London Air Quality and Health Programme Office
“We are currently facing a significant challenge in our city – the interconnected issues of climate change, air quality and the environments in which we live, work, learn and play – which have a critically important impact on our health. We need to talk to our patients about the air they are breathing.”
Blog by Professor Kevin Fenton, London Regional Director of Public Health, Office for Health Improvement and Disparities
The London Air Quality and Health Programme Office was established in 2022 to support the delivery of the recommendations of the Prevention of Future Deaths report issued following the inquest into the death of Ella Adoo-Kissi-Debrah.
The Programme Office is a collaboration between UK Health Security Agency (UKHSA), Office for Health Improvements and Disparities (OHID), Mayor of London and NHS England (NHSE) London and is funded by the London Health and Care Partnership. The Programme Office is led by UKHSA providing technical, scientific expertise and dedicated programme management support.
The purpose of the Programme Office is to combine and coordinate pan-London joint work on air quality across the health and care system, to ensure that poor air quality is recognised as a determinant of poor health outcomes and a key driver of health inequalities in London.
Background
The Chief Medical Officer’s annual report 2022 highlights that long-term exposure to low levels of pollution are harmful to health. The main pollutants of concern are nitrogen dioxide (NO2) and particulate matter (PM10 and PM2.5) – the pollutants with the greatest impact on health. Air pollution is a major cause of premature death and disease and is one of the largest environmental health risks in the UK. It is estimated that long-term exposure to manufactured air pollution in the UK has an annual effect equivalent to 29,000 to 43,000 deaths.
Air pollution can affect everyone, but people with cardiac or respiratory disease, older people, children, and pregnant people are at greater risk of health impacts. Air pollution increases the risk of developing lung cancer and cardiovascular and respiratory diseases and there is also growing evidence linking air pollution to a wider range of health effects including adverse birth outcomes, diabetes, and increased dementia risk.
All Londoners still live in areas that exceed World Health Organisation recommended limits for NO2 and PM2.5. It is estimated that average concentrations of NO2 are 17% higher and PM2.5 7% higher in the most deprived areas of London compared to the least deprived areas. People in racially minoritised communities are still more likely to live in areas with higher levels of air pollution. Moreover, forecasts show that our city cannot meet safe levels by 2030 without more action. Taking further steps to reduce air pollution is necessary not just to protect people from acute exacerbations of cardiopulmonary conditions but also to keep our brains and other organs healthy in the long term.’
Blog by Dr Jeremy Isaacs, consultant neurologist at St George’s and Kingston Hospitals. He has a specialist interest in cognitive neurology and dementia and is Clinical Director of the NHS London Dementia Clinical Network.
London has the highest percentage of deaths caused by particulate air pollution of all English regions, with an estimated 4,000 premature deaths due to air pollution each year and London’s most vulnerable citizens are disproportionately impacted. There are significant inequalities in exposure and vulnerability to air pollution in London.Ethnic minorities and deprived communities are most greatly impacted.
The evidence is clear – air pollution is a major public health issue. However, we know that improvements in air pollution can deliver great health benefits. We have seen significant improvement in air quality in recent years as a result of multi-agency partnership, air quality policies and action. The improvement in air pollution between 2016 and 2019 is associated with a reduction in the number of hospital admissions for asthma due to air pollution in London, by 30% in children and 27% in adults.
The London Air Quality and Health Programme Office aims to improves London’s air quality by:
- Air Quality Alerts: Build cross-sector partnerships and facilitate innovation. Develop, implement, evaluate, and improve targeted air quality alerts for health and care professionals in London.
- Comms: Raise professional awareness across the health and care system of the impact of air pollution on health.
- Education: Ensure healthcare professionals are equipped with the knowledge, skills, and confidence to integrate air quality within person-centred conversations and consultations.
- Legacy: Drive and influence strategic discussions, decisions and actions across the health and care system to tackle air quality, to shape and advance the agenda in alignment with wider public health priorities, and regulatory standards.
Air Quality Alerts – impact so far
One of the commitments at the Clean Air and Health Summit 2022 was for alerts to be sent to London healthcare professionals when elevated air pollution was forecast. The Programme Office has collaborated with a wide range of partners across London’s health and care system and the Mayor of London to develop targeted air quality alerts for healthcare professionals in London. The programme office recognises that air pollution often disproportionately impacts certain groups and therefore tackling health inequalities is central to our work. This impactful and innovative system launched on Wednesday 28 February 2024.
The air quality alerts provide healthcare professionals with clear evidence-based guidance to support person-centred conversations with patients and carers, and advice on how to reduce exposure and contribution to air pollution. The alerts will deliver an air quality email alert directly to general practices (GPs) and emergency departments (EDs) the day before an episode of high or very high air pollution is forecast. These alerts build upon the Mayor of London’s existing air quality alert system, which delivers alerts to schools and other London stakeholders. The alerts are triggered by forecasts from Imperial College London and are anticipated to occur 4-5 times a year
The development of the air quality alerts has been informed by the best available evidence and extensive engagement with the use of qualitative methods including interviews, surveys, and focus groups. This was conducted with a broad range of stakeholders and experts, including academics, clinical networks, third sector partners, behavioural scientists, and ethicists. The Programme Office also collaborated closely with clinicians who have local expertise to identify and potentially scale strategies for those living in deprived communities, who are more likely to be exposed to higher concentrations of pollutants than those in less deprived communities.
The Programme Office also collaborated with Primary Care UK to develop a podcast to discuss how healthcare professionals can help address the health issues around air pollution. The podcast aims to help health professionals understand more about how poor air quality is a significant contributor to the development and worsening of many long-term conditions. The podcast launched on 15 February 2024 in memory of the life of Ella Adoo-Kissi-Debrah.
Next steps
Future work will include evaluation of the alerting system, to expand on the reach of the alerts to further increase awareness and drive continuous improvement. Map education initiatives and resources alongside calls for evidence, gap analysis, evaluations of key learning and promoting existing tools and resources. The programme office is also seeking to create and maximise alignment with important pillars of work essential to delivering a net zero NHS, linking to the health benefits of active travel and the advantage of reducing personal contribution to emissions and poor air quality.
To find out more information about the work of the London Air Quality and Health Programme Office, please email aq.programmeoffice@ukhsa.gov.uk.