Whitty: ‘We can and should go further to reduce air pollution’

England’s chief medical officer says path to reducing outdoor pollution is clear, but more work needed on indoor air quality

We can and should go further to reduce air pollution, and it is technically possible to do so, says England’s chief medical officer Professor Chris Whitty in his annual report.

The report focusses on air quality and on makes 15 recommendations across a range of sectors, including transport, urban planning, industry and agriculture.

This is Whitty’s third report as chief medical officer (CMO). Last year his focus was on health in coastal communities, while the 2020 report looked at health trends and variation in England.

Outdoor air pollution in England has reduced significantly since the 1980s, but it still poses significant health threats including increasing heart disease, stroke, lung disease, cancer and asthma exacerbation. Pollution also leads to increased mortality and is associated with impacts on lung development in children. Whitty also highlights how indoor air pollution is becoming an increasing proportion of the overall problem as outdoor air quality improves.

In his report, Professor Whitty says: “Improvements in engineering for transport and industry, modifications to agricultural practice and improvements in the built environment are examples that should, once a change is made, be self-sustaining and allow us to reap health benefits for the foreseeable future.

“Many of the changes to improve outdoor air pollution have significant co-benefits. For example, reducing the use of fossil fuels for energy reduces both air pollution and carbon emissions; improving active travel reduces air pollution emissions from vehicles and has direct health benefits to those who are walking, wheeling or cycling. In particular, we need to concentrate on the places where people live, work and study; the same air pollution concentration in a densely populated area will lead to greater accumulated health effects than in a sparsely populated area as more people will be affected.

“The path to better outdoor air quality is clear, and we now need to go down it. Indoor air pollution is becoming an increasing proportion of the problem as improvements in outdoor air pollution occur. Most of our days are spent indoors whether for work, study or leisure, yet indoor air quality has been studied much less than outdoors. While there are some spaces such as owner-occupied houses that are fully private, many indoor spaces are public, including health facilities, schools, other public buildings, and also shops and workplaces. As with outdoor spaces, people in public buildings are exposed to air pollution but can do little about it, so society needs to act. A better understanding of how we can prevent and reduce indoor air pollution should now be a priority.”

The chief medical officer’s recommendations on outdoor air pollution highlight:

• accelerating the electrification of light vehicles and public transport
• innovation to reduce air pollution from non-exhaust sources such as tyres, and the need for a greater range of options for reducing air pollution from heavy and specialised vehicles
• local urban planning should support reducing air pollution locally – such as reducing air pollution near schools and healthcare settings
• in agriculture, ammonia air pollution emissions could be reduced through modified farming practices, such as applying slurry directly to soil

The CMO's report includes a chapter with case studies of three cities in England – Birmingham, Bradford and London. Each of these cities has had significant challenges around air pollution and has taken slightly different approaches to tackle it. These have included integrating actions including around transport, urban planning and design, reducing pollution around schools and monitoring at a city level.

Defeating an invisible enemy

Responses to the chief medical officer’s report

• Sarah Woolnough, chief executive of Asthma + Lung UK: “The report by the chief medical officer (CMO) should act as a rallying call to tackle air pollution. From our very first breath, air pollution has a significant impact on our health. Toxic air not only puts people at risk of potentially life-threatening asthma attacks and dangerous COPD (chronic obstructive pulmonary disease) flare-ups, it can also lead to the development of lung conditions including lung cancer. Chris Whitty is right to highlight the devastating impacts of air pollution and it is now vital that meaningful steps are taken to protect public health from this invisible threat. This includes schemes that work to get the most polluting vehicles off our roads.”
  
• Dr Charmaine Griffiths, chief executive of the British Heart Foundation: “We’re pleased to see the CMO focussing on air pollution in his annual report this year. Research the British Heart Foundation has funded has helped to show just how damaging air pollution can be to our cardiovascular health. We have the tools and understanding to make better air quality a reality, but we need to do more. Making sure this report’s recommendations are implemented will help to clean up the air in all our communities and deliver real improvements to the nation’s health.”
  
• Michelle Mitchell, Cancer Research UK’s chief executive: “We welcome the CMO putting air pollution in the spotlight with this report. Although smoking remains by far the biggest cause of cancer in the UK, air pollution increases the risk of lung cancer in both people with and without a history of smoking – causing almost 1 in ten lung cancer cases in the UK. With more ambition and a willingness to tackle air pollution head on, we know that this can be different. Air pollution is one of the biggest environmental threats to health in the UK, and although substantial progress has been made to reduce harmful levels of pollutants, more needs to be done. The adoption of national and local strategies will be vital in reducing indoor and outdoor air pollution across the country. But that has to start with the UK government making a bold long-term commitment to a reduction in air pollution.”
  
• Dr Sarah Clarke, president of the Royal College of Physicians (RCP), said: “Air pollution is a growing and significant public health challenge and we strongly welcome the chief medical officer making this the focus of his annual report for 2022. The RCP has been highlighting the harmful impacts of air pollution on health since 2016, when we published our report Every Breath We Take with the Royal College of Paediatrics and Child Health. We estimated then that around 40,000 deaths were attributable to outdoor air pollution, and since then a coroner found it to be a cause of death for the first time, that of 9-year-old Ella Adoo Kissi Debrah.”

Professor Chris Whitty

Professor Chris Whitty is chief medical officer (CMO) for England. He represents the UK on the Executive Board of the World Health Organization. He is a practising NHS consultant physician at University College London Hospitals (UCLH) and the Hospital for Tropical Diseases, and a visiting professor at Gresham College.

Whitty was the chief scientific adviser for the Department of Health and Social Care from January 2016 to August 2021. He was the interim Government Chief Scientific Adviser from 2017 to 2018, including during the Novichok poisonings. Before that, he was the chief scientific adviser at the Department for International Development (DFID), which included leading technical work on the West Africa Ebola outbreak.

Whitty was appointed as an expert adviser to Active Travel England on 22 October 2022.