February 23, 2016

expert reaction to new report on the lifelong impact of air pollution

The Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH) have published a report which estimates 40,000 deaths a year in the UK as being linked to air pollution.

All our previous output on this subject can be seen here.

Prof. Ian Colbeck, Professor of Environmental Science, University of Essex, said:

“Government estimates of UK deaths due to nitrogen dioxide (NO2) and particulate matter are 23,500 and 29,000 respectively. Many people are susceptible to both pollutants so the total number of deaths is not a simple case of addition.  As such the 40,000 deaths used in this report is a realistic estimate based on our current knowledge.

“People spend around 90% of their time indoors (whether at home, at work, or commuting) and this is one of the first reports which recognises the importance of indoor air quality on health. With 99,000 deaths across Europe due to indoor air pollution one would expect around 9,000 deaths in the UK. However it is extremely unlikely that any Government would try and impose air quality standards in private homes.”

Prof. Jeremy Pearson, Associate Medical Director, British Heart Foundation, said:

“This report adds to the growing body of evidence that shows the detrimental impact that air pollution is having on the public’s health. Our research has shown that both long-term and short-term exposure to air pollution can increase people’s risk of a heart attack or stroke and worsen existing heart conditions. Using this evidence, we need to work in partnership with the Government and other health bodies to identify robust measures to tackle many of the causes of harmful air pollution including our congested roads.”

Prof. Anthony Frew, Professor of Allergy & Respiratory Medicine, Royal Sussex County Hospital, said:

“While this report is interesting, its findings have to be seen in the context that on average we live longer, healthier lives than we did in previous generations, and that much of this is due to the industrial improvements that cause the pollution. Living has never been risk-free and we make compromises all the time between our short-term comfort and long-term health. Ultimately you have to ask the question, how much would you have to change things to achieve a defined improvement, and what would it cost – if the number of lives or days that can be saved is small and everyone would have to stop using cars to achieve this, then clearly it isn’t going to happen. In other words we have to trade off the cost and inconvenience of actions against the size and value of any proposed health benefit. I feel the report was very light on that aspect.”

“Furthermore, the “deaths caused by air pollution” are generally considered to be deaths that are brought forward, rather than deaths that would not have happened. In other words  these may be people who are about to die from lung or heart disease who, as a result of an air pollution episode die a few days (or weeks) earlier than they would otherwise have died. There is some evidence that a few deaths do happen due to cardiac rhythm events that are truly premature –in other words, without the air pollution they might not have happened for several years – but this is hard to prove. Additionally, the indoor pollution data cited here is almost entirely based on studies of indoor tobacco smoke, which is clearly a health hazard. In its conclusions the report tends to conflate this with other potential risks (for which there is little evidence) into a general statement that thousands of lives are being blighted by other forms of indoor air pollution, when the focus should really be on reducing tobacco smoking.”

Prof. Alastair Lewis, Professor of Atmospheric Chemistry, National Centre for Atmospheric Science, University of York, said:

“This is a thorough examination of the current state of understanding of air pollution on health, reconfirming the very significant impacts that can occur and costs associated. It is to be welcomed that it highlights the combined effects from both outdoor and indoor exposure and the impacts right through a human lifecycle.

“The report makes many sensible suggestions about how individuals could make small changes to minimise their exposure to pollution, and recommendations about possible action that could be implemented at a city scale. Devolving responsibilities to local authorities is one possible solution, but it is important to stress that the actual effectiveness of policies such as road closures and local traffic management are still very uncertain. There are major gaps in the science and technology needed to assess whether these sorts of local interventions would make meaningful contributions to reducing pollution locally.  Gaining public acceptance for potentially disruptive management for air pollution will need those responsible to also collect the evidence that shows their policies have been effective. Closing roads near schools for example has considerable appeal, but could also prove costly and disruptive; such actions need to be matched up with studies that can quantify the benefits.

“The biggest public health gains are likely to come from much more effective national management of air pollution, meaning more ambitious targets for reducing emissions outdoors and inside, matched with more effective policing of real-world emissions from individual source sectors, such as vehicles, power generation or agriculture.”

‘Every breath we take: the lifelong impact of air pollution’ published by the RCP and RCPCH on Tuesday 23rd February. 

Declared interests

Prof. Ian Colbeck: Member of Institute of Physics, Royal Meteorological Society, International Society of Indoor Air Quality and Climate, Aerosol Society. Grants funding: NERC, EU. Voluntary appointments: Essex Air Quality Consortium.

Prof. Jeremy Pearson: BHF didn’t fund/author the report, although we did contribute evidence to it. No other conflicts of interest to declare.

Prof. Anthony Frew: I have a long term interest in the area, but have no direct link to the report. I used to be a member of COMEAP and have researched the health effects of diesel exhaust. I am also the past-president of the British Society for Allergy and Clinical Immunology.

Prof. Alastair Lewis: Member Defra Air Quality Expert Group. Member UNEP and WMO science advisory panels. Receives funding from NERC, Defra, DECC and MOD for atmospheric pollution research. Receives funding from industry for research into analytical technology for the measurement of airborne chemicals.