Health at Risk: Air Pollution and Urban Vulnerability—Perspectives in Light of the 2030 Agenda

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors congratulations on a well written manuscript that brings together a revision of the literature and concrete exemples of the contribution of education  to raise awareness on air pollution and its health at early stages.
This said, I would like to leave some important adjustments to be address prior to publication. My main concern is the flow and organization - sequence of ideas.  It starts by the objective of the manuscript line 81. It needs to be reformulate as it implies that you are looking at the  health impacts of air pollution while your results show broader implications such as main pollutants...control policies. You need to make these adjustment and clarify your objective. 
Furthermore, the material and methods sections is concise but lacks to make the link with the use of school education with what you are trying to prove.
An option would be to add tables and  specify that you are looking at both mobile and fixed air pollution - contrary of what is mentioned in abstract that mentions only industrialized. You are not measuring it but rather shedding light of the effects of air pollution on health.
The discussion needs to be restructured: I would recommend to start with the Brazilian example and then continue on a broader discussion on the importance of education in long term air pollution control policies. Review conclusion accordingly.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

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Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The study covers a very current topic. I believe it will attract the attention of researchers interested in the subject. However, the study needs some further development. It is recommended that the study be developed with attention to the following points.

1) Although the study is very current and there are many articles on the subject, few references have been used. Moreover, most of the references used are outdated. The study needs to be updated with more recent references. Although the study covers the period up to 2023, it is recommended that references from the last few years be used, especially for general information.

2) The introduction (Lines 31-38) should explain the connection between air pollution, industrialization, urbanization, and global climate change. For example, the following paragraph could be used. “The industrial revolution and technological advancements occurring around the world in the past century have had a profound impact, causing radical changes in almost every domain of study. While the industrial revolution enabled rapid increases in production, it also escalated the demand for raw materials, energy, and labour. To meet the demand for labour, rural-to-urban migration has occurred, leading to the concentration of populations in specific areas and raising the issue of urbanization (Dogan et al. 2022; Key et al. 2023). Further, the use of fossil fuels to meet the required energy needs has significantly increased the atmospheric CO2 levels and become a major contributor to global climate change (Sevik et al. 2015; Tekin et al. 2022). The consequences of this process, which are urbanization and global climate change, have been defined as irreversible problems worldwide (Varol et al. 2022; Zeren Cetin et al. 2023)”

3) In the introduction (Lines 43-48), the importance of air pollution and its effects on human health should be emphasized with figures. For example, " Around 6 million premature births, 3 million low-birth-weight newborns, and 7 million premature deaths occur globally as a result of air pollution (Isinkaralar et al., 2022; WHO, 2023; Şevik et al., 2024). Epidemiological studies indicate that approximately 12.5% of global mortality can be attributed to air pollution exposure (WHO, 2023). This public health burden is particularly concerning in Europe, with an estimated 2.5 million residential areas currently affected by pollution (WHO, 2024). According to data from the WHO (World Health Organization), approximately all individuals on the planet (99%) inhale air that comprises high levels of toxins that are higher than the WHO's established limits, and the highest exposure occurs in low- and middle-income nations (WHO, 2024).”

4) In the introduction (Lines 60-61), air pollution components (particulate matter, heavy metals, noise pollution, etc.) should be mentioned. In this section, it is recommended to specifically mention heavy metals, which are the most dangerous to human health, and heavy metal sources in urban areas.

5) In the materials and methods section (Line 89), the phrase “databases such as LILACS and PubMed” is used. Is there a specific reason for using these databases? Why were WOS, Scopus, or Google Scholar not used?

6) In the Materials and Methods section (Lines 90-93), why were heavy metals, which are the most significant health threat, not used? Numerous articles emphasize that heavy metals are the most harmful air pollutants to human health. For example, “Gültekin, Y., Bayraktar, M. K., Sevik, H., Cetin, M., & Bayraktar, T. (2025). Optimal vegetable selection in urban and rural areas using artificial bee colony algorithm: Heavy metal assessment and health risk. Journal of Food Composition and Analysis, 139, 107169”, “Sevik, H., Koç, İ., Cregg, B., & Nzokou, P. (2025). Tissue-specific barium accumulation in five conifer species: a 40-year dendrochemical assessment from a polluted urban environment. Environmental Geochemistry and Health, 47(9), 1-13”, “Isinkaralar, K., Isinkaralar, O., Koç, İ., Şevik, H., & Özel, H. B. (2025). Atmospheric trace metal exposure in a 60-year-old wood: A sustainable methodological approach to measurement of dry deposition. International Journal of Environmental Research, 19(4), 1-14”, “Kulac, S., Pulatoglu, A. O., Koç, İ., Sevik, H., & Ozel, H. B. (2025). Assessing Tree Species for Monitoring and Mitigating Strontium Pollution in Urban Environments. Water, Air, & Soil Pollution, 236(9), 605”. It is recommended that this section and, in connection with this section, the entire article be developed and that heavy metal pollution be included in the study. If this is not possible, detailed information on heavy metal pollution should at least be provided in the introduction and conclusion sections.

7) The Results section (Line 107 - ...) does not mention heavy metals among air pollutants. However, the danger level of particulate matter, for example, varies depending on its heavy metal content. Studies state that “Between 5 and 9 December 1952 in London, approximately 4000 people lost their lives due to air pollution-related reasons; the total number of deaths, including those who lost their lives in the following months, reached 12,000. It has been shown that it is contaminated with very small particles at the level (Ateya, 2020; Shahid et al., 2017). Therefore, it is of great importance to monitor the change of heavy metal concentrations in the air.” This section needs to be developed.

8) The Results section (Line 189 - ...) mentions the monitoring of air pollution. Direct monitoring of air pollution is quite difficult and costly. Furthermore, it is not widely preferred because the effects on the ecosystem cannot be explained. Instead, biomonitors are used. Detailed information should be provided on biomonitors and their types.

9) It is recommended that the results and discussion sections be combined for this study.

10) The references must be developed and strengthened with new references.

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

This work presents a review on the effects of industrialization and air pollution on public health, emphasizing disparities between national and international air quality standards. This study apply a qualitative, descriptive methodology through a bibliographic review of national 15 and international literature published between 2005 and 2023, using databases such as LILACS and PubMed.

First of all, this work only consists of 9 pages, which is too short for a review paper. It should be increased to at least 25 to 30 pages (not including the references) for a solid review paper. 

Also, if qualitative methods were applied in this work, it should not be considered as a review paper. The authors should check with the journal guidelines for this work. 

PM10 and PM2.5 should be written in subscript. Please fix similar problems throughout the text. 

The use of first person tone (such as we) should not be used in scientific writing. Please consider to change to a third person tone throughout the text.

The conclusion is written in a point form which is not acceptable. Please consider to integrate your conclusion into a single paragraph. 

The number of references (23) is very low for a review paper. Please consider to increase to at least (50) entries for a solid review paper.

Some of the results should be presented in a figure or table for better clarity, which is clearly missing from this work.

Author Response

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Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

This timely review addresses the intersection of urban air pollution, regulatory disparities, and health vulnerability in the context of the 2030 Agenda. The manuscript is clearly structured, the rationale for comparing WHO, EPA, and CONAMA thresholds is compelling, and the call to embed environmental education into Brazilian curricula is well-grounded in national legislation. The qualitative synthesis is easy to follow and will be useful for policy-oriented readers. Nevertheless, several points deserve attention before the paper reaches its full analytical potential and more studies(https://doi.org/10.1029/2024JD041593 ) should be compared. First, although the article repeatedly states that “even legal concentrations” harm health, the evidence is illustrated with only a handful of Brazilian cohort studies. A more systematic presentation of the dose–response literature published since 2015 (e.g., global multi-city time-series in Lancet Planet Health or NEJM) would strengthen this central claim and clarify the magnitude of excess risk in sub-threshold exposures. Second, the comparison of limit values would benefit from a concise table that also includes recent EU and WHO-2021 guidelines; at present the reader must wade through the narrative to spot numerical differences. Third, the discussion of environmental education is largely confined to Brazilian legal documents. Referencing comparative experiences—such as the UNESCO “Education for Sustainable Development” programme or outdoor-air-quality school projects in Santiago de Chile and Mexico City—would demonstrate whether curricular interventions elsewhere have produced measurable behavioural or pollutant-reduction outcomes. Minor issues include occasional grammatical slips (“morbimortality” should be “morbidity and mortality”), the need to homogenise citation style (some references omit DOIs), and the absence of a short paragraph summarising the limitations of a purely bibliographic approach. Finally, please verify that all web links in the reference list are still functional; EPA and WHO pages were updated in 2024 and several URLs redirect.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors The manuscript has been sufficiently improved to warrant publication in Green Health

Author Response

I would like to express my heartfelt gratitude for your thorough reading, insightful comments, and valuable guidance. The manuscript has been substantially revised and expanded to a total of 26 pages, ensuring greater depth and coherence, particularly in relation to its relevance and connection to the concept of green health. All suggestions have been incorporated into the manuscript, significantly enhancing its clarity and overall quality. I am truly thankful for the time and effort dedicated to the review, as well as for your meaningful contribution to the development of this research.

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for your revision. 

Author Response

I would like to thank you for your careful reading, insightful observations, and valuable guidance. All suggestions have been incorporated into the text and have significantly contributed to the improvement and overall quality of this work. I sincerely reiterate my gratitude for the time devoted and for your valuable contribution to the development of this research.

Reviewer 4 Report

Comments and Suggestions for Authors

The length of this review paper has increased substantially to 19 pages, but there are still some room for improvements, especially on how does this work related and relevant to green health.

The citation format is still incorrect for the in-text citations, which should be corrected.

Figure 1 has a low resolution which must be improved.

The conclusion section are too short for a review paper, which must be significantly lengthened.

The text font must be uniform throughout the text. 

In section 6, the authors claimed that this study is based exclusively on a literature review. The authors must show the different literature being reviewed for this work in a table format to strengthen the case. 

Author Response

We sincerely thank the reviewer for the constructive comments and suggestions, which have greatly contributed to improving the clarity and quality of the manuscript. All recommendations were carefully considered and addressed as follows:

• The manuscript has been substantially revised and expanded to a total of 26 pages, ensuring greater depth and coherence, particularly in relation to its relevance and connection to the concept of green health.
• The citation format throughout the text has been thoroughly revised in accordance with the Vancouver style.
• Figure 1 has been replaced with a high-resolution version suitable for publication.
• The conclusion section has been expanded to provide a more comprehensive synthesis of the findings and implications of the reviewed studies.
• Font and formatting have been standardized throughout the manuscript to ensure visual consistency.
• In Section 5 (page 19), a detailed table has been added, presenting the key literature reviewed in this study, thereby strengthening the argumentation and supporting the proposed objectives.