Guidance

Air pollution: applying All Our Health

Updated 28 February 2022

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This publication is available at https://www.gov.uk/government/publications/air-pollution-applying-all-our-health/air-pollution-applying-all-our-health

The Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.

Introduction

This guide is part of ‘All Our Health’, a resource which helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice. This information will help frontline health and care staff use their trusted relationships with patients, families, and communities to take action on the health effects of air pollution.

We also recommend important actions that managers and staff holding strategic roles can take. View the full range of All Our Health topics.

Access the air pollution e-learning session

An interactive e-learning version of this topic is now available to use.

The Office for Health Improvement and Disparities (OHID) and Health Education England’s ‘e-Learning for Healthcare’ have developed this content to increase the confidence and skills of health and care professionals, to embed prevention in their day-to-day practice.

Why we focus on the health effects of air pollution in your professional practice

In the UK, air pollution is the largest environmental risk to public health.

The annual mortality of human-made air pollution in the UK is roughly equivalent to between 28,000 and 36,000 deaths every year. It is estimated that between 2017 and 2025 the total cost to the NHS and social care system of air pollutants (fine particulate matter and nitrogen dioxide), for which there is more robust evidence for an association, will be £1.6 billion.

Air pollution can cause and worsen health effects in all individuals, particularly society’s most vulnerable populations. Long-term exposure to air pollution can cause chronic conditions such as cardiovascular and respiratory diseases as well as lung cancer, leading to reduced life expectancy. Short-term increases in levels of air pollution can also cause a range of health impacts, including effects on lung function, exacerbation of asthma, increases in respiratory and cardiovascular hospital admissions and mortality.

Air pollution explained

Air pollution is a substance or complex mixture of particles and gases in the air that cause harm to peoples health. Air pollutants are emitted from both natural and human sources.

Damaging air pollutants, for which there are national emission reduction commitments, are fine particulate matter (PM2.5), ammonia (NH3), nitrogen dioxide (NO2), sulphur dioxide (SO2), and non-methane volatile organic compounds (NMVOCs). Other ambient (outdoor) air pollutants include ozone and carbon monoxide (CO).

Ambient air pollution originates from sources including transport, industrial processes, farming, energy generation and domestic heating. Concentrations of air pollutants can vary both temporally and spatially but are typically higher close to the source. In urban areas especially, concentrations of particulate matter and NO2 can be particularly high.

Infographic showing statistics of sources of air pollution, including transport, industry, agriculture and residential properties.

Indoor air pollution is also an important source of exposure. The average person spends around 80% of their time indoors and therefore, exposure to indoor air pollution is important to consider.

Pollutants and sources include:

  • CO, NO2 and particulates from domestic appliances (boilers, heaters, fires, stoves and ovens), which burn carbon-containing fuels (coal, coke, gas, kerosene and wood)
  • OCs from cleaning and personal care products, building materials and household consumer products (paints, carpets, laminate furniture, cleaning products, air fresheners, polishing)
  • environmental tobacco smoke (ETS) and second-hand smoke (SHS)

Also, radon which is a colourless and odourless radioactive gas that comes from the radioactive decay of small amounts of uranium and radium that occur naturally in all rocks and soils. The main danger of high radon exposure is the increased risk of lung cancer. It is generally not a problem in outside air but can accumulate in buildings.

The health impacts of air pollution

The health effects of pollutants will depend on many factors as to the level of harm an individual is exposed to. This includes the dose, duration, how an individual comes into contact with the pollutant, in addition to factors such as age, sex, diet, family traits, lifestyle and state of health.

Air pollution can affect the eyes, nose and throat, the heart and associated blood vessels and the lungs and respiratory system. Short-term exposure (over hours or days) can lead to a range of health impacts including lung function, coughing, wheezing and shortness of breath, exacerbation of asthma, increases in respiratory and cardiovascular hospital admissions and mortality. Over long timescales (years or lifetimes) exposure can lead to reduced life expectancy, due to cardiovascular diseases, respiratory diseases, and lung cancer. More recent research has associated air pollution with affecting the brain causing dementia and cognitive decline; diabetes and affecting early life leading to various birth outcomes, for example, low birth weight and developmental problems.

Infograhic showing individuals more susceptible than others, including children, the elderly, individuals with existing cardiovascular or respiratory diseases, pregnant women, communities in areas of higher pollution, low-income communities.

Air pollution can affect anyone’s health; nevertheless, some individuals can be more susceptible than others. These include:

  • children
  • the elderly
  • individuals with existing cardiovascular or respiratory diseases
  • pregnant women
  • communities in areas of higher pollution, such as close to busy roads
  • low-income communities

Core principles for health and care professionals

Health and care professionals have a vital role in supporting communities, families, and individuals to take action against reducing air pollution and the associated health impacts. Hundreds of thousands of patients are seen by UK health professionals daily. Many of these individuals have existing health conditions which can be exacerbated by increased levels of air pollution. Therefore, it is important that health and care professionals are equipped to provide support and advice to reduce exposure and offer measures to be taken to reduce any avoidable risks. Other public health teams can also influence the general population by providing whole system approaches. This is crucial to reduce the health impacts associated with air pollution to help people live longer and healthier lives.

Therefore, health and care professionals should:

  • know the needs of individuals, communities and population and the services available
  • consider the resources available in health and wellbeing systems and the potential impact of earlier diagnosis and better management
  • understand specific activities which can prevent, protect, and promote public health

Taking action

Frontline health and care professionals

Health and care professionals can have an impact on an individual level by communicating important messages and giving general advice to raise awareness of how to reduce exposure to those most vulnerable during high pollution episodes. Advice could include:

  • limiting or avoiding any strenuous activity in high pollution episodes or areas - this is further emphasised if an individual is experiencing symptoms such as sore eyes, throat or a cough
  • increasing the use of asthma relievers as necessary
  • reducing exposure to highly polluted outdoor air by closing external doors and windows facing a busy street during congested periods

Informing individuals where to keep up to date with information sources, including:

  • Defra’s UK air website which provides current and forecast levels of air pollution and associated health advice
  • social media updates (DefraUKAir on Twitter)
  • a free air pollution helpline (0800 55 66 77)
  • advising that individual contributions such as walking and cycling improve an individual’s health as well as improving air quality

Frontline health and care professionals can also register for text messaging services such as AirText in London, airAlert in Sussex and Know and Respond in Scotland. These are free services aimed at individuals suffering from existing conditions which could be exacerbated during episodes of air pollution. Alerts can be received mainly through text (other forms are available from some of the other services) which alert of the air pollution forecast for the coming day.

Team leaders or managers

Team leaders, managers, community health professionals and providers of specialist services can have an impact by:

  • advising local plans and other primary strategies on how they will address air pollution including promoting active travel, enabling zero and low emission travel; and how to design buildings and spaces to improve air quality using the review of interventions to improve outdoor air quality and public health
  • working with relevant individuals, groups, and organisations to promote initiatives facilitating active travel such as Healthy Schools Programmes, school travel plans, cycle to work schemes
  • spreading awareness as a champion amongst professional and personal colleagues

Senior or strategic leaders

Senior and strategic leaders should be aware of the requirements and interventions at population level, which include:

  • raising awareness of the health issues associated with air pollution - this should be in line with the 6 identified principles for communicating with the public about air pollution from Defra’s Air Quality: a briefing for Directors of Public Health report (PDF, 3.5MB)
  • supporting efforts to reduce air pollution

Understanding local needs

The Public Health Outcome Framework (PHOF) is a set of indicators compiled by the Department of Health and Social Care (DHSC) to measure how effectively the activities of each local authority are addressing the determinants of health. Within the PHOF there is one indicator which specifically measures air pollution:

  • 3.01 fraction of mortality attributable to particulate air pollution

In addition, there are a number of air pollution related indicators which could be improved through the co-benefits of certain measures to improve air quality.

Measuring impact

As a health professional, there is a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution. This could be about sharing what has worked well in order to benefit your colleagues and local people or to support your professional development.

Further reading, resources, and good practice

Advice for patients and the public

Professional resources and tools

Examples of good practice

Clean Air Day: this is the largest annual air pollution campaign aimed at enabling the public to improve air quality and their health.

Case Study: the National Health Service (NHS). The NHS, whilst trying to improve air pollution, are a major contributor themselves. It is estimated to cost £345 million associated with mortality and other social costs. Implementations have been introduced at some London Hospitals which allows them to measure their own impact and implement measures to reduce air pollution.

Why air pollution is an important issue for all nurses.

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