Dr Malcolm White – Clean Air Specialist at charity Global Action Plan (GAP)

Every year, air pollution causes upwards of 36,000 deaths in the UK. It also puts an enormous burden on the National Health Service (NHS) as air pollution can affect every organ in the body. When we breathe polluted air, it inflames the lining of our lungs and can move into our bloodstream causing lung disease, heart disease, dementia and even strokes. This translates to a significant financial burden on the NHS, predicted to reach £18.6 billion by 2035 in England alone.

The health sector plays a critical role in responding to and educating patients on a multitude of factors that impact health. Unfortunately, this is currently not the case with air pollution. At Global Action Plan we are making a concerted effort across public health and frontline healthcare services to make clean air healthcare a reality. We believe healthcare professionals play a vital role in tackling air pollution, as: 

• Educators: as trusted messengers in society, they play an important role in informing the public of the health risks, as well as measures they can take to minimise their exposure; 
• Role models: showing leadership in the NHS’s drive to minimise the air pollution the NHS creates and influences;
• Champions: supporting policy measures at local and national levels that will help ensure improvements to air quality. 

Health professionals as educators 

For health professionals in primary and secondary care to advise patients on the impacts of air pollution and how to protect their health, they must learn how. The gap in current medical training came to light through our Mobilising Health Professionals project in partnership with the UK Health Alliance on Climate Change (UKHACC). We trained 40 respiratory and paediatric health professionals on the impacts of air pollution on patient health and the measures people can take to reduce their exposure. While health professionals already provide health advice around lots of lifestyle issues including smoking, exercise and diet, health professionals reported that: 

• They were not talking to or advising patients about air pollution; 
• Air pollution is not uniformly integrated into healthcare professional training; and 
• Materials were not readily available for health professionals to share with their patients on air pollution. 

Harnessing this insight, we worked with them to create materials and resources to educate staff and facilitate sharing this learning with patients. Two similar pilots in the primary care setting have been run to broaden the utility of these resources. They are freely available on the GAP website Clean Air Knowledge Hub for the Health Sector (actionforcleanair.org.uk). These include educational videos, leaflets, posters, teaching slides and more. These materials have been adopted by the Royal College of Physicians and the Royal College of General Practitioners, and then shared with their members. 

Health professionals as role models

Inherently, by delivering healthcare, the NHS creates air pollution. The Chief Medical Officer (CMO) Professor Sir Chris Whitty dedicated his 2022 CMO report to the wider changes in society required to tackle air pollution. In this key document the NHS also committed to reducing its contributions to air pollution by half within a decade. 

GAP partnered with Great Ormond Street Hospital (GOSH) in creating the Clean Air Hospital Framework, which works at the trust level, enabling health boards to set ambitious targets and self-assess progress on tackling air pollution. Using the framework, air quality has since been built into GOSH’s new building developments and construction activities, contracts and tenders, training of staff, reviewing cleaning products and more. Their action has catalysed other hospitals across the UK to tackle similar barriers. 

GAP also have the tools to help the NHS reduce air pollution at a regional scale. In partnership with Newcastle Hospitals NHS Foundation Trust and Boehringer Ingelheim we developed the Integrated Care System (ICS) Clean Air Framework. This Framework aligns with sustainability requirements in trust/ICS Green Plans and supports the ICS leaders to incorporate air quality improvement measures around hospitals and health hubs. From the local GP practice up to the ICS level, the voice of health professionals is vital in driving forward the work to tackle air pollution while ensuring that health and health inequalities are considered across the NHS’s work on sustainability.

Health professionals as champions 

While resources, materials, and education help to arm the health sector in the battle against air pollution, this alone is not sufficient to drive the changes required in tackling air pollution while instilling mass behaviour change. We must push for more ambitious policies for tackling air pollution from UK leaders while implementing a nationwide programme to support the inclusion and integration of air pollution information into health-sector practice. It is my feeling that health professionals often underestimate or forget how powerful their professional voice is in speaking to local and national government.

Despite the success of our pilot projects and initiatives, we need to move from the testing phase to mainstreaming real action within the health sector. This requires integration of air pollution information into healthcare curricula, guidelines, and common practice while the sector rapidly curbs then eliminates its contributions to air pollution. By improving the air quality in healthcare environments, the positive effects will benefit everyone. 

Lastly, the onus to act on air pollution cannot be put on healthcare professionals and patients alone – we need ambitious and well-funded government action alongside sustained public health campaigns that teach the public what we all must collectively do to tackle air pollution. No one should have to breathe dirty air. 

For more information on our work with the health sector and health professionals, head to: www.actionforcleanair.org.uk/health.

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