Twenty first century epidemiological publications on urban air pollution are confirming that inhalation of fine, airborne particulate matter (PM) has serious chronic human health effects and is a major cause of premature death worldwide. Recently updated recommendations by WHO identify three “Interim Targets” for the stepped reduction in PM levels within world cities in the quest to achieve an annual mean Air Quality Guideline (AQG) concentration of 20 μg/m³ for particles less than 10 microns in size (PM₁₀). In this paper we offer a perspective from Spain, a country with the longest record of reporting pollution data from large numbers of urban traffic sites to a central European database (AIRBASE). We can demonstrate that average annual PM concentrations at urban traffic monitoring stations in many European cities continue to be 50–100% above the WHO AQG, a situation exacerbated by high urban PM_2.5/10 ratios which indicate a dominance of finer, more deeply inhalable particles potentially more detrimental to health. Given that WHO has estimated in 2000 there were well over 250,000 premature deaths in Europe attributable to PM inhalation, such continuing high urban pollution levels are placing a huge burden on European medical resources.