{"id":49278,"date":"2020-12-22T13:25:33","date_gmt":"2020-12-22T12:25:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49278"},"modified":"2020-12-23T18:50:32","modified_gmt":"2020-12-23T17:50:32","slug":"the-health-community-must-act-on-air-pollution-as-an-issue-of-health-justice","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/22\/the-health-community-must-act-on-air-pollution-as-an-issue-of-health-justice\/","title":{"rendered":"The health community must act on air pollution as an issue of health justice"},"content":{"rendered":"

On Wednesday 16 December 2020, air pollution was recorded as a cause of death for the first time, following a second inquest into the death of 9-year-old Ella Kissi-Debrah in 2013. Ella\u2019s death certificate now reads \u201cacute respiratory failure, asthma, and air pollution exposure.\u201d Expert analysis showed Ella\u2019s multiple admissions to hospital with severe asthma\u2014and her fatal exacerbation\u2014correlated with spikes in air pollution near her Lewisham home, and that she was exposed to levels \u201cconstantly exceeding\u201d EU limits in the three years prior to her death. Ella\u2019s mother, Rosamund, has been campaigning for the last 7 years for Justice for Ella. As Rosamund <\/span>powerfully reflected<\/span><\/a> after the ruling, \u201c<\/span>this was about my daughter…but also it’s about other children…there are still illegal levels of air pollution now.\u201d<\/span>\u00a0<\/span><\/p>\n

For Ella\u2019s legacy to be a <\/span>“turning point”<\/span><\/a> for accelerated action on air pollution, the health community must use their voice to advocate for justice. Justice is one of the core principles within medical ethics, often concerned with the fair distribution of finite resources. A wider conception of this views justice in broader terms of societal <\/span>fairness<\/span><\/a>. People in <\/span>working class communities<\/span><\/a> and people from ethnic minorities are disproportionately exposed to polluted air. As such, our responsibility to improve air quality relates not only to reducing disease, but to tackling a stark health inequality. As <\/span>Guppi Bola writes in Reimaging Public Health<\/span><\/a>, we must “use health justice in the vision of a fair and inclusive society.”<\/span><\/p>\n

In <\/span>“Build Back Fairer<\/span><\/a>“, Marmot and colleagues highlight a potential association between pollution in urban areas, more often inhabited by people from ethnic minorities, and excess covid-19 deaths. Air pollution follows a <\/span>strong social gradient<\/span><\/a>; more than <\/span>80%<\/span><\/a> of London primary schools surrounded by nitrous oxide (NOx) levels exceeding EU limits are found in deprived areas. Excessive comorbidity in deprived areas may interact <\/span>synergistically<\/span><\/a> with air pollution to exert exaggerated health effects in these groups compared with advantaged counterparts. The injustice of air pollution exposure has worsened over the past decade as households least responsible for emissions of PM and NOx are <\/span>the most exposed<\/span><\/a>.<\/span><\/p>\n

Rosamund described that prior to Ella\u2019s death she knew little about air pollution, \u201cI knew about car fumes, the phrase, but nothing else.\u201d It was some time later, when somebody contacted her with information about the high pollution levels in the two days surrounding Ella\u2019s death, that she started to <\/span>consider a link<\/span><\/a>. This failure to provide Ella\u2019s family with information about the potential for air pollution to exacerbate asthma was also noted by the coroner as a <\/span>possible contributor to her death<\/span><\/a>. It is key that within the health community, we are learning about the health impacts of air pollution, to support and advocate with patients. Not addressing the issue unequally disadvantages people living in polluted areas who are likely to be more deprived and pay the highest health cost.<\/span><\/p>\n

So, how do we bring this up with families? It\u2019s not easy for individuals to change their air pollution exposure, as much relies on systemic societal change. <\/span>A NICE guideline<\/span><\/a> was developed to provide specific recommendations for clinicians on how to address air pollution in patient management. Rosamund said that, had she known that living within 30m of the South Circular road in Lewisham was making her daughter\u2019s asthma worse, she would have moved house <\/span>\u201cstraight away.\u201d<\/span><\/a> The NICE guidance recommends supporting families to access air quality information for their area such as through the DEFRA “UK Air” <\/span>website<\/span>.<\/b><\/a>\u00a0<\/span><\/p>\n

The health community has unique insight into the health impacts of air pollution. We have a responsibility to use this understanding to advocate for meaningful changes in government policy, to tackle the root causes of air pollution. In the same way that health professionals have advocated clear opposition to tobacco as a major contributor to morbidity and mortality, so profession-wide unity of the centrality of clean air is equally necessary.<\/span><\/p>\n

Crucial steps forward include active participation in demanding a broad and timely <\/span>Clean Air Act<\/span><\/a> and pushing for low-carbon public transport\u2014an essential component in changing inactive, private-vehicle dependent lifestyles. Above all, the health community must advocate for socially just solutions that address the root causes and the injustices associated with air pollution. The health community must use its voice to act in solidarity with affected communities through campaigns such as the <\/span>Ella Roberta Foundation<\/span><\/a>, <\/span>Mums for Lungs<\/span><\/a> and <\/span>Choked Up<\/span><\/a>. Legal confirmation of the link between Ella\u2019s death and air pollution should now make action by the health community and wider society on this injustice impossible to ignore.<\/span><\/p>\n

Aarash Saleh<\/strong>, Respiratory registrar at Barts\u2019 Hospital and PhD student in Cystic Fibrosis Gene Therapy at Imperial College London @aarashsaleh<\/span><\/em><\/p>\n

Elizabeth Hobbs<\/strong>, Paediatric registrar at Royal London Hospital @lizzieannahobbs<\/span><\/em><\/p>\n

Victoria Stanford<\/strong>, junior doctor and MPH student at <\/span>\u00c9<\/span>cole des hautes \u00e9tudes en sant\u00e9 publique (EHESP), France. @VictoriaI_Stan<\/span><\/em><\/p>\n

Ben Eder<\/strong>, Climate & Health Campaigner, Medact. @beneder<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

On Wednesday 16 December 2020, air pollution was recorded as a cause of death for the first time, following a second inquest into the death of 9-year-old Ella Kissi-Debrah in […]<\/p>\n

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