Whilst it is imperative that we improve the air quality in healthcare environments, tackling air pollution goes beyond the boundaries of the hospital, writes Larissa Lockwood, Director of Clean Air at Global Action Plan

In line with new World Health Organization (WHO) guideline limits launched in September 2021, every hospital in London is now located in areas that breach limits for toxic air pollution.

Clean air in and around healthcare settings is crucial as patients in hospitals or GP surgeries are some of the most vulnerable to air pollution. Furthermore, healthcare professionals themselves should not be forced to care for patients in environments that can not only worsen their symptoms, but also put them at risk of a whole range of other health problems. This all being off the back of a respiratory pandemic, which we know the symptoms of can be exacerbated by air pollution.

Every year, air pollution causes up to 36,000 deaths in the UK and at least four million early deaths globally. This is hardly surprising since air pollution can affect every organ in the body. When we breathe polluted air, it can inflame the lining of our lungs and move into our bloodstream ending up in the heart and brain, causing lung disease, heart disease, dementia and even strokes.

With the WHO and UK government recognising air pollution as the 'largest environmental health risk we face today', you would not be wrong to presume that the health sector plays a critical role in responding to air pollution. This is currently not the case.

Legal history was made last year when a coroner ruled that air pollution was a cause of the death of nine-year-old Ella Kissi-Debrah. In the subsequent Future Prevention of Deaths Report shared by the coroner, one of the key recommendations was a call for health professionals in the UK to be trained to talk to patients about air pollution.

At Global Action Plan we are making concerted effort across public health and frontline healthcare services to turn this recommendation into a reality.

We believe healthcare professionals play a vital role in tackling air pollution as:
1)    Educators: as trusted messengers in society, they play an important role to inform the public of the health risks from air pollution.
2)    Role models: showing leadership by minimising the amount of air pollution the NHS creates and influences.
3)    Champions: supporting policy measures at national and local levels that will help ensure improvements to air quality.

Health professionals as educators
For health professionals in primary and secondary care to advise patients on the impacts of air pollution and how to protect their health, they must be trained to do so.

The serious gap in current medical training highlighted in the Future Prevention Deaths Report came to light through our Mobilising Health Professionals project in partnership with the  UK Health Alliance on Climate Change (UKHACC).

Throughout 2020 we worked with 40 respiratory and paediatric health professionals to train the group on the impacts of air pollution on patient health and the measures people can take to reduce their exposure to this hazard. While health professionals already provide health advice around lots of lifestyle issues including smoking, exercise and diet, health professionals reported that:

●    They are not talking to or advising patients about air pollution.
●    Air pollution is not uniformly integrated into healthcare professional training.
●    Materials are not readily available for health professionals to share with their patients on air pollution.

Harnessing this insight, we worked with these health professionals to understand what types of materials and resources would be most useful to share with patients on air pollution, and where in the patient pathway conversations could be best held. As a result of the project a selection of resources are now available for colleagues across the health sector to use and the pilot is now being rolled out again in Islington in partnership with the council.

Health professionals as role models
Despite being overlooked, equipping hospitals to respond to air pollution in and around the hospital, as well as surrounding communities is important when looking to improve air quality. Free initiatives such as the Clean Air Hospital Framework enable health professionals to set ambitions and self-assess progress on tackling air pollution in seven key areas: travel, procurement and supply chain, construction, energy, local air quality, communication and training, and hospital outreach and leadership.

Global Action Plan partnered with Great Ormond Street Hospital (GOSH) to develop this framework, which empowered GOSH to launch the first ever hospital clean air strategy. Using the framework, air quality has since been built into GOSH's new building developments, both within building design and during construction activities. The new buildings are designed to emphasise green spaces, use low polluting materials, and incorporate energy efficiency measures to reduce local fossil fuel energy generation. On the construction site ‘no idling’ messaging is provided to all vehicles arriving at the site, dust levels are monitored, and deliveries are restricted as much as possible.

Around the hospital, there are also now signs discouraging idling that have been co-created with patients. Play specialists and play workers have been engaging with children on clean air, including designing their own clean air superheroes, and a Young People's Forum have been sharing why they think it is important for hospitals to take action on air quality.

Going forward, GOSH is further embedding clean air requirements within new contracts and tenders, bringing clean air messaging into the GOSH school, training staff, reviewing cleaning products, and continuing to encourage other hospitals to take more action to make the air cleaner for everyone. Their action has further acted as a catalyst to help other hospitals across the UK to tackle similar barriers.

Health professionals as champions
While resources, materials and education help to arm the health sector in the battle against air pollution, this alone is not sufficient for mass adoption and action. UK leaders still need to implement a nationwide programme to support the inclusion and integration of air pollution into patient advice and health sector practice at a top-level, as per the coroner’s guidance in the Future Prevention of Deaths Report.

To help achieve this, we must work with national bodies and local authorities to promote collaboration across the public sector to increase awareness and encourage action. An example of this was the Clean Air Health Sector Summit that was held ahead of Clean Air Day 2020. The Summit brought together decision-makers across the health sector to discuss and agree the action needed from the sector to tackle air pollution.

The event resulted in immediate opportunities across the following areas:  
•    Reducing emissions: reducing patient travel, supply chain innovation, setting targets for management, and incorporating clean air in the NHS Net Zero Plan.
•    Advising patients: updating healthcare professionals’ practices, providing educational materials for patients in health centres, launching a national public health campaign.
•    Education: raising understanding of air quality inequalities and the need to protect those most at risk of health issues caused by pollution.
•    Collating experiences to influence policy: sharing the real and personal impacts that air pollution is having on patients to ensure the need for comprehensive and urgent action is understood across the political spectrum across the country.

Looking ahead
Despite the success of our pilot projects and events, we need to move this from testing to the mainstream and real action committed to within the health sector. The onus to act on air pollution cannot be put on healthcare professionals and patients alone – we need an accompanying, sustained public health campaign so that collectively everyone does more to cut air pollution.

To tie all these roles together, this Clean Air Day on 16 June 2022 we are asking everyone to play their part. For health professionals in particular, the key asks are:

•    Talk: to their patients about the health harms of air pollution.  
•    Walk: encourage staff, visitors and patients to walk those short distance trips and leave the car at home, where they can.
•    Ask: local and national decision makers for what would make it easier for them and their patients to walk more and have clean air in your community.   

Clean air in and around healthcare settings is crucial, but no one should have to breathe dirty air. Whilst it is imperative that we improve the air quality in healthcare environments, tackling air pollution goes beyond the boundaries of the hospital, clinic room or GP practice. By improving the air quality in healthcare environments, the positive impacts will impact everyone.

Global Action Plan is an environmental charity working towards a green and thriving planet where everyone can enjoy happy and healthy lives within the Earth’s limits. We tackle the root causes of our climate and nature crises through research, campaigns and collective action that reconnect human and planetary health.