Dr Frank J Kelly, Professor of Environmental Health, King’s College London
Mar 12, 2020
Breathing is one of those things that we take for granted, that is until we can’t. I distinctly remember two experiences that prompted me to appreciate how indispensable this bodily function is. The first was when I was ‘winded’ (several times!) on the rugby field. The second was when learning to swim. It is only when we are deprived of precious air that we are reminded that it really is a prerequisite for life. It is not of course merely the process of moving air into our body and removing waste gases that is important. What is in the air that we breathe is also crucial. Breathing polluted air, especially in urban areas, is now appreciated to impact our health in numerous ways and transpires to be the greatest environmental challenge we now face.
Air pollution has a very significant impact on the public’s health. In England, 5% of adult deaths in 2015 were attributable to outdoor air pollution, primarily due to an increased risk of cardiovascular and respiratory illness as well as lung cancer. Even short-term (day-to-day) exposure can worsen respiratory and cardiovascular conditions, trigger asthma attacks and bring about premature deaths. Of particular concern are the vulnerable segments of the population, such as children and the elderly, who are more susceptible to the effects of air pollution.
Given the clear evidence for the effects that air pollution has on our health, we desperately need interventions to improve air quality. These can vary to fit the need. For example, interventions can be designed to reduce emissions of air pollution at source, lower concentrations of air pollutants once emitted, or lessen peoples’ exposure to air pollution. Although we spend most of our time indoors, poor indoor air quality can contribute significantly to total exposure to air pollution and the consequent health burden.
As pollutants emitted in populated areas, or areas with a high proportion of vulnerable segments of the population, are especially harmful to public health they should be prioritised in intervention efforts.
There is a dearth of evidence about the effectiveness of interventions on air quality and public health. This is because few of the attempted interventions include an assessment of their impact on air quality, and even fewer consider the impact on public health.
King’s recent research of air quality interventions in inner-city London found the strongest evidence is for solutions which reduce emissions at source, but many need action on a large scale and political support. We also saw that not all interventions reduce both particulate matter (PM) and nitrogen dioxide (NO2) – in fact, some may reduce one but increase the other – and that each solution is likely to only have a small impact so many interventions are needed at once to have an impact.
The much-needed additional work in this area requires funding that is in addition to that required for the intervention itself and often this support is simply not available.
This is where the cavalry comes in. Guy’s and St Thomas’ Charity, whose remit it is to tackle urban health challenges, has decided to commit considerable resource and time to address the problems outlined above. It is launching a new ten-year programme addressing the health effects of air pollution. With an appreciation that in inner-city areas everyone is exposed to air pollution, they will focus their efforts on groups that are particularly susceptible to the health effects of poor air quality.
Appreciating that interventions (of all types) are needed to solve this challenge, the Charity will provide funding for interventions to be thoroughly monitored and assessed. Proving that public health has been improved is a complicated and costly process, but it is the only way to guarantee that an intervention has been effective and is worthy of being implemented. In order to monitor, assess and enact an effective air quality intervention in a specific area, a localised understanding of emission sources, atmospheric distribution of pollutants, and exposure hotspots is essential. The largest positive outcome in reducing the health burden of air pollution will be achieved by lowering the exposure of vulnerable segments of the population. To this end, the Charity is appropriately encouraging interventions that target emission sources around vulnerable people centres, such as schools, hospitals and nurseries.
12 March, 2020
How can we protect children’s health from air pollution? Larissa Lockwood from Global Action Plan shares the simple steps we can all take to help our families avoid toxic air and cut down on the pollution we emit.
12 March, 2020
How does toxic air worsen the health of people with heart conditions? Jacob West from the British Heart Foundation shares how the time is now to clean up our dirty air and what we can all do to demand change for clean air.