Health inequalities and air pollution: are we joining the dots?

Introduction

Addressing environmental topics beyond net zero, such as air quality, can have significant benefits across the population as they directly impact marginalised communities already at risk of poorer health outcomes. Black, Asian and minority ethnic groups are disproportionately affected by high pollution levels, and women and children exposed to air pollution experience an elevated risk of developing long-term health conditions.

Poor air quality is widening health inequalities, but it doesn’t have to be this way

Several NHS trusts have set up sustainability directors and teams to address the issue. But with little or no budget allocated to innovate and pursue improvements, progress is hampered. Poor air quality is widening health inequalities, but it doesn’t have to be this way.

The ICS Clean Air Framework was developed in 2022 by Global Action Plan (GAP) in partnership with Newcastle Hospitals NHS Foundation Trust and Boehringer Ingelheim to give ICS sustainability leaders a tool to tackle air pollution at a regional level. The framework aims to achieve the core NHS ambition of tackling health inequalities by robustly addressing poor air quality to benefit the communities most at risk. It focuses on eight key themes: digitalisation, educating staff, infrastructure, local authority collaboration, strategic decision-making, supply chain, transport, and a whole healthcare approach.

In a recent NHS Confederation member workshop, hosted with BI and attended by Sir Chris Whitty, chief medical officer (CMO) for England, senior leaders from across integrated care systems (ICSs) explored how systems can turn the tide. It discussed the CMO’s report on air pollution, strategies for adopting the ICS Clean Air Framework, and examined why connecting air pollution and health inequalities can enable ICS leaders to address both challenges effectively. Here’s what we learned.

A problem shared

While the NHS is undoubtedly confronting significant challenges related to elective recovery, workforce shortages and surging demand, it remains crucial to raise awareness about the harmful effects of air pollution on communities, which in turn impacts the already severe challenges facing the NHS.

Primary care colleagues have raised the issue of general practice having little resource to lead on air pollution projects, which effectively contribute to the overall ambition of the NHS’s net-zero target.  Efforts have been made locally to engage integrated care boards in creating a role for a primary care sustainability lead, and there is a recognised need for greater national leadership and direction to support primary care further. Similarly, local authority colleagues at the workshop raised the issue of needing more central budget to make local changes, such as improving road safety and cycle lanes to reduce car travel.

Attendees discussed the importance of working in partnership with local authorities and other local partners in a system. In one area, an attendee spoke about their development of an assessment to understand the health needs of the local population with a focus on inequalities and then looking at the impact of air pollution on the population. From this, a work programme was generated with the local university to support children in schools and playground initiatives.

Prioritising cleaner air policy

National policy must evolve and align with the strong body of evidence that demonstrates the worsening impact of air pollution on communities from lower socio-economic groups and existing health inequalities. By striving to improve air quality and lower levels of pollution, the NHS can also identify resource and capacity savings, as well as provide a significant intervention for preventing worsening health conditions.  

If NHS England is to support overall net-zero ambitions ... it must also gather and present data and evidence in the form of both quantitative and qualitative data

Collecting the evidence, the data and objectively presenting the findings underpins the case for improving air quality and sends the strong message that this focus on air quality can help achieve one of the key ICS purposes of tackling health inequalities. If NHS England is to support overall net-zero ambitions and specifically ensure air pollution is reduced as an essential component part of net zero, then it must also gather and present data and evidence in the form of both quantitative and qualitative data.

A clear recommendation was given by delegates for NHS England to utilise central data sources and align clean air goals with measurable targets.

Information sharing

Linked to the need for more evidence is the lack of case studies and good practice that show how clean air interventions bring benefits locally. To do this, public services must find ways to collaborate better to share evidence and information to ensure tackling air pollution is truly a joint effort. The NHS Confederation is committed to facilitating this, by providing numerous places for bodies to share case studies across the system.

...collaborating is key, as is having the leadership and confidence to start somewhere and share one another’s learning

The public services system is fragmented, with many departments needing to deal with the issue and impact of air pollution, and interventions are often not linked up and shared. Areas within the same locality could be working on similar – or contradictory - initiatives to address the problem.

Therefore collaborating is key, as is having the leadership and confidence to start somewhere and share one another’s learning.

The efforts require joint working between the NHS, public health, central government and industry partners to make a significant difference. It is from these efforts and partnerships that changes can be seen, and joint ownership expedites the solution.

Improved awareness and education

Educating and training staff on the harmful effects of air pollution is vital. There is now an increased need for clean air and health literacy for those training and working in healthcare and this should start with undergraduate and induction training. Preparing students who will be working in the NHS on the harmful effects and mitigations of air pollution could have benefits for the wider population through future clinical leadership.

Clear and increased communication on the impact of air pollution on health is required, as the more well-known the issue is, the more support will be demanded from communities. It is increasingly necessary to raise awareness among the public of the harmful effects of both outdoor and indoor air pollution - the latter including pollutants generated from heating appliances, cooking and chemicals in products - to help change behaviour and support education.

Moving forward, it will be important to empower healthcare professionals to confidently share guidance with patients, especially those with existing conditions.

Summary of discussion outcomes

Healthcare leaders need to better understand the thoughts, ambitions, frustrations and barriers that they each face as they try to make progress on health inequalities exacerbated by health pollution. One of the key ways to do this is to commit to sharing best practice between organisations and learning from one another via an agreed national process and accessible platform.

To make steps towards achieving this, NHS England and the government should commit to sharing data and evidence to support action on air quality and health, using central data sources that align clean air goals with measurable targets. 

Sharing best practice and case studies between ICS organisations that exemplify successful clean air interventions and their associated benefits, will also support this goal.

Moving forward, it will be important to empower healthcare professionals to confidently share guidance on air pollution with patients, especially those with existing conditions

Moving forward, it will be important to empower healthcare professionals to confidently share guidance on air pollution with patients, especially those with existing conditions. This can be achieved by enhancing education of air pollution and its impact among healthcare providers, and by promoting greater awareness of it among patients through locally communicated campaigns.

All efforts require joint working between the NHS, public health, central government and industry partners to make a significant difference. It is from these efforts and partnerships that changes will be seen, and joint ownership expedites the solution.

Actions for members

• Request access to a new report, Tackling Air Pollution and Health Inequalities at ICS Level, by emailing communications.bra@boehringer-ingelheim.com
• Commit to becoming a Clean Air Champion in your organisation. 
• Work towards adopting the ICS Cleaner Air Framework for your ICS.
• Actively share best practice and case studies which exemplify successful clean air interventions and their associated benefits.
• Facilitate patient education and public campaigns that promote greater awareness of air pollution and its impact on health.

NP-GB-103775 November 2023