To mark Clean Air Day 2018, the RCP clinical lead for sustainability Dr Toby Hillman encourages physician colleagues to fly the flag for patients by advocating more loudly for active travel choices.
Urban populations make up the majority of the world’s people. Globally, since 2008, more people live in cities than in rural areas. This population shift has been going on since the industrial revolution, and for clear reasons.
Cities bring with them significant benefits, and also - as we are increasingly being made aware, harms. The benefits of cities are mainly economic, with increases in productivity, and economic activity seen in major metropolitan areas.
The perennial challenge of city mayors and authorities worldwide is to protect their populations, while ensuring the continued viability of the industries and businesses within their sphere of influence.
However, there are downsides to increasing population densities as highlighted adeptly by the Clean Air Day campaign today. Pollution, noise, and pockets of deprivation exist in almost all cities. Indeed, in some cities, there are slums larger than entire towns in the UK. For example, Kibera in Nairobi is one of the largest slums in Africa, and has a population about the same size as Brighton and Hove.
The flow of people, goods, and information is essential to the functioning of a city. When any of these three break down, chaos tends to ensue - you only need to look at what happens when there is an industrial dispute which affects an essential service like refuse collection, or mass transport (like the tube strikes in London) to see this in reality. The perennial challenge of city mayors and authorities worldwide is to protect their populations, while ensuring the continued viability of the industries and businesses within their sphere of influence.
In recent years, car ownership has increased dramatically, and the use of cars and vans to transport goods and people in cities has also risen. These vehicles emit gases and particulates which cause harm to health, with a dose response which ensures that those in the most densely populated areas tend to suffer the most. These also tend to be those areas where there is greater deprivation and chronic ill health.
The 2016 RCP and Royal College of Paediatrics and Child Health (RCPCH) report Every Breath We Take highlighted the lifelong impacts of air pollution on the health of residents of the UK. The report estimated that air pollution contributes to a staggering 40,000 deaths in the UK each year. It is thought currently that our own sector, the NHS, is responsible for 10 per cent of all UK road journeys, contributing to 85 deaths and over 722 major injuries. And almost 9,000 years of life lost by the associated air pollution.
These figures are estimates, but they demonstrate that there is a cost to us delivering an NHS that is so reliant on patients and staff travelling by road.
The ongoing emission of harmful substances, and the attendant harms observed at a population level are not, however, simply a fact of life. There are cities that have taken bold steps in response to the crisis in the health of their citizens, and are tackling the seemingly intractable problems inherent in our reliance on the internal combustion engine.
Out to consultation now, the UK government’s Clean Air Strategy recommends a number of actions, but with the long-way-off target of phasing out fossil fuel-only vehicles by 2040, does it go far enough? Active transport offers the most compelling alternative to the car to achieve the win-win situation of improving levels of physical activity (and therefore population health), while reducing air pollution, noise, and congestion. However active transport is not only a personal choice, it is a political one. It is only with investment, political will, and changes to city infrastructure that a shift to active transport will genuinely occur.
[physicians] must remain our patients’ advocates and take action where we can for cleaner air and healthier lifestyles.
Cities like Amsterdam and Copenhagen are rightly held up as shining examples of what can be done to encourage active transport. However, surely they have always cycled in these cities? Well, no - this pictures shows how one street changed as a result of politics, not personal choice.
As evidence accumulates for the harms which come to people from the direct and indirect effects of the political choices our governments and authorities make for us, physicians must remain our patients’ advocates and take action where we can for cleaner air and healthier lifestyles.
Increasingly, the use of polluting vehicles in city centres seems to be a choice which puts the benefits of convenience for a privileged few high above the needs of the disadvantaged many. Physicians should support measures which help patients to make choices which benefit not only themselves, but society at large, no matter how unpopular that may seem.
Dr Toby Hillman is the RCP clinical lead for sustainability and lead consultant for pleural diseases at UCLH. You can follow him on Twitter at @tobyhillman
The RCP is responding to the government’s new Clean Air Strategy consultation which is open until 14 August 2018. Individuals are also invited to submit comments on the recommendations.