A new report from the Royal College of Physicians (RCP) has highlighted the growing evidence about the increased range of health impacts linked to toxic air even at low concentrations, urging governments to act on air pollution as a serious and preventable public health threat.
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In Wales, between 1,000–1,400 deaths each year are attributable to air pollution.
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The RCP is calling on the Welsh government to:
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Recognise air pollution as a key public health issue and take increasingly ambitious action to reduce people’s short and long-term exposure to outdoor and indoor pollution.
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Implement the Environment (Air Quality and Soundscapes) (Wales) Act 2024 to meet the WHO guidelines on air quality.
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Fund and deliver a public health clean air campaign to provide accurate and trusted information about the health impacts of air pollution exposure.
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To consider the disproportionate impacts of air pollution on certain groups, including recognised ethnicity- and deprivation-based disparities.
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The RCP has warned that air pollution affects almost every organ in the human body, estimated to contribute to the equivalent of 30,000 deaths in the UK in 2025 and cost more than £27 billion annually.
The new report from the RCP highlights studies in the last decade providing new knowledge about the significant health impacts of toxic air even at low concentrations, including on foetal development, cancer, heart disease, stroke, mental health conditions and dementia. As we spend more time in buildings, indoor air pollution also poses a growing concern. The report emphasises that poor ventilation, damp and mould, and emissions from domestic heating, gas cooking and household products all contribute significantly to poor health.
In A breath of fresh air: responding to the health challenges of modern air pollution, the RCP urges UK governments to recognise air pollution as a public health issue – rather than a solely environmental one – and take urgent and ambitious action to reduce preventable deaths and improve population health.
With impacts on both mortality and healthy life expectancy, the effects of toxic air on individuals, society, the economy and the NHS are huge. The RCP report estimates that:
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In 2019 alone, costs for healthcare, productivity losses and reduced quality of life due to air pollution cost the UK upwards of £27 billion – and may be as much as £50 billion when wider impacts, such as dementia, are accounted for.
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Annual costs could still be up to £30 billion per year in 2040, despite pollutant exposures being projected to fall in coming years under current government policies, including Net Zero policies.
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Air pollution could still be linked to around 30,000 deaths in 2025, compared to government estimates of the equivalent of between 29,000 and 43,000 deaths in the UK in 2019.
There is no safe level of air pollution. Despite some progress in recent years, findings about the wide range of health impacts suggest the threat to public health remains significant and greater than previously understood.
A toxic burden on the most vulnerable people
Air pollution is harmful to everyone, but the most deprived communities – who typically contribute least to emissions – disproportionately experience its effects and suffer the worst health outcomes.
The RCP is calling for urgent action from the Welsh government including:
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National and local governments in Wales must recognise air pollution as a key public health issue and take increasingly ambitious action to reduce people’s short- and long-term exposure to outdoor and indoor air pollution.
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The Environment (Air Quality and Soundscapes) (Wales) Act 2024 has introduced new duties and responsibilities for national and local government, including a commitment to development of targets in line with the most recent WHO guidelines on air quality limit values. It is imperative that the Environment (Air Quality and Soundscapes) (Wales) Act 2024 is implemented to meet the WHO guidelines on air quality.
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Welsh government should fund and deliver a public health clean air campaign to provide accurate and trusted information about the health impacts of short- and long-term air pollution exposure, the sources of indoor and outdoor air pollution, and practical advice to reduce personal exposure.
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All air quality policy developed by Welsh government and local government must consider the disproportionate impacts of air pollution on certain groups, including recognised ethnicity- and deprivation-based disparities. It should focus action on areas and populations with high levels of air pollution and greatest vulnerability to health harms from pollution.
Dr Hilary Williams, vice president for Wales at the Royal College of Physicians, said:
“The number of preventable deaths attributable to poor air quality makes clear that this is a public health crisis that cannot be ignored. For people living with asthma, poor air quality directly affects their risk of hospital admission and impacts everyday activities, and we’re learning more how it contributes to other conditions including dementia, heart disease and cancers. Clean air is a right, not a privilege and improving air quality must be treated as a core public health priority.
“We must see urgent action from Welsh government to reduce exposure across communities, focussing both on reducing the sources of poor air quality at source, but also delivering a sustained campaign to raise public awareness. With the right political will, we can save lives, reduce health inequalities and build a healthier Wales for future generations.”
Dr Magda Meissner, consultant in medical oncology at Velindre University NHS Trust and clinical senior lecturer at Cardiff University, said:
‘As a cancer specialist, I see the devastating effects of environmental exposures on health all the time. Poor air quality doesn’t just worsen existing conditions – it can be directly linked to the development of serious diseases, including cancer.
“The burden is especially heavy on the most deprived and marginalised communities in Wales. This report makes it clear: we must invest in clean air as a public health imperative. A well-funded public awareness campaign and stronger policy actions can help ensure a healthier future for everyone in Wales, regardless of their postcode or background.’
Professor Sir Stephen Holgate, RCP special adviser on air quality and the lead author of the report, said:
‘The science is now overwhelming; air pollution is a major driver of disease across the life course – from low birth weight and childhood asthma to heart attacks and dementia. It must be recognised and treated as a public health issue. The cost of inaction is measured not only in lives lost, but in people not being able to live healthily and in billions drained from our economy every year. We must act now – and we must act together.’
A breath of fresh air, with a foreword from the Chief Medical Officer Chris Whitty, is the latest in a line of authoritative RCP reports shining a light on the biggest public health issues facing society. It was the 1962 RCP report, Smoking and health, that definitively stated the link between tobacco smoking and lung cancer.
Publishing this major new report on Clean Air Day, the RCP is calling on government to treat air pollution as a serious and preventable health risk.