Although climate change is the primary motivation behind electric vehicle adoption, it isn’t the only consideration. Removing internal combustion engines from the road directly saves lives by reducing airborne pollutants that can cause and trigger asthma and other lung diseases.
Now, a report from the International Council on Clean Transportation has tried to quantify that effect, comparing various electrification scenarios over the next couple of decades. Currently, more than 41,800 premature deaths are attributable to air pollution from road transport, the ICCT says.
We’ve long known that living near a busy road is associated with worse health outcomes. Combustion products like nitrogen oxides (NOx), carbon monoxide (CO), particulates (PMs), and volatile organic compounds (VOCs) are all found around highways and busy intersections in concentrations high enough to cause health effects, and studies have repeatedly shown that living close to a major roadway is associated with increased mortality.
The ICCT worked with the FIA Foundation—yes, the road safety nonprofit is related to the same FIA that’s in charge of F1 and other global motorsport—to create a model to estimate road transport emissions through to 2050. The model included light-duty vehicles (passenger cars and trucks), heavy-duty vehicles (delivery trucks, buses, tractor-trailers, etc), and two- and three-wheel vehicles. It predicted levels of NOx, black carbon and organic carbon, sulfur oxides, ammonia, CO, and VOCs.
The study then calculated the heart impacts from conditions like asthma, chronic obstructive pulmonary disease (COPD), diabetes, ischemic heart disease, lung cancer, and stroke (all linked to PM2.5 exposure and ozone exposure), as well as pediatric asthma incidence caused by NOx and NOx-attributable premature mortality in adults.
Several scenarios were then run. The primary reference scenario uses August 2025 as the baseline, with a US government that’s openly hostile to the idea of clean energy. Another scenario considers what would happen if there is an ambitious effort to adopt EVs, assuming that 100 percent of all vehicles are zero-emissions by 2045, with some regions going all-EV for light vehicles by 2035 and for heavy vehicles by 2040.
Even under the baseline 2025 scenario, high-income regions like North America and Western Europe should see significant reductions in PM2.5 and NOx pollution. But in other parts of the world where incomes are lower, pollution could rise by 50 percent or more due to lax regulations and slower vehicle replacement. The ambitious scenario sees these disparities largely eliminated, with even the poorest countries seeing as much reduction in PM2.5 and NOx as the richest did in the baseline 2025 scenario.
A disproportionate amount of pollution comes from heavy-duty diesel-powered vehicles. Even though they account for only about one in 20 vehicles on the road, heavy-duty vehicles are responsible for 36 percent of transport energy consumption, 60 percent of tailpipe NOx, 55 percent of tailpipe PM2.5, and 65 percent of tailpipe SO2. Two- and three-wheelers are also rather dirty; despite representing just 4 percent of transport energy consumption, they contribute 14 percent of tailpipe PM2.5, 19 percent of tailpipe VOC, and 12 percent of tailpipe CO, according to the ICCT report.
The current health impact from transportation pollution amounted to almost 700,000 premature deaths worldwide in 2024 and nearly 250,000 new pediatric asthma cases. China saw the highest number of premature deaths, but the US was at the top of the chart for new asthma cases, with 23,100. Even under the baseline 2025 scenario, the US and other wealthy nations should see a 50 percent reduction in premature deaths and a slightly greater reduction in pediatric asthma cases. Ambitious EV adoption still has the potential to help prevent 108,400 premature deaths and 42,100 new pediatric asthma cases in the US by 2050.
While there is a growing number of zero-emissions heavy-duty vehicles, including both battery EVs and hydrogen fuel cell EVs, adoption lags behind light-duty passenger vehicles. Zero-emissions heavy truck adoption reached 4 percent in the second half of 2025, with a cumulative total by December last year of 72,308 nationwide. While that doesn’t sound like much, it’s almost 20,000 more trucks than at the end of 2024, which is promising growth, even in the absence of tax credits or corporate environmental stewardship goals.
“Zero-emission freight makes economic sense across a growing number of routes, especially where diesel health impacts are greatest,” said Ray Minjares, program director at the International Council on Clean Transportation. “With smart policies that further drive down the cost and drive up the sales of electric freight vehicles, US states will deliver economic growth, energy savings and a pollution-free future.”
