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U.S. Cities With the Worst Air Pollution

150 million people live in counties that received an F for either ozone or particle pollution. Here are the worst -- and best -- U.S. cities for air pollution.

The air you breathe matters. You can live three weeks without food, three days without water, three minutes without air, as the saying goes. But how is that air you’re breathing, and what’s it doing to your lungs?

In the 1960s and ’70s, cities like Cleveland, Los Angeles and New York would get so enveloped in smog that they issued pollution alerts -- New York’s third-stage alert asked people to stay indoors and imposed mandatory brownout conditions, placing a curfew on lighting and heating and curtailing all but "essential" transportation and industry. Some people wore masks outdoors. Sound familiar?

Since then, under the Clean Air Act, the country has made great strides in improving the air we breathe. But according to the American Lung Association and the Union of Concerned Scientists, polluters and our own government are taking every opportunity to roll back, weaken, or undermine the core healthy air protections provided under the Clean Air Act.

Thanks to about 4,000 air quality monitors installed around the country since those smoggy days of 1970, we can measure and monitor the ozone pollution, and the year-round and short-term particle pollution in our air -- the stuff that’s getting into your lungs. According to the American Lung Association’s State of the Air 2020 report, 150 million people live in counties that received an F for either ozone or particle pollution. Breathing ozone irritates the lungs, resulting in something like a bad sunburn within the lungs, the report says, and breathing particle pollution can increase the risk of lung cancer, lead to early death and heart attacks, strokes and emergency room visits for people with asthma and cardiovascular disease. And, according to the Centers for Disease Control, people with chronic lung disease or moderate to severe asthma are at greater risk of severe illness related to COVID-19.

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Based on the American Lung Association report, these are the metro areas with the worst ozone pollution, along with their rankings for particle pollution. Keep reading to see which four cities are the cleanest.