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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
as:
• 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)
NO2
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
0
1
2
3
4
5
6
7
1800 1850 1900 1950 2010
Wo
rld
Po
pu
lati
on
(b
illi
on
s)
Population
0
10
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50
60
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80
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100
1800 1850 1900 1950 2000S
hare
of
wo
rld
po
pu
lati
on
liv
ing
in
po
vert
y (
%)
Poverty
40
60
80
100
1800 1850 1900 1950 2000
Glo
ba
l li
fe e
xp
ecta
ncy
at
bir
th (
ye
ars
)
Life expectancy
0
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600
1800 1850 1900 1950 2000
Wo
rld
pri
ma
ry e
nerg
y u
se
(E
J)
Energy use
0
1
2
3
4
1800 1850 1900 1950 2000
Glo
bal
wate
r u
se (
tho
usa
nd
km
3)
Water use
0
20
40
60
80
100
1800 1850 1900 1950 2000
Lan
d u
sed
fo
r ag
ric
ult
ura
l g
lob
ally
(%
) Domesticated land
Environmental trends
0
10
20
30
40
1800 1850 1900 1950 2000
Glo
ba
l tr
op
ical
fore
st
los
s c
om
pa
red
wit
h 1
700
ba
se
lin
e (
%))
Tropical forest loss
0
1000
2000
3000
1800 1850 1900 1950 2000W
orl
d p
op
ula
tio
n a
ffe
cte
d b
yw
ate
r s
ho
rtag
e (
mil
lio
ns)
Extreme Shortage
High Shortage
Moderate Shortage
Water shortage
6
7
8
9
1800 1850 1900 1950 2000
Glo
bal
oc
ea
n a
cid
ific
ati
on
(m
ean
hy
dro
ge
n i
on
co
nce
ntr
ati
on
; n
mo
l/k
g)
Ocean acidification
−0.50
−0.25
0.00
0.25
0.50
1800 1850 1900 1950 2000
Tem
pe
ratu
re a
no
ma
ly,
°C
Temperature change
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
1800 1850 1900 1950 2000
Glo
ba
l v
ert
eb
rate
bio
div
ers
ity
(in
dex v
alu
e;1
97
0=
1)
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
fungi
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
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
42
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
hours
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.
46
Since 2007 when Carillion became a Ready for Work
national partner (to June 2016):
47
Ready for Work film
https://www.youtube.com/watch?v=WF7htqsYiqM
https://www.youtube.com/watch?v=WF7htq
sYiqM
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
Volunteering in Health
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
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
New
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
The habit loop
New habits
Craving reward!
Changing habits
Increased participation
Keystone habits
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
Small wins
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
H&S
IT
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
Pen
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?
Cue
Routine
Reward?
Craving!
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
Quorn
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
water
By working closely with Carbon Trust we have established that
Quorn Foods offer significant environmental benefits relative to
meat.
Quorn is the first and only meat free brand to have carried out
such a systematic third party analysis of its environmental
footprint.
137
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
138
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
141
Quorn fits easily into everyday life and makes meat reduction simple…
Thank you
Lunch & Networking
#Dayforaction
Welcome back
Fiona Daly, Associate Director of Sustainability and Patient Transport,
Barts Health NHS Trust
#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
The
Natural Health
Service
Programme
Our Approach
Partnerships
Conservation Regeneration
Objectives
Educational ProgrammesEnvironmental volunteer
activities
Our journey so far…
Broomfield Hospital
2013
A timeline of activities
• Woodland improvement activities
• Woodland Management Plan (S106)
• Woodland maintenance
• Improving access
• Heritage National Lottery Fund Grant
A timeline of activities
2013
2014• Introduced native woodland trees
• Bird/bat boxes in woodlands
• Community Vegetable Garden & Orchard
• Kirsty’s Elm
• Nurture 2014 Campaign
• Pudding wood path completed
A timeline of activities
2013
2014
2015• Wellbeing Terrace
• Health & Wellbeing Strategy Launch
• Dementia Garden
• Long Shapely Belt path completed
• Nurture 2015
A timeline of activities
2013
2014
2015
2016 • Wildflower Garden
• Seymour House Nursery
• Tesco Volunteers
• Nurture 2016
• Bat Walk
St Peter’s Hospital
A timeline of activities
2006
2016
• 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
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
Value
2015 1,539 £21,000
2016 1,319 £18,000
Sustainable Development in Action
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
Sustainable Development in Action
FinancialEnvironmental
Social
Thank
you
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
Barts Health NHS Trust
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
(10%)
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
www.bartshealth.nhs.uk/sustainability
Sustainability driving better healthcare
Alexandra Hammond
Associate Director, Sustainability
177
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
179
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
183
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
Furniture reuse, repair and remanufacture
184
Photo credit: http://www.ellenmacarthurfoundation.org/rypeoffice
Dedication to prolonging the life of products
185
Photo credit: www.usa.phillips.com
186
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
187
Sustainable and active travel
• Enabling active
travel
• Activity
“prescriptions”
• Sustainable Travel
Plan
188
189
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
190
Built to last
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
Fiona Daly, Associate Director of Sustainability and Patient Transport,
Barts Health NHS Trust
#Dayforaction
