a gas-based one, a mix of sustainable transportation policies, efficient residential stoves and boilers, andan adequate system of incentives for compliance at all levels. These are aligned with the MacedonianGovernment EU-backed regulatory efforts towards compliance with the EU environmental acquis,making the issue of implementation the most pressing concern. Such implementation is likely to bemore sustainable and effective if it is supported by adequate multi-level governance structures andinclusive policy processes .5. ConclusionsInhalable particulate matter causes significant mortality and illness in Skopje. The average lifeexpectancy of the residents of Skopje is being reduced by 2 to 3 years through a largely preventableenvironmental factor like anthropogenic air pollution. It also entails a sizeable welfare cost to society.While there is no safe level of PM, any decrease in concentrations will benefit health in Skopje bydecreasing premature mortality and morbidity, and related economic costs. The attainment of theEuropean Union standards for PM can provide substantial health and economic benefits, but theattainment of WHO air quality guidelines levels can provide further benefits and should eventuallyconstitute a policy goal. Our results underscore the urgency of implementation of measures to reduceemissions and, ultimately, exposure.Even a limited assessment like the one featured in this work can provide useful evidence forpolicymaking. This is currently very relevant, as MKD continues to align its regulations with the EUacquis  on environmental issues and is in the process of implementing a National EnvironmentalHealth Action Plan to tackle the main environmental concerns in the country. More research and localevaluations on the health and economic impacts of urban air pollution are needed, particularly in EUaccession countries and other neighboring countries in which the local evidence base on this topicis scarce.Supplementary Materials:The following are available online at.Figure S1—Time trend of mid-year population stratified by age under current conditions; Figure S2—Costs ofPM2.5concentrations and mitigation scenarios for the city of Skopje; Figure S3—Cumulative mortality cost basedon YLL for current pollution level.Acknowledgments:The research leading to these results has received funding from the European Community’sSeventh Framework Programme under (Grant Agreement No. 308497) (Project RAMSES). This paper reflects theauthors’ views. The European Commission is not liable for any use that may be made of the information containedtherein. We gratefully acknowledge the continued support from the Federal Ministry for the Environment,Nature Conservation, Building, and Nuclear Safety (Bundesministerium für Umwelt, Naturschutz, Bau undReaktorsicherheit) for our activities in this area, including research. We also thank Margarita Spasenovska, fromthe WHO Country Office in MKD, for her on-site coordination and support in data collection.
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