Sustainability Day London Road Show

Welcome to the London Sustainability Day 2016 Road Show

#Dayforaction

Welcome and introduction

Fiona Daly, Associate Director of Sustainability and Patient Transport,

Barts Health NHS Trust

#Dayforaction

Creating the right environmental

conditions for healthy lives

Professor Paul Cosford CB

Director for Health Protection and Medical Director,

Public Health England

16 September 2016

Your health is determined by:

what you do

who you are

where you live

Cities: challenges & opportunities for health

The Great Smog (London, Dec 1952)

Clean Air Act 1996

COMEAP (2010) estimated the

mortality burden of human-made

particulate pollution in UK in 2008

• an effect equivalent to

approximately 29,000 deaths

• a loss of 340,000 years of life

• average loss of 6 months of life

expectancy from birth

Committee on the Medical Effects of Air

Pollutants (COMEAP)

http://comeap.org.uk/

Nitrogen dioxide concentrations across London

Traffic-related Air Pollution in London

Source: Frank Kelly (2012)

Climate Change and Health

Public Health Outcome Framework

indicator for air pollution – PM2.5

Clean Air Zones

Action to improve air quality

Support for cities to grow

Encourage cleaner vehicles

Encourage healthy travel

Supporting local growth and

ambition

Accelerating transition to a low emission

economy

Immediate action to

improve air quality and

health

Clean Air Zone

Access restrictions to encourage cleaner vehicles

Source: Defra (2016)

CCRA – People & Built Environment

Climate Change, Sustainability and Public Health ResearchSource: Committee on Climate Change (2016)

Observed change in average

surface temperature (1900-2012)

Climate Change and HealthoC

IPCC, 5th AR

Paris AgreementParis climate conference (COP21) - December 2015

195 countries adopted the first-ever universal, legally binding

global climate deal.

The agreement sets out a global action plan to put the world on track to

avoid dangerous climate change, by limiting global warming to well

below 2°C.

The agreement is due to enter into force in 2020.

Our future…

IPCC Climate Change 2013 The Physical Science Basis.

Air Pollution and Climate Change

Climate Change, Sustainability and Public Health Research

Need to be treated together.

Common sources of air pollutants and GHG gases:

fossil fuel burning in industry, motor vehicles and

buildings

Climate Change impacts on Air Pollution

In the absence of additional emission reductions,

IPCC projected “declining air quality in cities”

Air Quality impacts on Climate Change

Conventional air pollutants (e.g. ozone and

particles) can contribute to climate change.

“Win-wins” from action to improve air quality

and mitigate climate change

Health Co-benefits of

Climate Change Mitigation• Mitigation policies may achieve health, GHG

and economic benefits simultaneously

(‘the triple bottom line’)

• Health co-benefits of policies to reduce GHG

emissions in transport, energy generation and

food production

• Evaluation of the health effects (both positive

and negative) of emerging ‘low carbon’

technologies and biofuel policies.

Sustainable, Resilient,

Healthy People & Places

Vision of sustainable health and care:

Working to reduce carbon emissions,

minimising waste & pollution, making

the best use of scarce resources,

building resilience to a changing

climate and nurturing community

strengths and assets

(SDU 2014)

NICE public health guidelines Existing:

Physical activity (2012)

Walking and cycling (2013)

Excess winter deaths and illness and the health

risks associated with cold homes (2015)

Under development:

Outdoor air pollution (2017)

Future work:

Indoor air quality (2018)

Conclusions

• Environmental change poses challenges but also creates opportunities

• The evidence is strong:

• For the impact of environmental harms on health

• For the benefits to health of a high quality environment

• We need to change the narrative

• From harms to assets and possibilities

• We need action across all sectors

• Across national and local government

• Across the health and social care sector

• With employers, industry, voluntary sector, local government

• We have a huge opportunity – let’s take it!

The 2016 Sustainability Day Action Report Launch

Scott Buckler, Campaign Manager, Sustainability Day

#Dayforaction

Our Planet, Our Health

Anne Johnson

What is Planetary Health?

Put simply, planetary health is the health of

human civilization and the state of the natural

systems on which it depends.

Commission on Planetary Health. Chair Sir Andy Haines

Human health and well-being in the Anthropocene

1800 1850 1900 1950 2010

Population

1800 1850 1900 1950 2000S

Poverty

1800 1850 1900 1950 2000

Life expectancy

1800 1850 1900 1950 2000

Energy use

1800 1850 1900 1950 2000

Water use

1800 1850 1900 1950 2000

) Domesticated land

Environmental trends

1800 1850 1900 1950 2000

Tropical forest loss

1800 1850 1900 1950 2000W

Extreme Shortage

High Shortage

Moderate Shortage

Water shortage

1800 1850 1900 1950 2000

Ocean acidification

−0.50

−0.25

1800 1850 1900 1950 2000

Temperature change

1800 1850 1900 1950 2000

Biodiversity

Effects of multiple environmental changes on food availability and quality

• Land degradation

and soil erosion

• Water scarcity

• Loss of pollinators

• Overfishing/Ocean

acidification

• Climate change

• CO2 fertilization

• Ozone

• Pests, mold and

Reduce GHG emissions and land use requirements-by cutting waste and promoting healthy diets

We are using grains

to feed animals !

Estimates of air pollution deaths (WHO 2014, Lim et al LANCET 2012 ;380)

• Ambient particulates ~3.7 m

deaths p.a.

• Household from solid fuels

~4.3 m deaths p.a.

• Around 7 million in total

• Tropospheric Ozone ~ 150 k

deaths p.a.

Developing sustainable and healthy cities

• Active travel /public transport

• Reduced fine particulate air

pollution

• Green spaces –biodiversity,

reduced heat island and

mental health benefits

• Watershed conservation

• Access to healthy food

• Increased resilience to

floods,storms and droughts

• Solutions lie within reach and should be

based on the redefinition of prosperity to

focus on the enhancement of quality of

life and delivery of improved health for

all, together with respect for the integrity

of natural systems.

o Wellcome Strategic Framework

o Our Planet, Our Health

o Pilot and programme funding

o Partnerships

o Engagement

Pilot Project: Seasonal drivers of human

movement and aggregation in a changing

climate: consequences for infectious disease

dynamics and control (Jessica Metcalf)

Predicting the human nutrition and health toll

of global fishery declines

(Christopher Golden)

Future diets and health: how will environmental changes

affect food availability, consumption and health?

(Alan Dangour)

Our Planet, Our Health

Two themes:

- Urbanisation and Health

- Global food security and Health

Policy & partnerships

Public engagement

Volunteering in Health

Busola Lagoke

Senior IMS Manager - Sustainability

“We will be recognised as a

leading sustainable business

and the leading sustainable

support services company.”

Richard Howson

Chief Executive

Carillion’s 2020 Sustainability Vision

Sustainability Performance - Our 2015 Story

Volunteering & Community Engagement

Employee Volunteering

• Making a difference to our communities, clients, people

and Carillion

• Enables employees to apply annually for six paid

volunteering days

• Carillion’s Vision – 50% of staff using the paid leave

programme towards community work by 2020

• Current target of 10% for working with schools,

unemployed and hard to reach groups

• Last year 18% of employees volunteered over 50,000

Why Get Involved?

• Personal development

• Employee pride

• Long Term Customer Relationships – up to 30 years –

embedded in local communities

• We recruit from local communities – today’s special needs

individual could be tomorrow’s Catering supervisor

• Volunteering enables us to help our ‘extended family’ – our

‘NHS Good Corporate Citizen’

Business in the Community

•Ready for Work - engages business to support disadvantaged groups,

particularly people who have experienced homelessness, unemployment.

•Carillion provide job coaches, placements and employment

• Clients

typically have

experienced

three or more

of these

barriers to

employment

The Impact on local communities

• Carillion has offered 1053 two week work experience placements in a variety of

contracts in both Construction and Services.

• Carillion employees have acted as Job Coaches for over 204 Ready for Work

participants after they completed their placement

• 466 Ready for Work participants have gone on to secure work either with

Carillion, a supplier or another business after their work placement at Carillion.

• Of those that have secured employment after their Carillion placement, 83.71%

gain and sustain work for at least 3 months and 65% for at least 6 months.

Since 2007 when Carillion became a Ready for Work

national partner (to June 2016):

Ready for Work film

https://www.youtube.com/watch?v=WF7htqsYiqM

https://www.youtube.com/watch?v=WF7htq

Hospice UK Partnership

• Raised £80,000 in 2016

• More than £58,000 raised from The

Big bike ride

• 800 hours volunteered

• Health contracts have fundraised by

combining our Global Corporate

Challenge to walk and fundraise

• A group walked across all 6 hospital

sites from Newham Gateway to

Barts Hospital.

• Colleagues have refurbished

Margaret’s Hospice garden

Volunteering in Health - RLUH

Volunteering in Health

Last year Carillion

employees engaged

with 45,000 school

children during voluntary

activities

Project SEARCH

• Project SEARCH first set up in a children’s hospital in

America to help young people with learning disabilities

find a job

• Several hospitals in the UK are engaged with project –

Carillion are supporting in Nottingham University

Hospital and Barts – in Barts, we have now

permanently employed two participants from this

programme

Measuring air pollution to save lives

Romain Lacombe, CEO & Founder, Plume Labs

#Dayforaction

Refreshments & Networking

#Dayforaction

Daniel Bede O’Connor

Head of Customer Happinessdaniel@warp-it.co.uk

078 0707 0339

@WarpIt_

Overview

Reuse Study Organizational

habits Story How it applies to

reuse or other sustainability activities

Staff get visibility on what is available elsewhere

Friend requestsSE over 35 orgs….

Priority 3

Priority 1 , 2 and 3- turn on and off

Like eBay-increases participation

Controls.

Diverse range of equipment.

Increase participation.

Increase impact.

Plan building moves.

Direct transfer.

External collab

Access to other organisation’s items

External Collaboration

NHS London save £3K , NHS Tayside save £15K

Demonstrate savings.

Metrics from NHS Tayside

The power of habitWhy do we do what we do and how to change.

Charles Duhigg

What habit would you like to develop or change?

You want to improve things right?

Organisationalhabits

Why habits form

Habit basics

The habit loop

New habits

Craving reward!

Changing habits

Increased participation

Keystone habits

Keystone habits in organisations

Reuse as a Keystone habit

Frame within crisis, not sustainability

Unacceptable to dispose of assets to skip

Change

Other sustainability behavioursor any change

Reuse as a Keystone habit

“Once a small win is accomplished , forces are set in motion that favouranother small win”

Small wins

“Small wins fuel transformative change by leveraging tiny advantages into patterns that convince people bigger achievements are within reach”

Small wins

Small wins for reuse

Just start off with a stationery amnesty? Show impact?

Ask procurement to block purchase of stationery

Demonstrate savings let’s do full reuse system

Develop intranet content

Deliver newsletter

First £20K saving

Feedback to staff

Feedback to senior staff

1st year review

Yes we’ve got the CE on board!

Review

Anatomy of habits

Keystone habits

Small wins

Do you want to improve things?

Collaboration

Procurement

Facilities

Logistics

Communications

Space manager

Asset manager

Capital development

Contractors

Do you

Hate buying new when the organisationalready has it?

Do you

Hate seeing surplus assets in skips?

Do you

Like reducing waste?

Do you

Like reducing procurement?

Do you

Like helping staff collaborate?

Do you

Like saving money and carbon?

Do you

Like collaborating with other Trusts?

Do you

Want to get me in to illustrate the hooks and benefits of reuse for each department?

MaximiseReuse

Clipboard

First name and second name only

I will find your details and book in a meeting

What habit would you like to develop or change?

Habit?

Routine

Reward?

Craving!

Daniel O’Connor

Head of Customer Happinessdaniel@warp-it.co.uk

078 0707 0339

@WarpIt_

Behaviour change and staff engagement

David Pencheon OBE, Director, SDU

#Dayforaction

…becoming experts in delicious, healthy

and sustainable alternatives to meat

Jen Wheildon

Marketing Manager

Unique benefits…

Health &

nutrition

Taste &

texture

Versatility &

familiaritySustainability

Behaviour Change

Remember the history…

Additional InterestSCFA productionFibre (chitin and ẞ-glucans)

Mycoprotein as a food ingredient

Physical

Properties (shape)

Denny, A, Aisbitt, B and Lunn, J (2008) Mycoprotein and health. BNF Nutrition Bulletin 33: 298 – 310.Bottin, J. (2014) Nutrition and Surgical Influences on appetite regulation in obese adults. PhD Thesis Imperial College London

BENEFITS

Texture creation• Authentic meat-like texture• Creation of fibrosity through fibre assembly

General Nutrition• High quality protein• Low fat content (membranephospho-lipids)

• High fibre (cell wall)• Low energy densityClinical Research Programmes• Lowering serum cholesterol• Satiety• Insulinemia and

glycemia in diabetics

Composition

Source: FCRN Food

Source, 2016

Quorn Environmental Footprint

Key Comparisons vs

GHG LAND WATER

Beef Mixed

x9 more GHG

x9 more land

x10more water

Beef Grazed

x36 more GHG

x12 more land

x11 more water

Chickenx3 more

GHGx2 more

landx2 more

By working closely with Carbon Trust we have established that

Quorn Foods offer significant environmental benefits relative to

Quorn is the first and only meat free brand to have carried out

such a systematic third party analysis of its environmental

footprint.

Quorn supported the following sites

Great Ormond Street

Hospital

Guys Hospital

St Thomas Hospital

St Barts Hospital

ULC Hospital

Whipps Cross Hospital

Newham University Hospital

Royal London

Mile End Hospital

Nottingham City Hospital

Nottingham QMC Hospital

Sheffield Teaching Hospitals

Sampling Quorn to over

2000 NHS Staff and Visitors

In the last 12 months, we have sold 105 tonnes of Quorn into the UK Healthcare sector.

Quorn in Healthcare

12 million calories

5 tonnes

Sat Fat

39439410

H2OC2O

Quorn in healthcare

Quorn fits easily into everyday life and makes meat reduction simple…

Thank you

Lunch & Networking

#Dayforaction

Welcome back

#Dayforaction

Natural Health Service Project

Elmarie SwanepoelHead of Sustainable Development

& Strategic Projects

Making a difference to secure our future

Community Engagement

Workforce

Facilities Management

Models of Care

Buildings & Adaptation

Travel & Transport

Procurement

Natural Health

Service

Programme

Our Approach

Partnerships

Conservation Regeneration

Objectives

Educational ProgrammesEnvironmental volunteer

activities

Our journey so far…

Broomfield Hospital

A timeline of activities

• Woodland improvement activities

• Woodland Management Plan (S106)

• Woodland maintenance

• Improving access

• Heritage National Lottery Fund Grant

2014• Introduced native woodland trees

• Bird/bat boxes in woodlands

• Community Vegetable Garden & Orchard

• Kirsty’s Elm

• Nurture 2014 Campaign

• Pudding wood path completed

2015• Wellbeing Terrace

• Health & Wellbeing Strategy Launch

• Dementia Garden

• Long Shapely Belt path completed

• Nurture 2015

2016 • Wildflower Garden

• Seymour House Nursery

• Tesco Volunteers

• Nurture 2016

• Bat Walk

St Peter’s Hospital

• St Peter’s Gardening Group

• Centre for Volunteer Services

• Running for over 10 years

• Volunteers of all ages/experience

• Sessions twice a week

• Funding

• Partnerships

• Projects

• 2nd dementia garden

• Sunken Garden

• Formal Gardening Club

Sustainable Development in Action

FinancialEnvironmental

Social

• Educational Programmes

• Promote physical activity and

therapeutic environment

• Community Engagement

(75% GCC)

Environmental

• 4 demolished building sites green

spaces

• Improved biodiversity

• Constant regeneration and

maintenance

Financial

• Funding

– £130k raised to invest in projects

• Volunteer hours

Volunteer Hours

2015 1,539 £21,000

2016 1,319 £18,000

Key summary

• Challenges

• Key ingredients

- Start small think big

- Leadership

- Building links

- Building partnerships

- Key skills

- Track record of successful delivery

- Mix of activities to meet local needs

FinancialEnvironmental

Social

Barts Health strategy, approach and

delivery of a sustainable healthcare system

Strategic Partnerships and

Sustainability at Barts Health

Fiona Daly

Associate Director of Sustainability and Patient Transport

An Introduction

Barts Health

• Large acute teaching trust, 5 hospital

sites spanning 4 London boroughs

• Centre of excellence: cardiac, cancer,

stroke and trauma services

• >574,000M2 real estate

• Occupying our buildings 15,000 staff

• >2.3M patients every year

• Turnover £1.25bn

• £1.3bn PFI

• Diverse building stock

• £15M annual energy spend (11% FM

budget)

Delivering behavior change from the Board

Strategic Vision

Sustainable vision; “Barts Health is committed to delivering world-class

healthcare and to ensuring our organisation remains fit to do so both now and

in the future. We understand that we need to embed a culture that enables

early adoption, adaptation and innovation to be driven throughout our

organisation and into the core of the health services we deliver.

Our ambition is to be the most sustainable trust in the UK by 2020.”

Organisational vision; “Our ambition is for east London to have health

services in which we can all take pride. These services will reach beyond our

hospitals and provide care where it is needed most - at home, in our

communities, or in specialist facilities across the boroughs…”

The health of our communities

Barts Health

Historical and modern day deprivation comparison

• Deprivation

• Poor health

outcomes

• Obesity

• Poor Life

expectancy

• Health

Inequalities

• Social

Inequalities

“Climate change is the greatest

global health threat of the 21st

century”

The Lancet (2009)

How we impact our systemOur approach

The health impact on society

Social Sustainability

Fuel Poverty - costs the NHS £850m a

year, 27,000 excess winter deaths from

cold homes

Air Quality – health costs £20bn a year

(twice as much as obesity), 9,500

Londoners die prematurely each year

Childhood Obesity – costs the NHS

£5bn a year, 25.5% of 11 year old

children in East London obese [2012]

People are dying because they can’t heat

their homes

Fuel Poverty

A variety of approaches

Community led Programme

Clinical engagement

Using clinicians as Trusted messengers

Social Media as the solution – Facebook

2 local coordinators, 28 local

stakeholders, 275 posts on

bills/energy/health, 432 householders,

reach – 42,565, 326 comments and

shares

Babu Bhattacherjee from local support group Poplar Harca: “Fuelling Connections is a

fantastic way to share ideas and to reach out to the Poplar and Limehouse community and

we are strong supporters of the initiative. For isolated residents this is a valuable and often

essential, community resource that will make all the difference in the colder months.”

A national health issue that needs

addressing at scale

Air Pollution

9,500 Londoners die prematurely

Hampers Child lung development

Affects those in deprived areas

Exacerbates serious health conditions

Leads to Stroke, Heart Disease,

Asthma

Collaboration for 3 year Programme

Working with Children's services -

maternity

National Clean Air Day

Health, Education and Sustainability

Food Education

25% <11yr olds are obese

FFLP pathfinder project

3 core themes; Health, Sustainability,

Education Food Education Skills

Catering Quality Standards and Certification

A Health Promoting Setting

Patient Dining Experience

Community and Partners

Vending and Retail

Supports public health and health and

wellbeing agenda

Put 500 8yr olds through programme

Fiona Daly, Barts Health NHS Trust

Contact details

Fiona.daly@bartshealth.nhs.uk

www.bartshealth.nhs.uk/sustainability

Sustainability driving better healthcare

Alexandra Hammond

Associate Director, Sustainability

The best healthcare runs efficiently, uses resources wisely, fosters healthy living and embeds long-term thinking to provide patients with the best possible care.

Sustainability Strategy 2013 – 2020Guy’s and St Thomas’ NHS Foundation Trust

Lighting the way

• £1m in LED lighting and

controls

• Energy efficiency focus

moved to wellbeing

• Wider energy efficiency

project

Moving from idea to action

• Engage the right people

• Put the project in context

• Understand wider drivers

Creating spaces

The new lights and controls are great – they are set up to meet the needs of the department,

and provide a bright environment that allows us to

work productively.

CLAIRE ELDRIDGE, PHARMACY SERVICES MANAGER

There was no disruption at all during installation and staff were accommodating to service needs.

CAROLINE CHURCHDEPUTY SERVICE MANAGER

I was very impressed. I loved the enthusiasm.

SIR HUGH TAYLORTRUST CHAIRMAN

Furniture reuse, repair and remanufacture

Photo credit: http://www.ellenmacarthurfoundation.org/rypeoffice

Dedication to prolonging the life of products

Photo credit: www.usa.phillips.com

Sustainable and active travel

• Enabling active

travel

• Activity

“prescriptions”

• Sustainable Travel

Built to last

Alexandra Hammond

Associate Director, Sustainability

alexandra.hammond@gstt.nhs.uk

@alexandrajhr

Professor Stephen HolgateMRC Clinical Professor, University of Southampton

Every breath we take: the lifelong impact of air pollution

Air pollution through the lifecourse

The Great Smog of 1952 took hold on London 64 years ago, claiming an estimated 4200 lives.

How the report came about

• Great strides made on tobacco control, alcohol and obesity

• Air pollution remains a major public health challenge

• RCP and RCPCH convened working party to discuss evidence and draw up recommendations

Why the RCP is tackling this issue

• Air pollution estimated to cause around 40,000 deaths per year in the UK

• Estimated cost of air pollution is £20bn annually in the UK

• Linked to major health challenges of our day such as heart disease, asthma, COPD, lung cancer, diabetes and dementia

Diseases, conditions and biomarkers affected by outdoor pollution. Conditions currently included in the Global Burden of Disease categories shown in bold.

Air pollution in our changing world

• Changes in the way we live have changed air we breathe

• Total distance walked each year decreased by 30% between 1995 and 2013

• In 2012, road traffic in the UK was 10x higher than in 1949

• Not just outdoor environment but indoor as well

Annual distance travelled by road in the UKNow, 774,513 diesel cars in London170,000 (30%) increase since 2012

Health effects of pollutantsacross 24 hours/day

of exposures

Protecting future generations

• First report to examine health implications of exposure to air pollution over lifetime

• Developing heart, lung, brain, hormone systems and immunity can all be harmed by pollution

• Effects growth, intelligence, asthma and development of the brain and coordination

Critical periods of risk from pollution duringfetal development

Principle stages of lung development in humans

Effect of air pollution in modifying gene expression - epigenetics

Health effects of air pollution overour lifetime

Vulnerable groups

Some people suffer more from exposure to air pollution because they are:

• More likely to live in polluted areas

• Exposed to higher levels of air pollution

• More vulnerable to health problems caused by air pollution

Recommendations for action

1. Act now, think long term. We must act now, and with urgency, to protect the health, wellbeing and economic sustainability of today’s communities and future generations. Government must empower local authorities and incentivise industry to plan for the long term.

2. Educate professionals and the public. The NHS and patient charities must educate health professionals, policymakers and the public about the serious harm that air pollution can cause. Health professionals, in particular, have a duty to inform their patients.

3) Promote alternatives to cars fuelled by petrol and diesel. Government, employers and schools should encourage and facilitate the use of public transport and active travel options like walking and cycling. Active travel also increases physical activity, which will have major health benefits for everyone. Local Transport Plans, especially in deprived areas, should:

• expand cycle networks• require cycle training at school,• promote safe alternatives to the “school run”, based on walking, public transport and cycling instead of cars• encourage employers to support alternatives to commuting by car• promote leisure cycling• develop ‘islands’ of space away from traffic, for safer walking and cycling.

European, national and local policies should also encourage the use of electrical and hydrogen-powered vehicles.

4. Put the onus on the polluters. Polluters must be required to take responsibility for harming our health. Political leaders at a local, national and EU level must introduce tougher regulations, including reliable emissions testing for cars. They must also enforce regulations vigorously, especially in deprived areas where pollution levels are higher and people are more vulnerable.

5. Monitor air pollution effectively. Air pollution monitoring by central and local government must track exposure to harmful pollutants in major urban areas and near schools. These results should be proactively communicated to the public, in a clear way that everyone can understand. When levels exceed EU limits or World Health Organization guidelines, local authorities must immediately publish serious incident alerts.

6. Act to protect the public health when air pollution levels are high. When these limits are exceeded, local authorities must have the power to close or divert roads to reduce the volume of traffic, especially near schools.

7. Tackle inequality. Our most deprived communities are exposed to some of the worst outdoor and indoor air quality, contributing to the gap in life expectancy of nearly 10 years between the most and the least affluent communities. Regulators, local government and NHS organisations must prioritise improvements in air quality in our most deprived areas, setting high standards of emission control across all sectors of industry.

8. Protect those most at risk. Children, older people, and people with chronic health problems are among the most vulnerable to air pollution. Public services must take account of this disproportionate harm through local tools such as planning policies for housing and schools, equalities impact assessments, and joint strategic needs assessments. At an individual level, healthcare professionals should help vulnerable patients protect themselves from the worst effects of air pollution.

Information packs developed as part of the Barts Health Cleaner Air Programme developed by the Global Action Plan

9. Lead by example in the NHS. The NHS is one of the largest employers in Europe, contributing 8% of the UK’s gross domestic product (GDP). The health service must no longer be a major polluter; it must lead by example and set the benchmark for clean air and safe workplaces. In turn, this action will reduce the burden of air pollution-related illness on the NHS. The Department of Health, NHS England and the devolved administrations must give commissioners and providers incentives to reduce their emissions, and protect their employees and patients from dangerous pollutants.

What can I do?

As citizens and members of the public, everyone can help by:

• trying alternatives to car travel: bus, train, walking and cycling• aiming for energy efficiency in our homes• keeping gas appliances and solid fuel burners in good repair• asking our local council and MPs to take action• learning more about air quality and staying informed.

It might seem as if individual actions will not make a difference, but it all adds up, and each one of us must act.

10.Define the economic impact of air pollution. Air pollution damages not only our physical health, but also our economic wellbeing. We need further research into the economic impact of air pollution, and the potential economic benefits of well-designed policies to tackle it.

11.Quantify the relationship between indoor air pollution and health. We must strengthen our understanding of the relationship between indoor air pollution and health, including the key risk factors and effects of poor air quality in our homes, schools and workplaces. A coordinated effort among policymaking bodies will be required to develop and apply any necessary policy changes

12. Determine how global trends are affecting air quality. From increased energy production and consumption to global economic development and urbanisation, we need to improve our understanding of how major social and economic trends are affecting air quality and its twin threat, climate change.

13. Develop new technologies to improve air pollution monitoring. We need

better, more accurate and wider-ranging monitoring programmes so that we can track population-level exposure to air pollution. We also need to develop adaptable monitoring techniques to measure emerging new pollutants, and known pollutants that occur below current concentration limits. We must develop practical technology – such as wearable ‘smart’ monitors – that empower individuals to check their exposure and take action to protect their health.

The Clean Air Act of 1956

14. Study the effects of air pollution on health. To appreciate fully the risk to health, we need further research on air pollution’s effects on the body. In addition to lung and cardiovascular disease, research into the adverse health effects of pollution should accommodate systemic effects such as obesity, diabetes, changes linked to dementia, and cancer, as well as effects on the developing fetus and in early childhood.

Magnetite pollution nanoparticles in the human brain.Maher BA et al. Proc Natl Acad Sci U S A. 2016 Sep 6. pii: 201605941. [Epub ahead of

print]

Those magnetite pollutant particles which are <∼200 nm in diameter can enter the brain directly via the olfactory bulb. Their presence proves that externally sourced iron-bearing nanoparticles, rather than their soluble

compounds, can be transported directly into the brain, where they may pose hazard to human health.

Sadiq Khan unveils action plan to battle London’s toxic air05 July 2016

Extending the Ultra-Low Emission Zone (ULEZ) to the North Circular Road and the South Circular Road and the possibility of bringing forward the introduction earlier than 2020. Under current plans the ULEZ will only operate within the Congestion Charging Zone and it is due to come in from 2020.

Implementing an extra charge on the most polluting vehicles entering central London using the Congestion Charge payment and enforcement system from 2017 (this would not mean an increase in the Congestion Charge but just the method for collecting the extra charge from people driving the most polluting vehicles).

Introducing ULEZ standards for heavy vehicles London-wide from 2020. Giving the go-ahead for Transport for London (TfL) to start work on the costs

and challenges of implementing a diesel scrappage scheme as part of a wider national scheme delivered by the Government.

Proposals to work with the Government to tackle air pollution on a national and international level.

In a further bid to tackle air quality in the capital, the Mayor has also joined a High Court challenge of the Government’s air pollution plans as an Interested Party. Environmental lawyers ClientEarth are suing the Government for the second time in a year, having won a case at the Supreme Court in 2015 which ordered ministers to fulfil their legal duty to cut pollution in “the shortest time possible”. The new case argues the government is still failing to do this.

The Mayor has now set out his view that London can meet the legal standards for NO2 well before 2025, which is the date the Government’s Air Quality Action Plan

projects London will be compliant.

Next steps: inform and empower the public on the serious effects of air pollution and lobby MPs for change as was so successful in

Clean Air Acts of 1956 and 1968 and more recently, the delivery of tobacco legislation

Closing comments

#Dayforaction

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