The Royal College of Physicians (RCP) has committed to reviewing how doctors are trained to make sure they better understand the impacts of air pollution on health, following the death of 9-year-old Ella Adoo-Kissi-Debrah in February, 2013.
The commitment is part of the RCP’s response to the Assistant Coroner’s (HM Coroner for the Inner South District of Greater London) Prevention of Future Deaths report. This followed the landmark ruling at the inquest into Ella’s death that she developed and then died of asthma contributed to by exposure to excessive air pollution.
The coroner was concerned that “the adverse effects of air pollution on health are not being sufficiently communicated to patients and their carers by medical and nursing professionals.” As well as reviewing the delivery of the internal medicine curriculum, the RCP has pledged to help doctors talk to patients and their families about air pollution, how to avoid it and how to lessen its effects.
The coroner also expressed concern about public awareness of information about national and local air pollution levels. But their chief concern was that the annual average limits for Particulate Matter (PM2.5) in the UK at 25mg/m3 are much higher than the World Health Organization (WHO) health-related guideline (currently set at 10mg/m3). During the course of her illness, between 2010 and 2013 Ella was exposed to levels of nitrogen dioxide and PM2.5 that exceeded WHO guidelines.
The RCP agrees that the national limits for particulate matter are too high, that the WHO health-related guidelines should be seen as minimum requirements, and that legally binding targets based on them would reduce disease incidence, morbidity and deaths from non-communicable diseases in the UK. There needs to be a particular focus on initiatives that reduce the exposure of those with pre-existing disease, women and children, older people, and people in lower socioeconomic groups, in which ethnic minorities are overrepresented.
Dr Cathryn Edwards, RCP registrar, said: “It is absolutely tragic that Ella died as the result of air pollution, a cause of ill health we have known about for years and could have done so much more to reduce. As the coroner said in the report to prevent future deaths, nobody at the inquest disputed the fact that air pollution causes thousands of premature deaths every year.
“The RCP accepts the evidence presented at the inquest and thanks the coroner for helping us think about our role with regard to it. There is more we can do to support doctors and other clinicians to talk to patients, their families and carers about avoiding and mitigating the impact of air pollution.
“But the risk of air pollution to public health will only be significantly reduced if government and other policy makers agree to widespread societal measures to regulate and reduce pollution-generating activity. The coroner identified that ‘legally binding targets based on WHO guidelines would reduce the number of deaths from air pollution in the UK’. The environment bill currently passing through parliament is an opportunity to do that; it is not too late for the government to commit the UK to meeting WHO guidelines for PM2.5.”
The RCP was one of the organisations required to respond to the report in relation to its responsibility for the postgraduate education of physicians. As well as reviewing the delivery of the medical curriculum, it has promised to work with specialist societies, the Academy of Medical Royal Colleges, other medical royal colleges and the UK Health Alliance on Climate Change, among others, to:
- Continue to raise the profile of the impacts of air pollution on health
- Decide how to increase knowledge among physicians of the impacts of air pollution on health
- Produce and actively promote resources that will help medical professionals
- better understand the impacts of pollution
- have conversations with patients and their families about avoiding air pollution and mitigating its impacts
- Work with central and local government and the NHS to improve incentives to have these conversations and systems that indicate when they are necessary
- Consider how they might help medical professionals become local advocates for reducing air pollution
- Urge national and local government to tighten regulation of pollution-generating activity and improve public information.
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