Agenda item

To update the Health and Wellbeing Board on the status of the Air Quality Action Plan (AQAP) and acknowledge the critical role that health partners can play in the delivery of the AQAP and improving health outcomes through reducing pollution and raising awareness of its impacts.

Councillor Krupa Sheth (Cabinet Member for Environment, Infrastructure and Climate Action) introduced the report, which presented the revised Brent Air Quality Action Plan (AQAP) for adoption. She reminded the Board that Brent Council declared a climate emergency in 2019, and air quality played a big role in that. There was a sense of urgency to tackle poor air quality, particularly in the most deprived areas in the borough. The updated plan strengthened the work to improve air quality across the whole borough rather than specific areas. Brent Council knew air quality affected everyone, but it could severely affect the health of babies, young children and the elderly, and it contributed to the development of asthma and many other health conditions, demonstrating why it was important to improve air quality, protect the health of residents and support the NHS. The AQAP would be presented to Cabinet for formal adoption in December 2023.

Lauren Salisbury (Air Quality Policy and Projects Officer, Brent Council) presented some data in relation to air quality. In presenting the information, she highlighted the following key points:

·         Globally, air pollution remained significant. In 2019, of the global estimated number of deaths attributable by different types of pollution, air pollution was at the top of the list, with 6.67 million deaths. When looking at the wider causes of death, air pollution was still a significant contributing factor and estimated to be responsible for the third highest number of deaths globally, following high blood pressure and smoking. Air pollution was estimated to cause 40,000 premature deaths per year in the UK and affected morbidity, where people living within areas of poorer air quality had an additional 20% chance of having multiple long-term illnesses. This had an impact on the health and social care system, and it was estimated that the health costs of air pollution could cost up to £20 billion by 2035.

·         In 2013, Ella Kissi-Debrah, a 9-year-old girl from Lewisham, died from an Asthma attack and was the first person in the UK to have her death linked directly to air pollution on her death certificate. Spikes in particulate matter and nitrogen dioxide near her home, which was close to the South Circular, corresponded with Ella Kissi-Debrah’s hospital admission in the lead up to her death. The outcome of this was a Prevention Of Future Deaths Report, published in 2020, which outlined three major concerns; that air quality objectives in the UK were too high, far higher than WHO guidelines, and there was no safe level for air pollution; that there was low public awareness on where to get information about air pollution in the local area and; that the effects of pollution on people’s health were not being communicated to patients by their medical care teams. Officers highlighted that these were all areas that the local authority could work together with health to alleviate through the AQAP.

·         In recent years, there had been 2 key developments in air pollution knowledge driving forward air pollution policy, which informed the AQAP. The first development was that pollution did not only affect respiratory systems, but adverse effects were documented across the majority of organ systems in the human body. This was especially true for fine particulate matter of PM2.5 and smaller. The second development was that these effects were felt at very low concentrations. This data came from a large population study of 50 million people in the US, and it showed there was a strong association between mortality and fine particulate matter exposure, even at levels far below the UK air quality objectives and WHO guidelines. The study concluded that there was no safe threshold in which PM2.5 exposure could exist.

·         The conclusion that there was no safe threshold in which PM2.5 exposure could exist led to WHO revising their guidelines for air pollution concentrations in 2021, significantly reducing the nitrogen dioxide recommendations from 40 micrograms per cubic metre down to 10, and the PM2.5 guideline was halved from 10 micrograms per cubic metre to 5. In the UK, the nitrogen dioxide target has remained at the higher level of 40, but for PM2.5 the target was reduced from 20 to 10, which was still above the WHO guideline but closer to it.

·         London had seen improvements in nitrogen dioxide and PM2.5 concentrations since 2013, but in 2019, maps still showed exceedances in UK legal limits, especially across the strategic road network, and WHO guidelines were not being met across the city. One positive was that the GLA models showed that the UK air quality objective of 10 micrograms of PM2.5 per cubic metre could be met by 2030 if bold action was taken with strong partnerships.

·         One study showed that spikes in pollution levels corresponded with an increase in the number of children going for consultation with their GPs for asthma and respiratory conditions in Lambeth, and another compared lung volume of children and found that those growing up in polluted areas of London had a significantly smaller lung volume than their peers in the rest of England. The picture in Brent was similar to that of London. Maps showed that there were high levels of air pollution around the North Circular and where the legal limits were not being met. Hourly readings showed that even when the monitoring station read close to the UK legal limits, there would be spikes of high pollution throughout the day, of nearly 120 micrograms of nitrogen dioxide per cubic metre in some of those readings, impacting Brent residents.

·         Brent had a statutory duty to improve air quality and reduce emissions across the borough for its residents. The approach for developing Brent’s AQAP had begun by reviewing community priorities. Officers conducted an outreach exercise, speaking with a representative sample of over 4,000 residents to understand their views around air pollution, how it affected them, and what they would like to see done. Officers then reviewed progress against Brent’s previous AQAP which expired in 2022, and undertook extensive modelling and a review of pollution concentrations, looking at population exposure particularly for vulnerable residents. Officers also held workshops with key stakeholders to update those actions that Brent wanted to focus on over the next 5 years. Those actions were then put out to consultation, with the aim to publish the final Air Quality Action Plan following its adoption at Cabinet in December 2023.

·         The vision developed from those data gathering and engagement activities was to provide clean air for everyone living in, working in, or visiting Brent. The core aims of the AQAP would be; to reduce concentrations of nitrogen dioxide and particulate matter, striving for WHO compliance; to raise awareness of the impacts of air pollution and address health inequalities and; to influence change by leading by example, including working with strategic partners, such as healthcare providers in the borough. Across those aims, the Council wanted to focus on where air quality was worst and where vulnerable residents were most at risk.

·         To achieve those aims, there were several themes; cleaner transport; monitoring air pollution; public health and awareness raising; homes, buildings and developments and; localised solutions. Within the theme most relevant to the Health and Wellbeing Board – public health and awareness raising – there were 6 actions[SM1] :

o   Joint work with the public health team

o   looking at raising awareness of the health impacts of poor air quality and encouraging community action;

o   working with health providers to reduce the exposure of those most vulnerable to indoor and outdoor pollution;

o   promoting services already in existence such as the air text service and pollution route mapping;

o   raising awareness of the impact of indoor air quality

o   sharing air pollution data transparently with residents so that they could understand the pollution level within their local area and what the health impact of that might be.

To conclude the presentation, Dr Melanie Smith (Director of Public Health, Brent Council) opened the discussion for the Board’s thoughts on how they could address the health inequalities exacerbated by poor air quality, focusing on the most vulnerable residents. She highlighted that people often felt that air pollution was inevitable and that there was nothing they could do, so it was important to get out messages about how residents could reduce their contribution to air pollution and also mitigate the impact of air pollution on their health by reducing exposure in practical ways.

In considering the presentation, the following points were raised:

·         The Chair highlighted that there was a clear correlation between poverty, ethnic diversity and poor air quality, particularly around the North Circular Road. While the whole of London was now within the ULEZ, the North Circular Road still carried a lot of traffic, and he asked what the impact of that was and how that could be measured as a Council. Lauren Salisbury felt this could be targeted through behaviour change messaging such as encouraging active travel like walking and cycling where possible. Health partners could help in this regard through their social prescribing work, and the Council were working with TfL to reduce the number of vehicles driving through certain areas of Brent. It was highlighted that London would not know the impact of the ULEZ expansion straight away, but it was likely that nitrogen dioxide would be improved significantly.

·         Chris Whyte (Director of Leisure and Environment, Brent Council) highlighted the complementary programmes running alongside the Council’s climate ambitions, such as the work being done to reduce the Council’s carbon footprint through the installation of Electric Vehicle Charging Points (EVCPs), the greening of the public realm, and sustainable transport methods. The Council needed to be seen to be reducing its own emissions, for example through its vehicle fleet. There was also a need to develop specific localised plans that were relevant to local communities.

·         Members highlighted the number of large truck deliveries by small businesses in Brent, and asked whether there would be a focus on what small businesses could do to change that behaviour with support from Brent. They were informed that one action that Brent had committed to within the AQAP was to provide subsidies through Brent’s ‘Bikes for Business’ Programme to help smaller businesses trial using cargo bikes for a smaller financial commitment. This would form a pilot project, running until Spring 2024, to see the impact of that. Trials had already taken place in Harlesden and Willesden Green Town Centres, which had been successful. Officers highlighted that it depended on the area how much that vehicle type contributed to pollution, which was why local plans were needed.

·         Members felt there was a shortage of cycling infrastructure in Brent, and that being close to the North Circular Road and other major roads made it difficult to travel by bike. Cycling infrastructure fell within the GLA’s remit, but members queried if Brent was lobbying for investment in that area, for example, through the income generated through ULEZ. Councillor Sheth informed the Board there had been conversations around the Wembley to Willesden cycle routes with some initial plans for two wards but there had been no confirmation of funding. Sandor Fazekas (Head of Healthy Streets and Parking, Brent Council) added that the Wembley to Willesden route was very much a part of the TfL Strategic Cycle Network planning, and consultation was due to start on the first section of that between Wembley to Harlesden. The Council did not yet know what level of funding would be available, but there would be significant benefits from providing that segregated cycle route and addressing that separation between the North and South of the borough, including issues around lighting and quality of public realm. Members attention was brought to the significant financial pressure TfL were under, and where the Council previously received around £2.3m per year plus £800k for bus priority, it now received £1.5m in total. The Council did target what money it had towards supporting active travel and cycling but putting in that larger infrastructure was more challenging. The Green Neighbourhoods being developed as part of the Council’s Climate Emergency Programme would focus on introducing localised cycling schemes as well, around Roundwood and Kingsbury.

·         Central London Community Healthcare (CLCH) had recognised that many of its community staff members travelled around the borough to visit patients, and had developed a green plan, part of which was to move lease cars from petrol to electric cars. With the expansion of ULEZ, some staff had been unable to pay for that, so had moved on to that lease plan. CLCH also leased electric bikes, but wanted staff to feel confident cycling and be mindful of the equipment they might need to carry, so the use of that service did vary. As an organisation, CLCH was working towards reducing its carbon footprint.

·         London North West University Healthcare NHS Trust (LNWUHT) also had a green car policy encouraging the use of electric cars, and had installed a new combined heating energy centre around 18 months ago which was much greener and more efficient. When looking at new developments, the organisation looked to reduce air pollution and its carbon footprint where possible. Simon Crawford (Deputy Chief Executive, LNWUHT) proposed that the Trust worked with Public Health around incidences of types of admissions relating to air pollution and lengths of stay, and analysing that in relation to equality and diversity. The Board agreed that this could produce some strong patient stories around how people’s health deteriorated due to the air they were breathing.

·         Officers working on the AQAP were invited to the GP forum to raise awareness. It was clear that all organisations within the health and social care system had a role to play in raising awareness of air quality, and the Board asked what the plans were for public health to raise awareness, including how Brent Health Matters (BHM) could support that through community events. Dr Melanie Smith highlighted there was a need for a combination of universal and targeted messaging, particularly that message that there was no safe limit of air pollution. She felt that the impact of poor air quality on all organs in the human body was not widely recognised. Where clinicians could help would be around targeted messaging for the most vulnerable, communicating what adaptations they could make with some ease to adapt their patterns of activity. If health providers put support behind the air quality agenda this would sent an important message to communities from a trusted voice about the significant impact of poor air quality. The combination of messages on an organisational level as well as individual clinicians having those 1 on 1 conversations could be significant.

·         The Chair concluded the discussion by highlighting that, ideally, the Board would look at how public investment, across both Health & Social Care and Environment, could be used to improve infrastructure. These initiatives did cost money but the return on that investment meant improved resident health and reduced costs to the health service in future years.

The Board RESOLVED:

i)              To note the content of the report and its progress on to Cabinet in December 2023.

ii)             For Brent’s Communications Team, the Cabinet Member for Environment, Infrastructure and Climate Action, the Director of Public Health, and local health providers to meet to consider local messaging and having a unified message around air quality and health.

iii)           For the Cabinet Member for Environment, Infrastructure and Climate Action, the Director of Public Health, and the Deputy Chief Executive of LNWUHT to meet to discuss the potential to conduct patient analyses around incidences of admissions relating to air pollution and length of stay, through an equality and diversity lens, and using the findings to tell patient stories relating to air quality and health.