The current smog – whilst unnerving for those living through it – is a welcome opportunity to focus on an under-reported scandal of modern British public health. We are being killed, silently and invisibly in the thousands, by the air we breathe. And few in Public Health, let alone the media, is noticing. Why?

The mainstream narrative on public health this century revolves around behaviour and chronic disease. The major health challenges were tackled by the Victorians and the social reforms of the 20th Century. First sewerage and water, through factory acts and public housing, then lately the clean air act in the 1950s meant the big industrial killers and (with vaccines and antibiotics) major infectious diseases were solved. In their place we have a new set of evils – diet, exercise, smoking, alcohol and sex, particularly amongst the poor.

Public Health England has a nice list in its priorities: “We know the most significant factors that lead to poor health: smoking; high blood pressure; obesity; poor diet; lack of exercise; and excessive alcohol consumption.”

This shift fit with the New Right and then New Labour focus on individual responsibility and (at best) a behaviour-regulating Government. Regulation gave way to nudge. For the right, moralistic victim-blaming whilst railing at a state reduced to nannying personal choices. For the left, a doomed mission to explain the complex social determinants (and commercial pressures) driving behaviour itself.

So it is not surprising perhaps that air pollution has gone out of fashion since the closure of heavy industry and this shift in political status quo. Until, that is, you learn (as I did today) that air pollution is responsible for 29,000 premature deaths, half a year off life expectancy and is the second biggest cause of premature death after smoking but before obesity or alcohol. In the light of these figures, the air-brushing of pollution from the priorities of public health policy is nothing short of surreal.

Perhaps our blindness to air pollution is that, apart from this week, it is usually invisible. Perhaps, it does not fit into our understanding of post-industrial Britain where dirty industry is off-shored to the Developing world. Perhaps it is a victim of Government departmental silos, but Defra lacks the budget or (potential) clout of the Department of Health. Certainly the Treasury has been keen to dilute the Cameron Greenwash as being anti-business. But I can’t remember Labour being much louder about it – with the notable exception of Livingstone’s pioneering policies.

Is there an opportunity here for Labour to mount a populist pro-green, pro-health attack on air pollution? Nothing apparently so far from our Public Health team, admittedly busy in pursuit of mental health, sugary drinks and plain cigarette packaging this week. Miliband made a tentative foray back into the green agenda during the floods, so following up with an attack on the Government (and Johnson’s) lamentable record would seem to be an open goal in the run up to local and Euro elections. As the UK breaches EU pollution limits, killing thousands more, what better example of the potential for progressive public health policy in Europe and in local government to bring tangible impact on life and death?

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2 Comments

  1. Tony Jewell says:

    I think this is a good point to make. It is certainly true that our UK atmosphere has improved hugely over the past 40 years ( see National Atmospheric Emissions Inventory at http://www.naei.defra.gov.uk ) However our dependence on coal burning for electricity generation has been rather high. The important public health “new area” for us to understand better is not only the large particles but the small particulates that are invisible and are less than PM10.

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