Public Health

Overview

Poor air quality is a significant public health issue. The Committee on the Medical Effects of Air Pollution have shown that air pollution was estimated to cause 28,000 to 36,000 deaths a year in the UK. It has been estimated that removing all fine particulate air pollution would have a bigger impact on life expectancy in England and Wales than eliminating passive smoking or road traffic accidents. The economic cost from the impacts of air pollution in the UK was estimated at £157 million in 2017 with the latest findings, published in a report from Public Health England warning that these costs could reach as much as £18.6 billion by 2035 unless action is taken.

The main pollutants of concern in the UK are particulate matter (PM), oxides of nitrogen (NOx), and ground level ozone (O3). Other important air pollutants relevant to public health include sulphur dioxide (SO2), non-methane volatile organic compounds (NMVOCs) and ammonia (NH3).

Both Local Authorities and Public Health Professionals play a role in ensuring air quality improvements are delivered effectively. This page provides the necessary resources and information that should be used to facilitate air quality improvements with a public health focus.

Resources

The importance of the effect of air pollution on public health is reflected by the inclusion of an indicator of mortality associated with air pollution in the Public Health Outcomes Framework (PHOF) indicator. This will enable Directors of Public Health to appropriately prioritise action on air quality in their local area. The PHOF indicator reflects the fraction of all-cause adult mortality attributable to long-term exposure to current levels of anthropogenic particulate air pollution.

The baseline data for the indicator have been calculated for each upper tier local authority in England based on modelled concentrations of fine particulate air pollution (PM2.5) in 2010. Estimates of the percentage of mortality attributable to long term exposure to particulate air pollution in local authority areas range from around 4% in rural areas to over 8% in cities, where pollution levels are highest.  These calculations of the mortality burden associated with particulate air pollution will be updated periodically.

The Defra and Public Health England Briefing for Directors of Public Health (Air Pollution) toolkit provides details on how local authorities can use the Public Health Outcomes Indicator to specify appropriate mitigation measures to reduce the impact of both short term and long term exposure of air pollution. The guide emphasises the importance of communication and engagement amongst all relevant local stakeholders on air quality issues.

Documents

Public Health Outcomes Framework Indicator

Hosted on www.phe.org.uk

Defra and Public Health England Briefing for Directors of Public Health (Air Pollution) Toolkit

Released: March 2017 (PDF, 3.5MB, 116 pages)

Role for Local Authorities

Local authorities in the UK have a responsibility under Local Air Quality Management (LAQM) legislation to review air quality. Where concentrations exceed national objectives, measures should be put in place to reduce emissions, and be reported in a local Air Quality Action Plan (AQAP). Most such Action Plans are designed to address difficulties in complying with national objectives for either NO2 or PM10.

The PHOF indicator, which focuses on PM2.5, encourages the co-operation of multiple local authority departments which can all contribute to the delivery of air quality improvements. The Defra and Public Health England Briefing for Directors of Public Health (Air Pollution) toolkit offers tools to help ensure air quality is prioritised alongside other public health priorities to ensure it is on the local agenda. Engagement with various stakeholders, including other members within the local authority, those in the local health sector and the wider community is foremost in ensuring air quality issues are tackled appropriately.

In order to specify relevant measures to reduce emissions, local authorities can use tools to appraise the scale of the air pollution issue in its area. The Defra and Public Health England Briefing for Directors of Public Health (Air Pollution) toolkit provides a methodology for ranking the local mortality attributed to air pollution against local mortality due to other sources. By assessing the location, extent and source of local problems action planning can be implemented strategically.

Typical measures to reduce emissions from local sources include traffic management, the encouragement of uptake of cleaner vehicles, and increased use of public transport along with more sustainable transport methods such as walking and cycling.  Such measures will also reduce emissions of PM2.5.

The use of smokeless fuels for industrial and domestic combustion is also important as are stringent industrial emission controls. The increased use of biomass as a fuel to meet renewable energy targets may give rise to increased particulate pollution if combustion plants are not well managed. Planning and development controls are also important for local authorities to reduce concentrations in local polluted hotspots.

Any improvements in air quality will have a positive health consequence and in turn can support other local priorities such as health inequalities, care integration and growth and regeneration.

Examples of how Local Authorities can help address health impacts and improve air quality

  • Encouraging schemes like ECOSTARS that recognise excellent levels of environmental and energy saving performance for the vehicles that operate within their area
  • Introducing intelligent transport systems that maximise the efficiency of the highway network and also give real time information on traffic delays and journey times, car parking availability, and bus arrival times; together, these allow people to make better informed travel choices and also reduce traffic emissions.
  • Incorporating air quality into planning considerations for new developments and refurbishments.
  • Promoting active travel, energy efficiency and sustainable transport to residents and businesses in the borough and putting in the necessary infrastructure to enable people to reduce the emissions they produce.
  • Localism and community engagement to involve local communities and neighbourhood groups in the decision-making process will widen the understanding of air quality issues associated with public health.

 

Defra has produced guidance to assist local authorities to develop Air Quality Action Plans which set out measures to reduce local emissions.

Role for Public Health Professionals

Public Health professionals are well placed to work with local communities and front line professionals to raise awareness of the health impacts of poor air quality, support measures to reduce pollution and encourage lifestyle adaptations to reduce the risk to individuals and to their families. This can be done through enhanced public communication and advice such as providing information on walking routes away from the most polluted streets and air pollution messaging services such as AirText used in London or AirAlert used in the South East of England.

Public Health professionals can also help to:

  • Explain to their local population the long term impacts of air pollution on health.
  • Communicate short term air pollution episodes with the public and tailor messages to target those members of the public particularly susceptible to air pollution.
  • Raise understanding that improving air quality would help to improve healthy life expectancy and reduce early death from cardio-respiratory diseases.
  • Work with others to promote initiatives to facilitate active travel (for example Healthy Schools Programmes, school travel plans; cycle to work schemes etc.
  • Raise awareness of the need to improve air quality through linking to other public health issues such as obesity and through working with Health and Wellbeing Boards to include air quality in Joint Strategic Needs Assessments and Health and Wellbeing Strategies.
  • Engage the media to provide credible briefings to spread awareness.

The Defra and Public Health England Briefing for Directors of Public Health (Air Pollution) toolkit helps to provide strategies for communicating air quality impacts to the public. Six principles have been identified which will help improve the understanding of air pollution issues and ensure people are aware of how they can protect themselves from health impacts. Air quality issues should be tailored to specific local areas to make the problems relatable. Public health professionals can help local authorities disseminate the local air quality issues amongst local stakeholders.

Active Travel

Active travel, such as walking and cycling, has the health benefit of increased fitness and helps reduce obesity and cardio vascular disease. The black carbon (soot) component of fine particulate matter makes a significant contribution to climate change. In addition, the soiling effect of PM may create a public nuisance, degrade materials and affect property and amenity value. Indirectly, actions taken to reduce pollutant concentrations lead to improved quality of life and the enhancement of the natural environment.

Air Pollution Forecasting

As an additional measure, providing early warning of elevated pollutant concentrations allows individuals that might be particularly vulnerable to the short-term effects of air pollution (e.g. asthmatics or those with pre-existing lung or heart conditions) to be alerted so that they can reduce strenuous activity outdoors.  Such alerts can also help to anticipate increased demand for medical services.  Public information services and pollution forecasts are provided throughout the UK and for some local areas. Public Health professionals can also help local authorities in promoting actions to improve air quality by highlighting the health impact of poor air quality in their local areas, in order to further assist with the aim of changing behaviour.

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