AIR QUALITY IN
LEWISHAM: A GUIDE
FOR
PUBLIC HEALTH
PROFESSIONALS
Air Quality Information for Public Health Professionals – London Borough of Lewisham
COPYRIGHT
Greater London Authority
February 2022
Published by
Greater London Authority
City Hall
Kamal Chunchie Way
E16 1ZE
www.london.gov.uk
enquiries 020 7983 4000
Air Quality Information for Public Health Professionals – London Borough of Lewisham
1
PURPOSE OF THIS DOCUMENT
Public health professionals in local authorities have a critical role to play in driving
systemic progress on air pollution. There is now an urgent need for ambitious local action
to protect both human and planetary health. In the context of the pandemic and the
escalating climate emergency, it is crucial that London’s recovery is socially just and
green. This will help to tackle these threats and prevent thousands of premature deaths
caused by air pollution.
We published our last borough-specific guidance documents for local authority public
health professionals in 2012. It is fair to say that a lot has changed since then.
Air pollution is a major cause of premature death and disease; and is the largest
environmental risk to public health in the UK. The Greater London Authority (GLA)
estimated that in 2019 there were between 3,600 and 4,100 premature deaths
attributable to air pollution
1
. Both short and long-term exposure to air pollution can lead
to a wide range of harmful effects which come about at every stage of life, from a foetus’
first weeks in the womb all the way through to old age. The main pollutants of concern
within London are nitrogen dioxide (NO
2
) and particulate matter (PM). Currently, there is
no clear evidence of a safe level of exposure below which there is no risk of adverse
health effects. Therefore, reductions in concentrations of NO
2
and PM below air quality
standards is likely to bring additional health benefits.
Air pollution affects everyone who lives and works in London. However, some –
especially, children, the elderly, and people with pre-existing health conditions – are
most vulnerable. People on low incomes or from ethnic minorities are also more affected
by poor air quality, partly because they often live in the more polluted areas of London.
Children in London are almost four times more likely than children elsewhere in England
to attend a school in a highly polluted area. In December 2020, a landmark ruling by a
London Coroner concluded that Ella Adoo-Kissi-Debrah died, aged nine in 2013, from a
combination of acute respiratory failure, severe asthma and air pollution exposure. It is
the first time in the UK that air pollution has been listed as a medical cause on a death
certificate. The Coroner’s Prevention of Future Deaths report also highlighted a lack of
public and professional awareness about the risks of air pollution.
Considering this it is more vital than ever for borough public health teams to work with
other relevant local authority teams on air quality as air pollution does not respect
borders. We recommend Joint Strategic Needs Assessments are regularly updated to
include the latest information shown in this document. They should also take account of
the recommendations set out in the Coroner’s Prevention of Future Deaths report.
Collaborative action is needed across sectors and systems to reduce air pollution, risks
1
http://erg.ic.ac.uk/research/home/resources/ERG_ImperialCollegeLondon_HIA_AQ_LDN_11012021.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
2
and health inequalities; and to ensure air pollution is considered in every relevant policy
at the local level. We must tackle different pollutants together and maximise societal
gains. There are a wide range of co-benefits to improving air quality. This is not just in
terms of improving health and reducing health inequalities; it will also help boost the
economy, environment and climate change adaptation and mitigation.
In 2012, we provided local authorities with borough-specific guidance documents to
support public health professionals who may not have previously worked in air quality.
Our aim was to provide all the information needed to quickly get to grips with the issue
of air quality. This updated document reflects the latest scientific evidence on both the
impacts of, and solutions to, air pollution. This will enable effective local responses
through setting out knowledge, recommendations, or approaches for action. It has been
tailored to support and enhance collaboration and public health leadership to address air
pollution. It presents the latest air quality and health data and analysis for London’s 32
boroughs and the City of London in 33 bespoke reports.
We hope you will find this report useful for:
- assessing and framing air pollution risks in a health and environmental context and
ensuring air pollution is prioritised appropriately
- extracting data and evidence that you can use in your Joint Strategic Needs
Assessment on air quality, Health and Wellbeing Strategy and Air Quality Action Plan,
including raising awareness of the health and economic costs of air pollution
- discussions with local authority colleagues around how to tackle the health impacts of
air quality ensuring a joined-up approach at local and at system level, including in the
context of action on climate change
- raising awareness of the contribution that action on air quality has to a range of
public health outcome measures
- reaching out to colleagues in healthcare organisations, such as doctors, nurses and
pharmacists around opportunities to strengthen their education, training and
awareness in relation to air quality
- spreading best practice to GPs and sensitive receptors
Authors
This document was prepared by the Greater London Authority in partnership with the UK
Health Security Agency (UKHSA). It includes input from the London Association of
Directors of Public Health, London Councils, and public health specialists from the London
boroughs of Croydon and Lewisham. It also includes input from environmental specialists
in the London boroughs of Merton, Richmond upon Thames, Wandsworth, Kingston and
Sutton.
To find out more, please contact: [email protected]
Air Quality Information for Public Health Professionals – London Borough of Lewisham
3
Contents
PURPOSE OF THIS DOCUMENT ................................................................................................................................... 1
1 INTRODUCTION ....................................................................................................................................................... 6
1.1 Air pollution in London: Facts and figures ................................................................................................................ 6
1.2 The case for tackling London’s air pollution crisis .................................................................................................... 7
1.3 Green Recovery from COVID-19 ............................................................................................................................... 7
2 AIR POLLUTION AND ITS HEALTH IMPACTS .............................................................................................................. 9
2.1 What is air pollution? ............................................................................................................................................... 9
2.2 Main sources of air pollution in London ................................................................................................................... 9
2.3 Main pollutant types of concern in London .............................................................................................................. 9
2.4 Health effects of air pollution and associated health inequalities ......................................................................... 10
2.5 Indoor air pollution ................................................................................................................................................ 14
2.6 Public Health Outcomes Framework ...................................................................................................................... 14
2.7 The Cost of Air Pollution ......................................................................................................................................... 15
3 POLICY AND LEGAL FRAMEWORKS FOR IMPROVING AIR QUALITY .........................................................................16
3.1 World Health Organisation (WHO) ........................................................................................................................ 16
3.2 EU Directive ............................................................................................................................................................ 16
3.3 UK Air Quality Policy............................................................................................................................................... 16
The Air Quality Standards Regulations 2010 ........................................................................................................... 16
Clean Air Strategy, 2019 .......................................................................................................................................... 17
Environment Act, 2021............................................................................................................................................ 18
3.4 Local authority responsibilities ............................................................................................................................... 18
4. AIR QUALITY MONITORING AND ASSESSMENT OF COMPLIANCE...........................................................................20
4.1 Air Quality Monitoring in London ........................................................................................................................... 20
4.2 Communicating levels of air pollution .................................................................................................................... 20
4.3 Actions already taken to clean up London’s air ..................................................................................................... 22
4.4 Impact of COVID-19 on air quality in London ......................................................................................................... 27
5 AIR QUALITY AND ITS HEALTH IMPACTS IN LB LEWISHAM ......................................................................................28
5.1 Location and monitoring ........................................................................................................................................ 28
5.2 Annual mean concentrations ................................................................................................................................. 28
5.3 Air quality focus areas ............................................................................................................................................ 29
5.4 Health Impacts in LB Lewisham ............................................................................................................................. 30
6 WHY FURTHER ACTION IS NEEDED ..........................................................................................................................32
6.1 Maximising the health benefits from improving air quality ................................................................................... 32
Air Quality Information for Public Health Professionals – London Borough of Lewisham
4
6.2 Communicating with patients and the public ........................................................................................................ 33
6.3 Actions boroughs can take to improve air quality ................................................................................................. 34
7 NEXT STEPS .............................................................................................................................................................36
8 APPENDICES ............................................................................................................................................................38
Appendix 1 National Air Quality objectives and European Directive limit and target values ...................................... 38
Appendix 2 Fraction (%) of mortality attributable to long term exposure to PM
2.5
(2019) .......................................... 40
Appendix 3 Public Health Outcomes Framework indicators that could be influenced by policies to improve air quality
..................................................................................................................................................................................... 41
Appendix 4 Relevant London Strategies ....................................................................................................................... 43
Appendix 5 PM monitoring in LB Lewisham ................................................................................................................. 45
Appendix 6 Population exposure .................................................................................................................................. 46
Appendix 7 Imperial College London study data sources and methodology ................................................................ 52
Appendix 8 Local Authority population, total deaths from all causes, range of mortality burden (deaths) for PM
2.5
and NO
2
and mean fraction of mortality attributable to PM
2.5
and NO
2
in 2019. ........................................................ 53
Appendix 9 Actions for Londoners to mitigate against air pollution ............................................................................ 55
Appendix 10 LEDNET/ ADPH Recommendations for action to clean up London’s air .................................................. 57
Air Quality Information for Public Health Professionals – London Borough of Lewisham
5
Figure 1 Types of particulate matter (UFP, PM
2.5
, PM
10
). Of these, UFP and PM
2.5
are the most
harmful types for health. Image source VFA ..................................................................................... 10
Figure 2 Impact of Air Pollution on Health throughout a lifetime. Taken from PHE Health Matters
2018.................................................................................................................................................... 10
Figure 3 Health effects of air pollution, taken from PHE Health Matters, 2018. .............................. 11
Figure 4 Air pollution affects everyone but there are inequalities in exposure and the greatest
impact on the most vulnerable. Taken from PHE Health Matters 2018 ........................................... 13
Figure 5 Trend in NO
2
in London vs no ULEZ scenario ....................................................................... 22
Figure 6 Changes in hourly average NO
2
(weekdays, central London) .............................................. 27
Figure 7 LB Lewisham Focus Areas, London Atmospheric Emissions Inventory (LAEI 2016) ............ 29
Figure 8 Mean fraction of mortality attributable to PM
2.5
and NO
2
in each London borough .......... 30
Figure 9 Illustrated Air Pollution Hierarchy, taken from PHE’s 2019 evidence review. .................... 32
Figure 10 Why travel makes a difference. Taken from PHE Health Matters 2018 ............................ 33
Air Quality Information for Public Health Professionals – London Borough of Lewisham
6
1 INTRODUCTION
1.1 Air pollution in London: Facts and figures
• In London alone, air pollution leads to thousands of premature deaths and costs the city’s
economy an estimated £3.7bn every year
2
.
• NO
2
and PM
2.5
, the two pollutants of greatest concern in London, are linked to a variety of
adverse health impacts.
• Air pollution affects everyone who lives, works, or visits London but it disproportionally
affects the poorest and most vulnerable communities, including children.
• In 2019, in areas where the least affluent Londoners live, the annual average concentration
of NO
2
was 3.8 µg/m
3
more than the most affluent areas. That is 13 per cent higher. For
PM
2.5
, the most deprived areas had an annual average concentration 0.7 µg/m
3
, six per cent
higher than the least deprived areas.
• There is currently no safe level for PM
2.5
or NO
2
. In recognition of this, the World Health
Organisation (WHO) recently lowered its guideline limits for PM
2.5
to 5 µg/m
3
and NO
2
to
10 µg/m
3
. The aim is to achieve the lowest concentrations
possible
3
.
• There have been improvements in air quality across London in recent years, especially for
NO
2
. In 2019, 84 per cent of major roads in London met the legal limit for NO
2
4
, compared
to 46 per cent in 2016 and just 37 per cent in 2013. Despite the dramatic progress to date,
air pollution remains the biggest environmental risk to health.
• London has already taken bold action with the introduction of the central London Ultra Low
Emission Zone (ULEZ) in 2018. This has reduced concentrations of NO
2
at roadside sites in
the central zone by 44 per cent. The ULEZ was further expanded in 2021.
• Since 1 March 2021, most heavy vehicles have had to meet Euro VI emission standards of
the London-wide Low Emission Zone (LEZ). This includes lorries, buses, and coaches. These
standards are the same as the ULEZ, so there is only one charge for heavy vehicles in London.
• The ULEZ expansion will reduce road transport emissions of nitrogen oxides (NO
x
) by 30 per
cent. This will mean an expected 92 per cent of roads in London would comply with legal
limits for NO
2
by the end of 2021. Combined with other measures, this puts us on track for
legal compliance by 2025 at the latest. Reducing NO
2
or PM concentrations below air quality
standards is likely to bring additional health benefits.
• More action is needed locally and nationally as most areas of London are exceeding WHO
guideline limits for PM
2.5
.
2
https://www.london.gov.uk/sites/default/files/asthma_kings_report_april_2019_final.pdf
3
https://www.who.int/publications/i/item/9789240034228
4
https://data.london.gov.uk/dataset/london-atmospheric-emissions-inventory--laei--2019
Air Quality Information for Public Health Professionals – London Borough of Lewisham
7
1.2 The case for tackling London’s air pollution crisis
There are a wide range of co-benefits to improving air quality. This is not just in terms of
improving health and reducing health inequalities. It is also good for the economy, environment,
and climate change adaptation and mitigation.
Air pollution affects everyone who lives and works in London; and London has some of the poorest
air quality in England. The Mayor’s vision is for London to have the best air quality of any major
world city. His ambition is to go beyond the legal requirements to protect human health and
minimise inequalities. The pandemic has highlighted stark health inequalities across the city. A
report by Imperial College London offered a comprehensive overview of the most credible
evidence for the links between air pollution and COVID-19. It found that there are a small number
of studies supporting a relationship between long-term exposure to air pollution and higher risk of
Covid-19 or its adverse consequences
5
. The report also highlighted air pollution’s role in increasing
vulnerability to, and severity of, a range of acute lower and upper respiratory infections.
1.3 Green Recovery from COVID-19
London is vulnerable to many of the impacts of the climate crisis, including worsening flooding and
heatwaves. That is why the Mayor has been clear that London’s recovery from the COVID-19
pandemic must be a green one.
The city’s recovery is led by the London Recovery Board, chaired jointly by the Mayor and Chair of
London Councils. It brings together leaders from across London’s government, business and civil
society, the health and education sectors, trade unions and the police. The aim is to oversee the
long-term recovery effort. The board, which includes the NHS, has committed to taking a missions-
based approach for both economic and social recovery.
One of the nine missions, the Green New Deal Mission, aims to tackle the climate and ecological
emergencies and improve air quality. It will do this by doubling the size of London's green
economy by 2030 to accelerate job creation for all. The Green New Deal Mission focuses on three
key themes:
1) Decarbonising and transforming the built environment;
2) Greening London’s transport and public realm; and
3) Mobilising new finance and support green jobs, skills and lifestyles.
Theme two has the potential to improve air quality. Project areas focus on supporting modal shift,
electrifying London’s vehicle fleet and infrastructure and developing zero emission zones.
Prioritising sustainability, climate mitigation, and resilience is also a cross-cutting principle
underpinning work across all the recovery missions.
5
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/environmental-research-
group/ReportfinalAPCOVID19_v10.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
8
The first national lockdown in the pandemic (from March to June 2020) led to behavioural changes
by Londoners which temporarily helped improve air quality. These included a reduction in
personal vehicle use, road traffic, and an increase in active travel whilst socially distancing. Cleaner
air and reduced traffic noise were widely noted and valued during this period. However, levels of
road traffic and air pollution have been increasing since then. We now need coordinated action to
ensure that these gains are not lost.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
9
2 AIR POLLUTION AND ITS HEALTH IMPACTS
2.1 What is air pollution?
Air pollution is the largest environmental risk to public health in the UK
6
. Both indoor and outdoor
air pollution can harm health. An air pollutant is anything in the air that could harm people’s
health, including small particles, liquid droplets and gases. Air pollutants are emitted from a range
of man-made and natural sources; and can be classified as primary or secondary. Primary
pollutants are emitted directly from a source whilst secondary pollutants form when other
pollutants (primary pollutants) react in the atmosphere.
2.2 Main sources of air pollution in London
Most of the air pollution in London is produced by traffic, heating, and burning of solid fuels. Over
40% per cent of the NO
2
in London comes from road transport (LAEI, 2019). This is why the highest
concentrations of NO
2
are recorded at busy roadside locations.
Around a third of the PM
2.5
emitted in London comes from road transport. A large proportion
(40%) also comes from construction, wood burning, and commercial cooking (LAEI, 2019).
Alongside emissions from local and regional sources, levels of PM are also influenced by emissions
from mainland Europe and further afield. The sources of larger PM
10
particles are broadly similar,
and road transport accounts for around a quarter of PM
10
in London. The 2019 London
Atmospheric Emissions Inventory (LAEI) was published in December 2021 and provides an update
to the previous LAEI2016 and a new baseline for 2019. Data from the LAEI is publicly available on
the London Data Store and includes concentration maps, population exposure data and emissions
by pollutant and source split by London Zone and by borough. Officers are encouraged to review
the 2019 inventory and specific data sets for their boroughs.
2.3 Main pollutant types of concern in London
The UK Air Quality Standards Regulations (2010) sets standards for a variety of pollutants
considered harmful to human health and the environment. These are detailed in Appendix 1. The
pollutants of most concern in London are NO
2
, PM
2.5
and ozone (O
3
). NO
2
is a toxic gas produced
during combustion processes, such as in the engine of a car. Some PM
2.5
occurs naturally, such as
dust and sea salt, and some is man-made, such as particulates from vehicle exhausts and burning
solid fuels. O
3
is a secondary man-made pollutant formed when air pollution from internal
combustion engines (NOx) and power plants (Volatile Organic Compounds (VOCs)) combines
chemically with oxygen. PM (see figure 1) and the gases NO
2
and O
3
are particularly damaging
pollutants for human health
7
. PM
2.5
is the air pollutant thought to have the greatest impact on
human health. There is no recognised safe level for health
2
.
6
https://www.gov.uk/government/publications/air-pollution-applying-all-our-health/air-pollution-applying-all-our-
health
7
https://www.blf.org.uk/support-for-you/air-pollution/what-is-it
Air Quality Information for Public Health Professionals – London Borough of Lewisham
10
2.4 Health effects of air pollution and associated health inequalities
The health effects of air pollution are complex, and range in severity. Air pollution can harm health
at every stage of life from the first weeks in the womb all the way through to old age (figure 2).
In some cases, the damage can be gradual and may not become apparent for many years.
However, it can also have short-term impacts which may exacerbate symptoms, increase hospital
Figure 2 Impact of Air Pollution on Health throughout a lifetime. Taken from PHE
Health Matters 2018
Figure 1 Types of particulate matter (UFP, PM
2.5
, PM
10
). Of these, UFP and PM
2.5
are the most
harmful types for health. Image source VFA
Air Quality Information for Public Health Professionals – London Borough of Lewisham
11
admissions and even death
8
(figure 3). Long-term exposure (over years or lifetime) reduces the
number of years we spend in good health (healthy life expectancy). There is no level of exposure
which doesn’t impact on health. As such, reducing NO
2
or PM concentrations below air quality
standards is likely to bring additional health benefits. This is reflected in the recently updated
WHO air quality guidelines, which are significantly tighter than their previous guidelines
9
.
Table 1 below summarises some of the main health impacts of NO
2
, PM
2.5
and PM
10.
Table 1 Overview of health impacts for key pollutants of concern.
8
Health matters: air pollution - GOV.UK (www.gov.uk)
9
WHO Global Air Quality Guidelines (2021) https://www.who.int/news-room/q-a-detail/who-global-air-quality-
guidelines
10
A mixture of particles and/or liquid droplets in the air that have a diameter less than 2.5 micrometres across (one
400
th
of a millimetre).
11
A mixture of particles and/or liquid droplets in the air that have a diameter less than 10 micrometres across.
Pollutant
Key health impacts
NO
2
Effects on lung development (lung function growth), respiratory
infections in early childhood and effects on lung function in adulthood.
PM
2.5
10
Based on current evidence, PM
2.5
is thought to be the air pollutant which
has the greatest impact on human health. Both short and long-term
exposure to PM
2.5
increases mortality risk from lung and heart diseases
and stroke as well as increasing hospital admissions.
PM
10
11
Like PM
2.5
(which is a subcomponent of PM
10
), PM
10
harms the
respiratory and cardiovascular systems, and increases the chance of
premature death.
Figure 3 Health effects of air pollution, taken from PHE Health Matters, 2018.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
12
When air pollutants enter the body, they can affect various organs and systems
12
. This includes:
• The eyes, nose and throat
• The lungs and respiratory system, including worsening asthma and chronic obstructive
pulmonary disease and as a cause of lung cancer
• The heart – heart and blood vessel diseases, including strokes and hardening of the arteries
(atherosclerosis), are some of the main health effects of air pollution.
There are several methods for measuring the impact of air pollution upon health. The Committee
on the Medical Effects of Air Pollution (COMEAP) has released a comprehensive document
13
collating its recommendations for quantifying air pollutants’ health impacts.
Long-term exposure to air pollution reduces life expectancy by increasing the incidence of lung,
heart and circulatory conditions
14
. Long-term exposure to air pollution in early life can have a
lasting effect on lung function, including suppressing children’s lung function growth
15
. Maximising
development of lung function in childhood is important as low lung function leads to less reserve if
lung disease develops. This is associated with higher health risks if lung disease develops later in
life.
Asthma, a long-term inflammatory condition of the conducting airways of the lungs, leads to
coughing, wheezing, chest tightness and shortness of breath. Asthma symptoms in those who
have the condition can be exacerbated by various stressors. These include respiratory viral
infection, allergen exposure, and episodes of elevated air pollution
16
.
There is increasing evidence of air pollution having a potential role in causing asthma, especially in
people who live near busy roads
17
. In addition, short-term peaks in pollution levels are a trigger
that can make asthma symptoms worse, increasing the risk of exacerbations
18
. This is also true for
chronic obstructive pulmonary disease (COPD)
19
. Quality and Outcomes Framework data from GP
12
https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution
13
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/927754/Summa
ry_of_COMEAP_recommendations_for_quantification.pdf
14
Jos Lelieveld, Andrea Pozzer, Ulrich Pöschl, Mohammed Fnais, Andy Haines, Thomas Münzel, Loss of life expectancy
from air pollution compared to other risk factors: a worldwide perspective, Cardiovascular Research, Volume 116,
Issue 11, 1 September 2020, Pages 1910–1917,
15
Schultz ES, Litonjua AA, Melén E. Effects of long-term exposure to traffic-related air pollution on lung function in
children. Current allergy and asthma reports. 2017 Jun;17(6):1-3.
16
https://www.nhlbi.nih.gov/health-topics/asthma
17
https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution
18
Orellano P, Quaranta N, Reynoso J, Balbi B, Vasquez J. Effect of outdoor air pollution on asthma exacerbations in
children and adults: systematic review and multilevel meta-analysis. PloS one. 2017 Mar 20;12(3):e0174050.
19
Song Q, Christiani DC, Ren J. The global contribution of outdoor air pollution to the incidence, prevalence, mortality
and hospital admission for chronic obstructive pulmonary disease: a systematic review and meta-analysis.
International journal of environmental research and public health. 2014 Nov;11(11):11822-32.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
13
registers shows approximately 508,000 people with asthma and 117,000 people with COPD live in
London (2019-20 data)
20
.
Emerging evidence suggests air pollution may affect the brain and is possibly linked to dementia
and cognitive decline
21
and mental health impacts
22
. There is also evidence associating air
pollution with impacts in pregnancy and early childhood, such as low birth weight
23
.
As shown in figure 4, some groups are particularly susceptible to the harms of air pollution. These
include older people, children, pregnant women and those with existing cardiovascular or lung
disease
24
. People who live / work in highly polluted areas, near busy roads, or who spend long
periods in traffic, are also at increased risk. This is because congestion is strongly associated with
air pollution, and car occupants are typically exposed to more air pollution than cyclists or
pedestrians
25
.
20
https://app.powerbi.com/view?r=eyJrIjoiMDZiMmI2MzEtMWVjZC00YTVlLWI5NjEtMTNkODM3M2M0NDk3IiwidCI6IjU
wZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9
21
Power MC, Adar SD, Yanosky JD, Weuve J. Exposure to air pollution as a potential contributor to cognitive function,
cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research. Neurotoxicology. 2016
Sep 1;56:235-53.
22
Braithwaite I, Zhang S, Kirkbride JB, Osborn DP, Hayes JF. Air pollution (particulate matter) exposure and
associations with depression, anxiety, bipolar, psychosis and suicide risk: a systematic review and meta-analysis.
Environmental health perspectives. 2019 Dec 18;127(12):126002.
23
Stieb DM, Chen L, Eshoul M, Judek S. Ambient air pollution, birth weight and preterm birth: a systematic review and
meta-analysis. Environmental research. 2012 Aug 1;117:100-11.
24
https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution
25
http://content.tfl.gov.uk/technical-note-20-what-are-the-main-health-impacts.pdf
Figure 4 Air pollution affects everyone but there are inequalities in exposure and
the greatest impact on the most vulnerable. Taken from PHE Health Matters 2018
Air Quality Information for Public Health Professionals – London Borough of Lewisham
14
Ethnic minorities and deprived communities are hardest hit by air pollution in London
26
. In 2019,
areas where the most deprived Londoners lived, had a higher annual average concentration of
NO
2
by 3.8 µg/m
3
than the least deprived areas. For PM
2.5
, areas where the most deprived
Londoners live had an annual average concentration 0.7 µg/m
3
higher than the least deprived
areas
27
. The Mayor is now taking measures to tackle London’s air pollution. By 2030, these should
reduce the gap in exposure to NO
2
between the least and most deprived by 70 per cent
28
.
2.5 Indoor air pollution
Polluted air is a problem not only outside our homes and workplaces but inside them too. It is not
the primary focus of this report. However, the WHO estimates that close to four million people
worldwide die prematurely each year due to household (indoor) air pollution (2018 data
29
). This is
a serious problem in countries where solid fuel is the main way to cook and heat homes, and
where ventilation is poor.
In the UK, indoor air quality is affected by domestic gas combustion from cooking and heating.
Other sources of indoor air pollution include wood-burning stoves and open fires, cleaning agents,
VOCs, tobacco smoke, mould, condensation and asbestos. The National Institute for Health and
Care Excellence (NICE) has recently provided guidance on improving indoor air quality
30
.
In recent years, wood burner use has increased. This means its relative contribution to local PM
2.5
is increasing even more rapidly as contributions of other sources like traffic are gradually reduced.
A European Environment Bureau report showed that even Euro-certified 'Eco-stoves' produce 750
times more PM
2.5
per gigajoule of energy than a modern HGV
31
. A recent study found that wood
burning accounts for between 23 and 31 per cent of urban-derived PM
2.5
in London
32
.
2.6 Public Health Outcomes Framework
The Public Health Outcomes Framework (PHOF) examines indicators that help to understand
trends in public health. It also enables local authorities to benchmark and compare their own
outcomes with other local authorities. For example, one indicator looks at the health impacts of
air pollution: the fraction (%) of mortality attributable to long-term exposure to PM
2.5
. This is
calculated using modelled PM
2.5
levels. A graph showing breakdown by borough of the percentage
of mortality attributable to long-term PM
2.5
exposure across London in 2019 is in chapter 5. The
underlying data are in appendix 2 and the Public Health Outcomes framework in appendix 3.
26
http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
27
https://www.london.gov.uk/sites/default/files/air_pollution_and_inequalities_in_london_2019_update_0.pdf
28
https://www.london.gov.uk/sites/default/files/air_quality_in_london_2016-2020_october2020final.pdf
29
https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health
30
https://www.nice.org.uk/guidance/ng149/resources/visual-summary-pdf-7022755693
31
https://eeb.org/library/where-theres-fire-theres-smoke-emissions-from-domestic-heating-with-wood/
32
https://uk-
air.defra.gov.uk/assets/documents/reports/cat05/1801301017_KCL_WoodBurningReport_2017_FINAL.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
15
2.7 The Cost of Air Pollution
The 2019 Clean Air Strategy
33
estimated air pollution in England could cost £5.3bn a year in terms
of health and social care by 2035. This is if no action is taken and includes both PM
2.5
and NO
2
. This
is a cumulative cost for health conditions strongly associated with air pollution: coronary heart
disease; stroke; lung cancer; and childhood asthma. When health issues with weaker evidence of
association are also added, the costs could reach £18.6bn by 2035. These include chronic
obstructive pulmonary disease; diabetes; low birth weight; and dementia. Air pollution can impact
people of working age, which can also have economic effects, for instance, if they must take days
off work. The Confederation of British Industry (CBI) estimates that improving our air quality could
benefit the UK’s economy by £1.6bn each year. This would be by preventing premature deaths
and providing three million additional working days. It also found that cleaner air in London would
benefit the city’s local economy by £500m, almost one third of the national yearly benefit
34
.
33
https://www.gov.uk/government/publications/clean-air-strategy-2019
34
https://www.cbi.org.uk/media/5539/2020-09-cbi-economics-caf-report.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
16
3 POLICY AND LEGAL FRAMEWORKS FOR IMPROVING AIR
QUALITY
3.1 World Health Organisation (WHO)
Most air quality legislation in Europe and the UK is derived from health-based evidence provided
by the WHO. The WHO has published various guidelines for both global air quality and European
air quality based on the latest worldwide research. In September 2021, the WHO announced
changes to its guideline air quality limits (previously published in 2005). The annual PM
2.5
limit has
reduced from 10 μg/m
3
to 5 μg/m
3
and annual NO
2
from 40 μg/m
3
to 10 μg/m
3
.
The Mayor’s current ambition is to meet the 10 μg/m
3
threshold for PM
2.5
by 2030. Many of the
Mayor’s strategies and policies (London Plan, LLAQM Guidance, London Environment Strategy)
refer to the WHO limits. This will continue to mean the WHO limits at the time of writing, which
was 10 μg/m
3
. Meanwhile, the Mayor continues to work for a zero-pollution city. This includes
efforts to achieve the health-based guidelines that WHO originally set for 2030 mindful of the
impacts on Londoners. He will also continue to lobby for a 10 μg/m
3
threshold for PM
2.5
by 2030.
3.2 EU Directive
The European Union has issued an air quality Directive (2008/50/EC – the “Air Quality
Directive”).
35
The directive sets standards for a range of pollutants considered harmful to human
health and the environment.
The UK is no longer a European Union member. However, the Air Quality Directive is now a part of
UK domestic legislation through the Air Quality Standards Regulation
36
.
The directive standards include limit values, which are legally binding and must not be exceeded.
These limit values include a concentration value for the pollutant, an averaging period over which
it is measured and when these should be achieved. In some case, it also includes an allowable
number of exceedances of the value per year. The directive also includes target values, which are
set out in the same manner as limit values. However, these should be reached where possible by
taking cost-effective measures.
3.3 UK Air Quality Policy
The Air Quality Standards Regulations 2010
The Air Quality Standards Regulations 2010 include criteria for determining how to assess
achievement of the limit values. This includes consideration of locations and length of exposure in
relation to the averaging period of the limit values. In addition, the regulations state sampling
points must be sited where the highest concentrations occur, and people exposed for longer
35
http://ec.europa.eu/environment/air/quality/legislation/existing_leg.htm
36
www.legislation.gov.uk/uksi/2010/1001/contents/made
Air Quality Information for Public Health Professionals – London Borough of Lewisham
17
periods of time. These should be significant in relation to the averaging period of any limit value
(that is, 15 minutes, one hour, 24 hours etc).
The limit values for the UK Air Quality Standards and the updated WHO guideline limit values are
shown below in table 2. The UK Air Quality Standards limit values for NO
2
were not met in parts of
Greater London in 2019. However, the number of Londoners living in areas exceeding the UK Air
Quality Standards for NO
2
fell from over 2 million in 2016 to 119,000 in 2019, a reduction of 94 per
cent.
In 2016, the whole of London exceeded the previous WHO guideline limit for PM
2.5
of 10 μg/m
3
.
The latest data from LAEI2019 shows there are now almost 1.2 million Londoners living in areas
below the 10 μg/m
3
limit and there has been a 19 per cent reduction in PM
2.5
across the whole of
the city since 2016. However, with the WHO guideline limit for PM
2.5
reducing to 5 μg/m
3
, there is
still work to be done to ensure Londoners can breathe clean air.
Table 2 Air Quality Standards Regulations and updated WHO guideline values
Clean Air Strategy, 2019
The Government’s Clean Air Strategy
41
provides a policy framework for air quality management
and assessment in the UK. It sets out these proposals in detail and indicates how devolved
administrations intend to make their share of emissions reductions. It identifies air quality
37
200 μg/m
3
hourly average is not to be exceeded more than 18 times a year
38
A mixture of particles and/or liquid droplets in the air that have a diameter less than 2.5 micrometres across (one
400
th
of a millimetre).
39
In 2020, the annual mean limit value was reduced to 20 µg/m
3
.
40
A mixture of particles and/or liquid droplets in the air that have a diameter less than 10 micrometres across.
41
https://www.gov.uk/government/publications/clean-air-strategy-2019
Pollutant
UK Air Quality Standards
(EU Limit Value)
WHO guideline value
(2021 update)
NO
2
40 μg/m
3
annual mean
200 μg/m
3
1-hour mean
10 μg/m
3
annual mean
15 μg/m
3
1-hour mean
37
PM
2.5
38
25 μg/m
3
annual mean
39
5 μg/m
3
annual mean
15 μg/m
3
24-hour mean
PM
10
40
40 μg/m
3
annual mean
50 μg/m
3
24-hour mean
15 μg/m
3
annual mean
45 μg/m
3
24-hour mean
Air Quality Information for Public Health Professionals – London Borough of Lewisham
18
standards and objectives for key air pollutants which are designed to protect health and the
environment. The Government has since brought forward plans to end the sale of new
conventional petrol and diesel cars and vans to 2030
42
. This is ten years earlier than previously
proposed.
Environment Act, 2021
The Act introduces a duty on the government to bring forward at least two air quality targets by
October 2022 for consultation. This will be set in secondary legislation. The first will aim to reduce
the annual average level of PM
2.5
in ambient air. The second will be a long-term target (set a
minimum of 15 years in the future). The Environment Act did not include legally binding PM
2.5
targets or provide cities with the powers and funding needed to meet them.
3.4 Local authority responsibilities
Under the Environment Act 1995
43
local authorities have a statutory responsibility in Local Air
Quality Management (LAQM). This is to make sure that the national air quality
objectives (appendix 1) will be achieved by the relevant deadlines. If a local authority finds any
places where the objectives will not be achieved, it must declare an Air Quality Management Area
(AQMA) there.
Much of London has been designated AQMAs. The DEFRA website has an interactive map of all
AQMAs in the country. Local authorities which have wholly or partly designated their boroughs as
AQMAs must under LAQM produce an Air Quality Action Plan (AQAP)
44
. AQAPs set out how local
authorities, working with other agencies, will use their powers to meet the air quality objectives.
The Mayor’s London Local Air Quality Management (LLAQM) framework
45
is the statutory
process for London’s local authorities to review and improve local air quality. In March 2019
boroughs were consulted on a range of updates and improvements to the LLAQM. After a
successful consultation, the new LLAQM was published in October 2019. The updates were done
to:
• ensure boroughs are taking ambitious action, which is properly coordinated at the regional
level, and which supports Mayoral objectives. This includes those set out in the London
Environment Strategy.
• ensure that London boroughs continue to work towards achievement of WHO guideline
values for pollutants even when legal limits are met.
42
https://www.gov.uk/government/news/government-takes-historic-step-towards-net-zero-with-end-of-sale-of-new-
petrol-and-diesel-cars-by-2030
43
www.environment-agency.gov.uk/netregs/legislation/.../107183.aspx
44
http://uk-
air.defra.gov.uk/reports/cat09/1107211126_Mapping_Action_Plan_Guidance_Final__Report_April_2011.pdf
45
https://www.london.gov.uk/what-we-do/environment/pollution-and-air-quality/working-london-boroughs
Air Quality Information for Public Health Professionals – London Borough of Lewisham
19
• update information in the guidance documents to reflect new research, policies, and
priorities.
There are 187 Air Quality Focus Areas in London. These are locations that not only exceed the
national air quality objective for NO
2
but also have high levels of footfall. These areas were
identified in the LAEI 2010 as requiring interventions to help reduce emissions and personal
exposure. This is not an exhaustive list of London’s hotspot locations. However, it is where the GLA
believe the problem to be most acute. We have selected Air Quality Focus Areas based on the
following factors:
- Baseline air quality for NO
2
and PM
10
by 20m grid resolution
- Locations where air pollution limit values have been exceeded
- Level of human exposure
- Local geography and topography
- Local sources of air pollution
- Traffic patterns
- Future predicted air quality trend
Air Quality Information for Public Health Professionals – London Borough of Lewisham
20
4. AIR QUALITY MONITORING AND ASSESSMENT OF
COMPLIANCE
There are several health and environmental strategies which are relevant to air quality. Details of
these can be found in appendix 4.
4.1 Air Quality Monitoring in London
London’s air quality is constantly monitored by high-accuracy Automatic Reference-Level monitors
at over 100 different locations. Most of these are owned and paid for by London’s boroughs.
These sites are mainly managed through the London Air Quality Network (LAQN) delivered by the
Measurement Team at Imperial College. Ricardo Energy and Environment also run several of these
sites. More information on this network is available on the Air Quality England website.
There is minimal PM
2.5
monitoring within the London network. We encourage boroughs to
consider increasing PM
2.5
monitoring capacity as this pollutant has the greatest impact on human
health.
Analysers on Air Quality England and the LAQN are Defra-approved and calibrated and maintained
in accordance with its technical guidance on air quality monitoring. You can read more here about
Defra’s approval method for gas analysers and particulate instruments.
The LAQN is supplemented by low cost Breathe London monitors and diffusion tubes. Breathe
London’s street-by-street sensor air quality monitoring system is being used to analyse harmful
pollution in toxic hotspots across the city. These include near schools, hospitals, construction sites
and busy roads. These data will support policymaking and help inform and engage local
communities. However, it is not a replacement for the Reference-Level monitors which are vital
for assessing trends and compliance with legal air quality limits. We recently launched two new
ways for people, businesses and communities to join the Breathe London Network. The Breathe
London Shop is intended for those who already have funding. There is also the Breathe London
Community Programme through which communities can apply for 10 fully funded nodes in this
round.
We are working towards consolidating these data, so they are freely available in one location on
the Breathe London website.
4.2 Communicating levels of air pollution
The Daily Air Quality Index
The Daily Air Quality Index (DAQI) offers information on levels of air pollution and provides
recommended actions and health advice. The index is numbered 1-10 and divided into four bands
(low 1-2, moderate 4-6, high 7-8, very high 9-10). This provides detail about air pollution levels in a
simple way, like the sun index or pollen index. The DAQI and its associated messaging are currently
Air Quality Information for Public Health Professionals – London Borough of Lewisham
21
being reviewed. This follows the Ella Adoo-Kissi-Debrah inquest and the need to include more
specific messaging for different population groups
46
.
Step 1: Determine whether you (or your children) are likely to be at-risk from air pollution. Adults
and children with heart or lung problems are at greater risk of symptoms. Older people are more
likely to suffer from heart and lung conditions than young people. It therefore makes good sense
for them to be aware of current air pollution conditions. Children with asthma may notice they
need to use their reliever medication more on days when air pollution levels are higher than
average.
Step 2: If you may be at-risk, and are planning strenuous activity outdoors, check the air pollution
forecast.
Step 3: Use the health messages corresponding to the highest forecast level of pollution as a
guide.
Mayor’s air quality alerts system
The Mayor’s air quality alerts system communicates to Londoners on days where air pollution is
elevated. It uses stakeholder organisations’ networks and messages displayed in public locations
(including bus countdown signs). It issues alert communications in several formats to reach as
many Londoners as possible. The system uses the same criteria as the DAQI.
During periods of moderate, high and very high air pollution the Mayor’s Air Quality Alert system
sends warning emails to signed-up stakeholders. This includes over 3,300 school contacts. Alerts
and guidance are also available via social media and the London.gov website.
When a high and very high air pollution day is forecast, air quality alerts are displayed at many
public locations across London. This includes all bus stop Countdown signs, the road network and
on the London Underground. These are combined forecasts - meaning they are based on a
number of public forecasts: airText, Defra (Met Office) and Imperial. Furthermore, for high and
very high air pollution episodes we also alert the London Resilience Forum (which includes the
NHS and UK HSA). This action enables more Londoners to be reached via their networks.
Work is underway to improve the reach of the alerts especially for vulnerable groups, including
understanding how alerts can work within health care settings. Local authorities can play a key
role in making this happen through their local health, education and social care networks and
involvement in integrated care systems. To find out more and for support on working with local
NHS networks, please email [email protected].
AirTEXT
airTEXT provides information on the level of pollution in an area using ‘low’, ‘moderate’ and ‘high’
bandings. Whenever moderate or high levels of pollution are expected, subscribers to the airTEXT
46
Government responds to Coroner after Ella Adoo-Kissi-Debrah inquest - GOV.UK (www.gov.uk)
Air Quality Information for Public Health Professionals – London Borough of Lewisham
22
service receive a text message, call or voicemail. This enables the recipient to determine what
steps they should take to prepare themselves for the expected level of pollution. For example,
taking a different route/mode of transport to work, keeping their medication with them or not
exercising outside on certain days. Currently around 10,000 people use the airTEXT service
through text, Twitter or the website.
4.3 Actions already taken to clean up London’s air
The Mayor is committed to cleaning up London’s air and is delivering an ambitious action plan to
tackle this problem. He has introduced a range of hard-hitting measures to reduce air pollution
and protect public health. These include:
Incentivising the use of cleaner vehicles. Much of the improvements in air quality seen in London
since 2016 can be attributed to the Central London ULEZ (figure 5). The ULEZ operates 24/7 daily,
within the same area of central London as the congestion charge. In October 2021, the ULEZ
expanded up to but not including, the North and South Circular Roads. Most vehicles, including
cars and vans, need to meet the ULEZ emission standards, or pay a daily charge to drive in the
zone.
In the first 10 months of the central London scheme (before the pandemic), the ULEZ had already
delivered a range of benefits:
ULEZ
impact
Figure 5 Trend in NO
2
in London vs no ULEZ scenario
Air Quality Information for Public Health Professionals – London Borough of Lewisham
23
• Trend analysis shows in February 2020 concentrations of NO
2
at roadside sites in the central
zone were 39 µg/m
3
less than in February 2017
47
. This is a fall of 44 per cent. After the first
ten months of operation average compliance with ULEZ standards were 79 per cent in a
24-hour period. This was 77 per cent in congestion charging hours. This is far higher than 39
per cent in February 2017 and 61 per cent in March 2019, the month before the ULEZ was
introduced.
• Analysis was carried out to determine the directly attributable impact of the ULEZ. In the
first two months of 2020. NO
2
concentrations in central London were on average 29 µg/m
3
lower than they would have been otherwise. This equates to a reduction of 37 per cent.
• Preliminary estimates indicate that by the end of 2019, the ULEZ had reduced NO
x
emissions
from road transport in the central zone by 230 tonnes. This is a reduction of 35 per cent.
• The ULEZ is also helping to tackle the climate emergency. Preliminary estimates indicate that
by the end of 2109, the ULEZ had reduced carbon dioxide (CO
2
) emissions from road
transport in the central zone by 12,300 tonnes. This is a reduction of six per cent.
• It’s too early to measure most long-term health benefits. However, we have commissioned
Imperial College London to measure changes in asthma exacerbations and hospital
admissions
48
.
• Compliance has steadily increased since its introduction. In May 2021, some 87 per cent of
vehicles seen in the central zone on an average day met the strict ULEZ emissions standards.
The expanded ULEZ was launched on 25 October 2021. It operates up to, but not including, the
North Circular Road and South Circular Road to create a single, larger zone. Nearly four million
people live within the expanded ULEZ zone. Here, six in ten households do not own a car yet suffer
poor air quality in part caused by polluting vehicles. The compliance rate (percentage of vehicles
detected in the zone that meet the strict emissions standards) during the first month was 92 per
cent
49
. This is a 53 per cent increase on the 2017 compliance levels of 39 per cent. On an average
weekday, there were 47,000 fewer non-compliant vehicles in the expanded zone than the two
weeks before the scheme was introduced. This is a 37 per cent reduction in non-compliant
vehicles. There were also 11,000 fewer vehicles driving at all.
The ULEZ expansion will result in a 30 per cent reduction of road transport emissions of NO
x
. This
means that 92 per cent of roads in London were expected to comply with legal limits for NO
2
by
the end of 2021. Combined with other measures, this puts us on track for legal compliance by
2025 at the latest.
Since 1 March 2021 most heavy vehicles, including lorries buses and coaches, have had to meet
the Euro VI emission standards of the London-wide Low Emission Zone (LEZ). These standards are
the same as the ULEZ meaning there is only one charge for heavy vehicles operating in London.
47
In February 2017 the Mayor confirmed the introduction of the T-charge as a stepping-stone for the ULEZ and this
can be seen as the start of the accelerated change in the vehicle fleet as Londoners and businesses prepared for the
new schemes and buses on routes in central London began to be upgraded to become ULEZ compliant
48
Health Impact Assessment of Air Pollution on Asthma in London | London City Hall
49
https://www.london.gov.uk/WHAT-WE-DO/environment/environment-publications/expanded-ultra-low-emission-
zone-first-month-report
Air Quality Information for Public Health Professionals – London Borough of Lewisham
24
Six months on from their introduction, these changes are already delivering results
50
. Ninety-five
per cent of large and heavy vehicles operating in London met the standards in August 2021. This is
up from 48 per cent in February 2017 when the scheme was announced.
The LEZ also has significant benefits outside of London. Independent analysis shows that vehicles
passing through London’s Low Emission Zone went through 95 per cent of towns and cities in
England and Wales. This has brought cleaner air to a combined population of 18 million people.
The Mayor has invested over £61m in funding for scrappage schemes that helped small
businesses, charities operating minibuses and low-income and disabled Londoners. These schemes
have helped replace nearly 15,000 older, more polluting vehicles. Over the past two and a half
years the Mayor’s scrappage schemes have proved very popular. Combined, they have helped
thousands of Londoners and small businesses prepare for the ULEZ and its expansion. Demand for
the schemes has been consistently high throughout that time. It shows how ordinary Londoners
are taking the steps they need to clean up London’s filthy air well in advance. The Mayor continues
to make the case to Government to fund a targeted national scrappage scheme.
Cleaning up London’s bus fleet. The Mayor continued transforming London’s bus fleet by phasing
out pure diesel buses and committing to buy only hybrid or zero-emission double decker buses
from 2018. As of 1 January 2021, all buses in Transport for London’s (TfL’s) 9,000-strong core bus
fleet meet or exceed the cleanest Euro VI emission standards. This effectively makes the whole
city a Low Emission Bus Zone and reduces bus-related NOx emissions by 90 per cent. There are
currently over 600 zero emission buses in the fleet. London now has the largest zero emission bus
fleet in Western Europe.
Cleaning up the taxi fleet. The Mayor is phasing out diesel taxis to help make London’s taxi fleet
the greenest in the world. Since January 2018, TfL policy has been for all newly registered taxis to
be Zero Emission Capable (ZEC). To support this, in 2017 the Mayor provided funding for taxi
delicensing, to help get rid of the oldest, most polluting diesel black cabs from London’s fleet.
There are currently well over 5,000 ZEC, including more than 100 fully electric, taxis in operation in
London. This is from a baseline of zero in 2017.
Cleaning up private hire (minicabs). Private hire vehicles are also subject to strict emission
standards. As of 1 January 2020, private hire vehicles under 18 months must be ZEC when licensed
for the first time. From 1 January 2023, this will apply to all private hire vehicles licensed for the
first time. With their 10-year age limit, this will help London’s private hire fleet be zero emission
capable by 2033 at the latest. There are now over 14,000 Zero Emission Capable private hire
vehicles.
Reducing air pollution from other, non-road sources. The Mayor is also acting on non-road
sources of air pollution, including construction. This includes the unique Non-Road Mobile
Machinery Low Emission Zone (NRMM LEZ). This has eliminated over 16.5 tonnes of PM and 297
tonnes of NOx emissions from construction between 2016 and 2019. The project has since been
50
https://www.london.gov.uk/sites/default/files/lez_six_month_on_report-final.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
25
expanded from the initial 13 boroughs and now covers the whole of London. It is managed by
Merton.
Cleaning up the air around schools. Since 2018 the Mayor has spent more than £1m on air quality
action at schools and nurseries. This includes auditing the air quality at 50 primary schools and 20
nurseries in the city’s most polluted areas. It also includes funding measures to help schools and
nurseries reduce local pollution. Based on the positive results of these pilot programmes this
approach is now being replicated by several London boroughs.
In February 2021 the Mayor launched the London Schools Pollution Helpdesk. This aims to support
schools across the city to carry out air quality audits and implement recommendations. Progress in
this area is particularly urgent for schools in Air Quality Management Areas. Public health
departments should be aware of the school audit programme. All schools, particularly those near
main roads, should perform air quality audits.
Cleaning up air pollution hotspots in London boroughs. The Mayor’s Air Quality Fund of £22m has
supported a variety of local and pan-London projects to improve air quality. For example, the
Hackney Low Emission Neighbourhood contributed to an estimated 16 per cent reduction in local
NOx emission. Find out more about Low Emission Neighbourhoods here.
Expanding London’s electric vehicle charging infrastructure. The Mayor has supported delivery of
over 300 rapid charge points – from zero in 2016 – and over 3,000 standard charge points. This
includes London’s first rapid charging hub at Stratford International. Two further hubs are planned
at Baynard House, City of London and Glass Yard, Greenwich. London now has over 600 rapid
charge points and over 8,000 residential charge points, a third of the UK’s total. These have been
delivered thanks to leadership and effective collaboration between the public and private sectors.
Empowering Londoners to take action to reduce their exposure to pollution. Alongside a
comprehensive air quality monitoring network, the Mayor operates a system of alerts on the days
with the worst air pollution. This includes providing information on more than 2,500 countdown
signs at bus stops. See section 4.2 for more on communicating levels of air pollution.
As well as the GLA funded Breathe London network, Sutton, Kingston, Merton and Richmond upon
Thames are using the network to install their own monitors. They are installing an additional 131
air quality sensors as part of the South London Partnership’s InnOvaTe Project. By the end of 2022,
the network will have over 300 sensors
51
.
Case study: School Streets
Between April 2020 and March 2021, over 300 School Streets have been delivered across London
with funding from TfL and the boroughs. The aim is to tackle children’s exposure to air pollution
and improve their health.
51
https://www.breathelondon.org/
Air Quality Information for Public Health Professionals – London Borough of Lewisham
26
School Streets are initiatives where roads surrounding schools are closed to motor traffic at drop-
off and pick-up times. This enables children to walk or cycle to school, reducing car trips and
improve air quality. School Streets also provide space for social distancing and help to reduce road
danger around schools, making journeys safer and easier.
To measure their air quality benefits, 30 sensors from the Breathe London network were installed
at 18 primary schools across Brent, Enfield and Lewisham. These record NO
2
levels on School
Streets. It found that stopping traffic at pick-up and drop-off times reduced NO
2
levels by up to 23
per cent at these schools. On average, 81 per cent of parents and carers supported the measures
at their children’s school.
Case Study: Idling Action
Vehicle Idling Action is a London-wide behaviour change campaign. It is funded by the Mayor’s Air
Quality Fund and led by the City of London and London Borough of Camden. The campaign is
helping to reduce localised air pollution caused by motorists leaving their engines running when
parked. The project team works directly with 31 local authorities. It runs school workshops,
engages businesses to use greener vehicles and cargo bikes, offers vehicle fleet training, and
ensures idling regulations are enforced across London.
Since 2016, over 1,500 idling action events have taken place, teaching 3,860 students about air
pollution and health. Their schools have also been supported to act on engine idling by delivering
77 air quality and anti-idling workshops across 31 boroughs. In addition, the project has delivered
Idling Action events at 35 schools and idling hotspots to engage idling drivers. Idlers were asked to
switch off their engines and informed about the impact idling has on air quality and health. In
2021, the project created a four-week billboard, radio and digital advertising campaign – Engine
Off Every Stop (EOES). It ran across London to raise awareness of engine idling and its health
impacts and reached an estimated nine million plus people.
Case study: StreetSpace for London
The emerging recovery from the spring 2020 COVID-19 lockdown presented a challenge for TfL.
This is because public transport was required to run at much lower levels of passenger capacity to
provide space for social distancing. There were concerns that car travel may be more attractive
than before the pandemic. This was due to temporarily lower congestion levels and public
perceptions about the risk of exposure to coronavirus on public transport. However, a potential
car-based recovery was recognised to have major risks to safety, public health, economic recovery
and the environment. In addition, it was contradictory to the aims of the Mayor’s Transport
Strategy.
In response, TfL developed the StreetSpace for London programme, in line with national
government guidance to urgently reconsider how street space is used. The aim was to provide safe
and appealing spaces to walk and cycle as an alternative to car use. Interventions included
temporary cycle routes to extend the strategic cycle network and footway widening to make more
space for people walking. This was applied in town centres and at transport hubs.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
27
StreetSpace for London focused on rapidly rolling out cycling infrastructure, bus priority,
neighbourhood improvements and lower speeds, using temporary materials and an accelerated
approach. By March 2021, almost 100km of new or upgraded cycle routes were built, and 86km of
bus lanes were upgraded to 24/7. In addition, 2,259 signal timing changes were made to prioritise
people walking, and 88 Low Traffic Neighbourhoods were delivered.
4.4 Impact of COVID-19 on air quality in London
In March 2020 strict measures were introduced to tackle the COVID-19 pandemic in London. This
had a significant impact on NO
2
levels, mainly due to less motor traffic. Once weather effects were
accounted for, reductions were, in general, greater at roadside sites than urban background sites.
The change in NO
2
concentrations from COVID-19 restrictions must be seen within the wider
context of improvements in London’s air quality in recent years. This is due to initiatives such as
the ULEZ. Additionally, during lockdown O
3
and PM concentrations increased highlighting the
importance of non-transport emission sources and the need for action on these also.
In 2020, hourly average NO
2
at all central London sites had already reduced by 35 per cent
compared to the same period in 2017. This was before measures to address the COVID-19
outbreak were introduced. During the first lockdown there was an additional reduction of 26 per
cent. This reduction was even higher at roadside sites (figure 6). NO
2
levels at monitoring sites in
central London remained low in 2021 despite increases in traffic following the end of lockdowns.
Just a 2.7 per cent increase was seen when comparing the first lockdown in 2020 to the same
period in 2021.
Figure 6 Changes in hourly average NO
2
(weekdays, central London)
Air Quality Information for Public Health Professionals – London Borough of Lewisham
28
5 AIR QUALITY AND ITS HEALTH IMPACTS IN LB LEWISHAM
5.1 Location and monitoring
The London Borough (LB) of Lewisham is situated in South East London. It is made up of 18 wards
and has a population of 303,536
52
.
In 2001 LB Lewisham designated four large areas and a series of ribbon roads AQMAs due to
exceedances in NO
2
and PM
10
. Air quality is monitored at five automatic monitoring sites in the
borough.
The annual mean limit value for NO
2
and for PM
10
is 40 g/m
3
. Concentrations within the limit
value are highlighted in green, exceedances of the limit value are highlighted in yellow, with
exceedances greater than 50% of the limit value indicated in red.
More information about air pollution limit values is included in appendix 1.
5.2 Annual mean concentrations
Annual mean NO
2
concentrations measured at all automatic monitoring stations have constantly
decreased since 2017, and more generally over the 7-year period (2014-2020) for which data have
been reported (see table 3, below).
The automatic monitoring stations at Catford, New Cross and Loampit Vale have previously
breached the annual mean objective of 40 g/m
3
(table 3). Although all sites remained below the
objective in 2020, all sites remain above the WHO guideline limit (10 µg/m
3
). Note, the monitoring
sites are described as either background, kerbside, roadside or industrial background. New Cross
and Loampit Vale are roadside sites, whilst Catford, Deptford Green and Honor Oak Park are
background sites. Specific details of each site can be found in the LB Lewisham annual status
reports.
Table 3 Annual Mean NO
2
Concentration monitoring results (μg m
-3
)
Site
2014
2015
2016
2017
2018
2019
2020
Catford
54
43
44
43
38
33
29
New Cross
42
47
46
49
42
38
29
Loampit Vale
56
51
58
54
46
43
36
52
https://directory.londoncouncils.gov.uk/demographics/population/lewisham/
Air Quality Information for Public Health Professionals – London Borough of Lewisham
29
Site
2014
2015
2016
2017
2018
2019
2020
Lewisham Depot
N/A
N/A
N/A
N/A
N/A
N/A
19
Honor Oak Park
N/A
N/A
N/A
N/A
N/A
24
16
The national air quality objective for PM
10
is 40 g/m
3
and for PM
2.5
is 25 g/m
3
. As mentioned
previously, the WHO has recently updated its Air Quality guidelines following an assessment of the
health effects of air pollution and thresholds for health-harmful pollution levels. The new WHO
guideline value for PM
10
is 15 g/m
3
and 5 g/m
3
for PM
2.5.
In LB Lewisham, PM
10
levels are below
the national air quality objective. However, concentrations at two of the three monitoring sites in
the borough remain higher than the updated WHO standard (15 g/m
3
) highlighting the need for
more action on reducing PM emissions in London (appendix 5). Currently there are three PM
2.5
monitoring stations in LB Lewisham which exceed the WHO guideline value.
There is no safe level of exposure which doesn’t impact on health. Therefore, further reduction of
NO
2
or PM concentrations below air quality standards is likely to bring additional health benefits.
5.3 Air quality focus areas
In 2016 the GLA identified nine Air Quality Focus Areas within LB Lewisham, these are outlined in
figure 7 below. Population exposure at schools, nurseries, care homes and hospitals can be seen in
appendix 6.
Figure 7 LB Lewisham Focus Areas, London Atmospheric Emissions Inventory (LAEI 2016)
Air Quality Information for Public Health Professionals – London Borough of Lewisham
30
5.4 Health Impacts in LB Lewisham
The Public Health Outcomes Framework, mentioned in Chapter 2, includes a benchmark tool
which enables the comparison of the fraction (%) of mortality attributable to long term exposure
to PM
2.5
in each local authority in the UK. Statistics for each of the London boroughs are included
in Appendix 2.
Imperial College London have recently carried out research looking at the health burden of current
air pollution and estimates of the mortality impacts of PM
2.5
and NO
2
in London
53
. See appendix 7
for data sources and calculations. The overall findings from this research are that in 2019 in
Greater London, the equivalent of between 3,600 and 4,100 deaths (61,800 to 70,200 life years
lost) were estimated to be attributable to human-made PM
2.5
and NO
2
, considering that health
effects exist even at very low levels of air pollution. This calculation includes deaths from all causes
including respiratory, lung cancer and cardiovascular disease. Local Authority population, total
deaths from all causes, range of mortality burden (deaths) for PM
2.5
and NO
2
and mean fraction of
mortality attributable to PM
2.5
and NO
2
in 2019 can be found in appendix 8.
Figure 8 below presents the mean fraction of mortality attributable to PM
2.5
and NO
2
in each
London borough compared to the London average. The boroughs with the lowest fraction of
mortality attributable to PM
2.5
and NO
2
are outer London boroughs and the boroughs with the
highest fraction of mortality attributable to PM
2.5
and NO
2
are inner London boroughs.
53
https://www.london.gov.uk/sites/default/files/london_health_burden_of_current_air_pollution_and_future_health_
benefits_of_mayoral_air_quality_policies_january2020.pdf
0
2
4
6
8
10
12
Havering
Bromley
Bexley
Croydon
Sutton
Harrow
Hillingdon
Barking and Dagenham
Enfield
Kingston upon Thames
Richmond upon…
Merton
Redbridge
Barnet
Greenwich
Hounslow
Lewisham
Waltham Forest
Ealing
Haringey
Newham
Brent
Wandsworth
Lambeth
Hackney
Hammersmith and…
Southwark
Tower Hamlets
Islington
Camden
Kensington and…
Westminster
City of London
% mortality (mean)
Borough
Mean Fraction (%) of mortality attributable to PM
2.5
and NO
2
Mean Fraction (%) of mortality attributable to PM2.5 and NO2 London Average
Figure 8 Mean fraction of mortality attributable to PM
2.5
and NO
2
in each London borough
Air Quality Information for Public Health Professionals – London Borough of Lewisham
31
The Imperial College research also looked at a breakdown of mortality burden and life years lost at
a ward level across London (table 4). Results are presented as an upper and lower range of life
years lost based on the multi pollutant exploratory method (including life years lost as a result of
PM
2.5
and NO
2
).
Table 4 Mortality burden and life years lost attributed to exposure to PM
2.5
and NO
2
pollution in
2019 in wards in the London Borough of Lewisham.
Ward
Population
Deaths
(all
causes)
Mortality
burden
(min)
Mortality
burden
(max)
Life years
lost (min)
Life years
lost
(max)
Bellingham
19170
163
11.86
13.62
214.76
246.50
Blackheath
18877
127
9.73
11.00
179.61
202.99
Brockley
20573
125
9.84
11.04
202.88
227.58
Catford South
19887
215
15.62
17.93
252.44
290.14
Crofton Park
19897
133
9.91
11.28
200.89
228.49
Downham
18869
203
14.35
16.65
296.05
343.44
Evelyn
20579
124
9.85
11.02
218.95
245.15
Forest Hill
19927
171
12.85
14.61
267.40
303.95
Grove Park
19218
229
16.15
18.67
253.77
293.34
Ladywell
17802
177
13.03
14.86
322.45
368.14
Lee Green
20511
155
11.56
13.20
213.57
243.64
Lewisham
Central
25350
195
14.98
16.99
284.84
322.86
New Cross
19075
157
12.34
13.81
256.48
287.02
Perry Vale
20753
125
9.21
10.55
204.66
234.43
Rushey Green
19450
166
12.85
14.49
218.40
246.61
Sydenham
21251
235
17.34
19.80
282.51
322.41
Telegraph Hill
20455
115
9.05
10.16
187.30
210.61
Whitefoot
18212
169
12.04
13.88
228.18
262.97
Air Quality Information for Public Health Professionals – London Borough of Lewisham
32
6 WHY FURTHER ACTION IS NEEDED
Some of the actions already being taken across London to improve air quality are presented in
section 4.3 above. However, there is much to do with most of London exceeding the interim WHO
guideline limit for PM
2.5
. In addition, areas of the capital still exceed NO
2
WHO guideline values.
Currently there is no clear evidence of a safe level of exposure below which there is no risk of
adverse health effects; therefore, further reductions in concentrations of PM and NO
2
likely to
bring additional health benefits. Coordinated action and collaboration is needed to reduce air
pollution, improve health and to reduce health inequalities.
6.1 Maximising the health benefits from improving air quality
Certain measures to improve air quality have significant co-benefits for health and reducing health
inequalities if appropriately targeted. PHE’s (now UK HSA) 2019 evidence review
54
looked at how
to reduce the harm to health from outdoor air pollution. It found that there is some strong
evidence that interventions in each of the five areas reviewed can reduce harmful emissions. This
includes vehicles and fuels, spatial planning, industry, agriculture, and people’s behaviour. They
recommend adopting an intervention hierarchy approach. That means taking measures to prevent
or reduce pollution rather than mitigation after it occurs or relying on reducing exposure. It also
recommends adopting a ‘net health gain’ principle so that any new development or proposed
changes should deliver an overall benefit to public health. Evaluation should be embedded in the
design and costing of all interventions to gather evidence to inform best practice in the future.
54
UKHSA (2019) Review of interventions to improve outdoor air quality and public health: Principal interventions for
local authorities
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/937341/Principa
l_interventions_for_local_authorities-air_quality_public_health.pdf
Figure 9 Illustrated Air Pollution Hierarchy, taken from PHE’s 2019 evidence review.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
33
6.2 Communicating with patients and the public
The Prevention of Future Deaths report after the Ella Adoo-Kissi-Debrah inquest highlighted the
public’s low awareness of the health impacts of air pollution. It made the case for better
communication of these risks and what people can do about them. Both local authorities and
medical and nursing professionals should provide this information, for example by signposting to
Defra’s pollution forecast and various online resources
55
,
56
. This is needed both during air
pollution episodes and more generally regarding the long-term benefits to health of improving air
quality. It is an important area with opportunities for stronger local authority - NHS collaboration
at local and integrated care system (ICS) level.
One of the many actions people can take to reduce their exposure and their contribution to air
pollution is to consider how they travel. Reducing unnecessary car trips can make a big difference.
It is important that health professionals and local government help communicate options to the
public to help them make the healthiest choices. Appendix 9 has a list of actions Londoners can
take to mitigate against air pollution. Local authorities also play an important role in enabling this
by investing in infrastructure, public transport and designing healthy environments.
55
https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution
56
https://www.cleanairhub.org.uk/
Figure 10 Why travel makes a difference. Taken from PHE Health Matters 2018
Air Quality Information for Public Health Professionals – London Borough of Lewisham
34
Case study: Mobilising GPs on air pollution
A recruitment campaign has been launched to engage 40 GPs from across England. The aim is to
explore the vital role they can play in protecting patients against air pollution. Learning from the
six-month pilot project will help shape a national model for GP action on air pollution. The 40
health professionals will become Clean Air Champions. Through the project they’ll discover how
best to engage patients on air pollution health risks, and what patients can do to reduce their
exposure.
Air pollution is well recognised as a critical public health issue. Evidence shows increases in the
daily number of GP respiratory consultations and inhaler prescriptions following short-term
increases in exposure to air pollution
57
. The project is supported by Defra and rolled out by Global
Action Plan and UK Health Alliance on Climate Change, with Imperial College London. GP Clean Air
Champions will be offered an air pollution training session and receive communications material
on air pollution to share with patients. Training materials for health professionals and patient
focused resources can also be found on the action for cleaner air website. For more information
contact [email protected] or visit the Clean Air Hub.
6.3 Actions boroughs can take to improve air quality
Boroughs have a statutory responsibility to deliver actions locally, and to detail these in up-to-date
Air Quality Action Plans. Boroughs should already use the LLAQM Borough Air Quality Action
Matrix as part of their London Local Air Quality Management action planning obligations. The list
of actions in the matrix use levers that are under borough control to help improve air quality. This
is not an exhaustive list, however. Boroughs should continue to explore new ways to improve local
air quality and build upon the suggested actions.
The Coroner for Inner South London, in his report following the inquest into Ella Adoo-Kissi-
Debrah’s death, noted there was low public awareness of pollution. It called for action to be taken
to improve public awareness about air pollution and its sources and impacts upon health. This
would help individuals reduce their personal exposure to air pollution. Central Government, the
Mayor of London, London Borough of Lewisham and medical professional organisations were
identified as the parties needing to take such action. However, the report is clearly also relevant to
all local authorities and other organisations responsible for protecting public health or improving
air quality.
Borough officers and public health professionals can play an important role in promoting and
empowering behaviour change for stakeholders and the general public to:
- reduce the sources of, and people’s exposure to, air pollution across the borough and
beyond
57
https://ehjournal.biomedcentral.com/articles/10.1186/s12940-021-00730-1#citeas
Air Quality Information for Public Health Professionals – London Borough of Lewisham
35
- achieve better health outcomes for all, particularly for vulnerable groups most impacted by
air pollution
Local Environment and Air Quality Strategies should be mindful of all forms of pollution. Risk
should be considered at both consistent low-level exposure and intermittent high-level exposure.
Borough officers and public health professionals should promote a step change in local transport
systems to prioritise air quality and public health. Investment in walking and cycling infrastructure
to enable active travel should be prioritised, alongside a rapid shift towards zero emission vehicles.
Boroughs and their local partner organisations have a key role to play in engaging with and raising
awareness among their residents. This includes informing them of London-wide measures and the
many initiatives in place to help reduce exposure to air pollution. For example, the new London
Schools Pollution Helpdesk, the Mayor’s pollution alerts and airTEXT alert service (see section 4.2).
Borough officers and public health professionals can also incorporate and promote adherence to
recently published NICE guidance on outdoor air quality and health
58
. This has guidance based on
four quality statements, spanning local authorities, public sector organisations and healthcare
providers, based on the most recent evidence.
Borough public health teams should work closely with air quality and environment colleagues and
prioritise communicating health messages to the public. This includes both during air pollution
episodes and more generally about the long-term health benefits of cleaner air.
In March 2021, Association of Directors of Public Health (ADPH) London and London Environment
Directors’ Network revised their joint position statement on air quality
59
. You can view their
recommendations for action to clean up London’s air in appendix 10. This includes the need for
London boroughs to support a shared narrative and campaign on air quality and public health
impacts across London. This will help change the public’s perception around their own
contribution to cleaner air.
Air pollution does not respect boundaries. Of course, localised emissions from transport, heating
and industry all contribute to London’s air pollution. However, it also receives a large amount
of transboundary pollution from outside the city. This is primarily true of PM, but to a far lesser
extent for gaseous pollutants like NO
2
. In fact, over half the city’s concentrations of PM
2.5
come
from regional and often transboundary sources outside of London
60
. Therefore, alongside local
action and collaboration with neighbouring boroughs, London needs national, European and
international action to meet the previous WHO guideline value of by 2030.
58
https://www.nice.org.uk/guidance/qs181
59
https://adph.org.uk/networks/london/wp-content/uploads/2021/03/ADPH-London-LEDNet-Air-Quality-Joint-
Position-full.pdf
60
https://www.london.gov.uk/sites/default/files/air_quality_in_london_2016-2020_october2020final.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
36
7 NEXT STEPS
We hope the updated air quality data and health information in this report will be of use
when developing local initiatives.
Under the Environment Act 1995
61
local authorities have a statutory responsibility to
participate in Local Air Quality Management. Actions must be delivered locally, and Air
Quality Action plans kept up to date and developed with public health involvement and
expertise.
Boroughs are encouraged to continue the ambitious action for cleaner air and improved
public awareness many already lead the way on. This work needs to be well coordinated
across London, particularly through work with neighbouring boroughs. Boroughs are also
asked to support Mayoral objectives around air quality including those within the London
Environment Strategy. This is part of the work towards achievement of the previous WHO
target for pollutants even when legal limits are met. Find out more and view resources
about borough obligations under the London Local Air Quality Management framework
here.
Public Health officers are asked to:
- work closely with relevant colleagues across air quality, transport, planning and housing
teams as well as wider stakeholders, as appropriate. This is in order to drive forward
action on the priorities and measures outlined in section 6.3
- include updated borough-specific data and updated epidemiological and health
economic evidence from this report in your Joint Strategic Needs Assessment (JSNA).
This will help ensure air quality is integrated into strategic decision making and relevant
council plans and strategies. The recent LAEI 2019 publication has useful data to include
in JSNAs
62
- act in line with the concerns raised in the Prevent Future Deaths report for Ella Adoo-
Kissi-Debrah
63
. Residents, especially those most vulnerable, must be informed about
both the impacts and sources of information about air pollution. It includes being
alerted to periods of higher pollution as well what steps they can take to reduce their
day-to-day exposure. This should be both through the local authority’s own public
communications and through partnership work with clinical and social care colleagues.
- ensure regular contact with your borough Air Quality Officer. Discuss what is being done
locally to tackle air quality and how to bring public health evidence and approaches to
bear in this work. Activities should include:
o Air Quality and Health agenda alignment
o Joint working on priority projects and input into key local strategies and the local
plan
61
www.environment-agency.gov.uk/netregs/legislation/.../107183.aspx
62
https://data.london.gov.uk/dataset/london-atmospheric-emissions-inventory--laei--2019
63
https://www.judiciary.uk/wp-content/uploads/2021/04/Ella-Kissi-Debrah-2021-0113-1.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
37
o Communications and messaging around air quality and health
o Reaching out to colleagues in healthcare organisations, such as doctors, nurses and
pharmacists around opportunities to strengthen their education, training and
awareness in relation to air quality.
o Funding for initiatives
o Sharing best practice to GPs and sensitive receptors
- ensure that you are consulted early on any planned Air Quality Action Plan updates and
identify opportunities for maximising the health benefits. Make relevant connections
with your Health and Wellbeing Strategy. For example, by promoting physical activity
through increasing walking and cycling or ensuring improvements to housing stock
tackle fuel poverty and improve ventilation.
Please share your thoughts on this report and what information would be useful to you. Let us
know about any innovative work on air quality and health you are doing in your borough.
Find out more at http://www.london.gov.uk/airquality
For any comments or questions please email [email protected]
Air Quality Information for Public Health Professionals – London Borough of Lewisham
38
8 APPENDICES
Appendix 1 National Air Quality objectives and European Directive limit and target
values
64
64
This does not include the 2020 amendments to PM
2.5
limit values.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
40
Appendix 2 Fraction (%) of mortality attributable to long term exposure to PM
2.5
(2019)
Local Authority
Fraction (%) of mortality attributable to long-term exposure to PM
2.5
Barking and Dagenham
6.8
Barnet
6.3
Bexley
6.1
Brent
6.4
Bromley
5.7
Camden
6.6
City of London
6.9
Croydon
6.0
Ealing
6.4
Enfield
6.5
Greenwich
6.4
Hackney
6.8
Hammersmith and Fulham
6.6
Haringey
6.6
Harrow
6.0
Havering
6.0
Hillingdon
6.0
Hounslow
6.2
Islington
6.8
Kensington and Chelsea
6.8
Kingston upon Thames
5.9
Lambeth
6.6
Lewisham
6.4
Merton
6.3
Newham
7.0
Redbridge
6.7
Richmond upon Thames
6.0
Southwark
6.6
Sutton
5.8
Tower Hamlets
6.7
Waltham Forest
6.9
Wandsworth
6.4
Westminster
6.8
London Region
6.4
England
5.1
Air Quality Information for Public Health Professionals – London Borough of Lewisham
41
Appendix 3 Public Health Outcomes Framework indicators that could be
influenced by policies to improve air quality
Theme
Public Health Outcomes Framework Indicator
Air pollution
Fraction of mortality attributable to particulate air pollution
Noise pollution
The percentage of the population exposed to road, rail and
air transport noise of 65dB(A) or more, during the daytime
The percentage of the population exposed to road, rail and
air transport noise of 55 dB(A) or more during the night-time
Fuel poverty
Fuel poverty
Sustainability
plans
NHS organisations with a board approved sustainable
development management plan
Life expectancy
Healthy life expectancy at birth and aged 65 (males &
females)
Life expectancy at birth and aged 65 (males & females)
Disability-free life expectancy at birth and aged 65 (males &
females)
Inequality in life expectancy at birth and aged 65 (males &
females)
Premature
mortality
Mortality rate from causes considered preventable
Under 75 mortality rate from cardiovascular diseases
considered preventable
Under 75 mortality rate from cancer considered preventable
Under 75 mortality rate from respiratory disease considered
preventable
Musculoskeletal
problem
Percentage reporting a long term musculoskeletal (MSK)
problem
Excess winter
deaths
Excess winter deaths index and in those aged 85+
Low birth weight
babies
Low birth weight of term babies
Use of outdoor
space
Utilisation of outdoor space for exercise/health reasons
Physical activity
Percentage of physically active children and young people
Percentage of physically active adults and percentage of
physically inactive adults
Overweight and
obesity
Obesity in early pregnancy
Reception: Prevalence of overweight (including obesity)
Year 6: Prevalence of overweight (including obesity)
Percentage of adults (aged 18+) classified as overweight or
obese
Air Quality Information for Public Health Professionals – London Borough of Lewisham
42
Theme
Public Health Outcomes Framework Indicator
Road traffic
accidents
Killed and seriously injured (KSI) casualties on England’s
roads
Injuries
Hospital admissions caused by unintentional and deliberate
injuries in children (aged 0-14 years; 0-4 years and 15-24
years)
Falls and hip
fractures
Emergency hospital admissions due to falls in people aged
65 and over; aged 65-79 and 80+
Hip fractures in people aged 65 and over; aged 65-79 and
80+
Social interaction
Social Isolation: percentage of adult social care users and
adult carers who have as much social contact as they would
like
Self-reported
wellbeing
Self-reported wellbeing - people with a low satisfaction score
Self-reported wellbeing - people with a low worthwhile score
Self-reported wellbeing - people with a low happiness score
Self-reported wellbeing - people with a high anxiety score
Sickness absence
Percentage of employees who had at least one day off in the
previous week and percentage of working days lost due to
sickness absence in previous week
There are other public health indicators which are included in other public health profiles rather
than the PHOF itself which could be influenced by policies to improve air quality. These include but
are not limited to the following:
Prevalence of and mortality from asthma and COPD and hospital admissions for asthma, COPD and
other respiratory diseases, which are found here: Inhale - INteractive Health Atlas of Lung
conditions in England - PHE
Prevalence of diabetes, coronary heart disease and stroke, which are found here:
Cardiovascular Disease - PHE
Additional indicators related to active travel and physical activity can be found here -
https://fingertips.phe.org.uk/profile/physical-activity
Air Quality Information for Public Health Professionals – London Borough of Lewisham
43
Appendix 4 Relevant London Strategies
London Health inequalities strategy, 2018
65
The London Health Inequalities Strategy sets out the Mayor’s aims and objectives for addressing
health inequalities in London. It provides a vision for the health of Londoners and sets a direction
of travel for collaborative working over the next ten years, with partners, agencies and
communities. The strategy is supported by a ‘health in all policies’ approach. This means that
many of the actions that the Mayor will take which will have an impact upon health inequalities,
originate in other Mayoral strategies. The Mayor’s key ambition under the strategy’s ‘Healthy
Places aim is ‘for London to have the best air quality of any global city, with progress fastest in the
most polluted areas, benefitting people most vulnerable to the effects of air pollution’.
The Health and Care Vision for London, 2019
66
The London Vision partnership is made up of the Greater London Authority, UKHSA, London
Councils and the National Health Service (NHS) in London. It exists to provide coordinated
leadership and a shared ambition to make our London the healthiest global city and the best
global city in which to receive health and care services. It reflects the Mayor’s Health Inequalities
Strategy, London Councils’ Pledges to Londoners, the Prevention Green Paper and the NHS Long
Term Plan. Air quality has been prioritised one of the ten key areas of focus where partnership
action is needed at a pan-London level, with the ambition that every Londoner breathes safe air,
and a commitment by the Mayor, NHS England, London Councils and UKHSA to work together to
reach legal NO
2
concentration limits and to work towards WHO PM
2.5
limits by 2030.
London Plan
67
The new London Plan (2021) introduces significant new protections for local and regional air
quality, including in relation to the most damaging PM
2.5
particulates. For the first time, the largest
developments will be required to take an Air Quality Positive approach, meaning that they will
have to consider in depth how they will contribute to improving local and regional air quality
through intelligent approaches to design, the urban realm and heating and transport
infrastructure.
More broadly the new London Plan requires all new developments to take into account local air
quality to ensure that they are suitable for their use and location, that they are Air Quality Neutral,
that they do not have unacceptable impacts during construction and that they take particular care
to protect the most vulnerable and most disadvantaged members of society.
65
https://www.london.gov.uk/sites/default/files/health_strategy_2018_low_res_fa1.pdf
66
11448_hlp_london_vision_-_annual_report_2019_full_version.pdf
67
https://www.london.gov.uk/sites/default/files/the_london_plan_2021.pdf
Air Quality Information for Public Health Professionals – London Borough of Lewisham
44
Mayor’s London Environment Strategy (LES)
68
The Mayor’s London Environment Strategy (LES) was published in May 2018. The LES sets out how
London will have the cleanest air of any major world city, meeting legal requirements and the
previous WHO health-based guidelines. The LES has multiple environmental objectives: improving
air quality to protect public health, creating new green spaces and improving biodiversity,
reducing greenhouse gas emissions and increasing efficiency of energy, waste and water, and
helping London to prevent and adapt against climate change. The three air quality objectives
under which all other polices and proposals are structured are:
Objective 4.1 Support and empower London and its communities, particularly the most
disadvantaged and those in priority locations, to reduce their exposure to poor air quality
Objective 4.2 Achieve legal compliance with UK and EU limits as soon as possible, including by
mobilising action from London Boroughs, Government and other partners
Objective 4.3 Establish and achieve new, tighter air quality targets for a cleaner London by
transitioning to a zero emission London by 2030, meeting WHO Health based guidelines for air
quality
The Mayor’s Transport Strategy
69
The Mayor's Transport Strategy (MTS) sets out the Mayor’s policies and proposals to reshape
transport in London over the next two decades with the ambition that 80% of trips are made by
active or sustainable modes (walking, cycling and public transport) with all Londoners achieving
the 20 minutes of active travel each day that they need to stay healthy by 2041.
Transport has the potential to shape London, from the streets where Londoners live, work and
spend time, to the Tube, rail and bus services they use every day. By using the Healthy Streets
Approach to prioritise human health and experience in planning the city, the Mayor wants to
change London’s transport mix so the city works better for everyone
68
https://www.london.gov.uk/what-we-do/environment/london-environment-strategy
69
https://www.london.gov.uk/what-we-do/transport/our-vision-transport/mayors-transport-strategy-2018
Air Quality Information for Public Health Professionals – London Borough of Lewisham
45
Appendix 5 PM monitoring in LB Lewisham
Annual Mean PM
10
Concentration monitoring results (μg m
-3
)
Site
2014
2015
2016
2017
2018
2019
2020
New Cross
23
23
24
23
21
20
19
Loampit Vale
25
17
26
21
19
20
19
Honor Oak Park
N/A
N/A
N/A
N/A
N/A
15
14
Annual Mean PM
2.5
Concentration monitoring results (μg m
-3
)
Site
2014
2015
2016
2017
2018
2019
2020
New Cross
17
16
19
16
15
15
13
Lewisham Depot
N/A
N/A
N/A
N/A
N/A
N/A
9
Honor Oak Park
N/A
N/A
N/A
N/A
N/A
N/A
9
Air Quality Information for Public Health Professionals – London Borough of Lewisham
46
Appendix 6 Population exposure
The table below summarises the number of care homes, hospitals and medical centres, schools,
and nurseries in Lewisham and shows the number of each exceeding the PM
2.5
legal limit
(25µg/m
3
), interim WHO guideline (10µg/m
3
) and final WHO guideline limit (5µg/m
3
). Full datasets
can be found in the LAEI2019.
The table below summarises the number of care homes, hospitals and medical centres, schools,
and nurseries in Lewisham and shows the number of each exceeding the NO
2
legal limit (40µg/m
3
),
interim WHO guideline (30µg/m
3
) and final WHO guideline limit (10µg/m
3
). Full datasets can be
found in the LAEI2019.
Number of care
homes
Number exceeding
PM
2.5
legal
(25µg/m
3
)
Number exceeding
PM
2.5
WHO interim
(10µg/m
3
)
Number exceeding
PM
2.5
WHO final
(5µg/m
3
)
3
3
3
Number of Hospitals
and medical centres
Number exceeding
PM
2.5
legal
(25µg/m
3
)
Number exceeding
PM
2.5
WHO interim
(10µg/m
3
)
Number exceeding
PM
2.5
WHO final
(5µg/m
3
)
4
4
4
Number of Schools
Number exceeding
PM
2.5
legal
(25µg/m
3
)
Number exceeding
PM
2.5
WHO interim
(10µg/m
3
)
Number exceeding
PM
2.5
WHO final
(5µg/m
3
)
98
98
98
Number of
Nurseries
Number exceeding
PM
2.5
legal
(25µg/m
3
)
Number exceeding
PM
2.5
WHO interim
(10µg/m
3
)
Number exceeding
PM
2.5
WHO final
(5µg/m
3
)
2
1
2
Number of care
homes
Number exceeding
NO
2
legal (40µg/m
3
)
Number exceeding
NO
2
WHO interim
(30µg/m
3
)
Number exceeding
NO
2
WHO final
(10µg/m
3
)
3
3
Number of Hospitals
and medical centres
Number exceeding
NO
2
legal (40µg/m
3
)
Number exceeding
NO
2
WHO interim
(30µg/m
3
)
Number exceeding
NO
2
WHO final
(10µg/m
3
)
4
1
4
Number of Schools
Number exceeding
NO
2
legal (40µg/m
3
)
Number exceeding
NO
2
WHO interim
(30µg/m
3
)
Number exceeding
NO
2
WHO final
(10µg/m
3
)
98
16
98
Number of
Nurseries
Number exceeding
NO
2
legal (40µg/m
3
)
Number exceeding
NO
2
WHO interim
(30µg/m
3
)
Number exceeding
NO
2
WHO final
(10µg/m
3
)
2
1
2
Air Quality Information for Public Health Professionals – London Borough of Lewisham
47
Care homes
London context
Of an estimated 322 care homes, none are in locations where the average NO
2
concentration was
above the legal limit in 2019. 281 (87%) of these facilities are in areas exceeding the WHO interim
PM
2.5
guideline of 10µg/m
3
and all are in areas exceeding the WHO PM
2.5
guideline of 5µg/m
3
.
Lewisham
All care homes in Lewisham exceed the interim WHO guideline of 10µg/m
3
for PM
2.5
(highlighted
orange below right) and the WHO guideline of 10µg/m
3
for NO
2
(highlighted yellow below left).
Data are presented in alphabetical order.
Care homes in Lewisham
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019 Average
PM
2.5
(ug/m
3
)
Brymore House Care Home
25.7
10.4
Flemming House
29.4
10.8
South London And Maudsley
26.3
10.5
Hospitals and medical centres
London Context
Of an estimated 291 hospitals it is estimated that 26 (9%) of these are in locations where the
average NO
2
concentration was above the legal limit for NO
2
in 2019. 295 (91%) of these facilities
were in areas exceeding the WHO interim PM
2.5
guideline of 10µg/m
3
and all were in areas
exceeding the WHO PM
2.5
guideline of 5µg/m
3
.
Lewisham
There are four hospitals and medical centres in Lewisham all of which exceed the interim WHO
guideline of 10µg/m
3
for PM
2.5
(highlighted orange below right) and one of which exceeds the
interim WHO guideline of 30µg/m
3
for NO
2
(highlighted orange below left). Data are presented in
alphabetical order.
Hospitals and medical centres
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019
Average PM
2.5
(ug/m
3
)
Northover Mental Health Centre
24.8
10.3
The Blackheath Hospital
28
10.8
The Blackheath Hospital
Outpatient Centre
30.4
11.1
University Hospital Lewisham
29.1
11
Air Quality Information for Public Health Professionals – London Borough of Lewisham
48
Schools and Nurseries
London Context
Analysis of NO
2
concentration data shows that the following number of each type of educational
facilities are in areas of NO
2
exceedance of the legal limit in 2019. Analysis shows that of 3,262
education establishments assessed in London, 52 (1.6%) are in areas exceeding legal limits for
NO
2
. Analysis shows that of 2,258 state primary and secondary schools, 20 (0.9%) are in areas
exceeding legal limit of 40µg/m
3
for NO
2
. The analysis of PM
2.5
concentrations (based on a 150m
buffer) indicates that 88% of schools (2,883 establishments) are in areas exceeding the WHO
interim guideline of 10µg/m
3
with all exceeding the WHO guideline of 5µg/m
3
.
Lewisham
There are two nurseries in Lewisham both of which exceed the interim WHO guideline of 10µg/m
3
for PM
2.5
(highlighted orange below right) and one of which exceeds the WHO interim guideline of
30µg/m
3
for NO
2
(highlighted orange below left). Data are presented in alphabetical order.
There are 98 schools in Lewisham, all of which exceed the interim WHO guideline of 10µg/m
3
for
PM
2.5
(highlighted orange below right) and 16 of which exceed the interim WHO guideline of
30µg/m
3
for NO
2
(highlighted orange below left). No schools in Lewisham exceed the legal limit for
NO
2.
Data are presented in alphabetical order.
Schools
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019
Average PM
2.5
(ug/m
3
)
Abbey Manor College
28.4
10.7
Adamsrill Primary School
26.1
10.6
Addey and Stanhope School
32.6
11.3
All Saints' Church of England Primary School
Blackheath
27.7
10.7
Allenby Tutorial Trust
27.2
10.6
Ashmead Primary School
30.5
11.1
Athelney Primary School
25.3
10.4
Baring Primary School
27.8
10.7
Beecroft Garden Primary
28.3
10.8
Bonus Pastor Catholic College
25
10.4
Brent Knoll School
27.1
10.7
Nurseries
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019
Average PM
2.5
(ug/m
3
)
Chelwood Nursery School
27.9
10.7
Clyde Nursery School
31.7
11.3
Air Quality Information for Public Health Professionals – London Borough of Lewisham
49
Schools
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019
Average PM
2.5
(ug/m
3
)
Brindishe Green School
27.2
10.6
Brindishe Lee School
26.3
10.5
Brindishe Manor School
26
10.5
Childeric Primary School
29.6
11
Christ The King Sixth Form College
27.1
10.6
Conisborough College
25.2
10.4
Cooper's Lane Primary School
24.9
10.3
Dalmain Primary School
28.7
10.8
Deptford Green School
30.4
11.1
Deptford Park Primary School
32.2
11.3
Downderry Primary School
24.5
10.3
Drumbeat School and ASD Service
24.5
10.3
Edmund Waller Primary School
28.6
10.8
Education-My Life Matters
29
11
Elfrida Primary School
25.3
10.4
Eliot Bank Primary School
27.9
10.7
Fairlawn Primary School
27.6
10.6
Forest Hill School
25.9
10.5
Forster Park Primary School
24.6
10.3
Goldsmiths College, University of London
31
11.2
Good Shepherd RC School
23.9
10.2
Gordonbrock Primary School
27.3
10.7
Greenvale School
27.2
10.7
Grinling Gibbons Primary School
31.8
11.4
Haberdashers' Aske's Hatcham College
28.2
10.8
Haberdashers' Aske's Hatcham Temple Grove
28.9
10.9
Haberdashers' Aske's Hatcham Temple Grove Free
School
28.6
10.8
Haberdashers' Aske's Knights Academy
24.2
10.2
Haberdashers' Aske's Knights Temple Grove
24.4
10.3
Haseltine Primary School
30.2
11.1
Heath House Preparatory School
31.2
11.1
Holbeach Primary School
26.4
10.5
Holy Cross Catholic Primary School
27.1
10.6
Holy Trinity Church of England Primary School
27.7
10.7
Horniman Primary School
26.6
10.5
John Ball Primary School
27.7
10.7
John Stainer Community Primary School
28.4
10.8
Kelvin Grove Primary School
27.1
10.6
Kender Primary School
31.6
11.1
Air Quality Information for Public Health Professionals – London Borough of Lewisham
50
Schools
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019
Average PM
2.5
(ug/m
3
)
Kilmorie Primary School
26
10.5
Kings Kids Christian School
28.8
10.9
Launcelot Primary School
25.2
10.4
Lucas Vale Primary School
30
11
Marathon Science School
33
11.4
Marvels Lane Primary School
24.7
10.2
Myatt Garden Primary School
29.1
10.9
New Woodlands School
24.2
10.3
Our Lady and St Philip Neri Roman Catholic Primary
School
27.7
10.8
Perrymount Primary School
26.3
10.6
Prendergast Ladywell School
26.0
10.5
Prendergast School
26.7
10.6
Prendergast Vale School
29.8
11
Rangefield Primary School
24.4
10.3
Rathfern Primary School
27.5
10.7
Rose House Montessori School
26.3
10.6
Rushey Green Primary School
29.9
11.1
Sandhurst Primary School
26
10.5
Sedgehill Academy
24.6
10.2
Sir Francis Drake Primary School
30.1
11
St Augustine's Catholic Primary School and Nursery
26
10.5
St Bartholomews's Church of England Primary School
25.9
10.5
St Dunstan's College
28.9
10.9
St George's CofE Primary School
27.7
10.8
St James's Hatcham Church of England Primary
School
30.8
11.2
St John Baptist Southend Church of England Primary
School
29
10.9
St Joseph's Catholic Primary School
29.5
11.1
St Margaret's Lee CofE Primary School
28.1
10.8
St Mary Magdalen's Catholic Primary School
26.9
10.6
St Mary's Lewisham Church of England Primary
School
30.1
11.1
St Matthew Academy
27
10.6
St Michael's Church of England Primary School
25.8
10.5
St Saviour's Catholic Primary School
28.3
10.8
St Stephen's CofE Primary School
28.7
10.8
St William of York Catholic Primary School
26.4
10.5
St Winifred's RC Primary School
25.9
10.4
Air Quality Information for Public Health Professionals – London Borough of Lewisham
51
Schools
LAEI 2019
Average NO
2
(ug/m
3
)
LAEI 2019
Average PM
2.5
(ug/m
3
)
Stillness Infant School
27.7
10.7
Stillness Junior School
27.7
10.7
Sydenham High School GDST
26.9
10.5
Sydenham School
27.4
10.7
The Family Learning School
29.6
11
The Young Women's Hub
28.8
10.9
Tidemill Academy
30.7
11.2
TLG Lewisham
31.9
11.3
Torridon Primary School
25.1
10.4
Trinity Church of England School, Lewisham
26.1
10.5
Turnham Academy
27.9
10.7
Watergate School
26
10.5
Air Quality Information for Public Health Professionals – London Borough of Lewisham
52
Appendix 7 Imperial College London study data sources and methodology
Air Quality data was taken from 20m grid data to OA concentration. Particulate matter with
diameter <2.5 um (PM
2.5
) and nitrogen dioxide (NO2) annual mean concentrations across Greater
London were predicted for a range of years between 2013 and 2050 using the London Air Quality
Toolkit (LAQT) model as part of previous studies commissioned and undertaken in partnership
with TfL and GLA. These included the “LAEI 2013”
70
, “LAEI 2016”
71
, “2019 snapshot (Dajnak et al.,
2020b)”, “Low Emission Zone (LEZ) Scenarios”, “Ultra Low Emission Zone (ULEZ)”
72
, “London
Environment Strategy (LES)”
73
and “PM
2.5
in London: Roadmap to meeting WHO (2005) guidelines
by 2030”
74
. PM
2.5
and NO
2
annual mean concentrations air pollution data were extracted at 20m
grid resolution and intersected with the latest Output Area (OA) layer from the Office of National
Statistics (ONS)
75
for the Greater London area (a total of 25,053 OAs). Each concentration grid
point within each OA was further averaged at OA level.
Population-weighted average concentration (PWAC): Population-weighting was done at LSOA
(Lower Super Output Area) and Ward level in the case of the mortality burden and impact
calculations, respectively. The OA averaged concentrations were multiplied by the population
aged 30 plus for each gender and the resulting population-concentration product summed across
all OAs in each LSOA and Ward and then divided by the LSOA and Ward population, respectively.
The LSOA and Ward population-weighted means were then used directly in the health impact
calculations across all LSOA and Wards in London (This process allows one health calculation per
LSOA or Ward rather than calculations in each separate OA).
Previously, burden calculations were based only on concentrations of PM
2.5
(COMEAP, 2010). The
new COMEAP report considers whether there is an additional burden or impact from nitrogen
dioxide or other pollutants with which it is closely correlated. The method considers both
pollutants together, as correlations between the pollutants mean that health studies in the
population for either pollutant alone, actually overlaps with the effects of the other pollutant.
Burden calculations are a snapshot of the burden in one specific year, assuming that
concentrations had been the same for many years beforehand. They are not suitable for
calculation in several successive years as they do not have a mechanism for allowing the number
of deaths the year before to influence the age and population size the following year as the
lifetables used in impact calculations do. The current (2019) burden and mortality impacts
calculations update the 2010 calculations in Walton et al (2015) with both the new methodology in
COMEAP (2018a) and new input data for 2019.
70
https://data.london.gov.uk/dataset/london-atmospheric-emissions-inventory-2013
71
London Atmospheric Emissions (LAEI) 2016 - London Datastore
72
https://consultations.tfl.gov.uk/environment/air-quality-consultation-phase-3b/user_uploads/supporting-
information-document-updated-12.12.17.pdf
73
https://www.london.gov.uk/sites/default/files/london_environment_strategy-_draft_for_public_consultation.pdf
74
PM2.5 in London: Roadmap to meeting WHO guidelines by 2030 | London City Hall
75
Statistical GIS Boundary Files for London - London Datastore
Air Quality Information for Public Health Professionals – London Borough of Lewisham
53
Appendix 8 Local Authority population, total deaths from all causes, range of
mortality burden (deaths) for PM
2.5
and NO
2
and mean fraction of mortality
attributable to PM
2.5
and NO
2
in 2019.
Results are presented as an upper and lower range based on the multi pollutant exploratory
method.
Local Authority
Population
Total deaths
(all causes)
Min Mortality
Burden (PM
2.5
and NO
2
)
Max Mortality
Burden (PM
2.5
and NO
2
)
Mean Fraction
(%) of
mortality
attributable to
PM
2.5
and NO
2
Barking and
Dagenham
112817
1196
84
97
7.6
Barnet
237392
2377
177
201
7.9
Bexley
152358
2030
139
162
7.4
Brent
194987
1695
133
149
8.3
Bromley
214539
2633
172
204
7.1
Camden
148202
1121
99
109
9.2
City of London
5336
39
4
4
10.1
Croydon
234684
2460
168
196
7.4
Ealing
208672
1926
147
165
8.1
Enfield
196590
1999
142
164
7.6
Greenwich
165076
1538
113
129
7.9
Hackney
159657
1051
86
96
8.7
Hammersmith
and Fulham
110435
904
74
83
8.7
Haringey
163007
1158
90
101
8.2
Harrow
154615
1459
102
118
7.5
Havering
161093
2372
149
178
6.9
Hillingdon
178404
1941
135
155
7.5
Hounslow
162861
1510
114
128
8.0
Islington
130719
1058
90
100
9.0
Kensington and
Chelsea
103440
801
70
77
9.2
Kingston upon
Thames
106433
1070
76
87
7.6
Lambeth
188880
1399
112
126
8.5
Lewisham
179928
1491
111
127
8.0
Merton
129272
1204
87
100
7.8
Newham
187014
1271
98
111
8.2
Redbridge
177858
1699
124
142
7.8
Richmond upon
Thames
129096
1190
86
98
7.7
Air Quality Information for Public Health Professionals – London Borough of Lewisham
54
Local Authority
Population
Total deaths
(all causes)
Min Mortality
Burden (PM
2.5
and NO
2
)
Max Mortality
Burden (PM
2.5
and NO
2
)
Mean Fraction
(%) of
mortality
attributable to
PM
2.5
and NO
2
Southwark
181281
1327
109
121
8.7
Sutton
129996
1481
101
118
7.4
Tower Hamlets
163630
1039
88
97
8.9
Waltham Forest
163151
1371
102
116
8.0
Wandsworth
194946
1475
115
129
8.3
Westminster
156281
1091
100
110
9.6
Air Quality Information for Public Health Professionals – London Borough of Lewisham
55
Appendix 9 Actions for Londoners to mitigate against air pollution
Travel
• If possible walk, cycle or take public transport rather than travelling by car, and choose less
polluted routes, for example by using the GLA’s Clean Air Route Finder.
• If you need to drive:
- ensure that your car is not wasting fuel by regularly checking oil levels and tyres are not flat
- use eco driving techniques as advised by the Energy Saving Trust
76
- avoid idling your engine when stationary
- consider joining a car club
• If you are buying a car:
- avoid older diesel cars, as they tend to be more polluting than petrol models
- buy the most efficient and cleanest vehicle that you can. Look for the car’s Euro standard –
this is the air pollution standard that the vehicle was constructed to meet, ranging from
Euro 1 (worst) to Euro 6 (best). Note, following the ULEZ expansion, diesel cars must be
Euro 6 or will be subject to ULEZ daily charge if in the expanded zone.
- consider purchasing an electric car and benefit from road tax and congestion charge
exemption, cheaper fuel costs and government subsidies. From 2030 it will no longer be
possible to buy a new conventional internal combustion engine car.
- Consider if you really need to own a car and if it would be more economical to join a car
club
At work
• Develop travel plans to encourage and support employees to use public transport, walk or
cycle
• Consider changes to reimbursement arranges that incentivise uptake of more active modes of
travel.
• If employees must drive as part of their jobs, organise eco-driving training for them
• Install workplace energy efficiency measures, including replacing old boilers
77
• Freight operators are encouraged to sign up to TfL's Freight Operator Recognition Scheme
which encourages safe and sustainable driving and maintenance practices
• Buy, or hire, the cleanest vehicles available
78
76
http://www.energysavingtrust.org.uk/Transport/Consumer/Fuel-efficient-driving
77
www.green500.co.uk
78
www.travelfootprint.org
Air Quality Information for Public Health Professionals – London Borough of Lewisham
56
At home
• Turn down the central heating when possible
• Install home energy efficiency measures
• Avoid installing polluting wood-burning stoves (and only use the cleanest approved fuels) and
avoid burning garden or domestic waste
• reduce use of household sprays, air fresheners and other aerosols, and always follow product
instructions
• if possible, avoid or reduce activities that produce particulate matter such as using open solid-
fuel fires or candles and always keep the room well ventilated during these activities
• reduce damp and condensation and prevent mould by:
• using background ventilation (such as trickle vents, or whole-house mechanical
ventilation systems)
• using mechanical ventilation (such as extractor fans), and opening windows where
possible and safe to provide temporary increased ventilation
• avoiding moisture-producing activities (such as air-drying clothes) indoors if possible,
or improving ventilation if these cannot be avoided
• repairing sources of water damage and ensuring that residual moisture is removed
More advice for improving indoor air quality at home can be found in the NICE guidance.
Air Quality Information for Public Health Professionals – London Borough of Lewisham
57
Appendix 10 LEDNET/ ADPH Recommendations for action to clean up
London’s air
In light of the COVID-19 pandemic, the Association of Directors of Public Health (ADPH) London
and London Environment Directors’ Network (LEDNET) have revised their joint position on air
quality.
79
They provided the following recommendations for action by a wide range of actors and
decision-makers, at national and local levels, to clean up London’s air:
• To advocate for at least 2.5% of UK annual GDP to be spent on tackling air quality and
climate change in the UK.
• Capitalise on behavioural changes on active travel during COVID-19 pandemic, protect
Londoners, particularly children and young people from exposure to poor air quality, and
promote further inclusive active travel.
• Support a London-wide shared narrative and campaign on air quality and public health
impacts to change perception on how they contribute to air pollution.
• Restrict driving fuelled by petrol or diesel and support cleaner alternatives by supporting
schemes such as the ULEZ and scrappage schemes. In addition, support local schemes such
as restricted and emissions-based parking, low emissions zones, school streets and Low
emission neighbourhoods. Finally, build better walking and cycling infrastructure.
• Support retrofitting schemes of London’s residential properties to reduce fuel poverty,
address health issues caused by inefficient housing and green the economic recovery from
the COVID-19 pandemic.
• Use public sector procurement and social value action to reduce our own contribution to
air pollution, particularly by moving faster towards ultra-low and zero emissions vehicle
fleets.
• Speak with one voice as boroughs to secure the resources and powers needed to reduce
air pollution and protect the health of our residents
79
https://adph.org.uk/networks/london/wp-content/uploads/2021/03/ADPH-London-LEDNet-Air-Quality-Joint-
Position-full.pdf
