Researchers from the University of Melbourne issued the warning on Monday in an analysis of dangerous emissions from trucks and buses on Australian roads.
They say the issue could be addressed with transport reforms, including changes to heavy vehicle inspections and low-emission corridors to protect communities.
The finding comes months before changes to Australia's Heavy Vehicle National Law are expected to be introduced that could affect vehicle weights and the quality of fuel used in them.
The discussion paper, called The Unpriced Burden, analysed the impact of long-term exposure to nitrogen dioxide emitted from trucks and buses that weigh more than 4.5 tonnes.
It found the heavy vehicles contributed about one quarter of the nation's transport emissions and could raise the risk of several health conditions, with children among the most in danger.
Four medical issues that had a strong link with air pollution were included in the report's financial estimate, with adult cardiovascular hospital admissions making the biggest impact, followed by adult respiratory admissions and childhood asthma onset.
Premature deaths caused by air pollution made up the greatest share of air pollution's cost at $5.8 billion of the total, with the study estimating it caused the lost of more than 23,800 years of life.
While the report called for more comprehensive research in the field, co-author and University of Melbourne urban transport and public health professor Mark Stevenson said changes to reduce transport pollution could benefit the public.
"We call on the review panel for the Heavy Vehicle National Law to consider health impacts from truck emissions," he said.
Researchers recommended transport regulators establish low-emission corridors to reduce the public exposure, prioritise low and zero-emission vehicles adoption in urban areas, and move freight away from residential zones.
Periodic heavy vehicle inspections to measure exhaust particles and determine their roadworthiness could also reduce and track pollution, the report said.
The findings proved transport rules should be created with health outcomes in mind, Parents for Climate senior campaigner Laura Billings said.
"Families living near busy freight routes can't simply move their childcare or their homes and they shouldn't have to carry this burden alone," she said.
"This new paper confirms what parents and communities have been saying for years: kids are being exposed to dangerous pollution and we need solutions now."
Change to the Heavy Vehicle National Law will apply to all states and territories except Western Australia and the Northern Territory when they come into effect in mid-2026 and are expected to update fuel, safety and weight rules for heavy vehicles.
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