What the party manifestos should cover on health and social care but probably won’t

David Oliver wrote an article on this in the BMJ(1). But he didnt mention clean air.

I sent a rapid response saying …
Surely we also need a Clean Air Election.
Everyone took notice when 230,000 people died from Covid in the UK in the last four years. There was lots of money. Lots of ideas. Incidentally, also lots of behaviour change.
There’s nowhere near so much input around the 50,000 people who die every year in the UK from pollution(2). Not in such dramatic and hospital-overwhelming peaks as in the pandemic.
But that’s still 200,000 deaths from pollution in the last four years.(3)With many many more through all the previous decades. And even more to come.  Unless we do something. 
Of course air pollution is about more than deaths or asthma in kids.
Its affects morbidity throughout the lifespan.(4) There are significant impacts on primary care and hospital admissions.(5,6)

That’s the why.
So what to do? Here’s some evidence-based ideas:
1. Make English clean air targets much more ambitious(7), much more quickly(8).
2. Focus on inequalities. More deprived areas, communities and individuals produce less pollution – but have to breathe the dirtiest air. Lets make advances by starting with the most polluted.(9)
3. Put health warning labels on / stop advertising woodburners / solid fuels. Lighting fires in our homes is the largest source of small particle air pollution in the UK – and produces more harmful PM2.5 than road transport in the UK.(10)
4. ULEZ was / is a great idea but London still has filthy air. We need more transport initiatives, across the UK. Manchester, for example, has free buses in its centre.(11) Asthma+Lung UK have specific – and money-saving – recommendations for accessible and inclusive clean air zones.(12)
5. Make SUV drivers pay. If SUVs were a country, they would be the world’s fifth-largest emitter of CO2. SUVs account for more than a quarter of – and are increasing – the overall annual growth in oil demand.(13)

Clean air is an enormous problem – and needs enormous solutions, including(14) :
6. Stop spending billions of our money subsidising big oil.(15)
7. Stop counting forest biomass as ‘renewable’ energy. Stop subsidising it.(16) Its bad for the environment; bad for biodiversity(17); and bad for communities(18).
8. Link with wider climate / net zero thinking(19)

Of course, clean air is not just for elections.
Or for politicians.
Clinicians could, for example, use pollution spikes(20,21,22) – rather than traditional QOF systems as prompts to review, advise and support the most vulnerable people. 

1) Oliver, D: What the party manifestos should cover on health and social care but probably won’t. BMJ 2024;385:q1202

2) UCL. 25 October 2023. UK air pollution regulations will reduce deaths, but do little to protect ecosystems. https://www.ucl.ac.uk/news/2023/oct/uk-air-pollution-regulations-will-reduce-deaths-do-little-protect-ecosystems  

3) With everything shut down during the pandemic, deaths and morbidity may have been temporarily lower

4) Baranyi G et al. Higher air pollution exposure in early life is associated with worse health among older adults: A 72-year follow-up study from Scotland. Health Place 2024 Mar:86 and see: The health impacts of air pollution. in. Air pollution: applying All Our Health. Updated 28 February 2022 . https://www.gov.uk/government/publications/air-pollution-applying-all-our-health/air-pollution-applying-all-our-health 

5) Sofianopoulou E. Association between respiratory prescribing, air pollution and deprivation, in primary health care. J Public Health. 2013 Dec;35(4):502-9. 

6) Asthma+LungUK. Spikes in air pollution increase pressure on the NHS. https://www.asthmaandlung.org.uk/support-us/campaign-with-us/clean-air-campaigns/how-air-pollution-impacts-our-nhs  

7) UK Health Alliance. Air pollution reduction targets bad for health. 16th December 2022 https://ukhealthalliance.org/news-item/air-pollution-reduction-targets-bad-for-health/ 

8) Stewart, Jack. WHO air quality safety targets achievable across most of the UK by 2030. 02 March 2022 https://www.imperial.ac.uk/news/234354/who-quality-safety-targets-achievable-across/

9) Air Pollution and Inequalities in London – update 2023.https://www.london.gov.uk/programmes-strategies/environment-and-climate-change/environment-and-climate-change-publications/air-pollution-and-inequalities-london-update-2023  

10) Global Action Plan. Facts about woodburning. https://www.cleanairhub.org.uk/clean-air-information/the-basic-information/wood-burners  

11) bee network. free bus. Free travel around Manchester city centre. https://tfgm.com/public-transport/bus/free-bus 

12) Asthma + Lung UK blog. Clean air zones: making sure no one is left behind. https://www.blog.asthmaandlung.org.uk/blog/clean-air-zones-making-sure-noone-is-left-behind 

13) Bloomberg UK. SUVs Keep Oil Demand Ticking, Add 20% to Energy Emissions Growth. https://www.bloomberg.com/news/articles/2024-05-28/suvs-keep-oil-demand-ticking-add-20-to-energy-emissions-growth  

14) More ideas at: Mawer, C. We need a clean air election. June 1. https://carolinemawer.com/we-need-a-clean-air-election/ 

15) Fossil fuels received £20bn more UK support than renewables since 2015. 9 Mar 23. https://www.theguardian.com/environment/2023/mar/09/fossil-fuels-more-support-uk-than-renewables-since-2015 

16) Forest Defenders Alliance. Simple, simple, simple: Two changes that would fix the EU’s dependence on burning trees for “renewable” energy. https://forestdefenders.eu/simple-simple-simple-two-changes-that-would-fix-the-eus-dependence-on-burning-trees-for-renewable-energy  

17) The Biomass Delusion. https://environmentalpaper.org/biomass/the-biomass-delusion/ 

18) Drax accused of driving ‘environmental racism’ after further pollution claims against wood pellet mills in US deep south.https://unearthed.greenpeace.org/2022/09/26/drax-accused-environmental-racism-further-pollution-claims-against-wood-pellet-mills-us/ 

19) UK100. What CANZ be done? Local Authorities leading the way on integrating Clean Air and Net Zero. 30 January 2023. https://www.uk100.org/publications/what-canz-be-done-local-authorities-leading-way-integrating-clean-air-and-net-zero 

20) Sign up for free texts warning you about air pollution alerts via https://www.airtext.info/signup 

21) McDonald A. Air pollution spikes cause hundreds more cardiac arrests and strokes in the UK. 21 October 2019. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/october/air-pollution-spikes-cause-hundreds-more-cardiac-arrests-and-strokes-in-the-uk-research-shows 

22) Ames C. Air pollution surges linked to increased hospital admission. https://www.transport-network.co.uk/Air-pollution-surges-linked-to-increased-hospital-admissions/16231 Transport Network. Oct 2019.

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