With climate change hogging the headlines work on air quality in the UK can sometimes feel like a bit of a backwater. Major policy announcements are few and far between, so it's surprising that when a significant shift in air quality policy happens it slips out quietly rather than being shouted from the rooftops.
The policy shift in question was contained in the dry sounding 'Public health outcomes framework for England, 2013-2016’ released by the Department for Health earlier this week. To give a bit of background here the document supports the Government’s earlier decision to hand back public health responsibilities to local authorities. This will take place via the appointment of Directors of Public Health in English county and unitary level authorities, who will be provided with ring-fenced funding to support their work.
The new document sets down the indicators by which public health will be defined and measured. The indicators span 4 categories, and focus on the factors that cause ill health rather than the health ‘outputs’ (cancers, heart disease, etc) that we usually see in Government health targets. Air pollution tops the list in the 3rd category of indicators, those concerned with protecting the public from ‘major incidents and other threats, while reducing health inequalities’.
The definition of the air quality indicator is given as ‘the mortality effect of anthropogenic particulate air pollution (measured as fine particulate matter, PM2.5 ) per 100,000 population’. This will be expressed as both attributable deaths (premature deaths) and years of life lost associated with these attributable deaths. A new body, Public Health England, will crunch the numbers to produce the indicator.
The inclusion of this indicator has two quite fundamental repercussions for how air quality is managed in England. The first and most obvious is the extra resources it will bring to local action on air quality. Local authorities in England currently work on air quality management through the mandatory Local Air Quality Management (LAQM) regime. Based in district/ borough level authorities LAQM has proved very good at identifying areas of high pollution but much less effective at doing anything about them, a situation exacerbated by chronic under-resourcing in many local authorities.
The inclusion of air quality in the new outcomes framework promises to change that. Not only will it bring new financial resources to efforts to improve air quality, but by highlighting the health impacts of air pollution it will end the befuddlement of local authority elected members by talk of micrograms of pollution, sources and receptors. Instead they’ll be provided with hard numbers for the health impacts of air pollution on the public in their area – a far more powerful figure to draw a compelling case for action.
This leads nicely on to the second repercussion of the new indicator. Air quality management in the UK is currently focused on the ‘input’, or the concentration of the pollutants in the air. The system is drawn from EU rules, which instantly alienate the UK’s Eurosceptic majority, and exists in a bubble of scientific language which confuses 90% of the rest. The new indicators suggest a move (at the local level at least) to focusing on the ‘health output’, or the impact of air pollution on people’s health.
There are of course some questions that need to be answered before the new system comes into effect. The obvious one is whether the current system of LAQM continues alongside work on the new health based indicator. Whist a twin track approach is potentially wasteful, the new indicator has a narrow focus on the pollutant PM2.5 only and some system of management for other pollutants is therefore essential.
The other obvious question is how a local air quality management system focused on health outcomes is married to a national system that is still rooted in pollutant concentrations. The national system of air quality management is based on the requirement to meet EU rules, and it is unlikely that these are going to change to a system based on health outcomes anytime soon.
However, whilst there’s still work to do air quality professionals should be celebrating a quiet victory here, one that no doubt involved some significant lobbying of the Department of Health by other branches of Government. We can look forward to a future where not only is there likely to be more local resources dedicated to improving air quality but also one where more people, including our elected representatives, understand that improving the quality of the air we breathe has enormous benefits to our health.