Exploring air pollution and health

Clean air is expected to be a substantial part of the upcoming Environment Bill. Pauline Castres, air pollution policy officer at the British Lung Foundation, looks at the Toxic Air at the Door of the NHS report and the urgent need for action

It might be invisible, but air pollution poses an immediate threat to the health of the 12 million people in the UK who live with a lung disease, such as asthma, COPD and lung cancer. People with a lung condition face worsening symptoms, exacerbations and increased hospitalisation just from breathing the air around them.

Nine out of ten patients we support at the British Lung Foundation (BLF) have told us that they struggle to breathe during high pollution episodes. For these people, air pollution has a very real and serious impact on their quality of life, interfering with every day activities including going to work, shopping and meeting with friends and family.

It’s not just anecdotal either; there is evidence of a clear link between high levels of air pollution and increased numbers of patients with breathing problems presenting at hospitals and GP surgeries. In a recent study carried out by the University of Dundee and funded by the BLF, researchers studied nearly 15 years of data for air pollution levels in Dundee, Perth and the surrounding area.

They matched air pollution levels to medical records of 450 patients who suffer from bronchiectasis, a long-term chronic condition which can cause a persistent cough and breathlessness as well as frequent chest infections. They found that on days when air pollution levels spiked, there was a large increase in admissions to Ninewells Hospital and Perth Royal Infirmary with breathing problems and visits to GP’s with exacerbations of their symptoms.

Children’s lungs are also disproportionally vulnerable to air pollution as their little lungs are still growing. Children exposed to severe air pollution are up to four times more likely to have poor lung development compared to those growing up in less polluted areas, and children with smaller lungs are more likely to face further health problems in later life.

And for the one in eleven children in the UK who have asthma, air pollution is an immediate danger. For the first time this year a report described the ‘striking association’ between a child's emergency hospital admissions and recorded spikes in air pollution. The case of Ella Kissi-Debrah, who died in 2013 after experiencing three years of asthma-induced seizures, has been described as the first reported 'pollution' death. The report concluded that there was a ‘real prospect that without unlawful levels of air pollution, Ella would not have died’. Children who have reduced lung capacity, such as children with cystic fibrosis and those whose lungs haven’t properly developed because they were born prematurely, are also more at risk. This is an unacceptable additional burden on their fragile health.

If all that’s not convincing enough, there’s also an economic argument to clean up our air; lung disease is the UK’s third biggest killer, costing the NHS £9.9 billion a year and business £1.2 billion through work days lost. At the same time, air pollution costs more than £20 billion every year to society.

Toxic Air at the Door of the NHS
In October 2018, the BLF published a report called Toxic Air at the Door of the NHS to highlight the urgent need for action. We decided to look at levels of particulate matter (PM2.5) around health centres as many of the groups that are most vulnerable to the effects of air pollution - such as children, the elderly and people with a lung or heart condition - often must visit and spend long periods of time in these places.

PM2.5 refers to tiny particles with a diameter 30 times smaller than the average human hair. They are particularly harmful to our health, as they are small enough to pass through the lungs and into the bloodstream. The particles come from various sources - with the majority coming from road transport in urban areas - and are linked to multiple health concerns including asthma, chronic obstructive pulmonary disease (COPD), heart disease, stroke and lung cancer.

Existing air pollution data mainly focuses on city-wide levels, and rarely looks at specific locations; so local authorities often lack specific data about PM2.5 levels in their local area. We hoped that by providing new analysis, we could highlight the immediate threat of dirty air.

Using existing modelled data, we asked Cambridge Environmental Research Consultants (CERC) to find out how many health centres across the UK are currently exposed to PM2.5 levels above what the World Health Organization (WHO) recommends.

The analysis revealed that in 2018, 2,220 GP practices and 248 hospitals are in areas that exceed the WHO’s safe air pollution limits. This includes major teaching hospitals, two of the biggest children’s hospitals in the country, small clinics, and GP surgeries. This represents a third of GP surgeries and a quarter of hospitals in England. We also found out that many cities including Birmingham, Cardiff, Leeds, Leicester, London, Nottingham, Hull, Chelmsford and Southampton have at least one large NHS trust in an area with unsafe levels of pollution.

The findings really are worrying. It’s not right that vulnerable people with NHS appointments are being exposed to toxic air that could make their health worse, and that hospital staff and GPs must care for people in environments that could be putting them and their patients at risk of a whole range of health problems further down the line.

Current PM2.5 limits
The UK is currently meeting legal limits for PM2.5. However, this is because the legal limit is more lenient than the limit recommended by the international health community. The UK legal limit for PM2.5 is more than twice as high as the WHO recommendation, 25µg/m3 instead of 10 µg/m3 for the annual average.

At the BLF we have increasingly focused our air pollution work on PM2.5 as research in recent years has strengthened the evidence that both short-term and long-term exposure to PM2.5 are linked with a range of health outcomes, including lung disease.

What now?
Clean air is expected to be a substantial part of the upcoming Environment Bill. At the BLF, we want the WHO recommended limit to be included in the Bill so that it becomes UK law. We also want to see charging Clean Air Zones in cities and towns with the highest levels of air pollution across the UK, and greater investment in air quality monitoring for places where vulnerable groups gather, so that where appropriate people can make an informed choice about where they receive care.  

Children are also a priority. Alongside ClientEarth, we’ve set up the Clean Air Parents’ Network to help give parents and carers who are concerned about the affect dirty air is having on their children’s growing lungs an outlet to campaign for change.

We will also continue working closely with government departments, MPs, local authorities and health care professionals to secure a clear commitment to adopt the WHO’s limit in the upcoming Environment Bill and continue to find suitable solutions to local air pollution problems. We believe that one day we can all breathe clean air with healthy lungs.