Air Quality Matters

One Take #13 - Clean Air Crisis: A Breath Of Fresh Air Report

Simon Jones

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What happens when the UK's medical establishment declares air pollution a public health emergency? The Royal College of Physicians' latest report "A Breath of Fresh Air" delivers a wake-up call that transforms how we understand pollution's impact on our bodies and minds.

The science has evolved dramatically since their 2016 assessment. While annual pollution-related deaths in the UK have decreased to approximately 30,000, this statistic merely scratches the surface. The report reveals how air pollution harms us throughout our entire lives—starting before conception by affecting egg and sperm quality, continuing through pregnancy with links to miscarriage and low birth weight, and persisting across the lifespan.

Most alarming is the growing evidence connecting air pollution to brain health. Ultra-fine particles don't just damage our lungs; they cross into our bloodstream and travel to our brains, potentially contributing to everything from learning difficulties in children to depression in adolescents and dementia in older adults. This isn't just an environmental concern—it's a mental health crisis hiding in plain sight.

The report also spotlights a disturbing "triple jeopardy" facing vulnerable communities who experience the highest pollution levels, suffer greater susceptibility to harm due to compounding factors like poor housing, and typically contribute least to creating the problem. As other nations adopt stricter standards aligned with updated WHO guidelines, the UK risks falling behind in addressing this fundamental social justice issue.

Medical professionals are being called to action, urged to incorporate air pollution awareness into patient care just as they once transformed the conversation around smoking. The solutions exist—from clean air zones to better indoor ventilation—but require greater urgency from society and policymakers. Listen now to understand why clean air isn't just an environmental luxury but a medical necessity, and stay tuned for our upcoming interview with the report's author, Sir Stephen Holgate.

A Breath Of Fresh Air Report

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Speaker 1:

welcome back to air quality matters, and one take one take, my take on a paper or report on air quality, ventilation and the built environment. One take in that it's well in one take and tries to summarise for you a scientific perspective on something interesting in well usually 10 minutes or less, because who has the time to read all these amazing documents? Right? This week we're looking at something a bit different Not a single research paper, but a real heavyweight report. It's called A Breath of Fresh Air, responding to the Health Challenges of Modern Air Pollution, and it's from the Royal College of Physicians here in the UK. Now, why this one? Because when a body like the Royal College of Physicians the people who literally set the standards for doctors releases a major 100-page update on air pollution, you sit up and listen. This isn't an environmental campaign group. This is the medical establishment, and what they've done here is essentially provide a state of the nation on air pollution and health, updating their landmark 2016 report. And what's really striking is how much the science and urgency has moved on from just those few years. This report it sort of reframes the entire problem, putting it firmly away from being just an environmental issue and placing it squarely where it belongs as a fundamental public health crisis. So let's get into it.

Speaker 1:

The first, and probably most important message that comes screaming out of this report is the sheer scale and scope of the health impacts. The 2016 report was famous for the headline figure of 40,000 early deaths a year in the UK. This new report updates that, giving a central estimate of around 30,000, which is good news. It shows progress, but and this is a huge but the report makes it crystal clear that these deaths are just and I'm borrowing their metaphor the tip of the iceberg. What the science now shows overwhelmingly is that air pollution's harm is a lifelong journey. It doesn't just start when a child gets asthma. It starts before that. It starts, incredibly, even before conception. This report discusses evidence linking pollution to the effects on sperm and egg quality. Then it moves into pregnancy, where it's linked to miscarriage, preterm birth and low birth weight, and these early insults have knock-on effects for a person's entire life. This is the concept of the life course that runs through the whole document. It's about how exposure in one part of your life can set the trajectory for your health decades later. And it's not just the lungs anymore. That's the other huge shift. We used to think air pollution lungs, asthma, copd, but the evidence now shows it impacts almost every organ of the body Because the smallest particles, the ultra fine ones, they don't just stay in the lungs, they can cross into the bloodstream and travel anywhere to the heart, the liver, the kidneys, the brain, and this for me is probably one of the most sobering new sections of the report the focus on brain health. This was touched on before, but the weight of evidence now is significant.

Speaker 1:

The report links details between air pollution and I'll try and say this right neurodevelopmental issues in children, things that can affect learning and behaviour. It highlights studies linking adolescent exposure to an increased risk of psychotic experiences and depression. Think about that for a second the air our kids are breathing on the way to school could be fundamentally affecting their mental health. And it doesn't stop there For adults. The report pulls together a growing body of evidence linking long-term exposure to air pollution with cognitive decline and an increased risk of dementia and Alzheimer's disease. The mechanism is complex. It's partly through damage to the cardiovascular system, which we know is crucial to brain health, but it might also be from the pollutants directly causing inflammation in the brain itself. The implication is staggering. Air pollution is not just a risk factor for dementia. It's a modifiable one. It's one we can actually do something about.

Speaker 1:

This leads to another one of the core themes inequality. This isn't a problem that affects everyone equally. The report is really powerful on this. It talks about a triple jeopardy for the most vulnerable communities. What does that mean? Well, it means that people in more deprived areas are often exposed to the highest level of pollution. That's the first hit. Second, due to other factors like poorer housing, nutrition and existing health conditions, they are also more susceptible to the harm that air pollution causes. And third, these are often the communities that contribute the least to the problem. They're less likely to own cars, for instance, so they get the most harm from the pollution they did the least to create. This transforms the issue from just a scientific one into a profound matter of social justice. So the report lays out this comprehensive and, frankly, quite scary picture of the problem.

Speaker 1:

But it's not just about doom and gloom. A huge part of the document is about solutions. It's a call to action, and this is where it gets really interesting from a policy perspective. It points out that, while the UK was once a leader, it's now falling behind. The World Health Organization dramatically tightened its air quality guidelines in 2021 based on all this new evidence. But the UK's legal targets set in the Environment Act are still aligned with the old, much weaker 2005 guidelines. In the UK they are aiming for a target by 2040 that other countries are already meeting or aiming to beat much sooner.

Speaker 1:

But the most compelling call to action is aimed squarely at the medical profession itself. The report makes the case that doctors and all healthcare professionals have a responsibility to act. This is a real paradigm shift For decades. A patient with asthma would come in and the conversation would be about inhalers. A patient with a heart attack? The conversation would be about statins. What this report says is that we need to start having a conversation about air pollution and the environment people live in. Just as around, the conversation around smoking shifted from being a personal choice to a major public health issue championed by doctors, the same needs to happen for air pollution, including the pollution and quality of the air we breathe indoors. The report recommends embedding this into medical training, from university all the way through to continuing professional development. From university all the way through to continuing professional development. It suggests using patient records to flag when somebody lives in a highly polluted area or is likely to be living in a home that's contributing to their conditions, so the clinician is prompted to have that conversation. It's about empowering patients with information and empowering clinicians to be advocates for cleaner air in their communities.

Speaker 1:

So, to wrap this up, what's my take on this massive report? It's a landmark document and, interestingly, authored by a guest we're going to have on the podcast in a couple of weeks, sir Stephen Holgate. It synthesises a vast and rapidly evolving field of science into clear, powerful narratives. The core message is simple Air pollution, whether indoors or outdoors, is a public health emergency that affects everyone, across their entire life, from before birth to old age, impacting every part of the body, especially the brain, and it's a crisis of inequality, disproportionality, harming the most vulnerable.

Speaker 1:

It's a comprehensive and frankly damning indictment of inaction, but it's also a clear roadmap. It shows that we have the evidence, that we have many of the solutions, from clean air zones to better ventilation in homes, to active travel, to better standards and more engagement with health services. The question it leaves us with is are we as a society, and are our policy makers, ready to follow it with the ambition and urgency it demands. This report says we have no other choice. If you're interested in this subject, do keep an eye out for the main podcast, where we'll have the main author of that report on to talk about this and much more to do with air quality and health. Sir Stephen Holgate, thanks for listening. This podcast would not be possible without our partners Safe Traces and Imbiot. Thanks a million. See you next week.

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