By Ruth Fitzharris, Mums for Lungs
We live in north London in an area that is between the suburbs and the inner city. The level of air pollution here is very high. During a period of poor air quality in the heatwave of 2018 my son had multiple emergency hospital admissions for very severe asthma attacks. Our paediatric respiratory consultant advised us to stay away from traffic filled roads and to take quiet routes where possible. In addition, our specialist at the Royal Brompton Hospital described air pollution as a ‘significant contributory factor’ in the development of his breathing problems.
An extensive number of scientific research studies prove that asthma is exacerbated, and in one third of cases caused, by air pollution. In London, one in ten children have asthma and on days with higher levels of air pollution more children and young people go to A&E needing treatment for attacks. A very significant proportion of this air pollution comes from road transport, primarily diesel cars, which are responsible for about 50% of the nitrogen dioxide in our city, a gas that irritates and inflames lungs.
So what can we do about living in such an unhealthy city, apart from moving? Of course, we can despair – but when we understand the problem of air pollution and its sources, we can do a lot about it. For starters, understanding the problem and raising awareness of it, will mean more people demand that the Government take action. The Government is more likely to take action if they have widespread support. Accordingly, the Mayor of London expanded the ULEZ (Ultra Low Emission Zone) to the North and South Circular in October 2021: within this zone the most polluting cars (diesels that are older than six years, and petrol cars that are older than 16 years), are fined when driving within the zone, which has encouraged drivers to get rid of or replace their car with a less polluting one. Harmful NO2 concentrations alongside roads in inner London are estimated to be 20 per cent lower than they would have been without the ULEZ and its expansion. In central London, NO2 concentrations are estimated to be 44 per cent lower than they would have been. Furthermore School Streets (roads adjacent to schools that are closed for through-traffic at drop off and pick up times) have become much more common in London, and around the country, protecting children from pollution on the school run.
But these, and the other schemes and approaches are not enough to prevent more illness and disease. We need a dramatic reduction in pollution from all its major sources, including road transport, wood burning and industry. We need strong legally binding targets, Clean Air Zones (like the ULEZ) in every city, real investment in active travel and an urgent phase out of dirty diesel vehicles
Whilst these changes are being fought for, we ourselves can do small things to make a positive difference to the air that we breathe. We can drive less or not at all. We can limit our use of polluting wood burners to special occasions, or even better stick to central heating only. We can get our deliveries by click and collect and ask people to switch off their idling engines. We can work with our school communities to raise awareness and even campaign for a School Street.
You are all invited to join us in campaigning for this at Mums for Lungs or drop us an email at email@example.com.
Visit the #AskAboutAsthma 2022 campaign page for more content.
By the Children and Young People’s Public Health Team, Haringey
We estimate that 5,038 children in Haringey have asthma. The incidence of asthma-related hospital admissions for children has been decreasing in the borough in recent years and is currently lower than both the London and England averages. Asthma is more prevalent within more deprived communities, and those living in more deprived areas, therefore we want to do as much as possible to address inequalities and wider determinants of health that are linked to asthma amongst children and young people.
In Haringey we are taking a whole systems approach to asthma management, including addressing environmental triggers, introducing a comprehensive education programme and promoting personalised care and effective preventative interventions to control and reduce the risk of asthma attacks in Haringey.
The picture in Haringey
Source: Hospital Episode Statistics (HES).
Definition: Emergency hospital admissions of children and young people aged under 19 years with primary diagnosis of either J45: Asthma or J46: Status asthmaticus.
What are the ‘wider determinants’ of health?
Wider determinants of health are a varied range of social, economic and environmental factors that impact on people’s health. The Marmot Review, published in 2010, raised the profile of wider determinants of health by emphasising the strong link between social inequalities and inequalities in health outcomes. Ten years on, a review in 2020 finds that almost all health inequalities in England have been increasing since 2010.
How are we addressing the wider determinants of health in Haringey?
Air quality has a direct impact on asthma. This is why we are working on a range of initiatives, which not only help us towards our climate change targets, but also improve air quality in the borough. You can visit Asthma + Lung UK for more information on understanding asthma, what the triggers are and what treatments are available.
Haringey has an ‘Air Quality Action Plan’
It outlines the action that we are taking to improve air quality in Haringey between 2019-2024. Click here to see the action plan.
Air Quality Monitoring
We monitor air quality by using monitoring stations (some of these are mobile and can be moved around). We use the readings to identify where air quality is poor.
Many schools experience parking, traffic congestion and air quality issues immediately outside their school. Our School Streets programme aims to address these issues. A School Street is where a walk and cycle zone is created outside a school during drop-off and pick-up times. Only people walking and cycling, and those with vehicle permits are permitted to enter the zone.
The School Street creates a safer, more pleasant environment outside the school where children, parents and teachers can travel to school using active modes of travel without the air pollution caused by motor traffic. Click here to see the School Streets Plan. We currently have 25 school streets and aim to introduce more in the future.Low Traffic Neighbourhoods
Low Traffic Neighbourhoods (LTNs) are residential areas where vehicles (except emergency vehicles) are prevented from passing. This is achieved by ‘filtering’ the key access points of certain streets using ANPR (Automatic Number Plate Recognition) cameras and planters so that people walking, cycling, or using a mobility scooter can still travel through.
Haringey has been divided into 25 LTN areas which is a starting point for exploring LTNs across the borough. Click here to see a map of LTNs in Haringey. LTNs contribute towards improving air quality by reducing motor traffic. This also helps to reduce noise pollution and road accidents.
A green screen enables vegetation to be introduced to places where other such green infrastructure is not possible, such as street furniture and underground services or where they would be restrictive to air flow. We have provided green screens to four schools in Haringey which are within Air Quality Management Areas. Green screens improve the playground air quality.
Asthma education is a key part of dealing with asthma in Haringey. We work to educate parents, schools, children and the wider community about the causes of asthma, and how to manage asthma.
Asthma Friendly Schools
The Asthma Friendly Schools Programme sets out clear, effective partnership arrangements between health, education and local authorities for supporting children and young people with asthma at primary and secondary schools.
Schools allocate an Asthma Lead and Asthma Champion who attend a training session. The Asthma Lead then delivers the training to staff at their school. The whole school then carry out their Asthma Friendly Schools responsibilities and implement changes, with help from their School Nurse. The School Nurse conducts an audit annually, and schools then achieve their Asthma Friendly School status.
Healthy London Partnership outlines standards and roles & responsibilities of schools in their London schools guide for the care of children and young people with asthma (April 2022). Click here to see the guide.
Parks and green spaces
Leafy greenery improves air quality by absorbing some of the pollutants that can trigger asthma symptoms. Trees, shrubs and turf remove smoke, dust and other pollutants from the air. Over a lifetime of 100 years, one tree could absorb around a tonne of CO2. We are continually improving our green spaces in Haringey, especially in areas with high pollution levels. Haringey’s Parks & Green Spaces Strategy is ongoing to maximise green coverage in our borough.
Good parks and green spaces also encourage our residents to get out and be active, which is beneficial for health and for people living with asthma.
Green Flag Awards
All 22 of our council-run parks have Green Flag Awards. The Green Flag Award scheme recognises and rewards well managed parks and green spaces.
Haringey were one of the first UK councils to join the National Street Tree Sponsorship Scheme, Trees for Streets, which aims to plant thousands of trees in streets across the borough through sponsorship by local residents. Street trees are important because they improve air quality by acting like natural filters, capture carbon dioxide and produce oxygen, absorb air pollution and much more. For more information, click here.
The Rangemoor Open Space project is an example of transforming unused spaces into valued assets that are inclusive and accessible, to encourage more positive uses and address the health and wellbeing of residents and the community.
We are taking various measures to encourage children to get fit and healthy. Daily exercise helps to improve lung capacity, which is an indicator of the maximum amount of oxygen your body can use. Children with an unhealthy weight are more likely to develop asthma when compared to those with a healthy weight.
Haringey has initiatives in place such as The Healthy Schools Programme, TfL Stars Active Travel activities, The Daily Mile, bike-ability training, and more. Click here for more information about the Healthy Schools Programme.
We are setting up several ‘Superzones’ around our schools which aim to create healthier and safer places for children and young people to live, learn and play. Within each zone, we will be looking to reduce unhealthy food and drink, advertisements, alcohol, smoking and poor air quality. The zones cover a 400m area (roughly a 5–10-minute walk) and are designed to protect children’s health and encourage healthy behaviours in more deprived communities. Encouraging children to eat healthier food and reducing air pollution will help to reduce asthma in Haringey.
We hope that you’ve enjoyed reading this Haringey #AskAboutAsthma blog, and if you have any questions, just send an email to: firstname.lastname@example.org and someone from the team will get back to you.
Visit the #AskAboutAsthma 2022 campaign page for more content.
The 4th Ask: what is the impact of air quality on your lung health?
TAPAS stands for Tackling Air Pollution At School and we are a network of experts working together to better understand the air quality inside and around our schools. Atmospheric pollution in the UK is responsible for approximately 40,000 early deaths and has a cost of around £20 billion to health services and business, per year1. Children are particularly susceptible to air pollution and dirty air has been linked to rises in child asthma GP visits.
But why are young children more vulnerable to air pollution? Children take in a larger amount of air per unit of body weight compared with adults so when this air is toxic it can have more damaging effects on their still developing immune systems and lungs2. The impact from this dirty, toxic air can ripple into other critical aspects of their lives such as needing more doctor visits, being hospitalised, missing days off school and generally affecting their well-being negatively.
Our TAPAS colleagues at Global Action Plan estimate that in the UK 3.4 million children learn in an unhealthy environment. Air quality is an environmental challenge that requires a collaborative effort from multiple disciplines and sectors and the TAPAS Network is one of several networks in the UK that are tackling this challenge.
3.4 million children learn in an unhealthy environment
TAPAS is one of six Clean Air Networks funded by the Government’s Strategic Priorities Fund ‘Clean Air Programme’. The aim of the Clean Air programme is to bring together the UK’s world-class research base and support high-quality multi- and interdisciplinary research and innovation to develop practical solutions for today’s air quality issues and equip the UK to proactively tackle future air quality challenges, in order to protect health and support clean growth. As a group of networks, we are working together to maximise the benefit to the air quality community.
Our work at TAPAS is broken down into four in-depth content areas relating to schools and air quality:
- Understanding the problem
- Understanding the solutions
- Prioritising the solutions and,
- 4) Dissemination and outreach. We host regular meetings and hold workshops on topics of interest with expert speakers.
To change the conversation on air pollution we believe it is essential to engage directly with children, schools and parents. Our team includes education and citizen science specialists who will help us to effectively build schools outreach into our work programme. A new project we are involved with is called SAMHE (Schools’ Air quality Monitoring for Health and Education, pronounced ‘Sammy’). This project is supported by the Department for Education and will help us understand indoor air quality in UK schools. SAMHE is important because poor air quality can have impacts on pupils’ concentration levels and their health, affecting both attendance and attainment. SAMHE also gives pupils the opportunity to be citizen scientists and do hands-on experiments with their monitors. If you would like to learn more about the project and how your school could get involved click here.
CoSchools is another project led by TAPAS researchers which was developed as part of the CO-TRACE project. CO-TRACE is an EPSRC funded project involving researchers from the University of Cambridge, the University of Surrey and Imperial College London. To assist with the UK government’s rollout of CO2 monitors to schools, CoSchools developed four videos, and other materials, that aim to explain how CO2 monitors can help teachers manage their classroom ventilation to provide a more comfortable and healthier learning environment. A PowerPoint presentation has also been developed for schools to download for free and use with staff, to help explain why CO2 monitors continue to be important, even after the pandemic. Maintaining low levels of CO2 in your schools may help improve children’s learning and concentration.
We are also funding three small and innovative research projects that support our ambition to develop the research base to design and operate healthy schools in the environment of the future. Each project focuses on the overarching question “How can we deliver timely and effective interventions to improve air quality at school?”.
TAPAS is funded until September 2023 but what will our legacy look like once the project comes to an end? We hope to build a central repository of research-based evidence and resources for schools, students and parents to use, to make it easy for them to get the help they require to empower their schools and pupils. We also hope to get air pollution onto the curriculum to educate the next generation and raise awareness of the impacts of air pollution on children, which can be linked not only to asthma but also to high blood pressure, heart disease and stroke, dementia, obesity and cancer2.
Every summer, Global Action Plan runs a Clean Air Day event which is gaining momentum year on year and 2023 will no doubt be even bigger. But you don’t have to wait for next year to get involved – Clean Air Day should be everyday! Download school resources now for activity sheets, informative posters and campaigning tips to help educate on air pollution and have some fun. Global Action Plan have also developed a Clean Air for Schools Programme which is a free, practical online tool for schools to create a tailored clean air action plan to tackle air pollution in and around the school. They have also developed a ‘Knowledge hub for health’ which is a great resource for information on clean air for health professionals, linking air pollution to asthma plans.
Another group linked to TAPAS is the Clean School Air not-for-profit campaigning and resources group which helps parents and schools who want to improve air quality for their children. They have guidance and practical interventions for parents and teachers to improve air quality and reduce pollution in their children’s schools.
Top tips for reducing your exposure to air pollution
- Keep yourself updated on high pollution alerts and notifications
- When air pollution is especially severe, try to avoid strenuous activity, and minimize playing or exercising in the harmful air.
- If possible, walk, cycle, or scoot to school and avoid busy roads where possible.
- Reduce time spent in areas where pollution is high, such as near or around areas of severe traffic congestion or sources of industrial pollution. Where possible, travel during times of day when air pollution is lower which can help reduce exposure.
- Ensure adequate ventilation when cooking to reduce indoor air pollution.
- Limit any wood burning stoves in the home as the tiny particle pollution can enter the bloodstream and be extremely hazardous to health3.
TAPAS welcomes any new members who are interested in working towards better environments for our children at school. Members of TAPAS are welcome to join any of our focus group activities or to work with us directly on bespoke research. If you would like to join TAPAS to receive our newsletters please click here or email the TAPAS Network Manager, Kat Roberts at email@example.com.
By Kat Roberts (Network Manager, TAPAS Network, University of Cambridge)
Visit the #AskAboutAsthma 2022 campaign page for more content.
Did you know that the average person spends 90% of their lifetime indoors? If you are 40 years old, that’s a massive 36 years. We spend so much time indoors that we should be called the indoor generation!
Sure, there are lots of studies, evidence and awareness of what contributes to outdoor pollution and how it is harmful to health, but have you ever considered the quality of the air that you breathe indoors? Outdoor air pollution does not bounce off the front door, and there can also be significant sources of indoor air pollution. This all means that indoor air can be more polluted than outdoor.
To address this, Torus Foundation and our Healthy Neighbours Project Hubs have teamed up with the Beyond Transformation Programme, NIHR Applied Research Collaboration (ARC NWC) Equitable Place Based Health and Care team and Airthings to install indoor air quality monitors in the homes of eligible residents of leading North West social housing provider, Torus, across Liverpool, St Helens and Warrington.
The aim of our campaign is to use the indoor air quality monitors to get a better picture of the home environment, identify any structural causes of poor indoor air quality, and to empower households to make changes to improve their surroundings.
A prerequisite of having an indoor air quality monitor installed is for the household to have a child / children under the age of 5. We are focusing on these households because children are especially susceptible to poor air quality, with respiratory illnesses accounting for the majority of infections in children of this age group. Research shows 96% of homes have at least one type of indoor air quality issue ranging from excessive dust, high humidity, or emissions from cleaning products, and/or building materials.
The data collected in the home is visible on a customisable screen and the tenant can choose to display the insights that matter to them. There is a colour-coded indicator which shows overall air quality good, fair or poor using a RAG rating. A QR code is generated and given to each household so tenants can see their data any time, anywhere.
The project group have access to an online dashboard. This allows overall access to each device where reports can be generated and shows a breakdown of data. Alongside this data, we are having regular conversations with tenants to ask about what changes they are making, and volunteers from the Foundation’s Healthy Neighbours Project are sharing hints and tips to improve the quality of the air.
Extraction from building ‘M’ for humidity:
Extraction from building ‘M’ for temperature:
In homes where the indoor air quality monitors have been installed, informal feedback from many participants has shown that changes are being made already. Extractor fans are being used, there is a reduction in misuse of cleaning products and fewer candles are being burned, alongside improved ventilation of the homes.
So, what’s your next move? Join the conversation, join the movement, and let’s improve indoor air quality together #ICareAboutMyIndoorAir
If you would like further information about the Air Quality Monitoring Project, contact Torus Foundation via firstname.lastname@example.org.
By Melanie Pilling, Torus Foundation and Douglas Booker, NIHR Applied Research Collaboration
Visit the #AskAboutAsthma 2022 campaign page for more content.