NHS can lead in reducing pollution to improve public health, says chief medical officer

BMJ 2018; 360 doi: (Published 02 March 2018) Cite this as: BMJ 2018;360:k1026
  1. Ingrid Torjesen
  1. London

The chief medical officer for England has urged the NHS to act as an example to the rest of the country by cutting its pollutant footprint.

Sally Davies said, “We all know the environmental impacts of pollution, but what is less recognised is the impact on health.” She was speaking at the launch of her latest annual report,1 which examines the effects on health from air, light, noise, and chemical pollution.

In researching the report Davies said that she had expected to find many concrete actions that official bodies could take to reduce the impact of pollution on the public’s health but was “surprised by how little we know about many of the common pollutants that surround us each day” and “the lack of evidence we have in this field.”

“We also urgently need to up our game and gather better information on how factors like light, noise, and chemical pollution are affecting us,” she said. “With [these] factors . . . the public is exposed to a daily cocktail of pollutants.

“Some of these can be linked to chronic conditions like heart disease and asthma. This increases the risk for some of the most vulnerable members of our society and places a huge burden on our health service.”

The report warns that pollution is currently considered an acute health threat—something that elicits a negative health response after a “dose” of exposure—but evidence shows that many pollutants are risk factors for a range of non-communicable disease such as cardiovascular disease, cancer, asthma, and chronic obstructive pulmonary disease. “This exposure is likely to have a significantly deleterious impact at a population level due to the extent of the exposure,” it says.

The report makes 22 recommendations, including studying the long term effects of low levels of pollutant exposure on human health. Public Health England should take a lead on monitoring pollution and its health impacts, it advises, by gathering surveillance data and publishing the findings regularly.

Within the NHS, the report adds, trusts should report progress against their sustainable development management plans in their annual reports, and NHS Improvement should monitor their performance.

Clinical commissioning groups should analyse local air quality monitoring data for breaches of air pollution standards and should publish these alongside hospital data on admissions for respiratory and cardiovascular disease.

Ambulance trusts should publish their progress towards phasing out diesel ambulances annually, and Health Education England should ensure that the health effects of pollution are included in training for all clinicians and in continuous professional development programmes for existing staff.

Local authorities should broaden their environmental strategies to consider all forms of pollution and its impact on human health, including low level exposure, the report adds. The UK government should develop national standards for air pollutants within the next five years, and the Department of Transport should agree with local authorities a standardised mechanism for road charging, if introduced, so that the system is consistent throughout England.


View Abstract