-sur-la-mortalite-en-france-metropolitaine.-reduction-en-lien-avec-le-confinement-du-printemps-2020-et-nouvelle#:~:text=R%C3%A9sultats%20%3A%20La%20limitation%20des%20activit%C3%A9s,juin%202019%20%C3%A0%20juillet%202020.)
2- INSERM, Pollution atmosphérique : Respirer est-il mauvais pour la santé ? Expertise collective, (Air pollution: Is breathing bad for your health? Collective expertise) 6 November 2023.
3- Whaley P., Nieuwenhuijsen M., Burns J., Update of the WHO global air quality guidelines: systematic reviews, Environ Int., 2021 142 (Special issue), accessed on 17th June 2021
4- WHO, Personal interventions and risk communication on air pollution, Geneva: World Health Organization (https://apps.who.int/iris/handle/10665/333781, accessed on 17th June 2021
5- Garcia E., Johnston J., McConnell R., et al. California’s early transition to electric vehicles: Observed health and air quality co-benefits. Sci Total Environ. 2023 April;867:161761. doi: 10.1016/j.scitotenv.2023.161761.
6-Doubleday A., Blanco M., Adar S.D., et al., Traffic-related air pollutant exposure and physical performance inthe Adult Changes in Thought cohort. Environ Int. 2025 Oct;204:109850. doi: 10.1016/j.envint.2025.109850.
7- ADEME, Benchmark des zones à faibles émissions – mobilité à travers l’Europe
https://librairie.ademe.fr/societe-et-politiques-publiques/6376-benchmark-des-zones-a-faibles-emissions-mobilite-a-travers-l-europe.html#, 2023
8- Mudway I.S., Dundas I., Wood H.E., et al., Impact of London’s low emission zone on air quality and children’s respiratory health: a sequential annual cross-sectional study. Lancet Public Health. 2019; 4, 1.
Bull Acad Natl Med 2025;209:pp-pp. [En ligne] Disponible sur : URL
