Intended for healthcare professionals


Air pollution—a wicked problem

BMJ 2017; 357 doi: (Published 14 June 2017) Cite this as: BMJ 2017;357:j2814
  1. Stephen Holgate, MRC clinical professor of immunopharmacology1,
  2. Helen Stokes-Lampard, chair2
  1. 1University of Southampton, Southampton, UK
  2. 2Royal College of General Practitioners, London, UK
  1. Correspondence to: S Holgate s.holgate{at}

Estimates of attributable deaths tell only half the story

The internal combustion engine is the principal cause of modern air pollution, with emissions consisting of small particulates (PM10, PM2.5, and PM0.1), oxides of nitrogen (especially NO2), volatile organic chemicals, and ozone. These pollutants are major risk factors for the development of human diseases, especially cardiovascular disorders such as heart attacks, arrhythmias, and stroke and respiratory diseases such as asthma, chronic obstructive pulmonary disease, pneumonia and cancer. Emissions of NO2 and particulates from diesel vehicles are a particular problem in the UK because diesel cars now comprise 50% of the car fleet compared with 9.4% in 1994, and they present a much greater problem than official emission inventories suggest.1

The increase in evidence linking pollution to adverse health across the entire lifecourse led to a 2013 report by the Royal College of Physicians and Royal College of Paediatrics and Child Health examining all aspects of this public health crisis, Every Breath We Take: The Lifelong Impact of Air Pollution.2 Drawing on data collated and analysed by the UK government’s Committee on …

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