2Health impacts
The health impacts of poor air quality
5.Poor air quality has been classified as the largest environmental risk to public health in the UK,8 and was described by the World Health Organization as “a public health emergency”.9 The total burden of outdoor air pollution has been estimated to be equal to 40,000 early deaths each year, though this figure is currently under review.10 We were told this figure would make air pollution the second largest cause of avoidable mortality after smoking.11 Air pollution also has a substantial impact on the environment. In 2014 over 90% of sensitive wildlife habitats in England, Northern Ireland and Wales had excessive nitrogen levels.12 Under the internationally adopted Sustainable Development Goals (3.9 and 11.6) the UK is committed to substantially reducing by 2030:
a)the number of deaths and illnesses linked to air pollution; and
b)the adverse impacts of cities on air quality and the environment.13
The current and future governments will need to take concerted action if these goals are to be met.
6.The Royal College of Physicians told us that the health damage caused by air pollution occurs across a lifetime, beginning with a baby’s first weeks in the womb and continuing right through to childhood, adolescence, adulthood and old age. In terms of specific impacts, we heard that:
The heart, brain, hormone systems and immunity can all be harmed by air pollution. Research is also pointing towards effects on growth, intelligence, and development of the brain and coordination. Both long-term exposure and acute air pollution episodes are linked to poor health.14
7.Long-term exposure to outdoor air pollution is associated with:
- premature birth;
- reduction in foetal growth and low birth weight;
- increased risk of death during the first year of life, particularly from respiratory illnesses;
- exacerbating the effects of respiratory infections in young children;
- affecting the normal growth of lung function during childhood;
- cardiovascular diseases (heart attacks, hypertension and stoke);
- chronic obstructive pulmonary disease, pneumonia, accelerated decline in lung function and lung cancer in adulthood;
- development of new onset asthma as well as exacerbating asthma in those who already live with the condition;
- impaired cognition, dementia and other neurodegenerative disorders; and
- Type II diabetes, obesity and metabolic syndrome.15
8.Our evidence indicated that, whilst poor air quality is harmful to everyone, some people suffer more. Children and older people are particularly vulnerable, as are people with pre-existing health conditions including asthma, chronic obstructive pulmonary disease and coronary artery disease.16 Air pollution can also produce health inequality. The Association of Directors of Public Health highlighted research showing that in England and Wales, those living in poverty were more likely to suffer from traffic-related air pollution than more affluent households. In 2010, 433 of the 1777 primary schools in London were in areas with average NO2 concentrations exceeding EU limits. Of these, 82% were in deprived areas.17
9.The health impacts of poor air quality also have economic consequences, though estimates vary. A report from Defra concluded the costs arising from just particulate air pollution amounted to £16 billion per year.18 The Royal College of Physicians (RCP) and Royal College of Paediatrics and Child Health found that:
The health problems resulting from exposure to air pollution have a high cost to people who suffer from illness and premature death, to our health services and to business. In the UK, these costs add up to more than £20 billion every year.19
10.The main air pollutants of current concern include nitrogen oxides (NOx), particulate matter (PM), and ozone (O3). Professor Holgate, special advisor to the RCP, told us that longitudinal studies had “absolutely confirmed that NO2 is contributing” to adverse health effects.20 He noted that people are generally exposed to a range of pollutants and that it can be difficult to determine which individual pollutant is responsible for a particular health issue.21
11.Air pollution is a national health emergency, resulting in tens of thousands of early deaths and costing billions of pounds in health impacts each year. It is unacceptable that successive governments have failed to protect the public from poisonous air. A step change in Government policy is now needed to address this.
Putting health at the centre of air quality policy
12.Professor Holgate told us that air quality problems need to be considered in tandem with other health issues. Active travel, for example, has considerable health benefits beyond improving air quality, such as increasing physical activity levels and reducing obesity.22 The British Lung Foundation also highlighted the link between policies to improve air quality, and other health and social benefits:
Local authorities should work with national public health bodies and local public health teams so that policies tackle a multitude of public health goals–such as improving lung health, increasing physical activity, reducing obesity and addressing health inequalities. Deprived communities are more likely to be exposed to toxic pollution levels, yet have less access to public transport, cycle paths, walking routes and green space. Reducing air pollution and promoting active travel will help create greener, safer and healthier communities.23
As the British Heart Foundation pointed out, whilst air quality has a major impact on health, responsibility for the issue and many of the policy levers required to improve it sit outside the Department of Health’s remit. They argued that the health community needed to play a central role in ensuring health outcomes are appropriately considered in local action and across central Government policies.24
13.We heard however that the health community has not been sufficiently engaged in the air quality debate:
Maggie Throup: Do you think we are missing an opportunity here? Public health is now being devolved to local government, but the focus is still on the transport side of it, rather than the health side of it. If we had more emphasis on public health at a local authority level, we would be addressing the situation.
Professor Holgate: I could not agree with you more. Absolutely spot on [ … ] the NHS should be taking a lead here, and it is not. If people walk into a general practice, for example, they should see evidence of where the public can get information about air pollution, what to do about it and so on. The health community—if I can use that as a broad descriptor—are not engaged in this discussion, and they need to be for all the reasons you have just set out. If the health people stood up and started to demand the changes from their local authorities, things would happen.25
14.Air pollution has a significant impact on health, but we heard that the health community has not been sufficiently engaged in the air quality debate. The health sector needs to play a stronger, more visible, and more vocal role in tackling air quality. This should occur at a national level, through the Department of Health and Social Care and Public Health England; at a local level, through local authority Directors of Public Health; and through NHS organisations.
Public health campaign
15.Despite its clear impact on health, not enough has been done to clearly communicate the risks of poor air quality to the public. The British Lung Foundation said there was an urgent need for a public awareness campaign targeted at vulnerable groups to inform people of the dangers of air pollution and encourage effective behaviour changes to reduce exposure. They highlighted the fact that most face masks do not protect people effectively from pollution, and that most drivers were unaware they may be exposed to far higher amounts of pollution inside a vehicle than outside of it.26 We were surprised to learn that air pollution levels may be up to ten times higher inside a vehicle than on the street.27 Professor Holgate noted that that choosing active transport such as walking or cycling offers the tripartite benefit of improving health through increased physical activity; reducing overall pollution levels through fewer car journeys; and not being exposed to high levels of pollution inside a vehicle.28
16.Other stakeholders noted that the avoidance of engine idling was an additional simple step people could take to improve air quality,29 particularly outside schools, hospitals and care homes, where people are especially vulnerable to poor air quality.30
17.Professor Holgate highlighted the need for better information provision, and said that information about air pollution and what to do about it should be more easily accessible in GP surgeries.31 Our written evidence called for air quality to be visibly monitored and measured outside schools, as well as other public areas including hospitals, parks and care homes, particularly in polluted areas.32
18.The debate on air quality is too often cast as a war against motorists, when in fact regular car users are among the worst affected. Pollution levels are often higher inside cars than on the street, meaning a switch to active transport offers dual health benefits. There is an urgent need for a national information campaign providing clear messages about the risks of air pollution and the actions people can take. This campaign should be run by Public Health England, and implemented no later than September 2018.
19.Better information about air quality is also needed at a local level. We recommend that air pollution levels should be monitored at key spots within local communities–for example near schools, hospitals and care homes–and the results clearly communicated to local residents and service users. This will not only serve to reinforce the value of measures such as anti-idling campaigns, but will also provide the public with the information they need to press their elected representatives for further changes at a local authority level.
8 Defra and Public Health England, Air Quality, March 2017, p.19
9 The Guardian, Shock figures to reveal deadly toll of global air pollution, 16 January 2016
10 Q11
11 Qq11–12
13 United Nations, Sustainable Development Goals
18 Defra, Valuing the Overall Impacts of Air Pollution, 2010, p.1
19 Royal College of Physicians and Royal College of Paediatrics and Child Health, Every breath we take, February 2016, p.xiii
20 Q5
21 Q11
22 Q18
25 Q33
27 Qq13–14
28 Q15, Q20
31 Q33
Published: 15 March 2018