<p>This paper aims to provide scientific support for decision-making regarding improvements in air quality by evaluating pollution reduction measures included in the 1st Spanish National Air Pollution Control Programme (SAPCP) at the city level. The study assesses the health impacts of the main air pollutants—particulate matter (PM), nitrogen dioxide (NO₂), and ozone (O₃)—on the population of Madrid. Two scenarios are analysed for 2030: one consisting of a package of existing measures (EM) and the other including additional measures (AM). First, the impacts on air quality resulting from emission reductions due to these measures are estimated using multiscale air-quality modelling, which provides changes in pollutant concentrations. Next, mortality resulting from exposure is calculated by comparing the scenarios to a reference year. Detailed data on the geographical distribution of the population and health statistics at the district level were utilised. Finally, results are expressed in terms of avoided external costs, measured by the Value of a Life Year (VOLY) and the Value of Statistical Life (VSL). An improvement was noted in the health effects associated with NO₂, PM₁₀, and PM_2.5, while there was a slight deterioration concerning O₃. The most significant benefits identified in the AM scenario indicate a potential reduction of 4643 premature deaths, which is more than double that of the EM scenario. The primary benefits are linked to the decrease in NO₂ levels. Regarding social costs, considering the additional measures in package AM, the benefits could amount to approximately €1189 million (VOLY) and €20,574 million (VSL).</p> Graphical abstract <p></p>