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In a landmark case in 2020 a coroner ruled that air pollution was a cause of a girl’s death. Ella Kissi-Debrah, a nine-year-old from south London, had grown up exposed to dangerous levels of pollution that exacerbated her acute form of asthma. She died in 2013.
“The whole of Ella’s life was lived in close proximity to highly polluting roads,” the coroner said at the time. “I have no difficulty in concluding that her personal exposure to nitrogen dioxide and PM [particulate matter] was very high.”
According to the NHS, around 30 per cent of preventable deaths in England are due to non-communicable diseases specifically connected to air pollution. And, over time, higher than recommended levels of PM have been shown to result in more people with lung and heart conditions being admitted to hospital. There’s also evidence that long-term exposure to PM can contribute to the development of lung cancer and possibly asthma. Research is also emerging around the links between pollution and dementia, mental ill health, severe cases of Covid-19, and problems in pregnancy and childbirth.
In fact, in 2019 Public Health England – a government agency dissolved in 2021 – declared that air pollution was “the biggest environmental threat to health in the UK”. It is not only the UK, however; the World Health Organisation (WHO) has referred to dirty air as “the new tobacco”. “No one, rich or poor, can escape air pollution. It is a silent public health emergency,” Dr Tedros Adhanom Ghebreyesus, the WHO’s director-general, said in 2018.
And yet, today, most people in the UK live in areas where pollutant levels exceed legal limits recommended by the WHO. A mapping project by the non-profit group the Central Office of Public Interest (COPI) and Imperial College London recently found that levels of at least one of three major pollutants – PM2.5, PM10, and nitrogen dioxide – go beyond WHO limits at 97 per cent of UK homes.
Looking at fine particulate matter (PM2.5) specifically, more than 70 per cent of towns and cities in the UK have unsafe levels, according to WHO estimates. PM is tiny particles of pollution smaller than the width of a human hair. “These tiny particles are the most dangerous for our health as they’re able to penetrate deep into our lungs, and potentially even into our bloodstream and our brains,” Unicef UK has said.
This exacerbates health inequalities. “Although air pollution affects everyone, we know that people in the poorest social class can have up to a 60 per cent higher prevalence for non-communicable diseases than those in the richest, and up to a 30 percent increased severity,” says James Bevan, national policy and partnerships manager at Boehringer Ingelheim, the pharmaceutical company.
This is as much of a problem for healthcare facilities, where people suffering from exposure to air pollution might seek help, as it is for private homes. According to the WHO and the British Lung Foundation, one in three GP practices and one in four hospitals in England are in areas that breach WHO guidance levels for PM2.5, which is one of the most common and dangerous pollutants.
There is an economic price to pay for inaction on pollution, too. Public Health England estimated that the health and social care costs of poor air quality in England could be £18.6bn by 2035.
To find a solution to this urgent public health crisis, Newcastle upon Tyne Hospitals NHS Foundation Trust, the environmental charity Global Action Plan and the pharmaceutical company Boehringer Ingelheim (BI) joined forces this year to support all 42 Integrated Care Systems (ICSs) in England – partnerships of organisations that run health and care services in an area – to become “Clean Air Champions”, actively making air quality improvements around hospitals and health centres in their communities.
In April the group launched the Integrated Care for Cleaner Air initiative, alongside the Levers for Change report, which details the findings from a pilot project with North East and North Cumbria ICS.
BI has “a profound sense of responsibility for the communities in which we operate”, explains Jacqui Macdonald, the company’s sustainability lead. “It’s the right thing to do to look upstream and think about how we can prevent their health from deteriorating in the first place.”
All ICSs were expected to submit Green Plans ahead of their launch. While measures to tackle air pollution had been incorporated by many, there was no official requirement on them to do so. Since the launch of the initiative, six ICSs have signed up to the Integrated Care for Cleaner Air Initiative. BI’s ambition, says Macdonald, is that all 42 ICSs will have declared themselves Clean Air Champions by 2025.
Claire Igoe, interim net-zero programme director for Greater Manchester Integrated Care, is one of the early adopters of the ICS Clean Air Framework, which BI and its partners have made free to access. With poor air quality contributing to 1,200 deaths a year in Greater Manchester, and the area having one of the country’s highest rates for emergency admissions of children with lower respiratory tract infections, tackling pollution is a clear priority. By tackling the causes of air pollution the ICS can “deliver substantial health benefits, and keep people out of hospital, as well as [reduce] carbon emissions,” Igoe says.
As part of its Green Plan, published in May, Greater Manchester ICS committed to addressing the impact air pollution has on healthcare delivery. It is still early days in terms of implementation, but Igoe and her colleagues have used the ICS Clean Air Framework to “identify opportunities where we can take action”.
So far the ICS has focused on transport. Work under way includes e-cargo bike trials, electric heavy goods vehicle (HGV) trials, cycle hire schemes and public transport information screens in key locations at hospital sites. Working closely with Transport for Greater Manchester, Igoe has been able to access expert advice, support and funding opportunities.
Partnerships are key to making this work, says Larissa Lockwood, director of clean air at Global Action Plan. “Collaborating with diverse but complementary organisations enabled us to reduce risk, utilise expertise and cement credibility for the framework.”
She attributes the framework’s success “to its alignment with current NHS priorities, including health inequalities and net-zero commitments”. She says: “It isn’t ‘just another’ task for health leaders to complete when they are already extremely time poor, but in fact guides and supports their wider sustainability goals, improving air quality and health outcomes at the same time.”
Offering advice to other ICSs that want to take practical action to improve air quality, Igoe says: “Refer back to your Green Plan and identify something where you can start to make a difference. Even if you don’t have all the stakeholders on board yet, there will be activities that you can get on with now. If you can leverage the system to take definitive action to tackle a contributor to poor air quality there will be significant co-benefits that you can deliver at scale.”
BI and its partners would also like to see Greener NHS (NHS England’s climate change programme) make clean air a mandatory part of the Green Plans that all ICSs are meant to produce.
“This project is centred on addressing this ubiquitous environmental determinant of health which disproportionately impacts the most vulnerable in our society,” says Bevan.
In ten years’ time, Macdonald adds, “we hope we’ve made a significant difference and that the air around every hospital in the UK is measurably cleaner and less of a threat to the millions of patients, staff, visitors and healthcare workers who go there every day.”
Job code NP-GB-103379 November 2022
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