Responding to air pollution : setting the agenda to improve air quality. Presentation for the Public Policy Exchange seminar on air quality 23rd October 2018 181022 middletonj final air pollution

1. www.fph.org.uk
Responding to Air Pollution
Setting the agenda to improve air
quality
Professor John Middleton

6. long-term effects
40000 deaths
associated with
air pollution

7. PM10 = less than 10m

8. Pinkerton EHP 2000
particles in tissues
PLOS one 2017

9. estimating exposure
-long term

10. Rennard 2015 Lancet
reduced lung function
– long term effects

11. Life Course Effects

12. how can we communicate risks?

13. communication of risk

14. Susceptibility
• Deprived populations disproportionately exposed despite being
modest contributors
• Stress can weaken the body’s defences and influence the
internal dose of toxicants
• Geographical region has a major impact on the health effects of
deprivation http://www.instituteofhealthequity.org/resources-
reports/fair-society-healthy-lives-the-marmot-review
• It is entirely plausible that environmental stressors such as air
quality contribute to this inequity Annual Report of the Chief Medical Officer
2017, Health Impacts of All Pollution - what do we know?
• https://www.gov.uk/government/publications/chief-medical-officer-
annual-report-2017-health-impacts-of-all-pollution-what-do-we-know

15. Susceptibility

16. Susceptibility
• Face multiple environmental and social stressors
• Deprivation increases susceptibility to PM including pre-
term birth and respiratory mortality
• Evidence that other factors, closely associated with
deprivation, such as obesity and pre-existing
cardiovascular and respiratory diseases increases
susceptibility
• Attenuation of age-related lung function decline is not
observed in the overweight or obese
• Obese young children may be more likely to develop
asthma in association with greater exposure to PAHs

17. Air pollution in our changing world
• Changes in the way we live have changed the air
we breathe
• Total distance walked each year has decreased by
30% since 1995 and has been static since 2002
(cycling up by 54%)
• People without cars walk 303 miles pa compared to
184 for those with cars and also cycle more
• In 2012, road traffic in the UK was 10x higher than
in 1949
• Far more diesel cars-unintended consequences
Royal College of Physicians. Every breath we take: the lifelong impact of air
pollution. Report of a working party. London: RCP, 2016.

19. road diesel
other diesel
why focus on diesel?

20. Real-world exhaust emissions ICCT 2014
...diesel performs poorly

22. Challenges: cheating
• 9 m fraudulent VW cars sold in Europe/US emitted
526 kt of NOx more than legally allowed (2009-15)
• Associated with 45,000 DALYs and a life lost value
of $39 bn, 5 times what VW has put aside
• Oldenkamp R, van Zelm R, Huijbregts AJ. 2016. Valuing
the human health damage caused by the fraud of
Volkswagen. Env Poll 212: 121-127

23. Challenges
• Air quality cannot be seen in isolation
• Some solutions are outside traditional
air quality management regimes
• Need more than reliance on CAZs
• Only a small fraction of deaths are due
to exceedences of air quality standards

24. Package of interventions and innovations
• Make the polluter pay
• Divest from fossil fuels
• Adopt WHO air quality standards
• A new Clean Air Act and an independent statutory body to
enforce these limits
• Powers and resources for local and regional enforcement
including responding to periods of high localised pollution
(e.g. closure of roads and/or diversion of traffic)
• Change the default
• Incentivise mass adoption of zero emission transport,
reduced use of vehicles in general, and increased use of
active and shared transport modes

25. Challenges
• Current commitment of £1.2 bn for walking and
cycling 2016-2021 is hugely reliant on investment
by local authorities and LEPs as the Government
has only committed £316m
• Funding for local communities in areas of poor air
quality for local and personal air quality
monitoring especially around sensitive receptors
(e.g. school-run traffic around primary schools)
• Communication strategy must recognise that
there are large numbers of people who do not, or
cannot, routinely access online resources

26. London in 2025
with same diesel fleet without diesel

28. Reflections
• Invest in integrated public transport rather than subsidise private
• Expand metros in major cities
• Electrification of all existing rail lines and re-opening lines
• End the sale of petrol, diesel and some hybrid cars and vans by
2025 rather than the current target of 2040
• Prioritise retrofit of buses outside London esp Euro 3 or older
• NHS related transport accounts for up to 18% of NHS carbon
footprint and 5% of road traffic in England
• Installation of green infrastructure (e.g. green walls, living walls,
hedges) can reduce pollutant concentrations in street canyons

33. Economic considerations
• Support for Green clean innovation welcome : conversion to electric
vehicle production potential growth area for UK economy 20% of
electric cars sold in Europe, built in England :
• Private car use and road freight costs greatly subsidised by the tax
payer: Vehicle excise duty and fuel duties greatly exceeded by
costs of road programme repair, maintenance, new roads £20billion
/year
• Imports of oil could be halved adding to balance of payments
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34. Economic considerations
• Poor air quality will put cities at competitive disadvantage:
unpredictable transport blockages, failures and congestion create
major interruption to business
• Increased footfall in more pedestrian friendly environments
• Active travel: healthier alert workforce, arriving on time in good
humour!
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35. Economic considerations
• Health and economic benefits of mitigating
climate change
• Cannot frack the ground from under us and still
say we are concerned about air pollution
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36. Omissions
• Aspirations not plans
• Unambitious in eliminating petrol and diesel cars by 2040 not sooner
•
• No reference to tobacco smoke as most important indoor pollutant
• Should aspire to zero carbon standard
• Contradictions in fracking vs reducing green house gases - and failure
to recognise air pollution from drilling processes
• Inadequate commitment to invest in active travel
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37. Reflections
• Pollution remains an avoidable and significant threat to health, well-
being and inequalities
• Environmental assets are the polar opposite
• The rate at which science turns facts into knowledge is increasing but
need to avoid evidence fetishism
• Horizon scanning for future and emerging issues
• In times of austerity our Government’s position is ‘can we afford to do
it’ rather than ‘can we afford not to do it’
• Local authorities, democracy, speaking truth to power, citizen science
and professional confederacy are key

38. Thank you
Professor John Middleton
president@fph.org.uk
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39. www.fph.org.uk
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