Now there is compelling evidence that air pollution is associated with new onset asthma in children and adults. When our patients are exposed to such a clear and avoidable cause of death, illness and disability, it our duty to speak out.
Today a new landmark report from the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH) starkly sets out the dangerous impact air pollution is currently having on our nation's health - with around 40,000 deaths a year linked to outdoor air pollution.
'Every breath we take: the lifelong impact of air pollution' presents that the harm from air pollution is not just linked to short term episodes but is a long term problem with lifelong implications.
The report notes examples from right across an individual's lifespan, during pregnancy, from a baby's first weeks in the womb through to the years of older age.
Examples include, the adverse effects of air pollution on the development of the fetus, including lung, brain and kidney development, and miscarriage, increases in heart attacks and strokes for those in later life; and the associated links to asthma, diabetes, dementia, obesity and cancer for the wider population.
In relation to asthma, the report stresses the significant point that after years of debate, there is now compelling evidence that air pollution is associated with both reduced lung growth in childhood and new onset asthma in children and in adults - whilst highlighting that air pollution increases the severity of asthma for those with the disease.
The working party for the report was chaired by Professor Stephen Holgate, who said: "We now know that air pollution has a substantial impact on many chronic long term conditions, increasing strokes and heart attacks in susceptible individuals. We know that air pollution adversely effects the development of the fetus, including lung development.
"And now there is compelling evidence that air pollution is associated with new onset asthma in children and adults. When our patients are exposed to such a clear and avoidable cause of death, illness and disability, it our duty to speak out"
The estimated cost of air pollution in the UK is £20 billion annually (in Europe €240 billion). Dr Andrew Goddard, the Royal College of Physicians lead for the report said: "Taking action to tackle air pollution in the UK will reduce the pain and suffering for many people with long term chronic health conditions, not to mention lessening the long term demands on our NHS."
Air quality should be getting better - but it isn't
In 2012, road traffic in the UK was ten times higher than in 1949. Nitrogen dioxide (NO2) and particulates in diesel exhaust have been poorly controlled and these are a particular problem. In the UK today, about half of cars run on diesel, compared to just 14% in 2000.
Last year, ClientEarth won a legal battle against the UK Government over their failure to meet EU limits on NO2. The UK's supreme court ordered the government to make plans for tackling the UK's air pollution problem, which has been in breach of EU limits for years.
Commenting on the report, ClientEarth lawyer, Alan Andrews, said: "The fact that these highly respected institutions have felt moved to produce such a strong report on the devastating health effects of air pollution in the UK should press the government into urgent action. All we've seen from the authorities to this point has been feet-dragging and excuses."
The Supreme Court declared that air pollution levels were already being breached in London, and fifteen other zones across the UK. These cities have failed to meet EU standards on NO2 levels since 2010, running the risk of fines from Brussels under the EU air quality directive which came into force that year.
However, since then, the Government's promise to clean up air quality has been condemned as vague, slow and weak.
Responding to the report, Oliver Hayes, Friends of the Earth Campaigner, said: "The evidence is clear: almost every breath we take is harming our health. That's why we're calling on all candidates in the London Mayoral election to publish a clear plan that will dramatically reduce deadly pollution in the capital in the next 4 years, starting by cleaning up London's iconic red buses.
"Smog and dirty air are already shortening people's lives which is why there is no time to lose, London Mayoral candidates, other city authorities and the UK Government must commit to tangible changes fast to put a stop to this invisible killer."
The hidden dangers of pollution
In recent years the dangers of outdoor air pollution have been well documented however, the report highlights the often overlooked section of our environment - that of indoor space. Factors such as, radon, second-hand smoke, kitchen products, faulty boilers, open fires, fly sprays and air fresheners, all of which can cause poor air quality in our homes, workspaces and schools.
The current estimate of 40,000 deaths in the UK only refers to outdoor air pollution such as particulates and NO2. However, a World Health Organisation report identified indoor air pollution as an important risk factor, accounting for an estimated 99,000 deaths in 2012 throughout Europe.
Although government and the World Health Organization (WHO) set 'acceptable' limits for various pollutants in our air, the report states that there is in fact no level of exposure that can be seen to be safe, with any exposure carrying an associated risk.
As a result, the report offers a number of major reform proposals setting out what must be done if we are to tackle the problem of air pollution.
- Put the onus on polluters. Polluters must be required to take responsibility for harming our health. Political leaders at a local, national and EU level must introduce tougher regulations, including reliable emissions testing for cars.
- Local authorities need to act to protect public health when air pollution levels are high. When these limits are exceeded, local authorities must have the power to close or divert roads to reduce the volume of traffic, especially near schools.
- Monitor air pollution effectively. Air pollution monitoring by central and local government must track exposure to harmful pollutants in major urban areas and near schools. These results should then be communicated proactively to the public in a clear way that everyone can understand.
- Quantify the relationship between indoor air pollution and health. We must strengthen our understanding of the key risk factors and effects of poor air quality in our homes, schools and workplaces. A coordinated effort is required to develop and apply any necessary policy changes.
- Define the economic impact of air pollution. Air pollution damages not only our physical health, but also our economic wellbeing. We need further research into the economic benefits of well-designed policies to tackle it.
- Lead by example within the NHS. The NHS is one of the largest employers in Europe, contributing 9.1% of the UK's gross domestic product (GDP). The health service must no longer be a major polluter; it must lead by example and set the benchmark for clean air and safe workplaces. In turn, this action will reduce the burden of air-pollution-related illness on the NHS.
A concerted effort must be made by all to reduce air pollution
Professor Jonathan Grigg, Professor of Paediatric Respiratory and Environmental Medicine at Queen Mary University of London and the Vice Chair of the working party and representing the Royal College of Paediatrics and Child Health, said:
"There is clear evidence to suggest that long term exposure to air pollution has a wide range of adverse effects in childhood, and exposure during early life can lead to the development of serious conditions such as asthma.
"As NHS costs continue to escalate due to poor public health - asthma alone costs the NHS an estimated £1 billion a year - it essential that policy makers consider the effects of long term exposure on our children and the public purse.
"We therefore call on Government to monitor exposure to air pollution more effectively to help us identify those children and young people who are most at risk. We also ask the public to consider ways of reducing their own contribution to air pollution by taking simple measures such as using public transport, walking and cycling, and not choosing to drive high-polluting vehicles."
Green Party Transport spokesperson, Caroline Russell said: "The writing is on the wall for our car dependent transport system. How much more evidence do we need that pollution from diesel is killing us and costing the country billions in health and other costs.
"The government must act now. We have to invest in alternatives to car use and ownership so that people have access to affordable and convenient transport options enabling them to avoid being exposed to air pollution and causing it."
The report also emphasises how the public can do their part to reduce pollutant exposure. Noting the impact collective action can have on the future levels of air pollution in our communities. Dr Andrew Goddard added "This is not just a job for government, local authorities or business - as individuals we can all do our part to reduce pollutant exposure."
Vanessa Amaral-Rogers is a freelance journalist writing mainly on environmental themes.
Principal source: Royal College of Physicians