Growing infrastructure needs worldwide have created an unprecedented demand for concrete. Its production results in high GHG emissions, the primary focus of research and mitigation strategies in the sector. However, emissions of air pollutants and the economic burden of resultant health consequences are not yet known. Here, we show worldwide concrete production contributes approximately 7.8% of nitrogen oxide emissions, 4.8% of sulfur oxide emissions, 5.2% of particulate matter emissions smaller than 10 microns and 6.4% of particulate emissions smaller than 2.5 microns. Economic valuation of the damages from these and GHG emissions total ~75% of the cement and concrete industry current value. Commonly discussed GHG emissions mitigation strategies can halve these costs but, under certain scenarios, may increase local air pollution and associated health damages. These findings highlight potential synergies and trade-offs between GHG mitigation and improvements in local air quality, with implications for the political feasibility of different mitigation options.