On 6th December UKHSA held the 2023 UKHSA Air Quality and Public Health Stakeholder Meeting in the city of Manchester. The meeting was well attended by researchers, policy makers, industry partners and civic sector groups who work across health, social and building science disciplines.
During the 2023 UKHSA Air Quality and Public Health Stakeholder Meeting we firstly heard from Dr Karen Exley who gave an overview of the UKHSA Air Quality Programme (National and Local Work). We then had an air quality update from DEFRA followed by a session on Sharing Stakeholder Case Studies, Good Practices – Community Programmes. This was followed by an interactive session on the Indoor Air Quality Observatory, and the day ended with a second session on Sharing Stakeholder Case Studies, Good Practices – Messages and Communication.
Overview of UKHSA Air Quality Programme (National & Local Work)
Dr Karen Exley
In 2023 UKHSA published their strategic plan covering 2023 to 2026 within which air quality lies under strategic priority 4: Protect health from threats in the environment. The goals of UKHSA are to further develop the evidence base on the health impacts of outdoor and indoor air quality, with a greater understanding of the health impacts on different groups and communities, and effective health interventions to address these, working closely with the Office for Health Improvement and Disparities. This has led to the development of the Cleaner Air Programme which aims to:
- Develop the evidence base on air quality, including on sources of pollution, levels of exposure and how this contributes to health outcomes.
- Improve the understanding of the holistic view of the effect of indoor and outdoor air pollutants; Improve how advice and information on indoor and outdoor air pollution can be communicated.
- Advise and influence decision-makers; Support the implementation sharing information and learning at various scales.
As part of their remit UKHSA have published two systematic reviews and meta-analyses on the exposure and respiratory health effects (link to doc) of solid fuel combustion. These papers were limited by the available data, including:
- Considerable heterogeneity in study design, exposure and outcome assessment and the type of fuel.
- In studies measuring the levels of pollutants the ability to exclude the outdoor PM contribution from other outdoor sources and the lack of data from indoor settings
- Issues with recall bias and potential misclassification of exposure and outcome self-reports in questionnaire based studies
- Issues around disease definition and a failure to incorporate a dose response element into studies
- A significant lack of details on the devices used to sample, the house conditions, climatic difference during sampling and between locations.
COMEAP (Committee on the medical effects of air pollutants) have published a ‘Summary of COMEAP recommendations for the quantification of health effects associated with air pollutants’.
UKHSA have also published on the burden of respiratory disease from Formaldehyde, damp and mould in English housing.
COMEAP have also released a ‘statement on the state of the science linking long-term air pollution exposure with SARS-CoV-2 infection and adverse COVID-19 outcomes’ this concluded that there was:
- no convincing evidence that air pollution can transmit and spread the virus
- not enough epidemiological evidence to suggest that air pollution increases the risk of infection but there are a small number of mechanistic studies which suggest ways it can alter the body’s immune function
- evidence that it can increase the severity of disease with an increased risk of hospitalisation following infection.
- less evidence to support that air pollution increases the risk of death from COVID-19
The paper on impacts of emission policies on future UK mortality burdens associated with air pollution estimates that by 2050 population-weighted exposures will reduced PM2.5 by 28% – 36%, NO2 by 35% – 49% depending on region and that mortality burdens (including population projections) will decrease by 26%. Most of these benefits will be achieved early on in the simulated future timeline.
In the paper ‘Future impacts of O3 on respiratory hospital admission in the UK from current emission policies’ it is found that reducing emissions results in overall benefits to population health, but due to the complex chemistry associated with secondary pollutants reduced NO emissions with result in local increase in O3 close to population centres and that this will result in an increase of 7078 respiratory hospitalisations by 2050 for current policy compared with respiratory hospitalisations in 2018.
Updates from Department for Environment, Food and Rural Affairs
John Newington
John gave an overview of the Environmental Improvement Plan which was published in January 2023 and sets the context for the Air Quality strategy and represents the first review of the 25 year Environment Plan. The document applies only to England and sets out a plan for delivering on targets and overall goals, including establishing interim targets for legally binding long-term targets for PM2.5 concentrations:
- The highest annual mean concentration in the most recent full calendar year must not exceed 12 µg/m3 of PM2.5.
- Compared to 2018, the reduction in population exposure to PM2.5 in the most recent full calendar year must be 22% or greater.
The Air Quality strategy was published in April 2023 following review of the 400 responses received as part of the public consultation. The Air quality strategy focuses on local delivery of air quality policy, recognising the local level as key to successful outcomes, it also clarifies, explains and raises awareness of recent changes to local Authority (LA) Framework. There is increased focus on enforcement, capacity building and boosting local action on PM2.5 emissions.
The Environmental Targets (Fine Particulate Matter) (England) Regulations 2023 set two air quality targets in legislation:
- An annual mean concentration target of 10 µg/m3 by 2040 (the AMCT)
- A population exposure reduction target of 35% compared to 2018 by 2040 (the PERT)
Progress towards the targets is reported annually on UKAIR (https://uk-air.defra.gov.uk/pm25targets/progress).
Also presented was overview of the domestic combustion communications campaign (see Burn Better webpage) which targets affluent homeowners in England who use open fires or stoves to create a cosy atmosphere in the home.
Sharing Stakeholder Case Studies, Good Practices. Session one: Community Programmes
Global Action Plan (GAP) – Relight My Fire? Understanding and addressing wood burning as a major sources of UK air pollution: Dispelling common myths and raising awareness
Dr Lucy Anderson
Dr Anderson explained how GAP have been leading the drive to dispel common myths about wood burning including that wood burning is cheaper than using alternative heating systems. The research showed that under their included scenarios that wood burners were almost always more expensive than other forms of heating if you have to buy the wood. Dispelling these myths can have a benefit to changing other publicly held opinions on wood burning such as that wood burning is environmentally friendly and carbon neutral, and that wood burners do not create indoor fine particle pollutants. To get involved in the clean air night – an initiative to promote a better understanding of the pollutant effects of wood burners email cleanerair@globalactionplan.org.uk.
Air Quality in Liverpool Schools Project
Keith Dooley and Paul Farrell
The Air Quality in Liverpool Schools Project was undertaken by Liverpool City council with funding from a DEFRA AQ grant in 2021 for a communication and engagement project. Four Liverpool primary schools participated in the project with 169 year five pupils taking part. Pupils were given backpacks containing PM2.5 air quality monitors and asked to complete a travel diary for a week. Air quality data from backpacks was analysed by Imperial College London. PM2.5 exposure was found to vary by route to/from school and pollution hot-spots could be identified allowing 50% of the children informed changes to their route to school to avoid cars and congestion.
Cleaner Construction for London- Putting Air Quality First. Addressing Emissions from NRMM
Andrew Gordon
Since 2016 the Non-Road Mobile Machinery (NRMM) low emission zone has delivered modelled reductions in the region of 48% for PM, 42% for NOx and 20% for CO2. Non-Road Mobile Machinery is a broad term used to describe industrial machinery that is mobile, but not classified as a road vehicle (e.g. diggers, generators, tractors etc). The NRMM Low Emission Zone covers the whole of Greater London, with different vehicle requirements in two zones. It has had success in reducing the number of non-compliant vehicles which are more heavily polluting. Andrew posed the question as to if this scheme could/should be implemented in other cities using the experience of London as a scalable template.
School Air Quality Challenge
Jennie McKeown and Victoria Chadderton
Ms McKeown and Ms Chadderton from Wirral Council talked about work they had undertaken at Grove Street Primary school who reached out for support to reduce the number of vehicles around the school at pick-up and drop-off with an aim to reduce the air pollution from these vehicles.
To increase active travel activities were undertaken to engage children including top trumps air pollution monsters, recruitment of mini-reporters, talking to parents/carers, and a children led assembly. These activities led to the recruitment of 16 other local schools which created their own projects, the project ideas were shared at the Clean Air Day 2023.
Traffic monitoring activities showed that there was a modest increase in walking, park and stride, and a reduction in car journeys immediately following the launch of the project, unfortunately this was not sustained. The project showed the challenges to creating lasting impact with regard to entrenched behaviours.
Interactive Session: Indoor Air Quality Observatory
Professor Sani Dimitroulopoulou, Ingrid Barnes, Dr Abigail Hathway and Professor Catherine Noakes
In this interactive session Professor Sani Dimitroulopoulou set the scene by addressing the challenges, barriers and opportunities associated with indoor air quality. Ingrid Barnes followed with a short presentation titled ‘understanding the health risks of damp and mould in the home’. Dr Abigail Hathway then introduced her recent work developing guidance on ‘Improving Ventilation and Indoor Air Quality in Small Businesses’. Then followed an introduction by Professor Catherine Noakes into the concept of an Indoor Air Quality Observatory. There followed a conversation about what this might look like and include considering the recent developments in lower cost, networkable air quality monitoring equipment. Find out more here.
Sharing stakeholder case studies, good practices Session one: Messages and communications
Global Action Plan – A collaborative, evidence-based approach to developing targeted air pollution engagement materials
Dr Lucy Anderson
Dr Anderson presented on Global Action Plans work identifying air pollution resource gaps for adults and children and there work to produce engagement material. In terms of adult resource gaps they identified significant gaps around materials addressing indoor air pollution, a lack of material covering those without health conditions, limited information for pregnant women, lower socioeconomic groups and adults aged 65+. They also found most resources focus on the sources and health impacts of air pollution but far fewer focused on personal or collective actions to reduce exposure and contribution.
Children’s resource gaps focused on younger primary aged children, again there was a lack of information on indoor air pollution. Resources were found to focus on active travel/anti idling as a means of minimising exposure/contribution. There was a lack of individual agency around solutions and a potential for more guidance around calling for (policy) change. Having identified the gaps, they worked with co-design panels to develop new resources, tailored to each specific audience and their needs. Including, for adults a clean air planner, training resources for health professionals and a website. For children, school resources, out of school resources and an online quiz on Nat Geo Kids. They have started the evaluation of these resources and they are showing positive effects.
Breathe London Community Programme: Facilitating air quality knowledge exchange in-person and virtually
Dr Kayla Schulte and Andrew Grieve
The Breathe London Network was launched in Autumn 2020. The aim of the Breathe London Network is ‘…to democratise air quality monitoring and create a community of groups who support each other and share their experiences and ideas.’ The research question for this specific piece of work was ‘Does the introduction of specific spaces and activities facilitate knowledge exchange and expand capacity with respect to data interpretation and engagement with the topic of air quality?’. The study tool place between Sept 2022 and Sept 2023 and included data collection in the form of contributions via the programmes virtual platform, surveys, transcripts from hybrid events and attendance at in person events. Highest participation was seen with circle, survey and in person events, and the most populate topic was making sense of sensor data. These findings will help with the design of future engagement, communication and impact events in the future.
Global Action Plan – Integrated Care System Clean Air Framework
Dr Malcolm White
Dr Malcom started his presentation by highlighting the fact that air pollution kills eight million people a year and 5 million of these are linked to fossil fuel use. The health effect of air pollution are unequal, with the greatest burden falling on people
- Already affected by inequality, often with existing health conditions/vulnerabilities.
- Who contribute least to the problem of air pollution
- Who have the least agency to tackle the problem of air pollution.
- Low income families and black, Asian and minority ethnic groups are disproportionately affected.
In the UK alone air pollution causes upwards of 36,000 deaths, over 6 million sick days, over 20,200 respiratory and cardiovascular hospital admissions and an estimated total social cost of £22.6 billion per year.
Air pollution is a health issue that requires a health sector response, but also creates air pollution – but we can work to minimise those contributions and protect staff, patients and the public. The aim of this work was to produce tools for all NHS trusts and ICSs with targeted action plans to reduce air pollution. In a pilot study Global Action Plan delivered
- Workshops to help each ICS use the developed framework to being/continue their clean air journeys
- Individual support to each ICS to aid delivery
- Webinars on shared topics
- Helped build relationships with local authorities in support of clean air actions
- Helped with governance and clarity of thought.
- Modelling the impact of tackling air pollution on population health and NHS costs.
Key ingredients for maximising collaboration included, aligning strategies, governance and communication.
