BLF new data on pollution levels around hospitals and surgeries
The British Lung Foundation has released a new report mapping out levels of particulate matter around health centres across the UK highlighting potential risks.
Summary
The British Lung Foundation (BLF) asked Cambridge Environmental Research Consultants (CERC) to use existing modelled PM2.5 data to find out how many health centres are currently exposed to PM2.5 levels above what the World Health Organization (WHO) recommends (10µg/m3 for the annual average).
Their analysis has revealed that in 2018, 2,220 GP practices and 248 hospitals are in areas that exceed the WHO’s safe air pollution limits. This includes major teaching hospitals, 2 of the biggest children’s hospitals in the country, small clinics, and GP surgeries.
This represents 1 in 3 GP surgeries and 1 in 4 hospitals in England, and many cities including Birmingham, Cardiff, Leeds, Leicester, London, Nottingham, Hull, Chelmsford and Southampton have at least one large NHS trust that is located in an area with unsafe levels of pollution.
This is not a problem which affects only London and other big cities. Smaller towns such as Ipswich, Westcliff-on-Sea, Gillingham, Worthing, Kettering, Basingstoke and Colchester, to name but a few, also have their main hospital located in an area with unsafe levels of pollution.
Background
The UK is currently meeting legal limits for PM2.5. However, this is only because the legal limit is more lenient than the limit recommended by the international health community. The UK legal limit for PM2.5, derived from EU regulation, is more than twice as high as the WHO recommendation, 25µg/m3 instead of 10 µg/m3 for the annual average.
Clean air is expected to be a substantial part of the upcoming Environment Bill, and the BLF wants the WHO recommended limit to be included in the Bill so that it becomes UK law.
The BLF has increasingly focused its air pollution work on PM2.5 as research in recent years has strengthened the evidence that both short-term (over hours to days) and long-term (over several years) exposure to PM2.5 are linked with a range of health outcomes, including respiratory effects (World Health Organization Regional Office for Europe. 2013.
Population studies have shown that exposure to particulate matter in the air is linked to a number of different health outcomes, ranging from short term changes in the respiratory tract, causing irritation and coughing, and impaired cardiovascular function, through to increased risk of symptoms requiring emergency or hospital treatment. At the most extreme, there could be an increased risk of death from respiratory or cardiovascular diseases or lung cancer.
There is also evidence of a clear link between high levels of air pollution and increased numbers of patients with breathing problems presenting at hospitals and GP surgeries. In a recent study carried out by the University of Dundee and funded by the British Lung Foundation, researchers studied nearly 15 years of data for air pollution levels in Dundee, Perth and the surrounding area.
Researchers matched air pollution levels to medical records of 450 patients who suffer from bronchiectasis, a long-term chronic condition which can cause a persistent cough and breathlessness as well as frequent chest infections. They found that on days when air pollution levels spiked there was a large increase in admissions to Ninewells Hospital and Perth Royal Infirmary with breathing problems and visits to GP’s with breathing problems, known as exacerbations.
What was involved?
In May 2018, the UK Government published its draft Clean Air Strategy, which included a new commitment, welcomed by the BLF, to halve the number of people living in areas with concentrations of PM2.5 above WHO guideline levels by 2025.
We explored ways to produce localised data on PM2.5 which could be easily communicated to the public and policymakers and demonstrate the need to implement more ambitious measures to protect the nation’s health.
Existing data primarily focuses on city-wide levels, and rarely looks at specific locations. As such, local authorities often lack specific data about PM2.5 levels in their local area, especially where vulnerable groups gather.
As a consequence, the BLF decided to look at levels of PM2.5 around health centres as many of the groups disproportionately affected by air pollution, such as children, the elderly and people with a lung or heart condition, often have to visit and spend long periods of time in these places.
The BLF asked the CERC to use existing modelled PM2.5 data to find out how many health centres are currently exposed to PM2.5 levels above what the WHO recommends.
The research covers England, Scotland and Wales. Postcodes for hospitals and GP surgeries were extracted from the NHS digital database. In total, 9,988 health centres (1,457 hospitals and 8,532 GP practices) were included. CERC used existing modelled PM2.5 data published by the UK Government and used predicted annual average PM2.5 data for 2018.
The report Toxic Air at the Door of the NHS (October 2018) focuses on 6 case studies, with towns and cities of different sizes, and from different regions, to cover a wide variety of air quality profiles:
- Birmingham, London, Nottingham, and Worthing for England
- Aberdeen for Scotland
- Cardiff for Wales
So that members of the public, patients and hospital staff can easily find out if their local services are in areas with dangerous air quality, the BLF created an interactive map where people can easily look up a health centre by postcode. At the same time, they have been clear that no one should avoid seeking medical help because they are worried about air quality in the area.
What went well?
This new report gives important information to health centres and gives them an opportunity to share the findings with local authorities.
Some of the hospitals mentioned in the report have also been keen to talk to the local press about the need to act urgently to reduce pollution levels and some of them have also shared examples of new initiatives they have introduced to reduce the hospital contribution to poor air quality.
The BLF will continue working with the hospitals and GP practices to support them and ensure better awareness amongst clinicians of the health effects of air pollutants, to allow them to provide appropriate advice.
What could be improved?
The data used by CERC have a spatial resolution of 1km x 1km, and therefore represent ‘background’ levels of PM2.5. These data give a representative indication of expected PM2.5 levels across the whole of the UK at sufficient resolution to provide good evidence.
However, they represent the annual average, and do not capture peaks and troughs in PM2.5 levels caused by road traffic, so-called ‘roadside’ levels, which fluctuate and sometimes exceed the 10µg/m3 WHO limit in a short space of time.
It would have been interesting to look at roadside concentrations to understand what people are exposed to when they travel from and to the hospital and consider other factors such as the impact of air pollution peaks, not just averages.
Next steps
The BLF will continue working closely with Government departments, MPs, local authorities and health care professionals to disseminate the results, secure a clear commitment to adopt the WHO’s limit in the upcoming Environment Bill, and continue to find suitable solutions to local air pollution problems.
Further information
Pauline Castres, The British Lung Foundation.
The views expressed in this case study are those of the BLF.