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Prescribing clean air

In the next few weeks, MPs will have the opportunity to vote on an amendment to the Environment Bill. This, coupled with a strong, independent watchdog and enforcement measures, would reduce the level of fine particulate pollution in the air across the country, writes RCP special adviser on air quality, Professor Sir Stephen Holgate.

The greatest environmental threat to health

In the 2016 Royal College of Physicians’ (RCP’s) report, Every breath we take, we estimated that around 40,000 premature deaths and 20,200 hospital admissions could be attributed to air pollution every year in the UK. The State of global air 2020 report found that air pollution was the fourth leading risk factor for early death worldwide in 2019, and the greatest environmental threat to health.

Accounting for a slight decrease this year due to changes in our travel behaviour and exposure to pollution, well over 150,000 people have suffered this fate in the 4 years since the RCP’s publication.

One such sufferer of high air pollution is currently in the headlines, as a landmark inquest began on 30 November into the death of 9-year-old Ella Kissi-Debrah, who lived close to the South Circular Road in Lewisham, London, and died in 2013 after numerous admissions to hospital for severe asthma. The inquest will examine the actions of the UK government and will consider if Ella’s death could have been avoided if it were not for the illegally high levels of pollution which coincided with each admission. Air pollution has never been formally identified as a cause of death before in the UK, despite what the science tells us.

How are legal, or illegal, levels of pollution determined?

The UK is currently subject to EU targets for air quality, and in the case of one of the worst pollutants – fine particulate pollution (or PM2.5) which is small enough to penetrate the lungs and enter the bloodstream – the legal limits for these particles are 25 µg/m3.

Around the time of Ella’s death, the levels of PM2.5 around her home were as high as 40 µg/m3. But, even if current targets were being met at the time, these are more than double the World Health Organization’s (WHO’s) guidelines, which recommend a maximum PM2.5 concentration of 10 μg/m3.

Unfortunately, air pollution levels which exceed the WHO’s recommendations, and the legally binding EU targets, are not uncommon. This applies across the country, and not just in our big towns and cities.

What can we do to reduce the threat of air pollution to health?

Now that the UK has an opportunity to set its own air quality legislation, many in the health community are calling for stronger, more ambitious targets, alongside other measures, to reduce deaths and long-term harm to health caused by particulate pollution.

It is undoubtable that, if air quality in the UK was improved in line with the WHO’s guidelines, lives would be saved. The WHO estimates that reducing annual average PM2.5 concentrations from levels of 35 μg/m3 – around the level recorded in Lewisham in 2013, albeit not the annual average – to their guideline level of 10 μg/m3, could reduce air pollution-related deaths by around 15%.

The Royal College of Physicians is a founding member of the UK Health Alliance on Climate Change (UKHACC), and has long supported its campaign for stronger protections for health – and, of course, for the environment – in the form of new air pollution targets, in line with WHO guidance.

You can help to change things now

In the same week as the inquest into Ella’s death began, Neil Parish – a Conservative MP, and chair of the Environment, Food and Rural Affairs Select Committee – has tabled an amendment to the bill that would introduce such targets.

All MPs in the UK Parliament will have the chance to vote on it in the next few weeks, and, as a health professional, you can make a difference now by asking your MP for their support. In just a few minutes, you can generate and personalise an email through UKHACC’s online #PrescribingCleanAir campaign.

Click here to take action and ask your MP to support Prescribing Clean Air.