From London to Guangzhou, Nepal to Rwanda, air pollution is rising up the political agenda as evidence of its far-reaching health consequences increases. But remedies can fail, or backfire, without robust behavioural, sociological and economic insights, argues Dr. Suzanne Bartington, Clinical Research Fellow at the University of Birmingham.
Air pollution contributes to 7 million early deaths annually, equivalent to 1 in 9 deaths worldwide, with effects that include but go beyond the respiratory system from before birth to old age, to include low birth weight, perinatal mortality, stroke and cancer. Data on air pollution is improving thanks to advances in sensor technology, and evolving research methods drawing from across disciplines.
The data is worrying. Population-dense locations around the globe have unsafe levels of particulates, especially Eastern Mediterranean, South East Asian, and Western Pacific countries, although there is also increasing concern in Europe and in the United States. Indoor pollution, for cooking and heating, is a particular threat in low and middle income settings.
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Dr. Suzanne Bartington has studied air quality in Nepal, among communities cooking indoors on solid fuel such as wood or dung, a common practice for over 2.6 billion people worldwide. Her research finds levels of pollutants exceeding World Health Organisation guidelines, with risks including not just inhalation effects but also accidents, burns and eye damage. Dr Bartington is also currently involved in a large cohort study of children born in Guangzhou, China and the effects of woodsmoke exposure on birth outcomes among women in southern Chile.
Improved sensor technology is having a significant positive effect on research. Previously, Dr Bartington describes being restricted to fixed sensors and proxy measures to explore the constituents of air pollution. Mobile sensors enable improved measurement, and allow drilling down to the effects on particular demographic groups, such as pregnant women.
However, while better data is critical, alone it is not enough to make for change. Understanding the real-world impacts of vaunted pollution solutions is also key. Otherwise well-intentioned interventions can fail or even backfire says Dr Bartington, who is involved in developing modelling tools to predict the impact of public health policy measures.
In Rwanda, for example, advice to open windows while cooking to improve ventilation and reduce the adverse effects of wood smoke, may be ineffective because women are more concerned about letting mosquitoes in than letting smoke out; understandable in a country where reported malaria cases rose 8-fold between 2012 and 2016. Therefore understanding local socio-cultural and environmental considerations is critical for successful intervention measures.
Policy interventions might not only fail to take root - they could lead to perverse and unintended consequences. In the UK, some local authorities have opted for strong measures to comply with European Union thresholds for pollutants like nitrogen dioxide, such as establishing Clean Air Zones and school road closures. Although action is needed to improve urban air quality, Dr. Bartington is concerned that this can lead to unanticipated consequences such as displacement of traffic into particular areas of cities, often of higher deprivation, further widening socioeconomic health inequalities.
To guide future research, Dr. Bartington calls for increased interdisciplinary research. Restricting air pollution to health sciences does not do justice to the complexity of the subject and evidence suggests that effective policy interventions need to be suitable for the specific local context. An interdisciplinary approach would enable the development of policies which are universally comprehensible, enactable and realistic. In particular, she is interested in the potential contribution of sociologists and behavioural experts to explore the impact of pollution remediation measures on individuals and populations, to see how humans and communities respond to air pollution policy interventions.
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