Cllr | The air that you breathe…


The air that you breathe…

One of the first announcements of the new Mayor of London was that of improving air quality was going to be a prime public health issue for him to tackle. Catherine Heffernan says why this is so important.

A clean air mask is seen placed on the face of the Oliver Cronwell statute outside the Houses of Parliament by Greenpeace activists to protest against air pollution quality in London and cities across the UK.

The announcement was perhaps no surprise given that local and national media have extensively covered the recent World Health Organisation [WHO] report that pollution had risen by 8% in the past five years.

While fast growing cities in the Middle East, south east Asia and the western Pacific were highlighted as showing pollution levels at five to 10 times the recommended WHO levels, UK cities had average levels of air pollution above legal limits.

Port Talbot was purported to be the worst in the UK for dangerous particles. London didn’t fare too well either, with reports that its level of PM2.5 – that is, tiny particulates of pollution which are less than 2.5mm in diameter had contributed to an estimated 4,267 deaths in 2008. Another article reported that due to the large volume of nitrogen dioxide also present in the air, up to 10,000 deaths could be attributed to breathing in fumes.

These reports very much hit home at a recent public health executive meeting I attended where I learned that 29,000 excess deaths in the UK each year have a causal factor of poor air quality, from cars, buses and lorries. (Air pollution is predominantly caused by road traffic). Effects are over a lifetime rather than being immediate.  Moreover, one in four adults further deteriorate their air quality by smoking.

Air pollution does affect health, but while there are concerns about the quality of air in many urban areas, the air pollution in the UK does not rise to levels at which people need to make major changes to their daily lives to  avoid exposure, such as not going  outdoors or not exercising for fear of inhaling more pollutants. Certain people are at higher risk of being affected such as adults with heart conditions, adults and children with lung conditions and/or asthma. Itcan be difficult to predict when air pollutants increase but they can flocculate and people with asthma may notice that they require their medication. There is some evidence that asthma can be induced by living near busy junctions or roads with heavy traffic.

Reducing air pollution is already a common issues for discussions at local authority level. WHO talks about global reduction in carbon emissions, moving away from burning coal and fossils fuels, and shifting our transport system from hydrocarbons to electricity. The European Union passed the Ambient Air Directive in 2008 that set legally binding limits for all its EU members for concentrations in outdoor air of major particulate matter [PM10 and PM2.5] and nitrogen dioxide.

Apart from the direct health effects, these gases can combine to form an ozone of harmful gases that can then be transported great distances by weather systems. Within the UK, local authorities have statutory duties to monitor air quality in their areas. What’s new is that for the first time the effects of air pollution has become a priority among the public health issues we need to tackle in the 2010s. So what can be done by local health partnerships to minimize the impact of air quality on health?

Apart from regulatory interventions, community level and individual level interventions can help. Reducing the community’s carbon footprint is a good first step. Walking or cycling to work, car sharing, using and demanding better public transport are excellent initial steps to reduce our carbon emissions. Fewer cars on the road means less traffic and less fumes to breathe in. This is something where local councils have an important role to play, for example by working with schools to encourage parents to  reduce use of cars in the drop off and collection from schools by joining ‘walking buses’ or taking it in turns to drive them.

Working with local businesses to reduce their carbon footprint is important too. The biggest carbon footprint of the NHS is the travel its procurement takes – for example, transport of its medical supplies. Encouraging local production and purchasing will not only help boost the local economy but will help reduce time and distance of the productson the road, reducing emissions.

Other community initiatives include considering the effects of air pollution when looking at planning proposals for new buildings for example the positioning of new schools in relation to busy traffic and roads and the expected pollutant emissions from commercial buildings.

Catherine Heffernan is Principal Advisor for Early Years Commissioning, Immunisations and Vaccinations, NHS England


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