Environmental Inequalities: Air Quality Policy Options

1. Environmental Inequalities:Air Quality Policy Options Dr Patrick Saunders Head of Environmental Health and Risk Assessment Chemical Hazards and Poisons Division Health Protection Agency

2. Introduction • Incontrovertible evidence that deprivation is intrinsically linked to health and disease • Chief Medical Officer noted the relationship between deprivation, mortality and region which showed that while relatively affluent populations experienced relatively good and similar levels of health irrespective of region, mortality rates in deprived populations showed a marked north-south trend

3. Introduction • Some of these differences will be due to lifestyle factors but there is almost certainly an environmental dimension to this variation-how much, what are the consequences, are they fair and what can we do about it if anything? • Considerable evidence of environmental inequalities with deprived communities experiencing the worst environments • Differential has persisted despite major investment aimed at reducing inequalities and improving environmental health and for some environmental stressors is predicted to widen further over the next decade

4. Introduction

5. Indoor Air Quality • Neuropsychological effects of chronic exposure to carbon monoxide in indoor air • measured CO concentrations in a sample of potentially vulnerable homes and tested the neuropsychological function of a sample of occupants • c. 20% of low-income families with gas appliances could be regularly exposed to CO levels above WHO guideline values • Further research in this area is being planned including extending CO project, input to developing WHO guidance, and a proposal for a systematic review of CO poisoning under consideration by WHO/DH

6. Children • Some evidence suggesting that deprived communities are also disproportionately vulnerable to its effects • Exposure to air pollution during pregnancy may interfere with weight gain in the foetus • Some adult diseases, even those that emerge much later in life (e.g. hypertension, type 2 diabetes, ischemic heart disease) have some of their origins in utero/childhood and childhood exposures may therefore constitute a source of inequity between generations

7. Policy context • Environmental inequalities recognised in public health strategies including ‘Choosing Health’ ‘reduce inequalities in opportunities for children to make healthy choices and address environmental inequalities that can undermine those choices’ and CMO’s working group on key environment and health priorities • The HPA is committed to a strategy ‘to protect children against infections, chemical and radiation threats which specifically addresses the impact of health inequalities’

8. Inequalities • Evidence of inequality in the location of industrial sites in terms of childhood deprivation and non-white communities • There has been some discussion about the need for tailored risk assessment and perhaps even the designation of appropriate standards to take account of residential proximity of some vulnerable social groups to some industrial sites • Proximity to a site is not necessarily associated with higher exposure to pollution or increased risk of a related adverse public health outcome

9. Environmental Inequalities • Regulators ensure that industry complies with statutory standards (often health based) and simple distance from site takes no account of operational, topographical or meteorological conditions or that most people spend large parts of their day indoors and/or away from home • Some have no effect thresholds-may have an effect in some populations • No standards for the majority of environmental chemicals or mixtures of chemicals • There may also be indirect effects -property values, visual impacts and ‘place stigma’

10. Environmental Inequalities • Transport is the main contributor to poor air quality in Air Quality Management Areas, and the cause of respiratory illness and deaths amongst vulnerable groups such as young children • These groups are least likely to live in areas of high car ownership • Traffic related pollutants might have contributed to the asthma epidemic that has taken place during recent decades among children?

11. Policy Options • If we accept that ‘deprived communities, which may be more vulnerable to the pressures of poor environmental conditions, should not bear a disproportionate burden of negative environmental impacts’ this requires prioritising action on deprived communities • Ensure strategies for tackling health inequalities recognise environmental factors • Encourage Local Strategic Partnerships, Local Area Agreements, New Deal for Communities, Neighbourhood Renewal and Community Planning to address environmental inequalities through the development of Community Strategies in deprived areas

12. Policy Options • Regeneration strategies to encourage quality economic growth that does not compromise people’s health or the environment • Ensure sites located in deprived areas are within the top performing level for their sector • Integration of Air Quality Action Plans with Local Transport Plans • Tighter standards for vehicles and industrial processes • National road charging and incentives for cleaner vehicles

13. Policy Options • Clear public health focus for indoor air • Ensure that communities continue to be supported and involved in decisions that affect their local environment-in the US communities can apply for funding for environmental scientists/advocates to represent them • Research into the most effective ways of addressing environmental health inequalities, differential exposures, indoor air quality, impact of climate change, the development of appropriate indicators of environmental inequalities

14. Policy Options • Development of an effective national environmental public health tracking system that links environmental, health, exposure and social factors such as deprivation