In September, the Royal College of Paediatrics published its updated position statement on air pollution in the UK. Dr Emily Parker, RCPCH Clinical Fellow and one of the position statement’s authors, explains the importance of this document and its relevance to healthcare professionals
I became interested in air pollution during a year working as a Sustainability Fellow at Newcastle Hospitals NHS Foundation Trust. I was working on a project to reduce the carbon footprint of paediatric asthma care by making changes to inhaler prescribing and recycling practices.
I started to realise that it made sense to focus further upstream and try to tackle the environmental causes of childhood asthma itself. This got me thinking about air pollution and how improving air quality can have a positive impact on both health and climate change.
When I think back to what I learnt about air pollution in medical school, it’s curious that it took me so long to make this link. I did my undergraduate training in Newcastle Upon Tyne in the northeast of England, which has a strong industrial heritage, so I learnt about how inhaled pollutants from the mining and ship building industries impacted both workers and their families.
However, I got the impression that air pollution’s impact on health was a thing of the past in the UK, and current issues were located further afield, such as the use of solid fuels for cooking in some parts of the world. We didn’t learn about how ambient air pollution at current levels is impacting people’s health.
The RCPCH’s published position statement counters this narrative and highlights the significant child health impacts of air pollution, including in the UK.
The impact of air pollution on children and adults
Air pollution exposure at every stage of the human lifecycle – from gestation right through to adulthood – adversely impacts health. Children are particularly vulnerable to air pollution exposure because they breathe more air than adults in proportion to their body weight, so they take in more pollutants, and the health impacts are amplified due to their smaller bodies and developing organs. In fact, air pollution is the second leading risk factor for death in children under five, both in UK and globally.
Fine particulate matter and nitrogen dioxide (NO2) are responsible for a significant proportion of air pollution’s health impacts. The term ‘particulate matter’ refers to very small solid or liquid particles, which are present in the air – or ‘everything in the air that is not a gas’. The term ‘fine particulate matter’ or PM2.5 refers to particles that are less than 2.5 micrometres in diameter (less than 1/20th of the width of a human hair), so small that they can cross from the lungs into the bloodstream, and even cross the placenta. NO2 is one of a group of gases known as oxides of nitrogen (NOX). These gases are highly reactive and can irritate the airways.
The air pollution-related health risks in children are far-reaching and span multiple organ systems. The impact on the respiratory system is perhaps best known and most relatable. Between 2017 and 2019, an estimated 7% of paediatric asthma admissions in London were linked to spikes in air pollution, and reductions in air pollution concentration correlated with reduced hospital admissions.
The cases of Ella Adoo Kissi-Debrah, who died of severe asthma aged nine, and Awaab Ishak, who died aged two due to exposure to black mould in his home, highlight the severity of this problem. These cases also draw attention to the health and racial inequalities that are exacerbated by unequal exposure to air pollution. As the RCPCH position statement points out, already deprived populations, despite contributing less to air pollution, experience greater health impacts from air pollution exposure.
Air pollution also impacts other parts of the body such as the cardiovascular system, metabolic system and brain. There is emerging evidence that air pollution is also contributing to diabetes, obesity, and mental illness. We know that it adversely impacts cardiovascular health in adulthood, leading to high blood pressure, heart attacks and strokes. It appears that the disease processes start in childhood.
Raise awareness, advocate for change
The RCPCH feels strongly that air pollution is an avoidable cause of morbidity and mortality, therefore governments, local authorities, and key anchor institutions should act to protect the most vulnerable, who have the least power and resources to control their environments.
Furthermore, measures to improve air quality often have additional health and environmental co-benefits. The solutions must come from all sectors of society, so our policy recommendations are aimed at schools, transport, housing, the NHS, and the Department for Environment, Food and Rural Affairs.
Healthcare professionals can play a role here too – both in advising their patients on the impact of air pollution and how best to avoid exposure, and in advocating for systemic change. At the RCPCH, we’re working with over 100 members of our Clean Air Network to amplify our policy recommendations both locally and nationally, including the need for the NHS to mandate the implementation of the Clean Air Hospital Framework across all NHS organisations.
Healthcare professionals are consistently among the most trusted professional groups in society, so their support can help to reframe divisive or overlooked political issues and lead to tangible policy change.
A version of this story was first published on our sister title Hospital Pharmacy Europe.
