Air quality response

Note: Impact on Urban Health is part of Guy’s and St Thomas’ Charity.

Guy’s and St Thomas’ Charity is an urban health foundation, exploring how living in cities impacts on people’s health. We take an applied approach, testing whole-system solutions to complex health issues. We focus our efforts in inner-city London and work in areas that experience the widest health inequalities. Our work as an urban health foundation is founded in the belief that urban health exists at the intersection of diversity, income inequality and the environments people live and work in.

This year, we launched an ambitious ten-year programme to explore how people’s health is affected by poor air quality, and test solutions in the heart of London. We are gathering evidence, analysing local data and exploring how people experience air pollution in our inner-city area, to identify interventions that will minimise negative health impacts. Like most complex health issues, air quality is an issue of health inequality: the negative impacts of air pollution are most keenly felt by certain vulnerable groups. As such, we focus our efforts on children under 15, older people and people with heart and lung conditions.

A core element of the Charity’s response to COVID-19 has been to fund rapid response research to better understand the impact of the pandemic on urban communities. Our submission to this Inquiry draws on this recent evidence, as well as the insights gained through our programmatic work on the health effects of air pollution.

Our submission below focusses on questions four and five in the Inquiry’s call for evidence.

4. What does the early evidence from the COVID-19 pandemic say about the impact of poor air quality on health, and health inequalities for disadvantaged communities and other at-risk groups, and possible policy responses?

5. What are the current and emerging risks and opportunities for air quality posed by:
a) Short-term policy and societal changes in response to the pandemic, for example changes to transport to reduce the risk of transmission, and;
b) Medium and long-term actions to promote economic recovery.

In addition to our responses to these questions below, we direct the Committee’s attention to a new research report from Guy’s and St Thomas’ and Charity and Global Action Plan, ‘Build Back Cleaner Air: COVID-19 and Air Pollution’ as a more in depth exploration of what we have learnt from COVID-19 and what future action is needed to tackle air pollution in the response to and recovery from COVID-19.

We urge the Committee to endorse full adoption of the evidence-based recommendations for Government in ‘Build Back Cleaner Air: COVID-19 and Air Pollution’. In addition, our submission below also recommends that:

• Tackling air pollution is regarded as a key lever to tackle the systemic causes of health inequalities faced by urban communities.
• A cross-Government Urban Health Strategy is developed to meet the immediate needs of communities hardest hit by the social, financial and health impacts of the pandemic, and ensure that the long-term response addresses factors, like air pollution, that so powerfully drive health inequality.
• Communities whose health is most vulnerable to air pollution should be at the heart of changes to our urban spaces to improve air quality and create more cycle and pedestrian friendly environments.
• Policy and financial support for businesses in the recovery from COVID-19 should require businesses to take action to reduce air pollution and provide support to do so where possible.

Of key interest to the Committee will be the Global Action Plan and Guy’s and St Thomas’ Charity report ‘Build Back Cleaner Air: COVID-19 & Air Pollution’, published in July 2020. The report draws on primary social research and secondary scientific data over the lockdown period, and makes recommendations for government, local authorities, and campaigners to build back cleaner air as we adapt and recover from COVID-19.

We would like to draw the Committee’s attention in particular to the following summary of relevant statistics and qualitative data.

In particular, this research, including a survey of 2002 adults, demonstrates that there is public appetite for action to reduce air pollution and that COVID-19 has starkly demonstrated the health benefits of doing so:

• 72% of people think that improving air quality is even more important now because of the impact of COVID-19 on respiratory health.
• 18% of all people have found it easier to breathe during the lockdown, which increases to 21% for residents of any urban area, and 36% for London residents. It’s 29% for those with asthma and 30% for those with a cardiovascular disease.
• 62% of people want the government and local authorities to tackle air pollution and traffic more urgently than pre-lockdown, with only 6% in opposition to this.
• 74% of people think businesses need to do more to reduce air pollution to try and maintain improved air quality experienced during lockdown¹. Further resources can be found on the Clean Air Hub.

Recommendation: We strongly encourage the Committee to draw on this timely research and would be happy to provide further detail if required. The recommendations in the report are evidence based, targeted and draw on the most up to date global expertise in how to tackle air pollution. We encourage the Committee to fully endorse these recommendations and recommend full adoption by Government and local authorities.

Inquiry question 4: What does the early evidence from the COVID-19 pandemic say about the impact of poor air quality on health, and health inequalities for disadvantaged communities and other at-risk groups, and possible policy responses?

The evidence of the health effects of air pollution are well established. For example:

Children under 15²

• Air pollution can impact on children before birth – research has found that pregnant women exposed to PM2.5 and NO2 air pollutants are more likely to have smaller, low birth weight children.

People with heart and lung conditions³

• Short-term spikes of NO2 have been associated with increases in hospital admissions for asthma and short-term spikes in PM2.5 and NO2 have also been associated with COPD related hospital admissions.

Older people⁴

• Exposure to air pollution has also been associated with cognitive decline in older people.

Emerging evidence from the UK and across the globe has shown that people exposed to high levels of air pollution are more likely to test positive for and die from COVID-19⁵. This is in part due to the negative health affects of air pollution on respiratory and immune health in isolation from COVID-19 itself.

However, the pandemic has also demonstrated more clearly than ever that health outcomes are the result of complex and inter-related determinants of health. If you live in an urban area, you are more likely to be exposed to higher levels of air pollution⁶. You are also more likely to live with multiple long-term health conditions⁷ and have lower paid employment or be unemployed: all factors that have been associated with a higher risk of testing positive for and dying from COVID-19⁸. Similarly, increasing evidence suggests that the higher prevalence of and mortality rates from COVID-19 amongst people from Black and other minoritised ethnic backgrounds is due to the complex intersection between these powerful determinants of health⁹.

Likewise, the non-clinical impacts of the virus – such as unemployment, social isolation and access to nutritious, affordable food – also hit the most vulnerable groups in society hardest¹⁰, notably people living in urban places who are simultaneously more exposed to air pollution.

Recommendations: Tackling air pollution should be regarded as a key lever to tackle the systemic causes of health inequalities faced by urban communities.

Tackling air pollution has potential to powerfully reduce health inequality, particularly as many actions that improve air quality have other health benefits. For example, active travel has an impact on obesity and improved streetscapes and green spaces can improve mental health and reduce the risk of cardiovascular disease¹¹.

The case for doing so is particularly strong when it is considered that people living on lower incomes in cities are least likely to contribute to air pollution (for example, are more likely to use public transport or walk than drive), yet are more exposed to air pollution and more likely to experience the health effects of air pollution.

Recommendation: A cross-Government Urban Health Strategy is needed to ensure that the immediate response to COVID-19 meets the needs of people hit hardest by the pandemic, and that our long-term recovery addresses systemic inequalities faced by urban communities, not least the health impacts of air pollution.

The Strategy should contain concrete goals and action to improve health outcomes in urban areas, with recommendations for transport, urban planning and housing, industry, investors and employers, culture and sport, as well as healthcare and public health.

The voice of urban communities themselves should be at the centre of developing this Strategy, as well as insight from industry, investors, academia and the third sector to ensure a 360 degree approach to tackling the relationship between the varied factors, including air pollution, that so deeply shape the health of urban communities.

Inquiry question 5: What are the current and emerging risks and opportunities for air quality posed by:

• a) Short-term policy and societal changes in response to the pandemic, for example, changes to transport to reduce the risk of transmission, and;
• b) Medium and long-term actions to promote economic recovery.

Changes to streetscapes

COVID-19 has accelerated changes to our city centres. As lockdown restrictions have eased, local authorities have focussed on street re-design in urban areas to enable active travel and social distancing¹². These developments are positive, both in the short-term in trying to maintain the initial, dramatic decrease in air pollution associated with lockdown as far as possible, but also in having longer-term beneficial impact on air pollution levels and creating more health-promoting urban environments.

However, many of these changes are necessarily being made in a reactive, and short-term way, with the risk that opportunities for longer-term, systemic improvements are being missed. For example, in the boroughs where Guy’s and St Thomas’ Charity works, improvements to neighbourhoods have often been driven by wealthier, more vocal communities who engage with crowdsourcing platforms such a Commonplace.

Recommendation: Change to our urban spaces to improve air quality and create more cycle and pedestrian friendly environments should be driven by – and benefit – the communities whose health is most vulnerable to air pollution.

This is particularly important as it is these communities – for example people with long-term health conditions, people on lower incomes and people who are unemployed – who have already been hit hardest by the clinical, social and financial impacts of COVID-19.

In addition, as lockdown restrictions ease there is a risk that car usage increases as people avoid public transport. This means it is even more important that investment in active travel and public transport is maintained, particularly as people living on the lowest incomes are least likely to own a car.

Case study: As stay at home guidance eases, people are being advised to stay away from public transport and to walk and cycle where possible. We’re working with Southwark Council to ensure that these rapid changes to our streets will help to protect the most vulnerable groups from air pollution by reducing traffic and creating more space in our city for people. Working with the Highways and Transport, Public Health and Environment Teams we’ve identified and are trialling street filters using temporary traffic orders in three areas of Southwark which are deprived, have high levels of air pollution and high levels of childhood obesity – North Peckham, Camberwell and Walworth. Over the trial data will be collected to understand the impact of these road closures on traffic levels in these areas and on neighbouring main roads.

After more than four months of closure or restricted operating, many businesses are facing huge financial strain and economic uncertainty. Supporting strong economic recovery is vital in the coming months, not least in mitigating the impacts of recession, which we know disproportionately affect vulnerable groups hit hardest by the pandemic¹³.

However, the pandemic has also demonstrated the important role businesses have in promoting health, both in relation to their workforce as well as their customer base; whether supermarkets providing delivery slots for shielding customers, or workplaces making provision for their workforce to work from home. We fully endorse the Government’s commitment to a green, resilient recovery: a healthy, resilient economy relies on a healthy, resilient workforce. The close links between exposure to air pollution and likelihood of testing positive for and dying from COVID-19 provide a double imperative for businesses to act on their social responsibility reduce air pollution.

Recommendation: Policy and financial support for businesses in the recovery from COVID-19 should require businesses to take action to reduce air pollution and provide support to do so where possible.

Case study: Guy’s and St Thomas’ Charity are working with Global Action Plan to understand how we could best support businesses to reduce their contribution to local air pollution as they open up – in ways that do not create additional financial pressure. This includes continuing to support remote working where possible, investing in freight consolidation and shifting to low emission deliveries such as cargo bikes. However, many businesses and business improvement districts are telling us that they will find it difficult to invest in the current economic uncertainty. This creates a compelling case for public sector co-investment to leverage wider business investment.

1 Global Action Plan and Guy’s and St Thomas’ Charity (2020). ‘Build Back Cleaner Air Report Statistics and Quotes for Campaigning Use’.

2 Guy’s and St Thomas’ Charity (2020). ‘Urban air pollution and children’s health: from pregnancy to early adolescence’.

3 Guy’s and St Thomas’ Charity (2020). ‘Urban air pollution and the health of people with heart and lung conditions’.

4 Guy’s and St Thomas’ Charity (2020). ‘Air pollution and the health of older people’.

5 Harvard T.H. Chan School of Public Health (2020). ‘Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study’.

6 Fecht, D. et al. ‘Associations between air pollution and socioeconomic characteristics, ethnicity and age profile of neighbourhoods in England and the Netherland’, Environmental Pollution (2014).

7 Guy’s and St Thomas’ Charity (2018). From One to Many: From one to many Exploring people’s progression to multiple long-term conditions in an urban environment.

8 Office for National Statistics (April 2020).

9 Public Health England (2020). ‘Disparities in the risk and outcomes of COVID-19’.

10 ENUF, Kings College London and Food Foundation (2020). ‘Vulnerability to food insecurity since COVID-19 lockdown: Preliminary report’.

11 Public Health England (2020). ‘Improving access to greenspace. A new review for 2020’

12 Sustrans (2020). ‘Re-allocating road space to make walking and cycling safer during COVID-19 and beyond’.

13 Joseph Rowntree Foundation (2011). ‘The impact of the global economic downturn on communities and poverty in the UK’.