The history of air quality legislation
The World Health Organisation defines air pollution as the ‘contamination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere’[i] and it is the largest environmental risk to public health in the UK.
In 2019, air pollution, which has been an issue in the UK since the 13th century, is estimated to have contributed to 900 premature deaths in Northern Ireland.[ii] [iii] Not only is it a significant issue for individual health, with between 28,000 and 36,000 deaths each year in the UK attributable to human-made air pollution, but the impact of air pollution is also estimated to cost our economy between £9-19 billion each year.[iv] [v]
The gradual increase in air pollution over centuries is largely as a result of urbanisation and a change of fuel use, from wood to coal, which paired with rapid population growth, resulted in a greater production of pollutants. The onset of the industrial revolution in the 18th century then led to more frequent pollution episodes, or smogs, in major cities which arose from a combination of smoke, SO2 emissions and cold weather conditions. As industrialisation increased, these episodes became more frequent and were linked to detrimental effects on health. One smog in December 1873, for example, saw a 40% increase above the normal death rate and The Great Smog of London in 1952 caused at least 4,000 deaths.[vi]
Smoke was initially seen by many as a sign of economic prosperity and a thriving economy in industrial towns and cities. However, activist groups began to lobby against the increasing effects that industrialisation and its pollutants were having on urban populations and in 1842, the Manchester Association for the Prevention of Smoke was established. In 1890 the Leeds Smoke Abatement Committee was formed, and in 1899 the London-based Coal Smoke Abatement Society followed.
By 1929 national organisations were set up, notably the National Smoke Abatement Society[vii]. Their members viewed smoke as a waste of fuel and life, and to be unproductive. Dr J Johnstone Jervis, VP of the NSAS and Medical Officer of Health for Leeds argued that:
“… the majority of lives lost from respiratory diseases are lives thrown away. Their prevalence and the high mortality due to them are a grave indictment of our modern civilisation. They are preventable; yet they are not prevented. They are curable; yet they continue to kill. Prevention can only be achieved by tackling the smoke nuisance resolutely.”
After The Great Smog of London, the Beaver Committee was set up, which identified pollution from solid fuels as the smog’s source and made a number of recommendations which would form the basis of the Clean Air Act 1956.[viii] The Act granted local authorities the power to create ‘smokeless areas’ in which only smokeless fuels could be burnt and provided Government grants for the domestic smoke control programme – in which households installed new heating appliances[ix]. Following the legislation, the age-specific death rates of men in Greater London fell by almost half.
In 1961 the National Survey, the world’s first coordinated national air pollution monitoring network, was established, monitoring black smoke and sulphur dioxide across around 1200 sites in the UK.[x]
More recently low emission zones have been introduced to combat air pollution within cities and urban areas throughout the UK. In Scotland, local authorities have introduced Low Emission Zones under the Transport Scotland Act 2019 across four major cities[xi] whilst in Ireland, there is an ongoing debate regarding the introduction of congestion charges. Perhaps the most well-known scheme is London’s congestion charge, first introduced in 2003 and since expanded to include the Ultra Low Emission Zone (ULEZ), a scheme which is reported to have reduced congestion by 30% and enabled 10% of journeys to be switched to active travel or public transport.[xii]
Despite growing awareness and mitigation, in 2013, nine-year-old Ella Adoo-Kissi-Debrah suffered a fatal asthma attack, becoming the first person in the UK to have air pollution listed as their cause of death. Ten years on, Ella’s death remains a stark reminder of the necessity for public health measures to mitigate air pollution and it’s impacts on our health.
Directors of Public Health (DsPH) play a crucial role in achieving improvements in air quality. Their local knowledge and understanding of communities, and relationship with local partnerships mean they are able to suggest and support the implementation of initiatives across departments and sectors to facilitate local approaches to reducing air pollution.
As a result of this collaborative work between public health teams and their partners, there are many examples across all four nations of schemes which are tackling the issue. For example, the City of York Council has retrofitted all sightseeing buses from diesel to electric to improve air quality, whilst Camden Council has installed cycle-friendly measures on a key-route to encourage active transport. Meanwhile, in Oxford, the City Council has implemented a Low Emission Zone for buses in the city centre, banning highly polluting vehicles from the zone.[xiii]
The 2022 Annual Report of England’s Chief Medical Officer specifically focused on air pollution[xiv]. It identified the scale of the problem, the progress which has been made in recent years and highlighted solutions. Recommendations outlined within the report considered indoor as well as outdoor pollution, and the development of transport and urban planning.
Air pollution has been a health problem for centuries and has evolved in its nature as our behaviours have changed. It is an ongoing threat to public health which requires innovative research and policy to ensure its impacts are mitigated, making full use of developments in technology and engineering. DsPH work with their Environmental Health colleagues and others to improve air quality for all and implement solutions which will best serve their communities and the unique threats that they face, while as their representative body, ADPH continues to advocate for national policy to drive forward change.
[i] https://www.who.int/health-topics/air-pollution#tab=tab_1
[ii] https://www.parliament.uk/globalassets/documents/post/pn188.pdf
[iii] https://www.bhf.org.uk/what-we-do/in-your-area/northern-ireland/campaigning-and-influencing-in-northern-ireland/taking-action-on-air-pollution-in-northern-ireland
[iv] https://laqm.defra.gov.uk/documents/air_quality_note_v7a-(3).pdf
[v] https://www.gov.uk/government/publications/air-pollution-applying-all-our-health/air-pollution-applying-all-our-health
[vi] https://www.metoffice.gov.uk/weather/learn-about/weather/case-studies/great-smog
[vii] https://www.historyandpolicy.org/policy-papers/papers/clearing-the-air-can-the-1956-clean-air-act-inform-new-legislation
[viii]https://navigator.health.org.uk/theme/clean-air-act-1956
[ix] https://www.jstor.org/stable/193598
[x] https://uk-air.defra.gov.uk/networks/brief-history
[xi]https://www.transport.gov.scot/news/low-emission-zones-introduced-across-scotland/
[xii]https://tfl.gov.uk/info-for/media/press-releases/2023/february/congestion-charge-marks-20-years-of-keeping-london-moving-sustainably
[xiii] https://laqm.defra.gov.uk/assets/63091defraairqualityguide9web.pdf
[xiv] https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2022-air-pollution