Memorandum submitted by the Department of Health (AQ 31)

1. What action is the Government taking to reduce the impacts of poor air quality on health?

Government set out the actions it is taking in the 2007 Air Quality Strategy for the UK. The strategy recognised the impacts of poor air quality on health, in particular the average reduction of 7-8 months in life expectancy. Additional impacts on health were recognised. The Strategy also set out actions to improve air quality, and thereby reduce the impact on health. The actions are directed at the main source of the polluting activities. These actions include:

· implementing European Directives to reduce total emissions of certain pollutants; control industrial pollution and improve ambient air quality;

· reducing air pollution from other industrial sources through domestic legislation and permitting;

· implementing improvements in vehicles emission standards to reduce emissions from vehicles and measures to incentivise these standards;

· transport related measures to reduce congestion or encourage modal shift;

· other measures to provide advice and assistance to local authorities to implement action plan measures to reduce vehicle emissions through providing guidance and assistance for the introduction of low-emission zones, low-emission vehicles or retrofitment etc.

In addition to these, government also takes action to raise awareness of risks of poor air quality particularly to vulnerable groups. This is done through public information services on air pollution and providing air pollution alerts - see UK National Air Quality Archive http://www.airquality.co.uk/index.php.

Actions from other policy areas across government can also help improve air quality and health. For example, Defra is working with the Department of Energy and Climate Change (DECC) to highlight the linkages between air quality and climate change; and DH and DfT work to encourage physical activity via active travel which also has benefits to the environment and health.

2. There are a range of air quality standards for promoting good ambient air quality. These include EU Limit Values, EU Target Values, national objectives under the Environment Act 1995 for the nine main health threatening air pollutants, exposure reduction objectives from PM_2.5 and Pollution days. How do these standards contribute to action on public health?

All standards contribute to the improvement of public health as part of a regulatory regime designed to incentivise, or enforce, their observance. Standards identify levels of pollution that would be regarded as acceptable in terms of their effects on health. Objectives define the time scale over which achievement of standards is required. EU Limit Values are incorporated into UK legislation.

a) Which of them is most important in delivering healthy air quality and reducing exposure to air pollutants?

DH does not rank such standards in this manner. They each have their merits.

Of the air pollutants, concern is currently focused on particulate matter, ozone and nitrogen dioxide. Ambient concentrations of sulphur dioxide and carbon monoxide have, in general, fallen and their further reduction is no longer a priority from a health perspective. It is accepted that, for pollutants such as particles (whether monitored as PM₁₀ or PM_2.5[1]), nitrogen dioxide and ozone, it is remarkably difficult to define a threshold of effect at the population level. Their impact on health remains a matter of concern and thus achieving standards for these is important. Standards and objectives for these pollutants might therefore be regarded as especially important.

Perhaps more important than standards, per se, are exposure reduction objectives. At present this approach is only applied to particulate matter monitored as PM_2.5. The exposure reduction objective approach is intended to reduce levels of pollutants, progressively, by the application of cost-benefit tested policies. This progressive reduction reflects the fact that health benefits can be achieved by reducing pollution below a specific standard, as the epidemiological evidence does not appear to suggest a threshold. As levels of air pollutants fall and costs of further reduction rise (unless new technology or modal shifts occur) the importance of exposure reduction objectives will increase.

3. How have the health impacts of poor air quality, in terms of mortality and morbidity, been quantified?

Briefly, the Department of Health's Committee on the Medical Effects of Air Pollutants (COMEAP) defines concentration-response functions that are combined with information on pollution concentrations and baseline rates for the health outcome to derive an overall health impact. For long-term exposure, the pattern of deaths varies over time and everyone dies at some point, so the preferred approach is to use life-tables to give results in terms of life-years or life-expectancy. This reflects when people die rather than that people die, which is more appropriate. Further details on the approaches are given below.

Overall approach

The quantification of health effects resulting from exposure to air pollution in the UK uses concentration-response functions (i.e. coefficients) that link concentrations of pollutants with effects on health. The concentration-response functions used within the UK's Air Quality Strategy are those recommended by the Department of Health's Committee on the Medical Effects of Air Pollutants (COMEAP) (Department of Health, 1998; 2001; 2006; COMEAP, 2009) for particles, sulphur dioxide and ozone. The quantified health impacts of air pollution in the UK are then valued (Interdepartmental Group on Costs and Benefits (IGCB), i.e. Volume 3 of the Air Quality Strategy (2007)). A monetary cost-benefit analysis (CBA) forms a major part of the overall assessment of the measures set out in the Strategy. The monetary assessment of benefits is based on an impact-pathway approach that follows a logical progression from emissions through dispersion, concentration and exposure to quantification of impacts and their valuation. The benefits are then compared on a consistent basis with the costs associated with the implementation of each policy measure.

The central analysis presented in the Strategy includes health benefits where: (i) there was clear evidence linking the pollutant to the health outcome; (ii) all necessary information to allow quantification (e.g. baseline rates) was available; and, (iii) COMEAP had recommended a concentration-response coefficient. COMEAP has recommended coefficients for mortality (all-cause and from specific causes) and admissions to hospital (for respiratory and cardiovascular diseases). The Committee, via its quantification subgroup, is currently considering evidence pertaining to additional health outcomes, i.e. effects on chronic morbidity, e.g. Chronic Obstructive Pulmonary Disease (COPD) and Chronic Bronchitis, and will report on these in due course.

Why life-years or life-expectancy rather than numbers of deaths?

 

The Government is often asked 'What is the impact of air pollution on health in the UK'? This question is not as simple as it sounds. If the question was a question about the proportion of total deaths that may involve a contribution from long-term exposure to air pollution and there were no plans to take any action to change levels of pollution, then an estimate per year might be appropriate. However, this is not usually the intention of the question. The intention usually comes from a concern that air pollution ought to be reduced and that lives would be saved as a result. To represent the effects of long-term exposure to PM_2.5 the question was therefore approached by modelling a hypothetical removal of anthropogenic PM_2.5 in the year in question and in subsequent years.

 

It is important to realise that if PM_2.5 is reduced in any one year, then more people will survive into the following year. If the reduction is maintained into the following year, then there will again be a reduction in deaths but the net result will be a combination of three factors:

 

(i) the reduction in fine particles (which will reduce numbers of deaths)

(ii) the increased size of the population due to survivors from the previous year (larger populations give larger numbers of deaths)

(iii) the increased age of the population due to the survivors from the previous year being one year older (populations with a higher proportion of older people give larger numbers of deaths).

 

Due to the counteracting effects of factors (ii) and (iii), the reduction in the number of deaths in the second year will be less than in the first. This counteracting effect due to changes in population size and age, accumulates over time so that the reduction in numbers of deaths becomes progressively smaller. Eventually, there will actually be more deaths in the reduced pollution scenario because those in the scenario where pollution was not reduced would have already died. Without new births, the final outcome after about 100 years is that everyone in both scenarios will have died and the net difference in numbers of deaths will be zero.

 

The complex nature of the change in the pattern of deaths over time, and the fact that, in the long-term, everyone will die, leads to preferring total life years and average gain or loss of life-expectancy as the appropriate metric. These metrics represent the fact that PM_2.5 affects the timing of people's deaths not whether they die. The impacts of long-term exposure to fine particles are therefore calculated by using the coefficient recommended by COMEAP to predict changes in life-expectancy or life-years using lifetables[2].

 

a) What is the cost to the economy and to your department from these impacts?

Cost to the Economy

In 2007, the Air Quality Strategy estimated that the equivalent health costs arising from man-made PM_2.5 pollution in 2005 might be as much as £20 billion each year[3]. This estimate is based on life-years lost and the monetisation of this loss reflects best estimates of the UK population's "willingness to pay" to avoid these health impacts. Between 1990 and 2001 reducing the health and environmental impacts of air pollution through road transport policies and the electricity generating sector generated health benefits (again monetised based on "willingness to pay" to avoid such risks) ranging from £2.9billion to £18.4bn and £10.8bn to £50.6bn respectively[4].

Costs to the NHS

There will also be costs to the NHS from, for example, respiratory hospital admissions triggered by air pollution. These were not included in the estimate above as they represent only a tiny fraction of the above costs (given the rounding of the numbers quoted above, they would be unlikely to alter these rounded numbers). The Committee on the Medical Effects of Air Pollutants' quantification sub-group will be updating its 1998 report on the total impact of air pollution in the UK and this will include updated estimates of numbers of hospital admissions. NHS costs will be calculated subsequent to that.

b) How current is the research that has been used to quantify these impacts and costs?

COMEAP is currently undertaking a programme of work to update its recommendations regarding estimates of the effects of exposure to air pollution (both long- and short-term) on health. This work began in June 2005. As the effect of long-term exposure to particulate pollution on mortality is known to dominate the total impact of air pollution on health, the Committee began its current quantification work program by considering that evidence.

 

COMEAP published in June 2009 its report on Long-term Exposure to Air Pollution: Effect on Mortality. This report summarised the new evidence published since the Committee's last report on this topic in 2001. The report put forward quantitative estimates of the effects of long-term exposure to particulate pollution on mortality for application in the UK. The report suggests that air pollution has a greater effect on mortality in the UK than previously thought, with a 10 µg/m³ increase in fine particles (measured as PM_2.5) being associated with a 6% increase in risk of death from all-causes. Risk estimates (i.e. coefficients) linking fine particulate pollution with specific causes of death are also recommended.

 

This latest report by the Committee is based on a consideration of epidemiological and toxicological literature. A cut-off in early 2006 was adopted for published work which was considered in detail. That recent material could not be included was inevitable because much time needed to be devoted to considering evidence and distilling conclusions after the evidence-collection phase was completed.

 

The Committee's quantification work program will also include consideration of the literature pertaining to chronic morbidity effects, an area that has not been considered by COMEAP in the past. Furthermore the program will provide updated coefficients relating to the effects of short-term exposure to air pollutants. These will utilise more recent evidence.

 

c) What would trigger a re-assessment of these impacts and costs?

Significant qualitative changes in the literature would necessitate a re-assessment of the health impacts, and by extension, costs associated with air pollution. These changes pertain to a range of factors, including: (i) the size of the coefficients linking air pollution and health outcomes; (ii) the emergence of evidence on new health outcomes; (iii) an increase in the evidence on health outcomes not currently included in health impact assessments.

Of course, if it very tempting to incorporate new evidence (e.g. an individual study) as it emerges. However, COMEAP has advised against 'cherry picking' the evidence and that it is important to consider any new literature in the context of the wider body of evidence before drawing conclusions.

 

In several instances, although COMEAP might not have considered a recently published study, the Committee may have previously commented on the design of such studies. In those instances, it may not be necessary to request a view on recently published evidence.

The Department of Health and COMEAP are fully committed to updating the coefficients for use in assessing the impacts of air pollutants on health in the UK. This commitment is demonstrated in COMEAP's recommendation of a coefficient for cardiovascular hospital admissions in 2001 and in its current program of work, which began in June 2005, to update its recommendations regarding coefficients.

d) How do these costs and impacts compare to other public health concerns such as smoking, alcohol or obesity?

The Department of Health has commissioned work from the Institute of Occupational Medicine[5] to compare the benefits of a 10 µg/m³ reduction in PM_2.5 (elimination of man-made PM_2.5 in 2005), the elimination of motor vehicle traffic accidents and the elimination of exposure to passive smoking[6]. The figures for gains in life-expectancy in a birth cohort were 7-8 months on average for man-made PM_2.5; 1-3 months for traffic accidents and 2-3 months for passive smoking. The equivalent total gain in life years in England and Wales from 2005-2110 for the whole population including people born during that time has been estimated as 39,058,000 life-years for elimination of PM_2.5, 8,126,000 for elimination of traffic accidents and 13,194,000 for elimination of passive smoking. The greater impact of PM_2.5 is mainly due to the fact that everyone in the population is exposed to air pollution. Further work on comparative risks is planned.

 

Economic costs associated with obesity, alcohol misuse and tobacco use are set out below.

 

Obesity

The Foresight report, published in October 2007, estimated that problems attributable to excess weight in the UK already cost the wider economy in the region of £16 billion per year, and that this would rise to £50 billion per year by 2050 if the issue was left unchecked.

 

Obese and overweight individuals' place a significant burden on the NHS - direct costs are estimated to be £4.2 billion per year, and are forecast that these will more than double by 2050.

 

Alcohol

The cost of alcohol misuse to society is estimated to be between £12-£18billion, with cost to the health service estimated at around £2.7billion per annum, £645.7million of this is estimated to be A&E costs.

 

Smoking

The current level of tobacco use is estimated to cost the NHS around £2.7billion every year (The cost of smoking to the NHS. Action on Smoking and Health (ASH) 2008). The NHS Information Centre calculates that in England in 2007/08 there were approximately 440,000 hospital admissions of adults aged 35 and over with a primary diagnosis of a disease that was caused by smoking. Recent research estimates that the decline in the number of smokers over the past decade has led to current annual savings to the NHS of around £380 million.

 

Tobacco use also has a significant impact on the wider economy - through lost productivity and other costs. Smokers take an average of 8 days a year more sick leave than do non-smokers and the current level of smoking costs the economy about £2.5billion each year in terms of sick leave and lost productivity alone.

 

4. What is being done to make all government departments understand the effects on health of poor air quality and it associated costs?

Defra leads a high-level officials group on air quality which brings together all major departments with a concern for air quality, including DH/HPA, DfT, CLG, EA, Treasury and other departments. Regular meetings are held with other government departments to ensure air quality risks and impacts are taken into account.

5. What is being done to make local authorities understand the effects on health of poor air quality and it associated costs?

Local authorities are required to monitor air quality at local level and where necessary to take steps to improve air quality. They are provided with guidance on this which includes guidance on the health impacts of poor air quality[7]. Guidance is also provided on assessing the costs of poor air quality and measures to improve air quality. Defra, DfT and HPA have worked together to raise awareness of health risks at the local level through speaking at local authority events and also through organising events to promote these issues.

Most recently (30^th November 2009) Jim Fitzpatrick, Defra's Minister of State for Environment, and Sadiq Khan, Minister of State for Transport, spoke at a joint Defra, DfT and LACORS (Local Authorities Coordinators of Regulatory Services) summit on Air Quality[8] and shared the platform with a speaker from the HPA. This event was attended by a cross-section of local authorities, government departments and external stakeholders. The health impact of poor air quality was a key theme of the Summit.

The Chemical Hazards and Poisons Report[9], which has contained a series of articles on air pollution and health, is published two-three times a year for staff in the Health Protection Agency, National Health Service, government departments, local authorities and allied organisations, as well as first line responders such as fire and ambulance services. LACORS are also sent a copy and provide a link to the report on their website.

This report performs an important role in sharing high-quality advice and new research with professional colleagues. Articles cover a variety of disciplines including environmental and public health science and policy.

The Chemical Hazards and Poisons Division of the HPA also provides training courses on environmental chemicals, including air pollutants[10]. These are available to people from local authorities.

Speakers from the HPA and COMEAP have lectured on air pollution and health at many conferences where local authority representatives have been in the audience. Examples include the Investigation of Air Pollution Standing Conference and conferences organised by Environment Protection UK. DH/HPA attend Defra's Air Quality Forum for stakeholders, including those from local government and the GLA, in order to respond to any questions on air pollution and health.

6. What responsibilities do strategic health authorities or primary care trusts have to consider air quality?

Primary Care Trusts (PCTs) are NHS bodies, performance managed by Strategic Health Authorities. As legally autonomous bodies they are responsible for complying with air quality regulations and are regulated, in this matter, by the Environment Agency. All NHS organisations, including PCTs, are responsible for reducing their own carbon emissions. PCTs work with Local Authorities through the Local Area Agreement process in to address issues, that may include matters that impact on air quality, that affect local communities.

The NHS Carbon Reduction Strategy for England, published in January 2009 by the NHS Sustainable Development Unit, recognises that improved air quality is a benefit both for patients and the wider population. The Strategy recognises that active travel, such as more walking and cycling, leads to a reduced risk of obesity, diabetes, heart disease, and mild mental illness, as well as reducing road traffic injuries and deaths, and improving air quality.

The Health Protection Agency (HPA) is a statutory consultee on IPPC (Integrated Pollution Prevention and Control) applications and consults the relevant PCTs on applications in their area.

7. What is being done to make the public more aware of the effects of poor air quality on health?

There are a wide range of actions undertaken by government and the UK's advisory Committee on the Medical Effects of Air Pollutants (COMEAP) to communicate the health effects of air pollutants to the public. The initiatives are targeted at varying groups in the population.

· UK National Air Quality Archive and the Air Pollution Information Service

This website provides users with detailed information on levels of several air pollutants in the UK. It includes both daily and historical information on air quality for varying locations in the UK. In addition, information on the causes and effects of air pollution is provided. The Air Pollution Information Service is a subset of the Air Quality Archive. The Archive is maintained and hosted by AEA on behalf of Defra and the Devolved Administrations.

The cost of the communications contract which covers the UK National Air Quality Archive and the Air Pollution Information Service for the financial year 2009/10 is £157,557.  This includes the hosting of the national air quality data and the presentation of information on the Archive.  There is also an air pollution forecasting contract of value £105,508 for the financial year 2009/10, the information from which is used in the air quality alerts system.

Available at: http://www.airquality.co.uk/ and http://www.airquality.co.uk/what_are_the_effects.php (accessed January 2010).

· COMEAP's website

The Committee's website provides all its statements and reports, in addition to Secretariat papers, on various topics. These include both technical scientific material and guidance and advice targeted at members of the public.

The Committee is currently developing a new website which will be made available in 2010. The minutes of previous meetings (http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_109026.pdf) provide details of discussions of the specification for the new website. The specification includes items such as an 'Easy Guide' which seeks to provide members of the public with user-friendly, non-technical information and advice on the health effects of exposure to air pollution.

Current website: http://www.dh.gov.uk/ab/comeap/index.htm (accessed February 2010).

· Initiatives on Carbon Monoxide (CO)

These initiatives are all targeted at members of the public.

- Carbon Monoxide: are you at risk Leaflet

Available at: http://www.dh.gov.uk/en/publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/dh_090124 (accessed February 2010).

 

- Press releases raising awareness of Carbon monoxide awareness week - 2007, 2008, 2009

 

- Press releases on the Dangers of CO whilst holidaying - 2008, 2009

 

All press releases had no associated publication costs.

 

- Inclusion of information on CO in the 'Keep Warm Keep Well' booklets.

Target audience: families, the elderly, people with disabilities. Available at: http://keepwarmkeepwell.direct.gov.uk/index.html (accessed February 2010).

 

- Information on CO given on the website of the Health Protection Agency:

http://www.hpa.org.uk/HPA/Topics/ChemicalsAndPoisons/CompendiumOfChemicalHazards/1190384159835/ (accessed February 2010).

 

· Air Pollution and Health Information Pack (2003)

 

This pack provides information on both indoor and outdoor air quality issues and is available from the Department of Health. It includes a series of fact sheets giving details of contact organisations, helplines, websites, official reports and other materials. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005207?ssSourceSiteId=ab (accessed January 2010).

 

· Air Pollution - what it means for your health? (2002)

 

This leaflet was designed to be an easy guide to the Air Pollution Information Service which provides information and alerts for the general public and for vulnerable groups in particular about high-pollution episodes and risks. It was published by Defra in partnership with the Department of Health, the Scottish Executive, and the Department of Environment in Northern Ireland. The text of the leaflet is available as a series of web pages and also as a PDF document:

http://www.defra.gov.uk/environment/quality/air/airquality/publications/airpoll/index.htm (accessed January 2010).

 

· The Health Effects of Air Pollutants: Advice from the Committee on the Medical Effects of Air Pollutants (2000)

 

COMEAP published a statement in 2000 giving advice to members of the public on the health effects of air pollutants. Available at: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_096837.pdf (accessed January 2010).

 

· COMEAP statement on banding of air quality (1998)

 

In the UK most air pollution information services use the index and banding system approved by the Committee on Medical Effects of Air Pollutants (COMEAP). The system uses a 1-10 index divided into four bands to provide more detail about air pollution levels in a simple way, similar to the sun index or pollen index. The overall air pollution index for a site or region is calculated from the highest concentration of five pollutants.

The system of Air Quality Banding used by the Department of the Environment (now Defra) since 1990 takes into account the Air Quality Standards, recommended by the Expert Panel on Air Quality Standards (EPAQS) outlined in the Air Quality Strategy for the UK. The system was revised in 1998 and is intended to provide guidance as to the effects of air pollutants on health and is linked with health advice provided via the Air Quality Helpline. Revision of the banding system has been based on advice from the Department of Health and its Committee on the Medical Effects of Air Pollutants (COMEAP).

Available at: http://www.airquality.co.uk/standards.php#band and http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_108460.pdf (accessed January 2010).

 

The Standards Advisory Subgroup of COMEAP (i.e. former EPAQS members) is currently reviewing the UK's bandings of Air Quality and will report on this in 2010.

 

· The Department of Health (DH) Handbook on Air Pollution and Health (1997)

 

COMEAP published the DH Handbook on Air Pollution and Health. This book provided an introductory, non-technical account of the effects of air pollution on health aimed primarily at students. The information provided is based on the detailed reports prepared by the Department of Health's advisory group on the Medical Aspects of Air Pollution Episodes (MAAPE) and COMEAP. It was hoped that the handbook would make available, more widely, the work of these groups and provide a ready source of advice and reference on the effects of air pollution.

 

COMEAP, in conjunction with its Secretariat, provided by the Health Protection Agency, is currently working to produce a new version of the Handbook on Air Pollution and Health. A prospectus (http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_096802.pdf, accessed January 2010) was presented by the Secretariat to COMEAP members at its meeting in October 2008. Minutes of that meeting are available on its website: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_109042.pdf (accessed January 2010).

 

The current Handbook is available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005373?ssSourceSiteId=ab (accessed January 2010).

 

Further work is currently ongoing to update the advice provided in many of the initiatives set out above. These include: (i) the UK's banding system on air quality, and (ii) the handbook on air pollution and health.

 

Where possible, costs associated with these initiatives have been supplied. These are mainly costs associated with publication/production. Costs pertaining to staff time are substantial but difficult to estimate.

 

At the local level a number of local authorities in London and the South East mainly provide text messaging alert services (Air Text or Air Alerts). These are aimed at persons with medical conditions which might be made worse by poor air quality or elevated pollutant levels, and alert them when such episodes are imminent or taking place so that they can take action to carry medication or to stay indoors etc.

In addition many local authorities have received support from Defra's air quality grant fund to produce locally-focused websites and information services on air quality in their area. Notable examples of this are the Care4air website in South Yorkshire (http://www.care4air.org/). In addition to providing advice for vulnerable groups during pollution episodes these websites also provide advice on actions individuals can take to improve air quality including smoother driving techniques; purchasing choices; controlling domestic bonfires etc.

a) How much is being spent on this?

Where possible, costs associated with the initiatives set out above have been supplied. These are mainly costs associated with publication/production. Costs pertaining to staff time are substantial but difficult to estimate since the provision of advice, both technical and non-technical, is part of DH/HPA core business.

 

Defra provides grant funding direct to local authorities to implement measures to improve air quality including public awareness and promotion activities. The total amount of air quality grant available each year is approximately £2.3million and around a third of this is utilised for awareness raising purposes by local authorities including developing local authority websites on air pollution and air quality, conferences and other action to raise awareness.

b) How does this cost compare to other public health campaigns, on obesity, alcohol and smoking for example?

DH public health campaigns focus on what individuals can do to improve their own health. Whilst individuals can do little to reduce the amount of, or exposure to air pollution, they can do a great deal to improve and protect their own health, by heeding the advice and information given in our campaigns on diet, exercise, alcohol and smoking. The reason for tackling air pollution lies in its adverse health impacts and the action required lies primarily in appropriate regulation of polluting activities.

 

Obesity

"Healthy Weight, Healthy Lives: a cross-government strategy for England" set out the Government's strategy to tackle obesity. Change4Life is the social marketing element of it which aims to inspire a societal movement through which all parts of society can play a part in improving children's diet and activity levels. We have spent £50million on the C4L campaign to date, out of an overall budget of £75million over three years. The campaign has been very successful both in terms of achieving behaviour change (over a million mums are already claiming to have made changes to their children's diet or activity levels as a result of C4L) and also value for money.

 

Alcohol

A new national advertising campaign "Alcohol Effects", was launched in January backed by major health charities that will warn drinkers of the unseen health damage caused by regularly drinking more than the NHS advises. The total campaign spend is £6.85m

 

This follows on from the Department's "Know Your Limits" campaign that was launched in 2008, to raise the publics' awareness of units. The campaign had an overall budget of £6m in 2008/09.

 

Smoking

In 2008/09 £23.4million was spent on advertising in relation to smoking cessation.

c) Are these campaigns on public awareness linked to any other programmes or policies aimed at changing behaviour?

The main synergies are with walking and cycling and "Be Active, Be Healthy" and active and sustainable transport policies.

 

In 2009 DfT produced a leaflet and posters, co-branded with Change4Life and distributed via local authorities, promoting walking and cycling as sustainable forms of transport. In addition, Change4Life has developed toolkits for use by Change4Life local supporters to support our Bike4Life and Walk4Life sub-brands (available as hard copy or for download from the Change4Life website).

 

These toolkits are to help local supporters promote cycling and walking amongst families in their communities, and contain materials such as activity sheets that can be given directly to families with practical advice on getting up and about and more active by foot or on their bikes. The toolkits talk explicitly about walking and cycling as alternative forms of transport (to save money and help the environment) as well as leisure activities.

 

Our national partners, both commercial and NGO, continue to support Bike4Life and Walk4Life with co-branded Change4Life activity, such as Walk on Wednesdays (to encourage families to walk to school at least once a week) run by Living Streets, and the Skyride (a mass participation "come and try" city centre cycle event) owned and run by Sky.

 

The 'Walk Once a Week' scheme run by the Living Streets charity encourages families to ditch the car and walk their children to school at least once a week. In addition to encouraging increased activity and reducing obesity the scheme will help to reduce congestion, pollution and carbon. In January it was announced by Public Health Minister Gillian Merron that the scheme will receive an £800,000 boost from the Government.

 

The Committee on the Medical Effects of Air Pollutants published a statement on their website providing health advice on the effects of air pollutants[11]. The statement advised members of the public on the benefits of eating fresh fruit and vegetables as well as ways that individuals could 'do their bit' to reduce air pollution by using their cars less, shared use of vehicles and by walking and cycling.

A report by the Department of Health and the Health Protection Agency 'Health effects of climate change in the UK 2008: an update of the Department of Health report 2001/2002' has a chapter on 'The health impact of climate change due to changes in air pollution'.

The Act on CO₂ campaign focuses on giving advice on carbon emissions, but it does include some advice on air pollutants and the important choice between petrol and diesel cars. This recommends that if you spend more time driving in town, where air quality is a greater consideration, then a petrol engine may currently be more suitable."

Link here - http://actonco2.direct.gov.uk/actonco2/home/what-you-can-do/buying-your-car.html

 

References

 

Committee on the Medical Effects of Air Pollutants (COMEAP) (2009). Long-term Exposure to Air Pollution: Effect on Mortality. Available at:

http://www.dh.gov.uk/ab/COMEAP/DH_108151 (accessed February 2010).

 

Department for the Environment Food and Rural Affairs (Defra) (2007) The Air

Quality Strategy for England, Scotland, Wales and Northern Ireland. Available at: http://www.defra.gov.uk/environment/quality/air/airquality/strategy/index.htm

(accessed February 2010).

 

Department of Health (2006) Committee on the Medical Effects of Air Pollutants. Interim Statement on the Quantification of the Effects of Air Pollutants on Health in the UK, January 2006. Available at http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_096803.pdf (accessed February 2010).

 

Department of Health (2001) Committee on the Medical Effects of Air Pollutants. Statement and Report on Long Term Effects of Particles on Mortality. London: The Stationery Office. Available at: http://www.dh.gov.uk/ab/COMEAP/DH_108596 (accessed February 2010).

 

Department of Health (2001) Committee on the Medical Effects of Air Pollutants. Short-term Associations between Ambient Particles and Admissions to Hospital for Cardiovascular Disorders. Available at: http://www.dh.gov.uk/ab/COMEAP/DH_108595 (accessed February 2010).

 

Department of Health (1998) Committee on the Medical Effects of Air Pollutants. The Quantification of the Effects of Air Pollution on Health in the United Kingdom. London: The Stationery Office. Available at:

http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_108458.pdf (accessed February 2010).

 

17 February 2010

 

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[1] Particulate matter (also known as PM, particulates or particulate pollution) is a term used to describe a mixture of solid particles and liquid droplets in the air which can be both man made and naturally occurring. Some examples include dust, ash, pollen, sea spray and smoke. One major source of particulate matter is automobiles (due to the combustion of fossil fuels by their engines). Particulate matter varies in size (i.e. the diameter or width of the particle). PM_2.5 means the mass per cubic metre of air of individual particles with a size (diameter) generally less than 2.5 micrometers. PM_2.5 is also known as fine particulate matter. (2.5 micrometres is one 400^th of a millimetre.) Research has shown that different sizes of PM are associated with different health effects. It has also shown that the smaller/finer particles have a greater potential to cause harmful health effects as they are able to penetrate deep into the lung.

[2] A lifetable is a technique used to summarise the patterns of survival in populations. It uses age-specific death rates, derived from numbers of deaths in each age group and mid-year population sizes for each group. Standard lifetable calculations compute survival rates at different ages, either from birth or from a specific achieved age. From these, the total numbers of life years lived at each age can be derived, as can average life expectancy.

(Taken from IGCB - Air Quality Strategy, Volume 3, 2007).

[3] http://www.defra.gov.uk/environment/quality/air/airquality/publications/stratreview-analysis/index.htm (Chapter 2)

[4] http://www.defra.gov.uk/environment/quality/air/airquality/publications/stratevaluation/index.htm

[5] http://www.iom-world.org/pubs/IOM_TM0601.pdf

[6] MVTAs based on 1999 lifetables; exposure to passive smoking based on Jamrozik (2005) BMJ 330(7495): 812.

[7] See http://www.defra.gov.uk/environment/quality/air/airquality/local/index.htm and http://www.defra.gov.uk/environment/quality/air/airquality/local/guidance/index.htm

[8] http://www.lacors.gov.uk/lacors/NewsArticleDetails.aspx?id=22650

[9]http://www.hpa.org.uk/HPA/Publications/ChemicalsPoisons/ChemicalHazardsAndPoisonsReports/

[10]http://www.hpa.org.uk/HPA/EventsProfessionalTraining/ChemicalsTraining/ChemicalsTrainingCourses/

[11] http://www.dh.gov.uk/ab/COMEAP/DH_108448 (follow link for 'Advice')