Tackling toxic air and climate change

The risk to non-smokers of developing lung cancer is rising significantly: in the UK 6000 people each year now die of lung cancer despite having never smoked, or having smoked a negligible number of cigarettes. This is thought to be as a result of increasing exposure to toxic air.

This makes lung cancer among non-smokers alone the eighth biggest cancer-related cause of death in the UK, ahead of leukaemia, lymphoma and head and neck cancer. However, as lung cancer remains strongly associated with smoking it has created stigma around the disease as self-inflicted, which has had an impact on the level of research into its other causes. Consequently, there is a need to raise awareness with clinicians and policy makers of the other risk factors – including indoor and outdoor air pollution.

While smoking is the single biggest lifestyle factor that affects lung cancer, accounting for around 86 per cent of cases, air pollution, fumes from coal fireplaces, and second-hand smoke are also linked to its development. Smoking history is often the first question clinicians will ask patients who come in with respiratory symptoms that could be an early warning cancer, but a history of not smoking could give false reassurance and send them down the wrong diagnostic path.

Even more worrying is the fact that worldwide nearly four million children develop asthma every year as a result of air pollution from cars and heavy vehicles, equivalent to 11 000 new cases a day. The key pollutant, nitrogen dioxide, is produced largely by diesel vehicles.

Childhood asthma has now reached global epidemic proportions: one in eight of all new cases is due to traffic pollution and evidence shows that existing WHO standards are not protective against childhood asthma. As a result of their high populations and significant pollution levels, the three countries with the greatest number of children developing asthma each year are China (760 000), India (350 000) and the USA (240 000). However, these data may underestimate the true levels in many poorer nations where asthma often goes undiagnosed and undertreated.

The risks to us all – and to all other species – from a combination of environmental pollution and climate change are plain to see: we cannot pretend to be unaware. Each and every one of us could and should modify our lifestyle, and encourage our friends, colleagues and patients to do likewise, by cutting back on air travel, reducing or cutting out the consumption of red meat and converting to a more plant-based diet.
What are your thoughts? How should we respond to the climate change emergency?

Comments (23) Add yours ↓
  1. Mamta Ruparel Respiratory ST7 and Clinical Lecturer

    Very pertinent blog – couldn’t agree more. 25% of lung cancers (the biggest cancer killer in the UK), are not caused by smoking. Outdoor air pollution also accounts for enhancing rates and severity of airways diseases such as asthma and COPD. And even short term exposures to outdoor air pollution can negate the positive effects of cardiovascular exercise such as walking.(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32643-0/fulltext)

    Urgent measures are needed to improve air quality, particularly in an era when the production of fossil fuels is being increased in the US when this needs to be urgently reduced.

    What can we do?
    – Boycott supermarkets that use excessive amounts of packaging
    – Switch toiletries to more environmentally friendly options where possible (eg bars of soap)
    – Reusable plastics (water bottles, coffee cups, plastic bags)
    – Save energy- energy saving bulbs, turn off lights and appliances, run dishwashers and washing machines only when full
    – electric cars, carpooling, cycle and walk more

    June 7, 2019 Reply
  2. Bill Dunsmuir Consultant

    A very timely editorial. This dovetails very well with the campaign on clean air being launched by the Times newspaper.


    The current BBC mini series “The War on Plastic” describes how respiratory disease is crippling the innocent people of Malaysia as they (‘illegally’) burn our (from the UK) plastic waste in open fires. We ship our plastic waste 6000 miles (at a cost 250 times greater than if it were dealt with on our own shores) to poison other people in SE Asia.

    June 13, 2019 Reply
  3. Roger Kirby Professor of Urology

    The risk of dying from long-term exposure to London’s toxic air has risen for a second year running in an “utterly horrifying” reversal of the previous improving trend.

    The rate of fatalities linked to breathing in killer particles went up from 6.4 per cent to 6.5 per cent in 2017, according to computer-modelled estimates from government body Public Health England.

    That followed a jump from 5.6 per cent to 6.4 per cent the previous year, suggesting that efforts to clean up particulate pollution are having little impact. Before that the death rate had been falling since 2010.

    Campaigners said the figures were a “terrible reminder” of the dangers of breathing in contaminated air over a long period.

    A breakdown also shows that the death rate for a lifetime of exposure to microscopic PM2.5 particles created by diesel engines, coal-burning power stations, wood fires, agriculture and building sites is rising in almost three quarters of boroughs.

    June 16, 2019 Reply
  4. Roger Kirby Professor of Urology

    Air pollution may shave as much as seven months off the life expectancy of children who live in congested cities, UK research suggests.
    The “mortality burden” of a lifetime of breathing toxic air has been calculated for one of the UK’s largest cities, Birmingham, by a team from King’s College London.
    Researchers estimate that an eight-year-old living in the city today can expect to die two to seven months earlier based on the expected pollution concentrations for the city.
    The impact was considered to be worse than some other major cities in the UK – with the report finding a higher loss of life expectancy in Birmingham than Manchester.
    It calculated the annual health cost of air pollution in Birmingham was between £190m to £470m per year.
    The study looked at the combined impact of two pollutants – particulate matter and nitrogen dioxide – two of the leading causes of poor health from air pollution.

    July 8, 2019 Reply
  5. Roger Kirby Professor of Urology

    Overall emissions of greenhouse gases increased by 2% in 2018. In the power industry, emissions rose by 2.7%, the biggest increase in seven years. This was driven by a high number of days that were either unusually hot or cold, which boosted total energy demand.
    Even more alarmingly greenhouse gases from the United States shot up by 3.4%
    last year, a major reversal from recent years. Republican politicians, including President Trump, who favour doing little or nothing on climate change argue that U.S. emissions have been declining without more federal intervention. However it is fantasy to imagine that the pace of decline, let alone the even more aggressive rate of change the world needs, is sustainable without government action. Clearly the US and other nations, including China and India, must adopt policies such as a carbon tax that would encourage economic growth without emissions growth.

    Recently, the journal Science published a study finding that the oceans are warming at an alarming pace, 40 to 50 percent faster than the United Nations had previously estimated. The world’s waters soak up nearly all the extra heat humans add to the Earth’s energy balance, and the consequences will include more massive coral die-offs, depleted fisheries, sea-level rise, flooding, mega-storms that pack more power and torrential rain, and less oxygen in the ocean that undersea creatures need to survive. Already, a fifth of the world’s corals have died in the past three years, a desperate harbinger of the changes to come.

    Carbon dioxide concentrations have shown several cycles of variation from about 180 parts per million during the deep glaciations of the Holocene and Pleistocene to 280 parts per million during the interglacial periods. Following the start of the Industrial Revolution, atmospheric CO2 concentration increased to over 400 parts per million and continues to increase, causing the phenomenon known as global warming. As of April 2019, the average monthly level of CO2 in Earth’s atmosphere for the first time exceeded 413 parts per million.

    The concentration of carbon dioxide in the atmosphere is this high for the first time in 55 years of measurement—and probably more than 3 million years of Earth history. The current concentration may actually be the highest in the last 20 million years. The risks to health are manifold and include, among many other hazards, hyperthermia, the spread of tropical diseases and pulmonary toxicity from polluted air.

    So what if anything can we as individuals do in our own small way to try to reverse this terrifying trend? Firstly, lobby politicians and other policy makers to address this “climate emergency” far more urgently and energetically. Secondly, do our best to reduce our own carbon footprint by flying less frequently and taking shorter haul flights, buying an electric vehicle and cycling or walking rather than driving, eating less red meat and dairy food, insulating our homes more efficiently and planting more trees. Thirdly, using our influence as clinicians with patients, family and friends to persuade them to do likewise.

    July 11, 2019 Reply
  6. Roger Kirby Professor of Urology

    Up to a third of new cases of childhood asthma in Europe could be caused by air pollution, a study has found.
    Hundreds of thousands of children from one to 14 years old are believed to have been made ill each year by breathing in pollutants, researchers estimate. Around 1.1 million children are believed to suffer from asthma in the UK.
    It is thought that pollution from traffic can damage airways, leading to inflammation and the development of asthma in children who are genetically predisposed to the condition.
    The study, led by the Barcelona Institute for Global Health (ISGlobal), looked at the burden of asthma on more than 60 million children across 18 European countries, including the UK. They compared asthma incidence with estimations of levels of exposure to pollutants.
    The research found that 11.4 per cent of asthma cases (66,567) could be prevented each year if countries adhered to the maximum air pollution levels recommended by the World Health Organisation (WHO) for the tiny particles known as PM2.5. This equates to more than 10,000 cases in the UK being prevented annually.

    August 8, 2019 Reply
  7. Roger Kirby Professor of Urology

    Switching to a plant-based diet can help fight climate change, UN experts have said.

    A major report on land use and climate change says the West’s high consumption of meat and dairy produce is fuelling global warming.

    But scientists and officials stopped short of explicitly calling on everyone to become vegan or vegetarian.

    They said that more people could be fed using less land if individuals cut down on eating meat.

    The document, prepared by 107 scientists for the UN’s Intergovernmental Panel on Climate Change (IPCC) , says that if land is used more effectively, it can store more of the carbon emitted by humans.

    August 8, 2019 Reply
  8. Roger Kirby Professor of Urology

    The UK needs to rapidly ramp up sustainable farming practices in order to maintain long-term food security and reduce emissions, government advisors have urged in the wake of the latest United Nations (UN) climate report.
    The Intergovernmental Panel on Climate Change (IPCC) has revealed humans have already damaged around a quarter of ice-free land on Earth. However, farming more sustainably and conserving peatlands, grasslands and replanting forests at a local level could repair land and help curb global warming, scientists said.

    August 9, 2019 Reply
  9. Roger Kirby Professor of Urology

    Long-term exposure to air pollution can exacerbate lung disease as much as a daily pack of cigarettes, a study has found. Researchers looked at how exposure to four main pollutants affected lung health in 7,071 adults aged 45 to 84 living in six US cities.
    They measured levels of fine particulate matter, nitrogen oxide, black carbon and ozone outside participants’ homes and carried out CT scans to track the development of emphysema and lung decline.
    Chronic lower respiratory disease – a catch-all term for emphysema, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and asthma – is the third leading cause of death globally.
    Following up on the participants for an average of 10 years, they found that long-term exposure to all of the pollutants was linked to an increased percentage of emphysema seen on a CT scan.
    The strongest association was found with ground level ozone, which was also linked to a decline in lung function. In areas with increased levels of ozone, they found an increase in emphysema roughly the equivalent of smoking a pack of cigarettes a day for 29 years.

    August 14, 2019 Reply
  10. Roger Kirby Professor of Urology

    July was officially the hottest month ever measured by humans on Earth, it has been confirmed. Meteorologists had earlier released preliminary data suggesting the record had been broken, leading to warnings about the urgency required to mitigate the effects of the climate crisis.
    But the US National Oceanic and Atmospheric Administration announced yesterday that July was 0.95C warmer than the 20th century average for the month and had narrowly topped the previous record set in 2016, by 0.03C. Temperatures have been recorded every year since 1880. July 2019 was about 1.2C warmer than the pre-industrial era, according to the data.

    August 16, 2019 Reply
  11. Roger Kirby Professor Roger Kirby

    People who grow up in areas with poor air quality are more likely to develop depression and bipolar disorder in later life, a new study has suggested. Analysis of health data from millions of patients found a “significant link” between mental health disorders and exposure to air pollution, especially in childhood.
    The research, based on population data from the US and Denmark, is the latest of a number of studies to link air quality to ill health. Led by scientists at the University of Chicago, the study used an American health insurance database of 151 million people with 11 years of inpatient and outpatient claims for neuropsychiatric diseases. Researchers then compared those claims to measurements of 87 potential air pollutants.
    They found countries with the worst air quality had a 27 per cent increase in bipolar disorder and a 6 per cent higher incidence of major depression when compared with those with the best air quality.

    August 21, 2019 Reply
  12. Roger Kirby Professor of Urology

    Flights produce greenhouse gases – mainly carbon dioxide (CO2) – from burning fuel. These contribute to global warming when released into the atmosphere.

    An economy-class return flight from London to New York emits an estimated 0.67 tonnes of CO2 per passenger, according to the calculator from the UN’s civil aviation body, the International Civil Aviation Organization (ICAO).

    That’s equivalent to 11% of the average annual emissions for someone in the UK or about the same as those caused by someone living in Ghana over a year.

    Aviation contributes about 2% of the world’s global carbon emissions, according to the International Air Transport Association (IATA). It predicts passenger numbers will double to 8.2 billion in 2037.

    August 24, 2019 Reply
  13. Roger Kirby Professor Roger Kirby

    Orders of vegan takeaway food in the UK have more than quadrupled over a two-year period, a study has found. According to the Vegan Society, as of 2018, 600,000 people in the UK identified as vegan, which accounted for 1.16 per cent of the population.
    New research commissioned by the British Takeaway Campaign has discovered that the increase in popularity of veganism in the UK is reflected in the quantity of vegan takeaway food being ordered by Britons. The study, which was conducted by consultancy Retail Economics, found that vegan takeaway orders increased in the UK by 388 per cent from 2016 to 2018.

    August 29, 2019 Reply
  14. Roger Kirby Professor of Urology

    Last year, researchers from the University of Oxford found cutting meat and dairy products out of an individual’s diet reduced their carbon footprint by up to 73 per cent.
    They also found the amount of farmland used could be reduced by 75 per cent, an area equivalent to the size of the US, China, Australia and the EU combined.

    October 3, 2019 Reply
  15. Roger Kirby Professor of Urology

    Air pollution could cause hair loss, according to a study that tested the effect of dust and fuel particles on human scalp cells.
    Researchers found that exposure to common pollutants reduced the levels of four proteins responsible for hair growth and hair retention. They also discovered that the effect increased when the amount of airborne particles increased – suggesting that those living in cities or close to industrial works are at greater risk of going bald.
    Air pollution has already been shown to increase the risk of cancer and heart and lung diseases and is estimated to cause 4.2 million premature deaths every year. It has also been linked to depression and low fertility.

    October 9, 2019 Reply
  16. Roger Kirby Professor of Urology

    Sir Simon Stevens, the head of NHS England, has warned of a “health emergency” as new figures revealed hundreds more children and adults are suffering cardiac arrests, strokes or severe asthma attacks because of days of high air pollution.
    Stunted lung growth in children and links between pollution and lung cancer was also found by researchers who looked at nine cities across England.
    Higher air pollution triggered each year an extra 124 cardiac arrests in people not already in hospital, 231 cases of stroke and 193 children and adults being admitted to hospital for asthma, the study found.
    The figures, from King’s College London and UK100, a group of 94 local government leaders, highlighted the “immediate, short-term and avoidable” impact of high air pollution, the experts said.
    Government data has previously shown that pollution contributes to up to 36,000 deaths every year.
    In London, days with worse pollution accounted for 87 extra cardiac arrests and 251 people being admitted to hospital for asthma or strokes, the research showed.

    October 21, 2019 Reply
  17. Roger Kirby Professor of Urology

    Eleven thousand scientists in 153 countries have declared a climate emergency and warned that “untold human suffering” is unavoidable without huge shifts in the way we live.

    The letter is based on climate science that was first established in 1979 at the first World Climate Conference held in Geneva. For decades multiple global bodies have agreed urgent action is needed but greenhouse gas emissions continue to rise.

    “Despite 40 years of major global negotiations, we have continued to conduct business as usual and have failed to address this crisis,” said William Ripple, professor of ecology at Oregon State University, who spearheaded the letter. “Climate change has arrived and is accelerating faster than many scientists expected,” according to the letter published in BioScience.

    Researchers say they have a moral obligation to “clearly warn humanity of any catastrophic threat” and “tell it like it is”. “Clearly and unequivocally planet Earth is facing a climate emergency,” they state.

    Although there are some positive indicators – such as declining birth rates and a rise in renewable energy use – most indicators suggest humans are rapidly heading in the wrong direction, they say.

    Backward steps include rising meat consumption, more air travel, chopping down forests faster than ever and increase in global carbon dioxide emissions. Scientists say they want the public to “understand the magnitude of this crisis, track progress, and realign priorities for alleviating climate change”.

    November 6, 2019 Reply
  18. Roger Kirby Professor of Urology

    There Was some grounds for optimism in Bristol last night when the mayor approved a ban on diesel vehicles entering the city centre. It would make the city the first in the UK to introduce such a ban.

    Marvin Rees, elected as the Labour mayor in 2016, told a council meeting: “We have a moral, we have an ecological and we have a legal duty to clean up the air we breathe.”

    Under proposals that will go to officials at the Department for Transport and Department for Environment, Food and Rural Affairs before a full consultation of residents and businesses, the owners of privately owned diesel vehicles that enter the city’s clean air zone between 7am and 3pm from March 2021 will be fined £60. A car scrappage scheme has also been proposed to encourage road users to switch to less damaging alternatives.

    November 6, 2019 Reply
  19. Roger Kirby Professor of Urology

    Living in the UK’s most polluted cities and towns increases the risk of an early death by the equivalent of smoking 150 cigarettes a year, a charity has warned.

    The British Heart Foundation (BHF) said air pollution must be declared “a public health emergency”.

    Its analysis shows that people living in the Newham, Westminster, Kensington and Chelsea, and Islington areas of London are worst hit by air pollution – the equivalent to smoking more than 150 cigarettes a year on average.

    December 6, 2019 Reply
  20. Roger Kirby Professor of Urology

    Smoke from bush fires has fouled Sydney’s air intermittently since November. The city recorded its worst air quality day last month, when fine particulate matter reached unhealthy levels. During the hour of highest pollution, PM2.5 readings hit nearly 400 micrograms per cubic meter, a level considered very hazardous over 24 hours.

    January 4, 2020 Reply
  21. Roger Kirby Professor of Urology

    More than 160,000 people could die over the next decade from strokes and heart attacks caused by air pollution, a charity has warned.
    This is the equivalent of more than 40 heart and circulatory disease deaths related to air pollution every day.
    There are an estimated 11,000 deaths per year at the moment but this will rise as the population continues to age, said the British Heart Foundation (BHF), which compiled the figures.
    The BHF wants the UK to adopt World Health Organisation (WHO) guidelines on air pollution and meet them by 2030. Current EU limits – which the UK comfortably meets – for fine particulate matter (PM2.5) pollution are 25 micrograms per metre cubed as an annual average.
    WHO limits are tougher – at 10 micrograms per metre cubed as an annual average.

    January 13, 2020 Reply
  22. Roger Kirby Professor of Urology

    The sale of the most polluting fuels burned in household stoves and open fires will be phased out from next year to clean up the air, the government has said.
    Plans to phase out the sale of house coal and wet wood have been confirmed, as part of efforts to tackle tiny particle pollutants known as PM2.5, which can penetrate deep into lungs and the blood and cause serious health problems.
    Wood burning stoves and coal fires are the single largest source of PM2.5, contributing three times as much of the pollution as road transport, the Department for Environment, Food and Rural Affairs (Defra) said.
    Sales of two of the most polluting fuels, wet wood and house coal, will be phased out from 2021 to 2023, to give householders and suppliers time to move to cleaner alternatives such as dry wood and manufactured solid fuels.
    These produce less smoke and pollution, and are cheaper and more efficient to burn, officials said.

    February 21, 2020 Reply
  23. Roger Kirby Professor of Urology

    As we pause in sorrow at the 15,000 UK and the 150,000 global lives already lost to the coronavirus, it is also time to remember the sorrow caused to the families of the 40,000 UK lives that are lost every year and the seven million globally to air pollution. A pollution largely caused by fossil fuels and other global warming gases.
    The World Health Organisation (WHO) reports that 600,000 children under five die every year from air pollution, largely due to pollution-induced pneumonia.
    The Covid-19 pause has caused a collapse in car and plane travel. Our skies have gone silent and the roar of car traffic has disappeared, allowing wonderful bird song and the whispering of the wind in the trees to be heard again in our cities. But they are not only silent, the air is also beautifully clean. We need to learn this important lesson from the current COVID-19 crisis. Let’s not go back to the choking fumes of yore!

    April 19, 2020 Reply

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